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Quoting DXing (Reply 49): If Congress was a rubber stamp for him why was Social Security not privatized?

Because, out of all those issues you brought up, there were enough what you would call RINOs that were convinced by their own constituants and Dems, those were very, very bad ideas. However, how many "emergency" war funding bills passed and how did Patriot Act get passed? Patriot Act was passed the first time on fear. The reason this country is trillions of dollars in debt because of all of the "emergency" war funding was thanks to the Republican Congress in the majority for six years. THAT was what I was referring to.

Quoting Seb146 (Reply 50): The reason this country is trillions of dollars in debt because of all of the "emergency" war funding was thanks to the Republican Congress in the majority for six years. THAT was what I was referring to.

???? The country was trillions of dollars in debt prior to Iraq. Iraq has cost but a pittance of all the social spending enacted by liberal democratic Congresses prior to 1994. Now, with 60 seats the Democrats can go back to their free spending days as we are witnessing with the health care debacle.

Quoting DXing (Thread starter): No longer can they use the excuse that the GOP is "being obstructionist". They don't need the GOP anymore so if they truly believe in cap and trade, socialized medicine, passing even more restrictive hate crime legislation, gun control legislation, windfall profit taxes on oil companies, immigration reform, then this is their chance to push that legislation on through. In addition there should be no stopping the recesinding of "Don't ask Don't tell", the defense of marriage act, no child left behind, heck they could quash the NAFTA treaty if they wished. And let's not forget judicial nominees. There shouldn't be any thing slowing down their nomination and confirmation. Virtually every bench vacancy should be filled in record time. There is nothing and no one that can put the brakes on, no procedural vote can stand in their way. So let's get to it Democrats. Put your money where your mouth is. You've been saying for years that these things are what the public really wants and only if the GOP would get out of the way you could turn this country into a modern day Nirvana. You don't have have that excuse to fall back on anymore. Time to get to work.

Haven't you watched ABCCNNNBCBS lately ? It is the GOPs' fault and will always be. They need two Americas' to keep the hate going. They all proclaim how wonderful the Emperors' clothes are, no matter that they really don't see any thing. Just wait till the money is gone and/or worthless.

Quoting Seb146 (Reply 48): We do not have one supreme ruler.

You were correct...

Quoting Seb146 (Reply 48): Except for six years of Bush, we do not have rubber stamps for passing laws.

...until you got carried away with this.

Quoting DXing (Reply 49): medicare reform.

It did happen. It's called part D, the prescription benefit, and it's one of the most expensive entitlement programs passed in recent history. It was also passed in a form that denied the federal government the ability to negotiate with drug companies to keep prices down. The Republicans were definitely looking out for the pharmaceutical companies on the latter point.

Quoting Lowrider (Reply 45): The Constitution means exactly what it says using the accepted definitions from the time when the words were set down. Occasionally, we have wanted to change what it says, so we go through the amendment process. Tortured interpretations are nothing more than a mechanism to try to circumvent this process.

Amen brother

Quoting Seb146 (Reply 48): Except for six years of Bush, we do not have rubber stamps for passing laws.

Once again Bush and the GOP never had 60 seats in the Senate in which they could kill a fillibuster by the opposition. So everything that passed did so with the help of Democrats. Nothing can be rubberstamped without a fillibuster proof majority.

Quoting Dvk (Reply 54): It did happen. It's called part D, the prescription benefit, and it's one of the most expensive entitlement programs passed in recent history. It was also passed in a form that denied the federal government the ability to negotiate with drug companies to keep prices down. The Republicans were definitely looking out for the pharmaceutical companies on the latter point.

Perhaps you need to do a little reading. Medicare part D is the Prescription Drug Benefit. That did nothing to reform parts A and B. BTW, part D is now projected to cost much less than originally envisioned, then scare tacticed by the left. That has never been true with parts A and B where the government does attempt to negotiate/freeze prices. Seniors that have signed up for part D poll that they are satisfied with it. The donut hole issue needs to be addressed but that affects a relative few in comparison to the program as a whole. Again, no excuses for the Democratic party here. Whatever plan they foist upon the general public, they own it.

Quoting DXing (Reply 56): Perhaps you need to do a little reading

No. I'm a physician, and I have dealt with Medicare EVERY day for nearly 25 years. I know more about it than you will ever know. Part D WAS a reform, and it directly affected part B, the outpatient coverage portion of Medicare, very much. Many of the part D plans are tied to choosing a particular part B plan, in fact, because many part B plans are now, in effect, HMO's. Medicaid successfully negotiates drug prices on a state by state basis, and there is no reason Medicare shouldn't be allowed to do the same, because it would decrease the cost of the part D program.

Quoting Dvk (Reply 57): No. I'm a physician, and I have dealt with Medicare EVERY day for nearly 25 years.

My apologies, I should have checked, However this is a political decision, not a medical one, and as such you should know that better than anyone.

Part D was enacted to lower prescription drug prices. Unlike Parts A and B the Federal government does not negotiate the prices. It has done this with financially stunning sucess. There can be no argument about that based on its original projected cost. When was the last time parts A and B did that?

Quoting Dvk (Reply 57): Medicaid successfully negotiates drug prices on a state by state basis, and there is no reason Medicare shouldn't be allowed to do the same, because it would decrease the cost of the part D program.

??? I would have to disagree. Costs of part D have dropped every year. There are currently over 1800 different part D plans to choose from. That is what is helping to keep costs down. Medicaid costs have risen every year since its inception. That is also not what is being legislated in Washington and no matter how much the GOP points to the sucesses of part D, and how if some simple reform were done to insurance regulations as well as tort reform prices would drop, it's not going to happen. Instead, while part D is voluntary and enjoyed by the majority of of subscribers, the Obama plan will force individuals to purchase health care and will institute a Federal government plan which will end up having all the financial drawbacks of medicare parts A and B. You, as an MD, ought to be able to see that train coming down the track. You would also have to explain to some satisfaction why it is that more and more physicians are refusing to accept new medicare patients. Seems it's the same old problem (no pun intended), too many patients, not enough money. And yet we are told that President Obama's plan will cover everyone and some how costs will go down. That is not the track record of medicare and medicaid which are nothing if not trial national health care programs. The only part that has worked to reduce cost is part D and that's because the federal government is kept out of the price loop.

http://www.usatoday.com/news/health/2001-02-19-medicare.htm

Nationalized health care legislation will be a democratic party owned piece of legislation. The White House chief of staff and the Presidents advisors can claim bipartianship all they want with some procedural amendments being added to the bill, but the vote will tell the tale.

Quoting DXing (Reply 58): Part D was enacted to lower prescription drug prices

Part D was enacted to lower Rx prices for the patient only. The patient pays a variable co-pay, but the actual cost of the drug is not lowered significantly. The plan pays the rest of the expense. When or if someone reaches the donut hole, it is based on the true prices of the meds the pt has bought, not on their co-pays. The only reason relatively few patients reach the donut hole is because most of them are taking mostly generic drugs. Guess what? They were already taking mostly generic drugs before part D was enacted because they couldn't afford brand name meds anyway. Part D has still been tremendously expensive to taxpayers, regardless of how you look at the statistics. Comparing part D's "stunning success" with parts A and B is like comparing apples and oranges, to a large extent, because part D covers a single item.

Your argument that the huge number of part D plans is keeping prices down is flawed, as well. Each state has a much smaller pool of plans from which to choose, yet the nearly universal agreement among both government and health care professionals is that there are far too many plans, which has actually led to an unwieldy system in which most patients find it extremely difficult to determine which plan is best for them. In fact, the total number of part D plans has been decreased, but not enough. The large number of plans has also created an absolute nightmare for health care providers, who cannot possibly know the regularly changing covered meds for each program in their state. This has created a horrible burden of extra labor and wasted time for providers who serve Medicare patients. In the beginning, one could access any part D plan via Epocrates.com, so things were a little easier. Now, there is no unified, user-friendly, easily accessible site to access all the plans because many of them tried to make Epocrates pay to publish their formularies, which Epocrates refused. It becomes a time-wasting guessing game because the part D plans usually just reject a Rx for an uncovered drug, without the courtesy of informing the pharmacy or provider what similar drug is covered. I favor part D, because it does provide greater access to medications (those that DON'T have generic equivalents), but its current version is not the Utopia you have claimed.

By the way, Medicare sets the national standard by which other insurers are measured. Private health plans would provide much less coverage and get away with much more in terms of the dreaded "preexisting conditions" as an excuse for denial of coverage without something else to set the benchmarks.

Perhaps the most basic point you miss in all of this is that Medicare and Medicaid cover the sickest populations in society: the old, the disabled, and the socioeconomically disadvantaged, who have many more health problems per person than the private insurer population. There is no fair way to condemn the federal programs compared with private insurers, because the federal programs cover MUCH sicker patients. Did you know that any patient who has to go on chronic dialysis automatically qualifies for Medicare, regardless of age? That is a HUGE cost to the program--one that most private insurers barely deal with by comparison.

By the way, Medicare part B is not mandatory for all Medicare patients. Many have part A only.

Why do an increasing number of MD's not accept Medicare patients? It's not as simple as you think. The increasing number of patients in Medicare part B HMO's with capped payments is one contributor. The much higher level of illness of Medicare patients is a major contributor. In the standard 15 minute follow-up visit, it is nearly impossible to address all the needs of a Medicare patient with a half dozen or more chronic problems plus one or more acute complaints. The incremental pay increase based on complexity of visit is not enough to make up for what an MD can make by seeing more comparatively healthy, insured patients during those 15 minute slots.

Nobody in Washington has put a serious proposal for Medicare A and B reform out there in recent years. The only "reform" that has gotten anywhere has been annual budgets proposing cuts in reimbursement. In its rare displays of bipartisanship, Congress has wisely rejected these cuts every year.

Private insurers have a lot wrong with them, too. There's a big reason that a crisis is looming in primary care medicine. Compensation is inadequate universally for the complex level of comprehensive care primary care MD's are expected to provide. The private insurers don't reimburse primary care MD's all that well, either. That's why so few graduating medical students choose primary care now. They see during their clinical rotations how much garbage a primary care provider puts up with for a comparatively much smaller paycheck. When the primary care MD's of my generation start retiring in large numbers, which will be fairly soon, access to a primary care MD will be MUCH more difficult in the US.

Despite the AMA's recently expressed reservations about the universal coverage proposals, most surveys of physicians have shown a great majority favoring some form of universal coverage for at least twenty years. A lot of us who have seen the crisis of the uninsured extensively know that universal coverage is going to have to come at some point. Most of us know, as well, that without a strong input from the federal government to force the necessary changes, universal coverage will never occur. The insurance companies and lobby are far too powerful and completely profit-driven, and they will never cooperate with reform without a strong edict from Washington. You may not like it, but it's the simple truth.