Great op-ed piece and some interesting letters from readers too.

One of the most unfortunate fallouts of this whole healthcare debate has been that we will not be able to talk sensibly about the costs of Medicare End-of-Life costs and any ways of handling those without someone starting to shriek of 'death panels' and 'rationing'.

Fiscal conservatives in this country have long bemoaned the 'runaway' costs of Medicare, and for a long time GOP agreed with them. Its unfortunate that now that a Dem Prez has expressed concern about the same and the Democrats for a change are talking about how to cut Medicare costs, the GOP are opposing it on grounds of.....I don't know what, I suspect just opposing it on grounds of 'anything Dems propose must be opposed'!

Pity. This might have been USA's best chance to get a handle on soaring Medicare costs that may cripple the economy in 3-4 decades. (BTW, I note with some interest that -- without having changed my stance on Medicare costs in past 5 or 6 years -- I have effortlessly gone from being a heartless cost-effectiveness calculating fiscal conservative to a pro death-panel liberal socialist :))

"I suspect just opposing it on grounds of 'anything Dems propose must be opposed'!"

That is a valid role for the opposition party, to oppose, rather than enable, as the Democrats did while Little George was blundering through his eight years. Not like the HCA/Pfizer Welfare Act isn't worthy of massive opposition. I think the Hpoieheads especially resent Republican opposition because it reminds us all of what the Democrats could have done had not half of them been running for president and the other half not been scared little bunnies.

The most unfortunate fallout from this whole healthcare debate is that the truth is not getting out there. I heard this on the radio on the way home tonight and I think this is the sort of information that isn't getting to people. Notice the difference between the public option medicare costs and what those costs soared to when medicare options were privatized... (You have to listen to the intro before it starts the interview with Judith Stein.)

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Basically, this is what I have been trying to get across - if you insure people for the things they are most likely to need for a reasonable price (preventative and maintenance largely), with your insurer advocating on your behalf with an eye towards getting the care people need at a price they can afford, then you lower costs for everyone. And this is perfectly achieveable through a public plan without harming anyone.

Her organization's website also has some interesting information.

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I think one of the major problems with Medicare is that people don't know what they are eligible for...

"Medicare would pay hundreds of thousands of dollars for endless hospital procedures and tests but would not pay $18 an hour for a non-hospice care giver to come into Annabel’s home and help her through her final days."

First and foremost, it has to be understood that any insurance, public or private, has to provide adequate care, due to the possibility of legal action taken against it in the event that adequate care is not provided or seems not to have been provided, resulting in some sort of loss for the patient. According to this, Annabel's home care would have been covered by Medicare as long as the provider(s) of the service, the home health care agency, were Medicare certified.

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No offense to the good doctor or the family, but any health insurer has the right to require that any health care services that it pays for be administered by actual recognized and certified healthcare providers, not just any schmuck who wants to make a few bucks off the Medicare system by stopping by the terminally ill patient's house to sweep the floor and chat for a few minutes. Annabel qualified for in-home hospice care, all the family had to do was hire Medicare certified providers to provide that care.

While it would be nice for Medicare to call you up and tell you what you're eligible for at any given time, that is a time consuming and costly process. Quite frankly, I think more people just have to learn to exist in this system assuming that they are eligable for all sorts of stuff and then ask the right questions that lead to figuring out how to apply for and get the coverage they need. (I think most places with UHC operate that way - people assume they are covered and seek the services they need without questioning whether or not they actually have that coverage. We tend to do the reverse here, assume we're not covered and don't bother looking for the services we need/want.)

"I suspect just opposing it on grounds of 'anything Dems propose must be opposed'!"

That is a valid role for the opposition party, to oppose, rather than enable, as the Democrats did while Little George was blundering through his eight years.

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Don't quite agree there -- it basically means the opposition party ends up being purely reactionary, rather than having any clear set of principles. Republicans are supposed to be the party of fiscal conservatism, not just the party of anti-WHATEVER-Dem-Prez might say.

Not that I mind if GOP-ers want to shoot themselves completely in the foot with the fiscal conservatives, and Obama starts looking like the guy who cares more about soaring entitlement costs :) I already know some fiscal conservative till-now-GOP friends who're beginning to mutter darkly about just staying home in 2012, since they've been worrying about exploding medicare costs for many many years and were expecting GOP to be party to rein that in!

"Don't quite agree there -- it basically means the opposition party ends up being purely reactionary, rather than having any clear set of principles."

Parties don't have principles, they have ideas that they try to market against the other party's ideas and marketing. Republicans haven't been the party of fiscal conservatives since Nixon declared that we are all Keynesians now.

"Republicans are supposed to be the party of fiscal conservatism,"

Yet the closest we've come to fiscal conservatism since Ford has been Carter and Clinton, with two years of Big George.

"not just the party of anti-WHATEVER-Dem-Prez might say."

I prefer that to the Reid/Pelosi Congress of pro-whatever the president says. You must have loved Reid, Biden, Clinton, Kerry, and Edwards' votes for Iraq and the Patriot Act. I didn't. Didn't care for Obama's pro-Bush votes either.

I prefer that to the Reid/Pelosi Congress of pro-whatever the president says. You must have loved Reid, Biden, Clinton, Kerry, and Edwards' votes for Iraq and the Patriot Act.

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I prefer that the senators vote after judging the merits of the issue, not do knee-jerk votes 'for' issues if Prez is from their party and 'against' issues if Prez is from other party. You may prefer otherwise......

"I prefer that the senators vote after judging the merits of the issue, not do knee-jerk votes 'for' issues if Prez is from their party and 'against' issues if Prez is from other party. You may prefer otherwise......"

You know my preferences, so your high ground is of sand.

Any examples in mind? Do you wish the Reps to go along with the health care sell out? Do you expect the Dems to defy their president and follow Al Franken in opposing the Patriot Act re-approval? Party politicians seldom go their own way, rather play follow the leader on most things and the leader is most often money. We may hope that career politicians suddenly decide that issues are important, but Obama charted a course for the Dems with his Senate votes and, I hope, Reps learned their lessons from the minority Democrats and their failures. Opposition parties oppose and, while I disagree with most of the GOP positions, I appreciate that they have slowed down the Medical Industry Welfare Bill so it didn't just blow through unread like TARP and Stimulus Act II and the Iraq Authorization.

Any examples in mind? Do you wish the Reps to go along with the health care sell out?

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Yes, I wish the Reps to remember that they used to be the party that worried about runaway Medicare costs and how to contain them -- instead of jumping on the 'death panel' bandwagon and CRITICIZING Obama for trying to contain those costs.

Like I said, I think it really hurts their own credibility with fiscal conservatives, which suits me fine.

But I think this country is in trouble if Medicare costs cannot be contained, and now that there's a Dem prez who is at least willing to consider that possibility, the Reps would be doing USA a bigger service if, instead of trying to sabotage the effort, they pressed him for not making *enough* of an effort.

Anyway, I heard that the public option is getting a new lease of life. A Baucus bill *with* a public option open to EVERYONE would be a very good package, so am allowing myself some cautious optimism tonight.......

"Yes, I wish the Reps to remember that they used to be the party that worried about runaway Medicare costs and how to contain them -- instead of jumping on the 'death panel' bandwagon and CRITICIZING Obama for trying to contain those costs."

You must be seeing a different bill than I am, the Baucus bill doing nothing to address Medicare and Obama willing to put it off for years. Obama's plans, including the mandate, will drive up costs and ending discrimination against pre-existing conditions will also cause premiums to rise, as will the various fees on big insurance companies.

There are only about five fiscal conservatives left in this country, as both parties are Reaganite Free Lunchers. There's Ron Paul, Bill Clinton, Me, and a couple of guys living in the woods in Idaho.

"But I think this country is in trouble if Medicare costs cannot be contained,"

Just a simple matter of uncapping the tax, which is on wages, which increase, at most, with CPI while health care costs rise at a much faster rate.

"and now that there's a Dem prez who is at least willing to consider that possibility,"

He's going after fraud and waste, like everyone else does, and that won't prevent the under financing noted above and won't stop the demographic bubble of the Boomers.

"the Reps would be doing USA a bigger service if, instead of trying to sabotage the effort, they pressed him for not making *enough* of an effort."

Should he ever get around to calling for specific legislation they should do that. Or the Democratic committee chairmen could hold hearings and start drafting bills, as they have all the marbles right now.

"Anyway, I heard that the public option is getting a new lease of life. A Baucus bill *with* a public option open to EVERYONE would be a very good package, so am allowing myself some cautious optimism tonight......."

We'll see what it says. We are getting close to the '10 elections and insurance has big money.

Obama's plans, including the mandate, will drive up costs and ending discrimination against pre-existing conditions will also cause premiums to rise,

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Not really. Bringing everyone into the pool brings down average risk and cost per policy (plus prevents the ER treatment of uninsured taht everyone who has insurance ends up paying for).

If you didn't allow mandates BUT refused discrimination against pre-existing conditions, that's when premiums would truly go through the roof.

Individual mandates are a necessary part of package (one thing during campaign that I thought HC got right and Obama played politics with). The other side of package is to give the consumer options so they have something besides profit-maximizing insurance companies to turn to -- hence a public option open to everyone. Brings us close to various European UHC models that seem to be working pretty well (at least better than the US)...........

If Obama WH follows polls as diligently as Clinton WH did, they should realize that public option is popular:

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(Personally, I think a health mandate that puts folks at mercy of insurance companies with no downward pressure on premium and co-pays at other end could be pretty dangerous for Dems......sure, insurance companies have money to support campaigns, but at end of day, they do not cast votes. A public option open to all creates that pressure).

"sure, insurance companies have money to support campaigns, but at end of day, they do not cast votes."

No, they pay for advertising that does win elections. '94 was one example of insurance company money in play, as well as the risks of tax hikes.

I haven't seen any details of the proposed public option, so will have to assume that is nothing of interest until I see otherwise.