IRS Reportedly Awards Company That Botched Obamacare Rollout A New Contract To Work On Obamacare

160px-IRS.svgWe previously discussed the gross negligence exhibited in the Patient Protection and Affordable Care Act (or Obamacare) rollout and how there appeared little accountability for such failures even when they cost hundreds of millions.(For a column, click here). Now it turns out that, after costing the country a fortune due to this shoddy work, the IRS has reportedly awarded the company yet another contract to do work on . . . you guessed it, Obamacare.

So it was only in January 2014 that Administration insisted that it had dumped the company despite CGI Federal’s connections to fundraising for the Obama campaign and personal connection to the First Lady (Toni Townes-Whitley, a senior vice president at CGI Federal, was a Princeton classmate and friend of First Lady Michelle Obama). The IRS contract is worth $4.46 million and will expire in Aug. 15, 2015. At the time, Health and Human Services Secretary Kathleen Sebelius told Congress that the CGI-designed website a “debacle” and “I am as frustrated and angry as anyone with the flawed launch of HealthCare.gov.” As I stated earlier, I still am mystified how Sebelius was not fired. However, if CGI is any example, she can now hope to be made Vice President or better.

Now the Administration has awarded an IT contract for its new Obamacare tax program. Wouldn’t the greatest failure in a federal contract weighed slightly against the awarding of the contract?

That seemed to be an issue with Vermont and Massachusetts which dumped the company last year.

However, CGI’s 2014 annual report reportedly omits its role in the prior disastrous rollout.

94 thoughts on “IRS Reportedly Awards Company That Botched Obamacare Rollout A New Contract To Work On Obamacare”

  1. Paul

    Stay on topic, otherwise what’s the point of exchanging ideas? If you want to insult people and get in a tit for tat, address Nick Spinelli. He’s always up for that.

    I think we all agree that there were problems with health care costs, are problems with health care costs, and will always be problems with health care costs.

    On the one hand there is the private sector which is not accountable to the public directly but does have considerable sway, ‘oligarch style’, in our government. On the other hand there is the government which can be voted in or out based on their performance. None of the countries with single payer systems are willing to go private. They want a private sector but every peer country considers the base public system to be the best. These countries experienced both. The US has only experienced the private for profit system.

    As long as there will continue to be problems with the health care system, I prefer to have it administered by the government which does respond, regardless of how, to the people, or is supposed to. The private sector responds to the profit margin only. The cardinal rule is ‘what the market will bear’.

    The evolved situation in our peer nations that started out on the far right then went to the left in varying degrees, is a public system for security, peace of mind, and economic stability, with a private system based on choice and affordability, or the best of both worlds. This is the two tier system now in use everywhere except here.

    So, the question is, do we take from the success of both sides, the left and the right, or do we stay on one side, victims of what you so aptly refer to as ‘blather’.

  2. Paul

    Sarah Palin Admits Going to Canada for Health Care– Why?
    Posted on March 8, 2010 by Maggie Mahar
    How rich is this?

    Over at “Think Progress,” Igor Volksy reports that, while speaking to a crowd in Calgary, Canada last weekend Sarah Palin revealed a tidbit about her life growing up not far from Whitehorse:

    “We used to hustle over the border for health care we received in Canada,” she said. “And I think now, isn’t that ironic?”

    Isn’t it? (I can imagine Palin, tilting her head slightly to one side, gazing into thin air, and referring to something that she will never understand: irony. )

    As Volsky points out, this admission doesn’t exactly square with Palin’s stand on health care. She has warned us all that U.S. health-care reform will lead to “socialism” and that Canada needs to reform its health care system to “let the private sector take over.”

    You might wonder: Why would Palin possibly disclose her across-the border excursions for care? The Globe and Mail reports that the Calgary crowd was “adoring”: in the end “about half of the 1,200 people in attendance gave Ms. Palin a standing ovation.” My guess is that Palin felt a need to respond to all of that love by acknowledging that, in the past, Canadians had bailed her out.

    Volsky observes that “This isn’t the first time Palin highlighted the difficulty of obtaining affordable health care in America.” During the presidential campaign, Palin discussed how she and husband Todd had “gone through periods of our life here with paying out-of-pocket- for health coverage until Todd and I both landed a couple of good union jobs.”

    Maybe that’s Sarah Palin’s solution for the health care problem in the U.S.? Bring back the unions, give them more power, and working-class Americans will have the benefits they need. Not a terrible idea. Except—what about workers in non-union shops?

    My take: There is little evidence that, these days, many Americans go to Canada for health care. (The cost of living in the U.S. is not that much higher than it is in Canada, so you won’t find the same very deep discounts that you might find in Thailand. Though, Americans do go to Canada for cheaper prescriptions.)

    But it is true that some Americans (who can afford the airfare) have been leaving the U.S. to go to India and other countries where expensive surgeries are much, much less expensive.

    I can well imagine that when Sarah Palin was growing up, her family would skip over the border for care. Many countries provide generous treatment for patients who are not citizens. (The U.S. is not one of them.) I wonder what story Palin’s family told the Canadian hospital: “we were here for the week-end and poor Sarah fell . .” ??

    – See more at: http://www.healthbeatblog.com/2010/03/sarah-palin-admits-going-to-canada-for-health-care-why/#sthash.6iIqBJIk.dpuf

  3. AARP

    It might be interesting to review how many Canadians retire and reside either part of the time or permanently in the US.

    Myth #1: Canadians are flocking to the United States to get medical care.

    How many times have you heard that Canadians, frustrated by long wait times and rationing where they live, come to the United States for medical care?

    I don’t deny that some well-off people might come to the United States for medical care. If I needed a heart or lung transplant, there’s no place I’d rather have it done. But for the vast, vast majority of people, that’s not happening.

    The most comprehensive study I’ve seen on this topic — it employed three different methodologies, all with solid rationales behind them — was published in the peer-reviewed journal Health Affairs.

    How Many Canadians Use the U.S. Health System?
    Do not come to the US for care: 99.39%
    Come to US for care electively: 0.5%
    Use the US for emergency care: 0.11%
    Source: “Phantoms in the Snow: Canadians’ Use of Health Care Services in the United States,” Health Affairs, May 2002.

    The authors of the study started by surveying 136 ambulatory care facilities near the U.S.-Canada border in Michigan, New York and Washington. It makes sense that Canadians crossing the border for care would favor places close by, right? It turns out, however, that about 80 percent of such facilities saw, on average, fewer than one Canadian per month; about 40 percent had seen none in the preceding year.

    Then, the researchers looked at how many Canadians were discharged over a five-year period from acute-care hospitals in the same three states. They found that more than 80 percent of these hospital visits were for emergency or urgent care (that is, tourists who had to go to the emergency room). Only about 20 percent of the visits were for elective procedures or care.

    Next, the authors of the study surveyed America’s 20 “best” hospitals — as identified by U.S. News & World Report — on the assumption that if Canadians were going to travel for health care, they would be more likely to go to the best-known and highest-quality facilities. Only one of the 11 hospitals that responded saw more than 60 Canadians in a year. And, again, that included both emergencies and elective care.

    Finally, the study’s authors examined data from the 18,000 Canadians who participated in the National Population Health Survey. In the previous year, 90 of those 18,000 Canadians had received care in the United States; only 20 of them, however, reported going to the United States expressively for the purpose of obtaining care.

    Myth #2: Doctors in Canada are flocking to the United States to practice.

    Every time I talk about health care policy with physicians, one inevitably tells me of the doctor he or she knows who ran away from Canada to practice in the United States. Evidently, there’s a general perception that practicing medicine in the United States is much more satisfying than in Canada.

    Problem is, it’s just not so. Consider this chart:

    Percent
    Physician Satisfaction with Practicing Medicine
    89
    89
    88
    81
    79
    77
    75
    76
    64
    48
    39
    Satisfied
    Very Satisfied
    NZ
    NOR
    NETH
    UK
    SWE
    ITA
    CAN
    FRA
    US
    AUS
    GER
    0
    25
    50
    75
    100
    Source: “2009 International Health Policy Survey of Primary Care Physicians in Eleven Countries,” The Commonwealth Fund, November 2009.

    The Canadian Institute for Health Information has been tracking doctors’ destinations since 1992. Since then, 60 percent to 70 percent of the physicians who emigrate have headed south of the border. In the mid-1990s, the number of Canadian doctors leaving for the United States spiked at about 400 to 500 a year. But in recent years this number has declined, with only 169 physicians leaving for the States in 2003, 138 in 2004 and 122 both in 2005 and 2006. These numbers represent less than 0.5 percent of all doctors working in Canada.

    So when emigration “spiked,” 400 to 500 doctors were leaving Canada for the United States. There are more than 800,000 physicians in the United States right now, so I’m skeptical that every doctor knows one of those émigrés. But look closely at the tan line in the following chart, which represents the net loss of doctors to Canada.

    Number
    Migration of Canadian Physicians, 1970-2010
    Doctors Leaving Canada
    Doctors Leaving for US
    Doctors Returning to Canada
    Net Loss
    1970
    1980
    1990
    2000
    2010
    -750
    -500
    -250
    0
    250
    500
    750
    Source: Canadian Institute for Health Information

    In 2004, net emigration became net immigration. Let me say that again. More doctors were moving into Canada than were moving out.

    Myth #3: Canada rations health care; that’s why hip replacements and cataract surgeries happen faster in the United States.

    When people want to demonize Canada’s health care system — and other single-payer systems, for that matter — they always end up going after rationing, and often hip replacements in particular.

    Take Republican Rep. Todd Akin of Missouri, for example. A couple of years ago he took to the House floor to tell his colleagues:

    “I just hit 62, and I was just reading that in Canada [if] I got a bad hip I wouldn’t be able to get that hip replacement that [Rep. Dan Lungren] got, because I’m too old! I’m an old geezer now and it’s not worth a government bureaucrat to pay me to get my hip fixed.”

    Sigh.

    This has been debunked so often, it’s tiring. The St. Louis Post-Dispatch, for example, concluded: “At least 63 percent of hip replacements performed in Canada last year [2008] … were on patients age 65 or older.” And more than 1,500 of those, it turned out, were on patients over 85.

    The bottom line: Canada doesn’t deny hip replacements to older people.

    But there’s more.

    Know who gets most of the hip replacements in the United States? Older people.

    Know who pays for care for older people in the United States? Medicare.

    Know what Medicare is? A single-payer system.

    Myth #4: Canada has long wait times because it has a single-payer system.

    The wait times that Canada might experience are not caused by its being a single-payer system.

    Wait times aren’t like cancer. We know what causes wait times; we know how to fix them. Spend more money.

    Our single-payer system, which is called Medicare (see above), manages not to have the “wait times” issue that Canada’s does. There must, therefore, be some other reason for the wait times. There is, of course. It’s this:

    Source: Organisation for Economic Co-operation and Development (OECD)

    In 1966, Canada implemented a single-payer health care system, which is also known as Medicare. Since then, as a country, Canadians have made a conscious decision to hold down costs. One of the ways they do that is by limiting supply, mostly for elective things, which can create wait times. Their outcomes are otherwise comparable to ours.

    Please understand, the wait times could be overcome. Canadians could spend more. They don’t want to. We can choose to dislike wait times in principle, but they are a byproduct of Canada’s choice to be fiscally conservative.

    Yes, they chose this. In a rational world, those who are concerned about health care costs and what they mean to the economy might respect that course of action. But instead, they attack the system.

    Myth #5: Canada rations health care; the United States doesn’t.

    This one’s a little bit tricky. The truth is, Canada may “ration” by making people wait for some things, but here in the United States we also “ration” — by cost.

    An 11-country survey carried out in 2010 by the Commonwealth Fund, a Washington-based health policy foundation, found that adults in the United States are by far the most likely to go without care because of cost. In fact, 42 percent of the Americans surveyed did not express confidence that they would be able to afford health care if seriously ill.

    Source: “How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries,” Health Affairs, November 2010.

    Further, about a third of the Americans surveyed reported that, in the preceding year, they didn’t go to the doctor when sick, didn’t get recommended care when needed, didn’t fill a prescription or skipped doses of medications because of cost.

    Finally, about one in five of the Americans surveyed had struggled to pay or were unable to pay their medical bills in the preceding year. That was more than twice the percentage found in any of the other 10 countries.

    And remember: We’re spending way more on health care than any other country, and for all that money we’re getting at best middling results.

    So feel free to have a discussion about the relative merits of the U.S. and Canadian health care systems. Just stick to the facts.

    1. issac – you do a better job of comparing apples and oranges than anyone I know. You do make a great case for making ‘blather’ a college course.

  4. I found this in Wikipedia and am enclosing it as it references the most conservative of several studies available. Also it gives a spread in years showing the increases in costs. As we both know endless statistics and reports are available. Your phrase dueling statistics is apt, therefore let’s focus on the parts and the logic.

    (A 1999 report found that after exclusions, administration accounted for 31.0% of health care expenditures in the United States, as compared with 16.7% of health care expenditures in Canada. In looking at the insurance element, in Canada, the provincial single-payer insurance system operated with overheads of 1.3%, comparing favourably with private insurance overheads (13.2%), U.S. private insurance overheads (11.7%) and U.S. Medicare and Medicaid program overheads (3.6% and 6.8% respectively). The report concluded by observing that gap between U.S. and Canadian spending on health care administration had grown to $752 per capita and that a large sum might be saved in the United States if the U.S. implemented a Canadian-style health care system.[69]

    However, U.S. government spending covers less than half of all health care costs. Private spending for health care is also far greater in the U.S. than in Canada. In Canada, an average of $917 was spent annually by individuals or private insurance companies for health care, including dental, eye care, and drugs. In the U.S., this sum is $3,372.[68] In 2006, health care consumed 15.3% of U.S. annual GDP. In Canada, only 10% of GDP was spent on health care.[5] This difference is a relatively recent development. In 1971 the nations were much closer, with Canada spending 7.1% of GDP on health while the U.S. spent 7.6%)

    Yes I focus on administrative costs as that part of the equation can be changed without affecting the medical care for Americans. My argument is straight math, the reduction in administrative costs by eliminating hundreds of thousands of jobs, CEO salaries, and shareholder profits versus the illusion of lower prices through competition. You can find this out yourself. I have already given you the names of the ‘big boys’ who Reinsure the 1,200+ insurance companies in the US that are working so hard on reducing costs. The numbers support my argument. The only point of contention is how much will be saved.

    As far as other costs they would have to be dealt with separately and with finer tuning. This is also an area of ideology regarding a person’s right to make as much money as he or she can versus that effect on the public. I personally know doctors and specialists in Canada and they are not hurting financially.

    One other fact to consider is that when factoring in administrative costs in the above and other arguments is that only the costs directly attributed to private insurance versus single payer insurance are used. In the US doctors, hospitals, and clinics employ at least twice as many clerical staff in order to deal with the mess. This, in part is responsible for the difference between direct medical costs in the two systems.

    (Some of the extra money spent in the United States goes to physicians, nurses, and other medical professionals. According to health data collected by the OECD, average income for physicians in the United States in 1996 was nearly twice that for physicians in Canada.[80]

    Canada has fewer doctors per capita than the United States. In the U.S, there were 2.4 doctors per 1,000 people in 2005; in Canada, there were 2.2.[81] Some doctors leave Canada to pursue career goals or higher pay in the U.S., though significant numbers of physicians from countries such as India, Pakistan and South Africa immigrate to practice in Canada. Many Canadian physicians and new medical graduates also go to the U.S. for post-graduate training in medical residencies. As it is a much larger market, new and cutting-edge sub-specialties are more widely available in the U.S. as opposed to Canada. However, statistics published in 2005 by the Canadian Institute for Health Information (CIHI), show that, for the first time since 1969 (the period for which data are available), more physicians returned to Canada than moved abroad.[82])

    Again, if you do the math, put the ideology aside, and look carefully at how private insurance is structured, you will find that direct administrative costs and indirect administrative costs are significantly higher using private, for profit, monopoly based insurance systems as compared with a single payer administrative system. Also the single payer government administrative system is directly tied to the political will of the people as well as the economy. This has been seen over the decades in Canada as well as other countries. The issues belong to the voter and the present economy, not the profit goals of mega corporations. Regardless of the ability of voters to sway the government, they have little to no effect on the half dozen Re insurers that set the prices. Also theoretically, the voter has access to the numbers as is not the case with the present system. In other democracies the economy of the day has loosened and tightened purse strings and parties have been voted in and out based on voters’ concerns over health care.

    Separate the problem into its different parts. Then deal with each part. The potential is there to maintain the present quality of medical care, which is no longer number one, and cut the overall cost of health care in half. Fixing no one part will achieve this, however, you have to start somewhere so why not with the parasites.

  5. Isaacs…a clarification on my first sentence…sorry that’s so muddle. What I intended to say was that I have not seen any estimates from you as to ADMINISTRATIVE cost savings you think single payer systems will produce.
    I have stated that bringing private carriers’ administrative costs even to ZERO would not make a huge % difference in overall U.S. health care system costs.

  6. Isaac…..I have not seen any estimates of potential savings from a single payer system. I have already expressed my skepticism that lower administration cost will produced huge savings.
    I don’t know if you have looked at the huge gaps in the incomes of U.S. MDs vs. those in single payer systems. I have seen nothing in your posts that even recognize these central cost drivers.
    Since you focused almost exclusively on exaggerated administrative savings from single payer systems, do you even recognize factors like higher U.S. MD incomes as key elements of higher U.S. costs?
    And if you have a proposal to bring US. MD’s income from c.$175,000 to more like $90,000 of other systems, are you going to basically tell American docs they’re now all enrolled in an income-capped single payer system?
    I’m not going to endlessly exchange “dueling studies” or “dueling statistics” with you on administrative costs; anything I submit in that area will be dismissed by you as “flawed and biased”
    I’m just trying to see if your vision if a U.S. single payer systems includes a huge reduction in MD incomes….and how you’d accomplish that reduction.
    Medicare currently contracts with about 30 PRIVATE insurers for billing….would you recommend an expanded Medicare staff to include government employees doing in-house billing?

  7. Paul

    Each pharmaceutical company pays for its own R&D regardless of which country they are in. There are plenty of Swiss, Canadian, British, French, etc pharmaceutical companies that compete successfully with US companies. There are more US companies. Six of the top ten are US. Google the top ten and take a look at R&D. The percentages of R&D to gross income might make you understand when you compare how much the consumer in the US pays for ludicrous advertising.

    The formularies, costs of experimental drugs, etc are applicable to the companies, not the countries. Americans pay more due in part to laws inhibiting the government and other American entities from negotiating bulk purchases. These laws do not apply to Canada or other countries. The game is rigged in the US. Might have something to do with the pharmaceutical lobby.

    The NHS in Great Britain is a basic service that allows participants to augment that coverage with private policies. The fact remains that the British are not left to the private sector alone. As far as the horror stories go, this is an ongoing NHS thing that ebbs and flows with the economy and dominant political party. There are equal and worse horror stories in the US with their own flavor. You could compare until the cows come home and on a per capita basis you are not better off in the US for the same cost. I personally know Brits who have nothing but good things to say about the NHS, primarily because they adapt to it. I also know Brits that have additional coverage and the cost of the two is still around half of what the average policy in the US costs, before and with Obama.

    This swapping of horror stories is not the issue. I can meet you horror story for horror story. The issue is the cost due to redundancy, and profit driven monopolies. The argument has been going on in the US for fifty years that the system would work if there was more competition. There is no competition. It is a monopoly, too many hands in the pot. We pay a third to a half for the health care and a half to two thirds for stuff that we don’t need, parasites.

    As far as “ALL” the Canadians coming to Arizona, what about “ALL” the Americans coming up to Canada for cheaper treatment, “ALL” the Americans who purchase drugs through the mail from Canadian companies, companies that do quite well financially?

    You can find statistics the point in either direction but the preponderance of the evidence points in favor of a base single payer program administered by the government with supplementary policies available in the private sector.

    1. issac – you are going to have to cite something about Americans going to Canada to get cheaper treatment. I do know about Canadians going south to get treated. I do know that for a time you could buy drugs in Canada cheaper online, but I thought they stopped that. I know the drug buses to Mexico have slowed down here in Arizona. I think Cabo has a trade in elective surgery going that is cheaper than the US, but most of that is plastic surgery.

  8. Paul

    You must be talking about pharmaceuticals. The reason Canada and other countries provide drugs at lower prices is because they negotiate bulk orders which brings the price down. They also have access to pharmaceutical manufacturers throughout the world. I have experienced this personally from a number of perspectives.

    When as a Canadian I had access to drugs developed in Canada, the US, and other countries. While the US is the leading developer of drugs it is not the only one. The incentives to develop drugs does not depend on high prices or on marketing. Their are plenty of pharmaceutical companies in the world that make tons of money. The need is there, established by the medical profession and those in need. It has nothing to do with advertising, yet 20% of the cost in the US goes for marketing. Prices in Canada are lower because Canada has access to the entire world’s pharmaceutical industry, Canada buys in bulk, and Canada does not advertise to its citizens the benefits of this or that drug. Canada and the other countries leave that up to the professionals.

    When as a resident of the US and eventually citizen, I need health insurance for myself, my wife, and our son, I was self employed and had no access to bulk relationships with the health care insurance industry. In 1996 the best I could do was $700+ a month. In BC a friend, his wife, and two sons, paid just over $300 month for the same coverage with no complaints. As an individual, I am sure you are aware, you get screwed.

    When as a teacher, in the US, I received a Cadillac policy for $1 a month. This was part of getting a low salary and partly due to purchasing power of a teacher’s union.

    My wife is a teacher for a private company and when under her policy the premiums from Aetna were $1,300 a month, $400 of that came out of her cheque and the rest factored into her salary or her cost to her employer.

    There is a potential reduction in cost when lots of people or perhaps everybody deals with the issue as a group, whether that be pharmaceuticals or medical care. There is no advantage to the individual in the US under the present situation other than the illusions of service and choice.

    Your statement that other nations pay less because we pay more argues my point. If the US government negotiated with the pharmaceutical companies throughout the world there would be significant reductions in cost. This would also be true throughout the rest of the medical and health industries. The main reason to regard our peer nations is that they have more cost effective ways of delivering the same services. They all went through the same evolution that the US should be going through. They all have more effective democracies with greater choice of representatives, less private money influencing politicians, and greater protection of the integrity of their democratic institutions.

    Regardless of how you cut it, we pay more for the same stuff, at least twice as much. There are no redeeming qualities to this system except for those who are paid for doing redundant jobs, those that collect millions in high paid CEO salaries, and those that make money from shareholder dividends. It should be obvious that with all those hands in the pot the pot needs more money.

    1. issac – WE pay for the R&D, Canada does not. Canada also has a smaller formulary as does the UK. If I take experimental drugs out of the formulary I can make the cost of drugs very inexpensive. If I spread the cost of R&D across the planet I can also make the cost less expensive in the US.

      I follow the NHS closely and they are a hot mess. And if Canada was so great why are all the Canadians coming to Arizona to have procedures done?

  9. Tom Nash

    If you google the issues you will find many, many, many studies. The range of the objective studies, that is studies not done by insurance companies or advocates for single payer programs you will present a difference of approximately four to five times the administrative costs, private-for profit versus medicaid/medicare. Some private insurers have higher and some have lower but the average is considerable at four to five times as much. I cited one study above, done by an actuary-Milman.

    The pharmaceutical industry spends two to three percent more on advertising than on research and development, yet uses research and development cost to justify, in part, the higher costs. Advertising runs from 18% to 20% of the industry’s budget. Aside from the obvious cost savings, the US is the only country that allows this, people to be targeted regarding the need and choice of potentially dangerous drugs, through the same media that advertises autos, fritos, coke, etc. Watch an add for anti depressants on TV and ask yourself if this is how people should be dealing with drugs that can be abused and perhaps are not even necessary. There is something extremely perverse in a TV add showing animated characters feeling better after they take Zaproc or Ziploc.

    There are over 1,200 private insurance companies in the US handling health care insurance. Each of these companies employs people administering the process. The redundancy is obvious. This is, perhaps, the only down side. Hundreds of thousands of people laid off. If all of our peer nations can do this, why can’t we? Perhaps I am simply a glass half full kind of guy.

    All of these insurance companies are themselves insured or underwritten by larger companies that are in turn insured and underwritten by a handful of global corporations such as Munich Re, Swiss Re, Lloyds, AIG, etc. In the end the costs all come down to the competition between a half dozen mega corporations, driven by shareholders dividends. There is no competition driving the prices down. Google Munich Re’s web site and you will find articles advising the insurance companies they underwrite to factor in the results of global warming etc. These are the big guys who run the industry. Insurance companies like Aetna, Humana, Blue Cross, etc. are nothing more than dealerships that offer dozens of models with or without chrome, something like the US Auto Industry in the 60s and 70s that tanked due to crappy products and the misery of choice.

    On the health care side of the equation the problems are more intricate and will be harder to deal with. Redundancy of equipment is one area that can be addressed. Fraud is another. The US government has had success as well as failure in dealing with these problems. Google REAC regarding HUD for a success story.

    The bottom line is that the high costs of health care in the US, several times higher per capita than its peer nations, which is statistically proven, is due to a multifaceted condition. The easiest facet to start with is the administrative one as it can be addressed without affecting the actual health care industry. The one truth that does surface, at least in the minds of some of us, is that left to the private sector the determining factor will be the golden rules: He who has the gold makes the rules. and What the market will bear. Competition is a ruse employed by the industry to address the ideology of the consumer. There is no need for dozens of different plans. A basic single payer plan administered by the government with available options through the private sector is proving to be the best solution. There is no competition in industries controlled by monopolies unless the government of the people, by the people, for the people steps in, as it has done in the past, and breaks up the monopolies. The successful paradigm in lowering costs is an administration by the people, for the people, of the people through the government of the people.

    The US is the only country that pays several times more per capita for this same thing. The US has the population to be at a greater advantage than all of these peer nations. Therein lies the question(s) that need to be asked.

    1. issac – why do we have to deal with peer nations? They get medication for less because we pay more for it allowing them to pay less. So, if we charged others what we really should, our prices would go down.

      Quite frankly there are a lot of people I don’t administering to me, especially the government.

  10. I don’t know how to post a link here, buy I recommend reading Drew Altman’s Jan. 12, 2015 column on U.S. “High Health Care Prices. ” Altman is concise in addressing the primary factors driving the huge disparity between U.S. health care costs, and those of other nations.
    I have seen numerous accusations leveled against the “greedy pharmaceutical companies, the greedy health insurance companies, the greedy malpractice lawyers, etc. I feel that there may be potential savings to be had in addressing some of these peripheral issues, but that claims of huge cost savings from reforms in these areas are grossly inflated.
    For example, private insurance companies’ payments/expenditures account for about 50% of the c. $3 Trillion annual U.S. health care tab. Even IF their administrative costs were reduced to zero, it would only make a small dent in the $ 3 Trillion annual tab.I don’t see how eliminating private carriers gets us anywhere near the level of ( much lower)costs seen in other developed nations.
    ISAAC…..You stated earlier that “studies that been not been refuted by either Democrats or Republicans have proven that the private health insurance industry’s administrative costs are five to eight times the costs of Medicaid, Medicare, and comparable systems in other country.”
    There is in fact an intense, ongoing debate as to Medicare’s reputed administrative cost advantage over private carriers. And we can each selectively dig up and post studies supporting either side of this debate.
    You now concede that there are studies and statistics that challenge Medicare’s reputed administrative cost advantage…..then dismiss them as “flawed and biased”.

  11. Isaac is smug. I saw that immediately. That’s one of his connections to Obama. Smug people are easy marks to get them to reveal their TRUE selves. I have made my living getting people to say what they really think. The smug are one of the easier marks. But, getting people to out themselves in written form is a challenge, even for the easy smug ones. As we know, 80% of all communication is verbal. At 12:56p, using food as the conduit into that cocky, smug, psyche; Isaac showed that when you whittle all his pontifications down, he simply thinks he is better than us here. Not just smarter, but better. I have made my living allowing people to think they smarter than I. One needs real self esteem to deprecate themselves w/ guys like this. Oh, Isaac is smart. But, about half as smart as he thinks. much like his beloved President who gets played by world leaders on a daily basis, who use the same techniques as I. Really smart people are not just book smart like Obama and Isaac. They are also street and people smart, the latter being my specialty. Isaac is 1 for 3.

    We will have to suffer many more polemics from Isaac. But when he is lecturing us stupid, fat, lazy, Americans from his living room, remember the most consistent part of smug people’s persona. They are really unhappy and insecure. That will help you get through the BS.

  12. Tom Nash

    Regarding the statistics being all over the map, the preponderance of proof points to a substantial difference in administrative costs between private and single payer insurance costs. Each major private insurance company releases ‘statistics’ that argue that the difference is negligible, however that is to be expected and these studies are flawed and biased as would be expected. If you look at independent studies and the facts and figures available the difference is between five and eight times in favor of consolidating insurance administration. The simple math of hundreds of thousands of unnecessary jobs should convince.

    That there are other factors goes without saying. There is a tremendous waste in the American system. However, the obvious place to start is where the health care system of hospitals, professionals, and the pharmaceutical industry is not affected at first. The insurance end of the equation in the US has nothing to do with the level of health care.

    The first move is to eliminate the for profit aspect of something that does not depend on competition as there is none, does nothing but interfere with the health of Americans, and in most cases restricts the level of care necessary.

    After this first move is accomplished the issues of waste, fraud, and efficiency in the medical end of the equation can be addressed, issue by issue. This is not something that can be accomplished all at once. This is also something that will have to be fine tuned, overseen, and scrutinized on a continual basis, but without the parasites.

  13. Since some of the posts here are longer than Prof. Turley’s column, I’ m not going to attempt to lay out all of my objections to cherry-picking statistics, and using those statistics as irrefutable “proof” of one’s own position on issues.
    Anyone interested in the Medicare v. private insurance
    administrative costs can easily find opinions and conclusions that are all over the map.
    As is often the case, the conclusions drawn from statistics can depend on WHAT statistics are used, and HOW they are used.
    In any case, I have yet to see anything close to “proof” that trimming administrative costs via a single-payer system would bring U.S. health care costs in line with most other developed countries.
    “Calypsofacto” ‘s posting was the only one I can cite that addresses the strict pricing/cost controls as the primary factor in they lower costs of single payer systems. Inflated estimates of savings via tort reform, re-importation of prescription drugs, lower administration costs, etc., often dodge the central factor that distinguishes single payer systems…..lower, government-set price controls for health care services.

  14. Paul

    History is written by the country to which it refers. When one takes a broader look at the human condition and the consistency of human actions, one tends to be less xenophobic and self absorbed. This tends to allow one to see the great contrasted against the not so great, the genius contrasted against the mediocre, the right contrasted against the wrong. almost three thousand years ago philosophers before Socrates and then Plato differentiated between the ideal and the action. All actions are not necessarily ideal even if that is how they have been recorded.

  15. Paul

    All things being equal, America came into being through a contradiction and continues that formula to this day. Washington, Jefferson, etc were the royalty of their time. They were early royalty and thus more vigorous and vibrant. The royalty of Great Britain, although it did allow for Alexander Hamilton types, was primarily resting their gouts on their hassocks.

    Without the opportunists like John Hancock and others who included in the formula of liberty, representation, etc the age old ‘coup d’etat’ formula of the colonel saying to himself, I could do this better, there would have been no revolution and at that time no USA. John Hancock sold supplies to the British that enabled the British to expel the Acadians, a people older than the Yankees.

    Obama and Clinton exemplify that vigorous, self made, part of the formula, the Daniel Boone/John Wayne ingredient. Interestingly enough they are Democrats and can see past the myth and not Republicans wanting to ‘take America back’. Both are self made men. Both were raised in single parent families with none of the advantages of the royalty, to which Americans seem to continue to be endeared.

    The establishment of Cheney and Rumsfeld, two guys that had been around but not in the power for long enough they knew the ins and outs of the palace, and W, a vacuous enough straw man that could be run the way royalty is run, by those behind the scenes, was as unAmerican as it could get under all that America holds dear. The littlest bush, son of a behind the scenes ineffectual member of a royal family, himself son of a globalist who dealt with the Nazis well into 1942, is anything but American. He is, if one is to believe the myth, all that Americans fought against, fight against, and should fight against.

    So, take your pick, Romney a member of some fantastic religious cult, son of a political house, mostly inherited everything, including money and politics. There is no there there. A younger McCain might be an argument, if he had not chosen a joke for a running mate and if he had not kowtowed to the party after standing up to W and his lunacy. There was a time I would have voted for McCain but two mistakes like that expose him for the political free ride that he is, gruff and tuff but no cattle.

    Hillary is self made, more experienced than any of the contenders, and a woman, something this country is dire need of experiencing. She should get in out of curiosity alone. None of the GOP candidates has anything more and on top of that, they are subject to a dysfunctional and self destructive political machine. Between the extremes of the Republican factions and the oligarchs like the Koch brothers, there is nothing American there. So, nothing American and no there-there. You can’t be serious about all three parts of the government in those hands, can you? Hillary is, at the very least a necessary safety net to offset the mess Republicans make.

    1. issac – I cannot believe how f**kup your take on American history, politics and mythology is. It must be lovely to live in the fantasy in your head. 😉

  16. Nick

    You introduce your dislike for Obama at every opportunity. There seems to be many chips there. First of all, your lifestyle is not unique. Most Americans eat well. The problem is that an unacceptable, unacceptable for the society as a whole that has to pay for their over indulgence, number of Americans are just like the three sports fans. This is not information generated by a chip on any body’s shoulder.

    Regarding Obama, I have yet to hear a criticism of Obama on this blog that is a balanced composite of any of the allegations backed up with proof through history. He has been unrelentingly accused of breaking the law, perverting the Constitution, and whatever the ‘lawyers’ on this blog come up with. He has yet to be convicted, by a court or through historical results. Whereas the greatest criminal travesty is found in that W, Cheney, and Rumsfeld are not in jail.

    There is no statistical proof that the ACA has resulted in an over all reduction in the quality and and increase in the cost of health care in the US. Some have benefited and as has been illustrated many times on this blog, some have not. The main problem, that is provable through endless statistics and studies, is that for some reason too many Americans feel that it is unAmerican to take greed and profit, redundancy and inefficiency, out of the health care insurance equation simply because it is ‘free enterprise’.

    America is doing vastly better under his Presidency than after the shame and destruction of his predecessor. The problems of terrorism go on but are addressed in a much more balanced and appropriate manner than as with the three stooges.

    There are those that can armchair quarterback, myself included, but only through hindsight. That all parts are not happy and have benefited is typical in any country, especially in this one which you so accurately termed bi-polar. The US is one of the most dysfunctional democracies in the world, vis a vis citizen to politician representation. Whether this is due to the fact that there are only two parties to choose from, one more than a dictatorship, or the fact that special interest groups and/or oligarchs pull the main ropes, is up for discussion.

    If you don’t like Obama because he appears more intelligent than you or your friends, well he is more intelligent than the average American and you appear to be an average American. He is certainly more intelligent than myself. Compare his journey and include all your slants on what he did in Chicago and with whom. Then compare him to the alternatives. Clinton and Obama are far, far, far, better people to lead the US than the likes of W, or Romney, or any of the other GOP candidates that are routinely trundled out for our amusement, perhaps not yours but for most of us.

    It’s nice to hear that you enjoy your food, however, lead with something else besides watercress and salmon and Obama not eating pizza and sausage.

    We agree and disagree, however, how about some facts and figures, statistics and historical results, instead of leading with Obama’s diet.

    1. issac –

      If you don’t like Obama because he appears more intelligent than you or your friends, well he is more intelligent than the average American and you appear to be an average American. He is certainly more intelligent than myself. Compare his journey and include all your slants on what he did in Chicago and with whom. Then compare him to the alternatives. Clinton and Obama are far, far, far, better people to lead the US than the likes of W, or Romney, or any of the other GOP candidates that are routinely trundled out for our amusement, perhaps not yours but for most of us.

      We only have Obama’s word on how intelligent he is. He has not proved it by any of his actions. Romney is going to be able to run on the the platform of I told you so!.

  17. Isaac, Reggie Love, Obama’s former right hand man[aka: butt boy], just wrote a book. It depicts a prissy, pontificating, judgmental Obama vis a vis food. I eat a healthy diet, a Mediterranean one, particularly when I’m in San Diego w/ superb access to fresh seafood and fruit. We always have a freezer full of nuts, the best way to keep and eat them. A pound of butter lasts us 2 months, olive oil is the staple. But, like all Italians, I will indulge. That’s healthy as well, rewarding yourself w/o guilt. I found Love’s portrayal of Obama, eating loose meat sandwiches in Iowa w/ both derision and fear, condescendingly saying to Love, “Who says I won’t do anything to get elected,” just disgusting. I know people like Obama. They do not understand the profound difference between living healthy and trying not to die. From comments Obama made to Love, it’s obvious he eats because he has to, w/o enjoyment, more like it’s medication. Isaac, that is antithetical to the way I was raised, and I sense not how you view food as well. Maybe I’m wrong, that chip on your shoulder makes it difficult @ times to understand you. The US has a bipolar food culture. You have those addicted to processed, corporate, fast food, and those like Obama. I have an idea. Start a program, sending the bipolar people to Italy for a month. They will be immersed in a culture that spends the highest per capita on food, but the lowest body fat ration in Europe. Fresh, local, food prepared and eaten w/ respect and love.

    So, Mr. Chip on Shoulder, I “prefer” someone who loves good food, not someone who hates bad food. See the difference? I SERIOUSLY, w/o spin or posturing, would like to know what sort of food person you are.

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