Obamacare architect Ezekiel Emanuel (brother of Rahm) and Bill O'Reilly go at it in this contentious clip. They both have good points, and they both overstate their points, but healthcare is evolving, and some of it is devolving away from physicians.
Link
45 comments:
Pogo is dead please pick up the red courtesy phone.
Dear Pompous architects of government run health care - go die.
I watch a lot of British TV. The NHS seems to be the most hated and ridiculed institution in the country. So maybe now here in the U.S., Christians and conservatives will get pushed out of that spot in our culture.
By the time Obama is done waver-ing and delaying away with the ACA, we will end up with the system the Republicans were trying to push all along. Of course the billions spent on websites and pretending it was going to work the dumb way all this time is just lost.
Dammit, government is good at that shit. I mean, if you want to make a body or some hazardous waste disappear, just put it in a drum labeled "Tax Payer Money" and it will be gone without a trace in no time, with nobody knowing who was responsible. It's magical.
By
Betsy McCaughey
Updated Aug. 27, 2009 12:52 p.m. ET
Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.
Link.
He is the most arrogant little prick. He said the other day that health insurance companies are going away. Who does he think he and his librul brethen are to just destroy and do away with an entire industry?
Instead, how about if we get rid of all community organizers and public policy experts and lastly we shut down the Kennedy School of Government at Harvard?
Focusing on healthcare needs for the lower economic strata for a moment, letting NP's and PA's provide care is better than nothing.
I'm also in favor of "WalMart clinics" and devolving some routine care away from higher priced MD's. Insurance companies aren't fighting this either.
Tort reform and liability issues remain unsolved.
I agree that we don't need doctors involved in as much as we have in the past, and we can use creative ways to deliver care. These are all fine ideas, until you put the government in charge of it. Then it will turn to a maze of waste, fraud, corruption, and incompetence.
With my own health care, I wish the doctors were less involved frankly, because for most things I need, I usually know what needs done, but I have to get one to sign off on even the most minor stuff. They do too much clerical work now, and most of that is due to government regulation which I know we could use less of. A lot of what is wrong with our system is due to over-regulation. The approach should be to have private options that can get creative in meeting needs, limit liability so they will experiment, and give individuals the right to choose what they want to risk and spend.
Oh yea, and no health care for lawyers. I think that goes without saying, right?
I haven't seen a doctor in decades.
I got a tetanus shot in 1999 2006 and 2014 from an open-access nurse, once each time I get a new puppy.
Poop city with puppies.
I hate to agree with Emmanual on anything, but I do believe that you don't need a Doctor for everything. Gateway issues that are normally simple procedures or that are routine events don't necessarily need a doctor. A Physician's Assistant or NP can do many of those routine tasks, as long as they are also qualified to recognize when a Doctor or Specialist is needed.
Since we pay CASH for our medical treatment, no insurance, these things are routinely done by people other than the Doctor. Blood draws, pap smear and other female check up routines, sore throat cultures, minor scrapes and cuts, sprained but not broken body parts, even broken body parts that don't require setting of bones.
The costs of not using a full blown MD are much less and frankly, there are really many times that you don't need the Doctor and many times that if you just wait, the problem will, literally, heal itself.
But...when you DO need a doctor or specialist, it is vital that one be available in a short period of time. Waiting for months to see the cancer specialist can mean life or death. Waiting because you have an owie on your finger or a wart on your foot....not so important.
What he said about using NP's and PA's is not a new idea or original thought or bold thinking.
That has been accepted for quite a while for many ailments and treatments so I am not faulting the little prick for that.
My company had a rather extensive medical office with clinics at all locations. Physician Assistants manned the satellite offices with Doctors coming in a couple of days a week. Loved the PAs. They could diagnose and prescribe for strep, flu, ear infections....Very handy. Mole patrols, shots .... I never felt underserved by these not-doctors.
I have several issues with Ezekiel Emmanuel.
First, he favors a single payor, government run healthcare system. I prefer the free market, with reduced governmental involvement.
Second, he favors limiting the care provided to those who have serious diseases. He wants the government to make the live/die decision. I believe that decision is not the government's to make.
Third, he hates insurance companies and hopes they are put out of business. I believe that competitive insurers are more cost efficient than the government, and that the government should butt out of the healthcare insurance business.
Fourth, he's probably a Bears fan.
@Haz: Your 4th reason carries a lot of weight. Think TY's love for the Pack. :)
The issue is not whether MDs are or are not needed for this or that. it's not about healthcare 'evolving' or 'teams' or any other blah blah blah.
Ezekiel Emanuel is just changing the subject.
What he is not telling you is that he will choose what you get.
He will decide.
Choice.
That is the main problem.
Who decides?
Ezekiel Emanuel, that's who.
He knows better than you what you need.
And it will never be your choice again if he has his way.
That's not fair chickie. I give the Pack all the respect that they deserve.
I even posted that photo of Michael Haz and Garage Mahal at the last Giants vs. Packers game.
What could be fairer than that?
Zeke Emanuel would have been right at home at Wannsee.
O'Reilly's incredibly ignorant. Most physician practices you go to for an ear infection or strep throat already had PAs and NPs staffing them who would be as likely to see you. It's been that way since the 1990s.
They do too much clerical work now, and most of that is due to government regulation which I know we could use less of.
Baloney. It's due to fear of lawsuits, which have existed before the American government did.
Obama offered Republicans a proposal to limit tort damages when physicians follow their own best practice guidelines. And the Republicans, those same Republicans claiming that limiting the lawsuit damages responsible for 1% of health care cost increases was such an important priority for the American consumer, those Republicans, what did they do?
They balked.
They're not serious. Never were. Everything they've said about all this was always just for political effect. Or as Reilly says, "fear". Which for him and people who think like him, is all the politics they need.
At least a more serious conversation is harder for them to avoid now.
The issue is not whether MDs are or are not needed for this or that. it's not about healthcare 'evolving' or 'teams' or any other blah blah blah.
Ezekiel Emanuel is just changing the subject.
No he's not. He's addressing the exact points that O'Reilly freaked out about. If they were off-topic then you need to blame Mr. Fear O'Really for changing the subject.
What he is not telling you is that he will choose what you get.
He will decide.
Choice.
That is the main problem.
Who decides?
Ezekiel Emanuel, that's who.
He knows better than you what you need.
And it will never be your choice again if he has his way.
This manifesto makes for a great pretension to ignoring the fact that you were never in control of your health care decisions ever since the AMA forced managed care upon us 25 years ago. They just had big insurance companies rationing the care and removing choices.
But Pogo's ok with that because rich princes and O'Reilly's could claim that at least they were rich enough to buy their way out of the rationed market. Well, I'm sure they still will be now, also. No change.
I believe that competitive insurers are more cost efficient than the government, and that the government should butt out of the healthcare insurance business.
You can believe that all you want, but it's nonsense. And if you don't believe me, go try finding anyone over 65 who would prefer a private insurer to government Medicare. It won't happen. You should really look into it, though. We're all pretty close to being 65 one day. But I'm sure if Medicare spent as much as big insurance did on overhead, advertising and executive bonuses, they'd waste as much as the market did, also.
Interestingly enough, the ACA now mandates that 85% of your premium costs go to pay for actual care, rather than administration. We'll see how much Americans squeak and prattle about the effects of that.
You can believe that all you want, but it's nonsense. And if you don't believe me, go try finding anyone over 65 who would prefer a private insurer to government Medicare. It won't happen.
I am over 65 and insured under Medicare. I would GREATLY prefer having the private insurance I had before being required to join government insurance.
Tell me, how much overhead does the FedGov run in it's healthcare programs? As a percentage of claims paid, what is the overhead? No pulling a number out of your ass, cite an audited number. Audited, like non-governmental insurers are required to have.
I am over 65 and insured under Medicare. I would GREATLY prefer having the private insurance I had before being required to join government insurance.
You assume whatever "favors" they did for you before 65 is what they'd do for you after. Not very likely at all.
Tell me, how much overhead does the FedGov run in it's healthcare programs? As a percentage of claims paid, what is the overhead? No pulling a number out of your ass, cite an audited number. Audited, like non-governmental insurers are required to have.
I don't know. I guess it would be interesting to know if anyone could find it, but it's obviously secondary to the preference most seniors I talk to (you're the only exception I've met so far, and you're comparing it to care you got before age 65 - not a true comparison) actually have.
Why are we even argue if Medicare is a popular program, let alone a decent one? If it were unpopular Republicans would be trying to slash it left and right. But it's not so they don't. They don't touch it. They leave it alone. They saw Tea Party banners that said "Government out of my Medicare!" I think they listened.
All that said, I'm safely deducing their overhead/admin costs are less than the 15% that the private healthcare rationing industry is now limited to - or else they wouldn't have chosen that number.
Wow. Information and the ability to search the internet really is a liberal's best friend. Here's a Stanford Business School professor's numbers on the 3% administrative healthcare overhead of his school's own insurance program, the 1% that Medicare has, and the previous 30% norm of the private healthcare rationing industry.
Wow. That's pretty huge.
Come on. If you disagree then find me some other numbers and sources. But that is some whopping admission of failure on the private healthcare rationing (managed care) industry's part.
You assume whatever "favors" they did for you before 65 is what they'd do for you after. Not very likely at all.
Oh bullshit. This makes no sense alt all. Favors? Insurance operates on what is stated in the policy. My private insurance was better than Medicare.
I don't know
I guess it would be interesting to know if anyone could find it
Bingo! You believe everything you say as soon as you hear yourself making it up. Typical progressive. Spout the dogma, while the facts and other peoples' experience be dammed.
Is Stanford running Healthcre dot gov? No. Answer my question - what is the FedGov's overhead in healthcare?
Dinner time here, Ritmo.
He quoted it, Michael. And you said Medicare not "healthcare" (which I'm hoping you still mean and aren't trying to use weasel words. It was 1%. You can read the article, too. 1%. Here's the quote:
(Note that the overhead costs of Medicare are less than one-third as much at slightly less than 1 percent.)
Right there.
Enjoy your dinner.
My only other quibble though was your reliance on "policy" in the private rationing industry's contracts. We all know there are a million different forms of fine print around those. Let alone the booklets of operational details they used to publish to outline anything remotely resembling any policy more stable than a claims administrator's fiat before.
They were the ones complicating it. They were the ones bloating the costs. It wasn't the government doing that.
You believe everything you say as soon as you hear yourself making it up. Typical progressive. Spout the dogma, while the facts and other peoples' experience be dammed.
And this is not an appropriate thing to say either. Just because I don't remember everything (do you? does anyone?) doesn't mean that I can't remember a massive difference between two things. Just because I didn't have numbers doesn't mean I can't remember that the rationing industry massively over-administers compared to Medicare. (But as it stands, I was right that they do. By a factor of 30 to 1).
Not having footnotes on hand does not mean one is making them up. You saw how quickly I was able to internet-search the answer to what you contested.
R & B .... I am absolutely astounded at your apparent ignorance of how health works before Medicare and after you have no choice but take it. You cite several absurdities that are inapplicable to say 75% of situations coast to coast. And, mind you I am not complaining about my care under Medicare A & B plus a private HMO supplement.
BTW...anyone who says Federal Government health care/Medicare overhead is 1% is either a flat out liar or has never ever worked in federal government accounting.
I have.
I am not going to bother responding to anymore of this on this thread...you hijacked it with nonsense. I thought that was beneath you.
Final word...had I been treated in accord with Dr Immanuel's theory, for my issues of the past 2 years, I'd be dead now. Under stand that should I ever meet the man face to face he will find himself on the floor very suddenly. One of the very few people I'd cheer if he got run over, then backed over again, by a large bus. He is a killer hiding behind a charade as a doctor.
The business professor disagrees with you but thanks for entertaining me with the spectacle of stomping off with all your toys. And the droning on with lurid murder fantasies you while accusing others of being murderous sociopaths in the same breath is cute.
Most people have no idea who Emmanuel is. Make sure to extend your death wish to the millions of Americans who disagree with you.
I am not going to bother responding to anymore of this on this thread...you hijacked it with nonsense. I thought that was beneath you.
Well R&B loves to fight. I've gone a few rounds with him back the Althouse days.
I don't know where to take this thread.
Lem, that damn meat log ad keeps showing up under this post. LOL.
Most people have no idea who Emmanuel is.
This is true. And he's not a very good face of what's needed. I haven't read his book and don't intend to do so, but one thing that is apparent to any casual observer is that the changes were planned and implemented by a narrow cadre of experts. And the political selling was too partisan.
And the lack of uninsured new enrollees was entirely too predictable if a guy like me predicted it. BTW, I'm looking for that thread because Aridog and I were in complete agreement.
Almost 5 years now, Darrell Issa asked his Twitter followers for their input into the developing ACA. I tweeted him the following (which I've rearranged in reverse chronology:
The "big government" solution to healthcare costs would be to subsidize tuition for doctors and nurses ala post Sputnik funding of science education. This would lead, as it did for science, to a glut of very good talent practitioners, who would work just as hard. In the long run, this would not be a good thing as people would leave again as they did science careers. Also, scheme would have to be coupled with tort reform--as if that will ever happen.
Bruce B. @chickelit 14 May 2009
In retrospect, I see that I was addressing the physician shortage more than escalating costs. No wonder he ignored me.
Nobody wants to make the hard choices: Europe and the places we are seeking to emulate have comparable life expectancies, and yet, they get by without many things American take for granted: hospital birthing; hospital deaths; heroic end-of-life hail Mary intervention. Europe also piggybacks on us for drug discovery costs. Europe, notably Germany, doesn't have a huge uninsured immigrant cohort; if you don't sign onto their healthcare system, you don't get a visa. We tolerate the rule breaking because our corporate and business concerns want the labor. That is not the case over there.
Is that enough red meat for you R&B? :)
As I just said on another thread:
I am sick of this fucking place. I need to be gone for a while.
See ya.
The only professional journal I still read is "Chemical & Engineering News." I used to read "Science" when I had better access. "Science" Is America's premier science journal, akin to Britain's "Nature." I used to wonder and marvel at the editorials in "Science" which typically bemoaned the lack of science funding on the one hand and yet promoted ever increasing expansion of experimental science, viz., the big costly collider projects and space programs. There was absolutely no sense whatsoever that there should be limits on spending. And I see their point: when the quest is more and more excellence, it's hard to cut costs. This, quite frankly, is why science will one day move to Asia in a bigger, more meaningful way: they have the means.
British science went through a painful period of "austerity" (R&B's favorite bugaboo word) and yet, they still punch well above their weight. It's the damn social programs.
When money and value are unhinged (as they are in healthcare) it's no telling where we'll end up.
See ya later, Ari. I've never said anything remotely belligerent to you, ever. As Chickie understands, some discussions get contentious, but they don't have to get nasty-personal. As someone who's skirted that line before, I know haven't done it here. I simply quoted something widely understood and happened to trust a business professor's citation of that fact over a guy who just said "I said it and I know so believe it's true". Sorry, I don't think are convincing credentials.
I also don't think that:
"cheer(ing) if he got run over, then backed over again, by a large bus,"
can be construed as anything other than an expression of murder. Most people don't and can't survive being run over by a bus, let alone a large bus. Let alone repeating it. Hence, dreaming of unsurvivable (and gratuitously repetitive) scenarios is ipso facto a death wish.
Do you actually pay attention to what you write? How stupid do you think anyone here is?
Try to be more honest and less unhinged when you return. But then, I'm saying this to someone who thinks wishing people to be run over multiple times by a bus is friendly banter.
And for the record, telling someone to "ESAD" (eat shit and die) is also a death wish, technically at least.
My best wishes for your recovery and a sane return to civilization.
R&B - what I challenged you to do was this:
Tell me, how much overhead does the FedGov run in it's healthcare programs? As a percentage of claims paid, what is the overhead? No pulling a number out of your ass, cite an audited number. Audited, like non-governmental insurers are required to have.
What you did was find an article in Bloomburg Business News that (1) referred to overhead data that was 20 years old, and (2) offer the author's unaudited opinion regarding his employer, Stanford University.
Sorry, not close, and it leads me to believe that your belief the FedGov as being a more efficient manager of healthcare program overhead can't be proved. Now, you could believe that the FedGov runs its healthcare plans by passing through 97% to 99% of it's revenues to pay claims, that's your choice. But it's a folly to believe that. Just look at the inefficiencies of of cost in setting up the healthcare dot gov website alone as an example.
Michael - the article's from April 2013, not twenty years ago. That doesn't mean that he can't refer to old data or Stanford data. He could talk about his family poodle, too. The quote is still there, though. I already provided it:
"Note that the overhead costs of Medicare are less than one-third as much at slightly less than 1 percent."
Why did you neglect to address that? Again, he could even talk about the bar scene between Greedo and Han Solo in Star Wars. No reason to be distracted by what else is in there. The analysis of the government's overhead is right there: 1%.
Did you want other citations? I noticed you offered no opposing data. Don't you think that the person who wants his, (your) belief to be properly challenged that you might want to bring your own data about where all this supposedly wasteful, supposedly so-much-greater-than-1% overhead data, is?
I think you're just saying what a politician said. "Wasteful" is a word that doesn't have to be quantified if Newt Gingrich doesn't want it to be quantified.
It reminds me of when Senator Kyl said that 90% of Planned Parenthood's activities consist of abortions (as opposed to the 3% that it really does), to which he responded, upon inevitable challenge, by saying that his remark "was not intended to be a factual statement."
This works both ways, Michael. You know, you could actually try convincing me of where all this waste that you believe in exists. All you have to do is cite a statistic, a number, a percentage and a source of your own. And that way you'd be performing a two-fer: Providing actual evidence for your own belief and actually having a shot at convincing me (or anyone who prefers data) of the validity and persuasiveness of it.
Michael - Politifact states that Medicare's overhead is somewhere between 1.3% and a high of 2% if going by CBO whereas the privatized managed healthcare rationing industry's overhead is at least 5 times that.
Politifact.
How come you want so many cites for what I'm saying but you seem so content not to provide any cites for what you say in the opposite? I'm not even noting a number in your argument -- just a vague idea that it would beggar belief to believe otherwise, which is itself an appeal to belief, not to evidence.
At some point, shouldn't there be some limit to how incredulous we should choose to be about basic facts and sources? If government waste is an article of faith I suppose we must believe it's more wasteful than the private rationing industry. But again, I'm open to evidence as to the power with which you've chosen to believe this is true. I just need evidence of it.
If the private market would work better at covering more for less cost and higher quality, I'll go with that as the policy argument. But I'm approaching this non-ideologically and therefore can't just sign-off on the assertion that the government wastes more without so much as a quantity, a cite or a source.
Thanks -
The numbers cited by Barbara Boxer were flawed. For one, they were not controlled for the cost of fraud. And Medicare fraud is high.
According to the Office of Management and Budget, Medicare "improper payments" were $47.9 billion in 2010, on estimated total Medicare spending of $528 billion in 2010.
That's 9.1 percent, and when added to the Boxer number makes Medicare essential equal to private insurers in overhead. There's no advantage.
Here's a part of the Politifact article you didn't include:
Adjusted estimates for Medicare’s administrative costs cited by the Urban Institute, a think tank that does research on issues such as poverty and economics, range from 3.6 percent to 5 percent, rather than the 1.3 percent using the data in the trustees’ report.
Now look at the numbers. The range is more like 12.5% to 14.1% overhead for Medicare, versus 11% for private insurers.
R&B, we aren't going to settle this question here. But it is fair to say that FedGov is not the clear winner in the contest for low overhead in healthcare plan management.
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