The guise - just tell the truth
Health care bill costs
Costs transferred to other citizens is same as a tax
Major factors in costs - that's where the big dollars can be saved
My recommendations
The key health cost cause
The Health Care Act itself
Excess profits of health care insurance companies - actual or not?


The costs of insuring 32 million more people over the first 10 years per the
Congressional Budget Office would be

                                                    more than $940 billion .

Other added costs, ten years:

                                          Extra insurance costs per person
                                          Anticipated extra costs for the states

The "included" items, comprising smoke and mirrors:

Taking $500 billion away from Medicare is illegitimate since it just has to be paid later.  It's like a loan, not an offset. 
Taxing for 10 years and only having six years of benefits is a special tilting, doesn't reduce the cost as of when it actually starts.
     Added taxes of 3.8% and .9% on people over $200K starts in 2013
Reducing medical costs by doing audits and efficiency studies could have been done on its own - only got attached for convenience of appearing to reduce the costs related to the bill - it is not related to the bill.


Estimated cost of Health Care Plan:           $2.8 Trillion over 10 years
Unfunded Medicare:                             $38     Trillion, current value of shortfall over                                                                             time to beneficiaries.

Medicaid is growing at 21% each year.

   Dissecting The Real Cost Of ObamaCare 

The costs of insuring 32 million more people would be more than $940 billion over
the first 10 years per the Congressional Budget Office.

Additional costs added back to seniors:  $132 billion over 10 years

Cut from home health care Medicare:  $40 billion
Unknown costs of healthy people in premiums to cover pre-existing conditions costs
Increased costs due to higher deductibles and copays to offset higher insurance costs for employers.  In a recent survey by Hewitt Associates, nearly half of employers say they plan to use financial penalties for workers who don’t participate in certain health improvement programs.


When $500 billion was taken away from the Medicare program, it was touted as a way of paying for the Health Care bill.  But, since $500 billion was taken from what would benefit seniors, the seniors would have to come up with that amount, since it would have paid for some of their benefits.  That is the same as taxing them to benefit someone else, without their permision.

The increase in actual costs for insurance companies of accepting people with pre-existing conditions, as noble as it may be, will cause other insured individuals to have greater insurance costs, as there is no free lunch.  (The pre-existing condition people probably should be permitted to get health insurance, but it would seem that some of the higher costs should be borne by them.)

What I believe is an actual cost cutting factor is that insurance companies are required to spend 80% of the premiums at a minimum on actual health care costs expended. 
("The law requires that policies sold to individuals and small groups pay out at least 80 percent of premiums for medical care. In the case of policies sold to larger groups, the minimum is 85 percent. To the extent insurers fall short of the standards, they must issue rebates to purchasers of the policies.")


"Put simply, health care costs are the single most important factor influencing the federal government’s budget trajectory—and they already exert a major influence, larger than most of us perhaps realize, on our paychecks. According to the Congressional Budget Office’s (CBO’s) projections, without any changes in federal law, total spending on health care will rise from being 16 percent of the economy in 2007 to being 25 percent in 2025 and almost 50 percent in 2082, and net federal spending on Medicare and Medicaid will rise from being 4.1 percent of the economy to being almost 20 percent over the same period. The primary driver of future costs will be the increasing cost for treating each beneficiary, rather than the increased number of older beneficiaries." 


The importance of this cost is such that it should be a high payoff for the government to invest in this area, especially in education both of patients and of doctors and in developing incentives for people to use preventitive care - plus, of course, ferreting out fraud and any cost areas where there is excess.

- Have health insurance be available from any US source, so that they are adequately competitive, with no state line limits.

- Obtain the pharmaceuticals from foreign sources if they are cheaper and screened
       adequately.  This should force US firms to lower their costs.

- Do group bidding for pharmaceuticals to cut costs

- Have the Federal Government run a competitive insurance fund but only for those who choose not to be covered by regular insurance companies.  This will isolate the cost, and the worth and the cost can be accurately assessed.

- Charge a higher premium for people with pre-existing conditions of 20%, to help cover part of the extra actual costs.

- Charge more for people who have self caused health factors - weight above a BMI of 25 (or some number close to that) or B/P and cholesterol above certain levels, to help adjust for the higher health costs AND to incentivize people to correct those condtions.
Charge even more for those who smoke.

- Give a credit for companies who do wellness programs that produce a verifiable benefit, as that will lower health care costs across the nation, if there is a great P/R and marketing program.  This will also lower costs all the way through the employees' lives as many will change permanently if educated.  Have training and learning videos on internet to use, along with programs to follow.  Have a tax reduction of $400 for all people who do the entire program.     "Financial Incentives for Weight Loss"

- Have advertised and known central websites to go to to get sound health care protocols, saving doctor visits.

- Structure preventive care focus for the medical entities, such as in Cuba.

- Organ Donor:  Assure that each citizen has either answered yes or no as to wishes to be an organ donor after death. 


Most of the costs are due to those with obesity and other poor maintenance AND the costs in trying to keep people alive in the last year of their lives, which costs are increased by previously poor self-care (25% of Medicare beneficiary costs are in the last year of life).

THE HEALTH CARE ACT: (March, 2010)

Helping out uninsured and uninsurable (pre-existing condition) people plus having the ability to have children insured on the policy of their parents until 26 are good social causes. 

AND there is a cost to it.

And, not to fault what happens to most big bills, there are flaws to fix - hopefully.

The basic contention of this act is that 31 million uninsured will be covered at little
extra cost.  Plus that we will somehow be able to absorb the costs of the uninsurable who have preexisting conditions that make them prohibitively expensive to cover. 

How can that be?   Smoke and mirrors???

Current waste should be reduced regardless of the bill, so that doesn't technically
offset the costs.  That is smoke and mirrors to put that as a way of paying for the bill.

It assumes the scheduled physician payment cuts will continue as planned.  How could that be?  Are the physicians willing to pay for that? (No.  In fact, there is a separate bill that was planned to pay physicians an amount to offset those cuts - it just wasn't added back in to reduce the offsets for the costs of the bill!)

The Senate Budget Committee chairman [Kent Conrad] said that this is a Ponzi scheme that would make Bernie Madoff proud.

The bill has 10 years of tax increases, about half a trillion dollars, with 10 years of Medicare cuts, about half a trillion dollars, to pay for six years of spending.  How's that for a ruse to make the bill break even, matching 10 years of taxes for 6 years of spending!!!

The true 10-year cost of this bill in 10 years? That's $2.3 trillion at a minimum.

If any of the underlying assumptions for the new law miss their target, the price tag is sure to go up.

ObamaCare's proposed expansion of Medicaid would amount to a $33 billion "unfunded mandate"  on the already cash-strapped states - necessitating higher state taxes.

Bottom line:  Government cannot provide free or subsidized care for someone without taking money from someone else - and that someone else may be you.

After the legislation passed in the House:  The President said, "Another stone laid in the foundation of the American Dream" and House Speaker Nancy Pelosi quipped, "No money exchanged hands"!


A falsehood.  Just evilizing others and making them the scapegoats.

“Overall, the profit margin for health insurance companies was a modest 3.4 percent over the past year, according to data provided by Morningstar.”  Also interesting, though a position statement based on small margin "Why Health Insurers Make Lousy Villains" - but people will tend to evilize them anyway, rather than address the actual problems.

A comment on the following blog, with a few other humorous comments, "There you go again! ruining a good argument with facts.".  This seems to make sense, based on my business experience:  Excessive Health Care Profits, by The American Catholic.

Various articles: No Free Lunch

Notes, not integrated yet: 

Of course, the limitations of shopping for policies over state lines should be eliminated!

we need to remove regulations such as the ban on cross-state insurance.

"Americans pay more for health care partly because they get more thorough treatment for some diseases, and partly because they get sick more often than people in Europe and other industrialized countries,

Using direct standardization (10), we applied the U.S. gestational-age specific infant
mortality rates to Sweden’s distribution of births by gestational age. If the United
States had Sweden’s distribution of births by gestational age, the U.S. infant mortality rate (excluding births at less than 22 weeks of gestation) would go from 5.8 to 3.9 infant deaths per 1,000 live births—a decline of 33%.

Associated with higher rates of chronic illness in adults (heart disease, diabetes, etc).
Associated with blacks and hispanics

The White Paper, for example, reports that number of premature births in the United States has increased 36 percent in the past quarter century. Factors contributing to
this increase include the rising number of women who are using fertility drugs and
other reproduction aids and a rise in the number of women older than 35 who are
giving birth (older women are more likely to give birth prematurely).

Estimates indicate that in 2005 the costs to the United States of America alone in terms of medical and educational expenditure and lost productivity associated with preterm birth were more than US$ 26.2 billion

Older mothers and young teen mothers also face higher risks.The U.S. has higher
rates of women in these groups getting pregnant, co-author of the report, Marian
MacDorman from the National Center for Health Statistics, tells NPR's Brenda
Wilson. And in the U.S., minority women also face much higher rates of preterm
births than white women

This rise has been tied to several interrelated trends, including an increase in
multiple births, greater reliance on Caesarean deliveries and induced labor to
manage risky pregnancies, and an increase in births to older mothers. Other
maternal factors are also associated with premature births, including behavioral
and socioeconomic characteristics such as smoking, teenage pregnancy, obesity,
poverty, and inadequate prenatal care.6 

And the preterm rate has increased fastest for white mothers, who tend to be older
and more likely to use infertility treatments than minority women—factors that
raise the likelihood of multiple births.

The National Center for Health Statistics study found that the U.S. health care system does a good job of saving premature babies—better than in many European countries—but there are too many of them born. Preventing preterm births is crucial to lowering the U.S. infant mortality rate.

Also, those premature births in foreign countries aren’t even counted as births for their infant mortality calculations. They simply count them as miscarriages. Sort of like a
sacrifice fly or sacrifice bunt not counting as an at-bat when you calculate your batting average.

When a severely handicapped or malformed baby is born in the US, we pull out all the stops to try to save it, but if the baby dies it is reported as an infant death. In Europe, they routinely just let it die, and if they don't try to save it they do not report it as an infant death. Major differences when conduct is governed by the ethic of life as opposed to the European culture of death.

Even with all that, it strains credulity to hear that the U.S. ranks far from the top. Sick people come to the United States for treatment. When was the last time you heard of someone leaving this country to get medical care?

The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries.
Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.

It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south.

For all its problems, the U.S. ranks at the top for quality of care and innovation, including development of life-saving drugs. It "falters" only when the criterion is proximity to socialized medicine.

This still leaves the question of why life expectancy is so low when the U.S. health care system is good. Likely the reasons are behavioral (e.g., smoking, obesity, stress) or
public health related (e.g., clean drinking water, sanitation, pollution), and are not due to problems within the medical system. While the U.S. health care system is far from perfect, it is likely comparable or slightly superior to the medical care received in other developed countries.

The bad news is that our obesity epidemic is the worst in the world.

Sweden 9.7%
US  30.6%
UK 23%
Canada 14.3%

Over the next few decades, life expectancy for the average American could decline by as much as 5 years unless aggressive efforts are made to slow rising rates of obesity, according to a team of scientists supported in part by the National Institute on Aging (NIA), a component of the National Institutes of Health (NIH) of the Department of Health and Human Services (DHHS).

Additional research has shown that people who are severely obese — with a BMI greater than 45 — live up to 20 years less than people who are not overweight.
On average, obesity reduces life expectancy by six to seven years. Over the last 20 years rates have gone from under 20% to over 30% now.


Under Obama’s health care plan, 16 million Americans are set to enter Medicaid programs by 2020.


use deductibles in some way but encourage preventive health care but not bankrupt citizens...

to prevent the physician shortage, decreased quality and limited access to care that would result from enacting this formula.

new main site for reference

patients continue to be shielded from the true costs of health care

Studies in economic and medical journals have repeatedly demonstrated that expanding government programs does not bend the cost curve. Medicare and Medicaid reimburse less than the cost of delivering care to the patient. This leads to cost-shifting, placing an even higher burden on patients paying for
private insurance. 

2010 Cost of health care bill 2010-2019:

Cost of expanding coverage 1,055 B

Medicare doctor “fix”* 245 B

Medicaid rates for primary care 57

Funds for new trusts 34 B

Extend FMAP in ARRA 23B

Other health spending increases 103 B

Total 1,517 B

Lovers doctor fees for medicare , BUT it is to be replaced by a separate bill which pays for it. So the net effect if we add the two bills together is 0, not a saving of $245 B.

designed to reduce the number of uninsured. While this is certainly a noble goal, these benefits come with corresponding costs.

Advocates of the bill have argued that while the bill comes with a hefty cost, the bill actually reduces the government’s budget deficit over the Congressional Budget Office’s (CBO) 10-year forecasting horizon.
This certainly makes the bill sound appealing as it implies that we can expand coverage while reducing the deficit. Unfortunately, this is somewhat misleading in the sense that it takes for granted some sketchy assumptions built into the funding structure of the bill.

But a closer look at the budget office report suggests that the number everyone should have reported was $1.055 trillion, which is the gross cost of the insurance coverage provisions in the bill before taking account of certain new revenues, including penalties by individuals and employers who fail to meet new insurance requirements in the bill.  The Atlantic

True Cost Of Health Care Bill

CBO Has Underestimated True Cost Of Health Care Bill Cry Opponents 

possible for good reference site:, Costs Health Reform 

The Conservative Case For Reform 

What are the bigfest factors: 
use of the scarce mediacl resources.  Over the compuer docs leveraged.  Better directions easy to access on how to take care of oneself and when to call the docotr,  email communication, unless required to be in personuse of the costly resources:  prescriptions (stop overprescribting)
Penalties for poor health practices:  added to what is owed to the government on the personal account if can't pay nowll
Key causes of costs:  chronic diseasess, caused mostly by poor health habits
Healthdramatic increases in penalties for health care, medicare fraud, owed forever
lower costs by biger deductibles, but those encourage not going to doctor and worst health
Required health education course to get paid benefits...
Problems: more of the population will be older
How much money do insurance companies make - A primer 
good source:  Uwe E. Reinhardt google to see what he writes
Have an 80?% payout requirement or publish the numbers for comparison?  already at that so probably okThe accounting firm PricewaterhouseCoopers issued a report this year stating that the country's seven largest commercial health insurers use only 83.1 percent of premiums received to pay for medical costs for large group policies.
The Congressional Budget Office, which measures the economic impact of proposed legislation, said the 90 percent figure was too high because it would leave insurance companies without profits and amount to a government takeover of the industry.
Minnpost, health care crisis good
Reward healthy lifestyle choices: Providing premium rebates and other incentives to people who make healthy  choices or participate in management of their chronic diseases has been


food stamps, foods not permitted, loss of benefits for a month each violation

Low income health insurance for the uninsured

Medicaid - Cost And Complexity Tax Reform Efforts  

Medicaid threatens budgets of US state governments


Expanding Medicaid - The Real Costs to the State

increase premiums for smokers

By Seung Min Kim, USA TODAY

WASHINGTON — The average U.S. family and their employers paid an extra $1,017 in health care
premiums last year to compensate for the uninsured, according to a study to be released Thursday
by an advocacy group for health care consumers.

Families USA, which supports expanded health care coverage, found that about 37% of health care costs for
people without insurance — or a total of $42.7 billion — went unpaid last year. That cost eventually was
shifted to the insured through higher premiums, according to the group.


Weiner after repeal vote: the Republicans don't even know we included tort reform in this bill.

At the time, Obama acknowledged that excessive litigation “may be” contributing to rising health costs, and he proposed state “demonstration projects” to test medical tort reform.

“I don’t know anybody who thinks this is actual medical-liability reform, or finds this meaningful at all,” says Lisa Rickard, the president of the U.S. Chamber of Commerce’s Institute for Legal Reform

separate article:

Howard Dean: Democrats Left Tort Reform Out of Health Care Bill Because They Feared 'Taking On'
Trial Lawyers

Newt Gingrich – Center for Health Transformation

Danger big bureaucracy
and the tremendous ineficiency of government, because of the politicized way it is run and the lack of effective controls and management.