Big Gulp, Meet Big Brother

[ApatheticNoMore]

Me, too. I think we would all agree some government controls are necessary (any true anarchists, here?)

Anarchists are interesting, real anarchy is on the left and I don't mind radical voluntary socialism, anti-hiearchy, egalitarianism etc. Perfectly ok with working toward that direction. But if you're looking for a model without the state tommorow - they definitely don't have it, you may look in vain forever. I have not seen it yet, though I have heard proposals for private police forces etc.. Now there are also those, not always true left anarchists, who will argue the state causes more harm than good. Even excluding all the cases of states butchering their own citizens, but counting things like Hiroshima, my goodness counting what this country has done to the middle east(!), it's very persuasive. Still if you have no state how do you address something like climate change? How do you address environmental crisis? Noone knows. With a government that believes none of those issues are real (look if anyone wanted to make a Republican party that wasn't this way, it might be one worth voting for, but we simply don't have that now) how do you address that type of crisis? Who knows. With a so called liberal administration that gives lipservice but seems to sell out those issues in practice (in climate talks etc.) how do you address that type of crisis? Noone knows that either . Join Bill McKibben's movement is the best I have ....

I actually agree with this, mostly. I do believe some powers that are in the states domain should be federal simply because this is such a huge, populated complicated country, nothing like the founding fathers knew, or probably could even imagine. Education, for instance, should be mandated at the federal level. If we left it up to the states only, well, then the education of our nation would be subject to local school boards who just might decide that science isn't so important, or who really needs math beyond adding and subtracting, or no one really needs to learn how to work computers.

It's not the first thing that I'd say rock bottom needs to be federalized. What is? Environmental regulations, because the climate isn't containable to state boundaries, because destroying the oceans isn't containable to state boundaries, because genetically modified organisms are not containable to state boundaries, because even pollution isn't containable to state boundaries and L.A. smog winds up in Colorado etc.. That's minimum standards, I am very happy for states to exceed minimum standards, like California does, proud of California this way (even if in general it's not a well-run state, still proud of this).

Now I'm all for local experiments or implementation of programs and charters, and fast tracking proven successful programs locally and hopefully nationally, but the standards should be uniform throughout the country. We need a well educated populace to move forward in this modern world, and really, better educated people in W. Virginia will benefit me in the long term.

I want educated people. I think school boards that want to eliminate the teaching of evolution are harmful to an extreme degree. Ban banning evolution and that's not a bad idea I mean really are there words strong enough for those fools! I don't however particularly trust the federal government being in charge of education in general. And by the way if you talk policies like No Child's Left-Behind, good teachers, the BEST teachers, the one's who you know by talking to them really taught kids to think, quit the profession over that law!!! So hey we'll have more automatons graduating, I can't wait. And the federal government in general has proven itself corrupt, at times a wholy owned subsidiary of corporate power. I know it shouldn't be that way, this *should* be fought, but that is a concession to what reality is now too. I don't want the corporatist totalitarian murder state (what is the war-making body of THIS federal government is) in charge of education. They have no real interest in people who can think, of people who can question their agenda right down to the core. They have an interest only in workers who can earn enough to be milked for labor (for their corporate paymasters) and taxes (for the government apparatus itself). WI was interesting, it was people seeming to willingly vote to destroy their own schools, I mean really, you really don't want to pay teachers well? But time foretells the future with accuracy, certainly not I, I just take my best guess.

The problem with all existing health care reforms is they are trying to reform a corrupt system (and lets face it insurance oligopolies are a corrupt system - near completley so). I don't think the outcomes of trying to do that will be good. Worse than doing nothing? Quite possibly. I can't say. Remember doing nothing is just another variant of that corrupt system (insurance oligopolies).

[catherine]

The problem with all existing health care reforms is they are trying to reform a corrupt system.

Absolutely.

I vote for razing the whole thing and starting over with something that actually makes sense.

[peggy]

Absolutely.

I vote for razing the whole thing and starting over with something that actually makes sense.

I'm all for that. Or anything that seems reasonable and works! But we can't ignore the here and now for some 'future' system. We have to work with what we have, right now, but also plan for the future. The problem being, people will die today. Hearts will malfunction, bones will break, cars will crash, TODAY! Is President Obama's plan perfect? Far from it, but it's the only thing out there. I don't like it because I think it's all that and a bag of chips, I like it because he is the only one actually TRYING to do something. All the republicans want to do is talk talk talk, and promise and hedge and wiggle away. Meanwhile, those bones are breaking and cars crashing today, right now. Probably hundreds in the time I took to write this.
But, Catherine, what do you propose? What sort of system do you want to see? I'm always interested in ideas to fix the system.

[JaneV2.0]

I'm always delighted to find myself agreeing with iris Lily and bae. The government, with its idiotic Food Pyramid, has proven to my satisfaction that it has no business telling anyone what to eat (see the movie and blog Fat Head for an eye-opening Libertarian take on the subject). Iris Lily's "fewer and more effective" is exactly what I want--not more and stupider.

As far as Roger and CathyA, I couldn't disagree more. The problem with health care isn't poor people or stupid people or everybody's favorite target, people shaped like me, the problem is layers and layers of greed that have been built into the system by insurers, Pharma, and related grifters since the sixties when non-profit medicine fell out of favor. Most of us will get old and sick at some point; some of us are young and sick now. Some of us make a virtual hobby out of obsessing over our delicate constitutions. We can point fingers all we want: people who have children, people who can't handle stress, people who have allergies, people who play sports, people who visit doctors on a regular basis...blah blah blah. Or we can, as someone suggested, tear it down and start over. I'd start with getting profit the hell out of the picture.

[catherine]

But, Catherine, what do you propose? What sort of system do you want to see? I'm always interested in ideas to fix the system.

Shoot, I don't know for sure. It's so tangled. I do agree with you that at least Obama is taking a stab at something. It's not perfect, but we have to start somewhere.

I'm thinking the system has to start from the ground up because:

• We didn't even HAVE insurance before the end of the 19th century, and it really took off when it was a good perk to provide employees during the industrial era. But there is no good reason to make private employer-based insurance the "norm" now. Under 50% have employer-provided insurance today. So what do we do with the other 50%?
• Medical technology has grown incredibly, and it SHOULD NOT BE another gap between the rich and the poor. We're not back in the old days where the most sophisticated medical procedure was an appendectomy. We have the power to put the brakes on a lot of cancers and debilitating disease and if it's good enough for some, it should be good for all.
• There are too many chefs in the kitchen. When no one person/body has direct accountability or responsibility for costs, they're just going to spiral upward. The payment for medical costs is like some big illusion, hidden behind the multiple parties involved. The costs have to be simplified. The patient has to bear some responsibility, to the best of his ability. Somehow, real money has to pay for medical care
• Doctors are not having fun. OK, we can't all have fun at our jobs, but doctors are opting out of the system because of the ridiculous bureaucracy involved in paying insurance companies. Doctors have to have large staffs to deal with claims and preauthorizations. It's ridiculous. They feel they have no control anymore. They are told what they will be paid for their services and what they will prescribe, by insurance companies who are only looking at the bottom line.
• Lifestyle diseases are hurting all of us. And what are the causes of these lifestyle diseases? Maybe our addiction to work, addiction to food; our succumbing to the seduction of advertising, our unwitting exposure to toxins that are sold to us at a cheap price by profit-seeking corporations.
• Pharma companies pay billions to keep the government in their pocket. Now, I could be an apologist for pharma companies because I work for them and I KNOW they have done tons of great things for patients. But I object to the manufacture of medical need (many lifestyle conditions have been created by pharma companies) and we now have a culture of there's nothing that a pill can't cure. My 92-year old aunt took an aspirin a day; my 85 MIL was on 13 separate drugs when she died.

This is a mess. So I think that we need to:

• Recognize that we need a combination of private and public funds to pay for healthcare. 50% of the rest of us need good healthcare at an affordable cost. Think about it--if we knew we didn't have to risk our health by going out on our own, that would feed entrepreneurship and economic growth (because a LOT of people only stay in their jobs to keep their health insurance).
• Privatize medical services in a creative way. I see nothing wrong with the trend of doctors forming healthcare coops that accept only cash. I don't mind incentivizing such creative ways to privatize care. I heard one idea on the radio where a doctor would be incentivized by the government to provide a certain level of services for people who can't afford them. Stuff like that.
• We need public health insurance because a lot of people just can't get affordable healthcare. I have spoken to so many REGULAR patients (not "bloodsuckers of the system") whose quality of life would be so much better if they could just get what any old middle manager at IBM has access to--it's simply not fair. In fact, sometimes when I moderate interviews with patients, it's hard not to cry with the injustice of hardworking people suffering because of this wacky system that just doesn't serve them.
• We need to invest in prevention, education, and awareness. We are a reactive society in terms of healthcare. Let's get creative! Let's accept that alternative therapies are another option. Let's invest in conscientious consumerism when it comes to food.*
• We have to make the patients accountable for his/her health. In that regard, the old fee-for-service model was much better than the convoluted HMO/PPO model in my opinion. At least it was a clear, understandable business model--cost-sharing between two parties and not a whole bunch of parties--none of whom are ACTUALLY taking the money out of their pockets.
• Incentivize doctors to do what they do best rather than making them bean counters. Take Big Brother off their shoulders.
• Certain healthcare services should be free. Child immunizations should be free.
• Change attitudes of the American people RADICALLY. We've opted for the burn-out life and we're burning out.

*THEN of course there's a whole other list for getting rid of the influence of outdated farm subsidies and other corporate/government dysfunctional arrangements.

I guess that's what I'm thinking right now.

[lizii]

Shoot, I don't know for sure. It's so tangled. I do agree with you that at least Obama is taking a stab at something. It's not perfect, but we have to start somewhere.

I'm thinking the system has to start from the ground up because:

• We didn't even HAVE insurance before the end of the 19th century, and it really took off when it was a good perk to provide employees during the industrial era. But there is no good reason to make private employer-based insurance the "norm" now. Under 50% have employer-provided insurance today. So what do we do with the other 50%?
• Medical technology has grown incredibly, and it SHOULD NOT BE another gap between the rich and the poor. We're not back in the old days where the most sophisticated medical procedure was an appendectomy. We have the power to put the brakes on a lot of cancers and debilitating disease and if it's good enough for some, it should be good for all.
• There are too many chefs in the kitchen. When no one person/body has direct accountability or responsibility for costs, they're just going to spiral upward. The payment for medical costs is like some big illusion, hidden behind the multiple parties involved. The costs have to be simplified. The patient has to bear some responsibility, to the best of his ability. Somehow, real money has to pay for medical care
• Doctors are not having fun. OK, we can't all have fun at our jobs, but doctors are opting out of the system because of the ridiculous bureaucracy involved in paying insurance companies. Doctors have to have large staffs to deal with claims and preauthorizations. It's ridiculous. They feel they have no control anymore. They are told what they will be paid for their services and what they will prescribe, by insurance companies who are only looking at the bottom line.
• Lifestyle diseases are hurting all of us. And what are the causes of these lifestyle diseases? Maybe our addiction to work, addiction to food; our succumbing to the seduction of advertising, our unwitting exposure to toxins that are sold to us at a cheap price by profit-seeking corporations.
• Pharma companies pay billions to keep the government in their pocket. Now, I could be an apologist for pharma companies because I work for them and I KNOW they have done tons of great things for patients. But I object to the manufacture of medical need (many lifestyle conditions have been created by pharma companies) and we now have a culture of there's nothing that a pill can't cure. My 92-year old aunt took an aspirin a day; my 85 MIL was on 13 separate drugs when she died.

This is a mess. So I think that we need to:

• Recognize that we need a combination of private and public funds to pay for healthcare. 50% of the rest of us need good healthcare at an affordable cost. Think about it--if we knew we didn't have to risk our health by going out on our own, that would feed entrepreneurship and economic growth (because a LOT of people only stay in their jobs to keep their health insurance).
• Privatize medical services in a creative way. I see nothing wrong with the trend of doctors forming healthcare coops that accept only cash. I don't mind incentivizing such creative ways to privatize care. I heard one idea on the radio where a doctor would be incentivized by the government to provide a certain level of services for people who can't afford them. Stuff like that.
• We need public health insurance because a lot of people just can't get affordable healthcare. I have spoken to so many REGULAR patients (not "bloodsuckers of the system") whose quality of life would be so much better if they could just get what any old middle manager at IBM has access to--it's simply not fair. In fact, sometimes when I moderate interviews with patients, it's hard not to cry with the injustice of hardworking people suffering because of this wacky system that just doesn't serve them.
• We need to invest in prevention, education, and awareness. We are a reactive society in terms of healthcare. Let's get creative! Let's accept that alternative therapies are another option. Let's invest in conscientious consumerism when it comes to food.*
• We have to make the patients accountable for his/her health. In that regard, the old fee-for-service model was much better than the convoluted HMO/PPO model in my opinion. At least it was a clear, understandable business model--cost-sharing between two parties and not a whole bunch of parties--none of whom are ACTUALLY taking the money out of their pockets.
• Incentivize doctors to do what they do best rather than making them bean counters. Take Big Brother off their shoulders.
• Certain healthcare services should be free. Child immunizations should be free.
• Change attitudes of the American people RADICALLY. We've opted for the burn-out life and we're burning out.

*THEN of course there's a whole other list for getting rid of the influence of outdated farm subsidies and other corporate/government dysfunctional arrangements.

I guess that's what I'm thinking right now.

I wish so much that Americans had the same health coverage that we enjoy in Canada.

At age 81, I have exceptional health (good genes) and have no health problems at all. I have an excellent family doctor but I seldom need to see him except for an annual flu shot, and even that is free.

I haven't been to a hospital except to give birth to my four sons, other than when I fell down at home a couple of years ago.

An ambulance was called by my one of my sons and I was taken to the hospital. I ended up staying there for two months to recover from my injuries--a broken back and wrist. I was sent home and was given two care aides to make my meals for me. I still get them every day, all without any cost to me.

[Gregg]

Like most of people in this country I realize we need to be doing a better job of providing care, especially preventative care IMO, to our citizens, but don't yet have a good handle on what the best approach would be. I'm opposed to Obamacare primarily because of the mandatory aspect of it and simply because I don't think its an approach we can afford. Why start something that big and expensive if you know from the beginning it isn't economically sustainable? Anyway, I'm also not sure there is a way to remove care from the private sector without either leaving an even larger percentage of folks uncovered for an extended period of time or just flat out resorting to tactics we don't really want to see the government using. Overall there aren't many ideas on catherine's list that I'm opposed to. A logical first step that seems to get danced around is setting the floor. What is the absolute minimum level of care that anyone, anywhere and at any time can expect to receive and how, as a society, do we pay for that? If we can just answer those two questions half the work is done.

[gimmethesimplelife]

I have read a good many of these posts here in regards to the US Health Care System. It dawns on me that I am such a fatalist - my first instinct with health care is run run run as fast as you can - have things done in Mexico and then when you get older, run off to somwhere like Peru or Uruguay or somewhere like that - somewhere with affordable health care that is easy to get permanent residency for. That should give a good idea of how little hope I have for health care in the US and how disgusted I am with the system as is. But, people like me don't stick around to change the system and I really respect those who have some hope and some gumption to believe that can change can be affected and are willing to converse and possibly do something about it rather than give up and run. My way strikes me as very self serving - but yet very practical, but like I said, if we all run, how is anything going to change for the better? Some food for thought......Rob

[peggy]

Like most of people in this country I realize we need to be doing a better job of providing care, especially preventative care IMO, to our citizens, but don't yet have a good handle on what the best approach would be. I'm opposed to Obamacare primarily because of the mandatory aspect of it and simply because I don't think its an approach we can afford. Why start something that big and expensive if you know from the beginning it isn't economically sustainable? Anyway, I'm also not sure there is a way to remove care from the private sector without either leaving an even larger percentage of folks uncovered for an extended period of time or just flat out resorting to tactics we don't really want to see the government using. Overall there aren't many ideas on catherine's list that I'm opposed to. A logical first step that seems to get danced around is setting the floor. What is the absolute minimum level of care that anyone, anywhere and at any time can expect to receive and how, as a society, do we pay for that? If we can just answer those two questions half the work is done.

Catherine has some very good ideas, very well thought out. Health care shouldn't be for profit any more than police and fire protection, but there you are. We can't go back and privatize the whole thing, but if we had universal health care, like other countries, there could still be a private element for those who so choose. Just as there is private options for seniors, but, how many exercise that option? How many republican seniors exercise that? How many republican congress-persons refuse government run health care, which is excellent I might add.

I know you are a compassionate person gregg, who really thinks of these problems and wants a solution, but to be honest guy, your response is typical of many people, especially on the right. You say the system is broke, we need to change it, it's not working..... but not what the democrats are trying, so let's go back to what was, which is still broken by the way, and talk about it and think about it and sing songs about it and have study groups and fact finding missions, yada yada yada...in other words, do nothing.
Unless, and until you (collective you) come up with some solutions, and not just bumper stickers about how broke the system is (yeah yeah we KNOW it's broke!) then I'm sticking with President Obama. At least he's trying, actual forward movement, and not just talk. The nation is tired of talk, it's time for action.
The mandate argument doesn't really pass the smell test, in that throughout history our government issued 'mandates' to purchase, starting with everyone required to have a gun, and more recently, women must get an unnecessary ultrasound to have a legal medical procedure and of course, everyone must purchase a picture ID to vote (student ID doesn't count but gun registration does...I wonder who thought that one up!) So, saying that is the problem is kind of bogus. (I'll refer back to my contention that until people are literally dying in the hospital parking lot because they are refused treatment due to no insurance, then I'm glad Obamacare is trying to address this and cover us taxpayers, the hospital, doctors and nurses from these slackers who don't think they need insurance..until of course they need it!)

Is Obamacare perfect? No. So, what about it would you change, besides the insurance part? Let's start there, and move forward, instead of backwards as most republicans seem to want. I know change is difficult, but we all agree it's broken, so now that we have some movement, let's start there, and continue forward.
You know, for all the hand wringing and demonizing, most of the plan hasn't even gone into effect yet (but you wouldn't know that from the average low information voter who thinks it's all in effect, free to everyone, failed, and ready to be tossed aside.)
I happen to like one of the provisions that HAS gone into effect, that which let's me keep my young adult daughter on the family plan while she finishes school. This is a good thing. Young people are generally healthy and don't usually require expensive meds or hospitalizations, so why not allow this. It's not like I'm getting this for free, we pay for this.
What other parts of the plan do you not like? You realize it's mostly insurance regulations, like not kicking people off who develop cancer, or not covering anyone who might ever get sick, or even think about getting sick, or who might have been sick as a baby but are quite healthy now. (oh, they will cover these people, take their money sure enough, but if they ever need it, a search of their life might find out they had acne, or a hernia or something so, no coverage) Maybe these provisions are what you object to? Maybe you object to hospice for end of life care, or a counselor to advise people about end of life care and what their options are? Is this what you object to? Or maybe you have the fear that more for everyone else means less for you?
I really want to hear your objections, besides the requirement that everyone plays so everyone pays. What provisions do you not like? Let's start there.

[Gregg]

Well peggy, maybe my response has become typical because there are so many people out there repeating it. I'm one of what I think is a pretty large group of people who chose to not associate with either political party. Healthcare is one of many examples of why. Speaking for myself, not for all independents, I actually like the compassion on the Democratic side as far as wanting to provide access to good quality care for everyone. I'm not naive enough to think that is the only motivation within that party, but nonetheless would love to see that situation come about. One obstacle in trying to account for everyone individually is that it naturally leads to crazy amounts of legislation being written (like 2700 pages) because the authors are trying to include every single possibility. That is very compassionate, but from a legislative standpoint it just doesn't make sense.

The other down side is that a lot of people with this vision don't seem to take a realistic look at what it really costs to accomplish. While I'm all for caring for anyone who needs it, I don't want to bankrupt the country to do it. People lose sight of the possibility that exponentially increased debt could ultimately cause more pain and suffering in different, but possibly much broader, ways than a lack of universal healthcare. It's a risk I see as very real and one I'm not comfortable taking.

The current Republican stance appears to be just slam anything the Dems come up with. They haven't really proposed anything of value and I don't expect they will in the next 153 days. I agree with you that they're basically a bumper sticker factory right now. The "anybody but XXX" is not the kind of platform that appeals to me.

The question for this fiscally conservative, compassionate voter is how do we care for everyone without breaking the bank. It's about that simple. I do not want to become a country with 60% or 70% base tax rates and a government that "provides" all the necessities for us. That apparently works pretty well for a whole lot of people in this world, it just wouldn't for me so I use my vote to head in a different direction. I think our ever increasing debt is close to reaching an unsustainable level and that if we do not manage it in a very astute fashion it could trigger a time when healthcare seems like a pretty low priority. If a candidate comes up with a solution I like believe me it will get posted here. In the mean time healthcare remains less of a priority for me than other issues I believe have a more significant and immediate impact on our country.