Letters to the Editor

Letter: Political malpractice

November 9, 2013

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To the editor:

It is interesting to note that states like Kentucky, which set up their own Obamacare health care insurance exchanges, are generally successful. Those states, like Kansas under Gov Brownback, which turned down over $30 million to set up an exchange, are still struggling. 

Brownback in my opinion was rooting for the health plan to fail. I call that political malpractice, and our citizens are poorer for it.

Comments

Brock Masters 1 year, 8 months ago

Interesting to consider it is a federal program but it is dependent on the states to make it work. I think Brownback was right in turning down the funds.

Some may disagree with me on that point and they'd be just as right in their opinion as I am in mine. However, what is not opinion is that Obama lied to us when he said we can keep our insurance plan and our doctors.

Bob Forer 1 year, 8 months ago

"Interesting to consider it is a federal program but it is dependent on the states to make it work."

Why is that interesting, or even unusual? Unemployment insurance, TANA (formerly AFDC), and Foodstamps are federally funded but state administered.

Brock Masters 1 year, 8 months ago

Interesting in that unlike the programs you mentioned this program has a federal exchange. Unfortunately it doesn't work very well.

Bob Hechlor 1 year, 8 months ago

Well it is new and repub states like ours are doing everything they can to sabotage it. If they would cooperate, everyone would benefit.

Bob Hechlor 1 year, 8 months ago

Obama did not lie. Rather, repubs like Brownback and some insurers have done everything they could to sabotage this law. They have lied, and spent probably into the billions of dollars on propaganda, which you among others have fallen for. Better wise up. ACA has already saved us money and would save us more and help the economy if you and your ilk quit opposing what is good for America.

John Graham 1 year, 8 months ago

Apparently you missed all the coverage about Obama and several democrats having to admit they lied about the whole keep your insurance issue. They also admitted that there will be millions paying more than the promised less. So yes Obama and the dems did lie repeatedly.

John Graham 1 year, 8 months ago

Come on now. Keep in mind all the gov't entitlement programs that are efficient, well managed, within budget and carrying out the original mission they promised. Oh, that's my mistake, there aren't any. Given time ACA will wind up like all other gov't run entitlement programs, a bloated over budget program beyond repair. Obama and the Democrats have already bowed to special interests with all the exemptions that have been granted and the "delayed" start for aspects of ACA. Obama and the democrats can't get the roll out right, why would anyone believe the typically inept gov't will actually improve healthcare. I admit the current system is far from perfect, but with the track record the gov't has in running any entitlement program that has existed, I have absolute faith healthcare will not be improved by Obamacare.

Brownback may not like Obamacare, but he doesn't have to "root" for its failure, he just has to give it time to fail like all the preceding entitlement programs.

Ken Lassman 1 year, 8 months ago

John, Well then, since our health care system is already efficient, well managed, within budget and carrying out the mission of keeping us the healthiest nation on the planet (not!) there really is no need for the feds to step in, is there? It seems to me that the only reason federal intervention was ever considered in the field of health care in the first place is that the insurance industry, medical providers and ancillary supports had created a system that had spiraled out of control, eating up ever increasing amounts of the GDP, leaving increasing numbers of individuals without any insurance at all, with outcomes that put the US well down the list of healthy nations.

So just as with the need for many other entitlements such as flood insurance, unemployment insurance, SSI for disabled, WIC, federal quotas for the blind, nutrition programs for the elderly and even social security, this entitlement was created to address a real problem. Getting rid of ACA would be an act of jumping out of the frying pan into the fire if there ever was one, and it seems to me that it's well past time that the Republicans and Democrats stop grandstanding from their ideological bunkers, roll up their sleeves and work together to create a viable federal program that better addressed the situation that created the need for federal intervention in the first place. There would be plenty of credit to go around for both sides to claim and we could have a health care system that begins to care about controlling costs, providing services to everyone and end up with a much healthier nation. The fact that these issues have become partisan speaks more to the sad state of our political system even more than our health care system.

Brock Masters 1 year, 8 months ago

Health insurance is not health care.

Blaming the insurance companies for poor health care is like blaming auto insurance companies for shoddy body work. No one is forced to buy insurance or at least they weren't until the ACA.

Ken Lassman 1 year, 8 months ago

If you drive a car, you are required to have at least liability insurance, and if you have a body you should pay health insurance for the same reasons you are required to buy liability insurance. Health insurance is an integral part of our health care system and to deny it is akin to saying that gasoline is not an integral part of the automobile.

Brock Masters 1 year, 8 months ago

But you're only required to purchase it if you choose to drive. The government has forced people to buy health insurance just for living.

Auto liability insurance is to protect someone else so, no they aren't the same

Ken Lassman 1 year, 8 months ago

In a similar vein, health insurance is designed to have folks pay at least something for their health care instead of getting the emergency room and those with insurance pay the tab for them.

John Graham 1 year, 8 months ago

Ken, if you bother to pay attention I said that "the current system is far from perfect". The argument remains the same. The gov't has failed repeatedly in managing entitlement programs. They are typically poorly managed, wildly over budget and often have changed from their original mission. Be it providing insurance (Medicare and Medicaid), providing actual healthcare (VA system) or other entitlement programs (food stamps, unemployment, or social security) the history of the gov't in providing efficient, on budget and original mission programs is simply poor at best. Could the current healthcare system be better? There certainly is great opportunity in many areas for the current system to be improved. I am stating that the gov't though maybe well intentioned, simply has a poor track record of doing entitlement programs and I expect they will make the ACA the same mess the other programs have turned out to be.

John Graham 1 year, 8 months ago

Example of the gov't inability to manage an efficient program is the healthcare.gov website. Cost estimates of the website range from a low of $70M to a high of $600M plus with the GAO estimate of approx $350M. Even at the low estimate of $70M, really $70M for a website? Whether it functions perfect or poorly as it is currently doing, $70M dollars for a website? Two computer geeks in half a day could have done better than the gov't and probably would have charged $1000 total. With this as the first impression, what makes anyone think ACA will be well managed, efficient and under budget when fully Implemented? What gov't program ever has been in the past 50 years?

Ken Lassman 1 year, 8 months ago

I would like to maintain a civil discussion with you, and will do so if you don't continue to make statements like "if you bother to pay attention..." My assumption is that we are both paying attention and if you don't understand what I'm getting at, please ask for clarification.

If you think that two geeks could put together a functional website in half a day that would function better than the actual one that took several years to put together, then you really need to investigate the complexity of that website. By the way, I really think that the requirement to register and get cleared and pre-approved for subsidy eligibility before you even get to explore your insurance options is a fundamental mistake at this website. I, too, fear that the feds are screwing up the possibility of a more efficient, more affordable and accessible health care system, but to think that the health care system we had before ACA was capable of reforming itself is just as unlikely, if not moreso. Just because the feds have the potential to leverage the various players into becoming more cost efficient, focus on prevention, make concentration of wealth less the focus and the nation's health more the focus doesn't mean that it will have the courage and leadership to actually do this. But I certainly don't see the industry doing it on its own, either.

Finally, I already listed federal programs that play an important safety net in our society that are all reasonably functioning, at least as far as I know. For your convenience, I'll list them again: flood insurance, unemployment insurance, SSI for disabled, WIC, federal quotas for the blind, nutrition programs for the elderly and even social security would be in good shape if congress hadn't raided its coffers for other uses.

John Graham 1 year, 8 months ago

Ken, review your initial statement, that was directed at me, and you should see that you, not I, initiated the snide comments. I clearly stated in my prior statements the current system is far from perfect. Your opening comment was an attempt to mock my prior statements which you failed to characterize accurately. Based your inaccurate characterization I was left to assume you had not paid attention to my prior statements before you chose to try to mock them. In short don't be so sanctimonious about any snide statement I made directed at you such as "if you bother to pay attention " when it was you that made the first snide statement.

Regarding the rest of my statements I stand by them. No one will convince me that $70M (or significantly more, GAO states more like $350M) was well spent on the healthcare.gov website. For that kind of tax payor dollars there should not been any "glitches". Your other statements only support my prior statements that the gov't will not manage ACA appropriately. You list mismanagement of funds with the programs you have listed. I agree those programs you listed benefit people but all of them are over budget and mismanaged. I fully expect ACA will benefit some people, it will also hurt millions of people with higher premiums and deductibles. I also assume the gov't will mismanage ACA like they have every other entitlement program.

Ken Lassman 1 year, 8 months ago

Your calling all government programs inefficient and poorly managed set the tone that I was responding to and that's where the conversation began. But If you want to make "who started the sarcasm first" the main topic of the conversation then our conversation is done as I have absolutely no interest in responding to your accusations of my being sanctimonious, inaccurate, mocking and so on.

You also seemed to ignore my agreeing with you that the website was poorly conceived and that the feds may very well be blowing a chance to step in and improve our health care system that is unable and unwilling to reform itself.

Finally, you are certainly entitled to your opinion that the list of entitlement programs I listed are all over budget and mismanaged but you provide absolutely no evidence to back up your opinion. Looking at the GAO reports on these programs, I found out the following information:

Flood insurance ( http://www.gao.gov/products/GAO-13-568 ) The flood insurance program is in debt primarily not due to mismanagement but because of the increasing frequency and severity of flooding, which began in 2005 and has not let up enough to allow the insurance revenues to catch up. The GAO recommends adjusting insurance rates to reflect the new realities, trying not to make the rates so high that it will result in fewer, not more folks enrolling in the program.

SSI for folks with disabilities: ( http://www.gao.gov/products/GAO-13-635 ) The GAO did find some evidence of some folks receiving overpayments, i.e. continuing to receive payments after they should have stopped. SSI is now figuring out how to monitor the situation more closely in a cost effective way in order to reduce the amount of overpayments. I would say that there is some evidence that some mismanagement of this program has occurred due to its current inability to determine when payments should stop.

WIC: (http://www.gao.gov/products/GAO-13-290 ) Seems that because states set their own criteria for Medicaid and then cross-enroll them in WIC, some states are having trouble tracking whether the individual is really meeting federal eligibility requirements. The feds are planning to assist states in tracking this better. In other words, any mismanagement seems primarily to be coming from the states.

Federal Blind Quota Program: ( http://www.gao.gov/products/A55081 ) supposed problems with this program were examined and were found to have no merit.

(continued below)

Ken Lassman 1 year, 8 months ago

(continued)... Nutrition programs for the elderly: ( http://www.gao.gov/products/GAO-11-782T ) looks like some of the same issues with states as is described with the WIC program above. In other words, the problems rest with the states with solutions coming from the feds.

Social security: ( http://www.gao.gov/key_issues/financial_security_for_older_americans/issue_summary ) This is a huge topic because of the size and scope of the program, the the key issues identified by the GAO are caused by the inability to reform the program to address the changing demographics of the country, the fact that the accrued money is being spent on other programs, and that there is insufficient "economic literacy" in the elderly for them to manage their own retirement funds in ways that would be more effective. Once again, the management of the program is not so much in question as the political gridlock that has created the potential crises that SSI faces in the future.

I'm certainly open to more civil discussion if you want, and know that I'll continue to back up my statements with relevant information that will hopefully convey that there are relevant facts and studies that inform my opinion.

John Graham 1 year, 8 months ago

Thank you for listing problems that the gov't is having managing each program you listed. Every problem you listed falls into the lack of appropriate management oversight or budgetary issue. What you failed to do is list any programs that are not having some kind of management or budget issue. You very nicely proved my point. Thank you.

Ken Lassman 1 year, 8 months ago

Wow, guess you're bent on blowing off any real discussion of the issues, so I will remember that the next time I'm tempted to try to engage you in a real conversation about a topic. In case you have never been around an audit, including one by the GAO, the nature of every audit is to find areas that could be streamlined, improved, and made more efficient. There is a huge difference between identifying ways to improve a service/program/business and concluding that it is being mismanaged. Look at any private company who pays for an independent audit, and if the auditor doesn't find anything at all to improve, then the company just got ripped off. Audits try to sort out the functional operations in order to identify potential directions to move to make an operation even more functional. To characterize the GAO summaries I provided you as proof of mismanagement is a fundamental distortion of what they are all about. Thank you for letting me see so clearly that you have no real interest in an honest discussion of the issue.

John Graham 1 year, 8 months ago

You yourself listed lack of appropriate oversight in WIC, SSI, and nutrition for elderly programs. You list multiple issues with social security including gov't raiding the trust and lack of gov't action to address future funding problems. I believe that you did a nice job of proving my prior point that entitlement programs have management issues. All of these entitlement programs are long standing in nature so the gov't has had ample time to get them "right" yet issues continue. The GAO audit is supposed to find areas of improvement. I would call issues regarding if recipients meet guidelines or not and overpayments of a systemic nature significant lack of oversight whether the state is managing the fed money or not. In a large conglomerate each subsidiary has it's own CEO and management team as well as budget they manage. This does not mean the conglomerate doesn't have responsibility to be sure the subsidiary is acting appropriately.

The flood insurance program is another mismanagement issue. The democrats and liberals (including this White House) have been screaming for years how global warming is an immediate threat that must be addressed. The global warming crowd has listed threats of increased severe storms, tornados, hurricanes, rising ocean levels etc all of which could lead to increased flooding. An insurance company uses actuarial models to determine risk and base insurance rates accordingly. Since this gov't is well aware of the global warming claims and are promoting those claims to the public, the gov't controlled flood insurance should have planned for the increased risks of severe storms and flooding. Since the clearly did not, that would be a failure of management oversight.

My original statement was that entitlement programs are poorly managed. You proceed to state I need to provide evidence to support my statement. You then proceed to list problems with each program that clearly are a direct result of poor management, lack of oversight or some other management issue (gov't stagnation). When I indicate you provided the facts to back up my original statement you state I am not having an honest discussion. I don't get it. You provide the ammo to shoot your own programs full of holes yet somehow are upset with me. You were the one that wanted to take exception to some of my statements yet in doing so you prove my point. If you want to be upset with someone it shouldn't be me.

Ken Lassman 1 year, 8 months ago

Your threshold for placing the boundary that crosses into the realm of what you call mismanagement is most interesting. Using the same criteria you just set for judging the GAO audits of these various federal entitlement programs, I challenge you to find a single national/multinational corporation that would meet your very high standard of what is considered mismanagement. I'm afraid every major private company, non-profit, and government program at any level you care to choose would fall short of this bar and would also qualify for the use of the term as you have defined it.

Fraud, embezzlement, keeping dual books and other illegal practices are examples of mismanagement by anyone's standards, but these GAO reports discuss these programs in conclusions that fall way short of uncovering any such practices. I don't want to repeat myself, but you seem to have a dual standard for private business audits and government audits, both of which if done correctly point to areas that hold the potential for saving money, removing duplication of services, that no longer are needed in the current form due to changes in the focus of the institution, etc. A good audit will not only identify those areas but provide potential options for the institution to consider as a means to address the situation if it chooses to do so.

If you want to continue to define your terms in the way you have, then there is no need for discussing mismanagement as it is everywhere. If you revise your definitions to a more standard view of the audit process, then you will have to conclude that the federal entitlement programs listed above (with evidence of SSI for folks with disabilities the possible exception) are implemented with a reasonable level of efficiency, and fill an important societal need, Unless, of course, you care to present evidence to the contrary, which you clearly have not.

John Graham 1 year, 8 months ago

Ken, I guess we will disagree on what mismanagement entails. GAO reported Medicare had $48B of "improper payments" in 2010, the number grew to $65B in 2011. Conservative estimates put fraud at approx 8% of Medicare payouts. Social security reports they are accurate 93.3% with respect to SSI overpayments. They boast this is a significant improvement from the recent past. This means they are still overpaying 6.7% of the time. This is SSI (social security) not SSDI (disability). You already mentioned problem with SSDI. GAO reported the following estimates of fraud or improper payments: food stamps 6-7%, Medicaid 10.5% $33B, HUD $1B, Student Aid $1B, School lunches $1.4B, Unemployment $4B, FEMA $1B, Earned Income Tax Credit $12B. These are numbers from the GAO regarding what they called waste due to fraud and improper payments. I don't have an MBA so maybe this doesn't fall under mismanagement in the classroom definition. I realize these are large programs but still $1B is a lot of money to most people to be wasting. When some of the biggest programs based on percent of overall budget such as Medicare, Social Security, and Medicaid are reported by GAO to have the level of fraud or improper payments of 8%, 6+%, 10.5% respectively that adds up to a very significant amount of money being wasted that could be better used to reduce deficit or tax rates or even increased benefits to rightful recipients. If you don't want to call this mismanagement, fine that is your right. I do call this mismanagement because the gov't should be taking better care of the tax payers money than they are. Maybe we will just have to disagree about what constitutes mismanagement. I don't know for sure but if a business audit showed numbers like these I think the CEO and upper management would have some explaining to do to the board of directors. I am purely guessing but I think the board might think mismanagement was an issue.

Ken Lassman 1 year, 8 months ago

You are playing bait and switch, it appears. Instead of looking at the list of agencies/programs I supplied you as a reply to your question asking for federal programs that are not mismanaged, you are talking about DIFFERENT programs that DO have issues with fraud and other illegal activities, such as Medicare, Medicaid, Food Stamps, HUD programs and FEMA. You continue to ignore my list of federal programs that are not mismanaged and instead talk about overpayments in the school lunches and earned income credit programs, which may or may not be caused by federal mismanagement or more likely misuse of federal funds by local and state administrators (and sloppy/shady tax accountants).

Regarding the SSI 6% overpayments, you did not cite your study so I cannot really comment on the reasons for these overpayments--there may be many reasons these were made besides fraud, embezzelment and other illegal activities, so please provide a citation so I can see the nature of these overpayments.

Finally, you throw unemployment overpayments as being 4 billion, but provide no citation. I can provide you with a GAO link http://www.gao.gov/products/GAO-12-408 to a 2012 study that discusses the real issue not being overpayments, rather that since the Great Recession that began in 2008, up to 1/4 of unemployment recipients exhausted their maximum payments and were still unable to find a job because of the poor conditions of the economy. So I am wondering if your citation was referring to a pre-2008 issue.

So back to your hypothetical board looking at audits, since you have switched to programs with real problems, they may very well be asking for explanations. But if you provided them with the list of federal agencies audited by the GAO that I provided you, the discussion would be about whether or not to adopt some/which of the recommendations of the GAO to make these programs even more effective, not trying to track down mismanagement in the form of criminal behavior.

John Graham 1 year, 8 months ago

Ken I can see that no matter what we will never agree on this . You asked for data to support my general statement that gov't entitlement programs are mismanaged. I provided data from GAO to support my claims. Social security officials reported the fact that they are proud that 93.3 % of their payments are accurate for not overpayment which means 6.3% are overpaid. I've given you GAO numbers on improper payments ie overpayments or fraud for many programs including the big three of Medicare, social security and Medicaid as well as smaller entitlement programs. I used the term mismanaged meaning inept. I didn't state criminal. You have listed some programs with talking points included that point to what I would call mismanagement but you want to call normal course of business. I have listed the three largest programs and all of them have serious issues which you seem to agree with in general. Even if I grant you that some of the programs you listed are not mismanaged they are quite small in nature to the big three with respect to overall dollars. Fine even if I overstated my opinion that "all" entitlement programs are mismanaged even you have to admit there are some significant management issues in the big three that are costing tax payers billions of dollars annually. GAO listed over $70B in Medicare/Medicaid alone. It is your right if the GAO numbers don't bother you, but I don't see it that way and never will. I am not going to bother to try to convince you any further of the mismanagement (ineptitude) of the gov't in managing entitlement programs that cost billions of dollars in waste. By the way read the article now on line at USA today about the wide spread mismanagement in the VA system. Maybe there is some reasonable explanation for that.

John Graham 1 year, 8 months ago

Seeing how well the gov't has done managing the big three of Medicare, Medicaid, and social security and that ACA will be at least as big, obviously it will affect more people, I am still quite comfortable in my original opinion that the gov't will mismanage ACA costing tax payers billions of dollars annually in waste of one kind or another.

Ken Lassman 1 year, 8 months ago

We actually have made some real progress in our conversation, and I thank you for your change in tone. You are no longer claiming that every federal entitlement program is guilty of being mismanaged which was a challenge you originally made that started this dialogue. I have also agreed with you that there has been some serious mismanagement of many of the biggest entitlement programs, and that the ACA may even fall into some of those same traps due to how it is designed.

You have not provided me with much reason to think that I was wrong that our health care system, insurance industry included, though. In my estimation, it remains incapable of reigning in itself and making serious reforms that will stop its inexorable consumption of our national wealth, and while the government seems so entangled in special interests that it seems unlikely to be able to rise to the challenge, what better hope do we have?

John Graham 1 year, 8 months ago

I having dealt with the healthcare industry and insurance companies for years would whole heartedly agree with your concerns. I never have argued that the current system is close to perfect. I have seen situations on a regular basis while not illegal at least pushed the boundaries of being immoral and unethical. There is too much money involved and too many people that have their thumb in the pie. I certainly believe there are significant opportunities to make dramatic improvements in healthcare and healthcare insurance. The problems include no one wants to see their portion of the pie get any smaller and everyone is suspicious that everyone else is trying to take something away from them so no one wants to work together (sounds kinda familiar doesn't it?). The problem I have is who can we trust to make tough decisions? I don't trust the gov't because they seem too worried about special interest money needed to get re-elected. And let's face it their history of running large programs is not necessarily a beacon of light in the darkness. But who else has the clout to force real change? The public while well meaning is often controlled by the "wing nuts" of the far extremes that drown out the moderate middle. We get what we vote for. Somehow I believe the American public deserves better.

Ken Lassman 1 year, 8 months ago

I agree with your points here. My sense is that without serious campaign reforms, the politicians will continue to grub after contributions and represent those big dollars instead of their citizen constituents. Alas, things seem to be getting worse, not better on that front, with contribution limits melting away under the guise of "free speech" that reminds me very much of the proverbial wolf with the sheep skin cover.

But are we reduced to saying things like I just said or your "somehow I believe the American public deserves better?" I personally support the work of such groups as Public Citizen ( http://www.citizen.org/Page.aspx?pid=183 ) who lobby against special interests in congress riding roughshod over citizens' interests, try to sort out the wheat from the chaff by utilizing resources such as the National Academies Press, which is part of the National Academies of Sciences ( http://www.nap.edu/ ), etc. How about you?

John Graham 1 year, 8 months ago

I still can't be convinced that is worth a minimum of $70M or more likely the $350M the GAO reported.

Bob Hechlor 1 year, 8 months ago

Graham, really two geeks? I have never seen a new system start up without problems. Even small companies take up to a year or longer getting their computer programs to work as needed. Some problems can linger much longer. You are just spewing out your prejudices, based on propaganda that tells you what you want to hear and believe. Don't worry about facts. They just get in your way.

John Graham 1 year, 8 months ago

The facts are the gov't has had years to do this and spent hundreds of millions of dollars by GAO accounting. If it wasn't ready then don't start using it. Also recently they announced they are no where near ready with the program to pay the insurance companies which is supposed to start after the first of the year. How about those facts?

John Graham 1 year, 8 months ago

Never let the facts get in your way of spewing the Democratic Party line. Even Obama and the party leaders have been forced to admit their claims are no where near the reality of the healthcare.gov website.

Bob Hechlor 1 year, 8 months ago

Oh,but there are many that were working just fine. Unfortunately, many of the programs have now been privatized, and become more inefficient and more expensive. The conservative experiment has failed, because it is just a program to help the most wealthy, while the rest are left to fall into poverty. Better wake up Graham. You have bought the propaganda.

Grégoire Guillaume 1 year, 8 months ago

If both parties would work together they could of forged a much better health care plan than the ACA. However, when you have one party that refuses to be constructive, and you have the special interest that own the congress what do you expect to come out of Washington? It's embarrassing to see the childish immature antics from our nations' capital. That being said, to refuse to expand Medicaid makes no sense. Without proper health care the 10% that make up 80% of the cost keep going back to the emergency rooms and the bill is passed on to the taxpayers. If these high-risk patients were on a routine health program that was managed it would cost us less in the long run and oh yes, we would be helping are fellow Kansans'.

Dick Sengpiehl 1 year, 8 months ago

For those who comment about the Federal government not being able to do anything right, I will mention these two facts. The first concerns Medicare. Are you aware that the administrative costs of Medicare are much less than privately run insurance companies? Has to do with for profit motive which includes salaries and advertising, staffing. MUCH less. Check it out if interested. That is why those who have insurance under the AFA are refunded premiums when the insuring company exceeds 20% admin costs, which is still very high.

Secondly, under prescription D in medicare, the GOP plan passed by Congress does not allow the government to bid for drugs like the VA does, resulting in overcharges for prescriptions. I have had Medicare for some time now and am very happy with the coverage. Being a Marine veteran, I get my prescriptions through the VA, which is able to buy the drugs for much less money than prescription D plans.

Obviously, something needed to be done concerning the uninsured in this country and at least the President has made the effort. Of course, its not perfect but if both sides of the aisle will improve it that's great. We have been ranked 38th by the World Health Organization among industrialized countries in health care outcomes. We can and must do better.

John Graham 1 year, 8 months ago

You prove my point. First Medicare is an over budget program only to grow as the baby boomers reach retirement age. Recent estimates indicate the Medicare trust fund will be depleted by 2024. The number of people on Medicare is expected to grow from the current 50M to 80M as the boomers reach retirement age. Second they run a drug program that as you point out is inefficient by the very nature of it. There are serious problems to the ongoing survival of Medicare that congress is well aware of but refuses to address. If the gov't can't or won't address problems in a program of 50M people how will they handle ACA that involves significantly more people than Medicare? Once the gov't starts an entitlement program they are required to manage it, which they are failing to do with Medicare.

Dick Sengpiehl 1 year, 8 months ago

Don't know where I prove your point. Yes, there is a structural problem with Medicare and Social Security which will need to be corrected which has not been dealt with It's obvious that as more baby boomers apply, there will not be enough money. Changes will need to be made which will be painful to some. In the Reagan yrs when parties could still talk to each other, changes were made and the life of Social Security was extended. Steve, you're right. Just being against something won't hack it. We're all in this together.

Steve King 1 year, 8 months ago

Not to name names, but the problem as I see it is are too many people like some of you here who offer nothing constructive but critique everything. You've all been very active and precise in placing the blame on a particular person or party but I have not yet read one positive solution offered. And yes, Health Insurance is a big part of Health Care. "You ain't got it, you don't get it."

We need a solution. Drop the complaining and become part of the solution not the roadblock.

John Graham 1 year, 8 months ago

I am not a road block. I am paying for my own insurance as well as providing for subsidies of others. The road blocks are those that for whatever reason don't pay

John Graham 1 year, 8 months ago

The 53% of us that pay federal income tax pay for the privilege to complain about how gov't doesn't work. The 47% that don't pay federal income taxes are the road blocks. Go talk to them. They won't listen to you because they too busy getting all the benefits of a gov't they don't pay for. People like me that pay for themselves and pay extra for others is what entitlement programs are built on. Since I am paying not only my share but some of someone else's share I pay for the privilege to complain.

John Graham 1 year, 8 months ago

Typical liberal dismissal of anything not approved by the Democratic Party.

John Graham 1 year, 8 months ago

If becoming "part of the solution" means being part of the Democratic Party, Absolutely not. The Republican Party offered options when how to address healthcare was being discussed which the ruling democrats at the time dismissed and refused to negotiate. Democrats controlled both houses and the White House so they didn't have to include the republicans and they chose not to. The republicans probably would have done the same if they had control of everything. But now the democrats say the republicans should "get on board". The democrats didn't want the republicans on board when they were passing the bill in congress. If republicans voice a complaint they are "roadblocks".

Steve King 1 year, 8 months ago

Ok, I'll be your huckleberry.

Same old tired talking points huh? They don't pay what? Insurance premiums? You're paying subsidies? For what? Their insurance? Then you should want everyone to have insurance and support the efforts to get them insured.

I paid into Social Security. I paid into Medicare. And if I take a benefit, you think you're subsidizing me? I got news for you. You're wrong.

And enough of the 47% line. It's been debunked over and over and over. Come on we're not that dumb. What percent are retired? They paid their Federal Taxes while you were still in diapers and they paid for the most of the roads you're driving on. I just hear the same old ultra right wing double speak. And what percentage pay sales tax? 100%? And what percentage pay property taxes? Or Excise Taxes, Use Taxes, ad nauseam.

And again I ask you. What's your solution? Getting on line and blogging all the negative, spouting all the right "talking points" and never being part of the solution is being a roadblock.

Is the current healthcare system working?

No?

So instead of burning down the house how about you tell us what we should do to save it?

John Graham 1 year, 8 months ago

I find it interesting whenever a conservative posts an opinion it gets quickly dismissed as "right wing" talking points and counter-productive, yet when a liberal repeats the Democratic Party line those statements get applauded as being profound and insightful. Despite being the "inclusive" party , the democrats don't seem to tolerate any thoughts contrary to their own.

Greg Cooper 1 year, 8 months ago

OK, then answer his statements and tell us where he is wrong and you are right.

47% is a great talking point. It does not convey the whole truth by any stretch of the (liberal or conservative) imagination.

John Graham 1 year, 8 months ago

The average senior receiving Medicare and social security is receiving more in benefits than they paid in with payroll deductions including adding interest to the deductions to account for what the total would be if invested. The numbers have been run multiple times. The difference between benefits paid and payroll deductions made is getting smaller over the years. Decades ago people received 2, 3 times more in benefits than they paid in. Currently the difference is often less than 2 times the benefits for the amount paid though the difference is still on average well over $100,000 more in benefits than what was paid in plus interest. So yes if you are receiving Medicare and social security you are receiving subsidies above what you paid in.

A bipartisan Congressional committee has reported that in 2007 prior to economic down turn that 40% of households paid no federal income taxes. In 2009 they reported the number grew to 51% that did not pay federal income tax. It is estimated in 2013 the number will be 43%. Yes those households paid other types of taxes but they did not pay federal income tax according to congress. If you wish to "debunk" those stats talk to congress.

I don't have the perfect answer to healthcare because there doesn't seem to be one. What I was pointing out in the original statement I made I feel is still correct as no one has offered proof to the contrary. The gov't may be well meaning when they start an entitlement program. The programs most likely help a portion of the society. Unfortunately the programs typically wind up mismanaged, bloated and over budget. I believe ACA is likely to wind up the same way. Can I prove it will, no. Just like you can't prove it won't.

Scott Burkhart 1 year, 8 months ago

I don't doubt that all of you that favor the ACA truly care about their fellow citizens. Like all of us, you don't want anyone to go without access to proper, affordable healthcare. The canard that conservatives don't want affordable healthcare for all is a talking point from left that has been repeated to demonize those that would oppose total government control of the healthcare sector of our economy. You ask, "What is your alternative to ACA if you care so much?" Alternatives have been offered. Two huge private sector alternatives that have been offered are tort reform and opening up competition across state lines. I'm not going to get into the weeds over why you haven't heard of it or why it gets little if any support from the Democrat Caucus, but these have been offered. Instead we now have a law that by design will throw millions of people off of healthcare policies that they liked. The argument is that they will receive something better, is more comprehensive, and will be cheaper. Better by who's standards? Comprehensive because it covers birth control and maternity care for a 50 year old man? Cheaper? Not yet. The people that are telling us this are the same people that told us the bill needed to be passed so we could see what was in it. It is the same person that told us we misunderstood what he said when he said we could keep what we have. It is the same people that had 3 years to have a functioning website to roll out the ACA. Seriously, does it not give anyone pause, who knows how to design websites, that the Federal government couldn't come up with a website that would handle the necessary hits when it came online. President Obama went to Boston and gave a speech about how great their healthcare insurance is and reiterated it was Romney's plan. Well, I ask you, genius, why didn't you hire Romney if he's so darned smart? The reason is the website was never supposed to work properly and the ACA is designed to move us toward a total Government run, single payer healthcare system like western Europe. People were supposed to get so upset with it and then those in power would step in and say, "Well, it just isn't going to work this way and things are so messed up now, we're just going to have to have the government do it all." Then healthcare insurers are gone the way of the dinosaur and if your company is big enough and has the grease for the machine, you'll get the healthcare contracts.

Mark Pickerel 1 year, 8 months ago

Tort reform savings wouldn't be nearly enough to make a dent in our skyrocketing healthcare costs. I think the last estimates had it saving about .5%.

Cross-state private competition would probably be a mess because of the tangle of different states' regulations; it seems like it would take considerable federal intervention to make this work. I doubt it would be a viable long-term solution.

John Graham 1 year, 8 months ago

Agreed, tort reform would not solve all the problems but even if it helped only 0.5% why not include it. Because the lawyer special interest group didn't want it and the democrats left it out of ACA. There are examples of federal programs (such as Medicare, social security and the VA system) that require uniformity across state lines. By mandating uniformity across state lines in how Medicaid expansion would be handled, how exchanges would be set up etc would have allowed insurance companies to sell across state lines which would have spread the costs more evenly across the country. More competition means better prices. There was a recent article how there was significant differences in premiums for the same policies between MN and WI. If there is going to be a national mandate that everyone must buy insurance then they should have set up the system so it would be equal for all across the country. This is a major failing of ACA.

Mark Pickerel 1 year, 8 months ago

Oftentimes administrative costs bump up the price of insurance, and ACA does have some regulations built in that will help control that variation somewhat. Not perfect, of course, but nothing will ever be.

I think also have to give the Feds the ability to negotiate drug prices. Stop giving the farm away to the drug companies.

John Graham 1 year, 8 months ago

Absolutely. The drug companies have to be dealt with in a serious way. Why spend so much money on advertising to the public when doctors have to write the rx? They want the patient to want the new expensive drug, knowing if the patient asks for it the doctor is more likely to give it in order not to upset the patient that then might go somewhere else. Bad medicine but doctors are worried about losing patients so they will sometimes do something to make a patient happy even if it is not the best practice. The drug companies payoffs to doctors is another source that must stop. There have been some rules to slow it down, but drug companies have found ways around the rules. When a drug company spends more on advertising to patients and doctors than in research/ development there is a real fundamental problem. Those costs are passed on to the public.

Steve King 1 year, 8 months ago

Well thank you John for a candid positive response. I'm glad we can agree to disagree amicably. And I do not discount that there are thousands skimming the system. And most do not pay Federal Income Taxes. And some don't make enough to pay taxes. The working poor. Walmart workers on food stamps? (They have a training/education program to tell their workers how to apply). Is that crazy? And those are the people on the non paying side of the equation. They are working, trying to make it. I'll bet everyone of them would love to make enough that they had to pay in.

But I also think if we have enough resources to spend a billion dollars a month in the middle east we can take car of our elderly and poor here at home.

And I appreciate your view you don't have the perfect answer, there might be one, or not. But if we don't try something we get nothing. Our history shows we've made a lot of mistakes. But it also shows we have the persevere to get it right. I hope it works. Something has to be better than what we have now.

Because personally I've heard nothing from anyone else outside of this is bad it must go. What is the alternative plan? Well I guess it is conspiracy week. Who killed Kennedy? And the ACA has been a scam from the beginning. It's also been torpedoed from the beginning.

There has to be standards. And only on a national level can that be implemented. The comment the States would be all over the page is correct. Right now you can get arrested and go to prison for what's legal in the next state over.

But times change. What we can do now was science fiction 30 years ago. And that costs more. And in my experience I've not found the problem with the Doctors and Nurses but with the Administration and Insurance Companies.

I hope it works. I need it to work. We need it to work.

And believe me when I say I am just as tired of the ultra left as I am of the ultra right. I've never seen so many kooks in class in my life.

John Graham 1 year, 8 months ago

Steve, believe it or not I too hope ACA delivers what was promised. I am not against more people having health insurance. I am not even completely against paying a "little more" to help subsidize others. What I am against is being lied to about keeping my insurance (which covered everything ACA does except maternity care so it was not a "bad" policy) and what ACA will cost. I am one that will be paying at least $1000 more per year in premiums and my deductible increases by $3700 per year. I am subsidizing others, not receiving subsidies. If the president and the supporters of ACA would have been upfront about these issues it would have been better instead of saying you will keep your insurance and ACA will save you money. What is most frustrating is the lack of cooperation between the democrats and republicans. It is a two way street. At the time the dems controlled everything so they didn't have to necessarily work with republicans so in the end they didn't. The repubs could have been more agreeable to work with but they weren't. Believe it or not I believe democrats/liberals have some good ideas. I also believe republicans/conservatives have some good ideas. When the two parties refuse to work together we are not getting the best possible solutions. Yes both sides are at fault for not working together. It takes two to have a disagreement.

And yes I enjoy needling people on this site. In general it seems if a conservative argument is put forth the majority dismiss the opinion without giving it any serious consideration by labeling it "right wing" or "tea party" which seems to indicate that anything "right wing" or "tea party" is obviously not worth reviewing. Even "right wingers" and the "tea party" have an occasional good idea.

Steve King 1 year, 8 months ago

Uh well, it's Lawrence John. Had you written in the Wichita paper the responses would have been 180 degrees in the opposite direction. I agree there are some good ideas from the right, but the bad ones are much too dangerous. More so than ever before.

I too enjoy stirring things up. Getting people motivated one way or the other is important. Way too much apathy. Half the people know nothing but the opposing talking points. And the other half don't have a clue. They don't pay attention. I loved the LJW street poll where 50% of the interviewees admitted they didn't know anything about what was going on politically in the county. You have to give Jimmy Kimmel (sp?) credit for showing the bias (and ignorance) from the man on the street.

My insurance experience is also 180 degrees from yours. I stand to reduce my group costs 2/3's when I convert.

And I was thinking; my policy is canceled every year. Every year. I have the same company insuring me year after year. The prior year policy is always canceled. You must renew your policy once a year. And always under different terms. Mostly higher premiums, occasionally a higher deductible, and in a blue moon a bit better coverage. So it's my choice if I want to keep my Insurance.

So are these thousands of policy holders that are getting cancellation notices also getting options to renew, albeit at a higher premium, a higher deductible, and perhaps a bit better coverage? An Insurance Company is going to drop 10,000 potential customers without trying to hook them on another drug? If you do, you've never worked around the insurance industry.

And so they too have a choice to keep their insurance? Right?

John Graham 1 year, 8 months ago

Yes I my single policy premium would increase each year but surprisingly to me it only would go up by less than $5 month. When I had a group policy my rates tended to go up by a larger percentage. I attribute this to the fact I rarely use healthcare so as a single policy that may have some benefit. I don't doubt people receiving cancellation letters were most likely offered new policies, but the new policies would be like mine in which I now have coverages I personally do not need such as maternity care. The additional coverage will add significantly to the new premium price. Is my new insurance policy that I am forced to buy (it so happens the same company my old policy was from has the best price on the ACA policy) really "better" if all it does is force me to pay for something I will never need. I understand the whole spread the cost to everyone argument. What I am talking about is the ACA supporters, Obama and the democrats say the new policies under ACA are "better" that is why some will have to pay more. I don't believe that maternity care makes my policy "better" for me. It seems to be another of those little fibs that have been told about ACA. Yes I realize in some cases people had really crap insurance so the new costs will be higher and it will cover things they really need. But this is not the case in all situations like it has been sold to us. I guess I am fed up with the gov't be it democrat or republican repeatedly failing to tell the truth. The parties simply spin the truth to fit their needs in order to do what they think will get them re-elected. The public is left to try to figure out what the real truth is. While some on here will disagree, I am not an idiot, and if I can't figure out where the truth is I am betting neither can a large portion of the American people.

Cait McKnelly 1 year, 8 months ago

For proof that the ACA can work one need look no further than the state where it originated, Massachusetts, under then Governor Mitt Romney.
The ACA WAS the compromise. The left wanted single payer. If it's having a rocky start because of the obstructionist efforts of Tea Partiers like Sam Brownback and the attempts of insurance companies to game the system (just in the six weeks since rollout, several have already been charged with fraud, including, unbelievably, a subsidiary of Blue Cross), it's not going to do anything but make the case for single payer.
It may be hard to see from the ivory tower of the Tea Party that is Kansas but their day is waning. The GOP has become the party of old white men and more and more of their demographic are dying off every year. See that 16 year old kid next to you in the grocery store line, texting at the checkout? In two years that kid will be eligible to vote. That kid will also be dealing with student loans and wanting birth control. Who do YOU think she will vote for?

John Graham 1 year, 8 months ago

And the middle aged couple who at one time were young idealists that are now fed up with ever more gov't intrusion into their lives are standing behind you. They see more and more of their paychecks taken in taxes to pay for entitlement programs that are out of control. They see the Democratic Party refusing to talk about cutting any entitlement programs, just wanting more taxes to address any issue on budget deficit. They are self sufficient people that didn't mind paying more to help subsidize others but the gov't keeps taking mor and more.They remember the bible story about the significant difference in giving a man a fish and teaching him how to fish. They are beginning to realize that short term subsidies can help but too many people are never progressing off the entitlement programs as they get accustomed to the subsidies. This in the long term takes away their individual freedoms and pride as it makes those people ever more in debt to the gov't. They realize that entitlement programs are not the answer to all the country's problems. They want a fiscally responsible gov't that encourages individuals to succeed on their own, and not to rely on gov't entitlement checks. They realize they are no longer democrats but are now republicans.

Mark Pickerel 1 year, 8 months ago

John...Maybe if we didn't start two wars and cut taxes while doing it, we wouldn't HAVE a deficit. I wonder which party did that?

John Graham 1 year, 8 months ago

The democrats, at least some, voted in favor of those military actions just like the republicans. So while I am not necessarily in favor of how either action turned out, both parties share in the blame even if lead by a republican president. If all the democrats had voted against all military action then you could rightfully put all the blame on Bush and the republicans. Since at least some democrats voted in favor of military action the democrats get to share in the blame. Remember at least some of this military action was a direct result of 9/11. Remember the democrats wanted some retaliation just as bad as the republicans and most importantly just as bad as most Americans.

Mark Pickerel 1 year, 8 months ago

Sure, but the intelligence gathered by the Republican administration was bad at the time. They were railroaded, plain and simple.

I don't want to go back and forth about this, it's true that both parties are to blame. But I hate it when Republicans grouse about the debt and blame it on entitlements when it exploded under a Republican president who spent it on stupid wars and a tax cut and told everybody to "go shopping".

John Graham 1 year, 8 months ago

You are entitled to hate as you please just as I am able to hate it when the president and his controlling party pass an enormous entitlement program by lying about keeping insurance you are happy with, period. And lying about everyone saving money. One could call what the democrats did as railroading ACA through congress. The democrats did vote in favor of military action. There were democrats at the time agreeing with the issue of WMDs including former Sec of State Albright. Multiple Clinton era officials including Clinton himself made statements about Iraq's WMDs in the late 1990s. Even Nancy Pelosi got in on the act. Democrats set in intelligence committees in congress and went along with the idea. So the democrats while not leading the charge of WMDs certainly followed along without significant complaint. I was not a fan of the whole WMD debacle that led to a mess of an expensive war not only in $ but human life and injury. But one can not fairly lay all of the blame on Bush and republicans, democrats were there and went along with it. So neither party has anything to brag about.

John Graham 1 year, 8 months ago

Since there was repeated statements by Clinton, Gore, and other democrats about Iraq's WMDs prior to Bush taking office, Bush can not be blamed for all misinformation regarding WMDs. The democrats share in that blame also.

Mark Pickerel 1 year, 8 months ago

I said that already, John, but thanks anyway.

John Graham 1 year, 8 months ago

I apologize. I must have not understood your prior statement. Sorry about that.

Cait McKnelly 1 year, 8 months ago

If the middle class is hurting (and god knows we are. I'm part of it too.) then consider this.: 80% of this country is now below, at or within 5 percentage points of the poverty level. Yes, I said EIGHTY PERCENT. Within the five years since the 2008 crash, that 80% has received less than 5% of the economic gains.
Y'all need to start reading Robert Reich's blog/Facebook page.

John Graham 1 year, 8 months ago

By the way the 18-24 year old age group of eligible voters had a turnout of less than 45%, substantially less than middle age and elderly. As people get older they tend to get more conservative particularly about financial issues. So raises in taxes to keep the entitlement engine running does not sit well with the aging population. Remember the elderly do not see Medicare and social security as entitlement programs. If you don't believe me go as an elderly person if they are getting a gov't subsidy. You better be swift on your feet because they are likely to try to hit you with their cane because many of them would be insulted to think they are getting any sort of subsidy(charity). They see all the other programs the democrats favor as entitlement programs.

Steve King 1 year, 8 months ago

John, the last thing I would ever consider you as is an idiot. And I would poke anybody in the eye with a shapr stick that says different.

Both sides deserve blame. And us as voters ( and non-voters) as well.

Sam Crow 1 year, 8 months ago

For Dick Sengpiehl:

The information you posted earlier on this thread is incorrect.

First, “administrative costs of Medicare are much less than privately run insurance companies”. This is a liberal myth resulting from partial information. Of course Medicare is administered by privately run insurance companies. The costs of the federal bureaucracy of HHS and CMS are not calculated in the costs of medicare, as those costs are impossible to separate from all else. Therefore, the resulting “costs” are strictly the costs of the carriers.

Additionally, the erroneous lower “costs” you refer to are not due to lack of profit motive by medicare. Another liberal myth. Once again, Medicare is administered by many companies across the country. Many of those carriers are for profit companies. For example, one Medicare carrier, CIGNA, is a stock company traded on the NYSE. Wisconsin Physician Services is the carrier in this area, and is not for profit.

Further, regarding insurance companies not affiliated with Medicare: Of the 154 health plans in the United States with at least 100,000 enrollees, 97(or 63%) are nonprofit, 41 are for-profit (27%), and 16 (10%) are government i.e. Tri Care. For example, BCBS in Topeka and Kansas City, who dominate the local market are not for profit entities. BCBS Topeka is actually the 39th largest insurer in the country.

Second, the VA does not take bids on drugs. Rather, federal law requires that they get the best price that is given to any health entity in the country. Pharmaceutical companies must report that pricing on a quarterly basis. For budget purposes, the VA formulary begins a new patient on the least expensive drug available in the class, and escalates up if it is not effective. Therefore the products available to the VA patients are very limited.

Third, regarding WHO outcomes, your statement is another liberal myth. Each country defines its own standard of statistical information. For example, the United States defines infant mortality differently than many European countries. Therefore, the WHO comparison is invalid.

Take it from someone with the specific education and 25 years experience in the business.

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