The New Republic

Again, as an Army veteran, I have access to a government healthcare program that comes closest to how the public option might work if it was an option everyone could choose. Overall the care is good. Sure, as with any healthcare program [private or public] there are going to be things some don't like, things they would like to see changed. But the private insurance companies don't want you snooping around the program, do they? The odd thing is that one might think conservative Republicans and their cohorts in the insurance industry would be clamoring for a broader public option approach to healthcare. After all, they are so convinced the government would fuck it all up, it would be a wonderful opportunity to demonstrate this. Hmm.... Maybe they just haven't thought of it like that. What a wasted opportunity. george walton

- iambiguous

October 28, 2009 at 2:12am

Another useless post by George the master of the obvious. "I post therefore I exist," is the real point of each and every gw comment.

- jacksondyer

October 28, 2009 at 7:40am

"which would allow people with access to employer-sponsored insurance to reject those plans, redirect their employer contributions, and buy coverage instead through the new insurance exchanges." This is a bad idea, Companies go in to the negotiating room with the awareness of how many employees they have and what the contribution will be, and the insurance companies can have that as a framework. This would fuck up this dynamic to the detriment of both the company and insurance company. All this will do is push towards the ending of employer sponsored health care as over time companies will simply not budget any money towards health care. Now this might be Wyden's ultimate goal, but lets be honest about this. Frankly, I just don't see we are anywhere near this stage. you are right Jackson, that was gibberish, but since it was short I had a go of it and found it factually incorrect from top to bottom. US military healthcare is not like the public option, not at all. Military Doctors and nurses are a whole other breed of people. The only analogy I could make with Military medicine is the British health care system, wherein everyone works for the NHS. (or is that France, I don't remember) "The odd thing is that one might think conservative Republicans and their cohorts in the insurance industry would be clamoring for a broader public option approach to healthcare. After all, they are so convinced the government would fuck it all up, it would be a wonderful opportunity to demonstrate this." Is ridiculous. You don't hire someone to build half a damn just to prove it won't hold water and to show the builder is incompetent. And how could you possibly clamor for something that is against your basic philosophical viewpoint without looking like an idiot, or reckless and irresponsible? I am beginning to understand why Walton writes so much philosophical gibberish, when he writes straight he gives Doug Feith a run for his money.

- blackton

October 28, 2009 at 12:17pm

IAM, you're missing the point, again. There is nothing odd about conservative, or insurance industry responses, go to the basics. First, we're asking you to consider an alternate approach to affordability: devise a catastrophic health plan which weeds out unecessary coverages (each state adds many) and let the insurance companies sell them across state lines. Second, understand that most employers have an exchange now-they can, and do, simply, bid out their coverage in the marketplace. In fact, consultants exist which can do this quickly and smoothly. Businesses and consumers do this daily with home, auto, property and liability coverage. Third, kindly study the numbers on public option premiums. The CBO says a public option with Medicare reimbursement rates (25% lower than what private insurers can negotiate), would carry premiums 10% less than private insurers. Clearly, if the Feds had to negotiate rates like private insurers, the Fed premiums would be 15% higher. The Center for Medicaid/Medicare Services, through their actuarial department, just published their projections: if the public option paid providers at Medicare, plus 5%, the Federal public option premiums would be 11% less than private insurers. Again, clearly, if the Feds had to negotiate rates like the private insurers, then, their premiums would be 9% higher. So much for lower Federal rates. Fourth, if you want competition and to keep the insurance companies honest-why not let the private insurers use the same reimbursement rates you intend to the seed the public option with-if it's Medicare, plus 5%, then private insurers get the same deal. Once you do that, no conservatiive or insurance company would oppose on fairness grounds. Fiinally, the bigger problem, courtesy of Secretary Sebelius-with a large current component of Medicare and Medicaid patients (Medicaid reimbursement rates are same or lower than Medicare), and health reform adding 10 million or more to the Medicaid rolls-a crisis within the doctor community approaches. She said, if Medicare rates for doctors were reduced by 10% (the existing law, which is never enforced, would reduce them by 21%)-a majority of doctors would cease accepting Medicare patients (the same would be true for Medicaid patients). I'm not a fan of threating the quality of care for Americans by reducing the dollars needed by doctors and hospitals to earn a living and service their patients. Strangely-in Europe-where doctors earn 33% to 50% of American doctors and the hospital reimbursement rates are much lower than in US-patients visit their doctors twice and much and stay in hospitals (the most expensive place to treat conditions) twice as much as the US. It's hard to believe that models is sensible. When studies are done comparing the exact treatment regimes between US and European medical care-for things like cancer and heart disease-three things pop-out clearly: (a) US results are better; (b) US uses fewer inputs; and (c) US inputs are more costly. These lower Medicaid and Medicare rates really accomplish two things: (a) government payments for those programs are lower; and (b) the rest of us pay more for our private insurance as doctors and hospitals cost-shift. Obama won't acknowledge this-but his Joint Session speech revealed his theoritical framework: he said, cost-shifting due to uncompensated hospital care costs each family $1,000 (sadly, this was one of his many misrepresentations-the best evidence suggests that the family cost is $200). So, if hospitals cost shift when they treat patients and receive no reimbursement, they'd do the same thing when the reimbursement is more than zero and less than 100%. Doctors do the same thing. Hey, start making sense.

- lobosven

October 28, 2009 at 12:20pm

"First, we're asking you to consider an alternate approach to affordability: devise a catastrophic health plan which weeds out unecessary (sic) coverages (each state adds many) and let the insurance companies sell them across state lines." Terrible idea. You will find a race to the bottom as states go to the state with the least regulations, and relying on an HMO based in Idaho to pick doctors in Pa. is bizarre. What the hell ever happened with state's rights? If a state wants to have stringent insurance regulations (or lax) let them. I see such a potential for abuse as fly by night organizations set up shop in Idaho and rip off people whereever they can (except in Idaho) just how motivated will Idaho be to go after these people? And catastrophic care is a pretty damn low bar, how about setting up policies that will prevent the catastrophe in the first place. Second, understand that most employers have an exchange now-they can, and do, simply, bid out their coverage in the marketplace. Damn, this is just loopy. The sensible purpose of an exchange is to allow many small companies to pool together to get better rates. Obviously lobo has never heard of economies of scale. Exchanges for companies are good, diverting money from your employer to an exchange is not for reasons I laid out above. Third, yes I acknowledge the unfair advantages of the PO, which is why it will remain limited in scope to those who would pretty much be eligible for medicaid in a fairer system. It is means tested. If Republicans got off their asses and added amendments to the PO they could get a workable system. Saying no will just screw themselves. "Fourth, if you want competition and to keep the insurance companies honest-why not let the private insurers use the same reimbursement rates you intend to the seed the public option with-if it's Medicare, plus 5%, then private insurers get the same deal." This is loopy anti-Capitalistic. Argue for the PO to negotiate the same as private insurers, instead of just laying it down as law, don't argue the reverse. We, the American people, subsidize medicare as a service to our elderly, it should be sui generis. Limiting the reimbursement rate fiat only to Medicare is something we can afford. And for God's sake stop bringing up Europe. I can counter with Japan, or Taiwan, countries which have much lower expenditures per capita with a much higher outcome. Learn from systems that have optimal performance and try to relegate it. Just shut the hell up about England (tell me one god damned thing you have that says made in England on it). It is beyond stupid for asshole Republicans to bring up England ever about healthcare since they sure as hell don't bring them up when they talk about the Computer industry, or auto, or you name it. Freaking morons. If you are going to talk about anyone, then talk about the country that is the second largest economy, and is an economic giant in Japan. Republicans don't because they are: 1. racist, (they will claim Japanese are not like regular people) 2. ignorant (Japan? what is that?) or 3. Dishonest scumbags. I go with 3.

- blackton

October 28, 2009 at 2:39pm

Bton-your silliness is rampant. I understand what you want. I and a majority of Americans disagree with you. Deal with it. Basic plan-interstate selling. Great idea. I said-"devise" a minimum plan, thus, states can have any requirements they want, but, let's give the consumer another option (just like what you want with the PO). I have no problem with an insurer competing across state lines meeting the regulatory-except with respect to that minimum health package-rules of any state it will sell insurance in. So, that problem disappears. Catastrophic care standard is not a low bar-it would cover all of the things that you progressives argue lead to bankrupcties. The goal is simple: for a low premium, get people covered. Exchanges-read HR3200, nothing in there about pooling customers. I agree, pool them. You don't need an exchange for that-just allow businesses to specialize in pooling small businesses and individual consumers and then let them bid out larger pools or customers. Why do we need government here? The PO, HR3200 simply says: year one, for exchange, businesses of 10 or fewer employees, year two, 20 or fewer, year 3 and beyond-any size business the government thinks is right. CBO assumes it will be extended to businesses of up to 50. I'm saying: with insurance reform (no exclusions for pre-existing conditions and community ratings) and private businesses which pool customers into large buying pools-who needs it? Medicare rates-I'm against the PO at any rates. I'm just making point to the progressives-if you want competition between PO and private insurers-make the playing field level. The end of my post warns against cutting doctor and hospital reimbursement rates-kindly notice that the Mayo Clinic just stopped admitting Medicare patients-for this very reason. Can you not read? Counter with Japan-you tell me why, with such low premiums and high outcomes, 9% of the Japanese citizens fail to buy insurance. That's right-at America's population level-Japan has equivalent of 28 million uninsured citizens. You are dead wrong on the outcomes argument-when experts control for lifestyle (obesity, drug use, highway deaths)-America is number one. I am not an ahole. I am not stupid. I am not a moron. I am not a racist. I am not dishonest. I am not a scumbag. Here's what I think-you are probably some of that. I can't follow your England rant-sorry-clarity is important.

- lobosven

October 28, 2009 at 3:48pm

Why adopt a public option if only a sliver of the public can qualify? Because it is a start. I actually think the public option will become so popular that in a few short years, people will clamor for its expansion. That is what scares the hell out of the insurance industry.

- poldpf

October 28, 2009 at 4:59pm

One thing I can never figure is the way the UK is, for conservatives, (a) the best place in the world after the U.S. when they are supporting us militarily in Iraq and Afghanistan, and simultaneously (b) the worst place in the world when we get around to discussing health care. Am I the only one to see a certain . . . er . . . inconsistency here?

- ironyroad

October 28, 2009 at 5:49pm

lobo, clarity? You bring up Europe as though it is a single country. Then why the hell not bring up all of North America as one unit too. Now unless you were sitting on a cave on mars, with your hands over the eyes and ears, then you know as well as anyone that asshole Republicans do just what irony said above. Now i didn't say you were any of these things, you cya'ed by chirping about Europe. Let me quote you: "Strangely-in Europe-" is not racist, or ahole, or scumbag, it is simply nonsensical. Yes, Moldava and Norway are the same. Unbelievable, and you rag on me about clarity. And what your wrote about Japan is utter bullshit. yeah like you factored in lifestyle choices. Japan spends 60% of what we spend and have better healthcare outcomes, this is a fact, don't make up "experts" when you don't know any. And don't ignore that Japanese smoke more, have more work related stress, live in far denser population densities, etc. Point out one reputable study. And show me the study that states 9% of Japanese don't buy health insurance. It is compulsory to be enrolled in a Japanese insurance program if you are a resident of Japan. The two main categories of health insurance are referred to as Kenkō-Hoken 健康保険 ([Employee's] health insurance) and Kokumin-Kenkō-Hoken 国民健康保険 (national health insurance). National health insurance is generally reserved for self-employed people and students, whereas social insurance is normally for corporate employees. If you want I can bury you with statistics about Japan so if you want to be destroyed, game on. Japan produces cars, color TVs and computers, but it also produces the world's healthiest people. It has the longest healthy life expectancy on Earth and spends half as much on health care as the United States. That long life expectancy is partly due to diet and lifestyle, but the country's universal health care system plays a key role, too. Everyone in Japan is required to get a health insurance policy, either at work or through a community-based insurer. The government picks up the tab for those who are too poor. It's a model of social insurance that is used in many wealthy countries. But it's definitely not "socialized medicine." Eighty percent of Japan's hospitals are privately owned — more than in the United States — and almost every doctor's office is a private business. Health Care for Anyone at Anytime Dr. Kono Hitoshi is a typical doctor. He runs a private, 19-bed hospital in the Tokyo neighborhood of Soshigaya. "The best thing about the Japanese medical system is that all citizens are covered," Kono says. "Anyone, anywhere, anytime — and it's cheap." Patients don't have to make appointments at his hospital, either. The Japanese go to the doctor about three times as often as Americans. Because there are no gatekeepers, they can see any specialist they want. Keeping Costs Low Japanese patients also stay in the hospital much longer than Americans, on average. They love technology such as magnetic resonance imaging; they have nearly twice as many scans per capita as Americans do. A neck scan can cost $1,200 in the United States. Professor Ikegami Naoki, Japan's top health economist, explains how Japan keeps MRIs affordable. "Well, in 2002, the government says that the MRIs, we are paying too much. So in order to be within the total budget, we will cut them by 35 percent," Ikegami says. This is how Japan keeps cost so low. The Japanese Health Ministry tightly controls the price of health care down to the smallest detail. Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug. That helps keep premiums to around $280 a month for the average Japanese family, a lot less than Americans pay. And Japan's employers pick up at least half of that. If you lose your job, you keep your health insurance. An Accommodating Insurance System Japanese insurers are a lot more accommodating than their American counterparts. For one thing, they can't deny a claim. And they have to cover everybody. Even an applicant with heart disease can't be turned down, says Ikegami, the professor. "That is forbidden." Nor do health care plans covering basic health care for workers and their families make a profit. "Anything left over is carried over to the next year," Ikegami says. If the carryover was big, "then the premium rate would go down." Perhaps Too Cheap? So here's a country with the longest life expectancy, excellent health results, no waiting lists and rock-bottom costs. Is anyone complaining? Well, the doctors are. Kono says he's getting paid peanuts for all his hard work. If somebody comes in with a cut less than 6 square inches, Kono gets 450 yen, or about $4.30, to sew it up. "It's extremely cheap," he says. Kono is forced to look for other ways to make a yen. He has four vending machines in the waiting room. In a part of Tokyo with free street parking, he charges $4 an hour to park at his clinic. The upside is that virtually no one in Japan goes broke because of medical expenses. Personal bankruptcy due to medical expenses is unheard of in Japan, says Professor Saito Hidero, president of the Nagoya Central Hospital. Hospitals Hit Hard But while the patients may be healthy, the hospitals are in even worse financial shape than the doctors. "I think our system is pretty good, pretty good, but no system is perfect," he says. "But 50 percent of hospitals are in financial deficit now." So here's the weakness: While the United States probably spends too much on health care, Japan may be spending too little. In a country with $10-a-night hospital stays, prices just aren't high enough to balance the books. Hospital prices too low? That's a problem a lot of countries would like. Now I am not saying Japan is perfect, but I am not going to lie about it like you do with this ridiculous "USA number one" stupidity. Have you Republicans learned nothing? Again, here is an intro to a very long (and real study, not one made up in your own head) Japan's health care system is characterized by universal coverage, free choice of health care providers by patients, a multi-payer, employment-based system of financing, and a predominant role for private hospitals and fee-for-service practice. Virtually all residents of Japan are covered without regard to any medical problems they may have (so-called predisposing conditions) or to their actuarial risk of succumbing to illness. Premiums are based on income and ability to pay. Although there is strong government regulation of health care financing and the operation of health insurance, control of the delivery of care is left largely to medical professionals and there appears to be no public concern about health care rationing. Like the Australian, Canadian and many European health care systems, Japan's national health insurance program is compulsory. But Japan surpasses all 24 member countries of the Organization for Economic Cooperation and Development (OECD) in life expectancy at birth and also has the lowest infant mortality rate (Appendix 1, Table 1).1 It achieves these successes at a cost of only 6.6 percent of gross domestic product, $1,267 per capita - half that of the United States http://www.nyu.edu/projects/rodwin/lessons.html OK. I officially win. Give it up Lobo, I own you.

- blackton

October 28, 2009 at 7:30pm

and lobo, You have no cred. Show me the web site where that percentage is quoted. SHOW ME "9% of the Japanese citizens fail to buy insurance" appears to me to be a fucking lie. Prove me wrong. Show me the statistics. If you lie about this, you got no cred. Unless you show me it, or man up and say you were mistaken, you are nothing but a troll.

- blackton

October 28, 2009 at 7:41pm

lobo: IAM, you're missing the point, again. IAM: You're an ideologue, aren't you? Objectivist? Libertarian? Republican? So, what you really mean, of course, is, "you're not agreeing with my point". And therefore, by definition, am wrong. "We're asking you...." Who are "we", the philosopher kings from Galt's Gultch? from Wall Street? from Fast Money? from Mad Money? You sound like me. But I sound like me the way Colbert sounds like Rush Limbaugh. So, am I dealing with yet another of the many irony-challenged literalists here at TNR? Capitalism is in the genes and/or a natural law like physics and chemistry. Which one? Then you pummel us with the usual raft of talking point dictums and statistics. As though the other sides [and there are many of them] can't do exactly the same thing. And come to completely conflicting and contradictory conclusions. All the while [like the religionists] claiming that only THEIR side is privy to The Whole Truth. My main point however revolves around discussions of the enormously complex hisrorical relationships between capitalism, government and citizenship. Again: One can make a rather convincing argument that the "free market" should be where folks go to buy stereos, recliners, pet supplies, sex toys and stocks and bonds. Hell, even Congressmen, right? But one can also make a rather convincing argument that when the "free market" interpolates itself in the transactions that revolve around the consumption of health care those who create the policies know full well the less money they dispense to pay for it the more money they make. And they sure as hell don't give a fuck about those who can't afford it, right? Unless of course the government can require them to purchase policies whether they can afford to or not. The genius behind the Baucus plan. As a "moral issue" this all comes down to how one views the relationship between a civilized government and its citizens. Every other nation we recognize as part of the civilized world refuses to allow its citizens to go through what so many millions of Americans endure year in and year out. How many horror stories did Obama and Clinton and McCain hear along the campaign trail? How many horror stories do we encounter in the media still today? This whole farce is not about numbers on an insurance industry report. Or yours above. It's about the bank accounts of those who rent the government every couple of years to do their bidding. Now, you will then have us believe we can deduce the most rational [and therefore ethical] relationship between the economy, the government and citizenship. As though you were regaling us with the most rational manner in which to land on the Moon. Something like that? Oh, and where DOES crony capitalism fit into your vaulted ideals? That is after all at the heart of our political economy. The revolving doors between political and economic power. How does THAT distort the "invisible hand" of the market in healthcare? george walton d/a

- iambiguous

October 28, 2009 at 8:23pm

I have a couple of thoughts: First, just heard on NPR-Pelosi admits not enough votes in House for robust (Medicare reimubursement rate payments) public option-so-your public option will have to build a company, negotiate rates and compete. Good luck. Second, explain why US GDP per capita is $42,000, with Japan's at $35,000. Third, explain this great fact: from OECD, 2002 (a pretty progressive group): consultations per physician, Japan-6,795, America-1,593 (4 times more and my guess-it's a witch doctor mill). Fourth, OECD 2002 again (they do extensive work on international health care): "financial position of insurers deteriorated to point where many can't meet payment obligations". Your own evidence shows that 50% of their hospitals are operating at a deficit. Fifth, McKinsey, 2008, Funding Japanese Health Care-page 7: "Japan's general good health may well be explained by a health lifestyle as opposed to a health care system that is particularly effective." Sixth, McKinsey, 2008-page 13: "In practice, some 9% of households either fail to enroll or fail to pay their premiums and as a result lose their right to insurance." Seventh: since 1989, with a stock market of over 35,000, it's like at 11,000 today-a nearly 70% fall which has never been regained. They took over a decade to purge their system of bad loans. Why, follow their lead in anything? So-some apologies? B-man, you own no one, certainly not me, maybe you were dancing before the rather large woman in the back had begun to sing. I use Europe, generally, as their actual perations are very similar-if you studied, you'd know that. Kindly, continue to amuse us all.

- lobosven

October 28, 2009 at 11:36pm

So, how do we get the "health lifestyle" right?

- ironyroad

October 29, 2009 at 1:12am

omg too funny. Japanese people go to the doctors more, are healthier, therefore it is a witch doctor mill, because we all know getting timely and preventative treatment is....its a witch doctor mill. yeah. explain the difference in gdp? what, as a function of our overpriced health care system??? truly loony tunes. schmuck, europe is a huge f-ing continent, again Norway and Greece do not share anything besides a currency. http://www.mckinsey.com/mgi/reports/pdfs/healthcare/Japan_Health_Care_Funding.pdf This is from the introduction to McKinsey: At first glance, Japan's health care system, like its people, seems to be in remarkably good shape. The country's National Health Insurance plan provides generous universal coverage. The Japanese suffer relatively low rates of disease and have among the highest life expectancy in the world. Moreover, spending on health care is lower than in most Organisation of Economic Co-operation and Development (OECD) countries, thanks to strictly controlled reimbursement levels. Oh, the horrors, Universal health care at better rates. Funding Japanese Health Care-page 7: "Japan's general good health may well be explained by a health lifestyle as opposed to a health care system that is particularly effective." May well be explained is now conclusive research? Jesus, how brain dead are you? It also might well be explained by a particularly effective health care system over a health lifestyle. Really, is this the best you can do? Um...how about the two are linked? More Republic party idiocy. "In practice, some 9% of households either fail to enroll or fail to pay their premiums and as a result lose their right to insurance." Amazing how you change your tune from above: "9% of the Japanese citizens fail to buy insurance. That's right-at America's population level-Japan has equivalent of 28 million uninsured citizens" Now it is either fail to enroll (which, if you read that report you know it is not the same as buying insurance) or failure to pay their premiums, so yes, you lied and I caught you in it. You should get down on your knees and beg an apology from me. And, of course, you left out the telling graphs before and afterwards, that all one has to do is make retroactive payments to get your insurance back. So effectively, Japan has no people who will be left without treatment or insurance, since to get it all you need to do is: A: Enroll, and B: pay your nominal fees, and if you don't simply make back some nominal payments to get full treatment. (for a student it will come out to about $220) Tell me what law in the US allows this? So yeah, you absolutely lied, you knew it and realized you had to pull up the quote that you totally misrepresented, thinking I would not read the report. And this is taking at value the methodology of this report. Japan maintains an egalitarian, state-controlled system in which insurers all offer the same services. An individual’s level of premiums and costs are based on their income level, and fees are relatively low. The Japanese then have the flexibility to choose their physicians and medical treatment providers. Also the Japanese government subsidizes the costs for low-income individuals. Overall, the system is funded by a combination of taxes and income-based premiums. This system has worked with very few minor adjustments. At the college level, Japanese public and private institutions are quite similar in their students’ health care practices. College students are enrolled in the Japanese National Health Insurance plan. The NHI is part of the universal health care insurance plan and is accepted by most Japanese hospitals. The public University of Tokyo has on-campus health services for students, faculty, and staff. The University encourages doctor visits and requires that all students visit the Health Service Center for an annual check-up. Like most universities, the University of Tokyo students are a part of the NHI plan, which covers 70 percent of their medical and hospital costs. As a college, non-income student, one’s annual insurance fee is $110. Private university students also use the NHI plan. Sophia University in Tokyo, for example, provides a reimbursement service known as Mutual Union All, which reimburses 80 percent of a student’s medical expenses that were not covered by NHI. Mutual Union All will reimburse students up to $4,391 a year. This reimbursement plan is common among other Japanese universities as well. The Japanese visit the doctor at an average of 14 times a year, which is far more often than Americans do, yet the Japanese also have significantly fewer surgical procedures done. The Japanese are almost always provided with a doctor visit on the day that they request and are all in all much healthier than Americans. An important factor in Japan’s healthier population is the large-scale availability of health services. The total expenditure on health as a percentage of GDP for Japan is only 7.9 percent, which is slightly more than half of the United States’ 15.3 percent. And as to the stock market in Japan, wow, just wow. So Toyota builds a better car, but why learn since there stock market was crippled by a real estate bubble, so we shouldn't learn anything from them? Or as you so pathetically state: Why, follow their lead in anything? For one, why a comma after why? Are you a non native speaker of English? Secondly, you follow the lead of anyone who does something better. I am astounded at your stupidity in uttering such a statement. Wait, no check that, not astounded...come to think of it, from you it makes perfect sense. Me Republic party people, why, learn? from annyone not, Republic party people¿ Sliced and diced, I just had me some grilled lobo. You have been served and utterly whipped. Is that shrieking sound I hear so utter cries of despair? Could be. Angry White Conservative = Loser Some advice there bubulubu, take a rest, get a drink (by the way I don't drink, never have, I go surfing at Zipolite all the time, like drinking and surfing mix, honestly, can you even read?) I say you should get a drink because with your high blood pressure a woman would probably kill you. I think I have figured you out. You look into a mirror and say "is this all there is?" and think more money, or a better car or job will matter. For me, I look in the mirror and say "there is too much, too much to do, to know, to see" This is why the teabaggers and angry white conservatives are so unhappy. If you are in jail for a crime you didn't commit, then be angry, or if your family was killed by a drunk driver, then be angry, or if your insurance claim is denied because you had your tonsils out when you were 10 after years of paying then...oops, sorry, for Conservatives this is just good business practice. But if you are angry for the reasons you teabaggers lay out, you are one serious loser. Seriously, relax, don't waste your time on anger. I got free time up the wazoo so driving conservative loonies batty is just a fun, non-serious pastime for me

- blackton

October 29, 2009 at 1:59pm

Wow, Blackton, I could have practically written that myself. Oh, BTW, if you bump into lobo again please remind him he still owes Iambiguous a rejoinder on this thread. Poor Lobo. Now I know what George Walton must endure going up against you!! Ouch. ; o ) gw

- iambiguous

October 29, 2009 at 5:58pm

Bton-you must lead a gifted life: you debate in your head and always win. You take 3 to 4 times as long in your posts to say little or nothing. In addition, your self-congratulations really, are meaningless, unless, your colleagues on the post are amused or your self-image is so very low. You said that Japanese spend considerably longer in hospitals, then, you say they have less surgeries. What is it? You spend longer in a hospital because your sicker-can't take care of yourself at home-or-you have an operation. No tune changing-no one, including you, has memorized full quotes from a myriad of sources. The point is-as the study points out-the equivalent of 28 million Americans are uninsured, at any time, in Japan. Do you deny that? Do you have an alternate source. McKinsey are international experts in health care-I've read many of their studies-their theory on the issue of Japanese health is important: is it lifestyle or is it the system. Because, with your answer, Bton, you can show us your critical thinking skills. You'd have to explain why, in all universal health systems, females outlive males by 10%. Or, you'd have to explain in Paris, why, office workers outlive manual workers by 15%. All having access to the same health insurance system. I can simply tell you who I am: I have a job in business, I have 2 kids, one in college and one a high school senior, I'm head coach of a high school debate team (unpaid), I fundraise for high school athletic programs and, at the request of the school or other parents, I mentor, at present, 4 at risk kids. I golf. I read. I like a good single barrel single malt scotch. Their real estate bubble was a partial explanation of their stock market crash-but-remember, they haven't recovered in 20 years. The point about doctor visits was a little more subtle than you apparently can understand: if you work 46 weeks per year (after holidays and vacations and some doctor golf), 5 days per week, 8 hours per day........they're seeing a patient every 15 minutes. This doesn't worry you? I bet you're just one impressive guy.

- lobosven

October 29, 2009 at 6:18pm

"The point is-as the study points out-the equivalent of 28 million Americans are uninsured, at any time, in Japan. Do you deny that? Do you have an alternate source." Yes, I deny it. Can you not read? The percentage is much lower. Even the report shows that. Go to page 41 of that report to chart A3 and do the goddamn math of percentage of people covered. The only people who really aren't covered long term are foreigners who are clueless about the system. In the report they admit they made some assumptions. Do I have to quote you on them, their math is different from the projections of the MLHW and they admit it. In addition, they do not source anywhere where they come up with this 9% figure, or what time period that entails. It says 9% of households, not 9% of the population, and it doesn't state whether that is over the course of a year, or a lifetime, or what, or at which point those covered fluctuate (young people enter the workforce, people lose their jobs, etc.) And from this non-sourced thin gruel you make up equivalencies of 28 million uninsured. The fucking paper is not sourced, where do they come up with that figure? I have searched high and low for anything that states this and I can find nothing. If this were a college paper I would throw it out based on the fact it is not sourced. You must really be on crack. Listen, you provide me with the Japanese government statistics that backs that up, it could even be in Japanese, I don't care, (my best friends wife is Japanese) but don't dump some non-sourced generalized bullshit on my lap and call it doctrine. That is truly pathetic. Oh, McKinsey wrote it, it must be right. I can show you a ton of websites excoriating McKinsey if you want. Listen, this is small potatoes. Go to the Ministry of Health, Labor, and Welfare and show me the statistics that say 9% of households are without health insurance. According to them I can't find any number like that. But sure, take a minor paper unsourced over the word of the Japanese Ministry of Health, Labor, and Welfare. And, again, you are confusing not being up to date on your premiums with not having access to health care, good affordable health care, not the abomination of people going broke from visiting er's in the US. http://www.sia.go.jp/e/ehi.html The system can be divided into three parts—employee health insurance, National Health Insurance, and a national health insurance plan for the elderly. Employee health insurance covers people who work for companies, the government, or private schools. Premiums are based on an employee's monthly salary. The average contribution is about 4 percent of the salary, with the employee paying half and the employer paying half. Those covered must make copayments for inpatient and outpatient medical care. Copayments may also be required for prescription drugs. Costs are shared by the patients up to a certain ceiling, after which they receive full coverage. National Health Insurance covers those who are self-employed (say, physicians in private practice) and those not employed. The premiums are based on income and assets. Similar to employee health insurance, individuals share costs up to a certain ceiling, after which they receive full coverage. The health insurance program for the elderly is funded by contributions from employee health insurance, National Health Insurance, and the government. Japan's universal health insurance system essentially pays for health care in Japan since private health insurance is rarely used there. Really, how dense are you? You constantly compare insurance as though they are equal between countries, they aren't. You Republic party people, I swear. It is like talking to a wall. You make up facts, quote unsourced and minor papers as though it were gospel, and not even quote, you distort the quotes and then make wild leaps from it. Provide me with the Japanese Government statistics that state that 9% of Japanese households today do not have health insurance. Fucking source it or shut the hell up. Goddamn brain dead Republic partyers. This report doesn't even have an index. I have seen better sourced papers from high school students. Is your attention span so low you can't read something above a 6th grade level? Oh wait, I have read the quality of your writing, so the answer is obviously no, and since you are having such a hard time rebutting anything I have written the answer is plain. Now all I want from you is a well sourced statistic from the Japanese government that confirms that statement you made, nothing else. Since you know and I know you can't possibly provide it I bid you adios. Oh, and my self esteem is fine, thank you very much. Why wouldn't it be? I have a hot young wife, 3 beautiful kids, a great job that helps a lot of people, good health. And most of those questions above are idiotic and nonsensical. Why do women outlive men? Really? How the fuck would I know? What kind of idiotic question is that? Are you going to ask me why water is wet next? I seriously pity those kids you coach in debate. And the sad thing is you have no idea just how stupid that question is.

- blackton

October 29, 2009 at 8:55pm

and bubulubu, when I lived in Shanghai, I did temp work at a Consulting company, I was involved with the magazine Biz Shanghai. I had 11 plus years in the Printing industry so I was kind of unique at the time since China had virtually no graphic arts industry back then. Look, at lot of the people who work for consulting companies are well meaning, but let me just say if I were you I wouldn't rely on reports from Consulting companies that much. That report has college intern written all over it.

- blackton

October 29, 2009 at 9:09pm

one last thing bubu, I suggest you give your "students" each a copy of the MLA Handbook for Writers of Research Papers. And while you are at it you should read it yourself so that in the future you can recognize a, shall we say, legitimate research paper, one that would pass muster with a University. And if you are too cheap for that, simply get the APA style sheet or MLA lite. None are perfect, but are essential if you want to be taken seriously. And please be aware in the future before you open your trap that the person on the other end might be a Tenured University Professor who has sat on a number of Tenure committees. As a Prof. I have to put up with idiocy from students all the time, it is part of the burder, yet also part of the charm. I don't have to put up with idiocy from you.

- blackton

October 30, 2009 at 11:20am

Professor of what and where? No need to name yourself. Your opinion, or temp work at one consulting company, hardly meets the burden of MLA. I've also witnessed too many newspaper articles, periodical articles and books falling below the MLA standards to wonder whether you've passed it out within your own profession. You are not the standard, or judge, to select which sources are valid or invalid. You simply pick what you like and reject what you don't like. As is noted below-I quote progressive sources, Washington Post and Kaiser Family Foundation. The 9% uninsured Japanese statistic can be harmonized with following facts: Numerous American studies establish that 12% of motorists don't carry auto insurance-risks, losing a car, or life savings, in a tragic accident The Federal Employee Health Plan-serving over 8 million workers and retirees-reports that 6% of their fellow workers fail to purchase health insurance (the Feds pick-up 75% of the premiums) The Kaiser Family report on employment based insurance notes that-for companies which offer plans and pay 75% of the premiums-10% of the workers fail to purchase health insurance Hence, out of the 40 million uninsured citizens, somewhere between 10 million and 15 million can afford it-$100 for single coverage premium share and $250 for family coverage premium share monthly-but they don't buy. Also, these consumers are not subject to the pre-existing condition exclusions and their premiums are community rated. The health care problem is more in the 25 to 30 million range. All experts agree-roughly 10 million Americans qualify for Medicaid by don't sign up. I've said on all my health care posts: this is the law, Obama could have been a star by simply gearing up HHS find them and sign them up. It's a $67 billion cost-I'll pay it. Now, your problem is down to 15 to 20 million Americans. That's how many Baucus wouldn't cover-so-why do we need the PO, exchanges, etc.? Thompson Reuters published a study this week-hyped on the Ed Schultz show-listing the top 3 ways to save health care monies: $250 billion-tort reform, $150 billion-medicare waste and $120 billion-move to electronic records. Let's do those immediately-as HR3200 doesn't pick up one uninsered citizen for 38 more months. Washington Post reported last month on Japanese health care: "Japanese are much less likely to have heart attacks than Americans-but when the do-their chance of dying is twice as high"---note, here's a lifestyle difference and a medical outcomes difference between US and Japan (you refused, above, to even speculate why women outlive men and office workers outlive manual workers in Paris despite the same health care system) "Skilled doctors tend to leave Japanese hospital, becoming primary-care doctors-typically treating 150 patients per day-for about 3 minutes each" I asked for your critical thinking on this one-Mr. Tenured College Professor-I'm happy to waste my time reading about descriptions of the 3-part health system and health care available to college students-is this a system which sounds "healthy" to you? "Dr. Oba pays only $1,000 per year in malpractice insurance." In the US-the average doctor pays $50,000. Howard Dean admitted that-instead of doing tort reform-the Dems weren't-as-they didn't want to piss off the tort bar. "new mothers stay in a hospital for 5 days after a routine delivery-in US, rarely more than 1 or 2"-with 3 times the hospital beds per capita (which cost like $1 million per bed in the US for new) and 4 times the per capita hospital nights-that system encourages patient care in the most expensive setting. Again, why model ourselves after this? "diet and lifestyles are generally healthier than in the US-less violent crime, fewer car accidents-only 3% of Japanese are obese-with more than 30% of Americans obese"-OK, Professor, here's your chance to shine-could those factors effect life expectancy and health care costs? I posit the notion that two or three of my best debaters could, easily, smash you into oblivion. Past notables are at U of Chicago and Cal-Berkeley. What's part of the charm with my team: most of our competitors have 3 to 5 classes daily on speech and debate during the school year (we have none) and most have multiple, paid, speech and debate coaches (we have two-both unpaid with regular jobs) and many are the highly selective $25,000 per year plus private institutions. We are a humble public school. Our kids do very, very well. Our most important contributions: to those kids with limited talent, who, over time, become important contributors to their school and their community. What makes little sense about you, Mr. B, if you truly are a professor, is: you jump to conclusions which are simply and totally wrong (unlike a careful academic mind), you continually and signficantly insult people you have no way of truly knowing (it's quite possible that I'm materially smarter than you-I admit I drop of few ad hominums for fun, your work is littered with the same and the tone of yours are base) and you play a "gotcha" game (saluting yourself like some elementary school kid who's ignored at home) which is incredibly immature (again, if your college prefers those kind of people to play role model to college students-more power to your college). My guess, you have something lacking in your self-image as I outlined earlier-what possible factor are these notions that your wife is "hot and young" or that your kids are "beautiful"? Pychologists would have a field day with this. Sparing has been fun. I dont' think much more can be accomplished here. So, I'm out and on to other posts. I know we'll run into each other again.

- lobosven

October 30, 2009 at 8:33pm