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  #1  
Old July 19th, 2009, 5:43 pm
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Health Care Politics

Health care reform is one of the most dominant political topics in the United States right now. In an effort to consolidate debate over the issue, we've closed two previously existing health care threads and we're also asking that discussion of US healthcare reform be moved from the Congress and Obama threads into this thread. We may add a poll to this thread at some point, but with the large variety of plans currently on the table a poll would likely be "out-of-date" rapidly.

1. What is your impression of the state of the health care system in the United States?

2. Do you think the United States could do better?

3. What countries do you think the United States may be able to look to for inspiration or lessons, good or bad? If you are covered under such systems, what are the positives and negatives of your country's system?

4. What do you think the cost of health care reform will be? Are you willing to pay the cost? If so, what costs are you willing to pay? If not, why not?

5. Any other thoughts?

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  #2  
Old July 19th, 2009, 6:04 pm
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Re: Health Care Politics

1. What is your impression of the state of the health care system in the United States?

Having not been a victim I can't recount personal experience but my brother while in the States dislocated a shoulder while on holiday. After his insurance was verified the surgeon proceeded to make matters worse by shattering the ball of his humerus before he was discharged.

Days later he fell on the ice and broke his leg. Given the option by his insurer he chose to fly home and have his leg treated (and shoulder repaired) for free in an Australian hospital.

2. Do you think the United States could do better?

Certainly do.

3. What countries do you think the United States may be able to look to for inspiration or lessons, good or bad? If you are covered under such systems, what are the positives and negatives of your country's system?

Having only experienced Australia's system I'd say it's a good one to try and emulate.

While imperfect, it allows me to see the GP of my choice free of charge (were I in full-time employment the cost would be nominal) and after a fall which left me paralysed I received treatment from a world expert in spinal cord injury and rehab as well as the equipment necessary to live independently.


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  #3  
Old July 20th, 2009, 2:56 am
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Re: Health Care Politics

1. What is your impression of the state of the health care system in the United States?

Embarrassingly inadequate.

2. Do you think the United States could do better?

I do.

4. What do you think the cost of health care reform will be? Are you willing to pay the cost? If so, what costs are you willing to pay? If not, why not?

Whatever it takes. I've had a eight-year ride compliments of George Bush. It's now time for my family and others in our tax bracket to pay the piper.

Following is the five-page memo from 1993, in which William Kristol advised congressional Republicans to do whatever it took to kill the Clinton health care reform bill. Not because the policy proposal was a bad idea; but because passage of the bill would help the Democratic Party for years to come. The GOP, he said, for the sake of its own future, couldn't compromise or negotiate.

Kristol Letter, 1993:    


  







  



Here we are sixteen years later, still trying to persuade self-serving GOPers and, believe it or not, a few recalcitrant blue dog Democrats to get with the program already! Matt Ygelsias notes:

YgelsiasIn 1993, we had a new president elected on a promise of providing access to high-quality affordable health care to all Americans. In 1994, that promise went down in flames. The result of that failure was not only substantively bad, but politically disastrous for Democrats. Now it's 2009 and we have a new president elected on a promise of providing access to high-quality affordable health care for all Americans. It's pretty clear that Republicans remember that dealing a humiliating blow to said president by blocking reform will be politically useful to them.

And it's curious that many centrist Democrats -- particular those now eager to delay action on a bill and give special interests and the right more time to kill it -- don't seem to remember this.


It's fair to say this message has been gotten and understood. Organizing for America, the offshoot of the massive body of volunteers who once formed the grassroots group called Obama for America, is now targeting both House and Senate blue dogs with ads running in their home districts. Here's one:



Republicans don't want to reform the health care system and certainly don't want President Obama to be the president who finally delivers the overhaul Americans have been wanting for the last several decades. The GOP has every possible reason to see this initiative fail, we understand that. But we are not going to sit by and let members of the Democratic Party tank health care.

Ain't gonna happen - not without a whale of a fight.


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Last edited by purplehawk; July 20th, 2009 at 3:00 am.
  #4  
Old July 20th, 2009, 7:18 am
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Re: Health Care Politics

Every thing I hear and read about the US system makes me rejoice I don't live there. I know that if you're rich you can get world class treatment but for the ordinary run of people it seems very expensive and not at all certain (An American I used to know said that in his opinion the purpose of the US healthcare system was to ensure that you died bankrupt)

3. What countries do you think the United States may be able to look to for inspiration or lessons, good or bad? If you are covered under such systems, what are the positives and negatives of your country's system?

Don't copy the sort of heavily centralised and politicised system we have in Britain. Physicians' clinical judgements are debated in the papers and the anti-government part of the press highlight every failing. This means that whilst people are very satisfied with their own treatment they think the system as a whole is on the verge of collapse.

It is interesting to me that all political parties here now support the NHS (though I am not sure about the honesty of the Tories on this - they starved the system of funds last time they were in power and were clearly trying to destroy it)


  #5  
Old July 20th, 2009, 7:33 am
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Re: Health Care Politics

Quote:
Originally Posted by Mundungus Fletc View Post
It is interesting to me that all political parties here now support the NHS (though I am not sure about the honesty of the Tories on this - they starved the system of funds last time they were in power and were clearly trying to destroy it)
Like in Australia the Conservatives realise that a policy of active destruction of the NHS would be political suicide despite their ideological position. Far better to kill it by neglect.


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  #6  
Old July 20th, 2009, 12:10 pm
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Re: Health Care Politics

Does "Tory" roughly tot up to "Republican?"


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  #7  
Old July 20th, 2009, 12:36 pm
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Re: Health Care Politics

Roughly. The party of the establishment but not quite as far to the right as the GOP.


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  #8  
Old July 20th, 2009, 1:30 pm
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Re: Health Care Politics

Most of you who know me, at least the COS me, know of my profession in healthcare, and my passion for issues revolving around it. In the past I have made no secret of my political views concerning the money-grubbing lawyers, bureaucrats and bean counters of healthcare, and how they have practically ruined healthcare in the United States. But, I shall rehash those sentiments now for the benefit of those who have not read my views.

I must admit that those same bean counters and bureaucrats, and, to some extent lawyers, were instrumental in bringing healthcare in the USA up to acceptable standards. For that, I am grateful. However, their time has come and long since gone in the traditional sense. Yes, we will continuously have need for all three of them in the future of healthcare, but they will need to take a new path. A path that no longer revolves around greed and covering their keisters.

Healthcare in the USA is on the ropes. Lawyers are mostly to blame, along with politicians who refuse to do anything to reign the lawyers in. If healthcare is to survive and be a right for all taxpayers, then the very first step must be tort reform. We must protect our doctors, hospitals, pharamcuitical companies, and medical device manufacturers. I am not in favor of an outright ban on lawsuits against them, but the cases in which suit may be brought, and the monetary amounts that can be awarded must be strongly curtailed.

Today, the average Ob-Gyn pays over $250,000.00 in malpractice premiums. Far too many patients disregard their advice, continue to smoke, use alcohol, drugs, partake of poor diets and poor prenatal care practices, then turn around and sue their doctors when the child is born with birth defects, or something goes wrong unexpectedly. Doctors are healers, who must make tough choices, but are far too often second-guessed by lawyers, who act as armchair quarterbacks. And it isn't just Ob-Gyns, but most specialities.

Because of this, many Ob-Gyns are getting out of the field all together. Some are going overseas, some are dropping medicine completely, and fewer are electing to go to medical school in the first place. This leaves openings at top schools being filled with candidates using less selective methods. The net result being poorer clinicians.

Hospitals often bare the brunt of lawsuits too. They have deeper pockets, so the lawyers go after them. Even more so are the pharmacuitical and medical device manufacturers on the block.

The companies that make medical devices and pharmacuiticals take great financial risks to bring products to market, products that save more lives than without them. Nothing works perfectly for everyone, but if one user out of 10,000 dies, then a dozen lawyers start running ads to generate clients and a class action suit. To me, that is bonafide ambulance chasing, and unethical. The companies go to great lengths and the Food and Drug Administration provide great scrutiny before a product is approved. That doesn't mean things don't slip through the cracks. Occasionally they do. If a company knowingly puts a bad product on the market, then I have no sympathy for them. But, most of these lawyers don't care if it was intentional, only if the tree will bare fruit...meaning money in thier pockets.

By tort reform I propose that only malicious intent be grounds for a lawsuit. Yes, many have said, "But what about medical mistakes?" To this I reply "That is why what doctors do is called PRACTICE." Medicine is trial and error. Not every remedy for every known illness works the same on everyone. Some work better on certain people, and others don't work at all. And, unfortunately, some remedies have adverse affects. C'est la vie! Many lawsuits have been brought against doctors for simply following the standard of care, and that standard resulted in adverse reactions or, yes, death. Sorry, but that's life. Patients die. It sucks, but that's life.

The next thing that must be done is increased internal oversight of doctors and hospitals. To ensure good care we must have periodic and random peer reviews and Quality Assurance. If a physician is making too many mistakes, then the peer review board will have the power to suspend or revoke his or her medical license. The loss of one's license is just as strong an incentive to provide good care as the threat of lawsuits.

Once these problems are addressed, then the costs of healthcare in the USA will go down exponentially. Most costs come from huge insurance premiums for malpractice, and people skipping out on the check.

Yes, doctors need to make money to pay those huge school bills too. For this I recommend compulsory service in either the Military or some other governmental branch, or a charitable organization at the end of which their medical school bills will be paid for by Uncle Sam. Right now, the military vigorously recruits doctors, dangling the carrot of student loans being repaid. However, most doctors no longer feel the need to serve, because they have attained the training they desired. Once the student loans are taken care of, the physicians will see another reason not to charge so much. I know it is wishful thinking that doctors won't get greedy anyway...lol

Finally, the question of How to proceed in our government with National Socialized Medicine?

This is a tough one for me. I have seen good healthcare and bad healthcare around the world under National Healthcare Systems. The best way I can see moving forth is to have two choices: Private insurance coverage or Tax Paid coverage. We offer both, and the head of the household, or head taxpayer, chooses for the family. If they elect government run healthcare, then they pay additional taxes as their premiums. In exchange, they get complete healthcare including dental and vision, but must go to doctors that accept that kind of payment. Or, they choose private insurance, and go to hospitals and doctors that subscribe to those guidelines.

They are committed to their choice for the full tax year, and must submit notification prior to the beginning of the next tax year indicating which they will choose for the coming year. This notice is submitted in triplicate to the IRS, Department of Health And Human Services, and their state's department of public health. If they are on taxpayer coverage, they will be issued a card from their state indicating so. This card is good at any state's healthcare facilities. Private hospitals must only provide emergency stabilization and surgical care, afterward the patient is transported to a taxpayer hospital of their choice. Hospitals, doctors, and other providers may accept both forms if they subscribe to both.

I think it is a foregone conclusion that National Healthcare WILL be implemented during my child's generation. The gaps between rich and poor are widening too much for the old system to stand, without our country imploding.


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  #9  
Old July 20th, 2009, 1:50 pm
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Re: Health Care Politics

Bri - this is a great post - thanks for summarising your views and expertise for all of us.
I totally agree on the lawsuits. This is a scandal, and it is starting to come over here to Eurpe as wel, which I find very worrying. I think there are cases of serious professional misconduct, but these are very rare, and (even more rarely) cases of harm done maliciously. But these qare exceptions. I would go a bit further than you and include 'serious professional misconduct' (i.e. unacceptable incompetence) in the failings that can be prosecuted - or there has to be a professional body to monitor this. But facetious lawsuits have to stop, as do the astronomical payouts which positively invite the vultures in.



Concerning the financing system - I think it is right that some kind of mix of public and private, with a good deal of choice is a good way to go, especially for the US.

I am not sure whether I'd suggest a total either/or syste as you seem to do, simply because even in a big country expertise can be pooled better if public healthcare is accessible to all (while your system sounds as if you choose between one set of hospitals or another, but not both).

Here in the UK the whole thing is far too centralised, I agree with Mundungus, but I think it might be a good solution to have everyone signed up by default, but with the option to opt out completely (see below). All people who are in, pay taxes on the basis of their income. This would offer a good basic service (let's say UK NHS-level: sufficient, but without bells and whistles, but usually especially good if you have something chronic), and people could opt to pay for add-ons, either individually when they want extras in a particular situation, or to take out an 'add-on' insurance for such perks, which would obviously be a lot cheaper than normal full health insurance.

At the same time people wouldbe allowed to opt out completely and to arrange theiur own healthcare finance - in this case one would have to ensure that in case of illness they can use public institutions where that is the best option for their case (and their insurance would pay), or they could go to private institutions, of course, a choice not open for those who don't have private coverage.

I would make sure that no-one goes without coverage, so if you opt out, you have to prove that you have taken out full coverage privately.


That way, you can actually make sure that the public system can develop some centres of specialisation and excellence, especially for rare problems: the system as I'd suggest it makes it worthwhile to do so, because you could attract people to come and bring their insurance money, too, if you are good enough. I think that kind of incentive may be too weak if you have a strict division between public and private systems. The boundary has to be permeable, with money flowing across where necessary (in the UK the NHS sometimes pays private institutions to take on procedures to shorten waiting lists, so it works both ways).




This is obviously a very crude sort of idea - unlike Bri, I am no expert!


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Last edited by Klio; July 20th, 2009 at 1:57 pm.
  #10  
Old July 20th, 2009, 1:58 pm
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Re: Health Care Politics

Quote:
Originally Posted by Klio View Post
That way, you can actually make sure that the public system can develop some centres of specialisation and excellence, especially for rare problems: the system as I'd suggest it makes it worthwhile to do so, because you could attract people to come and bring their insurance money, too, if you are good enough. I think that kind of incentive may be too weak if you have a strict division between public and private systems. The boundary has to be permeable, with money flowing across where necessary (in the UK the NHS sometimes pays private institutions to take on procedures to shorten waiting lists, so it works both ways).
A good example of that is Great Ormond St Children's Hospital. (NHS funded but with a private wing) If I had a very sick child however much insurance I had that is where I would want them to go


  #11  
Old July 20th, 2009, 2:06 pm
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Re: Health Care Politics

Great post, Bri!

I'm of two minds on tort reform. The frivolous lawsuits are there, obviously, but so are perfectly acceptable claims against malpractice. The woman who sued McDonalds for her burns after she spilled coffee on herself is a pretty good example of stupid lawsuits; on the other hand, the physician who amputated the wrong leg of a diabetes patient deserved to be sued. One of my sons is a physician, so health care is a frequent topic of conversation in our family. He has scaled back his practice in recent years to focus on his teaching position at a major university hospital.

I'm delighted a public option is still on the table because the competition should bring the cost of private insurance down. I'm sorry the single-payer option isn't politically feasible right now. It would make things so much easier and coverage more accessible for those who need it. The marketplace feature President Obama spoke of in his weekly address is a good stop-gap in lieu of single-payer.


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All opinions expressed are my own and do not reflect those of any political or government body.
  #12  
Old July 20th, 2009, 2:07 pm
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Re: Health Care Politics

Sounds similar to St Vincent's in Sydney which has both private and public facilities and requires doctors to work in both parts so that patients receive equal treatments, but with different decor.


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  #13  
Old July 20th, 2009, 2:34 pm
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Re: Health Care Politics

1. What is your impression of the state of the health care system in the United States?

It's good, but could be much, much better.


2. Do you think the United States could do better?

Absolutely. Lack of cost oversight and fraud are, IMO, the two biggest problems and are why so many Americans are uninsured.


3. What countries do you think the United States may be able to look to for inspiration or lessons, good or bad? If you are covered under such systems, what are the positives and negatives of your country's system?

I am a firm believer that one can always take lessons from other bodies of work. But the solution to health care issues in America will require different thinking overall. I believe it must start with independent oversight of and control of costs by insurance companies, and the reduction of fraud and frivolous claims which raise the cost of good healthcare beyond the means of too many Americans.


4. What do you think the cost of health care reform will be? Are you willing to pay the cost? If so, what costs are you willing to pay? If not, why not?

If Obama has his way, a lot. Of course this is the socialist way...the masses pay for universal healthcare. That's un-American, and I am not willing to pay one cent until I see the cost-side of this problem brought under control. I already pay enough for Medicare and Medicaid.


5. Any other thoughts?

I sincerely hope the GOP and conservative Dems kick Obama's socialist heathcare agenda to the curb and propose a solution that makes sense and is in tune with the economic realities that face the government and ordinary people.


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Last edited by pensieve_master; July 20th, 2009 at 2:43 pm.
  #14  
Old July 20th, 2009, 3:35 pm
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Re: Health Care Politics

Quote:
Originally Posted by pensieve_master View Post
If Obama has his way, a lot. Of course this is the socialist way...the masses pay for universal healthcare. That's un-American, and I am not willing to pay one cent until I see the cost-side of this problem brought under control. I already pay enough for Medicare and Medicaid.
Bromides, cliches, and unfounded rumors...

Quote:
Originally Posted by rigdoctorbri View Post
I think it is a foregone conclusion that National Healthcare WILL be implemented during my child's generation. The gaps between rich and poor are widening too much for the old system to stand, without our country imploding.
Your post seems most telling of our system. I recall reading of the incredible wait-time in a Queens hospital.
Additional material:
Excellent article on the matter. Especially when you dive into other attached links

Cigna whistleblower "I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry."

We know what the problems are. But the big one is Congress' protectiveness of the insurance lobby.


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  #15  
Old July 20th, 2009, 3:56 pm
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Re: Health Care Politics

First off I will admit to being quite ignorant to the health care problems in other countries. Where I live in Canada, health care has never been an issue.

Here is a basic rundown:
In B.C., premiums are payable for MSP coverage and are based on family size and income. The monthly rates are:

$54 for one person
$96 for a family of two
$108 for a family of three or more

Assistance with the payment of premiums is available to Canadian citizens or holders of permanent resident status (landed immigrants) who have held that status and been resident in Canada for the past 12 consecutive months.

Regular premium assistance offers subsidies ranging from 20 to 100 per cent, based on an individual's net income (or a couple's combined net income) for the preceding tax year, less deductions for age, family size and disability. If the resulting amount referred to as "adjusted net income" is $28,000 or below, a subsidy is available.

The current adjusted net income thresholds are:
$20,000 - 100 percent subsidy
$22,000 - 80 percent subsidy
$24,000 - 60 percent subsidy
$26,000 - 40 percent subsidy
$28,000 - 20 percent subsidy

To verify eligibility, each person who applies for premium assistance authorizes the Canada Revenue Agency to release income information to the Ministry of Health and/or Health Insurance BC from the person's tax returns. Verification takes place each year and, where appropriate, MSP adjusts the monthly premium of beneficiaries upward or downward based on the information received

Included in our premiums is 'FairPharmacare'

Your family pays your full prescription costs until you reach a level known as your deductible (2% of you net annual income). Once you reach your deductible, PharmaCare begins assisting you with your eligible costs for the rest of the year.

British Columbians with the lowest incomes do not need to meet a deductible and receive immediate assistance.

PharmaCare will pay 70% of your family's eligible costs for the rest of the year after you reach your deductible and until you reach your family maximum (up to 4% of net income)

In addition, if your employer doesn't have a medical/ dental plan, extended medical and basic dental coverage can be purchased individually or as a group plan on top of basic medical. This extended coverage included Chiropractic, physio, etc (as well as prescription costs incurred before the pharmacare deductable is reached). The Dental covers up to 80% of basic coverage.
.


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  #16  
Old July 20th, 2009, 5:26 pm
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Re: Health Care Politics

Quote:
Originally Posted by Midnightsfire View Post
Bromides, cliches, and unfounded rumors...
I don't think so. I've read enough of the Obama plan. And so, apparently, has Congress...judging by the opposition that Obama is getting. The public sees it, too: Obama's Public Approval on Health Care Reform Slipping


Quote:
Originally Posted by Midnightsfire View Post
We know what the problems are. But the big one is Congress' protectiveness of the insurance lobby.
What? A Dem-controlled Congress protecting Big Insurance? Puh-leeese. IMO, we need a better plan than the one Obama is trying force upon us and our pocketbooks.


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Last edited by pensieve_master; July 20th, 2009 at 5:28 pm.
  #17  
Old July 20th, 2009, 6:08 pm
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Re: Health Care Politics

1. What is your impression of the state of the health care system in the United States?
My impression is that a lot of complicated policies and procedures are in place that make it difficult even for insured patients to reach their doctors and get specific care for their needs. Prescription drug policies are very complicated for patients because of people who abuse them. However, for an overall healthy person who takes care of themselves and have few healthcare needs, I believe the current system is functioning just fine.

2. Do you think the United States could do better?
Sure, there is always room for improvement. Not a complete change, but improvement in the areas that are not working. Removing the beauracracy within the system of healthcare workers, patients, and insurance companies will make care more accessible and less complicated and expensive to maintain.

3. What countries do you think the United States may be able to look to for inspiration or lessons, good or bad? If you are covered under such systems, what are the positives and negatives of your country's system?
Countries with universal or socialized healthcare may have a handful of positive things to say upon which we could build a program, but ultimately it goes against American values. Our system is based on being able to access your own healthcare system and take care of your own needs. Having a mandated system will require people to follow the fold and base their lives upon dictations from Washington DC. I don't think Americans are built that way and shouldn't have to live under the thumb of an overly powerful government. That is not to say that any country with this type of system has an overly powerful government, but I believe adding the control of healthcare to the already overflowing plate of the US government would be a huge mistake.

4. What do you think the cost of health care reform will be? Are you willing to pay the cost? If so, what costs are you willing to pay? If not, why not?
I think the burden of healthcare is mostly going to fall upon the middle class, many of whom are already at their limit and sometimes beyond taking care of their own needs. I fit into that category and no, I am not willing to pay more in order to insure someone else. I have worked hard to be in the place I am and I do not feel I should have to give parts of that up or pay more for what I do have to pay for someone who isn't in the same place. I believe that is fundamentally wrong in a free society.

5. Any other thoughts?
I believe there is too much focus on "fixing" things by completely overhauling them in a short period of time. This is all being pushed through too fast. Surely things in the healthcare system could be improved, but the solutions being proposed are not well thought out and are rather short-sighted. There are few checks and balances happening in our government right now and thus a rather one-sided plan is being shuffled through our system without the lawmakers or the people really knowing what's going on and what the details are. It's way too complicated to be considered a solution to an already complicated system.


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Old July 20th, 2009, 6:11 pm
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Re: Health Care Politics

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Originally Posted by pensieve_master View Post
If Obama has his way, a lot. Of course this is the socialist way...the masses pay for universal healthcare. That's un-American, and I am not willing to pay one cent until I see the cost-side of this problem brought under control. I already pay enough for Medicare and Medicaid.
Where were you six years ago when the second round of Bush's tax cuts were enacted with no way of recouping the loss of revenue? Or when we went to war in Iraq - a war that has been totally funded by money borrowed from the Chinese and Japanese?

One of the problems health care proponents are having is finding the right mix of funds to cover the program... something entirely new in Washington.


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Last edited by purplehawk; July 20th, 2009 at 10:21 pm.
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Old July 20th, 2009, 6:14 pm
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Re: Health Care Politics

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Originally Posted by pensieve_master View Post
3. What countries do you think the United States may be able to look to for inspiration or lessons, good or bad? If you are covered under such systems, what are the positives and negatives of your country's system?

I am a firm believer that one can always take lessons from other bodies of work. But the solution to health care issues in America will require different thinking overall. I believe it must start with independent oversight of and control of costs by insurance companies, and the reduction of fraud and frivolous claims which raise the cost of good healthcare beyond the means of too many Americans.


4. What do you think the cost of health care reform will be? Are you willing to pay the cost? If so, what costs are you willing to pay? If not, why not?

If Obama has his way, a lot. Of course this is the socialist way...the masses pay for universal healthcare. That's un-American, and I am not willing to pay one cent until I see the cost-side of this problem brought under control. I already pay enough for Medicare and Medicaid.
I agree with your sentiments about independent oversight. That would be a HUGE improvement to our system. Right now too many expensive issues fall through the cracks and innocent people are having to pay for it.

This is why I take issue with the "czars" being hired by the current administration. They answer to no one but the President, and this goes directly against our fundamental system of Checks and Balances.


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Old July 20th, 2009, 6:14 pm
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Re: Health Care Politics

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However, for an overall healthy person who takes care of themselves and have few healthcare needs, I believe the current system is functioning just fine.
And for a person who works from home LA's public transport system is perfect.

But healthcare isn't about serving the healthy and in less than a heartbeat a person can go from healthy to requiring intensive care.

Quote:
This is why I take issue with the "czars" being hired by the current administration. They answer to no one but the President, and this goes directly against our fundamental system of Checks and Balances.
Well you can blame Nixon for that one. He was the first president to appoint a czar.


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Last edited by Wab; July 20th, 2009 at 6:20 pm.
 
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