For people without healthcare insurance and need it or want it the answer to the question posed is very obvious.  To moral people the answer to that question is most obvious as well.  But what is that answer for Republicans and people who have insurance under non-group rates that do not care about anyone else.  Well for most Americans a recent MIT study answers that question.  The reason healthcare reform should be so important to the vast majority of working and middle class Americans is that it will result in lower premiums.  Keep in mind that the Senate bill is far less generous than the house bill and subsidies kick in later but the following chart shows how the majority of American families will save thousands on healthcare premiums.

Healthcare Premiums Under Senate Plan

Based on the last figures by the Census Bureau the mean family income in the country for a family of four is $67,000/year.  However because of income disparity the median income for a family of four is about $52,000/year (it went down about $600 in 2008 alone) so the bottom line for these families is that healthcare reform will take a huge bite out of economic pressure they are feeling.

The amazing part is that even with these subsidies based on healthcare savings and new taxes on gold plated healthcare policies paid by insurance companies the Senate bill does bend the curve and the CBO estimates it will reduce the deficit in 10 years.  This may sound counter intuitive but when you consider how rising healthcare costs have outpaced almost every other industrial sector it becomes more understandable.  Besides the moral imperative if there is not a more compelling reason to pass healthcare reform now I cannot think of one.

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After 4 days on the McCain amendment(to re-commit the HC bill) and blocking a voe on their own amend. There will be a vote today at 2:45pm EST. Will the public ever know that this is the Rethugs tactic? Take 4 days on each of the many amendments! This bill may get passed in 2012! If I see McGrumpy speaking one more time……
This man has not spent one day of his life without government paid health care! He was wrapped in GI swaddling clothes when he was born!!


Oh, surprise, surprise, after 4 days after of gab and delay the McCain bill fails. 42-58. Now the rethugs are still talking about it.


I’m clinging to the words from Senator Klobuchar — the only thing left for them to do is delay.

So we just have to hang in there. Let them have their theater, and hang in there. Reid is making them stay through Christmas — a just reward for their stalling. Everyone knows what they’re doing.


When they (repubs) start in with the Large Government vs Small Government
I want to punch something. How about SMART Government?
Large or small- use as needed- Like a prescription
Our nations needs wax and wane and one size can not fit all.
We have to meet the needs of the time.
We need to have SMART Policies, Smart Government that may at times be large!
Ooooo Ooooo get over it, if it works, if it is smart, you will like it!

If we know that by doing nothing, costs will go thru the roof for everyone,
Then we must say –
We need to get everyone covered (if using the insurance model)
So that will mean subsidies and that will COST the taxpayers big $$$.
That is why PUBLIC OPTION is necessary-
So we do not have the extra taxes.
If we go the route of subsidies alone -no PO-
We are paying our tax Dollars to insurance for profit enterprises, ultra high CEO pay etc. .
We Must have a Not For Profit, Public Option and a very Strong One!!
This is the only way to get the costs down with out going for Single Payer.
I would have preferred Single Payer any day of the week, but we have The Public Option.
They could have used a better name maybe
Open Option or Free Beer or something like that.


Oh this is special. LOL The Rethugs have been discussing the McCain Amend. all week. DEMS. called for a vote, And the R’s objected to the vote. Dog, it’s their amendment! They want this bill to take 2 years.


I heard one of the senators interviewed — I forget who it was, maybe Amy Klobuchar — warning that the Republicans’ only strategy, at this point, is delay. That’s all they can do. So expect a procedural motion on every excruciating bit of minutia.


n’ellie, Just to back up your thoughts:
Yesterday, Politico


If Eric Holder would aggressively go after those that commit Medicare fraud, the RW would have to shut up. Medicare Fraud in
South Florida is a lifestyle of corruptness. I lived there for over thirty years and this fraud has been going on for decades.

Put 80-90% of your best agents in Miami and prosecute to the fullest extent of the law and publicize the arrests, trials, and

Mr. Holder please send a clear direct message that you are taking Medicare back, stop giving the RW whiners an excuse that government health care can’t work.;contentBody

Steve Kroft from 60 Minutes expose on Medicare Fraud

And the sad thing is most of the fraud is committed by illegals or immigrants that refuse to assimilate. Because of the language
barrier many immigrants are exploited and used and the fraud is considered their Monday thru Friday job.


I happened, for various reasons, to take the FBI Citizens Academy training in which they detailed that one of their top ten efforts was pursuing Medicare fraud. I was horrified at how easy it is – just set up a phony “durable medical equipment” site, get some junkie working in a medical office to steal social security numbers (easier than you’d ever want to believe) and you’re in business for the three months it takes for you to get tracked down – by which time you’re gone, and a new business at a new address is established. There is nothing under the sun so good that someone with real malice in them can’t screw up. I’d suggest vetting said people BEFORE allowing them to sign up – have to show you’re in business for X numbers of months or years – which might help. These fly by night thieves are almost impossible to catch. It is true that many immigrant do this – in CA they are ALL East European. Welcome to America.


What I find interesting is the ease at which east Europeans are able to get entitlements, using resident family members as their leverage. Theirs is a culture of graft. That’s how they survived before coming to this country. They bring that model with them and then scam the entitlements system, and there seems to be nothing anyone can do about it. It’s rampant in Washington State.

They are an incredible burden on the system.



Give us an essay defining “fee for service” and any models considered likely to lower the costs of health care.


Oh my.
Here’s where I chime in, but thank goodness this is not HP.

Tell me if I’m wrong, because I do hope that I am wrong.

My husband and I worked long enough and we have health insurance subsidized by our employer, but it’s going up come January by 35% per month.
We are too young for Medicare.

That’s half my husband’s pension, as my pension doesn’t kick in until I reach 65.

If I understand this new health care reform bill, it is not going to help us at all, but raise our rates even further

Hey, I am all for paying more in taxes so that the poor among us can have health care, but we cannot afford it.

Our state tax increases are killing us and we are not alone.

States are broke, so not only are we talking increased sales tax and property taxes, they are taxing us every way they can in the state, not to mention the increases for water, garbage pickup, electric, and telephone, we’re getting hit right and left with rising costs, and if I read the health care bill correctly, there is no relief, and we are going to pay more.

Tell me please, where am I wrong in not supporting yet another tax?

The health care bill as it stands, does not have a strong Public Option and that means no competition when it comes to health insurance.

The most important thing that our very wealthy lawmakers should do is take away the antitrust immunity within the system and take away their monopoly on setting costs.
They should regulate them like they do utilities so that they have to justify premium increases.


Hi javaz!

From KQ’s numbers, if you have a household income below $100k, your rates should go down.

Over $100k, it looks like a wash which sucks but if reform is effective and the monopolies of insurance companies are ended and the Public Option grows, there may be pressure on rates to come down across the board.


If that happens on the final bill, I agree with you.

Hiya AdLib!!!

(and my husband helped me write that!!!)


Hi javaz – at this point, you are facing the total “free” market increases that will continue unabated. The public option, for people not yet ready for Medicare, is only one option that might be open to your employer and should save the employer and you a lot of money. The taxes that are under consideration are on incomes above $250K (net) not on middle class incomes. There is also talk of rescinding the tax break that benefited only the very wealthy – VERY rich – not the rest of us. The House and Senate versions of the bill do have strong public options. The negotiated rates with doctors does not automatically make it less robust. There are very real differences regionally that probably need to be dealt with – what doctors in Alabama get is already very different from what doctors need to keep offices and hospitals afloat in San Francisco.

Antitrust immunity has been killed in both bills, but the most important aspect of any bill that comes out is an expansion of public programs – Medicare, Medicaid or something new – at rates shown here by KQuark to be vastly below market. Rates pegged to your income level are what Medicare now does and should do for any future program. When RW people say there is a new “tax” – that’s the code for “bad stuff” when what it REALLY would be is a premium paid by your employer, you, whoever. It would be lower than the market premiums, regulated as Medicare now is.

The problem? None of this is final, and the forces against it are huge. To assure a decent outcome – holler regularly at your Senators and Representatives! I’ve been in direct conversation with Nancy Pelosi’s chief consultant. She has advised us that nothing – NOTHING -speaks more loudly than constituent voices. Massive public input outweighs insurance company money. So raise your voice to lower your costs!


You are so right, KQuark! The key issue in having a public option of this nature is that it keeps premiums to an affordable percentage of family income. The market just doesn’t. When I turned a (cough) certain age, my premiums soared to 20% of my income (working for a non-profit, that’s not a lot of income but was a lot of outgo!) I had to transfer to an entirely different, cheaper plan lest my employer and/or I go broke.

The absolutely worst thing that could happen with this bill, in either house or in conference committee, is to have a mandate and NO public option. Since when is the government in the business of directing us what commodities to purchase? Might as well tell homeless people that they have to buy a house. There is no term in economics for government-mandated purchases of commodities. Closest thing I can find is feudal tribute. That is not progress!

It’s also much, much smarter to provide affordable premiums rather than subsidies for premiums in the private market. To keep government from going bust, the premium is kept artificially low, but the deductible and out of pocket are huge. In MA the plan has a $250 per month premium subsidized by the state, but the deductible is $5000 and the out of pocket is $10,000 PER PERSON PER YEAR. That’s making too many people use the coverage as catastrophic care – they can’t tap into it until they are desperate since they don’t HAVE the $5000 for preventive medicine. That is precisely the plan proposed by Arnold Schwarzenegger in CA – and it was supported by too many otherwise smart people. It would have been a disaster for CA where vastly more people are uninsured than in MA.

The House bill is better (with the Capps amendment not the Stupak one – Capps created a good balance of individual choices and rights on abortion options) so everyone get on board and press for this as the final outcome, please? It’s important. This is our last chance for decades. There is no reason to believe the US populace will be smart and vote for more Dems, and we may see a dwindling of margins even with the Republican bozos that are running. Without the requisite 60 votes to end a filibuster in the Senate, nothing can move to the floor, and that would be the death knell for health care reform. The election of Obama did NOT end our obligation to speak out on issues (though you’d think from HuffPo that it had – grrr) so this is one of the top priorities for all of us now and in the near future.

Thanks for reprinting the MIT study. More will come and soon that will reinforce this clear perspective that the plans are good, the time is NOW.


What do we do about the 30% of heath care dollars expended that are utterly wasted?

Spent on medications that we don’t need and tests that serve no purpose. And I am not talking about “defensive medicine”.


The public option, like Medicare, should eliminate that. Medicare carries a 3% overhead verses the 35% that private insurance wastes. Some of the “defensive medicine” will need to be tackled, to be sure, but eliminating the private “middle men” and the profits, administrative nightmares of each insurer having different codes for aspirin making it necessary for doctors and hospitals to have banks of manuals on coding – all that can be fixed. We can eliminate the Part D type waste by allowing – mandating – bulk purchases of pharmaceuticals and importation of lower-cost versions. All that can make the practice of medicine more efficient and less costly which, in turn, can eradicate the private insurance rip offs of us all.


No, no.

I am talking about people demanding medications and tests that serve no purpose, and doctors ordering tests for no reason.

Add to that the demand of Americans that we get only the best. We can’t settle for 95%. The Japanese use a lot of MRIs, but pay one tenth of what we do. Their machines cost a fraction of ours, and are about 95% as good.


I once hard a story on NPR that Americans are the only people who believe death is optional. We believe we can cure anything with enough bells and whistles – so we demand every test. The rage against the recent recommendations that annual mammograms not begin until 50 is a case in point. There is real concern about not just false positives and invasive biopsies but about the body burden radiation doses. But we think this is ‘rationing’ despite the fact that the actual recommendation comes from your doctor. NO one will be denied, but we think it’s worth 10 more years of radiation to catch something that’s not likely to be found. I, for one, think this is a wise decision. If I have reason (family history, suspicious lumps) I can get a mammogram. If not, I’m saved the radiation. Good call, IMHO. But you’d think this was another death panel. Yikes. Let’s think about the consequences of eternal testing – the money, the human impacts. We won’t be healthier for all that waste.


C-lady, you are so right. I work in healthcare and it’s amazing how many people feel that death is always an outrage–an injustice–and a failure of the system. Even if their family member is in his/her 90s.
I totally understand that very few people are actually indifferent to the loss of a loved one. After all, I’ve lost family members, too. But it seems to be currently common to react with rage. As in: if “you people” weren’t so stupid/incompetent/lazy/indifferent Grampa would still be here. Does it really make sense to start dialysis on Grampa when he’s in his mid-80s and already in congestive heart failure and blind? Apparently so, in some peoples’ book. So, to avert the wrath of the family, it’s amazing what will be ordered. So sorry, this sounds so negative. There are hundreds of lovely, supportive and rational patients/families, too. But it’s the others who really make the job “interesting.”


My own mother went on dialysis when (to quote a line from Milagro Beanfield War) everything below the neck had to go. Without it she’d have died a couple of years sooner but also with fewer complications and less pain. Was it worth it? Only to my Dad who loved her. But the outcome was inevitable, so why did she permit this to drag on so long? Turns out she was a rationalist who was actually very afraid of death. But none of us begrudged the docs (save for the stupid resident who gave us information on another patient by error)for doing what she had said she did not want but did. I’m not sure I’d face it all with aplomb either – HATE losing options! But someday death will be a blessing.


So true! And I have to admit, I had quite a “discussion” with my own father, who is refusing a pacemaker. Having one implanted is hardly major surgery and it could make his quality of life a whole lot better. But he won’t do it. Says that the time and equipment should go to someone younger. (As though there’s a critical shortage of pacemakers!) And when he goes to his cardiologist, he lies! 😮 Says he’s having no symptoms, when he tells me the complete opposite. It’s frustrating. But–as you say–this is something that’s hard to navigate until you’re actually right in the middle of the situation. And that’s where everything is often the least clear!
As with so many things, we muddle through somehow and the clarity comes later…