Relevant and even prescient commentary on news, politics and the economy.

Does Single Payer Pay for Itself?

by ProGrowthLiberal (originally published at Econospeak)

Does Single Payer Pay for Itself?

Was this the message of the title of the latest from Dean Baker:

The economies of a single system can be viewed as analogous to the Social Security system, which has administrative costs that are less than 1/20th as much as privatized systems in places like Chile and the United Kingdom. The analogous institution in the health-care sector is of course Medicare, which has administrative costs of less than 2 percent of benefits in the traditional fee-for-service portion of the program, roughly a tenth the cost for private insurers.

I will agree that the 20% gross margins received by the health insurance companies are obscene. This margin breaks down into a 14% operating expense to premium revenue ratio and a 6% operating margin. I would imagine competition could cut the former in half and the latter by a factor of two-thirds. I’m suggesting a 2% operating margin is reasonable as the reserve to premium revenue ratio is close to 25% for health insurance and an 8% cost of capital is more than reasonable. But Dean is arguing that we can live on a 1% gross margin, which seems to be very ambitious. OK- governments might be able to lower the cost of capital but nearly eliminating administrative costs sounds incredible. But what do I know – so I did a Google search and came across this interesting discussion:

The correct way to estimate administrative savings is to use actual data from real world experience with single-payer systems such as that in Canada or Scotland, rather than using projections of costs in Vermont’s non-single-payer plan. In our study published in the New England Journal of Medicine we found that the administrative costs of insurers and providers accounted for 16.7 percent of total health care expenditures in Canada, versus. 31.0 percent in the U.S. – a difference of 14.3 percent. In subsequent studies, we have found that U.S. hospital administrative costs have continued to rise, while Canada’s have not. Moreover, hospital administrative costs in Scotland’s single-payer system were virtually identical those in Canada.

Tags: Comments (17) | |

Breaking The Healthcare Cost Curve…Maryland

 by Run75441

Breaking The Healthcare Cost Curve
Re-posted from 2/20/2010

Quite a bit of the commentary has been written on the question of how-to-rein-in rising healthcare costs and to slow costs to less than the rate of inflation. Massachusetts has been able to provide healthcare to its citizens but still struggles with keeping healthcare insurance costs low and affordable. Healthcare costs continue to rise at 8% annually and will double by 2020 unless Massachusetts can find a methodology to control the rising cost of healthcare.

One answer might be Maryland’s solution, a regulatory commission of seven governor-appointed-commissioners serving 4 year terms and having the responsibility of setting appropriate rates for hospital inpatient, outpatient, and emergency department care to manage its rising healthcare costs by limiting payment to the minimum amount necessary to cover hospital operating expenses, and requiring all payers (both private insurers and Medicare) to adhere to the rates set. This regulatory commission is nothing new for Maryland and has been in place for years. At one time, 30 other states regulated hospital rates only to have them fall by the wayside in the late seventies and earlier eighties with the deregulatory movement.

When Maryland’s Commission determines what can be charged by each hospital, it takes into consideration a hospital’s wages, charity cases, and the severity of illnesses. If not satisfied with the commission’s decision, hospitals can appeal to the commission or go to court for a variance in prices. So what has been the success of Maryland in its attempts to tamp down healthcare costs? Separately, the net savings for Maryland was determined to be an ~$40 billion since 1976 (Health Affairs, “Setting Hospital Rates to Control Costs and Boost Quality,” 2009) and additionally:

“Had a similar system for all states been in place, a savings of $1.8 trillion dollars would have been achieved for the nation’s healthcare system.”

Emory University’s Elena Conis adds:

“The savings and financial stability engendered by the system also receive credit for granting the state (Maryland) the lowest health insurance premiums (as a fraction of income) in the country (‘Impact of a State-Level All-Payer System’).”

In her article “How Maryland Broke the Curve; A Solution for Massachusetts”Maggie Mahar (Health Beat) continues doing the yeoman’s work with additional research on whether hospitals had shifted medical procedure or device functions offsite to avoid regulation. Maggie’s research didn’t find evidence of a shifting of either offsite when compared to other states.

  • In 2004, Maryland was spending slightly more than the US average of $5283 at $5590 and was lower than 16 other states, Massachusetts included.  
  • The growth of its healthcare costs as compared to inflation was at the national average of 6.7% and less than 32 other states. 
  • In measuring against the state’s GDP, Maryland was at the national average or 13.3% for medical bills.

Maryland has managed to maintain the same markup over costs since the Commission’s beginnings as compared to the rest of the US (see chart “Keeping Costs Down”).

So what’s in it for Maryland hospitals? Hospitals are reimbursed at a higher rate for treating those who are uninsured and result in being charity cases; Medicaid and Medicare accept the Commission’s pricing and pays Maryland hospitals at the same rate as private insurance. The standardization of pricing goes a long way towards eliminating operations in the red; offers greater financial stability for hospitals as variation caused by the economy is minimized; prevents leveraging by insurance or hospitals and creates comfortable operating margins; lowers hospital administration costs with standardized pricing by eliminating insurance payout variation; and creates transparency for hospitals and patients on pricing.

What Maggie on Health Beat suggests for those waiting for a federal solution for rising healthcare costs may look to states to play a more active role in the control of cost. While the Federal Government may play a more efficient role in mandating healthcare insurance for people, states may actually hold the key to controlling healthcare costs. States are more knowledgeable regarding local conditions impacting hospital costs and pricing.

But what of Massachusetts? Realizing it could not maintain the same healthcare insurance prices against rising healthcare costs, The Massachusetts Division of Healthcare and Policy contracted Rand Corporation to strategize and help it develop a plan to contain healthcare costs. Besides the bundling of hospital and doctor fees, Rand recommended a similar approach to what Maryland has in place in addition to 10 other strategies and options, Controlling Healthcare Costs in Massachusetts,”

Estimated Massachusetts Cumulative Savings from Selected Policy Options, 2010–2020

As shown in Rand’s chart, the recommended actions and the resulting savings.

It appears to be a direction well worth taking and relieving the Federal Government of much of the responsibility of healthcare cost containment. Hat tip to Maggie Mahar at Health Beat, “How Maryland Broke the Curve; A Solution for Massachusetts”

Tags: , , Comments (6) | |

Still fixing the fixed, fixed healthcare system

by Daniel Becker

I posted in 7/2009 on the issue of fixing our healthcare system based on the Massachusetts model. The first was Massachusetts is fixing the fixed healthcare system.   The second was a followup to the first:  Fixing the fixing. Healthcare Deja vu.

The issue was that we are dancing around. All the proposals to date have been nothing more than a relabeling of already tried organizational structuring within the private insurance model.  I ended the first article with a quote from a NEJM report and a my question:

Despite these imprecisions, the difference in the costs of health care administration between the United States and Canada is clearly large and growing. Is $294.3 billion annually for U.S. health care administration money well spent?

Well, is it? Did they even ask?

I ended the second article with:

We’re talking the same old approach to what really is a problem with the product. At least in the bad socialist health care programs they recognize that a for profit third party only adds cost and thus do not have to account for that part of our problem (it’s called savings). They just need to resolve the product quality issue. It is the only common issue to all nations.

I’m taking bets on the date of the new fix of the newly fixed, fixed system.

Ok folks. The betting is closed. Time to lay the cards on the table.

US News and World Report: Mass. Health Reform Hasn’t Halted Medical Bankruptcies

“Health costs in the state have risen sharply since reform was enacted. Even before the changes in health care laws, most medical bankruptcies in Massachusetts — as in other states — afflicted middle-class families with health insurance. High premium costs and gaps in coverage — co-payments, deductibles and uncovered services — often left insured families liable for substantial out-of-pocket costs. None of that changed. For example, under Massachusetts’ reform, the least expensive individual coverage available to a 56-year-old Bostonian carries a premium of $5,616, a deductible of $2,000, and covers only 80 percent of the next $15,000 in costs for covered services,” the researchers wrote.

The results from the actual published article in The American Journal of Medicine:

In 2009, illness or medical bills contributed to 52.9% of bankruptcies in Massachusetts. In contrast, in early 2007, medical bankruptcies accounted for 59.3% of personal bankruptcies in the state (P#.44 for comparison with 2009 proportion) and 62.1% nationally (P#.02). Because the total number of personal bankruptcy filings in Massachusetts increased by 51% between fiscal years 2007 and 2009(6) the absolute number of medical bankruptcies in the state actually increased by more than one third during that period, from 7504 to 10,093.

The profile of the bankruptcies:

Most of the recent Massachusetts debtors were female (Table 1). Their average age was 48.2 years, two thirds of them had attended college, and 70.5% owned a home or had owned one within the past 5 years. The average debtor household included 2.94 persons; in three quarters of them, at least 1 adult was employed at the time of bankruptcy filing.

In 2009, 45.6% of the entire sample (86.2% of the medically bankrupt) had high medical bills or specifically cited illness as a cause of their bankruptcy, proportions that did not vary by insurance

status. The remaining 13.8% of the medically bankrupt (7.3% of the entire sample) were classified as medically bankrupt because they had lost significant work-related income because of illness or had mortgaged a home to pay medical bills.

As would be expected in a state where medical insurance is mandatory, the overwhelming majority (89.0%) of debtors had health insurance for themselves and all of their dependents at the time of bankruptcy filing…

The 2009 coverage rates in Massachusetts were higher than those for Massachusetts debtors in 2007 (before the coverage mandate was enforced), when 84.1% had insurance at the time of filing and approximately one third (34.1%) had experienced a coverage gap. In both 2007 and 2009, Massachusetts debtors’ had higher coverage rates than in our 2007 national sample, in which only 69.7% of bankrupt families were insured at the time of filing and 37.4% had experienced a gap.

Here we go folks, the table is open. Taking new bets.

Tags: , , , Comments (26) | |

Heath Care Reform– Looking at the Glass Half-Full

(Run 75441…h/t)

Maggie Mahar writes an essay that is now cross posted at Angry Bear with the author’s permission:

Health Beat, a Project of the Century Foundation;
November 4, 2009 Heath Care Reform– Looking at the Glass Half-Full

What Has Been Accomplished; What Still Must Be Done

These days, many progressives are expressing deep disappointment with the health reform legislation now moving through Congress. Some suggest that some legislators made deals with lobbyists and let them write the bills. Others complain that both the subsidies and the penalties are too low. Still others don’t like the fact that states can “opt out” of the public insurance option, and decide not to offer Medicare E. Finally, many ask:
Why can’t everyone sign on for the public plan in 2013? Why do we have to wait until 2013? Why cn’t they roll out universal coverage next year?”

Normally, I would be among the first to critique the bills. By temperament and training, I’m both a skeptic and a critic.
But in this case, I think it is important to recognize that we cannot expect this first piece of health reform legislation to be anything but wildly imperfect. In fact, I’m impressed by the progress Washington has made in just ten months. I’ve been watching the struggle for health care reform since the early 1970s, and compared to what has happened over the past 39 years, this is mind -boggling.

I also believe that those who favor overhauling our health care system should send a strong signal to legislators: we support you for having come this far. We realize that you have three years to strengthen, change and refine the plan before rolling it out in 2013.

What Has Been Accomplished

What is astounding is that this Congress has made as much progress as it has. We may have a new administration in the White House, but we do not have a brand-new group on the Hill. The majority of our legislators are moderates; many are conservatives. Nevertheless, a sufficient number have found the will to stand up and back changes that would make health care affordable for millions of poor, working-class and middle-class Americans.

For example, under the House bill,a family of three making $32,000 a year would pay just $1,360 in annual premiums for good, comprehensive coverage; under the Senate Finance Committee bill, the same family would be asked to lay out only $2,013. Today, without reform, if that family tried to buy insurance, it would find that the average plan costs $13,500. For this household, the current legislation makes all of the difference.

Too often, the press suggests that such a family would be expected to pay $10,000 out-of-pocket to cover co-pays and deductibles. That just isn’t true. Even if the entire family were in an auto accident and racked up $200,000 in medical bills, at their income level, the House bill caps out-of-pocket expenses at $2,000 a year. Under the Senate Finance bill, the family would have to pay $4,000. Moreover, under both bills, there are no co-pays for primary care. Even private insurers cannot put a $25 dollar barrier between a family and preventive care.

Moving up the income ladder, a median-income household earning roughly $55,000 would pay premiums of $4,300 to $6,500—depending on whether the Senate Finance bill or the more generous House bill sets the terms. Without legislation, they too would face a $13,500 price tag –and that is if they could get a group rate. If they are buying insurance on their own, coverage could easily cost $16,000.

For self-employed workers, early retirees, and those who work for (or own) a small business; the legislation offers major savings. They will be able to buy coverage on the Insurance Exchange, where they would suddenly become part of a group—which makes their premiums much lower. Whether rich or poor, this is great news for anyone who works for himself, retired early (voluntarily or involuntarily), or is part of a small firm.

Granted, the legislation now on the table still doesn’t make insurance affordable for many Americans at the upper-edges of the middle-class–-or the upper-middle-class. They don’t qualify for subsidies. But, as I discuss below, the legislation does point the way to lowering their premiums. Before reform becomes a reality in 2013, I am convinced that this will happen, in part because it must. We can no longer ignore the waste, inefficiency and pure fraud in our health care system. There is absolutely no reason why we should pay so much more for health care than any other nation in the developed world.

And at least the current legislation protects these more affluent households from medical bankruptcy. No matter how much a family earns, they cannot be asked to pay more than $10,000, out of pocket, in a given year. For households that have savings and property to protect, this means that they don’t have to worry about being wiped out by a medical disaster. Even if you and your family are in that car accident that leads to $200,000 in doctors’ and hospitals bills, you will owe only $10,000. In that situation, doctors and hospitals will let you pay off your bills over time, because they know you can. You won’t be forced into bankruptcy court. This represents an enormous step forward.

In addition, under reform, private insurers will not be able to put a cap on how much they will pay out to you and your family, over the course of a year, or over a lifetime. If tragedy strikes and a child needs six or seven years of cancer treatments, your insurance will not “run out.” For some families, this one provision will mean the difference between being able to care for their child and financial ruin (coupled with the suspicion that, if they had just had more coverage, they might have been able to save their child.)

Moreover, in the very first year of reform, the public plan will offer less expensive, higher quality coverage to millions of Americans. Congressional Budget Office director Douglas Elmendorf disagrees. He has been spreading misinformation about the government plan. First he low-balls the number of Americans who will be eligible for the Insurance Exchange where they can choose between a public plan and private insurance. . He then asserts that only 20 percent of Exchange shoppers will choose the government plan while 80 percent will pick private insurance. Here Elmendorf pretends that he can read minds:

“Elmendorf goes on to argue that despite the fact that its administrative costs will be far lower, the public plan will cost more than comprehensive private insurance. This theory is based on the unfounded assumption that very few people will select the public plan , coupled with speculation that the public plan will make no effort to control costs and utilization. This makes no sense; as reform legislation makes clear, part of the purpose of the public plan is to offer higher quality care for less. (In part two of his post, I will examine Elmendorf’s guesstimates in detail.)”

For peculiar reasons that I don’t fully understand, progressives have been listening to Elmendorf’s numbers. They seem to forget his past: a student of the Dean of Conservative Economists. Elmendorf first made his mark in Washington by helping to quash the Clinton’s hopes for health care reform.
Finally, under the House and Senate reform bills, insurers will no longer be able to deny coverage, or charge a customer more, because of a pre-existing condition. If you have begun to take that idea for granted, keep in mind the Republican’s recent 11th hour proposal for reform “gives the insurance industry more leeway” as the Wall Street Journal put it yesterday (Media Matters for America blog points out the disappearance of WSJ story; “GOP Health Bill Gives Insurers More Leeway” from the paper’s website sometime last night.) Under the Republican proposal, insurers would be able to take pre-existing conditions into consideration.

House Speaker Nancy Pelosi’s “Fact Sheet” offers two examples illustrating just how easy it is for insurers to deny coverage today:

Peggy Robertson: A Colorado mother of two who was denied health coverage because she had a c-section in 2006. The insurance company told her if she got “sterilized” she would be eligible for coverage.

Christina Turner: After being sexually assaulted in Florida, Christina Turner followed her doctor’s orders and took a month’s worth of anti-AIDS medication as a precautionary measure. She never developed an HIV infection. Months later, when shopping for new health insurance coverage, Ms. Turner was repeatedly denied coverage because of the precautionary treatment she received after being raped.

In most states today, this could happen to anyone. I live in New York where we have community ratings and I don’t have to worry about pre-existing conditions. My employer provides excellent insurance, with no annual or lifetime caps, so the current reform legislation would probably have no immediate effect on my life. But, we all should recognize that the bills on the table would change the lives of millions of Americans, giving them the security that they don’t have today.

Progressives cannot let this opportunity slip through our fingers because we are so busy critiquing the legislation–and arguing with each other. Online WS Journal reports that Senate Majority Leader Harry Reid has begun to warn that the Senate may not be able to complete the legislation by the end of this year.

Given all of the criticism he has faced, Reid could be losing heart. After all, Conservatives continue to argue that legislators like Reid will be punished at the polls. Congressmen who have been pushing for reform need our encouragement. Progressives should continue to make it clear that the majority of Americans want reform– and a public option– even if the legislation is far from perfect.

2010 is an election year. Fearful of losing, some Congressmen will begin to back away from change making it critical that broad reform legislation is passed this year. Over the next three years, it can be amended as the critical details are fleshed out. Anyone who thought that Congress would be able to overhaul a $2.6 trillion dollar industry with just one bill was, I submit, terribly naïve.

What Remains To Be Done In the Next Three Years

There is so much to be done and this is one reason why reform cannot be implemented until 2013:
– Congress must figure out how to regulate the private insurance industry. This will require enormous cunning.
– Reformers will have to find a way to stiffen the penalties for those who choose not to buy insurance, without alienating young, healthy voters. This is a job for a charismatic president.
– Legislators must map out how the Insurance Exchange will work.
– They also will need to come up with a formula that will adjust for risk if one plan winds up with a larger share of poor and sick customers. (Some fear that this will happen to the Public Plan, so this, too, is a crucial detail.)
– Finally, and perhaps most importantly, Medicare needs time to begin eliminating waste in the system—saving billions of health care dollars while simultaneously lifting the quality of care. In fact, while all eyes are focused on the legislation, Medicare already has begun putting its own house in order.

What many reformers don’t seem to understand is when the public plan begins to negotiate fees with providers in 2013, Medicare fees for some very expensive services will be significantly lower than they are today, while reimbursements to primary care doctors will be higher.

“Medicare already has announced plans to cut fees for CT scans and MRIs next year, and has proposed trimming fees to cardiologist by 6 percent . Meanwhile, it would hike fees for primary care physicians by 4 percent. Congress has just 60 days to respond to the changes in reimbursements to doctors or they will automatically take effect January 1. Over the next three years, we can expect more changes in the fee schedule. And private insurers will follow Medicare’s lead.”

As they have explained to the Medicare Payment Advisory Commission (MedPAC), they just want Medicare to provide political cover. In other words, in 2013 the public plan will be negotiating fees with providers in a very different, less expensive, and more rational context.
This is another reason why public plan premiums will be significantly lower than Congressional Budget Office (CBO) director Douglas Elmendorf suggests.

Over the next three years, Medicare will be realigning financial incentives to reward preventive care and management of chronic diseases, while reducing payments for overly aggressive tests and treatments that have no proven benefit– and penalizing hospitals that don’t pay enough attention to medical errors. In the process, Medicare will be conserving health care dollars while protecting patients from needless risks. As President Obama has promised, Medicare cuts can make healthcare safer and more affordable for everyone—including the upper-middle class. Because most private insurers will mime Medicare’s efforts to reduce overpayment, the cost of care will come down for everyone.

The Public Plan will incorporate Medicare’s reforms and it will have clout. Seven percent of Americans purchase their own insurance in the private sector market. Most of the seven percent are neither poor nor sick. If they were, they wouldn’t be able to buy insurance in the individual market.)( More than half of this group earn over $55,000. They will be able to go into the Exchange and sign up for the public plan. In addition, a large share of relatively young Americans (ages 25-34) are uninsured and relatively healthy. No one knows how many will choose the public plan; but since it will have much lower administrative costs than private sector plans, it will be less expensive and more attractive to younger Americans.

States will not opt out. It would be too difficult for politicians to try to explain to voters why they cannot have access to a government plan that will be able to offer comprehensive insurance for less.

In part 2 of this post, I will explain what Medicare is already doing to pave the way for a structural overhaul of our health care system, and why none of these cost-saving reforms need to be –or should be–spelled out in reform legislation.

Tags: , , , , Comments (13) | |

Health Care billing examples. The "public option" can’t work.

by Divorced one like Bush

For your consideration here are some real numbers from a Medicare Advantage policy via United Health Care

Cat Scan billed $1042.00
Not Covered $ 831.68
That means the contracted charge for this service with UHC is $210.32.
Copay $ 42.06
UHC payment $ 168.26

The “copay” is 20%.

Same plan has a “Deductible/Copay” individual combined limit of $3800.00/yr.

Ok, lets look at this. Eye Exam.
This is for my dad in the nursing home.
Service code 92004 $217.00. Medicare paid Zero.
Same code, 92004 via the doc my daughter saw was $160. This was discounted to $40.00and my share was zero.

Here is the issue, rational consumer and all that, how can we expect to get costs under control if the billed amounts and the paid/contracted amounts are so far apart? The consumer does not know the contracted rates, so the consumer can not purchase the insurance that pays the least. Thus, the consumer can not be “rational” when choosing health care. (Like we’re rational at anytime with this!) Basically, there is nothing in our current approach to the issue that economic theory would suggest is viable. Or maybe economic theory doesn’t apply?

At the same time, how do we know that these contracted prices are the correct price such that the market is “clearing” properly or in “equilibrium” of some sorts such that there is a reasonable profit for the providers and payers with reasonable cost for the consumer while producing the product of highest quality (as in it did not harm you and did actually help you)? These prices could be distressed prices in that the provider accepts them so that they can capture some of the patients planning to make up the difference in cash patients or other higher contracted fees. For the lawyers that read this blog, we are talking about “contracts of adhesion”. That is a contract signed where one party has most of the power. But then, what would you expect when you exempt a type of business from the anti-monopoly laws. In the past they were public utilities.

This leads to the question of just how can congress and Obama believe (and it is a belief because all examples of what is being proposed have failed in the past, MA being the most recent) their “public plan” is going to ultimately produce the savings that will allow coverage of 50 million more people, better product quality and happy, smiling Americans? After all, if the contracted rates are all over the map, then there will be massive cost shifting either by insured selection or subscriber (patient) deductible manipulation. And, there will still be a need for all the administration to “manage” the care which is in actuality a paper chase game.

We talk about pricing. Medicare wants to reduce the rates and that will just shift the burden onto the privates is the complaint. Well, I got news for all of you. The privates use the medicare fee schedules all the time and then start cutting from there. So, this is a bogus complaint by the privates/non-profits.

I assure you, though you may disagree, there is no way to fix health care via market theory when the approach is to believe that the market is with the middle man; the insurers. Private, public or non-profit, the problem with health care cost and all that leads to can not be found there because that is not the real market.

How much more and for how long do we continue to pay the privates more via Medicare Advantage before congress gets this message that the issue can not be fixed by focusing on a false market? From 2004.

Note this report on Nick Skala presentation of June 4, 2009 in front of the “Progressive Caucus”.

“Bill Gould emailed me after reading my testimony and materials I was going to present to tell me that they were not acceptable and that there could be no comparison between single payer and the public option with side by side comparison,” Skala told Single Payer Action. “Darcy Burner told me that they would construe talking about the public option — even comparing it to single payer — as an attack on the members of the Progressive Caucus.”

Darcy Burner; the candidate that Blue America backed. Head of the American Progressive Caucus Policy Foundation whose tag line is:

organization whose mission is to bring together the collective wisdom of progressives inside and outside of Congress to promote
* the health and economic well-being of us all.

Both are caucus’ that should be aware that the people want a medicare like program. The numbers are landslide size. The numbers should completely put to bed the meme of “not politically possible” if this nation actually worked it’s Constitution. And, if there is a caucus that should be working the Constitution as the normal course of it’s function, it should be a caucus that titles it’s self “Progressive”. Certainly a person who was a candidate for Blue America should get it!

Talking about a single payer system to the congress people who are part of a caucus FOUNDED by Senator Bernie Sanders, a “self described socialist” who is promoting single payer every chance he can, is to be construed as “an attack on the members”? ARE YOU FUCKING KIDDING ME! What! Prgressive suddenly do not like to learn about stuff…factually?

“During the presentation it was very nasty,” Skala said. “I got some very dirty looks from Darcy Burner. During the question period and once during the testimony, I was interrupted, told that the Progressive Caucus had taken a position on this issue and unless I had something positive to contribute, then there wasn’t really much point to answering my questions.

Here is Nick Skala’s actual presentation.

So, what does it say about a nation that states it is a democracy and yet the very organizations who should understand the implications of naming one self such, is unwilling to do the peoples bidding? This is not hard folks. A caucus’ job is not to do what is politically simple, it is to make the perceived politically impossible a social reality based on that caucus’ ideals. Well, if your ideals are “progressive”, if you are a part of a group founded by a socialist, and 65 to 70%of the people want something that by all Fox News reports is progressive and socialist then: How much easier can it get?

Tags: , , , , Comments Off on Health Care billing examples. The "public option" can’t work. | |