For 20 years, Steamboat resident Rob Douglas was a Washington, D.C. private detective specializing in homicide, political corruption and terrorism. Since 1998, Douglas has been a commentator on local, state and national politics in Washington, D.C., Maryland and Colorado. To reach Rob Douglas, email rdouglas@SteamboatToday.com.

For 20 years, Steamboat resident Rob Douglas was a Washington, D.C. private detective specializing in homicide, political corruption and terrorism. Since 1998, Douglas has been a commentator on local, state and national politics in Washington, D.C., Maryland and Colorado. To reach Rob Douglas, email rdouglas@SteamboatToday.com.

Rob Douglas: Health care responsibility reform

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Rob Douglas

Rob Douglas' column appears Fridays in the Steamboat Today. He can be reached at rdouglas@SteamboatToday.com.

Find more columns by Douglas here.

— The health care reform debate - pitting President Barack Obama and liberal Democrats on one side against Republicans and conservative Democrats on the other - is wildly misnamed.

After all, there is nothing wrong with health care in the United States today. Our health care professionals and the services they provide are the finest in the world.

The real issue is who is responsible for making health care decisions and who is responsible for paying for those decisions.

Simply put: Are you or the government responsible for your health care?

So, instead of talking about health care reform, we should have an honest debate about health care responsibility.

I believe it is every individual's responsibility to make his or her own health care decisions and to pay for those decisions. Notably, our nation's founders did not include the provision of health care within the Constitution. Besides the lack of constitutional authority, every existing federal health care program to date is an economic failure and does not provide care equal to that available in the private marketplace.

Is there a better way? Yes.

The economist Dr. Arthur Laffer, a member of the Reagan administration and for whom the "Laffer Curve" is named (the centuries-old concept that increasing taxes beyond a certain point results in lower, not higher, tax revenue), published a study this week evaluating the current health care legislation while simultaneously suggesting an alternative proposal emphasizing individual responsibility for health care.

Laffer's research concludes that during the next 10 years - and above and beyond the current spiraling costs associated with the status quo - the legislation currently before Congress would:

- Raise federal expenditures by 5.6 percent, adding $285.6 billion to the deficit;

- Increase heath care expenditures by 8.9 percent;

- Raise medical price inflation by 5.2 percent;

- Slow U.S. economic growth by 4.9 percent;

- Increase the cost of funding health care reform by $1.3 trillion, or $4,354 for every man, woman and child; and

- Insure one-third of those currently without insurance - at a cost of $62,500 per new person insured.

Instead of the current legislation, Laffer argues, "The path to true health care reform is through patient-centered solutions which emphasize the patient-doctor relationship : by allowing patients and doctors to make more effective and economical health care choices."

Laffer suggests it would be better to:

- Provide for individual ownership of insurance policies: The tax deduction that allows employers to own your insurance instead should be given to the individual;

- Better leverage Health Savings Accounts: HSAs empower individuals to monitor their health care costs and create incentives for individuals to use only those services that are necessary;

- Allow interstate purchasing of insurance: Policies in some states are more affordable because they include fewer bells and whistles; consumers should be empowered to decide which benefits they need and what prices they are willing to pay;

- Reduce the number of mandated benefits insurers are required to cover: Empowering consumers to choose which benefits they need is effective only if insurers are able to fill those needs;

- Reallocate the majority of Medicaid spending into simple vouchers for low-income individuals to purchase their own insurance: An income-based sliding scale voucher program would eliminate much of the massive bureaucracy that is needed to implement today's complex and burdensome Medicaid system and produce considerable cost savings;

- Eliminate unnecessary scope-of-practice laws and allow non-physician health care professionals to practice to the extent of their education and training: Retail clinics have shown that increasing the provider pool safely increases competition and access to care and empowers the patient to decide from whom they receive their care; and

- Reform tort liability laws: Defensive medicine needlessly drives up medical costs and creates an adversarial relationship between doctors and patients.

Before deciding that a federalized health care system is best, I invite you to read Laffer's full report at www.LafferHealthCareReport.org. You just might decide that a health care system that restores freedom and responsibility to individuals is the wisest choice.

To reach Rob Douglas, e-mail Rob.Douglas@Comcast.net

Comments

JusWondering 4 years, 11 months ago

Rob - some points I agree with. First is tort reform. At some point it has to happen. The cost of so many goods and services have some level of liability built into them for the "stupid person" rule. The one that has forced pages of disclosures on every contract you sign... the one that forces the manufacturer of toothpicks to place instructions for use on them. Just mitigating that risk to be built into all pricing would have a dramatic effect on the industry (of course there would be a lot of attorneys out of work).

Let that stabilize and then evaluate controls and ways to impact the system such as individual insurance, HSAs and your other suggestions.

HSAs... not a good idea! Just look at how well we all have done preparing ourselves for retirement through 401(k), 403(b), 457 plans and IRAs. These vehicles, like HSAs, were designed to augment an existing system (pension plans). They were never designed to replace.

I would state that a majority of Americans do not have the skillset to manage a checking account much less a complex HSA (if they did why would we have had a negative savings rate through the majority of this and the prior decade).

Absolutely allow for Interstate insurance with consistent pricing for services but allowing a menu of which services will be covered is not a good idea. Again, the complexities of health care... see comment on retirement above. Interstate rules would eliminate the need for a lot of State level burearacy and jobs.

Biggest thing is to convert the current mind set that healthcare service is a basic right to one that healthcare is a responsibility to be planned for... what happened to the days of personal accountability?

The problem I have with the current proposals is that they are ALL massive overhauls. Anyone that has had any exposure to systems theory would know that you just don't do that to a functioning system (albiet inefficiently). You insert a new variable and measure its effect before inserting another variable. Start with tort reform and measure the impact before inserting other variables.

I liken it to the meltdown in October. Which intervention actually "saved" our economy? Because of the widespread and immediate reaction we may never be able to define what worked and thank the person responsible.

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trump_suit 4 years, 11 months ago

Torte reform is clearly a required step. However, while the Healthcare delivery system works pretty well, the health insurance industry needs a few tweaks with a 2x4.

I do not agree with creating a large gov't run healthcare plan, but that might be better than the current system. Each and every one of us that pays for our Health insurance or Health care is subsidizing those that do not under the current system.

Health Insurance companies are driving small business out of business. I tried to get healthcare coverage for my 5 employees and was completely stymied by their rates and regulations. I was quoted rates as high as $2000 per person per month because of my history with cancer 25 years ago. When a large company applies for the same coverage they get competetive rates. WHY??

I do not understand that discrepancy and firmly believe that the regulatory changes are required. All Americans should have equal access to Health insurance for the same basic rates regardless of their status in life. Many good points have been made on this issue, that will help address the out of control cost structure, but our conservative friends are not addressing the problems of the health insurance industry with their continued diatribes against the current proposal.

What we need to see is some proposals that address the problems without creating this huge government agency and the corresponding tax structure. Failure to recognize that there is a problem will result in a plan that looks like socialized medicine. Doing nothing is no longer an option.

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seeuski 4 years, 11 months ago

"I do not agree with creating a large gov't run healthcare plan, but that might be better than the current system. Each and every one of us that pays for our Health insurance or Health care is subsidizing those that do not under the current system." trump, We are, and we are also paying for the deficiencies in the Government plans which include Medicare and Medicaid. Going to a Government run Healthcare system would not end that problem but as the CBO has estimated, very conservatively some experts say, it would add 1.6 trillion to the deficit over the next ten years. Estimates are that the new plan would balloon in cost past 10 years. So I agree with you that we don't want the Govy plan. Your situation frustrates me though because I have always been a problem solver and there is no way to verify your claim that your employees plan would be charged at your risk rate. I wonder if you have exhausted all avenues of possible carriers. Not trying to insinuate you haven't. Have you looked at Cinergy? http://www.cinergyhealthplans.com/

You further said: "Many good points have been made on this issue, that will help address the out of control cost structure, but our conservative friends are not addressing the problems of the health insurance industry with their continued diatribes against the current proposal." I have to disagree with you here big time, if it weren't for the passion of the people who are apposing this Government takeover plan, they are of all political persuasions, then this bill would have already been passed unread, unfinished and unknown to it's constituents as far as what it would do.

On that note, I am completely blown away by the lack of outrage from most Americans over the current POTUS sicking his dogs on the American people who disagree with his Healthcare bill. Setting up a snitch email account at the White House and sending the SEIU and ACORN groups to strong arm people at the Town Hall meetings. This is what could be the beginnings of a bad moment in American History. The President pitting his followers against the rest of us. Where is the outrage against this when there are laws against what the White House has done? It is illegal for the President to gather information on his detractors. Laws were put in place when nutjob Nixon did it. Does the rights to free speech mean anything?

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bubba 4 years, 11 months ago

Juswondering, I disagree with your assertion that HSAs are a bad idea, as well as your use of defined contribution plans as evidence.

Defined contribution plans were not created to supplement pensions, they were created as an alternative savings vehicle for people who do not have access to pensions. The Pension (defined benefit plan) is virtually extinct, as they take all personal responsibility away from the individual and put it on the shoulders of their employer. This is not a sustainable model for any business (just ask the automakers and airlines).

While an HSA is obviously in place to supplement a lower cost insurance policy, what it does do is get the consumer (patient) thinking about the cost, as it is their money. Without this concept, the consumer is isolated from the cost, and this disconnect is one of the major reasons for rising health care costs.

How's this for health reform: 1) Tort reform is necessary if we are going to control costs. 2) Eliminate the tax deduction for health benefits - we all know it needs to be done, it's obviously an unpopular move though. 3) Create a group called the Citizens of the United States, which health insurance companies need to recognize.
4) Look at McCain's idea of giving everyone a couple thousand bucks towards health care - it can either go to their insurance or into an HSA account.

A simple plan like this would cost a lot less than any of the ones being proposed, addresses the two major reasons for runaway costs, and keeps the government out of our healthcare decisions. Health insurance companies can structure products to compete for everyone's business, and individuals have the power to choose whatever they want.

The only drawback is that a lot of people would end up with HSAs, and as Juswondering said, a lot of those people are not clever enough to handle that responsibility, but I soundly reject the notion that caring for those people is my responsibility. This is, after all, America.

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Aspengold 4 years, 11 months ago

I must question the statement that "After all, there is nothing wrong with health care in the United States today. Our health care professionals and the services they provide are the finest in the world."

The World Health Organization has carried out the first ever analysis of the world's health systems. Using five performance indicators to measure health systems in 191 member states, it finds that France provides the best overall health care followed among major countries by Italy, Spain, Oman, Austria and Japan. The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The American people pay twice as much per person for medical care than the rest of the world combined.

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JLM 4 years, 11 months ago

Individual HealthSavingsAccounts and employer sponsored Cafeteria 125 plans are simply plans which provide for the use of "before tax" dollars to pay health care costs including coverage deductibles under health insurance, out of network expenses, disallowed/uncovered health care costs, preventative treatment and wellness programs.

It is insulting to suggest that the vast majority of Americans cannot understand, own or operate HSAs and Cafeteria 125 plans as well as defined contribution plans (IRAs, SEPs and Keoghs).

If you can understand how baseball is played or how the President is elected, you can certainly understand HSAs and Cafeteria 125s and defined contribution plans.

This intellectual arrogance is what is fueling in part America's disaffection with the Obama's paternalistic approach to healthcare reform. America is simply not that stupid and the big "patron" is not as smart as he thinks he is.

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JusWondering 4 years, 11 months ago

Bubba... I disagree; defined contribution plans/deferred compensation plans WERE NOT created in 1978 to replace traditional defined benefit plans. They were created as supplements to traditional pensions.

In the beginning they were primarily used for highly comp'd individuals as a way for them to hide money from the IRS. In the TRA '86 rules were set to create discrimination testing so that the plan did not provide favor for highly comp'd employees; that was sort of the beginning of the end for DB plans and the usage of defined contribution/deferred compensation plans for the masses (as a CEO I could not put as much away if you janitor put nothing away). It was further amended in 1998 and 2001 (EGTRRA) to become what it is today... a replacement for pensions.

The death of defined benefit plans in the corporate world really began as a result of changes in accounting rules eliminating PAYGO accounting (FAS 106 - 1990).

In the government world pensions are rampant (IMHO one reason governments are struggling now) It wasn't until EGTRRA that 457 & 403(b) plans were treated similarly to 401k plans... I cannot tell you how many governmental employers still refer to deferred compensation as an employee's "boat money" for retirement.... governmental DB plan reformation is coming.

As one intimately familiar with the legislation that has created the soup of retirement funding options we have today I am also intimately familiar with how we have gotten to where we are and how ill-prepared Americans are for a retirement that now lasts 20 - 30 years (15 years longer than the prior generation as retirement is really a one generation old concept).

To reform a defined benefit that many employers provide for today through an employer sponsored healthcare plan into a HSA account would be disasterous (forget that it is the fault of the Roosevelt administration that we have the problem in the first place)!

Can you imagine? It would be 401k & social security 2.0.

bubba writes: "The only drawback is that a lot of people would end up with HSAs, and as Juswondering said, a lot of those people are not clever enough to handle that responsibility, but I soundly reject the notion that caring for those people is my responsibility. This is, after all, America."

I hate to break it to you; you would be paying for the irresponsible behavior of others. You are doing it today through higher than reasonable premiums.

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JusWondering 4 years, 11 months ago

JLM, I mean no disrespect. Really I don't. Many would say that it is insulting to state that the average American can't manage a 401(k) but 31 years of experience have taught us differently.

Financial services companies have spent $billions trying to educate on topics such as asset allocation, diversification, the differences between stocks and bonds only to see the majority of account holders sell out of equities in December in a panic and then purchasing these same funds in June at a price higher than what they originally sold them for.

Prove to me that it would be different for HSAs... which are not the same as a §125 plan and I would happily go in my corner.

Privatizing social security (the next logical step) scares me even more and will only make some financial services companies, brokers and advisers rich. Is social security broken? Absolutely, but individually managed accounts is NOT the solution nor is it the solution for healthcare.

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JusWondering 4 years, 11 months ago

I stand corrected... it wasn't FASB 106. FAS 106 dealt with OPEB and PAYGO. I think it was more like FASB 87 & 88, but don't hold me to it.

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JLM 4 years, 11 months ago

JW ---

I would be the first to acknowledge that nobody ever lost money betting on how dumb "some" Americans can be --- Congress would be my first exhibit for the plaintiff.

However, every program is simply a tool in the tool box for the appropriate craftsman. Granted, one size cannot fit all.

Nonetheless, America is going to have to learn how to operate things in a progressively more complex technical world --- ooops, already happening, isn't it?

Forgot about computers, cell phones, digital photography, electronic tickets, Internet etc. Have a bit of faith!

To quote a fellow who has some real snakey charm: "Yes, we can!"

Hey, GAAP accounting? Huh? We go no damn gaps in our accounting, boy!

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Duke_bets 4 years, 11 months ago

Basing the entire article on a member of the Reagan administration truly depletes the validity of the argument.

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Duke_bets 4 years, 11 months ago

That's similar to placing GW in a spelling contest.

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Rob Douglas 4 years, 11 months ago

Here is Laffer discussing his research and perspective in the Wall Street Journal:

http://online.wsj.com/article/SB10001424052970204619004574324361508092006.html

Laffer's bottom line: "Because Mr. Obama has incorrectly diagnosed the problems with our health-care system, any reform based on his priorities would worsen the current inefficiencies. Americans would pay even more for lower quality and less access to care. This doesn't sound like reform we can believe in."

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Scott Ford 4 years, 11 months ago

Just thinking about health care reform gives me a headache. I think some of the ideas proposed by Dr. Laffer are worth giving careful consideration to. I am all for putting the individual at the center of the medical decision. Not only in the decisions about the type and scope of care provided but also paying for the full cost of it. The current health care cost reimbursement system has for too long isolated the individual consumer from the direct full cost of medical care as illustrated by the phrase, "don't worry your insurance will cover it." Combine this with a system that focuses on sickness and rewards volume of medical services that are provided, with a healthy dose of defensive medicine to avoid legation it is no wonder it does not work very well. Something needs to be done the challenge is deciding on what to do.

I think I am going to take two aspirin for my headache, have a beer and not think about this topic until Monday. I am not calling my doctor who could possibly order an MRI and argue with them why I do not think it is necessary even if a majority of the cost of the MRI would be covered by insurance. Come Monday I will just accept the return of my headache. I will need to remind myself that very little meaningful progress can be made without widely shared sacrifice that must be combined with a willingness to reach compromise. I can only hope that eventually my headache will go away.

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seeuski 4 years, 11 months ago

We are hip to the Saul Alinsky handbook"rules for radicals". Attacking the messenger has run it's course. Good luck though.

Scott, Demeaning the good Doctors that you have had to certainly rely on sometime during your life is a pretty sad affair don't you think? Insinuating, as Obama did on national TV, that they are in it for the greed factor and doing unnecessary procedures is pretty sad. I have a headache also but I may need a cat scan instead. It would be nice if some of the many Doctors in this community would defend themselves from these personal attacks. I wonder if any of the pro bill people are aware of Dr. Ezekial Emanual's influence on Obama and what this crack pot has proposed as far as rationing? I think not.

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seeuski 4 years, 11 months ago

So true Rob but they will just continue to shoot the messenger and then they complain when average Americans turn up and voice their complaints at the Town Halls. Anyone who honestly listens to the answers that are offered from the Representatives can see why anger is brewing. Talking points and lies are what is being offered.

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seeuski 4 years, 11 months ago

End of life and end of freedom which so many of today's Seniors fought for, how sad.

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Rob Douglas 4 years, 11 months ago

This is the most responsible and well-reasoned piece to date on end-of-life issues the current proposed legislation would codify:

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html

Bottom line: "Ideally, the delicate decisions about how to manage life's end would be made in a setting that is neutral in both appearance and fact. Yes, it's good to have a doctor's perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party -- the government -- recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don't have to be a right-wing wacko to question that approach."

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Scott Ford 4 years, 11 months ago

My headache is gone this morning. I feel so much better! It's a wonder what two aspirin, a cold beer and a day standing in the river waving a fly-rod can do. Rob- thanks for sending the link to the Wall Street Journal article. Arthur Laffer does a good job of highlighting the "Health-care Wedge" issue.

'The health-care wedge is an economic term that reflects the difference between what health-care costs the specific provider and what the patient actually pays. When health care is subsidized, no one should be surprised that people demand more of it and that the costs to produce it increase. '

From my perspective this wedge is at the core to the problem. How often is the phrase, "Don't worry it is covered by your insurance," is used. As consumers we are often so isolated from the cost we accept courses of treatment recommended by health care providers without questioning of cost. We do not take this financial naÃivete approach with our auto mechanics, construction contractors or lawyers.

If as consumers we expect to be isolated from the cost than rationing of care may be the only way to control cost on the wide scale necessary. I am not too sure there is the political and/or individual will power to remove the shield of cost isolation. I would appreciate hearing others thoughts on this.

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seeuski 4 years, 11 months ago

Tort reform has been ignored again and again. Cost can be lowered by tort reform. Why ignore that? Having Mr. Ford suggest that patients are to blame is like blaming the homeowners for Fannie/Freddie's lax programs that created liar loans which caused the market meltdown. If Congress would put restrictions on medical lawsuits the cost of care would go down by billions a year. Doctors who pay as much as a quarter million a year in malpractice insurance and order unnecessary tests to cover their buts wouldn't need to do as much of either. But we'll go round and round I guess. I am tired of this push towards rationing as if we deserve this because we have been bad Americans and didn't watch our health care diets. Absurd.

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Scott Ford 4 years, 11 months ago

Hi seeuski - Always good to hear from you. I agree that tort reform is an important part of the puzzle. I am not too sure how much judgment awards and defensive medicine adds to the overall cost. I think you and I can agree that it is some percentage. The best estimates seem to be as much as $150 to $200 billion per year.

So if total health care cost is about 17% of GDP (source: National Coalition on Health Care) and GDP is about $14 trillion, a savings of $200 billion is less than 10%. I agree that tort reform is necessary. Even if all judgment awards and defensive medicine practices could be eliminated tomorrow - it will not be enough. Efforts focused on the remaining 90% of the cost equation will likely have far greater impact. What to do? I think you and I both likely agree that doing nothing is not a reasonable option.

Arthur Laffer's proposals (the topic of Rob's column) advocates increasing the individual's responsibility in cost of health care delivery. I am willing to at least acknowledge the possibility that the health-care cost wedge Dr. Laffer describes could be a root cause of the current situation. If not at the root of the problem it certainly may have exacerbates the situation.

If all options are on the table, I think Laffer's proposals warrant some careful consideration. At present they just seem to be missing from any of the discussions. Agree?

A question for anyone - What is the root cause(s) for the current situation?

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mavis 4 years, 11 months ago

The root cause for the current situation is hospitals billing companies multiple times AFTER payment- Dr offices doing the same thing- and hopsitals charging over 45 dollars for a dose of Tylenol for an infant- Why should we pay that much for 1 dollar of medicine and two minutes of Labor?? But I must say not matter how disgusted with Health insurance I have been -- under no circumstances do I want the Obama plan I do like being able to pay and choose for my family so I know they will be taken care of and have been no matter how costly it gets.

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JLM 4 years, 11 months ago

The thing about it is that health care needs lots of reform and rethinking but it doesn't need to be abandoned and rebuilt from scratch. This is like a kitchen makeover --- you don't knock down the house because you don't like your kitchen cabinets.

We need:

Tort reform --- an end to punitive damages which simply reward attorneys who have taken cases on contingency. The money does not go to the injured victims. This is nuts.

Liability limitations --- liability limitations for doctors, nurses and hospitals which are fully funded by the payment of fees rather than by insurance. No more Irish Sweepstakes litigation.

Binding arbitration --- just like the securities industry.

More doctors --- get the AMAs thumb off the scale of determining how many doctors medical schools will graduate.

More GPs --- more lower level doctors IN the community providing routine medical care at the patient location. House calls to patients at the end of their lives.

Super Nurse practitioners --- at the clinic level, in the community, able to prescribe and administer routine medicines. House calls from clinics in the neighborhoods.

Purchasing cooperatives --- the acquisition of medical supplies, drugs and consumables in a purchasing cooperative with credits being transferable throughout the system. Hell, Amazon and Costco do this already.

An ombudsman --- a "final disinterested authority" empowered to instantly decide care related disputes in any aspect of care.

24 hour fixed base clinics --- leverage the investment of capital in expensive fixtures, machinery and facilities by providing services 24 hours per day --- hell, MRIs don't need to sleep.

Health Savings Accounts --- the ability for taxpayers to "save" before tax funds to defray medical costs at an agreed amount per family member.

Deductible insurance premiums --- businesses can deduct the provision of benefits (including specifically health insurance premiums) as a reasonable and necessary business expense. Allow individuals who are not covered by an employer plan to deduct health insurance premiums.

Immigration reform --- plug the borders for goodness sake, illegal immigration is just making things worse every day. Stop talking about it and start do something about it.

Almost all of these things are simple policy decisions which could be enacted by the Congress almost immediately. Tell your Congressman to get off his fat butt and just do it!

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steamboatsprings 4 years, 11 months ago

Excellent points and I appreciate your insights Rob.

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seeuski 4 years, 11 months ago

Scott, I can't add anything to the post by JLM or Laffer's recommendations and feel that Congress has the power now to make changes that would vastly improve the problems we all agree on. The issue is why won't they do it? And the answer as I see it is they want power over the people for the foreseeable future. I had a conversation last night with a Canadian citizen with many family members living in Canada. The truth is that they hate the health care system in Canada and don't want to see the US go into a Government run system. No matter how many Americans that support the Government plan put forth anecdotes from supposed Canadians who say otherwise the truth is out and it is spreading like wildfire. Voting for Congressmen/women who will act on the changes we know will address the real problems will be the only way to exact actions and not a power grab of the American monetary systems. As Scott Ford said- "So if total health care cost is about 17% of GDP (source: National Coalition on Health Care) and GDP is about $14 trillion, ". You do the math, that is big time power over our lives. I'm out.

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Rob Douglas 4 years, 11 months ago

Here's a worthwhile piece by Robert Samuelson (economics columnist for the Washington Post and Newsweek) on this topic. It's chock full of stats for my stat loving friend Scott Ford who needs to remember to remove his phone from his pocket when fishing:

Obama's Health Care Will Make It Worse

http://www.realclearpolitics.com/articles/2009/08/10/obamas_health_care_will_make_it_worse.html

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JusWondering 4 years, 11 months ago

Rob, thanks for passing this piece along. Well thought out and realistic.

He so rightly argued that healthcare and the various accoutrements are no longer looked at as a privelege or something with a real cost, but a right.

I have a great example.

Recently I was in the deep South visiting some family. It made the healthcare debacle... I mean debate, painfully obvious to me. I can tell the story of my wife's grandmother. She is on medicare and is having some difficulty walking. She can still drive, but is having challenges with stairs or walking for long periods of time. She has a "Hoveround scooter" that medicare purchased a couple years back and and since my last visit has acquired a really fancy wheelchair.

Now this wheelchair is no ordinary chair. It is called an iBOT and has gyroscopes for stability, 4WD for going through grassy meadows or rough terrain, can climb stairs and can raise the user to a standing height. It even had a remote control so if her hands got tired someone else could "drive" for her. I can tell you my 9 year old had fun with that feature.

Now, I asked her when the last time she climbed stairs or went frolicking across a meadow. Her response; "never". Now, she is not a woman of means so I asked her how she much she paid for this very ingenious and inventive device. Her response was that Medicare paid for it. I asked the price (I wish I would not have)... $35,000!

I then asked her if she really needed it. Her response; "not really, most places have ramps that my scooter can reach, but if the doctor is going to prescribe it and I don't have to pay for it, I am going to take it."

The more I thought about it the more infuriated I became on a variety of levels and the more it really illustrated the problems with the current system.

My take on the whole debate "I am paying for it anyways, make it all transparent".

Increase transparency with pharmaceutical "spiffs" paid to doctors, increase transparency in costs of providing service (why does aspirin cost $6 a pill in the hospital and 4.5 cents from City Market, increase transparency of the regulatory environement. Standardize insurance coverages and options across state lines. Make these options in plain English and make the process simple.

Finally eliminate the mindset that LUXURY healthcare is a right. What is wrong with "take two aspirin and call me in the morning" for a headache versus an emergency room visit?

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Catherine Carson 4 years, 11 months ago

Quote:

"Whether or not you have health insurance right now, the reforms we seek will bring stability and security that you don't have today.

This isn't about politics. This is about people's lives. This is about people's businesses. This is about our future."

President Barack Obama

Get the facts about the stability and security you, our community and country, will get from health insurance reform:

http://www.whitehouse.gov/realitycheck/

Catherine Carson Chair, Routt County Democratic Party

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Duke_bets 4 years, 11 months ago

Yo' Mavis, you'll still be able to purchase your own healthcare no matter how costly it gets. The Obama health plan won't take away what you already have. It will simply give you another choice and add some competition to the private healthcare industry. It may even save you some bucks by ditching the pre-existing condition clause.

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Rob Douglas 4 years, 11 months ago

Ten Questions Politicians Won't Answer by Sen. Tom Coburn

http://article.nationalreview.com/?q=ZDM5NDJkMDA2ODJlNmMxY2VhYmI2NGJhZGEwZGFlNjU=

"The past week's debate about health care has shown that in Washington the only things more stubborn than facts are politicians who evade them. In spite of a torrent of independent analyses showing that the so-called health-care "reform" bills moving through Congress will dramatically increase the deficit and cause millions of Americans to lose their health insurance, the politicians leading the effort have steadfastly refused to consider that their ideas and policies, rather than the character of their critics, may be flawed. At the same time, the politicians writing the bill still refuse to answer basic questions about how it will be paid for and how it will affect patients."

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seeuski 4 years, 11 months ago

Miss Carson, Thanks for speaking for Obama. I think I'll take him at his own word though.

These are the moments that I trust more than his constant campaign speeches he gives. He promised during the debates with McCain that he would take a scalpel to all pork and go line by line in any bill he gets. Why did he fire IG Walpin? Thanks again Miss Carson.

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JLM 4 years, 11 months ago

The simple truth of the matter is that the Obama administration desires to replace the entire health care system with a single payer --- government --- system. Whether you are happy with your lot in life or not.

He said as much in his comments to SEIU (Service Employees International Union). Comments which were recorded in real time and comments which are irrefutable.

It is without precedent that our government would kill a private industry business, replace that business with a government sponsored/run/managed enterprise and the citizenry would believe that the government could run it with any degree of customer service or business efficiency or profitably. That is not what governments are good at.

The Obama administration intends to provide comprehensive health care for all with the bill being sent to the 50% of Americans who already pay 99.9% of the income taxes in America.

This is not about health care or health care insurance but rather "free" health care for the bottom 50% of Americans.

The Democrats are attempting to ram this premature, ill advised, immature, evolving legislation through the Congress --- unread, undebated, without the benefit of committee consideration --- just like the Stimulus and the TARP and the bailout of GM/Chrysler.

A good idea can stand the test of public debate and consideration and, what the hell, maybe even a quick read!

The angry public reaction and the knee jerk idea to send in union goons and Acorn operatives to quell opposition shows that this idea is not quite ready for serious consideration.

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freerider 4 years, 11 months ago

ROB as usual you are full of it...our health care system is rated dead last of the industrialized nations..France is rated #1 ...where do you get your info...??? I'm guessing you just make stuff up as you go to fit your agenda. Also in France they only pay out 9% of there GDP to cover everybody . we don't have to re-invent the wheel here. Just follow a system that works. I'm sick of so called journalists that just make crap up. It also kills me to see the Republicans bashing the Dem's on this one. In case you repukes out there haven't noticed we are all getting it in the rear from both sides

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JLM 4 years, 11 months ago

Actually, freerider, I am quite content w/ the health care system in general.

Reform? Sure, one can always get better.

Destroy the current system and build it again from scratch w/ the gov't playing the central role? Hmmm, not so much!

One thing I do agree with is that both sides are devoid of any real solutions. That's an argument for doing nothing, unfortunately.

Our medical prowess is the best in the world and our health care system is pretty damn good but could always improve.

Emulate the French? LOL

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JusWondering 4 years, 11 months ago

Freerider... emulate the French; seriously? Was this your own idea or one that some journalist fed to you? Check your facts on expenditures. They are the second HIGHEST of industrialized nations as a percentage of GDP! Further, their version of universal care has been in the red since 1989.

http://online.wsj.com/article/SB124958049241511735.html

Agreed that our system is ranked lowly. Interesting though that Japan ranks low in infant mortality and high in life expectancy yet they have low expenses relative to GDP... admitedly I don't know much about their system, but on the surface they look like someone much more worth emulating than France.

I agree with JLM... no one has presented a real solution yet. I don't agree that we can afford to do nothing... but certainly no massive overhaul (see comments on Systems theory).

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Rob Douglas 4 years, 11 months ago

It appears the health care responsibility debate may be impacting Obama's approval rating.

Daily Presidential Tracking Poll

http://www.rasmussenreports.com/public_content/politics/obama_administration/daily_presidential_tracking_poll

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Rob Douglas 4 years, 11 months ago

Health Debate Isn't About Health

http://online.wsj.com/article/SB124993227709320287.html#mod=article-outset-box

"The health debate, which now has moved beyond the Beltway and into raucous town halls across the land, is so intense in part because it's not really about health care at all. On a deeper level, it's about the role of government in America's economy. And that is a raw and unresolved topic, only made more so by months of exceptional government intervention amid a deep recession."

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freerider 4 years, 11 months ago

hey Rob these are not my numbers, this is according to the WHO rankings in health care .. look it up BEFORE YOU SPEW NEXT TIME..where do you get off saying our system is the best...you are full of it...Insurance executive's are spilling the beans all over the place exposing their system of denial and as standard operating procedure they blatantly deny claim's as a numbers game to see who gives up first. You think this is the best system in the world? How did you get a job as reporter when you can't get your facts straight..? your not doing anybody a favor by lying about out health care system like everything is just fine...it's not fine and it needs to be fixed. Opponents of Obama's plan are using scare tactic's and lying about what's up...we don't need more B.S. from you

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Rob Douglas 4 years, 11 months ago

more from Camille:

"What do Democrats stand for, if they are so ready to defame concerned citizens as the "mob" -- a word betraying a Marie Antoinette delusion of superiority to ordinary mortals. I thought my party was populist, attentive to the needs and wishes of those outside the power structure. And as a product of the 1960s, I thought the Democratic party was passionately committed to freedom of thought and speech.

But somehow liberals have drifted into a strange servility toward big government, which they revere as a godlike foster father-mother who can dispense all bounty and magically heal all ills. The ethical collapse of the left was nowhere more evident than in the near total silence of liberal media and Web sites at the Obama administration's outrageous solicitation to private citizens to report unacceptable "casual conversations" to the White House. If Republicans had done this, there would have been an angry explosion by Democrats from coast to coast. I was stunned at the failure of liberals to see the blatant totalitarianism in this incident, which the president should have immediately denounced. His failure to do so implicates him in it."

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JusWondering 4 years, 11 months ago

Clearsky, AIG was not a major player in healthcare insurance. Look at their 10-Q or corporate overviews. They were/are primarily a life insurer and financial services company. For the most part the health insurance they provided was supplemental insurance. Not a good comparison to make your point. It would be much better to look at companies like United Healthcare, WellPoint, Aetna, Humana, etc. According to Forbes Stephen Hemsley, CEO of United Healthcare made $3.2 million in salary and bonus in 2008 (granted he has over $600 million in unexercised stock options).

On your point about "controlled costs" for Medicare/Medicaid... not sure how well this works. In Colorado we spend $2.56 billion on Medicaid... ever wonder why Colo 131 can't be widened to accommodate bicycles?

Some numbers for the number guys: Colorado spent $2.6 billion in 2005 on Medicaid It covered 8.3% of our population (about 381,800) In 2005 our population was estimated at 4.66 million Federal government covers about 57% of expenditures on Medicaid in Colorado for a total outlay of around $6.04 billion. So, we spent an average (unweighted) of $15,819 on each covered person. Now, this $2.6b figure represents 15% of our State's budget. Now ask yourself honestly whether or not that is a cost effective program? Given previous arguments on the efficiency of France's system (measured as a percentage of GDP and coming from the pro-universal healthcare side) I would argue not. It could be worse... we could be in New York where Medicaid accounted for 40% of State expenditures.

http://www.coloradohealthinstitute.org/Documents/colorado_medicaid.pdf http://www.colorado.gov/cs/Satellite/Treasury/TR/1190277266217 http://www.cbcny.org/medicaid04.pdf

And "Every rule instituted by Medicare is copied by the insurance Co." Not at all accurate. Research before you spout opinion as fact.

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JusWondering 4 years, 11 months ago

Our system is definitely broken and unsustainable. Report after report and estimation after estimation will tell us that. Only a complete imbicile would argue for a maintain status quo approach (or someone with their heads so far in the sand they can see the deserts of Iraq).

The Obama approach simply will NOT lower my healthcare expenditures. If you are going to tax me; fine tax me but I should expect to see a reciprocal effect on what is being paid now to providers and insurance companies. I do not see that happening with the current proposed plan. I see increased costs for more of the same.

Before republicans get smug... I haven't seen anything much better from you (except maybe the Wyden - Bennett bill). I read all of it and although it is not perfect legislation it is better than what has been presented so far.

The bill was radical, but considering what we are doing now, pretty cheap to administer. It even had significant bi-partisan support (granted not from strong union presence states like Michigan). It would have:

  1. removed healthcare coverage as an employee benefit (unions lose power if that is done)
  2. Mandated coverage for all
  3. Mandated a tax premium to be paid by all
  4. Replaced a variety of outdated and inefficient programs (Medicare, Medicaid, Federal Employees Health Benefit Program, SCHIP and others)
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JusWondering 4 years, 11 months ago

I remember sitting in a conference on "managing retiree healthcare" October. The audience was primarily corporate and government employers that traditionally provided some sort of post-retirement health benefit. The "emergency" need for reform was talked about then in the context of where President Clinton failed. The words were very telling on how the new administration would tackle it. The speaker mentioned that if the new administration did not push it as an urgent and dire circumstance there would be no success in his first term. The presenter (Steve Wetzell of the Healthcare Policy Roundtable) forecast that if there were not legislation before the expiration of the August session Americans would lose their appetite for change. This gentleman had a very pro universal healthcare agenda so his words were tainted as such but he brought out some very good points that still have value: 1. health insurance as a non-cash benefit was brought on as a result of government intervention during World War II (wage freezes). Government intervention is needed to fix it (debatable). 2. A solution is needed... at current rates healthcare expenditures are expected to be 20% of GDP by 2017. 3. Costs of coverage for over 45 million uninsured are shifted to those that are insured. 4. Employers are not focused on cost conscious delivery systems... they are not in the business of providing healthcare. 5. It is a non-cash benefit for many employees (all or part) so the intrinsic value is not what it should be. 6. Employers and insurers do not focus enough on preventative care. 83% of expenditures for healthcare are for the chronically ill; 85% of the conditions were preventable. 7. HSA/HRA accounts will only mitigate part of the problem. I should be a strong proponent of these vehicles as I have a vested financial interest in these types of accounts; but I realize and know based on individual investor/consumer behavior that they will not solve it. 8. (and this is one of the biggest). Because our expenditures on healthcare far exceed other industrial nations we are at a disadvantage for attracting international employers. He had some very telling case studies of two different manufacturers in two different industries... over 90% of their healthcare expenditure was in the US. Less than 20% of their workers reside in the US.

He also mentioned that one reason that there was so much attention was Senator Kennedy's diagnosis. He believed that was a catalyst for Congress to want to pursue some solution.

His final remark was that anyone that could solve these problems would ensure themselves a re-election.

The fact is I wrote an internal whitepaper on the topic as my company was considering a sizable investment (over $300 million) on account based healthcare. The point of the whitepaper... slow and methodical changes to the delivery system and a "wait and see" tactic as the full scope of the issue is defined.

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JusWondering 4 years, 11 months ago

Is government intervention necessary... that is the big question? Is an overhaul necessary?

Well, what we have now ain't working... just don't do it for political motives. It needs to be well thought out and the full impact understood. The plans presented thus far have not done anything but shift a cost... far too little focus on cost containment, preventative care, or changing a mindset that access to healthcare is a right.

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JusWondering 4 years, 11 months ago

Does anyone know what ever became of the Wyden Bennett Bill S.334? It has bipartisan support. Did it ever get out of committee?

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Clearsky 4 years, 11 months ago

The US is rated 41 st in the world for health care quality. If you have the money you can get the best care money can buy. If you are poor you can get the best health care someone elses money can afford .If you are a Federal employee, Medicare/medicaid recipient you are covered. If you are part of the working poor who cannot afford insurance then you have to loose everything to get treatment. The AIG CEO made $358 million in 5 years, Dahhh! that's one place the money went. The government does it cheaper. Just let me pay for Medicare. My family will be better off. I'm paying for other people's coverage but can't afford my own.

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Clearsky 4 years, 11 months ago

Sorry, actually the US is rated 37th in the world.

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Duke_bets 4 years, 11 months ago

Rob has only a couple of opinions on this entire column that are his own. One being, "there is nothing wrong with healthcare in the United States today". That's a good one. 95% of the article and comments thereafter are based on a political agenda. That is similar to seeuski and JLM. If it comes from a republican, it must be the gospel. If it comes from a democrat, it must be a sham. A truly sad state of mind in my opinion.

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seeuski 4 years, 11 months ago

You guys are in the minority of opinions in America and the polls show it. Doctors are leaving the AMA and seniors are leaving AARP because they are reading the bill and can see that HR 3200 is NOT a healthcare bill, it is because HR 3200 is a power grab and aims at controlling our lives. I am sorry people like duke-bets see it the way they do but this is a very deep move that we will all have to deal with down the road. The Government has several health plans that they are in charge of and none are popular or efficient. Why would anyone then want the Government to run all of healthcare? Many of us who oppose hr 3200 have expressed our views on what changes we would like to see, it is not about Right or Left, Dem or Repub but freedom from Government control. If George Bush had proposed this exact bill and the Repubs were behind it, those like duke-bets would then oppose this bill. I would be on their side in that opposition and we would march together.

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seeuski 4 years, 11 months ago

Doctors are lining up behind HR3400 and oppose HR3200.

"America's neurosurgeons are working to achieve meaningful healthcare reform legislation that will fix what is broken with our current healthcare system, without destroying what already works well," stated Troy M. Tippett, MD, President of the AANS. "The Empowering Patients First Act includes a targeted set of reforms that will help individuals obtain health insurance coverage and ensure consumer choice without a lot of new government mandates."

http://www.aans.org/Library/Article.aspx?ArticleId=62331

This type of reform is what is needed.

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JLM 4 years, 11 months ago

dukie ---

Your comments are completely unfair and wrong. Not a thing I have stated about healthcare reform has an iota of political philosophy attached to it. Read what I wrote and find me the political implications.

The sad truth of it is that Obama is in the White House and he is a Democrat (I think he's also black but I might be wrong.) How does one ignore the obvious?

The American people have finally had enough of intervention by government --- this government in particular --- in their lives. They may not have understood the exigencies of TARP, the Porkulus, GM --- whatever.

But, they understand their own health situation.

The same perfect storm which swept Obama into office has been conflated into a malestrom of anger. This anger is what is driving these town hall meetings.

Americans --- not just conservatives --- ordinary, prudent, real Americans realize that this administration has undermined the basic values which have defined this country as special for over two centuries.

Americans are tired of being promised chicken salad and getting chicken excrement. This is not the hope and change America voted for.

The sleeping tiger has been awakened and the sleeping tiger is pissed!

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Clearsky 4 years, 11 months ago

The government sets the stage and all the insurance companies follow suit. Every rule instituted by Medicare is copied by the insurance Co. The ins Comp set the premium price and tell the health care institutions what they will pay. Their profit is always 33%. Ask anyone who is in the health care field. I'll pay to join any program the government puts out. They can do it cheaper. The President makes only $500,000 a year. AIG CEO made $358 million in less than 5 years. Ask yourself Do I base my decisions out of love or hate? I'd say Republicans do things from the hate in their hearts where Democrats decide based on love. The truth hurts.

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seeuski 4 years, 11 months ago

I give the Woman credit, it is admirable of her as an Obama supporter to express the reasons the masses are against this bill so honestly. She obviously is concerned about her and her families health care under a Government run system.

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JLM 4 years, 11 months ago

Hehehehehehe, Clearsky, you love child, you! LOL

I knew I was feeling something --- it's all that Democrat love! Yeah, I can feel the love.

Raise your taxes? Hey, feel the love!

Bail out their friends on Wall Street? Well, it's just the love in their hearts!

Save the unions' butts at GM? It's just the L-O-V-E in their hearts.

I doubt I have heard a more nonsensical utterance than the fact that the Democrats act from the love in their hearts!

Obama, the only honest politician to ever come out of the Chicago machine --- and a guy with a whole lot of love in his heart!

OK, Clearsky, get ready for bed and Momma will read you a nice bedtime story filled with loving Democrats and hateful Republicans! Of course, it will be fairy tale but what the heck. Sheesh!

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Rob Douglas 4 years, 11 months ago

From one of the most influential liberal writers:

Obama's Healthcare Horror by Camille Paglia

http://www.salon.com/opinion/paglia/2009/08/12/town_halls/

"As with the massive boondoggle of the stimulus package, which Obama foolishly let Congress turn into a pork rut, too much has been attempted all at once; focused, targeted initiatives would, instead, have won wide public support. How is it possible that Democrats, through their own clumsiness and arrogance, have sabotaged healthcare reform yet again? Blaming obstructionist Republicans is nonsensical because Democrats control all three branches of government. It isn't conservative rumors or lies that are stopping healthcare legislation; it's the justifiable alarm of an electorate that has been cut out of the loop and is watching its representatives construct a tangled labyrinth for others but not for themselves. No, the airheads of Congress will keep their own plush healthcare plan -- it's the rest of us guinea pigs who will be thrown to the wolves."

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Clearsky 4 years, 11 months ago

Let us choose between paying for Medicare coverage or private insurance. Simple!

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JLM 4 years, 11 months ago

Uhhh, at a certain age, isn't that exactly what happens? So, maybe, we should just leave things alone for a bit longer?

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Rob Douglas 4 years, 11 months ago

When Liberal Leaders Confront a Centrist Nation by Michael Barone

http://www.realclearpolitics.com/articles/2009/08/13/when_liberal_leaders_confront_a_centrist_nation_97873.html

"The Democrats have a problem here. The party's leadership currently tilts heavily to the liberal side. Barack Obama is from the university community of Hyde Park in Chicago. Speaker Nancy Pelosi is from San Francisco, and important House committee chairmen are from similar "gentry urban" locales...But their policies have been meeting resistance from the three-quarters of Americans who don't describe themselves as liberals.

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JLM 4 years, 11 months ago

The Democrats are like a couple of dogs who chased a pick up truck and then caught it. Surprise, surprise, surprise!

Dog #1: "What the Hell do we do now?"

Dog #2: "Let's go lick ourselves."

The Democrats have all the power necessary to change the country and we have an abject failure of leadership.

Why? Because socialism is simply not the answer to our problems.

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seeuski 4 years, 11 months ago

This takeover attempt has been around for a long time and this 1961 audio of Ronald Reagan is as poignant today as it was then.

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