Donna wrote: "One of the resons this man became President is becasue the "majority" vote made it so....and one of the biggest changes he addressed all the while he was campaigning was to change the health system..If the people voted for him knowing this, where is all this disruption coming from...you don't have to be a scientist or genius to figure it out, and non of us should be surprised that they are playing down and dirty..."

Donna, with all due respect, Adolf Hitler was originally elected bt a majority vote.  It doesn't give any politician a blank check to do whatever they wish regardless of the impact on the American people.  And when the actual reality of what an elected official attempts  to do to achieve that end is presented, it is illogical to conclude that opposition to it is phony.  In fact many people who voted for Mr. Obama, including members of my own family, are not in favor of the only plan we have right now, the House Bill, or the government option. 

We really need to acknowledge the genuine problems and concerns that Americans have with this Adminsitration.  Many independents and Democratics, our neighbors and friends, who are speaking out will really resent being cast as right wing extremists.

James Dunham gets it wrong from the start: "Donna, with all due respect, Adolf Hitler was originally elected bt a majority vote."

Hitler was never elected president or head of state. He was beaten by large margins both times he ran. He siezed power by entirely non-democratic means.

My point remains valid Harvey.  You are pushing a Red Herring. 

The Nazis were democratically elected, although their democracy gave representation at the table for various groups democratically elected.  Here are some facts:

Hitler's rise to power

The July 31, 1932, election produced a major victory for Hitler's National Socialist Party. The party won 230 seats in the Reichstag, making it Germany's largest political party, but it still fell short of a majority in the 608-member body.

On the basis of that victory, Hitler demanded that President Hindenburg appoint him chancellor and place him in complete control of the state. Otto von Meissner, who worked for Hindenburg, later testified at Nuremberg,

Hindenburg replied that because of the tense situation he could not in good conscience risk transferring the power of government to a new party such as the National Socialists, which did not command a majority and which was intolerant, noisy and undisciplined.

Political deadlocks in the Reichstag soon brought a new election, this one in November 6, 1932. In that election, the Nazis lost two million votes and 34 seats. Thus, even though the National Socialist Party was still the largest political party, it had clearly lost ground among the voters.

Attempting to remedy the chaos and the deadlocks, Hindenburg fired Papen and appointed an army general named Kurt von Schleicher as the new German chancellor. Unable to secure a majority coalition in the Reichstag, however, Schleicher finally tendered his resignation to Hindenburg, 57 days after he had been appointed.

On January 30, 1933, President Hindenburg appointed Adolf Hitler chancellor of Germany. Although the National Socialists never captured more than 37 percent of the national vote, and even though they still held a minority of cabinet posts and fewer than 50 percent of the seats in the Reichstag, Hitler and the Nazis set out to to consolidate their power. With Hitler as chancellor, that proved to be a fairly easy task.

Awful is putting it midly...Wow.....where is the Separation of Church and State??????

Robin, that's disgusting! The right-wing nut jobs, on the payroll of the insureance lobbyists, are purposely disrupting town halls. We who are more sane to step in and cut them off at the pass! It's time to start shouting them down!

Sorry to break it to you, but no one is being paid to disrupt town halls.  The media reports that Oh, its AstroTurf so that you will believe the movement is not legitimate.  It is this government that is illegitimate.  The media wants to distract us and turn this into a left vs right issue when it really is a people vs the state issue.  Yes health care needs to be fixed but this is not the solution!

And you have proof that absolutely no one, at any town hall has been paid by anyone to disrupt?  Unless you do, you do not "know" that "no one is being paid to disrupt town halls".

What proof do you have that this government is "illegitimate"?  That you disagree with it on principles or policies doesn't make it illegitimate. 

In many ways this IS a left vs. right issue, a people vs. the state issue AND a people vs. corporations along with at least some elements of state vs. corporations.  You're trying to oversimplify on this point.  Each of these groups has an interest in how this mess gets "solved."

Finally, since you seem so certain, what is the "solution"?  Keep in mind that health care is a human right per many international organizations - starting with the UN Declaration of Human Rights and that our long standing failure to deal with the crisis in health care is a major contributor to the economic crisis. Realize too that many simply cannot access the system as it stands without some form of assistance and failure to provide assistance leaves this group to face anything from disability to death due to lack of access to health care.

For those who feel there is no one being paid to be part of the disruptions going on...do some research on Brook Brothers and Tom Pile and Coke....and they were the same links connected to the Florida recount!

Guess where the Brooks Brothers rioters are now

August 7: Ms. Information: Rachel Maddow reports on some stories that didn't make the front page, including what ever happened to the participants in the Brooks Brothers riot- the fake protest during the 2000 election recount.

 http://www.msnbc.msn.com/id/26315908/vp/32337799#32337799

What a revelation!  SOME people are actually organizing to protest the non-bill-reading, deficit exploding plans of this Administration?  Wow.  If that delegitimized any objection to an issue, the Liberals wouldn't have a legitimate objection to anything.  The smear machine is in full operation!  Try reading some polls.  Democrats, Independents and Republicans who are pro-Reform hate this plan and the rush to pass it before anyone understood what was being proposed. 

As a side note, please have a little honesty and stop claiming that the argument is reform vs. status quo.  NOONE is proposing the status quo.  We kust want change we can REALLY believe in.

In regards to polls...

"The same survey offered a preview of the debate that now awaits us. When voters were asked to rate Obama's health-care plan, 36 percent said it was a good idea and 42 percent called it a bad one. But later in the poll, when the interviewer read an accurate, neutrally phrased description of the main features of the plan that Obama supports, it commanded strong support -- winning approval 56 to 38 percent."

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/31/AR2009073102614.html

Again, Mr Foley you seem to miss the point.  Which Obama Plan has passed the House or Senate?  The supposed Obama plan doesn't exist in the House Bill. 

Mr. Obama describes what he would allegedly support, but the fact is we can all describe what we WANT in a Bill. That is all he has done.  The Congress is writing it, and most versions have not been finsihed being drafted.

It is misleadiing to say that the "Obama Plan" garners great support when the only offering we currently have to consider is the House bill.  That Bill accomplishes little or none of what "Obama supports;" quite the opposite per the CBO.  The only thing we know for sure is that all proposals but one have the troublesome and costly government option.

In short, giving us a "wish list" that is currently not being offered by Congress and advocating for whatever eventually comes out by polling people about a non-existent plan is manipulative and dishonest.

James or Danetta, I was wondering if you had pondered my questions about treating the root cause of the health care fiasco and how the government has unintentionally caused it?   You seem fixated on helping to ramrod a band aid down our throats as opposed to fixing the underlying causes of poor health.  

So here is another question for you.  People are leaving this country for health care in other countries as it is cheaper, I agree.  However, what causes our system to be more expensive? 

It does not have to do with the insurance issue as insurance as even the government will require a profit to cover the overhead of dispersing payments to doctors.  

It could be the cost of living in this country is much higher than others.  It could be that in other countries, Thailand for example, they do not change the sheets between patients, according to my cousin who lives there with both a cook and a housekeeper on an income that would not come close to affording either in the US.

Why is our cost of living so much higher?  Part of it is that we have much higher wages mandated by our government, raising the cost of food production which is the foundation of an economy. 

One could argue lots of reasons for our care being more expensive.  

Also, if you really believe that a single payer plan would not ration health care you have no idea about finance.  

So if we get a single payer plan is the government going to determine what I get to eat on a daily basis, as what I ingest is one of the largest factors in health.  Maybe as commented before, if the government did not subsidize corn production we would not be so obese as sweeteners would not be so cheap.

oops the comment was directed to Tim and Danetta not James.

John, you're going to have a hard time convincing me that our wages are substantially higher across the board than Japan, Taiwan, Switzerland, France, the UK, Germany.  Although no one's economy looks great these days, you're talking about our major competitiors in the global economy.

Even if our are higher, I think we can agree they're not 2 to 3 times higher.  The closes country in health care spending per capita to us is Switzerland,  at slightly more than half.  Japan's health care per capita is a third of ours, despite having a greater share of their health care budget taken up by pharmaceuticals, and with more MRI machines per 1,000 than we have.

Eventually, the numbers just don't add up.

James, oddly enough, you and I are making the same point.  This is not the "Obama plan" because the White House has proposed no legislation, yet it is the "Obama plan" with the lagging poll numbers you cite.  Your comment, "Try reading some polls.  Democrats, Independents and Republicans who are pro-Reform hate this plan and the rush to pass it before anyone understood what was being proposed."

However, when polled about the specific components of the bills on the table (rather than the "Obama plan" that we agree is mythical), support is above the majority.

Now no one had polled the House bill or Senate HELP bill specifically.  I would imagine a majority of Americans would actually respond, "I don't know enough to have an opinion."

Regarding Polls, not too long ago I listened to comments about why polls are misleading...one of the biggest reasons was the fact that polls are scheduled in like area's....Democratic populations and Republican populations....I pay no attention to them now, not like I use to...

Timothy (if I may),

I am glad to see we are coming together.  But doesn't this mean that we also agree that what the President promised (no increase in the deficit, for example) does not exist currently in any Bill? 

And insofar is we agree that the President is not writing the legislation, are we not now also agreeing that he is making promises that he may not be able to keep?  We already know that the CBO has indicated that the deficit will explode unless something is changed in the House Bill, for example.

And on that note, are we not just hoping that the practical realities don't run contrary to even the best intentions, as they already have elsewhere?  This is such a large undertaking that to predict what will happen with great assurances is ambitious at best, no?  We have already seen the results not match the promises with other emergency legislation.

Tim, You still fail to address the crux of my questioning.  Why are you trying to address a symptom of a broader problem, poor nutrition and a toxic environment.  Why not focus on health as treating the sick.

Should the government make every act illegal that might hurt us.  Where would you draw the line in regulating activities?  Skydiving that should be off limits in order to control costs or should those that participate just be left for dead?  Driving a car as many accidents occur?  Walking across the street?  Maybe we can be put in bubbles as most accidents occur in the home.

Without some level of personal responsibility in any program they will fail.  however, you probably are a proponent of the nanny state and the state should take care of all our needs.  If so then why should anyone work.  Why should I work hard?  

Sorry a typo in my first line.  Should have said why not focus on healthy activities as opposed to treating sickness and disease.  

What about a gym membership for all?  Why subsidize grain and create so many health and environmental problems, in addition to the people that are put out of work by tractors.

Seems like our Unemployment program, we charge employers a tax on employed workers.  While those who outsource their jobs to China or a machine do not pay for that.

Maybe you do gooders should use your brain and look for the root cause of our problems as opposed to trating the symptoms of the problems that exist out there.

I am not against charity as I give 20% of my time and more of my income to help others.  But that is my choice not forced on me by some draconian government.

John:  We "do-gooders" ARE using our brain.  We don't appreciate your holier-than-thou attitude. Your rambling leaves a bit to be desired.  That said:

It's a bit silly to ask: "Should the government make every act illegal that might hurt us."  No, John, they shouldn't. And no one is asking them to. And funny you should mention sky-diving. Private insurance companies don't like sky-divers or race car drivers (in fact, any racing is a problem).  But I ask you this:  What about TV advertising of PRESCRIPTION drugs?

As to working hard? You should because it's the right and good thing (for you) to do.  Many people retire, quit working and find they don't like it.   We have an innate need to be useful and busy. It's OK.

Now, let's use our amazing and God given brains to be civil, sensible and get this health care thing straightened out, eh?

On the other hand, where's your proof that all people needing assistance are there due to a complete lack of personal responsibility?  I know for a fact that's not why *I* need assistance. I worked my rear off in IT from when I graduated college until the Tech Bust, then I made the technical error of getting employment with an employer who waited until I was at the job site to tell me I had been recategorized as an independent contractor (and I still strongly suspect that was done almost entirely to get out of benefits and other labor laws), I went uninsured and used a sliding scale clinic since that made a LOT more fiscal sense than paying $850/mo for "insurance" with $1K PER PERSON annual deductibles (plus high copays that varied by in or out of network and were based on "reasonable and customary" and with the coverage specifically excluding everything they legally could exclude that remotely related to a pre-existing condition my husband or I had - including a lot of women's health care - and also specifically excluding any chance at a prescription rider), then managed to go through what savings I had trying to survive while waiting for SSI & SSDI because my next move ended up being to a California County where even PUBLIC health required having Medicare or Medicaid (Medi-Cal) to access most of the specialists I needed to see and getting Medi-Cal meant getting declared disabled by the SSA since I don't have dependent children.  The lone mistake I made was not checking out to see if that California County was doing ITS responsibility in operating PUBLIC health so that the PUBLIC could actually access it instead of just those with Medicare or Medicaid.  OK, two if you want to count falling for an employer that pulled some weasely tricks for solely THEIR benefit... Still, I'd done the important thing and stayed employed.

That people who need assistance are all lazy and unwilling to take personal responsibility is a common misconception.  I suggest you go over to the poverty blog and read a few of the posts about what the poor are like.  Good posts to start with would probably be http://uspoverty.change.org/blog/view/attitudes_about_poverty_need_to_change or http://uspoverty.change.org/blog/view/measuring_elderly_poverty orhttp://uspoverty.change.org/blog/view/stop_with_the_scapegoating_and_the_victim_blaming

While you're at it, you might also think about reading http://uspoverty.change.org/blog/view/poverty_and_disablism

But even without what I've learned over at Leigh's blog and from her references, I know from the lives of the people I've watched struggling to survive poverty that if anyone's abdication of responsibility is behind poverty it's usually that of someone other than the one in poverty. It's usually someone like an employer who won't pay reasonable wages, legislators who won't pass laws for workers' rights or to enforce things like keeping public health PUBLIC, etc.  Only very rarely have I seen lazy people who are poor and usually they're not truly poor, they're the near mythological "welfare queen" committing the supposedly "rampant" fraud often talked about by Reagan and still mentioned today as if such were fact.

My rant comes from the fact that Tim, decides to pick apart an argument based upon a cost of living fact.  Yet he fails to address the heart of the dialogue that is that nutrition and toxins are mostly to blame for the health care problems in the US.

While Danetta, or another talks about how she can not pin down which toxin is making her sick.  Yet fails to realize that it is the toxin which our EPA allows its discharge without penalty is causing many health care problems.

I disagree about any low fat diet idea (as most studies indicate that our diets should contain 30% fat), the problem is we are getting the wrong kind of fat.  An acquaintance had been to a dermatologist 5 times to treat a skin disorder to no avail, I told him to take a flax seed oil supplement to get more omega 3 fatty acids in his diet (a fat) and his condition cleared up in 2 weeks.

Our government has created very poor dietary habits, by subsidizing grain.  If you want to fix health care start there and keep the government out of how I grow my food.  Which proposed legislation has the ability to dictate how I grow my crops.  As my soils differ from pasture to pasture no paper pusher sitting behind a desk is going to do a better job of knowing my land and how to address problems better than I.

Maybe to solve most of the poverty and income disparity issues, we do away with government subsidies of farming and return to regional food systems.  With corner groceries, local butcher shops where the guy cutting your meat (oops probably too many vegans here) has to look you in the eye and is concerned about your welfare, more so than the government.

Maybe the government is not the solution, maybe it unintentionally is causing some of the problems you are trying to fix.  At the very least it is not doing its job in protect the people and making us sick in the process.

Hi John--

You seem to be taking issue with a point that I didn't make.  I don't believe I've ever mentioned cost of living or comparative salaries.  There is a moment deep in this thread where I talk about health care spending per capita, but that is a completely different issue altogether.

I generally don't disagree with your concerns about nutritions and toxins which is why I haven't, well, disagreed.

But since you seem focused on disagreeing with me, please narrow down the health care topic you would like to argue with me about, and I'll see what I can do.  If all else fails and you really had your heart set on arguing with me, I suppose I could just make something up.

08/10/2009 @ 09:05AM PT, is the post where you did.

I am sick of everyone treating symptoms and would prefer you all to fix the core problems before I ever jump on your health care for all bandwagon.

Maybe, there are ideas out there that encourage personal responsibility, while taking care of everyone.  

Prior to gaining my support, why don't you lefties try and address the problem as opposed to its solution.  That is why I am so upset and voice my opinion.  Maybe in a discussion those of you on the left could say, hmm.... maybe there is a point here and we should look at it first.  Addressing my issues would probably eliminate much of the expense in health care and serve to right this country and make it the envy of the world again.

I believe you've misinterpreted my comment, but that's OK, it's beside the point now.

I think the short version is that yes -- we should encourage better nutrition and move away from the high-fructose diet we have been marketed (I highly recommend fellow Change.org blogger Natasha's section devoted, in part, to this topic.  http://food.change.org/)  This point is so unobjectionable, it's contained in the House bill, which provides money for community-based prevention services, particularly towards educating about healthy food, and increasing opportunities for those on mid- to lower-income budgets to obtain them.  Ditto community-based education programs on blood sugar for diabetes, cholesterol, etc.

Environmental toxins are as large a problem here as they are in any other country.  You're not going to get an argument from me.

I will suggest that there are both short term and long term goals to improving the health of Americans.  You have latched onto a few of the long-term factors.  This means it will take a long time to see the benefits, but it's worth it.  However, there is also making sure that all of the short term effects of a sytem rigged for disease care instead of health care, for giving us more care rather than better care, and by determining your access to primary care and prevention based on arbitrary factors and decisions beyond your control (such as income, whether your employer offers benefits, etc.)

I don't disagree with you.  I just think it's a both/and instead of an either/or.

So next question is how do you suggest you incorporate personal responsibility into any health care plan.  NPR did a story on paying people to be healthy.  

See, If the government did not intervene into the economics of food, then organic food production would be the least expensive.  Tossing in the costs born by society in general then it is much less expensive.

Today by eliminating grain subsidies you would work to reduce our dependence on oil.  As agriculture would move back towards a pastoral setting, with dynamic layered production systems. You would reduce unemployment as more people are needed in an organic model of agriculture.  You would reduce atmospheric carbon, as pastures are retain carbon as opposed to tillage which releases it.  It would reduce the the impacts of drought and flooding as pastures are spongy and retain water containing 10% organic matter whereas todays soils contain 3-4% (a 1% increase worldwide would eliminate almost all human induced carbon in the atmosphere).  

Why does the federal government need to micro manage everything?  In trying to do the right thing it tends to create more problems.

We could use some background proof, please. I refer to your edict:

"...pastures are spongy and retain water containing 10% organic matter whereas todays soils contain 3-4% (a 1% increase worldwide would eliminate almost all human induced carbon in the atmosphere). "

Let me see if I heard you right.  You claim that if we increase the organic matter in our soil by 1%, that alone would get rid of most all human induced carbon in our atmosphere?  right?  

Seems pretty outraegous to me.  Do you have some believable sources for this?   I hadn't realized that the solution was so simple and quick. Forgive me if I don't breathe a sigh of relief.

Hello Dirk I was impressed enough by this article to save it; 

“The first European settlers staked a claim to that topsoil nearly 180 years ago. Now farming accounts for nearly 92 percent of Iowa’s land use, according to the Iowa Association of Naturalists, and less than 0.1 percent of its prairie remains. Jessica Veenstra, an Iowa State University graduate student in soil science and environmental science, said when pioneers first broke the prairie sod with simple tools, they found topsoil nearly 16 inches thick.

 “Half of that was lost in the first 50 to 100 years, and we didn’t even know it,” she said.

 Her research finds all the plowing, mixing and tilling activity on the landscape since has eroded and compacted the topsoil, and stripped it of its organic matter.”

http://amestrib.com/articles/2009/03/15/ames_tribune/news/life_and_leisure/doc49ba8d8048cb2693116807.txt

Dirk,

Go ask this guy, he is the one I heard it from I believe.  http://www.carbonfarmersofamerica.com/Jones5.htm

I know of a rancher in ND who has taken his soil from the point where it would incorporate 1 inch of rainfall per hour in the late eighties to 13 inches of rainfall per hour.

Go google mob grazing and acres USA to hear about what is happening by copying the predator prey relationship with livestock, hotwire fences and moving livestock four times a day.  Cowboy evidence shows that they are seeing a 600% increase in forage production (that is atmospheric carbon being captured). 

They were going to do a study on it in Canada.  The University researchers saw the evidence and thought it would be good to provide a study showing the results.  Unfortunately, that profit motive was not there for the university profs to pay their bills, as no one stood to make anything on this.  So the study was tabled and no research is being done on the subject.

So we will have to depend on those studies funded by Monsanto et al, to help the government determine how best to farm.  Which then they can tell me and if proposed legislation passes they might force me to farm in an acceptable fashion.  Which I have no desire to do so and as such I will put up a stink at every piece of legislation that does not pass the test of treating the problem.  

Which the proposed health care bill does not.  As it only works at treating the symptoms, which is more profitable and will provide more tax revenue in the long term and help sustain our government leviathon.

Uh Gilbert.......So you are so appalled by people coming to town halls and shouting, that your "sane" response is to show up and shout them down?  How about trying to objectively understand who they REALLY are, address their concerns, and set an example of civility?

Michelle, most older Americans who have to rely solely on Medicare are in the same boat, but it wasn't always this way. In the past, those on Medicare paid very little for their prescriptions. The problem began when Congress, backed by corporate health insurance and the Republican campaign to further decrease what Medicare actually pays for while increasing insurance company profits, offered, instead, confusing, inadequate, and costly prescription drug plans to all those on Medicare. This was not an option, but a requirement. Those with only Medicare to sustain them have no choice but to pay the outrageously expensive "donut holes" that are suspiciously opaque in the respective plans.

I am on Medicare, and it works very well for me; however, if it were not for my secondary insurance, one which I was fortunate enough to keep through my former employer (with a strong State Teacher's Union), I would not be able to afford my medication, and I would not be writing this post.

Medicare needs to eliminate the "donut hole" of prescription drug plans by eliminating the prescription drug plans that are underwritten by the private insurance companies, and bring back a "public option" which has always inherently been connected to the entire Medicare program.

Oh, I wanted to add that I would have preferred keeping the health insurance I had with the school system, which was excellent and affordable, but which our insurance provider would no longer allow for me, as I was told that once I was "eligible" for Medicare, that is, two years after I have retired, due to a disability or age 65, I MUST go on Medicare, and be covered instead under a 'supplemental plan'. I, however, cannot complain, as this plan really does pay for what Medicare does not.

Single payer as proposed by HR 676 includes prescription drugs as a benefit.  HR 676 funds single payer through a payroll tax of 3.3% for employees, 4.5% on employers & 7.8% on self-employed (employee + employer) og gross or taxable income.  The Medicare tax remains, there's a surtax on the top 5% income households.  Benefits are quite comprehensive with no co-pays or deductibles - just your payroll tax.  95% of people would pay substantially less for health care that would be guaranteed from birth to death. 

Barbara hit it right on the head..."The problem began when Congress, backed by corporate health insurance and the Republican campaign to further decrease what Medicare actually pays for while increasing insurance company profits, offered, instead, confusing, inadequate, and costly prescription drug plans to all those on Medicare. This was not an option, but a requirement. Those with only Medicare to sustain them have no choice but to pay the outrageously expensive "donut holes" that are suspiciously opaque in the respective plans.'  and the controll of not allowing generic drugs to be created until they have made the millions they feel they are owed on the "new" drug created...

Worked for a "dougnut hole" company by the name of Medco in Tampa, Fla that offered a Prescription Plan to supplement Medicare...it offered discounts on prescriptions for Senior citizens..the discounts amounted to a hill of beans because the seniors had to pay, up front to become a member...Medications obtained in Canada were still about 50% less than the Medco discount membership plan..what a rip-off!!  My heart would just about break into pieces when I heard the horror stories of how senior citizens "were doing without" life-saving medications because they just couldn't afford them at any cost..They were making the choice between eating and medicines...this un-exceptable.....!!!

The best description I ever heard of the donut hole in Part D was run in a Seattle PI editorial and went something akin to this: Imagine that you're buying a car.  Now imagine that when you hit, let's say 7,000 miles for each year that the car arbitrarily quits running until it's decided on the basis of your driving habits that enough time has passed that it's now the time at which you would have reached 12,000 miles for that year.  This is what Part D is like - only instead of not having a car THAT YOU ARE PAYING FOR from 7K to 12K miles each year, you've got INSURANCE COVERAGE YOU ARE STILL PAYING FOR THAT IS ABSOLUTELY USELESS UNTIL YOU'VE SPENT THAT YEAR'S "DONUT HOLE" of THOUSANDS of dollars.  What's the point of buying that sort of insurance?  Anyone who can afford the donut hole doesn't need the insurance and those who can't won't make it out of the donut hole and were better off when still eligible for patient assistance programs.

Social Security: 2009 Update http://www.cbo.gov/ftpdocs/104xx/doc10457/08-07-SocialSecurity_Update.pdf 

Today, Social Security's annual revenues exceed its
annual outlays. But as the baby-boom generation (people
born between 1946 and 1964) continues to age, growth
in the number of Social Security beneficiaries will pick
up, and outlays will increase much faster than revenues.
The Congressional Budget Office (CBO) projects that
the Social Security trust funds will be exhausted in 2043.1
(Unless otherwise stated, the years referred to in this
report are calendar years.) Thus, if the law remains
unchanged, CBO projects that 34 years from now, the
Social Security Administration (SSA) will not have the
legal authority to pay full benefits. Such long-term projections
are necessarily uncertain; nevertheless, the general
conclusions presented here hold true under a wide
range of assumptions.

As regards social security funding .... it's also been conclusively shown that by removing the cap on amounts of income subject to social security withholding, the fund would be solvent for much longer.  Right now earnings over $97,500 are not SS taxable, so removing the cap would provide substantially more income for the fund.  There's more complexity than that but it would extend the fund's life while only providing some "pain" to the more wealthy among us.

Hi Pat--

I'm very sorry for what sounds like a hellish experience.  This clearly and justifiably puts you in the 17% who would give the VA an "unsatisfied" rating.

Hi Pat,

When my Mom was diagnosed with breast cancer at 66 y/o  her prescription medications costs were equal to her Social Security benefit..well actually she had $3.00 left after paying for her Meds...Thank God, we lived in Cleveland, Ohio and a wonderful social worker at University Hospital assisted my Mom.  She was from the "old-school" and wouldn't take anything that was "free".  Her prescriptions cost $3.00 a piece at the hospital pharmacy..that made her feel much better..she lived for another 5 years!

actually webboy, the reason that these townhalls are getting disrupted is because these phonies are being paid to disrupt,  and even given scripts to do it! These shouters don't want any answers, they just want their money! They are hired by lobbying firms to disrupt these meetings, because the insurance companies are afraid that they will have to compete in the free market, rather than having a monopoly. That's why healthcare reform has been defeated time after time.

Back in the day, after my husband left me and the kids to fend for our selves..we lived on food stamps and were covered by Medicaid..you can say what you want and be judgemental or hear me out..I remember being in a doctor's waiting room and overheard a patient being denied service because her private insurance didn't cover her visit..When I was asked for my provider information, I responded by "flashing" my Medicaid card and was told "you'll be seen by the Dr. in about 15 minutes, please have a seat..it was like having a "Gold American Express Card" back in the day..

"the reason that these townhalls are getting disrupted is because these phonies are being paid to disrupt" Actually I don't buy that. People are tired of government taking more and more control of our lives. I personally think it's wonderful that people are waking up to the FACT that BOTH parties are corrupt and promise the stars but don't deliver (ending wars in middle east) and as we fight each other they destroy our country.

One of the resons this man became President is becasue the "majority" vote made it so....and one of the biggest changes he addressed all the while he was campaigning was to change the health system..If the people voted for him knowing this, where is all this disruption coming from...you don't have to be a scientist or genius to figure it out, and non of us should be surprised that they are playing down and dirty...People can work together if they choose to for the good of the majority...if that were not true, Obama would not have won..We all should have rasied as much of a stink when Bush raised the cost of drugs in the Medicare Program...that was suppose to help the average American...DUH...What a misguided joke that was...

As far as I can tell, there's no evidence that anyone's paid to go into rants at town hall meetings. But that doesn't mean they aren't paid, or not, it just means there's no evidence (and maybe there is but I just haven't found it, people on this site claim to think there is). Yet either way, we do know what's being stated on both sides, getting people so irate to the point that they spew out ridiculous comments like "keep your government hands off my health care". While sadly, there are two sides to this debate, these ignorant remarks discredit and anger, and keep the true issues from getting through.

Excellent post!!!

Maybe the reason why we are so unhealthy is our government intervening into food production via subsidies.  These subsidies have created high fruitcose corn syrup which the body can not absorb and goes straight to fat cells.  It has also created a situation where livestock are fed a grain based diet as opposed to a grass based diet throwing the omega 6-3 ratio out of whack.

Maybe without looking at the whole of the problem you will never understand the health care woes our country has.  Maybe if the EPA enacted impact fees on pollution and constitutionally protected private property rights from being treaded on by polluters then we would not have many of the cancers that have grown to effect such a high percentage of the problem.

Maybe as opposed to trying to treat the symptoms of the problem you should be looking to address the root causes of the problem and treat them.  If you really are for change then maybe you should look at fixing problems and not simply applying a band-aid.

James, perhaps you should have read through some previous posts.

On the absence of people coming from Canada for American health care (and the many people who leave America for cheaper care elsewhere):

http://healthcare.change.org/blog/view/traveling_for_care_--_outside_the_us

Lovely Ad Hominem attack james, Bravo. If you can't attack the message, attack the messenger, right?

Our medical system is awful, generaly speaking. Its expensive and below par, because it has been incentivized by PROFIT. This means health care conglomerates reporting to share holders whose only interest is next quarters profits, not caring for the sick. Which means layoffs, bad working conditions, cut corners, HUGE bills ($1000+ for a 15 mnute emergency room visit?) and ridiculous situations like in Pittsburgh where the health care company there REMOVED SOAP from doctors and nurses stations and said they now had to provide THEIR OWN SOAP.

Profit incentivized corporate health care does not work. We've had years of it to show us its completely broken, just like trickle down economics. And these days there isn't enough money around to support charity hospitals without patients paying for care, as was true in our nation's past. That sort of care is almost non existent in the US.

I could go on, but many others have already done so. It is simply a fact that Canada has a better health care system than us, its population is healthier and happier than ours, and its all much cheaper than here. This is true even for the UK, which is held up as the horrible example, but if you look at the real situation (I know a number of brits) its actually extremely good (for $20 a month you get a VIP card that gets you better access to doctors. Yes, $20 a month. Even without it, though, the wait times are EQUIVALENT TO THE US.

No, this is not going to be obscured by smoke and mirrors. Throw a tantrum and collect your check from Freedomworks, but I won't be playing that game.

Nice burying actual criticism with attacks on someone who is not posting on this thread!

Gosh Timothy, all your conclusory assertions are not only highly debateable but in certain points irrefutably wrong.  Anecdotal evidence is not the best, as we can find examples in both systems.

When you get down to comparative life expectancies, there are many elements that go into it other than quality of care.  If you are going to look at stats, however, it certainly would be good to look at those with serious life-threatening conditions.  For example, the survival rate of prostate cancer in the US is materially greater than in Canada.

So let's stop taking sides and really inquire rather than advocate, shall we?

Mr. Balcer:

"One often hears variations on Krugman's argument-that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use, and cultural values. It pains me as a doctor to say this, but health care is just one factor in health. Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall, or a car accident. Such factors aren't academic-homicide rates in the United States are much higher than in other countries (eight times higher than in France, for instance). In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don't die in car crashes or homicides outlive people in any other Western country."

If I recall correctly, the access to medical care is a "right" in every country except two..The United States of America and in South Africa, where it is a "priviledge".

Friend, you are lying so much it isn't even possible for me to blot the leakiness.. I'd need a horse bucket.

To say that you are a bigoted, narrow minded plebe would be a compliment.

Illegals costing us money? They cost STATES money yes. Do you know why? Because the conservatives refused to do anything about the businesses that employ them. Clinton WAS doing something about it by chasing the companies that used them and IT WAS WORKING. Bush, on the other hand, dismantled that IRS program immediately and even made it easier for companies to exploit migrant labor. In other words, conservatives want slave labor, and want our system to be broken so it can be called broken and dismantled. No, its not the "Illegals" fault that they took an opportunity for a better life and were dumb enough to believe the coyotes.

And that's just the first thing.  Get with the prigram. 75% of americans WANT THIS PROGRAM. We  dont want to have to pay literally thousands of dollars per year for health care, funneling that money into corporations back pockets. I am sick of it, to coin a phrase. So please stop quiting talking points at us, ok?

PS: Everything is politics.

1)  YES Tim everything is politics as usual, but the intelligent people who want to see the problems correct right the first time, know how to keep the politics out of a hot political debate.  I really expected better from you.

Tim you are a perfect example of those who stop the needed debate on heathcare reform because of your LIE’S (95% of what I state can be documented!)  I advocate for all veterans of different sexes, color, race, religion, and politics’.  It is deplorable and a crime that since we have a black dude as our president liberals are presently using their definition of political correctness as the tool to invoke the fear of ethnic intimidation or racism, and it is our American children who are paying the highest price. Subtlety is not the best approach when trying to solve the SAME problems in society which keep getting worst as each decade passes… but explaining it respectfully while putting our own American children first is.  

2)  The lack of state funds for veterans nationwide is deplorable. So if government run healthcare is passed how much of the cost will fall back on the state’s?  The lack of state funds for veterans nationwide is deplorable!  Yet the tax money of veterans is NOW used to help those less fortunate (??) than most of us… and this healthcare reform is going to pay for 23 million ILLEGAL alien’s….just can’t wait for a no speak English illegal border jumper too wait in line before  war veterans at the VA free healthcare clinic.

“Hispanic Caucus Members said confidentially that the Caucus told Speaker Pelosi not to change a thing because as written illegal aliens will get the benefits. Asked if CHC leaders will ask Pelosi to specifically spell something out in the bill to address illegal immigrants, the Member said no. Rather, the Member said the CHC simply wants to make sure the bill — as drafted — doesn’t prohibit illegal immigrants from accessing care.”
-- Roll Call (subscription) – This is the majority of uninsured! 

Back in ’86 when the illegal’s got the “one time” free amnesty from congress I was working around them at the race track’s (you know the jobs Americans’ don’t want?).  Did my college paper in 1996-97 on the Infinite cost of illegal alien’s… during a time when Clinton’s needed (but unfinished) welfare reform documented even more illegal’s brought here because of/since the free amnesty.  Take 30 years plus with some who still do not want to speak or read English, but they have learned the correct pronunciation of every single female body part.  While coordinating veteran articles/issues all over the nation I always check the newspaper, television, etc website for any article on illegal aliens.  I now talk on the phone & computer all over, and the majority of the PEOPLE in the United States are presently justifiably very angry at the destruction and cost of illegal alien’s.  

The liberals are claiming that republican owned drug company’s lobbyists’ are planting the people yelling all over at town hall meetings on healthcare.  Personally I removed the reference to republicans and really gave it some needed thought. Neither way drug companies nor union money belong in any government business.  Both have too much money, power, and influence where they do not even belong. 

Start this needed health–care reform at the foundation instead of at the top with trillions of dollars of our children future taxes;

A.   Since this reform is suppose to lower the cost of healthcare, use the cost of everything remotely medically related, and place an immediate PRICE FREEZE on the costs for at least 18 month’s.  B.  While mal-practice insurance cost is being reformed. C.  Get the drug industry lobbyist’s (& unions) corruption the heck out of government business. D.  Use tax payers’ money that has been used for decades to support illegal aliens, and this ludicrous war on illegal drugs.  Use tax money for once to the advantage of tax payer’s.  E.  Add the question of insured or uninsured to the 2010 Census.  This will give real numbers to work with not polls numbers.  Using this five suggestions starting now, (with regulation of Wal-Mart monopoly for health-care if needed), will allow the foundation for healthcare reform to be fixed and strengthen so healthcare reform can be done right the first time and not waste anymore tax dollars.  Is that too much to ask?

I, too, want to know the answers to these questions. This is the very thing that Congress has been arguing about for the past several weeks. What is happening, though, is that the Republicans, along with the Blue Dogs, are preventing any kind of meaningful discussion. In fact, they are simply not interested. Instead, they are attempting to stall any efforts for true reform, if not bi-partisan reform, by keeping people distracted from the real issues and real proposals, in the hopes that NO reform gets enacted.

I'm sure you're familiar with the fiasco of these town hall meetings throughout the country. These are not attended by 'grassroot' communities at all. The people "planted" in these meetings are being bussed in by lobbyists for the health insurance companies and those that want to see that NO reform actually occurs. These are people that want to see our president fail. Those protesting at these 'town hall' meetings, sadly, have no idea what they are protesting. They were hired to prevent a real 'town hall' discussion from occurring. They were hired to STOP the process. One of the attendees actually stated that he did not want socialized medicine, but that they better not take away his Medicare. This gives you some idea of the mentality of those being positioned to do the dirty work of the corporate elite. They are absolutely clueless and pitiful. This is what President Obama and the true progressives in Congress are up against.

Michelle,

We all want to know these answers, but Nancy the Democrats have been using their significant majority status to exclude all the Republican ideas.  If it were not for the Blue Dogs (thank God), this thing would have been rushed through without the public even knowing what's in it and without most Congressman having READ it. 

Senator DeMint has offered a plan that had some bi-partisan support.  Also, the bi-partisan plan being worked on in Committee in the Senate may be a good alternative but we will have to wait and see.  Unfortunately, those opposed to a bi-partisan effort on the Left had threatened to use a procedural rule to bypass this bi-partisan committee.

Anyone who accuses the Republicans of not having offered alternatives, or not being interested in bi-partisanship when that is the ONLY way their minority would even have any input is just spewing Democratic Party talking points nonsense.

Study the bills for yourself when they all are drafted and make up your own mind.

Thank you Barbara my reading time is limited because of damage done to my eyes. Imagine what a bunch of VA medication does to one’s eye sight over time, plus the wrong prescription for my glasses.

“Now that's a novel idea! As it is now, insurance companies have an absolute monopoly, and history has shown over and over again, that monopolies only benefit the companies themselves, certainly not the consumers.” – I totally agree you are very correct. We also have a growing monopoly Wal-Mart starting to offer medical care to the public.  While the cost of malpractice is being reformed and the foundation is being fixed (4 things I mentioned above) if state welfare can not handle those presently uninsured – then – the government can regulate the Wal-Mart monopoly while they provide more government funded medical care.

“President Obama wants to allow for insurance similar to the kind that members of Congress currently have for those who are without.” – 20 million veterans and their families, our military along with their families, and the majority of our elderly now has very substandard healthcare. That number is very high I’d estimate over 1/3 of the population now considered covered, probably higher.  And you want to give free health-care like our elected officials’ have now? Or will the congress and senate start using the VA for their healthcare?  Please do all Veterans the big favor and have anyone in office use the VA heath-care system.  I’m sure all judicial system employees’s can have their own entrance at every VA nationwide.  Is that much to ask?  While our government run healthcare sucks, our taxes are being used for decades for free welfare and illegal aliens.  We are already dirt poor that is why healthcare reform has to start at the foundation not at the top with trillions of wasted tax dollars.  People do not have the money to support their own families anymore and our taxes are being used on others.  We need to use tax money to the advantage of tax payers for a Change… starting at the foundation.

Hey Pat you forgot to mention the biggest and most corrupt monopoly of all...the federal government!

" I worry that the government can't compete with private insurance." What, are you crazy! The government prints all of the money! Haven't you seen the video of obama wanting to put private insurance out of business!

Ken, the government only prints the money the Federal Reserve Bank tells it to print.

That's why your paper money says "Federal Reserve Note" on it. Check it out.

Furthermore, it's important to understand that there is NOTHING federal about the "Federal Reserve Bank." It is a private institution run by, and for the benefit of, its member banks.

The banks decide when to print more money. The banks determine monetary policy, because We, The People (the U.S. Government) have abdicated our responsibility in this regard.

That "we the people" have allowed our elected representatives who form the government to sell out our nation to private interests (meaning for the most part privately held corporations) is at the root of most, if not all, of our modern problems. It's not a right vs. left issue.  It's not a conservative vs. liberal issue.  It on some levels MAY be a rich vs. poor issue because of whom it's allowed to so directly but relatively covertly control the government via its purse strings.  This is a HUGE part of why health care reform is such a hard fought fight, in many ways as much as - if not more so than - the issues of things like states' rights and even individual rights, it's that all these corporations that are by way of their greed and profits LITERALLY making a killing off of the American people DO NOT want to give up an inch in negotiations.  To do so is literally "too expensive" for them.  They don't give a rat's butt what their policies and behaviors are doing to society and its people, they care for the most part only about their bottom lines.  But if they can cover that in flags and rhetoric about patriotism, rants about socialism and states' rights or patients' rights or flat out lies about what the government will do to patients while totally ignoring that they ALREADY do the SAME THINGS (or worse), they'll gladly do so since it suits their interests.  And, sadly, "our" representatives won't stop them since they're pretty well owned by one or more or these corporations directly or via lobbying groups.

Blech.

Danetta:

But don't forget that the corporations are partially worried about their bottom lines because of our investments in them.  Admittedly the bigshots in the companies own a large share of the stock, but we 401(k)-mutual-fund owners are "in it for the money too".

We have met the enemy and he is us! (with thanks to Pogo)

For the most part, "our" investments are pocket change to them. Besides, historically, they're a bit of an afterthought. Major public investment in larger corporations is a new thing. Bad corporate behavior and manipulation of government isn't.  Look back to the late 1800's and how/why we got things like monopoly laws (not that our government is bothering to enforce them any more)...

You say ".... our investments to them are pocket change" ?  I don't think so!  Some of the largest investors in the world are "us".  Take the California Pension Investment Fund, for instance.  Or Fidelity and Vanguard.  I'm sure you get the idea.  It's a serious amount of stock.  Everytime a large entity like these threatens to pull their stock, those "corporations" sit up and listen ... very carefully.

It doesn't really matter if this public investement is new or not.  Fact is that it exists and we're partly responsible for what's happening.

It was Bush & Cheney that ignored the monoply laws.  Hopefully enforcement is on the way back.  We can help that along by yelling at our Congress.

and it works...and can be enhanced to work better!

Brilliant.  Thank Allah we have no enemies that make it necessary to have military bases on foreign soil.

First off the whole "co-op" is a joke. We can blow that off without further discussion.

Secondly, let's admit it. The elderly and otherwise vulnerable are ALREADY the victims.  This is a major part of why Medicare and Medicaid are bankrupt - they're covering many more people than they're supposed to have to cover because they're absorbing huge numbers of the "uninsurable".  People like me with "pre-existing conditions".  It's also not helping that states have been allowed to form some sort of unholy union between Public Health and Medicaid so that they shore each other up in such a way that many or even all Public Health services require Medicaid for access, which denies the PUBLIC access to PUBLIC health until they meet the requirements for Medicaid. This puts even more pressure upon Medicaid and unnecessarily while DENYING health care to some of our nation's most vulnerable, since those being denied healthcare are often disabled adults or children of parents who just barely aren't qualified for programs like Medicaid and SCHIP.

And who do you want to solve this?  The insurance companies who've repeatedly proven that they have no conscious or soul and care only about money, but not at all about lives or quality of life?  Personally, I'd rather have the "incompetent politicians" involved since Medicare and Medicaid have both provided much better care than any private insurance I've ever had.

James, you attribute an awful lot that is counter to what the CBO has said.

1.)  The CBO did not project that 81 million people would leave employer-based insurance.  Instead, they projected that 3 million more people would have employer-based insurance, and that the public health insurance option would only cover about 10 to 15 million people.  That's not my opinion.  That's what their report said (type CBO into the search engine on this site.)

2.)  The CBO projects the total cost will be about $1 trillion over 10 years.  However, the CBO assesses that with all the new revenue and savings in the bill, there's only about $250 billion left accounted for.  At no point did they say the bill under discussion will not be paid for -- finding that extra $250 billion is a work in progress.

3.)  The CBO never found that medical costs would go up.  Instead, they noted that federal spending will go up, largely because of subsidies.  That same statement indicated that federal spending on Medicare and Medicaid would go down, rather definitively. 

For more on the CBO's accounting:
http://www.cbsnews.com/stories/2009/08/05/politics/main5215880.shtml?tag=contentMain;contentBody

I don't know about you, but I am using them and they are not broke....put facts up instead of making the statement....if they were broke, I, myself and many others I know who are using them and satisfied would not be using them.

Dannette,

I also have a pre-existing condition.  I don't know if co-op as will be offered sucks or not---the point was that they are mindful of trying to remove the profit motive by making it not-for-profit.  I would love read that legislation and hear what the CBO says.

And the excuse for bankruptcy is there are too many people?  Wait until you add 50 or 100 million people to it, many "uninsurable" as they say.

And the government is playing games?  Sounds like a great endorsement indeed.

Why are we trying to change an entire system rather than target the problems that exist with specific solutions?  

You may feel the government is better for the most vulnerable, but as a person with a serious pre-existing condition over 40, having a government board decide whether my life as I get older is worth the cost of a particular procedure that my Doctor recommends because I am no longer young and productive, is frightening.  They do that in Canada and Britain, and if they actually tried to balance the medicare budget they would be doing that today.  If you think that the US government is just too darn honest and moral to do such things, then sleep well.  I think most of us know better.  There is a reason the Founders were most concerned with restricting the government's powers and balancing them.

I *do* have a serious pre-existing condition.  Several of them actually and I *am* 40.  BTW, common courtesy demands that since my name is spelled correctly for you that you at least spell it correctly in your reply.

I know what my care has been like throughout my life at various times and with various insurances.  I've had Blue Cross/Blue Shield (HMO, POS and Indemnity plans), Aetna (twice), FHP, Kaiser of Northern California, Medi-Cal, Medicaid of WA, Medicare, and I think I'm leaving out a plan or two.  BY FAR, in order, my best access to care has been 1st Medicare, 2nd tie between Medi-Cal (which I had before the current Governor gutted it) and Medicaid of WA and - this may surprise many - 3rd was when UNINSURED.  As an uninsured patient, as long as I could find a way to get basic, minimal access to the system such as with a sliding scale or free clinic; then I could get free (or free plus a dispensing fee) medications, get testing for free or next to free, get referrals to specialists generally as charity care and all for just the minor inconveniences of paperwork and waiting to find a willing provider. With private insurance, I *inevitably* had to undergo arguments with insurance adjusters about everything from whether or not a referral or test was necessary/appropriate, whether or not the prescribed treatment was the "best" one or - and my favorite - they'd even argue my diagnoses, commonly trying to argue that just about everything was a side effect of my having PTSD (as if ocular migraines or seizures come from PTSD - but I guess any stupid and unbelievable excuse works when trying to deny coverage, huh?).

So yeah, I *will* sleep better at night.  Anything beats private health care. Anything PARTICULARLY beats leaving my hopes of survival and quality of life in the hands of someone who expects to turn a massive profit off of my care.  So if this means "socialized" or "government" health care or a set of laws forbidding profit in health care - it's got my vote.

One more question: what makes a for profit medical board guaranteed to be any more compassionate and ethical than the government?  I'd suspect they'd be LESS compassionate since their primary interest is in PROFIT not PEOPLE.  If I were to have to pick one and worry which would leave me to die because it's cheaper - and they do already do this through delays and denial of care - it would be for profit insurance.

Because they are bound by contract and don't have the authority to make decisions based upon my age, productivity, value to society.  They have to argue that is is not covered by the contract.  So if Congress wants top pass a law outlining what cannot be excluded by the insurance contract (policy), they can do that and solve the evil insurance company's denials of care.  Then the issue is just cost, and openining up the competition so it is interstate rather than bound within a specific state, the costs will go down--guaranteed.  And if they don't go down enough, then the government can offer incentives or other alternatives. 

How in the name of all that's holy is opening up the insurance market to interstate competition going to change MOTIVE?  I can easily see where it would change COST, but MOTIVE?  There's no legal or economic standing for a change in contract status.  Actually, from what I can see, unless the Feds step in with mandatory coverage requirements similar to or better than those of the strongest state requirements, what we're going to have is WORSE coverage AND we're still going to have the issue of denial of care and delay of care just because they "can" and they'll continue to do it on the basis of fuzzy things like "terms of contract" that take media wars and teams of attorneys to argue (and hopefully settle before you die or become permanently disabled).  After all, a contract is STILL a contract whether you sign it in Montana or Florida and whether they're based in Indiana or Idaho.

James,

Please, please, please go slowly on the "interstate" idea of insurance.  Insurance is a highly regulated product for many very good reasons.  The contracts are tricky and have been developed over hundreds of years (thru legal interpretations).  Suddenly making every insurance company's contracts available in every state would create a nightmare of legal issues. Contradictions would rule the day.  And you can bet if there was an interpretation question the company wouldn't pay until forced to.  Don't rush in where angels fear to tread, please.  This idea needs a LOT of development.  Remember, new solutions always create new problems.

Here's one thought.  Have you heard of "Inland Marine" insurance coverage.  What do you suppose it is?  It certainly has absolutley nothing to do with "marine".  It got that nomer long, long ago when teamsters (you know, the guys with the horse teams and the wagons with wooden wheels) hauled goods from the ship to inland locations. Over the years the horses and the wagons went away and the policies morphed into other uses. But the name remained.  To change that title now, with all the legal findings that refer to it (to this day) would be a real mess.  So they just leave it alone. It's safer and easier and the public just has to struggle with trying to figure it out.

Here's another. Do you suppose a surfboard being hauled on top of a car, that blows off and causes damage is covered by .... a boat policy or an automobile policy?  It took the courts in one state to figure that one out. And it didn't happen quickly as you might imagine.  

Insurance is tricky.  Mess with it at your own risk.

Danetta,

You need to reread my post.  I said that the government can pass laws that require coverage of pre-existing, and define what must be in the contract.  In fact, that is EXACTLY what the House Bill does before it adds the government option.  So "unless the Feds step in with mandatory coverage requirements similar to or better than those of the strongest state requirements"  is exactly what I am proposing.

Dirk,

I am an Attorney so I understand very clearly what you are referring to.  I am also familiar with Inland Marine Insurance.

Going about it very carefully is to be expected.  The lower courts of the state, however, will now be interpreting the intent of the language in light of the intent of the Federal legislature which mandated the provisons rather than the intent of the contracting parties.

It is also fundamental to contract law that any ambiguous terms are to be interpreted against the drafter of the contract, which in this case is the insurance company.

There is more that can be said, but given the fact that this would be defined by a federal statute, the individual interpretations and policies of the states which conflict would largely be destroyed by the new law.  It would be far more uniform.

It definitely warrants a lot of thought however.  And the insurance companies themselves may try and use your argument.

No I don't.  That the feds can tell them what to cover still doesn't override that it continues to be a CONTRACT and as such operates under the same set of laws and principles.  Nothing changes other than you'll live in one state and the home office could suddenly be across the country.  There's NOTHING in mandatory coverage that says that they still have quit dismal, derogatory, inhumane crap like "reasonable and customary", "standard practice", "proven treatment", etc. or any of the other reasons commonly and standardly written into insurance contracts and policies that are used to deny and delay treatments.  Heck, this alone is one of the biggest beefs about Part D after the damned "donut hole".  That the private insurance companies make flat out arbitrary decisions about which medications they're going to cover despite laws about HAVING to cover a certain percentage of medications in various categories and making similarly arbitrary decisions to deny treatments (like I can't get a particular anti-nausea medication simply due to my diagnosis code with my Part D plan).  It's not about what they're told they have to cover, it's about how they CHOOSE to cover or not cover things.

James,  So sorry to learn about the "Attorney" thing. We all send our condolences.  :-)

I have no idea what you mean by: "The lower courts of the state, however, will now be interpreting the intent of the language in light of the intent of the Federal legislature which mandated the provisons rather than the intent of the contracting parties."  But it sounds scary. New solutions = new problems.

"any ambiguous terms are to be interpreted against the drafter of the contract..."  Sure. But oh that it were that simple.  If it becomes abiguous merely by the inactment of cross border selling ... well, it just ain't that simple.  In any case the insurance companies will spend a LOT of time (and money) making sure they are covered. We'll have to work that out ourselves over MUCH time and many court cases.  Not an encouraging thought, eh?

...this would be defined by a federal statute, the individual interpretations and policies of the states which conflict would largely be destroyed by the new law.  It would be far more uniform."  Uniform is only good if the uniformity is in my favor.  That's not likely.  As an atty you know that this whole idea would take years to sort out -- and endless waiting and legal wrangling (which could be windfall for YOU, but not do much for us).  I'm sure the insurance companies (I worked for three during my career) would do all they could to make sure it 'spins' in their favor -- and in the case of Private health insurance, that means AGAINST the insured.  Better we should just start with a Public Option.  Govt doesn't tend to spin things in their favor (or if they do, that tends to be in OUR favor, since we ARE our government).

Yep. I'm more in favor of a single payer universal coverage solution than ever.  That way we could be uniform with the rest of the first world countries.

Danetta,

I have read the house bill.  It does not outlaw insurance contracts.  It does say that the government option and the carriers will be offering the same coverage.  And mandates it.

So where does it say that the panel of government doctors are NOT going to review what's medically reasonable and necessary, proven treatments, etc.  Remember, President Obama knows we need to cut costs.  When asked on a Wednesday evening by a woman whether her 100-year-old mother would still have gotten her surgery recommended by her doctor now under the new Plan, he said she might just be given a pill.

It doesn't sound like what is being proposed is going to meet your expectations.  I think you will be somewhat disappointed no matter what happens. 

I really wish you the best, but if you think the government is just going to give you what you ask for and never deny a particular treatment in favor of a different approach, the clearly seems to be contrary to what the President as said as I have recounted in one instance above.

Dirk,

Thanks for the condolences.  I have represented injured people and carriers.  So I have seen both sides.

How is it any different in terms of private carriers challenging any new federal law in the courts?  ANY reform is going to be incredibly complicated, no?  But we must do it.  We agree on that.

And the government spinning medical care in your favor under a single-payer system is simply contrary to the results seen in Canada and Britain.  There they have rationed care.  How is that to the patient's benefit? You have to wait 6 months for an MRI, and that has actually been a death sentence to some. 

The response seems to be that that is happening now as a practical matter.  But we are all looking for reform, not the status quo.

If a patient and his or her doctor agree that a particular course of action should be taken, it should be done.  And any reform should not take that decision away from the two.  But the House Bill interjects the government.  In my response above I reference the President's admission of that fact.

You know, the sad thing is that we all really want the same thing.  And the Congress can help us get it.  We disagree over a government option (not regulation--I favor that).  If the politicians didn't demonize their opponents so that we think that the other is only out to do evil, or part of some conspiracy, we might get a great result.  

James,   I rather hope the private carriers won't spend time challenging the Feds in court. We'll be losers in that round (but that's nothing new in dealing with health insurance cos in the USA).

I visit Canada a lot. I have a vacation place in Nova Scotia and my teacher father built a cabin in Ontario in 1950 and we have spent a good portion of every summer up there ever since (entire summers when we were young). In the process we talk to Canuks and we use the facitlities ourselves from time to time.  I am (sorry for this) damn sick and tired of Americans who know so much about Canadian health care!!  The 20 or 30 families I know well (and for a very long time) speak well of their system -- every single one.  They hear about our methods and they just shake their heads in amazement.  They clearly don't even want to *think* about it.  You would have us believing that everyone up there is in line for years, dying in place. It's stupid, unfair and utterly ridiculous.  A good neighbor of mine was proud to be the first Canadian to get a stainless steel hip replacement at about age 80.  He lived nicely to about 92.  He never had anything but good things to say and he'd take a stake in the heart before succumbing to our system.... besides he'd be uninsured. He couldn't possibly afford it. 

Are you implying that you don't wait for health care down here?  If so, you'll be one of the very few south of Canada that does. I'm waiting 6 months for a simple physical here -- under an HMO (with emphasis on the "M"). Ever try to get an appt with an eye doctor.  It's always months at best!

Get off this kick about other county's health care plans until you go there and USE them and talk with dozens of their users. And don't forget to ask what it costs them to have a baby or a hip replacement or dialysis treatments or chemo or pharma drugs or ANY health care.   Ask their hospitals where you can find the cashier or billing dept or insurance depts?   Now ... ask any family Doctor in the USA about dealing with insurance companies -- and stand back because the explitives will explode from their lips. Many talk about completely unreasonable lost patient time having to deal with those damn companies. Some just plain refuse to accept insurance. They became physicians to practice medicine and they're determined to do it.  This never, ever happens in Canada (or Britian, or Denmark, or France, or Norway, etc.)

One last one ... my father contracted cancer late in life. He had it for years and got treatment in Oregon thru Kaiser Permanente and at the local hosptial and Dr. office in a very small town in Ontario.  Each had their strengths and weaknesses but overall he preferred the Canadian system even tho he still had to pay and fight with Kaiser about getting reimbursed.  The Doctor was terrific and went to some considerable personal trouble to visit with him before he left to go back to Oregon for the last time. It was impressive and heartening. Canadian health care is fine -- my family is a living example for over 50 years.  USA health care for us has been OK too, except for the idiotic insurance co. practices and the billing messes, which are psychologically damaging.

If you ever had coverage wherein absolutely NO billing or questions about seeing your Doctor ... and then had to go back to our current system, you'd catch on quickly.  Our health care system has some built-in pain and no solution in sight.

Well said, Mr. Faegre.  You can find people who "love" any insurance company here in the US (or of examples of people who've experienced socialized medicince whether abroad or at the hands of the VA, Medicaid or Medicare and suffered - such as Mr. Dunham's tale of his friend's wait time for an MRI) if you hunt long enough, but the truth of the matter is there are tons of people who have insurance, who deal with insurance or who live abroad and who watch this horrific train wreck we call a "health care system" who can tell plenty of stories in detail about how what we're doing does NOT work and WHY it does not and there are far more examples of how socialized medicine WORKS (even here with the VA - whose quality varies from facility to facility and even due to why you're there - Medicare and Medicaid).  So digging up horror stories about "why change won't work" like "but my friend (or my cab driver's best friend's hairdresser's third cousin's little sister's boyfriend) had to wait almost a year for an elective procedure" really doesn't compare to the suffering created by a system that literally allows people to DIE or face PREVENTABLE disabilities all because no one is willing to address the problem of lack of timely access to appropriate care beyond pointing fingers at those who, for whatever reasons, don't have insurance while ignoring that the most common reasons are variants of "can't afford to buy it" combined with "can't afford to use it, if I had it". 

Danetta ~

Thanks for that great moment! I loved it.  But I forget his name ... you know. The boyfriend?

... "but my friend's cab driver's best friend's hairdresser's third cousin's little sister's boyfriend) had to wait almost a year for an elective procedure"

Very good point James: “If the politicians didn't demonize their opponents so that we think that the other is only out to do evil, or part of some conspiracy, we might get a great result.” -  James while I view conspiracy theories as ludicrous I do have a justifiable ‘trust’ issue in our government, and then there is also the understanding problem.  Can you please be kind enough to give me your explanation on this below, some of which I understand just fine, but I am asking a few specific questions.  

H.R.676
United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) (Introduced in House)

SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.

(a) REQUIREMENT TO BE PUBLIC OR NON-PROFIT-


“(2) CONVERSION OF INVESTOR-OWNED PROVIDERS- Investor-owned providers of care opting to participate shall be required to convert to not-for-profit status.” – Why would this be done except to make billion’s?

“(3) COMPENSATION FOR CONVERSION- The owners of such investor-owned providers shall be compensated for the actual appraised value of converted facilities used in the delivery of care.” – In the long run compensated by our tax dollars!

“(4) FUNDING- There are authorized to be appropriated from the Treasury such sums as are necessary to compensate investor-owned providers as provided for under paragraph (3).” – Read this a few times and still don’t understand it.  What does it mean in English?

“(5) REQUIREMENTS- The conversion to a not-for-profit health care system shall take place over a 15-year period, through the sale of US Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits, but may be made only for costs associated with the conversion of real property and equipment.” – Yes I understand this much was written by an attorney for profit, but what does it mean in English?

AND FROM THE BEGINNING:

“H.R.676
United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) (Introduced in House)” – the “for ALL Act”; did you know out of 47 million uninsured 23 million are illegal border jumper illegal alien’s? - This one particular question is rhetorical of course ;)

Pat ~

A scan of the word "alien" thru all the posts here, show this is an issue that affects you strongly. Very strongly.  In fact, you seem to be the only one here constantly focused on it.

But here's what bothers me. I googled "uninsured illegal aliens" and got a lot of facts and figures, not many of which agree with one another. But it's worth noting that your number of "... out of 47 million uninsured 23 million are illegal border jumper illegal alien's ..."  Ignoring the "border jumper" part, I find that your number is clearly the highest of them all (on Google).  Here's a different view from a National Public Radio story recently:

"We've estimated about 6.1 million of the uninsured are actually undocumented," Sheils says.  John Sheils of the Lewin Group, a nonpartisan health care consulting firm owned by UnitedHealth Group, has looked at numerous studies to extrapolate a best guess.

And more from the same report:

"The economics aren't as great as they've been made out to be," says Paul Fronstin of the Employee Benefit Research Institute.  Fronstin says illegal immigrants are younger, and so generally healthier, than the overall population, and studies show they go to the doctor far less than the native born. He estimates their total share of the health care system at about 1 or 2 percent, with only a small slice of that paid for in public money.

There are a lot of numbers and a lot of arguments you've ignored in this.  Seems to me you completely dislike those illegals and are anxious not to see them get any healthcare. That's your right but please use more realistic arguments.

Me, I like to think of my self as a bit more understanding and commpassionate.  I'm not willing to throw their babies and young children on the trashheap, for there but for the grace of God, go I.

Dirk,

Again I thought you and I were setting an example for others in our tone and civility as opposed to Danetta's snide remarks and combative tone.  And yet she accuses others of not wanting a respectful dialogue.

And if we are going to criticize anecdotal testimonials of real-life examples, then one should hardly base THEIR argument on anecdotal evidence.  It's a it hypocritical; yet everyone advocating the government option is really quick to tell THEIR stories to justify the overhaiul of an entire system, some even advocating single-payer.

With regard to your comment: "You would have us believing that everyone up there is in line for years, dying in place. It's stupid, unfair and utterly ridiculous." 

That is simply not true.  I never stated an extreme like that.

However it is true that folks in these systems have suffered irreparable harm and death because they did not get timely and the highest quality care.  The fact that people are denied care under the current situation and also suffer irreparable harm and death is a ridiculous argument for implementing  a national system that will institutionalize it further.

We in fact need to implement a system that does NOT have the same result that is etter than both the status quo and these other programs.  Can we not do that?  Wouldn't we all prefer that?

I am a little tired of getting responses as though I am against reform or government regulation or acceptance of pre-existing conditions (which I have) or removal or minimization of the profit motive and holding carriers accountable.

Can we not think beyond the House Bill and a government option vs no government option?

As an aside, I know a highly trained specialist physician who was born and raised in Canada and lives and works in the USA.  She states unequivocally that, for SPECIALTY CARE, the US is far superior.

And the survival rate for prostate cancer for example (as well as other such maladies) is materially HIGHER in the US.

I want the est healthy care for you ALL.  Keep that in mind efore you spew venom on me ecause I am not in love with the House Bill.

James ~

I said to you "...With regard to your comment: "You would have us believing that everyone up there is in line for years, dying in place. It's stupid, unfair and utterly ridiculous." 

And you responded: "That is simply not true.  I never stated an extreme like that."

May I quote you from a previous post? "... in Canada and Britain.  There they have rationed care.  How is that to the patient's benefit? You have to wait 6 months for an MRI, and that has actually been a death sentence to some. "

Sorry to puncture your hot air balloon but we have rationed care in this country (in many ways including insurance companies refusing to allow Drs to do what they need to do), and we have people dying for lack of health care -- lots of them. Have you seen the compassionate free medical service being offered in Virginia and Nevada recently? Have you seen how long those lines are and how many are turned away? Have you seen the stories about LA hospitals dumping patients wearing only hospital gowns in poor sections of town?  There are many stories of this sort.   Go to any large ER and see how long you wait!!  Insurance or no insurance.  It's an eye-opener if you've not witnessed it. And we're talking USA.  Not Canada. This doesn't happen in Canada.

You have a nice anecdotal story about a physician born and raised in Canada. I don't doubt it. But it misses the point.  Now listen up and listen carefully.  It's been pointed out over and over and over again: The USA is far below Canada in quality of result. We are far, far below them in infant mortality.  We are far, far, far ahead of them in per capita spending for health care. Our life expectency is well below thiers.  The list, James, is long and highly embarrassing. And it's not anectdotal. We lose in EVERY category. Every single one.  In fact, out of the top 30 countries we tend to rank in the high 20's on just about any measure except $$ spent. On that front we are the clear winner.   Our expenditures per capita are 50% greater than Canada -- THAT'S A HUGE AMOUNT OF MONEY! And for that we get an overall worse result.  With all due respect, sir, get off the Canada kick. They got us beat cold. You wanna get off onto drug prices next?????

And .... as to the BEST health care. Only the rich will EVER get that. No country including ours can possibly give all citizens the best care.  It's not an option. It doesn't pass the straight face test.

As to single-payer.  You bet, I'd go for it in a heartbeat.  What is it that you don't get about decades of a failing health care system in this country??????  What's so hard to figure out?   We're here arguing because it's such a mess and it's been brought to us by private insurance companies and "managed health care".  This isn't hard, James.  But you gotta let go of the idea that the free market fixes all.  Somehow you got the idea that if existing health insurance cos. just sell across state lines prices will just collapse. That's nuts.  For pities sake: We already have a good bit of competition in each state.  Look: It didn't work for the banks and investment firms (just ask Greenspan) and it's not working any better for the private health sector.  Your suggestions, to my way of beliefs, are simply a way of continuing this mess.  I can't abide that. We gotta break out of the old failure and get on with change.  Way too many people are desparate to hang on to failure. The result is wholly predicable.

Dirk, Dirk, Dirk.....You did not need to go to a different post.  That is what is said in this post.  And that is a FAR CRY from your attribution to me of "everyone up there is in line for years, dying in place."  And I further already in that post to which you replied stated: "The fact that people are denied care under the current situation and also suffer irreparable harm and death is a ridiculous argument for implementing  a national system that will institutionalize it further." 

I was talking specifically about what is happening under the status quo HERE, which is your "it's happening here" argument.  Doesn't puncture my "hot air balloon" at all.  (I will assume you did not mean anything by the "hot air" reference".)

I have given you irrefutale facts already and in other points where we are in fact SUPERIOR.  So I am listening up, but I wonder if you are?  When it comes to specialty care we blow canada away.  That is a fact.

And I have already commented about those other statics, some of which are true.  And factcheck.org, and I believe Timothy Foley too, concedes that in things like prostate cancer we have a success rate noticeably better than Canada and Britain.  True for other serious conditions as well.  You overtstate your case when you paint a broad picture and only acknowlede statistics that support your vision and reject the others that take a closer look.

And I seem to have more faith in government than you.  I believe that we CAN have as good health INSURANCE as rich people if we do it right.  If they can pony up $1 million bucks cash if they need to, c'est la vie!  But we are reforming insurance here, according to the Administration, not solely healthcare. 

The point is we need to raise the standard.  We can do better than Canada or Britain if we are willing to try.  Why settle for less?

Even if the status quo SUCKS, we are not talking about status quo.  We are talking about the best reform.  People seem to forget that.  So go ahead and rail on the status quo---I have NEVER been defending it. 

And you should not assume there is only one solution just because you don't undertstand fully the ins and outs of private sector economics.  The real-world example I gave as to how it will work is true---GUARANTEED. 

Lastly, I don't believe the free market fixes all.  I am FOR REFORM.  UGH!  I am FOR REGULATION.  I am FOR trying to minimize or remove the PROFIT INCENTIVE.  I am FOR accepting PRE-EXISTING CONDITIONS.

Just concede some of my undeniale truths and maybe we can further the discussion.  I have conceded some of yours.

Just to chime in, although prostate cancer usually gets cited as showing the preeminence of American medicine, it is always a mistake to base it on one particular type of disease, because for everyone we excel at curing, there's another one that we stink at.  The same is true of most Western countries -- good at some, less good in others -- as well as for different regions in the U.S.

If we look at all types of cancer in aggregate, the U.S. has five-year survival rates that range from 78% to 90%, depending on the region of the country.  Canada's cancer survival rates ranged from 79.3% to 85.4%, again varying from region to region (source:  The CONCORD study, as published in The Lacent Oncology -- no link that I've been able to find).  Counterintuitively, New York City is one of the worst regions for cancer survival, below any region in Canada, where Hawaii and Seattle are some of the best.

In general, although the U.S. is better than most European countries for most types of cancer, we're not appreciably better than Canada, Australia, New Zealand, and we're slightly behind Japan and France, particularly in terms of colon and rectal cancers.

All of which is to say -- it's pretty complicated.  What's not complicated is who pays more for these treatments.  That's unquestionably us.

Here is a 2007 article from a Canadian which also references other countries.  It is very enlightening:

Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux-a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body-and Aucoin went to a clinic to begin treatment. But if Erbitux offered hope, Aucoin's insurance didn't: she received one inscrutable form letter after another, rejecting her claim for reimbursement. Yet another example of the callous hand of managed care, depriving someone of needed medical help, right? Guess again. Erbitux is standard treatment, covered by insurance companies-in the United States. Aucoin lives in Ontario, Canada.

When Aucoin appealed to an official ombudsman, the Ontario government claimed that her treatment was unproven and that she had gone to an unaccredited clinic. But the FDA in the U.S. had approved Erbitux, and her clinic was a cancer center affiliated with a prominent Catholic hospital in Buffalo. This January, the ombudsman ruled in Aucoin's favor, awarding her the cost of treatment. She represents a dramatic new trend in Canadian health-care advocacy: finding the treatment you need in another country, and then fighting Canadian bureaucrats (and often suing) to get them to pick up the tab.

But if Canadians are looking to the United States for the care they need, Americans, ironically, are increasingly looking north for a viable health-care model. There's no question that American health care, a mixture of private insurance and public programs, is a mess. Over the last five years, health-insurance premiums have more than doubled, leaving firms like General Motors on the brink of bankruptcy. Expensive health care has also hit workers in the pocketbook: it's one of the reasons that median family income fell between 2000 and 2005 (despite a rise in overall labor costs). Health spending has surged past 16 percent of GDP. The number of uninsured Americans has risen, and even the insured seem dissatisfied. So it's not surprising that some Americans think that solving the nation's health-care woes may require adopting a Canadian-style single-payer system, in which the government finances and provides the care. Canadians, the seductive single-payer tune goes, not only spend less on health care; their health outcomes are better, too-life expectancy is longer, infant mortality lower.

Thus, Paul Krugman in the New York Times: "Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes." Politicians like Hillary Clinton are on board; Michael Moore's new documentary Sicko celebrates the virtues of Canada's socialized health care; the National Coalition on Health Care, which includes big businesses like AT&T, recently endorsed a scheme to centralize major health decisions to a government committee; and big unions are questioning the tenets of employer-sponsored health insurance. Some are tempted. Not me.

I was once a believer in socialized medicine. I don't want to overstate my case: growing up in Canada, I didn't spend much time contemplating the nuances of health economics. I wanted to get into medical school-my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.

My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic-with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

I decided to write about what I saw. By day, I attended classes and visited patients; at night, I worked on a book. Unfortunately, statistics on Canadian health care's weaknesses were hard to come by, and even finding people willing to criticize the system was difficult, such was the emotional support that it then enjoyed. One family friend, diagnosed with cancer, was told to wait for potentially lifesaving chemotherapy. I called to see if I could write about his plight. Worried about repercussions, he asked me to change his name. A bit later, he asked if I could change his sex in the story, and maybe his town. Finally, he asked if I could change the illness, too.

My book's thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada's population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment-patients who suffered and, in some cases, died from the delays. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system. To capture Canadian health care's growing crisis, I called my book Code Blue, the term used when a patient's heart stops and hospital staff must leap into action to save him. Though I had a hard time finding a Canadian publisher, the book eventually came out in 1999 from a small imprint; it struck a nerve, going through five printings.

Nor were the problems I identified unique to Canada-they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled-48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August 2003 heat wave-when many doctors were on vacation and hospitals were stretched beyond capacity-15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren't available. And so on.

But single-payer systems-confronting dirty hospitals, long waiting lists, and substandard treatment-are starting to crack. Today my book wouldn't seem so provocative to Canadians, whose views on public health care are much less rosy than they were even a few years ago. Canadian newspapers are now filled with stories of people frustrated by long delays for care:

   vow broken on cancer wait times: most hospitals across canada fail to meet ottawa's four-week guideline for radiation
   patients wait as p.e.t. scans used in animal experiments
   back patients waiting years for treatment: study
   the doctor is . . . out

As if a taboo had lifted, government statistics on the health-care system's problems are suddenly available. In fact, government researchers have provided the best data on the doctor shortage, noting, for example, that more than 1.5 million Ontarians (or 12 percent of that province's population) can't find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who'd get a doctor's appointment.

Dr. Jacques Chaoulli is at the center of this changing health-care scene. Standing at about five and a half feet and soft-spoken, he doesn't seem imposing. But this accidental revolutionary has turned Canadian health care on its head. In the 1990s, recognizing the growing crisis of socialized care, Chaoulli organized a private Quebec practice-patients called him, he made house calls, and then he directly billed his patients. The local health board cried foul and began fining him. The legal status of private practice in Canada remained murky, but billing patients, rather than the government, was certainly illegal, and so was private insurance.

Chaoulli gave up his private practice but not the fight for private medicine. Trying to draw attention to Canada's need for an alternative to government care, he began a hunger strike but quit after a month, famished but not famous. He wrote a couple of books on the topic, which sold dismally. He then came up with the idea of challenging the government in court. Because the lawyers whom he consulted dismissed the idea, he decided to make the legal case himself and enrolled in law school. He flunked out after a term. Undeterred, he found a sponsor for his legal fight (his father-in-law, who lives in Japan) and a patient to represent. Chaoulli went to court and lost. He appealed and lost again. He appealed all the way to the Supreme Court. And there-amazingly-he won.

Chaoulli was representing George Zeliotis, an elderly Montrealer forced to wait almost a year for a hip replacement. Zeliotis was in agony and taking high doses of opiates. Chaoulli maintained that the patient should have the right to pay for private health insurance and get treatment sooner. He based his argument on the Canadian equivalent of the Bill of Rights, as well as on the equivalent Quebec charter. The court hedged on the national question, but a majority agreed that Quebec's charter did implicitly recognize such a right.

It's hard to overstate the shock of the ruling. It caught the government completely off guard-officials had considered Chaoulli's case so weak that they hadn't bothered to prepare briefing notes for the prime minister in the event of his victory. The ruling wasn't just shocking, moreover; it was potentially monumental, opening the way to more private medicine in Quebec. Though the prohibition against private insurance holds in the rest of the country for now, at least two people outside Quebec, armed with Chaoulli's case as precedent, are taking their demand for private insurance to court.

Rick Baker helps people, and sometimes even saves lives. He describes a man who had a seizure and received a diagnosis of epilepsy. Dissatisfied with the opinion-he had no family history of epilepsy, but he did have constant headaches and nausea, which aren't usually seen in the disorder-the man requested an MRI. The government told him that the wait would be four and a half months. So he went to Baker, who arranged to have the MRI done within 24 hours-and who, after the test discovered a brain tumor, arranged surgery within a few weeks.

Baker isn't a neurosurgeon or even a doctor. He's a medical broker, one member of a private sector that is rushing in to address the inadequacies of Canada's government care. Canadians pay him to set up surgical procedures, diagnostic tests, and specialist consultations, privately and quickly. "I don't have a medical background. I just have some common sense," he explains. "I don't need to be a doctor for what I do. I'm just expediting care."

He tells me stories of other people whom his British Columbia-based company, Timely Medical Alternatives, has helped-people like the elderly woman who needed vascular surgery for a major artery in her abdomen and was promised prompt care by one of the most senior bureaucrats in the government, who never called back. "Her doctor told her she's going to die," Baker remembers. So Timely got her surgery in a couple of days, in Washington State. Then there was the eight-year-old badly in need of a procedure to help correct her deafness. After watching her surgery get bumped three times, her parents called Timely. She's now back at school, her hearing partly restored. "The father said, ‘Mr. Baker, my wife and I are in agreement that your star shines the brightest in our heaven,' " Baker recalls. "I told that story to a government official. He shrugged. He couldn't fucking care less."

Not everyone has kind words for Baker. A woman from a union-sponsored health coalition, writing in a local paper, denounced him for "profiting from people's misery." When I bring up the comment, he snaps: "I'm profiting from relieving misery." Some of the services that Baker brokers almost certainly contravene Canadian law, but governments are loath to stop him. "What I am doing could be construed as civil disobedience," he says. "There comes a time when people need to lead the government."

Baker isn't alone: other private-sector health options are blossoming across Canada, and the government is increasingly turning a blind eye to them, too, despite their often uncertain legal status. Private clinics are opening at a rate of about one a week. Companies like MedCan now offer "corporate medicals" that include an array of diagnostic tests and a referral to Johns Hopkins, if necessary. Insurance firms sell critical-illness insurance, giving policyholders a lump-sum payment in the event of a major diagnosis; since such policyholders could, in theory, spend the money on anything they wanted, medical or not, the system doesn't count as health insurance and is therefore legal. Testifying to the changing nature of Canadian health care, Baker observes that securing prompt care used to mean a trip south. These days, he says, he's able to get 80 percent of his clients care in Canada, via the private sector.

Another sign of transformation: Canadian doctors, long silent on the health-care system's problems, are starting to speak up. Last August, they voted Brian Day president of their national association. A former socialist who counts Fidel Castro as a personal acquaintance, Day has nevertheless become perhaps the most vocal critic of Canadian public health care, having opened his own private surgery center as a remedy for long waiting lists and then challenged the government to shut him down. "This is a country in which dogs can get a hip replacement in under a week," he fumed to the New York Times, "and in which humans can wait two to three years."

And now even Canadian governments are looking to the private sector to shrink the waiting lists. Day's clinic, for instance, handles workers'-compensation cases for employees of both public and private corporations. In British Columbia, private clinics perform roughly 80 percent of government-funded diagnostic testing. In Ontario, where fealty to socialized medicine has always been strong, the government recently hired a private firm to staff a rural hospital's emergency room.

This privatizing trend is reaching Europe, too. Britain's government-run health care dates back to the 1940s. Yet the Labour Party-which originally created the National Health Service and used to bristle at the suggestion of private medicine, dismissing it as "Americanization"-now openly favors privatization. Sir William Wells, a senior British health official, recently said: "The big trouble with a state monopoly is that it builds in massive inefficiencies and inward-looking culture." Last year, the private sector provided about 5 percent of Britain's nonemergency procedures; Labour aims to triple that percentage by 2008. The Labour government also works to voucherize certain surgeries, offering patients a choice of four providers, at least one private. And in a recent move, the government will contract out some primary care services, perhaps to American firms such as UnitedHealth Group and Kaiser Permanente.

Sweden's government, after the completion of the latest round of privatizations, will be contracting out some 80 percent of Stockholm's primary care and 40 percent of its total health services, including one of the city's largest hospitals. Since the fall of Communism, Slovakia has looked to liberalize its state-run system, introducing co-payments and privatizations. And modest market reforms have begun in Germany: increasing co-pays, enhancing insurance competition, and turning state enterprises over to the private sector (within a decade, only a minority of German hospitals will remain under state control). It's important to note that change in these countries is slow and gradual-market reforms remain controversial. But if the United States was once the exception for viewing a vibrant private sector in health care as essential, it is so no longer.

Yet even as Stockholm and Saskatoon are percolating with the ideas of Adam Smith, a growing number of prominent Americans are arguing that socialized health care still provides better results for less money. "Americans tend to believe that we have the best health care system in the world," writes Krugman in the New York Times. "But it isn't true. We spend far more per person on health care . . . yet rank near the bottom among industrial countries in indicators from life expectancy to infant mortality."

One often hears variations on Krugman's argument-that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use, and cultural values. It pains me as a doctor to say this, but health care is just one factor in health. Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall, or a car accident. Such factors aren't academic-homicide rates in the United States are much higher than in other countries (eight times higher than in France, for instance). In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don't die in car crashes or homicides outlive people in any other Western country.

And if we measure a health-care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50 percent; the European rate is just 35 percent. Esophageal carcinoma: 12 percent in the United States, 6 percent in Europe. The survival rate for prostate cancer is 81.2 percent here, yet 61.7 percent in France and down to 44.3 percent in England-a striking variation.

Like many critics of American health care, though, Krugman argues that the costs are just too high: "In 2002 . . . the United States spent $5,267 on health care for each man, woman, and child." Health-care spending in Canada and Britain, he notes, is a small fraction of that. Again, the picture isn't quite as clear as he suggests; because the U.S. is so much wealthier than other countries, it isn't unreasonable for it to spend more on health care. Take America's high spending on research and development. M. D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.

That said, American health care is expensive. And Americans aren't always getting a good deal. In the coming years, with health expenses spiraling up, it will be easy for some-like the zealous legislators in California-to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like-minded politicians could take off the shelf, dust off, and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.

But such initiatives would push the United States further down the path to a government-run system and make things much, much worse. True, government bureaucrats would be able to cut costs-but only by shrinking access to health care, as in Canada, and engendering a Canadian-style nightmare of overflowing emergency rooms and yearlong waits for treatment. America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home-in the other four-fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.

http://www.city-journal.org/html/17_3_canadian_healthcare.html

Pat,

I have not had an opportunity to study this, but here it goes: 

H.R.676
United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) (Introduced in House)

SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.

(a) REQUIREMENT TO BE PUBLIC OR NON-PROFIT-


"(2) CONVERSION OF INVESTOR-OWNED PROVIDERS- Investor-owned providers of care opting to participate shall be required to convert to not-for-profit status." - Why would this be done except to make billion's?--- To address the argument that the unfair denial of care was driven by the insurance companies' need to realize increasing profits.  The belief is that if it is profit, it was taken from an insured who didn't get deserved treatment.  There may be some truth to that.  Now a lot of folks want to throw the baby out with the bathwater.

"(3) COMPENSATION FOR CONVERSION- The owners of such investor-owned providers shall be compensated for the actual appraised value of converted facilities used in the delivery of care." - In the long run compensated by our tax dollars!- yes

"(4) FUNDING- There are authorized to be appropriated from the Treasury such sums as are necessary to compensate investor-owned providers as provided for under paragraph (3)." - Read this a few times and still don't understand it.  What does it mean in English?---This is specifically where the money in the prior paragraph will come from.  It is important to know that this is to compensate investors.

"(5) REQUIREMENTS- The conversion to a not-for-profit health care system shall take place over a 15-year period, through the sale of US Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits, but may be made only for costs associated with the conversion of real property and equipment." - Yes I understand this much was written by an attorney for profit, but what does it mean in English?-- Again it is an anti-profit statement as profit is evil nowadays.  They are also concerned that investors will make the argument that the conversion will have cost them years of compounding growth on their investment and want to be compensated for it.  That would mean millions more of tax-payer dollars also.

AND FROM THE BEGINNING:

"H.R.676
United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) (Introduced in House)" - the "for ALL Act"; did you know out of 47 million uninsured 23 million are illegal border jumper illegal alien's? - This one particular question is rhetorical of course ;)

Posted by Pat Smith on 08/12/2009 @ 04:48PM PT

James thank you for answering me, please just one more question which I asked many people back in March.  I do believe everyone would appreciate the answer; 

For such a small population of Veterans (8 million using VA medical care) why does the whole VA medical system hold the record for Hospital Seclusion and Restraint Occurrences? 

In a message dated 3/10/2009 3:11:35 P.M. Central Daylight Time,:The full data is available on a PDF here - Hospital Seclusion and Restraint Occurrences per 1000 Patient Days: 2008

Seclusion and restraint are consider last measures in most if not all inpatient facilities, so this data acts as a “canary in the coalmine” to express the stress of under-management or under-staffing a facility is experiencing.

Highlights

Seclusion is when a patient of the medical facility is locked in a room alone. We assume “patient days” equal 24 hours.

The Portland Veterans Administration Medical Center (AKA “The Flight Deck”) shows the highest figures for seclusion occurrences divided by patient days. The VA’s numbers are FAR higher than other similar facilities, and the VA has failed to submit data for the 2nd, 3rd, and 4th quarters on restraint and seclusion to the state, as we understand it, which is proscribed by law.

VA 1st quarter - 67 seclusions over 1620 patient days for 41.4 seclusions per 1000 patient days.

http://www.mentalhealthportland.org/?p=1437 

 Thank you again, Pat

Interesting report on value for money comparing Canada with Europe.  Canada was last.  Wait times and delays were the big element, I think.  US was not reviewed.  We obviously shouldn't want single-payer.

http://www.fcpp.org/images/publications/6.%20Bang-For-The-Buck%20Adjusted%20Scores.pdf

It's called the Employer Mandate and you can read about it here.

http://healthcare.change.org/blog/view/can_kennedy_revive_the_debate_on_pay_or_play

Ronald,

The mandate means you either provide your employees with health insurance or pay a percentage of your payroll to the government to help with subsidies.  The article linked to above answers your question thusly:  "If the "pay" part is significantly lower than the cost of providing benefits, more and more companies will opt to pay, leading to more people in the Exchange."  And certain business are exempted from the "pay" penalty.

So the answer to your question is that, if employers do the math and it works for them, or they are exempt, there is nohing stopping them from dropping the provision of healthcare.  There are no guarantees, no matter what has been promised unless the Bill passed by the House is amended or others are passed that make the penalties too high or remove exemptions. 

James:

You say: "The problem is that once the government itself is providing you with these things, it controls you because it has the frightening power to change it or completely take it away.  And you may be powerless to do anything about it."

Sorry to have to report to you .... WE have the power over government.  Always have, always will.  The fact we sometimes don't choose to act on something, well, that's a different problem. We are not powerless.  We throw the bums out all the time and nothing can stop us from continuing to short of a military coup.  Unfortunately, we also tend to keep other bums in office .... and I for one, don't understand why.  For example, keeping Strom Thurmond in office when he was a basket case (his staff had to lift his arm and press his finger on the vote button as he could not -- and he clearly had no idea what was going on around him) was a travesty of the public.  Why in heaven's name did the people of his state keep electing him???  It was nuts.  But I digress...

Your premise is, of course, that if government has some control over health care, that this necessarily defines "bad" or "trouble".  Many of us argue that there are plenty of good government programs and departments and people which dispell your assertion.  The fact some can YELL louder is not reassuring to us who find much good in our government.  I always say, if you hate our government so much, I can offer some other countries where you can move and see how well thiers function.  Need a list?

I am, within the past few years, on Social Security.  The experience of getting signed up was awesome ... truly awesome.  The staff at my local office were simply terrific.  I have had zero problems. None. Nada. Zip.  It works. But what's even better is that I can find none of my friends or compatriots who have had any other experience than mine.  I'm sure there are some but I've not found a one yet.  So your idea that when govt runs the program, it will be "bad" or "scary" or "dangerous" is simply dead wrong. Proven wrong. Factually wrong. 

Here's my question to you.  What is it that prompts you to make such an all-sweeping and fearful diatribe?  What drives such an lopsided terror?  What's wrong with a sensible, well-thought-out, response to this whole health care problem?  We KNOW that there are problems with the existing methodology.  We KNOW our health care community is not happy.  We KNOW our country ranks exceptionally low on most any measure of health care (except expenditures).  With all this -- what's your inate fear of the government you help elect?  The one that we all straighten out when it goes too far afield, that we have been fixing for over 200 years?

If the current health system isn't working well (and it sure isn't) then let's try something else and not cling to a sinking ship for fear of what "might happen" if we let go (with apologies to the waaaay overpaid execs in the private health insurance industry, who will surely suffer ... but which won't upset me any).

James: There's a good way out of this mess, and, sorry to report, it most likely involves government.  The private sector has had decades and billions to improve it and the best they can do is continually make it worse each year. We're on a collison course with destiny if we continue down the present path ... and we're smart enough as a nation to not let THAT happen. So I say, move over or offer a better solution.  We're comin' thru, ready or not!

Amen Dick Faegre...Amen!

Dirk,

I am happy that you have had a good experience.  But you are uttering pure nonsense.  If there is any clearer example of a "sinking ship" it is the political system that constantly does a poor job and only manages to keep providing benefits by running in the red.  How many government-run programs have to go bankrupt before you let go of your pro-government bias?  The benefits you are receiving are one of several that are on an equally unsustainable cost.

And the founding Fathers very wisely feared too much government.  Read your history books.

On a positive note, we both agree that the current status is unsustainable and we must try something new.  And if there needs to be some level of government regulation as in many areas, then we may both be happy with that.  And I am in favor of ideas that can remove or limit the profit motive in healthcare if it results in the denial of care.  I am also in favor of requiring pre-existing conditions to be covered.

But let's try making the government the last option as a provider.  That's all I am suggesting.

James,

Thanks for the psssionate reply. However, contrary to your beliefs I am NOT uttering pure nonsense. Not even close.  In fact, I would suggest those that think private health insurance is the solution are the ones in the nonsense column and not able to face the obvious:  The mess we're in is directly and clearly a result of private insurance companies practices. Pure and simple. And they've done everything they can think of to prove it to you for last 20-30 years, without shame or embarrassment or even trying to cover it up.

That's not to say the path we are on with govt pgms is sustainable ... it's not.   But it's solvable. Govt has been robbing the Social Security fund for a long time and it's a crime. But we can stop that any time we want.  Medicare is tougher. But the idea that we must use the 'for profit' model that skims upwards of 20% off the top for itself, when Medicare runs at under 5% .... well that doesn't even pass the straight face test.  How is it that a more expensive overhead is better??  You talk of Govt going bankrupt -- have you been observing private industry recently????? Again, it doesn't pass the straight face test.

And it rankles me to no end that we allow prescription drugs to be advertised on TV.  That's nuts! Completely nuts. And stupid to boot. My doctors tell me (I've had 2 in the past 15 years - because I moved once) that they have patients that demand these TV drugs even tho they have no indications for them.  My doctors say "No." and the patients just said "I'll find a Dr. who will prescribe them."  And they do.  And you and I pay for that.  It's nuts.  But private drug companies don't think so. For them it's income! 

Your last big paragraph makes some real sense. I like it.  But I fear you're not going to find a for-profit company that's going to willingly take pre-existing conditions.  Why would they. It's murder on profits ..... and get this ... they are in it for the MONEY.  They give a damn about your health.  That's NOT why they do what they do.

Your last paragraph is the problem. You say:  "But let's try making the government the last option as a provider.  That's all I am suggesting."  Sorry to have to report .... it IS the last option. We've been letting the private ones muck it up for decades.  The most we get is LESS.  They are the ones willing to dump you the first chance they get when you start costing them. As long as you're a profit center, you're in good hands. The moment something goes wrong ... God help you (or you might turn to your elected officials).

Mark Twain said:  A banker (substitute "private health insurer here) is one who will lend you his umbrella when it's not raining but he wants it back as soon as the rain starts.  The private health insurer will give you coverage as long as you don't need it, but heaven help you when you do.  Government doesn't work that way -- see Medicare.

Can you please, James, explain to me in clear terms (not cute phrases like "read your history books") why you fear the US Government so much?  Why are you willing to trust private health companies?   What's wrong with Medicare (and remember, by the time Medicare goes bust your private health insurance premiums are predicted to run about $22,000 per year). Help me out here.

And whilst you're thinking about that would you keep in mind some very successful govt programs (like SS and Medicare and the CDC and ... the list is long) and some very sick non-govt companies. (see; GM, Chrylser, CitiBank, Bear Stearns, AIG, Wells Fargo, Lehman, Equity Funding, Maddox, Long Term Capital Funding, Lehman, Merrill Lynch, the FDIC is going broke paying out on many, many smaller banks -- but Congress will shore it up so don't have mass financial failure --, you want I should go on? I could.  For hours.  You know about Eddie Bauer?  Hartmarx? Six Flags?  Crabtree & Evelyn? Filene's Basement? Pilgrims Pride? Lear Corp?  and on and on and on and on.  None of these are US Government agencies or programs.

Dirk,

I apologize for calling it nonsense.

You write: "But I fear you're not going to find a for-profit company that's going to willingly take pre-existing conditions."  But the current House Bill forces them to acccept pre-existing conditions.  If they just removed the "government option", and if it was rescored by the CBO, maybe it would fly.

But the point is I am OK with the government telling them they have to cover pre-existing, and other protections.  Then the issue just becomes cost.  So the government CAN play a role in outlawing certain practices and not leaving it to the insurance carrier to freely determine what it will cover.

And we have not exhausted the free market alternatives.  For years the Congress has blocked attempts to allow interstate competition so we could find the best deal without being limited to only purchasing policies within our state.  We allow this with car insurance, why not health insurance?  I am sure the insurance industry opposed this.  Two people living literally 1 mile apart on different sides of a state border are sometimes paying DRAMATICALLY different prices for the same coverage.

There are many reasons to fear government, mostly by examining history.  But a specific answer is contained in your post where you say: "Govt has been robbing the Social Security fund for a long time and it's a crime."  I agree.  And they will get away with it for as long as they can until it becomes a crisis----Oh yeah, it is!  If the private industry ran Medicare, Medicaid, etc it would have gone out of business and people WOULD have gone to jail.

And when they actually get around to fiscal responsibility, government programs have ALWAYS ended up rationing care.

A very good article was written by a Democrat who supports Obama but is asking all the right questions.  She is being vilified of course.  It can be found here:

http://www.salon.com/opinion/paglia/2009/08/12/town_halls/

She's being vilified because trusting insurance reform to work as health care reform is like trusting the dog that's attacked you to babysit or buying a guard dog only to find he bites you instead of intruders.  Too many people ALREADY know that insurance companies CANNOT be trusted.  If they COULD they'd have VOLUNTARILY done much of what they're saying they'll do with new laws.  Why do they NEED laws to tell them to do what's right?  Mere ethics should tell them to do those things and should be enough to make them actually DO them.  It shouldn't take a reform effort that threatens their very existence.  It's clear to quite a lot of people that insurance companies are, to put it gently, less than sincere in their efforts.

James, thanks for a well thot out reply.  The major issue I'd take with this is your lumping all "government" into your rants.  There's govt that are the elected officials and then there's all those thousands of employees and agencies that interpret and enforce the laws.  The problem with the Social Security money is US. Yeah. You and me.  We want all these programs (many are earmarks that make us happy in our districts) and they gotta get paid for. Our officials are deparate to be reelected (they sure love that power and control and ALL that money flowing thru their fingers) and so SS gets a back seat -- it's fluid at the moment, so why worry?  We (you and me and the others here) can fix that in a flash (at the next election).  Trouble is, we don't.  We keep wanting the goodies.  Those earmarks and programs are not often for the benefit of the elected officials. They are for US (so that they can get reelected).  Our problem is any time a candidate for office is completely honest in their approach to the office, they lose. Bigtime.  The guy/gal that promises everything gets the vote. As I love to say:  We have met the enemy and he is us. 

I think it would help these discussions if we separated elected members from "government".  Govt is the FBI, the FDA, the CDC, the EPA, The Judicial System, ad nauseam.  The other govt is the one we elected when they promised us everything we wanted to hear.

Oops!  James, I gave you credit for a good response. Is it too late to recind it????  I refer to the Salon article you linked to.  It was T-E-R-R-I-B-L-E.  A-W-F-U-L!  J-U-N-K!

Here's an example:

CAmille says: "I realized that Palin's shrewdly timed metaphor (death panel) spoke directly to the electorate's unease with the prospect of shadowy, unelected government figures controlling our lives. A death panel not only has the power of life and death but is itself a symptom of a Kafkaesque brave new world where authority has become remote, arbitrary and spectral. And as in the Spanish Inquisition, dissidence is heresy, persecuted and punished."

EXCUSE ME!?  She gives credit to Sarah Palin's 'death panel' comment?!!! You simply gotta be kidding!  And then she goes drags in the Spanish Inquisition, too?!!!  Am I missing something here James? Because, that's completely nuts and stupid. Plain S-T-U-P-I-D.   It's great for riling up the uninformed but it has no place in trying to have a national discourse on healthcare. None. Nada. Zip.She should be ashamed and apologize for such trash.

How in God's name do we put this sort of idiotic dramatics to rest?  It just pollutes the whole process.  If this stuff continues (along with the Yellers at the town meetings) health care reform will fail.  And well it should.  I'm mad at Obama for not being much more aggressive (yes, aggressive) about this idiot's stuff.  We'll never get anywhere if we fall into putdowns, name-calling, unrealistic rants, and downright dumb, dreamt up foolery.

This Salon article falls right into that category.  Her first few sentences were good but she promptly jumped right over the edge.

For example.  Why is it that everyone goes around saying the the democrats 'control' all the branches of govt.  Phooey.  In the Senate, they have 58 votes when Ted Kennedy is present.  True, the two independents usually vote in the Democratic column but there are Democrates that are there in name only.  Same for the repubs.  These political parties don't always vote as a block -- thank heavens.  Things just aren't that simple and I'd think that Camille would know that and not go waltzing down the primrose path of ridiculousness.

Lousy article full of profound foolishness and downright lies.  I'm sure we can do MUCH better.

Here's the link for others to see how they feel about her:

http://www.salon.com/opinion/paglia/2009/08/12/town_halls/

Dirk,

I only suggested she was asking the right questions rather than blindly advocating a position because she hates Republicans or insurance companies.  That doesn't mean that I agree with everything she says.  And I don't agree with the quote you copied.

Again, we need to stop advocating before we ask plenty of questions.  Most are advocating and defending without asking questions and getting answers because of party bias, it seems.

Danetta,

I have said ad nauseum that I am not advocating trust in insurance carriers.  I am advocating passing laws to eliminate the objectional behavior, increase competition to reduce costs, without the government option.  The whole reason given for it is to have the government "compete" and presumably keep them "honest".  And it has been stated the government would follow the same rules.

Why do we need that?  Does the IRS keep employers honest because the government employs people?  It's irrellevant.  They get a look at your books annually and audit you to keep you honest.  Why can't they just audit the carriers and punish them accordingly?

You also say: "Why do they NEED laws to tell them to do what's right?  Mere ethics should tell them to do those things and should be enough to make them actually DO them.  It shouldn't take a reform effort that threatens their very existence. " 

I am glad you acknowledge it threatens their very existence.  However, the same could be queried about people who commit insurance fraud.  Or how about the politicians of both parties who irresponsibly bankrupted Medicare, Medicaid, etc and waited until it was a national crisis.

If we are going to advocate distrust of human beings in the insurance industry, we need to acknowledge the appropriate equal distrust of the human beings who hold elective office.

"Power corrupts.  And absolute power corrupts absolutely."

Wow, for an attorney, you know little of who does what in government.  It's not the IRS's job to keep employers honest by looking in their books.  The only reason the IRS looks in an employer's books is to make sure they paid all appropriate taxes.  Other agencies take care of things like pay, workplace sanitation, workplace safety, enforcement of the ADA, enforcement of civil rights in the workplace, enforcement of benefits, etc. Agencies that have nothing to do with the IRS.

And I say to not trust the insurance companies because insurance companies have PROVEN that they cannot be trusted to be part of delivering medical care.  The government may have proven they're not much better than the average household in managing finances (and may be worse than the average household) but they DO manage to do a better job in DELIVERING access to health care than ANY insurance company I've ever come across.  I see no reason to distrust THEM - unless they continue their pattern of blindly being beholden to the insurance companies to the point of making this INSURANCE REFORM rather than HEALTHCARE reform...because insurance doesn't guarantee access, what we need is ACCESS to appropriate care in a timely manner for ALL..

Yes, James,

And "Great men are almost always bad men." I guess the paraphrase of Lord Acton's banality reaches even here. I, for one, am willing to leave healthcare in the hands of the least and exclude all egos and self-interest.

When one is in pain or bleeding,worry about contract terms should not be relevant. Nor should reading the fine print to make sure that your purchase choice of coverage will cover all the most likely scenarios to the extent that you'll most likely need, at prices you can afford. Why should anyone gamble with their healthcare, deciding now what their best bets are for the future? Human life is messy, things happen. Why add the suffering of a missed gamble on care to the misery of injury or disease?

At least within our Constitution, we are the seat of power. To mistrust the government is to mistrust ourselves and our ability to make rational decisions. Such mistrust would leave us defenseless as even the courts have only the laws made through our rightful power to work with.

If our laws are made by an untrustworthy source deriving power from self-interested scoundrels, then you, as a lawyer, ought to be considered a persecutor of the people and an untrustworhty advocate of a corrupt power.

Corporations are not human beings. People work for them and, in doing so, pursue the coporate goal of profit, not human goals of caring and relationship. It is not human beings in the insurance industry that I mistrust, it is the non-human motivation of profit without a purpose other than profit that I mistrust.

Broad participation in a republic decreases the chances of wholesale moral and legal bankruptcy to the extent that we can defend and govern ourselves. It is better for a beating heart to trust an organization composed of ourselves and dedicated to rights and general well-being, than to trust a corporation which cannot even distinguish personalities within it's ranks but simply responds to functions performed in pursuit of profit.

I don't like HR 3200. It leaves too much in the hands of corporations and leaves insurance as primary means of access. Decisions to treat us will still be made by non-living entities. The responsibility for costs is still individual, not common. Under the bill, healthcare is still a decision, an option, a choice.

I, along with most of the civilized world, consider it a fundamental right. That we're letting this issue go by the wayside to debate over who gets paid and what gets treated is reprehensible. If we can look around at those in need of care, those in pain and suffering, and procrastinate selfishly asking "who will pay", "I don't want to pay", "how will we find the money", "what will it cost me", "who should be in control", then we have a soul-sickness, for which, there is no Earthly cure.

Let's just treat all that needs to be treated and pay what we can afford to pay. I have no qualms about taking what's needed once the money runs out. We are human lives, ends in ourselves, not means to profit.

Danetta,

Ouch!  I thought we were having a town hall? :o)

Anyway, I am saying it is not their job to keep them honest BY PROVIDING INSURANCE any more than the IRS keeps employers honest in paying taxes by being an employer itself. 

The justification for doing the government option is to provide competition that will keep prices low.  You don't need the government to compete to keep it low, you need as many entities competing as possible and allow purchasing interstate just like car insurance.

And access in fact can be addressed by federal law without a government option.  The House Bill arguably does that even if stripped of the public option.

Tim Foley has pointed out that the CBO says the cost of the public option would be at most 10% lower for insurance.  On $1,000 annually that would be $100, in the example he gave me. 

In concluding that that price difference did not act as a compulsion into the government option for poorer folks, he therefore must also conclude that the same 10% difference in private insurance should not be a bar to access to insurance.

Concerning a timely manner, every instance where government has provided the healthcare it has resulted in greater wait times.  For example, my buddy needed an MRI and ultimately surgery to his knee.  He went to the VA and had to wait 6 months for an MRI.  Needless to say I had one done within a week.

You and I have the same goals in mind, I think.  I just think that the government has more than proven it cannot be trusted.  And who regulates THEM?  Obviously noone otherwise we wouldn't be in this mess.

The government is better off regulating and enforcing, not providing.

Harold,

An enjoyable read.  You are an intelligent soul.

I think you overstate your case, but it still boils down to you and I don't like the House Bill, albeit for different reasons. 

They have not outlawed insurance contracts, nor will they.  And the government will have guidelines and limitations, make no mistake about it.

You state eloquently that: "At least within our Constitution, we are the seat of power. To mistrust the government is to mistrust ourselves and our ability to make rational decisions"

But that is what the Constitution in restricting government action (the Bill of Rights) and balancing power in three branches is all about.  the Founding Fathers knew by experience that power corrupts and that humankind needed safeguards to protect the citizenry from the unrestrained power of even our democratically elected leaders.  That is why we are also a Republic in addition to being a Democracy.

Also, corporations only pursue what the human hearts running them allow them to pursue.  The corporation is not a living entity, so the mistrust has to be in the motivation of people.

And the motivations of politicians, even if not for profit, can be for things just as aggregious.  Otherwise they would have taken care of this before it became a crisis, no?

I agree with much of what you said about the virtues of our system of government.  I am sure we both lament the surprising lack of participation of far too many.

James ~

You say: "I just think that the government has more than proven it cannot be trusted.  And who regulates THEM?  Obviously noone otherwise we wouldn't be in this mess."

Huh?  Whaaaa?  You mean we're in this mess because Govt didn't regulate?  Where'd you get that idea?   The problem is clear. Private insurance companies are beholden to their bottom lines/shareholder value/Executive salaries and Wall Street. This isn't tricky.  We don't need those attributes in our health care system, in fact, we can't afford them.  Govt doesn't have them.  Get rid of the profit motive and we can focus on health care like we should.  Leave it in private hands and they'll go on buying off officials, sticking it to us and laughing all the way to the bank.  They've gone to great lengths to prove this for decades, very successfully. 

Govt can be trusted for lots of things, we all do every day. It's silly and disengenuous to imply otherwise.  It's so easy to provide ancedotal items and then sweep the entire US Govt into the same dustpan.  Shame on you.

As to who regulates them?  We do. Every time we vote.  You need to brush up on how our system works.  It's really cool.

Dirk,

Of anyone I thought you and I were becoming friends.  What's with the derision? :(

In any event, I don't think you understand my meaning.  In terms of TRUST, if the government could be trusted then they wouldn't have been stealing from Medicare to continue spending more than they took in. 

If someone was "regulating" them and holding them accountable for the criminal failure of blancing a budget and failing to fix healthcare before it became a crisis. 

There are "must haves" in healthcare reform, such as additional tort reform for example.  A government option is totally unnecessary to spur competition when interstate competition would likely do a significantly better job in that area.

I do have a question for you though.  Tim Foley I believe said that you have to meet certain criteria under the House Bill in order to be allowed admission into the government option. If I am wrong, I am sure Timothy will correct me.

Do you know if you would even qualify?  Or would you have to take another option or face being fined every year for not having insurance?  Apparently the only way to be excluded as an individual from these requirements is if you are an illegal alien.

I think everyone here needs to answer those questions.

James ~

Sorry about the derision but I can only urge you to reread my post.  I just reread it.  I think it makes sense and I don't worry about trusting government. I do worry about some who vote -- esp. when they demonstrate a great love of people like Sarah Palin. That worries me plenty.

What's so hard about understanding that WE are the government.  We elect the officials and we can dump 'em any time we so choose.  You can't do that in many countries around the world. What's to be afraid of?  We can fix SS and Medicare any time we choose to. So far we haven't decided to.  But health care is getting sooo far over the edge we're beginning to realize that we're going to HAVE to, like it or not. Or... the whole thing comes crashing down (and it's already started, of course). 

Now to your points.  Government didn't 'steal' from Medicare.  That's cute phrasology. Elected officials decide (along with the administration) where monies will go.  In the case of SS they decided we wouldn't like what we heard if they didn't "borrow" some from the trust fund.  They were right. We wanted other programs more.  That's why Al Gore talked about a lock box for those funds.  America wasn't interested.  It seems that they're slowly getting the idea. When they finally do (this tends to happen around age 65) they can insist that those officials put it back and leave it alone or we can dump the ones that refuse. Easy as pie and we're in control. If we don't do that, then we get to suffer. It's our choice. 

I could not agree less with your example of no need for a govt option to spur competition. How in the world do you ever come up with the idea that allowing cross state border selling will create the necessary push??  To me, that makes absolutely zero sense.  They all have high admin costs and little to spur them to improve anything but their bottom lines. They don't provide health care, they try to make (more) money and satisfy Wall St. Hospitals, doctors and nurses provide health care and they HATE the insurance cos. with a passion. This has been going on for decades.  You seem to be trying to use the same tactics (with a minor variation) that have been employed for a long, long time and expect different results. We all know where that leads. The ins cos give oodles of $$ to our elected officials. They protect the cos. and we suffer.  And that's because we don't like hearing the truth during the election cycle. We fall for the false promises every time. We's met the enemy ....  you know.

As to your mention of illegal aliens. FactCheck.org was on national news tonight and put to rest the drama being spewed by many about this.  Forget the "aliens", that's not the problem.  It's another hoax just like the "death panels". As long as people like you keep 'dropping in' these little bombs, we'll never get to discussing real health insurance reform.

Criteria, schiteria.  Everyone gets health care that needs and wants it.  None of these bills are close to being final in any way.  The Senate has to check in and then they go to conference.  We have a long, long way to go to get to a bill.  And I think, at this point, we're not likely to get a bill. I think the yellers and the dramatic big mouths will prevent it with their idiotic lies, fear mongering (they're up to calling the Obama plan {which doesn't exist} China communism, nazi tactics, Russian socialism and God knows what all).  Many uninformed people hear this and fall for it instantly. Then there's the angry guy who insisted that "government keep it's hand off my Medicare".  We're going nowhere at that rate.

I find it sad that you have so little faith in our government -- the one we elected.  I suggest you do something about that and forget the insurance cos.  They are the ones you don't want to trust -- for sure.  Take AIG for example .............

My friend Dirk:

My fear is well-founded.  These folks wanted to draft and pass a bill literally within weeks or months and complained that we expected them to read and understand it. 

So I love this country and believe that we have the best government structure in the world. And the break-neck speed at which we have been spending money we don't have, while drafting a budget to spend trillions more, has made me nervous for the first time.

By the time we remove the bad ones from office the damage has been done.  So they need to slow down, take a careful look at what they are doing, get feedback from the people they represent and then act accordingly.  Once the government get's too intwined, it is very hard to reverse it.  Imagine if they tried to reverse the singl-payer system in other countries.  Not gonna happen.

Now in reply.  Call it what you want, but it waas wrong to take money given for a specific purpose.  If a non-governmental agency did that, it would be a felony.  I don't see how you can just give them a pass.  And we can only fix it if they LISTEN.  And with all due respect, it sure seems like but-for the Blue Dogs, the majority did not want to listen.

And one representative actually started talking on a cell phone while a constituent was reading a question to her at a town hall.  Rude in the very least.  Disturbing. 

You say "You seem to be trying to use the same tactics (with a minor variation) that have been employed for a long, long time and expect different results."  Not true.  I support reform and have said so ad nauseum.

You further state: "How in the world do you ever come up with the idea that allowing cross state border selling will create the necessary push??  To me, that makes absolutely zero sense.  They all have high admin costs and little to spur them to improve anything but their bottom lines. They don't provide health care...."

It is an irrefutable law of economics; because of the limitations folks living literally within a mile of one another on opposite sides of the state border pay significantly different amounts for the same coverage.  If the limitation was removed, the guy getting the raw deal could buy from the other-state carrier.  If the carrier in his state would survive, it would have to lower it's price to get business.  That is the idea behind the government option "competition."

Of course they don't provide healthcare.  They provide insurance, as will the `government.  And considering the issue of overhead and administrative costs, the CBO report says that it's projections of the balooning deficit do NOT include the government cost of the administration, nor does it take into account the impact on other government provided benefits.

You say "You seem to be trying to use the same tactics (with a minor variation) that have been employed for a long, long time and expect different results."  Quite to the contrary, I seem to be one of the very few here who is crying out to think outside the box and try to build something new that achieves our goals without copying anyone else and/or institutionalizing the same flaws in government systems elsewhere.  The folks who want to duplicate prolematic systems seem to want to "settle" and I am saying "let's be more creative."  As you say, we can always change it.

As to the illegal alien issue, if factcheck.org has more info and has debunked something, I would love to see it as I have faith in their analysis for the most part as they do not seem partisan (as do most people here who don't seem to undertsand I am not advocating a "republican" policy. But I think you may be assuming I meant something about that issue that others have stated, and I do not necessarily agree in the first instance.

You also state, "As long as people like you keep 'dropping in' these little bombs, we'll never get to discussing real health insurance reform."  First of all, I don't know what you mean by "people like me" as I think I have been respectful, open, honest, factual and logical.  I think I have been discussing it in great detail and looking at the CBO, the Bill, factcheck.org and other analysis and commenting therefrom as factually as I can.

I therefore think the didain directed at me y these folks is entirely unwarranted.  But I understand this is an emotional issue.

Again, I think the trust issue is on my side.  I will not restate my arguments but history, The Constitution, our structure of government, and the Founding Fathers seem to support my position.  And if a bunch of Sarah Palins were running the show, you might see my point more clearly.  A lot happens between elections.

I have faith in our people and our democratic republic institutions.

I awaits the folks response to my other inquiry:

"I do have a question for you though.  Tim Foley I believe said that you have to meet certain criteria under the House Bill in order to be allowed admission into the government option. If I am wrong, I am sure Timothy will correct me.

Do you know if you would even qualify?  Or would you have to take another option or face being fined every year for not having insurance?  Apparently the only way to be excluded as an individual from these requirements is if you are an illegal alien."

Respectfully,

Morning Bell: Is Obamacare Consistent With Our First Principles? Posted August 14th, 2009 at 9.42am http://blog.heritage.org/2009/08/14/morning-bell-is-obamacare-consistent-with-our-first-principles/

During one of Sen. Arlen Specter's (D-PA) early health care townhalls in Lebanon, Pennsylvania; mother of two Katy Abram told the audience: "I don't believe this is just about health care. It's not about TARP. It's not about left and right. This is about the systematic dismantling of this country. I'm only 35 years-old. I've never been interested in politics. You have awakened the sleeping giant." Abrams is dead on. Our federal government has, unfortunately, long been drifting away from the limited government principles first envisioned by our founders. But over the past eleven months, that drift has turned into an all out sprint towards an undemocratic, technocratic, leviathan state ... a type of government that our Constitution was specifically designed to prevent.

As Abram points out, both political parties have been complicit in the rapid deterioration of our founding principles. It was after all President Bush who pushed for and signed the Emergency Economic Stabilization Act of 2008 which created the Troubled Asset Relief Program (TARP). When the Bush administration submitted their legislation to Congress we warned: "From a constitutional standpoint, the current versions of the legislation are different in scope, and especially in kind, from almost any federal legislation that has come before." Specifically we identified: (1) Congress's enumerated power-or lack thereof-to intervene with private markets in the manner contemplated, (2) the lack of meaningful standards to guide the extremely broad grant of discretion to the Treasury secretary (the "legislative delegation" problem), (3) limitations on judicial review over the exercise of that almost limitless discretion, and (4) related separation of powers concerns.

The only thing that truly surprised us after the legislation's passage was just how quickly our worst fears were realized. The TARP plan, as sold to Congress, was never even implemented and, instead, it quickly devolved into a political slush fund. Because of the broad delegations of authority in the bill, the American people were left with no real avenue to check the federal government's unprecedented interference in the U.S. economy. When Members of Congress voted for the bill in October 2008, could any of them honestly say they thought they had just voted to bailout General Motors and Chrysler?

The proposed health care legislation is just as bad, if not worse, than TARP. Sec. 142 of H.R. 3200 grants the new Orwellian-titled "Health Choices Commissioner" broad lawmaking authority, including the power to: set standards for every Americans health insurance plan, determine which of your current insurance plans do or do not meet that standard, and then  punish plans that do not meet that standard. Even worse is what is not yet in the bill, but is desperately wanted by the Obama administration. A super-empowered Medicare Payment Advisory Commission that is specifically designed to "save money in an apolitical, technocratic way." The entire purpose of this part of Obamacare would be to take medical decisions away from patients and vest it in a panel of experts specifically designed to be completely unaccountable to the American people. Is this what the Framers of the Constitution had in mind?

When the Constitution was being ratified, James Madison, writing as Publius, sought to allay fears that the new national government would turn into a Leviathan. In the 45th Federalist Paper he emphasized that adoption of the Constitution would create a government of enumerated, and therefore strictly limited, powers. Madison said: "The powers delegated by the proposed Constitution to the federal government are few and defined... [and] will be exercised principally on external objects, as war, peace, negotiation, and foreign commerce...." Federal tax collectors, Madison assured everyone, "will be principally on the seacoast, and not very numerous." Exactly six months after publication of this essay, New York became the 11th state to ratify the Constitution. Is turning over one-sixth of our nation's economy over to Obama's super-MedPAC panel in any way consistent with this vision?

Interesting. I wrote many blogs ago that I was concerned about this panel of experts. Particulary, with regard to the panel's make-up. It was one other thing I disliked about HR 3200.

But my concern is not the extent that government can and should fill the role and manage a better care system. Rather, it is solely the manner in which they propose to do it. I found the bill vague and broad powers invested too narrowly. I don't believe in "drug czars" and the like. I even believe that committees and aides do too much for Congress - that bills should be simpler and not have unrelated riders attached. That the issue of health care reform should be taken in stages, the most important of which, in my opinion, is universal access.

Among our founders, perhaps only Hamilton could have found a justification for Social Security or Medicare. I would have more respect for the more "conservative" arguments if they took on Reagan's tone from the 1965 discussion and applied such originalism and freedom rhetoric to Medicare and Social Security. But that's a grey-haried giant that is more mightily feared than the workers supporting the programs.

Neither program has been stunningly managed and are both certainly beyond the scope envisioned by our founders. At best, they promote the General Welfare. I have no problem with that but, from Betsy McCaughey to Sens. Grassley and DeMint, the "right" has mobilized a campaign, including TV ads, aimed at gathering support from the recipients of these programs against HR 3200 from an anti-socialist POV.

News clips show these single-payer, social welfare recipients mobilized against health care reform and the public option to keep the government out of their programs as if they'd worked their whole lives for the value of what they receive.

I want Mr. Grassley, Mr. DeMint, and Ms. Abram to hold a town hall meeting in front of retirees, including her children's grandparents and elderly neighbors and get originalist and free market on them concerning their benefits. Tell them the truth - you're benefitting from socialism and denying it to your children. Then ask -do you still want to collect? or would you rather die free?

That's the option they're giving us. I want every voting American to receive the same option before making a decision on what Congress should be doing.

James:  Hi there.  Long time no talk.  But you've pushed me over the edge (again) so I can't resist.

It's all well and good to go bashing government for all it's ills (real and percieved).  But what about all the families and people directly hit between the proverbial eyes by having no health coverage?  I know you think it will all be solved by either shrinking government so small you can step on it and squash it like a bug or by letting free enterprise follow it's own nose.  But that ain't gonna help those who have had (and will have) to declare bankruptcy over medical bills (because they're honest and actually PAY them), or the ones denied coverage and left to die (yep. there's plenty of them out there, but they have a problem in trying to speak for themselves).  And ad nauseam. 

Nice of you to sit up on your lofty throne and dictate to us what we need. But there's one small problem with that ... we already know what we need without your proclamations.  We need single-payer universal coveage. We've known this for a loooong time and nothing these posts have had to say has changed anything.  We are very aware of the motivation of private health insurance companies (and it ain't health care) and we've recently seen what happens when we leave mighty corporations to their own devices (they go right for our wallets just as quick as they can. For a good example -- look at what credit card companies are doing right now, quickly, before the September law kicks in. It's shameful).

I can see nothing that private administration of health care rationing ("rationing", that's what we have now and always will, since everybody getting everything ain't never gonna happen), nothing they can do that government can't do better.  Period.

We tried your way for the last 30 years or so and it simply gets worse every year.  So now may I suggest that you quit trying to protect the theives and just give us a chance at a system we think will work as well (at least a lot better than the existing one, that's a given).

Nice of you guys to point out that a chunk of the uninsured are aliens, but you sure do short change the ones who aren't, in the process.  They are dying, homeless, hurting and Americans.  You might try to face the prospect that you are arguing for your interpretation of the Constitution, and catatrophizing the future if we don't toe your line, whilst many don't care about you.  They just want coverage and a chance at a healthy life. 

Your putting words and ideas in the mouths of our founding fathers is a bit arrogant if you ask me. They were alive then -- not now. They didn't have to deal with a boatload of facts that we do.  I rahter think they would be smarter than to not be flexible to the times.  Remember they were all mostly in favor of slavery and many actually HAD slaves but my reading of the Constitution and Bill of Rights talks to me of "ALL MEN (and women? eh?)" BEING EQUAL".  Shame on them for being hypocritical.

What's so bloody wrong about giving us a shot at a system we think will work and work well? We can adjust it as we go along -- we always do.  It's our turn now.  You had yours and you blew it.

Harold:

You say:"But my concern is not the extent that government can and should fill the role and manage a better care system. Rather, it is solely the manner in which they propose to do it.

That's fine. Glad to hear you're not bashing government's ability to function well (at times). We can all worry about how it will come out.  How would you do it?

Hi Dirk,

Sorry to have offended you with my opinion, especially since we have been pretty respectful of one another.  I actually agree with almost everything Harold has said in the first several paragraphs.  I also think the challenge he proposes to the members of Congress is exactly what the Town Hall should handle.

Now, if you go to Tim's latest postings and the three articles he links to, you will see that I have always been advocating for a discussion based upon as much facts as we can agree on.  I was practically ecstatic to see something that was laying out a real picture of both systems, the good and the bad, as a basis for true discussion.

Instead, I have actually been accused of being a right wing nut, paid to infiltrate the site because I listed a series of 5 or 6 questions and directed people to the CBO reports to read the answers.

And for trying to engage people in specific answers to specific questions, and directing people to the CBO, I have frustratingly been accused of not being interested in the "truth" to then be lectured and insulted by people talking about how much they hate private insurance companies.

We all have our convictions and opinions.  I am surprised at how frequently people just want to label people and create false pictures of villains to avoid answering questions. 

So ALL town hall protestors are paid right-wing nuts; the insurance companies have all politicians in their back pockets so the polls don't matter; everyone has been duped by lies so the polls should be ignored; we have allegedly tried every private sector option, so now the government is the only option ("shut up an get out of the way"); I supposedly am AGAINST reform; I supposedly HATE the government; I am "protecting thieves", sitting on my "throne"; I am a "dictator"; I don't care if people die in the streets.

I actually feel sorry for politicians now as that is their daily food. 

I actually think Harolds suggestion, which I stated in a different post, of dealing with the issues separately is the best way.  I already said in another post, that we could get everyone who allegedly is uninsured (even assuming the 47 million number which I believe is an unexamined exaggeration which has been a part of an earlier post) we could get that done almost immediately.

Given the numbers we are talking in trillions, it would cost just 235 billion (or maybe half that) to fully insure every uninsured person by just paying for it. 

The legislature could separately pass a law like is already contemplated mandating coverage of pre-existing conditions and perhaps subsidize that further to offset if necessary the burden on carriers, etc. and still mandate that the coverage stays with you at the same cost until you have found a new job or policy.

And the carriers could be audited for best practices as is already contemplated.

We have never had competition across state lines which would likely significantly reduce prices with a flood of new competition.

And more.

But if nothing short of the government allegedly rationing care rather than insurance companies with government oversight and regulation allegedly rationing is going to please some Americans, so be it. Just as some want even less regulation than we have now.

I think I have been pretty straight forward and honest as an independent, albeit conservative.  I have voted for a Democrat before by the way.

But it seems a true discussion is unlikely.  Too bad.

James,

Thanks for the replly. 

You say:"But it seems a true discussion is unlikely.  Too bad."

Here's partially why.  We got people like Sarah Palin making up slanderous and derailing comments.  We have Rush Limbaugh who admittedly simply wants to pour gas on the fire (best way to increase his ratings and make even more money.) And we have you, admittedly not a fair comparison to Sarah and Rush, but with some pretty spacey ideas. 

I worked for private insurance companines (3 of them, but never health insurance) for about 15 years (in IS/IT).  I got a good taste of how they work.  It isn't pretty.  They aren't exactly outright crooks, but they come mighty close.  I sat in plenty of senior officer meetings where they continually said words to the effect "this is off the record" ... things like red-lining or how to bend the rules or cheat.  They want good, clean, safe risks and the rest be damned. Cause they're in it for the money. Nothing else.  If they could find an easier way to make more money they wouldn't miss a heartbeat moving to it and leave us in the lurch.

So you got this (sorry but I believe this) STUPID idea that by expanding their territory they get to lower rates.  It just doesn't pass the straight face test, not even close.  Man, if you're sucker enough to believe that, I got a neat planet I'd like to sell you .... dirt cheap. 

And you might go on to explain HOW this would improve healthcare. You think that you and I would get better results from the care. ??  And raise our current rating above Bermuda! The only thing you offer is that it will cut rates (boy, oh boy would the insurance companies like to have YOU in their ads.)  James, hear me.  They never cut rates ever -- unless the state government forces them to, which, by the way state govt does all the time. Or not allow their requests to raise rates as much as they want. Without that state government regulation you'd be looking at another sub-prime crisis, in health ins this time.

You complain that others ignore your questions or points.  Here's my complaint about you.  You don't tell how you know that the rates will come down if it becomes fed regulation instead of state. We nationalized the banks regulation and just "how many" state (type) banks have failed this year?  And where's all that FDIC money coming from to save the depositers? You think that's saving taxpayers money? You complain mightly about Fed regulation but in this case it's different. How, exactly? 

And here's the last thing.  What we left-wing crackpots want is single-payer universal health care controlled but not delivered by the federal govt. and delivered as a right, just like justice or civil rights.  That is EXACTLY what we have in Medicare. Medicare works. Say what you will but it works. I know it's going broke but we can fix that with a simple dope-slap to Congress.  And if they didn't protect the drug companies profits (I drive to Canada to fill my wife's expensive prescriptions -- it's not that far away and they treat us well, too. You see a way to save a fraction of a trillion dollars there? Look closely.). I digress.  KEEPING WHAT DOESNT WORK but expanding it across state lines is folly. Complete folly.  People are worried that the system that is failing them will go away.  What in the name of God is wrong with that????????????????   The private health insurance companies are killing us, slowly but surely.  I say it's time for some of their own medicine. And I say you show me clear evidence that if they continue in the mix anything will be different.  I maintain you can't do it. Which is why I feel the way I do.  Sorry, old boy -- you need a lot better arguments to get your nose under this tent.

James, One other thing. Yeah, yeah. I've voted for Republicans.  But so what?  It's not about political parties (or at least I SURE HOPE NOT).  It's about good solid health care for all Americans.  No forcing bankruptcies.  No going homeless.  No being left to die when the private health care company decides you're not worth it or cost them too much (we might refer to this as 'death panels', no?).  No "previous conditions".  No super salaries for CEO's and other senior officers.  No shareholder value.  Just H-E-A-L-T-H  C-A-R-E.  Is that too much to ask of, for and by our people? I think not. It's long, long overdue.

Dirk,

I have really tried to give you respect and dialogue.  I have asked to look at the same documents like the CBO and the bill to have a discussion about what we do know.  I applauded Tim's most recent offering as a basis for further discussion.

But you obviously aren't in a position to do that. You only constantly offer your ridiculous conclusory diatribe as to what passes your famous "straight face test" with nothing to back it up but angry rants.   

Looks like the only thing we can agree on is your self-description as a left-wing crackpot.  Which I now, sadly, have come to believe is an understatement.

Post what you will.  I am no longer wasting time on you. 

Oh yeah, one last thing.  Though you are not interested in facts that get in the way of your conclusions, you should probably read the following (as well as Timothy's latest posts about Canada) before you move to Canada.  It's a mystery to me why you haven't moved there.  That is my final word to you, old boy.

Overhauling health-care system tops agenda at annual meeting of Canada's doctors

By Jennifer Graham (CP) - 2 days ago

SASKATOON - The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it.

Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country - who will gather in Saskatoon on Sunday for their annual meeting - recognize that changes must be made.

"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.

"We know that there must be change," she said. "We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands."

The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet, the current president of the CMA, who has said there's a critical need to make Canada's health-care system patient-centred. He will present details from his fact-finding trip to Europe in January, where he met with health groups in England, Denmark, Belgium, Netherlands and France.

His thoughts on the issue are already clear. Ouellet has been saying since his return that "a health-care revolution has passed us by," that it's possible to make wait lists disappear while maintaining universal coverage and "that competition should be welcomed, not feared."

In other words, Ouellet believes there could be a role for private health-care delivery within the public system.

He has also said the Canadian system could be restructured to focus on patients if hospitals and other health-care institutions received funding based on the patients they treat, instead of an annual, lump-sum budget. This "activity-based funding" would be an incentive to provide more efficient care, he has said.

Doig says she doesn't know what a proposed "blueprint" toward patient-centred care might look like when the meeting wraps up Wednesday. She'd like to emerge with clear directions about where the association should focus efforts to direct change over the next few years. She also wants to see short-term, medium-term and long-term goals laid out.

"A short-term achievable goal would be to accelerate the process of getting electronic medical records into physicians' offices," she said. "That's one I think ought to be a priority and ought to be achievable."

A long-term goal would be getting health systems "talking to each other," so information can be quickly shared to help patients.

Doig, who has had a full-time family practice in Saskatoon for 30 years, acknowledges that when physicians have talked about changing the health-care system in the past, they've been accused of wanting an American-style structure. She insists that's not the case.

"It's not about choosing between an American system or a Canadian system," said Doig. "The whole thing is about looking at what other people do."

"That's called looking at the evidence, looking at how care is delivered and how care is paid for all around us (and) then saying 'Well, OK, that's good information. How do we make all of that work in the Canadian context? What do the Canadian people want?' "

Doig says there are some "very good things" about Canada's health-care system, but she points out that many people have stories about times when things didn't go well for them or their family.

"(Canadians) have to understand that the system that we have right now - if it keeps on going without change - is not sustainable," said Doig.

"They have to look at the evidence that's being presented and will be presented at (the meeting) and realize what Canada's doctors are trying to tell you, that you can get better care than what you're getting and we all have to participate in the discussion around how do we do that and of course how do we pay for it."

James:

You say: " what passes your famous "straight face test" with nothing to back it up but angry rants."

Nice. I offer plenty to back it up, but you simply dismiss it.  Reminds me of Sarah's technique.

As to your "post what you will" .....ditto.  I find your posts a waste of time to respond to also.  At least we can agree on ONE thing.   

God willing we won't get these useless private insurance companies in more places (states)!!

OK, I'll bite. One last (probably wasted) post.

I've thot often (esp. in the last 8 years) of moving to Canada.  There's much to like up there (beyond health care) but their not too anxious to have us and you can't blame them. Can you imagine what they think when they hear someone like Sarah mouth off about "death panels"?  They must think we're a bunch of goofy misfits.

In any case.... (oooooo, nice SLAM on the "facts and conclusions" -- thot you had put yourself above this sort of thing. Oh well.) I read the Canada stuff you included.  I have first hand experience with the Canada system (fact).  I never maintained that it's perfect or even close. But it sure beats the hell out of our system. Waiting and wanting the perfect system is ... well, a loooong wait. Very long. Probably measured in centuries. Probably long after climate change has caught up with us and passed us by.  So let's not even attempt to go down THAT road.  Both systems have there problems (fact).  But I suspect you can't even imagine what it's like NOT to have to worry about IF you'll get health care (and that feeling goes to every single Canadian and it's terrific!!). It's amazing. No bills (fact), no payments (fact).  No rejections for not having insurance (fact). All treated the same (fact).  Can you spell Bankruptcy? --how many in Canada? Answer: Zero (fact). Can you spell homeless?  Can you even imagine how much our senior officers of these 'private' companies make ... in just bonuses?   It's non-sensical, it's obsecene (fact).  And the list goes on.   Canada may have problems but they don't have THOSE problems.  And they beat us cold on "effectiveness of care" (fact).  Their drug costs are much less than ours (fact). They wait in line (sometimes and we wait in line (sometimes) (fact)  We lose. Bigtime. And we spend 50% more than they do (fact).

It would be mighty interesting to see what happens to you if a dear loved one to you got caught in a "no-insurance" situation and needed very expensive care.  You might change your mind in a heartbeat.  It hurts beyond belief to get caught in our system and be on the wrong side. Just stop and think for a moment.  Tomorrow you feel tired and listliss.  You call the Dr.  Blood tests show you have advanced leukemia.  Just think about how you'd feel.  Stop here for a moment and "feel" it.  Really FEEL it!!  Scared? You bet. Worried. Of course.  Now picture yourself, having been laid off a month earlier and you had to choose between food & shelter or insurance. We all know what we'd do.  But now, what do you do.? You wouldn't even be thinking about it in Canada (fact).

My brother lays in Northwestern Medical Center at this very moment with leukemia (fact).   It's costing a big fortune.  A very big fortune (he's in a single room -- has to, he has no immune system -- with positive pressure to keep bugs and infection out (fact) .  He needs a bone marrow (or stem cell) transplant.  You wanna speculate on what this will all cost?   For him? GET THIS:  Nothing! (fact). He has medicare (it's a lot like the Canada health care sysem, if you were wondering).  He doesn't worry; at least not about the money.  But if he had contracted this a few years ago ..... well, he didn't have insurance.  I can guess just how many feet underground he'd be right now.  Leukemia patients like him are turned away in our nation all the time -- have to.  It's too expensive, the private companies could never make enuf to keep Wall Street from hanging them.

Give me Canada any day.  But esp. these days. May you never have to personally discover what I'm talking about.  But you might (fact).  Because tomorrow could change your life in a flash and you could be without health care (fact) not just coverage but plain old health care.  But not if you lived in Canada (fact).

The Canada report you sent says: "Doig says there are some "very good things" about Canada's health-care system, but she points out that many people have stories about times when things didn't go well for them or their family."   ... and her point is?????  Every big system in the world has it's failures (fact).  And will continue to, no matter what (fact).  The question here is, are large segments of our society being dumped on the trashheap because they can't afford insurance or have the cash for care.  Answer: YES (fact)   Is this samew thing going on in Canada.  Answer: NO (fact).  They are a wee bit smarter than us.  Good for them. Shame on us.

Bye.

I read that Canada piece the other day. What I liked about it was that the DOCTORS were empowered to come up with solutions and they investigated several mixed, highly-regulated models.

Our Congress, the medical establishment, and many on this blog are looking inward, operating from the standpoint that we have the best. Canada's system is routinely villified and deified.

A little humility and openness to the many nations and systems devoted to providing health care a s a right would go a long way.

Whats interesting is I live in an area of a major major company that has employed many from Canada...and become friends with their wives who live in my neighborhood..and they have nothing but good positive things to say about their health system back home...and are amazed at what the company pays for theirs here in the states as part of their package deals...They cannot even begin to understand how any family working for less that 5 figures could even begin to pay for it for thier families.  Your last line is very profound...A little humility and openness to the many nations and systems devoted to providing health care a s a right would go a long way.

great post...sadly the ones who should be reading it and some of the other posts are not reading it..their out there wearing their "guns" to promote their rights for freedom..........??????????

Debi,

I would think you would want to know the answers to many of these questions and more BEFORE taking a position and demonizing anyone who is not excited about a government option.  I'm just sayin'.......

1) As far as I know, the CBO has not evaluated HR676 or the proposed alternatives. That's a flaw in our system. All the options should be assessed by some independent agency.

2) The political opposition to Medicare was Ronald Reagan, Barry Goldwater, Ayn Rand & Co. - enough said. The insurers are still alive and kicking, bided their time and worked with recent presidents and congresses to get a slice of  the pie through Medicare Advantage.

As President Obama has stated, it must not add to the deficit.  We simply cannot afford a bad, poorly thought out plan like the House Bill.  I am anxious to read the other proposals when they are drafted.

If they weren't constantly raiding the coffers of Medicare to spend the money elsewhere, (remeber when Al Gore promised to put it in a "locked box" while campaigning?) maybe Medicare would not be so "broken."  Or is that just "broke?"

We can provide affordable healthcare without excluding pre-existing conditions for everyone if we work together with government regulation, and without a "government option".

James,

Would you abolish all socialized healthcare programs, including Medicare, Medicaid, and VA staff and facilities?

Harold,

No I would not given the place they have in our society.  BUT if they failed to provide quality care and needed to ration care in order to balance their budget, I would be looking for significant changes.  And if their is another option that is better, like the not-for-profit non-governmental entities providing care as is being explored in the Senate, then I would consider a change.

I think there is a much bigger dialogue that needs to take place beyond whether we support a government option or not.  It is sad that it has degenerated to that point, but politics usually does that --- choose either A or B because no other options are offered.

What makes one person entitled to socialized care and another not? Are there any objective or just criteria? Given that the current workforce funds these programs, it would seem a wise investment to keep those taxpayers healthy.

Can you provide an example of a non-profit entity, not created by or subsidized by the government, which is capable of providing universal, unrationed, full-choice healthcare including dental and pharmaceutical care? If one does not exist, how would you propose to found such an institution and how long will it take to make it work? What would be the basis of its long-term financial stability and how could it leverage pricing if it were simply one among many possibilities? Who would fund the start-up? Would it be beholden to the interests with the start-up capital?

Harold,

These are AWESOME questions and should be fully vetted and researched.  That is a part of what I think Congress should be doing. And this is what Town halls should be discussing and comparing alongside all other plans and evaluating the merits.

So, I don't know those answers.  But the people we pay to research and draft legislation should be looking into it!  I hope they do!

How would you treat people who develop cancer or are otherwise made ill by factors not of their choosing or who have congenital disorders? How would you rapidly adjudicate responsibility?

Where do you draw the line at which business rules you would regulate and legislate and which you would allow to continue under free-market rules? Why should illness bear either penalty or profit? Isn't the misfortune penalty enough?

Monied interests keep the subsidies flowing to agribusiness and polluters. Together, monied interests, their leaders having swallowed Rand and rational market swill for the better part of 50 years, have worked to undermine our governmental authority to the point where many, like you, have simply surrendered the republic as something that does not derive its power from the governed. It isn't government that you should fear, it is unbridled profit and financial interests which aim to replace us as the source of power.

The health insurers have had decades to control costs by going after causes of ill health. Service providers, likewise, have had the same opportunity. They have not because the interest of business is profit and non-competing  businesses do not interfere with the profit of other businesses.

As to your not wanting to pay for the costs of someone else's decision, let me pose this to you:

A man is in a car accident and severely injured. The party at fault is a drunk driver with no insurance who dies in the accident. There is no means of recovering costs from the at fault party. The injured man cannot cover the medical costs. Should the injured man be denied any treatment for his inability to pay? If yes, why? If no, who should pay?

Oh, but if only it were as simple as being PURELY personal responsibility.  Surely even YOU are aware that a person can eat nothing but low fat, organic, whatever along with all the appropriate exercise habits and STILL die of a heart attack.  Or that they can, as Harold mentioned get run over by a drunk driver (or someone too busy chatting on their damned cell phone to realize they've got all 4 wheels on the sidewalk) only to find out that their medical bills aren't adequately covered by that individual's insurance or that the individual wasn't even insured. 

Or how does someone like me figure out who's to blame for my migraines? What about my seizure disorder?  Ok, admittedly the seizure disorder MAY have something to do with any of the many toxins easily found in the Salinas Valley area, but WHICH toxin and even if you or I can figure out WHICH toxin how on earth do we figure out who was responsible for the bit of that toxin that caused my neurological problems?  I'm so nearsighted I can barely see the end of my nose, but that's just genetics.  Do I sue all my surviving older relatives for passing along bad genes?  Do I do the same for my "idiopathic" gastroparesis or do I hope to pin the blame on the toxins of the Salinas Valley where I was born and raised?  My diabetes almost certainly traces to my ancestors since I eat well and exercise and always have - but come in part from a tiny ethnic group that gets type 2 diabetes at a rate of 2 out of 3 when eating even a healthy variant of the "modern american diet".  Do I get to sue them too? And who's to blame for my low back problems?  They trace to a mix of orthopedic problems that are congenital but many of them were known to my parents and left untreated.  I didn't even know about them until my doctors started telling me about them and my Mom started saying, so that WAS a big deal?

Do you get where your idea leads?  It isn't purely "personal".  It's SOCIETAL responsibility. Food needs to be pure, food needs to be available, people need to take advantage of healthy food once it IS made available, but even doing so won't guarantee health so health CARE still needs to be AVAILABLE.  Anything less and we still have what we have now - people suing other people in HOPES of getting money to pay for health care and people who die or become disabled unnecessarily due to lack of timely access to appropriate health care.

What if eating right, exercising and reducing toxins eliminated 50+% of the health care needs in this country.

Would that not be a step in fixing the problem as opposed to treating a symptom.  

My friends High cholesterol probably can be attributed to his ancestors, being Northern European.  He saw Doctors for years trying to treat the problem getting different drugs.  None worked, finally the doctor put him on a highly concentrated fish oil pill.  This fixed his problem as it increased his omega 3 intake. 

Unfortunately, what worked for him because of his heritage, might not work for someone else.  

By the way my ideas lead to a limited government protecting peoples rights to private property.  The government allowing others to pollute without penalty causes health issues, makes coal power cheaper than it should be and transfers wealth from one class of people to another.  Mainly that transfer of wealth ends up in the grain silo owners hands, Cargil mainly. 

Yep there are people with Autism, Spinobifida(sp?) that need help and I do so.  What caused their problems though, probably toxins.  

Work on these problems first and I will support some way of helping all with health care.  That is as long as there is some way to encourage good behavior.  

Yep that person that consistently uses up their deductible should be helped.  Maybe a lifetime deductible (that gets paid back a portion of the rebate check that an individual would receive for maintaining good health).  

However, if we do not look at the root of the problem, our costs are going to rise through the roof and the US will end up a third world nation, if we are not already there based upon the fact our debt is exploding and that other countries are looking for other currencies to be the reserve currency of the world.  Which if happens then our standard of consumption is going to crash and we will likely have to hyperinflate the dollar.  Which is probable if we are to get all the local, state and federal government agencies out of debt.

But good nutrition will NOT manage to ALWAYS prevent disease nor will it ALWAYS manage to REVERSE disease.  Quit presenting false information.  If what you're saying worked, my Grandmother's people could eat at least the healthy version of the "modern american diet" and not get diabetes at a rate of 2 out of 3.  Go bark up a tree where people are willing to believe your snake oil always works.  Sure, it IMPROVES ODDS and it does work SOMETIMES - it's just NOT the PERFECT CURE you're trying to pretend that it IS. Thus, this whole idea of "personal responsibility" via diet is a red herring.

Why do you fear private enterprise?  The fear you should hold is of a privately controlled banking system, as that has been shown throughout history to be a major problem and concentrator of wealth.

Why do you fear private enterprise?  The fear you should hold is of a privately controlled banking system, as that has been shown throughout history to be a major problem and concentrator of wealth.

John:  Not sure who you were directing your question to --- but I'll take a shot at it.

You asked: "Why do you fear private enterprise"

Simple!  I worked in it for almost 40 years (mostly insurance & banking as an IS/IT guy) and they are definitely to be feared.  Let me put it this way: I think the most obscene phrase in our language is; "Bottom Line and Shareholder Value".  This is because the money thing gets in front of the clients, the employees, the product, everything except Wall Street.  And too many companies I worked for did just that.  It was sickening.  Every quarter it was a mad scramble to figure out how to squeeze a bit more into this quarter's results (at the expense of next quarter).  A few companies out there are smarter -- they know that if they take good care of their employees and build a better mousetrap the rest will follow.  It's obvious. Except most companies don't get it.  Especially private health care insurers.  Health care is not their business.  Wall Street is.  Just like the banks endlessly trying to figure out one more way to make fee income from their depositers, the health insurance companies spend their time trying to figure out how to NOT pay claims.  We know of cases where claims employees are rewarded for figuring out how to avoid paying.  Anything goes.

So..... THAT's WHY.

John:  Slow down, eh?  I KNOW that govt is trying to protect my food -- you'd know that if they weren't!!  Bigtime.  A LOT went wrong under the hands of the last adminstration. They spent 8 years mucking it up. It's going to take awhile to get up back on track. Be patient.

You say: " If you think that the government is trying to protect food safety then look to the USDAs actions in forbidding Creekstone Farms from testing all of their beef cattle for Mad Cow disease."    John, John, John ... anectdotal evidence is not going to get us anywhere. Let's get this straight:  Govt ain't perfect. But it is (thankfully) of the people, for the people and BY the people.  They are only there by our grace, period.  And we can dump 'em any time we want. It's the nice thing about our government that isn't so much in evidence elsewhere in this world.

Now ..... no need to fear that which work for us. And they are not "totally inept", not even close. I can show you some governments that ARE and you'd start thanking your lucky stars for this one (if not, start packing! You're gonna luv 'em).  That's not to say we don't need to be diligent and fix things when they're wrong.  And right now, Private Health Insurance is WRONG.  Dead wrong. And we ain't gonna fix it without government.  Not possible (or you'll need to explain to me how that's so).

John:  Oh for pities sake.  Are you going "Palin" on us?  You say: "Their is a profit motive in the government also as that profit goes to pay wages and pensions, which I do not have, I only have the benefit on my hard work to provide for my retirement (which I will probably work through) as the Social Security system and other government unfunded liabilities of nearly 70 trillion will not allow me to receive any benefits."

Sorry you chose to work for a "private" company that doesn't pay benefits. Why'd you do that?  I chose to work for ones that did pay benefits. And I worked hard too. Damn hard.  I did not work for govt. Anyway,  government does NOT work for profit.  Never did, never will.  Yes, people who work for our governments get paid (go figure!) but that has nothing to do with "profit" as you call it. It a bit premature for you to be declaring the SS system as bankrupt, no?  Most know that we can fix it in a flash if we just get the urge ... and with all those retirees coming at us like a freight train, the urge is going to be massive.  You paid in for a lot of years and you deserve recompense.  You fight for it with your elected reps and you'll get it. Amazing how this works, eh?  It's one of the very nice things about our form of government.

Now about all those little guys working their tails off in our government .... you're going to have some fighting mad people in them, ready to straighten you out about "hard work".  Slandering them isn't nice.  And many of them have done you some good favors you might do well to thank them for. You can start with the Centers for Disease Control -- you may well be alive thanks to the many people there working to keep you alive. And you can thank the ones over at the FCC for keeping your airwaves in sane condition (try that in some third world countries).  And then there's the Bureau of Statistics without which you'd be amazed at what life could be like around here. And how about the National Institutes of Heath? And then ..... oh well, you get the idea. I could go on for hours.  No, John, our governments (city, state, federal) do a pretty good job.  Always room for improvement and you should work towards that, but never forget what you have.  Be thankful that government is not like CitiBank or AIG or Leahman Bros. or Wells Fargo or Long Term Capital Management or Mr. Maddof! (or PRIVATE HEALTH INSURANCE COS!!) ..... the list is very, very long.  And be thankful you didn't work for any of them either!

John:  What a sad post.  You do exactly what all the dramatic soothsayers do: Pick some cute anecdotal evidence (one for each US Government Agency) and then mould that into a "convincing" (at least it convinces YOU) proof of how Govt is dangerous and useless. Yup. You've gone "Palin" on us, for sure.

But the really sad thing is how idiotic your anecdotal evidence is.  To wit, and I quote you here: "The EPA's lack of any penalty for harmful emissions contributing to our health woes...."

John? Are you kidding!!??  How about this... Diesel-engine manufacturer Caterpillar Inc. paid $128 million during federal fiscal 2003 in penalties on its heavy-duty, on-highway "bridge" engines that had exhaust emissions exceeding government standards,...

That is one quick example .... there are hundreds and more likely thousands of examples of EPA fines for violating emissions standards, done to protect the public.  Where in the name of common sense, do you get these goofy ideas????????   It's just like Palin's "death panels", no basis in reality.  Just quick, made up, dramatic, junk ideas.  

Cash for Clunkers?  Same thing.  OF COURSE it's robbing Peter to pay Paul -- THAT'S THE WHOLE IDEA!   We're trying to get the economy moving NOW while it's slow.  And, get this, .... IT'S WORKING!  Auto manufacturers are calling people back to work and building cars.  Tricky, eh?  AND, we're getting some "harmful emissions vechiles off the street so that they won't be contributing to your health woes.  It's a two-fer.  Sometimes referred to as a win-win.  Think a bit, will you?  Please? 

I'm going to quit responding to your posts as it's clearly a waste of time (makes me the dumb one, doesn't it).   Do everyone a favor -- write your post and then before you send it, reread it and try to find some fault with it -- for instance you could have Googled: EPA emissions penalty fines .... or something similar and instantly found out that your edict was so full of holes it wouldn't hold a Caterpillar truck.  This way you could appear a bit more intelligent.   Believe me, Palin doesn't need any help!!!

So Dick, the government standard is set to high.  Any pollution causes harm and should be penalized as diesel exhaust causes asthma.  As such it is taking the private property right of good health from another without penalty.

Cash for clunkers, hmm... some cars would have been traded in anyway.  So what is the marginal reaction of that spending.  The 4500 rebate to all, might actually have cost 12000 per additional vehicle sold.

Boy you're sure reading a ton of things out of my posts.  Who said I'd never heard of that theory? I sure didn't.  Of course figuring WHICH set of ancestors to eat like might be a problem in my case, though I do try to eat as much like the one whose people's metabolic issues I most closely match - not that it's easy to do (or affordable) in a grocery store.

What I'm debating and have debated all along is the second paragraph.  That nutritional treatment worked for your friend's cancer proves nothing beyond that it worked for your friend.  Same with the example of having other friends use nutrition to treat skin disorders and cholesterol problems. You've established solely that there are these lone examples in YOUR experience that they work.  How about SCIENTIFIC PROOF?  What you'll most likely find is that, like medication, sometimes they work and sometimes they don't.  Which is why I'm arguing that your argument needs to be toned down about personal responsibility - because personal responsibility at best can lower risk, not totally prevent it.

Danetta what an excellent point you made here; 

“What you'll most likely find is that, like medication, sometimes they work and sometimes they don't.” – This problem is also one of the few problems’ interacting with other problems (within healthcare) which has no solution.  The one I mentioned here before does; 

The VA Medical Faculties is government health care which the government NEVER has enough money to properly fund for just the 8 million veterans/patients presently using it.  What would occur with universal government run healthcare?  Civilian doctors would be mandated by government management because of low government funding too medicate the majority of  millions of people’s symptoms’ instead of costly, prolonged, or unproven treatments.

For decades our government has done a very good job of saving taxpayers’ money with inadequate Veterans Affairs funding.

President Obama recently made excellent leadership appointments to Veterans Affairs. Even with their proven leadership abilities, and impeccable credentials, both Secretary Eric Shinseki and Deputy Secretary W. Scott Gould are facing the cumulative inadequacies of decades past. The tiny fuse of overmedication that has kept this whole VA system operational for 30-some years now desperately needs to be replaced with major re-wiring.

This young generation of veterans should not have to experience the palliative treatment of health care most veterans using the VA have experienced for decades. It would be great to see the VA step into the 21st century as the leader in world-class health care.

But after decades of under-funding, this proposed new VA budget is not enough. For our new leadership to achieve its full potential along with world-class VA health care, a one-time, additional funding of $20 billion for a ‘21st century investment in VA healthcare’ is desperately needed.

The VA has many good doctors working there who will feel much relief to actually have the opportunity to treat their patients instead of just medicating their symptoms.

FOR THE RECORD:  Use Airline liability as a model when reforming medical liability.  Right from the start, even before the start you will find those who have the power to stop healthcare reform.  What we will hear the loudest is how something is not humane or compassionate enough [the newest one being used is your “racist”], another example of why to keep all religion, along with lobbyist’s & unions out of government business.  Watch all the very bipartisan attorneys, corporate money, our politician’s in Washington dictate at home in your state which health insurance companies are presently contracted in your state right now.  House and Senate member’s are regularly handed thousands upon thousands of dollars in donations (bribe money) both when in Washington and at home in their your state.  When a bill is up for vote a “no vote” is the easier one to obtain assurance on.  As I have been saying you can not properly reform healthcare to be even remotely cost effective without first fixing, repairing the very foundation.

John,

I support CSAs. I have endorsed raw milk (still illegal in my state). I buy local eggs. I have even invested in organically raised beef and pork by buying shares in the livestock. I oppose the infrastructure and subsidies supporting unsustainable agribusiness and I have a healthy diet. My chloesterol is low, my kidney and liver function fine. I enjoy good wine with a meal, buy organic beer, hike, fish, camp.

I still have asthma, am still very nearsighted, have terrible allergies to mold, ragweed, and cats, have a bad knee from an injury while I had no insurance many years back, have two kids and a lovely wife who need care for various conditions.

On a previous post, you cite toxins as a possible cause of autism. I would agree. However, waiting for toxins to be cleaned up before treating the symptoms for this or any other disease makes no sense from wither a moral or practical angle. It is cruel to tolerate suffering and I do not believe you are cruel.

My neighbors are, to say the least, more to the conventional right-wing of the spectrum and would dismiss you as an environmental crackpot in the same wave as they would dismiss me as a socialist. From their perspective, that their personal food choices and other consumption choices are polluting my air and water, harming us all in the long-run. They support "family" farms but never go to one - you know the type.

Convinced that their personal choices affect only themselves (and even if they don't, we've no right to tread on their "pursuit of happiness"), they are immune to logic and cannot fathom that our health is tied to one another and demands that we take personal responsibility not simply for our own well-being but to avoid undercutting someone else's. The only acquiescence seems to be the milk/egg/wheat/soy/nut-free school buses and classrooms (I still don't know what the kids are supposed to eat in common areas.)

I suspect such "individualists" are making up much of the anti-reform faction. But, in speaking with someone like you, I think we have some common ground against the reform killers and willfully blind.

Could you not accept that if healthcare is first made a common concern through a single-payer, that we would be forcing the environment and nutrition to become a common concern and not simply a matter of individual choice?

Something has to give and the alleviation of symptoms, of suffering, is an immediate need of common concern. Healing ourselves and the environment over the long haul because more realizable, apart from governmental regualtion and control, if there is an impact on our wallets.

You see I am a libertarian at this point.  Forcing the environment can be done by protecting private property rights, to clean air and water.  Proper nutrition would come with the elimination of grain subsidies which are not constitutional.

Asthma is linked to diesel emissions.

Without movement towards ending the insanity that our government is serving up, (animal tracking, Not allowing individuals to test for Mad Cow disease if they want, proposing to classify my farm as a food processing facility making it very difficult for me to comply with regulations and probably unable to sell direct to consumers in the future.

The government today, still is of the corporation and needs to be restrained.  Heck Salon, a lib publication, just had a good article on how the libs are simply rubber stamping everything.  

Obama's Healthcare Horror
by Camille Paglia

http://www.salon.com/opinion/paglia/2009…

Asthma is also linked to the second-hand smoke I grew up with. No matter what you do now, I lived with heavy smokers for 18 years. I'm better than ever and only need limited maintenace medication. There is healing over time but I don't expect 100%.

But my point is simply that we cannot wait for the causes to be eliminated. There is an immediate need for treatment. What you're suggesting would be like closing down fire departments until we rid ourselves of flammable construction.

First things first, treat the sick and injured, all of them, out of human compassion. If we're all commonly concerned with the causes and costs of poor health, we can govern and legislate the necessary protections. You have to invest up front for the long-term returns.

First, if you do not remove the causes, then the problems will persist, health care costs will continue to skyrocket and our government will be forced into insolvency.  

You see, the investment up front in my proposed change is nothing.  It is simply a matter of getting the government out of programs it should not have been involved in.  While at the same time having them enact impact fees on activities which have a negative impact on the general public.

First remove the root causes of the problem and then work at treating those issues that were caused by it.

As far as treating the sick all of them, how much do you spend on an elderly person, how far do you go in treatment before just letting hospice come in.  Obama's chief of staffs brother who is speaking in favor of reform, stated that some rationing would need to occur to keep the system solvent.

So how do we treat all the sick and with every possible means.  There are limited resources on this planet and we have been lulled into a false sense of prosperity by the Dollar and its reserve currency of the world status.  Facilitating other governments manipulating their currencies to extract our manufacturing sector.

Since the infrastructural reforms you seek are not even considered essential by 90% of the voting population, your approach of fixing causes first is death to the reform movement.

No one is ready to tax or remove diesel vehicles from the roads, shut down the coal mines, cap the oil wells, stop flying, stop driving, stop working - basically bring our lives to a halt in order to stop polluting. We'd all be staring at each other waiting for the next move.

The changeover to cleaner energy takes an expenditure of current fossil fuel resources. Toxins still persist in the materials used for low-consumption devices. Separating farmers from modern methods takes and investment in education on both the production and consumption sides. Clean water and air will happen over time after pollutant sources are cut - we're talking generations.

I'm behind you in the need for these changes but there isn't even a public forum convened to seriously deal with these issues and we have other immediate needs. Beyond that, disease pre-dates the industrial era and the treatment of many of these diseases - TB, polio, leprosy, parasites, rheumatoid arthritis, typhoid, cholera - derive from the ability to mass produce antiseptic agents, inoculations, and medications. Something as simple as the widespread production and use of soap has helped. So has the development of sewer and septic systems.

Broken bones, cataracts, and birth defects are recorded by the ancients. These are no needs exclusive to the industrial age.

Unless we isolate ourselves, the inevitable contact among people makes the health of all a major concern.

Would it be fair to say that your stance is that we are engaged in the wrong dialog and that universal care is not the issue. Rather, it is universally greater health and the making of medical care a less-needed commodity that ought to be the issue. That, unless this issue is made part of an even more ambitious and greater movement toward personal responsibility, the continued suffering, death, and economic privations should continue as motivating factors toward the evolution of such a society and infrastructure regardless of how long it takes.

The thing is that if you phase in impact fees on those activities which harm the public interest, those old technologies either invest in equipment to clean up their act or go out of business.  While at the same time clean technologies take their place.

You see the most fundamental change that needs to occur is nutrition.  Which studies have shown lifestyle changes reduce the cost of health care by 2/3.  Yep there are those instances which can not be addressed by nutrition alone.  However a large part can.  The system can change yes it will take time, but phasing out grain subsidies will move it in that direction quickly.  people act with their pocketbooks more so than any other deciding factor.  So removing grain subsidies from the equation makes factory farming uneconomical.  Which will cause a return to pastoral farming methods with layered crops and crop rotation.

Use some of those funds to help rebuild and  remineralize soils.  Rebuild the local infrastructure which made a local food economy viable and then get out.  

Cash for clunkers, so we invested in a depreciating asset, which produces no/little income during its life.  It only consumes capital, which in the beginning came from sunlight.  Why not demand real change in this country and return it to a time with corner groceries as transportation costs go up with environmental impact fees.  People work in ag and local communities are more vibrant.

Take my potatoes, I am growing a pound per linear foot this year, of fingerlings.  The rows are 3 foot wide, I sell the potatoes for $2/ pound.  This yields $.60/square foot.  Which on an acre (42,000 sq ft) does not provide for a poor wage.  

It seems that the educrats have convinced us that farming is not profitable.  Except for the seed potato and rototiller the half acre is test plot is going to provide a nice income this year.   Next year I will try and go after a larger yield/acre not need to charge as much for my organic potatoes. As opposed to Cash for Clunkers, invest in a more historic and sustainable society.  One in which production and distribution systems are in the hands of small business owners, who have a vested interest in their business' success or failure.  The current, government/banker induced, system has people playing with other peoples money.  Where they have no real concept of what hard work is.  They are making money on peoples retirement incomes or by getting people to commit the future earning potential for some product.

Used to not be this way, but we have been brainwashed into thinking we need everything now, and a big house where 30 years ago a 1200 sq foot home was a medium sized house and 50 years ago, a family would live in a 600 sq foot house as they did not want to go into debt.  Now we are a debtor nation and still want more.

When you rob peter to pay paul, you can always count of pauls support.

John,

I understand what you're saying in terms of gratification it is true for most Americans, I work in energy management and efficiency and have pored over the studies.

It doesn't change the fact that you are trying to replace the healthcare discussion with an environmental and infrastructural debate that is, admittedly, realted to the probelm but which is denied as relevant by at least one major party and significant elements of another.

I don't see that we can wait for you to drum up support before treating the symptoms. For all your concern for humanity, you're overlooking the immediate needs of many people. I applaud your fight, have participated myself in many greening efforts. Should I stick to those and let this one drop? No way.

Harold, I am sticking to the fight of keeping the government from intervening in every aspect of my life.  

Animal Tracking that will serve very little purpose except to line the pockets of tracking software/hardware mfgs.  

There has been no change except in the deification of the President, who goes around hosting town hall meetings to push his agenda without listening to the other side.  I am not advocating any greening of the world.  What I am advocating is that manufacturing costs be internalized within this country.  

Why is it so hard to not realize that the larger issue here is actually in promoting good health.

Even if you want universal health care, you need to find a way to get people to be responsible for their actions.  Universal health care will allow people to continue the path of doing whatever they choose.  Well that is until the government decides that what they are doing need to be restricted or made illegal to keep health costs down.

Why not use the consumer mentality in this country to work for restraining costs.  Make the individual feel the pain of going to a doctor, so they do not run in every time they have a runny nose.

I am not talking about the very sick, I am talking about the majority who health care works for, except the rising costs, who do not pay their insurance bill, their hospital bill, etc..  Those people need to think about what they are doing.  

NPR had a good story on this very issue yesterday or this morning.  That we need to involve the consumer in restraining the skyrocketing costs.

On the nutrition front, this can be done by getting rid of the subsidies which make row cropping the least expensive production model, unless you factor in the hidden costs of pollution, environmental degredation, etc..

Why not fight for a change in consumer behavior, the individual on the radio stated that lifestyle changes would reduce medical expenses by 50+% and would lead to problematic problems to get better.

Here is a 2007 article from a Canadian which also references other countries.  It is very enlightening:

Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux-a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body-and Aucoin went to a clinic to begin treatment. But if Erbitux offered hope, Aucoin's insurance didn't: she received one inscrutable form letter after another, rejecting her claim for reimbursement. Yet another example of the callous hand of managed care, depriving someone of needed medical help, right? Guess again. Erbitux is standard treatment, covered by insurance companies-in the United States. Aucoin lives in Ontario, Canada.

When Aucoin appealed to an official ombudsman, the Ontario government claimed that her treatment was unproven and that she had gone to an unaccredited clinic. But the FDA in the U.S. had approved Erbitux, and her clinic was a cancer center affiliated with a prominent Catholic hospital in Buffalo. This January, the ombudsman ruled in Aucoin's favor, awarding her the cost of treatment. She represents a dramatic new trend in Canadian health-care advocacy: finding the treatment you need in another country, and then fighting Canadian bureaucrats (and often suing) to get them to pick up the tab.

But if Canadians are looking to the United States for the care they need, Americans, ironically, are increasingly looking north for a viable health-care model. There's no question that American health care, a mixture of private insurance and public programs, is a mess. Over the last five years, health-insurance premiums have more than doubled, leaving firms like General Motors on the brink of bankruptcy. Expensive health care has also hit workers in the pocketbook: it's one of the reasons that median family income fell between 2000 and 2005 (despite a rise in overall labor costs). Health spending has surged past 16 percent of GDP. The number of uninsured Americans has risen, and even the insured seem dissatisfied. So it's not surprising that some Americans think that solving the nation's health-care woes may require adopting a Canadian-style single-payer system, in which the government finances and provides the care. Canadians, the seductive single-payer tune goes, not only spend less on health care; their health outcomes are better, too-life expectancy is longer, infant mortality lower.

Thus, Paul Krugman in the New York Times: "Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes." Politicians like Hillary Clinton are on board; Michael Moore's new documentary Sicko celebrates the virtues of Canada's socialized health care; the National Coalition on Health Care, which includes big businesses like AT&T, recently endorsed a scheme to centralize major health decisions to a government committee; and big unions are questioning the tenets of employer-sponsored health insurance. Some are tempted. Not me.

I was once a believer in socialized medicine. I don't want to overstate my case: growing up in Canada, I didn't spend much time contemplating the nuances of health economics. I wanted to get into medical school-my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.

My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic-with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

I decided to write about what I saw. By day, I attended classes and visited patients; at night, I worked on a book. Unfortunately, statistics on Canadian health care's weaknesses were hard to come by, and even finding people willing to criticize the system was difficult, such was the emotional support that it then enjoyed. One family friend, diagnosed with cancer, was told to wait for potentially lifesaving chemotherapy. I called to see if I could write about his plight. Worried about repercussions, he asked me to change his name. A bit later, he asked if I could change his sex in the story, and maybe his town. Finally, he asked if I could change the illness, too.

My book's thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada's population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment-patients who suffered and, in some cases, died from the delays. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system. To capture Canadian health care's growing crisis, I called my book Code Blue, the term used when a patient's heart stops and hospital staff must leap into action to save him. Though I had a hard time finding a Canadian publisher, the book eventually came out in 1999 from a small imprint; it struck a nerve, going through five printings.

Nor were the problems I identified unique to Canada-they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled-48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August 2003 heat wave-when many doctors were on vacation and hospitals were stretched beyond capacity-15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren't available. And so on.

But single-payer systems-confronting dirty hospitals, long waiting lists, and substandard treatment-are starting to crack. Today my book wouldn't seem so provocative to Canadians, whose views on public health care are much less rosy than they were even a few years ago. Canadian newspapers are now filled with stories of people frustrated by long delays for care:

   vow broken on cancer wait times: most hospitals across canada fail to meet ottawa's four-week guideline for radiation
   patients wait as p.e.t. scans used in animal experiments
   back patients waiting years for treatment: study
   the doctor is . . . out

As if a taboo had lifted, government statistics on the health-care system's problems are suddenly available. In fact, government researchers have provided the best data on the doctor shortage, noting, for example, that more than 1.5 million Ontarians (or 12 percent of that province's population) can't find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who'd get a doctor's appointment.

Dr. Jacques Chaoulli is at the center of this changing health-care scene. Standing at about five and a half feet and soft-spoken, he doesn't seem imposing. But this accidental revolutionary has turned Canadian health care on its head. In the 1990s, recognizing the growing crisis of socialized care, Chaoulli organized a private Quebec practice-patients called him, he made house calls, and then he directly billed his patients. The local health board cried foul and began fining him. The legal status of private practice in Canada remained murky, but billing patients, rather than the government, was certainly illegal, and so was private insurance.

Chaoulli gave up his private practice but not the fight for private medicine. Trying to draw attention to Canada's need for an alternative to government care, he began a hunger strike but quit after a month, famished but not famous. He wrote a couple of books on the topic, which sold dismally. He then came up with the idea of challenging the government in court. Because the lawyers whom he consulted dismissed the idea, he decided to make the legal case himself and enrolled in law school. He flunked out after a term. Undeterred, he found a sponsor for his legal fight (his father-in-law, who lives in Japan) and a patient to represent. Chaoulli went to court and lost. He appealed and lost again. He appealed all the way to the Supreme Court. And there-amazingly-he won.

Chaoulli was representing George Zeliotis, an elderly Montrealer forced to wait almost a year for a hip replacement. Zeliotis was in agony and taking high doses of opiates. Chaoulli maintained that the patient should have the right to pay for private health insurance and get treatment sooner. He based his argument on the Canadian equivalent of the Bill of Rights, as well as on the equivalent Quebec charter. The court hedged on the national question, but a majority agreed that Quebec's charter did implicitly recognize such a right.

It's hard to overstate the shock of the ruling. It caught the government completely off guard-officials had considered Chaoulli's case so weak that they hadn't bothered to prepare briefing notes for the prime minister in the event of his victory. The ruling wasn't just shocking, moreover; it was potentially monumental, opening the way to more private medicine in Quebec. Though the prohibition against private insurance holds in the rest of the country for now, at least two people outside Quebec, armed with Chaoulli's case as precedent, are taking their demand for private insurance to court.

Rick Baker helps people, and sometimes even saves lives. He describes a man who had a seizure and received a diagnosis of epilepsy. Dissatisfied with the opinion-he had no family history of epilepsy, but he did have constant headaches and nausea, which aren't usually seen in the disorder-the man requested an MRI. The government told him that the wait would be four and a half months. So he went to Baker, who arranged to have the MRI done within 24 hours-and who, after the test discovered a brain tumor, arranged surgery within a few weeks.

Baker isn't a neurosurgeon or even a doctor. He's a medical broker, one member of a private sector that is rushing in to address the inadequacies of Canada's government care. Canadians pay him to set up surgical procedures, diagnostic tests, and specialist consultations, privately and quickly. "I don't have a medical background. I just have some common sense," he explains. "I don't need to be a doctor for what I do. I'm just expediting care."

He tells me stories of other people whom his British Columbia-based company, Timely Medical Alternatives, has helped-people like the elderly woman who needed vascular surgery for a major artery in her abdomen and was promised prompt care by one of the most senior bureaucrats in the government, who never called back. "Her doctor told her she's going to die," Baker remembers. So Timely got her surgery in a couple of days, in Washington State. Then there was the eight-year-old badly in need of a procedure to help correct her deafness. After watching her surgery get bumped three times, her parents called Timely. She's now back at school, her hearing partly restored. "The father said, ‘Mr. Baker, my wife and I are in agreement that your star shines the brightest in our heaven,' " Baker recalls. "I told that story to a government official. He shrugged. He couldn't fucking care less."

Not everyone has kind words for Baker. A woman from a union-sponsored health coalition, writing in a local paper, denounced him for "profiting from people's misery." When I bring up the comment, he snaps: "I'm profiting from relieving misery." Some of the services that Baker brokers almost certainly contravene Canadian law, but governments are loath to stop him. "What I am doing could be construed as civil disobedience," he says. "There comes a time when people need to lead the government."

Baker isn't alone: other private-sector health options are blossoming across Canada, and the government is increasingly turning a blind eye to them, too, despite their often uncertain legal status. Private clinics are opening at a rate of about one a week. Companies like MedCan now offer "corporate medicals" that include an array of diagnostic tests and a referral to Johns Hopkins, if necessary. Insurance firms sell critical-illness insurance, giving policyholders a lump-sum payment in the event of a major diagnosis; since such policyholders could, in theory, spend the money on anything they wanted, medical or not, the system doesn't count as health insurance and is therefore legal. Testifying to the changing nature of Canadian health care, Baker observes that securing prompt care used to mean a trip south. These days, he says, he's able to get 80 percent of his clients care in Canada, via the private sector.

Another sign of transformation: Canadian doctors, long silent on the health-care system's problems, are starting to speak up. Last August, they voted Brian Day president of their national association. A former socialist who counts Fidel Castro as a personal acquaintance, Day has nevertheless become perhaps the most vocal critic of Canadian public health care, having opened his own private surgery center as a remedy for long waiting lists and then challenged the government to shut him down. "This is a country in which dogs can get a hip replacement in under a week," he fumed to the New York Times, "and in which humans can wait two to three years."

And now even Canadian governments are looking to the private sector to shrink the waiting lists. Day's clinic, for instance, handles workers'-compensation cases for employees of both public and private corporations. In British Columbia, private clinics perform roughly 80 percent of government-funded diagnostic testing. In Ontario, where fealty to socialized medicine has always been strong, the government recently hired a private firm to staff a rural hospital's emergency room.

This privatizing trend is reaching Europe, too. Britain's government-run health care dates back to the 1940s. Yet the Labour Party-which originally created the National Health Service and used to bristle at the suggestion of private medicine, dismissing it as "Americanization"-now openly favors privatization. Sir William Wells, a senior British health official, recently said: "The big trouble with a state monopoly is that it builds in massive inefficiencies and inward-looking culture." Last year, the private sector provided about 5 percent of Britain's nonemergency procedures; Labour aims to triple that percentage by 2008. The Labour government also works to voucherize certain surgeries, offering patients a choice of four providers, at least one private. And in a recent move, the government will contract out some primary care services, perhaps to American firms such as UnitedHealth Group and Kaiser Permanente.

Sweden's government, after the completion of the latest round of privatizations, will be contracting out some 80 percent of Stockholm's primary care and 40 percent of its total health services, including one of the city's largest hospitals. Since the fall of Communism, Slovakia has looked to liberalize its state-run system, introducing co-payments and privatizations. And modest market reforms have begun in Germany: increasing co-pays, enhancing insurance competition, and turning state enterprises over to the private sector (within a decade, only a minority of German hospitals will remain under state control). It's important to note that change in these countries is slow and gradual-market reforms remain controversial. But if the United States was once the exception for viewing a vibrant private sector in health care as essential, it is so no longer.

Yet even as Stockholm and Saskatoon are percolating with the ideas of Adam Smith, a growing number of prominent Americans are arguing that socialized health care still provides better results for less money. "Americans tend to believe that we have the best health care system in the world," writes Krugman in the New York Times. "But it isn't true. We spend far more per person on health care . . . yet rank near the bottom among industrial countries in indicators from life expectancy to infant mortality."

One often hears variations on Krugman's argument-that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use, and cultural values. It pains me as a doctor to say this, but health care is just one factor in health. Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall, or a car accident. Such factors aren't academic-homicide rates in the United States are much higher than in other countries (eight times higher than in France, for instance). In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don't die in car crashes or homicides outlive people in any other Western country.

And if we measure a health-care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50 percent; the European rate is just 35 percent. Esophageal carcinoma: 12 percent in the United States, 6 percent in Europe. The survival rate for prostate cancer is 81.2 percent here, yet 61.7 percent in France and down to 44.3 percent in England-a striking variation.

Like many critics of American health care, though, Krugman argues that the costs are just too high: "In 2002 . . . the United States spent $5,267 on health care for each man, woman, and child." Health-care spending in Canada and Britain, he notes, is a small fraction of that. Again, the picture isn't quite as clear as he suggests; because the U.S. is so much wealthier than other countries, it isn't unreasonable for it to spend more on health care. Take America's high spending on research and development. M. D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.

That said, American health care is expensive. And Americans aren't always getting a good deal. In the coming years, with health expenses spiraling up, it will be easy for some-like the zealous legislators in California-to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like-minded politicians could take off the shelf, dust off, and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.

But such initiatives would push the United States further down the path to a government-run system and make things much, much worse. True, government bureaucrats would be able to cut costs-but only by shrinking access to health care, as in Canada, and engendering a Canadian-style nightmare of overflowing emergency rooms and yearlong waits for treatment. America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home-in the other four-fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.

http://www.city-journal.org/html/17_3_canadian_healthcare.html

Check this out:

http://www.dailymail.co.uk/news/article-1205953/NHS-branded-evil-Orwellian-high-level-US-politicians.html

Consider that the "facts" we receive are too often filtered by interested parties. It might make be interesting to seek out sources, with nothing to gain, looking in on our debate. Let them tell us about what they have instead of letting the wonks and corporations tell us.

Excellent post robin...the older I get the more I realize we have allowed our America to become a Capalistic society which dose not allow any form of socialism ( so to speak ) but most definetly dose NOT follow the constitution for "We the People" and it is my belief that until this society gets off the greed wagon that comes with egos and free enterpize that supports Capitalism, we will not achieve a healthy society that has the same concern for his neighbor as he dose for the rest of the world.  I find it appalling the hate is still alive and well and will continue to be so until we address our EDUCATION system, and stop allowing hollywood and the media to run our way of life. War is alive and well, injustice is alive and well...Alcoholism is alive and well, Child abuse is alive and well, and Pornogropy is a live and well - just to name a few "Freedoms" we do allow in our country...Mrs. Clintons recent trip to Africa was given little if any attention in the media...other than the fact that a statement was made regarding her husband....like that is really important...

I worked and voted for Ralph Nader, twice - '96 & '00. I realize you and he disagree on health care - he supports single-payer.

However, I was moved by the people I met to support CSAs and I've been a raw milk advocate because I want to support local agriculture. I believe that the market can be opened as it shrinks and becomes more local. Right now, this would take a massive change of American heart and conscience to go beyond my own decisions.

The article you sight clearly states that self-regulation doesn't work. I thought it was your position that self-regulation based on your market success is the only solution.

If we eschew public regulation and get the government out of it all, these agri-giants will overrun the biodynamic operations, anyway, and harm many Americans' health.

I would rather see stiff regulation on the giants to keep their refuse and GMO pollens out of my food chain and water supply. I like the size-based regulatory thresholds and would like to see the parties at risk, the small operations, be the panel making the decisions or, at least, the primary advisors on policy.

This is why I'm uncomfortable with the medical panel in HR 3200 - it is not composed of the parties at risk.

There is a great blog devoted to these issues on change.org.

As I said maybe there is room to compromise.  That being there needs to be some sort of accountability for peoples lifestyle choices.  Without legislating that you can not smoke, drink, eat meat, consume fat, etc..  As I do not believe any human has the ability to comprehend the ramifications of their actions.  Thus an annual deductible, with a lifetime deductible, probably a limit as you could keep someone on life support forever costing a small fortune putting any system at risk.

I have never said anything about self regulation, I have stated that I have a fear of the government coming in and dictating to me what I should grow and where.  This would go to health care also, and the government with its self righteousness might decide something is harming the health of the population and as such should be made illegal.

I believe there needs to be some regulation.  As I said with the EPA there should be an impact fee on pollution to protect the private property rights of individuals.  With food, there should be some form of inspection, the states do a pretty darn good job today, for the most part. 

Actually these agri-giants would be out of business tomorrow if we got the government out of subsidizing grain.  

Throw in the federal reserve which is a private corporation which has fixed interest rates at artificially low levels concentrating wealth in the hands of those who access that "created" wealth first.  The government rules and regulations that created tax havens to carry debt on a home "as home ownership is good for the community", guaranteed by the government.  To invest for retirement in Stocks and Bonds, as opposed to paying down debt.

The individual who has posted to the thread who demonizes capitalism as being not what the founding fathers envisioned is delusional.  Capitalism is the process in which sees and opportunity and capitalizes on it.  

For example me seeing a weed problem on my farm, realizing there is a problem and getting goats to get rid of the weeds.

The regulation of GMO's and pollen drift should be a huge issue and should be regulated.  As I have ZERO desire for there tainted pollen to effect my crops and reduce my potential marketplace.  But that is also part of the private property debate as protected by our constitution.

BY the way, the EPA should be funded entirely by a tax on pollutants.  The USDA really serves little purpose and today causes a transfer of wealth from the poor and middle class to the wealthy.  The department of energy, could be funded by EPA impact fees to help develop alternatives to the polluting models we have today.  The department of education really does little in my opinion that could not be accomplished better by open sourcing discussions on education on the internet.  

Unemployment funding, my favorite, currently is paid for by taxing employers on the employees they have as opposed to taxing the causes of unemployment (technology and energy).  

Heck, if you wanted to put people back to work, rebuild the local food system that existed 50 years ago.  With root cellars, pay people to work the fields pulling weeds and harvesting crops.  I could make $10000 an acre wholesale on my potato crop at conventional prices not organic.  This is me doing the work by hand, yes it is work but maybe as opposed to getting fat and needing more health care services people would once again be healthy.

Chew on that, why not treat the PROBLEM NOT THE SYMPTOM!

Thanks Robin.  Fair question.  I have said that I am in favor of options that deal with the issue of corporate profits at the expense of medically appropriate and necessary care.  I have not dogmatically said I don't want to see a Bill that purports to do that.

And I have said repeatedly that I was responding to another post with a commentary on the definition of a Constitutional right.  I have said, however, that it is really irrellevant and a red herring; if the American people consider it a moral imperative then laws can be passed mandating it. 

There are literally thousands of such laws on the books that are not, by definition, unconstitutional despite creating a legal duty to act, or refrain from acting, under certain circumstances.

Here is the approach that I believe facilitates true discussion, which I hope is not just wishful thinking due to the political realities and partisanship mentality: 

1.  The Congress drafts Bills based upon various models and options balancing the wants, needs and concerns of the American people.  Hopefully they are doing that now.

2.  Each Bill is scored by the CBO.

3.  We all read the CBO's analysis of every option.

4.  Any ideas or plans not scored by the CBO, we look to see if we can find a non-partisan analysis of the plan(s) not so scored.

4.  Based upon CBO analysis, and/or that of the non-partisan group(s), we review and discuss which Bill(s) best meet the goals of:  a.  expanding access to healthcare, b.  reducing waste and unnecessary costs, c. not adding to the deficit, d. improving the quality of care while e. leaving the decision-making as much between the doctor and patient as possible and f.  without unfairly impacting the most vulnerable of citizens.

Right now, we have primarily been duscussing only the House Bill which the CBO concludes does not meet all of these objectives.  Further, it does not fulfill some other specific promises made.  It also raises valid concerns which, presumably, will be the case with all options.

Anyway, with whatever options this Congress offers us, that will be my approach.  I just hope the politics do not end up removing options that should be scored by the CBO from the table.   In all honesty, I believe politics will rob us of some valid options.

And I think this can be done more effectively if targeted to specific problems in stages, but we seem to be moving in a direction of one big overhaul.

Perhaps I hope for too much from Congress and partisans.  We'll see.

Related to the above, some folks may be interested in this side-by-side comparison of the various plans offered to date.  It's a lot of reading but not as much as the plans themselves (which is still better.)  You can list all options or build a chart based on the areas that concern or interest you most.

http://www.kff.org/healthreform/sidebyside.cfm

I agree.