There is no wait for one where I live; same business week appointments. In fact, we have a private clinic that offers MRI and PET scans as well. When my second daughter was born 8 years ago, PET scans were not very commonly available due to the newness of the technology, but now there's a mobile unit that does a circuit of hospitals. Both of these situations would be "streamlined" out of existence if this BS is passed.

I just had an cardiac ultrasound and EKG within a day of seeing my general practitioner. To boot, it was not an emergency situation.

However, we are stuck with the Lab Card through our idiot insurer. Lab Card also does all the Medicare and uninsured lab work. We can only use one specific lab out of over twenty others in this city to keep our coverage, so whenever we go to the lab, there's dozens of people waiting at 8 a.m. for Coumadin levels, fasting draws, seizure meds, all log jammed for that precious 8 a.m. slot. Hungry, cranky, pissy and anxious for not having had meds yet.

Dearest Amy—

At the risk of sounding like a scratched CD:
There are some places in the great nation where you CANNOT GET HEALTH INSURANCE. You live in California, you lucky dawg, and so you have liberal options. In Maine, in the hope of helping people keep their homes in spite of their stupidly getting cancer, we passed a law making it necessary for insurers to cover people with pre-existing conditions.

All the insurers fled.

"Health" Insurance companies are in the business of making money, not meting out health care. Now, I love capitalism, but these companies want untold wealth—the minute they can actually count what they're making, it's not enough.

In the state of Maine THERE ARE NO OPTIONS. The idiotic "Dirigo" health plan the state created has so many restrictions on it—Like the number of people allowed to be in the group!!!— most people who need it don't qualify. To quote from the official website: "DirigoChoice is closed to new subsidized Sole Proprietors at this time. It is also closed to subsidized and non-subsidized Individuals at this time."
Suck it, bitches of Maine.

My younger son, who is in perfect health, should be contributing to some kind of health fund pool, but he can't— he doesn't qualify for any available group. He's too old to be a dependent, so I can't keep him on my union-provided insurance plan, he's not working full time, and is not attending school full time. He's the perfect, non-demanding guy you WANT in an insurance plan and no one will take him.

So, until there's a universally-available medical plan, I'm afraid your arguments are going to remain off the mark.

I got an MRI fast through Kaiser. They couldn't do it so they sent me to a facility in Beverly Hills. Cost me $50 copay.

When I've needed a mammogram they just send me down to the mammo department. Ultrasound I needed once -- discovered the need on Friday, wanted to book me in for Monday morning. I took Wednesday because I'm on deadline on Monday and I wasn't going to explode or anything or die of cancer in two days.

And I'm fine, thanks!

The other part is the fact that Deirdre is legally forbidden from doing business with insurers outside of Maine.

You think Maine did what it did not knowing what would happen? It was intentional.

"It's still around $300 a month, and I'm 45. And that's the standard price for people my age."

Yes, because you have the option to buy into a fabulously well-managed care system. Your $300 a month does not exist outside of California as far as I know.

You are getting a comprehensive health plan for $300 a month.
Before I qualified to join my union's health fund, the only "option" available for people who are self-employed was a catastrophic hospitalization plan for $500 a month. They cover no care, no doctor visits, no procedures, no labs. They're just the "oh god, you got hit by a truck and lived" policies, administered by people whose job it is to deny your claim, and deny you benefits.
Did you realize there is an entire industry the health insurers outsource to, made up of call centers full of people whose only job it is to deny any and all claims? Anyone willing to burn $6000 a year for no real coverage needs his head examined. (at his own cost, of course— it's not covered.)

Unless we can all move to California, or until Kaiser sets up shop in 50 states, your complaint is unreasonable, and I don't understand that kind of thing from you.

Deirdre -

Do you have any suggestions for improvement? And they better not involve nationalized health care, because if you think corporations are heartless bastards, they ain't got shit on government.

At least a corporation will piss on you if you're on fire. They've got a reputation to maintain. Government doesn't.

In fact, I would say that government is your problem in Maine. Government pulled the same shit in Massachusetts, and insurance can't be had for a reasonable price anywhere in the state.

And they're looking to do the same thing in CT. It will turn out to be cheaper for me to pay the fines than to buy insurance. I won't do either, of course. I'd love to see how THAT one plays out in the paper:

"Area man sentenced to fifteen years for not purchasing health insurance."

I really appreciate that question for Deirdre (and anybody feel free to answer if you have solutions). I'm looking for advertisers now, and I have to say, there's a really smart flock of people here. I realize that day to day, but as I keep telling potential advertisers that, I'm reminded of it myself. The people employed by government are often not the innovative thinkers of society but the buttlicks who machinated their way up the political ladder.

I find the truly smart people are usually in business. I'm doing a web TV deal with a company where the guy who runs it is, in my opinion, one of the great innovative biz thinkers out there. I don't always agree with him, but he's always brimming with ideas, and is smart enough to listen to other people's ideas. It's so refreshing, especially after dealing with the Hollyweasels, who are often not thinkers at all, just people who are in the habit of wetting their finger and sticking it out to the wind, or just reading the trades and seeing what made money for somebody else, and then doing a bad copy of it, for bad money, with a lame cast.

You want to now how government care will run?

Ask a vet, any one remember the fiasco at Watler Reed?

I had to go down to the VA hospital here in phoenix the other day for a compensation and disability calim evlauation.

I spent less than 10 min talking to the doctor, about 10 min on the x-ray machine, got 3 x-rays taken and was there from 9 am to 1pm

FOUR HOURS of my day for less than half an hours worth of time if you were to count my walk across the building to radiology and back.

And thats in a state with a senetor using his influence to make thing run "better"

I cant imagine what a shit hole most VA hospitals in the midwest are. But there bad enough that my uncles brother took a years worth of medical leave from his job in order to move to a different state long enough to get his kidney transplant done in a different VA region.

So seriously ask a vet how they like their government health care

Deirdre,

You seem to think there are only two choices. A communist style system (like Canada's) or a fascist style system (more like the US). Have you ever thought of liberalizing your health care system. The problem isn't really that companies are in it for the money. The problem is the laws and regulations in place that have created a cartel. For example, have you ever thought about how much the FDA actually costs consumers and what benefit it actually brings (if any)? Your government controls almost every aspect of your health care system. More control isn't likely goint to help.

Trust me. Canada's health care system is not the way to go. 15% of our population does not have family doctors. People wait 6 months for hip surgeries. Our system will be bankrupt within 15 years if we don't change it.

"So seriously ask a vet how they like their government health care"

I say, why not ask a SENATOR how much they like their taxpayer-paid health care. They're not made to wait, or do with less than excellence, so why on earth should our military men and women? Talk about bullshit.

I agree that government-run anything can be a recipe for disaster, so what else can we invent that will serve all 50 states?

It takes real guts to be self-employed in this country. Nothing quashes the entrepreneurial spirit as much as the threat of losing your home if you commit the sin of getting ill. So how many people don't, try a new business idea simply because they have to work a shit job to keep their family insured?

I say, why not ask a SENATOR how much they like their taxpayer-paid health care. They're not made to wait, or do with less than excellence, so why on earth should our military men and women? Talk about bullshit.

There isn't enough money in the world to supply that level of coverage to everyone. Look at what trying to do so has done to General Motors.

If we get Obamacare, people WILL die. It's already built into the assumptions.

"Hey, you U.S. citizens, ever had a CT scan? How long did you wait?"

You are over-simplifying your statistics, because in the US only some people can get CT scans - those who can afford them, either through insurance or by paying directly. With nationalized healthcare, everyone can get a scan.

There's probably no waiting list for Rolex watches, either.

With nationalized healthcare, everyone can get a scan.

Well, if they live long enough, they get a scan.

The only reason my father didn't get his PET scan last week is that the machine went tits-up.

Natasha Richardson was very unlucky. Montreal does not have fast transportation to a full-service hospital, even near a ski area. Why not? Patients are a cost to the system.

All people and organizations seek income and avoid costs. Socialized or centralized healthcare gets its payments up-front and delivers services after the fact. How hard will a system work to earn the money that they have already been paid? This is something that everyone can understand in their gut. A customer is lost without competition for his dollar.

Begging for Medical Care

A big part of the problem with US healthcare is that the insurance companies paying for it are tied to state boundaries. Insurance companies must operate one legal entity per state and each entity must abide by each state's laws.

Maine is a small state. Not enough people without conditions are available to pay for people with conditions. So, it makes more sense to leave the state. And Maine residents cannot go outside of Maine for coverage.

One of McCain's proposals during the campaign (perhaps the only one that really made sense) was to eliminate this balkanized system and allow a truly competitive nationwide health insurance industry.

Before we socialize our healthcare system, let's at least give this a try.

With nationalized healthcare, everyone can get a scan.

With nationalized healthcare, you don't get scan, scan gets you.

Suppose Natasha Richardson had fallen on a ski hill in the U.S.

Can anyone tell me if all or most of the ski hills have helicoptors available if they are far enough from a major hospital?

Who pays for the transportation? Does the insurance company pay and do they need proof of insurance before you get the ride?

I am asking because ambulance rides in my city (in Canada) are a municipal responsibility. My step daughter broke her ankle, had aambulance ride to a hospital and received a bill from the city. It doesn't seem that getting you to the hospital is a function of the medical system.

One of the most non-boring articles I've ever read on the crisis in US healthcare. It doesn't paint a happy picture of the people who fall through the system, but you can't claim it has a "hidden" agenda!

http://women.timesonline.co.uk/tol/life_and_style/women/ariel_leve/article6015125.ece

Richardson declined treatment for her injury. Consequently, several hours passed before she was examined by medical professionals. This delay was crucial. Her death has nothing to do with the Canadian health care system.

I don't imagine that, had she lived, you would all be citing that as evidence the US needs to replicate the Cdn system now, would you...?

"If we get Obamacare..."

There's no if, Brian. You WILL get Obamacare. The Chocolate Messiah & his administration are absolutely hell-bent on it. And yes, people will die. If you don't want to be one of them, you'll have to open your wallet wider.

I won't dispute what Charles said above about Canadian health care in general, and I won't recommend it as a model for Americans. But please remember that there are big disparities from place to place within Canada. The regional hospital in my corner of rural Ontario is very well-stocked with CTs, MRIs, & the latest gizmos. I got my MRI scans within a few days when I needed them. In fact, our hospital has managed to lure some outstanding American doctors up here. I know this because one of them saved my life on the operating table 2 years ago. With anything less than the best care, I wouldn't be here today. One of the reasons why our hospital is in such good shape is because local residents & employers have donated millions of $ to it's fund raising efforts. I've donated a fair amount myself over the years, and as it turns out, the life I helped to save was my own. Excellent health care is expensive. Someone has to pay for it. There's no getting around that. So my only advice to you regarding the perils of Obamacare is to get yourself & your company involved in your hospital's fund raising, & to donate generously.

> we passed a law making it necessary
> for insurers to cover people with
> pre-existing conditions.

> All the insurers fled.

Pre-existing conditions are endlessly expensive things. Maine's basically insisting that insurance companies provide a stream of wealth to someone who hasn't put any money into the enterprise yet... And whose productivity is unlikely to increase.

Isn't this the first stage of the Obamazoid socialism?

If every shoe store in Bangor were required to give new employees eight weeks of paid vacation, everybody'd go barefoot through the snow.

Amy - I understand what you mean by people wanting a FREE RIDE...

I wound up incredibly ill three years ago and I had no insurance because the insurance offered through my employer was too high. To cover myself, it would've cost me $700 a month in premiums - not to mention the deductible was unreasonably high as well. (These fees were so high because my employer chose to add a pre-exisitng clause for a senior employee who had terminal Leukemia.)

I went to the ER and was diagnosed with a terminal illness. Because I had no insurance, they (the hospital) were limited on the services that they could offer.

So, I found myself sitting in a 24 hour waiting line at a government hospital. I learned that I did not qualitfy for temporary government assistance because my income was "too high". Funny because we were barely getting by at that time!

My husband and I were sitting in the third hospital waiting room where we met these two women who told us how THEY scammed our government. They were both driving BMW's and worked at jobs where they were paid under the table. It made me sick! Here I was - diagnosed with a devestating illness and these two able-bodied crooks were bragging about their crimes as they crunched on Cheetos and licked their neatly manicured fingertips?!

There needs to be a better system but how it should be structured remains to be seen.

> In fact, I would say that
> government is

We love it when Brian blows hard about insurance!

Hey Brian... Are you insured? How old are you? Dependents? What's you net gross, Buddy?

Who's going to wipe your pink ass if you get sick?

All I can say is that having spent my first 34 years in Canada and the last 6 in the US, I would prefer that the US not follow Canada's route. I have friends who can't get family doctors in several Canadian provinces and I watched my Mom's wait for cancer treatment result in her death. Two years ago, I found a lump in one of my breasts, It was removed slightly over a month later after mammograms and ultrasounds. 4 months faster than my mother's treatment. While managed care can be a pain in the butt, it served me better than the Canadian system served my family.

He Crid, not all "pre-existing conditions" mean that someone is unable to work or even requiring any current medical treatment. My thyroid cancer a couple years ago? That would now get me a big fat "pre-existing" rejection from insurers, even though I require no ongoing treatment (other than extremely cheap daily thryroid hormone replacement pills) and according to my doctor is "100% cured." My husband has well-controlled asthma...pre-existing condition. We both are gainfully employed and plan to be for a good long time.

I meant adjusted gross, not net gross.... Teasing Brian makes me all giddy...

(And yes, my insurance did go up 11% already this year, and it's only springtime.)

Socialism is theft. They want you to pay for their healthcare because they want to steal from you. Simple as that. They are common crooks, attempting to put a fake veneer of altruism and legitimacy over theft. Bureaucrats go along with this because it gives bureaucrats jobs.

"... we passed a law making it necessary for insurers to cover people with pre-existing conditions. All the insurers fled."

Wait a minute, you blame the 'evil companies' for a problem that you yourself just stated was directly *created* by stupid government meddling in the market in the first place?

It's a never-ending downward spiral. Pass some stupid law, it causes problems, then cry to government to pass more stupid laws to "solve" those problems, thereby creating even more problems, creating even more crying and "evil company blaming" etc. I've seen entire countries crumble into complete collapse.

Hey Brian... Are you insured? How old are you? Dependents? What's you net gross, Buddy?

I have no dependents, Crid. If I drop dead, it's all on me.

I got a quote for bare minimum accident and critical care insurance. With what worked out to be a nearly $10,000 deductible, it was still over $200 a month.

Meanwhile, I've got a rider on my motorcycle policy that gives me $5,000 medical coverage with no deductible (it's pretty much designed to cover deductibles in other insurance), and it's $100 a year

Don't tell me that they can't sell critical care and accident coverage to a 40 year old for $100 a month. They can. They don't want to. They want you in the HMO cost-spreading scam to cover their losses because the law requires them to cover pretty much everything no matter how much it's over-used.

"I agree that government-run anything can be a recipe for disaster, so what else can we invent that will serve all 50 states?"

Excuse me Deirdre B., but we live in a Federal Republic, not a unitary state. In our Federal system, states are supposed to be responsible for everything not specifically enumerated as Federal powers in the Constitution.

The 10th Amendment to the United States Constitution reads:

"The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

Our health care system need not be, nor necessarily even should be, identical from state to state. our Republic was founded in part upon the idea of home rule - issues are to be resolved at the lowest political unit possible. This means that states and localities should have the freedom to set health care policies that best serve them in their unique circumstances.

Scott has it right - Richardson repeatedly declined treatment, after which point she crashed (medically speaking). Had a helicopter been available at that very moment, it still would, most likely, have been too late for her. Canadian health care did not fail her.

I'm in Canada. My most recent hospital experience involved my husband suddenly developing extreme abdominal pain. We went to ER (by cab, by choice... we could have called for an ambulance, but the hospital was relatively close) and were triaged within moments. Put into a room and hooked to IV and pain meds in minutes. Blood taken. Results brought back quickly. Meds prescribed to take home. Specialist appointment booked for the following morning. Immediate cost to us? $10 for the cab.

I've been chucked off a horse and had an x-ray within 15 minutes. My routine annual mammogram was booked just a couple of weeks in advance. An "OMG a lump!" would have been faster. My gallbladder was removed (non-emergency) about 2 weeks after diagnosis. My ENT specialist was about 2 weeks, then 2 more for surgery (again, non-emergency). I can go to a walk-in most times of day or night for things that are worrying but not going to kill me, at no immediate cost. (I keep saying that, because yes, I know I am ultimately paying for it). My husband's vasectomy was arranged at a walk-in, and performed by a specialist a couple of weeks later. His knee surgery (investigative, non-emergency) was only about 3 weeks' wait.

My father was diagnosed with Non-Hodgkin lymphoma. Specialists out the wazoo, every test in the book, full courses of treatment, great care, negligible delays.

My uncle was hospitalized with unknown cause - delirium, neuro weirdness, and more. He was in hospital for several weeks. Had tests daily looking for a diagnosis. His bill would have been $750,000 if not for health care coverage. He's now healthy as an ox.

And we do have air ambulances. I know, because I used to live next to one of their waiting pads, and am currently living under a flight path to our city's major trauma center. But Canada's a big place, with some major urban centers and a lot of more widely-spaced, less-populated areas. Realistically, there can't be a helicopter poised every 10 miles, y'know? Just like not every town in the US has a world-class trauma center, even with a for-profit system.

Is the Canadian system perfect at all times? No, of course not. Though neither is a fully for-profit/private system. But in our system, people who need help get it, regardless of ability to pay. And for every horror story of someone needing to wait for an MRI, there are fifty of someone who got awesome, prompt treatment they didn't have to sell the house to get.

Most of us like it. I respect your personal preference against it, Amy, but it's hardly the disaster some seem to get a kick out of claiming.

And that author dredging up Natasha Richardson's situation - with incorrect facts - is quite tacky.

"I say, why not ask a SENATOR how much they like their taxpayer-paid health care. They're not made to wait, or do with less than excellence, so why on earth should our military men and women? Talk about bullshit."

One more thing Dierdre B. -

The reason that senators representatives can get such a gold-plated health care plan is that there are only 535 of them. That kind of coverage breaks down when you extend it to 300,000,000 people.

This should make sense to anyone who has ever compared premium hand-made goods to utilitarian mass produced ones, such as the handmade shotgun for sale here http://www.artfact.com/auction-lot/fantastic-ivo-fabbri-superposed-hand-made-shotgu-1-c-sq2k0vj0dt (estimated replacement value $100,000), as opposed to this commercial Remington Model 870, retailing at $319.67 http://www.ableammo.com/catalog/product_info.php?products_id=84835

Absolutely universal coverage like our Senators have can only be made available where the target population is both tiny and has fantastic resources at its disposal.

The Department of Medicine will follow exactly the same playbook as does the Department of Education: an advocate for the desires of entrenched labor unions for whom the answer to every question is More Money.

We've seen the wonderful improvements in quality, efficiency, and outcomes that have been wrought by our teacher's unions and their lapdogs in the Dept of Ed. Now we're going to see it repeated by the soon-to-be-organized physician's union and their lackeys in the Department of Medicine.

But hey, it will all be paid for by Other People, so why should any of us complain?

Lauren -

I've always liked Canada and Canadians and I appreciate your description of the excellent experience you've had with your health care system. You comment is valuable because, admittedly, we really do only hear the horror stories (however, we hear a lot more horror stories about the UK's National Health Service).

All of this said, there is one thing that has to be considered when comparing anything in Canada to anything in the United States: Despite the strong cultural similarities between our two countries, and despite the shared ancient political and legal traditions that we have received from our common mother country, the fact remains that our two nations operate politically and culturally from some rather different starting assumptions. We place a higher premium on liberty and personal autonomy, while you place a higher value on equity and fairness. We have a higher risk tolerance; you are more concerned about equitable outcomes. We worship competition, you venerate cooperation.

These differences profoundly influence the range of choices available to each country when confronting problems of any kind, including health care.

> If I drop dead, it's all
> on me.

Yeah, and life's a tragedy, ain't it? A black pit of despair and all that. But we're not talking about death, we're talking about health care.

And if you merely drop sick, it's 'all on' us, the surrounding community. Amy's inquiry was as follows:

> I pay for my own health care, and
> unless you're destitute, completely
> unable to work and/or seriously
> crazy, please tell me why I should
> be paying for yours.

Sorry Lauren, one more thing. In your post, you say:

"But in our system, people who need help get it, regardless of ability to pay."

This is simply not true. The whole point of the the "horror stories" you reference is that lots of people DON'T get the help they need -- they die while they wait for the help they need.

The difference is that ability to pay is not what determines whether or not you get the care you need. But even this isn't completely true - as some people in Canada do travel to the US to get procedures and care that they can't get in a timely manner at home.

And one more thing - perhaps the most important thing, and we've all been ignoring it throughout this whole discussion: What about clinical outcomes? One thing I know about medical care in the US: We have the best clinical outcomes for patients in the world, and we are the source of a huge amount of medical innovation and development that not only continues to keep those outcomes high here but helps people throughout the world.

I do not know how clinical outcomes in Canada stack up, but I have read that clinical outcomes in the UK, with its government run and government funded system, are worse.

One key thing in this debate: While there are lots of details to be worked out, I don't think that a Canadian single-payer type system is on the table. Instead, I believe that the the plan is to permit anyone to buy into an inexpensive government insurance option; however, private insurance would not be abolished. People with the means could still purchase superior coverage.

Barnes is right about one thing - if this plan passes, it will probably be irreversible, like Social Security or Medicare. From what I've been reading, the Democrats' plan is to use the threat of reconciliation to force a deal. If they don't get one by October 15, they'll use reconciliation to pass health care reform in the Senate with a procedure that can't be filibustered. While I'll never underestimate the fecklessness of the Democratic Congressional leadership, my guess is that some version of the Obama plan passes this year.

> permit anyone to buy into an
> inexpensive government insurance

Will payouts from this pool of wealth be directly proportionate to incoming premiums?

Hmmmmm.... Whaddya think? Wanna wager on it?

Of course not, on an individual level. As with all insurance, the low risk people pay proportionately more and take out less, effectively subsidizing the high risk people. However, when the pool gets large enough, the effective risk of any one person approximates overall population risk.

> Of course not, on an
> individual level.

No. You misunderstand. What I'm asking is: Will payouts from this pool of wealth be directly proportionate to incoming premiums? I'm not talking about individual anything. I'm not talking about individual DICK.

The large pool won't help. Liberals live in a zero-sum fantasy where once enough rich white guys are put on the tax roles, the whole country can fart through silk instead of burlap.

But, y'see, we have folks like Brian who need to be dealt with. Now, Brian likes to call people names and blow hard, but in the final analysis, he's more socialist than Obama could ever dream of... He enjoys doing trapeze work above the public net today, and he'll enjoy it even more when "they"...

> They can. They don't want to.
> They want you in the HMO

...when "they" cover all his needs without sacrifice on his part.

I think in the years just ahead, you and Brian are going to very disappointed in the capacity of our government to wring value from "they".

Hi, Dennis,

Thanks for the civilized discourse! I'm not sure I agree 100% with your comparison of the differences between Canada and the US (particularly since East Coast, West Coast, and Ontario/Quebec Canadians are all really very different), but I suppose "grand scheme" it's not terribly far off.

As for outcomes, we have a longer life expectancy and lower infant mortality rates, which tends to suggest (tends being a pertinent word) that our health care is, overall, a success. And we do have world-class research and treatment facilities, so definitely pull our weight in that sense.

It might also be worth noting that I, individually, do not consider myself a socialist. I like capitalism. I would love to be filthy rich. I don't like institutionalized welfare, and I do think Canada coddles far too many people who milk the system. I loathe that we pay Unemployment Insurance (which we cheerily call Employment Insurance) to people who choose to stay home for a year with babies, but won't pay it to someone who quits a dead-end job in order to take a training course to start in a high-demand, well-paying field (my husband, in my case). I'm much more fiscally conservative than my country, and I do have a libertarian streak about many things. BUT, I just can't shake my gut feeling that people shouldn't have to choose between food and antibiotics, or rent and an appendectomy. Or that it's wrong that a spouse might spend the rest of their lives in massive doubt because their partner had the misfortune to linger a few extra days before dying.

I'm the first person to sneer at a story about some poor woman with five kids, no husband, and a welfare cheque, whining that the kids can't have a Wii. Hell, I don't think people on my dime should have CABLE, for heaven's sake. And if I was elected Dictator, I'd freeze welfare payments to prevent people from having more kids on my dime. I'm no bleeding-heart. But, as I said, my gut tells me that decent medical care should be supported for all. I can't claim a fully logical position - why I say "sucks to be you" to people who make stupid breeding/career decisions, but not to those who wouldn't be able to scrounge up insurance. But I personally can't ethically justify not having social medicine.

I'm also a heretic among some lefties (including my in-laws) for not being *opposed* to a two-tier system that allows queue-jumping for money, though. I say that departments that would normally be closed overnight can be opened (and staffed and maintained) during off-hours with private insurance funds if they're willing to do it. If two weeks is too long for you to wait for a routine mammogram, hey, pay for it and have it done tonight at 2am. Enjoy!

I think in the years just ahead, you and Brian are going to very disappointed in the capacity of our government to wring value from "they".

"They" is me, dude. And I'm well aware that my taxes will ultimately be going up. As will most people.

Presumably, that translates as: I know a ckever accountant... *I* won't have to paymore taxes, but Dick Cheney will...

Oh, I know what you're up to - you're trying to bait me by saying Cheney!

Is it inconceivable that reasonably successful liberals are actually willing to spend more to get more? My tax lady doesn't make with the shady tax stuff; we take reasonable steps to minimize them, and then write checks for the difference. I see it as a sign I'm doing OK.

"As with all insurance, the low risk people pay proportionately more and take out less, effectively subsidizing the high risk people."

In other forms of insurance insurers use actuarial data to assess the level of risk and charge accordingly - higher risk, higher premium.

Crid:

...when "they" cover all his needs without sacrifice on his part.

I think in the years just ahead, you and Brian are going to very disappointed in the capacity of our government to wring value from "they".

Who is this "they" you refer to? I'm a single, middle-class white male. I don't qualify for any government handouts. If I get sick enough, I go into debt. If I skip that debt, I'm pretty much fucked. Which you just can't seem to get through your addled mind. NO MATTER HOW HARD I TRY, I WON'T BE GETTING A FREEBIE. PERIOD.

And so far, the math is on my side. Because I wasn't blowing $3600 a year on insurance I don't use (that's what it was costing me when I worked for someone else) for the last 7 years, I've had 25 grand to invest in other things, like a house. And I'm in a position where if I break my leg, I can get a loan for the 15-20 grand it will cost to put it back together. And I'm STILL ahead of the game.

Why you cannot grasp this is beyond by comprehension. You wanna throw away your money, go right ahead. Don't demand that I do the same.

Lauren

As for outcomes, we have a longer life expectancy and lower infant mortality rates, which tends to suggest (tends being a pertinent word) that our health care is, overall, a success.

No, it tends to indicate that the books are being cooked. I've been over this before. If it comes out of the woman and draws a breath, we count it as alive, even if it's seven weeks premature. If it dies, we count it as infant mortality. Europe (and probably Canada, since they use the same accounting methods) don't do that.

And the life expectancy numbers are equally cooked. You don't have the inner-city crime statistics we do. Tends to lower the average age of death when people in the cities are getting shot to death at 22.

Cheezburg

Is it inconceivable that reasonably successful liberals are actually willing to spend more to get more?

Look, if they try to go the "private/public" thing, what will happen is what happened in Massachusetts. They mandated that everyone carry health insurance. The price of private insurance went through the roof, and they don't have sufficient resources in the public pool to subsidize everyone at reduced cost.

If it weren't for the mortgage interest deduction, I'd have coughed up better than 50% of my income in taxes. I'm not willing to cough up $250 a month for shit insurance in the private market. Why would I want to pay twice that in taxes for even shittier government insurance?

As with all insurance, the low risk people pay proportionately more and take out less, effectively subsidizing the high risk people.

The problem is, until you're dead, you don't know what risk you are. You don't know how much of the insurance for which you've paid you will actually use. Will you get cancer? Will you be exposed to a disease? Will you sustain a crippling injury?

Better to have it and be low risk.

"As with all insurance, the low risk people pay proportionately more and take out less, effectively subsidizing the high risk people."

In other forms of insurance insurers use actuarial data to assess the level of risk and charge accordingly - higher risk, higher premium.

The insurance companies have been forbidden by law from doing this with health insurance.

There is no free market in health care or health insurance. The former is a cartel, with limits on growth imposed by the AMA. The latter is a pseudo-fascist hybrid entity that must toe the government line to be allowed to exist.

"BUT, I just can't shake my gut feeling that people shouldn't have to choose between food and antibiotics, or rent and an appendectomy."

Lauren -

I don't want people to have to make that choice either. And frankly, a lot of people don't have to because the social safety net in the States catches a whole bunch of folks (like some dead-beat relatives of mine who have had major highly invasive medical procedures wholly on the people's dime and have hardly worked an honest day in their lives).

Having said that, I also realize that there are a lot of folks who fall through the gap - too poor to afford the care they need but too wealthy to qualify for government assistance.

In my view, the debate is not about whether everyone should have the health care they need, but rather, what approach will best deliver care to the people.

In a way, the matter is academic to me - I'm a military officer and therefore have the benefit of a very good health care system, both in terms of military facilities and the Tricare insurance program.

That said, as a military officer I have spent much of my life working inside government have developed a fair understanding of what the basic operating principles of government are. I have worked a little in the private sector, and of course all of my relatives still do, and I can say definitively that government works on entirely different operating principles than does any person or business in their private lives, and this can and will have a profound impact on the quality of the health care the government delivers.

The problem with American health care today is not one of quality but of access - specifically, high costs restrict access for some. My opposition to a government run solution to this problem does not stem so much from a philosophical opposition to government action in this area as from a deep conviction that government just won't prove any more able to solve this problem than the private sector, and in the end will probably worsen health care for many even as it improves it for some.

The reason I believe this is based upon how I perceive that government operates. The basic, bedrock operational principles of our government are these:

- The executive branch has no inherent authority to spend one red cent, but only derivative authority delegated by the legislature to spend funds in a manner and within guidelines prescribed by the legislature.

- The executive branch is accountable, not for spending funds wisely, efficiently, and effectively, but rather is accountable for the extent to which they comply with legislative guidelines about how much money they can spend and how they spend it. In other words, spending decisions by government agencies are not based upon what is fair, just, reasonable, sensible, or wise, but are based only upon whether the agency has the authority to spend a given sum of money in a given way.

For example - if you want to use your hard-earned cash to tattoo a naked man on your chest and get your nose pierced, no one will say a word because it is your money. You own and have an unfettered right to dispose of it as you please. Likewise, if you own a business and decide to invest in the latest Ron Popeil Ginsu cutlery, again no one cares because it is your money.

Things change when the government gets involved. If you find yourself living under a regime of government-supplied body art and cutlery, you may not be able to get your tats and knives -- the appropriate government administrator will have to check and see whether those kind of piercings, tats and knives are approved procedures or not.

Only, with a government health care system, it won't be frivolous baubles like tattoos and silly knives, but rather the experimental cancer treatment that you need or the latest prosthetic limb that will return your mobility to 100% that will be getting scrutinized by the bureaucrat; and if these do not appear on the pre-approved roster of authorized treatments, you won't get them no matter how much you need them.

It isn't that the administrator denying your claim is a heartless, venal jerk; quite the contrary, he probably wants to help. The problem is that, given the way that government works, he may not have the authority to help you.

And it isn't as easy as saying "hey, let's just give the administrator lots of discretion in what he can approve." That won't work because if you give him discretion, inevitably somebody will abuse it and the public will be outraged. For example: Remember all those debit cards the government gave out after Hurricane Katrine? At first the government was pilloried for not getting help out fast enough. The debit cards are great solution to that problem - they get cash into peoples hands right away so that people can alleviate their suffering immediately. Problem is, some of them spent their debit cards on booze and lingerie. Result: The government got beaten up again, so that you can bet they'll never release assistance in such an expeditious manner again - people will just suffer like hell until the slow-moving bureaucracy is able to get to them. This is future of your health care under a government program.

In practice, all of this means that when the government agency ultimately charged with deciding who gets what care starts making the call about what procedures you can or cannot have or how quickly you can get them, it won't be clinical judgments or considerations of compassion or fairness that drive the choice, but the pre-existing statutory and regulatory guidelines that constrain the decision maker. He will have very little latitude.

To illustrate how this will go down, let me offer a couple of examples from my own government experience, namely from Iraq.

In Iraq I roamed around the battlefield in an M1114 up-armored HMMWV, an excellent platform that saved my life during an IED attack on my vehicle in April 2007. All that armor protection is very, very heavy however - so heavy that, much to our dismay, we found that the standard issue jack that comes with a HMMWV could not lift our vehicle when we needed to change a tire in the middle of Baghdad. Bad, bad thing to find out (yes, the HMMWV has a run-flat, but if you drive more than a short distance on it it will catch fire). What we needed were large hydraulic jacks. When I directed my logistics officer to procure three of them on the local economy using the $2500 monthly operational fund the Army provided to us, I was told that, because the Army had already identified the need for these jacks and added them to our official table of authorized equipment, I was NOT ALLOWED to buy them on the economy but rather had to get them through the supply system. Problem was, there weren't any in the supply system in Iraq. So, the bottom line was that under the government's procurement process I was prohibited from buying mission essential, life-saving equipment BECAUSE the Army had recognized it as mission essential. How's that for a kafkaesque predicament? Now imagine that some government deciding whether your child or elderly mother get the life-saving or palliative care they need We did get our jacks, but only buy cheating. In other words, we ignored the rules and bought them anyway. In order to have the mission-critical life-saving equipment I needed, I had to break the rules, theoretically at least, risking punishment.

In the government health care system, there won't be any workarounds and nobody will be willing to stick their neck out for you!

Another example. I had interpreters that traveled around in my convoy with me exposed to the same enemy threat that I was. But the rules forbad arming them so that they could defend themselves, on the grounds that the interpreters hadn't been "qualified" on their weapons - in other words, they hadn't been to the range and hit a certain number of targets. In the government's view, it was better that they potentially face the enemy armed with nothing, than armed with a weapon they hadn't "qualified" on. Imagine how this will play out in your future government health care system! "Yes, we know that you have a 95% chance of dying in the next six months if you don't get this new treatment, but that treatment is not among the authorized treatments."

Yes, I know that some of these problems exist under our current system as well, but at least now you have the option of paying out of your pocket, going into debt, shopping around, negotiating a better policy, etc. Under a government system you wouldn't have these options - you'll just go without.

So, to me it isn't a matter of whether the current gaps in coverage are wrong or not. The question is whether government intervention will make matters better or worse. Given the inherent nature of government, I fear it will make the problems worse.

I'm not knocking government. Our government does many things well. However, in its interventions into private peoples' lives, it doesn't do so well.

> Who is this "they" you refer to?

You tell me; I quoted from your comment.

> I don't qualify for any government
> handouts.

If you get sick, hospitals are required by law to treat you. The people who *do* live responsibly enough to pay their bills will have to pick up the slack... That's why our premiums keep going up.

> You wanna throw away your money,
> go right ahead.

You're throwing it away *for* me.

But rest assured, somebody out there loves you...

Pelosi loves you as a statistic in uninsured America.

> I'm a single, middle-class white male

She loves that a taxpayer need only be as incompetent as you are to require her supervision of health care (and God knows what else).

Obama doesn't mind when you call him stupid. He loves you for your socialist nature, even as you mock him. The reliable self-centeredness and irresponsibility of your conduct means much more to him than does your tough-guy rhetoric... And it's certainly worth more than your vote.

Crid -

You must be on the other side of the looking glass.

And for the last time: Health insurance is not the same as health care.

I have to assume that since you live in the People's Republic of Kalifornia that you have some system by which employed white people manage to walk out on hospital debts. I assure you no such system exists here in Connecticut. The hospital will chase you to the ends of the Earth to get their money.

I assure you, unless I die you won't be paying for a cent of my health care.

She loves that a taxpayer need only be as incompetent as you are to require her supervision of health care (and God knows what else).

uh... yeah. So I should pay for a product that is utterly without value to me to knock her made-up statistic down from 45,000,000 to 44,999,999? Please.

Obama doesn't mind when you call him stupid. He loves you for your socialist nature, even as you mock him. The reliable self-centeredness and irresponsibility of your conduct means much more to him than does your tough-guy rhetoric... And it's certainly worth more than your vote.

How the fuck do you even come up with "socialist nature"? Expecting to pay my own way is socialist? What color is the sky on your planet?

Next thing you know he'll be saying that not buying the extended warranty on your dishwasher is socialist.

You have thus far over the course of the past two years failed to prove that my not buying insurance is "irresponsible". You'd think that given that length of time you'd at least come up with something better than "Shut up, that's why."

Oh, and Crid - the "they" was all yours. I assume you mean "the taxpayers" by your "they" that you assume will be picking up the tab for those of us who aren't tossing money into a hole that it will never come back from.

There is no free market in health care or health insurance.

I agree with you.

The problem, as I see it, is that the various imperatives in health care are something that pose fundamental problems for market-based economics. As Dennis noted above, in most types of insurance, as people are likely to cost more to cover, we raise their premiums accordingly.

However, with health insurance, it's basically not if there's an expensive problem, it's when. We all will die at some point in time, many of us after lengthy and expensive illnesses. Some of us will have manageable but costly conditions, like diabetes, kidney disease, heart disease, etc. With these people, if the insurer has full knowledge of their condition and is rational, there's essentially no premium at which it is in the economic interests of the insurer to cover that person. Thousands a month probably wouldn't do it, and few could afford it.

Right now, people like these can get coverage through work (or Medicare, but that's only old folks, so I'm focusing on the young), because work policies pool those with increased risk with those with lower risk; when taken in aggregate the risk of a pool of people is more likely to approximate the risk of the population as a whole. The guy with diabetes is balanced by the young healthy guy, and the math works; everyone gets insurance for a premium that can be afforded. On average, they pay less if they work for a great big company than for a small one, because small companies are more likely to differ from the population mean and are therefore riskier.

The employment-insurance connection sustained the U.S. through the second half of the 20th century. However, treatments have gotten more expensive, medicine plays a bigger role in our lives, we go to the doctor more, we keep old and sick people alive for much longer, and to top it all off, more people than ever before work for themselves, or for small companies, and change jobs frequently. These factors have broken the old model.

Now we have more medical expenses than ever, with people spending more money on insurance than ever before, a growing body of uninsured - a decent chunk of whom are that way because shit happens not because they were morons.

I think what I've written so far is pretty uncontroversial. Let me know if I'm wrong.

The problems I outline above are why I think the Obama plan isn't crazy. I think it may be a good idea to create a public insurance pool into which anyone can buy. Exactly what Barnes fears. This is because I see no other option under which many people who don't fit into the old employer-health insurance model can be part of the sort of large pool that's necessary to make health insurance economics work. When you get enough people into a sample - and the millions who would buy into a public insurance pool would do it - their aggregate risk is almost exactly the aggregate population's risk, which makes it possible to do predict costs with a fair degree of accuracy. I don't see another way to accomplish the sort of pooling that I think is necessary to make health care math work, without totally abandoning the U.S. system with private health insurance.

Is it inconceivable to you that I don't want to pay more to get less?

It's entirely conceivable. These are the kinds of things make people say, "This is why elections matter." In our country, elections let people compel other people to do things they don't want to do. I'm sorry you're not happy about it, for what it's worth.

If it weren't for the mortgage interest deduction, I'd have coughed up better than 50% of my income in taxes.

You must earn good money. And state taxes where you live must be a bitch, since the upper Federal rate is 35%, just what Reagan had.

Cheezburg - nice way to call me a moron. Of the so-called 45 million uninsured, less than 9 million of them actually WANT insurance and cannot afford it.

And the Obama plan IS crazy for one simple reason: once there's a public-funded alternative available, employers will simply stop offering health insurance as a benefit.

Why do you think GM was advocating so hard for single-payer? It would have gotten them out of paying for insurance for all their retirees in one swell foop.

I've already told you how to "reform" the system. Get rid of the employer tax break for health insurance and make it a personal deduction. And get rid of the whole "co-pay" bullshit. The reason that health care costs are going up at 5-10 times the rate of inflation is that too many people are going to too few doctors for trivial shit.

If it "cost" you $90 to go to the doctor for every little sniffle, even if you got reimbursed, maybe you'd be a bit more judicious in going to the doctor for a runny nose.

Do you want to know how much I've spent on health care for myself in the past 7 years? Including my prescriptions, about $8,000. Two doctor vists in that time. Because I don't go to the doctor just because I have a headache.

You must earn good money. And state taxes where you live must be a bitch, since the upper Federal rate is 35%, just what Reagan had.

Actually, it was 27 when he left office.

I make enough. I'm not in the top tax bracket. But I am in the 25% bracket, plus 5% to the state, plus 15.3% self-employment tax. My effective tax rate last year after deductions was 21%. And I still have to come up with a largish chunk of cash to put in the IRA before 10/15. Of course, then there were the property taxes, gas taxes, sales taxes, you get the idea.

I'll bet you a steak dinner in the best steak house within 50 miles of either of our houses that when Obamacare passes it costs the average schmuck like me at least $5,000 a year in additional taxes.

> And for the last time:

Aw, if you're busy, we can come back later..

> Health insurance is not the same
> as health care.

Did anyone say otherwise?

> The hospital will chase you to the
> ends of the Earth to get their
> money.

Why should you force them to? What's admirable about that?

> I assure you, unless

We don't want your assurance, we want you to be insured. It's a grown man thing.

> So I should pay for a product
> that is utterly without value
> to me

Ten seconds ago you were being chased by hounds for that money.. Suddenly its 'utterly without value?'

> Expecting to pay my own way
> is socialist?

You're not expecting to, else you'd prepare to.

> not buying the extended warranty
> on your dishwasher

The community is happy to let you eat off paper plates. Letting you bleed on the street is illegal. But Lord, we're tempted.

> failed to prove that my not
> buying insurance is
> "irresponsible".

Naw, you just won't take the point. Like a child who covers his eyes after throwing his applesauce on the floor....

> the "they" was all yours.

Review your comment for the cited passage.

I've already told you how to "reform" the system. Get rid of the employer tax break for health insurance and make it a personal deduction. And get rid of the whole "co-pay" bullshit. The reason that health care costs are going up at 5-10 times the rate of inflation is that too many people are going to too few doctors for trivial shit.

This has merit. We'd need to figure out how to make it work for the long-term sick, though. However, it strikes me as a non-starter because the level of reform is simply too radical for people to take. The Obama plan looks more like what people are used to and would be an easier sell. I lack your deep antipathy to all things government, so his plan troubles me less than it does you.

> I lack your deep antipathy to
> all things government

You are going to love, just adore, the next three or four decades.

Crid - the "they" in my comment was the insurance companies. It makes no sense for you to imply that the insurance companies are picking up the tab for me when I pay cash.

And the product that is utterly without value to me is the so-called insurance.

So it is you that is confusing health insurance for health care.

See, you don't NEED insurance to get care. You don't need insurance to pay for it either.

You have this child-like view that insurance will actually pay for care, rather than find every sneaky way they can to deny payment. I'm simply saving myself the hassle. If I want care, I pay for it. End of story.

Naw, you just won't take the point. Like a child who covers his eyes after throwing his applesauce on the floor....

No, Crid. It's that you haven't MADE a point. You think you have, but all you've done is attempt to convince me that I'm somehow less of a man for not buying a health insurance plan that is almost but not entirely useless to me. I think what it is, in your case, is jealousy. You've been healthy all these years, paying all that money for insurance that you never used, and you know damn well that when you're diagnosed with something bad, they're gonna drop you like a hot potato, and all that money you put into that company is gone.

Cheezburg:

This has merit. We'd need to figure out how to make it work for the long-term sick, though. However, it strikes me as a non-starter because the level of reform is simply too radical for people to take. The Obama plan looks more like what people are used to and would be an easier sell. I lack your deep antipathy to all things government, so his plan troubles me less than it does you.

Well, tell me how the current plan works for the long-term sick. That's right, they deplete their life's savings, and then beg the government to care for them. Because the insurance companies all have lifetime maximum payouts.

Don't think that the first thing a government plan does won't be something along the lines of cost control through denial of life extending treatment at the margins.

You don't share my antipathy to government because you're just naive enough to think that they actually give a fuck.

Read a little history. That'll change your attitude real fast.

Remember, the state is not your friend.

Quite frankly I never understood the imperitive geriatrics who dont have the fucking energy to swallow 47 pills a day let alone stnad long enough to piss in a an actual toilet have to hold on to life so tightly.

I could understand if they were in good health and moblie, but death is inevitable right? So why the grim hold on a crap life you wouldnt inflict on livestock, let alone a pet?

The state may not be our friend, but neither are for-profit insurance companies.

If we had a one-payor plan, at the very least costs at the point of purchase would plummet. How many women are employed at YOUR doctors office simply to manage the insane amounts of paperwork required as a result of 5 thousand insurance companies?

I don't have an objection to socialized medicine, I really don't.
I like the idea like I like our interstate highway system.
So shoot me. I happen to be a member of the exclusive club of Insured people of America, so at least I can afford to have someone help save my life.
(Incidentally—my union, thru which I get my health insurance spends an ungodly amount of time and treasure to keep people from qualifying for admittance into the insurance pool. Awesome, ain't it?)

It would be nice to have someone like the guys at the Toyota plant in Smyrna to run a universal plan.
Health services are being rationed now.
Denial of services is happening now. How much worse can it be?
Don't give me this "people will die" shit. People fucking die NOW because of mismanaged,incompetent care at top-rate hospitals.

My pals in Scotland can get a housecall from a nurse practitioner.
Hey, you U.S. citizens, ever had a housecall from a health professional? How long did you wait?

If we had a one-payor plan, at the very least costs at the point of purchase would plummet. How many women are employed at YOUR doctors office simply to manage the insane amounts of paperwork required as a result of 5 thousand insurance companies?

You've never worked with the government, have you?

Fifteen or so years ago, I worked in the engineering office of a paging company, filing licensing applications. After the "Paperwork Reduction Act", the application (which had to be filed in triplicate) was only a hundred pages.

It would be nice to have someone like the guys at the Toyota plant in Smyrna to run a universal plan.
Health services are being rationed now.

Only for those who deal with cheap-ass insurance companies or the government. Were you not paying attention last month when the so-called "stimulus" passed? They created an office at the federal level whose sole job is to determine which treatments are too expensive and "recommend" that doctors not offer them.

My pals in Scotland can get a housecall from a nurse practitioner. Hey, you U.S. citizens, ever had a housecall from a health professional? How long did you wait?

Actually, my grandmother had just that in the last weeks of her life. But for reference sake, keep in mind the massive difference in size between our countries.

If there is one leftist talking point about health care I'll cop to, it is the shortage of qualified medical personnel in the United States. But we also know who is at fault for that: the trial lawyers and the AMA - both large Democratic donors.

In other words, don't hold your breath waiting for a larger graduating class from your local medical school.

I'm glad your grandmother was helped at home! But in Scotland, anyone can get a housecall within an hour any day ANY TIME.

I have a friend who makes a quarter of a million dollars a year, working for a medical supply company. He goes to hospitals all over New England. He's not there to show technicians how to use the machines his company makes, he's not there to facilitate delivery of those machines His sole job is to instruct the hospital HOW TO BILL for the use of the machine.

The fact that a job like this even exists makes me sick.
(Good thing I'm insured!)

Hey, Rad, play that song again!

OK:

"Dear Senator Graham:

I believe I have a model for health care which could revolutionize the industry, improve efficiency and even put you in the White House. Bold claim, no? Well, let's see.

I think you and your staff know the issues with health care today, so I won't bother you with outlining the status quo. I'll get to the point.

We should set up the "Medical VISA Card".

For easy consideration, here are features and points, in no particular order:

1) This card would either be issued by an existing Federal agency or designee to every person attaining majority, and to the guardian of every person for whom one is appointed, or be elective. There would be benefits to this - see below. I call this a VISA card just because that company has all the assets in place to do this already.

2) The card would be usable ONLY for prescription medicine and for visits to licensed doctors and dentists.

3) The card would have a nominal limit. Reaching this limit would trigger agency review of the use of the card. Think, "$20,000", or a value determined by the person's economic status. This could be determined from tax returns.

4) The balance would be due from the holder to the agency, exactly as bank and other credit cards apply today.

5) An interest rate on outstanding balances would be established to collect two things: direct cost of the program, and an investment fund to be used by the plan for catastrophic illness and disability. A minimum payment would be required of the holder monthly.

6) Legislation could require preference for reducing the card's balance, to prevent holders from running up bills on other credit cards, paying them and leaving the Medical VISA Card unpaid.

7) Card holders could be setup with on-line and telephonic instructions for getting medical attention, and encouraged to avoid using emergency rooms for routine care. Emergency rooms can require the medical card to divert patients to other clinics.

8) Unlike with credit cards - which purpose is to make money for the card company - Medical VISA card holders could be encouraged to invest in their own, portable (not job-dependent) medical insurance through building a positive, interest-paying balance in their medical account.

9) Make no mistake about the fundamental nature of this card: up to the spending limit, the holder MUST pay. People simply won't be careful with other people's money.

Senator, people understand credit cards, however woeful the current credit situation might be because of public confusion between ownership and possession. I myself am mystified by my own Blue Cross, Blue Shield statements, which routinely say my treatment cost twice what anyone was paid.

It's time to re-establish the patient-doctor relationship in a way that will get doctors paid for their actual services. This will do that.

I recognize that a lot of work would be necessary to turn this into reality; I don't pretend to know this field as well as you and your staff must, just to run your office.

But I suggest that this is a good start.

Very Respectfully,(Rad)"

Nobody HAS to have this card, just as nobody HAS to have health insurance. But as long as people are required to be responsible for another's foolish choices or bad luck or both, something is needed to provide the carrot and stick guidance to a sustainable system.

Regarding Canadian versus US health care: How many Canadians come to the US for treatment? How many Americans go there? This reminds me of the Berlin wall. The people who thought that communism was a good idea had to go through some serious mental contortions to explain that, too.

The US system is already mostly socialist and consequently seriously fucked up. Yet I would guess that we're still responsible for funding 80+% of the innovation in medicine. We're subsidizing most of the rest of the world.

I forgot to add:

My wait time for a CT - about 2 hours in urgent care. That included 1 hour of drinking Iodine solution.

It cost a pile of money, though. And the entire reason I ended up in urgent care was because my normal clinic was taking so long. I've since switched clinics. I wonder how that works under nationalized health.

Uh, Brian, my medical insurance company has paid out around $325,000 so far for my son's illnesses. And is still paying. Without a hassle, whatsoever.
However, I have also gone through the "refile claim with more info" hell with one medical insurance company in the 1990s and am glad to be away from them.
Not all insurance companies, medical, life, or property and casualty, are bad. I worked at a life insurance company that paid out on at least one soldier I know of that died in Iraq in 2003, even though there was no legal obligation. It depends on the company's culture.

So Brian, your answer to Amy's question:

> I pay for my own health care, and
> unless you're destitute, completely
> unable to work and/or seriously
> crazy, please tell me why I should
> be paying for yours.

is

> The hospital will chase you to the
> ends of the Earth to get their
> money.

I regard this as argumentum ad miscordium: 'Don't punish me for killing my parents... I'm an orphan!'

No, you neutronium-skulled donkey.

My answer is "I AM paying for my care, on an as-needed basis, and if I get a really big bill, I'll pay in installments."

My comment about chasing to the ends of the Earth was a response to your assertion that I'm somehow guaranteed to skip out on such arrangements. The response was basically that I could not skip out on them if I wanted to.

I regard this entire conversation as argumentum ad nauseum. Having the same argument over and over again without you getting it is making me sick.

We're subsidizing most of the rest of the world.

Don't think so. Aren't US companises making scads of money being medical innovators? And doesn't this happen because we have a robust public system which funds basic research (the stuff that isn't likely to make money) and a robust private system that takes promising publicly-funded work and turns it into helpful and profitable treatments?

Cheezburg - we pay as much as we do for drugs in this country because countries like Canada have instituted price controls and subsidies on pharmaceuticals.

In other words, I pay 50% more because other countries have said "we will pay this and no more", and the drug companies were "ok, we'll just fuck the Americans over so we can sell you drugs" instead of "fuck you, pay me."

And there's a lot less publicly funded work in pharma than you want to believe. Most of the breakthroughs are coming from either private equity or private grants. Which is as it should be, if you ask me.

Of course a single-payer system takes away the profit motive, which means that innovation will pretty much stop. I mean, what was the last great medical innovation to come out of a European pharma company's home lab, and not their American subsidiary?

> I could not skip out on them if
> I wanted to.

Acknowledging that you could have the shorts sued off your asscheeks is not the same as responsible financial conduct. 'K? In a lower gear: Saying that you understand that you can go to jail for stealing food doesn't mean you're morally justified in dashing out of the drive-thru at Taco-Doodle.

> Having the same argument over and
> over again without you getting it

I get it all, every word. Never doubt your power to amuse, Brian... You crack my shit up! There's just no comparable example of continuing shamelessness in electronic media. It'd be like learning that Maureen Dowd isn't registered to vote. All your name-calling, all your cussing, all your self-righteousness insight... and you don't even insure your own ass.

Seriously, Babe... Don't change a hair for me.

wha?

amy, amy, amy....

aren't we all here to take care of each other? you should pay for my health care because well, .. i need your help?

what? you aren't willing to help? you need to be re-educated (guess where). once you realize that you NEED to work more to help me, you will truly realize the meaning of, work will set you free!

and don't you dare think i don't work as hard as you. my paintings are brightening the very existence of humanity. i work. hard

but i need your help! (cough cough)

/sarcasm