Medical Student Suggestions for Comprehensive Healthcare Reform

[277768]

I'd like to hear a comprehensive view or some brainstorming on what student doctors would suggest to health care policy makers to a) reduce costs b) cover 20+ M uninsured people and c) maintain quality....


A few helpful uggestions?

1. Make Medicare and government programs negotiate with Drug Companies to reduce Rx costs....especially drugs that have generic options...for patented drugs, make the government pay about 1/2 the cost to keep the pecuniary concerns managed for patients.
2. Pass a comprehensive tort-reform (federal) bill to limit malpractice awards....Create state/federal slush funds to pay for huge catastrophic awards for pediatric cases and extreme negligence...
3. Institute a loser-pays system, to impede trial lawyers from suing physicians and hospitals without fear of retribution.
4. Allow the purchase of health insurance policy across state-lines, make the current insurance market more competitive.
5. Finding a solution to cover uninsured Americans by 1) expand the risk pool for insurance companies by forcing young, healthy people who can pay premiums to buy health insurance (hell, we force them to buy car insurance?)and force insurance companies to cover pre-existing conditions or 2) tax the rich and develop a public option that will only fund people who can demonstrate an inability to get private coverage through the normal underwriting process.
6. Compensate doctors tied to a mean-tested system. Pay big big bonuses when patients recover and show demonstrable improvements in quality of life...find a way to cut down the procedure-oriented, reimbursement system and find a way to tie compensation to a base + wel-being of patients.
7. Raise taxes to bridge the Medicare/SS gap...will go broke in 8-10 years otherwise.


Hopefully all these things will help keep costs managed and will not explode peripheral problems. These are just some innocent suggestions. Tear these ideas to shreds or suggest your own.

As future docs, we need to brainstorm how to attack these problems.

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[OnDemond]

This is a great post for between semesters, and will be sure to generate a productive discussion. However most med student are curently trying to memorize where the illiocostalis muscle originates and inserts; what the complement steps are, and how to evoke a patellar reflex. We're too busy to attempt at solving the world's problems as of now...

 

[rachmoninov3]

Now, assuming $ is not an issue, the first part of healthcare reform is the workforce:

1. Use US census data to calculate population to hospital bed ratio, and adjust accordingly using tax incentives to start hospitals with larger incentives for non profits.

2. All new hospitals will be required to have primary care clinics, both walk in and pre-made appointments to increase access to care and so hopefully effect change in people's behavior to where they DO have a PCP. This way when people go to the ED for their care, they can get set up with a PCP instead of taking time and beds away from the ED.

3. Increase number of nursing programs, PA, and MD/DO programs

Inorder to pay for this:

1. Find out where the $$$ for GME is going and put some of it to work to pay for this.

2. For every Mexican national who goes to the US for care, and for everyone living here illegally, bill the Mexican Government (or goverment of their home country) for their care.

 

[OnDemond]

However, these are my really brief two cents:
Provide a healthcare tax credit to lower income families who file taxes. That way everyone as the freedom to choose their own docs and to use the money as they wish.
As for tort reform, here's how: create a "legal insurance" system where legal services can be provided through insurance companies; just like with healthcare. Very soon, lawyers salaries will be controlled by legal insurance companies as well. Subsequently, there will be millions of americans who will not be able to afford legal insurance. You will have politicians vying for votes who will run on the platform of "legal representation is a human right", because you never know when you might have a divorce, will, real estate transaction, criminal defense, patent, medical malpractice, or any legal representation. Soon, politicians will push through a nationalized (read socialized) legal services program, and lawyers will be SCREWED!!!
MWAHAHAHA!!!
C'mon, it's really a great idea. Let's see how long it will take for someone to steal my brilliant idea...

 

[OnDemond]

Hmmm...it seems like there are companies which offer a form of legal insurance, so there goes my big money-making scheme...
However, how cool would it be if lawyers came face-to-face with the same threat doctors now face? I think that seriously it would be nice to let the lawyers have a taste of their own "medicine"...

 

[xanthomondo]

I honestly don't think it's possible to increase access for 20+ million, decrease costs overall, while providing the same quality of care and keep the research/advancements going at the pace they are. There's just not enough time, money, or people.

 

[phospho]

This is a great post for between semesters, and will be sure to generate a productive discussion. However most med student are curently trying to memorize where the illiocostalis muscle originates and inserts; what the complement steps are, and how to evoke a patellar reflex. We're too busy to attempt at solving the world's problems as of now...

too funny

Earlier this morning I was studying monosynaptic responses, and last night I was memorizing a table of about 60 muscles - along with their origins/insertions, and innervations.

 

[badasshairday]

3. Institute a loser-pays system, to impede trial lawyers from suing physicians and hospitals without fear of retribution.

This one is my favorite.

 

[deleted50478]

5. Finding a solution to cover uninsured Americans by 1) expand the risk pool for insurance companies by forcing young, healthy people who can pay premiums to buy health insurance (hell, we force them to buy car insurance?)and force insurance companies to cover pre-existing conditions.

Forcing people to buy health insurance is unconstitutional. Most things the government does are actually unconstitutional but the power grabs of the fed are allowed by an untrustworthy court intentionally misinterpreting the interstate commerce clause. The important difference between car insurance and health insurance is that buying car insurance is an option connected to the option of owning a car, buying health insurance is connected to the non-option of being alive. Not the same. Not justifiable even by a power hungry government/court.

If pre-existing conditions are covered, it is not insurance. It is theft from the pool of money provided by people who bought their insurance before getting sick. Nothing is free. Everything government 'gives' takes from someone else.

Forcing young healthy people to buy insurance is just a way to steal from the young to give to the old. There are already two terrible federal Ponzi schemes that do that: Medicare and Social Security.

 

[MOHS_01]

Forcing someone to "purchase" anything from a private entity constitutes an egregious abuse of power and is tantamount to levying a tax on the individual by a private corporation, an involuntary theft deemed permissable by a runaway government...

 

[LeemerDO]

As for tort reform, here's how: create a "legal insurance" system where legal services can be provided through insurance companies; just like with healthcare. Very soon, lawyers salaries will be controlled by legal insurance companies as well.

I like this idea. The U.S. Constitution already clearly states that everyone has a right to counsel, a.k.a. legal representation as stipulated by the 5th amendment. By that fact, lawyers are required, if not obligated to serve. And of course, this is done through the use of the public defender's office. So why not rather than not only pay lawyers through 3rd party legal insurance, but also compel them to serve "x" many years after law school in the public defender's office for marginal wages, much like a law residency. Then on top of that, force them to have a certain percentage of "public option" clientele that can call on them for all their legal needs, sometimes at the expense of the lawyers themselves. Sure they have their pro bono work, but let's do what the government does best and make a law to start compelling them to do so at marginal, unsustainable cost. Oh, and if you bring lawsuit and lose more than three times, your license to practice is put under review. Let's also expand the Bar exams to three levels, requiring periodic retesting thereafter in their chosen specialty.
As far as legal insurance, what would be better?
A Legal Maintenance Organization or a Preferred Counselor Organization?

Very interesting. Hope it comes true.

 

[RGMSU]

I honestly don't think it's possible to increase access for 20+ million, decrease costs overall, while providing the same quality of care and keep the research/advancements going at the pace they are. There's just not enough time, money, or people.

Now here is someone who understands reality. My prediction is that we will increase access, costs will also INCREASE, not decrease, and quality will go down.

 

[koopa_troopa]

Now here is someone who understands reality. My prediction is that we will increase access, costs will also INCREASE, not decrease, and quality will go down.

I'm not even sure if access will increase without an increase in PCPs. Or alternatively, PCPs may end up spending less time with patients (maybe 5 minutes?) to accomadate everyone, of course at the expense of quality. This is kind of why Obama's whole health care reform switch to health insurance reform does not make sense. There are things outside of insurance reform that needs to be done to make this system sustainable. I guess Obama is counting on the nurses that he loves so much to fill in the gap.

 

[RGMSU]

There will definitely be an increased dependence on non-physician providers. I have nothing against them, but I don't particularly think it's fair to equate someone with half the education to someone with double the education. I guess I shouldn't be surprised since we are an anti-intellectual country where most people care to do only the minimum amount of preparation to get by, whereas some of us don't see a problem with being "overprepared" some of the time. The problem is that you can never predict when a case will come along where additional preparation may make a difference. Unfortunately, we are in a self-perpetuating cycle where low pay and low prestige encourage most medical students NOT to become primary care physicians. An increased dependence on non-physician providers to fill in the gap only makes the problem worse rather than better by discouraging even more medical students from tacking that direction. 99% of the time you cannot cut the visit back to 5 minutes. That's barely enough time to listen to a patient complaint much less conduct any physical diagnosis or go through review of systems questions for a meaningful differential diagnosis. Something else is going to have to give somewhere.

 

[dynx]

Forcing people to buy health insurance is unconstitutional.

yeah well so is forcing an EM doc to care (for free) for the drunk that fell down and hit his head that showed up in the emergency room. As long as the american people are going to run rampant over the right of the dr. to practice as he'd like, I'm okay with this little f-you to the american people's rights. ANY solution that focuses on insuring everyone is going to be unconstitutional....this is just the best of all the unconstitutional options.

Forcing young people to buy insurance is a great way to increase the amount of money in the healthcare pool for a population that will eventually use those resources anyway (everyone uses healthcare eventually).

Mandated insurance along with using the interstate commerce laws to develop federal minimums for insurance coverage would be a GREAT solution.

1. It pulls people in early and gets more money into the system
2. by making it federal you can get larger groups of people into the same pool.
3. with federal standards (if done right...and they won't be, but we're hoping here right?) you can cover the biggest things preventative care/HTN/CAD/cancer/emergency care/COPD...insure everyone continuously and you've virtually eliminated the "pre-existing" condition problem for the majority of illnesses.
4. Federal standards would eliminate interstate brokers and decrease costs to implement private insurance.
5. You could effectively and covertly include in the standards guides for futile care that could eventually be applied to medicare in terms of the "do everything" for my 99 yo grandma with an intra-cranial hemorrhage sucking up a million before her inevitable demise.

I see a lot of promise with this option.

 

[meister]

Forcing someone to "purchase" anything from a private entity constitutes an egregious abuse of power and is tantamount to levying a tax on the individual by a private corporation, an involuntary theft deemed permissable by a runaway government...

For once you're 100% correct, but you are never going to see congress directly affront the lobbyists they are all in bed with.

Eliminate private insurance, Medicare for all, end all of this hand-wringing.

Forcing people to buy health insurance is unconstitutional. Most things the government does are actually unconstitutional but the power grabs of the fed are allowed by an untrustworthy court intentionally misinterpreting the interstate commerce clause.

Things like wars without a declaration? Torturing prisoners in direct conflict with the Geneva Conventions? Ignoring treaty obligations? State secrets privilege? You are correct about that. However you're wrong about the ICC being used erroneously here.

Between the ICC, the general welfare clause, or probably a couple others I could pull out of my ass, I could justify just about any domestic policy I wanted. The constitution is what SCOTUS and the public will accept, just deal with it. It's 200+ years old, there's no point trying to divine what James Madison would have thought about modern society. (hint: blacks voting?? women voting????? non-property owners voting???????????????????)

 

[meister]

yeah well so is forcing an EM doc to care (for free) for the drunk that fell down and hit his head that showed up in the emergency room.

So the hospital takes the loss and you get paid anyway.

 

[RabbMD]

So the hospital takes the loss and you get paid anyway.

You obviously have no clue how medicine works. Most er and anesthesia groups are independent of the hospital and do their own billing. Thus while the hospital does tax deduct the loss, doctors get paid nothing because they bill inpendently. The drunk does not pay his bill doctors do not get paid. AND they also can not deduct the loss like hospitals can. The only way they may get paid is through a contractural hospital subsidy. That of course us at the whim of the hospital and my group currently gets none.

I hate when idealistic medical students who have never worked a day in their lives mouth off about things they have no clue about.

 

[meister]

You obviously have no clue how medicine works. Most er and anesthesia groups are independent of the hospital and do their own billing. Thus while the hospital does tax deduct the loss, doctors get paid nothing because they bill inpendently. The drunk does not pay his bill doctors do not get paid. AND they also can not deduct the loss like hospitals can. The only way they may get paid is through a contractural hospital subsidy. That of course us at the whim of the hospital and my group currently gets none.

Interesting. By at the whim of the hospital do you mean at the whim of whatever contract your group is able to negotiate?

I hate when idealistic medical students who have never worked a day in their lives mouth off about things they have no clue about.

Actually I have worked for years in the real world but thanks for being a smug jerk anyway.

 

[dynx]

So the hospital takes the loss and you get paid anyway.

While it's clear you have no idea what you're talking about this post does add a lot to the discussion:
1. it serves as a warning to others that when they read your posts in the future they should not take your level of "knowledge" for granted.
2. It, as a correlate to number 1, tells you exactly how little all these people that just want to go-ahead with national healthcare and quite the "hand-ringing" know about the actual day to day function of medicine.

So, for all those people out there that actually want to inform themselves, find a source that actually knows what is going on and ignore people that make obvious factual errors in support of thier points.

 

[meister]

While it's clear you have no idea what you're talking about this post does add a lot to the discussion:
1. it serves as a warning to others that when they read your posts in the future they should not take your level of "knowledge" for granted.
2. It, as a correlate to number 1, tells you exactly how little all these people that just want to go-ahead with national healthcare and quite the "hand-ringing" know about the actual day to day function of medicine.

So, for all those people out there that actually want to inform themselves, find a source that actually knows what is going on and ignore people that make obvious factual errors in support of thier points.

It's funny 'cause if we actually were to simply provide Medicare for everyone then there would be zero problem because by definition the drunk who hit his head would have insurance already. This is like 50% of the problem everyone is talking about.

You don't have to be an emergency physician to understand that. You might have to be one to understand the ins and outs of contractual obligations between hospitals and physician groups as far as caring for uninsured patients goes. But you don't need to have that specific knowledge to discuss healthcare reform.

 

[dynx]

It's funny 'cause if we actually were to simply provide Medicare for everyone then there would be zero problem because by definition the drunk who hit his head would have insurance already. This is like 50% of the problem everyone is talking about.

exactly! And if we just provided food to everyone in the world there would be no hunger! WOW! problem solved...I can't believe how easy it was!

I'm sure that's not the extent of your understanding but when you make a post like this its so oversimplified as to be stupid.

You don't have to be an emergency physician to understand that. You might have to be one to understand the ins and outs of contractual obligations between hospitals and physician groups as far as caring for uninsured patients goes. But you don't need to have that specific knowledge to discuss healthcare reform.

No, you have to be a simpleton to "understand" it. It's like people who "understand" that noah put 2 of each animal on the Ark and thats how animals survived the great flood. It sounds good in thier own mind because they have no clue what they are talking about.

 

[meister]

exactly! And if we just provided food to everyone in the world there would be no hunger! WOW! problem solved...I can't believe how easy it was!

Except we already provide Medicare to millions of Americans and it's not exactly providing food to the entire world? What a bizarre thing to say.

I'm not some college marxist suggesting doctors work for $30k and give up their Mercedes, so let's stick to reality and not misrepresent everyone lest this turn into another Obama=Hitler vs. Obama=sun-god worthless thread.

 

[psy]

It's funny 'cause if we actually were to simply provide Medicare for everyone then there would be zero problem because by definition the drunk who hit his head would have insurance already. This is like 50% of the problem everyone is talking about.

You don't have to be an emergency physician to understand that. You might have to be one to understand the ins and outs of contractual obligations between hospitals and physician groups as far as caring for uninsured patients goes. But you don't need to have that specific knowledge to discuss healthcare reform.

I'm not understanding how having everyone under medicare would have zero problems. Do you understand the current problems with medicare at all? Do you understand the lower than market rate reimbursement and paper filling you have to do with medicare? The cost of new medicine won't go down. If you want medicine to cost less you have to stop innovation. Medicare is projected to have a huge deficit in the coming years as more people retire but not enough new young bodies to pay taxes to support it. How then would we be able to support the medicare system if everyone is in the program? We could charge 70% income tax... I mean Canada is already charging 60% even though they have a lack of CT and MRI machines.

 

[RGMSU]

The costs of a public healthcare system would indeed be monstrous. My prediction is that the healthcare reform initiatives will actually increase rather than decrease cost. You bring more people into the system which requires more workforce, more overhead, etc. Revenue may remain much flatter than expected since it will be dictated by the government and insurance companies. If the costs spiral out of control, which they likely will, Obama has suggested he will cut costs further in the system, which I guess will translate into cuts in physician reimbursement, just like they regularly do with Medicare now. It's nice to know that the government and our society values the work we do and the sacrifices we make to get there.

 

[koopa_troopa]

I mean Canada is already charging 60% even though they have a lack of CT and MRI machines.

Were you being serious about 60%? People might become misinformed by your post.

 

[meister]

I'm not understanding how having everyone under medicare would have zero problems.

I said there would be zero problem because the drunk would be 100% guaranteed to have coverage. I didn't say there are no problems with Medicare.

Do you understand the current problems with medicare at all? Do you understand the lower than market rate reimbursement and paper filling you have to do with medicare?

Well, medical costs have skyrocketed across the board, why would Medicare be an exception? In addition, Medicare deals specifically with the elderly and the disabled. Gee, can you think of any reason why insuring them and not younger patients would be more expensive? Do you deny that having single-payer would dramatically decrease overhead costs associated with billing? And that Medicare runs on 3% administrative overhead compared to 12% for private insurers? Canada runs on 1.3% overhead, by the way. Not that you'll care about any of this.

Click here if you care.

As far as "lower than market rate reimbursement," I feel that primary care physicians and other cerebral non-procedure based specialties are already vastly underpaid. This is not Medicare's fault, it's the AMA's fault for neglecting PCPs for decades in favor of propping up surgical subspecialists and other proceduralists. Why don't we cover all medical student tuition fees and then see what people say when they graduate with zero debt? Not sure about you, but I'd much rather make $150k a year with zero debt than $300k a year with $300k in debt. Or how about $400k a year with zero debt?

The point is that the entitlement complex some physicians seem to have over their huge salaries is based almost entirely on their indebtedness and on a questionable physician culture. We can solve the first problem pretty easily (probably cost $3-5b a year.) The second one will take some time.

 

[RGMSU]

If you think the government is going to pass a retroactive loan repayment for all of us who are already in medical school at the same time they want to drop our salaries, you are indeed in never-never land my friend. You will have the same loan indebtedness you always had and less salary. The government will have enough difficulty paying for the proposed system, much less paying to educate everybody who is a part of the system. This is not Canada here. Whole different ballgame.

 

[MOHS_01]

For once you're 100% correct....

That is frequently the case... you just don't always agree.

These discussions would be a lot more productive if people would just accept the irrefutable conclusion that no system is, or ever will be, perfect. You will always be making compromises, and there will always be drawbacks to any system. There exists no perfect system for healthcare delivery anywhere in the world; where the disagreement comes in is on a basic and fundamental level that tends to separate everyone out into their relative camps on the philosophical divide of life. I personally believe that "Medicare for all" is not a great idea for a whole host of reasons.

 

[MOHS_01]

... Not sure about you, but I'd much rather make $150k a year with zero debt than $300k a year with $300k in debt.

That just goes to show that you did not pay much attention in math class... you probably should not even be handling your own finances. Marry well, friend, and allow the significant other to handle the checkbook.

Or how about $400k a year with zero debt?

Now you're talking!!!!

Look, most docs never see $400k/yr. That's a fairly high figure to achieve in today's reimbursement environment. We simply do not make as much money as people believe, and the ignorance on how our incomes are realized permeates our own ranks very deeply.

 

[RGMSU]

We simply do not make as much money as people believe.

Truer words have not been spoken on this forum.

 

[meister]

That just goes to show that you did not pay much attention in math class... you probably should not even be handling your own finances. Marry well, friend, and allow the significant other to handle the checkbook.

Massive debt creates the siege mentality that permeates the medical field. Considering median income in the US is like $40k I'm sure you could find a way to handle 4x that much. But to each his own I guess.

We simply do not make as much money as people believe, and the ignorance on how our incomes are realized permeates our own ranks very deeply.

People believe doctors make a lot of money. People are right, doctors do make a lot of money. Considering there are 800k or so physicians, and that the average income for all of them is well over $100k, it's fair to say they make a lot of money. Is it enough considering how insanely expensive medical school is? Or is it enough compensation for the 20s we are all forced to give up? Or is it enough considering we all have buddies from college making $70k right now while we toil away in four more years of school and then 4+ more years of residency at negative income? Not really, for quite some time. That's why if you eliminate that whole debt issue $150k starts to sound a lot more fair. A lot of people will be bitter about their lost 20s or lost income years no matter what their future salary will be.

If you think the government is going to pass a retroactive loan repayment for all of us who are already in medical school at the same time they want to drop our salaries, you are indeed in never-never land my friend.

Of course that won't happen right now, no one really believes it will. However, it's what I would do as benevolent dictator, since what is actually going on in DC is just a bunch of worthless posturing to appease Wall Street.

 

[Dr Oops]

Massive debt creates the siege mentality that permeates the medical field. Considering median income in the US is like $40k I'm sure you could find a way to handle 4x that much. But to each his own I guess.

People believe doctors make a lot of money. People are right, doctors do make a lot of money. Considering there are 800k or so physicians, and that the average income for all of them is well over $100k, it's fair to say they make a lot of money. Is it enough considering how insanely expensive medical school is? Or is it enough compensation for the 20s we are all forced to give up? Or is it enough considering we all have buddies from college making $70k right now while we toil away in four more years of school and then 4+ more years of residency at negative income? Not really, for quite some time. That's why if you eliminate that whole debt issue $150k starts to sound a lot more fair. A lot of people will be bitter about their lost 20s or lost income years no matter what their future salary will be.



Of course that won't happen right now, no one really believes it will. However, it's what I would do as benevolent dictator, since what is actually going on in DC is just a bunch of worthless posturing to appease Wall Street.

So the average athlete in the nfl makes well over a 1mill a year. Thats way more than the average american and way more than the average doctor.

You say all the reasons why the pay for physicians is high but then write them off without any reason. Its like why garbage men get paid so much, few would want to do the job otherwise.

explain to me why 8 years of trainning, actually 8 more years of trainning than the average american does not equal an increase in pay. Its not even economics its common sense. When you have a difficult path its more valued because not everyone can do it. That kind of value in our society = money, hence why everyone wants to be an athlete or a rockstar, but only few can ever pull it off.


you also understand that politicians in DC just cater to their own benefits by pandering to wall street, so what makes you think they will just magically do the right thing when it comes to healthcare?

 

[meister]

you also understand that politicians in DC just cater to their own benefits by pandering to wall street, so what makes you think they will just magically do the right thing when it comes to healthcare?

And this is really the bottom line which I can't emphasize enough: they will not magically do what I want. I am not sitting here arguing they are going to do anything I'm suggesting. They are not going to open up Medicare for anyone. They are not going to pay for medical education. They are not going to really try and tackle sky-rocketing healthcare costs.

They are going to pass an individual mandate with federal subsidies for the "poor" and it will be a massive give-away to Wall Street. Hence the insurance company stock prices rallying this past week. Obama's plan is exactly the same as Clinton's original plan and is nearly identical to Romneycare in MA. And it's precisely what McCain would have done. THEY ARE THE SAME GODDAMN PARTY.

The GOP and the dems are both too busy sucking off monied interests to give two sh*ts about the average American. The real debate we should be having is whether or not we should murder private insurers and whether or not we should provide government administered healthcare to all or whether we should just enact HEAVY regulation of nonprofit entitites and ensure 100% coverage.

 

[MOHS_01]

And this is really the bottom line which I can't emphasize enough: they will not magically do what I want. I am not sitting here arguing they are going to do anything I'm suggesting. They are not going to open up Medicare for anyone. They are not going to pay for medical education. They are not going to really try and tackle sky-rocketing healthcare costs.

They are going to pass an individual mandate with federal subsidies for the "poor" and it will be a massive give-away to Wall Street. Hence the insurance company stock prices rallying this past week. Obama's plan is exactly the same as Clinton's original plan and is nearly identical to Romneycare in MA. And it's precisely what McCain would have done. THEY ARE THE SAME GODDAMN PARTY.

The GOP and the dems are both too busy sucking off monied interests to give two sh*ts about the average American. The real debate we should be having is whether or not we should murder private insurers and whether or not we should provide government administered healthcare to all or whether we should just enact HEAVY regulation of nonprofit entitites and ensure 100% coverage.

Holy ****, I believe that he does get it. Their goal is to execute private insurers and then "trigger" the public option by default. Voila!!! Defacto single payer system -- without it ever being discussed as an option in public forums for debate.

 

[meister]

Holy ****, I believe that he does get it. Their goal is to execute private insurers and then "trigger" the public option by default. Voila!!! Defacto single payer system -- without it ever being discussed as an option in public forums for debate.

This is hyperbole and will not happen. If the plan that gets signed by Obama has a public option predicated on a trigger mechanism, it will never happen.

Triggers are designed to fail, and there will be thousands of highly compensated attorneys descending on DC from Wall Street the day that bill gets passed to determine just how much private insurers have to do to maintain their bloated, unnecessary, ugly game of f*cking over low and middle class America.

F*ck Wall Street and f*ck DC, this is the worst display of cowardice and naked greed in the public discourse in decades.

 

[chessknt]

Welcome to the USA, where each generation becomes markedly more ****ed up than the previous.