There has always been a right-wing authoritarian portion of the human species. They periodically gain power and do terrible, terrible things. The amount of control and power and influence they have in America today is frightening and disheartening.

The people who rush to use phrases like “Obamacare” and “Hillarycare” and “Bush Derangement Syndrome” and “Borking” and “Teleprompter-in-Chief” and “Breck Girl”, and who immediately started calling it “The *Terrorist* Surveillance Program” the moment the Bush Administration did, and who gleefully wore purple-heart Band-aids in 2004… THESE are the people who poison our discourse on a daily basis. I don’t think there’s anything we can do about them, now that we no longer have any functional secular civic organizations or journalism in this country. Oh, well, it was nice knowing you…

The largest cost center in our current healthcare system is doctors and hospitals. Our physicians are highly rewarded. Hospital administrators, and there are plenty of them, have very high salaries. Pharmaceutical manufacturers and medical equipment makers are making money hand over fist. I’ve seen equipment markers try to charge $60k for a pacemaker. I’ve seen hospitals with flat screen TVs in every room (all private) of their brand new wings.

The federal government has historically done a poor job of running programs at or below estimated budgets. Medicare, social security, defense programs (remember the $1,000 screwdriver) etc. You have to admit the results have been poor. Other countries such as France and England have been running deficits for years in their health system programs. I’ve seen cost numbers thrown around for the reform programs being debated. I know one thing, whatever public option is chosen will cost more than we are being told.

Savings from electronic claims processing, unified claims forms, free preventive services and free wellness programs will not be realized until the distant future if ever. These are upfront costs, gambles, that may or may not provide savings. When an actuary costs out an insurance plan for a large employer he does not provide an estimated savings for wellness and preventive services. He tells the employer they will actually pay more.

I work for self-insured employers. These are companies generally with more than 200 employees that pay claims out of their own pockets. These companies pay fees (relatively low)of around $15 – $25/employee/month to a third party to pay the claims their employees incur. There is no “profit” to the company. There is no “advertising spending”. No super high executive compensation as a result of denial of services. These companies do however have an incentive to keep their employees happy and healthy.

Private insurers also are incented to keep costs down. They want healthy people to buy insurance and not use it. They also have an incentive for people to have good outcomes from the procedures they receive. Good outcomes = low follow up costs. Good outcomes are driven by early detection and treatment and by drugs. Insurers are also incented to not provide coverage to unhealthy people and to deny treatments that aren’t proven effective.

If you asked me who I would rather give my tax dollars to in order to provide coverage to all people in the U.S. I would say the insurers with some caveats. As Mr. Franken says, we should mandate coverage for everyone (no preexisting conditions), no annual or lifetime limits and we should cap the amount of payments insurance companies can receive from both the people and the government. I’ll bet the insurers will find a way to improve outcomes, improve member health and sqeeze reimbursements to providers and hospitals in order to make a profit better than the federal government will.

Anyone who disrupts a town hall meeting (which is *not* a campaign rally or a football game) should be expelled. We all have the right to be heard, and no one has the right to shout-down those with whom they disagree.

But one can hear the anger and anxiety in the confusion they display. And Al Franken does a good job to listen to them and adress both the fear and the confusion, in a rational and civil way. As a wise person once said: “Sometimes, just talking sense is an act of revolution.”

http://www.youtube.com/watch?v=rFJefhHAzZI&feature=PlayList&p=87B8E28DD509DBC9&playnext=1&playnext_from=PL&index=36

Not my problem anymore since they decided to bring those people in from India to take my job. Anybody got a link to famous South Park episode? You know the “They took our jobs!”

Something MUST be done…as a layperson, I am not so arrogant as to propose that I have ANY answers — but as a patient, I know that the current system is dysfunctional at its very best.

I DO know that we need far more rational conversation like this, and far less hysterical ranting.

Anyway, the honorable Senator uses examples of health care systems in other countries to make his case. Does that mean that is what Americans will get? Not necessarily, for It is unlikely that Senator Franken nor any other member of congress will even have the opportunity to read the legislation in its entirety. Buried in hundreds or thousands of pages will be the devil’s details. Basically what these massive government overhauls come down to is this phrase… “Trust us.”

It’s wonderful to see Franken engaging with people who clearly want some answers, but to exaggerate this way is embarassingly similar to the right’s habitual characterisation of everything as a conflict with winners and losers, right and wrong.

Surely, the beauty of the piece is seeing people talking to other people, with a genuine exchange of information? It’s to everbody’s credit. Franken does an honest job of answering the questions with a minimum of political evasion and the crowd, even while in disagreement, allow him the opportunity to respond.

Heart-warming clip, but maybe the headline could use a re-think.