I hear you about the insurance industry, but the one thing they did that I think Medicare flops at is cost control.

ANything in anyone'e plan that addresses hwo to keep pricing down on medical care or is that going to be a perpetual fait accompli?

"When you want everything then you have no choice." Some form of this statement appears seemingly everywhere from cheesy church bulletin boards to a great Elvis Costello song.

A public option to compete with the insurance companies is a good idea. But Obama was blowing smoke at the AARP sponsored forum when he would not staight up admit that some form of rationing services even under a public plan like Medicare was inevitable.

A health care system that implies "the sky's the limit" is irrational and impossible to sustain.

The first cost that has to be "controlled" is insurance company overhead. And if you don't think rationing is taking place right now, then you've been lucky.

Turn about is fair play. We traded Gorden Smith for a light weight Democrat, let's trade Wyden for a conservative Republican in 2010.

Speaking of "Blue" and health care, did anyone else see that Blue Oregon is advocating Nazi-style "kill the fat" tactics?

Supposedly, overweight Americans cost our health care system an additional $147 billion each year. That's huge.

We have 47 million uninsured Americans. If we reallocated that money away from treating overweight people, we would have $3,100 per year available to put toward health insurance premiums for the uninsured.

"No health care for fat you!." As I pointed out (at great length in comments, I'm afraid), the uninsured and the overweight aren't exactly mutually exclusive groups.

No idea what the plan would mean for Kari. Last time I saw him, he'd be a prime candidate for having his coverage reassigned to some uninsured vegan.

Senator Wyden is diplomatically trying to say that, as bad as he considers the present system to be, the major proposals he sees coming from Congress will actually make the health care system worse, not better.

Change for the sake of change is not necessarily good.

His position is a thoughtful one and doesn't mean that he has been bought off by anybody. If you see everything in black and white terms, you may have a problem with what he is saying.

But Wyden knows state-by-state or even regional public health insurance would be weak or powerless to reduce costs.
Sustainability? Medicare alone will break the bank in a decade -- as the former comptroller of the currency went around the country warning a couple of years ago.
That won't happen for about 10 years, which I guess is when Congress will finally do something.

I used to think of Wyden as the "peoples" Senator. On this issue, I'm afraid he has become the Insurance lobby's Senator. Give me a "peoples" candidate in the next Senatorial election, and we can let Wyden know how we feel about his change in philosophy. Spineless in the face of greenbacks - Gordon Smith (light) indeed.

"The first cost that has to be "controlled" is insurance company overhead. And if you don't think rationing is taking place right now"

Well, that's my point, we replace insurance comp overhead with govt worker overhead and insurance rationing with govt rationing. What's the gain?

I still think (I am going to get Dean's book) focusing on costs should be the first step in any of these deals.

we replace insurance comp overhead with govt worker overhead and insurance rationing with govt rationing. What's the gain?

Government overhead will be a lot cheaper. It won't include shareholder profit or massive compensation packages for somebody's nephew who gets named CEO.

Ah the Health Reform debate. It is a needed tumult that continues to skirt our painful and true issues. I wish to add my 626,400 cents worth. This is my annual Kaiser premium as a single 57 year old male.

Having been born we will all die. However we would like to have a quality of life that, tempered by our genetic potential, allows us the highest degree of connectedness to people and the natural world that is reasonable. In the health care industry we have costs and sources of funds. In our collective health care requests for service we, as consumers each with a certain level of denial, have set a path of 9% annual increases in health care costs. This is more than twice wage inflation so is thus untenable.

Costs:
• Insurance industry overhead & profit
• Capitalized cost of all of the physical plant, medical devices & supplies
• Drug industry costs, overhead & profit
• Wage cost of salaried health care workers
• Fee for procedure payments to physicians
• Physician group overhead & profit
• Liability costs

Sources of Income:
• Payments by individuals for; insurance premiums & co-pays, drugs or any other medical bills
• Payments by employers for; insurance premiums or any other medical bills
• Payments by all government entities, much of which is borrowed money
• Insurance industry investment returns

The Kaiser model, an HMO with an extensive physical plant and trained staff, gives us some direction towards a solution. At Kaiser the gatekeeper, in most cases, is the primary care physician whom has a patient load of about 1,500. These physicians are paid a salary and a potential capitation bonus if the costs for their patient load are less than some set maximum. Drugs, generic preferred, must come from a set list or the physician has to petition a committee. The main drug dispensary is a highly automated industrial plant. At this dispensary managers not only buy generic drugs in bulk but they also seek out the lowest cost supplier of each generic drug. They also stock name brand drugs as needed. Using a corner drug store is so 1950’s.

In the Kaiser model only certain procedures are covered, thus there is inherent rationing of low cost/benefit treatment options. Also in this model there are fixed covered lifetime cost limits for individual in the range of $1,000,000.

Should a highly trained neurosurgeon make $900,000 per year? No. The bills being debated in congress might reduce that figure to $750,000. I assure you that the family unit relying on this Portland physician will have an adequate lifestyle on $250,000, which is more than five times larger than the Portland median family income.

Should an underemployed person or their partner or child present on a gurney at the ER from a cardiac event caused by untreated hypertension? No. We, the US citizens, collectively have 305,000,000 beating hearts, 610,000,000 kidneys, etc. When there is a problem we will collectively pay the bill. Lack of preventative care for the uninsured is the primary cause of our low shockingly low ranking against other industrialized countries.

I welcome other rational and constructive suggestions to address cost reduction and fair apportionment of such costs.

"Government overhead will be a lot cheaper."

Sorry, I'm going to have to disagree, compare FedEx/UPS to USPS for a start.

As far as nepotism, you don't need to go further than Portland to see who is on the short list of all the city money.

I've said it before and I will say it again:
To make whatever plan work, everyone including all the folks in the Senate and Congress must have the same plan. Otherwise they are just a bunch of slimey hypocrites.

Kathe, the slime and the hypocrisy aren't going away no matter what they do. But forcing people who are currently insured (with all kinds of different plans) onto a single government plan just isn't politically feasible. So I guess you vote for the status quo?

Government overhead won't be cheaper if you have morons like Sam and Randy running the show. Do you really think you want a public healthcare system with a clown like Randy in charge?

At least with multiple private insurance companies in the system you have some ability to switch vendors if one of them isn't working. But with a single payer system there is nowhere else to go. That works fine if it is perfectly managed but if you put idiots in charge then it is basically hell. A quick visit to the old Soviet Union shows you what happens when a government monopoly is combined with idiots. (Or just visit the Portland planning department.)

Great argument andy, but neither plan under consideration is single payer - that aint happ-in-nin yet. The public option is a must, along with necessary regulation preventing refusal of coverage for pre-existing conditions. There are many upper income individuals who will simply continue with their pricey plans. There will also be private supplements to the public plan. (overpriced coverage for a 20% co-pay) The trough will remain, but just a bit smaller. Trust me the insurance industry won't starve. Public/private competition is not socialism, so hang that moniker on something else.

"No health care for fat you" as Darrelplant posted has a solution on page 1095 in Obama's plan.

There's a Cap&Trade provision in the plan whereby a fat you can trade your obesity with a skinny guy. Their skinnyness reduces their premiums and is added to the fatties.

There's still Hope for BlueOregon.