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September 30, 2009

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I can definitely say, flyoverstate, that they didn't listen at the town meetings but they heard the rumble in the background like a storm coming. It apears that all that did was make them hurry to get the picnic over before the rain hits. Obama is a very smart operative. He deliberates when his choice, like Afghanistan, is a likely lose-lose proposition so that he can say it wasn't his fault. Healthcare could end up to be similar but he'll be able to blame that one on the fall guys: Pelosi, Reid, Snow etc. Iraq is a win for Bush but Obama will take the credit. Frustration is something most politicians create with super high expectations for their ability to lead. Few an live up to their promises, smart or not. You might have to accept that you are not in the segment of the electorate that thinks he is doing just fine. Sobering thought, isn't it?

I've got a problem. I'm a moderate to conservative guy doing the best I can for my family, community and small business. This wrangling is nuts! We elected a President to lead...that's what Presidents do. I didn't vote for the guy but I wish him well. If he does not succeed, we all lose. Right now, from my vantage point, he has abdicated that leadership to Pelosi, Reed, and to all of those non-elected folks on his advisory boards. He won't even let his general's lead but passes it on to others...not even himself.

He needs to step up to the plate and control his own party. He has a majority and can do whatever he wants. I may not like it but so be it. We don't need a "community organizer" who never has to make the tough decisions...we need a President. And he is a spin guy so when and if he ever leads, he'll know how to come across as a good guy not a hard nose. He's trying too hard not to be George Bush and not hard enough to lead this country. No one trusts our government...not foreign folks or our own people.

If you think "move on.org" was tough on Bush, just wait until the rest of us vote in 2010. Look at how many folks actually watch FOX...you may not like it but we didn't like Soros controlling everything in the last election. (check him out in wikipedia) At least Fox is upfront with their stuff...not stuffing money into little groups behind the scene. And we're tired of being put down as rubes or hicks by all of the elite folks from the east and west coast. We just want low taxes, nice family life, live within our means, health care of our choosing, security, and then let us control our life. We aren't the fat cat bankers from NY or the trial lawyers or rich corporate gurus. A bigger government role is not the answer because they don't even know us. Makes me angry when they say they speak for us. Didn't they listen at the town halls meetings?

A very nice discussion going on. Harrycat, it is nice to see your views. I believe that what you say about the right and what Bo says about the President's sales job are both correct. The problem, I am quickly learning, with the American political system is that we have forgotten how to compromise and solve problems. In elections both parties sell to the middle while asking their base on the right or left to "trust" them. They need the center to win. Once they do win then the process of implementing the solutions of the base begins. And because the ideas of the base are so far away from the ideas of the other parties base the wars begin. And, we, the electorate in the middle, who were so hopeful, are left frustrated by the positioning and accusations rather than watching a consensus and conpromise to move forward come about.

I am beginning to get a better look at it and I am wondering if it can ever be ended except in 9-11 type situations. Perhaps the legislative bodies have just gotten too big for any true discussion and debate to lead to compromises. Or perhaps the politicians are too beholding to special interest groups to put the country first. Keep your thoughts coming. It is interesting that all of America wants reform--they should spend the time to get it done in a way that it doesn't have to be undone next election.

There is a lot of truth in all the previous arguments - on both sides. I would simply observe that one thing I have not seen -- and perhaps I just missed it -- is that the law of supply and demand is very much alive, regardless of all the other issues. If we could remove the barriers to training more physicians/health care professionals (there are legal and political constraints), there would ultimately be a reduction (dare I say a reversal?) of health care costs. The training could be subsidized by mandatory service by advanced medical students in local primary care clinics in an appropriately supervised setting. This would answer, at least partially, the problem of the huge costs of untreated disease (e.g., hypertension) that could be intercepted in the un-insured sector. A very small part of the solution, I admit.

And who is among Republicans and conservatives who will call out the Republicans on untruths and unfounded scare tactics and risk the wrath of O'Reilly and Beck?

Dear harry: I concur with your hope that we can confront untruths. I would start with the President's claim that we can insure 40 million people, raise the standard for others, not reduce anybody's coverage, not raise any taxes on anybody earning under $250,000 per year,not force anybody to change insurers or doctors, and do it without increasing the national debt - largely by taking "waste and fraud" out of Medicare and Medicaid, and taxing evil insurance companies. Joe Wilson was right; his timing was off. I have yet to find anybody - liberal, moderate, or conservative - who believes Obama on this.

A couple of notes:
Republicans have been obstructionist. There remains a blind faith, not to be questioned, that a private solution is always the best answer. I don't believe that. Programs need to be considered on a case by case basis. Also, which political party made sure that the government can't negotiate drug prices. I will give you one guess.

Of course Medicare is going broke. It only insures the sickest people in the country - the old. Insurance only kicks in when the pool of payers is at most risk. Perhaps a Medicare system for all (including the young of course) would balance income with payments.

The Republican Party has done its best to sink health care. One reason is that they fear allowing Obama getting credit. It is past time for conservatives to decide whether they are Americans first, or Republicans first. I firmly feel that there are health care solutions that most Americans would support. But Republicans for political advantage have poisined the water so thoroughly that nothing of real value can be passed. (ex. "death panels")

Do Conservatives want to continue to support the party of our worst instincts? Do you really think that, should Republicans come back into power, that the Libertarians and TV kooks will turn the Party back to you? Conservatives need to take the Party back so that those people don't wind up in charge of the national agenda? Grow a little spine and speak out when obvious fear mongering and untruths are spoken.

Nice discussion, Bo. The healhcare problem has several components that I believe, politically, can only be negotiated and passed separately. In effect on several fronts including energy the President proposes changes in far too big and broad proposals inviting dissent from all fronts. They are also too expensive at a time America is reeling from financial shocks.

Without a long discussion of the issue I believe it would be more likely to pass solutions if congress took them one at a time and if the President were to include moderate AND conservative leaders in the structure of the plan. If I were to divide up the major issues to be worked on it would be these:

1. State control of insurance provider licenses and offerings limits insurance competition within the state. We need national pools and laws on preexisting conditions, portability and rate increases on long term tratments. Pools should be available for both employer and individual plans so that employers can offer monitary supplements to individual plans or employer paid insurance if they want to. In modern Ameica few people work 50 years for one company and then retire so insuraance benefits post retirement should be the responsibility of the individual.

2. Tort reform or if the Democrats cannot pass it some form of Govt subsidized insurance for medial providers against huge legal penalties.

3. A national drug purchasing program. This pooled purchasing system will bring drug costs down just as it has in Canada where many Americans purchase them on line.

4. Poor people below a certain income AND net worth level are provided insurance coverage in a pool system just as if they were govt employees. To make this work the country must secure it's borders and register the illegals in the country today. Unless the border is secured the problem becomes unsolvable.

5. Catastrophic healthcare insurance pools for all citizens and a requirement for each person to carry if you are above the income limit (just like car insurance). Because it is mandatory the insurance company can set the rate for each individual when they come one line and actuarily amortize the premiums over an 80 year life expectancy.

6. Uninsured unemployed people. There are several possibilities to look at--perhaps the govt offers a national COBRA system that pools these people or they temporarily are covered in the poor people sysem. It is tricky and needs study because there is unemployment, there is under employment, there is self employment, the are leaves of absence. All have different motivations. This problem is similar to dual working spouse coverage and insurance company (lack of) cooperation. Both employers pay full premiums.

7. Death. I have been the family leader during the death of my father, aunt, uncle at advanced age and my wife at 43 from cancer.
I have seen the $100,000 plus hospital bills for all of them. This problem drives the medicare system bankrupt. In the case of my aunt who suffered in the nursing home for more than 5 years, the total was easily $500,000 of which my brother and I paid more than $150,000. This problem is an emotionally charged political issue and requires great study. However, if the qualifying conditions can be defined for end of life care then we can build an amortization table of what the annual premium is to make it affordable. It could be as simple as a childbirth payment into a trust that amortized over 80 years will pay the bill. Who makes the payments? Medicare, parents, remains to be seen.

Ok so I've divided it up somewhat. We can argue about the partitions but if we bite at this problem a piece at a time and include both sides then maybe a system (that can be adjusted with time) can be agreed on and implemented.

First, this is not a "rushed" process. We've been talking healthcare reform since the Truman Administration.

The U.S. is the only industrialized nation without a comprehensive healthcare system. We rank first in costs and 37th in care. So much for the myth we have the "best system on earth".

Insurance is the wrong model for healthcare. An insurance model is designed to spread risk. The simple fact is everybody uses healthcare--eventually. The profit built into the system for insurance companies--along with the bureaucracy it must maintain is on top of the cost of direct services.

United Health Care and others are incentivized to provide coverage to healthy people and deny services whenever possible. Bureaucrats already make most healthcare decisions, they are just not "government" bureaucrats.

Moreover, the taxpayer pays more for those who are uninsured. Doctors treat the uninsured and pass on the costs to the insured. Hospitals do the same. Denying treatment is not an option, bot on a humanitarian level and for the public health. Moreover, these patients cost more because they are treated as emergencies, there is no preventative care.

The deficit will balloon if healthcare costs do not get under control. Medicare and Madicaid will go BK under the current system, but you can be sure that Congress would print money to make sure these too big to fail systems continue to provide care.

As for those happy with their coverage, many are already in the Government System of Medicare--nary a person I know in the system would give it up for private insurance.

A single payer system makes the most sense, but politics does rear its ugly head. A public option is just that--an option. If it evolves to a single payer system, that is the best evidence that the insurance companies are not providing the service we Americans need.

The rich will always have healthcare for they will pay. It is the poor who need the system for healthcare and the middle class who need it to avoid Bankruptsy.

It is not an easy issue and competition in the "insurance market" is not an answer.

The President has shown leadership, the Congress is acting and healthcare delayed is healthcare denied. The Conservatives know this and their delaying tactics are designed to kill reform not improve it.

The Republcan mantra is to oppose Obama. If the Republicans truly thought the American people would reject the system being proposed, they would let it pass and blame the Democrats. What they want is to show the President is not competent. As one wag noted, "if we defeat healthcare it is Obama's waterloo."

We had an incompetent President for 8 years. I heard nary a peep from the fiscal guardians about his prescription drug giveaway program. Popular with seniors, it was the largest spending program in our history.

Now, the fiscal guardians are feigning concern. The simple fact is that if we do nothing our fiscal house falls off a cliff. The key to reform is to reduce costs, the key to reducing costs is competition from a public option. Anything else simply exacerbates the problem.

Sorry I will miss your presentation on Friday. I would love to expand this debate.

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