Making Room for Market-Driven Health Care in an Obamacare World

It doesn’t have to be this way…

With the passage of Obamacare, responsibility for health care policy passed decisively to the federal government. If the polls can be trusted, it looks increasingly like Barack Obama will be re-elected president, which means the chances of repealing the health-care overhaul is just about nil. The question for Virginians then becomes, is there anything we can do at the state level to reform the health care system in accordance with our own philosophies and values?

There are near-term decisions that must be made in response to the federal law. Do we expand the Medicaid program? Do we set up a state health insurance exchange? Those issues can be debated, but the discussion should not stop there. We should never stop asking ourselves, what can we do to boost productivity and quality in Virginia’s health care system?

The General Assembly took one important step earlier this year when it created the Virginia All-Payer Claims Database with the goal of facilitating “data-driven, evidence-based improvements in access, quality, and cost of health care” by analyzing spending patterns and the performance of different providers. Aside from setting up an Advisory Board on Health Care Data Reporting, it is not clear from the description of the legislation how the data will be used. But there can be little doubt that better data will help drive better results.

And that brings us to an idea discussed in the Wall Street Journal today, “How to Stop Hospitals from Killing Us.” Author Marty Makary writes that a quarter of all hospitalized patients will be harmed by a medical error of some kind. “If medical errors were a disease, they would be the sixth leading cause of death in America — just behind accidents and ahead of Alzheimer’s.”

Makaray says that every hospital should have an online information dashboard that makes public its rates of infection, readmission, surgical complications and inexcusable errors, such as leaving a surgical sponge inside a patient. According to the limited experience so far, he says, “Nothing makes hospitals shape up more quickly than this kind of public reporting.”

Virginia should take the lead in getting hospitals to report quality data like this,  along with price data for common procedures. The health care marketplace cannot function without price and quality data to empower consumers (or for insurance companies working on their behalf) to make informed decisions. The main question worth debating is whether the state should mandate the reporting of the data or if there is a way to coax the industry into implementing the standards voluntarily.

Makary also recommends the use of video cameras to ensure compliance with best practices during surgery, and even in rest rooms to ensure that employees wash their hands (the single-most effective method of preventing the spread of disease). Sounds like a great idea. The hospital industry may have other thoughts, but it’s certainly worth discussing.

Obamacare has many abominable features — it imposes taxes, fees and levies out the wazoo, it adds regulations and mandates out the ying-yang and it will trigger a massive influx of new patients — all of which will drive up health care costs. Even though the law appears increasingly likely to survive, Virginia does not have to sit by passively as our health care industry staggers under the burden. We still have some latitude to pursue our own vision of what health care should look like. Instead of weeping in our beer, we should take maximum advantage of the opportunities left to us.


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  1. ObamaCare requires States, like Virginia, to set up health insurance exchanges and only has the Fed do it if Va will not.

    Massachusetts and a couple other states have set up their own health care systems and are not subject to ObamaCare.

    We need to be precise when we talk about what ObamaCare is – and is not.

    There is way too much rhetoric and way too much just plain wrong information being spread willy nilly across the internet and media and beyond.

    the idea that all we need to do is set up a free market and health insurance will be available to all is … well.. it’s ludicrous.

    How many folks 65 years and older could find affordable insurance if it were not for Medicare?

    Now how many people could find affordable non-employer health insurance if they have a pre-existing condition?

    the free market folks live in a dream world.

    they think the free market is going to offer affordable insurance to someone who has a serious health condition.

    they will not and that’s the issue. How can people who are not
    “preferred risk” get affordable health insurance?

    Show me one single country in the entire world where this free market idea actually works.

    there are NONE!

    the only countries that have true free market insurance are 3rd world and those that do not see that irony – are just not looking.

    I’m not saying people should be given “free” health care at all.

    I think folks should pay for health care like they do Social Security with a mandatory requirement because ultimately most everyone needs medical care.

    We are also totally avoiding the reality with respect to where MedicAid comes from, why it is so costly and why EMTALA is Americas version of Universal Health Care – but only when you getting really sick and need really expensive “heroic” medical care – which is then added on to the bills of those who do have insurance.

    We simply live in denial in this country. We refuse to recognize the simple realities of why every single other industrialized country in the world – including Singapore and Hong Kong have – compulsory saving and compulsory health care.

    it does work in a “free market”.

  2. Oh – an no it is not a GIMME that Obama will be re-elected.

    If Romney would get off his pompous ass and actually talk about HIS Vision for the country instead of endlessly blathering anti-Obama right wing talking points – he could actually win.

    but right now, who the hell knows what the hell Romney really stands for other than his willingness to repeat what his handlers tell him to say.

    Inside – there is a real man with some real ideas but right now, he
    is a sock-puppet of right-wing-world. Ryan, bless his pea-picking soul is the epitome of the evil munchkin movies.

  3. I believe there should be room for additional insurance and other health care options above the minimum mandated amounts.

  4. re: Obama, Romney, health care

    what is Romney’s “REPLACE” of ObamaCare? Do we know?

    Part of the reason why Romney has never strongly challenged Obama is because he is basically running an anti-Obama campaign rather than a pro-Romney campaign.

    I’d not a huge admirer of Obama – but in order for me to consider a
    vote for Romney (and I HAVE voted GOP before), I’d have to believe the man has a real alternative approach to our health care challenges and all I get from Romney is bad, bad Obama; bad bad ObamaCare.

    I’m sorry just being opposed to Obama is not good enough for me and as the polls are showing not for a lot of people.

    If Romney and Ryan actually believes what Jim Bacon has opined here – I’d like to hear it instead of just endless “bad bad Obama”.

    Actually if Jim Bacon has a better market-based idea, I’d like to hear it but we already have a market-based, non-govt environment for reporting health care providers performance metrics and how well has it worked?

    Is Jim actually proposing that the govt step in and REQUIRE that these metrics be collected and made available to consumers – much like it has done with regulations such as nutrition labels or the like?

    One of the very best ways to cut down on errors is electronic medical records – that are common in other industrialized countries and common with our own military and VA system.

    Anywhere a patient goes, his entire medical history including all his current providers and medications go with him/her.

    The question here is – will such a universal system happen through Jim’s “market-driven” idea?

    I do not think it will. Many doctors and providers are less than luke-warm to the idea because it will “cost” them. This is pretty ironic, the financial well-being of the doctors is more important to them than the use of electronic medical records in reducing errors that harm their own patients.

    Do we really think the free market will do this any more than the free market encouraged standardized nutrition labels?

    What does Mitt Romney say specifically about what he would advocate for to improve our health care and reduce the horrendous costs currently in our system?

    The man says NOTHING other than he is opposed to ObamaCare.

    This is the problem.

    Why would anyone sign on to Romney’s view of how we should do market-based health care or any kind of health care for that matter when his primary message is negative ?

    You cannot win like this.

    why should a reasonable person support a challenger whose primary message lacks vision and specifics and relies on attacks on the incumbent along to gather votes?

    and of course, a deeper message here, how about the folks who support Romney no matter the lack of vision and specifics? What are they really expecting?

    It’s almost like ” I don’t like Fords so I’m buying a Chevy”. This is how we vote for leadership?

    so I come back to the original tome – and ask – where is the opposition party’s alternative vision for health care to ObamaCare?

    It’s not there. It’s a series of Op Eds in WSJ and other right wing media. That’s a recipe for losing. More than that – it’s a cynical disservice to the whole idea of electing leaders.

  5. DJRippert Avatar

    Obama’s overall philosophy is very European. From Obamacare to extended unemployment, he believes in a broad and deep safety net for all in society. Obviously, this will cost somebody a lot of money. To date, that money has come from increasing deficits. However, even Obama knows that approach to financing his European – style safety net will be unsustainable. So, prepare for extremely high taxes on everyone and every corporation. Just like Europe.

    The problem with Obama’s liberal philosophy is that it seems to have been formed somewhere around 2005 when the European model appeared to be working. I can remember liberal after liberal on the two coasts speaking in glowing terms about the European approach. LarryG was a leading proponent of doing things the European way. However, a funny think happened on the path to Euro-utopia – the European model failed. Even countries like the UK, who are not in the Eurozone, have slipped into a double dip recession.

    The real question is why Obama thinks the United States will fare any better than the European countries that have embraced pseudo-socialism. Yes, it looked promising in 2005 but the last seven years have brought nothing but failure for the pseudo-socialists. Now, as the Europeans are rolling back their endless safety nets, Obama is rolling out that same safety net in America.

    This is not just about Obamacare. It is about extended unemployment benefits, waivers for work requirements to those collecting unemployment benefits, a record number of people on food stamps, almost half of all wage earners paying no income taxes, an open borders policy that keeps low skill job holders from earning a living wage. It is, in my opinion, an orchestrated effort by America’s liberals to create a dependent class that constitutes the majority of Americans. At that point, the liberals will be able to remain in office for life by simply promising to continue the supposedly endless river of benefits to the dependent class.

    Of course, as liberals contemplate this “progressive utopia” they should hear one of those little voices speaking in their ear. The voice has a British accent. And the voice is saying, “The problem with socialism is that you eventually run out of other people’s money.”.

    If Obama is re-elected, I believe America will fall into an utter and disastrous economic spiral. Trying to buy the votes of the majority of Americans with an endless flow of federal freebies will prove no more viable here than it has proven in Europe.

  6. Peter Galuszka Avatar
    Peter Galuszka

    One of the problems with this posting is a common one on this blog. The author has not kept up with the news and doesn’t seem to know what Affordable Care Act. I.E. exchanges. States will have to set up their own exchanges or the Feds will. That’s it. Supreme COurt has already upheld it. This is not something open to debate any longer, despite what Jim Bacon may believe. The only way this act would be history is if an overwhelmingly conservative and Republic Congress is elected and Obamacare.
    Still, Bacon may not understand. He has this way of putting down things he doesn’t like or agrees with in a strange kind of denial mode. Example: when he reviewed my book on Massey Energy is has to add the word “allegedly” when I state, accurately, that no other U.S. coal firm had as many safety violations. These are not statements of opinion. These are statements of fact. Jim doesn’t lack them, so he diminishes the reporting of the “fact” by trying to morph into an unproven opinion.
    Same with with the health exchanges. Jim, please do a little research before you write this stuff. I, for one, am getting tired of reading your wishful thinking and certainly am tired of debating such things that have already been through the wash a million times.

    1. Hey, smart guy, maybe you ought to get own facts straight before you accuse me of getting mine wrong.

      Obamacare does not require states to set up their own health insurance exchanges. The law creates a framework for them to do so, and it says that if the states don’t do it, the federal government shall. But the issue is still under consideration here in Virginia. Don’t believe me? Maybe you’ll believe the Kaiser Family Foundation.

    2. As for the Massey quote, I did not say that “no other U.S. Coal firm had as many safety violations.” That may be the way you read it, but that’s not what I wrote. When you take me to task for ignoring statements of fact, perhaps you should start by getting straight certain statements of fact — like what I actually said — yourself.

      Here is what I wrote: “He proceeds to escort readers through the history of the entrepreneurial Massey family and the company it created, the rise of the ruthless, hard-nosed Blankenship to corporate leadership, Massey Energy’s (allegedly) appalling safety record and the sale of the company to Alpha Natural resources.”

      The reason I put “allegedly” in parenthesis is that Massey officials would disagree with you. You might be factually correct to say that Masssey has been charged with more mine safety violations than any other company, I don’t know.

      But the larger point is this: Massey is the No. 1 target of the UMWA. The two have been locked in a state of labor war for a couple of decades. The UMWA will do anything to make Massey look bad. A lot of former UMWA miners now serve as W.Va. mine safety inspectors. Massey management believes that those inspectors target Massey, especially its non-union mines, for violations that they would never write up for anyone else.

      Maybe Massey management is correct in its suspicion of bias, maybe it is wrong. I don’t know. But the suspicion is not something that can be blown off with a wave of the hand and a huff of exasperation. That’s why I said “allegedly.”

  7. nope. this is more of the right wing narrative. Japan, Singapore, Hong Kong, Australia, New Zealand and how many other countries have universal health care / ObamaCare and what the right wing narrative basically boils down to if you ask for and receive their bigger view is that ALL industrialized countries that have UHC are “doomed” because of entitlements.

    All the other industrialized countries require compulsory saving to pay for health care. It’s an entitlement, yes, but it is payed for by each person in their payroll taxes.

    Attempts to paint Obama as a socialist are part of the ” he ain’t one of us” narratives that emanate from the right and the American people are smart enough to know that this is not only an unfair characterization but that it is inherently corrupt in that the folks who make this claim about Obama – don’t have any real alternatives even as they say “Repeal and Replace” – there is no replace.

    The “Replace” – as Romney is proving is “ideas” and little else.

    that’s not leadership.

    you cannot win by demonizing the current President – but the right wing has yet to figure that out and Romney is apparently either equally clueless or trapped by the anti-Obama base.

    Romney can win once Romney proves there is something of substance to his own vision and leadership potential but he won’t win by listening to the right wing “he is a socialist” blather.

    look at the polls. How many people are NOT buying the right-wing narrative?

    1. Larry, how is my post “right wing narrative”?

      Do you have a problem with creating more price and quality transparency for consumers? Do you have a problem with combating medical errors in hospitals? Nobody disputes the value of those ideas.

      Do you have a problem with videotaping surgeries? That ideas is a bit newer and more controversial — but is it “right wing”?

  8. DJRippert Avatar

    I agree with Peter that this is a “done deal”. The only way it will unwravel is with an Obama victory in November and then a very serious blowback election in 2014. It’s a possibility, albiet a slim one.

    Obamacare will cost vastly more than was advertised when it was passed. Obama will continue to extend unemployment benefits. The Social Security Trust fund will continue to be depleted until it is exhausted. After that, taxes will be raised to continue the same level of benefits.

    This is Euro-socialism, plain and simple.

    Lots of European leaders were elected under this premise. They tried hard to make it work and it failed. Meanwhile, they didn’t have the American defense spending issue or (at first) the level of debt we have.

    Obama’s Euro-socialism will fail here too. Japan’s economy is a basket case. I’ll be there next week. Happy to let you know, first hand, how things are going. Citing city states like Hong Kong or Singapore or countries with endless natural resources and low populations is silly. How are Spain, Italy, the UK and France doing with Euro-socialism?

    They are failing, LarryG. And so will the US.

    You used to write about European countries when you commented about the wonders of a broad and deep safety net. Why have you stopped citing European countries in your narrative?

    Obama’s economic approach is suicidal. Romney doesn’t seem to be able to say what he wants to do but that’s still better than economic suicide.

  9. Peter Galuszka Avatar
    Peter Galuszka

    Bacon i am right on both counts. No more comment from me. This islike atv courtroom drama with no commercial breaks

  10. Peter Galuszka Avatar
    Peter Galuszka

    Bacon one morething in your coal apologia. The 2010 blast at massey’supper big branch mine that killed 29 miners was the worst deep mine disaster in 40 years in the us. There is nothing “allegedly” about it . Itis not union spin. What the directors thing does not matter. They lost their jobs in 2010.

  11. Yes, the mining disaster and 39 deaths is a hard, cold fact, and Massey bears responsibility for that.

  12. Peter Galuszka Avatar
    Peter Galuszka

    Thanks for your comment but it is 29 dead not 39. Txs.

  13. re: European socialism and the failure of all industrialized economies that have UHC including Singapore and Hong Kong.

    re: right wing narrative

    see above: it’s not European socialism – it’s worldwide “socialism” across every single industrialized country – in the entire world.

    Do we consider the leadership in Singapore, Hong Kong, Australia, New Zealand, Japan, and all of Europe to all be socialism that is doomed to fail?

    Isn’t that essentially the right wing rhetoric?

    You cannot win with this kind of argument. Although a good number of Americans will believe such wretched sound-bite blather – enough of them will not – and that is likely what we are now seeing in the polls.

    If Obama is a socialist for wanting universal health care, doesn’t that make the rest of the industrialized world – socialist?

    re: ” Do you have a problem with creating more price and quality transparency for consumers? Do you have a problem with combating medical errors in hospitals? Nobody disputes the value of those ideas.”

    I have no problem at all IF it was actually some of the specifics in a real proposal from Romney (or the GOP) rather than yet another Op Ed in the WSJ which is little more than the print version of FAUX NEws these days on many political issues.

    Singapore has a 30% payroll tax that includes both social security and health care. The working poor and indigent are subsidized. Providers are required to disclose prices for all procedures and people are free to pick. It’s not perfect but it IS govt-sanctioned market-based health care that takes what Jim is advocating and making it a govt policy – the health care equivalent of our own nutrition labels.

    We could do something LIKE THAT. Romney could propose that we do something LIKE THAT but what is he saying instead?

    he’s just blathering right wing anti-Obama talking points.

    this is a losing strategy.

    1. You said, “I have no problem at all IF it was actually some of the specifics in a real proposal from Romney (or the GOP) rather than yet another Op Ed in the WSJ which is little more than the print version of FAUX NEws these days on many political issues.”

      Why does it have to be a “real proposal from Romney”?

      I was writing about what *Virginia* could do, given the reality of Obamacare.

      Larry, you’re sounding a bit like Pavlov’s dog here: Mention health care, and you go into a spiel about Romney and Republicans in Washington. I’m trying to get people to think differently about health care in Virginia.

  14. re: ” Why does it have to be a “real proposal from Romney”?”

    because you prefaced it with this: ” If the polls can be trusted, it looks increasingly like Barack Obama will be re-elected president, which means ….”

    why is Romney not getting traction? In part, because he is running an “anti-Obama” campaign rather than a Romney campaign – that could/should include HIS PLAN for market-driven healthcare.

    no Pavlov Dog here. I’m frustrated because we ought to be comparing two visions for the country and instead what we’re doing is comparing Obama to the “I’m not Obama” .. no specifics, trust me.

    so you wrote this as if Romney might lose and in that case what Va should do – to essentially do a modern-day version of massive resistance health-care style.

    Why would Va be in this mess to start with if Romney had demonstrated real leadership on the issue – if Virginia -had demonstrated real leadership on the issue BEFORE ObamaCare came down the pike.

    If Va had done what Mitt Romney had done in Mass and if Mitt Romney would actually claim his signature achievement – we would have a legitimate contest between Obamacare and alternatives.

    Instead, we are not, in part because the right wing will not allow it because they consider Massachusetts health care – “socialism’” just like they do ANY kind of govt-sanctioned health care.

    Romney has allowed the right wing to define his options on health care and the party line is that any vision of health care that involves the government is de-facto socialism.

    how can you win like this? Do you REALLY think that the GOP in Va, Cooch or other GOP leader would put together a real Va approach?

    I don’t.


  15. You wrote, “so you wrote this as if Romney might lose and in that case what Va should do – to essentially do a modern-day version of massive resistance health-care style.”

    Massive resistance? Are you crazy? How do my proposals undermine Obamacare in any way?

    Are you saying that price transparency and fewer medical errors are antithetical to Obamacare? Really?

  16. the issue is govt involvement in health care and if it is involved in health care does that make the President a “socialist”?

    Massive Resistance? Yes. You do listen to the Cooch don’t you? How about McDonnell? How about the decision from Va to NOT begin the process of setting of Exchanges at all – in hopes that Obama would lose and ObamaCare would be dismantled?

    You say price transparency and other market-driven ideas.

    I ask you – WHERE ARE THEY and why are they not already advocated by folks like McDonnell?

    Why are these things based on what happens or not to ObamaCare and Obama rather than Va proceeding in a way that they feel is right for Va from the get go?

    You’re playing off the right wing narrative here – IMHO – perhaps unwittingly but you are basically buying their built-in premise about what the landscape looks like and what states should do – not on their own regardless of what Obama did or does – but in response to it.

    I ask you – is that a principled approach or a partisan approach and why are they using the “socialist” epitaph for any/all govt involvement in health care to start with?

  17. I just would reiterate my comment that Va has never been limited in what they could do about health care – long before Obama came upon the scene and that includes MedicAid costs. In fact, MedicAid is voluntary, Virginia is not required to use MedicAid to start with.

    So Va has basically CHOSEN to do little or nothing about health insurance for Virginians – for years, for decades…

    and now, all of a sudden, with the “specter” that SCOTUS has ruled in favor of ObamaCare and even worse, Obama might be re-elected, there NOW, after decades of willful inaction, is a feeling that VA should “explore”…. ALTERNATIVES to ObamaCare health exchanges including the GOPs favorite “idea” – ” market-driven health care”.

    This is why I call the opponents of ObamaCare – hypocrites – independent of the political label but if the shoe fits the GOP party, so be it.

    Even now, Va, COULD, go ahead and USE the advent of Health Care Exchanges as an impetus to actually do something about health care to INCLUDE market-driven changes but what is Va doing?

    They are, in effect, continuing their “massive resistance” to ObamaCare refusing to take the steps to even start the process of implementing the exchanges – much like their denial of documenting flood-prone geography if the oceans will rise…

    There is a sense of denial among so-called GOP “leadership” on a variety of issues in fact, because their fundamental premise was to deny Obama legislation ( which led directly to the tortured process and final product for ObamaCare) and, in fact, deny him a second term.

    As heard recently, Romney and the GOP have run out of feet to shoot.

    Nothing has kept Va from going forward with it’s own market-driven approach to health care and, in fact, nothing has kept the GOP from going forward with a viable, competitive alternative to ObamaCare but in both cases – fetid hypocrisy defines both the GOP and Va on these issues.

    Oh and one more thing – if health care is socialism, what are public roads?

  18. Getting back to health care, two points.

    First Obamacare (beginning to like the sound of that) hasn’t kicked in yet. We have lots of wild accusations about how burdensome it will be, new regulations, stifling of free enterprise, and so on, but that’s simply not the case. It requires everyone who can afford it to buy health insurance, because nearly everyone will need it. The current system has the same costs, but is vastly less efficient and emphasizes care of sick people rather than prevention. The true free market approach would be to deny care to those who can’t afford it – I don’t see anyone on the right actually admitting that is the solution. No matter how the healthcare system is reformed, it’s going to be an effort and there are going to be winners and losers – a similar process will be required when the tax system is reformed. Lots of complaining, but in the end we’ll have a better system.

    Second, Obamacare and HIPAA will result in a tremendous increase in digital data about healthcare – which will result in more complete and accessible data for the individual and provider, less duplication, and the ability to compare costs. If you want to inject the market into healthcare (which has been sadly lacking), the consumer has to have the data and the power to make decisions, and Obamacare moves sharply in that direction.

  19. re: getting back to health care…

    okay … but recounting what ObamaCare REALLY does and does not do – will not mollify those who are politically and philosophically opposed to the core idea – of govt and healthcare.

    the same people who oppose ObamaCare ALSO oppose Medicare and SCHIPs and MedicAid but seem to be more accepting of military health care and the VA system. For instance, I’ve never heard these folks say that the govt should just give a voucher to military families or to those who go to VA hospitals – to use those vouchers to get health care from the private sector. I wonder why?

    Virginia has had ample opportunity to develop it’s own approach to health care – not unlike what they’ve done to insure that drivers in Va have access to auto insurance.

    Virginia could have said “no thanks” to MedicAid and developed their own system – like Massachusetts and Vermont have.

    So Richard, I much respect your sentiment to keep the topic to health care but my view is that health care these days is unfortunately heavily infested with politics …. and it’s politics that have kept us from doing anything about health care.

    You’d think that since we spend twice as much per capita and that the costs of healthcare threaten to eat up about 1/3 of our economy that this would be a non-partisan issue.

  20. larryg – well I think there is a lot of hypocrisy displayed by the most vehement critics of Obamacare. Medicare and VA benefits and state-controlled Medicaid = good; anything but the present system for everything else = bad.

  21. Since Obama is doing all this for the “middle class,” why aren’t those people supporting Obama?

    The federal government generally works against the middle class. It favors the East Coast Elites, Hollywood stars and those who live lives of dependency.

  22. The folks who are going to be able to get insurance from the exchanges are not really middle class. Many will be people who are working at jobs that do not provide health care.

    If you want to make ObamaCare more popular, especially to the middle class – do what Mitt Romney is proposing but it’s not being noticed – and that is take away the tax benefits of employer-provided health care both from the employer and the employee and let the employee go out into the marketplace and find their own “market-driven” health care and I’d predict ObamaCare would suddenly become much less hated.

  23. A lot of people will lose their employer-provided insurance because of Obamacare. But they deserved to be screwed in the Obama world because they have something.

  24. Define a “lot”, especially compared to the numbers of people who just lose their health care or never had it to start with.

    We have 401(k)s now instead of defined benefit pensions and that allows people to be job mobile and take their own 401(k) wherever they go.

    Why not health insurance that is also portable or at least you can get when you change jobs? How many people stick with a job just because it offers health care and they are afraid to pursue opportunity for fear of losing their insurance?

    I’d only say again – the GOP (and Virginia) have had every opportunity to put forth a better approach that did not “screw” people, to do something to actually help the people who were already “screwed” and what have they done besides blather, attack Obama and gridlock?

    We still don’t know who might win. I still think it’s highly possible for Romney to win but here’s what folks should pay attention to.

    A good solid 50% of the people in this country LIKE the approach that Obama is putting forth, are not convinced at all that the GOP is really serious about real solutions vice silly ideology and reject the lies and disinformation being spouted by the PACs.

    I’m going to call it the “cry wolf” effect. Once people start to disbelieve the Karl Rove and Koch brothers-financed narratives, it won’t matter later even if some is actually true because people have had enough of their disingenuous approach to “dialogue”.

    You can fool some of the people all of the time, and all of the people some of the time, but you can not fool all of the people all of the time. Abraham Lincoln

  25. The GOP needs to come clean and be honest about what they think government should or should not do with respect to health care – and then let the voters render a verdict on their fitness to lead.

    As opposed to what is going on right now in which the GOP dances around about “ideas” but never really puts together a cogent statement of what they believe, support, and what they will pursue if elected as a majority – as well as agree to as a compromise if not elected as a majority.

    The current orthodoxy seems to be – “here’s what we will do if we win in a winner-take-all election …. trust us”.

    You cannot sustain yourself as a viable party when your primary promise is opposition to everything and compromise nothing if you fail to win everything.

    This seems to be the current GOP mindset. winner take all or trench warfare until they do win all.

    You may not like what Obama supports but at least the man is clear about it and not evasive and disingenuous – unlike the GOP – who are all over the map and less than honest about what they’d do or not do if elected.

    And again – there is NOT A SINGLE industrialized country IN THE ENTIRE WORLD that does not have coverage for ALL of their people and they do it at 1/2 our costs and yet the GOP says this is “socialism” and EVIL and doomed to fail.

    Yes Greece and Spain are in trouble. But what about Sweden which has a balanced budget and Singapore and Hong Kong which not only have powerhouse economies BUT also have Universal Health Care and Germany which has had it since 1900?

    Don’t like Obama’s approach? Fine – propose something better.

    but just opposing him and promising nothing else but gridlock if you don’t get elected is a losing proposition IMHO.

    It might take Americans a while to get there but they will and when they do – the GOP is going to become the minority party it deserves to become if it continues it’s current “do nothing” trajectory.

    Who would have ever thought that Virginia might vote Democratic two elections in a row – and it’s not because the Dems are that popular, nope, it’ s because the GOP apparently cannot help from becoming a party full of really stupid people who are willing to harm the country rather than compromise.

    To finish. Virginia has options for health care. So far, they’ve chosen the blame game rather than lead and govern.

    McDonnell and the Cooch owe Virginians a simple statement of what they support and if it is the status quo – then say so.

  26. Tom Bowden Avatar

    Larry – I can’t get past your unsupportable assertion that compulsion is the only solution. What is it about compulsion that you find so seductive? Isn’t compulsion the essence of fascism? Don’t all dictators say the same thing: “Just do it my way and everything will be simpler – trust me! I am the beloved/dear/fearless/wise and powerful LEADER!” (usually while standing in front of a phalanx of generals and other armed enforcers of the received wisdom.) And are you not aware that current Rube Goldberg mechanism that we call the “healthcare system” is a direct result of government compulsion in the first place – i.e. wage and price controls imposed during WWII, that Kaiser Shipbuilding skirted by offering employees “free healthcare”. That was the only way they could attract workers away from competitors and build the ships and other materiel needed for the war effort. Over decades, this temporary expedient morphed itself, with lots of well-intentioned government assistance, in the form of tax policy and anti-trust waivers for health insurance companies, into the swamp we now know as “healthcare”. I’m not saying unbridled free enterprise is the solution to all problems, but neither is unrestrained government compulsion, regardless of its constitutionality. I approve of many of the changes in the affordable care act – but I don’t buy into the notion that compulsion is the best answer to the problem. Wake up dude.

  27. re: ” What is it about compulsion that you find so seductive? ”

    not seductive Tom – the reality. Every single industrialized country in the world has compulsory savings because they know that if people do not save – they will end up expecting others to pay for their needs.

    there is no dictator. All of these countries have representative governance and all of them have had the opportunity to do away with compulsory savings and Universal health care and none have chosen to do that.

    Tom – How many people currently receiving Social security would have saved for it if not for the mandatory payroll tax?

    and what would you do with elders that did not save for their retirement?

    would you let them die in the streets or live in cardboard boxes like they do in 3rd world countries?

    I’m looking at this pragmatically.

    what is the answer? so far, the answer is compulsory savings. The countries that don’t do it are all 3rd world countries.

    I tend to agree with you about free enterprise and I like Singapore’s approach which has compulsory savings but also has govt requirements for providers to post prices and quality, performance data generated and disclosed.

    You may (or may not) have noticed that in this country – Medicare already collects that data; it’s a start but it does require the govt to do it as the private sector will never do it on it’s own.

    Tom – can you name the top 3 best countries in the world that do not have compulsory savings for pension and health care?

    what are the 3 best countries that do no “compel” ?

  28. in terms of “compulsion”.

    the mortgage company “compels” you to get insurance on THEIR home (if you think about it).

    and the State “compels” you to obtain insurance if you plan on driving.

    the locality “compels” you to pay property taxes for education and deputies.

    when you buy fuel for your car, the State “compels” you to help pay for maintenance and operations.

    The problem with the Libertarian philosophy is that it ignores realities of what people would willingly pay for (or not) and then leaps to the conclusion that the govt is using “coercion” in compelling you to do something.

    My view is that some people will not pay for their share nor plan ahead to pay for their share and if the govt does not step in and require us to pay our share – some/many of us will end up having to pay much more than our share.

    We see this even now as some people buy health insurance while others do not – and yet the people who buy health insurance also have to pay for the ER use for people that do not buy insurance.

    so how do you get people to buy insurance if you do not “compel” them to and if we do not compel them to do so – do the rest of us end up having to pay not only for our own insurance but theirs also?

    so what would be your alternative to compelling people ?

    don’t say, we turn them away from the ER and let them die in the streets. Say something that is reasonable, viable, likely…

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