Obamacare: Big Options

ObamaGrav.jpgThis from this morning’s NY Times by Paul Krugman. Are these the big options for Obamacare?

Let’s talk about health care around the advanced world.

Every wealthy country other than the United States guarantees
essential care to all its citizens. There are, however, wide variations
in the specifics, with three main approaches taken.

In Britain, the government itself runs the hospitals and employs the
doctors. We’ve all heard scare stories about how that works in
practice; these stories are false. Like every system, the National
Health Service has problems, but over all it appears to provide quite
good care while spending only about 40 percent as much per person as we
do. By the way, our own Veterans Health Administration, which is run
somewhat like the British health service, also manages to combine
quality care with low costs.

The second route to universal coverage leaves the actual delivery of
health care in private hands, but the government pays most of the
bills. That’s how Canada and, in a more complex fashion, France do it.
It’s also a system familiar to most Americans, since even those of us
not yet on Medicare have parents and relatives who are.

Again, you hear a lot of horror stories about such systems, most of
them false. French health care is excellent. Canadians with chronic
conditions are more satisfied with their system than their U.S.
counterparts. And Medicare is highly popular, as evidenced by the
tendency of town-hall protesters to demand that the government keep its
hands off the program.

Finally, the third route to universal coverage relies on private
insurance companies, using a combination of regulation and subsidies to
ensure that everyone is covered. Switzerland offers the clearest
example: everyone is required to buy insurance, insurers can’t
discriminate based on medical history or pre-existing conditions, and
lower-income citizens get government help in paying for their policies.

In this country, the Massachusetts health reform more or less
follows the Swiss model; costs are running higher than expected, but
the reform has greatly reduced the number of uninsured.
And the most
common form of health insurance in America, employment-based coverage,
actually has some “Swiss” aspects: to avoid making benefits taxable,
employers have to follow rules that effectively rule out discrimination
based on medical history and subsidize care for lower-wage workers.

So where does Obamacare fit into all this? Basically, it’s a plan to
Swissify America, using regulation and subsidies to ensure universal
coverage.

  • http://mythreecents-cb.blogspot.com/ ChrisB

    #1: “We’ve all heard scare stories about how [the British system] works in practice; these stories are false.”
    Really? So it’s not true that 1,300 cancer patients were denied life-saving drugs because of NHS postcode lottery? Women aren’t suffering from cancers that went undetected because they’re “too young” for a pap smear?
    You can say people are exagerating or blowing things out of proportion, but let’s not pretend the British system doesn’t leave gaping holes in their “safety net.”
    As for the VA, I can’t speak for every speciality, but when I left Houston in Dec 2007, the VA was just beginning to impliment prostate cancer treatments that had been in use everywhere else for 10 years. If folks want the best treatment 1993 had to offer, that’s fine, but I would like to keep up with technology, especially when it improves cure rates and reduces side effects.
    #2: Medicare’s going broke. Canada’s got the same problems (lots of patients, little money). I don’t know much about France.
    But I see Medicare up close all the time. I don’t want that for us.
    #3: Massachusetts is trying to get people off their system before their hospitals go broke.
    And saying that what Obama and the Dems want is a Swiss system is either dishonest or ignorant. He and many other Democratic officials have stated their goal is to use the public option to move us toward a single-payer system.
    If these systems are so great, why do they all send us patients? They survive because they can lean on us, buy our technology, and let us pay for the R&D for their drugs. If we go the way of “every other wealthy country,” this planet may no longer have health care advancements, and certainly not like we’ve had for the last century.
    The truth the liberals won’t admit is that a great many of our problems are due to government — federal and state. They have created a monster and now pretend that they can tame it.
    Just once I’d like to see this country try the small government approach. The problem with reforming our health care system is that all the best solutions are illegal! Drop the regulations, unfunded mandates, minimum requirements, and interstate restrictions and see what that nasty ol’ profit motive can do.
    The most amazing thing is that Christians who know what human nature is like won’t trust humans to do what humans do best — act in their enlightened self-interest — but will trust a handful of extrememly powerful and extremely proud politicians to “do the right thing.”

  • Your Name

    “In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false”
    False? Really?
    http://www.dailymail.co.uk/news/article-1041968/National-Filth-Service-Report-reveals-wards-overrun-rats.html
    http://newshttp://news.bbc.co.uk/2/hi/health/7542718.stm.bbc.co.uk/2/hi/health/7542718.stm
    http://www.telegraph.co.uk/health/healthnews/5955840/Patients-forced-to-live-in-agony-after-NHS-refuses-to-pay-for-painkilling-injections.html
    Shhh… don’t tell the British!
    “Canadians with chronic conditions are more satisfied with their system than their U.S. counterparts”
    Really? Honestly?
    http://www.theglobeandmail.com/news/national/we-have-to-improve-patient-care-period/article1253871/
    Don’t tell Canada’s top doctors who are trying to solve patient satisfaction problems!
    “In this country, the Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. ”
    Costs are running higher than expected? Even people who are pushing for single payer systems are urging congress to stay away from the MA model.
    http://www.pnhp.org/news/2009/february/massachusetts_is_no_.php
    Paul Krugman is consistenly liberal and keynesian. He’s long on rhetoric, and short on facts.
    As to the original question: Are these the big options for Obamacare?
    I’d love to see a post on the WSJ Editorial by the Whole Foods CEO that offered a different set of solutions. Or maybe one about the solutions that Bobby Jindal proposed.
    There are better options. These options distort fact to force people to believe there is only one logical path to follow.

  • SAM TICKLE md

    THE SYSTEM IS BROKEN AND NEEDS TO BE FIXED. PAYING MORE INSURANCE COMPANIES TO SPLIT UP THE BONUNTY DOES NOT SEEM TO WORK … NOT FOR PATIENT CARE. WHAT WOULD JESUS DO WITH ALL THESE CHILDREN AND OLD FOLKES. SOME ONE SAID HE WOULD LOVE THEM. (LAST COMENT IN DEFFERANCE TO THIS SITE.

  • Heather

    I’m not sure the “it needs fixing but all the solutions are wrong” will work for you guys. I have British friends who are more than happy with their health system. Yes, it has a few problems – all systems do – but overall they know if they get sick they will be OK and they won’t be paying off their hospital bills for the rest of their lives.
    I live in Australia. There are some hospital overcrowding issues. There are some nurse shortages. But none of these are really problems if you are seriously ill. I can walk into any public hospital at any time and get world-class, completely free care for any problem. If I need to stay a month I can. If I need an expensive test or procedure it costs me nothing. I can visit a doctor for free too, and most common medicines are subsidised to the point where a prescription costs only a few dollars.
    The Medicare system isn’t as bad as you all seem to think it is. It’s worked here for many, many years.
    Don’t look at the attention-grabbing headlines that the papers throw out there, look at the fact that millions of people in this country and in Britain and many others around the world are not afraid of getting sick or hurt because their insurance has run out or they can’t afford it.

  • Jjoe

    Here’s a list of the countries where the citizens are more satisfied with their health care than the U.S., according to Gallup (2009). For every horror story about British or Canadian care, I can find 10 about the U.S.
    Ireland
    Switzerland
    Belgium
    Luxembourg
    Italy
    Mexico
    New Zealand
    Spain
    Netherlands
    United Kingon
    Austria
    Canada
    France
    Greece
    Finland
    Denmark
    Iceland
    United States

  • http://grasshoppersdreaming.blogspot.com :mic

    The one question which has never been satisfactorily answered on this . . .
    What business/enterprise has the government run better than the private sector?
    This would include:
    1) efficiency
    2) cost
    3) advancement
    4) profit
    I’m sure that you cannot name one. In fact, the President himself has admitted the private sector does things better than the government, TWICE admitting in the last week that UPS and FEDEX beat-out the USPS.

  • Jjoe

    Point 2: “Why do they send us patients?” In fact, TEN TIMES as many people leave the US for medical care as come here, and this doesn’t even include prescription drugs.
    According to Wikipedia:
    “An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that a million and a half would seek health care outside the US in 2008″ while
    “a report from 2008 found that a plurality of an estimated 60,000 to 85,000 medical tourists were traveling to the United States for the purpose of receiving in-patient medical care.”
    Why do Americans go to other countries for health care? Because it’s just as good, but cheaper. I know a person who broke their collarbone badly in Thailand on their honeymoon, and when it came time to get the pins out, he went back to Thailand!!

  • Sophy

    There are definitely problems in our health care system, but do we really want to pay higher taxes to fix them?

  • Jjoe

    Let’s see if Fedex will deliver a letter for $0.50 across the nation.
    Let’s privatize our police departments and only protect those with paid-up crime insurance.
    Let’s privatize our libraries and charge admission to schoolkids, and rent books by the week.
    Let’s privatize our fire departments and let it burn, baby, burn if the subscriber were stupid enough to buy insurance from the wrong company.
    Let’s privatize our schools so that only those kids with parents who can afford it get an education.
    Let’s privatize our national defense and sell it to the cheapest group of mercenaries.
    Let’s privatize our legislature….. wait, we’ve already done that, and the health care industry has bought them all up.

  • Matt K

    Most of Medicare’s deficits are coming from the unfunded prescription bill passed by the GOP controlled congress, signed by then President Bush. It was the pharmaceutical companies dream come true. Where were the protests about deficits then?
    The Bush tax cuts contributed $1.8 trillion dollars to the deficits. Most estimates put the cost of HCR in the neighborhood of $1 trillion.
    The last time any Federal taxes were ever raised was in 1993, a small gas tax. Taxes have been at their lowest in decades. Americans will have to come to grips with the fact that we either have to raise some taxes or we have to cut things like vital social services or make some cuts to the largest portion of the federal budget: national defense.

  • JRS

    With freedom comes responsibility.
    Do we really want to give responsibility for health care to the government and lose that freedom?
    Freedom is not free, but it is worth it.
    Freedom to manage our own health care is not free.
    But do we want to give up that freedom?

  • Rick

    What seems to be missing from this debate is:
    1) the income tax rate in all of the countries cited for their exemplary national health systems hovers around 50%++
    2) probably wouldn’t have this problem if the church had not abdicated its responsiblity for the disadvantaged and let Caesar take that responsibility.

  • http://krusekronicle.typepad.com Michael W. Kruse

    On the Swissify option:
    “everyone is required to buy insurance, insurers can’t discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.”
    It seems to me that requiring everyone to buy insurance would help with the pre-existing conditions conundrum. Requiring insurance coverage is essentially a tax increase, you buy the insurance in lieu of having to pay higher taxes in the form of other government approaches. I presume you get to shop for which plan to choose and that introduces a market mechanism I like.
    What are the drawbacks to it?

  • NancyS

    Re: With freedome comes responsibility.
    Under the current system we do not have the “freedom” to manage our own health care. At least I am not wealthy enough for that. I am lucky because my family has employer provided health insurance. But does this mean we can manage our own health care? No! The insurance company decides what health care I can receive.
    Add to this the possible financial catastrophe if we were to lose this insurance. My sister lost her job last summer and has no health care. She cannot afford cobra and needs medicine for high blood pressure and other issues. Even if she could afford the premiums she would not be able to receive insurance. And she is one of millions.
    A nation that will not take care of “the least of these” is in no way a Christian nation… at least that is my opinion.
    I used to be a conservative Republican and thought that everyone should be responsible for themselves… but then I became a Christian and started to see things differently. We can say the the responsiblility for care for “the least of these” should be in the churches. Personally I wish this were possible… I would love to see the Christians involved in healing (as many are). But when we live in a representative demoncracy, we also participate in providing help by using our voices in the public realm. I am now using my voice to call for reform of a system that is focused upon profit rather than health.

  • Dana Ames

    Dr. Tickle! Nice to “see” you! Your wife is very dear.
    The ENT group for which I transcribe agree with you. In fact, one of them told me that if she had her druthers, she would not accept any insurance assignments except Medicare, but would have a baseline price list to start with and adjust charges according to people’s ability to pay.
    Patient care is the most important thing… I don’t hear many voices bringing that concept to the conversation. How do these various ideas about “who pays” relate to patient care? ISTM that taking the “middle man” out from between doctors and patients would cut costs all by itself. Being able to choose our doctors would foster good competition and weed out less careful providers.
    I would gladly shift the money we currently pay for insurance premiums into an account (read: taxes) that would enable the “middle man” to be eliminated and provide care for not only myself, but my fellow citizens. Just like the VA. Just like Medicare (for which I’m already paying anyhow). Just like roads, fire, military, schools, etc. as Jjoe points out above.
    Dana

  • Kyle

    “And saying that what Obama and the Dems want is a Swiss system is either dishonest or ignorant.’
    Here’s the fundamental problem in this debate: It’s impossible to discuss the actual legislation being considered and voted on in Congress (which would clearly establish a Swiss-style system, rather than a single-payer system) because those on the political right insist on talking about some hypothetical top-down, government-run system that no one in a position of power is proposing.
    We live in a democracy. The president cannot impose his preferences by fiat.

  • http://krusekronicle.typepad.com Michael W. Kruse

    #9 and #16
    If your just going to lob grenades into the discussion at least have the integrity to own them by identifying yourself (or selves.)

  • Scot McKnight

    Michael, thanks for pointing to the problem comments. I didn’t get them as emails so I missed them. We want commenters to own up to their comments by posting their name.

  • http://krusekronicle.typepad.com Michael W. Kruse

    Kyle #18
    “… because those on the political right insist on talking about some hypothetical top-down, government-run system that no one in a position of power is proposing.”
    That isn’t entirely true. Obama has said on many occasions he supports a single-payer plan … just can’t get it all at once. From St. Petersburg Times Politifact, “I have not said that I was a single-payer supporter”, an Obama quote in 2003:
    “I happen to be a proponent of a single-payer universal health care program,” Obama said. “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its gross national product on health care, cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. That’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we’ve got to take back the White House, we’ve got to take back the Senate, and we’ve got to take back the House.”
    The article reports:
    “… at several town halls this year, Obama has been asked by single-payer supporters why he doesn’t propose a single-payer system. Obama’s consistent answer has been that if he were designing a health care system “from scratch,” he would go with a single payer system. So that certainly indicates philosophical support for the idea, even if Obama has also consistently concluded that single-payer is not politically feasible.”
    Those who fear there is an incermentalist attempt are can’t just be brushed of as right wing nut cases. This is a complex bill and based on repeatedly stated objectives by Obama himself it isn’t irrational to be concerned that something is being set up that will drive things toward single-payer. Whether that is bad or not is separate question but it is not irrational for those worried about it to be worried about it.

  • Kyle

    @Michael
    It strikes me as a bit irrational. The argument seem to go something like this: (1) the current health care reform plan will be adopted, (2) this will lead to a disastrous decline in the quality of health care we receive in this country, and (3) we will then tell our elected officials to give us even more of the disaster.
    More broadly speaking, the “slippery slope” view of the world is no way to go about business. Every new government regulation puts you on the slippery slope to communism. Every repealed regulation puts you on the slippery slope to anarchy. Either the plan being considered is preferable to what we have now or it isn’t; it should stand or fall on its own merits.
    Finally, from a political analysis standpoint, it’s hard to see how we’re going to have a more Democratic Congress than we have right now in the foreseeable future (presuming the GOP finds its footing at some point). Whatever you get on this pass at health care reform is going to define the basic structure of our system for quite a while. (Or, at least, things aren’t going to move further toward government control. I suppose the GOP could win back power and move us back toward what we have right now if things are really as bad as the opponents tell us they will be.)

  • Doug Allen

    And Mr. Kruse, why is it not irrational to be worried about a single payer, universal health care program? It works very well in all those countries JJoe cited (post #5) and also with our very own VA healthcare program and with our medicare. Costs per medical visit and per medical procedure are lower, satisfaction (see Gallop pole) is higher. No one goes bankrupt becaue of medical bills.
    If those at the town meetings who yell and scream that their parents or childern are going to be put to death or who try to bring loaded guns or who call Obama a nazi are not nut cases, then who is?
    :Mic asks what business/enterprise has government run better then the private sector. One answer is, of course, healthcare. See sentence 2 and 3 above.
    Who here thinks the real patriots and disposers of healtcare wisdom are Fox news with their “Obama is the most untrustworthy politician who ever lived” Sean Hannity; and “Obama is creating concentration camps” Glen Beck; and EIV network “I hope Obama fails” Rush Limbaugh? I fear for my country and my president.
    Doug

  • Matt K

    Obama is a pragmatist/realist, which I like to remind my friends on the Christian Left of this. Obama’s favorite theologian is Neihbur, not Hauerwaus. He may have a personal preference for a single-payer option, but he knows that the cult of the free market in American society will probably preclude that for a long, long time– if ever. Obama the realist instead pushes a modestly progressive plan for expanding coverage and cutting cost. Hardly looks like a radical Marxist revolution.
    Many European countries with similar systems as this proposal seem content with them. I’ve heard from both Germans and Danes that there is plenty of market competition among insurance providers and public options in those countries.

  • http://grasshoppersdreaming.blogspot.com :mic

    Jjoe @ 9
    Sorry, but your rapid-fire arguments don’t follow. There are certain responsibilities that governments have to ‘provide for the common defense’ and ‘promote the general welfare’ which do not allow for private entities to control. For example, defending and policing are necessary functions of the government. (Actually, delivering mail and providing access to books are not RIGHTS to life, liberty and the pursuit of happiness.)
    But you quickly blur the definitions of private sector and government responsibility with your comments, assuming that the logic will follow. It doesn’t, because you have not properly defined the roles of private enterprise and government responsibility BEFORE you made your accusations. So your premise is flawed.
    However, to engage your first point (which I take is a response to my initial comment): No, FEDEX and UPS will not deliver a letter for 50¢ . . . but neither are they running a massive deficit year-after-year. Remember, the President said (TWICE in one week) they do a “better job” than the USPS . . . his words, not mine.

  • http://faithandfood.morizot.net/ Scott Morizot

    :mic, The TSP runs more consistent rates of returns at a tiny fraction of the administrative cost of any privately managed 401K plan. The SSA operates at a tiny fraction of the administration cost percentages of any privately administered retirement plan. Fedex and UPS don’t operate under the same service mandates as USPS. We do, however, have by far the least expensive first class mail of just about any country and it’s highly reliable. We have a tax system and agency in the IRS that countries study and send people to try to figure out how to mimic the low operating costs, high voluntary compliance rates, and effective enforcement. Every attempt to get private debt collectors involved in just the enforcement part has not only been disastrous to taxpayer privacy rights, but has actually cost the government more money than debt collected.
    So there are a great number of things that government agencies do very well, thank you very much. And frankly, it’s hard to imagine any government involvement that would be worse and more costly than the unmitigated disaster we have right now. We spend an order of magnitude more per capita than any other country on the planet and we yet we rank lower than many in every objective measure people have been able to come up with.
    My wife and I are in pretty good shape. But then I get the assurance of participation in the FEHB which is strictly regulated by OPM. Even with no changes, I’ll carry that insurance into retirement and it will continue to be a secondary payer even when I’m under Medicare. However, I have adult children who are struggling with health care right now. I have a granddaughter I worry about. And I have two children still at home and worry about what options they will have when they pass the magic age of 22 and can no longer share my coverage. I’ve also been recently diagnosed with celiac disease, so that means they all have a potential genetic predisposition to develop the autoimmune disease at some point in their lives. And so does my granddaughter and any future grandchildren.
    And *Christians* are among the main voices opposing reform in the US? Really? Do you have the slightest conception what message that sends? Or are you so embedded in your subculture that it completely flies over your head? I seriously wonder.

  • http://faithandfood.morizot.net/ Scott Morizot

    Oh yeah, I was listening to this this morning. It echoes the reaction from everyone I know who lives in Britain. And is well worth listening or reading.
    http://www.npr.org/templates/player/mediaPlayer.html?action=1&t=1&islist=false&id=111976190&m=111976234
    http://www.npr.org/templates/story/story.php?storyId=111976190
    I would also tend to describes France’s system as somewhere between the Canadian and the Swiss system. On most measures it’s also one of the most effective systems.

  • http://krusekronicle.typepad.com Michael W. Kruse

    #20 Kyle
    A part of getting legislation passed is the need for trust because the issues are so complex. The challenge is that Obama has explicitly stated he has ulterior motives. Folks know many congressional Democrats are openly aiming for a single-payer program. The bill is exceedingly complex and the implications are hard to understand. So even if it is a modest step as you say, Obama and the Democratic leadership have not placed themselves in a good place to be trusted. I think that is an obstacle to be overcome.

  • http://faithandfood.morizot.net/ Scott Morizot

    Matt K (#22), I do enjoy the irony that the histrionic voices against including a public option as one of many players simultaneously claim that would place the private sector at a competitive disadvantage AND that the private sector is more efficient, produces better value, and does a better job. And seem completely unaware of the contradiction between the two claims.

  • http://krusekronicle.typepad.com Michael W. Kruse

    #Doug #21
    “And Mr. Kruse, why is it not irrational to be worried about a single payer, universal health care program?”
    I wrote at the end of #19:
    “Whether that is bad or not is separate question but it is not irrational for those worried about it to be worried about it.”
    I didn’t say they weren’t irrational or wrong. I said that was a separate issue. I was speaking to the concern of whether there was an incrementalist effort underway. That is not an irrational belief based on what I presented.

  • http://krusekronicle.typepad.com Michael W. Kruse

    #20 Kyle
    Also, while they are similar, I don’t see incrementalism as the same as slippery slope. Slippery slopes are the when one foundation falls a domino effect is set in motion that probably requires little intentional effort. Incrementalism is a highly intentional strategy to move things from one place to another. I do think your observations about push back at various future points is valid, but we all know that once a program gets rolling, even if it is a bad one, it is hard to derail.

  • http://krusekronicle.typepad.com Michael W. Kruse

    Scott M #26
    Having the government in the picture is potentially like having a huge corporation with deep pockets in an industry with other much smaller players. The big corp undercuts the prices of everyone else, even at a loss to themselves, until they drive competitors out of the market. Then they have monopoly.
    The government can raise money endlessly. Private firms can’t. And in light of the comments I gave above, this dovetails nicely with an incrementalist approach to move to single payer. Thus the anxiety.
    The comparison of the government becoming a competitor, versus private firms competing against each other, is apples and oranges.

  • Jonathan Blake

    I honestly have preferred France’s system since I first learned of it in my high school French class.

  • Nitika

    We need to remember that all these other systems exist in a world that also includes the current American system. How well they would operate in a world in which America used a system similar to one of theirs is an unknown.
    In other words we need to consider to what degree the high cost of health care that Americans currently pay contributes to the ability of other countries to provide less expensive care.

  • Kate

    ChrisB @1, “Your name” @2: Do the newspapers in America really tell the unembroidered truth without sensationalism? Please don’t expect the Daily Mail to be a reliable indicator of the state of the NHS.
    “Really? So it’s not true that 1,300 cancer patients were denied life-saving drugs because of NHS postcode lottery?”
    You’re right, it’s absolutey not true, the best cancer drugs are available free to all who need them. Unproven drugs that may or may not have benefits are not covered unless there is a good case for using tem. No one is denied truly “life-saving drugs” in the UK. Some people are denied drugs that they BELIEVE might have a chance of helping them.
    Rick @no.12: “the income tax rate in all of the countries cited for their exemplary national health systems hovers around 50%++”
    Actually in the UK it’s currently 22% not anywhere near 50%++. The average American spends 7% of their income on healthcare or insurance, so you’re paying the “tax” anyway.
    But because of your private system your healthcare is twice as expensive as any other, you’re paying more than you need to. There’s no incentive to providers to keep costs down, so they don’t.

  • Kate

    Heather @4: “Don’t look at the attention-grabbing headlines that the papers throw out there, look at the fact that millions of people in this country and in Britain and many others around the world are not afraid of getting sick or hurt because their insurance has run out or they can’t afford it”
    Exactly- just try suggesting to the UK papers that we privatise medicine in the UK along US lines and than see what they have to say about the NHS. We grouse about the problems, but we love (and take for granted) our free medical care.

  • Rob Grayson

    As a Brit living in France, though I know little of current healthcare arrangements in the US, I do have experience of both the British and French systems. On that basis, I offer the following observations:
    - It seems to be implicit in some of the comments that there is such a thing as a perfect healthcare system, where everyone is happy with what they pay and how they pay it, and everyone is happy with the healthcare they receive in all circumstances. There is no such system, and never will be, in any country. Implying that another country’s healthcare system is to be avoided like the plague because it has some faults is therefore not very productive, because every healthcare system has faults.
    - The British NHS, of course, has its faults. However, as Kate (#32) pointed out, in the vast majority of cases, pretty much every UK citizen can be sure that they will receive treatment for pretty much every condition without having to worry about how they are going to pay for it. yes, there are exceptions, but these are statistically very few, and mostly relate to exotic and/or experimental treatments. I see no way around this as long as you accept that there can never be a limitless healthcare budget.
    - Extreme care should be exercised when quoting stories from the UK (or indeed any) media as evidence that the British system is broken. Britain has more than its fair share of sensationalist media where creating hype and whipping up emotion is more important than presenting facts in context. And even with better quality journalism, it’s very easy to present a skewed picture of reality by always and only focussing on the 0.1% of the overall picture.
    - Many have said that France has the best health care in the world. This may be true in terms of quality of care. As a Brit, the first time I went into a French hospital I was amazed at how modern and superbly well-equipped it was. The French expect to receive high quality treatment, and are used to being routinely prescribed all kinds of drugs for ailments that wouldn’t even even be treated in the UK (other than the doctor telling you “It’s a virus, get plenty of rest and drink plenty of fluids”). However, nothing comes without a price, and in spite of very high social security contributions (way higher than in the UK), France has a truly enormous social security budget, which is only going to keep getting bigger until attitudes towards health care change and/or the system changes.
    Perhaps none of the above points help get you any closer to the best solution for the US today; my plea is only for a bit more balance in the debate.
    Rob

  • Rob Grayson

    Sorry, I meant to say “France has a truly enormous social security budget DEFICIT”…

  • Kate

    “Really? So it’s not true that 1,300 cancer patients were denied life-saving drugs because of NHS postcode lottery?”
    They were only “denied” drugs in as far as they had to go private and pay to get drugs they felt they needed. How many in America are “denied” life saving drugs, ie have to pay for them?
    We have a private system in the UK too, don’t forget, you can buy health insurance if you want to. But most of us prefer our first class treatment free, thank you. I actually have a pretty comprehensive health insurnce from my employer, but I trust the NHS system more (I used to work in it)so I avoid the private system. Private healthcare has too much risk of uneccessary tests and procedures, in my experience. As a doctor I prefer a solid evidence base to a profit motive.
    I hate to see chronic back pain in those who paid for surgery they “needed” when the NHS doctor, in line with best evidence, recommended they wait. I hate to see small kids undergoing the risks and stress of tonsillectomy because the parents paid to “get something done” when the NHS paediatrician said that the child did not need surgery. This is the kind of thing that you get in consumer-driven private healthcare. This is why government provision of healthcare, based on the best available evidence is safer and more efficient than a private system, driven by consumer-wants and provider profits.

  • JRS

    NancyS
    I agree and share your concern that health care costs more than people can afford.
    I think that’s the point and the essential problem. If health care was affordable we wouldn’t be having this national discussion.
    Part of our responsibility is to point that out to the providers. They have failed to contain costs and at the same time benefitted financially.
    When health care providers become quite wealthy from the sickness and suffering of people, don’t we have a responsibility to challenge them? If they care about people don’t they have a responsibility to manage the physical issues while making sure the costs are as low as possible?
    Part of the discussion must surface that aspect of the problem.
    It is our responsibility; an unpleasant responsibility to be sure. But if our concern is providing health care for people, it is inescapable.

  • http://mysticallimpet.blogspot.com Travis Greene

    :mic @ 6, “What business/enterprise has the government run better than the private sector? This would include:
    1) efficiency
    2) cost
    3) advancement
    4) profit”
    You’re right, the private sector will tend to do better at those things. But I notice that nowhere on your list is “accessibility”. There are some things that business simply cannot provide for, because you can’t make any money at it. Or even if you can, we don’t want to do it that way. I think we can agree that even if outsourcing national defense to private firms of mercenaries were cheaper, it would be a bad idea. Not that we don’t already do that to a depressing degree.
    Let’s stop the myth that government is bad at everything. Can we agree that some tasks are better suited to the private sector, and some tasks are better suited to the government? We can debate which category healthcare belongs in, but can we at least admit that the categories exist?

  • Dianne P

    I’m a nurse who once worked in clinical research for the pharmaceutical industry. As global program manager (whatever that means), I was very apprehensive about traveling to the UK to begin some clinical studies in kidney failure and transplantation, sure to find that I would be traumatized by all the untreated patients there, left to die outside hospital, perhaps left in rows in the car park *ok, I’m talking “UK” now*. Imagine my surprise to find that not only did they get good care, but far better, imho and in their humble opinion, than kidney failure patients here. And my further surprise to find that most docs in western Europe look at the pitiful treatment of kidney failure patients here and view us as providing far inferior treatment.
    Bottom line… I had fallen for that tired old litany of the far right… we have the best health care in the world… blah blah blah. NOT. Not by a long shot. We are so accustomed to looking to the US as THE standard and presuming that others line up somewhere below us, that it becomes almost impossible for us as a nation to see the truth. Virtually every other first world industrialized nation gives better healthcare than we do – cheaper, and people there, overall, are far happier with their healthcare than we are, overall, here in the good old USA.

  • ChrisB

    @Jjoe,
    You can’t site wikipedia on anything controversial. It’s just not reliable.
    Do Americans go to other countries? I’m sure they do. It’s cheaper.
    But those who come here don’t come because it’s cheaper. They come because the treatment they need is not available elsewhere. Important distinction.
    @Kyle,
    There’s a great new video out showing various Democratic government officials saying the public option is the first step on the road to single-payer. We’re not being paranoid. We want to talk about options that won’t go down that road.
    @Kate,
    I hate that y’all are getting sucked into our debate. Please don’t feel like we’re attacking your country; we just don’t want your health care system.
    “Unproven drugs that may or may not have benefits are not covered unless there is a good case for using them.”
    And… drugs are approved much slower there than here. To keep costs down.
    “They were only “denied” drugs in as far as they had to go private and pay to get drugs they felt they needed.”
    So your great public system that pays for everything for free so people don’t have to worry about health care costs … asks them to pay for their own medicine. Sounds like a break down of your safety net.
    @Dianne P,
    My question is, would your company have developed those drugs if they knew there was little to no chance they would ever get their R&D costs back?
    @all
    Hospitals lose money on every Medicare patient — it costs most to treat them than they get from the government. Private patients pick up the slack. When that option is gone, we will be in a sad state.
    My experience with Medicare, and my conversations with co-workers who have lived and worked in places with socialized medicine, have taught me this: They are great systems if you’re basically healthy. But don’t get sick.

  • Doug Allen

    ChrisB, my friend,
    Are you reading the other posts. Diane P #40 above, like many, many others posting here, say you are flat out wrong. She has first hand experience and is more than qualified to make the judgment. I’m trying to see where you’re coming from Chris, but your comments in light of all the posts here and other evidence to the contary make no sense.
    We had a “heathcare” town meeting in Spartanburg, SC, last evening. Two quotes from today’s Spartanburg Herald-Journal newspaper article,
    “More than half(the 150) attending said they were on medicare and clapped every time medicare was mentioned.”
    Spartanburg resident “Dr. Brad Whitney said his nurse spends more time trying to figure out 20 insurance companies than providing patient care, but his office loves working with the medicare system.”
    There, in a nutshell, is one reason our healthcare system is so inefficient (and so expensive) and why a single payer system like medicare would be so much more efficient.
    Doug

  • Deyo

    Thanks for doing this series, Scot. Much appreciated.

  • http://grasshoppersdreaming.blogspot.com :mic

    Doug @ 21
    Dismissal by name-calling isn’t going to help the rhetoric, nor is it going to help your case. Simply pushing aside high-profile talking heads does not prove your point.
    Scott @ 24
    First, the FEDEX/UPS v. USPS statistics are Obama’s, not mine. He as a head of government said that the government doesn’t do as well RUNNING A BUSINESS than the private sector. Yes, our mail is fine for what it is. Yes, it is better than other countries. And, yes, IT LOSES BIG MONEY EVERY YEAR!!

  • http://faithandfood.morizot.net/ Scott Morizot

    :mic, I see you conveniently ignored the bulk of my comment to spout back the one topic. The USPS “loses” money each year because we, through our representatives, mandate the extensive level of service it provides and that it undercharge for that service. We are essentially subsidizing several areas of our country when we then cover the losses at a national level. Notably, we are subsidizing rural areas, senior citizens, and similar groups who rely more heavily on the service at the cost provided.
    We also require that the USPS provide excellent benefits to its employees. UPS and Fedex have better benefits than large segments of the US economy, but they don’t compare to the USPS. And we require that they do things like fund retirement benefits up front.
    It doesn’t make money because, as far as I can tell, we neither expect nor desire for it to make money. The “smart” business decisions that would make it “profitable” would essentially be to cut the unprofitable service areas and focus on the revenue generating sources like UPS and Fedex do. Stop universal free mail pickup at or near all residential areas or even actually at the home. (Delivery would have to be balanced, probably charge a lot more to delivery to remote destinations.) Raise prices on services. There are experts who balance the whole ratio thing there. Cut benefits to employees to the bare minimum you need to retain an experienced work force.
    Hmmm. The more I think about it, the more the idea of truly privatizing the postal service and turning it into an entity driven only by profit provides a really good illustration for the sorts of problems we actually have right now in our health insurance system and which we need to fix.

  • http://grasshoppersdreaming.blogspot.com :mic

    Scott @ 45
    Well, in actuality, my comment was a bit fragmented – parts of it got lost (my response to Travis @39). But you’re right, I didn’t really have much to say regarding the rest of your comment.
    But since you asked: Yes, we could cut overhead or raise prices to deal with the USPS. That’s business. And you could argue that this proves your point, but in reality it does not. Because, even though that is the way profits are made, the government does not need to make a profit to stay in business. Let me put it this way: Can you be certain that healthcare will be a government-run entity that doesn’t turn out like other government-run entities? And (here comes a BIG ISSUE for the debate), when those costs need to be cut, what will be cut from healthcare?
    All of the sudden, citizens become budget line-items that have to be dealt with, not cared for. There goes all of the so-called compassion within government-run healthcare.
    And, regarding your final line: What’s so wrong with companies that make profit? Without profits, things don’t work. That should be relatively clear. If hospitals lose money, they aren’t around very long. And then we’ve no care to offer. If our entire healthcare is built upon a business plan which leads to losing money, then it won’t be around after a while. Remember, our President has already admitted that we cannot currently pay for what he has in mind.
    Here’s an example that got chopped off of my last comment:
    You can now obtain prescriptions for $4 (some for free), children’s eyeglasses for $9, and get free eye exams. Who did this? Not the government. Walmart. The same “greedy profitable corporation” which has been maligned by the Statists for years – they have delivered what Lefist politicians have only promised.
    If you truly want to get costs down and healthcare quality up (though, people still come in droves to have our healthcare over any other nation’s – something I wish was more recognized in this debate: the fact that we have THE BEST quality of healthcare and medical advancement the world has ever seen – how about some thankfulness and pride here?) . . . if you want costs down and quality up, get the government COMPLETELY out of it and you will see a radical transformation in the system for the better (i.e., remove MEDICARE/MEDICAID/SOCIAL SECURITY). This is the economical solution.

  • http://faithandfood.morizot.net/ Scott Morizot

    Ah, I see. You place your faith and confidence in some idealized vision of “private industry” that has never existed in reality and can never exist. Fortunately, anyone who actually tried to implement what you say you desire and eliminate social security, medicare, and medicaid (you neglected to include VA) would immediately be marginalized and it’s very unlikely they would be reelected, Democrat or Republican.
    So *that’s* not going to happen. Nice of you to spell out what you actually want, though.

  • Travis Greene

    :mic, is there anything you think the government actually can do? Should we get the government completely out of education and criminal justice as well?

  • Kate

    Chris B @41, sorry, maybe I wasn’t clear, but you’re not understanding me:
    You quoted me:”They were only “denied” drugs in as far as they had to go private and pay to get drugs they felt they needed.”
    You replied: “So your great public system that pays for everything for free so people don’t have to worry about health care costs … asks them to pay for their own medicine. Sounds like a break down of your safety net.”
    No, people only very rarely have to pay for drugs, although there is a prescribing fee to pay if you are earning (about $12 whatevever however expensive the meds, to a max of $172 per year) I was simply trying to explain the fact that these cancer patients who are being “denied life-saving drugs” according to the sensationalised story you link, are not being refused drugs, but are told they will have to go private if they want non-standard drugs that are not considered part of established treatment.
    The safety net remains intact, but you are free to jump out if you choose.
    Don’t worry, “I all” am enjoying the debate. But don’t criticise the NHS if you know so little about it. If you think Wikipedia is “just not reliable”, please realise that the sources you quoted are many degrees less reliable! Please read Dianne P’s post at #40 if you want a more accurate source.

  • http://grasshoppersdreaming.blogspot.com :mic

    Scot @47
    I really don’t know why your tone has turned more hostile towards me. The whole point of this discussion is “to spell out what we actually want.” I don’t assume that people are lobbying for positions they don’t really care about.
    My *faith* is placed in nothing human, private or public. In fact, it is less faith in humanity that leads me to the belief that people should not be tied to governmental decisions for their own health and well-being. My faith in the Almighty dictates that I hold conservative views, for it is here that the founders sought a more-perfect union based upon the divine blessings of LIBERTY. Please, do not take a condescending tone when attempting to articulate ‘my’ faith.
    You were seeking a solution, I gave you one. I didn’t claim that it would be ‘electable’ (but, Obamacare doesn’t appear to be either), I claimed that it would be the right thing to do. Actually, I am concerned that we are now making moral decisions based upon what is politically feasible.
    Travis @ 48
    In a previous comment (@ 23) I made it clear that there are things which are necessarily bound to the role of government. As for education, the system is almost completely broken. And the more federal government is involved, the worse it gets. How about Federalism? State’s rights? Local control? That is what the Framers intended, and that is what we have strayed away from. Defense and civil justice systems are not included here because of the definable role of a government. In other words, the public sector is comprised of SERVANTS who work to defend the rights of liberty, not control the definitions of liberty regarding various aspects of daily life.

  • Kate

    Chris B, re socialized medicine: “They are great systems if you’re basically healthy. But don’t get sick”
    Big misunderstanding: it’s when you’re sick that the NHS is at its best. Private healthcare is OK for a nip-and-a-tuck, or maybe if you want your varicose veins fixing tomorrow, ie if you’re basically healthy (and wealthy). But don’t get sick. (Or poor.)

  • Kate

    :mic, I am a little confused. “we have THE BEST quality of healthcare and medical advancement the world has ever seen “are you talking about the USA?!

  • http://faithandfood.morizot.net/ Scott Morizot

    Kate (and ChrisB), ChrisB is not being up front to you that exactly the same thing happens here, only it’s the private insurance companies that make that decision. Very rarely will insurance pay for a drug or treatment that is not yet approved and a standard treatment. You might be able to get into a trial program in which the company seeking to have it approved and become a standard treatment foots the bill. But such trials are not necessarily easy to get into.
    However, it’s actually worse here where insurance companies regularly and routinely look for ways to avoid paying for treatments and drugs that actually are approved. I think ChrisB’s problem is that the “government” is making the decision about covering something either not approved for that purpose or otherwise not a usual treatment versus a “private company” making that decision. That’s a guess, of course. But it seems to be more an ideological matter than anything else. Especially in this case, since it’s more, not less, likely to happen here. In fact, that’s one of many reasons why so many of the measures of the quality and effectiveness of our health care as so far below Britain’s (and a lot of countries).

  • Travis Greene

    :mic,
    So because people from other countries come to America for our healthcare system, it’s the best in the world, but when they come to America for our education system, it’s “almost completely broken”?
    Look, I get your point of view, even if I don’t agree with it: the private sector will do a better job at healthcare than the public sector.
    What I don’t understand is this belief that government is always and inherently corrupt, incompetent, and slack-jawed. The free market needs rules to function well, just as when you drive down the road (somewhat like operating in the market), you rely on certain publicly enforced rules and regulations, not to mention the tax-funded road itself, to keep you safe and able to make free decisions about where to drive.

  • http://grasshoppersdreaming.blogspot.com :mic

    Travis @54
    Very good inference on education v. healthcare. Interesting take on my prior logic. Perhaps both sides would be in trouble from making that simple equation. However, those who come over our borders for (public) education typically aren’t from nations with a comparable standard of living. It is not a matter of socialized v. non-socialized, but rather education or no education. That is a difference.
    The free market needs to function, with certain regulations stemming from the law. But, that is not what the perspective on the free market is here – we are dealing with leaders who tell private CEOs that they cannot fly their own private jets to vacations on their own salaries, while they spend millions of public money to buy private jets and have lavish outings. It is not that I think that government is inherently corrupt, but that bureaucracy never remits power. And when governments achieve power, history tells us that they rarely give it up. This is what prompted Reagan to say: “No government ever voluntarily reduces itself in size. So, governments’ programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this earth.”
    I do appreciate the work of government in their mandate to secure the blessings of liberty and promote the general welfare. But I also think about the efficiency of government when I drive over potholes that haven’t been fixed despite numerous complaints from the community over the past couple of years. These things happen, and they don’t necessarily mean that government is inept . . . but are we so certain that this will never happen to individuals in nationalized healthcare?
    I am not pessimistic here, but realistic. Can you identify a government program that isn’t bloated, mismanaged, and/or corrupt. Because FannieMae and FreddieMac come to mind really quickly, even when the architects of that corruption are trying to get healthcare through the House. Government isn’t necessarily corrupt, but I have every reason to believe that the current Congressional leadership is quite corrupt.

  • Kate

    If Reagan really said: “No government ever voluntarily reduces itself in size. So, governments’ programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this earth.” He was obviously not watching what his friend Mrs Thatcher was doing in the UK, as she and her successors privatized great chunks of our nationalised infrastructure. Privatization / nationalisation neither is a one-way process, merely depends on the colour of the party in power.
    Interesting too, to note how much worse some of the services have been since the government handed them over to the free market economy- I believe the people running the businesses have done well for themselves (good old free market!), but the services themselves have not been up to much. I suppose it’s no major disaster when the train system and utilities no longer provides the service they used to when nationalised, but it would no doubt cost a lot of lives if the healthcare system was privatized, so I hope we never go down that route.
    There seems to be a worry in the US that only private companies can run a profitable healthcare system. What’s not so clear is why on earth you think anyone should be making a profit from illness, rather than viewing healthcare as an essential right, like education. It doesn’t have to be so expensive as at present, either- most of Europe and other countries like Singapore spend less than half what the US does and still get better results than the US.

  • http://grasshoppersdreaming.blogspot.com :mic

    Kate @ 56
    Yes, Reagan actually said this. The economy under him was booming, too. And he didn’t care what his friend Ms Thatcher was doing to run HER country, he was interested in this country doing what it was supposed to do. That’s what leaders do . . . evaluate and move forward without trying to be like everyone else. And it is naive to think that nationalization is a one-way process . . . government does not release power, and a decision of the magnitude will not be ‘reversible.’
    You number yourselves with those who attack the free market. The free market is NOT bad, it is the best economic system anyone has ever come up with . . . if there’s a better one, I’m all for it! But the principle of get paid for what you do and earn what you can is simple. The premise is straightforward, and has inspired and motivated people to do great things. (For example, against certain caste systems and communist regimes, people can make their lives what they want, not what they are ‘told’ they can be.) And the numbers of advancements from the free market outweighs what governments have produced – right down to the computer you type on – because free spirits have inspiration and motivation.
    You mention trains. If you want to ride the trains, go ahead. But most people hop on a plane or get in their cars. That’s decision and progress. In regards to utilities, I have no real idea of what you’re speaking of . . .
    Why make a profit from illness? Can I return the question: ‘Why do you think that people should work in the healthcare field for little to no money?’ Because that is what you seem to be implying. When there is no profit on the business end of healthcare, then there is no money to stay in business. But since healthcare is given as a ‘right’ (which is a dangerous concept to define), we must provide it. So the implications (working backward in the premise) is that doctors should not make very much money and that people who research and develop drugs and machines and medical devices should not earn money either. Interesting. But it is your premise, not mine.
    And that is what typically happens, along with the loss of the best medical minds who find they can do other things and be better off. I know, it’s ‘heartless’ isn’t it? No. Because this system has been the system which has brought the level of care, cost, and accessibility to great levels. And only now is it being perceived as a crisis. You will need to recognize one thing in our current discussion . . .
    THIS DEBATE IS NOT ABOUT HEALTHCARE. IT IS ALL ABOUT POLITICAL POWER.

  • Kate

    Er, :mic, you don’t seem to be reading what you’ve written, never mind what I’ve written.
    You quoted Reagan to show that nationalisation is a one way process. I merely pointed out that that is proven false by what happened in the UK. I never suggested he should “care” about the UK, only that it refuted his point. You then say “And it is naive to think that nationalization is a one-way process . . . government does not release power” Did you miss a negative there, you seem to be accusing yourself of being naive? Either way, you still missed the point, governments DO release power, there are examples aplenty and I gave you some.
    I do not “number [myself] with those who attack the free market]”, I only claimed that profit motive is a poor way to run healthcare. Your defense of the free market is off topic, it only shows that you haven’t read what I wrote properly: I was dismissing the importance of trains and utilities (that is: water, gas, electricity etc) compared to healthcare. Sure, we don’t get the services we did when these services were nationalised (ie, from a consumer point of view they often worked better under government control, like your postal service) but I can live with that. However, the increase in costs and reduction in quality and accessibility of healthcare that comes with privatisation of health services is something few in the UK would accept. We can see the mess that results in the US.
    You ask ‘Why do you think that people should work in the healthcare field for little to no money?’ The answer is, I don’t think that, doctors are paid perfectly well in the UK.
    “So the implications (working backward in the premise) is that doctors should not make very much money and that people who research and develop drugs and machines and medical devices should not earn money either. Interesting. But it is your premise, not mine.”
    No, wrong. Working for a national program like your USPS does not mean volunteering, and having a national health service does not mean doctors have to be badly paid. As for drug/medical device manufacturers, these do not fail to make a profit just because the government is paying for the drugs instead of an insurer or patient.
    “Because this system has been the system which has brought the level of care, cost, and accessibility to great levels” NO, this system has indeed brought costs to “great levels”, but the level of accessibility you have is the worst in the developed world and your health outcomes (even by USA’s own reckoning) are some of the worst too.
    “You will need to recognize one thing in our current discussion . . .
    THIS DEBATE IS NOT ABOUT HEALTHCARE. IT IS ALL ABOUT POLITICAL POWER” That’s your point of view. As a doctor, I was discussing healthcare.

  • http://grasshoppersdreaming.blogspot.com :mic

    Kate
    I am not interested in getting into a discussion built upon hubris. There are figures which indicate that the US healthcare system is superior, and figures which indicate the inverse to be true. The facts of the matter are that the free market will bring down costs and heighten quality WHEN THE MARKET SUFFERS NO INTERFERENCE FROM THE GOVERNMENT. Most of the problems with cost that have been cited in this ongoing debate come down to the overstepping of government into the private sector. I am not talking about ethical oversight, but the notion that they must control the costs. That notion is simply false. And that is an economic discussion.
    Also, I can appreciate that you are trying to approach this as a discussion regarding healthcare. I’m not sure you can sustain that, but go ahead if you think you can. My final point @57 is simply that the current political discussion in American government has ABSOLUTELY NOTHING to do with healthcare. This is a power-grab which is occurring at great damage and threat to our Constitution. And therein lies the rub with the MAJORITY of Americans who oppose Obamacare: this is the biggest removal of individual rights our country has ever faced, and it is happening without the majority of the country supporting it. Healthcare, economics, politics and the rest aside . . . you simply cannot change the rights of the citizen against the majority opinion.
    My assertion of this being more about power than healthcare also stands in the fact that our legislators and the President himself have repeatedly admitted their ignorance to the 1000+ page bill on healthcare. The people who are protesting this decision have actually read it . . . more than those who are promoting it. Why would you be changing healthcare and not know what your legislation asserts? Because it’s not about healthcare! (And this isn’t my so-called cynicism, this is the admission of key leaders – including the President!)
    In the end, this country cannot sustain a government-based healthcare system without 1) bankruptcy; 2) loss of individual rights to choose; 3) a decline of healthcare. The latter two have been debated, but the first also needs to be included: again, the President has said that we cannot afford this proposal – he will have to raise taxes. This will stifle our economy even more, which appears to be one of his primary agendas at this point. And, again, our citizens do not want to be taxed at rates necessary for socialized medicine – our money, our choice, not the government’s. (Certainly the British could mention how touchy these Americans are over the taxes . . .)
    Er, Kate . . . I know what I have written, and if you don’t appreciate my responses please indicate so without assuming that I don’t get it. You mention some movement in the British government and that’s fine. But when I invoke Reagan, I do so in context – and you can’t cite a well-running, slim and trim government agency in this country. (I’m not necessarily asking that be able to, only that this is the context of the comment.) I will admit to my failure to understand why you are so quick to be able ‘to live with that’ loss of quality for nationalization. And then you promote healthcare as a similar move? Of course, I have pointed out repeatedly that it was the President who also admitted the ability of the private sector to do better than the public – his assertion.
    And, as I stated in the first of this series . . . This discussion is overly theoretical, as the President has indicated NO plan of his own – he just refers to ‘my plan’ which is not the same as the House bill, the only document up for discussion. And this bill has atrocious language and implications which undermine the foundations of this country. Either he doesn’t care about the healthcare, or his plan is so radical that he isn’t able to unveil it quite yet . . . (the latter making sense when you consider the extremism of his czars and appointees).


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