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This page contains a single entry from the blog posted on February 19, 2007 2:50 PM. The previous post in this blog was Blazer trade in the works?. The next post in this blog is I have a theory. Many more can be found on the main index page or by looking through the archives.

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Monday, February 19, 2007

Something or nothing

John Edwards has a smart and surprisingly detailed universal health care plan.

Hillary Clinton doesn't have one, and is so busy having a conversation with America that it seems unlikely she'll be releasing one until her pollsters tell her what to say.

Barack Obama doesn't have one, and is currently trying to figure out how much weed he is going to have to confess to smoking once his Hawaii high school buddies start talking.

If you'd like to read the Edwards camp's official description of his plan, you can go here.

Comments (60)

Jack, if you want to pay for some obese person to get his/her stomach stapled then feel free to give them your money - don't mandate I pay for their bad health habits.

If you want to pay for the medical care of some smoker then feel free to write the hospital a check of your own - don't mandate that I pay for their bad health habits.

If you want to pay for someones sexually transmitted diseases then go for it, but please don't mandate that I pay for their bad habits.

If you want to pay for the healthcare of illegal aliens then please just hand them your money. Don't demand bigger government to rape my pockets for them.

Get the point? How about promoting self-responsibility some day?

And, if you want to pay for our city to have parks, where I might have to be subjected to the site of gay people holding hands or giving each other a kiss, go ahead. But don't rape my pocketbook by using my tax money to fund places where they can flaunt their bad habits in public.

Also, if you want Democrats to be in government, go ahead and vote for them, but don't you dare steal my tax money to pay for the salaries to support their bad governmental habits.

One provision of the Edwards proposal certain to draw fire is a requirement that companies provide health insurance for all workers or pay 6 percent of their payrolls into a government fund to buy insurance for them.

I think we need a definition of "provide" health insurance. Does that mean its available to the employee, or available at no cost to the employee? Because I think I know where companies would go with it. They would pay the 6 percent to the feds. Thats FAR cheaper than paying for health coverage. I have health insurance "available" to me, but its a limited plan, with a very low max. payout per year. Insurance is available to my wife too, through her work, but she has to pay for it. At about 15% of her pay. Six percent is a steal.
Of course, if the feds end up covering it all, the deficit will go into the stratosphere because the insurance companies will raise rates now that they have "government" contracts, just like everyone else does.

How about promoting self-responsibility some day?

You're right. The working poor who get sick should just be left to die and decrease the surplus population.

High cost health care makes it hard for U.S. business to compete in the global marketplace. In turn, U.S. business either cuts health-care benefits or squeezes our pay.

Conservatives saw this as a nasty fact of life that we just have to live with. But people don't want to live with these facts anymore...

Business wants to find a solution just as badly as anyone. Republicans don't seem to want to put forward any answers. I guess it's time to turn to the Dems to figure it out. The current system is unsustainable. Period.

Democrat solution: Tax the hell out of everyone - and make sure it's all unionized!

Jack: Don't put words into my mouth! "Working poor" - who is this? People that decided to goof off in school instead of study? People that decided to have kids when they can not afford to care for themselves? Or maybe you're talking about illegal aliens? Or maybe the "poor" that made the choice to buy a big plasma TV instead of health insurance.

At the most maybe take health insurance premiums out of people's paychecks (even the poor workers) and let people choose a private health insurance company. No difference than taxes being taken out and it would keep health care OUT of government control.

Why is it that Democrats think BIG GOVERNMENT is the savior of everyone? Geesh!

What a rant. You're not going to like the next 6 to 10 years, my friend. Your hero the Chimp has sealed your fate.

WHAT? Like that is suppose to be some type of "intellectual" response?

Again, typical liberal retort.

I think the voters gave people like you all the retort you need last November. It was fun, but you're done.

Liberal interpret the last election wrong, thinking it's a mandate for Democrats to advance socialist "solutions" via bigger government, fewer personal liberties, bigger government control, forced unionization (which Barack Obama has already directly endorsed), etc.

Beware of the less-than-2-years of control you have - I don't think people crave more government and taxes.

I think most Americans are tired of being screwed by Halliburton and Dick Cheney and being hated by the world. It's over, dude.

Halliburton and Dick Cheney - old liberal BS Jack, along with it is for the oil. Blaa, blaa, blaa.

Stop blaming phantom bogymen and get a dose of reality.

My last comment on this post, but I dare you to answer one question:

Do you, Jack, want BIGGER government or smaller government?

It's a rather simple question Jack, with just two possible answers - unless you want to deceive your readers.

Your answer? [BIGGER] or [smaller]?

""Working poor" - who is this? People that decided to goof off in school instead of study? People that decided to have kids when they can not afford to care for themselves? Or maybe you're talking about illegal aliens? Or maybe the "poor" that made the choice to buy a big plasma TV instead of health insurance."

Wow, that is breathtaking: mean and compassionless.

No, "working poor" is people in the service industry, the only growth industry in the US, b/c the "world is flat" so the middle class jobs are going elsewhere. They cannot support families on full time minimum wage; they have a heavier tax burden than their multinational corporate employers. Unions are the only way they can gain any kind of bargaining leverage with their multinational corporate employers.

What we need is Medicare for everyone. It's obvious.

Alternatively, the obscenely wealthy, untaxed Christian fundamentalist mega-church industry could follow Jesus's teachings and contribute a smidgen of its resources to health care and food for the poor.

Alternatively, maybe the likes of Liberal Democrat Billionaire George Soros, or mega millionaires Kennedy and Kerry?

service industry, the only growth industry in the US - better do a reality check with Business week Sambo - you don't know what you're talking about.

mean and compassionless - sorry but your guilt trips don't work with me.

They cannot support families on full time minimum wage - then why did they have families?

What we need is Medicare for everyone. It's obvious. - Oh man, another socialist speaks.

At the risk of seeming uncivil, may I point out that JustaDog made at least one more post after saying that he/she wouldn't post any more?

Which do you want, JustaDog? [MORE] posts or [less]?

"Then why did they have families?"

Because they're idiots. It doesn't mean their children don't deserve health care, especially in the richest country on Earth.

"Oh man, another socialist speaks."

What's wrong with socialism, if by that you mean a single payer system; it leads to longer life spans, lower infant mortality rates, and better quality of life in Canada, Sweden, Germany, Japan . . . Everywhere in the industrialized world except the US, where everyone (insured or not) is terrified to go to the doctor because of the expense, so less preventative health care occurs, so people end up in ER's with worse, more intractable problems later.

Sorry, Justadogbo, but your using "socialist" as an insult doesn't work for me.

"Alternatively, maybe the likes of Liberal Democrat Billionaire George Soros, or mega millionaires Kennedy and Kerry?"

I completely agree. However, their hypocrisy is less flagrant than that of the Pat Robertsons of the world, who will have less trouble fitting through the eye of a needle than getting into heaven, according to Jesus.

From the PDF linked above:

The time has come for a universal health care reform that covers everyone, cuts costs, and provides better care.

I think the time has come for some economic reality. You can cover everyone, obviously. You might be able to improve care, perhaps. No doubt you could cut costs if you wanted to.

But you can't do all three at the same time.

I have no doubt at all in my mind that most Americans want a "solution" to the health care "crisis". But what they want, and what they can actually have, quite often are two different things.

It seems that the critical element in that troika of desires is the "cover everyone" part.

So, if you cover everyone while maintaining (or improving on) current levels of care, you will have a net increase in costs overall.

If you cover everyone while reducing costs, you will necessarily have a net decrease in level/quality of care overall.

So what are you willing to give up in order to cover everyone? Money, or quality?

I expect the "average American" would say money -- as long as it's somebody else's money (like business or government... as if that doesn't ultimately come out of your pocket too). But I can just about guarantee that the reality will be some mix of both.

I kinda like Edwards. He was my favorite Democrat in 2004. But I'm concerned about this kind of irresponsible "tell the people what they want to hear" B.S. If he wants to really fix health care, tell us what it's really going to cost -- in terms of direct expense or lost quality -- and we can make an informed choice.

BTW, I absolutely agree about the 6% thing... businesses across the country would be stupid not to drop their own health coverage and just pay the 6%. And my question is this -- if it costs businesses about 15% or so (for arguments' sake) of payroll to provide health insurance to employees now, how is cutting that amount by 60% to help cover everyone in the country going to improve health care quality for those employees?

"Most of America is not this stupid?" Don't bet on it. Seventeen percent of Americans (according to a poll) consider themselves to be in the top one percent ranked by wealth. It's that good old high-minded rugged individualism and self-reliance that will see us through. None of that Euro-Socialized Medicine for us. Better outcomes for less money? No, thanks. We're smarter than that. We'll take higher cost and higher mortality, because we can't accept the moral hazard of some schmuck getting a benefit she didn't actually earn or pay for. Unless, of course, it's the CEO of Health South. Next topic.

David, you may not be right about the threefer. We currently spend 15% or more of GDP on health care. Other countries with single-payer systems do it for much less with better outcomes, measured by longevity and infant mortality. It's not a stretch to imagine that what we now spend is enough to expand coverage to everyone and maintain and improve the quality of care -- say, up tot he level of those other countries. We would do that mainly by eliminating the administrative cost incurred by health insurers to avoid paying claims, and by avoiding the excessive, unreimbursed cost of emergency care to the uninsured. There are two good domestic models for this idea -- the VA and Medicare (pre-2006).

The insurance companies spend enormous amounts of money on marketing and looking for ways to deny coverage. Edwards's plan would eliminate a lot of that.

Allan & Jack, do you suppose that for-profit insurance companies today spend more in administrative costs to deny claims than it would cost them to pay the claim in the first place? Would that make any business sense at all?

So, okay, you'd get some administrative costs being shifted from avoiding claims to paying claims... but presumably it'll cost more to actually pay those claims than it did to avoid them, and that's for people who are already in the system. How does adding 47 million people to the system generate less cost?

Measuring health care outcomes based on longevity and infant mortality is fine, but it's not the whole picture. If a health care system manages to keep you alive for 5 years longer than you otherwise would -- but won't treat your low-level chronic pain because that ailment isn't high enough on the list -- is that a better outcome?

And the health care system overall is but one of many factors that impact those mortality stats.

If you want to talk about socializing a whole lot more than just health care, then we might expect to achieve similar results. But as long as we're only talking about changing the health care system -- and frankly, so far we've just been talking about changing how we pay for the health care system -- the results are bound to be disappointing.

I used to work with several Canadians. Ask them where they'd rather be if they needed medical care.

The answer will depend a great deal on the nature of the problem.

No question, Canada (and I assume other similar systems) deals with certain health problems better than we do. And in many cases, they don't.

My point is that "outcomes" are not uniformly better in other countries than in the U.S., it all depends on the illness. And suggesting that we can adopt one element (single-payer) of other industrialized nations' systems to achieve similar results is just not realistic.

Health care is always rationed, one way or another, in every country on the planet. You can't treat unlimited needs with limited resources. The question is, what's the mechanism for doing so? Our current system ain't perfect, I'll certainly grant you that. But putting all of those rationing decisions in the hands of a single payer may not be an improvement.

Here are some real reimbursement numbers from the back of a doctor's office. Let's say a doctor charges $100 for a typical mid-level office visit. Here's what the doctor gets paid.

-Competitively negotiated contract with a private insurer: Blue Cross, Providence Health Plan, ODS, United Healthcare, etc,:
doctor makes upwards very close to the whole $100. You may make a copay or pay coinsurance as part of that $100 payment.

-Medicare: $53.00. Medicare pays for about 80% of that. You can either pay for a second insurance to pay for the remaining 20%, or you can pay it out of pocket.

Oregon Health Plan Medicaid: $45. Patient has no responsibility, doctor is forced to write most of it off.

Oregon Medicaid: $37. Patient has no responsibility, doctor is forced to write most of it off.

I'm trying to point out the discrepancies of reimbursement of the different insurances. I just don't think that universal health care advocates think about how much less government insurances pay, which is a big reason why they "cost less". The doctor is accepting less money. This is why many doctors limit the number of government insured patients, especially Medicaid. I don't think doctors are going to want to accept less money.

But the whole point is to make it so that they have no choice. Plus, the drug companies and the insurance companies could and should accept way less money.

Edwards's plan is not cheap. There'd be a tax increase on everyone making more than $200,000 a year. Most of them probably doctors. Cry me a river.

doctor makes upwards very close to the whole $100. You may make a copay or pay coinsurance as part of that $100 payment.

Not true. If it's covered by most private insurance, the doctor takes a writedown of what he or she would charge some poor uninsured schmuck.

"Allan & Jack, do you suppose that for-profit insurance companies today spend more in administrative costs to deny claims than it would cost them to pay the claim in the first place? Would that make any business sense at all?"

It's a good question. Administrative costs are not the whole picture in terms of the distortions in our existing system. And denying a particular claim or avoiding coverage of a particular individual can result in collateral savings beyond the cost of the claim at issue. So, if administrative costs were allocated solely to denied claims, I think they would loom large as a cost, compared to the specific claims. Bear in mind that insurers can't deny all the claims they process -- they have to pay some. As a percentage of total health care costs, administrative costs are stunningly high in the U.S. And, yes, it makes business sense. It's a profitable activity, highly rewarded by investors.

Doctors, even solo practitioners, have to have specially trained people on staff to fight with the insurance companies to get paid a proper amount in a timely way. Those are all payroll employees with benefits. How much do you think that adds to your doctor bill?

Perhaps Justadog is a bit clueless about the working poor. I do, however, find it a bit odd that he repeatedly suggests that they should not produce offspring. So is that another abstinence advocate or what? Because the last time I checked, condoms have a (ballpark) 20% failure rate and birth control pills still require a prescription.

As far as feasability of universal coverage vs. economic projections go, I think it is really difficult to forecast. Most of these plans emphasize preventative care. I think we all are aware (to some degree at least) that emergency room visits are incredibly expensive. Many, many uninsured people wind up there and their costs are passed back down to insured patients. We're talking maybe a couple hundred bucks at the doctor's office vs. thousands in the ER. If everyone is covered and has access to basic (preventative) care then doesn't it seem logical that overall costs should go down? Not to mention actual health benefits...

Jack writes: "Doctors, even solo practitioners, have to have specially trained people on staff to fight with the insurance companies to get paid a proper amount in a timely way. Those are all payroll employees with benefits. How much do you think that adds to your doctor bill?"

It does add to costs. However, the government insurers aren't any less troublesome to deal with than private insurers. So what if the doctors still have the same problems, but with less money with the government having a near monopoly on insurance? (I'm not talking specifically about Edwards plan, just insurance in general if the government were to take over health insurance).

True enough, Jack... there are certainly inefficiencies in the system that incur costs not directly related to the provision of health care. Administrative overhead is a drag on efficiency/productivity in any industry.

BTW, what happens to all those specially trained staff people with salaries and benefits, when they are no longer needed because of the magic of single payer? What happens to the thousands upon thousands of clerical workers at the several hundred insurance companies in the country, when their services are no longer needed? There's gonna be a lot of lost jobs over this.

That's not a reason not to switch. But it needs to at least be a logistical consideration as the switch is planned.

Here's a thought... and I realize that this is going to sound at bit too Reaganesque in this forum... but how about we tackle health care issues from the supply side? One of the forces driving higher health care costs is the shortage of qualified health care workers.

If you really want to improve quality and access to health care by spending a bunch of government money, why not offer free medical training to qualified people? True, it wouldn't pay dividends for several years until the first participants come through the program. But then you'd start to have more health care providers available, which would improve access and reduce cost. And, incidentally, you'd be helping out the workers themselves, potentially improving the economic situation for large numbers of currently disadvantaged people.

As I say, just a thought.

Perhaps Justadog is a bit clueless about the working poor.

You didn't need to continue past the word "clueless".

My *completely* apolitical brother was really impressed with Edwards -- he met him when he shot an interview for one of the networks last week. I thought he was the best candidate last time, and I think he'll be the best this time, too.

the government insurers aren't any less troublesome to deal with than private insurers

But they would be under this plan. There'd be no possibility of denying coverage. Everyone is covered, period.

Everyone is covered, period.

Ah, but is every-thing covered, period?

If so, forget about cost containment.

If not, you haven't really saved much in the troublesome department.

The trouble in dealing with insurance providers isn't so much about whether a particular patient is covered at all (that's pretty easy to figure out). The trouble is in whether a particular service/procedure/whatever is covered under that patient's plan, under the specific circumstances involved, etc.

By the way, an interesting side note about how the Canadian system works. Apparently, it is possible to obtain private supplemental health insurance in Canada, for those who wish to pay extra for the extra services.

But, by law, private insurance is not allowed to cover what the national insurance covers. Otherwise, health care would become a market commodity as those who are willing to pay more for a service get preferential treatment.

So essentially the Canadian system limits choice dramatically. If the government will provide it, then the government must provide it. And patients must get it on the government's terms, including when and where treatment is to be had.

Bureaucracy is bureaucracy whether private or public. Except that a public bureaucracy is generally less accountable than a private one.

Keep preachin', rev.

Wow. Talk of universal health care can really bring out the self-involved and self-righteous in some folks. Yes, people do make poor choices and engage in risky behavior that can be filed under “self-destructive”. If you are not able to get insurance, and you make a bad choice or a series of bad choices – does this mean that you should be punished for all of eternity? Are people in this country that mean spirited? Who on Earth is really qualified to judge who “deserves” healthcare and who doesn’t? Would it really kill you to see everyone (even the overweight, the smokers, the drinkers, the diabetics, the stress cases with high-blood pressure and so on) get health coverage and be taken care of? Or should we just shoot the losers now and really save some cash? I would rather see my tax dollars go towards saving lives instead of taking lives.

www.wecandobetter.org

David you make a great point about cutting costs in glaringly obviously areas. 1) Government subsides for people to become RN's, Physician Assistants, MRI Techs..etc 2) Some form of government control on Pharmaceutical companies.

Those cats are pulling in billion and even trillion dollar profits. Much more than any other health care based business. I guarantee that would end up being just as effective, less problematic, easier to implement and plain smarter than health care for everyone. Let's start at the least polarizing changes first and work our way up, not the other way around.

Edwards spiel screams false bleeding heart pre-election BS. He has always made it clear his thoughtfulness for the poor of our country. Yet he remains extremely wealthy and cut off from most of said poor issues. Every politician is, just a simple fact. Then again, the issues that arise when a political candidate comes out against large business scale down.

Doctors, even solo practitioners, have to have specially trained people on staff to fight with the insurance companies to get paid a proper amount in a timely way. Those are all payroll employees with benefits. How much do you think that adds to your doctor bill?

And you think those people are going to go away when they have to collect from the government? And what about the federal bureaucracy required to run the system? How much do you think that will add to our taxes?

Some form of government control on Pharmaceutical companies.

Those cats are pulling in billion and even trillion dollar profits.

Yet saving countless lives in the process. Just plain evil.
And just what should be controlled? Because whatever you do, I guarantee it ends with less help to the people. Take away the incentive to research, no more "wonder drugs."

Just remember, the last time the government tried to fix individual health insurance, we got the HMO act.
Seems to me, that the system was better when doctors charged you depending on your income. Which, if you think about it, is not any different than taxing the rich more now to pay for it. The insurance industry is just a middle-man.

And who championed the HMO as the answer, none other than Senator Ted Kennedy. Those of you who always point to Canada as an example of a great system leave out several facts. The waiting time to even see a doctor can be months. It can also take months to have a surgical procedure. You can't pay a doctor directly for services without you and the doctor being subject to arrest. Why is it Canadians who can come to the US for treatment. For those of you who point to low drug prices in Canada, name me one Canadian drug company that has brought to market anything.

And just what should be controlled? Because whatever you do, I guarantee it ends with less help to the people.

One word. Marketing. Get rid of the TV ads that whip up the armchair MDs and hypochondriacs and ditch the twentysomethings with fresh biology degrees pulling down six-figures to wine and dine my doctor and suddenly costs go waaaay down. That $100 my dad is spending on the latest greatest pill isn't going toward more research. It's going toward his doctor's next trip to Whistler.

Last time I checked, drug companies were spending almost as much on marketing as they were on R&D -- somewhere in the range of $20 billion a year on each. Let's cut the marketing, bump the R&D to $30 billion, and we not only get MORE lifesaving drugs, but we also save $10 billion!

David raises some good questions about government-run healthcare. It's no panacea, but our current system has become so dysfunctional that it's not unreasonable to think that it might be better.

By the way, an interesting side note about how the Canadian system works. Apparently, it is possible to obtain private supplemental health insurance. . . but private insurance is not allowed to cover what the national insurance covers.

Medicare works the same way. You can buy Medigap insurance to help with the patient copay and non-covered services, but private insurance cannot pay more for Medicare-covered services. And doctors are also prohibited from charging more to patients for those services. Even with these systems in place the elderly are still very happy with Medicare.

If you really want to improve quality and access to health care by spending a bunch of government money, why not offer free medical training to qualified people?

We already do this. One part of the Medicare program is Graduate Medical Education (GME) payments to hospitals -- I think these payments are approaching $10 BILLION a year. They pay for the stipends, benefits, and overhead for doctors who are being trained in teaching hospitals -- which includes almost all doctors at some point in their education.

Oh, and finally, HMOs were not a government creation. The private sector created "managed care" as an answer to ever-higher health care costs. If anything, the government cut HMOs off at the knees with things like the "Patients' Bill of Rights" and coverage mandates. Consumers hated the product that the market created, and so it failed.

The market alone cannot fix our current health care crisis. Some combination of market and government is needed.

"Working poor" - who is this? People that decided to goof off in school instead of study? People that decided to have kids when they can not afford to care for themselves? Or maybe you're talking about illegal aliens? Or maybe the "poor" that made the choice to buy a big plasma TV instead of health insurance.

OK, let me quickly mention just a few of those on Justadog's list eligible for euthanasia:

--folks with learning disabilities. Better and cheaper to kill them young, of course, before they become a public burden.
--The brown skinned.
--The stupid, as defined by Justadog. Again, best to kill them young before they can breed a new generation of the stupid.

Canada: Ask your Canadian friends how dissatisfied they are with their health care. Mine aren't. Another thing--salaries for MDs in Canada are not exorbitant as in the US. (Got this factoid from a Canadian friend whose father is an MD.)


"Another thing--salaries for MDs in Canada are not exorbitant as in the US..."

Yeah, those damn MDs -- 20 years of education, working their asses off and saving/improving people's lives. They don't deserve these 'exorbitant' salaries.

Gimme a break. Next time you doctor haters get sick, go visit a shaman instead and see hoe long you last.

If there's one sector of our populace that deserves to make tons of money it's doctors.

If there's one sector of our populace that deserves to make tons of money it's doctors.

Oh my, that's interesting. And where exactly would you draw the line? Median salary of >$200,000? Already there. Median salary of $400,000? $600,000?

Unlike most industries, there is not a "market" for physician services that is self-correcting. Many health care services could be done by someone below the level of MD, but the AMA fights those proposals tooth and nail because doctors incomes would go down. The true "cost" of providing a service is impossible to figure out, so there's no ability for anyone to audit those services.

Doctors salaries are part of the US health care problem, as are hospital profits, drug companies profits, insurance companies profits, and patients who are insulated from true costs. Any attempt to protect one of these can only come at the expense of the overall system. Doctors are fine human beings, but let's cut out the "doctors are altruistic" crap. A whole lot of them go into the field to make a lot of money, and those high salaries are a contributing factor as to why millions of people can't afford decent health care in the first place.

If there's one sector of our populace that deserves to make tons of money it's doctors.

And don't forget those free getaways to Cancun paid for by Merck. They've earned those too.

Miles and Chris S: MDs pay a giant chunk of their salaries to malpractice insurance thanks to shysters like John Edwards. They also spend more than any other profession on education.

Take away an incentive for a good living and our best and brightest won't be going into the medical field -- the USA's doctors will quickly fall from being the best in the world.

25% of medical expenses go to MD salaries -- sounds totally fair for a profession that demands such massive sacrifices. The remaining 75% of healthcare expenses are what should be scrutinized.

I'd like to see you two go through the cost and turmoil MDs go through and see if you have the same attitude.

I'd like to see you two go through the cost and turmoil MDs go through and see if you have the same attitude.

I don't begrudge most MDs a penny of what they make. They certainly earn it. Although longtime readers of this blog will note it's possible to deliver a baby in one's bathroom with only the soothing voice of John Dunshee (or an acceptable substitute) guiding you. No doctor needed at all. But I digress.

It's the other 75% I'm talking about. Specifically the kids hired straight out of college who make six-figures wining and dining their best MD clients. I'd love to see a spreadsheet comparing Pfizer's best clients nationally and their malpractice rates.

Yeah it sucks that the majority of our doctors have to pay for the sins of the few. But capping damages while telling a single mom she gets to work two jobs so she can afford to take care of her kid who was disabled by a doctor's negligence doesn't seem all that fair either. Unfortunately I don't have the answer.

"Unfortunately I don't have the answer."

I do:

Medicare for all.

Cap insurance company and hospital profits.

Outlaw ALL insurance and pharmaceutical marketing.

Total insurance premium rate setting transparency.

Outlaw all deductibles and co-pays.

Oh, and finally, HMOs were not a government creation. The private sector created "managed care" as an answer to ever-higher health care costs.

True, but once the government got involved, everything went to hell. In 1973 the Nixon administration passed a bill that provided money to build or expand HMOs, and it also required employers to offer them alongside regular insurance.
Unfortunately, the HMO that was used as a template was Kaiser Permanente, and Mr. Kaiser's philosophy was "the less we provide, the more we can earn."


I'd like to see you two go through the cost and turmoil MDs go through and see if you have the same attitude.

Yeah, doctors are such a persecuted bunch. Please.

My only point is that doctor salaries are part of the problem -- 25% according to your figures. To solve the health care problem will involve sacrifice from everyone -- if we exempt one group, it makes the problem worse.

Take away an incentive for a good living and our best and brightest won't be going into the medical field.

I think our disagreement is around what constitutes a "good" living. Top 10% of all wage earners I can live with. Top 1% seems a little extreme to me. Particularly since those salaries are a direct cause of people being unable to afford health insurance. So by making more money, on average, than almost ANY other profession, doctors do actual harm to real people.

That reminds me of an old oath. . . .

Take away an incentive for a good living and our best and brightest won't be going into the medical field.

Funny, same thing could be said about taking the profit incentive from pharmaceutical companies. And the only oath they have is to stockholders.

The problem with the pharma companies and their oath to shareholders is that they can only deal with diseases that produce big gross margins for them. That means big numbers of people in wealthy countries and a treatment that they can monopolize. It's at best a crude and imperfect way of allocating resources to health problems. Example: we get 'Nexium' to replace 'Prilosec'. Same function, slightly different molecule, lawyerly spin on the patent application, and millions of health care dollars into a funnel leading to a rathole. It's a sweet deal for investors and executives, but not helpful, really, for anyone else.

"Yeah, doctors are such a persecuted bunch. Please."

Miles, I don't know where you got so much acrimony toward MDs, but you obviously have no idea what doctors go through in order to practice.

A friend of mine was on call at a local hospital (as required for him to practice) as their only reconstructive hand surgeon. He was called in on a Sunday to operate on some guy who had his finger severely broken at the knuckle. The patient didn't speak a lick of english and had no insurance and no money (except he could afford to smoke a pack of cigarettes a day).

If this guy was in his home country, the hospital would have amputated his finger. However, my friend did a $20,000 surgery on this guy totally free -- consequently his finger was saved and is totally functional. Moreover, my friend had to hire an interpreter and deliver the patient's meds personally.

This ordeal took twelve hours out of his day off -- away from his wife and young kids. And he got paid nothing for it. This is one of about four other similar situations he's gone through in the past few months.

Now tell me he shouldn't make $250,000 a year.

Now tell me he shouldn't make $250,000 a year.

He shouldn't make $250,000 a year.

Chris, I have no acrimony towards doctors. But neither do I think most of them are eligible for sainthood. They are decent, smart people who get immensely wealthy doing something they (hopefully) enjoy. Congratulations to them for finding and achieving the American dream. It's legal to take advantage of the current health care system, and that's what they're doing. But I will not pity them or omit them from overall reform, because they are part of the problem.

I obviously can't speak to the details of your friend's case, but one reason he gets paid $250,000 a year (and I suspect it's much, much more if he's a reconstructive hand surgeon) is to be on call when needed. And your friend didn't do the surgery without getting paid. If he's on call at a hospital his salary is paid regardless of whether the hospital is reimbursed for the surgery or not. And the hospital IS reimbursed for that surgery because you and I get charged far more for medical services than the "cost" of those services in order to pay for care in exactly those situations. (This case also points out the inefficiency of the current system -- another reason reform is needed.)

Your friend if probably a very nice guy. But if you're telling me that cutting his salary by $50,000 -- allowing five families to get basic health care coverage -- would cause him to quit medicine, well maybe he's in the wrong field.

OK, let me quickly mention just a few of those on Justadog's list eligible for euthanasia:...

Euthanasia?

That's your word. Beat yourself about the head and temples.

JustaDog, however bluntly, raises a point that no one has adressed - namely, where's the line? Or, to read some, is there a line? What value, morally and practically, is there to personal responsibility? Conversely, is there a limit to government's responsibility?

I suspect that, in many cases, the test of whether or where the line is drawn has more to do with politics and class envy as some of the earnest comments like lin qiao's above. Like any number of issues, this one is important to some only insofar as it can be used as a club.

...like this:

lin,

Sounds like you don't believe in evolution - does that make you a creationist?

"MDs pay a giant chunk of their salaries to malpractice insurance thanks to shysters like John Edwards."

Yeah, it's those damn shyster lawyers - who stand up against poor, defenseless doctors, hospitals, and insurance companies - on behalf of those greedy dead, deformed and brain-damaged babies and their families that are obviously the root of the whole problem.

Madam:

If the personal injury lawyers are just trying to help brain-damaged babies, why do they keep 40% of the monetary awards for themselves? And what about the many specious/nuisance class action lawsuits where the majority of the eventual payout stays in the attorney's pockets?

If y'all think CEO's shouldn't earn ten million dollars per year, are you willing to cap the fees deducted from the plaintiff's award?

Only if, like personal injury attorneys, they don't get paid if they lose. How many CEO's are willing to take a gamble like that do you suppose?

I have read about CEOs that receive no salary or guaranteed bonus. They are paid exclusively in stock which they 0NLY RECEIVE IF THE VALUE OF THE STOCK goes up.

I believe Steve Jobs (at Apple) is one such example. Warren Buffet is another.

Granted, those who accept such an arrangement probably have reason to be optimistic about their company's growth prospects (and they're so wealthy they don't need any salary). But the same could be said about most attorneys who agree to work on a contingency basis: they don't take just any case that walks in the door. Widows and orphans need not apply unless there's a slip-and-fall or botched medical procedure, etc.


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In Vino Veritas

Louis Jadot, Pouilly-Fuissé 2011
Trader Joe's, Grower's Reserve Pinot Noir 2012
Zenato, Lugana San Benedetto 2012
Vintjs, Cabernet 2010
14 Hands, Hot to Trot White 2012
Rainstorm, Oregon Pinot Gris 2012
Silver Palm, North Coast Cabernet 2011
Andrew Rich, Gewurtztraminer 2008
Rodney Strong, Charlotte's Home Sauvignon Blanc 2012
Canoe Ridge, Pinot Gris, Expedition 2012
Edmunds St. John, Bone-Jolly Gamay Noir Rose 2012
Dark Horse, Big Red Blend No. 01A
Elk Cove, Pinot Noir Rose 2012
Fletcher, Shiraz 2010
Picollo, Gavi 2011
Domaine Eugene Carrel, Jongieux 2012
Eyrie, Pinot Blanc 2010
Atticus, Pinot Noir 2010
Walter Scott, Pinot Noir, Holstein 2011
Shingleback, Cabernet, Davey Estate 2010
Coppola, Sofia Rose 2012
Joel Gott, 851 Cabernet 2010
Pol Roget Reserve Sparkling Wine
Mount Eden Chardonnay, Santa Cruz Mountains 2009
Rombauer Chardonnay, Napa Valley 2011
Beringer, Chardonnay, Napa Reserve 2011
Kim Crawford, Sauvignon Blanc 2011
Schloss Vollrads, Spaetlese Rheingau 2010
Belle Glos, Pinot Noir, Clark & Telephone 2010
WillaKenzie, Pinot Noir, Estate Cuvee 2010
Blackbird Vineyards, Arise, Red 2010
Chauteau de Beaucastel, Chateauneuf-du-Pape 2005
Northstar, Merlot 2008
Feather, Cabernet 2007
Silver Oak, Cabernet, Alexander Valley 2002
Silver Oak, Cabernet, Napa Valley 2002
Trader Joe's, Chardonnay, Grower's Reserve 2012
Silver Palm, Cabernet, North Coast 2010
Shingleback, Cabernet, Davey Estate 2010
E. Guigal, Cotes du Rhone 2009
Santa Margherita, Pinot Grigio 2011
Alamos, Cabernet 2011
Cousino Macul, Cabernet, Anitguas Reservas 2009
Dreaming Tree Cabernet 2010
1967, Toscana 2009
Charamba, Douro 2008
Horse Heaven Hills, Cabernet 2010
Lorelle, Horse Heaven Hills Pinot Grigio 2011
Avignonesi, Montepulciano 2004
Lorelle, Willamette Valley Pinot Noir 2011
Villa Antinori, Toscana 2007
Mercedes Eguren, Cabernet Sauvignon 2009
Lorelle, Columbia Valley Cabernet 2011
Purple Moon, Merlot 2011
Purple Moon, Chardonnnay 2011
Horse Heaven Hills, Cabernet 2010
Lorelle, Horse Heaven Hills Pinot Grigio 2011
Avignonesi, Montepulciano 2004
Lorelle, Willamette Valley Pinot Noir 2011
Villa Antinori, Toscana 2007
Mercedes Eguren, Cabernet Sauvignon 2009
Lorelle, Columbia Valley Cabernet 2011
Purple Moon, Merlot 2011
Purple Moon, Chardonnnay 2011
Abacela, Vintner's Blend No. 12
Opula Red Blend 2010
Liberte, Pinot Noir 2010
Chateau Ste. Michelle, Indian Wells Red Blend 2010
Woodbridge, Chardonnay 2011
King Estate, Pinot Noir 2011
Famille Perrin, Cotes du Rhone Villages 2010
Columbia Crest, Les Chevaux Red 2010
14 Hands, Hot to Trot White Blend
Familia Bianchi, Malbec 2009
Terrapin Cellars, Pinot Gris 2011
Columbia Crest, Walter Clore Private Reserve 2009
Campo Viejo, Rioja, Termpranillo 2010
Ravenswood, Cabernet Sauvignon 2009
Quinta das Amoras, Vinho Tinto 2010
Waterbrook, Reserve Merlot 2009
Lorelle, Horse Heaven Hills, Pinot Grigio 2011
Tarantas, Rose
Chateau Lajarre, Bordeaux 2009
La Vielle Ferme, Rose 2011
Benvolio, Pinot Grigio 2011
Nobilo Icon, Pinot Noir 2009
Lello, Douro Tinto 2009
Quinson Fils, Cotes de Provence Rose 2011
Anindor, Pinot Gris 2010
Buenas Ondas, Syrah Rose 2010
Les Fiefs d'Anglars, Malbec 2009
14 Hands, Pinot Gris 2011
Conundrum 2012
Condes de Albarei, Albariño 2011
Columbia Crest, Walter Clore Private Reserve 2007
Penelope Sanchez, Garnacha Syrah 2010
Canoe Ridge, Merlot 2007
Atalaya do Mar, Godello 2010
Vega Montan, Mencia
Benvolio, Pinot Grigio
Nobilo Icon, Pinot Noir, Marlborough 2009

The Occasional Book

Maria Dermoȗt - The Ten Thousand Things
William Faulkner - As I Lay Dying
Markus Zusak - The Book Thief
Christopher Buckley - Thank You for Smoking
William Shakespeare - Othello
Joseph Conrad - Heart of Darkness
Bill Bryson - A Short History of Nearly Everything
Cheryl Strayed - Tiny Beautiful Things
Sara Varon - Bake Sale
Stephen King - 11/22/63
Paul Goldstein - Errors and Omissions
Mark Twain - A Connecticut Yankee in King Arthur's Court
Steve Martin - Born Standing Up: A Comic's Life
Beverly Cleary - A Girl from Yamhill, a Memoir
Kent Haruf - Plainsong
Hope Larson - A Wrinkle in Time, the Graphic Novel
Rudyard Kipling - Kim
Peter Ames Carlin - Bruce
Fran Cannon Slayton - When the Whistle Blows
Neil Young - Waging Heavy Peace
Mark Bego - Aretha Franklin, the Queen of Soul (2012 ed.)
Jenny Lawson - Let's Pretend This Never Happened
J.D. Salinger - Franny and Zooey
Charles Dickens - A Christmas Carol
Timothy Egan - The Big Burn
Deborah Eisenberg - Transactions in a Foreign Currency
Kurt Vonnegut Jr. - Slaughterhouse Five
Kathryn Lance - Pandora's Genes
Cheryl Strayed - Wild
Fyodor Dostoyevsky - The Brothers Karamazov
Jack London - The House of Pride, and Other Tales of Hawaii
Jack Walker - The Extraordinary Rendition of Vincent Dellamaria
Colum McCann - Let the Great World Spin
Niccolò Machiavelli - The Prince
Harper Lee - To Kill a Mockingbird
Emma McLaughlin & Nicola Kraus - The Nanny Diaries
Brian Selznick - The Invention of Hugo Cabret
Sharon Creech - Walk Two Moons
Keith Richards - Life
F. Sionil Jose - Dusk
Natalie Babbitt - Tuck Everlasting
Justin Halpern - S#*t My Dad Says
Mark Herrmann - The Curmudgeon's Guide to Practicing Law
Barry Glassner - The Gospel of Food
Phil Stanford - The Peyton-Allan Files
Jesse Katz - The Opposite Field
Evelyn Waugh - Brideshead Revisited
J.K. Rowling - Harry Potter and the Sorcerer's Stone
David Sedaris - Holidays on Ice
Donald Miller - A Million Miles in a Thousand Years
Mitch Albom - Have a Little Faith
C.S. Lewis - The Magician's Nephew
F. Scott Fitzgerald - The Great Gatsby
William Shakespeare - A Midsummer Night's Dream
Ivan Doig - Bucking the Sun
Penda Diakité - I Lost My Tooth in Africa
Grace Lin - The Year of the Rat
Oscar Hijuelos - Mr. Ives' Christmas
Madeline L'Engle - A Wrinkle in Time
Steven Hart - The Last Three Miles
David Sedaris - Me Talk Pretty One Day
Karen Armstrong - The Spiral Staircase
Charles Larson - The Portland Murders
Adrian Wojnarowski - The Miracle of St. Anthony
William H. Colby - Long Goodbye
Steven D. Stark - Meet the Beatles
Phil Stanford - Portland Confidential
Rick Moody - Garden State
Jonathan Schwartz - All in Good Time
David Sedaris - Dress Your Family in Corduroy and Denim
Anthony Holden - Big Deal
Robert J. Spitzer - The Spirit of Leadership
James McManus - Positively Fifth Street
Jeff Noon - Vurt

Road Work

Miles run year to date: 119
At this date last year: 21
Total run in 2013: 257
In 2012: 129
In 2011: 113
In 2010: 125
In 2009: 67
In 2008: 28
In 2007: 113
In 2006: 100
In 2005: 149
In 2004: 204
In 2003: 269


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