How ObamaCare Plays Games with Your Life
Whenever Congress attempts to “reform” the tax system by passing new laws, they inevitably create new winners and losers. But one group always wins — the consultants and special interest groups best able to “game” the system to their advantage. The same is happening now with Obama’s health care “reform,” except this time the stakes won’t just be money, but Americans’ lives.
We’ve already seen such political gamesmanship with the over 1400 ObamaCare waivers granted disproportionately to the president’s labor union supporters or to businesses in the congressional district of former House Speaker Nancy Pelosi.
Similarly, Politico reported on how the new government-mandated health exchanges are a “gold mine“ for consultants collecting federal dollars for helping to implement the new laws.
Another gold mine for consultants are the new government-driven accountable care organizations (ACOs). ACOs are the federal government’s latest attempt to control health care costs. Through financial carrots and sticks, doctors and hospitals would be “encouraged” to merge into large provider groups to deliver medical care according to government practice guidelines. Government would monitor ACO performance with mandatory electronic medical record systems. ACOs that saved money would be financially rewarded; ACOs that spent too much money on their patients by government standards would be penalized.
And even though the official ACO guidelines have not yet been finalized, a massive industry of consultants has already sprung up to advise hospitals and doctors who don’t want to be left behind in the new system. The Washington Post notes that some consultants charge as much as $25,000 a day for ACO strategy sessions, or $1 million to actually implement the strategy.
Under the ACO system, patients basically become cost centers for hospitals and doctors. ObamaCare legislation states an ACO patient should be free to see whatever doctor he wishes. But for the purpose of “accountability,” all the costs he incurs will be attributed to a single physician within the ACO. Hence, even if a patient sees a specialist in another city who then orders expensive tests or performs some specialized procedures, those costs will still be “attributed” to his primary ACO physician.
In theory, this “assignment” system is supposed to encourage doctors to work together to provide efficient “integrated” care. But in practice it also creates tremendous perverse ethical incentives for primary care physicians. If his patient has chest pain and needs to see a cardiologist, should his physician recommend the better but more-expensive expert across town — or steer him towards the cheaper but not-quite-as-good cardiologist in the same ACO?
Even worse, ObamaCare allows patients to be “invisibly assigned” to an ACO. Suppose a patient sees his doctor for a bad headache and the doctor says, “No, you don’t need an MRI scan for that headache; just take two Tylenol and call me in the morning.” The patient may never know if the doctor is giving his best objective medical advice, or being swayed by the latest memo from the ACO administrator demanding greater cost savings.
Every health-care system in the world has these same perverse incentives—including (especially) the free-market sector of America’s health-care system.
At our medical school, the only revenue-positive class of patients are what we call (delicately) “sponsored” patients: (1) who have good insurance, and (2) are basically healthy, except for (3) a single well-defined medical problem, that is (4) curable with a single, preferably high-technology and expensive, medical procedure. A 35-year-old stock-broker who has injured his knee skiing is perfect.
A 35-year-old Afghanistan combat veteran with PTSD and concussion injuries? From an economic point-of-view, not only is this guy a money-loser, but his whole family is likely to be money-losing. Thats what the computers say, anyway. Shun them. Kids with juvenile diabetes? Shun them. Healthy kids whose relatives have diabetes? Shun them too.
Shun everyone, even healthy folks, whose computer records whisper have relatives aren’t healthy, who live in the wrong part of town, are the wrong race, or have the wrong job. Not for moral reasons, but because that’s what the market (which knows no morality) requires.
There are health-care systems that handle the perverse economic incentives inherent to medicine (relatively) gracefully, but America’s isn’t one of them.
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Consumer-driven health care: lessons from Switzerland
URL: http://www.ncbi.nlm.nih.gov/pubmed/15353534
“…the free-market sector of America’s health-care system.”
Oh please, oh wonderful omniscient A physic, pray tell where this mystical “free-market sector of America’s health-care system” exists.
Why, one might conclude from your mentality that the government itself is the embodiment and the only proprietor of the glorious A psychic projection of a free market system.
Indeed, Big psychic, Free Market Is Government, and Freedom Is Slavery.
Or should that be, A parsons?
Mr. Lucky, for answers to your questions, see my post at the end.
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Consumer-Driven Health Care: Lessons From Switzerland
URL: http://pajamasmedia.com/comment/1222123/
I think what Mr. Lucky is trying to say, A Physicist, is that your characterization of America’s healthcare system as a “free market” system is erroneous. Because the sale of health services is restrict across state lines, Health insurers can set up de facto monopolies within individual states. The state bureaucrats collude with the insurance lobby’s to set rates and billing practices. They look the other way when insurers double and triple bill for products and services. Naturally health care costs become inflated to the point where patients need to seek government assistance. Boom! Now you’ve got a constituent beholden to the “good graces” of their political betters. That citizen will likely continue to vote for said politician to guarantee that the entitlement gravy train keeps a rollin’. Truly free markets would allow insurance providers to compete directly with one another across the entire nation in order to offer products, services, and billing practices that more closely align with the demands of the consumers. In most cases this translates to high quality services for competitive low prices. But this type of system would commit the sin of (in the eyes of our technocratic betters) cutting the government out of your healthcare decision making. And lord knows the technocrats think they know how to take care of you better than yourself does.
Another error you are making is trying to translate the experiences of a single European country with that of the entire United States of America. Switzerland’s GDP is about the same as the state of Georgia. There are fewer people living in Switzerland than in just the city of New York alone. Plus we are talking about a fairly homogenous population of people who’s belief systems and values align with one another fairly closely. It’s easier to get a group of people to go along with a grand central plan when their goals are relatively closely aligned to achieving the same outcome. Here in America we have a extremely diverse population of people with wildly differing points of views. This is one of our greatest strengths as a nation but indeed poses several issues as well; the U.S of A is called a melting pot for a reason.
Thank you, left/liberals, for making death panels cost-effective.
Whether the doctors and hospital people are genuine humanitarians or just cashing in at the public trough will not make any difference. Certain people with very serious diseases (and friends in the right places) will get excellent care (and coverage in the newspapers). The rest of the people will get minimum care, or no care at all. The system will have too many people with medical “needs” and not enough doctors or hospital beds. Real doctors will quit. Be prepared for it. Eventually, there will be one class of patients who will get the most care: patients with a hopeless terminal disease and assets to pay an exorbitant amount for a few more days or weeks of life. Those patients will voluntarily assign their assets to the governement with a special form which supercedes their will and disinherits their heirs. Life and health is not the objective of Obamacare, it is death and taxes. Maybe the plan will be called the Medical Unification Plan and be desgined to preserve the funtioning of the largest medical care networks.
There is a small group against Obamacare because it is morally wrong. There is a small group against Obamacare principally because it violates the Consitution. The largest group against Obamacare are Medicare recipients who don’t want to lose their existing benefits (which are provided by government subsidies to the insurance companies). That group recognizes that the subsidies will be wiped out by this plan. That group is yelling the loudest for increasing taxation on the “billionaires.” They don’t pay taxes and they don’t care who pays for the plan, just as long as they can continue getting their “fair” share.
The current US healthcare system encourages moochers, but the one coming in will encourage health care networks to have huge patient lists but see only the minimum number of patients and do the minimum of actual health care. That is because the health care networks will be paid generous monthly amounts for the number of people on their rosters (your tax dollars at work) and will be penalized for actual providing of health care services to sick people.
“Let them discover the kind of doctors that their system will now produce. Let them discover in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it — and even less safe, if he is the sort who doesn’t.” [Atlas Shrugged]
“If Americans don’t want to become sacrificial pawns to ObamaCare gamers, they must speak out before it’s too late.”
Excuse me, Americans are speaking out. They have been for decades. In the last 3 years they’ve been screaming as loud as they can.
But typically, in a city with one half million citizens you cannot find two doctors from the medical structure empires that will stand up and say jack squat against Obamacare.
About the best you can hope for is a sheepish smile with something like, “Something needs to be done..” tacked on to the end.
Why is this?
Why do doctors cover their own bloopers and stick together like superglue when it comes to the yellow-pages and countering dissatisfied Internet patient reviews, yet not even stick their tongues out or mumble when it comes to submitting their own careers and lives to Obamacare?
If the doctors and medical care providers had united and stood up against Obamacare from day one, the damn thing would have never seen the light of day much less created the national crisis we have on our hands now.
In short, less than 35 – 40% of the doctors and medical care providers in America with one unified demand statement to Congress would have stopped the entire mess dead in it’s tracks; while 70, 80, even 90% of American citizens speaking out against Obamacare are still being ignored.
There is a very simple answer why the doctors have not stood up to this. Doctors are a protected monopoly. No one can be a doctor (charge for medical serices) without going through medical school and being certified to practice medicine. The state goverments in the guise of “public welfare” stepped into health care many years ago and decreed that the public cannot determine if a doctor is qualified, so the state has do it.
The state-doctor monopoly racket keeps competition out of the system. It also makes for deep pockets in cases of malpractice. That’s where the lawyers jump in to support the system. The system is not about health care services, it is about redistribution of health care dollars and increasing the number of dollars for health care providers and protected participants. It has been this way for many, many years.
If an ordinary mother opened a store front clinic just to treat cuts and bruises (as she is used to doing with her own children), and to collect money for doing so, she would be shut down as practicing medicine without a license. It is not healing or helping which would be her offense, but charging money for her services which would get her fined or thrown in jail. That would happen even if she never saw anyone who needed more than a swipe of peroxide and a bandage strip.
That an independent business could rate doctors and publish information on their practices for consumers to judge them is thought of as pie-in-the-sky. The idea of a voluntary society of independent, rational, self-directed and self-actualizing beings is beyond the scope of our current culture. Don’t expect the doctors to be able to stop this — but do expect them to quit when they can’t take it any more.
Ilene, your statement better illustrates my point; which is with all of the horsepower and infrastructure they have going for themselves, I get a little cranky when they (doctors and medical care) whine and moan around for me (you, I etc.) to do their dirty work for them.
Politicians do the same thing. Campaign on their ability to solve governing ailments, then once elected turn right around to the voters with their hands out saying, “If you expect me to do whatever, then I need more of your money.”
The however with doctors is, unlike dealing with politicians it isn’t as easy to cut off our checks to them; else we also make a mess of our blood pressure, cholesterol and pain prescriptions.
You are exactly right! And I speak as a physician: I am partially protected from competition because of the medical practice acts, through which the gov’t pretends to be competent to tell you who is a competent physician. The medical practice acts, plus the FDA, are the reasons why healthcare is as expensive as it is. Eliminate them, and watch medical costs drop like a rock as the supply of medical care blossoms, costs of production shrink, and competition drives the price down. There would be no ‘Obamacare’, Medicare, Medicaid, BC/BS, etc, because there’d be no need for them.
But alas, We the People are a wicked and lazy sovereign, long ago having traded our birthright, the Constitution, for a mess of pottage, honoring it with our lips, but our hearts are far from it. This does not end well.
The specialty boards have come a long, long way in the last few decades. They’re no longer a rubber stamp that doctors all get for life if they just pay their dues, but have real teeth to make sure that people keep up on their field. It seems to me that beyond this, there is no need for the government to meddle. If people want to pay for a board-certified doctor, fine. And if they don’t, it’s their choice. But right now, there isn’t a choice because no one can practice unless they are certified by the state medical board, which ironically has the lowest qualifications. If I pay my dues and stay out of trouble, they certify me year in and year out.
But hey, if interior designers, real estate agents and your local barber all have to be licensed, there is no way the state is going to give up licensing the medical field.
Doc, Obamacare greases the path for one more huge aspect of the degeneration of our country.
Illegal immigration. Illegal immigration fosters and promotes massive influxes of foreign educated and trained care takers, doctors and physicians that are doing the jobs that Americans are no longer willing to do.
Sound familiar? So now with hundreds of thousands of American old timers saying enough is enough, and no new ones willing to endure the system ordeals, we have hospitals and medical care clinics that are manned up with combinations of legal and illegal immigrants; many of which don’t speak English and a bunch of diagnostic incompetents referring patients to butchers that call themselves surgeons and billing out the tax payers with ridiculously high fees.
Where are these so-called “specialty boards” I’m reading about at and what are they doing..?
Medical tourism is going to see a big bump.
But medical tourism only works for one-time, planned interventions such as elective surgery. The ones hurt by the ACOs, i.e. those with chronic illnesses who run up big bills, usually have frequent encounters with the medical system.
This is one of the reasons that I decided against going to medical school.
I am part of the Tea Party rebellion. I’m doing my part to try to defeat big gov’ment liberals in BOTH parties. If that fails and the courts don’t strike down Obummercare, I’m on the plane to Costa Rico or some other foreign destination to get whatever medical care I need.
Excellent post, Dr Hsieh.
“If Americans don’t want to become sacrificial pawns to ObamaCare gamers, they must speak out before it’s too late.”
We spoke in November, 2010, and we will speak more loudly in the elections to be held in November 2012.
The freedom-loving Swiss refuse *all* government-supplied health-care, relying instead wholly upon market forces to drive improvements in quality. The resulting choice-driven system works outstanding well.
Q: Why haven’t conservatives embraced Swiss-style health-care?
A: Romney-care does look much like Swiss-style health-care.
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Q: Why haven’t liberals embraced Swiss-style health-care?
A: Hillary-care did look much like Swiss-style health-care.
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Q: Why haven’t Americans embraced Swiss-style health-care?
A: Americans will embrace Swiss-style health-care … because Obama’s health-care system is not going to go away—… rather it will evolve in the direction of the Swiss/Romney/Clinton systems.
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That’s what the senior MDs at our medical school expect will happen … once the pundit-driven panic and the ideology-first slogan-shouting quiets down.
And these senior MDs are looking forward to it … because it will be far better than what Americans have now.
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Consumer-Driven Health Care: Lessons From Switzerland
URL: http://www.ncbi.nlm.nih.gov/pubmed/15353534
I agree this is by far the best plan, but it also involves invoking the individual mandate, which may very well be held unconstitutional by our Supreme Court.
Getting healthy people to buy into the insurance market is the linchpin for universal insurance. There are ways to incentivize people to do that, but unless that is done the price of insurance will simply be unaffordable for the rest of us. Sadly, Obamacare went the heavy-handed route of mandating insurance, when they could have tried other things such as waiting periods for coverage and enrollment periods- basically the same thing companies do now to get their people to enroll.
Now we’ll have to go back to the drawing board. I just hope there is time to work that out, because the alternative is Canadian style health care- which only limps along because the US exists as a safety valve for those who can afford it.
Dana, you are wrong on the facts.
Here in Seattle USA, our medical school presently receives near-zero patients from nearby Vancouver CA.
The opposite is true: whenever possible, families with dual-employment and/or dual citizenship (one member working in the USA, one in Canada) do all they can to retain their Canadian coverage, even if it means a border-crossing to get their checkups.
The reason is simple: families receive equivalent medical care quality, at substantially lower cost, with infinitely less hassles and paperwork, with zero chance of their family ever becoming “uninsurable” or being driven into bankruptcy, on the Canadian side of the border. And they know it.
What sane family would ever tolerate the American system?
Perhaps you should find out my background before your assert I am wrong on the facts. The reason why I suspect you don’t see any patients from Canada is BECAUSE you are at a medical school. I live in a border state, and we do in fact see many people from Alberta who come down to take advantage of the private medical system, which is easier to use, more efficient and cheaper than anything affiliated with a medical school.
Joint replacements and other elective surgeries in particular, because they’re tired of the wait, but also problem pregnancies because of the worry. Don’t forget the governor of Newfoundland flew to the US for his surgery, and there was that very high-profile case of a mother wanting to keep her critically ill child alive when the state decided it wanted to pull the plug. And these are the recent ones I can recall off the top of my head.
Also, the companies running the oil sands operations are so desperate for medical care they’ll actually fly us up for a few days at a time to staff a company clinic. You would not believe what they’ll pay.
While I would agree with you that for basic medical care, Canada provides for its people quite well, it does not do it well for specialty care because of the high cost. In that we are a safety valve, because in Canada one is not allowed to go out of the system and pay for their own care. That’s anathema to the average US citizen. So the ones who can afford it can and do come here.
Also, the claim that medical illness cannot drive a Canadian into bankruptcy is simply false, so take that out of the arrogant bolding, please. Do you know why sick Americans go into bankruptcy? It’s because they can’t work to pay their OTHER bills, not usually because of the medical bills themselves- that statistic you hear about “medical illness being the number one cause of bankruptcy” isn’t due to the health system. Thus the root cause applies to Canadians as well.
The charity system in American hospitals is fairly fined tuned and we know that you can’t get blood out of turnip, plus it’s very bad for business and makes the government think twice about letting us file as tax-exempt. So, in order to prove that we deserve to be tax-exempt and to preserve their image the hospitals in my town all have charity policies that simply don’t send anyone into bankruptcy. They just suck it up, and the rest of us pay for it through our insurance.
This is also why the mantra “40 million Americans don’t have health insurance” DOESN’T mean that “40 million Americans don’t have health care.” They do. They get it in thousands of private charity and public hospitals and clinics all across the US every day. It’s not a perfect system, but it’s not what the media (and the professors at your school) would have you believe.
As we teach our residents: “the plural of anecdote is not data.”
Dana, your post was dead-wrong on the facts.
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Medical Bankruptcy in the United States, 2007: Results of a National Study
The American Journal of Medicine
URL: http://www.amjmed.com/article/S0002-9343%2809%2900404-5/abstract
One little addendum- Obamacare’s provisions for insuring people with pre-existing conditions has been in effect for a year now. The worry was that the program would be flooded- but six months in there were only 12, 000 enrollees in the program. So where are all those people who were denied insurance? Isn’t this one of the major reasons we had to redo the system in the first place?
Well, here’s the answer_ they were already taken care of by a combination of state high-risk pools and charities. All the gov’t had to do was expand the state high-risk pools and this problem (that the media trumpet every chance they get) wouldn’t even exist anymore.
Exactly, Dana. Our MD faculty foresee that similar processes of (reasonably) smooth adaptation will continue — accompanied by intermittent turbulence — as US health-care steadily learns, evolves and adapts toward a Swiss-style health-care system.
This evolutionary process already has gained unstoppable momentum … which is good news … because liberal politicians and conservative politicians alike (eventually) will proclaim a great victory by it.
And why shouldn’t they? … both factions will be correct.
And that’s what American democracy is all about. Seriously.
Your lecturing me about anecdotes is pretty rich, considering you started slinging the anecdotes with this little statement, “Our medical school presently receives near-zero patients from nearby Vancouver.” That is an anecdotal statement, it’s not statistical and it doesn’t represent the entire population of medical facilities in the US.
Furthermore, it’s not my experience. It’s simply yours. I’m countering anecdotes with anecdotes, considering there are no stats available on the problem. I’m not wrong on the facts, unless you want to tell my patients they don’t exist.
I don’t doubt those are the facts at your place of employment. You have no basis whatsoever to discount the facts at mine.
Also, the paper you quoted, physics, is exactly what I said. My statement is not false, but yours is, so thanks for finding that article. Most “medical bankruptcies” were, in fact, due to loss of income just like I said they were- which would happen to Canadians as well. You asserted they could NEVER have a medical bankruptcy, and that is just plain false, unless they have some source of magic money up there that disabled people here don’t have access to. When you’re sick, you can’t pay the bills. How are Canadians immune to that?
Bill for one week’s groceries:
CN: $100
US: $100
Bill for cancer treatment:
CN: $0
US: $50,000 — $1000,0000+
And yes, we *do* bill *all* our patients—even indigent ones—such billing is standard practice for *every* American medical center. And that’s why poor/uninsured/underinsured American families file for bankruptcy—*after* the American health-care system has exhausted all their assets.
I’m sure you know this, Dana.
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Costs of cancer care in the USA: a descriptive review
URL: http://www.ncbi.nlm.nih.gov/pubmed/17965642
Of course I know that everyone gets billed. But do you know what goes on in your billing department after that? No one EVER ACTUALLY PAYS what’s billed- not the insurance company and not the patient. It’s a farce propagated by Medicare rules that insist on paying a percentage of what is billed.
And if a person has no insurance it’s given over to the charity department. Do you even know what your institution’s charity policy is? All hospitals have them- the means by which hospitals decide who can pay and who can’t, and how to help people apply for medicaid or medicare if they’re eligible. But all bets are off if a poor patient lands at a for-profit hospital, God bless their little souls. They WILL get skewered there.
I will admit the “system” we have here (it’s not systematic- it’s organized chaos) is far from perfect. But some needed changes for those with pre-existing conditions, along with tort reform and reining in the drug companies (neither of which issues was addressed by Obamacare), is what is needed. Instead, we’re going to be buried in paperwork.
Dana, the Swiss don’t tolerate (in your apt words) “organized chaos that skewers patients, God bless their little souls”.
The Germans don’t tolerate it. The British don’t. The French don’t. The Scandinavians don’t. The Canadians don’t.
Americans too, shouldn’t tolerate “organized chaos that skewers patients”.
No, we shouldn’t tolerate it. But my point is not to throw the baby out with the bathwater. As you and I both agree, it’s not insurmountable to gradually move to a better system, but we don’t have to destroy what we have since the quality is the best in the world. If you can afford it.
But the British system? I don’t think so. I had the dubious privilege of touring their system a couple of years ago, along with health care people from other countries in Europe, and we all could see it’s falling apart. It has enormous problems with quality of care and they’re running out of money. In fact, that’s part of the reason why we were there- the NHS wants to privatize as much as possible, and wanted input from countries with experience in that area. To say the NHS is preferable to our patchwork of services simply because it is systematic is like praising Mussolini because the trains ran on time.
In fact, during my last trip there, I looked up the phone number and address of The London Clinic just to have on hand so my family and I could avoid the NHS. I had no such worries in France.
This says it all -
CN: $0
Bill for cancer treatment:
CN: $0
US: $50,000 — $1000,0000+
CN: $0… One wonders how this cancer care simply materializes from nothing. A zero. This is the thinking that has produced our present dilemma. $0. How about 30 pack of beer? Can that be had for $0? Why not just have everything be $0? Mr. President will pay my car payment. That house is mine because the government says so. Or, Mr. parsons says so with his PJM comments. Everyone go to Canada. Now. It’s all $0.
Wow, really! This lack of critical thinking skills is… well, the new normal. Here is it is, I link therefore I am.
Now A parsons, come up with a defense for you denial of reality. Just make it up. You’ll feel so much better. $0. That works, certainly. Yes $0.
Well A parsons, do you think Winston will get that scab on his ankle treated anytime soon?
Hey, are the chicks free too?
Dana, the British system is very good for emergencies. If you have an accident or are suspected of having an aggressive cancer, you will be treated very quickly. But it is not good for less life-threatening or for chronic illnesses. Every health system has some kind of rationing; the British system is rationed by queuing. If you want to go private, you can. For hospital treatment the main benefit is quick service and more comfortable surroundings. If you are unlucky in your hospital, the treatment or nursing care may be bad, but that is mostly down to bad management, which could happen anywhere. For any NHS treatment, there is no mention at all of payment, unless you are known to be a foreigner.
Currently, I live in France, where you pay for everything and get it partially reimbursed. Everyone (who can afford it) has top-up insurance to cover the rest. The destitute have everything paid by the state. Treatment is far faster here; I will be given an appointment to see a specialist the same week, maybe even the same day, but the bureaucratic procedures are a pain.
Oliver, I completely agree with you that every nation has to ration, and the UK does it by waiting times. Here in the US, we do it by nearly pricing ourselves right out of the market. If an entity tries to do it in a rational way, by basing it on cost-effectiveness, then that becomes “death panels”.
I honestly don’t know what the answer is. All countries have to face this issue, and I think what all of our discussions show is that collectively we’re bumping up against the limits of what society can provide and what people are willing to pay.
I must respectfully disagree with you about the state of the NHS though. Even within the hospitals, the care is not as good as it should be. There’s a nine times higher postop death rate than in the US. A man with prostate cancer has a 50% five-year survival rate, compared to 90% in the US. MSRA (a dangerous superbug) is rampant, probably from understaffing. It’s not just a waiting problem. It’s good that people can go outside the system, but they already pay a 20% VAT- why should they have to pay again to see a private doctor?
No, you’re wrong. My brother-in-laws’ daughter lives in Vancouver (and through marriage is a Canadian citizen) but comes to the U.S. to see the doctor because the care is so poor in Canada.
The physicist at the med school in Seattle should check the statistics for Canadian patients who get their care at St. Josephs Hospital in Bellingham, an hour an a half north of Seattle. The Canadians are the primary financial resource for the beautiful cardiac care and joint replacement centers that have been built there in recent years. The medical field in Bellingham has had significant growth – it is only an hour drive from Vancouver – why wait on a multi-year Canadian wait list for an appointment or surgery when you can go to the U.S.? Especially now that the Canadian dollar is so strong…..
I am a dual American/Canadian citizen who moved back to the U.S. when I needed better access to health care. Unless you have lived in Canada and actually experienced the complete lack of choice available to you there, you cannot relate. Many Canadians love their health care because it is “free”, and they’ve never been exposed to anything better, but A)you get what you pay for and B) they’re paying for it with high taxes. Oh, and not getting care in a timely fashion.
Just in my immediate (Canadian) family alone – my mother had a stroke and was on a waitlist for a CAT scan for 11 months. She couldn’t get adequate treatment without a proper diagnosis (was it a bleeding stroke or a clot?)and is permanently affected. My uncle had a brain aneurysm that took over a year to get diagnosed (those MRIs are expensive you know) & then they said he needed immediate surgery. He was on the surgery schedule but it kept getting canceled and rescheduled because of the limited availability of operating rooms & staff, and another 9 months later he became “inoperable” and he died. Being “inoperable” means he didn’t die while on a waiting list. (It helps the stats.) My 32 yr old (Canadian)daughter waited over a year to see an orthopedic specialist and finally went to one in Bellingham WA that only cost $115 for a visit that lasted over an hour – it was the first time she had ever had a doctor spend more than 5 minutes with her. (In Canada you’ve got to pump ‘em in and pump ‘em out) The specialist gave her a 15% discount because she had no insurance and was paying cash. She is now sold on the American system, even if she has to pay out of pocket. What price do you put on your health & mobility?
I have numerous other family members in Canada who have also endured unacceptably long waiting lists just to get in to see a specialist, and then additionally long waits for diagnostics, let alone any actual surgeries or treatments. They’re happy they got it all “free”, even though they endured great pain and anxiety while waiting. Also, in British Columbia, unless you have a referral from your GP, you cannot even make an appointment with a specialist. The government there doesn’t allow it. My American health insurance does allow it. Hmmmm…….that “choice” thing again – I’m willing to pay extra to have that choice and I live frugally so I can afford that choice.
Canada has a constant crisis with funding their “free” universal health care, and their population is smaller than California’s. The “two-tier” system is coming to Canada amid semi-furious public debate. When governments can’t run a post office or a department of motor vehicles efficiently, why does anyone trust them with their health?
Any sane,thinking person knows what the government gives they can also take away. Or just ruin.
“once the pundit-driven panic and the ideology-first slogan-shouting quiets down.”
From the Libtard playbook: Avoid or squelch the use of logic in discussions by claiming punditry or ideology.
“Q: Why haven’t liberals embraced Swiss-style health-care?
A: Hillary-care did look much like Swiss-style health-care.
As I recall, HillaryCare required discipline specific quotes for medical schools and the usual diversity (so many Hispanics, so many Native Americans, etc.) baloney in medical school enrollment. Also, if you decided that you wanted to see an unauthorized specialist that you felt was the best for your situation both you and he/she could be punished with fines and jail time. Is that a part of the Swiss plan?
This is just HMO-style medicine under a new acronym. The big differences being that it’s imposed by the government instead of there insurance company and that people don’t know what is going on. So we’ll see some of the same kinds of abuses under this as we’ve seen with HMOs.
The one thing that is better than HMOs is under ACOs there is a recognition that some people simply will cost more than others based on their illness, and so the ACO will be paid accordingly. In HMOs there was no recognition of this fact and so ALL sick people were cost centers. Any person that darkened one’s door could cost money (which explains why I never joined an HMO as a primary care provider- the incentives were too perverse).
What ACOs do is pay for a diagnosis. This is much better than HMOs which typically just paid per capita. This doesn’t get around the fact that not everyone with the same diagnosis is in the same shape, so there will be disincentives to see the sickest of the sick. But most doctors will just suck it up and continue to see all comers under the ACO.
What the better (or at least more independent) docs will do is leave organizations that have ACOs, and when the time comes that they can’t do that they’ll develop alternative career paths or retire early. There’s already a lot of that going on- Obamacare is just going to accelerate the exodus, and discourage the best and brightest from ever entering the field at all.
Tampering with free markets has a long track record.
Check it out.
And all of this back-and-forthing about Obamacare/Medicare/CanadianCare etc etc is being played out against the backdrop of the fact that Fed involvement in healthcare of almost any kind is unConstititional. It’s not listed. Therefore it’s left up to the states and to the people. If it’s so all-fired important to have a Fed healthcare plan of some kind, get a Constitutional amendment passed authorizing it. Otherwise, let’s quit breaking our own foundational Law!
Among the largest of the reasons that nearly everyone feels he needs medical insurance is that the great majority of us already have it — and that and federal intervention via Medicare and Medicaid have caused the cost of medical products and services to explode.
When an anonymous third party will bear the cost of your decisions, you’re far less interested in what the cost will be. Alongside that, someone has to pay the legions of meddlers at the insurance companies and in the government bureaucracies for their time and “effort,” to say nothing of the need to return a profit to the company itself. (Shareholders expect that, you know.) Unless you’re the Federal Reserve Bank, you can’t just wish the money into existence.
Ironically, the prevalence of medical insurance can be traced to the wage and price controls of World War II. Those controls were not lifted immediately after the war, so employers desperate to compete for skilled labor offered noncash benefits, including life insurance and what was once so quaintly called “major medical,” to desirable salaried employees. After a while, it became the default condition of white-collar employment…and as American enterprise mushroomed through the postwar period, ever hungrier for more and more workers, of blue-collar employment as well.
We will not see rationality return to the pricing of medical products and services until the overwhelming majority of purchases thereof are made directly by him who needs them, without any intervention or “assistance” from an insurer or a government. We can only tolerate a tiny percentage of third-party payments if we don’t want the system to do what ours has done, these past sixty-plus years. How do we get there from here? As the teacher replied to the fifth grader who asked, “What do they make in Washington:” That’s a very good question; let’s save it for another day.
Health insurance isn’t the solution. It’s the problem.
You’re right about the origins of insurance and how it served to drive up the cost of care. I think, though, that the biggest driver at this point in time is technology. When health insurance was first dreamed up, care didn’t cost that much because there wasn’t that much that could be done. Now, there is- and that costs money. Lots and lots of money. Of course, much of this has do to the inflation caused by insurance as you correctly pointed out, but much of it isn’t.
For example, in the UK medical services are very tightly controlled by the NHS. People may not be paying the bills directly, but there are plenty of other things keeping demand down such as statutory waiting periods for surgery (deliberately set at up to 18 months in some areas) and de facto waiting periods caused by shortages of personnel and equipment. People do not get what they want in the UK any time they want it. It’s nothing like what your average insured American experiences, for sure.
But still the cost exceeds the ability of the country to pay for it. Despite all of the controls and rationing that goes on, it’s still bankrupting the country. There has been an absolute increase in the costs of goods and services over time. High tech care isn’t cheap. Drugs aren’t cheap. Lifesaving cardiac devices unheard of in the 1940′s are very, very expensive. Even if you took insurance or gov’t payment out of the mix entirely (which would lower the cost quite a bit), these things would still be out of the reach of most people should they fall ill.
It’s not possible to get rid of gov’t funding or insurance now. It would be no different than telling all homeowners to do without homeowner insurance, or go “bare” on owning a car. Who among us would be willing to do that? What we need to do is move away from covering every little thing back to high-deductible catastrophic coverage where people do bear more of the cost, but have protection from losing everything if they get sick. Unfortunately, under Obamacare, we are moving in exactly the opposite direction.
Sure it’s possible, just not likely. It’s about as likely as We the People suddenly deciding to do something outrageous, like, I dunno, maybe following the Constitution. Crazy, I know…
All we’d need to do is abolish the Medical Practice Acts and the FDA. Do that, and watch the supply of medical care of all kinds skyrocket, prices drop like a rock, my poor patients benefiting from specialists, medicines, and technology currently too expensive for them. Will there be quacks etc? Sure. Is the gov’t competent to tell you who’s a quack and who’s not? About as competent as a screwdriver is to pound a nail. Perfectly good tool, just the wrong tool for the job.
I dunno, Doc. While I thing the FDA gets a lot of things wrong, it has prevented some pretty big disasters here- thalidomide springs to mind. Of all the pieces of the cost puzzle, that’s the one I have the least trouble with. People truly can’t judge the safety and effectiveness of most medications on their own. Hell, sometimes I can’t, either- just look at the up/down/up course that estrogen replacement therapy has been on through the years. Same for medical devices. You know as well as I do those company reps will do what it takes to sell a product, it’s not like we can rely on what they have to say. Plus, these vendors spend only a fraction on following the regs as they do on advertising- they spend more on advertising than on R & D. Seriously. You could cut the cost of a drug in half tomorrow if companies were forbidden to advertise in the US, like they are in every other sane country in the world. And I could watch TV without suffering through a dozen different ways to dramatize erectile dysfunction without actually showing anything.
Tort reform could bring down the cost of technology quite a bit, though. That’s about as likely as following the Constitution, I guess….. certainly it is not contained in the thousands of pages of Obamacare.
Yep, they definitely do get some things right. But point 1 is that they do so at an enormous cost, the collateral effects of which probably cause way more suffering than what might happen if the FDA were to disappear. Even if I were not a physician I am confident that I would be able to locate reasonably safe and effective medicines for myself and my family w/o the gov’t's assistance. W/o the FDA they would be far more readily available and cheaper. The fact that there might be others who would not be able to do so does not necessarily mean that the gov’t should do be given the authority to tell every citizen what medicines they may and may not take. Especially in light of point 2, which is:
It’s unConstitutional. If it’s so all-fired important to have Big Daddy gov’t tell you and me what medicines we may and may not take, I’m sure you’ll have no problem getting an amendment passed authorizing it.
Obamacare will also penalize hospitals for too many re-admittances.
This is done in such a way that 10% of hospitals WILL be penalized, because whoever is on the bottom, with the most re-admittances compared to all the other hospitals, will be penalized.
(That is my understanding of it, anyway.)
Old people, close to dying, often need to return to the hospital a number of times before they die. My mother was one of those. If she hadn’t been able to come in for hospital treatment several times before her death, she would have suffered horrendously at home (in the assisted living home).
Obamacare means many old people will have to suffer unnecessarily before they die.
The sensible solution for anyone old and in ill health would to be to put themselves out of their misery. However, the powers that be would just applaud the action.
I live in New Zealand and can warn you about the outcome of socialised medicine, our system here is broken due to lack of resources, lack of specialists.
I am waiting for 2 ultrasounds one for my kidneys one for my liver and the waiting list is about 3 months. This means my doctor and I have to wait three months to find out what is wrong with me and until then nothing can be done.
Most people unless they are quite wealthy try to avoid going to the doctor because of the cost involved, but going to the emergency room at a hospital is “free” so hospitals are swamped with people presenting with eg the flu.
There is a lot of misdiagnosis and plenty of unnecessary deaths due to the third-world doctors’ incompetence, and there is no one to sue, the best you can hope for is to get your name in the paper posthumously.
Wally, I don’t think you quite realize what health care is like in the USA.
Think about this: in the US they will say that you need advanced imaging, but they’ll give you a business card and say, call this person and get it done, while you are in pain, and no its not in the hospital, where you are. And there will be someone pestering you about your payment.
“And there will be someone pestering you about your payment.”
Because nothing is more unfair than having to pay someone to provide goods and services that you want.
With the help of the government I had great health care in Canada. This article demonstrates that this debate is 40 years behind the rest of the developed world. Sorry Paul, you are contributing to keep the USA in the bronze age of medicine.
“…you are contributing to keep the USA in the bronze age of medicine.”
Because the USA has always trailed the rest of the world in medical research, innovation, technology, and treatment.
Jeff, I want to politely ask what specifically makes the Canadian healthcare system superior to the USA’s in your eyes.
More directly, what is your response to the problem of emergency rooms being overwhelmed with non emergency patients, and waiting lists for diagnosis procedures that can last for months?
From my experience in the health care industry, the patient has an ability to access the treatment and make a payment plan so that at the very least, they get the treatment out of the way. I happen to think that is superior to letting the problem fester for long periods of time.
Hey, wait a minute–those ACOs sound very, very, very much like the HMOs of the 1980s and 1990s. Weren’t there a kajillion lawsuits against HMOs for being too money-conscious and hog-tying the doctors? Didn’t Hollywood make movies-of-the-week about the eeeeeeeeevil HMOs? And now our wonderful government is going to do the EXACT SAME THING.
AARGH!
BTW, Dr. Hsieh has been all over this from Day 1. Another great article, Doctor!
No, HMOs didn’t have the benefit of a large pool. Since almost all citizens will be payers health insurance companies will be able to provide greater health care since their revenue will be so high, and healthy people will be paying in.
YES! Free enterprise and Capitalism! 30 million more people paying money into our companies!
“Free enterprise and capitalism!”
Because nothing says “Free enterprise and capitalism!” like forcing, at gunpoint, 300 million people to “buy” something they don’t want to buy.
They don’t have the benefit of a large pool at all- in fact, quite the opposite since the payment is based on the health of a specific individual, not a payment that covers an entire population. With an HMO, a doctor would be more likely to say, “Ah well, sick patients cost more, that’s figured into the payment I’m getting to take care of everybody.” With an ACO, it’s more like, “This sick patient is costing more.” Period. The financial risk is entirely focused on the management of that one patient, not the management of the group.
A lot of good civil comments. I’ve enjoyed reading them all. My two cents are the cost of anything is its costs of development, production, management, quality control, legal fees, and taxes, etc. The reason health care costs have gone up is the increase in all of these costs. How much does it cost to train a physician or any health professional? Lots more today than 50 years ago or even 10 years ago. Look at the massive costs and time to develop a new drug, any drug, its billions more and years longer than 10 years ago. How many people are involved in running the doctors or the hospitals business and maintaining an increasing mountain of “mandatory” documents? The record keeping and the army of clerks and auditors is growing exponentially. How much does medical malpractice insurance cost? A million or more if you’re a specialist. How many lawsuits do physicians and hospitals face yearly? Their costs and awards ultimately get passed to the consumer. How many with serious life debilitating illnesses or injuries sue because they think their condition should be better than what the doctor or hospital provided? Could this be the reason some doctors refuse to take on risky cases and health insurance companies try to deny insurance coverage? Our problem in the US is we want a sure bet, a perfect health system, and we think if we demand more and more controls on the healthcare industry they will provide it. Yet the more we add health regulators, health lawyers, health laws, clerks, auditors, and managers, and the more we push for the perfect product, the higher the costs go and the less perfect the outcome. We need to realize that health care is not a perfect science and our demanding it won’t make it so. There has got to be a balance and we’re way past it in probably the most over-regulated over-managed, over-litigated industry in the US today. Adding more will only make it worse. Sometimes less is more. It’s time to cut back on the armies of people and mountains of regulations and laws imposed on the healthcare and insurance industry. Its the only way to really reduce costs. As for those who think the government can and should cover those costs, in the end it’s the taxpayers who are the ones who pay. There is no free lunch.
Not to worry they have a plan, it’s call your duty to die! But they are calling it compassion an choices. My local town will be holding talks on how great this will be. If you get alzheimer’s. They would like you to decide for the good of society to end your life before you get to sick. An if you want to live an have that extra heart work done once more you will be seen as having mental illness an someone could need to make that duty to die choice for you. Like I said they are even coming to my small town to promote this point of view but with nice words. After all if they can get you to go along much better for them. My guess is people who get no care in this new system will want death. Win Win for them. 78 or 74 boomers a problem no more.
Do you happen to live in The Netherlands?
VP Dick Cheney was every insurance company’s nightmare … five horrendously-expensive heart-attacks. For any insurance company, by far the most direct path to maximizing shareholder value is to find a bureaucratic excuse to drop Mr. Cheney’s coverage, and drop also the coverage of everyone related by blood to Mr. Cheney.
Humans might debate: “Would this action be morally right? Or wrong?” But corporations ask a far simpler question: “Would we get caught?”
The answer (nowadays) is “No”. Patient-dumping is not merely possible, it’s easy … dead-easy … especially with the help of corporate databases that know every detail of every patient’s health-care record. If your competitors patient-dump, then you have to patient-dump it too … because that’s how the market works. And that’s the simple reason why patient-dumping has become economically mandatory under America’s present health-care system.
And that’s why anyone think patient-dumping doesn’t happen is utterly deluded. Use common sense, folks. Haven’t you ever wondered why American medical paperwork nowadays is so hopelessly complicated … and getting steadily worse!? The answer is simple market economics: when an insurance company makes the paperwork sufficiently complicated, a significant fraction of patients stop seeking care and die, thus dramatically reducing business expenses.
And that’s why American insurance companies have a name for their frustrated-to-death patients: profit centers.
With respect to the harsh reality and devastating consequences of these perverse incentives: (1) willful ignorance is morally wrong, (2) denials are false, (3) quibbling is foolish, and (4) smearing is contemptible.
When we take-away the willful ignorance, denial, quibbling, and smearing that is PJM/Tatler’s ideology-first position on health-care, what is left? Not much, is the plain answer.
American conservatism deserves better.
—————————————–
American Medical Association Journal of Ethics
Refusal of Emergency Care and Patient Dumping
URL: http://virtualmentor.ama-assn.org/2009/01/hlaw1-0901.html
Hey A parsons, what part of State Run Health care don’t your get? Your notion that the present U.S. system is capitalistic and is an expression of free enterprise is something that you simply make up.
Your argument relies solely on notion that somehow this industry, that is one of the most highly regulated by the State, somehow has freedom from those regulations and has the power to do as it pleases. In reality healthcare now is nothing more than a State run enterprise. The notion that more of what has failed will be successful… Your willful ignorance is absurd. Let’s all dumb down to A parson’s level. Let’s ignore that major player that has failed big time. The State. Let’s have more of it, because A parson says so. More, more, until there is nothing more.
Imagine, having A parsons telling you how many pushups to do each morning. Why? Because he loves you.
If you wish so much for your utopia, then find like minded individuals to form an enterprise, using your ideas along with your own funds, and move forward with your own version of health care. That is free enterprise. But you can’t do that. The State will not allow you. Not unless they have control over your pursuit of your happiness. So you greedily want others to be forced into accepting your dream, and you do want the force of the State to back you. What else?
You can attempt to sugarcoat with the testimony of failed experts, who suit your blood sucking, piping in, but all you are doing is maintaining a long dead corpse with the unwilling lives of others.
Did Winston get his scab treated? Careful, your children are watching.
Michelle Obama is an expert on patient dumping……look it up
Mr. Lucky, perhaps the opening scene of The Incredibles (link below) can assist your understanding of the perverse market incentives associated to health-care. Because thirty-five million Americans saw this The Incredibles opening scene … and the sober fact is, they vote.
American conservatism must supply thoughtful and effective answers to these legitimate public concerns (which are solidly-grounded in the perverse incentives of the health-care markets) … because American families will not accept the vacuous rhetoric that PJM/Tatler’s peculiar brand of conservatism is presently providing.
The Swiss took sober-minded, conservative-centric action to mitigate these perverse market incentives. American conservatism should too.
————————————
The Incredibles ~ Beginning
URL: http://www.youtube.com/watch?v=aJeHhCYGZ_g
I’m an American who, because of marriage to a Canadian, has been living in Ontario for the last four years. I can tell you through personal experience that the Canadian health care system sucks.
It took two and a half years to find a doctor. The one we found was the only one in a 100-kilometer radius who was taking new patients.
He is not a good doctor (and I’m being kind). However, I am stuck with him. I cannot seek out another doctor without going through a legal hodgepodge of getting him to release me. It’s a moot point anyway because, as I said, there are no other doctors taking on new patients. I don’t live in a sparsely populated area. There are plenty of doctors around. They are just unavailable.
Physicist, you say the cost to Canadians for medical care is zero. You are WRONG. We pay for our medical care every time we go to a cash register to pay for something. Everything here costs two to three times what it does in the U.S. Over 50 percent of GDP in Canada goes to health care. I saw Ann Doid, President of the Canadian Medical Association, on TV not too long ago and she said this is unsustainable and that the estimates are that the share of GDP going to health care will rise to 80 percent in the next few years.
Last spring, my mother-in-law had an urgent medical problem. The paramedics were called. Four EMTs showed up to transport her to the hospital. We waited for five hours before a bed was assigned to her. During that time, the four EMTs were required by law to wait at the hospital until she was assigned a bed. They sat around, twiddling their thumbs, at taxpayer expense. They were taken out of the field for five hours and not allowed to go on other calls. This is nuts!
I have been having a medical problem since March. An MRI was requested at that time. I finally had the MRI on August 7–that’s five months of waiting. An EMG was requested in May. I finally had the EMG on August 11. That’s three months of waiting. If I had been in my native Minnesota, all diagnostic tests would have been performed in late March and I would have been treated by mid-April. I’m still waiting and here it is September. My doctor has left me swinging in the wind with no suggestions. I’m seeing a naturopath next week and hope to get some answers from the private sector.
The only thing that obamacare will do is take the best medical system in the world and screw it up. If the laws that prevent the sale of medical insurance across state lines were repealed and tort reform was put in place, medical costs in the U.S. would come down immediately. Also, the regulations that mandate that Americans’ insurance policies pay for things like sex-change operations, aromatherapy, massage, marital counseling, in vitro fertilization, etc., should be repealed. If people want these extra things, they should pay for them themselves out-of-pocket and not put the costs on the back of every American.
Liberals claim that socialized health care is “compassionate” and the right thing to do. I say this is rubbish. It is a way to control people–who gets treated and who lives and dies. There is a reason why all the monsters of the 20th century–Hitler, Stalin, Mao, Pol Pot, Castro, Chavez–instituted socialized health care. It is the crown jewel in the socialist/communist ideology. If obamacare is not repealed, it will be a nail in the coffin of our republic and the end of individual liberty in the U.S.
MK, in a Swiss system you would immediately switch providers … problem solved.
That consumer-control is the simple reason the Swiss *love* their system.
… and that’s why Hillary and Mitt both advocated it …
… and that’s why Obama-care is evolving toward it …
… and that’s why American conservatism should get-in-front on it!
Not least because Swiss-style administration costs are incredibly low (thanks to the elimination of perverse market incentives) whereas in America these wasteful/hateful processes are incredibly costly and expensive.
The plain fact is, it doesn’t matter which brand of health-care system one compares — Swiss, German, Canadian, British, Scandinavian — the American system is by far the most wasteful by *any* measure compared to *any* other national health-care system.
—————————–
Costs of health care administration
URL: http://www.ncbi.nlm.nih.gov/pubmed/12930930
“The plain fact is, it doesn’t matter…” No kidding.
Like –
“… and that’s why Hillary and Mitt both advocated it …
… and that’s why Obama-care is evolving toward it …”
What a cast. Is the cast evolving too? Is there a link here somewhere? Let’s see, Brave New Same Old! Yeah!
“The plain fact is, it doesn’t matter…”
Nothing like a programmed bootlicker with an insatiable need for oral gratification.
Boom! Free teeth courtesy of the State! Get in line!
Hey, A parsons, is that telescreen set to loop endlessly?
And Winston’s scab? Still there!
Is there *anyone* on PJM/Tatler who understands Mr. Lucky’s references to “Winston’s scab”? In Mr. Lucky’s world, this phrase somehow explains health-care policy, Libya, and the War in Iraq and Afghanistan … all lumped together.
Is it a Randian code-phrase? Neo-con? Libertarian? John Birch? Lyndon LaRouche?
Please help us out, Mr. Lucky!
Ominous News on Our Doorstep, on Our Horizon
There was a time in America in the not very distant past when things were very different.
Just a few decades ago, we were respected in the international community, rarely loved, sometimes hated, but usually respected. There was a time when America had a secure border which defined us as a nation, when we felt free to voice our opinions without being condemned as bigots, when government functioned in the interests of the governed, a time when we were a free and sovereign nation not subject to the vagaries and enmities of the 191 other countries in the United Nations.
That time and those times are long past and not solely because of a single political party or one politician, although our current president has far outdone the others, busily undermining not only our economy but everything the United States of America has stood for, starting with our status as a country worthy of respect.
Last Thursday we saw a vivid example of international disrespect that would never have occurred in the past: A contingent of of Mexico’s Secretaria de Seguridad Publica federal police force perpetrated an incursion onto American soil not seen since the insolence of Santa Anna during the Mexican War.
Santa Anna was crushed in the battle of San Jacinto but last week Mexican forces showed their contempt for that American victory and for the American nation.
An El Paso witness reported that Mexican police fired at American hunters on the U.S. side of the Rio Grande and other Mexicans followed that attack “with automatic weapons into the U.S. side . . . stole hunters’ chairs and drove back into Mexico.”
Our authorities are investigating the incident but aside from the theft of a few chairs, will they investigate the temerity of Mexicans invading our nation? Not likely, since we have already granted carte blanche to them and everyone else to violate our borders, thumb their noses at the United States–and steal our chairs.
Almost worse, some Americans are now so terrified of political incorrectness that they have sacrificed lives on the PC altar.
Former-Democrat, now Independent, always-liberal Connecticut’s Senator Joe Lieberman has offered the very valid opinion that had it not been for fear of being labeled prejudiced Muslim Major Nidal Hasan wouldn’t have been able to kill and maim innocent people at Fort Hood in 2009. . .
(Read more at http://www.genelalor.com/blog1/?p=5347.)
If you want a good health care system you need what America used to give its physicians–freedom.
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