House passes health care bill on 219-212 vote

[moe.ron]

David Frum's take on the political fall out:

Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.

It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:

(1) It’s a good bet that conservatives are over-optimistic about November – by then the economy will have improved and the immediate goodies in the healthcare bill will be reaching key voting blocs.

(2) So what? Legislative majorities come and go. This healthcare bill is forever. A win in November is very poor compensation for this debacle now.

So far, I think a lot of conservatives will agree with me. Now comes the hard lesson:

A huge part of the blame for today’s disaster attaches to conservatives and Republicans ourselves.

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.

Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.

So today’s defeat for free-market economics and Republican values is a huge win for the conservative entertainment industry. Their listeners and viewers will now be even more enraged, even more frustrated, even more disappointed in everybody except the responsibility-free talkers on television and radio. For them, it’s mission accomplished. For the cause they purport to represent, it’s Waterloo all right: ours.

[Kappamd]

Originally Posted by Beryana

Umm...I don't go to doctors because I'm typically not sick. . . I just don't like your attitude that people can't know their own bodies or do their own research and bring some intelligence to the table. I also don't put doctors up on a pedestal as you are also human and don't necessarily know everything about everything.

I've had bad experiences with Family Practitioners as well as specialists. Not spending more than a few minutes with a patient missed a MAJOR diagnosis (a STROKE!!). Why bother going in to see a doctor if they don't care about a patient?

And I really don't care what you think about me because I'll never be coming to see you or your husband in any capacity, professional or otherwise.

You have no clue.

And your responses to AOII Angel are getting a little out of hand considering how cordial she has been to you.


Anyways, I am super happy to see the tanning tax included in the bill. Disappointed about a lot more (lack of tort reform, medicare spending, etc.) There are a lot of major problems that are not being addressed with this bill.

[ZTA72]

Originally Posted by Kappamd

Until something is done about the SKYROCKETING cost of of med school...

I feel ya...
We've got two daughters to bankroll/get loans starting this fall.
It is truly shocking how much it is going to cost.
I'd like a little of that stimulus money to come our way.

[Beryana]

Originally Posted by Kappamd

And your responses to AOII Angel are getting a little out of hand considering how cordial she has been to you.

And since when is calling someone a fool 'cordial'?

And I do know plenty about what is going on in the insurance industry as well as with healthcare (from a patient perspective as I am not and do not want to be in the medical profession). Oh, and I also understand socialized medical care from a political perspective as well as the Constitution, etc - where is it that I have no clue?

[Kappamd]

Originally Posted by ZTA72

I feel ya...
We've got two daughters to bankroll/get loans starting this fall.
It is truly shocking how much it is going to cost.
I'd like a little of that stimulus money to come our way.

It's ridiculous.
I am one year in and ~$50,000 down. By the time I'm done I'll have over $200,000 in loans/interest. THANK GOD I didn't have any from undergrad.

And they wonder why no one wants to go into primary care.....

[Kappamd]

Originally Posted by Beryana

And since when is calling someone a fool 'cordial'?

And I do know plenty about what is going on in the insurance industry as well as with healthcare (from a patient perspective as I am not and do not want to be in the medical profession). Oh, and I also understand socialized medical care from a political perspective as well as the Constitution, etc - where is it that I have no clue?

Her calling you a fool was generous considering some of the disparaging remarks you have made.

And your having no clue refers to some of the completely naive comments you have made about healthcare delivery.

[ZTA72]

Originally Posted by Kappamd

It's ridiculous.
I am one year in and ~$50,000 down. By the time I'm done I'll have over $200,000 in loans/interest. THANK GOD I didn't have any from undergrad.

And they wonder why no one wants to go into primary care.....

Yep, and that's the sad thing about it...that's where the need is.

[KSUViolet06]

Originally Posted by Kappamd

It's ridiculous.
I am one year in and ~$50,000 down. By the time I'm done I'll have over $200,000 in loans/interest. THANK GOD I didn't have any from undergrad.

And they wonder why no one wants to go into primary care.....

Wow.

My med school friends tell me that med school is much more expensive than other programs, but seeing it typed out is crazy.

Kudos to you for sticking with wanting to be a primary care Dr. (the cost is a huge disincentive for some.) There is a huge need for good physicians who are interested in it.

[PeppyGPhiB]

Originally Posted by AOII Angel

You are still WRONG about the thyroid and T3/T4 levels. It's rather insulting, too, that you think that your research with hypothyroid patients trumps 13 years of education that endocrinologists have with regard to the thyroid. Maybe they know what they are talking about. Taking extra synthroid may make you feel better, but it's also associated with a lot of other side effects. You do what you want, but leave the ugly commentary about physicians behind.

I will tell you that my sophomore year in college I gained 40 lbs in one year despite eating better and getting a great workout every day on my hilly campus. I was pre-med at the time and noticed that I had a number of symptoms of hypothyroidism (we were studying the endocrine system at the time). So when I went home at the end of the year, I went to the doctor. And she wouldn't test me. Told me I was too young to have hypothyroidism and that I just needed to exercise more. By the time I came home from winter break of my junior year, I had gained another 20 pounds. I went to the doctor, crying, and she finally tested me. My TSH test came back at a 45 - but she still didn't want to treat me! So I asked for a referral to an endocrinologist and I've been treated ever since. Through REALLY hard work, and medication, I've been able to lose 20 of the pounds, but not all 60. My TSH is still around 10.

Some doctors who are more recent graduates and know all of the latest research on this stuff may know better than their patients, but not all doctors keep up on current research and treatments. Any patient who has had to change doctors due to new insurance or lack of "chemistry" with a given doctor knows that there is a huge variety of doctors out there, all with different methods. My doctor was old school, about five years out from retiring, and though she was a smart lady, she used old-fashioned approaches that were not appropriate for an unusual case like myself. She needed to recognize her areas of weakness and refer me to someone who knew more about my condition than she did.

[DaemonSeid]

Amazing, people are being investigated because of death threats they made via twitter after the bill passed.

link

[chickenoodle]

Originally Posted by DaemonSeid

Amazing, people are being investigated because of death threats they made via twitter after the bill passed.

link

Death threats? Really?

[DaemonSeid]

Originally Posted by chickenoodle

Death threats? Really?

Rearlly

[ASTalumna06]

Originally Posted by AOII Angel

Exactly, that's where they got the idea, and it's working in Massachusetts. That's why Massachusetts didn't want a new federal mandate, they already have universal care in that state. For anyone who says that including everyone doesn't bring down rates, just look at Massachusetts. The only real issue they are currently having is that they have a shortage of primary care physicians. This is what we really need to worry about!

Whether or not it's working in MA overall, I'm not really sure. However, I do know that it didn't work for me (at least as far into it as I was able to get before I moved). The state wanted everyone to have healthcare, and if they didn't, they were penalized. The first year, I had $219 (I believe that was the exact figure) deducted from my tax returns, leaving me with next to nothing. For someone who was making $7.80 an hour at a part-time job, unable to find a decent one, that sucked. The following year, they penalized me $72/month for not having insurance. In October of that year, I moved to PA.

So basically, I lost almost $900 over the course of 6 months, and I still didn't have insurance. But if I got health insurance, I would have paid more than that, and I simply couldn't afford it. I pretty much got screwed and paid a whole bunch of money for nothing.

[VandalSquirrel]

Originally Posted by PeppyGPhiB

I will tell you that my sophomore year in college I gained 40 lbs in one year despite eating better and getting a great workout every day on my hilly campus. I was pre-med at the time and noticed that I had a number of symptoms of hypothyroidism (we were studying the endocrine system at the time). So when I went home at the end of the year, I went to the doctor. And she wouldn't test me. Told me I was too young to have hypothyroidism and that I just needed to exercise more. By the time I came home from winter break of my junior year, I had gained another 20 pounds. I went to the doctor, crying, and she finally tested me. My TSH test came back at a 45 - but she still didn't want to treat me! So I asked for a referral to an endocrinologist and I've been treated ever since. Through REALLY hard work, and medication, I've been able to lose 20 of the pounds, but not all 60. My TSH is still around 10.

Some doctors who are more recent graduates and know all of the latest research on this stuff may know better than their patients, but not all doctors keep up on current research and treatments. Any patient who has had to change doctors due to new insurance or lack of "chemistry" with a given doctor knows that there is a huge variety of doctors out there, all with different methods. My doctor was old school, about five years out from retiring, and though she was a smart lady, she used old-fashioned approaches that were not appropriate for an unusual case like myself. She needed to recognize her areas of weakness and refer me to someone who knew more about my condition than she did.

Seriously, I've had some not great doctors and I think what we need people to do is to learn to advocate for themselves and do some research. I don't mean spending hours on WebMD, but keeping track of changes/norms so when something comes up there is a baseline and a time line. If I go to the doctor and my blood pressure is high and I ate a high salt meal or was running late, that would make sense. If I just drank coffee, that could account for an elevated temp. So much of that behavior for me is left over from having to keep track for health issues I just kept doing it and I always bring that to an appointment, as well as writing down my concerns. I want to make the most of my time and the doctor's time.

I was dismissed once for breast cancer and I was so fortunate the ENT surgeon (huge a-hole, but good surgeon) refused to operate until a doctor he trusted ruled out cancer as the person I normally saw was on maternity leave and the other doctor didn't find my concerns important (that person is no longer in the practice). I have the option of a second opinion but it is so annoying when office #1 will not send your records in a timely manner to office #2. If I had cancer and they blew me off I'd have considered filing a law suit because it shouldn't take three months to send records. I go to the biggest practice in town and thankfully they also run the Urgent Care but one practitioner doesn't get butt hurt if you see someone else because they aren't available, nor is there drama if they consider different treatments. Living in a rural area makes it hard at times, and many people make the 1.5 hour drive to Spokane for specialists.

My time in Alaska is always a crap shoot because the clinic is either 30-100 miles away and because I'm an outsider the med student who is doing a rotation always wants to see me because I'm less likely to object (I don't have tinfoil underpants and believe in conspiracy theories) and have some strange shizz in my medical history. I've only been cranky once when one young woman was telling me I should be concerned about osteoporosis, when my only risk factor is being female. No one in my family has had it, I've never broken a bone, my bone affected surgeries healed freakishly fast, I'm not lactose intolerant, and I'm Norwegian so eating cheese on the daily.

My temp is low though, constantly, about 97.5-97.9 but allegedly it is genetic. I'm willing to have my thyroid checked though because I tolerate cold too well for some people's liking.

[xp2k]

Originally Posted by ASTalumna06

Whether or not it's working in MA overall, I'm not really sure. However, I do know that it didn't work for me (at least as far into it as I was able to get before I moved). The state wanted everyone to have healthcare, and if they didn't, they were penalized. The first year, I had $219 (I believe that was the exact figure) deducted from my tax returns, leaving me with next to nothing. For someone who was making $7.80 an hour at a part-time job, unable to find a decent one, that sucked. The following year, they penalized me $72/month for not having insurance. In October of that year, I moved to PA.

So basically, I lost almost $900 over the course of 6 months, and I still didn't have insurance. But if I got health insurance, I would have paid more than that, and I simply couldn't afford it. I pretty much got screwed and paid a whole bunch of money for nothing.

Not trying to pick any fights, but if you made $7.80 an hour, were you not eligible then for the low income plan?

Also, there are partial insurance plans cheaper than $72 a month.