[e digicons]:karma:[/e]  

That's one of the biggest problems right now.  People don't see beyond his teleprompter reading abilities. 

Bill O'Reily asked a couple of his guest to grade Obama's speech. I gave him a C, he spoke good, threw a bone at the Republicans but failed to convince me to approve of "his" idea of reform. He did point out some of the problems that everyone agree's exist. What he failed the most was in trying to find a bipartisan way to resolve it. It's one thing to be open for ideas, it's another to actaully take them into consideration.

Tova,

You raise good questions! I too am always a fan of the nuts and bolts details vs rhetoric. With that said, I'm sure for the president to jump into technical details on the air would have extended his speech quite a bit and taken some of the "oomph" out of it (we are in the age of the 30 second sound byte now, aint it grand?) And I'm sure that the bill will still have more changes done to it before it passes, the millions of dollars in campaign contributions from the medical industry will see to it I'm sure. But you are absolutely right in that it's best to wait for the main course before deciding how

With that said, the only thing I would really like to comment on is this;

I've learned that the term "non-profit" encompasses an extremely wide range of organizations- many are true to the name but many are predatory or even borderline fraudulent. The reasoning behind non-profit hospitals goes (and please do jump in and correct me if I'm wrong) that they still have to cover their operating costs- pay their doctors, nurses, administrators, pay the light bill, drug and materials costs, blah blah blah.

Because of this, that means they still have to take in money from paying customers. So, that means that only a certain percentage of patients they see don't have to pay, or pay very little. This means that some organizations will only see the absolute bare minimum number of patients at little or no charge to fall into the "non-profit" category, or even fudge the numbers, or only decide that patients who come in with a superficial cut or sprain will be seen at no charge while anyone with a more serious and more expensive condition will pay.  A lot of "non-profits" actually do turn a profit, but they can't technically declare it as such. So, with the surplus money they bring in they use to open up another "non-profit" hospital or find a way through tax write-offs or inflated payrolls to essentially, funnel the actual profits in such a way that they can make it look like they're barely breaking even.

And then, there are non-profits that truly are exactly that and should be commended for their selfless contribution to society and humanity in general. The problem then becomes, how can you tell who is doing the right thing and who is playing the system?

As with the banking meltdown, Enron, mortgage fiasco, health insurance giants who drop coverage to those who need it when it hurts profits and so forth, it is evident that in an unregulated marketplace those who can abuse the system, will. So, when Obama says that much will be turned over to non-profit hospitals, the question then is raised as to what KIND of non-profits will they be and who will be making sure they play fair?

I wanted to link to the raw data/questions I found last night but today I can't find it.  The actual Census 2000 (long form) doesn't specificially ask about health insurance.  What I looked at was actually raw data from the CPS.   

"The Annual Social and Economic Supplement (ASEC) to the Current

Population Survey (CPS) asks about health insurance coverage in the previous calendar year. The survey asks separate questions about the major types of health insurance, and people who answer “no” to each of the coverage questions are then asked to verify that they were, in fact, not covered by any type of health insurance. For reporting purposes, the Census Bureau broadly classifies health insurance coverage as private coverage or government coverage."

http://www.census.gov/Press-Release/www/releases/archives/health_care_insurance/000525.html

http://www.census.gov/sipp/index.html

http://www.census.gov/prod/2008pubs/p60-235.pdf

Sorry for any confusion.  I actually found the supplement questions/raw data from taking several links off the census website.

There was a lot to wade through, but in short, they found the original methodology associated with the 2000 census for uncovering the # of people uninsured was faulty. 

Just one quick note, I believe when he mentioned the 30 million, he said American citizens which wouldn't count illegal immigrants.  That's probably the cause behind the discrepancy.

Arty -

'Not-for-profit' is the correct and more accurate terminology, at least in health care facilities.  That's not to say that such organizations must not have any money left over from operations at the end of the year to qualify as such.  To endure, they must accumulate reserves over time from which to retire startup debt and to fund capital improvements and facilities upgrades.  Those reserves come from net 'revenue' on operations (if it's not negative) and charitable contributions.  Nowadays, grants get tossed in to the mix as well.

They don't have 'investors' expecting returns, which simply means that all of any such 'profits' as they make can be plowed back in to meeting their capital and service improvement needs.  They are exempt from certain taxes, in return for which a certain amount of pro bono care is expected.  There are other 'expectations' tied to external community needs & involvement as well, not involving direct patient services.  Almost without exception, meeting the needs of the communities they serve is the sole reason for their existence.  Some have, at times, been victimized by self-aggrandizing megalomaniacs insufficiently controlled by Boards of Directors, diverting focus from the community mission to empire-building.  Fortunately, that has been the exception and limited by appropriate watchdog activities of regulators & the press.

There are, without question, countless 'charitable' organizations which are more cash cows for the founders than charitable, but not so much in provision of health care.  There's really no 'payoff' in health care not-for-profits 'playing the system.'  That concept ('playing the system') also belies one of the ironies here.  There has to be a 'system' before someone can 'play' it.  And the difference between 'competitive compensation' to attract quality employees and 'padding the payroll' inevitably boils down to a difference in political point of view.

Once all healthcare facilities are 100% dependent on federal dollars for survival (charities will move their focus - why give money to something that's fully taxpayer funded?), you'll see a whole new set of behaviors focused on 'getting fair share.'  UHC will not solve the problem, to the extent there currently is one, of 'playing the system' - it will do just the opposite, making 'playing the system' the primary activity, health care being what you do after you've managed to 'play' it.

I agree.  He's trying to create/maintain the fiction that they won't be covered, by using that number rather than the one he's been pounding to death all along.  Like all magicians, he's trying to subtly distract us.  Fortunately, most of us understand that 'magic' and reality are two different things.

A very progressive friend of mine from college pointed me toward this article from the wall street journal which essentially outlines exactly what you assert here.

http://www.wsbt.com/news/consumer/17296354.html

How can you tell?  There are protocols in place with the IRS to flag/penalize offenders.

The reality is, the wording of the law is so vague there is a LOT of wiggle room.  Nonprofits by law are prohibited from distributing surplus revenues to individuals.  That’s it.  And anyone who can define their organization as in the “public’s good” can be given 501(c)(3) status (tax exempt).

It doesn’t matter what I (a citizen) believes is the intent of the law.  What matters is how our gov and courts interpret it.  And its all so vague...well, wiggle room.

Gov wrote the law and monitors the non-profits.  These organizations (which are allegedly corrupt) stay in business for one of two reasons.  Either the gov understands the problem and is ok with it, or the gov has no idea how to fix it.

People can get angry at non-profits all they want but in many cases they are not breaking the law, they are operating within the boundaries set by the gov.  I submit the beef should be with the gov.

We’ve already established the gov is either complicit or incompetent when it comes to non-profits operating outside of the intent of the law.  We also know the gov admits to extensive waste and abuse in the two other medical systems it manages.

I don’t know if any organization is up to the task frankly since there seems to be corruption everywhere humans actually manage....heh. 

Ironically……..most large non-profits are run by public administrators.  Meaning they acquire the same degrees and certificates as public managers/administrators that work in local/state/fed gov.  Running the FDA and running a large not for profit hospital…as far as education and legislative/policy experience go… is pretty much the same.  In short, these professionals are all coming out of the same bureaucratic pool.

I think it would be a WHOLE lot easier to try and address it locally first.  Give people tax credits and breaks, let them cross state lines, maybe use people's tax returns to do things like set up health savings plans, open clinics like here in Dayton (AND ADVERTISE THEM!)

The Dayton Daily News TODAY has a story on the front page about a man in Washington Township.  The man thinks he has cancer again and no insurance so he can’t be treated.

Except he can and based solely on his income at one of several local not for profit clinics.

If I were cynical I might believe the DDN first paged that story because they want to support Obama and its dramatic.

If I give them the benefit of the doubt, I might believe they don’t know about the vast array of free services and clinics available in the city.  (Which is likely since the paper is no longer even located in the city.)

More likely it was both.  But in the end that man will want Obama’s plan because he is not informed about what is available less than 10 miles from his own front door.

(When I asked an official about this lack of advertising I was told some law (maybe its just Ohio, I don’t know) says they can’t use any money for advertising.  And since these not for profits don’t have a good relationship with the media for whatever reason (mostly because they want free advertising is my guess) few people (usually those who seek some type of aid/welfare where this info is on tap at the front door...) know about them.

Now that is more information than you ever cared to read about Dayton I'm sure.  Heh.

That's irking me because last night I read the actual questions and today I can't find them.  It's fairly unusual to find the actual survey instrument so I was excited to find it.  I checked my history and it just took me to the aggregated data in the CPS site...

Oh well.

I think its safe to say, no one knows at this point how many uninsured AMERICANS there are.  haha.

Great explanation D.  It becomes even more complicated when you realize there is a distinction between public, private and not for profit hospitals.

Public means government owned and operated (about 17% of hospitals).  Private is self-explanatory (about 23% of hospitals), and not for profit (about 60%) is generally run by a board of directors and CEO/ staff.  They may or may not get gov grants, but if they do, there are generally mandates.

That's dumbing it down quite a bit, but its the jist.

I think people do, but it looks like "politics as usual" when it gets pointed out. 

I consider myself an American.  I thought George Bush spent like a drunken sailor....but Obama spends like a drunken sailor in the last stages of syphilis.

At this point Charles I really don't care where the ideas come from so long as they're good.....and economical.

And this is always the crux of the argument..... the idea that big government is woefully incompetent and inadequate. Now, in this case, yes, I agree with you one hundred percent. But it doesn't have to be that way. You know the massive recession you're experiencing in the States? It hit us here too in Canada but not nearly as hard. While the U.S banking system would have completely collapsed were it not for hundreds of billions of federal dollars and buyouts, the Canadian system pretty much weathered the storm with no major banks under any serious threat. The reason for this? Because in Canada our banking laws and regulations are much more stringent and 'boring' as we were mocked by the U.S. We kept much of the laws designed to prevent another great depression while the U.S did away with them in the late 90's in the name of unfettered markets and 'new paradigms' of economics. Oh what heady days!

Meanwhile, your SEC was asleep at the wheel while folks like Madoff "made-off" like bandits and bankers made up fictitious risk models for loans.

I also agree wholeheartedly with you Tova about the FDA, horribly, horribly mis-managed and in cahoots with the very industry they are supposed to regulate. A prime example of a key difference between our two countries is in the milk we drink.

In the U.S, dairy producers can use bovine growth hormone which can allow for up to 20% more milk production. Sounds great right? Well, in Canada this is banned, because the increased milk production meant larger than normal glands in the cows, which meant more infections and other health problems in the cows, which is counteracted with antibiotics.

So the difference? In the States you drink milk that now has

1) Antibiotics- not a good idea to give them to someone unless they actually need it, massive use means that bacteria has a much better chance to adapt and thus render it useless

2) Bovine growth hormone (long term effects on humans still TBD)

3) Pus- tests have shown that yes, pus is now getting into milk in much greater quantities and occurrence than that produced by cows without growth hormone.

Now in Canada, our equivalent of the FDA banned the use of bovine growth hormone outright. In the U.S, the FDA caved in to the demands of agro giant Monsanto.

So, to argue that -all- government run organizations are incompetent by default, is simply not true. If managed poorly, yes absolutely. If managed properly, then the reverse is true.

Again, the proof is in the pudding. Show me one survey in which the majority of Canadians, or Brits, or Australians, or Germans, or French, or Japanese citizens say they are unhappy with their government healthcare and would like a privatized system like the States?

Daiwa,

Thanks indeed for shedding more light on the issue. As a medical professional you absolutely have much more insight and knowledge of the inner workings and technicalities of your system than I could ever even dream of! And, I'll be the first to admit that my understanding of your nation's medical system is.... anecdotal... at best.

With that said, you mentioned that presently there is no "system" to be gamed and that government run healthcare would create something wherein the main goal would be to game the system as much as possible.

This is sort of true. However, with the right regulations and enforcement, "gaming the system" changes from an attempt to make as much money as possible while still staying in the boundaries set down as a "not for profit" and then make it look like you haven't made a lot of money so you can keep getting the tax breaks, into an attempt to get more doctors, more beds, more MRI machines and the like from a central source. End services that actually benefit people vs playing the numbers game.

There's all kinds of benefits. Drugs are much, much cheaper here because the government negotiates in bulk with the drug producers... they represent a single customer with 30 odd million users. Same for medical machinery, and so on.