Having just lambasted you down below on Hillary's plan, the reality is that on this, as so many other issues, she and Obama are not that far apart. There is so little separation on the issues that they (well, she, at least) is forced to focus on personality or other irrelevancies. I think it's fair to say that issues like health care will come to the forefront during the general election because the differences between McCain and either Democrat are so pronounced.

LAMBERT: Well, I hope so, because everyone from GM to Lambert World Trading, LLC would like a way to hold health care costs to something much less than two and three times the rate of inflation.

How about we eliminate the uninsured illegals from running up the healthcare costs?

LAMBERT: I'm thinking more a "knucklehead test" for access to affordable heath care.

Its still all about the money. Whats a practicing MD earn, GPs to specialists? Anywhere from $200k to the low millions?

Its some irony that these folks are among those not subject to FICA and medicaid/medicare taxes after the first $95,000 of income or so. This block of people, along with lawyers and well paid professorial types, make up a substantial group of Democrat voters who would no doubt howl if they had to pay the percentage the rest of us pay. John Edwards was a prolific evader of medicare taxes. Perfectly legal, of course.

LAMBERT: Edwards, as I'm sure you know, was also the only candidate who proposed anything remotely resembling tort reform.

No doubt it would put a strain on the Timberwolves beat travel budget, but how about the Strib takes a look at health care by drawing a comparison between life under our "system" and one those dreaded socialist countries with the higher standard of living and happiness quotient?

Take a listen to this old broadcast of North Carolina Public Radio's, The Story, with Dick Gordon, wherein Gordon talks to two men with the same disease, Lyme, one an Amsterdam resident who sought treatment under the Netherlands system and the other a man living in Chapel Hill, NC under ours.

http://thestory.org/archive/the_story_397_A_Tale_Of_Two_Health_Care_Systems.mp3/view

LAMBERT: Haven't you heard? Everyone in Europe is miserable. They all live in cardboard boxes. Muslims everywhere. Not enough handguns to protect themselves. They can never see a doctor. Two month waiting lines for appendectomies. Hellholes, from Sweden to Gibralter. Sean Hannity says so.

108:

Do you actually know any doctors, family practice, in particular? They sure as hell aren't getting the kind of money you attribute to them. They work a murderous pace seeing patients in fifteen-minute increments the way Lucy and Ethel were coping with chocolates and then hang around the office another couple of hours wading through the crushing paperwork.

Save your dudgeon for the gonzamachers who make the real money: the insurance and HMO executive ranks. The gatekeepers of our medical system, the people who can actually help keep your health up and costs down, are not getting wealthy at it. We're running low on them, actually, and I can easily understand why.

LAMBERT: Those doctors are such an impediment to shareholder value. I mean, that's the whole point of medicine isn't it, profit?

Actually, your very own health columnist and fellow PiPress alum, Laura Billings, has an excellent piece on the plight of family practice physicians in MSP's current edition:

http://www.mspmag.com/health/features/83129.asp

LAMBERT: When do they find time to play golf at Pebble Beach?

How can Leinfelder claim such "inside" information on how a doctor conducts his / her day to day job?

I demand some attribution.

The man is rather annoyingly clairvoyant, or something.

Ooops, gotta run, there's that sniper fire again!

LAMBERT: That's not sniper fire. It's your own concealed weapon firing at your feet.

Yes I do know some. My supposition is that GPs / FPs make say 200k. If I'm wrong, I bet I'm not off by over 25%.

I'm not critiquing how hard they work. My larger point is why the left doesn't make a bigger deal about payroll taxes, which are relevant to this discussion.

LAMBERT: You'll correct me, but I believe both Democrats have put the idea of applying SS taxes to incomes higher than the $95,000 currently used. McCain?

Per Lauras article, average base for an FP is $161k nationally.

Its been insinuated from Obama's campaign.

Not off by 25%? I'd say that in many cases, you are off by that considerable margin. My, such an exacting standard of measurement you set for yourself. And BTW, many of them have health care plans with $2,000 deductibles. If you're looking for the problem with this country's health care crisis, I'd look elsewhere than family practice physicians.

If you're looking for something worth getting your thong in a knot, 108, perhaps a word about Pawlenty robbing the health care tax fund to shore up the general fund would be in order here. We all pay that tax at the doctor's office and it should be going to the purpose for which it was first levied, health care for the indigent, not to bail out Pawlenty's parsimonious pandering to the taxpayer's league.

LAMBERT: My point: What's the counter-plan? Has there ever been a conservative plan, other than HSAs?

Gun fire? Perhaps one of Bertram's peers out there in the wild exurbs is installing him that new fangled satellite Tee-Vee:

http://www.kmbc.com/news/15701029/detail.html?rss=kc1&psp=news

Brian, those stalwart conservatives are guarding your health care "choices." Surely you remember the right's scare ads with those two geezers fretting their loss of "choice."

Universally available health care that you don't lose along with your job should you be laid off, that can't be denied you for a pre-existing condition, well, golly jeepers, THAT horror would threaten your choice of health care providers, Brian.

They're preserving the Hobbesian choices so many Americans face under the conservative approach to health care: bankruptcy v. death from disease; meds v. rent. You get the idea. it's all about the freedom, brother. But you'll have ready access to a pistol if you can't afford hospice. Another choice, preserved just for you by the innovators on the right.

LAMBERT: And heck, as the President said, if you don't have health insurance, well, just go to the emergency room.

108: Point of Billings' article from which you disingenuously cherry pick utterly and entirely missed. You could be making the big bucks putting up billboards for Clear Channel with that broad brush you use.

I am for universal coverage. I am against tax increases. The way I look at it, a government that can borrow this much money to fund a war and then inflate away the debt ought to just pay insurance claims out of the general fund. I'm just a skeptic.

LAMBERT: You know, you're closer to clear-eyed reality than I thought.

And you, sir, could be the James Carville of the "Franken campaign".

Left unchecked by a sleeping media, one would think that Minnesota's health care program -- MinnesotaCare -- is a gaping wound in the state budget. Many people even think it's paid for with state taxpayer money.

But shouldn't the fact that MinnesotaCare has been able to run a surplus, to the point where it's become the Pawlenty go-to fund to balance the state budget indicate that the program in Minnesota has been a success?

LAMBERT: I'm only going to go far pretending to be an expert on health care finances, but that one did jump out at me when I read it a couple days ago. "What? There's EXTRA money in there?"

From David Gratzer's book, "The Cure: How Capitlism Save American Health Care", I have summarized some of this findings. Note that Dr. Gratzer is a psychiatrist and physician from Canada.

The governors with the best of intentions have been shocked and moved to action by two fundamental claims—there are 46 million US uninsured and there are 18,000 unnecessary deaths because of this. Both of these are powerful political statements demanding redress and the governors have redressed them each in their own way. But the real issue is not what to do but why do it?

The 46 million figure is an estimate of “point prevalence” of those uninsured. At a given point in time this figure is correct, but people do transfer from one insurance company to another. In a given year there are only 21-31 million uninsured for the entire year. Twenty percent of these are not citizens. About one third of all households without insurance have incomes of $50,000 a year or more and 16% have incomes of $75,000 a year or more.

Since 2003 the alleged percentage of uninsured has been 14-15%; however, if you correct for those who are eligible for Medicaid and have not applied, illegal aliens and those with high incomes who refuse to pay for health insurance you probably are talking abut 7% of the population who are actually uninsured at any given point in time.

Statistics done on length of time uninsured document that only 13% of those uninsured have been so for 12-24 months and only 16% have been uninsured for longer than 24 months. Most find insurance in four months (45%) with another 26% finding insurance from 5 to 12 months. The point is, many of the “uninsured” find ways to remedy the situation.

All told, the chronically uninsured are no more than 8.2 million. A conservative estimate then would suggest that over a year’s period of time a full 93% of all Americans either have or will have health insurance.

Even the “uninsured” receive health care. They can apply for Medicaid right in the hospital ER room and no hospital can refuse them care. The Emergency Medical Treatment Act (EMTLA) of 1986 mandates any hospital to treat in an emergency situation regardless of ability to pay.

As far as the 18,000 deaths per year this statistic was forwarded by the prestigious “Institute of Medicine.” This as a statistical inference not an actual nose counting study. Indeed it was based on the increased mortality of the uninsured vs. the insured; however, using the same data and approach, it is also found that those on Medicaid have even a higher mortality rate than those uninsured.

Something is wrong with the way this 18,000 figure was arrived at. What seems to be a play here is the “use of statistics like a drunk uses a lamp post—for support rather than illumination.

The ”Institutes of Medicine” has been a long time proponent of single payer health care. Confirmation bias is the sine qua non of health care political argumentation—even among the medical cognoscenti.

Almost as an afterthought the author discusses the effect of health care mandates on the cost of insurance. Legislatures want to do “good.” They often see this “good” as mandating more and more services on insurers licensed in their state.

Lately the big state legislative thrust has been to make all “community rate” and for all to practice guaranteed issue.”Community rating means premiums are not based on age, sex or health status. It is a way to shift costs from the chronically ill to the healthy. Guaranteed issue means insurance companies must sell policies to all applicants. This results in people getting sick, applying for insurance and paying the same rate as everyone else in the community.

Vermont was the first state to require “guaranteed issue” and “community rating.” Only a few insurers remain and premiums are almost twice of the neighboring state of New Hampshire. Even worse is New Jersey. Because of the mandates, insurance costs for a $500 deductible, family policy now range from $3,700 to $7,400 a month! In New Jersey, it is now cheaper to rent the most expensive Ferrari than to provide private family insurance.

LAMBERT: Well, I agree with the line about using statistics like a drunk uses a lamp post. And I will not dispute a churn factor. But really, most of this argument reminds me a lot of Gen. Buck Turgidson in "Dr. Strangelove" assuring the president that while "we might get our hair mussed" casualties from a nuclear exchange would result in "20 million" dead, "tops".

Does any of what you say argue that we have an effective, fair or affordable "system". How much different, better would this be if the entire country operated under a universal, standardized program without wide variations from state to state?

All sorts of earnest lefty sites I checked project a much darker view of what we've got ... so I followed a link to The Heritage Foundation, I'm sure you're familiar with their perspective. I found this:

"Although the actual number of "churners" is dif­ficult to pinpoint, many of the 47 million people uninsured in 2006 were not the same as the 44.8 million people uninsured in 2005. In fact, 89.5 million people were uninsured for at least one month during 2005 and 2006, which is signifi­cantly more than is reflected in the Census Bureau's Current Population Survey (CPS) estimate of 47 million. Both liberal and conservative health policy analysts agree that the uninsured population is dynamic and diverse and that many of the unin­sured are uninsured for different lengths of time. For example, of the 89.5 million people uninsured during 2005 and 2006, 36 percent were uninsured for five months or less, and 38 percent were unin­sured for more than one year.[1"

If 38% of almost 90 million were without insurance for more than a year ... well, you're good at math.

And while I'm at it, this persistent issue about the over-the-top cost of treating "illegals". If reform brought nothing more than access to routine check-ups, minute clinic availability for flu and minor problems -- anything that stopped the clogging of emergency rooms, it'd be a resounding success.

But run the numbers on garden variety prescriptions -- cholesterol, depression, high blood pressure -- here and in Canada or France. Hell, for real socialist science fiction, what if you issued free anti-depressants to street people and the indigent? Do you think there might be a cost benefit somewhere else in "the system"?

I've spent some time reading Clintons health care plan. I like some of the ideas, but it misses the elephant in the room -- cost.

I work in the dreaded insurance industry for a company that does not make United Healthcare like profits. Medical costs are out of control, but for reasons that are not all that popular (in no particular order)

1. Technology. Newer treatment methods with diminishing (or no) returns. Think failed back surgeries, prescription drugs (non-generic), etc.

2. There is no ultimate gatekeeper to care. We try to save every life regardless of the resulting quality. Many of the "life saving" therapies only extend life for a few months at very high costs. No one wants to talk about this.

3. America is getting FAT. We are out of shape and diseases like diabetes are out of control.

4. Our legal system needs reforms (limits).

5. Our administrative systems for health care are a mess. Hillary is right on this, but she underestimates the difficulty in fixing it.

Clinton's plan really doesn't address reducing the costs where it is needed. Squeezing the family doctor to reduced medicare rates does not fix the problem (she does hint at doing this). Reducing back fusions, fancy stents, and TV sponsored prescription drugs does. Be very careful here, doctors need to make a profit -- their schooling costs are high and the majority of them work very hard. We need smart doctors (and nurses).

My guess is that Clinton is trying to keep the lobbyists at bay by not touching some of the big profit centers out there.

I give Hillary credit for putting a plan together. It will need billions more than she estimates and the savings through technology will not be as great as she expects. That said, her plan has some parts that are keepers.

I'll be blunt. I'm not ready for universal healthcare if it means supporting a bunch of fat people that never exercise, live at McDonalds, and cost the system thousands in care each year. But -- if people commit to a healthy lifestyle and care is kept to the essentials, then there is potential.

I'm not sure that people understand that they are already paying for the uninsured. Hospitals lose billions each year on no payers and the uninsured. Guess who pays for that? The paying customers.

The lobby impact on healthcare it incredible. Insurers, lawyers, hospital, pharmaceutical companies, medical device companies, doctors, etc. Getting that bunch to agree to anything will be a major win.

LAMBERT: Dave! My man! Someone's going to yank your Republican card. (Not that the average Democrat is exactly astute about this stuff.) Off the top of my head I can't remember who is where on the incentives/disincentives for personal responsibility -- i.e. smoking, junk food, boozing -- but there's no question that has to be in the "system" when we get one.

But the current arrangement, where everyone without insurance -- 47 million at some point of the year -- wanders into an emergency room when they are wretchedly ill and runs up a huge tab on taxpayers is lunacy. There should be RNs at clinics in strip malls doing quick checks, flu shots, strep tests, etc.

Boiled to its basic, can't we get smart about this? We've got all sorts of models in the First World to learn from. But there has to be political will -- supported by a "sustainable majority" - to battle the lobbying pressure, because the HMO administrative ox has to get gored. It is a business model antithetical to delivery adequate health care across the entire spectrum of society.

Bleuler says capitalism can save the practice of medicine, then uses misleading figures to show how many Americans are covered. What's not said is that even those who are "covered" are forced into bankruptcy by medical bills. "Insurance" companies have entire divisions dedicated to finding loopholes in their contracts to not have to cover people when they get sick. Add in deductibles, inability to pay premiums once someone gets sick, and our medical coverage sucks. And oh by the way - ask a doctor about the so-called "production model" that is being used in almost all practice these days - as if they were building Toyotas.

LAMBERT: "Cost" is the elephant. But to certain mindsets, the "free market" types, an effective "system" (and I'm agreeing with Dr. Cortese from Mayo that there really isn't a "system") is whatever produces profit for shareholders. The short-sightedness of the negative effects of cost, unattended illnesses, loss of productivity, the inability to change jobs, relocate, yadda yadda based on access to affordable health care is astonishing.

This 47 million uninsured is almost identical to the 45 million enrolled in Medicaid. Serious question - is this the same group of people? What is Medicaid anyway, if not a vehicle to insure those who wouldn't otherwise be?

MinnCare is the state's implementation of Medicaid. And yes, if they're running a surplus theyre either taxing too much or not offering its services to enough people. But I don't consider it a sin for Pawlenty to look to this pot under the circumstances. Social Security taxes are purportedly not supposed to fund the general fund of the federal government, but they do. That train long left the station.

LAMBERT: And who exactly is driving that train?

Does Mr. Collins mean to assert that the 2% "sick tax" on health care services does not amount to a tax on Minnesota health care consumers, that it is not passed on as a regressive sales tax on service that falls most heavily on the state's sickest and least insured citizens?

Seems to me it ought to go to the purpose for which it was collected, in the same spirit that the newly enacted gas tax increase is constitutionally dedicated to the transportation infrastructure.

That was my understanding. But I stand ready to be disabused of this take if there is something I've missed.

LAMBERT: Any loose "social service" dollar is fair game.

My small business healthcare plan, an HSA, increased 24% for 2008. That was with minimal office visits and prescriptions. No one in the family used up their deductible. My older son has a BC/BS policy that increased 19% with no claims at all. Health Insurance costs have to be reigned in. That doesn't even address the uninsured.

Additionally, the large healthcare companies are dictating what providers can charge for their services. My wife has a practice that does not accept health insurance. Doing so would give her two choices, artifically inflate her rates or accept inadequate fees for service.

There are many key issues to the presidential race. None of them can be anymore important than a healthcare system that is a runaway train.

LAMBERT: The amount of money that is locked up in two sectors of the economy -- energy and health care -- is absurd. But talk to a financial advisor and what do they tell you? "Energy and health care ... with a little municipal bond action on the side." Not exactly a healthy situation anyway you look at it.

I know it doesn't go here, but didn't know how to pose the question seeing there's no email listed for you.

Any comments on the Reger dismissal from WCCO along with the other budget cuts throughout the country? Looks like a ton of people are out at CBS' LA station, Chicago station, and SF station. By the way, are budget cuts the reason Rosen isn't doing his show from a dedicated set anymore and doing it from the usual newsdesk?

LAMBERT: As soon as I get a good explanation, I'll post it.

Regarding Jim Leinfelder's last post: (1)You and your son are probably community rated. That means you are put in a pool containing everyone;hence, you are paying the freight for old people like me and women like my wife. (2) When you reach 65 and go on Medicare, you will find the government has restricted physician and other vendors fees such that when they see you they do so at a loss unless they do a procedure or do laboratory work. The point is that the government has tried and tried to reduce costs by favoring first this group and then another. (3) And finally don't forget Technology has changed cost structure. We have 60% fewer hospital beds than we did fifty years ago but each hospital bed costs 40 times more! Hospital days have been cut but we now have almost 10 times more hospital personnel for these fewer beds

The whole system is flawed. I note that both Lambert and several others questioned my statistics. They might be interested that they were vetted by Milton Friedman. Professor Friedman wrote the introduction to the book. He was, of course, a Nobel Laureate.

The big game in health care is trying to get someone else to pay your bills. So far the middle class through community rating and taxes is the last source of funds.

LAMBERT: Mr. Friedman is of course of a certain school of economic thought. But my (short) argument is that the current system-less "system", with no universality of premiums, service or oversight contributes mightily to irregularities in who pays what and who gets treated how. But yes, absolutely, we are all well aware that each hospital bed is now far more expensive than it was ... well hell, than it was a week ago.

Here's the problem with private insurance in health care: The costs incurred by a single individual are spread over an entire lifetime. Most medical expense is in the early and late years, and if there are children, and if there is some kind of catastrophic disease. Insurance companies only really want to insure people in the middle of their lives, when the only big risks are children and severe illness. The idea with one single payer that covers an individual over the span of a length of his or her life is that the payments and cost average out, and here's the key, over the length of an entire life.

Paul Douglas the latest out at WCCO. Very surprising cut considering they have Trenda, Shaffer, and Fairbourne. Who gets the 5,6 and 10 shows now?

LAMBERT: There's a new post up on the Douglas move. And the answer to your question is ... they don't know. By the sound of it every CBS O&O has spent the last week red-lining costs and employees.

I'll miss that John Reger. Met him once out on a story. Got the impression that, like so many good anchor people in the biz, John's sensibility was, perhaps, a little too hip for the room. With TV execs, when in doubt, shoot low.

Meanwhile, this from Krugman breaking down the utter the vacuity of McCain's health care "plan," the former subject of this thread:

http://www.nytimes.com/2008/04/04/opinion/04krugman.html?em&ex=1207454400&en=af86cd2cf2a089b4&ei=5087%0A

I realize everyone's moved on to the woes of Paul Douglas and the Tiffany Network, but I thought I'd draw your attention to this excellent piece of documentary filmmaking from the folks at California Newsreel who've been staying true to the mission of public television since 1968:

http://www.unnaturalcauses.org/about_the_series.php

Aside from its overarching confirmation of what most of us know but would rather not admit about this country, that our profound economic inequality translates directly to inequity in health and longevity, it was striking to me that poor Latino immigrants come to this country with even better health than our well-to-do residents but once they become assimilated into the culture, their health suffers. We are a fundamentally unwell culture, and we pay though the nose for it.

LAMBERT: I spilled Velveeta from my Triple Dago Burger watching that one.