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May 03, 2017



regarding the public option, it was also obama's preference.

see, common ground!

but it wasn't on offer. politically unachievable.

so, what we got was what we could get.

we are a mulish and stupid nation. we get what we ask for, nothing more or less.


This is not complicated.

- We want people with pre-existing conditions to get health insurance at below market price.

- Someone has to pay for that

- That someone is either the government, funded by taxation, or healthier people, by paying higher premiums.

Marty seems to want it to be paid for by unicorns. Which Republicans but not Democrats can persuade to stump up the cash.

The rational alternative would be to follow every other wealthy nation and abandon the whole concept of individuals paying the market price for health insurance. I'm not holding my breath.

What market price would that be?

Per Russell, we are indeed stupid and mulish.

never fear: the market will sort us out.

We, by which I mean they, are stupid because the mules' asses keep kicking themselves in the head:


I'm a muleskinner.


After the conference, Martha McSally, the cuck republican quoted in the article (yeah, right, cucko, the democrats made them hurry and get it done), rushed over to the white house to witness the signing of the religious freedom EO, held Mike Pence's hand and on her deeply chaffed knees at about eye level with Donald's dollar-sign belt buckle and with the furrowed brow of the deeply, convictionally righteous Dagny Taggart declared: "By our fucking Savior on Earth, Jesus Mother Fucking Christ, let's pigfuck more of our fellow fucking Americans, and get this motherfucking thing done!"

Have you noticed how republican filth never count bullet wounds as a non-covered pre-existing condition cover under unhealthy insurance schemes.

You know why?

Because they figure they will need that coverage before America gets done with them.

“I shouldn’t say this to our great gentleman and my friend from Australia, because you have better health care than we do.”

says Trump, about Australia's universal health care system, while talking up TrumpCare.

the man is a fncking moron.

Step right up! We've got yer generals, yer dictators .... everything!


I agree with trump. It would be cheaper to burn Bedminster, New Jersey to the ground than to ruin the great city of New York.

The American Christian Right, who up to now have had to host their mutual blowjobs with republican politicians at cheap motels on the edge of town, hands the offering plate to trump, who fingerfucks beauty queens with one hand and removes their IUDs with the other.

Some people need links to ignore:



That's a biased article, written from the conservative perspective, but it's very revealing about that perspective. Although Kentucky care is popular with Kentucky residents, said residents were stupid enough to elect a Republican governor who is now hell bent on screwing them over. Why? Apparently he thinks that Medicaid is a subsidy for bums who should be made to get off their lazy asses and work. He sees the acceptance by Kentucky of funding fro Medicaid as a burden. He actually is out of touch with reality enough to think that people can be "weaned" on to private insurance,as if people were just deciding not to have private insurance because they were somehow morally or intellectually defective and have to be carrot and sticked into doing the right think. The possibility that maybe they can't afford it does not seem to occur to him.

Off topic here, but does anyone else find it odd that this article from 538 doesn't mention that that Trump lost the popular vote and that France doesn't have something like the electoral college?

a lot of people seem to forget that trump lost the popular vote.

about 10 million more people voted against DJT than voted for him.

Well, maybe not ten million:

"The Democrat outpaced President-elect Donald Trump by almost 2.9 million votes, with 65,844,954 (48.2%) to his 62,979,879 (46.1%), according to revised and certified final election results from all 50 states and the District of Columbia."

It was only the third largest delta for an electoral college loser.

Actually it is ten, my bad, just not ten for Clinton. Reading comprehension fail.

Voted for Clinton and voted against Trump are not the same. There were other not-Trump candidates.

Or never mind.

I think it is interesting that more people voted against Clinton than voted for her, also. People forget that.

We should have a runoff.

but that doesn't stop the revolting lead-idiot from talking about his HISTORIC Electoral College Victory! the 46th-largest EC Victory of the 58 US Presidential elections!

such a great win.

Got the insurance summary of my son's recent medical care, these amounts are before the "Provider Discount" so what someone uninsured would owe:

9 days in hospital (2 diff visits): $120,400
Surgeons: $6,470
Radiology: $1,472
Pain Management: $2,145
Anesthesia + other: $8,348

Total: $138,835 (and not sure this is the complete detail of all charges)

For comparison, the "allowed amount" for the 9 days of hospitalization was $38,346.

Make of it what you will.

Pro Bono has it exactly right:

- We want people with pre-existing conditions to get health insurance at below market price.

- Someone has to pay for that

- That someone is either the government, funded by taxation, or healthier people, by paying higher premiums.

Arithmetic cannot be fooled, not even by a demented ideology.

People, OTOH, can be fooled. Not wanting to be fooled myself, I'd like to ask Marty: can you help me find your earliest comment in favor of the public option in the ObWi archive?


I can try.

TP, Here is an early one. Not very detailed but, still.


Read the Bill We will ensure that bills are debated and discussed in the public square by publishing the text online for at least three days before coming up for a vote in the House of Representatives. No more hiding legislative language from the minority party, opponents, and the public. Legislation should be understood by all interested parties before it is voted on.

Page 33 of the GOP's "Pledge To America"

We want people with pre-existing conditions to get health insurance at below market price.

So why is "market price" so much higher in the US than anywhere else in the world?

Not market price for insurance. Which, after all, has to reflect the cost of the medical care being insured for. But the cost of medical care itself?

TP, Here is another old thread that only proves that I have mellowed some with age but have not changed my position:



Thank you. That "Medicare Part E" discussion was an interesting blast from the past. (Haven't read through the 2nd link yet.) I still have to say: if you favor a "public option" and I favor a public option, it may still happen once the Republicans get their asses kicked out of power.


A nation of people with unhealthy habits (obesity, smoking, gun ownership, etc.) will likely require more units of medical service per capita than a similar nation with healthier habits. Even if the price per unit is the same in both places, the less-healthy nation will spend more of its income on "health care" -- assuming they each cover the same fraction of their population.

A nation which pays more per unit of medical service will spend more of its income on "health care" than an otherwise identical nation where prices are lower. If US anesthesiologists, frex, make 3 times what French ones do, you can expect that to contribute to higher costs in the US.

Combine the two effects -- more units of service bought, at a higher price per unit -- and you have a higher fraction of GDP going to "health care" instead of "entertainment" or "financial services" or any other not-health-care category of spending.

Add to that some amount of vigorish for insurance companies, and you're well on the way to explaining the mechanics of higher "health care spending" in the macro view. The ideology behind it all is harder to explain in any rational way.


We should have a runoff.

bring it.




and this:


And yet, Americans, as a class of human being, held to be exceptional by objective observers .... ourselves .... do their damndest to bend the medical cost curve downward by denying and preventing their fellow human beings safety, health, and medical care.

I think we have a character problem in this civilization.

Here's a photo shoot of the stinking, fucking American character:


A link illustrating my 5:02 pm comment:


Odd that denying safety, health, and medical care to a guy who has his leg torn off in an entirely preventable accident, if the chicken producers were run by your average empathetic 11-year old rather than by educated corporate chicken experts, only gets me cheaper chicken but not cheaper medical care if I ever my leg torn off.

This photograph was taken as these ilk responded to trump's remark that Marty at OBWI wanted the public option:


trump and the republican party won't host cinco da mayo at the White House. Instead, they hosted their supporters for lunch. Taco bowls optional:



Not everyone thinks it won't work.

Not everyone thinks it won't work.

Most of them admit to not having read it.

I wonder what this guy thinks about the GOP plan.

Take a look at this graph:
It's from the Count's 1st link in his 4:55 comment. It shows health care spending as a percentage of GDP from 1980 to 2013 for a bunch of countries.

Note that in 1980 the US was at the upper end of the range, but not an outlier: it was at 9% or so; the other countries were in the 5-9% range. Since then, the other countries have all drifted up in a somewhat tightening band; in 2013 they were all in the 8-11% range. Meanwhile the US galloped ahead to 17% or so.

I would purely love to hear both liberal and conservative hypotheses as to why the divergence and why 1980 might have got it going bigly.


Kathy Mcmorris Rogers is full of shit:



She has coverage under the FEHP, I mean, who knows, she probably voted for her and her kid to be on Obamacare when they made themselves martyrs against Obamacare, named as such by them because it invoked a well-known nigger's name. They also quit their cushy jobs in Washington D.C. and went to work with Burger King's coal mining division, which then laid them off because her son's health expenses broke the American rule of fucking Americans in favor of low wage/no health insurance Texans and third world labor.

The point is, before Medicare, I was on the FEHB and if I was a rationalist fucking republican, the first thing I'd do is get her subsidized kid off my plan because it was raising my insurance rates.

She can shop for insurance up my ass, where the private market tries to crawl every day.



Only trump can put a finer point on cleek's point above:


Not just Australia.


Pence must be neglecting his hand-job duties to the President.

trump and Putin weigh in on La Pen's account:


Both corrupt American and Russian conservatives have the support of their radical christian paymasters to put their righteous killers in power across the globe.

It's going to require nuking from space, don't you know?

Not everyone thinks it won't work.

she refers to 2 million people with pre-existing conditions.

2 million?

there are, apparently, almost 30M people with diabetes. that's just one disease.

her kid has downs syndrome. under the house bill, states can decide to let insurers charge whatever additional amount they like for pre-existing conditions. including downs syndrome.

devolve these decisions to the states and some folks will be ok, while others will simply die from preventable causes.

folks in MA will probably be sort of OK. other places less so.

other places less so.

The cruelty brigade controls gerrymandered Virginia. Maybe if we can convince people to vote D in gubernatorial election this year, we'll get the gerrymandering fixed by 2020. No luck for people who might be affected by whatever transpires in the meantime though, even assuming victory this year, which I'm cautiously hopeful about, given that the majority of Virginians are Democrats. I'm pretty sure, though, that the Russians and Republicans are onto the fact that VA is important, so I'm worried about hacking and interference.

Hate to be paranoid, but as the Count's link and other sources suggest, we're not safe.

Perhaps a partial explanation for healthcare cost:

William Baumol, whose famous economic theory explains the modern world, has died

Charles, that is one interesting link.


Baumol, who I will read when I get a chance, may underestimate the sheer malignity in human affairs, American-style.


Also, Russian state television:


The proper solution is obviously to have Mexico pay for US healthcare. Following the logic of some prominent GOPers, THE WALL is actually an important part of fighting the health crisis since it is all those illegals that carry lots of icky diseases into the US (leprosy etc.). And if THE WALL is huuuuuge enough, it will also keep the ZIKA mosquitos out. That could be a flaw though since ZIKA babies are natural GOP voters (in two decades only, therefore less relevant now).

A helpful service if anyone needs it:


If you can get the current addresses of the cowards:


An armed society makes republicans go into hiding.

good news everybody!

it turns out we've been thinking about this health care thing all wrong!

"Nobody dies because they don't have access to health care."

problem solved by it not being a problem in the first place!

What I find particularly irritating/distressing is the frequency with which comments like this turn up. That is, people saying things which are so utterly ridiculous that it seems like they have to be intended as over-the-top parody. Except the speaker turns out to be entirely serious. Nutty as a fruitcake, of course, but serious.

Ryan's press secretary, saying they scored the AHCA twice.


Lovely people leading the country.

Just to be completely clear, by the previous comment I meant the lawmaker quoted, and not cleek.

Ugh, they scored something with that name. Does that not count, even though the content (which creates the score) has drastically changed? Who knew?

Wj - The sad (pathetic?) thing is that is exactly the poor fourth grade game she was playing. So why would the press trust anything she says anymore? How does that help Ryan do his job?

Maybe she previously got reamed out for making Spicer look bad by comparison? It could have been just a correction.


Sorry, private message to the Count: Please watch this. Please, oh please.


Ryan's press secretary, saying they scored the AHCA twice.

tough crowd in that comment thread

Watched the whole thing. Thanks, Sapient.

Yeah, thanks for sharing, sapient. That was cool.

Total: $138,835 (and not sure this is the complete detail of all charges)... For comparison, the "allowed amount" for the 9 days of hospitalization was $38,346.

This is roughly consistent with advice given to me by a friend who worked in a hospital business office for a few years. What he told me was, in the event I was ever uninsured and faced with a large hospital bill, to go to the business office and speak to the manager. Not to anyone lower than the manager, because they're not authorized to cut deals. Offer 25% of the bill total in cash (or certified check, or whatever), in exchange for marking the bill "Paid in Full." He said the manager will take it -- or offer you a deal close to that -- because 25% is the most that a debt collector will pay them.

Insurers get the same deal because they're good for the payment.

More places are opening, like the Surgery Center of Oklahoma, that perform procedures for published prices payed in advanced. No insurance, Medicaid, Medicare, etc. accepted.

Glad you liked it!!

Yup, it was great sapient.

I didn't realize when I posted it that it won an Academy Award for best documentary in 1987. Sorry to derail the thread, but I enjoyed it immensely, and am glad that others here watched!

Offer 25% of the bill total in cash (or certified check, or whatever), in exchange for marking the bill "Paid in Full."

if I follow it all correctly, which might not be so, the total charges minus the allowed amount is about $100k.

25% of that is $25k.

how many people can put their hands on $25k in cash?

No insurance, Medicaid, Medicare, etc. accepted.

concierge GP practices are doing well, too.

we have the best medical care in the world if you have the do-re-mi.

Even though patients have to pay for procedures up front, they can file insurance claims after the fact. Sometimes, when insurers pay predetermined amounts for a procedure, the claim payment can be more than the procedure cost.

Traditioanl GOP health insurance, in a 2017 world: "Okay, I'm delivering 25,000 live chickens if you mark this bill'Paid in Full'. No? Okay, TEN live chickens, and that's my last offer. OKAY, we have a deal."

Even though patients have to pay for procedures up front, they can file insurance claims after the fact

pacemaker placement is a little over $10k. even something like a carpal tunnel release is $2750.

half the people in the us half less than $1k in the bank. saving for a new set of tires would stretch their household budget. fronting $5k or $10k for a surgical procedure is about as realistic as a trip to mars.

maybe they could crowd-source it.

there are ways to address this, most or all of which involve public intervention. we won't pursue them because we think relying on public means represents some kind of moral failure.

for some stuff, anyway, other stuff less so.

my opinion about this stuff is that no significant or permanent progress will be made until the folks who buy into the whole "evil nanny state" crap get to marinate in the world they prefer for a while and figure it out for themselves.

it's been not quite 40 years since Reagan's nine scariest words showed up on the scene. stuff like social security, medicare, medicaid, tanf are still with us, the greedy creeps who won't rest until they get every freaking dime haven't managed to tear down every last legacy of the mid 20th C. environment. God knows they've tried, it's just taking a while.

when people start losing that stuff, or when all the folks who think they're safe because they have insurance through work or yhink their jobs are, somehow, semi-secure start seeing all that chipped away, it will begin to dawn on them that they've been rogered.

all the crap they were happy to see land on other people heads is going to land on theirs.

my guess is that one in three or one in four will figure it out. hopefully that will be enough to tip it back.

otherwise, we will become a second rate banana republic. with really good guns.

good luck everyone!

maybe they could crowd-source it.

Possibly successfully in many cases. Except for the little difficulty that, in most cases, the folks who have the need have never even heard of "crowd-sourcing." Let alone having any idea how to go about it.

I know a lot of people who don't have insurance and have never had insurance. mostly self-employed musicians.

I probsbly get 2 or 3 requests a month to contribute to crowd funding efforts for medical expenses for these folks.

stroke rehab, replacement of teeth lost to untreated diabetes, surgeries of all kinds. money for families when people die.

it's an approach. works OK if you have 100 friends who can each afford to kick in $50, and if you aren't unlucky enough to be the third person they know to need help that week.

stuff like... tanf are still with us

Yeah, but TANF is a whole lot more restrictive than AFDC, the program that TANF replaced in 1997: block grants rather than entitlement, 60 months lifetime cap on benefits (with some exceptions), ability to shift money into state legislatures' pet projects, etc. WRT the last one, the NCSL maintains a database that tracks things TANF dollars have been spent on and the statutory language that the feds found acceptable. Nationally, something less than a quarter of block grants plus state maintenance of effort dollars are spent on direct cash assistance.

I don't know if any of you are still interested in this story, the ongoing investigation the Observer and Carole Cadwalladr have been carrying out into the whole Brexit/Trump/Mercer situation, but they are continuing to burrow away, and finding out more and more important things. On the offchance, I attach a link to today's 4-page (in a broadsheet!) piece, headlined The Great British Brexit Robbery: How a Secret Network of Computer Scientists Hijacked Our Democracy. I think (and hope) that there's a chance that the investigative work they are doing will eventually pay off, in the US and here, as more proof comes to light which shows how big money and dark forces are fucking around with western democracies, if there's a will to do anything about it that is.


I don't know if any of you are still interested in this story

I'm interested, and I really appreciate the links.

Yeah, but TANF is a whole lot more restrictive than AFDC


Thanks sapient, then it's worth it to keep posting them.

Crikey, here's a thought: maybe you would have been better off after all without your revolution:


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