ESRD and the public option

I Love My Socialist Kidney

We already have a public option. How it saved my life – and my dad’s life – and how it may one day save yours

By Jennifer Nix and Salon.com

Monday, Sep 28, 2009 00:10 PDT

The day after this country elected Barack Obama its 44th president, a doctor told me I’d inherited from my father a rare form of cystic kidney disease and that I was already in renal failure. Beyond the devastation I felt on hearing this news, and despite having health insurance, my greatest fear in those first, foggy days was one that haunts millions of Americans. I was more terrified of being dropped or denied treatment by my insurer over some minuscule technicality than I was of facing the disease. After four years of progressive activism, delivery of Obama’s campaign promise of universal healthcare suddenly became very personal and urgent rather than simply a political goal for me.

A few weeks into my ordeal, however, I learned that my diagnosis qualified me for a little-known existing “public option,” or government health insurance plan. The same program had saved my father’s life, but I was frankly surprised to learn it still existed despite numerous legislative changes through the decades. Today, almost a year after my diagnosis and amid the disheartening acrimony and willful misinformation pervading our healthcare debate, I can bear witness to what constitutes “socialized medicine” in the United States.

My family’s 36-year journey with end-stage renal disease – the only long-term, chronic disease classification for which the U.S. government provides insurance coverage, regardless of age or income – offers a telling case study into what once met Congress’ standard of an unequivocal, moral imperative to provide public-financed health insurance. My family history mirrors exactly the period from 1973 to 2009, during which this entitlement program has allowed access to life-saving dialysis and kidney transplants, treatments previously denied to all but a very privileged few.

The story of the Medicare End-Stage Renal Disease (ESRD) Program is illustrative of a government plan compelling private insurers to cover more Americans than they ever did when induced solely by market forces or their own good intentions. In today’s political parlance, as the president put it in his Sept. 9 address to a joint session of Congress, this translates to a public option that will “keep [private] insurance companies honest.” This history also presents a cautionary tale of how profit-driven forces chipped away at Medicare ESRD’s effectiveness, resulting in higher treatment costs and worse patient outcomes (compared with those of other industrial nations) for the 506,000 ESRD patients in the U.S. today.


It was the summer of 1972 when my 30-year-old father, Wayne Nix, learned his kidneys were failing. As a high school teacher, with a wife and two little girls to support, his only two choices were death or financial ruin. Doctors at the University of Michigan Medical Center estimated he had six months to live without beginning hemodialysis – a process by which plastic blood lines are connected to the body via needles (usually in the arm) and blood is mechanically pumped out of the body and circulated through an artificial kidney for three to four hours at a time, usually three days a week. Back then, dialysis costs ran between $10,000 and $15,000 a year.

On short-term disability leave from work, with no savings to speak of and a brand new mortgage on a $27,000 house, my father found himself in possession of an employer-provided medical insurance policy with a high deductible and a low lifetime cap on payments for healthcare and prescription drugs. With hospital stays, doctor visits, medicines and dialysis costs, my parents quickly approached the dizzying precipice of bankruptcy. To help stem our financial hemorrhaging during those initial months, my parents’ friends held parties at which there would often be the benevolent and anonymous device known in 1970s Midwest vernacular as the “money tree”: a small tree branch set in a makeshift pot with $10 and $20 bills fastened with twist-ties, like so many leaves. Even as my father hoped for a transplant, though, he knew there would be no money to pay for it.

By the 1960s, dialysis and transplantation were established as effective treatments for kidney failure, which could allow ESRD patients to live full and productive lives. With no funding for long-term, chronic dialysis, however, hospital committees decided who would live and die. These committees looked at age, complicating health concerns, psychological well-being and a patient’s “social worth,” but because the wealthy could afford to pay for their treatments outright, they were the most often treated, resulting in a class-driven mortality rate. The government “death panels” decried in the hyperbolic rhetoric of today’s right-wing anti-healthcare reform fanatics may be imaginary, but in the 1960s and early '70s there really were death panels for ESRD patients.

It was the federal government that put an end to this practice.

“At that time, simply put, there were no private insurers willing to cover ESRD patients,” according to Richard Rettig, an adjunct social scientist with the Rand Corporation and a leading authority on the history of the Medicare ESRD Program. "I have a letter from [dialysis pioneer and physician] Belding Scribner to Met Life, imploring that company to initiate coverage for life-saving medical treatments for chronic kidney failure patients. Scribner and others went to all the big insurers at the time, and not one answered the call to cover chronic ESRD treatments.

“We had established treatments for chronic kidney failure available, but they were beyond the means of Joe Citizen, and our society had a very real dilemma concerning how to balance proven care against scarce resources,” Rettig told me by phone.

But even if he didn’t know it back in that summer of '72, my father had reason to be hopeful. By then, after years of activism carried out by advocacy groups, pioneering dialysis and transplant physicians, a growing community of nephrologists, patients, elected officials and congressional staffers, the stars were aligning for the inclusion of ESRD in the Medicare insurance program. The passage of Medicare and Medicaid in 1965 had opened a legislative door, and in the fall of 1971, Congress held hearings on the idea of national health insurance for all. Advocates for ESRD’s inclusion in any proposed legislation were well represented, particularly by dramatic testimony from Shep Glazer, then the vice president of the National Association of Patients on Hemodialysis (today the American Association of Kidney Patients), who shared his story while dialyzing right there on the chamber floor.

“I am 43 years old, married for 20 years, with two children ages 14 and 10. I was a salesman until a couple of months ago, when it became necessary for me to supplement my income to pay for the dialysis supplies. I tried to sell a noncompetitive line, was found out, and was fired,” he said. As his blood pumped through the artificial kidney for all to see, Glazer asked the House members: “Gentlemen, what should I do? End it all and die? Sell my house for which I worked so hard, and go on welfare? Should I go into the hospital under my hospitalization policy? Then I cannot work. Please tell me. If your kidneys failed tomorrow, wouldn’t you want the opportunity to live? Wouldn’t you want to see your children grow up?”

It is impossible to determine the deciding factor, but eventually Democrats and Republicans in both the House and Senate agreed nearly unanimously that the plight of ESRD patients constituted a moral imperative to provide access to healthcare through government insurance. A Democratic Congress passed the Medicare ESRD Act in October 1972, for the first time singling out a specific disease for Medicare coverage without requiring beneficiaries to be age 65 or older. (Lou Gehrig’s disease is also covered similarly under Social Security, but patients generally live only two years past diagnosis.) A Republican president, Richard M. Nixon, signed the act into law, and by July 1973, the entitlement was paying for my father’s dialysis, along with that of about 7,000 other kidney patients.

Medicare ESRD would pay for my father’s home-based dialysis for 17 years. It also paid for an unsuccessful transplant attempt in 1975 and a successful cadaveric transplant in 1991, as well as hospital stays and some of his prescription immuno-suppressant drugs, which kept his body from rejecting the new kidney. Without passage of this landmark legislation, those doctors who first told my dad he had six months to live would have been right. Instead, he lived another 27 years – teaching, coaching and creating a National Kidney Foundation program for the vocational rehabilitation of kidney “consumers” (he hated being called a patient). Wayne Nix became a nationally known activist and even testified before Congress about the need for better regulation of dialysis centers.

He also happened to outlive a couple of those doctors.

Some call it the “silent disease,” because there are few symptoms until the very end, when your kidneys give up on you. Even though I’d been steeped in my father’s illness and activism, kidney disease sneaked up on me, too. Having been told that my dad’s was not a hereditary form of kidney disease, I’d operated under the assumption that it would not be passed on to me or my younger sister. My father died in 1999, so he wasn’t around to talk to, or to pick up on little signs he might have noticed. It didn’t help that no physician or psychologist I’d sought out ever suggested there might be actual physiological reasons for my fatigue and depression. I was just another woman around 40 complaining about having no energy or interest. In fact, in October last year, instead of giving me the blood tests that would have confirmed the irreversible damage to my kidneys, one 50-something male doctor even looked down at me over his bifocals and said, “Stop thinking you’re so fragile. Try yoga.”

Two weeks later, I learned I’d been in renal failure for months and that my type-2 medullary cysts had been forming over a period of probably 10 years.

I am one of the lucky few ESRD patients, covered by both private insurance and Medicare, who go from diagnosis to transplant within six months. There are more than 80,000 people waiting for kidneys in this country. Last year, according to the United Network for Organ Sharing, only 16,517 got transplants: 10,550 with the cadaver organs allocated through the national waiting list, and 5,967 from living donors. More than 4,000 people on the waiting list died – that’s about 13 a day. The list has been growing by about 3,500 names a year, and the wait varies from state to state; in California, where I live, the average is seven years. Because a friend graciously and miraculously stepped up to give me another chance at a full life, I didn’t have to rely on the list. We had the surgeries on May 22, at the University of California, San Francisco. I can only say that I simply have no words to express the depth of my gratitude to my living donor.

Fortunately, I’m also able to focus on getting back to life, and not on how to pay a mountain of medical bills. Most of my bills – for both the donor’s and my own surgeries – arrive saying they’re already paid in full, between the private insurance we have through my husband’s job, and Medicare ESRD.

Today’s Medicare ESRD Program is somewhat different than in its early days. Among the many legislative changes to the program, those that most affect me are the Medicare Secondary Payer (MSP) provisions enacted by Congress in the 1980s. These laws stipulate that as a transplant recipient, I qualify for three years of Medicare ESRD coverage, but because I also have private insurance, my private insurer is mandated to be the primary payer for the first 30 months after my transplant, and Medicare is primary for six months (it’s an 80 percent primary, 20 percent secondary split). Should my body reject my transplanted kidney at some point, and I find myself in need of dialysis, my private insurer would be the primary payer for another initial 36 months, and Medicare ESRD would then pick up primary costs for as long as I stayed on dialysis – be it days, months or years.

Without my husband’s private insurance, Medicare ESRD would have been the primary payer for all ESRD treatments after an initial three-month waiting period for dialysis or as soon as I needed a transplant. And should my husband lose his job, and our health insurance with it, Medicare ESRD is there to fall back on. But to qualify for the program these days without other insurance, the patient or the spouse must have worked a minimum amount of time, paying into Social Security. (So, in case you were wondering, Rep. Joe “You Lie” Wilson, no illegal immigrants are eligible for this government program.)

When I brought up the fact that my transplant and immuno-suppressant drugs are primarily being paid for at this point by Aetna, not Medicare ESRD, Richard Rettig (the Rand social scientist) clarified my statement for me. “Yes, Jennifer, but let me assure you. Aetna would not be covering your care at all if not for the passage of the Medicare ESRD Act in 1972, and the MSP provisions in the '80s and early '90s. Full stop.”

Without the government stepping in to remedy a situation that the market and private business willfully ignored, both my father and I would most likely have died within a year of our diagnoses. I believe every American citizen deserves the same kind of health security. Even before I got sick, my father’s story was the reason I became an activist myself during the Bush years, as I saw people’s faith in government dwindling. It’s why I fought so hard to get Obama elected, and why I’ll be gravely disappointed if he gives in on the public option.


But, truthfully, all of this costs a lot of money. Legislative changes to Medicare ESRD over the years, in particular the shared-payment provisions, have attempted to rein in taxpayer-funded costs as the program took in greater numbers of beneficiaries. These mandated the shifting of some costs to private insurers, though they still only cover about 10 percent of the total ESRD population, while Medicare covers 75 percent. Medicaid and Veterans Affairs cover the bulk of the remaining 15 percent of ESRD patients in the United States.

“This program has provided vital insurance coverage to more than a million Americans, and patients eligible for Medicare ESRD are very happy with their coverage,” says Bobbi Wager, board president of the American Association of Kidney Patients (AAKP). Wager, who’s undergone dialysis and two kidney transplants, also told me, “Kidney patients are very fortunate to have this safety net, but this program is not cheap, so we have to constantly be looking for ways to control costs, or risk losing it.”

Opponents of “government-run healthcare” in general, and now President Obama’s public option in particular, point to the fact that Medicare ESRD’s costs have far exceeded initial projections and extrapolate from this the wrongheaded notion that the program’s problem is simply that government is inefficient or inept. So, let’s dive into the numbers.

According to AAKP, 1972 estimates had program costs at $250 million, while today approximately $23 billion is spent on Medicare ESRD, out of a total Medicare budget of $355 billion (for some perspective, the GAO reported that U.S. defense spending in 2008 was around $800 billion). The U.S. Renal Data System’s (USRDS) 2008 annual report shows Medicare ESRD consumes 6.4 percent of Medicare’s budget to cover 1.2 percent of its total population. While we’re deep in these weeds, I’ll also report that Medicare’s average cost per ESRD patient per year is $61,164. Breaking that down, Medicare spends an average of $71,889 per year on a hemodialysis patient and $24,952 per year on a transplant patient.

Critics, like John Graham at the National Review in his spectacularly ill-informed post, fail to acknowledge several major points, however. First, what these numbers don’t show is that, even with the major increase in total costs over original projections, compared with other areas of Medicare, the ESRD Program has restrained its per capita costs, and the reimbursement amount for dialysis, roughly $160 per treatment, has not gone up since the mid-1980s. Second, contrary to the notion that private companies can more efficiently and cheaply insure healthcare, consider these facts: Total public and private spending on the ESRD population, according to the USRDS 2008 report, was $34 billion. So, if we revisit the percentages above, Medicare covers 75 percent of the ESRD population for $23 billion, while $11 billion is spent to cover the remaining 25 percent of ESRD patients, including the 10 percent covered by private insurance. In other words, private insurance pays $4.4 billion to cover 10 percent of ESRD patients, which suggests that it would cost private insurance $33 billion to cover 75 percent of the ESRD population – $10 billion more than Medicare now pays. So, who’s more cost-effective?

The major contributing factor to Medicare ESRD’s overall cost explosion is the larger-than-anticipated number of beneficiaries, due to diabetes and heart disease patients being successfully treated in far greater numbers, resulting in correlating numbers of patients reaching end-stage renal disease and qualifying for the program. Early on, most diabetics and hypertension patients died before that point. In the 1990s, incidence of diabetes-caused ESRD rose almost 200 percent. Today, diabetes is the cause of 43 percent of ESRD, while hypertension accounts for 23 percent. By contrast, all the genetic cystic diseases, such as mine, account for less than 3 percent of ESRD cases.

Another part of the cost equation is that in other industrialized countries, which provide universal healthcare for their citizens, more people are diagnosed early and benefit from cheaper, preventive care. In the U.S. with our tens of millions of uninsured and underinsured, people avoid doctors and get diagnosed later in the progression of disease, when treatment is more expensive.

Medicare ESRD has grown by 2 to 4 percent each year since 1973, but with an estimated 26 million people now walking around with some level of chronic kidney disease, combined with the diabetes and obesity epidemics in America, the number of patients qualifying for Medicare ESRD is projected to double by 2020. About 60 percent of these people could slow or prevent the progression to kidney failure through diet, exercise and preventive disease management.

Want some advice? Get your kidneys checked.


Medicare ESRD’s real problem, for critics and advocates alike, is the higher mortality rate for U.S. dialysis patients, compared with that of other industrialized countries. But again, the critics’ refrain that this is proof of a “bloated and inefficient government program” is not accurate. The exact opposite is true. It’s the private portions of the plan that cause problems. That ESRD patients’ first-year dialysis mortality rate is 21 percent, while Japan’s is 9 percent and Europe’s rates hover around 15 percent, can be traced primarily to profit-driven forces.

Though U.S. dialysis began in Seattle with Dr. Belding Scribner’s vision of nonprofit, community-based dialysis, with a major push toward having patients dialyze at home, where overhead is cheaper and outcomes have long proven superior, the Medicare ESRD entitlement instead spawned a disease-profiteering industry and the proliferation of corporate, for-profit dialysis centers. DaVita and Fresenius Medical Care, the two largest chains, now control about 60 percent of the nearly 5,000 dialysis centers in the U.S., and in-center dialysis overall accounted for 92 percent of dialysis in 2008. While Medicare’s reimbursement rate is regulated by Congress, there is no regulation of what dialysis centers can charge private insurance, so rates can be much higher and vary greatly.

“Profit-driven dialysis is a problem,” says Bill Peckham, a 19-year dialysis patient and a trustee of Seattle’s nonprofit Northwest Kidney Centers, founded by Scribner. “With Medicare reimbursement not going up, the centers need to squeeze profits out of patient care, essentially through shorter hours of operation, using techs instead of nurses, shorter dialysis treatments so they can flip the chairs, and reusing artificial kidneys. They don’t push patients to get optimal treatment, because it comes out of their profits. And patients feel sick all the time because they’re not getting enough dialysis.”

“The mortality rates in Australia and New Zealand are among the very lowest, around 14 percent, and they have much higher percentages of patients on home dialysis,” adds Dr. Christopher Blagg, professor emeritus at the University of Washington, and a former CEO of Northwest Kidney Centers. “Why the difference? They say it’s because their publicly funded universal healthcare program focuses on early diagnosis and prevention, and that their doctors are on salary, not fee-for-service. Dialysis care is also run out of major hospital centers, their government’s reimbursement rate for home dialysis is bigger – and they have no for-profit dialysis.”

In 2007, the Journal of the American Medical Association published a report that for-profit dialysis centers had also been overprescribing an expensive anemia drug. In an effort to boost certain blood levels to suggested levels, which is done elsewhere through optimal dialysis runs, the for-profit centers reportedly ran patients for shorter periods, but gave them higher, sometimes dangerous levels of the anemia drug. This move allowed them to squeeze more profits out of Medicare ESRD due to shorter dialysis times and the separate billing of drugs not included in the regulated dialysis reimbursement rate. This profit-driven use of drugs cost Medicare ESRD $1.8 billion in 2004 and is the largest single drug expenditure for Medicare overall.

Forbes reported in April that DaVita CEO Kent Thiry’s average compensation over the past six years was $22 million, and the company reported $6 billion in revenues, according to Fortune, which ranks DaVita as 433rd on its Fortune 500 list. Their profits, Peckham believes, can be directly linked to poor patient outcomes. This is by no means the only factor, but everyone I interviewed – even the employee of a for-profit dialysis center who asked not to be identified – agreed that the drive for profits has contributed to Medicare ESRD’s higher dialysis mortality rate; the differences among them were only in degree.


As I watch the cable news loops of all the vicious language and wild-eyed imagery aimed at killing healthcare reform, I can’t help but be amazed that Medicare ESRD was ever passed. I wonder how so many Americans today can be made to believe that healthcare is “anti-Constitutional” or that a fascist/socialist (and, let’s not forget, African) Obama wants to kill their grannies, but I am awestruck by the headstrong self-destruction of the Republican Party. There is no clearer proof of GOP decay than comparing the Republican leadership of the 1970s with those controlling the party today.

Republicans in the 1970s were on the side of healthcare for all Americans. In a message to Congress on Feb. 18, 1971, Nixon himself proposed the National Health Insurance Partnership Act. This was a moment in our history when most Americans believed some form of all-inclusive, national health insurance would soon be a reality. Republicans and Democrats alike were working hard to find the best way to make it happen. In 1972, a generation of pragmatic and compassionate Republicans voted in large numbers to help pass the Medicare ESRD Act. It was seen by legislators as a test case, to be followed by government insurance programs – be they catastrophic or comprehensive – for other diagnoses.

This never happened, of course, and right up until our summer of angry town halls, Medicare ESRD has remained what former Senate Finance Committee staffer James Mongan called “the last train out of the station for national health insurance.”

Today’s Republican leadership follows the lead of hate-speech blowhards and injects vitriol and proven lies into our national discourse, instead of engaging in honest negotiations over the best way to bring healthcare to all Americans. They are ginned up for an Obama defeat, by any means necessary – good policy and the American people be damned.

If we don’t get healthcare reform this time around, I have to wonder what will become of the programs caught in the middle, like Medicare ESRD. It’s unknown at this point whether I’ll need another transplant or long-term dialysis at some point, but it’s highly likely. The bottom line is treatments for ESRD are expensive and ongoing. With this diagnosis, it’s either dialysis or, if transplanted, expensive immuno-suppressant drugs for the rest of one’s life. But because I have this benefit, when my fellow citizens with, say, cancer do not, it’s hard not to feel some guilt.

This nation must face difficult questions. Will this society continue to be willing to bear the costs of an entitlement program for ESRD patients, as the market has proved that it will not if left to its own devices? Should we simply let ESRD patients die? Or do we believe that as a society, certain of us will develop catastrophic illnesses and that we all deserve health security? Is this “charity,” as a conservative friend of mine suggests, or a society sharing the risk that any one of us could face illness and financial ruin tomorrow? Should the “right to life, liberty and the pursuit of happiness” be interpreted literally? If so, shouldn’t guaranteed healthcare be the right of every U.S. citizen? If the answer to that question is yes, shouldn’t all of us – Democrats, Republicans and Independents – be working together to find the most effective and cost-efficient system for its delivery?

It remains to be seen whether Congress will pass healthcare reform this year. Like many before it, this effort may not succeed, and we’ll remain, as Obama has said, “the only advanced democracy on earth – the only wealthy nation – that allows such hardships for millions of its people.”

For now, I’m just grateful there was a time when Congress felt the moral imperative to provide a public health insurance option that allowed both my father and me to live.

http://www.salon.com/news/feature/2009/09/28/kidney_disease/

I knew Jennifer Nix’s father who was a kidney patient and a very active NKF volunteer. He believed strongly in helping people fulfill their goals in spite of kidney disease/kidney failure. He helped establish and ran NKF of MI’s employment support program that became the national NKF’s RISE program. Jennifer’s a chip of the old block!

I keep wondering why people are so vehemently opposed to a public option that would help people who do not currently have and can’t get commercial insurance. Medicare is a government run health plan and was a first step toward providing universal coverage. I had to laugh when I saw people carrying signs outside my representative’s office that said “Keep government out of my Medicare.” Do they live have any idea how ignorant that makes them seem?

Medicare isn’t perfect and Part B isn’t free (Part A is for most people). Medicare doesn’t cover enough screenings or preventive healthcare. However, Medicare helps millions of people (aged, disabled, certain illnesses including kidney failure) have basic coverage for many (not all) of their health needs for a lower premium than what they could find on the open market – assuming they could insurance insurance that would take them at their age or with their health condition(s). And unlike most commercial insurance, Part B has no maximum on how long it will pay for covered services. Although payments to providers are established based on “reasonable and customary” charges, there is no lifetime maximum benefit in Part B. Everything isn’t covered and some things require medical justification, but the people I know who have Medicare don’t have that many complaints about it.

When I hear horror stories about care in other countries under their nationalized health insurance programs, I wonder who those people have been talking with. I’ve talked with people from Canada, the Netherlands, France, and Germany and every single one of them say they wouldn’t trade their coverage for our non-system. Do some people have to wait for care in those countries? Yes. Ask me how many months I have had to wait when I call for an appointment for anything but primary care for an urgent health need.

I just got my Social Security statement this week and was looking at it yesterday. It said that my Medicare taxes have been almost $20,000 and my employers have matched that amount during my work life. How far would $40,000 go in treating almost any illness today? Medicare is a bargain and I hope it’s still around when I’m eligible for it.

[QUOTE=Beth Witten MSW ACSW;18853] I had to laugh when I saw people carrying signs outside my representative’s office that said “Keep government out of my Medicare.”
[/QUOTE]

That is funny! Or is it more scary?

Probably their insurance agent.

It is amazing how many people can ignore facts like the following:
"After analyzing the costs of insurers, employers, doctors, hospitals, nursing homes and home-care agencies in both the U.S. and Canada, they found that administration consumes 31.0 percent of U.S. health spending, double the proportion of Canada (16.7 percent). Average overhead among private U.S. insurers was 11.7 percent, compared with 1.3 percent for Canada’s single-payer system and 3.6 percent for Medicare. "
http://www.pnhp.org/single_payer_resources/administrative_waste_consumes_31_percent_of_health_spending.php

Hi y’all,

The letter below was written by Dr. Michael J Klag, Dean of the Bloomberg School of Public Health at Johns Hopkins–and a member of our Medical Education Institute Board of Directors. (In fact, I’ll see him next week at our Board meeting).


Reform 2.0

By Michael J. Klag
Johns Hopkins Public Health Magazine, Fall 2009

I have to find a new doctor.

Last month, my primary care physician wrote me a letter. He said he was leaving private practice. He’s an outstanding physician-a doctor’s doctor whom I’ve known since he was a medical student. His reason for closing up shop? The sheer frustration of getting paid by private insurance companies.

When a physician of his stature and skills departs private practice for a reason like that, it is an indictment of our health care system-that is, if we had a health care system. We all know the U.S. has great physicians and the world’s best medical technology. But the best health care system? Not in the least. Our crazy patchwork quilt is an accident of history and one that we need to fix. It fails us in so many ways, from its gross inefficiencies to the fact that it has left 47 million Americans without health insurance.

The evidence of our ailing health care system is pretty clear: Despite spending twice as much (more than $7,100 per capita) as the rest of the industrialized countries, we have poor health outcomes. Our life expectancy is below many other industrialized countries’ and perhaps more significantly our life expectancy has improved less than that of nearly all industrialized countries in the last 20 years. On some health status indicators the U.S. is near the top, on many near the middle and on some near the bottom. Not very good value for the extra money we spend. Where does the money go? Some of it is lost to in- efficiency. We all know you get 10 pieces of mail for every procedure or hospital visit and almost certain confusion about what you’re supposed to pay. In addition, our fee-for-service model encourages utilization of resources, especially expensive technology. Lastly, systems that emphasize primary care have lower costs and better outcomes than those that don’t, but we have created incentives that push physicians away from primary care and into increasing specialization.

We have inherited a system that doesn’t work and desperately needs to be fixed.

This was the challenge that President Barack Obama vowed to address. Six months ago, his administration’s leadership on health care looked like our best chance in a generation for genuine reform. However, the political compromises that have been made thus far make it clear this historic opportunity will probably increase the number of Americans with insurance coverage but not reduce growth in costs.

To put things in perspective, let’s look back on another historic opportunity that our government did embrace. Almost half a century ago, our government committed to improving the health and economic welfare of older people in the U.S. by creating Medicare. And Medicare has been a tremendous success. Before it was instituted, 29 percent of those 65 and older lived in poverty. After Medicare, that proportion fell to about 10 percent because it provided health insurance coverage to all Americans over age 65. Since then, the health status of older people has improved markedly. Even its critics admit that Medicare’s administrative costs are a fraction of those of private insurers.

Medicare is not perfect, of course. Despite its warts, however, Medicare has been a success and a huge benefit to our older population. Now, we need to take that kind of step for the rest of Americans.

As I write this, I am not sure what the outcome of health care reform efforts will be. The sausage will go through the grinder, and we’ll get, in my view, a suboptimal solution. Far from wallowing in disappointment, however, I’m moving on and so should our country. President Obama’s reforms can serve as the foundation for the more comprehensive fix that’s needed. Call it Reform 2.0.

If we want true health care reform, we need a single-payer system. In this system, the government would act as administrator, paying for all patient visits, prescription drugs, medical procedures, and so on. Instead of thousands of different insurance companies, HMOs and others with all of their separate forms and billing contacts, doctors, hospitals and others would deal with a single administrator-eliminating waste in our system. At a large hospital, this would dramatically reduce overhead costs, allowing hundreds of people to be retrained so that their talents could be directed to ways that would have greater societal benefit than paper shuffling.

Those of you shaking your heads and saying it can’t be done should know that it has been done-repeatedly. Korea in the 1980s and Taiwan in the 1990s, for example, revamped their health care systems. They have multiple insurers but all follow the same rules. Korea’s and Taiwan’s leadership (including many of our alumni) scrutinized health care programs around the world and chose a system that works best. It is not socialized medicine. The hospitals and providers do not work for the government, they work for private organizations. They just don’t have to deal with the time-sapping, unnecessary administrative burdens of our inefficient system.

Every system is perfectly designed to obtain the results it produces. Ours produces poor outcomes, inadequate access and great inefficiency. It places tremendous burden on both providers and payers and drives great doctors like mine to other careers. As hard as it is, we must completely reform our system. Otherwise we risk bequeathing to the next generation the same problems we struggle with today.

[QUOTE=plugger_;18852]I Love My Socialist Kidney

We already have a public option. How it saved my life – and my dad’s life – and how it may one day save yours

By Jennifer Nix and Salon.com

Monday, Sep 28, 2009 00:10 PDT

The day after this country elected Barack Obama its 44th president, a doctor told me I’d inherited from my father a rare form of cystic kidney disease and that I was already in renal failure. Beyond the devastation I felt on hearing this news, and despite having health insurance, my greatest fear in those first, foggy days was one that haunts millions of Americans. I was more terrified of being dropped or denied treatment by my insurer over some minuscule technicality than I was of facing the disease. After four years of progressive activism, delivery of Obama’s campaign promise of universal healthcare suddenly became very personal and urgent rather than simply a political goal for me.

A few weeks into my ordeal, however, I learned that my diagnosis qualified me for a little-known existing “public option,” or government health insurance plan. The same program had saved my father’s life, but I was frankly surprised to learn it still existed despite numerous legislative changes through the decades. Today, almost a year after my diagnosis and amid the disheartening acrimony and willful misinformation pervading our healthcare debate, I can bear witness to what constitutes “socialized medicine” in the United States.

My family’s 36-year journey with end-stage renal disease – the only long-term, chronic disease classification for which the U.S. government provides insurance coverage, regardless of age or income – offers a telling case study into what once met Congress’ standard of an unequivocal, moral imperative to provide public-financed health insurance. My family history mirrors exactly the period from 1973 to 2009, during which this entitlement program has allowed access to life-saving dialysis and kidney transplants, treatments previously denied to all but a very privileged few.

The story of the Medicare End-Stage Renal Disease (ESRD) Program is illustrative of a government plan compelling private insurers to cover more Americans than they ever did when induced solely by market forces or their own good intentions. In today’s political parlance, as the president put it in his Sept. 9 address to a joint session of Congress, this translates to a public option that will “keep [private] insurance companies honest.” This history also presents a cautionary tale of how profit-driven forces chipped away at Medicare ESRD’s effectiveness, resulting in higher treatment costs and worse patient outcomes (compared with those of other industrial nations) for the 506,000 ESRD patients in the U.S. today.


It was the summer of 1972 when my 30-year-old father, Wayne Nix, learned his kidneys were failing. As a high school teacher, with a wife and two little girls to support, his only two choices were death or financial ruin. Doctors at the University of Michigan Medical Center estimated he had six months to live without beginning hemodialysis – a process by which plastic blood lines are connected to the body via needles (usually in the arm) and blood is mechanically pumped out of the body and circulated through an artificial kidney for three to four hours at a time, usually three days a week. Back then, dialysis costs ran between $10,000 and $15,000 a year.

On short-term disability leave from work, with no savings to speak of and a brand new mortgage on a $27,000 house, my father found himself in possession of an employer-provided medical insurance policy with a high deductible and a low lifetime cap on payments for healthcare and prescription drugs. With hospital stays, doctor visits, medicines and dialysis costs, my parents quickly approached the dizzying precipice of bankruptcy. To help stem our financial hemorrhaging during those initial months, my parents’ friends held parties at which there would often be the benevolent and anonymous device known in 1970s Midwest vernacular as the “money tree”: a small tree branch set in a makeshift pot with $10 and $20 bills fastened with twist-ties, like so many leaves. Even as my father hoped for a transplant, though, he knew there would be no money to pay for it.

By the 1960s, dialysis and transplantation were established as effective treatments for kidney failure, which could allow ESRD patients to live full and productive lives. With no funding for long-term, chronic dialysis, however, hospital committees decided who would live and die. These committees looked at age, complicating health concerns, psychological well-being and a patient’s “social worth,” but because the wealthy could afford to pay for their treatments outright, they were the most often treated, resulting in a class-driven mortality rate. The government “death panels” decried in the hyperbolic rhetoric of today’s right-wing anti-healthcare reform fanatics may be imaginary, but in the 1960s and early '70s there really were death panels for ESRD patients.

It was the federal government that put an end to this practice.

“At that time, simply put, there were no private insurers willing to cover ESRD patients,” according to Richard Rettig, an adjunct social scientist with the Rand Corporation and a leading authority on the history of the Medicare ESRD Program. "I have a letter from [dialysis pioneer and physician] Belding Scribner to Met Life, imploring that company to initiate coverage for life-saving medical treatments for chronic kidney failure patients. Scribner and others went to all the big insurers at the time, and not one answered the call to cover chronic ESRD treatments.

“We had established treatments for chronic kidney failure available, but they were beyond the means of Joe Citizen, and our society had a very real dilemma concerning how to balance proven care against scarce resources,” Rettig told me by phone.

But even if he didn’t know it back in that summer of '72, my father had reason to be hopeful. By then, after years of activism carried out by advocacy groups, pioneering dialysis and transplant physicians, a growing community of nephrologists, patients, elected officials and congressional staffers, the stars were aligning for the inclusion of ESRD in the Medicare insurance program. The passage of Medicare and Medicaid in 1965 had opened a legislative door, and in the fall of 1971, Congress held hearings on the idea of national health insurance for all. Advocates for ESRD’s inclusion in any proposed legislation were well represented, particularly by dramatic testimony from Shep Glazer, then the vice president of the National Association of Patients on Hemodialysis (today the American Association of Kidney Patients), who shared his story while dialyzing right there on the chamber floor.

“I am 43 years old, married for 20 years, with two children ages 14 and 10. I was a salesman until a couple of months ago, when it became necessary for me to supplement my income to pay for the dialysis supplies. I tried to sell a noncompetitive line, was found out, and was fired,” he said. As his blood pumped through the artificial kidney for all to see, Glazer asked the House members: “Gentlemen, what should I do? End it all and die? Sell my house for which I worked so hard, and go on welfare? Should I go into the hospital under my hospitalization policy? Then I cannot work. Please tell me. If your kidneys failed tomorrow, wouldn’t you want the opportunity to live? Wouldn’t you want to see your children grow up?”

It is impossible to determine the deciding factor, but eventually Democrats and Republicans in both the House and Senate agreed nearly unanimously that the plight of ESRD patients constituted a moral imperative to provide access to healthcare through government insurance. A Democratic Congress passed the Medicare ESRD Act in October 1972, for the first time singling out a specific disease for Medicare coverage without requiring beneficiaries to be age 65 or older. (Lou Gehrig’s disease is also covered similarly under Social Security, but patients generally live only two years past diagnosis.) A Republican president, Richard M. Nixon, signed the act into law, and by July 1973, the entitlement was paying for my father’s dialysis, along with that of about 7,000 other kidney patients.

Medicare ESRD would pay for my father’s home-based dialysis for 17 years. It also paid for an unsuccessful transplant attempt in 1975 and a successful cadaveric transplant in 1991, as well as hospital stays and some of his prescription immuno-suppressant drugs, which kept his body from rejecting the new kidney. Without passage of this landmark legislation, those doctors who first told my dad he had six months to live would have been right. Instead, he lived another 27 years – teaching, coaching and creating a National Kidney Foundation program for the vocational rehabilitation of kidney “consumers” (he hated being called a patient). Wayne Nix became a nationally known activist and even testified before Congress about the need for better regulation of dialysis centers.

He also happened to outlive a couple of those doctors.

Some call it the “silent disease,” because there are few symptoms until the very end, when your kidneys give up on you. Even though I’d been steeped in my father’s illness and activism, kidney disease sneaked up on me, too. Having been told that my dad’s was not a hereditary form of kidney disease, I’d operated under the assumption that it would not be passed on to me or my younger sister. My father died in 1999, so he wasn’t around to talk to, or to pick up on little signs he might have noticed. It didn’t help that no physician or psychologist I’d sought out ever suggested there might be actual physiological reasons for my fatigue and depression. I was just another woman around 40 complaining about having no energy or interest. In fact, in October last year, instead of giving me the blood tests that would have confirmed the irreversible damage to my kidneys, one 50-something male doctor even looked down at me over his bifocals and said, “Stop thinking you’re so fragile. Try yoga.”

Two weeks later, I learned I’d been in renal failure for months and that my type-2 medullary cysts had been forming over a period of probably 10 years.

I am one of the lucky few ESRD patients, covered by both private insurance and Medicare, who go from diagnosis to transplant within six months. There are more than 80,000 people waiting for kidneys in this country. Last year, according to the United Network for Organ Sharing, only 16,517 got transplants: 10,550 with the cadaver organs allocated through the national waiting list, and 5,967 from living donors. More than 4,000 people on the waiting list died – that’s about 13 a day. The list has been growing by about 3,500 names a year, and the wait varies from state to state; in California, where I live, the average is seven years. Because a friend graciously and miraculously stepped up to give me another chance at a full life, I didn’t have to rely on the list. We had the surgeries on May 22, at the University of California, San Francisco. I can only say that I simply have no words to express the depth of my gratitude to my living donor.

Fortunately, I’m also able to focus on getting back to life, and not on how to pay a mountain of medical bills. Most of my bills – for both the donor’s and my own surgeries – arrive saying they’re already paid in full, between the private insurance we have through my husband’s job, and Medicare ESRD.

Today’s Medicare ESRD Program is somewhat different than in its early days. Among the many legislative changes to the program, those that most affect me are the Medicare Secondary Payer (MSP) provisions enacted by Congress in the 1980s. These laws stipulate that as a transplant recipient, I qualify for three years of Medicare ESRD coverage, but because I also have private insurance, my private insurer is mandated to be the primary payer for the first 30 months after my transplant, and Medicare is primary for six months (it’s an 80 percent primary, 20 percent secondary split). Should my body reject my transplanted kidney at some point, and I find myself in need of dialysis, my private insurer would be the primary payer for another initial 36 months, and Medicare ESRD would then pick up primary costs for as long as I stayed on dialysis – be it days, months or years.

Without my husband’s private insurance, Medicare ESRD would have been the primary payer for all ESRD treatments after an initial three-month waiting period for dialysis or as soon as I needed a transplant. And should my husband lose his job, and our health insurance with it, Medicare ESRD is there to fall back on. But to qualify for the program these days without other insurance, the patient or the spouse must have worked a minimum amount of time, paying into Social Security. (So, in case you were wondering, Rep. Joe “You Lie” Wilson, no illegal immigrants are eligible for this government program.)

When I brought up the fact that my transplant and immuno-suppressant drugs are primarily being paid for at this point by Aetna, not Medicare ESRD, Richard Rettig (the Rand social scientist) clarified my statement for me. “Yes, Jennifer, but let me assure you. Aetna would not be covering your care at all if not for the passage of the Medicare ESRD Act in 1972, and the MSP provisions in the '80s and early '90s. Full stop.”

Without the government stepping in to remedy a situation that the market and private business willfully ignored, both my father and I would most likely have died within a year of our diagnoses. I believe every American citizen deserves the same kind of health security. Even before I got sick, my father’s story was the reason I became an activist myself during the Bush years, as I saw people’s faith in government dwindling. It’s why I fought so hard to get Obama elected, and why I’ll be gravely disappointed if he gives in on the public option.


But, truthfully, all of this costs a lot of money. Legislative changes to Medicare ESRD over the years, in particular the shared-payment provisions, have attempted to rein in taxpayer-funded costs as the program took in greater numbers of beneficiaries. These mandated the shifting of some costs to private insurers, though they still only cover about 10 percent of the total ESRD population, while Medicare covers 75 percent. Medicaid and Veterans Affairs cover the bulk of the remaining 15 percent of ESRD patients in the United States.

“This program has provided vital insurance coverage to more than a million Americans, and patients eligible for Medicare ESRD are very happy with their coverage,” says Bobbi Wager, board president of the American Association of Kidney Patients (AAKP). Wager, who’s undergone dialysis and two kidney transplants, also told me, “Kidney patients are very fortunate to have this safety net, but this program is not cheap, so we have to constantly be looking for ways to control costs, or risk losing it.”

Opponents of “government-run healthcare” in general, and now President Obama’s public option in particular, point to the fact that Medicare ESRD’s costs have far exceeded initial projections and extrapolate from this the wrongheaded notion that the program’s problem is simply that government is inefficient or inept. So, let’s dive into the numbers.

According to AAKP, 1972 estimates had program costs at $250 million, while today approximately $23 billion is spent on Medicare ESRD, out of a total Medicare budget of $355 billion (for some perspective, the GAO reported that U.S. defense spending in 2008 was around $800 billion). The U.S. Renal Data System’s (USRDS) 2008 annual report shows Medicare ESRD consumes 6.4 percent of Medicare’s budget to cover 1.2 percent of its total population. While we’re deep in these weeds, I’ll also report that Medicare’s average cost per ESRD patient per year is $61,164. Breaking that down, Medicare spends an average of $71,889 per year on a hemodialysis patient and $24,952 per year on a transplant patient.

Critics, like John Graham at the National Review in his spectacularly ill-informed post, fail to acknowledge several major points, however. First, what these numbers don’t show is that, even with the major increase in total costs over original projections, compared with other areas of Medicare, the ESRD Program has restrained its per capita costs, and the reimbursement amount for dialysis, roughly $160 per treatment, has not gone up since the mid-1980s. Second, contrary to the notion that private companies can more efficiently and cheaply insure healthcare, consider these facts: Total public and private spending on the ESRD population, according to the USRDS 2008 report, was $34 billion. So, if we revisit the percentages above, Medicare covers 75 percent of the ESRD population for $23 billion, while $11 billion is spent to cover the remaining 25 percent of ESRD patients, including the 10 percent covered by private insurance. In other words, private insurance pays $4.4 billion to cover 10 percent of ESRD patients, which suggests that it would cost private insurance $33 billion to cover 75 percent of the ESRD population – $10 billion more than Medicare now pays. So, who’s more cost-effective?

The major contributing factor to Medicare ESRD’s overall cost explosion is the larger-than-anticipated number of beneficiaries, due to diabetes and heart disease patients being successfully treated in far greater numbers, resulting in correlating numbers of patients reaching end-stage renal disease and qualifying for the program. Early on, most diabetics and hypertension patients died before that point. In the 1990s, incidence of diabetes-caused ESRD rose almost 200 percent. Today, diabetes is the cause of 43 percent of ESRD, while hypertension accounts for 23 percent. By contrast, all the genetic cystic diseases, such as mine, account for less than 3 percent of ESRD cases.

Another part of the cost equation is that in other industrialized countries, which provide universal healthcare for their citizens, more people are diagnosed early and benefit from cheaper, preventive care. In the U.S. with our tens of millions of uninsured and underinsured, people avoid doctors and get diagnosed later in the progression of disease, when treatment is more expensive.

Medicare ESRD has grown by 2 to 4 percent each year since 1973, but with an estimated 26 million people now walking around with some level of chronic kidney disease, combined with the diabetes and obesity epidemics in America, the number of patients qualifying for Medicare ESRD is projected to double by 2020. About 60 percent of these people could slow or prevent the progression to kidney failure through diet, exercise and preventive disease management.

Want some advice? Get your kidneys checked.


Medicare ESRD’s real problem, for critics and advocates alike, is the higher mortality rate for U.S. dialysis patients, compared with that of other industrialized countries. But again, the critics’ refrain that this is proof of a “bloated and inefficient government program” is not accurate. The exact opposite is true. It’s the private portions of the plan that cause problems. That ESRD patients’ first-year dialysis mortality rate is 21 percent, while Japan’s is 9 percent and Europe’s rates hover around 15 percent, can be traced primarily to profit-driven forces.

Though U.S. dialysis began in Seattle with Dr. Belding Scribner’s vision of nonprofit, community-based dialysis, with a major push toward having patients dialyze at home, where overhead is cheaper and outcomes have long proven superior, the Medicare ESRD entitlement instead spawned a disease-profiteering industry and the proliferation of corporate, for-profit dialysis centers. DaVita and Fresenius Medical Care, the two largest chains, now control about 60 percent of the nearly 5,000 dialysis centers in the U.S., and in-center dialysis overall accounted for 92 percent of dialysis in 2008. While Medicare’s reimbursement rate is regulated by Congress, there is no regulation of what dialysis centers can charge private insurance, so rates can be much higher and vary greatly.

“Profit-driven dialysis is a problem,” says Bill Peckham, a 19-year dialysis patient and a trustee of Seattle’s nonprofit Northwest Kidney Centers, founded by Scribner. “With Medicare reimbursement not going up, the centers need to squeeze profits out of patient care, essentially through shorter hours of operation, using techs instead of nurses, shorter dialysis treatments so they can flip the chairs, and reusing artificial kidneys. They don’t push patients to get optimal treatment, because it comes out of their profits. And patients feel sick all the time because they’re not getting enough dialysis.”

“The mortality rates in Australia and New Zealand are among the very lowest, around 14 percent, and they have much higher percentages of patients on home dialysis,” adds Dr. Christopher Blagg, professor emeritus at the University of Washington, and a former CEO of Northwest Kidney Centers. “Why the difference? They say it’s because their publicly funded universal healthcare program focuses on early diagnosis and prevention, and that their doctors are on salary, not fee-for-service. Dialysis care is also run out of major hospital centers, their government’s reimbursement rate for home dialysis is bigger – and they have no for-profit dialysis.”

In 2007, the Journal of the American Medical Association published a report that for-profit dialysis centers had also been overprescribing an expensive anemia drug. In an effort to boost certain blood levels to suggested levels, which is done elsewhere through optimal dialysis runs, the for-profit centers reportedly ran patients for shorter periods, but gave them higher, sometimes dangerous levels of the anemia drug. This move allowed them to squeeze more profits out of Medicare ESRD due to shorter dialysis times and the separate billing of drugs not included in the regulated dialysis reimbursement rate. This profit-driven use of drugs cost Medicare ESRD $1.8 billion in 2004 and is the largest single drug expenditure for Medicare overall.

Forbes reported in April that DaVita CEO Kent Thiry’s average compensation over the past six years was $22 million, and the company reported $6 billion in revenues, according to Fortune, which ranks DaVita as 433rd on its Fortune 500 list. Their profits, Peckham believes, can be directly linked to poor patient outcomes. This is by no means the only factor, but everyone I interviewed – even the employee of a for-profit dialysis center who asked not to be identified – agreed that the drive for profits has contributed to Medicare ESRD’s higher dialysis mortality rate; the differences among them were only in degree.


As I watch the cable news loops of all the vicious language and wild-eyed imagery aimed at killing healthcare reform, I can’t help but be amazed that Medicare ESRD was ever passed. I wonder how so many Americans today can be made to believe that healthcare is “anti-Constitutional” or that a fascist/socialist (and, let’s not forget, African) Obama wants to kill their grannies, but I am awestruck by the headstrong self-destruction of the Republican Party. There is no clearer proof of GOP decay than comparing the Republican leadership of the 1970s with those controlling the party today.

Republicans in the 1970s were on the side of healthcare for all Americans. In a message to Congress on Feb. 18, 1971, Nixon himself proposed the National Health Insurance Partnership Act. This was a moment in our history when most Americans believed some form of all-inclusive, national health insurance would soon be a reality. Republicans and Democrats alike were working hard to find the best way to make it happen. In 1972, a generation of pragmatic and compassionate Republicans voted in large numbers to help pass the Medicare ESRD Act. It was seen by legislators as a test case, to be followed by government insurance programs – be they catastrophic or comprehensive – for other diagnoses.

This never happened, of course, and right up until our summer of angry town halls, Medicare ESRD has remained what former Senate Finance Committee staffer James Mongan called “the last train out of the station for national health insurance.”

Today’s Republican leadership follows the lead of hate-speech blowhards and injects vitriol and proven lies into our national discourse, instead of engaging in honest negotiations over the best way to bring healthcare to all Americans. They are ginned up for an Obama defeat, by any means necessary – good policy and the American people be damned.

If we don’t get healthcare reform this time around, I have to wonder what will become of the programs caught in the middle, like Medicare ESRD. It’s unknown at this point whether I’ll need another transplant or long-term dialysis at some point, but it’s highly likely. The bottom line is treatments for ESRD are expensive and ongoing. With this diagnosis, it’s either dialysis or, if transplanted, expensive immuno-suppressant drugs for the rest of one’s life. But because I have this benefit, when my fellow citizens with, say, cancer do not, it’s hard not to feel some guilt.

This nation must face difficult questions. Will this society continue to be willing to bear the costs of an entitlement program for ESRD patients, as the market has proved that it will not if left to its own devices? Should we simply let ESRD patients die? Or do we believe that as a society, certain of us will develop catastrophic illnesses and that we all deserve health security? Is this “charity,” as a conservative friend of mine suggests, or a society sharing the risk that any one of us could face illness and financial ruin tomorrow? Should the “right to life, liberty and the pursuit of happiness” be interpreted literally? If so, shouldn’t guaranteed healthcare be the right of every U.S. citizen? If the answer to that question is yes, shouldn’t all of us – Democrats, Republicans and Independents – be working together to find the most effective and cost-efficient system for its delivery?

It remains to be seen whether Congress will pass healthcare reform this year. Like many before it, this effort may not succeed, and we’ll remain, as Obama has said, “the only advanced democracy on earth – the only wealthy nation – that allows such hardships for millions of its people.”

For now, I’m just grateful there was a time when Congress felt the moral imperative to provide a public health insurance option that allowed both my father and me to live.

http://www.salon.com/news/feature/2009/09/28/kidney_disease/[/QUOTE]

By the way, how do you propose to make sure that illegals do not obtain health care in a Universal Health Care, when you are not going to demand the checking of identification? As unemployment goes up, there will be less and less tax revenue to pay for the proposed Universal Health Care system. There are more people in Canada that file for medical bankruptcy than in the United States. How can we trust these people to run health care when they could not even distribute the H1N1 vaccine? Having worked for the government, Medicare and Medicaid deny more procedures than private insurance. The moral imperative is for the government to mind its own business, eliminating mandates and regulations, purchasing health insurance across state lines, and creating competition in the health care industry. Face it, DaVita and Fresenius treat dialysis patients poorly because of their current monopoly on dialysis treatments. It is time that we introduce cost cutting to health care to force the elimination of excessive overhead costs.

If we have Universal health care and the government denies your treatment, what then?

I think it is great that this person was able to have a transplant, Yet, the sad fact, is that only 1/3 of individuals on the transplant list will ever receive a transplant. The socialist policies of the transplant list are great according to this person because they were not required to suffer thru years of dialysis.

Obama and his crowd have introduced many hardships for millions because of their belief that they and only they know what is right for the American public. How do Obama, Pelosi, and Reid know what is right for you, when they do not even know you? Do they really believe that they and only they have the necessary information to make the correct decisions for millions of Americans? The arrogance of these people is amazing.

Even if we eliminated the salary of DaVita’s CEO, what evidence do you have that it will improve patient outcomes? By the way, what right or authority does a third party have to dictate another individual’s salary?

The Republicans do not even have enough votes to stop Universal Health Care. Harry Reid has 60 votes to pass any legislation he likes, why does he not pass it? Harry Reid stated that Republicans that oppose Universal Health Care are like the individuals that supported slavery. I hate to tell you, Harry, the Radical Republicans led the charge to stop slavery in the United States, your party was defending slavery and passed Jim Crow laws to discriminate against African-Americans.

Hate speech? Would you like to hear some of the comments from your friends in the Democratic Party, calling people that disagree with them, “Nazis?” I guess dissent is only approved when the dissenters tow the Democratic party line. Freedom of speech is not just for Obama, Pelosi, and Reid.

Do you think that Nancy Pelosi should give up her private plane paid for by taxpayer dollars and donate it so poor individuals can have health care, do not hold your breath.

Government programs suffer from cost overruns in every aspect of government spending. Democrats support Medicare because they are wealthy and they want to get rid of their guilt, In addition, they want to control everything and everyone.

I wonder if Rettig has ever worked in the private sector or if he has any business experience? I wonder if Rettig would work for free?

I do not think that for-profit dialysis is a bad thing, provided that the dialysis consumer is charge of the situation. We need to create a situation where dialysis companies compete for dialysis patients. Lack of competition is why the dialysis industry treats dialysis patients so poorly. Selling health insurance across state lines, Health Savings Accounts, slashing taxes, eliminating mandates and regulations, reining in trial lawyers, would greatly help to reduce health care costs. Creating competition serves the dialysis consumer, and controls the abuse of power by the dialysis chain providers. In regards to the dialysis companies, “Absolute power corrupts absolutely.”

Extremely one sided article laced with insults for people that disagree with the poster’s morally superior attitude.

The Government does not produce wealth, pure and simple.

Your rants are always entertaining (and sometimes maddening) because your opinions are so different from mine. They also make me wish I had more time to look for the sources that you use for your arguments.

Let’s take some of this apart, shall we? You’re just tossing everything into the mix, hoping something will take.

This is a straw man argument, NDXUFan12. No-one said ID’s wouldn’t be checked. I don’t think anyone is asking for a plan that covers illegals.

As unemployment goes up, there will be less and less tax revenue to pay for the proposed Universal Health Care system.

True, but if we don’t get a healthcare plan passed, more employers will cut back on jobs because they can’t afford the costs of health insurance for their employees. And sick workers don’t tend to be as productive.

There are more people in Canada that file for medical bankruptcy than in the United States.

And the source of this “fact” is where? Let’s see some proof, preferably in the Canadian press.

How can we trust these people to run health care when they could not even distribute the H1N1 vaccine?

I think the problem with the H1N1 vaccine boils down to the use of older vaccine production technology that is much slower than newer–but not yet approved–methods. Once the newer methods are approved, vaccines will be able to be produced 10 or even 100x faster. This may still take a year or two. Either way, it has nothing to do with ensuring that all Americans have access to healthcare.

Having worked for the government, Medicare and Medicaid deny more procedures than private insurance.

Again, I’d like to see proof, in the form of a published, outside analysis by a credible third party. “I say I saw this” is not evidence.

The moral imperative is for the government to mind its own business, eliminating mandates and regulations, purchasing health insurance across state lines, and creating competition in the health care industry.

The “moral imperative”? This clearly comes from your own personal and political perspective. I assure you that there is no UNIVERSAL moral imperative that the entire U.S. population agrees on. I do agree, however, that lifting the restrictions on selling insurance across state lines could only help. Getting rid of ERISA would be a start–and that’s not something I’ve heard is in the bills (doesn’t mean it isn’t there, but you’d think someone would mention it).

Face it, DaVita and Fresenius treat dialysis patients poorly because of their current monopoly on dialysis treatments. It is time that we introduce cost cutting to health care to force the elimination of excessive overhead costs.

Who says DaVita and Fresenius treat patients poorly? Within the constraints of the guidelines and reimbursement, I believe both track quality and outcomes very closely, and do the best they can to improve both. Within any individual clinic (no matter who owns it) there is always the potential for conflict between patients and staff and unprofessional behavior. Unfortunately, that’s human nature, and no healthcare system will ensure that every person who works in healthcare has chosen the right profession. Competition has nothing to do with it.

I do not think that for-profit dialysis is a bad thing, provided that the dialysis consumer is charge of the situation. We need to create a situation where dialysis companies compete for dialysis patients.

I hate to break it to you, but that’s precisely what we have now. Every dialysis clinic competes with every other for patients who have insurance that pays more than Medicare will. If we weren’t throwing hundreds of billions of dollars out the window on health insurance administration and profit, we could better fund Medicare so that every patient was one that clinics wanted.

Rants, an interesting way to define my viewpoints. My viewpoints come from practical experience in dealing with the dialysis industry. I also have experience in working for the government, which most of you do not. The government will care even less about the dialysis patient that the dialysis chains. I know this is hard to believe, and it would be for most people, I know this fact from experience. A very good friend of mine agrees with this position, he has been visually impaired all of his life, his job is working as a Customer Service Rep for the I.R.S. . I also use my experience of growing up with a learning disability to know how individuals with a disability or illness are viewed by society. In the 1970’s, the LD label was extremely difficult to obtain, many tests and specialists. I have worked with individuals with disabilites or out of the mainstream for around 20 years.

I fail to understand why individuals like Obama, Pelosi, and Reid should have the best treatment in the United States, while dialysis patients suffer, day in and day out. Why in the world should Pelosi have a private plane, paid by taxpayer dollars, while they claim they do not have enough money for more dialysis? I thought Obama, Pelosi and Reid were about compassion for the little guy? How much compassion do they have by taking the hard earned tax dollars from the working class to give money to their corporate friends? Obama received more campaign donations from Wall St. than Hillary Clinton or John McCain(Wall Street Journal). To say or to claim, the Republicans are the party of the rich is just a false claim. I do not see the Democrats giving their own personal wealth away to help individuals who need insurance, they just want to give away everyone else’s money. How wonderful it is that they are so compassionate with other people’s money? Have you ever seen the house of John Edwards and his mansion, oh the double standards of these people.

I have worked in the real world for years. I also do an incredible amount of reading on the machine and the library. Some of my sources, Wall Street Journal, Financial Times, Investor’s Business Daily, U.S. News and World Report, various local business papers in Cincinnati, The Lancet, and just about any publication I can get my hands on. I love to read the Late University of Chicago Economist and Nobel Prize Winner Milton Friedman, which the New York Times has admitted is the greatest economist of the 20th centry, U of Chicago Economics Professor Gary Becker, Nobel Laurate, Dr. Thomas Sowell of Stanford(Economics) and Professor of Economics Walter Williams of George Mason University, along with Professor Emeritus of Organic Chemistry Joel Kauffman.

I realize that majority of posters do not have a business or economics background, that is why you do not think like I do. I do not trust the insurance companies, the government, dialysis chains or anyone else in this field, they will do what is it their self interest. Let us say that you want to build a three bedroom house. Now, do you believe that the builders will build it because they love to give of their time to help their fellow man or do you think they will build the house because they want to make some money? Does anyone on this board ever question why third parties complain about the amount of profit in business, while that third party is making a huge profit in another field of economic activity? Economics runs on the basic theory of supply and demand. It is easy to pass a law stating that you may not sell kidneys, because the author of the law(ALGore) is not paying the costs associated with restricting the sale of kidneys. Does anyone on this board truly believe that if ALGore needed a kidney, he would have sponsored and pushed for the law in the halls of Congress? I really doubt it.

When I go to the store and I want to buy a few juicy steaks, and I say to the local supermarket, “I want 3 big juicy steaks.” The local supermarket says to me, “Mark, what have you done to serve your fellow man?” I say that I work for the XYZ Corporation. The local supermarket says, “Prove It!” Then, I take out so many dollars bills as proof of my service to my fellow man or certificates of service.

Why should people who need a kidney or bone marrow transplant be forced to beg for their lives? Dialysis chains and clinics need to be pushed to become more dialysis consumer friendly. The dialysis chains and clinics have been treating dialysis patients like dirt for years. It is time we start to fight back. Many of these people forget who is paying their outrageous bills. Again, in any other industry, people who generated these types of revenues for a business, would be treated like royalty.

Mark

[QUOTE=Dori Schatell;18932]Let’s take some of this apart, shall we? You’re just tossing everything into the mix, hoping something will take.

This is a straw man argument, NDXUFan12. No-one said ID’s wouldn’t be checked. I don’t think anyone is asking for a plan that covers illegals.

True, but if we don’t get a healthcare plan passed, more employers will cut back on jobs because they can’t afford the costs of health insurance for their employees. And sick workers don’t tend to be as productive.

And the source of this “fact” is where? Let’s see some proof, preferably in the Canadian press.

I think the problem with the H1N1 vaccine boils down to the use of older vaccine production technology that is much slower than newer–but not yet approved–methods. Once the newer methods are approved, vaccines will be able to be produced 10 or even 100x faster. This may still take a year or two. Either way, it has nothing to do with ensuring that all Americans have access to healthcare.

Again, I’d like to see proof, in the form of a published, outside analysis by a credible third party. “I say I saw this” is not evidence.

The “moral imperative”? This clearly comes from your own personal and political perspective. I assure you that there is no UNIVERSAL moral imperative that the entire U.S. population agrees on. I do agree, however, that lifting the restrictions on selling insurance across state lines could only help. Getting rid of ERISA would be a start–and that’s not something I’ve heard is in the bills (doesn’t mean it isn’t there, but you’d think someone would mention it).

Who says DaVita and Fresenius treat patients poorly? Within the constraints of the guidelines and reimbursement, I believe both track quality and outcomes very closely, and do the best they can to improve both. Within any individual clinic (no matter who owns it) there is always the potential for conflict between patients and staff and unprofessional behavior. Unfortunately, that’s human nature, and no healthcare system will ensure that every person who works in healthcare has chosen the right profession. Competition has nothing to do with it.

I hate to break it to you, but that’s precisely what we have now. Every dialysis clinic competes with every other for patients who have insurance that pays more than Medicare will. If we weren’t throwing hundreds of billions of dollars out the window on health insurance administration and profit, we could better fund Medicare so that every patient was one that clinics wanted.[/QUOTE]

First, it was proposed in Congress that ID’s would be checked so illegals were not receiving health care under the proposed Universal system, it was voted down by the Democrats. It is called the Hellner amendment.

Second, you are not breaking anything to me. We DO NOT have a capitalistic medical system or a free market system. Do you believe 45 percent of all grocery bills are paid for by the government? Well, 45 percent of medical bills in the United States are paid for by the government. Have you ever wondered why medical prices never come down or the consumer has absolutely no idea what the price will be for their time in the hospital? You will be able to cut insurance adminstration costs by competition, selling health insurance across state lines, and when you have competition and profit, you will have more companies jumping in the pool, decreasing profit, Economics 101. By the way, how do you add millions of people to Medicare and cut costs? The Federal Government cannot afford the current Medicare costs. Future Medicare liability is in the range of $50-$100 trillion. If you believe that people will pay more and more taxes, I have a fairy tale for you, the public is angry and a tax revolt is coming. The math does not add up. By the way, would your Institute survive without a profit. If you need profit, how much is enough, would you like a third party to determine that for you?

"As for the notion that greater government involvement in health insurance will reduce bankruptcy, it is helpful to compare personal bankruptcy rates in the United States and Canada. Unlike the United States, Canada has a universal, government-run health insurance system. Following the logic of Himmelstein and colleagues, we should therefore expect to observe a lower rate of personal bankruptcy in Canada compared to the United States.

Yet the evidence shows that in the only comparable years, personal bankruptcy rates were actually higher in Canada. Personal bankruptcy filings as a percentage of the population were 0.20 percent in the United States during 2006 and 0.27 percent in 2007. In Canada, the numbers are 0.30 percent in both 2006 and 2007. The data are from government sources and defined in similar ways for both countries and cover the time period after the legal reforms to U.S. bankruptcy laws in 2005 and before the onset of the 2008 economic recession."

http://www.american.com/archive/2009/august/the-medical-bankruptcy-myth

Why do we need the approval of some government bureaucrat to get that medicine out faster? Do individuals that need surgery have a year or two to wait, to satisy some government hack? I did not use the “I saw this” method, it was from the Secretary of Health, thank you.

Have to be at the clinic, tomorrow, to be continued…

Mark

It’s always good to test your assumptions. You appear to be making assumption that those who post here do not have as much experience as you have and are too naive in the ways of the world to know myth from fact. I am not as naive as you think or as jaded as you appear to be. I have been employed by a state university, a state government run medical center, two for-profit dialysis facilities (one corporate and one physician owned), a large nonprofit organization, plus I have received federal appointments to workgroups for the Rehabilitation Services Administration (federal) and Centers for Medicare and Medicaid Services. In addition, I have operated a consulting business since 1997 through which I coordinate state funded classes for people with CKD and do consulting work for MEI. I have met with federal and state legislators and testified before state legislative committees in support of funding for people with kidney disease. I have also had to fight through my state insurance department an insurance company’s refusal to accept my teenage son on a policy I was applying for based on a doctor’s “rule out” cardiac diagnosis that testing showed he did not have. I believe I have a varied enough paid and volunteer experience and contacts with enough state and federal government employees, renal community leaders and workers, and people with kidney disease and their family members and read enough newspapers, books, journals, and websites for factual information to trust my instincts about the healthcare/health insurance industry today.

The amendment to check IDs of people before providing healthcare was by Rep. Heller (not Hellner) from NV. I did see some conservative websites listing his name as Hellner.

Information on immigrants and health reform can be found at these two nonpartisan sites. The 9/09 link discusses the president’s position on verification of status:
http://www.kff.org/healthreform/upload/7982.pdf (December 2009)
and
http://www.factcheck.org/2009/09/immigrants-and-insurance/ (September 2009)

Multiple conservative websites have posted Brett Skinner’s article about the Fraser Institute study of Canadian vs. U.S. bankruptcies whose data have been called into question by still others. From reading Canadian and U.S. websites, it appears that one significant difference is that U.S. bankruptcies occur in part because people (even those with health insurance) have medical bills that they can’t afford to pay in addition to other debts because of illness, missing work, etc. In Canada, bankruptcies for medical reasons occur because people can’t pay their debts because of illness, missing work, etc., but they don’t have the medical bills people in the U.S. have. If Brett Skinner thinks the healthcare system in the U.S. is so much better than the Canadian system, instead of knocking their system, why doesn’t he leave Toronto and move to the U.S.?

So far as competition is concerned, health insurance companies don’t want competition. If they did, why did Medicare have to subsidize insurance companies to get them to buy into the idea of offering Medicare Advantage plans or to participate in Medicare Part D. Insurance companies aren’t turning down government money for those. In fact, when there is a hint that the government might stop paying 15% more to private insurance companies for their Medicare Advantage plans, they cry foul and send scare tactic letters to their members to get them to lobby their representatives to stop cost cutting measure. Few people with chronic illnesses see any “advantage” to having a Medicare Advantage plan. And selling across state lines sounds like a nice idea, but regulation would be impossible, which you’d probably think was a good thing until your insurance company screwed you over.

Finally, you say why do we have to wait for a government bureaucrat to get medicine out faster. I’d prefer to have as many safety checks for my drugs as possible. You can find many, many supplements on the Internet sold by unscrupulous people who make unproven claims to make a buck and who do not worry about who suffers. The FDA has shut down some but not all of them. Hopefully you or a loved one won’t be scammed into buying something harmful that a government bureaucrat didn’t have time to test.

To your point about how dialysis patients are treated when they’re paying the bills…truth is that most patients don’t pay the bills themselves; it’s their insurance or Medicare that pays the bills. From what I’ve heard from colleagues who work for large dialysis providers, they do give perks and offer special favors and greater support to patients with employer group health plans that pay more than Medicare. People with Medicare may be treated better than those with Medicaid and we all know what happens to patients who have no health insurance – they’re discharged to dialyze on an emergency basis out of hospitals. Is a tiered system of dialysis care fair or just?

You’ve vented your complaints about the dialysis industry and you’ve vented your opposition to healthcare/health insurance reform. What is your solution to the problems you perceive in dialysis today? As they say, if you’re not part of the solution, you’re part of the problem.

I would be a bit leery of quoting the Fraser Institute: they take money from the tobacco companies to do work for them, ExxonMobil also donates for “climate change” work - gee, I’m sure their work would contain no bias!

They also don’t seem very open about their finances: “In 2003 Fraser Institute income was $6,620,038. In its annual report it discloses that 52% was from unspecified foundations, 38% from unspecified “organizations” (presumably corporations) and only 10% from individuals.”
http://www.sourcewatch.org/index.php/Fraser_Institute.

So, do you believe that everyone on your side of the fence is holy and pure? I hate to dispel the myth that health reform is not about assisting the poor, it is about elites having and using control over the population. Again, the reason for expensive health insurance is a lack of competition in the states and selling health insurance across state lines. In my system, health care consumers would have choices from thousands of insurance companies, not just three or four. In addition, I would slash taxes to a one percent flat tax rate, this would guarantee that every individual and family would be able to afford health insurance and health care. When you have large profits in the system, this gives incentives for more companies and providers to join the system. At this point, with more providers and companies in the system, costs will greatly decrease, in regards to insurance companies, physicians, or any other economic venture. By the way, I would eliminate ERISA.

Do you really trust these people to run our health care system, given their past track record? It is estimated that Medicare is going to be in red in the neighborhood of $50-$100trillion, if this were a private company, the executives would be in jail. Many of the cities and states are running out of money, what does this tell you? Where do you believe that the tax money is going to come from to pay this estimated Medicare bill of $50-$100 trillion? Santa Claus? The Tooth Fairy? The Money Tree in the Backyard? If our nation does not get its financial house in order, the financial community will force us to change, they will not buy our government bonds, how will we finance our incredible debt? Obama has enough money to finance his spending because other countries are buying our debt, what happens when they lose faith in our markets and currency, what then? What will the people on Social Security Disability do, when the taxpayers cannot pay their benefits, because the other countries have stopped buying our debt?

How will these folks survive when they lose their SSI benefits and they cannot find a job because the employers are terrified of Obama’s huge tax increases and overwhelming health mandates, which will be costly and expensive? The private sector is not some golden piggy bank in which Obama, Pelosi, and Reid can constantly plunder and steal from working people. Your friends, Obama, Pelosi, and Reid have talked a great game of bipartisanship, yet, I have never seen them put bipartisanship into action. Obama, Pelosi, and Reid have not considered not even one opposition health care plan, zero. Obama, Pelosi and Reid want everyone else to compromise, when are they going compromise?

Obama received more money in Wall Street donations than John McCain. Obama, Pelosi, and Reid want to restrict competition, Conservatives want to liberate the market, and free the health care consumer from outrageous price increases and monopoly behavior.

By the way, how do you think the average family with two adults, two children making $88,201 will react when they have to pay $15,200 in health care premiums per year, under the plans of your fearless leader? Individuals that work with their hands, will have their Union health care plans taxed, Cadlliac plans. I wonder how they will vote at the polls when they find out how their friends in Congress took care of them?

What do you believe will happen when the public finds out what a fraud has been put upon them by Obama, Pelosi, and Reid? How will they react when their child, spouse, or their parents are not going to be taken care of, by the Obama, Pelosi, and Reid medical system? Civil Unrest?

I have paid for my dialysis thru private insurance. I am not aware of any special treatment that I have received, I would hate to see what bad treatment would be, amazing. I am happy to tell people in the dialysis field when they have done a good job. Yet, I am just willing to tell what I think is lousy and stinks. When I posted on a Nursing board, that the dialysis industry should become more consumer friendly, you would have thought I was waving the vampire cross around a room. These people are used to running around acting like dictators and tyrants, who died and left them as boss? We are adults, not children.

In any other field, private insurance individuals would be treated as royalty. My Nephrologist made a great point. When I told him I had been on dialysis for three years, he said, “It does not seem that long to me, but, I know it feels like more than that to you.” Excellent, he gets it, Amen! Have more than a few Nursing people at my clinic that are outstanding, I am lucky. I just want to be treated as a adult, not a child, very simple. Please stop obsessing, if you have control issues, please seek professional help. I realize that many are trying to do their best in a very difficult situation.

I will praise the ones who are really trying to help the patient. Would never let a patient assault the staff or vice versa.

I know that tax cuts and competition worked, it was proven in the 1980’s. The recession was much worse in the early 80’s and we made it because of tax cuts. I want to help the sick with cures and compassion. I think about the children at St. Jude, how can we help them? We can help them with being able to choose from hundreds, if not thousands of insurance company policies. We can also help them by eliminating thousands of pages of mandates and regulations, greatly decreasing the cost of health insurance policies. In addition, in creating profit, we will enable to increase the pace of technological advancement in the future and hopefully, cures for many health conditions. What would we rather have, sitting on a machine or a kidney belt, what is more compassionate?

It is time that the income of the American citizen to be returned to the rightful owner. I know and realize that people like Obama, Pelosi, and Reid believe that you are just too stupid to make it in this world without them, 61 percent of the American public do not support your plan.

If the Obama, Pelosi, and Reid health care plan is so wonderful, why are they exempt?

Mark

[QUOTE=plugger_;18942]I would be a bit leery of quoting the Fraser Institute: they take money from the tobacco companies to do work for them, ExxonMobil also donates for “climate change” work - gee, I’m sure their work would contain no bias!

They also don’t seem very open about their finances: “In 2003 Fraser Institute income was $6,620,038. In its annual report it discloses that 52% was from unspecified foundations, 38% from unspecified “organizations” (presumably corporations) and only 10% from individuals.”
http://www.sourcewatch.org/index.php/Fraser_Institute.[/QUOTE]

By the way, Plugger, how are those Global Warming memos from England working for you? I wonder how open Greenpeace and others with that agenda, I wonder how unbiased they happen to be? Do you believe that none of the individuals who receive grants and funding to study “global warming” are biased towards having that funding continue, I know they would not dream of such a thing!

I wanted to let you know that most groups that espouse liberal causes receive their funding from major corporations and their greedy profits.

I would love to believe climate change isn’t for real, however I think hanging your hat on a few emails falls into the category of “grasping at straws” - but good luck with that!

Rather than making some vague accusations, how about something more specific? One of my favorite sources is Physicians for a National Health Program. It looks like they quote sources like the Congressional Budget Office, Harvard, the New England Journal of Medicine, and have articles from all over the country - they don’t use made-up, paid-for reports. But maybe you can find something in their funding and all that, that I missed.

As for your idea about more insurance companies, I remember when my kid was in a clinic - my private insurance got gouged. Why? My recollection is they don’t have the leverage Medicare has and can’t negotiate prices. I don’t see how fragmenting insurance pools even more is going to help that situation. I also don’t see anything that gets past the fundamental fact that health insurance companies make their money by keeping our money, so therefore have a big incentive not to pay for health care. Nor do I see anything that gets past the fundamental fact that health insurance companies compete not with each other, but by cherry-picking out the healthiest individuals they can find.

I also believe buying health insurance across state lines would encourage health insurance companies to move to a state where they are required to cover even less than what they do now.

First, insurance companies pay medical bills by contract. Second, if the physician’s office or hospital billed higher than allowed by contract, the insurance company would be within their legal rights to refuse payment and then, they could take that entity to court. You honestly believe that health insurance companies like Blue Cross and Blue Shield and United cannot stand up to the physician and hospital. I hate to inform you, they do it all of the time. Insurance companies receive discounts, they never pay the full price. The vast majority of physician offices and hospitals do not want to confront a major health insurance company. In fact, the insurance company protects you from being robbed by these people.

Physician offices and hospitals are the only place on this earth where you do not know the prices before the treatment. For too long, physician offices and hospitals have not been questioned about their prices and business practices. It is high time that we start to use consumer power to put these abuses to a stop. In fact, many of the procedures are just big business, such as mammograms, for the vast majority, they are a scam. The absolute risk that a woman under 50 will get breast cancer without a mammogram is 0.2 percent per year. If you are over 50, it is 0.009 percent absolute risk, in other words, it is a fraud.(Professor Emeritus of Organic Chemistry Joel Kauffman)

The way Medicare sets rates is that they go to the physician and hospital and say, “Here is what we will pay, take it or leave it.” If Medicare sets payment rates, hospitals and physicans will go bankrupt.

How does your supermarket stay in business, they keep your money. Health insurance companies make a profit of 2-3 percent per year(Wall Street Journal) In contrast, the manufacturing sector makes a profit of about 8 percent per year(Wall Street Journal). Do you ever worry about the Toy store keeping your money when you buy toys for your child at Christmas? Does the company you work for, keep the money that consumers pay to use your services? I do not know of anyone that works for free. Why should you work for a profit and the physician or nurse work for free? Who is a third party to decide or determine what is an acceptable rate of profit? 1 percent, 5 percent, 10 percent, 30 percent, or 50 percent, what is an acceptable profit and who gives a third party the right to decide that basic question?

Would you rather the physician stay at home to cut the grass because he is not making enough money to stay away from home or tend to your child when he or she is very sick? Would you spend years of your life to train to be a physician, only to receive pennies on the dollar for all of that time and effort? Would you appreciate a third party telling you that after all of that training, that you, “make too much?” Would you like a third party to come to your office and say, “You make too much.”

I never knew that like ALGore, who has no scientific training, that Obama, Pelosi, and Reid have enough medical and business training to make medical decisions for millions of Americans? Who is more qualified to make medical decisions for your child, you or Obama, Pelosi, and Reid?

In relation to global warming:

Boston (MA) - Scientists at MIT have recorded a nearly simultaneous world-wide increase in methane levels. This is the first increase in ten years, and what baffles science is that this data contradicts theories stating man is the primary source of increase for this greenhouse gas. It takes about one full year for gases generated in the highly industrial northern hemisphere to cycle through and reach the southern hemisphere. However, since all worldwide levels rose simultaneously throughout the same year, it is now believed this may be part of a natural cycle in mother nature - and not the direct result of man’s contributions.

http://www.tgdaily.com/trendwatch-features/39973-mit-scientists-baffled-by-global-warming-theory-contradicts-scientific-data

My supermarket reliably gives me a product for my money. They buy it from the producer, give me the convenience of gathering it in one place so I can do all my shopping at once, and mark it up. I happily pay it, rather than trot around from farm to farm.

A closer analogy would be Vegas casinos. They make their money by taking in LOTS of people’s cash, and paying out very little. You play for the CHANCE of winning big, knowing that the vast majority of the time you will lose. That’s how insurance companies work. The problem is, we ALL need healthcare to some extent, some more than others. So, the problem is, we nearly all lose under this “system.” It’s a bad model.

Quite honestly, we need to be protected from the government. If there is one system of insurance and that insurer denies your claim, what then? These people are engaging in an incredible abuse of power. Threatening Senators to close military bases, if they do not vote for the health care bill? I am tired of them with them and their, “I know what is best for you” attitudes. It sounds like the attitudes of people who work in the dialysis clinics. The insurance companies and grocery store cannot force you to buy their product. I am curious, where in the Constitution does it give Obama, Pelosi, and Reid the authority to impose jail time for not buying health insurance? When you go to the XYZ grocery store, you have the freedom to purchase the products or food that you wish to buy for you and your family. Yet, with National Health Insurance, there will not be any freedom. The average American and American family will have to purchase a health insurance policy that Obama, Pelosi, and Reid think they should buy. How do Obama, Pelosi, and Reid know the health care needs of millions of Americans? This is much more arrogrant than even the dialysis clinics. Like the dialysis clinics, Obama, Pelosi, and Reid believe that Americans, especially dialysis consumers are just too darn stupid to make it without their infinite wisdom, what a joke.

Even with the gambling casino, people still have the freedom of choice to walk into or out of the casino, not so with the Government. I thought of each and every one of you, a few nights ago. The party is that is most popular with Americans right now is… drum roll please, the Tea Party. So, do each of you believe that the Government should use force to make people buy health insurance? Should government take the earnings of one American to give to another American? It is easy to be compassionate with the money of your fellow citizens, not your own personal wealth.

NDXUFan12, amazingly you and I agree on something related to healthcare! (This is rare, so we may as well celebrate. :-)). IMHO, the Senate bill, as it is currently constituted, is an AWFUL idea. Forcing people to buy health insurance (with penalties if they don’t) is a giveaway to an industry that I don’t even think should exist at all, since it’s a parasite.

The bill does not have enough provisions to reduce prices. So, people will be forced to buy something that gets more costly every year–out of proportion to any other expense in our economy except possibly college tuition (which is voluntary).

That said, a single payer system is dead. The point of a public option was to HAVE some competition for private insurance companies. Without it, they can collude to fix prices (yes, this is illegal, but do you think that will stop them? I don’t.) They will be in a race to the bottom to give out the fewest “wins” and keep as much of our money as possible. NONE of them may choose to cover your pricey condition–why should they? You’re forced to buy their product whether or not it meets your needs.

I truly hope this bill does not get passed as it is now.

So far as your idea about thousands of companies competing for business across state lines keeping costs down, I use as evidence that this may not work as well as you think it would by offering up the Medicare prescription drug plan (Part D).

In Medicare Part D private insurance companies have the option to sell stand alone drug plans (PDPs) to those who have Original Medicare or to sell plans that include health as well as drug coverage to people who wish to have both together in Medicare Advantage plans with drug coverage (MA-PDs). There are so many options for who want to obtain coverage and so many ways that coverage is designed that historically people with Medicare have become overwhelmed and confused. In spite of recommendations from government, pharmacies, and organizations, too many people stay with the same plan they had over the past year or they choose a plan that worked well for their spouse or Aunt Nellie and fail to compare costs or coverage among plans, all to avoid having to spend the time it takes to shop. Do you honestly believe that the American public would take the time to make the best choice for them or would they buy the plan that spent the money to advertise the most to have the name recognition?

BTW, Medicare Part D premiums continue to go up – 11% between 2009 and 2010. In 2009, revenues for Part D plans were expected to be $49 milion of which 79% came from general revenues, 12% from states, and only 9% from premiums. Plans continue to change what drugs are on their formularies. Plans that used to cover drugs in the coverage gap have stopped offering brands and only 20% of plans even offer generics during the coverage gap. Newer drugs that are covered on plans’ formularies are on higher tiers (higher copays) making them less affordable and causing people with kidney disease to hit the coverage gap sooner each year. Hitting the coverage gap means you pay your premium and get no coverage until you’ve paid enough out of pocket to get the catastrophic benefit. Whoever conceived this way of setting up a drug benefit must have been on crack!
http://www.kff.org/medicare/upload/7044-10.pdf
www.kidneyhealthcarecoverage.org

Speaking of setting up the drug benefit…Part D was hammered out in the middle of the night with strong arm tactics by Bush and Republican congressional leadership and threats of job loss to at least one actuary for divulging to interested members of congress that expected costs would exceed what Republican leaders had told their colleagues in the U.S. House and U.S. Senate.
http://feinstein.senate.gov/04Releases/r-medicare-scully.htm

Incidentally, the administrator of CMS at the time, Thomas Scully, obtained a waiver from Bush to be able to ignore ethics rules in government when he acted for the White House to promote Part D. He now works as a lobbyist for a DC lobbying firm lobbying legislators for the drug industry. Billy Tauzin who was chairman of the House Committee on Energy and Commerce and was leading the charge for Part D and who did a fair amount of arm twisting to get enough votes to pass Part D is now the president and CEO of PhRMA, the membership and lobbying organization for pharmaceutical companies. Others who were legislators or their worker bees are now wandering the halls of Congress. Many say that Part D benefitted drug and insurance companies more than it helps those who have Medicare Part D.
http://www.propublica.org/ion/health-care-reform/item/medicare-drug-planners-now-lobbyists-with-billions-at-stake-1020

When people talk about the threat of Medicare insolvency they’re referring to Part A (hospital), not Part B (medical). Part B is what covers dialysis and immunos. Not to be living in a world of denial but every year the year that Part A will be insolvent changes to the point that it’s hard to believe any of the estimates, near or farther into the future. One of the hopes for health reform was that it would help keep Medicare Part A solvent for longer. Too bad that point isn’t raised as much as it maybe should be.
http://aging.senate.gov/crs/medicare14.pdf