So your sense is that these new bills might force more disable people into care homes?

I have a hard time figuring out what these bills are supposed to do. I think we will have to wait and see how a new set of rules this complex is going to work in practice.

I'm also not sure what the time frame for these new rules is supposed to be - when do we start seeing the effects?

I do wonder if the dems expect to be lauded or blamed for this. One assumes they want to be re-elected.

That's a lot of stuff, Joel, I'm not sure I gathered everything you wanted to convey.

I was reading a newyorker article today that expresses a concern that I have, that I imagine many have, as I've seen dozens of articles commenting on it in some form or another. The thesis is that the bills under consideration are basically insurance expansion bills, requiring mandatory insurance and mandatory poorfolks insurance, but that the bills aren't saying much about controlling rising costs or improving medical care.

Health-care costs are strangling our country. Medical care now absorbs eighteen per cent of every dollar we earn. Between 1999 and 2009, the average annual premium for employer-sponsored family insurance coverage rose from $5,800 to $13,400, and the average cost per Medicare beneficiary went from $5,500 to $11,900. The costs of our dysfunctional health-care system have already helped sink our auto industry, are draining state and federal coffers, and could ultimately imperil our ability to sustain universal coverage.

What have we gained by paying more than twice as much for medical care as we did a decade ago? The health-care sector certainly employs more people and more machines than it did. But there have been no great strides in service. In Western Europe, most primary-care practices now use electronic health records and offer after-hours care; in the United States, most don’t. Improvement in demonstrated medical outcomes has been modest in most fields. The reason the system is a money drain is not that it’s so successful but that it’s fragmented, disorganized, and inconsistent; it’s neglectful of low-profit services like mental-health care, geriatrics, and primary care, and almost giddy in its overuse of high-cost technologies such as radiology imaging, brand-name drugs, and many elective procedures.

At the current rate of increase, the cost of family insurance will reach twenty-seven thousand dollars or more in a decade, taking more than a fifth of every dollar that people earn. Businesses will see their health-coverage expenses rise from ten per cent of total labor costs to seventeen per cent. Health-care spending will essentially devour all our future wage increases and economic growth. State budget costs for health care will more than double, and Medicare will run out of money in just eight years. The cost problem, people have come to realize, threatens not just our prosperity but our solvency.

So what does the reform package do about it? Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.

Read more: http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande#ixzz0gnjDakpR

I am thinking you are saying something similar in being alarmed that the current bill may reduce medicare and disabled care and the like?

What's wierd about this health care debate is that it's all so hidden. We can't really see what they are debating about, we can't trust the news to tell us anything real, and even crowdsourcing, aka the collective "wisdom" of the net, seems to be failing at telling people what's really going on.

You mention the abortion funding issue - which is another of those things that feels like a red herring, an indicator of just how pathetic and unmanly a nation we have become. "Look, we won't fund abortions, so you all get your moral scapegoat, so don't you worry your pretty little heads about whatever else we do...".

It all seems like nonsense to me, because I take a longer view of things than most people. Our whole economy and society is transforming, and is about to transform even more and much faster. Very soon many of these people who have employer health insurance will no longer have it, or it will be MUCH more expensive. And because we have not been growing our national economy, we've been shrinking it, and are changing our economic profile permanently, permanent unemployment and underemployment will afflict an ever higher percentage of working age people. Underemployed working age people means less tax income and less economic activity in general. All our assumptions about health care will be shattered in the next few decades.

Bill:

I obviously have not been clear. Meet Audrey Nichols, 81, who used to be my neighbor here at Addison Court until she moved to a more preferable (she thinks) location. I like living in Downtown State College, but that is another issue.

The issue in my mind is not health care reform because President Obama’s behavior in that respect have turned me into a one-issue voter, advocate, and irate columnist for Voices of Central Pennsylvania.

The issue for me is the neglectful way Medicare has treated Audrey and me in terms of getting needed assistive technology and other care so we can function as healthfully and productively as possible in this society.

When I responded to Candidate Obama’s call for universal health coverage, I supported it because I thought it was a good idea. But I also supported it because I thought Obama’s would improve treatment of those of us with disabilities who were the victims of George Bush’s cutbacks in medical oxygen, wheel chairs, mobility devices and medical technology for people with vision and hearing problems.

The problems of Medicare are not simply expense. A major problem is that the cutbacks aimed at reducing costs do just the opposite. So cutbacks in servicing home oxygen lead to more expensive visits to the emergency room. Cutbacks in providing and servicing mobility devices lead to victims like Audrey or me falling.

Falling too often or in the wrong way could easily raise Medicare costs by tens of thousands of dollars a year because we then would not be able to take care of ourselves and we would have to live at Centre Crest or other assisted living facilities at great additional expense to the government.

I assume that the President is not aware of what he is doing to Medicare. The fact disturbs me that during the entire year-plus long debate over health care reform, the President has not yet seen fit to appoint anyone to head Medicare, the largest health insurance company in the United States. This fact disturbs me because I have come to admire the President’s excellent judgment especially in appreciating the grass root details that got him my vote during the primary and general election.

Surely the President of the United States should not be involved in the minutia of Medicare details. It is bad enough that I have to be involved in them. But the President should appoint someone to lead Medicare, an agency where morale currently is understandably low; whom the President can trust to make the right decisions—namely, reversing many of the Obama Administration’s misguided decisions.

The President also suffered this year because he needed someone during the health care reform debates in Congress to set him straight and not try to fool us into believing that there is half a trillion dollars in Medicare savings from fraud, abuse, and efficiency that can be used to pay for health care reform. Statements of that sort harmed the President’s credibility.

I do not have the energy [total body radiation for cancer really continually wears one out], the time, or the ability to concern myself with other issues no matter how noble they are. My issue is to improve the quality of life for me and people like me who cannot walk, cannot see, or cannot hear. Or who are elderly, which is a disability in and of itself.

Right now my principal health reform interest is in insisting that President Obama appoint a Medicare administrator. I make a close-to-home recommendation on this subject in my column From Where I Sit, appearing Monday afternoon, March first, in the Voices of Central Pennsylvania rack at Webster’s Bookstore and Café and other fine places in Centre County. Note: Be sure to check the Voices web page for huge quantities of material on the subject straight from this horse’s mouth. As for you, Bill, I am sorry to disappoint with my answers that do not answer.

--Joel Solkoff

Ahhh, now my understanding becomes much more complete.

I like the focus, the use of personal examples we can all identify with, and the clearly stated goal - getting someone appointed head of medicare.

How come nobody has been appointed yet? Has a possible appointee been named?

I rather liked an idea floated earlier this year, then abandoned; that we allow everyone to buy into medicare as a public option. Oh well, so it goes.

My cynicism is flaring up, I'd best stop there.