The oddest thing about the debate over the “public option” is not that the centrists and the moderates immediately seized on it to attack the dirty hippies to earn some street cred with the beltway media, but that every time the public is polled, they support it by a good margin. Same too, for doctors:
A RWJF survey summarized in the September 14, 2009 edition of the New England Journal of Medicine shows that 62.9 percent of physicians nationwide support proposals to expand health care coverage that include both public and private insurance options—where people under the age of 65 would have the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans. The survey shows that just 27.3 percent of physicians support a new program that does not include a public option and instead provides subsidies for low-income people to purchase private insurance. Only 9.6 percent of doctors nationwide support a system where a Medicare-like public program is created in lieu of any private insurance. A majority of physicians (58%) also support expanding Medicare eligibility to those between the ages of 55 and 64.
In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists. Among those who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options.
It even has support among the AMA members, and the AMA isn’t so much about medicine as it is about making sure doctors fees never go down. You’d think the media would notice this, but they are probably too busy interviewing Newt Gingrich and Dick Armey to tell us how real Americans think.
Full report here (.pdf). And it is duly noted that statistics have a left wing bias. Also, too.
*** Update ***
More here.
Jim
All of which underscores the point that the “centrists and moderates” of the Mr Broder’s Village are well to the right of the center of the rest of the country.
To my surprise, Roger Cohen of the NYT came down pretty clearly for the puplic option today, making the most essential point, I think:
GambitRF
Obviously, this is just physicians cozying up to Obama, vying for top spots on the death panels.
Demo Woman
Nice to know that a large percentage of doctors are concerned about their patients
Demo Woman
@GambitRF: What’s not mentioned is that every 30 minutes a real American dies because of lack of health insurance. That sounds like a real death panel to me. Maybe someone should ask Sarah what she thinks.
Michael
Its all bubblicious, baby.
It is on an unsustainable high, and we’re probably close to the max on it. Some of the doctors sense it, and know that in the future, they’ll have less money with which to set their incompetent and cosmetically altered spouses up to run toney suburban boutiques. They won’t have the extra funds to send their worthless lump sons off to Caribbean medical schools, or their tarted up daughters to multiple semesters abroad.
The folks who don’t know it are the teabaggers and the Titans of Finance and Insurance, who’ve never gotten anything right.
I don’t think we’ll reach one dollar in four, because it’ll crash before it gets there, taking down a number of specialty surgery centers when it goes.
General Winfield Stuck
Yes, but but but but, Chuck Todd said mentioning to polled folks that it is a choice was nonsense, even though it is collectively true. So one poll is writ in stone and is true for ever and shut up that’s why. Murrikins hate the public option, it be right har in an NBC, Or Never Believe Chuck, pollisimo.
Demo Woman
OMG Little Bitsy is a steelers fan.
feebog
Read an interesting and heart breaking OpEd from a doctor yesterday in the LA Times. He told a story of a young teen who had suffered a massive stroke that will leave him disabled for the rest of his life. Seems the young boy suffered a small stroke when he was seven, and his mother was advised to see specialist and have multiple tests to find the cause. But the Mother was a single mom with no insurance on a minimal income. In another words, exactly the kind of person a public option would be designed for. This young man will now be permanently disabled, and in addtion to that fact, taxpayers will now helping to support him for the rest of his life. Tragic.
BDeevDad
Doctor’s realize they’ll actually save money and see more patients if they don’t have to deal with insurance companies.
Shawn in ShowMe
KEEP TEH PHYSICIANS AWAY FROM MY HEALTHCARE!!!
Numberwang
Remember when Rudy Giuliani’s campaign convinced the media that his entire strategy, through the entire campaign, was to campaign exclusively in Florida, avoiding Iowa and New Hampshire, where he’d lost by big margins despite spending tons of time and money? And no amount of fact-checking could change the way that this story was reported for weeks?
The same thing has happened with the public option. Every single media outlet has to report that support for the public option is weakening. Is it polling at 70%? 56%? 48%? Doesn’t matter. It’s going to keep “weakening” until it fits into one of two storylines: it passes and it demonstrates the power of Obama’s rhetoric or it doesn’t and it demonstrates how America is a center-right nation.
The Moar You Know
Who would have guessed that doctors don’t like treating patients that can’t pay them?
The Grand Panjandrum
Come on Cole give the establishment media a break for once. Jesus Babbling Christ! You know damn well their voicemail and email inboxes are overloaded with messages from the 87 billions people who attended the Patriot 912 march. Sheesh.
El Cruzado
Yeah, the thing that no one (at least in the MSM) talks about is that doctors are about as fed up with insurance companies as patients, if not more so (at least healthy people don’t have to deal with health insurance companies except for giving them money).
The fact of the matter is that, in general, doctors are worse off now that some years ago. They keep increasing their fees, but those increases just go to pay administrative assistants and exploding malpractice insurance fees (how those keep going up despite no increase in malpractice payments is a story that also deserves more scrutiny).
Not to mention that, greedy or not, the vast majority of doctors are genuinely worried about doing the right thing for their patients. They’d rather have more discretion about what to do than what the insurance companies let them, and at this point it doesn’t look like the government would be any worse than the corporations (they have Medicare et al to compare, and the comparison looks good to most of them).
Just 2c.
BDeevDad
What was also interesting was there was little difference when broken down by demographics. Results were consistent.
JK
Michele Bachmann Turner Overdrive blasts Obama’s speech and defends Joe Wilson
huffingtonpost.com/2009/09/14/bachmann-defends-joe-wils_n_286036.html
slag
The thing I don’t get is why media even poll the issue if they’re not going to use the results in their reporting. I mean, polls cost money, no? So, if you’re not going to go beyond saying that the public option is “controversial”, then why poll it at all? Wasteful spending.
dr. bloor
NPR report actually had the audacity to note that the AMA membership consists of only about a third of the country’s physicians, and I think (I was driving at the time) they referred to it as a “lobbying” organization.
MK
@Shawn in ShowMe:
I think you should print 2xeleventy billion copies and hand ’em out at the next tea party rallies since the movement is only going to gain more momentum. lolz
MK
@slag:
Methinks they’re got the old adage slightly confused. That is, doing the same thing over and over again and expecting a different result, ostensibly the one that they like.
cleek
well sure. because such a program would be the dumbest fucking program ever enacted.
kay
Doctors and patients don’t know anything about health care.
Max Baucus and Olympia Snowe know health care, and health insurance should be purchased and delivered via a co-op because co-ops are just more…wholesome.
MikeJ
I will cross the beams, err, threads, and argue to call them coöps.
GregB
They only polled Dr. Mengele, Dr. Kevorkian and that crazy, really loony screaming doctor from Vermont.
Lie-beral polls!
-G
kay
@MikeJ:
Conservatives like the silo imagery, to appeal to The Heartland. That’s all I can figure.
Radon Chong
@dr. bloor: MY friends all look at me like I’m from Mars when I complain about what Republican stooges NPR “reporters” are these days. For some reason, everyone seems to think we’re all still living in the world of 15 years ago (or whenever NPR was supposed to be liberal, though I really don’t know when that was, if it ever was so).
Shawn in ShowMe
Snowe won’t support a public option because you can’t use the words “public option” without getting your GOP card revoked. Baucus won’t support it because he’s the Senate version of Alan Colmes.
slag
@MK: It certainly does make one wonder.
Radon Chong
The other day NPR called the Lewin Group a “non-partisan think tank.” Also.
The Grand Panjandrum
@Radon Chong: Technically that is true. One party is the wholly owned subsidiary of corporate America, but they only have a controlling interest in the other one.
calipygian
Off topic, but this Red State thread in which a poor guy tries to convince the crazies that maybe there were significantly less than 2 million people at the Million Moron March is hillarious.
Becker finally settles it by posting a pic of a cartoon bunny on meth.
During the thread, another guy finally puts the gun to his own head by writing that he never liked Sarah Palin anyway and could prove it because he’s the only guy at Red State who types with both hands when writing about her.
Is there any wonder why these guys are way, way, WAY out of power?
Tsulagi
Easy explanation. Those physicians in favor of a public option weren’t educated at the Regent or Liberty universities. Obviously they succumbed to relentless subliminal socia1ist indoctrination in their schools. Those who adhere to the Dr. Frist Video School of Medicine are the true really smart patriots who know a tax break would provide all the trickle down health care we crave.
brent
Yeah well doctors don’t like insurance companies anymore than anybody else. Knowing that, this doesn’t surprise me at all.
Jen R
@El Cruzado:
This is one of those things I don’t know enough about. I keep hearing that more and more doctors are refusing to take Medicare patients. Is that because the fees are too low? If so, then it seems to me that either the public option will have to pay higher fees, which would make cost-containment a problem, or a lot of doctors won’t see the patients covered by it. Am I missing something?
The Very Reverend Battleaxe of Knowledge
So let me see if I’ve got this straight:
The president, who was decisively elected with an actual majority of the vote for the first time in 20 years, wants a public option.
The majority of Congessmen want a public option.
The majority of the public wants a public option.
The majority of doctors want a public option.
The majority of the AMA wants a public option.
The majority of the Senate probably want a public option, even though the knuckle-draggers in the red states have twice their fair share of representation there.
But because we have to get 60% of even that skewed group to vote for it, it’s dead?
Is this what they call Democracy in Action™?
Tsulagi
@calipygian: Yeah, saw that thread yesterday; cracked me up. I don’t know what that guy, likely an actual conservative, was thinking. RedState is the place where critical thinking and facts go to die.
jl
Support for public option by docs is not surprising to me. Say what you want about arrogant money-grubbing status- and country-club hungry attitude of many US doctors, they do tend to be smart, consciencious people with surprisingly well rounded education. In other words, they mean well even if they don’t look it.
They also have a relatively good knowledge of other high income countries’ health systems and outcomes, which in effect serve as over 24 experiments in how to do things better and more cheaply, or about as well but much more cheaply. The average US citizen does not have this knowledge because of the total corruption and incompetence of our horrible ghastly worthless national affairs media.
The groups of right wing docs who would support GOP positions are very, very small, and have no visible presence among any younger docs I know.
I wonder if the AMA will reflect this sentiment among US doctors? It may not. I don’t think the AMA even formally represents a majority of US physicians anymore, and many primary care and even specialist docs I know are alienated from it. The AMA’s history of reactionary attitudes, and its arrogant dismissal of any conflect of interest between its role as a professional organization and a trade interest group disturbs many younger doctors I know, who feel the AMA has mainly blown off their concerns over recent years. The AMA is the ‘rich older doctors’ club’ in many minds.
The most usual reaction among medical students and residents I know, upon receiving the AMA junk mail, has been to throw it away.
One cardiologist I know (note well, that is a specialist) says that the AMA’s approach to medicine is “corrupt and insane’ and says that they have concentrated, knowlingly or not, on guiding medicine towards selling tests and procedures rather than improving human welfare. He says “you can’t make a living treating patients, but you can make a living ordering test and doing procedures, whether they are useful or not” So, it will be interesting to see how the AMA’s role evolves.
Most yuonger primary care docs feel totally ripped off by the system, and complain of being asked to do more and more, while being paid less and less relative to more favored classes who get income from prescribing patent drugs, ordering exensive tests, and doing procedures (and even less and less compared to productive heroes of patriotic greatness, like, um… youngish drones in investment banking)
linda
good grief:
t: San Diego Sheriff Bill Gore deployed (but did not use) military type sonic crowd-control devices at two town hall meetings, one held by GOP Darrell Issa and the other by Democrat Susan Davis. These devices are the same as those used to control crowds of insurgents in the Iraq war theatre and have been linked to ear and brain injury.
Both town halls took place without incident; however the use of the military device concerned San Diegians. The LRAD [Long-Range Acoustic Device] crowd control is primarily used in Iraq to control insurgents and can cause serious and lasting harm to humans.
According to the manufacture, American Technology Corporation, the LRAD provides “military personnel the capability to transition through the rules of engagement to determine a target’s intent and also provides greater assurance that innocent lives on both sides of the device are not lost due to miscommunication.”
examiner.com/x-10317-San-Diego-County-Political-Buzz-Examiner~y2009m9d11-San-Diego-Sheriff-deployed-…
Zifnab
@brent: I’m in IT down in the medical district in Houston and I can’t tell you how true this is. The folks we work with absolutely revile the insurance industry. There are not enough dirty words in the English language to satisfy what they think of them. Because it’s always a tug-of-war. Always a fight.
I mean, they don’t have the nicest things to say about Medicare either (mostly, it doesn’t pay enough) but insurance companies are almost synonymous with “scum” in the doctor’s office lexicon.
John D.
@brent:
Doctors like insurance companies significantly LESS than anybody else. I run the IT for a group of doctors, so I get to hear first-hand how much they loathe them. And frankly, they have damn good reason too.
The administrative staff has to verify coverage before they can even see the patient. The medical staff has to document everything under the sun, other wise the insurance company simply refuses to pay. And then, they often refuse to pay ANYWAY, usually for “This test/lab/procedure is unnecessary.” (Perfect example last week: Elderly lady falls, hits head. Comes to us 2 days later, complains of continuing headaches, dizziness and blurred vision. Doctor prescribes cranial CT. Insurance company refuses payment, claims insufficient documentation. She hit her fucking head and is showing classic intercranial bleed symptoms. What more fucking documentation do you need?)
When insurance companies get to determine what your DOCTOR gets to do medically, it’s fucked up.
winguts to iraq
whatever. docotors no crap. Private always works better than public. Nevermind the $700 Billion we had to dole out to private banks. That’s just walkin around money.
Zifnab
@The Very Reverend Battleaxe of Knowledge:
That’s Democracy Inaction!
John D.
@Jen R:
Yes.
Most doctors realize, however, that Medicare and the proposed MedicareForAll is turning out to be a good deal — they may not make much per patient, but THEY WILL GET PAID. Which is a huge leap forward from where they are now.
Uloborus
Yeah. I’ve worked in health care. I live in a family where almost everyone’s in medicine. I’ve never met a doctor who didn’t want health care reformed because they hate the fact that everyone is uninsured and people suffer because they can’t afford treatment. Most of them feel, very strongly, that the current system allows insurance companies to bleed and corrupt the entire health care system. It’s only beyond that where you get much disagreement.
Ash Can
@Jen R:
Who are you hearing it from?
Shawn in ShowMe
Compensation is going down because the program is on the verge of bankruptcy. And the medical community realizes this.
Martin
Sure, the insurance companies aren’t just raising rates for their own advantage.
As the number of uninsured goes up, the amount of money that physicians need to get out of insurance holders to subsidized the uninsured goes up – and Medicare isn’t going along.
Remember, all health care is paid for in this country. All of it. The uninsured pay some out of pocket, but the rest comes from non-government subsidies from the insured by way of doctors and hospitals manipulating the agreements with insurance companies to cover their costs. They can’t do this with Medicare though.
The edge case of this system (the one we are heading most toward, but would never reach) is that there would be one insured person left in the country paying premiums that would cover the cost of all non-Medicare healthcare in the nation.
The equitable solution – which is the single payer solution – is to spread those premiums out to every single citizen. No need to charge more money, you just need to charge it evenly.
geg6
I don’t know a medical professional or administrative staffer who doesn’t revile insurance companies with the angry heat of a thousand suns. Medicare doesn’t pay as much, but it always pays. Big bucks are to be found in cutting administrative costs and in actually being paid for doing their jobs. Plus, most of the people who are involved in actually treating patients are compassionate and want to help people. The system as it is makes it difficult for them to do what they do best to help. It is an often expressed frustration among my friends and acquaintances in the medical field.
jl
Latest horror story from doctors and pharmacists I know is that insurance companies are refusing payment for long standing Rx’s for drugs in favor of medically inadvisable substitutes. The insurance companies simply will not relent even when given documentation showing the substitution is inadvisable. A pharmacist who understands the pricing in detail, claims it is because the insurance companies are looking situations where they can make a few bucks off the co-pay (the co-pay is, say $20, and the old drug costs $25, but new drug costs the insurer $15).
Most doctors and pharmacists I know think the insurance and healthplan industry has evolved into a dishonest racket.
Jen R
@Ash Can: Honestly, I don’t know. Like I said, this is an aspect of the debate that I don’t know enough about.
Martin, I totally agree about single payer, but I know we’re not going to get there in one jump. It seems like the public option is the way to start getting there, but there’s just some stuff I’m not clear on. Your comment helps.
Cat Lady
@Jen R:
On the NPR interview, the pollsters said doctors weren’t keen on Medicaid, but there was virtually universal approval for Medicare. I think it was because of the how and how much reimbursement formulas for doctors.
jl
The reimbursement system is totally messed up. Medicare does pay below cost in some areas for some services. Commercial insurance makes up the difference. There is significant cross-subsidization.
Any health care reform must lead to provider payment and reimbursement reform, in order to control costs in the long run.
I think the concept of ‘Medicare for all’ needs to be separated from the details of how Medicare and commmercial reimbursements are currently determined. The former is may be a very good approach, but will cause problems unless the latter can be changed.
IndyLib
@linda:
I miss the beach, but I swear, not a week goes by that I’m not glad I don’t live in San Diego County anymore.
Zifnab
We have a couple of major hospitals in Houston that are actually doing the exact opposite. Getting money out of Medicare has traditionally marked you as a “low rent” hospital – in part because you are recouping less money per patient and in part because you are serving a certain lower class clientele. But, again, Medicare doesn’t fuck you over on payments, so you don’t need an army of administrators backed by another army of lawyers to process every patient. So the hospital got into a nasty economic situation and realized it couldn’t afford to be so selective anymore.
I’m sure we’ll see hospitals in the future that try to be more elite than their public insurance accepting peers. But economic reality drags many of those high fliers back down to earth.
Ash Can
@Jen R: I see. I should clarify that I wasn’t trying to be snotty or anything, I was just curious.
oh really
They probably figure that they’ll get more business if more people can afford insurance (and more people with insurance can actually afford to go to the doctor).
So, the people are for a public option. Doctors are for a public option.
But there is probably no chance we’ll get a public option unless Obama is willing to demand and fight — hard — for one. If I were a betting man, I’d put my money on no public option. (It wouldn’t be a bad bet for me — if I lost I’d get a public option to ease the pain.)
As numerous commentators have begun to acknowledge, Obama isn’t much of a fighter. Unfortunately, there is only so much a president can accomplish if he insists on always remaining above the fray.
Jen R
@Ash Can: It’s cool. This idea is … out there in the ether, I guess. I don’t remember hearing/reading it anyplace specific.
EEH
@jl: This happened to my husband several months ago. The drug that he had been taking for ages for his ulceritive colitis and had been routinely paid for by the insurance company was suddenly denied coverage. To pay for it ourselves would have been $2000 a pop. Fortunately in his case, a substitute that is available as a generic works fine for him. If that had not been the case, my husband would have had to forgo medication altogether because there was no way we could afford to pay for it out of our own pockets.
Someday my husband will more likely than not require a liver transplant. I dread it because unless things have changed by then, we will go bankrupt despite being insured.
Scottofny
@MK:
Do you really think these people even read???
Hell, their signs are illiterate….
Cat Lady
OT, OK but now it’s officially football season. Tom Brady’s back.
jl
@EEH: Sorry to hear about that. The thing about the stories I have heard is that they are medically inadvisable substitutions. Like to a cheaper drug for someone with compromised liver that can cause liver damage. Or for a person on blood thiners that can cause bleeding. Or for a person who has to commute everyday that causes severe long-duration drowsiness. I ran these by a pharmacist who specializes in bulk drug puchasing who said all the examples were substitutions to drugs so cheap, that the insurer could make a profit off of even off low co-pays.
So, that is what the GOP means when they talk about the market magic solving the health cost crisis, at least in practice, regardless of what their fantasies are.
Uloborus
Doctors are refusing Medicare? That… sounds bizarre. At Kaiser, Medicare was viewed with reverence. For financial reasons, even. It was viewed as good, reliable money, and the intricate paperwork required was a small sacrifice. (The paperwork really IS intricate. Describe a patient’s diagnosis by slightly different terms on a form and you get a fraction of the money.) A Medicare patient could afford whatever treatment they needed. You didn’t have to worry about it.
Travis
@calipygian: first, great user name! one of my favorite words.
second, thanks for the link to the red state swamp! I rarely go over there, but the thread — ending with the guy being banned — was a fascinating journey of group-think and bad arguments. I loved how they disagreed with him when he said there were 2m million people there, then denied that they were disagreeing at all. Then banned him for being a jerk. wow!
it’s kind of off-topic, but there was another exchange that was very revealing of the twisted thinking. a user with the account name “mall cop says no” wrote a post in August called “Mr. Five Deferments” where he wrote this about Cheney:
And one of the enforcers, Moe Lane, wrote this just before banning him:
Not the most amazing thing ever written, but the twisted nature of this thinking is so fascinating to me. It is little wonder they march in lockstep. If you want to be popular with your little right-wing buddies, you will say the right things, or you can’t say anything. Apologies if wordpress turned this nice HTML into a complete hash
Travis
@Travis: good heavens, this wordpress is a complete POS.
Both blockquotes above have two paragraphs in them, which is not shown in the final HTML.
Bubblegum Tate
@calipygian:
I can’t believe that guy could say he doesn’t like Governor Mooseburger and not face an angry, geriatric lynch mob.
kay
@oh really:
I object to this not because Obama shouldn’t fight for effective reform, he should, but because we actually do have a legislative branch, and they are supposed to function in that role.
I know they have not done so. For years. Still, that’s not acceptable.
The “centrists” (conservatives) in the Senate jumped in front of the cameras because there was a void, and that void was left by the members of Congress who are passionate about reform.
Where were they? Why are we accepting such a cowardly showing?
They’re were waiting for Obama to get out front and take all the heat.
In the meantime (surprise!) Snowe and Baucus took the whole thing hostage.
I mean, this is the way the world works. Ambitious people fill voids. Why don’t liberals in Congress know it? This is THEIR ISSUE. They ran and hid at the first sign of opposition.
Calouste
@El Cruzado:
If you are a mainstream media personality whoring for your corporate paymasters and only caring about your paycheck and your status (and heaven forbid that those dirty bloggers actually check your “facts”), you just don’t have the brains or emotional maturity to understand that a lot of people take pride in doing their job and doing it well.
Steeplejack
@Radon Chong:
There was a time when NPR was, if not truly liberal, at least middle-of-the-road, but they have crept quietly to the right in the last 10 years or so. Sometimes I am amazed at how far right they have crept. And, yeah, I agree with you, there seems to be this unexamined belief that they’re still “out there” on the mythical left. I have some middle-aged friends who are in the prime NPR demographic, donate quite a bit, etc., and I get that “WTF?!” look you describe when I tax them with some of the right-leaning bullshit from “their” network. Sometimes I think all they listen to is Terry Gross and Car Talk.
jl
@Calouste: In the corporate butt-kisser world that dominates US mass media and ruling class, doctors have worked hard to master specific skills that are of great use in improving human welfare, sort of like electricians, plumbers, engineers, teachers, and all sorts of other everyday people.
The work involved in mastering these kinds of expertise leaves too little time to learn the skills of stuffing all possible cash into one’s pockets by any means necessary while leaving no trace, and leaves too much integrity. Thereby producing in the minds of the corporate celebrities in finance and the media, the attitude of complete and utter contempt for loser penny-ante chumps.
These pathetic peasant ‘medical doctors’ are more like gardners and pool boys than equals to the intellectual and moral pratfalls that are advertised as Serious and Knowledgable People in the corporate media. These little poeple put on airs, and think their skill and knowledge qualifies them to have any kind of say at all. Silly ordinary people. They are considered amusing, thought their pretensions do irritate our more worthy overlords.
Comrade Jake
OT, but del Potro just pushed it to a fifth set with Federer.
Oh, and he looks like Glen Frey, also.
Ash Can
@Travis:
It’s sad, isn’t it? I much prefer the food fights and pie salvos here and at sites like this. It’s more like, I dunno, freedom of speech?
oh really
@kay:
Kay, the Congress ceased being a force for positive action (most of the time) years ago.
Historically, great presidents have not left it to Congress to lead — it can’t. After all, Congress is made up of 535 individuals, most of whom directly represent a relatively small number of people (several hundred thousand). The president receives his support from every state.
You said that this is Congress’ issue. In fact, there are probably lots of representatives who barely mentioned health care in their campaigns — depending on the makeup of their own districts. On the other hand, Obama made this his “signature” domestic issue.
The failure of Congress is a known (and accepted) fact. No one expects guys like Baucus or Conrad to step up and suddenly start working for progressive change. The advantages that the president has over Congress are many, and he will almost always be the key to any remotely controversial legislation.
One of the reasons Obama’s popularity has slipped is because of the significant number of core supporters who are becoming increasingly disillusioned with his performance. I never expected him to be a staunch liberal or devoted progressive — he’s a centrist with some fairly conservative leanings. But he has fallen down badly on health care, allowing the lunatics to dominate the dialog. In my opinion, if Congress passed a reform bill that included all the main features that Obama has called for, including a strong public option, the bill would still fall far short of what we need. There are lots of good books available about the failings of our health care system. I strongly suggest “Money Driven Medicine” by Maggie Mahar. When you finish reading it, you’re not likely to conclude that Obama has proposed adequate reform.
Could he have gotten an adequate bill through Congress? Probably not. But history is filled with great surprises. One thing is certain, we’re never going to get a single-payer system if it is taken out of play before the discussion begins. Apart from the public option, little of the proposed initiatives provide anything like a logical path toward a comprehensive system. They are steps forward at all. This was the year we should have begun the serious fight for a real health care system. Instead, we’re arguing about how to make what we already have work better.
Every time Obama speaks “for” the public option, he seems to put yet another straw on the camel’s back, because he makes it clear that he will sign a bill without a workable option to private insurance companies.
The driving force during those times when big things, for good or ill, have been accomplished in this country has been the president. Whether Lincoln, or FDR, or Reagan (he’s the ill part), the president pushed Congress, not the other way around.
Steeplejack
@Shawn in ShowMe:
Compensation is going down because the [Medicare] program is on the verge of bankruptcy. And the medical community realizes this.
Linky, please. Not trying to oversimplify, but isn’t it almost impossible for a federal government program to “go bankrupt.” Whatever the actual financial situation is, I presume, the doctors would get paid.
Pardon me if you were just being snarky.
Steeplejack
@Martin:
The equitable solution–which is the single-payer solution–is to spread those premiums out to every single citizen.
Amen. In the perfect construct, all those young people who never need to see a doctor, except in the case of an accident or (for women) an annual gynecological exam, would more than subsidize the end-of-life care for the aging geezers.
kay
@oh really:
I think you’re letting liberals off way too easy. I know Baucus and Conrad aren’t going to lead on anything progressive. I also know Baucus and Conrad are only two members, from small states.
I don’t want to hear liberal Senators claim victimization by Max Freaking Baucus, on health care. That’s ridiculous.
Health care was a central plank of the Democratic Party when Obama was in high school.
What, they needed more time to ‘craft a message”? They’ve had 40 years.
Leelee for Obama
Just read on HuffPo that Patrick Swazye died. 57, he was younger than me, Jesus! This just sucks.
kommrade reproductive vigor
Any one who talks to doctors for 5 seconds would not be surprised by these results. I feel sorry for the docs who have to listen to patients rant on about ebbil sozialist medicine. Especially since prescribing hourly enemas for a year would certainly violate the Hippocratic Oath.
chopper
so john, how long was your post in moderation because of the title?
Chuck Butcher
Speaking as one whose wife’s medical problems ended with us in bankruptcy it was the doctors who got stiffed. An initial problem I could have dealt with, albeit with difficulty, accelerated into disaster and bankruptcy. Health insurance was simply unaffordable without peonage to HealthInc, so…
OTOH, I am one of those a Medicare for all would profit from, I’m 56 and my entire life’s medical billing minus dental and eye correction would amount to a couple thousands of dollars despite being a smoker and eating exactly what I want. Over that time my Medicare For All premiums would probably have paid for my wife’s disaster.
Shawn in ShowMe
boston.com/news/globe/editorial_opinion/oped/articles/2007/06/09/the_coming_crisis_for_medicare/
THE TRUSTEES of the nation’s Medicare trust funds have just released their 2007 annual report, and once again the news is grave. As the result of health care costs increasing at a much greater rate than wages, the hospital insurance trust fund is projected to be exhausted by 2019.
Steeplejack
@Shawn in ShowMe:
Thanks for the clarification. The year 2019 is ten years out, which, in my mind, does not equal “the verge of bankruptcy,” which is what you originally said. I know Medicare has problems, but I think probably they can be addressed in the next 10 years without doctors having to bail on it today.
I don’t think this stands up as the reason doctors are refusing Medicare patients today, if in fact they are.
Wag
As a primary care doctor who has practiced in both private practice adnd in a large (600+) multi- specialty academic group, I can confirm the findings of this study. In my clinic of 15 Internists, all but one support Obama’s goals. Single payor would be the prefered mechanism for most of us.
In private practice, 68% of my collections (which ran around 60% of billings) went to overhead. The only way to survive in private practice was to do as many proceedures as possible, because payment for proceedures so far outstrips payment for Evaluation and Management (E and M codes vs Proceedure codes)
I would like give a real life example of the disparity between E and M codes and proceedure codes. If you see your PCP for follow up of your hypertension, cholesterol and diabetes, and they spend 25 minutes in counselling about diet exercise and medication, your PCP will be reimbursed around $75. A dermatologist (or your PCP, if they have any brains) who spends 2 minutes freezing a wart will be paid the same amount of money, or even more.
Do the math, and you will soon see the peverse incentives that keep all but the most dedicated of physicians from going in to Primary Care.
Brian J
The cynic in me wonders if a large number of doctors support it because they figure they can game the system. Any thoughts on that?
kay
@oh really:
Obama aside, here is what worries me about this line of thought. This has to work, in practice, or it’s an ideological theory and not a governing philosophy or mechanism.
I think you’re going to end up where conservatives are: “it sounded so good, but we were stymied! Retreat to the federalist Papers! Solace in theory! ”
There’s Obama and there’s the Democrats in Congress. There aren’t any other rational actors. This is it. It’s what we have.
No one is going to care about the trials and tribulations and angst liberals in Congress suffered on the way to some rational health care delivery system. No one is going to care why they couldn’t get it done, or how it would have been wonderful, but for that Barack Obama, or those lobbyists, or those mean Republicans.
Because they’ve been saying that for 40 years. They can’t keep saying that. They CAN, I guess, but then liberalism is a theory, and I’m not much interested in those.
I don’t expect all that much. I expect 5 or 6 or 7 liberal Senators from large and influential states to appear regularly on television and say simply why they support reform, and what specific reform they support.
Over and over and over, because they have to repeat it 5000 times.
Obama does his thing, they do theirs. Why is that so hard?
86'd from every Irish bar in midtown
My former family doctor of 20+ years left a partnership in a very busy and lucrative group practice to work for…the VA. When I asked why, he said he was tired of the business of medicine and wanted to spend his time on actually treating actual patients. My eye doctor, who knew my family doctor fairly well, and I were discussing this career change, and I could tell he was verbally tap dancing around something. I told him, “it’s OK, I’m a socialist,” and he absolutely teed off on the need for single payer.
Sure, the plural of anecdote isn’t “data,” but I find it interesting that my entire interface with the medical-financial complex in my very, very red state has gone Bolshevik.
Brian J
jl
@Brian J: I think they have learned that they are too far from the real money to game, but rather will be gamed in anything put a system that protects them from the underregulated private insurance companies and health plans.
Molly
@calipygian: “Off topic, but this Red State thread in which a poor guy tries to convince the crazies that maybe there were significantly less than 2 million people at the Million Moron March is hillarious.”
It’s sickening. My God. The man provides pictures, and they argue with the pictures. What the hell is wrong with these people?
jl
@Brian J: I would like to see that link. Please provide a link if you can find it again. My only comment without seeing it is that it is easy to tick off numerous faults with studies. No study is perfect, or even close to it. I would want to at least line up the studies and see whether they had common serious faults so that they all let something serious through that biased all the results in the same way and to the same maginitude.
The tobacco industry spent decades finding numerous serious faults with research on smoking and health. But the tobacco industry was wrong and others were right, so what happened was that evidence against tobacco accumulated until there is a strong consensus today, even though if you pick out a few given studies, each one of them will have serious faults, because research is done in the real world, not a perfect world.
Bubblegum Tate
They are absolutely invested in the right-wing worldview, the whole “conservatism cannot fail, it can only be failed” thing. As such, they’ve developed a pattern wherein when their beliefs and observable reality are at odds with one another, it’s reality that must be “incorrect,” not their beliefs.
Brian J
Mike
I’m not sure where the “doctors are refusing Medicare patients”
meme is coming from, but I do know that doctors are refusing
to take patients in Medicare Advantage plans such as Senior Dimensions, and others. My doctor refused to see my wife’s
mother until she ditched the Medicare Advantage plan and went
back to regular Medicare, citing too much interference in medical
decisions.
kay
@Bubblegum Tate:
Plus, they’re genuinely confused. They don’t know the Million Man March from Promise Keepers, at this point.
I think they have to start over.
kay
@Mike:
Conrad just announced that he’s managed to get rid of the cuts to Medicare Advantage, which is a taxpayer rip-off, and cutting the over-payments would have saved 200 billion over ten years.
Why is he a “fiscal conservative”, again? What does that phrase even mean? It means, “serve my corporate donor’s interests”, I think.
jl
@Brian J: Health care professionals run high fixed cost operations, provide services that are often very time-senstive, with extremely variable costs that are difficult to predict. They are very vulnerable to interruptions in payments. Non-profit comprehensive medical insurance spread widely in the 1930s as a method to ensure steady income streams to doctors during the Great Depression when insurance companies were reluctant to enter the comprehensive health insurance market.
I think doctors are vulnerable to any group of third pary payers unless there is robust competition keeping the payers honest. They will be vulnerable to uncertain income streams from patients if we go to high deductable consumer driven care.
I do not think they are in a position to game any payment scheme unless the laws and regulations explicitly permit them to do so (for example, as it currently does with physician owned private clinics, labs and hospitals).
So, I think doctors who like a strong public option do so because it promises robust competiton to keep the payers honest. Those who like single payer have come to the conclusion that they can trust the government more than private insurers and healthplans to not mess with them in order to grab money.
Brian J
@jl:
Here’s the link: medinnovationblog.blogspot.com/2009/01/interveiw-with-richard-buz-cooper-md.html
I found it by way of Marginal Revolution. It’s apparently a lot older than I realized, but I guess it’s still relevant since the debate is still revolving around these terms.
As I said before, I need to read through it again before I give any complete thoughts, but still, my initial reaction is just shock. This guy isn’t just some random crank, but a professor of medicine.
Please tell me what you think.
jcricket
I can 100% confirm this: family full of doctors, many otherwise Republican, not a single one in favor of current system.
The only doctors against the public option in the medical field are the grossly overpaid specialists (note: not all specialists are grossly overpaid) who stand to have their $500k/year incomes cut to $350k/year if some of that money was instead diverted to primary care physicians, nurses, etc. Waaaaaahhhh. Cry me a fucking river.
Bah, if we just did Medicare for all, plus moved away from fee-for-service in general, this whole fucking mess would be about 1/10th the size it is now (oh, and healthcare outcomes would improve, no one would go bankrupt, no uninsured people, etc).
I hate America.
jl
@Brian J: Thanks for the link. It covers so much ground that I can’t review everything in detail. I am not a doctor. While my work has allowed me to see ‘live the system’ in terms of talking with health care providers and healthplan executives doing real stuff, still I am not a doctore, and I think Cooper would say I am not allowed to have an informed opinion, me not being a doctor.
I think Cooper is correct about the problems with US doctor supply. There is a crackpot theory that more doctors will automatically increase costs. Studies that compare costs and docs across countries show that the more doctors the lower the cost of a doctore (competition!) and no relationship between supply of docs and % of GDP on health care.
Right now supply of docs is controlled by Medicare and AMA, neither of whom want to pay for more docs. Medicare pays for most advanced doctor training after graduation from medical school, and they do not want to break budget by expanding those training programs (but you will never get world class care without that advance training, which is universal in high income countries). AMA clearly fears effect of more docs on their members incomes, but they will never say this out loud. I think this is huge issue that is not even discussed and may well doom reform to failure.
It also blows a big hole in GOP market-based proposals since I do not see how you can have a good market solution without something approximating market supply, which we do not have.
Other countries have more specialists providing care than US, at lower costs and more efficient care. I agree that some of the research on regional variations in cost is dubious. Academic and inner city providers have gotten hammered for being ‘inefficient’ but their higher costs may be due to unmeasured factors, such as more severe cases.
Main thing I find doubtful is the claim that ‘prevention’ cannot save money. But since Cooper never defines what ne means by ‘prevention’. I think ‘prevention’ includes proper management for high blood pressure and diabetes, and you definitely save money that with that. ‘Prevention’ in terms of early disease screening may not save money.
jl
@Brian J: my response is in moderation, so check back latter. Thanks very much for the link.
J Bean
Here are some more polls showing similar results.
I’m a primary care doc in Orange County, California, the only coastal county to vote red in 2008, the birthplace or Richard Nixon, the launching place for Phyllis Schlafly and Ronald Reagan and numerous other righties to gruesome to name. Most of the docs I know are in favor of single payer, even the one Republican in my office. I work for a large group and we employ upwards of 100 people to extract money from insurance companies. We would like to just practice medicine.
jl
@Brian J: I had time to check out some stuff from that link. A final note, at least until my longer comment comes out of moderation, is that Cooper is advocating a quite strong reform compared to what is being proposed now by Obama. He mentions the ‘Baucus’ plan, which as of January, and at that time it would have referred to Baucus’ 2008 plan, which was closer to Ted Kennedy’s ideas than anything being proposed now.
The bottom line for Cooper, I think, is that the most reliable sources of cost reductions are reducing price per unit of input by expanding doctor and other health care professional supply, universal coverage, simplified reimbursement systems.
Cooper is skeptical that much saving can be found by reducing variations in care (as touted in the New Yorker article comparing different cities in Texas, or prevention programs when broadly construed to include, for example, eary detection of cancer and subclinical heart disease.
I really do not know whether I agree with Cooper on whether cost savings can be found from prevention or not, unless I can get a better idea of how he is defining ‘prevention’.
But seems to me that Cooper is advocating very strong single option of Medicare for all for whoever wants it, and universal coverage.
jl
Sorry, I meant to type:
But seems to me that Cooper is advocating AT LEAST very strong PUBLIC option of Medicare for all for whoever wants it, and universal coverage.
oh really
@kay:
If we disagree, it may only be that I assumed that Congress would fail unless a strong leader forced them to deliver. It’s difficult to be disappointed in someone when you have no expectations whatsoever. I think the Democratic Party is almost worthless at this point.
I’m disappointed in Obama because he promised to be different.
wag
@
I’m glad to hear that docs in the OC is in in line with the docs in CO on this issue.
oh really
@kay:
I think someone is misunderstanding someone. It’s quite unlikely that I will “end up where conservatives are.”
My point was simple. I have no confidence in Democratic senators and representatives and even less in congressional leadership (especially in the Senate). Therefore, my expectation is that if there is going to be meaningful health care reform (and I believe it was possible) it is never likely to arise spontaneously in either house, and almost certainly not in the Senate. Therefore, since we desperately need major health care reform (beginning with junking the old system entirely — since it fails every meaningful test of a health care system, it has nothing to offer), I believe the only way it will happen is if a committed Democratic president puts it all on the line and fights for reform. That will necessitate recruiting key congressional leaders to aid in the effort and the willingness to play rough when dealing with Blue Dogs and other Conservadems. Obama offered the promise of change without being willing to do what is necessary to bring it about. No matter what representatives and senators promised in their campaigns their past performances should give no one the expectation they would actually deliver on their own.
I think you are wildly optimistic to expect that. I don’t expect my cats to be nice to each other — I just do my best to minimize the full expression of their instincts. Normally they tolerate each other, but they never hesitate to inflict pain and suffering if one has what the other wants. Harry Reid’s instinct is to be a spineless, wishy-washy, slug. A strong president could force Reid to deliver more.
In reality, probably only relatively senior senators are in an institutional position to speak out. Junior senators and those not in leadership positions are generally not free to chart an independent course. Can you name six or seven relatively senior senators from large and influential states who are truly liberal? Depending on how old you are, we may have very different definitions of what constitutes being a true liberal. In my lifetime the political spectrum has shifted dramatically to the right. Most of the so-called moderate Democrats would have been considered conservative Republicans when I was a kid.
Nixon started the EPA and proposed a plan for universal health care — yet he was definitely not considered a “liberal” Republican. Ben Nelson would probably have fought both with all his might, yet people refer to him as a moderate Democrat. Times change. My perspective is outdated, but, I would argue, historically more useful than that of someone who thinks that left and right should be defined by todays politicians.
I know you think we disagree, I’m just not entirely sure what the nature of that disagreement is. I think you expect more of representatives and senators than I do. I’ve been watching them for six decades; I no longer have any reason to expect them to deliver — they don’t know how.
NR
@Jen R:
It’s actually even worse than that. Doctors won’t be the only problem; hospitals will, too. Right now, any hospital that accepts any public funds at all is required by law to take Medicare patients – it’s called consignment. However, the House bill does not have a similar provision for the public option, so even at Medicare plus ten percent, most patients would be turned away.
oh really
@Jen R:
@NR:
This is all the more reason why we need a single-payer system. Whatever the fees were, they would be more or less the only fees available.
Doctors and hospitals (and everyone else) would figure out how to make things work out of necessity (that old mother of invention).
On the other hand, we might find that all of our doctors would go practice medicine in another country. Who knows maybe the greed drain would reverse flow and Canada would begin to get American doctors looking for top dollar. Or they could switch professions here. They could always sample just how lucrative working for Wal-Mart is. Either that or those superior beings could re-embrace a childhood dream, park the scalpels and stethoscopes, and find out how difficult it is to hit a 98 mph fastball.
Scott
My work works at a hospital in Ohio and I golf with a lot of doctors and there is no way that this poll is accurate. I have not talked to one single doc who supports any part of this plan. I am sure they exist but those numbers are wildly off in my opinion.
JohnR
You seem to misunderstand, Mr. Cole. Armey and Gingrich _are_ real Americans. You and your hippie commie-fascist-socialist-atheist-gay-illegal 70% minority of the country aren’t. When you know The Truth, mere numbers can’t shake your faith.
jacksmith
Why A Strong Public Option Is Essential – By jacksmith — Working Class
Robert Reich explains the pubic option: bit.ly/dDYSJ robertreich.blogspot.com/
John Garamendi on the Public Option and the Grassroots: bit.ly/TJMty
It’s not just because more than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 77% of all Americans want a strong government-run public option on day one (86% of democrats, 75% of independents, and 72% republicans). Basically everyone.
It’s not just because according to a new AARP POLL: 86 percent of seniors want universal healthcare security for All, including 93% of Democrats, 87% of Independents, and 78% of Republicans. With 79% of seniors supporting creating a new strong Government-run public option plan, available immediately. Including 89% of Democrats, 80% of Independents, and 61% of Republicans, STUNNING!!
It’s not just because it will lower cost. Because a strong public option will dramatically lower cost for everyone. And dramatically improved the quality of care everyone receives in America and around the World. Rich, middle class, and poor a like.
It’s not just because it will save trillions of dollars and prevent the needless deaths of millions more of YOU, caused by a rush to profit by the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX!
It’s not just because every expert in every field, including economist, and Nobel laureates all agree that free market based healthcare systems don’t work. Never have and never will. The US has the only truly free market based healthcare system in the World. And as you all know now, IT IS A DISASTER!
It’s not just because providing or denying medically necessary care for profit motivations is wrong. Because it is WRONG! It’s professionally, ethically, and morally REPUGNANT!, Animalistic, VILE and EVIL.
THE REASON THE PUBLIC OPTION IS ESSENTIAL:
The public option is ESSENTIAL because over 200 million of you are trapped in the forest of the wolves. Which is the forest of the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! With no way out except through needless inhumane suffering, and DEATH. While the wolves tear at your flesh, and rip you limb from lib. Then feast on your lifeless bodies like a dead carcase for transplant parts.
At the most vulnerable times of your lives (when you were sick and hurting), millions of you have had to fight and loose cruel, but heroic battles. Fighting against the big guns of the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! in the forest of the wolves. All because you have no place else to go. You have no other CHOICE!
But the PUBLIC OPTION will give you someplace safe to go. And it will give us someplace safe to take you. The public option will be your refugium (your refuge). Where the wolves cannot get at you when your down, hurting, and vulnerable. Where everyone who needs it can find rest, security, comfort and the care they need. Protected by the BIG GUNS of We The People Of The United States. THE MOST POWERFUL PEOPLE AND COUNTRY ON EARTH.
This is why it is so critical that we do not lead another 50 million vulnerable, uninsured Americans into the forest of the wolves, without the protections of a Strong Government-run public option. We The People Of The United States MUST NOT LET THAT HAPPEN to any more of our fellow Americans. If healthcare reform does not contain a strong public option on day one. YOU MUST! KILL IT. Or you will do far more harm than good. And millions more will die needlessly. Rich, middle class, and poor a like.
To those who would continue to obstruct good and true healthcare reform for the American people, and who seek to trap millions more vulnerable Americans in the forest of the wolves. We will continue to fight you. We are prepared to wage all out war against you, and will eagerly DESTROY! you. Time…is…UP! YOU HAVE BEEN WARNED! No Co-op’s! No Triggers! NO INDIVIDUAL MANDATES! without a Strong public option on day one.
Healthcare reform can be the GREATEST! Accomplishment of our time and century. A time when future generations may say of us, that we were all, AMERICAS GREATEST GENERATIONS.
BUT WE MUST ACT!
I therefore call on all my fellow Americans and the peoples of the World. To join us in this fight so that we may finish becoming the better America that we aspire to be for everyone.
SPREAD THE WORD!
I have been privileged to be witness as many of you fought, and struggled to take your first breath, and your last breath on this earth. Rich, middle class, and poor a like. Life is precious.
Whatever the cost. WE! MUST SUCCEED.
God Bless You My Fellow Human Beings
jacksmith — Working Class
No Triggers! huffingtonpost.com/jason-rosenbaum/a-trigger-for-the-public_b_277910.html
Triggers huffingtonpost.com/david-sirota/weve-seen-these-triggers_b_283583.html
Krugman on heathcare (krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/)
Senator Bernie Sanders on healthcare (youtube.com/watch?v=RSM8t_cLZgk&feature=player_embedded)