Obamacare - Confessions of an MIT Bunko Artist, Jon Gruber

[Sabine Grant]

An interesting confessional from a Democratic activist, former hospital insurance coordinator, and two time voter for Obama...



http://online.wsj.com/articles/burke-beu-this-democrat-is-giving-up-on-obamacare-1415919619

I agree with max that a public option should have been included.

Absolutely. A hybrid system would have been the best solution.

 

[Nice Squirrel]

I like that "voter for Obama" has some kind of weight. People are dumb.

 

[dismal]

I don't know the first thing about the health system in France. However, if they don't have some ability to limit the healthcare resources spent on people who are dying that would be really, really stupid.

You realize I said earlier that I view death panels as a plus? We need to limit the amount of resources we spend on the dying that do not improve outcomes?

If you are saying the French system does not do this you are saying the French system is flawed.

I have never claimed that any patient on their death bed is going to be able to demand and receive life saving treatments. Death bed indicates patients who are in their process of death and the result of a terminal prognosis. However, they will receive what is commonly known as palliative care and/or pain management care. And the decision to withdraw life support measures such as respiratory support (vent) or hydration/nutrition support (G Tube/IV) is not in the hands of a "death panel". It rests with the patient on life support devices.

I'm sure you don't intend to be Grubering me but it's sure starting to feel like it.

If a patient is not allowed to demand and receive all life saving treatments he might want then a patient is not making all the decisions.

Who is?

 

[dismal]

People are dumb.

You went the full Gruber. You never go the full Gruber.

The funniest thing about the whole Gruber thing is Democrats have yet to piece together that he is insulting them.

Republicans never voted for this. Voters never voted for this. In fact they voted out congress people who voted for it in spectacular numbers. Starting with the Ted Kennedy seat and continuing through the 2014 midterms. The people that needed to be duped were the Democrats in congress. Particularly the Democrats in competitive seats who are now mostly ex-Democrats in congress.

 

[Jarhyn]

Yes. But according to Gruber, you can't pass a law by telling people they are going to pay more to cover the sick people. This is the issue he is talking about here:

“Mark [Pauly] made a couple of comments that I do want to take issue with, one about transparency in financing and the other is about moving from community rating to risk-rated subsidies. You can’t do it politically. You just literally cannot do it, okay, transparent financing…and also transparent spending.” Gruber said. “In terms of risk-rated subsidies, if you had a law which said that healthy people are going to pay in—you made explicit that healthy people pay in and sick people get money, it would not have passed, okay. Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass…Look, I wish Mark was right that we could make it all transparent, but I’d rather have this law than not.”

So what do you suggest? We leave sick poor people to die? Welcome to the death panel!

- - - Updated - - -

Let's be honest here, dismal, what would you see happen to sick poor people?

Have you ever heard of Medicaid? My understanding is that it existed before Obama was even president.

I don't have a problem with some sort of social safety net for the very poor.

That's not what Obamacare is.

No, it is EXACTLY what Obamacare is supposed to be. Obamacare is supposed to be the for those who are too poor to afford medical care, but who are not in abject poverty.


So let me ask you again, what do we do for poor sick people?

You seem to propose that we let them die or give them inferior care only when they are on their deathbeds, as Medicaid often does.

 

[Sabine Grant]

I have never claimed that any patient on their death bed is going to be able to demand and receive life saving treatments. Death bed indicates patients who are in their process of death and the result of a terminal prognosis. However, they will receive what is commonly known as palliative care and/or pain management care. And the decision to withdraw life support measures such as respiratory support (vent) or hydration/nutrition support (G Tube/IV) is not in the hands of a "death panel". It rests with the patient on life support devices.

I'm sure you don't intend to be Grubering me but it's sure starting to feel like it.

If a patient is not allowed to demand and receive all life saving treatments he might want then a patient is not making all the decisions.

Who is?

For a patient to be on their "death bed" it signifies that nothing can be medically done to prevent the completion of their process of death. When nothing can be medically done to prevent such completion, why do you think that health care professionals are to be expected to pull a rabbit out of their hat or do some type of magic trick to prevent the completion of such process?

"demand and receive all life saving treatments" : again when a patient is on their "death bed" it is because all attempts relying on all possible life saving treatments have failed.

Connecting you back (again) to existing realities : with my diagnosis, life saving treatments would go through the steps of a pharmacology based approach with the most efficient monoclonal drugs and/or with a combination of conventional chemo. If they fail, the next step would be a bone marrow transplant. If it fails, please inform me as to which other life saving treatments I could "demand and receive". I am certain that experts in oncology and hematology would be vividly interested in your plan of other life saving treatments.

 

[Sabine Grant]

Yes. But according to Gruber, you can't pass a law by telling people they are going to pay more to cover the sick people. This is the issue he is talking about here:

“Mark [Pauly] made a couple of comments that I do want to take issue with, one about transparency in financing and the other is about moving from community rating to risk-rated subsidies. You can’t do it politically. You just literally cannot do it, okay, transparent financing…and also transparent spending.” Gruber said. “In terms of risk-rated subsidies, if you had a law which said that healthy people are going to pay in—you made explicit that healthy people pay in and sick people get money, it would not have passed, okay. Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass…Look, I wish Mark was right that we could make it all transparent, but I’d rather have this law than not.”

So what do you suggest? We leave sick poor people to die? Welcome to the death panel!

- - - Updated - - -

Let's be honest here, dismal, what would you see happen to sick poor people?

Have you ever heard of Medicaid? My understanding is that it existed before Obama was even president.

I don't have a problem with some sort of social safety net for the very poor.

That's not what Obamacare is.

No, it is EXACTLY what Obamacare is supposed to be. Obamacare is supposed to be the for those who are too poor to afford medical care, but who are not in abject poverty.

The AHCA was designed to broaden access to health care for households and individuals who could not otherwise afford the cost of an insurance plan covering their medical needs, whether they be pre existing needs, present needs or projected future needs. We are a middle class household. The AHCA facilitated our access to health care as I fall under the category of pre existing and present needs as well as projected future needs. Pre existing as diagnosed in 2005 with a chronic and incurable type of blood cancer and present as a type of blood cancer which recurs every couple of years( as it is the case this year) and future needs as projected to recur in between periods of remission.

So let me ask you again, what do we do for poor sick people?

Again, among the millions who enrolled in plans offered under the ACHA Exchanges, it is not even about "poor people". It is about millions of middle class households who, prior to the AHCA, could only afford "crumb" plans which in no way could cover their medical needs. It is about households and individuals with pre existing conditions who kept being rejected by insurance companies because they were financial liabilities due to a medical diagnosis.

You seem to propose that we let them die or give them inferior care only when they are on their deathbeds, as Medicaid often does.

Medicaid coverage varies from one State to the other. Some delivering and meeting medical needs better than others. For example, under Governor Jed Bush, the legislature and Jed placed a cap on Medicaid expenditures eliminating coverage for organ transplants. Which of course is a situation resulting in sending x number of Medicaid dependent Floridians to their "death bed".

 

[Axulus]

Like "death panels"? That no one would be able to keep their doctor?

I'm sure there are examples of idiots on the right saying things that aren't true. This doesn't change the point that virtually everything main selling point used to sell Obamacare was a lie or distortion.

However, I think it is obvious that big government healthcare requires death panels. I would be more afraid of government healthcare without death panels than with.

If the big government healthcare supporters were honest they'd have been like "fuck yeah there are going to be death panels do you know how much money we piss away on healthcare that does not improve outcomes". So, amusingly enough the specific example you picked I would score as an example of dishonesty.

The problem with the "death panels" lie is that the conservative plan is that the panels would deny care to everyone (no government payment) rather than just a few select scenarios and situations. It is a deliberate distortion and a complete joke preying on the conservatives who ate lead paint chips as children, of which there are many, unfortunately.

You are right, however, in that it is a mystery to me why the Democrats didn't reveal this reality. I guess they thought the public was too stupid to understand these basic concepts. Sadly, they could be right.

 

[dismal]

I'm sure you don't intend to be Grubering me but it's sure starting to feel like it.

If a patient is not allowed to demand and receive all life saving treatments he might want then a patient is not making all the decisions.

Who is?

For a patient to be on their "death bed" it signifies that nothing can be medically done to prevent the completion of their process of death. When nothing can be medically done to prevent such completion, why do you think that health care professionals are to be expected to pull a rabbit out of their hat or do some type of magic trick to prevent the completion of such process?

"demand and receive all life saving treatments" : again when a patient is on their "death bed" it is because all attempts relying on all possible life saving treatments.

You keep avoiding the question by assuming the problem away. Let's take this hypothetical:

Jacques has been given a diagnosis of advanced cancer an told he has two months to live. While reading about his disease on free government broadband, he sees an article about the Sultan of Brunei paying $20,000,000 to receive an experimental treatment in japan for the exact same disease that extended his life by a year. Jacques asks his doctor for the treatment. What happens next?

A) the French taxpayer foots the $20,000,000 bill to send Jacques to Japan and he gets the treatment
B) the French taxpayer pays for Jacques to get some painkillers and a bed in which to die

Who makes this decision?

 

[Loren Pechtel]

For a patient to be on their "death bed" it signifies that nothing can be medically done to prevent the completion of their process of death. When nothing can be medically done to prevent such completion, why do you think that health care professionals are to be expected to pull a rabbit out of their hat or do some type of magic trick to prevent the completion of such process?

"demand and receive all life saving treatments" : again when a patient is on their "death bed" it is because all attempts relying on all possible life saving treatments.

You keep avoiding the question by assuming the problem away. Let's take this hypothetical:

Jacques has been given a diagnosis of advanced cancer an told he has two months to live. While reading about his disease on free government broadband, he sees an article about the Sultan of Brunei paying $20,000,000 to receive an experimental treatment in japan for the exact same disease that extended his life by a year. Jacques asks his doctor for the treatment. What happens next?

A) the French taxpayer foots the $20,000,000 bill to send Jacques to Japan and he gets the treatment
B) the French taxpayer pays for Jacques to get some painkillers and a bed in which to die

Who makes this decision?

Keyword: "Experimental".

 

[Sabine Grant]

For a patient to be on their "death bed" it signifies that nothing can be medically done to prevent the completion of their process of death. When nothing can be medically done to prevent such completion, why do you think that health care professionals are to be expected to pull a rabbit out of their hat or do some type of magic trick to prevent the completion of such process?

"demand and receive all life saving treatments" : again when a patient is on their "death bed" it is because all attempts relying on all possible life saving treatments.

You keep avoiding the question by assuming the problem away. Let's take this hypothetical:

I am not assuming any problem away. I am trying to reconnect you to existing realities. No different than the way I handled your hypothetical of an individual affected by "6 types of cancer" and a "chest wound" where applying life saving treatments would be about " a sex change operation" and a "lobotomy". You construct lalaland scenarios while speaking of a patient on his "death bed" while assuming that an individual on his "death bed" can still be receiving life saving treatments as if every medically possible treatment/procedure had not been exhausted. And that after I had detailed for you the determination of the French health care system to promote survival and recovery. You create imaginary problems which are NOT even connected to the existing realities of human health and how our modern medicine will deal with it.

Jacques has been given a diagnosis of advanced cancer an told he has two months to live. While reading about his disease on free government broadband, he sees an article about the Sultan of Brunei paying $20,000,000 to receive an experimental treatment in japan for the exact same disease that extended his life by a year. Jacques asks his doctor for the treatment. What happens next?

A) the French taxpayer foots the $20,000,000 bill to send Jacques to Japan and he gets the treatment
B) the French taxpayer pays for Jacques to get some painkillers and a bed in which to die

Why in the world would you think that the French health care system would or should pay for treatments to be received in Japan? Is it part of existing realities (there we go again) that US Insurance Companies would send Jack to Japan to receive life extending treatments and cover for the cost of medical care delivered in a foreign nation?????

Is there any way you can cite REALITY based cases rather than pursuing with absolutely ridiculous hypothetical. You seem to be so desperate to rationalize your initial claim of "death panels" that you are digging your grave of absurd scenarios disconnected from the existing realities of human health and how modern medicine deals with it.

Who makes this decision?

Cite a case from France where such scenario has occured and then we can research how it was handled. Once more and for the last time, I am talking reality and you come up with invented and non existent scenarios. You made a claim and you have NOT been able to support it. You were challenged by me head on and by my providing reality centered facts regarding how a "big government" health care system, namely the French health care system, supports and promotes survival and recovery versus your claim of "death panels".

With hypothetical after hypothetical, I could make Paris fit into a bottle.

 

[Loren Pechtel]

Why in the world would you think that the French health care system would or should pay for treatments to be received in Japan? Is it part of existing realities (there we go again) that US Insurance Companies would send Jack to Japan to receive life extending treatments and cover for the cost of medical care delivered in a foreign nation?????

Is there any way you can cite REALITY based cases rather than pursuing with absolutely ridiculous hypothetical. You seem to be so desperate to rationalize your initial claim of "death panels" that you are digging your grave of absurd scenarios disconnected from the existing realities of human health and how modern medicine deals with it.

If that's the only place the treatment could be had, yes, they should pay for treatment in a foreign land.

The key here is "experimental".

 

[laughing dog]

I'm sure there are examples of idiots on the right saying things that aren't true. This doesn't change the point that virtually everything main selling point used to sell Obamacare was a lie or distortion.

However, I think it is obvious that big government healthcare requires death panels. I would be more afraid of government healthcare without death panels than with.

If the big government healthcare supporters were honest they'd have been like "fuck yeah there are going to be death panels do you know how much money we piss away on healthcare that does not improve outcomes". So, amusingly enough the specific example you picked I would score as an example of dishonesty.

The problem with the "death panels" lie is that the conservative plan is that the panels would deny care to everyone (no government payment) rather than just a few select scenarios and situations. It is a deliberate distortion and a complete joke preying on the conservatives who ate lead paint chips as children, of which there are many, unfortunately.

You are right, however, in that it is a mystery to me why the Democrats didn't reveal this reality. I guess they thought the public was too stupid to understand these basic concepts. Sadly, they could be right.

I agree. Health care is not an infinite good - any system rations care. The question is what is the most appropriate or best way to ration it. For some reason, conservatives appear to have sold the public that the appropriate death panel is the invisible hand of the market place via lack of resources.

 

[Jimmy Higgins]

For a patient to be on their "death bed" it signifies that nothing can be medically done to prevent the completion of their process of death. When nothing can be medically done to prevent such completion, why do you think that health care professionals are to be expected to pull a rabbit out of their hat or do some type of magic trick to prevent the completion of such process?

"demand and receive all life saving treatments" : again when a patient is on their "death bed" it is because all attempts relying on all possible life saving treatments.

You keep avoiding the question by assuming the problem away. Let's take this hypothetical:

Jacques has been given a diagnosis of advanced cancer an told he has two months to live. While reading about his disease on free government broadband, he sees an article about the Sultan of Brunei paying $20,000,000 to receive an experimental treatment in japan for the exact same disease that extended his life by a year. Jacques asks his doctor for the treatment. What happens next?

A) the French taxpayer foots the $20,000,000 bill to send Jacques to Japan and he gets the treatment
B) the French taxpayer pays for Jacques to get some painkillers and a bed in which to die

Who makes this decision?

The good news is that we know under the current American system, we don't have to ask such questions, as we already know it'd be B.

 

[Sabine Grant]

Why in the world would you think that the French health care system would or should pay for treatments to be received in Japan? Is it part of existing realities (there we go again) that US Insurance Companies would send Jack to Japan to receive life extending treatments and cover for the cost of medical care delivered in a foreign nation?????

Is there any way you can cite REALITY based cases rather than pursuing with absolutely ridiculous hypothetical. You seem to be so desperate to rationalize your initial claim of "death panels" that you are digging your grave of absurd scenarios disconnected from the existing realities of human health and how modern medicine deals with it.

If that's the only place the treatment could be had, yes, they should pay for treatment in a foreign land.

The key here is "experimental".

Do you place the same expectation on the US private insurance industry? But you are correct that "experimental" excludes dismal's scenario.

 

[dismal]

Why in the world would you think that the French health care system would or should pay for treatments to be received in Japan? Is it part of existing realities (there we go again) that US Insurance Companies would send Jack to Japan to receive life extending treatments and cover for the cost of medical care delivered in a foreign nation?????

OK, same question but it's not in Japan. It's in France.

Now can you actually, you know, maybe answer it?

 

[Sabine Grant]

Why in the world would you think that the French health care system would or should pay for treatments to be received in Japan? Is it part of existing realities (there we go again) that US Insurance Companies would send Jack to Japan to receive life extending treatments and cover for the cost of medical care delivered in a foreign nation?????

OK, same question but it's not in Japan. It's in France.

Now can you actually, you know, maybe answer it?

I certainly will address (once more) what is connected to existing realities versus your persistence in concocting fantasy scenarios :

1) Experimental drugs/treatments undergo Clinical Trials in France just like in the US. The major difference though is that under Phase 3 Trial, patients do not receive a placebo in France but the actual treatments (the Phase 3 in the US involves a placebo only group and a treatment only group). As a result Jacques would be enrolled in the Clinical Trial experimenting on the said treatment with the guarantee that he would not be stuck in a placebo group. FYI, Clinical Trial enrolled patients are a necessity to measure the efficacy and side effects of any experimental treatment. It always is a cost the health care system is willing to assume in view of that indispensable necessity. Such patients are selected based on (of course) their diagnosis being compatible with the therapeutic goal of the said experimental treatment.

2) Without fueling your fantasy based scenarios and reconnecting you to existing realities : were I to seek treatments in France addressing my type of lymphoma, the current monoclonal I am being treated with would be of course fully available (Rituximab or Rituxan) with the alternative of an upgraded monoclonal such as the equivalent of Bexxar. The cost of such equivalent being higher than the cost of the first innovative monoclonal based treatment, Rituxan. The reason why Rituxan would be the first choice from the get go is its remission duration property versus newer monoclonal treatments. The reason why the focus would be on Rituxan alone versus adding C.H.O.P to Rituxan is because there is no proven superior efficacy by adding C.H.O.P (meaning not a decision based on cost but clinical data).

Assuming while in France I would become refractory to Rituxan and other alternate monoclonal treatments, I would become eligible to enroll in a Clinical Trial experimenting on yet to be approved treatments. The cost would not be a concern since Clinical Trials are absolutely essential to test the efficacy and side effects of experimental drugs/treatments. My eligibility would not be evaluated based on cost but (again) whether my diagnosis is compatible with the therapeutic goal of the said experimental treatment. And the precedent/antecedent of my not responding to currently approved treatments.

Aside and a beneficial one, as I am a cancer patient in the largest oncology/hematology center in Florida and they are also a research center (they conduct Clinical Trials), if I were to not respond to any applied and currently approved treatments, I would already be a candidate to enroll in their Clinical Trials.

I am still waiting for you to provide documented data supporting your initial claim. As I have demonstrated that a "big government" health care system( relying on the example of France) is in fact promoting and supporting survival and recovery versus "death panels".

Whereas, it is undeniable that your hyper privatized health care system had empowered the insurance industry to be the ultimate "death panels". An industry which certainly does not promote and support the survival and recovery of your millions of ailing Americans.

 

[dismal]

1) Experimental drugs/treatments undergo Clinical Trials in France just like in the US. The major difference though is that under Phase 3 Trial, patients do not receive a placebo in France but the actual treatments (the Phase 3 in the US involves a placebo only group and a treatment only group). As a result Jacques would be enrolled in the Clinical Trial experimenting on the said treatment with the guarantee that he would not be stuck in a placebo group. FYI, Clinical Trial enrolled patients are a necessity to measure the efficacy and side effects of any experimental treatment. It always is a cost the health care system is willing to assume in view of that indispensable necessity. Such patients are selected based on (of course) their diagnosis being compatible with the therapeutic goal of the said experimental treatment.

So, in this situation if Jacques requested this treatment the government would immediately initiate a clinical trial in which some people would get the $20,000,000 treatment and some would not?

Let's say the clinical trial occurs (FYI, Jacques didn't get the treatment and is dead.) and it shows that the treatment extends patient with similar conditions lives by 4 to 6 months.

Henri is later diagnosed with the same disease. Henri wants the treatment. Does the government pay $20,000,000 for Henri to get the treatment?

 

[ksen]

So, in this situation if Jacques requested this treatment the government would immediately initiate a clinical trial

You so silly, sabine never said anything about the government setting up special clinical trials.

in which some people would get the $20,000,000 treatment and some would not?

Let's say the clinical trial occurs (FYI, Jacques didn't get the treatment and is dead.) and it shows that the treatment extends patient with similar conditions lives by 4 to 6 months.

Henri is later diagnosed with the same disease. Henri wants the treatment. Does the government pay $20,000,000 for Henri to get the treatment?

Maybe you should first document a case where it costs $20,000,000 for an individual to get treatment for something . . . anything. Otherwise this argument of yours is about as sensible as the "what if minimum wage was $1,000,000/hr?" or "hey, if you don't like it then go out and build your own business to compete with (insert name of multinational conglomerate here)?" herping and derping.

 

[dismal]

You so silly, sabine never said anything about the government setting up special clinical trials.

See this article of punctuation you edited out: "?"

That's called a "question mark". It is used to indicate a question has been asked.

She said: "Experimental drugs/treatments undergo Clinical Trials in France just like in the US."

Since this was in response to my question about what would happen if Jacques requested this treatment I asked a clarifying question to confirm the two were related.

If not, I don't think the question of what happens when Jacques makes his request for treatment has yet been answered.