patrick.net

Having worked in many different types of systems, pure HMO, VA, private medical group, public hospital, it's very interesting how distorted and how much misinformation there is out there in the media about the various types of systems.

My feeling that is that the most cost effective system would be the VA system. Having said this, there some things that I hear that I think is more spin than reality. It's often quoted that the VA system has very high rates of satisfaction. I think this is very true. Veterans are by far the most appreciative patients that I have ever treated. If not for the very very low pay at VAs and my need to pay off $240K in loans, I would love to work at a VA. I doubt that if you took a bunch of Dot.com professionals(who tend to be very demanding) and Stanford professors(who are even more demanding) that they would appreciate the care they get at a VA. There are VERY long waits for everything. I once ordered a sleep study on a patient who almost certainly had sleep apnea. It was contributing to his obesity(which was contributing to his sleep apnea) causing worsening diabetes and hypertension. The first available sleep study was 18 months away!!! (In a private clinic, it can be done in less than a week). By the time of his sleep study, he forgot and missed his appointment. I called begging the sleep specialist to get him in sooner, and he got scheduled for 6 months. I can tell you story after story like this. Another drawback of the VA is that they have very poor ancillary services. Most VAs are fortunately staffed by medical residents who end up drawing blood, putting in IVs, sometimes administering meds, wheeling patients around the hospital. In almost all private hospitals, these are done by medical assistants and techs. VAs very strictly limit the amount and types of meds that are allowed to be prescribed. Also, because of the low pay, they also tend to be staffed by foreign medical doctors and since they are not well funded, the buildings tend to be older and more run down. But despite all of this, the VA hospitals do follow evidenced based medicine well, there is a reasonable amount of clinical research done, and considering their limited resources, do provide quality care. (Simpsons fans may disagree if they remember the episode where Monty Burns is shot and pronounced dead at a VA, then is taken to a "better hospital" and is pronounced alive.)

...and yet, there you are justifying why the govt should pay your car insurance.

I hope for you that your life continues on its perfect keel - that you never need to learn the horrors of pre-existing conditions, unemployment, and financial devastation. I hope for you that your attitude never needs to change because of personal tragedy - only that it changes because you gain compassion and understanding for others.

elliemae,

I am well aware of the "donut holes" as I often save up my samples this time of the year to provide these patients.

Medicare has many faults such as paying waaaay to much for procedures(the reimbursement systems was initially set up by an anesthesiologist who obviously valued procedures over things such as prevention and office visits) and next to nothing for office visits.

I guess this is my fear with a single payer system. Some individual or individuals, who likely hasn't or isn't practicing, will inevitably set the rules and decide what is allowed and not allowed.

To the supporters of Obamacare:

Is it too much to ask that I be exempted from the benefits and payments for the Obamacare plan? If you want to be a part of it then how about a special social security type tax just for those who want it and let the rest of us keep what we got. That sounds fair to me, anything else is wealth redistribution (also known as theft).

The insurance companies are a big problem but our elected leaders have been living off of the campaign donations of these corporations since at least the Nixon years, this new plan is not going to change that, it is just going to change which companies make more money.

So how about it, at least give us all a choice not to be a part of it.

cab said:
"It makes a world of difference to people which is why older Europeans often look so incredibly healthy."

I think the reason why Europeans often look so healthy is that they don't eat Krispy Cream every day, drive a block to go to work, and sit around watching TV all weekend like most Americans(including myself).

Yes, I’ve descended to their level. I’m a bit ashamed of the f-word, but otherwise at a loss for how to express just how stupid medical reform opponents are being. They seem perfectly willing to cut their own throats just to express their displeasure with:
1. Having lost the election.

2. Having lost the election to a black man.

3. Having lost the election to a black man who is ten times smarter than Bush.

You just brought race into it.

I've followed you for years expecting more and getting more from you. Sure I don't offer anything in return... but now that you've shown your colors, I'm deleting your bookmark and walking away shaking my head at someone I thought could offer logic and reason without race emotions.

2ndClassCitizen,

that's not a bad idea. Can I do that with other things like choosing not to have my taxes go towards paying for a statue of some obscure politician in Alabama, roads to nowhere, or bailing out AIG and Goldman Sachs? I'd be all for that.

DT:
I agree that a single payer system may have its faults. But it will be better than our current system, where people must go to the ER for anything if they lack insurance - and become critically ill before receive treatment. Any system should focus on prevention and ongoing care, rather than expensive procedures.

The VA works in the bigger cities, but sucks in rural areas without clinics. People must travel hundreds of miles to receive treatments otherwise available in their area. And medications can be hard to obtain - if a Vet is discharged from a non-VA hospital he must have his scripts rewritten by a VA doc in order to receive them.

We see many things the same - but I see Seniors on a daily basis who are sick because they can't afford their medications and/or the cost of medical expenses. It's a shame when people must choose between keeping their home or receiving medical care - by this I mean that in order to qualify for Medicaid (even short term) a patient's income is used as a deductible. The patient can't afford to maintain his apartment or home if everything he earns goes to the facility and has no savings - so he ends up staying in a nursing home long term. He no longer has a home to go to. What an asinine system.

Is it too much to ask that I be exempted from the benefits and payments for the Obamacare plan? If you want to be a part of it then how about a special social security type tax just for those who want it and let the rest of us keep what we got.

This is a pinhole point of view, and it also assumes that what insurance you got now is the same type of coverage you will always enjoy. It isn't.

Would you feel the same way about road repairs if you only drove once a month or not at all? Do you feel that way about the Fire Department, even though you've maybe never had a residence catch fire?

That sounds fair to me, anything else is wealth redistribution (also known as theft).

Wealth redistribution aka theft...kinda like Trickle Down Economics.

Must see this!

http://www.thedailyshow.com/watch/mon-august-10-2009/healther-skelter---obama-death-panel-debate

DT says

2ndClassCitizen,
that’s not a bad idea. Can I do that with other things like choosing not to have my taxes go towards paying for a statue of some obscure politician in Alabama, roads to nowhere, or bailing out AIG and Goldman Sachs? I’d be all for that.

We didn't pay for the road/bridge to nowhere. It didn't happen. The great state of Alaska just kept my (and your) money 'cause they could.

The problem with opting out is, when a person needs the medical coverage, he will expect that it is available to him and expect to receive the same treatment as though he had paid in. After all, he shouldn't be treated like a second class citizen...

Austinhousingbubble,

I take it your answer is yes. It is too much to ask that I keep what I have.

Just send your money and mine to Washington and everything will be OK.

Sounds like a pinhole point of view to me.

ellimae,

Go ahead treat me like my name says. I'm starting to get used to it. In fact that dog pictured on your postings probably gets more respect than most libertarians these days.

elliemae,

for the VA system to work, there would definitely need to be outreach clinics in rural areas. I had a patient who had to drive 200 miles to see me. Fortunately, he had a daughter in our area who he could stay with.

I think the single payer system(unless it's a single payer HMO system) would be a bit more advantageous for providers and probably for patients a well, but many countries that have single payer do eventually run into some cost issues since there is less rationing than in a system like the VA. The waits would definitely be less in a single payer system than in a system like the VA.

A simple google search shows that for my bracket, I pay 25% income taxes in the US. If I lived in Canada, I'd pay 22% and get this, they don't tax gifts, inheritances or lottery winners!

We spend too much on war and "homeland security." Why don't terrorists bomb Canada? The money is there and I'd much rather see it spent on an alternative health care method.

I find it ironic there's a Kaiser ad by google below....

Constitutionalist says

elliemae says

…and yet, there you are justifying why the govt should pay your car insurance.
I hope for you that your life continues on its perfect keel - that you never need to learn the horrors of pre-existing conditions, unemployment, and financial devastation. I hope for you that your attitude never needs to change because of personal tragedy - only that it changes because you gain compassion and understanding for others.

The car insurance analogy was meant to illustrate the absurd claim that anyone without health insurance will die. We are ALL going to die regardless. Sorry it went over your head, which was evident in your highly articulate reply to “take the fucking bus”.

Yes, we will all die someday, but your analogy was nonsensical and didn't apply - it certainly didn't go over my head. And thank you for pointing out that I'm highly articulate, I appreciate that you're one of my fans. However, I actually replied that you should take the fucking bus. I didn't reply to my own comment.

jessica said:

"Why don’t terrorists bomb Canada? "

Because there's nothing to bomb in Canada. Have you ever been there? There's nothing there. Just snow and ice.

It's pretty stunning just how much disinformation and outright lying has been hitting the airwaves lately on this subject. One of the talking points seems to be that the Democrats are staging a "power grab" in which the government "takes over a large chunk of health care". Never mind that the government already pays for 60% of all U.S. healthcare through Medicare/Medicaid and other programs. 60% of 2.4 trillion is 1.44 trillion - which the government ALREADY pays each year. In the worst-case scenario, in which the additional 1 trillion in costs over 10 years is not reduced by any sort of savings, this would mean an additional one tenth of a trillion per year, or a mere 6.5% annual increase in government healthcare spending - to ensure 50 million more Americans.

THAT is the massive "power grab"? And don't forget, we're assuming NO savings under the plan. We're taking the Republican PR at face value and assume that full 1 trillion is added to the debt over the next 10 years. And STILL, we would be increasing healthcare expenditures by a mere 6.5%.

Now the idea is that a public plan would work to drive down costs through forcibly injecting competition into an increasingly monopolistic marketplace. And somehow this is perceived as "socialist".
What the vast majority of us don't realize is that we are completely uninsurable in the individual marketplace if we have had any medical issues at all in the last ten years, no matter how small (my agent's real life example is a family rejected by all insurers on the basis of a diaper rash diagnosis). So if your employer decides to stop paying for your health care or decides to give you money towards buying your own care, you are S.O.L.

I have group insurance, but still have to keep private insurance, since my group coverage tends to lapse now and then due to the vagaries of a labor contract. If I were to go to the doctor under my group plan, I would be uninsurable and forced to pay for COBRA (a whopping $750 a month to cover just me). When that expired in 12-18 months, I too would be S.O.L. Thus I pay for double coverage as per the advice of every agent I have spoken with.

People who have employer coverage are simply shielded - for now - from how bad things are getting. The reason they are shielded? Big, bad government intervention (and massive tax subsidies). The government mandates that nobody be denied employer-based coverage. They simply have chosen not to do so for those with individual plans, in effect throwing the self employed and many small business owners under the bus first.

But make no mistake, that bus is gunning for us all, and with healthcare costs going up 17% a year, it is only a matter of time before employers can no longer foot the costs, and the rest of us are S.O.L. as well.

DT:
In order for a single-payer system to work, they need to get all of us in the room. US, the ones on the front lines who are providing the care or helping people to navigate the system. Almost every MD I've ever met has expressed frustration at the system, as do pharmacists, nurses, social workers, etc. It's the bean counters and profiteers that screw the whole thing up.

srla,

If health care costs are going up, they will reach a limit where no one can pay. At that point they will either level off or come down. Prices cannot go up indefinitely, that is what this housing bubble website is all about!!!!! See the connection??????????????? Should we subsidize housing to bring the cost down?

If you think that subsidizing housing is ridiculous, health care is even worse. Are you listening Patrick?

2ndClassCitizen,

I don't think Obama stated that the public plan would be subsidized. I think he hopes that it would be sustained with what is put in by subscribers.

But I do understand the fears of those who believe that it is a slippery slope and that once enough people have signed up and if it starts to lose money, the government may end up subsidizing it like they did for Fannie and Freddie.

Instead of a government option, the government could just mandate that all insurance companies must be non-profit(no shareholders), that it not spend more than what Medicare spends on administrative costs, etc. and in effect get the same thing. This is similar to healthcare cooperatives that have formed in some parts of the country. But considering how heavily the insurance industry funds the campaigns of some of the major players in the healthcare debate, that is very unlikely to happen.

Constitutionalist says

Yes, we will all die someday, but your analogy was nonsensical and didn’t apply - it certainly didn’t go over my head. And thank you for pointing out that I’m highly articulate, I appreciate that you’re one of my fans. However, I actually replied that you should take the fucking bus. I didn’t reply to my own comment.

No worries. Your HealthScare Reform is dying on the vine … I will be back to gloat once it meets with resounding defeat in October. See you then

Aww, don't go away mad. Just go away.

This is a serious issue that provokes serious thought. That you would gloat if our healthcare system overhaul fails is disturbing - the current system is a failure. That is, unless you're heavily invested in insurance companies (their profits continue to soar).

DT,

I am not sure what you mean. If the public plan is not subsidized by taxpayers then who will pay for it? The federal reserve!!??

Let's make no mistake about it. The government has inflated (with plans like Medicare and tax exemptions for corporations who buy health insurance for employees) and is proposing we continue to inflate the health care bubble.

Patrick, I'm sorry to hear about your parents. I can't comprehend what that must have been like for you. I need clarification regarding your post. You say that the insurance system is what is killing people and that a government system would be better. You mentioned that your parents were on Medicare. Is that not the government system? As for the Americans flying to India for treatment, I don’t know the statistics but I’m pretty sure those are elective treatments (plastic surgery). The U.S. may not have the best system for the payment of health care but I know we have the best quality of care. Many people come to the U.S. when they can’t get the care they need from their health care system (Canada, UK).

>>>>"srla,
If health care costs are going up, they will reach a limit where no one can pay. At that point they will either level off or come down. Prices cannot go up indefinitely, that is what this housing bubble website is all about!!!!! See the connection??????????????? Should we subsidize housing to bring the cost down? "

In response to that last quote...

This assumes that normal market rules apply to healthcare, which they don't (quite a bit of research has been done that shows this is true). Subsidies themselves will not DIRECTLY bring down healthcare costs. But until everyone is insured, we will continue to pay massive costs, both financial and humanitarian, quite simply because we are not utter savages and do not turn away those in need of urgent medical care.
So we have 50 million people for whom we pay nothing until they are bankrupt and dying from a lack of preventative care and treatment. Then, once they are severely ill, we foot the bill. Is this really acceptable to you?

Healthcare costs are skyrocketing not because of free market forces but because of intensive lobbying efforts to keep competition OUT of the healthcare marketplace. Well qualified foreign doctors are prevented from entering the country. Pharmaceutical companies are granted 15 year monopolies on new drugs. Medicare is prohibited from using its buying power to negotiate lower drug prices. And it often costs upward of $300 just to sit down with a specialist, let alone to get a "price quote" or competitive diagnosis.
The only way to lower prices (short of your solution to simply wait until nobody can afford care, and presumably, millions die needlessly) is to forcibly inject competition into the marketplace (the hope of a public plan) or to simply convert to a single payer insurance plan like Canada's.

Of course, we ignore that Canadians overwhelmingly support their system, pay 60% of what we do per person, and have a longer lifespan, and instead we concentrate on decade-old rumors of long waits for hip replacements and a single story about a woman who claims she couldn't get proper treatment for a brain tumor. Why rely on actual surveys and statistics when we have lies, exaggerations, and one single story?

By the way, Canada set those "benchmarks" for wait times during the mid-'90s, when a recession led to steep cuts in healthcare. Due to public outcry (and a Supreme Court decision), they poured hundreds of billions into the system and cut the wait times way down. And still, they pay more than 1/3 less than we do. If you want to know their wait times, they publish them on provincial government sites. Unlike here, they are transparent about their healthcare system, honest about its shortcomings, and dedicated to making improvements that impact all their citizens. Too bad the richest country on Earth can't do the same.
More facts and less fearmongering would go a long way towards improving the level of dialogue.

Has anyone checked out Singapore's healthcare system?
In Singapore, the government has everyone working contribute to a fund (compulsory personal saving) called the Central Provident Fund (CPF). This fund is basically used for one's retirement and for buying a home. People are allowed to use this fund to buy basic healthcare plans for themselves & their children too.
The government allows her citizens and all who has contributions to this compulsory savings/CPF Fund to buy insurance from private providers. It is used for basic healthcare needs (no hair transplant, breast augmentation, etc). There are many options provided by the different insurers, thus cost is lower... and best benefits suffice! Also, there is the option of co-payment or none...
At the Singapore's govt hospital level, there are three classes of wards.. and one can go to any based on their affordability:
(a) BASIC Subsidised (no air-con, no TV, 6 beds thus 6 patients in one room, cannot choose your MD to treat you)... cost very low... cost can be offset by the BASIC level healthcare plan you bought (may not completely offset cost - really depends on the plan you have bought...)
(b) MIDDLE (air-con, 4 beds in 1 room, has personal TV, can choose MD to treat you)... cost slightly higher... cost can be offset (maybe not totally though) by the healthcare plan you have bought...
(c) First-class (air-con, 1 bed in each room... no sharing of room)... cost expensive... foreigners go to this class... cost can be offset (maybe not totally though) by healthcare plan you have bought...
Other than the healthcare plans one can buy using his/her CPF, one can also use part of his/her CPF to offset treatment costs that are approved by government. For eg, this year, the birthrate in Singapore is low and to encourage higher birthrate, the govt has approved the using of one's CPF for IVF (with certain $ limit though... and the govt further subsidized IVF treatments too, for approved cases, eg if you are under 40 years old)
If you are interested to read more, search under "CPF", "Medishield", "Medisave" in Singapore. Private insurers providing the plans are from AIA Singapore, Great Eastern Singapore, NTUC Singapore, etc., just to name a few...
I guess what I like is the all-facet healthcare plan involved: the government ensures the poorer individuals has the option of going to the subsdized ward with lesser amenities of course, yet there are also many different choices/options available for the individuals (can choose different healthcare plans... can choose the class of ward you want if you can afford & are willing to pay for it)
Note: I am a Singaporean who has lived in Singapore for 34 years before moving to the States. From my experiences as a RN in both countries, I can say I like Singapore's system better. Also, I think Singapore's healthcare system has worked very well for Singaporeans :)
A few questions/concerns I have of Obama's proposed Health Care Reform Bill:
(1) May I suggest that all of us read the 1000+ pages of the Bill before making the comments here?
(2) We cannot take the chance of having a good-intentioned but with-little-specifics-and-too-much-generalization bill take over our healthcare system... see what our taking the chance with the FED cum the Treasury has done to us & the economy?
(3) I think the problems we experienced in our healthcare system is not just a result of the kind of system we have... it is also the result of the kind of leadership we have... abuse and neglect have ruined our country, despite our greatly-admired Constitution... what makes us so sure our politicians or won't ruin a good thing with greed even if the reform is a good thing? Even if we don't trust the private health insurance providers, do we really trust our politicians?
THUS, it is EXTREMELY IMPORTANT that we make sure our politicians come up with a CLEAR bill before we decide to approve it. I am not against such bill... I am against UNCLEAR bill, which incidently is also how our politicians are able to greedily abuse & take advantage of us for so long.
I love USA (my husband is a citizen of USA) and I want the best for all of us! :)

Australia has all kinds of problems with its health care system, but I look at what my US friends have to deal with and there's simply no comparison. You guys have one totally f**ked up health system. I don't know whether Obama's plans are any good, but you really need to do something, so I can't believe there are people opposing any and all attempts to improve things.

Let us all who love America refrain from making comments that are a little too "emotional", what do you think? Let's all carry this "conversation" civilly and concentrate on the issue. Let's give thought-provoking comments, without the raised "voice" if you will, please. Thank you very much in advance :)

srla,

If "normal market rules" do not apply to health care, please explain what rules have got into this mess.

If you are honest in your search for the answer you will find it was government who inflated this health care bubble by driving up costs through the fee for service programs like Medicare and offering tax exemptions for employers to purchase health insurance, but not offering those same tax exemptions to the consumers who alone are capable bringing accountability to the pricing situation in health care.

Say it with me now, health care is a bubble. The government created it and now wants to blow it up bigger. Anybody got a pin?

Australia has all kinds of problems with its health care system, but I look at what my US friends have to deal with and there’s simply no comparison. You guys have one totally f**ked up health system. I don’t know whether Obama’s plans are any good, but you really need to do something, so I can’t believe there are people opposing any and all attempts to improve things.

It's called one or two vested interests very thinly disguised as furious opponents of Socialized health care.

To be fair, there are a lot of good arguments for not being excited by a government run health care plan; any trip to the DMV or through the TSA line at the airport is enough to give anyone at least some misgivings. I'm also not a fan of this newly kindled dependence on government largess, but I wonder where the sound & fury was over the expanded taxpayer backed FHA mortgage plan or HOPE, or PPIP, or Cash for Clunkers or any of the other absurd boondoggles. No, this is a touchy subject because, first and foremost, insurance agencies/pharmaceutical companies are making cash hand-over-fist with the way things are now, and they will defend their very lucrative business model to the end. I wouldn't expect any less.

10 x 0 = ?

2ndClassCitizen says

srla,
If health care costs are going up, they will reach a limit where no one can pay. At that point they will either level off or come down. Prices cannot go up indefinitely, that is what this housing bubble website is all about!!!!! See the connection??????????????? Should we subsidize housing to bring the cost down?
If you think that subsidizing housing is ridiculous, health care is even worse. Are you listening Patrick?

the problem is that below the upper limit where 100% of people cannot pay, you have the limit where 90% of the population cannot pay. insurance cos can keep going on the profit from 10% of the population while 90% continue with no insurance. not a good model, at least for this member of society

and yes, i think that subsidized housing to keep costs down is GREAT; subsidized homeownership is terrible. but the myriad federal, state, and local programs that subsidize housing for renters are great programs

I don't understand Medicare/Medicaid very well. At first, my parents had huge medical expenses (my mother was still working and not on Medicaid when she got sick) and ended up with no money and a second mortgage on their house, in spite of paying a large fraction of their small income for private "insurance" that didn't seem to cover anything. My mom owned a small travel agency, so it was not any employer-sponsored plan. I remember my dad telling me about a medicine that was $20 per pill and not covered by his Medicare, which meant my siblings and I were paying their living expenses so he could pay for drugs.

On the other hand, when they really had nothing, my mom had a brain surgery that must have cost a huge amount of money, but we never saw the bill. Must have been covered by Medicaid.

taunger says

If you think that subsidizing housing is ridiculous, health care is even worse. Are you listening Patrick?

The idea as I understand it is not a subsidy, just a national insurance plan that would be funded by ongoing contributions. Yes, some people would get more out of it than others, but insurance is like that now anyway.

I am guessing not one of you (and not one American in 100) know the historical origin of our present "healthcare system" and can accurately identify why it is that "costs" have been rising at an unsustainable pace for decades. There is not a tennis ball cost crisis. Food prices aren't spiralling out of control. Flat screen TVs, cars, gasoline, computers, auto insurance, boat insurance, apartment insurance, etc... As usual, it is Government intervention within the private markets which distort individual incentives/actions and create unsustainable situations. Even worse, the Government has fomented this unsustainability because it is useful to them and creates pressure to "socialize" the system.

A perspective on one piece of the puzzle:

http://theaffordablemortgagedepression.com/2009/07/28/common-sense-solutions-to-the-us-healthcare-problem-part-i-a-tragic-mistake-of-history.aspx

Patrick,

Very sad to hear about your parents.

As a life long Republican (until I found Ron Paul), it saddens me to see how misinformed current Republicans are about our healthcare systems. It's very similiar to the doomsday global warming threat the Democrats soaked up. Neither topic has or is being openly debated the way they both deserve.

But I must agree that a universal plan is needed. However our current government implementing this plan scares the hell out of me. The very first question that must be asked is how are we going to pay for it? Were broke!

If future entitlements are almost $50 Trillion just for a minority of the population, what will it be for all? With the illusion of it being free, everyone will eventually sign up.

The real debate needs to be the size and responsabilities of a (our) government. A true President would address this first. We havent had a true President in a long long time. Obama is as much of a puppet as any of them. Am I wrong? Afghanistan........... Does moving our troops from Iraq to Afghanistan really make a difference? The military industrial complex is so mighty, they still call those shots.

Our foreign policies suck!

Our monetary policies suck!

The Fed sucks!

Bought politicians suck!

The sooner Americans as a whole learn that they are being played, devided, manipulated and coerced, the sooner we as a nation will wake up and hold our politicians accountable. Only then, will we be able to have open discussions about how to truly do what is best for all of us (healthcare, trade, war, money).

I welcome any new discussion board, forum or topic jsut so we can actually have these conversations.

Thanks again for this great site Patrick,

Tim

It kills me that free market advocates claim the private health care system is so great when we have had 20% year over year increases in per payer costs. The worst government systems have never been that bad.

No rational human can really believe that it costs $12,000/day to stay in a middle of the road hospital - that two asprin should cost $150.00 It is hard to believe that a government system could be any worse

srla says:
"More facts and less fearmongering would go a long way towards improving the level of dialogue."

Other people mention fearmongering not being an effective method for spirited discourse, and still others ask why some of us are against improving a broken system. There's one simple answer: NIMBY.

NOT IN MY BACKYARD. We should help the poor, give them housing opportunities. But not in my backyard. We should feed people without food, but not in my backyard. We should offer healthcare options for people, but not in my backyard. I'm doing just fine, don't need those poor people driving down my property values or clogging up the sidewalks begging for food.

The people who are against this plan don't have a problem with healthcare, have jobs that offer several options to them and can afford their medications. They don't understand that healthcare is already rationed and denied on a regular basis, and that those denials translate into millions in bonuses for insurance company CEO's. One catastrophic illness and they'd change their tunes - and I hope they never are forced to do so - but until then they can't relate with the masses. Medicare & Medicaid aren't available to everyone, death often occurs before the patient is eligible.

We have doctors paying huge malpractice insurance premiums, not only because there are out of control court proceedings but also because a few (a very few) physicians are allowed to continue practicing even tho they're incompetent. Drug companies ply them with free medications, which thankfully they are able to give to patients who can't afford their medications. These are patients with insurance who haven't met their deductibles or co-pays.

We have companies that deny benefits and receive bonuses for it. We have people without insurance who must choose between healthcare and food/clothing/shelter. This isn't fearmongering - we do have people who are able to afford their healthcare and those who work for companies that "take care" of them and offer affordable healthcare.

But our country is in a financial crisis. People are losing jobs at an alarming rate and even tho COBRA payments are subsidized they still can't afford the 40% of more than $500 per month. We have companies who manipulate the system to gain as many patients as possible (see my article on hospice high pressure marketing tactics on the nursing home page)... Yea, we have problems now, and will continue to do so even if we overhaul our healthcare system.

But it's not a lib v. conservative thing. It's not a dem v. republican thing. It's a human thing. People are afraid of change, and I get that. But healthcare should not be an option. In our current system, people often don't receive ongoing preventative care and become sicker in their later years. Costs would surely decrease if we were providing adequate care for all and not treating throwing procedures at the sickest at the very end.

If Physicians and Nurses and Social Workers and Pharmacists and xray techs ran the system, everyone would receive care and costs would decrease. Profits would also decrease - we'd all make a living but those poor CEO's would have to find somone else to fuck.

I also wanted to add:

I live in Utah, my wife is a school teacher with a great medical plan. On our second day here, I had to make a trip to the ER. Un-flippin beleivable! in a good way. I was in and out in 30 minutes, including my prescription. It gets better. How about two follow calls from the Dr. directly!

With two small children, we have had our fair share of sickness and broken bones. All were met with the same kind of efficiency and compassion.

I truly believe that because Utah being such a proud community driven place, their motives of being in the medical profession are driven more than by a paycheck.

As a child, we had Kaiser. For 90% of ones needs, it was great. A possible model of a universal system. As an adult, I/we have had many different types. Most offered total care with co-pays or percentages. We definately had issues with Dr. choice & billling, but never with care.

I think a middle ground can be achieved here. A social/universal basic care with a supplimental insurance for major medical. Where the line is drawn, could only be settled upon by open discussion.

So turn off your MSNBC & FOX and start thinking for yourself America!