Tag: public option

Building a Name-Brand Health Care System, Not a Low-Cost Generic Alternative

Much as credit card companies have charged exorbitant interest rates in the period leading up to the passage and enactment of reform, so too have prescription drug companies added more cost to their already prohibitively expensive products.  Afraid that health care regulatory legislation will cut too heavily into their soaring profits, the industry feels no shame, nor any compulsion to give heavily burdened consumers much of a break.  This is a side of the debate that has not gotten the same attention as other areas and one that I have tried to bring to light quite frequently, being that I myself stand to lose quite a bit if out-of-control price increases are not sharply curtailed.  I do not deceive myself into thinking that I am the only one who stands to lose.  Though I do not mind invoking personal experience if it facilitates greater understanding and urgency, I wish it didn’t take the anecdotes of the chronically ill to impress upon a skeptical public the importance of health care reform.          

On the subject of psychotropic medication, something of which I am an amateur expert, I have closely monitored new classes, types, and formulations of prescription drugs in a desire to find the best way possible to treat my condition.  For every new medication that breaks new ground, wins approval by the FDA, and is then prescribed by GPs and psychiatrists across the country, it is a never-ending source of frustration for me to observe the three new offerings which are merely slightly different formulations of existing medications.  This is a covetous process undertaken mainly to reap maximum profit when older scripts are on the verge of losing patent status and thus being offered as generics.  For example, the anti-depressant which is the most recent addition to a family of medications known as SSNRIs has been marketed under the name Pristiq.  Pristiq has a very similar chemical structure and as a result works only slightly differently from an existing drug in the same school, Effexor, that has been around for over ten years.  Sometimes, however, even generics occasionally have limitations.  Though a lower-cost equivalent to Effexor exists, the less-expensive form has been reported to work not nearly as effectively as the name brand formulation.

An article in today’s New York Times reports on Big Pharma’s side of the story.

But drug companies say they are having to raise prices to maintain the profits necessary to invest in research and development of new drugs as the patents on many of their most popular drugs are set to expire over the next few years.

That may be, but before one gets misty-eyed listening to the woe-is-us violin, rest assured that the pharmaceutical industry isn’t exactly hurting for business.  Conveniently they don’t mention the larger picture.  Another example of this kind of infuriating slight-of-hand is the sleep aid Ambien, which has had a sufficient generic alternative for a while.  A relatively new formulation dubbed Ambien CR produces an only a slightly different reaction, mainly by time-releasing the absorption of the drug into the blood stream.  The drug is the same, but the gimmick is different.  Returning to psychiatry, it is either a testament to how little we know about the function of the brain or how unwilling we are to risk radical change that the medications used to treat depression, anxiety, bipolar disorder, and schizophrenia have broken only relatively limited ground in decades.  The best treatment for depression are still a class of powerful anti-depressant known as a MAOI inhibitors, which are close to fifty years old.  They are rarely prescribed, however, because taking them requires strict dietary restrictions that, if not adhered to, can result in serious damage to the body and, in extreme cases, even death.  In treating bipolar disorder, some patients still respond best to Lithium, which has been used in treatment for over a century, but extensively since the Fifties.    

Newer medication often cut down side effects and make the period of adjustment less painful, but do little to increasing the stated objectives of the drug, namely to drag people out of depressive episodes and set them on a course towards health and functionality.  Experimental trials are often plodding affairs proceeding at the pace of a snail, targeting a relatively limited area of the brain, and unwilling to take any unnecessary chances.  Despite this, some medications do pass muster and do end up being taken by who are suffering in the hopes of providing relief.  Even so, the drug makers and those who formulate them sometimes fail to take into account such crucial details as major side effects in a rush to get out the next big thing.  SSNRIs like Effexor, for example, are infamous for producing absolutely awful issues when someone stops taking it.  Though not strictly classified as such, one might even say that such drugs are addictive because the brain acts violently when the medication is discontinued.  These serious matters somehow never find their way onto the commercials on television or the ads inside glossy magazines.  

The difference in cost between name brand and generic drugs is quite vast.  Often it is a matter of several hundred dollars for a one month supply, though it can be as high as a thousand dollars or more.  As one might expect, those with employer-based or individual plans paid for out of pocket have to pay substantially higher co-pays for name brand drugs.  When I had private insurance, the co-pay for generic medications was $10 and for name-brand drugs, it was $60.  Sometimes I had no choice but to take a name-brand medication, which are often treated by insurance companies as something bordering on cosmetic and not essential, when the fact of the matter is that they are highly necessary and highly unavoidable at times.  

Those who don’t have the luxury of private insurance, of course, have it rougher.  Those who have to rely on Medicaid find that they have no choice but to settle for generic medications when a name-brand drug would be a much better fit and work much more effectively.  Medicaid programs vary, but in the state of Alabama, the most expensive medications are only covered if a doctor or specialist one can provide proof that at least two lower-cost alternatives have failed or been insufficient to treat the condition.  Not only must they have failed, one must also work within the confines of a 90 day coverage window.  If a claim to cover a more expensive medication is not filed within 90 days of failing the requisite two medications, then coverage is not granted.  This is ridiculous in lots of ways, mainly that few medications used to treat mental illness work quickly, and many take weeks upon weeks before any psychiatrist or doctor can make a judgment either way.  It’s also ridiculous because it uses a broad brush of convenience, painting all illnesses as basically the same and all treatment regimens as similar.  Some name-brand medications, regardless of the need are not covered at all, since whomever set up the system decided that covering it would unnecessarily drain the General Fund and that it was an unnecessary prescription in the first place.      

Returning to the Times column,

But the drug makers have been proudly citing the agreement they reached with the White House and the Senate Finance Committee chairman to trim $8 billion a year – $80 billion over 10 years – from the nation’s drug bill by giving rebates to older Americans and the government. That provision is likely to be part of the legislation that will reach the Senate floor in coming weeks.

But this year’s price increases would effectively cancel out the savings from at least the first year of the Senate Finance agreement. And some critics say the surge in drug prices could change the dynamics of the entire 10-year deal.

Those who trust Big Pharma do so at their own peril.  

Additionally, The news broke today that, quite unsurprisingly, much misinformation exists surrounding the Public Option™.  As Politico points out,


The debate has placed disproportionate emphasis on the creation of a government insurance plan, raising the expectation that everyone could ditch their employer-provided coverage and enroll in the public option.

But that won’t happen, at least not at the start. The reality is that only about 30 million Americans – 10 percent of the population – would even be eligible.

It could be accessed only through a new insurance marketplace known as an exchange, where consumers would shop for plans. Only certain categories of people could use the exchange: the self-employed, small businesses, lower-income people who qualify for tax credits to purchase insurance and those who are otherwise unable to find affordable private coverage.

This might deflate the hopes of supporters and pacify opponents, but since so much of this debate has been a three-ring-circus based on raw emotion and faulty logic, I sincerely doubt it.  However, as proposed, it is interesting to note that the Public Option™ would be more like Medicaid than anything else.  My hope is that we do not make the same mistakes with the current bill as we do with existing systems it seeks to augment or replace, particularly those in red states who likely would opt-out altogether if provided the opportunity to do so.  Though at least red state residents would presumably have the fall-back of Medicaid, provided they could qualify, the framework is based on ignorance and tunnel-vision of an almost incomprehensible degree.  One cannot simplify the complexities of humanity, nor its diseases, which are as multifarious as its people.  

Returning to the treatment of mental illness, what is often not cited is the disconcerting fact that often African-Americans and Latinos respond much less favorably to medications used to treat the condition.  This is a contentious topic with lots of disagreement, but the argument some advance is that cultural stigma factors in to a very large degree.  If minorities feel shamed or guilty about seeking help for psychiatric needs, they are much less likely to engage in medical research.  Furthermore, many believe that therapy is a more viable option than medication.  Often it is difficult to make any kind of pronouncement when the truth is obscured by so many different interrelated factors.  And though one can easily make a case for mental illness, one could also make a case that minority and low-income residents might be less inclined to visit a doctor for a more run-of-the-mill ailments as well.    

The lifetime prevalence of major depression in the United States is estimated to be 16.2 percent, with considerable social and role impairment evident in the majority of patients. Previous studies found only minor differences in depression rates among African Americans, Latinos and whites. But various studies have found patients from lower social economic groups often have less access to mental health care, are less likely to be prescribed and to fill prescriptions for new antidepressants and are less likely to receive care beyond medications when compared to whites.  

 

This fear and anxiety so many have that resembles to these eyes a case of St. Vitus Dance may not have any basis in reality.  Doesn’t matter how good the system is if no one uses it.  God forbid everyone in this country have a high standard of living and good health.  As the article points out, minorities and low-income citizens often have the highest need for quality care and are apt to put off seeking help until the pain becomes intolerable.  That these are the people most likely to be eligible for enrollment in the government-run (gasp) option, those now building it from the ground up would do well to consider its target audience.  We speak out of our own privilege when we assume that somehow the Public Option™ will directly affect us for better or for worse, when the poor and less fortunate will be the ones who either reap its rewards or suffer from its limitations.  While it is true that middle class individuals and the reasonably affluent have struggled under the yoke of skyrocketing health care costs, I recall going in that I assumed the changes needed and intended were meant to appeal to our tired, our poor, our huddled masses yearning to breathe free.  Somewhere along the way this became all about us.        

Don’t Let the Imperfect, become the Frenemy, of …

Don’t Let the Perfect become the Enemy of the Good” — it’s common knowledge, right?

Important words of wisdom with Great Historical Significance, right?

OK, if you say so …

François-Marie Arouet, better known by his pen name Voltaire, was a French writer, deist and philosopher.

Le mieux est l’ennemi du bien.

* The better is the enemy of the good.   — La Bégueule (1772)

 Variant translations:

   The perfect is the enemy of the good.

   The best is the enemy of the good.

http://en.wikiquote.org/wiki/V…

Voltaire

Author and Philosopher, 1694 – 1778

Francois Marie Arouet (pen name Voltaire) was born on November 21, 1694 in Paris. Voltaire’s intelligence, wit and style made him one of France’s greatest writers and philosophers.

[…]

In 1726, Voltaire insulted the powerful young nobleman, “Chevalier De Rohan,” and was given two options: imprisonment or exile. He chose exile …

Woooo, some drama … could be a notable lesson here?  

Bernie Sanders may filibuster if there ISN’T a ROBUST public option for everyone

Crossposted at Daily Kos

    The ONE Senator that I can safely say is NOT bought off, the one Senator that we can be certain is NOT owned by the banks is Bernie Sanders (I-VT). It looks like good ole Bernie is putting his left foot down on the public option and threatening a filibuster of his own if there isn’t a ROBUST public option that is available to everyone in the Senate version of the health care bill.

    I think this is GREAT news, and I’ll explain why below the fold, where you can find a full transcript of this video as well.

Why The Democrats “Health Reform” Deserves To Be DEFEATED

The total vacuum of any principled leadership from President Obama, has inevitably produced the most directionless, anti-consumer, Insurance Monopoly boondoggle fraud imaginable — which is now masquerading before Congress as “reform“.

In fact, the Insurance Companies are silently doing cartwheels over this, and stand to jack up rates even more, and fatten their considerable death grip over the American public.  The people who bother to read the fine print, like Congressman Dennis Kucinich, know this.

Who’s to blame?

Well, for starters, Capitulator-in-Chief Barack Obama, Rahm Emanuel, Nancy Pelosi (who lied to us, and promised “a robust public option”), Max Baucus, …. and the list goes on and on. In other words, The Democratic Party and it’s entire leadership structure (do we have any?) created this fiasco all by themselves — the same people who also want to keep funding and expanding the Bush Wars, Bailout Goldman Sachs and give them (crooks) your tax money for CEO profits, and who blindly support the unconstitutional Bush U.S. Patriot Act.

Some remarks from Congressman Kucinich:


Speaking to liberal MSNBC anchor Ed Schultz on Friday, Kucinich continued:

They’re being mandated to buy private insurance. If you read the bill, the people are going to end up paying — the insurance companies can raise rates 25 percent right off the bat, if you read the bill.”

Schultz encouraged Kucinich to repeat himself on that point.

“It’s on page 22 of the bill,” he replied. “Right here, it says that rates shall be set at a level that does not exceed 125 percent of the prevailing standard rate for comparable coverage in the individual market. Now … It’s very easy to understand what that means.”

“It’s not reform,” Schultz insisted.

“It means a 25 percent increase, they’ll have the ability to execute and since insurance companies have already raised rates for the last four years by double-digits, we can expect — based on the bill — another rate increase by the insurance companies.”

And what about the so-called “public option“?

Health Care Reform: Who Will Make the Final Call?

Over one-hundred and seventy-five years ago, an obscure Louisiana senator awaited his time to speak in front of the Senate gallery.  In a few short days, what would have seemed to be a relatively limited debate about the merits of selling public lands in the western states of a still relatively small nation had been transformed into an expended discourse about whether secession from the Union had any legal basis.  The senator in question, Edward Livingston, had listened to a series of variously thrilling, erudite, and eloquent emotional addresses given by the giants of that body in those days.  Each trying to outdo the other, perhaps concerned a tad more for his legacy than specifically for the cause at hand, a highly competitive chamber in the best of times had grown even more charged and partisan.  Livingston had no intention of bettering what anyone had said before, rather his desire was to appeal to a sense of hopefully uniform conscience and fair play.    

The best speakers had already writ their words into if not immortality, at least a place in the history books for several generations.  Daniel Webster’s thundering, inspiring speech imploring for national unity did much to keep together an increasingly fragile peace, but words alone would prove insufficient to prevent Civil War.  Giving birth to generation of brilliant statesman after brilliant statesman would not reconcile the divisions based far more on passions than on more cerebral pursuits.  From this point onward, slavery and states’ rights overshadowed every issue on the agenda, and this singular focus inevitably drew debate back to a raging boil, regardless of how seemingly innocent and harmless was its basis.  

Upon this context, Livingston spoke.

The post of partisanship for partisanship’s sake–of seeing politics as blood sport, where the kill is the only object of the exercise–was, Livingston said, too high for a free society to pay.  Differences of opinion and doctrine and personality were one thing, and such distinctions formed the natural basis of what Livingston called “the necessary and…the legitimate parties existing in all governments.”

Parties were one thing; partisanship was another.  “The spirit of which I speaking,” Livingston said as he argued against zealotry, “…creates imaginary and magnifies real causes of complaint; arrogates to itself every virtue—denies every merit to its opponents; secretly entertains the worst designs…mounts the pulpit, and, in the name of a God of mercy and peace, preaches discord and vengeance; invokes the worst scourges of Heaven, war, pestilence, and famine, as preferable alternatives to party defeat; blind, vindictive, cruel, remorseless, unprincipled, and at last frantic, it communicates its madness to friends as well as to foes; respects nothing, fears nothing.”  

American Lion:  Andrew Jackson in the White House by Jon Meacham.

We have had our allotment of that madness after a long hot summer of discontent, but what has recently calmed down into something like order if not decorum constantly threatens to regenerate into something much more sinister.  Our own weariness and fatigue with this recession may be the only thing that keeps down the thermostat to a tolerable level.  Red state governors and representatives learned that the quickest way to win short-term accolades and the war whoops of the crowd is to obliquely raise the specter of nullification and even withdrawal from the Union, a battle which is long since past us, but still immortalized in the myth of the Great Lost Cause.  Indeed, as a native Southerner, even I was exposed to such a romantic, dashing ideal only present in the psyche of those who win the first half’s worth of play on sheer emotion, but ultimately lose the game in the fourth quarter against fresher legs and superior depth.  This is a very dangerous construct, one shared by Germans and utilized by Hitler for his own ends in advancing a narrative of historical oppression and imaginary enemies that gave unity to many but led to brutal slaughter of many others.  Given half a chance, the masses will always clamor for a re-match.

Livingston at a slightly later date stated,

There is too much at stake to allow pride of passion to influence your decision.  Never for a moment believe that the great body of the citizens of any State or States can deliberately intend to do wrong.  They may, under influence of temporary excitement or misguided opinions, commit mistakes; they may be misled for a time by the suggestions of self-interest; but in a community so enlightened and patriotic as the people of the United States, argument will soon make them sensible of their errors, and when convinced they will be ready to repair them.”

Ibid.



A belief in the inherent decency and rational sense of the American people often reads like empty rhetoric in this day, especially when so much ink gets spilled about how clueless and uninformed are the average citizen.  However, in this instance, modern day Senators and Representatives would be wise to heed the wishes of those whose trust they are the supposed stewards.  Poll after poll has shown a slow, but nonetheless undeniable upward tick in support of Public Option and other reforms.  Legislators, much like we ourselves, seem to be caught in that eternal quandary, pondering whether the commoners can act in their own best interest, or whether it is the unenviable burden of the elites to superimpose their own will in its place.  The paramount lesson to be learned here is that Americans are frequently slow to warm to and inherently suspicious of expansive change, no matter whether or not self-interest is keenly involved.        

Speaking specifically to the months-long debate with ourselves and our government, whichever health care bill is passed may likely include a provision whereby states can opt-out of a means to establish parity among health care providers, and no matter how what blend of incentives or threats of consequences, many GOP-dominated states simply will not follow suit.  The often unsatisfying compromise between centralized power and regional control known as Federalism will often materialize in these situations.  Both perspectives, either for or against are under-girded by a strong sense of distrust of distant bodies and corresponding fear of corruption.  Certain, usually conservative states are fearful of Washington’s seemingly limitless expansive control into their own affairs and even more fearful of Capitol Hill’s perceived incompetence and wasteful behavior.  The destructive power of yahoo moralizing, especially when wedded to a fear of the bumbling, slothful behavior of nameless Federal Government bureaucrats remains a force, particularly in solidly red states.  Those who would keep our union together have no choice but to navigate this rocky course and in so doing cobble together one unsatisfying compromise measure after another.          

Even so, I do believe that much good will stem from reform, whenever it shall arrive on President Obama’s desk, and though the deletion of certain particulars is not exactly to my liking, I will have to grit my teeth and live with the cards I am dealt.  It is foolish to wish for failure in the hopes that dismal outcomes will produce eventual success based on public outcry and this goes for Olympic games, the success of the first African-American President, or health care reform.  Instead I wish for resounding positive results and with it the recognition that there will be an inevitable need to tweak or slightly modify the existing framework with the passage of time.  Perhaps a true public option will arrive with time, once states that refuse to participate recognize the great benefit other states derive from its existence.  We ought to have learned by now that all or nothing thinking isn’t just unfair, it goes against logic itself.  The American people, after years of being talked to like children are being faced with a very adult decision, and unaccustomed to such treatment, do not quite know how to respond.  My hope, as it is always, is that all Americans are invited to the table and in so doing dealt a hand, so as best able to recognize that the political process is frequently a high stakes game of chance and strategy.      

Livingston concluded,

“There are legitimate and effectual means to correct any palpable infraction of our Constitution,” he said, “Let the cry of Constitutional oppression be justly raised within these walls, and it will be heard abroad–it will be examined; the people are intelligent, the people are just, and in time these characteristics must have an effect on their Representatives.”

Ibid.  

May it be so.

The Amazing About-Face of Orrin Hatch — Mr Entitlements

Back in August, barely 2 months ago, Senator Hatch (R-UT), displayed a graciousness and a spirit of bipartisanship, rarely seen among the Party of NO.

Senator Orrin Hatch on Ted Kennedy’s Life

The Situation Room — Aug 26, 2009

BLITZER: […] the issue that was the most important to him, health care for the American people, you were — you’re a member of the Finance Committee. […] And since this was so important to your good friend, Senator Kennedy, I’ll ask you directly, Senator Hatch — are you willing to get back into those negotiations with the Democrats right now in memory — in honor of Senator Kennedy?

You know how important health care reform was for your friend.

ORRIN HATCH: …

Pawlenty says Minnesota will Opt Out of Public Option if he has his way

     Crossposted at Daily Kos

    Today on ABC’s Top Line, co-host David Chalian asked Republican Gov. Tim Pawlenty (R) if he would “opt-out” of the public option for his state if the measure passed. Pawlenty dodged: “Well, I don’t know if we would opt out but I personally would like to opt out because I don’t like government run health care.” But Chalian persisted, and ultimately, Pawlenty said that he would oppose the public option for Minnesota:


CHALIAN: But you would lead a charge in your state to opt out if that was an option available?

PAWLENTY: I think so because I don’t like government run health care.

ThinkProgress.org

     Sorry Minnesota. Looks like your Asshat Governor wants you to buy for profit insurance and like it, if you can afford it.

     More, with analysis and my take on the Faux Reform that is the Opt Out Cop Out below the fold.

Poor Poor Pitiful Harry

Pelosi Prepares To Move Ahead With Robust Public Option

by Brian Beutler last night at TPM, October 20, 2009, 8:09PM

A preliminary analysis from CBO may have sealed the deal. Speaker Nancy Pelosi is preparing to move ahead with a “robust” public option–one that reimburses hospitals and providers at Medicare rates, plus five percent–in the House’s health care bill. She is briefing her caucus about the plan’s savings tonight, and, pending the approval of a sufficient majority of members, will adopt the measure as part of the complete reform package.

The analysis finds the reconstituted House proposal to be deficit neutral, and require less than $900 billion in new spending, over ten years.

The bill remains nominally more expensive than the Senate Finance Committee proposal, but would cover 96 percent of all Americans, providing greater bang for each federal dollar spent. And, aides note, the bill that comes to the floor of the Senate will be a hybrid of the Finance and more expensive HELP Committee bills, so the price is expected to rise.

The move is sure to make progressives ecstatic, and puts Senate leaders, who have been unable to reach any decisions about their preferences for a public option in their own bill, in an uncomfortable position.

Read the whole thing at TPM…

Rep. Weiner: Obama Admin “Half Pregnant” with Insurance Industry


    Rep. Anthony Weiner (D-N.Y.) said on Tuesday that the Obama administration is “half-pregnant” with health insurers and pharmaceutical companies, which may jeopardize the success of reform.

     The congressman — who is a leading liberal voice in the healthcare reform debate — said that rumored deals the White House has struck with big pharmaceutical companies and insurers may guide them to abandon key elements of reform, such as a public health insurance option.

    “The Obama administration is trying to be, I don’t know how to put it, half-pregnant with the insurance industry and the pharmaceutical companies,” he told WNYC Radio today. “They’re to some degree the source of our problem.”

TheHill.com

Bold added by diarist

    I for one APPLAUD Rep. Anthony Weiner’s knee jerk Truth Telling. Face it, President Obama has NOT done ANYTHING to fight for a Public Option, without which this is the subsidize and mandate private insurance bill, NOT the Health care Reform that would give Americans Universal coverage that we NEED.

Medicaid is No Public Option

The news broke late yesterday afternoon that the Senate Finance Committee sought to broker a compromise measure regarding the Public Option.  Giving each individual state a choice of whether or not to provide a public option appeals to fiscal conservatives and red state legislators whose most coherent reservation regarding health care reform is a concern over cost.  Still, these kind of messy federal/state mandates reinforce substantial inequality.  A Medicaid-style measure like this would mean that those who lived in most well-funded blue states would have superior health care coverage, while those who lived in most, if not all red states would have their health care costs still largely dictated by private carriers, many of which hold near-monopolies in individual states.  If the aim of reform is to level the playing field for every American, this falls well short of the stated objective.  

Today’s Politico contains a brief, but noteworthy column written by Ben Smith, which underscores the controversy regarding Medicaid reform.  


The Medicaid expansion would, in a stroke, add 11 million people to the program’s ranks by raising the income cap, and one key negotiating point at the moment is the share of that cost the federal government will pick up.

The income cap, however, is only one facet to increasing eligibility.  Many states, particularly red states, do not extend coverage to single adults at all, no matter how dire their need.  Coverage is often provided only to adults with children and sometimes Medicaid coverage is granted to children only, leaving their parents with nothing.  As a result of this, many adults are forced to file for SSI disability to obtain Medicaid coverage, since doing on is the only means by which they might attain any health care coverage at all.  However, this removes individuals from the workforce, reduces tax dollars paid into the tax system as condition of employment, and places a drain upon the never-ample General Fund out of which all Medicaid expenses are paid.  Removing these strict qualifying factors might costs more in the short term, but the long term consequences are much more detrimental.  Someone pays the cost when a person goes bankrupt from enormous medical bills or visits the Emergency Room without insurance, having no means to pay at all.  Still, to simplify this unnecessarily as another annoying example of the red state/blue state divide would not be a fair telling of the truth.    

Republican governors haven’t been the only ones raising doubts.

Tennessee Democratic Gov. Phil Bredesen has been an outspoken foe of the plan, and a senior Republican aide notes that two more left-leaning Democrats are also raising complaints.  According to the Columbus Dispatch, Ohio Gov. Ted Strickland “warned on a recent visit to Washington that the ‘the states with our financial challenges right now, are not in a position to accept additional Medicaid responsibilities.’

“Strickland said that he wants a health care package that is inclusive and provides for all citizens’, but he adds that if Medicaid is expanded, he hopes to see the Federal Government assume the greater portion of the costs, if not the total costs.'”

And New Hampshire Gov. John Lynch last week refused to sign a letter than other Democratic governors sent to congressional leaders urging passage of a health care bill this year, because it failed to “address concerns regarding potential cost shifting to the states,” according to a spokesman for the governor quoted by the media.

States do have to adhere to balanced budgets and in times of economic famine like these cannot resort to deficit spending.  However, budget priorities are often disproportionately skewed away from social services and relegated to other matters, which are just as wasteful, if not more so than any pork barrel project pushed by a House or Senate member.  Before Republicans and Democrats criticize Washington for its excesses or its financial demands, they would be wise to start first in their own backyards.  Citing specific instances of pork barrel projects is a rhetoric device which borders on cliche, so I will spare you another retelling of it.  Needless to say, room could be made even in a much reduced year of tax revenue.  The obscene amount of tax breaks and concessions made to foreign automakers in order to entice them to build auto manufacturing plants is a good place to start.  Those states who have never made an attempt to reform their image as little more than an endless supply of cheap labor have shortchanged themselves in ways they seem incapable of comprehending.      

A more streamlined approach would, in my opinion, be best.  Each state sets its own criteria regarding Medicaid in accordance to how the program was set up in the 1960’s and I have no doubt that similarly messy compromises would likely typify the efforts the states willing to institute a public option.  Most red states would opt out altogether, of course.  I will note that a complete reliance on the superior wisdom and judgment of the Federal Government might be naive, but I have rarely seen any state government be more efficient.  What I have seen is a multitude of red states whose efficiency and collective wisdom resembles a Banana Republic combined with a slap-stick comedy routine.  That they are the ones who are so quick to  shoot barbs at Washington, DC, strikes me as biting the hand that feeds you.  Many of these states would have nothing if it hadn’t been for the generosity of Capitol Hill and many of their universities would find themselves without needed funding if they couldn’t achieve Federal Government grants.  So it is here that I’m afraid I can’t muster much sympathy for those Governors who rarely pay more than ten percent of the cost of Medicaid anyway.  The real lesson to be learned here is that long-term gain is much more important than the facade of short-term cost reduction.  

Rahm to negotiate for WH in Conference! If you wanna kill the PO you gotta do it yourself

Crossposted at Daily Kos

    If you missed the last two nights of Countdown with Keith Olbermann you missed a lot of new details in the Health care Reform debate, and I don’t want to sound bleak, but things do not look good. The main points are these.

Wendel Potter:      “If there’s not a public option, the plan that is passed, if it’s passed and signed by the President, will not be sustainable. And it ultimately will be a disaster for the middle class and ultimately be a disaster for the Democratic party . . .

~snip~

    “We’ll be paying a lot more out of our own pockets. We’ll have the appearance of being able to afford premiums but we won’t be able to afford health care. That can not be sustained.”

    You can watch the video here

    And then there is the news that Rahm Emanuel will be representing the White House in the presumably upcoming Houuse-Senate Conference committee. Thus the title “If you wanna kill the (Public Option) you gotta do it yourself.

    More below the fold, and it ain’t pretty, with a call for action that puts it all on the line.  

Who was Grayson really Apologizing to?

also posted on dkos

Rep Alan Grayson’s Apology



http://www.youtube.com/watch?v…

Well, I would like to Apologize —

I would like to Apologize to the Dead.

44789 Americans die every year because they HAVE NO Health Insurance,

according to this Harvard Study.  http://grayson.house.gov

That is more than 10 x the number of Americans who’ve died in the War in Iraq

It’s more than 10 x the number of Americans who died in 9/11

but that was just once.

THIS IS EVERY SINGLE YEAR!

Take a look at this — read it and weep.

and I mean that Read it and WEEP!

Let’s remember we should ‘care about people’ — EVEN after they’re born.

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