Feb 23, 2010
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Well, here we are, after almost an entire year of exhaustive bickering, negotiating, "back-door" dealing, whatever you want to call it... it seems the grand finale is near, and according to Newsweek, "if Republicans don't play ball, Democrats will go ahead regardless" and pass the Health Care Reform bill.

Seems like when President Obama unveiled his reform plan today, the idea of "Reconciliation" was in mind... my guess? Not much will be accomplished in this public summit, and the House will pass the Senate bill, and through budgetary reconciliation, the Senate Bill will become modified to the liking of the Democrats. With President Obama with the upperhand as moderator, and given his incredible skill to tackle tough questions, I think it'll be a political victory for him. But I don't think he cares about that, he wants this bill to pass once and for all to stop insurance outrages.

Republicans will obviously not give an inch, despite the fact that a lot of their ideas are in the bill already (but I understand their stance against it - the majority of their ideas ISN'T, ...but then again they're the minority so they shouldn't be complaining). The summit might bring in tort reform into the bill, if it's shown to save sufficient money.

A few things I'm finding interesting about the entire ordeal. A lot of the public seem to be opposed to the bill, Newsweek saying 49% against to 40% in favor. However, and this is a big however, it seems that when they actually understand what's in the bill, the polls show a different story: 48% in favor to 43% opposed. I honestly believe that a decent bit of the opposition is not due to the bill itself, but rather angst towards the bickering and arguments going on for a year on this overhaul... that much discord can turn the whole picture sour despite what the topic at hand was to begin with. I assume this since the majority approved (and it seems will again once they all understand what's in the bill) when this entire episode began last year.

What are your thoughts on what'll happen? And where do you fall in as future doctors on favoring or opposing this measure? Last I heard, the AMA is in support, as was another large medical association... the name of which eludes me right now :confused:, something to do with seniors :p.

One of the most unpopular aspects of the bill is the mandate, requiring everyone to get coverage. Now, there are about 46 million Americans without coverage, but in a nation with some 300 million people, this mandate shouldn't really bother THAT many people... and of these 46 million, many of them WANT health insurance but can't due to pre-existing conditions, accessibility, affordibility, etc. I don't love the idea of the mandate, but there really isn't any other way around it. Once we let EVERYONE get insurance (no pre-existing conditions guard), then only the sick'll get insurance and premiums will balloon up bad... so everyone'll have to get it. It's a huge step towards preventative care - something I'm personally a big supporter of, and I don't think anyone isn't really.
 
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TooMuchResearch

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There are no health care reform bills or plans to reform health care. There are plans to create a moderate overhaul of the insurance system and nothing more.

Edit: And I support this moderate overhaul (though I wish they would have done a much better job) and actual health care reform.
 
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Oh yeah, you're right. I guess what I mean in "Health Care Reform" is not the CARE that's being reformed, but the accessibility and affordibility.
 

JaggerPlate

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Hmmm it was my understanding that there was a new revised 'white house bill' with no public option, tweaked abortion language, and a lot of the BS (like the Nebraska 300 mil medicare thing) taken out. Obama is going to bring this plan to the summit, and he encourages the GOP to bring their own plan. I hadn't heard anything of him trying to pass the Senate plan through the House. Pelosi said last month she didn't have the support in the House. Can you post your source???
 

JaggerPlate

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If he passes the Senate bill and medicare reimbursement still gets cut by 21% in March ... we should all seriously take a step back and re-analyze this situation.
 
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Obama is going to bring this plan to the summit, and he encourages the GOP to bring their own plan. I hadn't heard anything of him trying to pass the Senate plan through the House. Pelosi said last month she didn't have the support in the House. Can you post your source???
The Senate plan through the House is just speculation on my part as to what will ultimately happen. I've been following this debate for the better part of last year and this, and I just don't see there being any real changes in the way the two parties will handle this... public summit or not - so after Thursday, I'm assuming the Senate bill will have to be passed through the House and reconciliation will be used to bridge the differences.

Honestly, I think the real GOAL of the summit will not be to reach Republicans, but rather energize the moderate Democrats in the House to vote for the bill. This is BY FAR a much easier goal to reach.

Anyone know why the House Democrats won't pass the Senate bill (even if they're promised reconciliation by Senate Democrats to fix what they don't like in the Senate bill)?
 

JaggerPlate

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The Senate plan through the House is just speculation on my part as to what will ultimately happen. I've been following this debate for the better part of last year and this, and I just don't see there being any real changes in the way the two parties will handle this... public summit or not - so after Thursday, I'm assuming the Senate bill will have to be passed through the House and reconciliation will be used to bridge the differences.

Honestly, I think the real GOAL of the summit will not be to reach Republicans, but rather energize the moderate Democrats in the House to vote for the bill. This is BY FAR a much easier goal to reach.

Anyone know why the House Democrats won't pass the Senate bill (even if they're promised reconciliation by Senate Democrats to fix what they don't like in the Senate bill)?
Dude if this is all speculation ... wow. Hahah.

Anyway ... the House won't pass the Senate Bill. I'm really confident about that. They won't do it because the House passed a bill with a public option and different language regarding federal money and abortions. People who voted for these provisions will not support a bill without them. However, the REAL reason why House demos won't pass the Senate bill is because after Brown took the Kennedy seat, they all saw their reelection bursting into flames. Many people look at Brown's election as the public's attitude towards this bill (Mass is very liberal and also has a lot of independents, 60+% of independents voted conservative and part of Brown's platform was 'being the man who would stop Obamacare.'), and I don't believe a lot of dems are going to commit political suicide for Obama. Especially when he is pretty unpopular and campaigned for Coakley (and she lost). FURTHERMORE, Pelosi said she didn't have the votes to pass the Senate Bill in the House, and at one point, Obama said he didn't want to use reconciliation. So unless you know something I don't know, my guess is that it will go like this ...

They will both go to the summit, no progress will be made, the GOP will reject anything he puts forward, Obama will say the GOP's ideas don't save enough money, etc, nothing will get passed, and he will revamp the focus back to jobs and pass small, popular items through the House for moral boosters.
 
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Clyburn, the House Majority Whip, said today he believes the House will have enough votes. The way I look at the moderate Democrats is... if they DON'T pass the bill, it'll show the country they cannot lead. It's catch-22 for them: pass something that isn't exactly what they want (a loss) or not pass anything at all (a bigger loss). In addition, in a conference call recently, Pelosi clarified a key point, saying the Senate must pass a reconciliation fix to its bill before the House passes it. If they pass the fix, then the House'll pass the Senate Bill... and everyone's talking about reconciliation now.

I've read articles saying the White House plan was framed with the idea of reconciliation in mind by Obama, so I think he's open to using it now. Newsweek:
White House officials emphasized to reporters that "the president believes people deserve an up-or-down vote" on health-care reform, so they've structured their plan with the "flexibility" to achieve passage should Republicans take the "extraordinary step" of filibustering. When asked, officials said that meeting the procedural requirements to pass their fixes through the budget-reconciliation process, which circumvents the filibuster and only requires 51 votes, "was certainly a factor" in their thinking.
Also, I think a major popular talking point Obama'll bring up is expanding government to limit outrageous insurance hikes (like Anthum in California and like 6 others in various other states). It's big government, GOP won't like it, but I think it's something the American people will.

I don't know man, a lot of things are still up in the air, and the House Democrats hold all the cards now. Obama will not quit no matter what to get the uninsured insured it seems. He even ended it in his State of the Union address: "We don't quit. I don't quit." I have a feeling he was referring to particularly Health Care Reform in that finishing line.
 
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JaggerPlate

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Clyburn, the House Majority Whip, said today he believes the House will have enough votes. The way I look at the moderate Democrats is... if they DON'T pass the bill, it'll show the country they cannot lead. It's catch-22 for them: pass something that isn't exactly what they want (a loss) or not pass anything at all (a bigger loss). In addition, in a conference call recently, Pelosi clarified a key point, saying the Senate must pass a reconciliation fix to its bill before the House passes it. If they pass the fix, then the House'll pass the Senate Bill... and everyone's talking about reconciliation now.

I've read articles saying the White House plan was framed with the idea of reconciliation in mind by Obama, so I think he's open to using it now. Newsweek:


Also, I think a major popular talking point Obama'll bring up is expanding government to limit outrageous insurance hikes (like Anthum in California and like 6 others in various other states). It's big government, GOP won't like it, but I think it's something the American people will.

I don't know man, a lot of things are still up in the air, and the House Democrats hold all the cards now. Obama will not quit no matter what to get the uninsured insured it seems. He even ended it in his State of the Union address: "We don't quit. I don't quit." I have a feeling he was referring to particularly Health Care Reform in that finishing line.
Expansion of government is such a bad, bad thing. Especially with regards to Healthcare. I really hope Obama doesn't just muscle this thing through. I'm not one of those people who is just anti the bill, but not aware of what it entails ... I'm pretty familiar (familiar enough) with the House, Senate, and I've read a litttle bit about the WH one now, and I still think it's a really, really bad idea. Furthermore saying passing it is a 'bigger loss than nothing at all' is thinking from a different pov. In my opinion, congress, Obama, GOP, etc, no one really gives a **** about getting the uninsured covered, or fighting big insurance, maybe in the beginning they did, but not now. No, it's now just one side with a vendetta and the other one completely refusing to even SNIFF anything he pushes forward. It's dumb. Really dumb. The biggest loss to these people in the congress is losing their seat ... not American's getting healthcare. In that respect, pushing through a bill that most Americans still oppose (last time I checked Rasmussen at least), is 'losing.' Furthermore if Pelosi is squawking that you need reconciliation AND the House passing the Senate bill for this thing to happen ... I smell problems. I know Obama portrays himself as the defender and he won't quit, etc, but I just don't see this move playing out right now. It's political suicide ... it really is.

Also, I'm not kidding that if government expands with regards to health care and medicare gets a 21% cut ... we should all think long and hard about going 200k into debt.
 
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I don't get it though, and I'd be happy to know what other solutions there are. I'm really looking forward to seeing what the Republicans put forward this Thursday. I'm not a cynic, hoping whatever they put forth crashes and burns, I legitimately want to know how they'll lower premiums and get the 46 million uninsured Americans to get coverage. All I hear is the Democrats this and Democrats that, I just don't know what other plans there are. President Obama isn't someone who will push HIS ideas when there are better ones out there, anything that passes and solves the problems will be his victory - doesn't matter what party the ideas came from.

Things like tort reform with medical malpractice reform, electronic medical records and other non-contentious topics will save money in the administrative costs side of the equation. But what about preventative care? Getting the uninsured covered so they can get help before treatment becomes long and expensive? Lowering premiums? I wanna' know!

In my opinion, congress, Obama, GOP, etc, no one really gives a **** about getting the uninsured covered, or fighting big insurance, maybe in the beginning they did, but not now. No, it's now just one side with a vendetta and the other one completely refusing to even SNIFF anything he pushes forward.
I don't get this either. Why would President Obama even tackle such contentious and near-impossible reforms if he didn't really care about fixing these problems? Tackling these things don't boost polls, changing the status quo isn't easy, what's Obama's agenda then?

Also, what's so bad about expanding government here? They aren't changing the CARE itself, just the costs and accessibility. He said this a billion times, if you are covered and like your insurance, the only thing that will change is that the insurance will be cheaper for you and your family, or employees.
 

JaggerPlate

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I don't get it though, and I'd be happy to know what other solutions there are. I'm really looking forward to seeing what the Republicans put forward this Thursday. I'm not a cynic, hoping whatever they put forth crashes and burns, I legitimately want to know how they'll lower premiums and get the 46 million uninsured Americans to get coverage. All I hear is the Democrats this and Democrats that, I just don't know what other plans there are. President Obama isn't someone who will push HIS ideas when there are better ones out there, anything that passes and solves the problems will be his victory - doesn't matter what party the ideas came from.
The thing about the GOP plan is that they want to fix a good, but wounded system. The dems, in my opinion, want to rip the guts out of our system, and replace it with one that is doomed to fail. This is why it seems like the repubs aren't offering the big, shiny, hail mary solutions ... because they aren't.

Things like tort reform with medical malpractice reform, electronic medical records and other non-contentious topics will save money in the administrative costs side of the equation. But what about preventative care? Getting the uninsured covered so they can get help before treatment becomes long and expensive? Lowering premiums? I wanna' know!
Well I posted a story here a few weeks ago that said tort reform will save 54 billion. It will also stop the practice of defensive medicine, which I think will increase the overall quality of care. Here's the thing about preventative care ... patients don't want it. Preventative care is GREAT on paper, and it does work in some specialty practices, but in general ... here's a scenario:

50 year old, obese male. Been eating like crap all his life, doesn't exercise, etc. Doc says you have diabetes. Says two options 1. You can change your diet, monitor your blood sugar carefully, exercise, turn your life around, and really get this thing under control or maybe even get rid of it (ie something that would have been preventative care his whole life). 2. Your wife can inject you in the ass twice a day with this. Ummm ... 2 please. It's sad, and you can call me jaded, cynical, etc, but from what I can tell now ... it's true (also, if I have any medical info wrong there, it's late and I'm a pre-med, I'm using it to make a point ... not show off how much I know bc I shadowed a radiologist).

Also, technically there are only 12 million people who are uninsured and have absolutely no options. The other millions are made up of people who are eligible for one thing or another, or illegal aliens (small portion) so wouldn't be able to get their hands on government insurance anyway (wink, wink).

So, if we be realistic for a second, look at the economy, the rising debt, everything else ... I think it would be better for baby steps to fix the system. Personally, I like when Senator McCain says he wants to start out with tort reform and insurance competition across state lines. Start with this, see what happens, then we can move on to bigger things. Ripping the system apart and putting another one in its place is a poor decision right now, especially one that puts government in charge.



I don't get this either. Why would President Obama even tackle such contentious and near-impossible reforms if he didn't really care about fixing these problems? Tackling these things don't boost polls, changing the status quo isn't easy, what's Obama's agenda then?
FTW. He's an idealist, a narcissist, and sees himself as the great hope for America. In reality, he's pretty damn inexperienced, super stubborn (even in the face of American's saying, we're good ... quit treating us like idiots and telling us what we want), and bad about taking criticism and losing. He's been awful. What's funny though is that I thought he always wanted a second term, but I think he's just going to do whatever he can to go down in history as the guy who changed this and that, etc. I 100% do not believe he's genuine. I've never 'liked' the guy, but I thought he was legit at first ... I no longer feel that way, and I think he's dangerous right now.

Also, what's so bad about expanding government here? They aren't changing the CARE itself, just the costs and accessibility. He said this a billion times, if you are covered and like your insurance, the only thing that will change is that the insurance will be cheaper for you and your family, or employees.
You ever been to the DMV? Dealt with the post office? Heard issues with social security??? If so ... thank the government. Do you really want ANYTHING run like that related to your healthcare? Ugh. Also, changing the costs and accessibility does change the care. If he gets some sort of government run option (there is no public option now, but I believe there are still 2 government run insurance companies included in the Senate and WH bill), this insurance becomes the big daddy and sets market price, much like medicare does now. Now, if the government is trying to cut costs, and cover 46 million people, do you think they are going to pay docs the higher rates like private PPOs? No. Do you think the PPOs are going to keep their rates high if government run insurance is low? No. This means docs start rejecting it left and right, like medicare, and accept the now crappier payments from PPOs, and the docs who DO accept this insurance have offices that run and look like the DMV. So he can say, nothing will change, but say you have X PPO, the government option comes in and pays docs poorly, X PPO follows suit closely. Your PCP now goes ... ehh government insurance and X PPO aren't worth my time, I no longer accept patients who have either. UH OHHH!!! Look what just changed? Your doctor.

He says lots of things ...


Anyway ... this is my outlook on it ... remember, most of it is my interpretation and opinion.
 

7starmantis

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Parts Unknown, you get points for humor and a little bit of wit, but minus points for lack of originality and logical arguments against what was actually said. If I had your sick interweb skilz I would find pictures of some olympic grading cards or something to post, I just haven't the time or inclination. But, that was pretty funny.

Personally, I like when Senator McCain says he wants to start out with tort reform and insurance competition across state lines. Start with this, see what happens, then we can move on to bigger things. Ripping the system apart and putting another one in its place is a poor decision right now, especially one that puts government in charge.
I'm not a McCain fan by any means, but I agree with this. When 84% of Americans are happy with our system, we need to do whats right for them as well as those that are uninsured. Just a point of fact to others here, the 46 million number has been proven false, even Obama isn't using it anymore. However, people keep mentioning quality of care, imagine throwing 46 million (or 12, or whatever number you would like to use here) patients into the healthcare system with no new doctors, nurses, hospital beds, etc. You think quality of care will stay the same?

We all know there is no panacea to fix all these issues, but we wont consider anything except the "public option", why is that? Why not make incremental changes and see how best to really address the issues? I think the real answer to that as far as the politicians is a partisan win, not a care for the uninsured. Why not address tort reform? Oh because its only going to make a small difference right? So a small difference isn't worth doing? It seems to me the argument against the incremental idea is that they are smaller scale changes, yet we know nothing by itself will fix everything, even the old public option left millions uninsured. So lets look at many small fixes that each address a specific problem and see if we can really change the problems and keep the best healthcare system in the world functioning. Look at HSA for the uninsured, even include a "public option" where the government contributes to uninsured/indigent people's HSA if you like. Work on opening up state lines, etc. One thing just isn't going to work.

On a side note, I think if the dems muscle through this earmark laden, bloated, tax increase (without benefit for years) the populous is going to start showing up at government buildings with pitchforks. Its ridiculous, lets listen to the american people and not just decide we are smarter than them and know whats best for them even when they are too stupid to understand. Honestly I think this whole thing has turned into political suicide for the head dems (and repubs that support it). Why they (Obama, Reid, Pelosi, etc) are continuing to push their own ideas here is telling of their true agenda. We could already have had some smaller incremental changes passed and working for the uninsured and under insured NOW, but no, political partisans need the win. We could already have changes made into law but instead certain politicians want their own ideas so bad they are willing to sacrifice the very people they claim to be trying to help. Sad really.
 

startswithb

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Clyburn, the House Majority Whip, said today he believes the House will have enough votes. The way I look at the moderate Democrats is... if they DON'T pass the bill, it'll show the country they cannot lead. It's catch-22 for them: pass something that isn't exactly what they want (a loss) or not pass anything at all (a bigger loss). In addition, in a conference call recently, Pelosi clarified a key point, saying the Senate must pass a reconciliation fix to its bill before the House passes it. If they pass the fix, then the House'll pass the Senate Bill... and everyone's talking about reconciliation now.

I've read articles saying the White House plan was framed with the idea of reconciliation in mind by Obama, so I think he's open to using it now. Newsweek:


Also, I think a major popular talking point Obama'll bring up is expanding government to limit outrageous insurance hikes (like Anthum in California and like 6 others in various other states). It's big government, GOP won't like it, but I think it's something the American people will.

I don't know man, a lot of things are still up in the air, and the House Democrats hold all the cards now. Obama will not quit no matter what to get the uninsured insured it seems. He even ended it in his State of the Union address: "We don't quit. I don't quit." I have a feeling he was referring to particularly Health Care Reform in that finishing line.
Actually, I'm pretty sure it's the opposite. Better to do nothing as to not ruffle any feathers so you can keep your seat. After all, politics is a CAREER now, so they have to keep their job, right?

However, in Obama's case, he might not care about getting reelected, because he's just trying to write the history books for himself. When he was first appealing to Democrats on healthcare, his persuasion was "this could be your legacy!" "WE did this!" It's about his career, his image, himself. So wrong.
 

Parts Unknown

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Parts Unknown, you get points for humor and a little bit of wit, but minus points for lack of originality and logical arguments against what was actually said.
Every vapid talking point that has been regurgiposted onto the interwebs has been pulverized by this point in the game. Watching the public, and even premeds, debate health policy is like watching third graders discuss sex after watching hardcore pornography. There are a multitude of intelligent points that could be raised and debated, but they aren't being made here. As there is literally nothing left to say in a morass such as this, we should all just sit back and enjoy the show.


Well, okay, I have one thing left to say. If anyone really wants to become educated on these matters, read Understanding Health Policy once or twice, read The Health Care Blog about every other day, and read Health Affairs for about an hour a week.

God help you all.
 

plauto

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Also, what's so bad about expanding government here? They aren't changing the CARE itself, just the costs and accessibility. He said this a billion times, if you are covered and like your insurance, the only thing that will change is that the insurance will be cheaper for you and your family, or employees.
Since the govt got involved with the credit card business, there is no month that goes by where I don't get a notice in the mail from one of my credit cards saying their rates are going up, annual fees are being considered, reward plans being slashed. BUT, I have 5 extra days to pay my bill and the interest rates are clearly written on the bill thanks to our govt. This is what an expanding govt does. Ever wonder why our funding fathers wanted to keep the federal government as small as possible?
 

morning

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It's so odd to have people upset that Medicare is being cut AND be completely against any government involvement in healthcare.

Think about it. Does it hurt your head yet?
 

JaggerPlate

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Every vapid talking point that has been regurgiposted onto the interwebs has been pulverized by this point in the game. Watching the public, and even premeds, debate health policy is like watching third graders discuss sex after watching hardcore pornography. There are a multitude of intelligent points that could be raised and debated, but they aren't being made here. As there is literally nothing left to say in a morass such as this, we should all just sit back and enjoy the show.


Well, okay, I have one thing left to say. If anyone really wants to become educated on these matters, read Understanding Health Policy once or twice, read The Health Care Blog about every other day, and read Health Affairs for about an hour a week.

God help you all.
Enlighten us ... because right now, you're the creepy high school kid hanging out at the Jr High dance calling us scrubs and throwing water balloons.
 

GH253

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Whatever the most destructive action is, they'll take it.
 

chessknt87

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I don't get it though, and I'd be happy to know what other solutions there are. I'm really looking forward to seeing what the Republicans put forward this Thursday. I'm not a cynic, hoping whatever they put forth crashes and burns, I legitimately want to know how they'll lower premiums and get the 46 million uninsured Americans to get coverage. .
Think about that using math--how is it economically possible to expand coverage and lower costs? It isnt unless you SERIOUSLY cripple access to care for everyone.

The Dem plan is FUBAR and has more feel-good measures than a city council run by your local HOA. The primary functional significance of the senate bill is that it will obligate the government to pay (and control) more. The insurance cards being handed out to homeless people isnt going to make anything cheaper, especially when there are no doctors that can see them.

Things like tort reform with medical malpractice reform, electronic medical records and other non-contentious topics will save money in the administrative costs side of the equation. But what about preventative care? Getting the uninsured covered so they can get help before treatment becomes long and expensive? Lowering premiums? I wanna' know!
It has been shown time and time again that (most) preventative care=more expensive. That would be more in line with increasing premiums.



I don't get this either. Why would President Obama even tackle such contentious and near-impossible reforms if he didn't really care about fixing these problems? Tackling these things don't boost polls, changing the status quo isn't easy, what's Obama's agenda then?
Because he is ambitious and egotistical, like every person who has ever held the office of the president. I am sure he honestly believes hes doing the right thing, but belief doesnt make reality. If this succeeds his legacy will be hallmarked by it. He thought Congress would be a pushover and the American people would just tolerate a government takeover, boy was he wrong. Now he could let it die and be dredged up against the dems later this year (and they WILL lose), or he can do what hes doing now--resurrect it and FORCE the republicans to take an attributable position on it. The primary purpose behind this new push is to take the republicans off the pedestal they have put themselves on from last year, if he doesnt his "agenda" will be dead in the water for the next two years.
 
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It has been shown time and time again that (most) preventative care=more expensive. That would be more in line with increasing premiums.
Prevention may be?:laugh:

When I was about 9 years old, I would always read the inscription below a statue near the state hospital as "preventation is better than cure."
So cute, and my brother corrected me each time
 
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It's so odd to have people upset that Medicare is being cut AND be completely against any government involvement in healthcare.

Think about it. Does it hurt your head yet?
Seriously. I hope to read a historical fiction about this mess in about a decade.
 

Parts Unknown

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Enlighten us ...
Enlighten yourself, because nothing else will work.

Here is a starting point: go back and reread your pitiful example of preventive medicine. Then look up the definition of preventive medicine. Then go to Pubmed and read literature on preventive medicine. In fact, you can attempt to answer an honest preventive medicine question I have been pondering lately: how does our rate of childhood vaccinations and prenatal care compare to other developed nations?
 
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MDub1

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Personally, I like when Senator McCain says he wants to start out with tort reform and insurance competition across state lines. Start with this, see what happens, then we can move on to bigger things.
I'm not a huge Senator McCain fan myself either, but I think that this approach would certainly be the most sensible.
 

7starmantis

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Enlighten yourself, because nothing else will work.

Here is a starting point: go back and reread your pitiful example of preventive medicine. Then look up the definition of preventive medicine. Then go to Pubmed and read literature on preventive medicine. In fact, you can attempt to answer an honest preventive medicine question I have been pondering lately: how does our rate of childhood vaccinations and prenatal care compare to other developed nations?
:barf:

Oh mighty fellow, thou hast past the sands of time in hallowed halls. Thou hast proven thine own superiority and intellect, and canst now be elitist and a douchebag.

Your posts in this thread (I'll keep it confined to this thread) are verbose in their bravado and lacking in logic. If you can do nothing but appeal to your own authority via educational status (without sources, because its a well known fact that what you say needs no source since anyone within your range of intelligence would see your point) and act like a tool kindly STFU.

If "these kinds of threads" are beyond you, by all means, move along. If you have something to add other than trying to appeal to humor and ad ad hominem attacks (ad nauseum) why bother? You can point and laugh all you want, but until you offer some point or stance of your own in any sort of organized fashion with anything resembling a source, your just the jester in the corner people are trying to avoid.
 
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Oh mighty fellow, thou hast past the sands of time in hallowed halls. Thou hast proven thine own superiority and intellect, and canst now be elitist and a douchebag.

Your posts in this thread (I'll keep it confined to this thread) are verbose in their bravado and lacking in logic. If you can do nothing but appeal to your own authority via educational status (without sources, because its a well known fact that what you say needs no source since anyone within your range of intelligence would see your point) and act like a tool kindly STFU.

If "these kinds of threads" are beyond you, by all means, move along. If you have something to add other than trying to appeal to humor and ad ad hominem attacks (ad nauseum) why bother? You can point and laugh all you want, but until you offer some point or stance of your own in any sort of organized fashion with anything resembling a source, your just the jester in the corner people are trying to avoid.
Did you miss the links that he provided? There's one in the quoted part of your post. He (she?) never mentioned his or her educational status. Your post is seriously bizarre (ad hominem, where?).

Jagger, you forgot the most appropriate comparison to gov run programs in your list, the VA, and Medicare, both of which have high satisfaction rates among the people who participate (since you yourself acknowledge that public opinion is important). A glaring example of your position as a fair weather libertarian comes in your willingness to have the government regulate malpractice insurance and in your desire to have Medicare rates propped up; both of which are government interventions that interfere with a free market.

You'll have to explain to me how selling insurance across state lines will make it affordable without government subsidies. If you could include a source, that would be nice. All of your "solutions" have virtually nothing to do with lowering health care costs, but have a lot to do with keeping (specialty) physician compensation at its current levels.

PS. Explain to me how malpractice reform will eliminate unneeded care. Will a doctor really not order that extra test knowing that the max that they can be sued for is 500K?
 

Parts Unknown

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Since the govt got involved with the credit card business, there is no month that goes by where I don't get a notice in the mail from one of my credit cards saying their rates are going up, annual fees are being considered, reward plans being slashed. BUT, I have 5 extra days to pay my bill and the interest rates are clearly written on the bill thanks to our govt.
Yes, some day we will all look back fondly on arbitrary, unlimited interest rate hikes, universal default, hidden morning payment deadlines, credit cards being sent to 18 year olds with no income and no co-signer, double cycle billing, and automatic direction of payment to low interest balances before high interest balances. If there is one thing this country needs now more than ever, it's less consumer financial protection.
 

chessknt87

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Yes, some day we will all look back fondly on arbitrary, unlimited interest rate hikes, universal default, hidden morning payment deadlines, credit cards being sent to 18 year olds with no income and no co-signer, double cycle billing, and automatic direction of payment to low interest balances before high interest balances. If there is one thing this country needs now more than ever, it's less consumer financial protection.
You have to draw a line somewhere though. While this is good for people who arent responsible, it hurts people who rarely used their CCs (inactivity fees=legal now....), enabled unjustified rate hikes against good customers, and enabled fees on reward programs that thrifty people liked to take advantage of.

People need to learn how to protect themselves, not rely on the government to do it.
 

morning

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Yes, some day we will all look back fondly on arbitrary, unlimited interest rate hikes, universal default, hidden morning payment deadlines, credit cards being sent to 18 year olds with no income and no co-signer, double cycle billing, and automatic direction of payment to low interest balances before high interest balances. If there is one thing this country needs now more than ever, it's less consumer financial protection.
I agree. Deregulation never caused any massive financial collapses; certainly not in the latter half of the '00s or anything like that.


...I wonder - for those who think the answer is less government regulation more of the time - how would you feel if the government actually did something about the student loan crisis? Would you be complaining then? Isn't tort reform government intervention? If physician student loans became partially or fully subsidized, would you be complaining about the ebbbil, eeeebbbil gubment? Don't you want the government to fund Medicare, and how do you reconcile all this?

Free industry is happy to bend you over and work you over if they think they can make a buck out of it. It's something they're already doing. Maybe the government wants to do it too, with different methods...but if you're screwed either way, I'd choose the side you can actually vote out of office if things go wrong.
 

chessknt87

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I agree. Deregulation never caused any massive financial collapses; certainly not in the latter half of the '00s or anything like that.


...I wonder - for those who think the answer is less government regulation more of the time - how would you feel if the government actually did something about the student loan crisis? Would you be complaining then? Isn't tort reform government intervention? If physician student loans became partially or fully subsidized, would you be complaining about the ebbbil, eeeebbbil gubment? Don't you want the government to fund Medicare, and how do you reconcile all this?

Free industry is happy to bend you over and work you over if they think they can make a buck out of it. It's something they're already doing. Maybe the government wants to do it too, with different methods...but if you're screwed either way, I'd choose the side you can actually vote out of office if things go wrong.
Medicare is a perversion of free market. The reason why physicians need it to be funded isnt because they need to suck the governments teat to survive, but rather to ensure their survival in the free market. The government wields a disproportionate market share and are effectively able to set price controls via medicare rates (with it serving as a baseline for private insurance markups). If your baseline drops 20%, all of your income is going to drop that much.

If the government subsidized our education we would end up paying it back 10-fold through taxes. Nothing is free and the money has to come from somewhere--at least when we borrow it we know exactly how much we have to pay back, instead of having to pay an extra x% of our income for every year we work for the rest of our lives instead.

PS--Check out the housing bubbles causes. The vast majority of the bad loans made were ones that the government mandated banks make to people who clearly were not responsible enough to own houses. This is why the government's mortgage companies (fannie and freddie) imploded first. The regulation of free market caused the collapse far more than deregulation.
 

BuckFMP

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You have to draw a line somewhere though. While this is good for people who arent responsible, it hurts people who rarely used their CCs (inactivity fees=legal now....), enabled unjustified rate hikes against good customers, and enabled fees on reward programs that thrifty people liked to take advantage of.

People need to learn how to protect themselves, not rely on the government to do it.
Good customers = good credit and companies will compete for them on the basis of rates and rewards. This was discussed on Marketplace last night. The pundit on the show said a lot of reward programs would actually improve.

Also, the companies will still compete based on annual fees. One of my cards (Citi) implemented a $60 fee at the start of the year, but they refund it after I total $2400 spending. My other card did not implement any new fees (MBNA via a credit union). I fired Citi. They could have kept me as a customer if they'd just give me three months to accrue the minimum charges, but the policy is to charge the fee at the start of the year. The irony of me lending money to a credit card company for free is nauseating.

The big concern for me is the interchange rates. These are going to rise to help the companies retain revenues and these price hikes will be passed on to consumers. I've always wondered if the inflationary pressure of transaction fees actually exceeds my measly 1% reward??? Anyway, if we want to mitigate these costs, we should cash.
 

plauto

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Yes, some day we will all look back fondly on arbitrary, unlimited interest rate hikes, universal default, hidden morning payment deadlines, credit cards being sent to 18 year olds with no income and no co-signer, double cycle billing, and automatic direction of payment to low interest balances before high interest balances. If there is one thing this country needs now more than ever, it's less consumer financial protection.
what can I tell you...on paper what you say sounds great. However, in practice a lot of folks like myself who were always careful with their money (i.e. spent only the money they have) are seeing the situation get worse where interest rates are going up every month and yearly fees are being implemented by several companies and reward programs are being slashed. Don't take my word for it, look at your own credit cards. Unless you were one of those irresponsible people who spent money they did not have, the terms are worse now than they were a year ago. And if you were one of them, I don't want to be paying for your stupidity. It's typical of the govt to reward bad behavior after all (look at bailouts and such), isn't it? It almost makes you feel like an idiot for following the rules and doing the right things.
 

Parts Unknown

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You have to draw a line somewhere though.
Absolutely, but I think the rules taking effect now will make the business more fair than it was before. I received my first credit card in 1993, back when a late payment would result in a late fee. Fifteen years later that same late payment would result in a much larger fee and an automatic doubling or tripling of my interest rate.

With perhaps the exception of the under-21 crowd, I don't think people are suddenly going to reduce credit binging because of these rule changes. If anything, most of them seem designed to allow people trying to act responsibly to do so with less of a chance of getting screwed by the fine print.
 
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The thing about the GOP plan is that they want to fix a good, but wounded system.
I disagree, it's not a good system. When anyone's premiums can go up almost 40% without a second notice... that's not in a good system. Right now, there has to be something done about THIS problem right here. This entire ordeal isn't so much health care reform as it is health insurance reform. I think I read somewhere that 80-something % of people are happy with their insurance. Well, that's because the vast majority hasn't been hit with where the system is headed. In a few years, premiums will go up, and up, and then they'll start clamoring. It's something that will, without any dispute, will happen... so why wait till that far off to do something about it? A majority like their coverage now? Well that's because the majority isn't sick... and if they do get sick, they think they'll be covered when really, health insurance companies can still just drop their coverage when they need it most - that's not a good system. Majority will like it, until they actually start to need it.
 

BuckFMP

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I disagree, it's not a good system. When anyone's premiums can go up almost 40% without a second notice... that's not in a good system. Right now, there has to be something done about THIS problem right here. This entire ordeal isn't so much health care reform as it is health insurance reform. I think I read somewhere that 80-something % of people are happy with their insurance. Well, that's because the vast majority hasn't been hit with where the system is headed. In a few years, premiums will go up, and up, and then they'll start clamoring. It's something that will, without any dispute, will happen... so why wait till that far off to do something about it? A majority like their coverage now? Well that's because the majority isn't sick... and if they do get sick, they think they'll be covered when really, health insurance companies can still just drop their coverage when they need it most - that's not a good system. Majority will like it, until they actually start to need it.
I'm no fan of the insurance industry. In fact I know many docs who, if they had one bullet, would put it in an insurance exec long before big tabacco or fast food. That being said, I did recently hear an interview with an Anthem CxO who said that their margins are only 3%. Take it with a grain of salt, but that's pretty tight. Also, the pool of insured has been declining thus reducing the size of population over which risk is spread. This is how they're justifying their rate hikes.

This tells me that insurance reform alone won't get it done. Even though I can't stand the insurers, I do think they are being scapegoated to some extent. For them to stay in business, other costs in the system must be addressed. The drug companies recognized this long before big insurance, and that's why they struck a deal early. Insurance got stuck holding the bag. We'll see where it goes now.
 

chessknt87

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I disagree, it's not a good system. When anyone's premiums can go up almost 40% without a second notice... that's not in a good system. Right now, there has to be something done about THIS problem right here. This entire ordeal isn't so much health care reform as it is health insurance reform. I think I read somewhere that 80-something % of people are happy with their insurance. Well, that's because the vast majority hasn't been hit with where the system is headed. In a few years, premiums will go up, and up, and then they'll start clamoring. It's something that will, without any dispute, will happen... so why wait till that far off to do something about it? A majority like their coverage now? Well that's because the majority isn't sick... and if they do get sick, they think they'll be covered when really, health insurance companies can still just drop their coverage when they need it most - that's not a good system. Majority will like it, until they actually start to need it.
Insurance is a scapegoat, not a cause. Unless you can provide evidence that their profits go up by the same amount they raise their premiums, it isnt their greed as much as it is the rising costs of healthcare (technology, defensive medicine, poorer overall health of their clients).

Think about the bad PR they would get for increasing premiums.... Why the hell would they risk it when they stand to lose so much in DC unless they HAVE to do it in order to stay solvent?
 
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True, they are being scapegoated a little, but at the same time I hear the insurance companies made record profits (I think $12 billion? Might be wrong on the number) last year. Also, a lot of the money they get go right back to administrative costs and advertising, and not actual care for their consumers. I think the new plan will make it mandatory to spend a set amount on actual care.
 

chessknt87

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True, they are being scapegoated a little, but at the same time I hear the insurance companies made record profits (I think $12 billion? Might be wrong on the number) last year. Also, a lot of the money they get go right back to administrative costs and advertising, and not actual care for their consumers. I think the new plan will make it mandatory to spend a set amount on actual care.
The administrative costs are, in part, due to governmental regulations and could be lessened by changing those. If you think the government can run an administrative operation more effectively than a profitable multi-million dollar company playing under the same rules, then I suggest you check out the DMV, FEMA, your state government, etc etc etc.

I will trade my money going to advertising (which helps fuel the economy) over fraudulent claims (which fuels criminals) any day. Medicare fraud is astronomically higher than any private insurance company.
 

morning

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True, they are being scapegoated a little, but at the same time I hear the insurance companies made record profits (I think $12 billion? Might be wrong on the number) last year. Also, a lot of the money they get go right back to administrative costs and advertising, and not actual care for their consumers. I think the new plan will make it mandatory to spend a set amount on actual care.
Yes, they made a record profit and covered hundreds of thousands fewer people than previously. Reconciliation came back on the table after a large insurer recently raised their premiums 40% and then was forced, by public outcry, to rescind that.

The public option is not the BEST option, but if it's the best they can come up with than it's good enough for now. What the public option exists to do is not replace private insurance, but create a viable option for the UNINSURABLE. The obese toddler who was refused insurance in Colorado, for instance. The rape victim who couldn't get insurance because domestic violence was a pre-existing condition. It also creates a viable option for those who had work-based insurance and then lost their job. The fact that you can go from having insurance one day to completely losing it the next day despite paying premiums is ridiculous and untenable.

Private insurance obviously exists already. It's also a minefield. Insurance you get from your employer is often quite good...private insurance is an absolute mess, some Mad Max crap that can turn on you in any second. Private insurance is where most of the profits come from, for instance. GOOD insurance companies already spend over 85% of their revenue on actual billing, whereas private insurance policies spend 60-75% and skim the rest off as profit. They can drop your policy for no reason and often do.

It's not as if the uninsured go off the grid. You still pay for them via ER visits.

Mandates still suck and the thought of mandating someone to buy PRIVATE insurance is vomitous. Like I'm supposed to prop up an industry I hate with a passion because Joe Lieberman wants his kickbacks...


The administrative costs are, in part, due to governmental regulations and could be lessened by changing those. If you think the government can run an administrative operation more effectively than a profitable multi-million dollar company playing under the same rules, then I suggest you check out the DMV, FEMA, your state government, etc etc etc.
I've never had ANY problem with the DMV or secretary of state's office, so I dunno why people are always complaining about it. I also take advantage of one major government project and have done so since I was 12 years old...public education. It's not the best, and it often sucks, but I'm still grateful for it and would hate if it disappeared and I was all of a sudden paying 30k a year in tuition.
 

chessknt87

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I've never had ANY problem with the DMV or secretary of state's office, so I dunno why people are always complaining about it. I also take advantage of one major government project and have done so since I was 12 years old...public education. It's not the best, and it often sucks, but I'm still grateful for it and would hate if it disappeared and I was all of a sudden paying 30k a year in tuition.
Have you ever had to stand in a line without an appointment? How long did you wait? Have you ever seen how many people work there vs how much work is actually done? Have you ever seen a postal employee move faster than tar, even when the line is 20+ people long and another employee stands by idly sorting mail that wont be going anywhere for hours?

As for public schools--check out LAUSD some time. Its pretty much the worst (and most well-funded) school district in the US. The charter schools in LA are doing fine.

Government administration is riddled with inefficiencies, refusing to acknowledge them doesnt really make them nonexistent.
 

morning

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Have you ever had to stand in a line without an appointment? How long did you wait? Have you ever seen how many people work there vs how much work is actually done? Have you ever seen a postal employee move faster than tar, even when the line is 20+ people long and another employee stands by idly sorting mail that wont be going anywhere for hours?

As for public schools--check out LAUSD some time. Its pretty much the worst (and most well-funded) school district in the US. The charter schools in LA are doing fine.

Government administration is riddled with inefficiencies, refusing to acknowledge them doesnt really make them nonexistent.
I've never made an appointment to go to the Secretary of State's office. The longest I ever had to wait was an hour, when I went late on a Wednesday, the only day they're open after normal working hours and it was packed to the gills. I was getting my "over 21" driver's license (in my state you have a different shaped license when you're under 21), brought all the proper documentation and the money in cash, and once I was at the counter I was out in 10 mins. Including the time it took to take the new photo.

I'm curious, do you have Stafford loans?
 

Parts Unknown

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However, in practice a lot of folks like myself who were always careful with their money (i.e. spent only the money they have) are seeing the situation get worse where interest rates are going up every month and yearly fees are being implemented by several companies and reward programs are being slashed.
I find it more likely that your credit card companies are jacking your interest rates and slashing your rewards programs because:

1. Credit card debt has decline 4.6% since it peaked in October of 2008.

2. The companies can use the rule changes as political cover.

plauto said:
Don't take my word for it, look at your own credit cards.
I have, and they haven't changed a bit. BOA was going to float my interest rate but then changed its mind.
 

JaggerPlate

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Ugh damn ... I left this thread for too long and now there are too many replies to respond to at once!!!
 

JaggerPlate

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Enlighten yourself, because nothing else will work.

Here is a starting point: go back and reread your pitiful example of preventive medicine. Then look up the definition of preventive medicine. Then go to Pubmed and read literature on preventive medicine. In fact, you can attempt to answer an honest preventive medicine question I have been pondering lately: how does our rate of childhood vaccinations and prenatal care compare to other developed nations?
It causes autism and red hair ... Jenny McCarthy told me so. Ergo, I will not vaccinate my children.


Seriously though man ... if I make a claim, you say it's asinine, I ask you to describe how/why and then give ur your POV and you respond with 'enlighten yourself' ... there's no argument there. Also, if the only beef you had with my point was my example of preventive medicine (which I prefaced with the disclaimer that I'm not in medical school/residency/practice yet ... ergo I'm using this example to respond to and make a point), then I really don't think such backlash is necessary.
 
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chessknt87

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I've never made an appointment to go to the Secretary of State's office. The longest I ever had to wait was an hour, when I went late on a Wednesday, the only day they're open after normal working hours and it was packed to the gills. I was getting my "over 21" driver's license (in my state you have a different shaped license when you're under 21), brought all the proper documentation and the money in cash, and once I was at the counter I was out in 10 mins. Including the time it took to take the new photo.

I'm curious, do you have Stafford loans?
I have no idea where youre from, but here in CA if you dont make an appointment with the DMV you expect a minimum 1 hr long wait, no matter what it is that you need to do.

My brother lost his license last year and we stood in the initial line for 20 minutes--the useless secretary guy hands us a form and a #. Then we waited 1.5 hours, got called to the window, then handed in the form and paid the lady, got a temp license, bam done. Why didnt the first guy do that? Why did we have to wait through two lines? Why cant this be done online, or by turning in a form+check?

I need a proof of a clean driving record--bam another 1 hour wait for a form they can just print off any computer.

How about the post office: Its Tuesday morning and I need to mail a book for an ebay sale I made w/ delivery confirmation. I get in a line thats 3 people long. How long do I wait there? 35 minutes! Why? One employee was on a break (2 hours into her shift apparently), the second employee was sorting through mail, and the employee helping the person fill out the forms couldnt give a flying **** that she had a line building up out the door.

I want to complain to a manager for their poor handling of the situation--guess who it is? Thats right, incompetent employee #3 who was sorting through mail, occasionally staring through the window (right past the angry people standing in line).

Its really cool that every government encounter youve had runs like butter, but the vast majority of them do not, especially when they are overloaded because they are in populated areas.
 

JaggerPlate

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Jagger, you forgot the most appropriate comparison to gov run programs in your list, the VA, and Medicare, both of which have high satisfaction rates among the people who participate (since you yourself acknowledge that public opinion is important). A glaring example of your position as a fair weather libertarian comes in your willingness to have the government regulate malpractice insurance and in your desire to have Medicare rates propped up; both of which are government interventions that interfere with a free market.
High satisfaction with medicare??? Hmm. The VA? I've worked in one ... the patients were anything but happy. It was gross, really gross. And this was in a huge 'metropolis.' Again, if your evidence is n=? claims, then so is mine.

me =/= libertarian by any means.

You mistook my point on medicare. Given the opportunity between blowing it up and propping the rates up, I'd blow it up. I'd rather have a big non-profit or several private sector companies cater specifically to the medicare crowd and reimburse appropriately than a government funded/run plan. However, this isn't going to happen. Medicare is here to stay, and in driving its rates lower and lower ... it is demolishing the market (which is NOT a free market because it is driven by Medicare). So, because there is NOTHING I can do to get rid of it, and it does set the rates at which other PPOs pay out ... I'd rather not have them pay docs 21.2% less. Don't kid yourself that it's an example of a free market. If it was all private insurances competing ... it would be, but they are not, so it is not. It's a slightly varying market driven by medicare.

All of your "solutions" have virtually nothing to do with lowering health care costs, but have a lot to do with keeping (specialty) physician compensation at its current levels.
If it makes you feel any better, I don't plan on my biz revolving around any sort of insurances, so any feelings I have towards specialists salaries are based on the fact that I know how hard these people bust their asses, the debt they do into, etc, and I think it's fair to reimburse them properly.

However, my solutions probably seem pretty small, because admittedly, they are. I don't think it's the time for a huge health care/health insurance, whatever over hall. I think it's horribly timed and is going to drive us deeper into debt and economic depression. If people want changes, I'm all for small, reasonable changes, but I would really, really like Washington's focus to be on debt, the economy, and the unemployment rate. Don't know if that makes me a bad future doc, but I think it's a hell of a lot more reasonable in this current climate.



PS. Explain to me how malpractice reform will eliminate unneeded care. Will a doctor really not order that extra test knowing that the max that they can be sued for is 500K?
Will eliminate unneeded care??? Did I ever claim that? If I did, show me, and I'll do my best to explain my logic.
 
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JaggerPlate

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I have no idea where youre from, but here in CA if you dont make an appointment with the DMV you expect a minimum 1 hr long wait, no matter what it is that you need to do.

My brother lost his license last year and we stood in the initial line for 20 minutes--the useless secretary guy hands us a form and a #. Then we waited 1.5 hours, got called to the window, then handed in the form and paid the lady, got a temp license, bam done. Why didnt the first guy do that? Why did we have to wait through two lines? Why cant this be done online, or by turning in a form+check?

I need a proof of a clean driving record--bam another 1 hour wait for a form they can just print off any computer.

How about the post office: Its Tuesday morning and I need to mail a book for an ebay sale I made w/ delivery confirmation. I get in a line thats 3 people long. How long do I wait there? 35 minutes! Why? One employee was on a break (2 hours into her shift apparently), the second employee was sorting through mail, and the employee helping the person fill out the forms couldnt give a flying **** that she had a line building up out the door.

I want to complain to a manager for their poor handling of the situation--guess who it is? Thats right, incompetent employee #3 who was sorting through mail, occasionally staring through the window (right past the angry people standing in line).

Its really cool that every government encounter youve had runs like butter, but the vast majority of them do not, especially when they are overloaded because they are in populated areas.
My dad tried to register a motorcycle in CA last week at a DMV with no appointment. Waited 4 hours, after finally got up there, he was missing some small little esoteric thing and went home empty handed (my dad is a huge motorcycle guy and has registered hundred of bikes ... he knows what he's doing, but had to go to an unfamiliar DMV).
 

morning

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I have no idea where youre from, but here in CA if you dont make an appointment with the DMV you expect a minimum 1 hr long wait, no matter what it is that you need to do.

My brother lost his license last year and we stood in the initial line for 20 minutes--the useless secretary guy hands us a form and a #. Then we waited 1.5 hours, got called to the window, then handed in the form and paid the lady, got a temp license, bam done. Why didnt the first guy do that? Why did we have to wait through two lines? Why cant this be done online, or by turning in a form+check?

I need a proof of a clean driving record--bam another 1 hour wait for a form they can just print off any computer.

How about the post office: Its Tuesday morning and I need to mail a book for an ebay sale I made w/ delivery confirmation. I get in a line thats 3 people long. How long do I wait there? 35 minutes! Why? One employee was on a break (2 hours into her shift apparently), the second employee was sorting through mail, and the employee helping the person fill out the forms couldnt give a flying **** that she had a line building up out the door.

I want to complain to a manager for their poor handling of the situation--guess who it is? Thats right, incompetent employee #3 who was sorting through mail, occasionally staring through the window (right past the angry people standing in line).

Its really cool that every government encounter youve had runs like butter, but the vast majority of them do not, especially when they are overloaded because they are in populated areas.
And you couldn't print the form off online?

It's really your responsibility to know what you need for X process. A lot of people who go to the DMV/SoS are NOT prepared and I've seen it many times.

You didn't answer my question. Do you have Stafford loans or not?