The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Random Thoughts on Health Care Reform

Posted by Alan on March 4, 2010

Just some random thoughts while we see if the Democrats can muster enough votes to enact health care reform. None of them are worth a separate post (and may not be worth being in any post), but I thought I’d clear the decks before the real fun starts over the next few weeks.

It’s Franken’s Fault: If health care reform fails I blame Senator Al Franken. Elected by a mere 206 votes, Senator Franken became the 60th Democratic vote, the super-majority the caucus needed to overcome, in theory, any Republican filibuster. This enabled President Barack Obama and Democratic leaders in Congress to treat health care reform as a Democrats-only endeavor. Yes, Senator Max Baucus tried to work out a compromise with a few Republicans (and actually got one of them to vote for the Senate Finance bill). But liberals in the party and in the land of pundits were constantly and consistently pushing reforms to the left.  For example, Democrats insisted health care reform include a government-run health insurance plan far longer than would have been the case if they lacked a super-majority. Want proof? The public option fell to the wayside within 58 hours of the loss of their super-majority.

Of course, liberal Democrats had already made the mistake of believing that all Democrats think alike. Proud to be the party of inclusion, they forgot that they had included moderates and conservatives into their ranks. They somehow thought they could get Senators Ben Nelson, Joe Lieberman, Blanche Lincoln and other centrists to go along with the liberal wish list for health care reform. Having a super-majority masked this illusion. So if 104 Minnesotans had voted the other way, who knows, health care reform might have passed months ago.

Republicans Will Vote to Keep the Sweeteners.  Republicans hate being called the Party of No, but they’ve earned the epitaph. They seem to have adopted a political strategy that Democrats can achieve no victories. Whether that’s to embrace the Tea Party advocates who want the federal government to go away, acquiescence to Rush Limbaugh who is on record saying he wants President Obama to fail, or, who knows, a sincere expression of their public policy beliefs, the outcome is they act in near lockstep to defeat any proposal with the Administration’s finger prints on it. Which may create an interesting spectacle: Republicans voting to preserve the Cornhusker Kickback and the Louisiana Purchase.

These are among the legislative sweeteners added to the Senate health care reform bill to gain the support of Senators Ben Nelson and Mary Landrieu. And to deprive President Obama of a victory on health care reform Republican may need to defeat legislation to repeal them. Here’s why:

Under the legislative dance Democrats are likely to use to pass health care reform, the House will pass the Senate’s version health care reform bill. Since the Senate bill already passed that legislation – with a super-majority no less, House passage sends it directly to the President’s desk for his signature. At the same time Democrats will introduce legislation aimed at modifying the Senate legislation to, among other provisions, repeal the sweeteners, bribes, backroom deals, whatever you want to call them. Among those “other provisions,” by the way, are a number of items on Republican’s health care reform wish list. To deny Democrats the a victory on health care reform, Republicans may have to defeat the clean-up legislation – a vote to keep the sweeteners and to defeat their own reform proposals. The word “ironic” comes to mind – along with many others.

Politicians Need an Asterisk Projector. President Obama likes to say that “If you like your current health insurance you can keep it.” Well, in theory maybe. For awhile perhaps. But even in the short-term there’s a huge caveat: there’s no guarantee you can keep your health insurance in the current health insurance system and the reform bills do nothing to change that. When employers changes coverage, their employees change coverage. Whether they want to make that change or not. If a carrier drops a particular health plan in the individual market, insureds have to choose another plan. So when President Obama makes this pronouncement, he should project an asterisk over his head to cover these contingencies.

When Republicans condemn Democrats for even thinking about using the reconciliation process to pass the health care reform clean-up legislation discussed above they should project an asterisk. That’s because they were very happy to pass tax cuts a few years ago using the reconciliation process. So what Republicans mean when they oppose reconciliation is that they’re for it when it’s helpful to them and they think it’s un-American when it’s not.

For a Rookie He’s Gotten Pretty Far. Regardless of what you think of President Obama’s ideas or his tactics, you have to give him credit for getting further with health care reform than any of his predecessors. Pretty impressive for someone who was a State Senator just five years ago.

Whether It’ll Make Things Better or Worse is A Guess. Of course, it would be nice if the health care reform package he may get through was better than what will emerge from Congress, but let’s face it: no reform proposal would be popular. This is one of those issues in which there are no popular options. Everyone recognizes the status quo can’t endure. Everyone knows every proposal to fix the system is gravely flawed.

My first political mentor, Cathy O’Neill, used to say, however, “The test of whether to vote for something is not whether it’s perfect, but whether it’s better than what we’ve got.” When it comes to health care reform, however, there’s no way to know if a particular bill will make things “better” or not. The system is too complex. The opportunity for unintended consequences is too great. It’s likely only comprehensive reform can fix the system, but there’s no way to truly understand what comprehensive reform will accomplish until well after it’s implemented. Not a reassuring prospect, but it’s reality.

We’ve Only Just Begun.  Let’s say health care reform passes. That’s just the start. States and regulators will need to interpret and implement the reforms. Future Congress’ may seek to change or repeal the bills. Yogi Berra is supposed to have said, “It’s not over until it’s over.” When it comes to health care reform, “It’s not over even when it’s over.”


35 Responses to “Random Thoughts on Health Care Reform”

  1. We are not thinking machines that feel.

    We are feeling machines that think.

    As much as many of us believe we can divest our (preceived) self-interest from our ability to analyze complex situations rationally and logically, I am increasingly convinced this is virtually impossible for the vast majority of human beings.

    Fear, aspirations, group allegiance, animosity to outsiders, status consciousness, enmity towards those higher and lower than ourselves on the hierarchy: these are just a few of the potent emotions that incline our views. All are easily manipulated by various appeals and code words and the like. It is not till our orientation is set that we begin to gather the “overwhelming preponderance of facts” that proves to anyone who is not willingly blinding themselves of the accuracy of our position.

    With the Bush Cheney years, this already sad state of affairs got yet another blow: total disregard to science, ridicule of the “fact-based community, and the allowance–indeed encouragement–of each person to select their own “data.”

    To me, Fox News is a spectacular example of how emotional appeals to the reptilian brain all but overwhelms any hope for rational analysis. I am sure that Fox News watchers believe the same thing about, say, readers of the New York Times. It is, I feel, a spectacular triumph of cynicism and manipulation that these two institutions are even held up for comparison–as if each has absolutely equal claims on objective truth.

    No one is likely to ever convince anybody in the opposite camp to switch his or her views by appeals to rational analysis. The only hope is to out-manipulate their manipulations.

    Right now, I am one of the few people on this excellent blog to be waylaid in the rat trap of unbelievable unfairness in the health insurance status quo. The fact that I am in this position has variously earned me the vituperation of some of you (quit being a whiner and earn more money) and occasionally some half-hearted sympathy though no real empathy.

    Ask yourself these two question:

    A) Am I benefiting from the status quo?

    B) Am I being harmed by it?

    Everything else you have to say on the matter–given how absolutely impotent each one of us is in affecting any change whatsoever in a system where mega millions call the shots–is nothing, absolutely nothing, more than icing on the cake.

    • Jim, you said:

      “Right now, I am one of the few people on this excellent blog to be waylaid in the rat trap of unbelievable unfairness in the health insurance status quo…”, AND,

      “Ask yourself these two question:

      A) Am I benefiting from the status quo?

      B) Am I being harmed by it?”

      First, while I don’t know how many on this blog have been adversely affected by the terrible economic situation we are currently experiencing, I know of many (friends, relatives, and “did you hear about”) who have. It is one reason that I am as disillusioned as I am regarding Barack Obama and his, in my opinion, total lack of leadership in focusing first on America’s economic “black hole”. I’ve discussed my thoughts in other posts about this and won’t take up more time here.

      Frankly, and candidly, you are one of the few who I’ve read who really gives a damn about your ability to insure your family. I’ve been in this field my entire life, and it was the rare person who felt responsible enough to put insurance ahead of a new car or a trip to Reno.

      Regarding your last two questions:

      I think that anyone who is content with the “Status Quo” and thinks that they are benefiting from it, isn’t really “thinking”. “Enjoying” the status quo can only be the luxury of a fool.

      Last question first: “Are you being harmed by it?”…about 15% of Americans are, because they have no health insurance. The other 85% have good protection, so harmed (?), no, benefiting as well as they could, IMO, no.

      However, I also think that there is another, a SECOND response to that question and that is “Will I benefit from the Proposed Change to that Status Quo Now On the table?” In the case of the mega millions of Americans who have paid into Medicare since its inception in 1965 is a resounding “NO.” How can any Medicare beneficiary, who can “think”, agree that they will be better off with One Half a Trillion dollars being cut from Medicare funding? $500BILLION is a Half a trillion, and that is huge! It is also about one half of the estimated cost of this current HCR proposal, and I think it is appalling that Obama or any member of Congress thinks that it is okay to cut those on Medicare or who have yet to go on Medicare off at the knees after their many decades of paying into Medicare, simply to pay for their vision, not the vision of the majority of Americans as currently proposed, especially given every president’s (until now) and every Congress’ promise that Medicare will be strengthened, not weakened. In the case of the many who have better than average coverage (EXCEPT for the now protected “Endangered Species” called UNION Employees, thank you “Behind Closed Doors”, screw Transparency Barack Obama) they too, will suffer the penalty for wanting to carry better than average coverage because if this morass of a poorly done HCR pan becomes law, they will have to start paying a 40% penalty tax. How can anyone think that is a good idea?

      Your last comment, Jim, may be the “shut the door” on any further comments not directly germane to your questions for you, but may not be the last others may have to say on these issues, said with all due respect.

      • My understanding of the $500 million is that it is not a cut, but rather the absence of an auto-pilot increase.

        I furthermore understand that most of this is subsidies to for-profit health insurers that sell supplemental policies to those over 65.

        Perhaps I am wrong here–Alan, who I think we can all trust, might give us his reading on what the $500 Medicare “cuts” really mean.

        The other thing I would point out is that if Medicare is ANYTHING like social security, the vast majority of older people who live more than a few years after they begin receiving benefits are deluding themselves into thinking they paid in more than enough to justify the money they take out of the system.

        Within a remarkably short time (3-4 years I heard once), most recipients of SS have taken every dime they put into it, along with compound interest of something close to 9 percent, and from that point on, they are living off gravy they in no way, shape, or form “earned” by the sweat of their own brows.

        To be honest, the thing that troubles me most about the Obama system–and the mandate that the young and healthy must buy coverage–is that this is just another example of the transfer of wealth from the young to the old. We Baby Boomers are one rapacious generation, I give you that.

        But do not delude yourself into thinking the Senior Entitlements of Medicare and Social Security are 100 percent deserved. A small portion yes, but the majority is no better than the welfare so many tea baggers decry when it goes to either Section 8 housing residents or farm and corporate subsidies for whatever loophole their lobbyists can “shove down” the greased throats of our “outraged” representatives!

        I challenge you, Spencer, to do the math: add up everything you have put into SS and Medicare over the course of your life, compound this annually at 9 percent, and see how long it takes to run the well dry completely.

        Then look at the mirror, swallow hard, and repeat after me: “Maybe yet but very soon, I will be the face of the new American Welfare Queen.”

        Not saying there’s anything wrong with it.

        But as Lil Abner’s author once put it, “We have seen the enemy, and he is us.”

        • Jim,

          I specialized in Medicare and Long Term Care (Medicare since 1967 and LTCi since 1974). I’ve been among the first to say that Medicare beneficiaries didn’t pay their fair share into Medicare, and are only recently paying in on a means tested basis, as it should have been from the beginning.

          However, while the beneficiaries paid in, so did their employers, and if self employed, we paid in far more than did employees.

          I delude myself of nothing. I am among the first to decry this country’s use of entitlements. Nonetheless, they exist, we pay into them, and we are entitled to take from them. I didn’t make the rules and have tried to change them to a more fairly “devised” system, but living in a country that has been changing from a “Free-market” capitalist system to a more social welfare one makes change difficult, especially when our lawmakers are exempt from following the laws that they make for US because their own system, devised and implemented by them, is so far more lucrative.

          Please, don’t challenge me, Jim, I’ve done the math. I know that we don’t pay in what we get (and I’ve been paying into SS since 1964), have been lecturing that for years, and that has zip, nada, nothing to do with Obama and Congress wanting to change the rules in the middle of the game…their plan is unethical, lacks moral integrity, is dishonest and would affect mega millions of Americans who canNOT afford the deterioration of an entitlement program that I can afford. You want to change the rules (however unethical) for me and those in my category who can afford it? No problem, just give me a fair warning…but you want to do so in fast track legislation that hasn’t been well researched? Nope. That is an action of a small minority of Americans (less than 6% – 18 million divided by 300 million) who have been betrayed by Bill Clinton through Barack Obama and their attendant Congress’, and it is wrong to lay that onto the other 94% of Americans because they aren’t “squeaking” as loudly (the squeaky wheel gets the oil?).

          Jim, suggesting that I look in the mirror and see the face of the new “Welfare Queen” is beyond the pale. You don’t know what I have given, continue to give, the hours I have worked when others were playing or the charities I help run and fund, or for what causes. I am not insulting you and I don’t appreciate your “having at me”. While I understand the position from which you’re speaking, that doesn’t give you the right to “flay” those not in your position simply because you feel wronged.

          Please, let us attempt to debate with civility and respect. Alan’s blog clearly demands that kind of adult behavior. Let’s try to honor that.

        • A quick correction:

          Per Barack Obama and Company, working age unemployed versus employeds: 10% and change, unemployed.

        • Jim and Spencer.
          It seems to me that you are both in agreement and very articulate; even poetic. Reading these riffs makes me appreciate the experiences you both have in your banks to teach from. The one difference evident to me is that one of you is still fighting and the other has laid down in total exhaustion.
          Nevertheless, I thought I would share how I propose to affect change in the status quo. will have activist / citizens running campaigns in 300 districts in this 2010 election cycle. I have been speaking with #2 there and he seems quite enamored with “The American Care Card”. He is quite certain that the GOOOH candidates will likely align with the principles outlined in the Initiative. Those that are will talk about it on their campaign trails. The Banking and Insurance Industries would both, without doubt, prefer the institution to the HCR Bill. They have much at stake. They will surely be forthright with funds to help raise campaign finances for these candidates.
          Let me just reiterate. This is it and this is the plan that free enterprise will align with. It just so happens that the one plan that could finally fix all that has been wrong for the last many decades can be fixed. Fixed with finality. If it can happen? If it has support from the forces that be? If there is a plan in place to bring it to the front of the debate? If it will finally leave our politicians neutered for all the generations to follow?
          Can we try just once more? Fight just once more?
          This can be done.
          Please read it and understand it.. please help however you can..
          This is the moment where everything anyone could want for America could really happen..muster that last measure of integrity.. support what is right and just..even if it hurts to fail in the effort.
          This is it.

        • Gentlemen.

          The American Care Card is not a commercial endeavor. It is a Legislative Initiative. I wrote it and continue to improve upon it in all the spare time I have when the business I run to support my family doesn’t require me. I ask that you read it please. If you agree with it, please help me to promote it. Put me in touch with the right people in the Insurance Industry or make phone calls yourself. I will never be able to profit from the Care Card. I have only spent my time and my money promoting it. My wife thinks I’m obsessed, but I see the writing on the wall. I’m only very very concerned about “our” future.
          Do you guys listen to Herman Caine or Gallagher on the Radio. I was on with Caine on Friday and Gallagher today. Consider helping.
          The Care Card Initiative represents a fundamental change in the relationship between the taxpayer, the government, and entitlements. It renders our elected officials harmless for the generations that will follow. It will end the insanity and in my estimation, it could save the America we love from it’s rapid desent. Rome is burning.

          That’s all.


        • Steven,

          I’m sorry about the misunderstanding.

          Thanks for the good explanation. I’ll check it out.


        • Steven,

          I read the opening paragraphs on your “Goooh” website.

          It says from the “get-go” that the intention of “Goooh” is to replace every member of the US House of Representatives.

          I’ve been involved in politics in this country since I was 21, and with all due respect, what is being suggested is simply not feasible, nor desirable, IMO. While I may be unhappy, nay, very unhappy with many members of the House, and the Senate, some of these members are good legislators. I’m not about to agree that we need to replace them all, or even half of them, and certainly not with inexperienced novices.

          Thanks, but no thanks.

  2. altruance said

    Back in January we blogged that although the current bills stink we really have no choice but pass them. The system is simply collapsing on itself and it is happening much faster than anyone projected. We had many of our clients tell us back then that they were upset that we were in favor of these bills but as soon as renewal rate hikes began mailing with 20-30% increases people have come around to the idea that we need to do something. While it is true that there are many unforeseen consequences that will surely emerge from such comprehensive bills at the very least we may be able to avoid the dramatic rate increases that are sure to continue with the status quo. Passing something now opens the door to make the tweaks over time that will be required to get costs under control.

    • Altruance:

      I’d like to offer a bit of a different perspective. The system, while not doing well, is not collapsing on itself.

      The latest Rasmussen Poll (today) shows that 53% Remain Opposed to the current Health Care Plan while only 42% favor the plan (

      Not knowing what might slam us in the back of the head (unforeseen consequences) in passing a Health Care Reform Bill that will cost us upwards of $1Trillion (One Trillion Dollars) in addition to our already unfathomable Mega Trillions of Dollars in debt it would be unconscionable for us to pass such legislation that will leave the vast bulk of debt to our progeny to resolve. Further, if history has taught us nothing it should have taught us that performing legislative “fixes” to law made is a very difficult and time consuming problem. We either do it right, or as right as we can, from the beginning, and live with the results, OR: We don’t do it until we can do it right; doing it right, performing true “Due Diligence” has not been a priority of the Obama Administration or the Democratic Controlled Congress since the beginning of this poorly performed folly. What you are suggesting seems to be no different than what Obama & Friends have tried to do from day one.

      Some, a minority of the electorate will be disappointed if Health Care Reform is put on the back burner until the Economy and Unemployment have been truly been put back on the road to recovery…people need to be able to buy food and pay their mortgage before paying their health care funding costs becomes primary; and the majority of the electorate will be pleased if this does not pass now, to see that the Obama Administration and the Congress finally seem to have the interests of the public at heart.

      I was stunned when after the very loud noises made by the public toward the end of 2009 and the beginning of 2010, including the newly revealed studies showing that “independents” now outnumber the Republican and Democratic Party members singularly, and nationally, that the Obama White House and Congress have literally paid their concerns no apparent heed. It is like watching a Bull chasing after the object of his affection, with no regard for the 18 Wheel Semi Truck heading for his mid-section, dead on. And during this little (?) drama the American Public is one again, ignored.

      • With all due respect Spencer, I don’t think citing popularity polls of public opinion on the reform plan does much to bolster the case for or against it.

        In the days when most people believed tomatoes were poisonous, I suspect a public poll asking, “Do you think eating tomatoes is a good idea?” would have netted an even more negative view.

        Personally, I think the New York Times editorial published March 6, “If Reform Fails,” summed up things quite well.

        The editorial ends with a sobering note about the Republican campaign of frightening our countrymen into doing nothing:

        Any change as big as this is bound to cause anxiety. Republicans have happily fanned those fears with talk of “dangerous experiments” on the “best health care system in the world.” The fact is that the health care system is broken for far too many Americans. And the country cannot afford the status quo.

        • Jim,

          And with respect, this is an issue in which, given the current makeup of the proposed HCR Bill, we will have to agree to disagree.

          While polls don’t make a Bill (imagine if all of Congress were afraid to pass any tax bill), public opinion on this issue is not analogous to what public opinion may have been regarding tomatoes.

          Yes, Republicans have happily fanned flames of dire outcomes regarding this Bill, and the Democrats have happily done a great deal of politicking behind closed doors, in secret, cutting deals, bribing Democrats who have let themselves be bribed, bribing others who held up their votes for “pay”, and doing all the things that they should have learned to not do from the “Hillary Care” years, when secrecy was the word of the year and they failed miserably, as they should have.

          The Obama Administration, Obama himself, and the Democrat Party controlled Congress have done little to nothing to explain themselves to the public, the electorate, the taxpayers to whom Obama spent two years telling that he would be the agent for “Change”, and for “Transparency”, and for honest government, and has instead proven himself to be no different than any other slick pol, who speaks with incredible eloquence and articulation while keeping his fingers crossed behind his back.

          I’m sorry, Jim, but I voted for Obama, I encouraged a lot of others to vote for Obama, and he let me and this country down, and STILL refuses to get his priorities straight regarding the Economy and Unemployment, now hitting over 18 Million and growing. It is time for this president to get his head out of the ether and start leading this country, an important function of the presidency that I and mega millions of Americans have yet to see him do. Jobs and the Economy must come first in my opinion.

          I am not a Republican, nor a Democrat, and I do not fall victim to either party’s rhetoric, whether it be about “Death Panels” (give me a break!), “Birther” bullsh*t, or the nonsense that none of the goals about jamming this HC Plan down the throats of Americans who don’t want it in this form have anything to do with socializing our system, from top to bottom, with HCR being the first major step. Free-market enterprise and Capitalism have become very dirty words, and it is precisely those philosophies that helped to build this country into a great one. The sending of millions of American jobs overseas, and to Mexico, and to Canada (willingly done by Democrats like Clinton as well as their Republican counterparts), combined with an irresponsible removing of teeth from a strong regulatory environment (and a continued removing of teeth by Democrats such as Christopher Dodd regarding AIG in their last mega-Billion dollar bailout, who at first lied about it to the American Taxpayers who must pay for it) have helped to bring an end to the “American Era”.

          This is a badly researched, badly done plan put together behind closed doors in secret, with neither the Senate nor the House, nor President Obama himself wanting to wait for CBO scorings before shoving this legislation through the system. Obama, in spite of the calls for “Due Diligence” continues to attempt to strong-arm this legislation through to his desk for signing.

          I’m no more impressed by the meanderings of an Editorial Opinion in the NYT than you are by polls done by Gallup, Rasmussen, or anyone else. Less so, because anyone can write an Opinion, but many polls we read are done well, and are sound. This is not a case of “Make the kids eat their spinach, because it’s good for them, they just don’t know it!” Majority votes rule in the USA the last time I looked, and the majority of Americans don’t want health care reform in this structure. They have stated so, loudly.

          I do know that when someone says that they are going to do something in order to get elected to office and then does the opposite I feel completely betrayed as do millions of other Americans. I was had. America was had. And we still, to this day, have yet to see this president follow through on his campaign promises, and I do not remember one of his campaign promises being that his first year, and now three months into his second year, would be to attempt to socialize this country’s health care system, and climb in bed with Big Pharma, Unions, and anyone else that he thinks will help him achieve his private agenda (in my opinion).

          Jim, I respect your right to your opinions. I understand that you are stating them from a position, economically, that I would have found to be horrific, but that doesn’t alter, for me, my opinion that this entire exercise, which may yet pass into law, has not been in the best interests of the vast majority of Americans.

      • Spencer. I can’t agree more.


        You can keep your eyes closed all night while you’re laying in bed. Things might work out better if you opened them while you were walking around though.

        When you follow the money, it seems that Lobbyists know who can be bought and who can’t. Look to and check out the top 20 in the list of big money campaign dollar donors. It seems that the only people who prefer Conservatives are Constitutional Rights Organizations. Free Enterprise seems to favor Republicans a little bit too. Corrupt Unions though…..Democrats resoundingly.
        Check out number 10 “SEIU”
        Guess which Lobbyist had the most facetime with Obama in the Oval Office since he took office?
        Guess which Union owns over 80% of the contract for Massachucett’s Social Health Care System?

        Don’t fall for the retoric about how Insurance Companies are lead by fat cat CEO’s either. Go to the Forbes list to understand. Only 2 of the top 80 in America are Insurance Company CEO’s. Talant is necessary and appreciated when you run a company that gainfully employs 10’s of thousands of familys.

        The state of Health Care in Europe is awful. Not acknologing that is just mis-information. Get yourself upto to par with the rest of us who are informed by going to the OECD website. Click on Frequently Requested Data.

        It might also be helpful if you gave this site a good read too. Pay attention to how The World Health Organization omits important Cancer Stats for the top 6 cancers in the “over 55” crowd of their populations. They also like to leave out the infants under the age of 3 months from their “infant mortality” stat.

        Don’t be fooled by the uninformed. Don’t be another sheep when we deperately need shepards.

        If you’re really concerned about Jobs, Deficit Spending, and Health Care Access, read and support the Care Card Initiative. Read it at:

        • Stephen,

          I checked out and must say that I am impressed. Their list of funders is short and very respectable (Carnegie Foundation, Pew Charitable Trusts, Ford Foundation, and the Sunlight Foundation, among others). That they do not accept contributions from corporations, trade associations or labor unions speaks highly for them. Their Board of Directors appears to be equally impressive.

          Reviewing the Forbes list was surprising. While I had to really search to find Insurance Company Execs, Banks and Financial Institutions were plentiful. I agree that if companies are to keep the best possible to run them, they are going to have to pay for them. While we aren’t the only country to have established high paying positions for acquiring the best, we have certainly done an excellent job of promoting that philosophy. We can hardly expect highly paid executives to accept a major “cut in pay” when we have not demanded that they do until now. More importantly, if the stockholders of these major corporations don’t have a problem paying their executives large incomes and bonuses then the American electorate can expect nothing. We don’t employ these executives, the stockholders do.

          Regarding your comments about the state of health care in Europe (and elsewhere in the world where socialized systems are a mainstay) you’ll get no argument from me. I’ve been studying them for years, have many relatives and friends from various European countries who have told me horror stories about the socialized systems under which they and members of their families suffered, and those in America who have promoted a socialized system simply refuse to acknowledge the truth about other countries’ systems (Sweden is often held out as a “monument” to socialized systems…google Ingmar Bergman, the great film producer, and read why he went into exile when the Swedish Government taxed him at 102%…you read right, 2% more than he earned). Great Britain, Canada, and many other systems have been promoting the sale and purchase of Private Sector insurance for years. They are going broke trying to maintain their wonderful “One size fits all” systems, and Great Britain has been in the new a great deal lately, promoting the purchase by their citizens of Private Long Term Care insurance because of the concerns they have about their “Aging population” (sounds like home, doesn’t it?).

          Stephen, I do not think it appropriate for you to promote your own company (The American Care Card) while providing such a terrific list of sites to research in your otherwise well written post, and on a “health care blog” of this nature where “self-promotion” is rarely seen. I think that doing so can have the effect of closing off minds that might otherwise be open. That is simply my own, personal opinion.

          Lastly, it is my opinion that you were a bit too acerbic in addressing Jim Thorton. Those who have been seriously harmed by this very serious “recession” (too gentle a word for what we’ve been experiencing) will undoubtedly become more “jaded” toward capitalist and free-market philosophies when having the ability to feed, house, clothe, and insure their families becomes the paramount and primary focus.

          I appreciate your agreeing with my previous comments and think that, with the exception of my just mentioned concerns, you wrote a well-researched and soundly presented post.

  3. Roxann Breazile said

    Who’d of thought we’d still be debating HCR a year later? Thank you, Alan, for your spot-on commentary and bringing your humor to lighten things up.

    Kudos for the asterisk idea — maybe we can just ask the networks to run disclaimers at the bottom of the screen whenever a politician is speaking.

  4. After watching Wendell Potter (former VP for Cigna) and Marcia Angell (former editor of the New England Journal of Medicine) on Bill Moyer’s Journal last night, I had something that has rarely happened to me before, once my opinion of something has become fixed: an epiphany.

    It wasn’t a 100 percent change of heart, more of a move from certainty to doubt.

    Mr. Potter argued for holding ones nose and passing the reform through reconciliation, then have something to build on in years to come.

    Ms. Angell argued for letting it die and allowing nature to take its course. She believes the current system is “unravelling so quickly” that it will collapse faster–and allow for a single payer Medicare for all style replacement–if we do not try to keep the Healthcare as a for-profit model alive longer by mandating coverage for all.

    As a canary in the mind, so to speak, who has seen his own oxygen usurped by the methane-rich flatulence of health insurance CEOs ($24 million in salary last year to the head of Cigna), I now find myself wavering on the Obama plan.

    The only reason I still am inclined to back it is the cynicism of the Republican Party, and the unregulated greed of our capitalistic system run amuk, is such that the dwindling American middle class, so easily-scared and rallied by racist subtextual animosities, will find themselves rooting for the Banana Republic-style oligarchy to come until it dawns on them they were never destined to be anything but peasants by the puppet masters who seduced their votes.

    And then it will be too late.

    • JimK said


      I know your present financial standing is precarious to say the least because of the cureent healthcare system but as I have written to you in the past I think the current proposal will do more harm then good.
      While it is not exactly a source of bi-partisan reporting, the talking heads on CNBC have repeatedly stated that a partial reason for the lack of hiring is uncertainty over the current healthcare plan. I must say that I am in agreement with them on this issue.

      Jim Kirk

      • That is good reasoning, Jim.

        I concur, and Jim (T), while you certainly have no reason to feel heartened by anything I may say, as with my son-in-law (45, and out of work for about a year…WAMU Computer IT, top position), I believe that once the Health Care Issues are “put to bed” things on the economic and “jobs” front should begin to open up.

        These are really tough times, the worst I’ve seen in my (almost…July) 65 years, including those early years when my partner and I were hanging on by a thread to keep our business afloat. I wasn’t being cavalier when I said on another Topic that I “hurt” for you (paraphrasing). I do. I can’t even imagine what it must be like to be going through what you, and several of my friends, who are my age or almost, are experiencing. It must be incredibly frustrating.

        I don’t mean to overstate what Jim K just said, and you said it really well, JimK …I just want you to know that I can’t imagine anyone not being incredibly sensitive to what you must be feeling.

        Hopefully, the next few months “will see” an improvement for you and the many others who are going through a “hell on Earth”.

        With great respect,


  5. Would be great to see health care pushed through, but some people would rather see the nation’s weak and underprivileged die off rather than pay a few extra bucks each year. It’s this same kind of selfishness that makes these certain people look truly evil.

    • “Would be great to see health care pushed through, but some people would rather see the nation’s weak and underprivileged die off rather than pay a few extra bucks each year. It’s this same kind of selfishness that makes these certain people look truly evil.”
      I’ve read a lot of really “off the wall” knee-jerk reactionary nonsense from both the extreme left and the extreme right since this latest incarnation of Health Care Reform began, but this one takes the brass ring for over-reaching, knee-jerking, ludicrous, vomiting an alphabet soup of “mentally challenged” garbage I have seen on display, yet.

      • JimK said

        Mr. Lehmann

        The author of the original post did not specify which type of healthcare should be passed, the author just stated a fact that both major political Party’s readily acknowledge, which is some type of healthcare reform is necessary.
        I do not know the author of the original post but based upon the brevity and content of the post I am assuming that this individual does not have your depth of knowledge about our current healthcare system or the Democratic healthcare proposal and if the author is a true idealogue nothing you write will change their opinion.
        While there are certain aspects of the current debate in which we would probably disagree, the present healthcare proposal not being one of them, the majority of your posts are informative and well written. Any casual observer of this blog who is not familiar with your past writings would look at your response here and view you as the reactionary.

        Jim Kirk

        • Jim,

          Your point is well taken. My comment was reactionary, as in “ready, fire, aim”.

          It won’t be the first time I’ve “shot from the hip”, perhaps won’t be the last, but hopefully will mark a beginning for my being far more thoughtful before I post.

          Thank you for the observation.

    • “Pushed through” is a good expression for it. “Forced through” might be more accurate, since although most of the country wants healthcare reform, a great number don’t wish it legislated, at least not in the way of the bills currently considered.

      Saying “health care pushed through” might not be so accurate, however. After all, we’re now looking at requiring everyone in the nation to purchase health insurance or face stiff fines. Requiring everyone to have an insurance plan is not the same as actually providing health care to the poor and weak. (If you’ve ever had to go through a PCP to get permission to see a specialist, you’ll know the difference. It’s your insurance plan that keeps you from getting the care you need in that case; the caregiver would see you right away if you were ready to pay out of your own pocket. Yes, this is me speaking against my own industry.)

    • Billy B said

      The thing you completely missed is that many of the poor spend their money on big screen TV, fancy cars, etc. including those that are taking Section 8/Welfare from the govt. If they are not paying for their healthcare, it’s their own fault.

      These people are killing themselves off. Don’t put the blame on others.

      Note: there are the true poor who does need our help. I used to deal with people in the govt assistance programs and 75% of them did not need our help, but a kick in the pants to stop freeloading.

  6. Robert Lehrer said

    Once again, you’ve written a compelling article that shows great insight and tremendous objectivity for a health insurance industry veteran.

    I’m afraid that if we in the industry win this battle today, we may lose big in the future. If we keep fighting structural reforms, skyrocketing costs will make the changes that are being debated today fluff, several years from now.

    • Robert,

      I beg to differ. Our “winning big” today may insure and assure that tomorrow may witness tremendous Insurance Reforms, and Health Care Reforms of a structure and type that doesn’t penalize the American Public for “thinking ahead’ and being “Individually Responsible”. The Senate Bill as currently written and as would be adopted as the “New” Obama Health Care Reform Plan does penalize the American Public and penalizes those who have paid for decades into an already socialized health plan called “Medicare”. Further, it penalizes those who would carry more coverage than the average. Why should individuals be penalized if they can afford to carry more protections than others by paying a higher premium? When did this country decide to punish those who feel it necessary to protect their families to a greater degree than others? When did it become immoral and wanton for Americans who choose to be responsible to exercise that right, and need to do penance in paying a higher premium or rate than those who have a cavalier “give a damn” attitude, and would have others pay for them? When, when, did we become so weak?

      Our destiny is being decided as some attempt to push America in the direction of spreading the wealth some make to be distributed to the many who choose to not make anything. Let the few do well, let the few work hard, so that the many may glean the pickings from the few who produce, to be spread and spent by the many who have chosen mediocrity, or sloth, or some other less than responsible avenue of forging ahead that requires far less energy, far less work and can result in far greater socialistic gains, you know, do little, get lots? And, this makes sense? How? I don’t understand this kind of spread the wealth concepts promulgated by the lazy who want to take from the not lazy to spread the earnings of the one over the many. This isn’t “Individual Responsibility”, it isn’t even a simple phrase of “Spreading the Wealth” because it only rewards the spreading of the wealth of the few to satisfy the greed and sloth of the many who would rather just take up space on someone else’s nickel. Is that what the things that made this country great have been reduced to providing? We know pay eight to get back six? We as a vibrant country are simply reduced to sloth, to a mediocre nothingness? This is our destiny? Oh my, what has become of us? Let us pray not.

      It is imperative that we continue to hold forth for those markers of ethics, integrity, and responsibility to be held accountable for our own actions, that we may present to our progeny a better place than we have found. A place that rewards hard work, sacrifice, integrity and ethics with a substantive plan for growth that all can take pride in and feel proud. We can persevere, if we just try a bit harder, and don’t give in to the easy road. We used to be a country proud of its individual actions, responsibility, accountability and can do attitude. It is now time to regain that feeling and not capitulate to the feelings of “let someone else do it”. Strong actions are being called for in the next two weeks. Lets make sure that they are the right actions, being lead from a position of strength, not one of weakness. And let’s not dilly dillay…let’s make certain that we take the necessary actions, now.

      As Nike put it so well, “Let’s just do it!”

      • Spencer.
        You’re right on. I’ve been fighting the good fight. I was at the Summit two Thursdays ago. I was at the HIMMS10 Convention in Atlanta last week. I’ve been on the phone almost everyday calling our Senators and Congressmens Staffers to tell them about the only alternative that makes sense to me. I might be a little biased though; It’s my design. It’s exactly what you’re clamouring for. Accountability. The American Care Card takes from a Politician the ability to inflict damage on the Tax Payer. Read the Initiative at: If you love it, tell others.

    • We spend twice as much per capita as any other industrialized nation on earth, and the results prove we have little to show for it. With the exception of AHIP profiteers, “top” specialists, PHARMA and medical device executives, lobbyists, health insurance brokers, greased politicians, and old folks who mostly get tortured by medical interventions in the last six months of life (PAP smears and colonscopies of 84-year-old women in end stage kidney cancer), there are very few beneficiaries here.

      It is fundamentally absurd to think that a for-profit “free market” system will bring down health care costs.

      A system this broken, corrupt, an immoral cannot be sustained forever.

      And it won’t.

      Check back here in five years, and we will see who was correct.

      PS Spencer, no matter how much your doctor may recommend it as a “medical necessity,” do NOT let him give you a PAP smear.

      • Hey, Jim, I won’t!

        And he’s been pushing for it, but I told him, “No way, Jose!” (His name is Jose Martin.).

        PSAs, fine, but no Paps! 🙂

        • Actually, PSAs are another example of a highly problematic test–way too many “positives,” leading to a carousel of needle biopsies, anxiety, surgery, incontinence, erectile dysfunction, and misery for many, many guys for whom their prostate cancer would have been, as the forensic pathologists say, “icing on the cake”–something that might eventually have killed them, but didn’t. Old age got them first.

          I would rather take a Pap smear than a PSA!

        • Actually, Jim, we will need to agree to disagree on the issue of PSAs.

          An favorite uncle of mine died from Prostate cancer after not paying attention to his PSA levels even after being warned by his doc. He died young.

          I’ve never had a “false positive” with a PSA test, and won’t stop getting that test now. Just as I was appalled that Obama’s Health Committee Study (don’t remember the name) stated publically that women don’t need Mammograms before age 50.

          That was a stupid result, and produced many angered comments from women who had had early Mammograms and had breast cancer removed when it was a small excision, instead of needing to have an entire breast removed. Several women who were angered were Members of Congress.

          Preventative care is still the least expensive method of “delivering” health care and should be encouraged. I have always been disappointed that the insurance companies don’t always require tests of a preventative nature, rather than waiting until the small bud has grown into a gnarly and dangerous human eating problem, resulting in dangerous, often unsuccessful, very expensive surgery.

          The companies really need to “come to the party” and cease being so damn concerned about making profits when they should be spending a little to keep from having to spend a lot.

          It’s simple economics.

      • Mr. Thornton.

        Do you just say things to get me started so you can benefit from the data you know I’ll spew at you? What you’ll find in this link to the O.E.C.D. are the facts displayed by the foremost authority in the world. The OECD is based in Paris and it has been gathering stats from its first-world country members since 1961. You’ll find out we’re about 500% better than France or Germany at Curing Cancer. That right; about 500% better. Do you know what the Average General Practitioner makes per year in France? Less than 70K; that’s right, Less than 70K. Do you want your Doctor to only make 70K? How much is OK for you? Who gets to decide how much you make? Can it be me? hmmmm… I think you should make 20K. Do me another favor while you’re there on that site. Do some math and tell me how much Frances health care expenditures per capita went up in the last 10 years they have on file. About 80%? And the USA? About 80%? Hmmmm… Looks like we’re containing costs as well as anyone else. Will you now tell me how many Cat Scan Machines and MRI’s European Countries have per million persons compared with the USA? Oh…we have that many more? WOW. I guess that’s why they have to wait 3, 4, 5, and 6 months on an MRI. Maybe that’s why they die of Cancer so much. If socialized Health Care is so wonderful, why is it that Massachusetts has the honor of having ‘THE HIGHEST AVERAGE FAMILY MEDICAL INSURANCE PREMIUM’ in the US. Why is that they have wait times that are 3 times as much as my home state on average? The President says that 30,000 people die every year because they don’t have adequate Health Care. If we had Health Care results that were as abysmal as France or Germany, that number would be 530,000. Can’t we all just care for each other enough to not want lots of people around us to die needlessly? We need to remain calm and use some common sense. We can’t just throw crap in the fan when people are standing in front of it. You’ll get crap all over the people standing in front of the fan. Right? Is this a Liberal BLOG? Is that why my blood pressure is going up? lol… Please do me the favor of reading my Health Care Reform Legislative Initiative when you get a couple of minutes. It’s taken that long at least to respond to your rant. You can find it at I would appreciate a comment or two from you also. Thanks in advance.

        Mr. Wolf.

  7. Alan,

    I like your “Random thoughts”…maybe more would be good?

    I see that I get to post right under my buddy, Jim. Hey there, Jim! Gave you another thumb’s up on your post! Again, we agree. 🙂

    Alan, Yogi Berra is responsible for that saying, or at least one similar to that; he said, “It AIN’T over ’till it’s over.” He also said, “You should always go to other people’s funerals; otherwise, they won’t come to yours.” Now there’s a thought! LOL

  8. Your random thoughts are more interesting than all the incessantly hammered bullet points of the vested interests put together.

    As far as blog topics go, Alan, you have certainly picked one you can continue in perpetuity!

    Keep up the good work.

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