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Koch: Falling Out of Love With Barack Obama

I just got this from former New York Mayor Ed Koch. It's gives a bit of insight why Obama's poll numbers keep going south among older, moderate Democrats.

Falling Out of Love With Barack Obama
Ed Koch Commentary
August 10, 2009


I continue to be a supporter of President Barack Obama. He has had several outstanding successes. The major one has been a positive change in the economy due primarily, I believe, to his hand-picked team of economic advisers who, from all indications, have fashioned an effective economic recovery plan. The recovery still has a long way to go, but using the language of my doctors at the hospital in which I recently spent six critical weeks recovering from open-heart surgery, "All the numbers are going in the right direction." I also believe his reaching out to our allies and those not allied with us has somewhat calmed the world's roiled waters.

Yet, strangely, the President's support is waning. A recent CNN poll gave him a C-minus after 200 days in office, whereas at the end of his first one hundred days, he got almost universally a B-plus.

I think most people would say that the President's standing with the American public has suffered as a result of his handling of health care policy. During the election, Barack Obama promised to speedily deliver universal health care. However, to date President Obama has presented no health care bill to the Congress and that legislative body has come up with a number of proposals for which he is being held responsible. Furthermore, the President has seemingly caved on important aspects of his health care agenda such as not restricting private insurance coverage and obtaining volume discounts from drug companies.

In order to keep costs from rising, most people acknowledge the need for some kind of limitations on spending. Rationing of public monies makes sense, e.g., should public monies be used to give a kidney or heart transplant to a 90-year-old patient, when it is necessary to reduce the costs of Medicaid and Medicare to keep them solvent? Both programs are totally government funded and operated. I would say no. Then the question becomes what about private funds being used by an individual willing to buy gold-plated insurance to provide unlimited medical expenditures for their health and survival? Should the government be able to limit such expenditures? My answer would be no.

I speak from personal experience. I have been told that the cost of my hospital care, including the services of 20 doctors and 72 nurses and medical technicians over a six-week period may ultimately cost a million dollars. My private insurance policy is paid for by my law firm, Bryan Cave LLP, and because I still work full-time, that insurance policy is my primary one, not Medicare, even though I am 84 years old. Will that continue to be the case under any law signed by President Obama or will I be denied the right to spend my own money and my law firm's for such unlimited coverage?

The President, I believe, has said that there will be no restrictions on private insurance coverage, other than to expand that coverage for all by, for example, denying the insurance companies the right to reject persons with prior existing medical conditions. But he has not spoken loudly enough, nor has there been any discussion on the premiums that companies will be able to charge in such cases.

Most alarming for people like me, who at 84 years of age recently needed a quadruple bypass and aortic valve replacement, are the pronouncements of President Obama's appointee, Dr. Ezekiel Emanuel, brother of Obama's Chief of Staff Rahm Emanuel, who, according to a New York Post op ed article by Betsy McCauley, former Lt. Governor of the State of New York, stated, "Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, 'as an imperative to do everything for the patient regardless of the cost or effects on others' (Journal of the American Medical Association, June 18, 2008)." He also stated, "...communitarianism' should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those 'who are irreversibly prevented from being or becoming participating citizens...An obvious example is not guaranteeing health services to patients with dementia.' (Hastings Center Report, Nov.-Dec. '96). "

Opponents of Obama's health care proposals raise the specter of a panel making decisions on who should receive health care. I am not aware of any proposed panel. However, an article in today's New York Times, referring to a Senate bill, stated, "The legislation could have significant implications for individuals who have bought coverage on their own. Their policies might be exempted from the new standards, but the coverage might not be viable for long because insurers could not add benefits or enroll additional people in noncompliant policies."

So, where lies the truth? I don't know. But I do know that I want the continued right to purchase and have available insurance that will permit me, no matter my age and physical condition, to purchase with my own money all the medical care I can afford.

Perhaps the most egregious mistake the President has made regarding health care was the statement by a White House spokesman on the subject of using volume discount pressures on the drug companies in order to save money on Medicare prescription drug purchases which now cost over $800 billion a year. The spokesman for the drug industry, former Congressman Bill Tauzin, recently announced that the drug industry had entered into an agreement with the White House in exchange for its support of universal medical coverage. Under the agreement, the drug companies would contribute $80 billion over a 10-year period to defray the cost of universal medical coverage, while the White House has agreed not to require the drug industry to make any further financial contributions, meaning no change in the law barring the use of Medicare volume discounts and probably continuing the prohibition against importing American-made prescription drugs from Canada which are sold there at up to 50 percent less.

On August 6th, The New York Times reported, "Pressed by industry lobbyists, White House officials on Wednesday assured drug makers that the administration stood by a behind-the-scenes effort to extract cost savings from them beyond an agreed-upon $80 billion," over a 10-year period which confirms the Tauzin statement.

Following that statement, Speaker Nancy Pelosi and a number of Congressmen, including Henry Waxman of California, said they would not be bound by the White House agreement. According to The Times, Waxman "vowed to fight the White House, asserting that it was conceding too much to the powerful drug industry lobby PhRma."

Incidentally, why wouldn't the drug industry support universal medical care under any and all circumstances? With such legislation will automatically come more people covered by insurance that will provide prescription drug coverage to more people, creating an enormous new market for them. Volume discounts at only ten percent with existing expenditures by the government will bring in more than $80 billion a year, as opposed to the drug companies' offer of $80 billion over 10 years, or $8 billion a year.

President Obama might not be persuaded to rethink some of his positions on health care because of the protests of moderates like me who support him, but he surely has to be alarmed by the comments of his most ardent supporters like New York Times columnist Frank Rich who, discussing the pending health care legislation warns, "It's in this context that Obama can't afford a defeat on health care. A bill will pass in a Democrat-controlled Congress. What matters is what's in it. The final result will be a CAT scan of those powerful Washington interests he campaigned against, revealing which have been removed from the body politic (or at least reduced) and which continue to metastasize. The Wall Street regulatory reform package Obama pushes through, or doesn't, may render even more of a verdict on his success in changing the system he sought the White House to reform...The larger fear is that Obama might be just another corporatist, punking voters much as the Republicans do when they claim to be all for the common guy."

Love, we know, is never having to say you're sorry. When falling out of love, hopefully, a reversible process, saying one is sorry is not enough; change is required. Why do so many of our heroes ultimately have clay feet?

The netroots aren't so happy (for different reasons) President Hopey McChange either.


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Comments (18)

"All the (economic) numbers... (Below threshold)
GarandFan:

"All the (economic) numbers are going in the right direction."

What planet is Koch on?

As for Koch's private health care, the answer is easy. NO YOU CAN'T HAVE IT!

Reading the Daily Kos (link... (Below threshold)
Lisa:

Reading the Daily Kos (link you provided) was quite enlightening. Almost made me feel sorry for those who are becoming disillusioned. Almost.

After the quadruple bypass,... (Below threshold)
Trajan:

After the quadruple bypass, his heart still
beats....for Obama. I's enough to bring a
tear to my evil eye.

Koch is so freakin' dumb he... (Below threshold)
GarandFan:

Koch is so freakin' dumb he doesn't realize that a 4x bypass at his age would be deemed 'inefficient use of resources' under ObamaCare.

Koch was for Bush in 2004. ... (Below threshold)
RickZ:

Koch was for Bush in 2004. Now he's one of those fellating Obama? That seems just a li-ttle inconsistent to me.

I think the take away from ... (Below threshold)
HughS:

I think the take away from Koch's article is that he is the recipient of superb medical care at age 84, paid for by a private insurance policy. Koch may live another ten years or more because of the excellent medical treatment he received.

I could care less about his political positions, he is LIVING proof that that a private sector insurance industry will continue to pay for this type of care. The problem with ObamaCare is that very few in Koch's demographic believe what they are being told about what Washington is promising them.

"The problem with ObamaCare... (Below threshold)
GarandFan:

"The problem with ObamaCare is that very few in Koch's demographic believe what they are being told about what Washington is promising them."

The problem is that THEY DO BELIEVE what they're being told. Barry's going to cut Medicare payments so that he can pay for universal health care. Yeah, I know the math doesn't add up. Unfortunately, Barry and Company think it does.

Ed, you're a good Democrat.... (Below threshold)
John S:

Ed, you're a good Democrat. You weren't supposed to waste that million dollars of healthcare. Involuntary physician-assisted suicide costs less than $400. Get with the program!

An exception to Garandfan #... (Below threshold)
RicardoVerde:

An exception to Garandfan #7: I believe that Barry and company DO know the math doesn't add up, but they don't care. The thing is to get the single payer system in place. It institutes control by 'they who know better' (their prospective, they're Ivy leaguers ya know) now, and 'we' can worry about paying for it later.

You and I can see we're driving over a cliff, but they think they have it all figured out.

The runaway premium similar... (Below threshold)
hsr0601:

The runaway premium similar to the peak fuel price last year and left so many folks in despair insists on staying the course with the attitude 'unchanged', clearly this trend could bankrupt individual, business, and government. Now the government subsequently is tasked with these two main assignments, first, to address premium inflation, second, to expand coverage to all in urgent need.
In order to cover all and not to add to the deficit, the public option can not set the same rates of private market, rather, it needs to have the function to keep it in check in terms of inflation, too. Unfortunately, this 'unavoidable' direction is aggressively being accused by the runaway premium, citing government 'take-over' .
Under the circumstances the energy bill to determine human future and the other major issues is presently piled up, who wants to waste time making enemies ?, which also does not benefit the forthcoming election.
On the other hand, to make things worse, critics say the savings from the proposed public option is not enough to meet the revenue goal. Furthermore, on another hand, some say 'hands off' . Where do these No tax, No saving and the like intend to force this reform to go ? The conclusion by 'just-say-no' is no doubt. Ironically, the Deficit-sensitive groups have a distinctive common ground, they all have a Deficit-driven background out of question.

Of all choices, the best thing would be savings through efficiency. Considering the wasteful structure, the highest premium in the world, and the most expensive part of medicare, with the prevention / wellness program in place, an American style innovation, an 'outcome'-based payment founded upon IT system may be enough to save more than 50 billions per year (500 / decade), both 'improving quality' and removing the unnecessary procedures (as pay is dependent on patient's outcome). Young folks and advocates need to explain the notion of a pay for outcome agreement to the elderly misled by the disinformation.

Unlike private market, this public option includes large-scale investments, these large investments still does not get the fair score, instead seem to become a source of acute conflict, even so, this common sense-based program needs to develop further as early detection goes beyond monetary value.

In short, with the heartbreaking tears in mind (Nearly 11 Million Cancer Patients Without Health Insurance), private market also needs change and should join together to complete this reform , as promised, if not, the runaway premium only has itself to blame. Job-based coverage (indirect payment), mandate code, and ample capital might be favorable to the private market. And It can be said that fair competition starts with fair market value.
Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.

Thank You !

You're welcome, Mr. Copy'n'... (Below threshold)
Dr. Carlo Lombardi:

You're welcome, Mr. Copy'n'Paste!

Part 1. Probl... (Below threshold)
hsr0601:

Part 1.

Problems :

1. No systematic, expansive Prevention & Wellness Program.

According to the scoring of CBO on the prevention & wellness program, all fitness centers around the world should close down immediately and all media have to end
reporting health tips about prevention. Rather, all of the excellent health systems seem to have one feature in common, a expansive, systematic preventative program
requiring immense investments.
I think a prevention system works as a 'levee' built against flood by the government, similarly, it also needs non-profit investments from the government 'on a large scale'.
This might offer us one clue of why all of the free states have public insurance policy in place.

Surprisingly enough, the system today is designed around treating patients once they become sick. As far as I'm concerned, the congress affected by the special interests
has turned down the budget request for prevention program in Medicare & Medicaid, which are the most expensive parts of the health program. Let's imagine the astronomical
costs and invaluable lives following the levee breach.


2. A pay for each service / volume compensation, & No E-Medical Record.

As much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the
recipients, and this 700 billion dollars a year can cover a lot of uninsured people, in return, it could lessen the tragic, prohibitive ER cares.
Medical errors ( No e-Medical Record ) & lawsuits, more profits motive, and indirect payments from employers etc would account for it.

Supposedly, 'a pay for each service / volume' compensation seems to leave the medical institutes unequipped with the essential IT system. To understand its importance, If
we imagine the cost difference between the previous and current system in financial institutes, the magnitude of cost-savings and the mess in health care system can
be easily explained.

3. Premium Inflation.

This last spring, due to the demand decrease, the peak fuel price came down below $40 per barrel, though, the
'Similar' insurance premiums keep on rising, accordingly the inaction could bankrupt family, business, and
government 'BEYOND this recession' , as all across the spectrum agree.

Insurance premiums have nothing to do with the law of demand & supply and the free / fair market concept.
Basically, as demand diminishes, the price tends to reflect it, nonetheless, the insurers that formed a cartel through
consolidation have replenished the loss by exercising inhumane malpractices involving denying, capping, cherry-picking, rationing, rapid
premium increase and the like. And this runaway premium ended up in the collapse of middle
class ranging ' from finance to mental health' , alongside the peak fuel price and fast-growing mortgage rate, as all of
us know. Thereby they could be cited as an objective for anti-trust or anti-corruption. If the public plan sets the same rate of the insurers, it will be another headache.

Ironically, the Deficit-sensitive groups have a distinctive common ground, they all have a Deficit-driven background out of
question. Therefore, I'd say they have nothing to say about deficit unless they are free from the sponsors.
And the spoiled menu, 'Takeover and Rationing Cliche' is still marching for bankruptcy, as opposed to its motto.


4. 'Work or Break' health system with no brake or safety system.

Just like marriage, economy also undergoes up and down, however, economic downturn is not reflected in the employment-based system.
The rising mental stress or illness & 'keep eating habit' , which are the epicenter of a number of different diseases,might be traced
to this insecure system and exorbitant premiums.



Part 2.

The Public Plan:

1. Thankfully, the health care reform bill currently before Congress makes several key investments including more primary care doctors in preventive care, and those pieces
of the public plan must be maintained .

2. The pay for 'Outcome' pack is most likely to expedite the introduction of Health Care IT SYSTEM, and it will help doctors focus on their patients.

3. The 'innovative' idea of a 'pay for value / outcome' pack will allow for Quality and affordability
. If you are a physician, and your pay is dependant upon your patient's outcome, you will most likely strive to
prescribe the best medicine earlier in the process, let alone skipping the wasteful, unnecessary risk-carrying
procedures.
Young folks and advocates need to explain the notion of a pay for outcome agreement to the elderly misled by the
disinformation.

4. The synergy effect of the combined Health Care IT & a pay for 'outcome' system may allow the clinicians to
'correctly' diagnose and effectively treat a patient earlier in the process so that it can measurably decrease the
crushing lawsuits and deter the excuse for unnecessary cares to make fortunes.


5. The creative idea of 'a pay for outcome' will more likely prompt team approach and decision, as at Myo clinic.
Under the 'pay for outcome' pack, for good reason, best practices as 'recommendations' would simply help them
make a better decision, and the government won't still have to meddle in the final, actual decision-making
process as a non-expert.

6. This New 'Payment Reform' could accelerate the progress in medical science, in return, it will save more cash.
And this idea will be able to bring 'competition' to the private market, as a result, it can contribute to mitigating premium inflation.

7. Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve'
care, that means more than $1trillian over next decade, and virtually needs no other resources including tax on the
wealthiest. Supposedly even the 'conservative' number of such savings might be able to meet the objective of revenue-neutral.
(Please visit http://www.kare11.com/news/news_article.aspx?storyid=820455&catid=391 for detailed infos).

8. Through clinic's network, users of its health-care services can keep up with their health information and information for family members, and receive health guidance and recommendations from clinic that is optimized for each person.
The system also allows patients to upload information from home-health devices such as blood glucose monitors and digital scales. Patients can authorize whether they want to share their health information with doctors or other caregivers, and those caregivers can provide health-care and general wellness recommendations based on the information patients provide.

9. In case the health care reform provides the general public with peace of mind, the rising mental stress, obesity caused by the insecure system and
exorbitant premiums may bend the curve surprisingly.


10. Clearly, the positive impacts involving massive job creation, promising stem cell research, several times more economic effects of 'from bed to work' lie ahead, these will lead to economic recovery.



Part 3.

Conclusion ;

1. The last thing to expect is rallying for premium inflation, JUST SAYING NO.

2. Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.

3. With the Prevention & Wellness Program as a stable levee in place, the promising pay for value/ outcome reimbursement reform based on IT system could clear the way for revenue-neutral. Some say the installation of IT network will take time, but once this new outcome-based payment system is implemented, the hospitals reluctant to adopt it will most likely rush to introduce it.

4. The final hurdle looks like a scoring issue surrounding the savings on Prevention & Wellness Program, but I'd like to say
health clubs and media reports on prevention tips must be maintained.

5. People would be entitled to various services whether you are employed, unemployed or self-employed, homeless or housed, young or old, chronically ill or mentally ill, moving from job to job or from town to town or from state to state.

Thank You !

hr0601 must have answered o... (Below threshold)
Oyster:

hr0601 must have answered one of those Craigslist ads for 11$ an hour to promote ObamaCare. And they're accusing the right of astroturfing?

I continue to be a suppo... (Below threshold)
Paul_In_Houston:

I continue to be a supporter of President Barack Obama. He has had several outstanding successes. The major one has been a positive change in the economy due primarily, I believe, to his hand-picked team of economic advisers who, from all indications, have fashioned an effective economic recovery plan.

JESUS!!!

Up to now, I had great regard for what I thought was common sense from him.

Now, (as GarandFan asked in comment # 1),
"What planet is Koch on?"

-

Cleanup on Aisle 15 - rando... (Below threshold)
JLawson:

Cleanup on Aisle 15 - random spew, sans rational punctuation or spacing...

"All the (economic) numb... (Below threshold)
James Cloninger:

"All the (economic) numbers are going in the right direction."

What planet is Koch on?

The planet of Manhattan.

hsr0601Use ... (Below threshold)
James Cloninger:

hsr0601

Use url links or GTFO.

This isn't your personal blog to post tl;dr propoganda that will be scrolled though with a flick of the forefinger. Learn to cogitate.

franklkinney<p... (Below threshold)
James Cloninger:

franklkinney

And that goes for you too. See the big rectangular key to the right of your right hand pinky?

That's call an "enter" key.

USE IT.




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