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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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In the Pipeline

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March 22, 2010

The Health Care Bill: A Therapeutic Rant

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Posted by Derek

Since I've written occasionally about the current health care reform efforts here, I feel as if I should say something now that a bill has passed the House. To be honest, though, I'm having a bit of trouble getting my thoughts in order, although I do feel the need to vent. Readers who aren't in the mood for my political opinions can skip this one.

Here goes: first off, it's rather hard for me to get past my anger at being told (repeatedly, by both the President and members of Congress) that this bill will "bend the cost curve" and on top of that, actually reduce the deficit. This is, in this case, such a transparent lie that it indicates actual contempt for their audience on the part of those repeating it. We can start with history and general principles: I have yet to hear of a state or federal health care system in this country that has not ended up costing hugely more than it was ever slated to.

I can get more specific in this case, though, since the entire bill was carefully structured to show a spurious deficit reduction (in order for it to be pushed through the budget reconciliation process, without which it could not have passed at all). Costs are pushed out past the Congressional Budget Office's ten-year time horizon, offloaded onto the states (whose Attorneys-General are now frantically trying to figure out what to do), or just blatantly left out. In the last category is the "doc fix", the adjustment to Medicare reimbursement rates that had to be dropped from the current bill in order to hocus the CBO numbers. The firm understanding between the interested parties is that the House will quietly pass that in the near future when not so many people are paying attention, and damn the numbers anyway. As I said above, "contempt" is the word that keeps coming to mind.

To my mind, this bill will indeed manage to provide health insurance to a portion of those now uninsured, but at a ferocious cost. And to that point, I was unhappy with the amount of money the Bush administration spent, but had I only known what was coming, I would have enjoyed the fiscal restraint while I could. I believe that we're spending entirely too much money that we don't have, and not getting that much in return for it (other than lots of warm, heartfelt favors to friendly constituencies that can be expected to support the current administration).

And here's my last point: my own industry's trade association, PhRMA, believes itself to be in that last category. Whether you felt like it or not, if you work in the drug industry, you spent a lot of money to help get this bill passed. I haven't heard the details of the quid pro quo deals for our business, but no doubt there are some nice ones hidden in the recesses of the bill (or just outside it, like the doc fix). My worry, though, is that dealing with the government on this level is like dealing with a hungry bear. Sooner than we think, the costs of this bill will kick in. At that point, I predict that we will find ourselves in yet another Health Care Crisis, having failed to bend any cost curves whatsoever. Then the bear will turn its head to us again, but this time, with a new look in its eyes.

Comments (153) + TrackBacks (0) | Category: Current Events


COMMENTS

1. Yes we can on March 22, 2010 7:43 AM writes...

The drug industry are actually winners in this bill. The bill passes a provision allowing 12 year exclusivity in biologics. Also, since more people are insured, there will be more people buying prescription drugs.

The downside is that there will be a 85billion "fee" assesed over 10 years. This payout is determined by marketshare of companies making more than $5 million per year.


All in all, I think it's a good plan even though it comparable to Bush era spending. Providing relief to millions without access to health care is an admirable goal. I can't see anything as beneficial to the average American that came as a result of Bush era spending.

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2. RB Woodweird on March 22, 2010 7:50 AM writes...

So your position is that something even France can do

http://www.businessweek.com/magazine/content/07_28/b4042070.htm

the United States of America cannot?

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3. Old Timer on March 22, 2010 8:10 AM writes...

At first I was very excited about the idea of reeling in health care costs and getting more people insured. But the former is needed before the latter. I don't know the first thing about what's contained in this new bill, but I do know that discussion about actually decreasing costs seemed to disappear long ago. This is bound to fail (and by fail, I mean astronomical costs).

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4. Mark Polokoff on March 22, 2010 8:22 AM writes...

I couldn't agree with you more. It's documented that the bill was written by health insurance companies, and why not? They will reap a double windfall: 40 million Americans will be forced to buy their insurance that don't have it now, and the type and amount of care that one can receive will be determined by the government, rather than by your physician. And that's just for starters. Lurking inside this 2700 page behemoth are many nasty surprises that nobody in Congress considered when voting.

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5. Dachen on March 22, 2010 8:31 AM writes...

What does this mean to big pharma industry? Will be hard to market a high price patent product? More generic products are getting popular?

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6. road on March 22, 2010 8:41 AM writes...

Well, politics is the art of the possible. What do you suggest that could actually pass in today's political climate? Or are you suggesting that everything was fine with our health-care system before congress started meddling? I'm sick of all the potshots and complaints without any realistic, pro-active suggestions.

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7. alex on March 22, 2010 8:49 AM writes...

> I have yet to hear of a state or federal health care system in this country that has not ended up costing hugely more than it was ever slated to.

I have yet to hear of a government-run health care system in any of the dozens of countries that have them that has not ended up costing *hugely* less (per-capita) than ours, while delivering comparable or better benefits. I think on average, they cost around half as much.

The following specific criticism is factually wrong:

>Costs are pushed out past the Congressional Budget Office's ten-year time horizon

In fact, while the CBO says the plan will save $130bn in the first decade, it also says that in the next decade (i.e., beyond the "ten year time horizons") it will save nearly ten times as much.

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8. Marcus on March 22, 2010 8:49 AM writes...

The big Pharma fix that I know about-- from reading you, as I recall-- was the horrible medical devices tax. Another brazen lie is that this is somehow compensatory in nature, as though the device industry somehow signed up for it as a reward for the increased business they'll see.

The Democrats have to eat this one. I'm perfectly willing to cede them all the political benefits if this thing actually works as advertised. Fair is fair. But if, as is nearly certain, this blows up in their face, I don't want to hear any rubbish about how it's not their fault.

I have never voted a straight party ticket in my life. Never even considered it. But after this, my choices seem clear for the fall.

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9. LeeH on March 22, 2010 8:53 AM writes...

While I agree that in the short term we will almost definitely see no cost savings, this bill was the right first step. Why?

1. It's unconscionable that we allow people to go without health care, and to allow families to be ruined by the cost of treating disease. Creating a mechanism to help this is just the right thing to do. It's worth the risk to start the process of protecting these people.

2. We weren't going to get everything right all at once. C'mon, this is the government we're talking about. Improvement by successive approximations is all we can ask.

3. I have confidence that if we suck it up we can do at least as well as most of the rest of the industrialized world. Many people get great health care (myself included), but overall we suck at providing decent health care to most of our people, especially considering what we pay.

What we should do now:

1. Create one big insurance pool with everyone in it. Allowing people to opt out, even with a rather paltry penalty, is not going to cut it. If the auto insurance industry just had bad drivers in it, it would be a disaster too. People accept needing car insurance (even when they don't have accidents), they would accept having to pay for health insurance.

2. Force insurance companies to pay a fixed percent of revenues for health care. Companies in Massachusetts are pretty good about this, but it can't be said for much of the country.

3. Create a single medical records system. We pay double what most countries spend, 30% vs 15%. The savings in administrative costs alone would pay to cover the uninsured, and then some.

4. Force public disclosure of reimbursements to hospitals.

5. Change the patent law so that drug companies got a fixed number of years of patent protection for new drugs from the time it comes to market, not from the time it is disclosed. This would give companies a greater chance of recovering costs, and might promote less price gouging.

6. Graduate more doctors. More competition would keep salaries down, and there would be more doctors for rural areas.

7. Encourage centers of excellence, hospitals that would specialize more in specific clinical areas, to lessen expensive duplication. Remember the old footage of Russian PRK assembly lines? It was the right idea.

I'm sure there's lots more...

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10. SP on March 22, 2010 8:57 AM writes...

1) The medicare prescription drug bill, in fact, ended up costing less than projected so far (http://voices.washingtonpost.com/ezra-klein/2010/03/notes_on_cbo_skepticism.html)
2) The second ten year window, to where you say the "costs are pushed out," in fact has a much larger savings than the first ten years (although with a greater error bar)- 134B in the first 10 years, 1.2T in the second 10 years.
3) The bill was not passed through reconciliation at all. It passed with 60 votes in the Senate and 219 in the House. This is pathetic, Derek, you have basic facts wrong. Only the minor changes which remove the parts most people complain about ("Cornhusker kickback," etc.) are being done through reconciliation.
4) The doc fix is a separate issue from this bill. Whether it's done or not is totally separate from this, and baseline budget projections assume it's not going to be done either (since the CBO only scores written law, not proposals or what everyone thinks will happen.) So the bill was scored relative to current baseline- if the bill hadn't passed, the doc fix would happen anyway. Say the fix is $25B/yr- without the bill, the 10 year deficit change is 250B. With the bill, it's 250B - 134B- the 250 is constant because the fix happens either way (or, if you are concerned about cost controls, could be still implemented whether this bill passed or not.) The only thing Dems are doing on the doc fix is being more honest- it's passed every year anyway, they're just making it permanent instead of continuing the fiction that it will happen. It the same as how Bush never accounted for the cost of wars in his annual budget, they'd be allocated by "emergency" each year because that made the initial budget look better, and Obama decided to put them on the books even though this made it appear that his deficits were worse.
5) The general deficit projections (not related to this bill) are done by the same office and formulae that were used to score this bill. If you believe we have huge deficits ahead, then you should believe this bill will reduce them. If you think this bill will not match its CBO score, then you can't put any faith in the general deficit projections either. You can't pick and choose, and if there's any evidence that something may be incorrect, it's that the savings on the bill may be underestimated (http://www.commonwealthfund.org/Content/News/In-The-Media/2009/Aug/Congressional-Budget-Office-Has-Underestimated-Savings-and-Overestimated-Costs.aspx)
6) I find it quite ridiculous that the same people who complain about lack of cost controls are the same ones who complain about how the bill is too ambitious. I agree that this bill alone won't bend the curve enough over the long term, but it's the most ambitious program yet to do so, putting in place things such as comparative effectiveness research and incentives to pay for outcomes rather than volume. Doing nothing by definition doesn't bend the curve at all (and let's be honest, despite the Republican claims that they had alternative proposals, if this bill had died, the status quo is what we'd have for at least another 10 years.)
I guess I should have heeded the warning to skip this post, but I'm always astounded that there are people who know what they're talking about when dealing with scientific data who then make egregious errors of fact in non-scientific areas and are completely unaware or unrepentant about it.

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11. SP on March 22, 2010 8:58 AM writes...

I just posted this but it went for moderator approval (likely because I had links initially) but since I criticized Derek pretty harshly I wanted to put up a version that would post without approval:
1) The medicare prescription drug bill, in fact, ended up costing less than projected so far (link)
2) The second ten year window, to where you say the "costs are pushed out," in fact has a much larger savings than the first ten years (although with a greater error bar)- 134B in the first 10 years, 1.2T in the second 10 years.
3) The bill was not passed through reconciliation at all. It passed with 60 votes in the Senate and 219 in the House. This is pathetic, Derek, you have basic facts wrong. Only the minor changes which remove the parts most people complain about ("Cornhusker kickback," etc.) are being done through reconciliation.
4) The doc fix is a separate issue from this bill. Whether it's done or not is totally separate from this, and baseline budget projections assume it's not going to be done either (since the CBO only scores written law, not proposals or what everyone thinks will happen.) So the bill was scored relative to current baseline- if the bill hadn't passed, the doc fix would happen anyway. Say the fix is $25B/yr- without the bill, the 10 year deficit change is 250B. With the bill, it's 250B - 134B- the 250 is constant because the fix happens either way (or, if you are concerned about cost controls, could be still implemented whether this bill passed or not.) The only thing Dems are doing on the doc fix is being more honest- it's passed every year anyway, they're just making it permanent instead of continuing the fiction that it will happen. It the same as how Bush never accounted for the cost of wars in his annual budget, they'd be allocated by "emergency" each year because that made the initial budget look better, and Obama decided to put them on the books even though this made it appear that his deficits were worse.
5) The general deficit projections (not related to this bill) are done by the same office and formulae that were used to score this bill. If you believe we have huge deficits ahead, then you should believe this bill will reduce them. If you think this bill will not match its CBO score, then you can't put any faith in the general deficit projections either. You can't pick and choose, and if there's any evidence that something may be incorrect, it's that the savings on the bill may be underestimated (link)
6) I find it quite ridiculous that the same people who complain about lack of cost controls are the same ones who complain about how the bill is too ambitious. I agree that this bill alone won't bend the curve enough over the long term, but it's the most ambitious program yet to do so, putting in place things such as comparative effectiveness research and incentives to pay for outcomes rather than volume. Doing nothing by definition doesn't bend the curve at all (and let's be honest, despite the Republican claims that they had alternative proposals, if this bill had died, the status quo is what we'd have for at least another 10 years.)
I guess I should have heeded the warning to skip this post, but I'm always astounded that there are people who know what they're talking about when dealing with scientific data who then make egregious errors of fact in non-scientific areas and are completely unaware or unrepentant of it.

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12. milkshake on March 22, 2010 8:58 AM writes...

Now that I am unemployed and have to deal with the retarded COBRA bureaucracy just to get my dentist bill paid, suddenly the idea of universal health coverage does not seem so bad. Call it class welfare but I would rather have a costly entitlement for low -income folks rather than tax breaks for bankers who fuck over everyone from both ends, run the economy zugrund, and they still get their seven-figure bonuses while taking the federal bailout to the tune of tens of billions.

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13. David Arkham on March 22, 2010 9:02 AM writes...

Mark Polokoff: I think the real losers are the insurance companies. They get new customers, but they also have to insure people with preexisting conditions and cannot deny coverage if you become ill. Based on the costs of health care, they stand to lose a large amount of money if they have to start paying for that kind of insurance group.

I think pharma will did in fact cut several deals. One of which is patent exclusivity for biologics for 12 years.

http://www.nytimes.com/2010/03/22/business/22bizhealth.html?hp=&adxnnl=1&adxnnlx=1269266418-1CKGPBDJkn5/StiL4++0hQ

There are also some bits and bobs here and there, but that is the main point I think.

The real question then is how this bill reshapes the pharma landscape. Patent protection was not extended to small molecules. And in addition, the large companies have to pay fees totalling $85 billion over ten years.

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14. p on March 22, 2010 9:04 AM writes...

Quote: 6. Graduate more doctors. More competition would keep salaries down, and there would be more doctors for rural areas.


Yes, by all means, let's be sure to keep the salaries of doctors down. After all, it isn't as if they do the important jobs like financial guys, lawyers and bureaucrats.

Speaking of, I think all y'all kvetching about what this bill does don't have any idea. Like any massive federal bill, it will do what the bureaucrats say it will and there is damned little the elected leaders can do about it. It will be interesting, over the next decade to see how how the bcrats interpret it.


(To be fair, anyone who complains that a federal system will limit choice and create a horrible bureaucratic mess must admit that the current "free market" system has done exactly that while leaving vast numbers uncovered. No, the status quo wasn't good enough, but that doesn't mean this is a good bill).

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15. Marshall on March 22, 2010 9:09 AM writes...

Then the bear will turn its head to us again, but this time, with a new look in its eyes.

And the conversation will sound like a bit of dialog from Star Wars...
Lando: That was never part of our deal!
Vader: I am altering our deal. Pray I do not alter it further.

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16. Anonymous on March 22, 2010 9:12 AM writes...

#2, While I agree that this is a windfall for the insurance companies and that they are the single biggest beneficiaries of the new legislation, I have to roll my eyes every time I hear the talking point about how government bureaucrats are going to determine what type of healthcare you get and when. Members of congress have the "government healthcare" they love to demonize and I don't see any of them offering to voluntarily give it up or complaining that the government dictates their health care. Right now the insurance companies determine what is covered, what is not and for how much, they determine what tests you can take and what the level of reimbursements are. I guess "for profit" "private sector" "healthcare bureaucrats" determining how much and what type of care is o.k. but "government bureaucrats" not. Corporate insurance bureaucrats doubling premiums just when you need to use your healthcare or dropping your coverage if you don't take the hint and "go away" are just making an honest free market profit but government intervening and saying NO to corporate insurance death panels is just evil socialism or communism. Just let them eat cake or drop dead, right? Yes there are legitimate holes in the arguments on either side of the political divide, but the hysteria and over the top scare mongering stuff is just that.

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17. Wavefunction on March 22, 2010 9:16 AM writes...

I think simply that this bill will make 32 million Americans actually feel like waking up and going to work every morning to do their bit for the economy. That can't be all that bad. It's not perfect, but I think it's a positive development for the mental health of this nation.

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18. imarx on March 22, 2010 9:21 AM writes...

I'm sorry Derek, but it's hard to take you seriously when you wax nostalgic for the "fiscal restraint" of George "double federal spending and double the national debt in eight years" Bush. Between two unfunded wars, a completely unfunded trillion dollar expansion of Medicare, and trillions of dollars in tax cuts, where is this "fiscal restraint" you speak of? At least the current health care bill proports to be cost saving - Medicare Part D was passed without even a suggestion of how to pay for it. And for those of you complaining about the maneuverings used to pass this health care bill, you should read about how Medicare Part D was passed (sneak preview: it involves extending what is legally supposed to be a 15 minute vote into three hours while the Republican leadership browbeat its dissenting members into voting for it).

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19. Anonymous on March 22, 2010 9:36 AM writes...

P

I'm not defending the ridiculous salaries of the bankers, I'm just addressing the lack of physicians and how this lack has caused the market to push their incomes up.

And if you think they wouldn't do as good a job if they made less money, try visiting Western Europe or Canada. If doctors in the States were really in it for the money, they'd be bankers.

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20. milkshake on March 22, 2010 9:50 AM writes...

American Medical Associacion has been very effective in lobbying for regulations that stem the flow of foreign medical graduates to US, such as increasing the difficulty and number and cost of the exams required to pass in order to be eligible to apply for a residency training in US, cutting off state subsidies to hospitals for the residency training of non-US residents.

I wish ACS took the heed of AMA, instead of cheerleading for big pharma/chem manufacturing industry

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21. CanChem on March 22, 2010 9:53 AM writes...

As an aside to this: I'm Canadian, absolutely love my health care, and can't for the life of me figure out what the American fear of it is all about. After taxes (higher to pay for health care) I still take home more (as a percent) than my father-in-law in the US (after paying for private health care). And I have never had a problem going to see my doctor or getting any prescribed treatment.

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22. Derek Lowe on March 22, 2010 9:55 AM writes...

Imarx, the way Medicare Part D was passed by the Republicans was also outrageous. And as for fiscal restraint, Google "CBO deficit chart". You'll see that even the White House's own numbers (which, you can bet, are the rosiest available) show the smallest projected deficit to be well over anything that Bush had the nerve to run. The largest (this year, for example) break all previous records.

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23. m on March 22, 2010 9:57 AM writes...

I should add: Many foreign medical graduates used to enter under J visa. Now, J-visa stipulates the requirement to leave the country at the end of job and not to return to US for few years. Unless you get a waiver. Getting waiver has not been much of an issue for chemistry postdocs, but it became nearly impossible to get a waiver from J visa to transfer to H1-visa if you were a foreign medical graduate.

A friends in New York, a family with 3 young kids, both physicians, finished their residency. He got a tenure-track assistant professorship, she got staff physician job in a hospital. Their J-visa waiver was denied because they were foreign medical graduates, and despite them having good lawyr and appealing on grounds of hardship (3 young kids) they were denied and sent back to Europe.

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24. anonymous on March 22, 2010 10:04 AM writes...

Anytime you go to bed with the knowledge that you helped 32 million Americans, you can't feel that awful. CBO says not only will the plan break even, it will save us money in the future. Win and win.

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25. Mark on March 22, 2010 10:14 AM writes...

As a Canadian I can assure you that you won't like what's coming.

The Canadian system is cheaper because health care is rationed. Want an MRI? Prepare to wait a month or two. Want orthopedic surgery? Prepare to wait a year. Want the latest cancer treatment? Buy yourself a plane ticket to the US, it's not available here. Live in a rural area and need a primary care doctor? Put your name in the lottery and hope you win. However, if you're the Premier of Newfoundland, you can just fly to the US for cancer treatment. The rabble can find their own way.

Mark

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26. anonymous on March 22, 2010 10:15 AM writes...

Mark: That's not what the bill says though. There is no single payer government controlled system like Canada. Why would you think we will all of a sudden turn into Canada?

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27. Vader on March 22, 2010 10:20 AM writes...

I wonder why it is that, as soon as a discussion turns to politics, the average IQ drops into the single digits?

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28. Paul on March 22, 2010 10:20 AM writes...

The post that had a link to the French system and asked the question of if the French can provide healthcare why cant we. I just read the article, it states that costs have gone up from 7% to over 40% since inception. Deficits for healthcare have been run for quite some time was one of the main quotes and yet they will likely only make some minor fixes. Why? because folks want it to stay the same

So when you add 30 million people to the healthcare ledger and claim you can reduce costs. Probably not a good idea to use France as an example. At some point its unsustainable just like where we are with social security and medicare.

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29. p on March 22, 2010 10:20 AM writes...

Quote: And if you think they wouldn't do as good a job if they made less money, try visiting Western Europe or Canada. If doctors in the States were really in it for the money, they'd be bankers.


But how are you going to recruit more doctors if their salaries are lower, compared to bankers, lawyers, etc.? I teach a lot of kids who look at what they'll have to do to get into med school and survive and then what their life will be like. Many/most decide that the business school across the way looks more attractive. I know you're not defending high salaries in the slimier areas of finance, but the fact is people like to make money, under any system, and will gravitate to where it is. If you're told you can make as much with a 4 year degree as you can with a decade or more of grueling training/education, it's a simple calculation.

As to overall cost, if there is unlimited demand for a limited supply, the costs will go up. Somehow, they'll have to ration what is available if they want to bring costs down.

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30. SP on March 22, 2010 10:21 AM writes...

Say it with me now- Health care is rationed in the US right now. It's rationed by the size of your bank account, or by who you work for, or by whether you've been sick previously.

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31. Mark on March 22, 2010 10:25 AM writes...

Anonymous:

Correct, but what do you think the long term goal is? The bill defines a gov't panel that will approve/disapprove premium hikes by insurance companies. Not much of a free market anymore, now is it? Anyone who has taken a micro-econ course can tell you price controls don't work. There is no free lunch. Somebody in the end pays. You can try and get the rich to pay for it, but guess what? There aren't that many rich people in the US. In the end, the cost will be saddled on the middle class as either higher taxes and/or lower quality care (most likely both).

Mark

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32. Derek Lowe on March 22, 2010 10:26 AM writes...

SP (comment 10): one big reason that Medicare Part D has been coming as less expensive is that we in the industry haven't been turning out as many new drugs as the program planned for. (That's not my own opinion, that's from the government's own documents - see http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.pdf, page 119). Note that expenditures for Part D are still growing substantially faster than GDP.

As for this bill not being passed through reconciliation, I'm puzzled by your argument. Would this health care bill have been passed if it were not aimed at the budget reconciliation process? No, because the Republicans would have filibustered it in the Senate. It's the very differences between the House and Senate bills that make all the difference. The reason it passed with 60 votes in the Senate is because the makeup of the Senate chamber was different then that it is now - you'll note that a Senator was elected from Massachusetts in the interim on the explicit platform of torpedoing the bill.

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33. SP on March 22, 2010 10:27 AM writes...

28- From Ezra Klein, who's analyzing all the major provisions in a series of posts today:
"Starting in 2010, a variety of new [medical school] loan repayment and scholarship programs kick into effect. But more importantly, in 2011, the government directly expands primary-care training programs and sends a 10 percent increase in payments to primary care doctors in the Medicare program (which makes being a primary care doctor relatively more lucrative). "

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34. anonymous on March 22, 2010 10:30 AM writes...

Mark: The free market is a myth anyway. See: government bailouts of nationally crucial industries.

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35. Marcus on March 22, 2010 10:38 AM writes...

in 2011, the government directly expands primary-care training programs and sends a 10 percent increase in payments to primary care doctors in the Medicare program (which makes being a primary care doctor relatively more lucrative). "

Is that before or after the 20% Medicare cuts that are supposed to hold down costs and reduce the deficits?

It's a neat trick for supporters of this to claim credit for both slashing and increasing the same benefits. Seriously, that's awesome.

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36. LeeH on March 22, 2010 10:46 AM writes...

P

The premise that people won't want to be doctors if they make less is ridiculous to me. It would still be a prestigious and well-paid profession. Perhaps some of the more self-centered would be dissuaded, but there are plenty of people who would kill for a secure, relatively highly paid profession. I agree that American culture is rather self-absorbed, but I still think that there are more than enough intelligent and benevolent individuals to more than fill the medical profession.

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37. rhodium on March 22, 2010 11:03 AM writes...

It is impossible to be as quantitative and analytic about politics as one is about science. However, there are some facts that we can agree on. First, the hcr bill that will be signed was not a reconciliation bill, it got 60 and 219 votes in the two houses. Second, the CBO, which is not any party's shill, scores it as reducing costs. We get mad when outsiders imply (or state) chemists are evil or stupid: we have the cures for cancer and Alzheimer's, but we are keeping them off the market to make more money, or we sell poisons when natural or homeopathic remedies work better and safer, or how hard can it be to just make a pill that lets one eat all the ice cream one wants? Yet we are all, from time to time, happy to denigrate experts in other fields because we can see they (who feed their families and buy their kid's toys from the money they make thinking daily about these specialized problems) are gullible fools who, if they thought carefully for a few days, could understand everything they have been saying is unsustainable garbage. Just because you want an expert to be wrong does not mean they are wrong (or right). However, their opinion, if not bought and paid for (like some chemist's opinions of old that cigarettes' relation to lung cancer was unproven) is at least defensible and more defensible than most "venting". Now we do the experiment and see what happens. It is probably one of these high risk/high gain things but maybe it will turn out like adding diethylZn to PhCHO with a new chiral ligand.

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38. noname on March 22, 2010 11:25 AM writes...

Why must we discuss politics here? Aren't there enough venues for this kind of thing elsewhere that we could just concentrate on the fun stuff like exploding cylinders and incompetent pharma?

Oh well, you started it: Derek, you're positive comparison of the Bush years with the present adminstration in the area of fiscal discipline completely mystifies me. It is unimportant at which point in time (and under whose administration) the deficits grow. The point is whose policies and budgets caused those deficits to appear. The deficits of today are mostly caused by: a) less revenue thanks to Bush tax cuts, b) less revenue because of the economic slowdown (started under Bush), c)unfunded liability of the prescription drug benefit (fomented under Bush), and d) two unfunded wars (one of which was necessary, both of which started by Bush). On the other hand, the CBO and other objective analysts say that HCR will not increase the deficit but shrink it. Obama made that a hardline criteria and I've heard no credible refutation. I will freely admit that the stimulus bill will grow the deficit, but even you must conceded Derek that the economic situation of last year demanded stimulative spending to prevent a real catastrophe. Belt-tighthening will certainly be necessary once the economy stabilizes. But I just don't accept that this is step towards a fiscal calamity. for you to suggest so when you don't say a peep about the 4 items above is puzzling and depressing, coming from one of my (usually) favorite rational thinkers.

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39. just a chemist on March 22, 2010 11:43 AM writes...

Derek, I've read each of your health care "rants" over the past 15 months and I always have the same question. It's clear what you are opposed to, but what are you for? Is it the status quo?

Perhaps the discussion in the comment section would be more constructive if the debate were framed more constructively in the original post.

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40. p on March 22, 2010 11:45 AM writes...

LeeH, yes, I think we'll always have people who want to be doctors even if they must take a vow of poverty to do so. Equally clearly, no one is suggesting that. I was addressing the oft-stated "need of more doctors". If we need more doctors, then cutting their salaries is not a good way to go about that.

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41. Derek Lowe on March 22, 2010 11:52 AM writes...

Noname, I still can't figure out how anyone can believe this bill will shrink the deficit. The CBO works with what they're given, and what they were given in this case is a bill with all its features carefully tailored to produce the desired answer.

As for the deficit, the defense budget (and all discretionary spending) pales next to entitlements. (And yes, as mentioned above, I'm not happy with the Bush administration for the way it handled Medicare Part D). It's not like I think that the Bush years were wonderful examples of fiscal discipline, believe me. But adding to entitlement spending even more doesn't seem like a wise move right now: http://en.wikipedia.org/wiki/File:GAO_Slide.png

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42. Hap on March 22, 2010 11:57 AM writes...

I'd have an easier time swallowing Republican criticism of this bill if 1) they hadn't spent $8e12 of money they didn't have over the last 30 years (all while talking about their fiscal responsibility - sort of like complaining about "big government" while expanding it massively and trimming its restrictions) and 2) had come up with a serious and more market-friendly health care plan instead of chanting "High-deductible insurance and health savings accounts" and hoping that their chant would somehow morph into an effective health care plan.

I'm sure someone from the conservative side of the aisle can explain to me how people with pre-existing conditions are going to get health care or insurance coverage without a government mandate, and without bankrupting Medicaid/Medicare. I can only think of one way, which involves mostly not covering those people at all, not mandating that hospitals pay for them, and hoping they die quickly and peacefully. Somehow, I think the effects of that might be a little hard for most people to swallow, though.

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43. LeeH on March 22, 2010 12:08 PM writes...

P

I'm not sure how cutting doctor's salaries equates to "taking a vow of poverty". They could still make a very good living (as they do in most of the industrialized world). I'm not suggesting such extreme measures, just some common sense.

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44. KJS on March 22, 2010 12:15 PM writes...

Either way if this bill actually goes threw completely the middle class will suffer. More taxation on this class will completly devistate it. Also the government cant force anyone to have health care! whats constitutional about that this is not a comunist country as much as the polititions want it to be. I vote NO!

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45. p on March 22, 2010 12:37 PM writes...

LeeH, I acknowledged that no one is asking them to take a vow of poverty. No one is but even if that was asked, you'd still have some that would choose the life.

However, if you state that we need MORE doctors (and many say we do and many in nations with public health plans say they do - and as you did in point 6 of your initial post) then decreasing salary is not going to do the trick. That is especially true if bright folks can game the finance sector to make orders of magnitude more money with much less training or work as a bureaucrat overseeing doctors.

Believe me, I teach and most of my fellow teachers like to talk about how they take less money to do a job of service and passion. But as soon as a 12 month position as associate assistant provost for dean's services opens up, bang, they're out the door.

It's just simple economics: if there is more demand than supply, prices (in this case salary) must go up.

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46. Against Lowe on March 22, 2010 12:40 PM writes...

You said it properly in your first sentence----keep your political views to yourself. I just hope you never find youself with a serious health problem without insurance, or denied coverage because of a loop-hole, or can't get medical care for your children because you've just lost your job. Or, maybe, you (and many others who don't see around them) should have to have the experience.

This blog site is an indulgence to Derek Lowe. Why so many people think he has something positive to contribute in all topics of his own chosing amazes me. Wny is it that company specific related posts never include the company where he works, for example. More and more, he represents the epitomy of the twitter world...lots to say of little context & less consequence.

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47. Tom Lee on March 22, 2010 12:46 PM writes...

LeeH: I agree with most of what you've said, but it's worth noting that this bill already does some of the things you prescribe as next steps. In particular, I believe that items 2 and (arguably) 1 are included, and there are pilot programs for items 3 and 7. Not sure about the other suggestions, but there's a lot in the bill aimed at trying out curve-bending ideas. It's also worth noting that CBO did not feel that these portions of the bill could be scored, and so the potential cost savings they represent is not reflected in their projections.

No one thinks that this is a perfect bill, or the end of the fight for a working health care system. But it establishes the expectation that all Americans should have access to affordable health care, just as citizens of every other industrialized nation do. That entitlement is unlikely to go away -- nor should it, in my opinion -- though we will no doubt have to continue to work to make it a promise that can be affordably fulfilled. Those pilot programs in the bill will have to prove their worth, and congress will have to have the courage to implement the successful ones on a larger scale.

Derek, I'm disappointed in the weakness of the arguments you've mounted here. The assertion that this bill will blow up the deficit has been justified by saying there are huge projected deficits in the future. The latter assertion is true enough, but the specific argument is not only specious, but not particularly clever. Nearly all of us who follow politics are subject to our various tribal biases, and you are usually quite thoughtful and gentle in giving voice to yours (I aspire to that standard!). In this case, though, I'm afraid you're wearing them on your sleeve in a less-than-convincing blog post.

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48. pEvans on March 22, 2010 12:49 PM writes...

I want to second, third, fourth, N+ the whoop of laughter about enjoying the fiscal restraint of Bush. Hi-lar-ilty, but much needed on a Monday...

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49. Dad on March 22, 2010 12:55 PM writes...

Enjoy reading my daughter's perspective on Canadian health care. She lives in Canada and her observations point out where the US needs to go and not go in health care for its citizens.

I asked her for the good, bad and ugly of their system. She is obviously a big fan of their system, but she is not old or a major consumer of health care yet. She is one example of the very type of person we are trying to address in this debate.

Hi Dad,

Okay, this is a much more complicated question then you think it is but here goes.

As you know or have heard Canada possesses what is often called free or socialized healthcare. This is not precisely true, what they have is actually government- subsidized healthcare. Everyone who is not desperately poor, at least here in this province pays a small amount (like a HMO co-pay) towards their healthcare, and the government subsidizes the rest to a certain point. I say to a certain point because it is not unlimited. There are certain procedures, medicines, and wait times that are part of rationing care a la Canada. For non-essential healthcare the wait times can be extreme or even the care indefinitely deferred. I know someone who has been trying to get a tonsillectomy for the last three years. His tonsils were damaged partially because of a misdiagnosis but until the problem was very extreme they kept putting him off the list. Also malpractice is very, very hard to prove. There is a government established "standard of care" and good or bad, if the doctor does not deviate from it there is no "cause" to say they made a mistake. There is no such thing as negligent care as long as the standard is upheld. I know someone whose wife was paralyzed from the neck down and there was nothing anyone could do just because of this legal approach. If the procedure or medication isn't approved to use by the Canadian government it just doesn't exist as far as the patient is concerned. They would have to go to the United States to get care and pay for it privately. This is especially true with cancer, as you know, cancer is a difficult medical problem and there is lots out there for treating it, some very expensive, unproven and risky but not available for Canadians. Mom would probably not have survived her breast cancer had she lived here and I have many, many friends whose parents have died because of it.

The upshot to this is that basic care, primal care like the kind I received for my strep and in the ER. It is easy to get and inexpensive. Getting a regular doctor is difficult simply because there isn't enough of them. Lots of them move to the United States because doctors in the States make way, way more money. However, there are clinics everywhere that serve the public much like the free clinics in New York or anywhere else. Most of the doctors I have encountered are pretty competent although I have heard of some complaints. Certainly they have cured any of the minor illnesses I've presented to them -- two bladder/kidney infections and one case of strep. One even prescribed anti-depressants and sleeping pills when I first separated although in the end I wound up taking neither. My weekend trip to the ER was phenomenal, or as much so as a trip to the ER gets. The paramedics, who are on strike here treated me as if they were paid in the millions for what they did. When I mentioned it they said, "that's not your concern, we just want you to be okay." In fact everyone, the nurses and the doctor in the ER were kind, intelligent, competent and professional. The doctor seemed visibly disconcerted he couldn't figure out what was wrong with me. His bedside manner was impeccable, and much appreciated considering the invasive and uncomfortable exam he conducted. I have ZERO complaints about that. In fact I want to send them all a thank you note even though we are no closer to diagnosing what is wrong. In any case it isn't the first time my biology has confounded the doctors in case you forgot our little trip to the ER so many years ago when I was puking out the side of the car. I don't think they ever figured out that either.

However, I suspect you are asking me this because you want to disseminate it to someone else and I want you to have the context in which it exist. Canada has a tenth of the population of the United States and sits on massive, massive deposits of natural resources which it sells on the world market, mostly to the United States. Potash, diamonds, wood, sulphur, natural gas and massive amounts of oil tar are torn from the ground and sold to others. Most of this work is seasonal, hard, cold and dangerous. It would be a requirement of this economy to keep healthcare available everyone no matter what kind of work one is doing, or when they are doing it. As far as I know there is very little innovation in the medical fields. The last two studies I've heard about were on whether or not we would survive a "zombie apocalypse" and one finding that women aren't really into sports as much as guys. I mean, duh. Sometimes it amazes me these are the same people who discovered insulin. In any case, most medical advances and medication come from you, as you should know. I am not sure the United States would have the same experience or find they get the same results as we do. As you know, cancer treatment in the United States is unparalleled and in fact were I diagnosed with it, and had the money, or even the credit, you could count on one hand the hours it would take me to return. For me, at this moment, unable to secure steady work, or continuity with my insurance which I know is just looking for a reason to deny me care a la pre-existing condition, I would not change a thing about Canadian healthcare. Unfortunately as the population ages and costs spiral out of control for the elderly, the system may have to change whether it wants to or not. There is already discussion about letting private clinics take over some area of elective or even non-essential medical care. They've also had to recently slice a bunch of services for the public, much to the shock of everyone but me. The traditional bread and butter economics of this area, softwood, tourism, software have taken a huge hit. Unless it turns around there will probably be more cuts. At least they are willing to make them, unlike the US where the AARP will sacrifice nothing. Still, I will be able to get antibiotics at a discount from the same doctor or clinic every time. He will know I’m allergic to penicillin and latex and what other medications I may be taking even if I forget to tell him. He will know my entire medical history. He does not need to be on my network or plan and if I lose my job, and go on EI, I will not lose him as my doctor when I can no longer afford my cobra. I can have all the pre-existing conditions I want, diabetes, cancer, heart disease, insanity. It is way better then hand carrying my medical files to every doctor every time I get the flu or having to pay $400 for a doctor’s appointment after I’ve gotten too sick and lost my temp job.

And this is why I don’t move home.

BTW as an epilogue to my little dissertation on healthcare, keep in mind that we also pay %12 sales tax on almost everything now, they recently "harmonized" the federal and provincial tax and that added a whole bunch of new taxes, a pack of cigarettes will run you about 10 dollars and a six pack of beer almost $15.

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50. Tom Lee on March 22, 2010 12:56 PM writes...

However, if you state that we need MORE doctors (and many say we do and many in nations with public health plans say they do - and as you did in point 6 of your initial post) then decreasing salary is not going to do the trick. That is especially true if bright folks can game the finance sector to make orders of magnitude more money with much less training or work as a bureaucrat overseeing doctors.

The architects of this bill quite deliberately decided not to take on the doctors, but yes, from what I understand, sending less money to them will ultimately be an important part of getting our health system on a path to sustainability. It's worth keeping in mind that this can be accomplished in a number of ways less draconian than slashing salaries: empowering nurse practitioners to prescribe some common classes of drugs; lowering artificial barriers to entry in the field like the brutal and nonsensical hazing system we have for apprentice doctors; paying for outcomes rather than volume of services performed. These would all ultimately mean less money for doctors, but hopefully sound relatively palatable. And I have a feeling that being a doctor will still be a pretty good job for a long time to come.

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51. Ronathan Richardson on March 22, 2010 1:09 PM writes...

I understand taking issue with the cost sustainability of many measures here--but note that the CBO score doesn't take into account most of where this bill hopes to save money (Electronic medical records, larger "healthy" pool due to the mandate, the 85% loss ratio requirement for insurers, the pilot projects, etc)...the CBO score only really takes into account decreased payments for medicare.

But in a larger sense, what this bill does is begin to put the healthcare bill in the hands of the government--there is a lot in this bill making HHS a hugely powerful entity. And in reality, the only countries that have solved the cost problem in healthcare are those in which the government has taken such an active role in price negotiation and insurance/hospital regulation. This bill gives HHS the power to now do what is necessary to rein in costs, even if the specific provisions of the bill aren't powerful enough yet.

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52. p on March 22, 2010 1:11 PM writes...

I agree that being a doctor is likely a stable and profitable career path for a good long while yet. It's just odd to me that a bunch of lawyers just decreed that doctors should make less money while they seem to make ever more.

Reading the constitution, I see at least as much call for nationalizing legal services as I do health care. Certainly one expects different legal outcomes based on ability to pay. But you'll never get the powers that be to do that, because it cuts them instead of "others".

But that is wildly off-topic. Suffice to say that though I think this bill is probably not going to work nearly as well as its supporters think, I also doubt it does as much damage as say its critics.

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53. Will on March 22, 2010 1:25 PM writes...

- exchanging pay for procedure with pay for outcome, along with some sort of tort reform that reduces defensive medicine would go along way in reducing health care costs at the physician level

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54. Anonymous on March 22, 2010 1:37 PM writes...

#43 said: "Also the government cant force anyone to have health care! whats constitutional about that this is not a comunist country as much as the polititions want it to be. I vote NO!"

For all of you who love to embrace the tea party talking points and scream communism and socialism, were I the one crafting the bill I would put in an opt out provision. People like you who are young, healthy and feel immortal or have jobs and don't think you will ever lose the healthcare you are so satisfied with that costs you so little out of pocket or don't believe that you will ever come down with a costly disease or want hands off YOUR government healthcare aka medicare, would be allowed to opt out in return for accepting the consequence that after you opt out, for the rest of your life you will be required to purchase insurance whenever you feel you need it on the open "free market" at the mercy of the poor needlessly maligned insurance companies. If, on your way from work, some drunk driver rear ends you and you are taken to the hospital, you must put up or shut up with regards to your chant about personal responsibility. Pay every dime of the emergency room bill out of your pocket and agree to a clause that you cannot discharge your debts in a bankruptcy court and shove the bill unto the hospital or taxpayers. Good luck grabbing your cell phone and trying to buy a policy from the beloved non-government regulated insurance company of your choice as you are being rushed via ambulance to the hospital. You won't have a "pre-existing condition" but you might as well have. The whole point of insurance is that you buy it before you need it. Otherwise pay as you go and don't expect anyone else to feel sorry for you when you change your mind only after the shoe is on the other foot. There are millions of people living in Western Europe who are on average even more healthy than your typical tea partyer and I don't see them rioting in the streets and screaming no to socialism. You shouldn't have to first get sick and have your policy dropped or find your job outsourced to China or India before you accept that prevention is better than cure or doing nothing.

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55. Derek Lowe on March 22, 2010 1:37 PM writes...

"Against Lowe", I do a political post around here once or twice a year at most, and I tend to regret it each time. As for your complaints about the blog, I'll be glad to refund what I charged you for reading. And my standing offer applies: start one of your own, and I'll link to it.

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56. Dennis on March 22, 2010 1:42 PM writes...

#45: Seriously? I strongly disagree with Derek's political views, but how often is there even the slightest mention of them? Once every couple of months? If you don't enjoy his writings on chemistry and the state of the pharmaceutical industry, what are you even doing here? Finally, with regards to where he works, I had assumed that was common knowledge. If not it's relatively easy to find out on the google once you get past the hits for the Braves' pitcher.

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57. p on March 22, 2010 2:06 PM writes...

Hang on. He's not the pitcher? What the hell do I come here for, then?! I've been duped!

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58. SRC on March 22, 2010 2:11 PM writes...

Well said, Derek.

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59. Canuck1 on March 22, 2010 2:28 PM writes...

@Dad - Don't know where your daughter lives, but my brother had his tonsils out two years ago after about a month and a half of waiting and he didn't have to pay a thing. Couple years before that mom had surgery to repair severely broken humorous. Had surgery after a day or two, again didn't cost her a thing. It would have been sooner but some emergency stuff came in and was put before her.

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60. Anonymous on March 22, 2010 2:29 PM writes...

The healthcare bill has nothing to do with healthcare. Obama is a marxist radical, raised by marxist radicals. Public healthcare is the holy grail of marxists. Once the government can decide who gets healthcare and the extent of that healthcare, government then controls individuals and their behavior.

This is about power, pure, vile, unadulterated.

The public was overwhelmingly opposed to this steaming pile of shit, and yet the radicals in this government jammed it through anyway. This kind of stuff only happens in dictatorships.

I'm not being hyperbolic. Anyone with their vision clouded by the ins and outs of the trivial details of healthcare will think this is just a lunatic talking. Fine, think what you like.

No-one likes to think that their elected officials aren't working in the best interests of the people. The fact is that this administration is infested with people who HATE this country, who think the US is responsible for all the evil in the World, and who want us to suffer just like those we have wronged.

RIP USA. It was fun while it lasted. To think we once landed on the Moon...

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61. Dave L on March 22, 2010 2:42 PM writes...

Derek, I stand with you. Government intrusion is rarely good nor cheap.

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62. isaac on March 22, 2010 3:11 PM writes...

Leah #35
"...there are plenty of people who would kill for a secure, relatively highly paid profession. I agree that American culture is rather self-absorbed, but I still think that there are more than enough intelligent and benevolent individuals to more than fill the medical profession."

Spoken like someone who has NO clue what the training of a physician involves. Huge personal and financial sacrifices are required. Massive. It's not some secure well-paid gig that someone chooses on a lark. Start making it harder to make a living from it and I'll show you a reduction in standards that'll result.

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63. LeeH on March 22, 2010 3:14 PM writes...

Anonymous

It is a very astute observation that countries with public healthcare tend to be Marxist. Having grown up in Canada, I can tell you from personal experience that it is a hotbed of Marxism.

In elementary school, we did not have Dick and Jane readers, rather a pictoral version of "The Communist Manifesto". One year in high school, we became so enraged at capitalism that we rounded up our bourgeois teachers and exiled them to the Yukon, ostensibly to mine gold and diamonds for the benefit of the common people (who, after acquiring those items, had to be exiled themselves). And the proletariat has long rejected the luxuries of eating fries with ketchup, preferring simply to douse them with the people's vinegar (although sadly socialism has been somewhat perverted and drifted towards the indulgent use of gravy).

I suspect that you would be uncomfortable visiting Canada, with it's rampant extremism and strange ways, but be assured that your moderate manner and being obviously a member of the intelligentsia you would surely be turned back at the border anyway.

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64. oMan on March 22, 2010 3:18 PM writes...

Derek: Thanks, this is very thoughtful as usual. You're a brave one to talk politics but on the whole I see the discussion here as productive and civil. People like #45 are free to go blog elsewhere. Regarding Canadian healthcare, I have family there and I concur, it's OK for routine/minor stuff. If you've got cancer, they'll give you palliative care, opiates, etc. There is little innovation. Once the US goes fully to single-payer (for which this bill is the door-opener) I don't see much innovation happening here either. Basic economics: when price is forced down, supply goes down even as demand goes up. It won't be pretty. I continue to be amazed at how smart people keep falling for socialism.

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65. Robert Bruce Thompson on March 22, 2010 3:18 PM writes...

Hey, Derek, congratulations on your first evil troll, or at least the first one I remember seeing here.

And please don't apologize for posting political rants. As it happens, I agree with you, but even if I didn't I can't imagine telling you what to write about on your own page. It takes a special sort of clueless arrogance to do that.

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66. Anon on March 22, 2010 3:23 PM writes...

Let's see. USA, check. Canada, check. I assume every country in Western Europe is also Marxist. Can you provide examples of some shining beacons of capitalism that are not marxist / communist / socialist and feel people should live or die based on the size of their bank account or accident of birth?

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67. LeeH on March 22, 2010 3:27 PM writes...

Isaac

I know many people who are physicians and I am very aware of the process of becoming a physician. However, if the financial payoff were the key determinant to finding and creating well-trained and motivated people in a field, two things would happen.

1. The best and brightest would end up in the financial world. Obviously not the case (not that there aren't smart people there, but they hardly represent a genius class).

2. Physicians in other countries would be substandard. Perhaps you've never been outside the U.S., but this is clearly not the case.

I'm also not suggesting we make it any harder for physicians to make a living compared to other professional fields, I'm just suggesting that the financial advantage not be quite so extreme. In addition, training for the medical profession should be made less expensive to compensate, and somewhat less draconian in terms of how the interns and residents are treated.

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68. Diehard BUSHkovic on March 22, 2010 4:05 PM writes...

While we are all holding hands, singing Kumbaya and waxing nostalgic for the "government is the problem not the solution" "let everything in our lives be dictated by the free capitalist markets unless they screw up and bring the world to its knees and need a government bailout" "Bushkovic era", let us pause and remember that in his infinite wisdom of and faith in all that is the free market, Dubya used to delight the cheering hand picked town hall free marketeers with jeers that the "government bureaucrats" were controlling the People's social security contributions (those evil socialists) and investing it low 4% yielding safe US treasuries when it could be turned over to the genius bankers on Wall Street to invest in the US stock market so we could all retire as filthy rich capitalists. If only he had gotten his way and the evil marxists Democrats in congress had gotten on board the Republican free market train and allowed him to invest the social security trust fund in the "stock market" in 2006. All the private and state pension funds run by the big wall street geniuses dove in head first in 2005 and 2006. Any one want to take at stab at explaining how a small "marxist government mandated" 4% gain is inferior to a 40% "private sector managed" loss?

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69. fragment_boy on March 22, 2010 4:11 PM writes...

As a british citizen who spent a short time working the US, I must say that I found the lack of 'free' healthcare ridiculous.

IN the UK the NHS may be in a bit of state but at least here if you are in the country and you become ill then the doctors will deal with you and treat you..... and not check for your health insurance before even looking at you.

It disgusts me that a country as rich as the US doesnt have an inclusive health system. There are a lot of poor people in your country that are very ill but cant get treatment because they cant afford it.

Access to a doctor, regardless of your financial state, should be a given in a developed country.

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70. Anonymous on March 22, 2010 4:53 PM writes...

What it basically boils down to is that the "haves" enjoy having it all and worry that the price for allowing the "have nots" to have some is that the "haves" will not have as much.

If Marie Antoinette were alive today she would insist that the marxist leaning free-loading government hand-out seeking "have nots" should learn to take responsibility for themselves like "real Americans" and learn to eat cake!

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71. swan song Marxist on March 22, 2010 5:44 PM writes...

Marxism is the only way to fly. You get to sit on your ass and let the government take care of you. Personally, I can't wait to sit on my fat ass and eat Cheetos all day long while some former banker (who is in jail-the Evil Capitalist Bastard) has his former money spent to make me fat. Who could't love that. (And Cheetos) Then when I have my second or third heart attack and I'm getting quadruple by-pass surgery, I still don't have to pay for it or take responsibility for my life, since, after all, the government is in charge of me. Whoop-te-do!!!!

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72. Im Special...so Special on March 22, 2010 6:01 PM writes...

On the link below is a "FRESH AIR" piece from 2007 with Jonathan Oberlander, a political scientist with an expertise in health-care politics and policy, where he discusses problems with the U.S. health-care system and considers how other countries handle health care. He'll also provides a critique of Michael Moore's documentary Sicko. Oberlander is an associate professor at the University of North Carolina at Chapel Hill.

What I thought was interesting is his explanation of why the costs of health care are so high in this country: The large costs come because of medical underwriting (figuring out how sick, people are; how much insurers should charge based on their level of sickness). None of that happens in Canada. While in the US, we spend 30% of all costs on adminsitrative costs (30% of 2Trillion health care costs is a ton of money), only 17% of the Canadian costs are in these types of costs. He cites a McKinsey Institute Report which states that high costs in US are spent not on better care provided, not on quality of care, better value. High costs are strickly related to the costs of medical underwriting according to their report.

http://www.npr.org/templates/story/story.php?storyId=11826524

He talks with hope in 2007 about universal coverage in 2007.

Reagarding international reactions on the radio this morning to the passed Bill, I think its interesting when you hear the British talk about Americans and their healthcare system, they refer to it as related to this idea of "American Exceptionalism", or, that "we're special".

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73. Anonymous on March 22, 2010 6:23 PM writes...

I think there is something wrong with our priorities...
1)750 billion needed for banks..okk by both democratic and republican presidents ...THATS OKK.
2)Republican president expands prescription bill coverage without paying for it ...THATS OKK.
3)Republican and Democratic presidents start and expand war & nation building in foreign countries...
THATS OKK.
3)Democrat President expands health coverage..
BAD IDEA, IS IT???

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74. SRC on March 22, 2010 6:42 PM writes...

Lot of young 'uns in here, passionate about the opportunity/requirement to work their asses off for the rest of their lives for us geezers.

We appreciate it, guys. Now get back to work. There's bills for you to pay, and lots more of 'em coming.

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75. Anon on March 22, 2010 6:54 PM writes...

Let me explain it. Corporate welfare is good because the wealth will eventually trickle down to all the "little people". Don't forget. Leona Helmsley went to prison not because she didn't pay her taxes, but because she had the stones to laugh in the judge's face and proclaim that only "little people" should pay taxes.

In keeping with #71's sentiments, it is o.k. for corporate fat cats to sit on their ass and let the government take care of them. They need to have their taxes cut now and their bonuses raised. When they screw up they must be bailed out or they will bring the economy down with them. Why shouldn't the CEO of Merril Lynch spend 2 million dollars redoing his office, gold encrusted commode and all and then months later have Bank of America hit up the marxist government for 25 billion dollars in bailout money in order for the private capitalists at BofA to absorb all the billions of losses the Merril Lynch CEO was hiding? Did you really expect them to take responsibility for their screw ups? Why not socialize the losses and privatize the gains like a real card carrying capitalist. ANy other solution is marxist.

The same argument applies to the 30 or so million who don't have healthcare. They refuse to "take responsibility for their lives". They don't have healthcare because they are lazy and sit around all day eating Cheetos instead of going out and finding a job with subsidized medical benefits. All 30 million of them have pre-existing conditions or health issues which are their own fault. Why should we care? If you ran an insurance company wouldn't you want to collect premiums only from clients who don't use the services or use them sparingly? Otherwise, where is the profit going to come from? Why bother?

I see nothing in the legislation that says free healthcare for all, the government will pay for it but facts won't put an end to the demagoguery.

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76. Skeptic on March 22, 2010 6:54 PM writes...

You people simply cannot grasp the consequences of a point in time (like right now) when debt saturation has been reached. The Health Care Bill has nothing to do with health care. The fact you cannot understand the economic system you participate in makes you worthy of contempt.

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77. SRC on March 22, 2010 6:58 PM writes...

You people simply cannot grasp the consequences of a point in time (like right now) when debt saturation has been reached.

I believe the Greeks could enlighten them on this topic.

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78. Lilly the Pink on March 22, 2010 9:24 PM writes...

We are out of money, folks. We can't pay for ANY of this crap. We are out of money. Yes, it is sad that some people have no health coverage. It is sad that there are people living on the street. It is sad that there are children with no parents. It is sad that there are widows who mourn their husbands of 40 years. It is sad that there are wars and destruction and death and hate and disease and social injustice. WE DON'T HAVE THE MONEY TO FIX ONE DAMN ONE OF THEM!!!!!!!!!

You talk about Marxism. Marxism is about spreading the wealth. There is no more wealth to spread. We have sold our souls, and our wealth, to those who have no interest in our future.

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79. alex on March 22, 2010 9:34 PM writes...

"The architects of this bill quite deliberately decided not to take on the doctors, but yes, from what I understand, sending less money to them will ultimately be an important part of getting our health system on a path to sustainability."

Yes, clearly. The one fifth of American health care expenses that go towards doctors (i.e., the people that actually produce something in the health care system) are obviously the culprit. Why, if we paid them absolutely nothing, zero dollars, health care expenses would still be on an unsustainable course. Obviously, then, this is the solution.

Equally dumb is the suggestion that cranking out many more doctors is the solution. We do not live in Cuba. When you see a doctor here, they actually do something, such as ordering a test, and quite often that something is much more expensive than the doctor visit. There is a cliche that "the most expensive thing in the hospital is a doctor's pen" and it's true; if you doubled the number of doctors to cut their salary in half you'd end up spending ten times the savings on ancillary services.

Yesterday (well, today I guess) I worked a 31 hour shift in which I had to admit six patients, juggle thirty more and and go to the OR emergently twice. Upon arriving home, I fell asleep in my driveway for some unknown period of time. Quite frankly, I would never put up with the amount of bullshit this job requires without the prospect of a serious payday at the end. Fortunately, I'll be in a specialty where I can tell Medicare to suck it when their inevitable axe comes down on doctor salaries and is cheered on by the rest of America that believes as always that everyone in every field but theirs is overpaid.

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80. Against Lowe on March 22, 2010 9:51 PM writes...

Hit a nerve, eh? Seems you are a bit too thin skinned to be hosting a very opinionated blogging, blabbing, gossip column run in your own way and choosing. While you set yourself up to be a target for those with opposing views, it's increasingly clear in your defensive outbursts that you can't handle the idea that others will take you on. All you can do is attack. Just like the do-nothing Republicans in Congress.

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81. Against Lowe on March 22, 2010 9:51 PM writes...

Hit a nerve, eh? Seems you are a bit too thin skinned to be hosting a very opinionated blogging, blabbing, gossip column run in your own way and choosing. While you set yourself up to be a target for those with opposing views, it's increasingly clear in your defensive outbursts that you can't handle the idea that others will take you on. All you can do is attack. Just like the do-nothing Republicans in Congress.

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82. Lilly the Pink on March 22, 2010 10:06 PM writes...

The republicans are do-nothing because they can DO NOTHING right now. The democrats own this pile of feces they just grunted out.

Derek, there are more of US than there are of them. Let not your heart be troubled.

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83. Stubbie on March 22, 2010 11:56 PM writes...

To push a bill through the way this one was--gotta get something passed, to protect the president's legacy, for gosh sakes--is no way to bring the country together to deal with an issue of this import. A bill that's 2700 pages long does not pass the smell test. At least it's shorter than the tax code.

Congress doesn't have the guts to tackle funding for Social Security or Medicare, but somehow this is all going to come together and save money? I think not. Massachusetts residents, how's the cost curve bending on your state's version of universal health care? It's going up.

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84. Skeptic on March 23, 2010 1:20 AM writes...

Here's a summary of why this country is going down the toilet.

http://www.alternativeinsight.com/Tulips_of_Stone.html

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85. tav on March 23, 2010 4:52 AM writes...

Echoing previous comments: it in incumbent upon reform critics, particularly one as respected as Derek, to describe alternative solutions that attempt to cover most Americans and protect the insured from arbitrary denial of coverage by insurance companies in the pursuit of further profit. Alternatively, if you don't believe all Americans are entitled to basic health care regardless of means or existing medical conditions you should state that directly. I look forward to hearing your views.

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86. SP on March 23, 2010 7:54 AM writes...

Derek @ 31: Your statement was: "I have yet to hear of a state or federal health care system in this country that has not ended up costing hugely more than it was ever slated to." Yet you just admitted that part D (for whatever reason) was in fact less than it was projected. It's not just part D, one of the links I tried to include pointed out that other (albeit smaller) health care program changes were overestimated as well- Medicare hospital reforms in the 80s, nursing home payments in the 90s. I don't know how to include links without my comment being eaten- google "commonwealth fund CBO health policy underestimated savings."
Re Reconciliation: I agree that if Brown hadn't won they might have gone to a conference committee instead of passing then amending the Senate bill (although maybe not since then they'd still have to keep Lincoln and Nelson on board.) But to claim that the entire bill was structured to hide costs so it could eventually pass via reconciliation is ignorant of what happened. The original House bill, passed in the fall when there were still 60 Dems in the Senate, covered 36M more people, was scored at $859B with a 10 year deficit reduction of $104B. (There was also a Republican alternative that only covered 3M more people and only reduced the deficit $68B.) The core Senate bill that was just passed by the House, which passed the Senate on Christmas eve when there were still 60 Dems, was $849B with $127B in deficit reduction. The reconciliation amendment does improve these numbers, as it legally has to, but the bills were already structured to reduce costs when it still looked like it would pass via conference committee. Sometimes the incentives in the system really do align- they were designed like this because politically they wouldn't have gotten conservative Dem votes, it had nothing to do with "spurious" cost savings to push it "through the budget reconciliation process, without which it could not have passed at all." Your facts and inferences are simply wrong.
I think the reason this and other political posts upset a lot of your commenters (leaving aside the trolls) is because you enter this fact-free zone that is normally ridiculed in your science-related posts. If I came here and said that I had a great drug, it's only 950 Da with 3 biphenyl rings, everyone would point out that existing evidence suggests problems with that claim. Yet here you are, claiming that you know better than the budget experts what's really going on and misstating what actually happened, and evidence and facts have no apparent effect on your beliefs.

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87. Hap on March 23, 2010 10:11 AM writes...

I think the word "contempt" was used in referring to the Democrats' stance and the health care bill in general. I might question whether this bill is an example of contempt, but I'm pretty sure the Republicans have ample experience with the topic. From starting a war on insufficient and misleading information without the forces to wage it properly (and without evidence of the necessity of waging it with what was present), telling the Senate Intelligence Committee to "f*7% off" to deciding that the Eighth Amendment (and the President's oath of office, as well) didn't actually mean what it said, it's clear that the Republicans have lots of contempt for...pretty much everyone but themselves and their paymasters. Considering their time in full possession of the federal governmental organs, it is the only activity at which they have apparently been effective. (And giving money away to wealthy people and campaign donors - but I didn't want to spoil chapter XXXVIII of "Socialism for the wealthy, capitalism for the poor", coming to an unemployment line or tax bill near you, for anyone else.)

While I respect (in a manner of speaking) the Republican Party's encyclopedic knowledge of contempt, I think there is a fair amount of reason to doubt its committment to either the country's best interests or to intellectual honesty as a mental stance. Given that, I'm not particularly swayed by its judgment of contempt.

Oh, and for the economists out there: Why the hell would I trust the judgement of a group of people who've spent the last thirty years pawning the family china to pay off their friends on matters of fiscal sanity? It's like trusting Rush Limbaugh's opinion on preventing drug use, or Liz Taylor's opinions on sustaining a long and happy marriage. Other than its ability not to follow its own (alleged) advice, what competence in economics has the Republican Party shown in fifty years?

It's time to ask EPA to have a look at the water supply, I think.

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88. expharma on March 23, 2010 10:35 AM writes...

Although there will be a lot of sturm and drang regarding this bill and its effects (healthwise, budgetwise), think of it as a transitory phase to single payor with tight cost controls. It is inevitable.

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89. come now on March 23, 2010 12:09 PM writes...

To Lilly the Pink:

When the Republicans had a chance during the past few administrations, what did they actually accomplish for the good of the country? What do they try to do now, except to get in the way?

1) Two wars. One based on imaginary WMDs.
2) Huge governement budget overuns.
3) Fake budgets where the cost of the wars was not included in the country's budgetary deficit.
4) Oversight of the biggest economic bubble & subsequent burst since the Great Depression.
5) Greater economic disparity between those who have and those who don't than the country has seen in 50 years
6) Increased benefits to members of Congress and governement (pensions, special health care, raises). Why are these people not expected to be included in Medicare/Medicaid as part of their health-care future?

One could go on.

At least the Obama administration is willing to stand by their word in making the country better for millions of citizens who need help, particularly in today's world. What would baby Bush do? Get us into another war? Daddy Bush raised taxes (to his credit) after his famous words of "No new taxes". Reagan? It was simply all a sit-com.

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90. Tom on March 23, 2010 12:15 PM writes...

alex@78: well, look, don't take my word for it. I'd suggest googling for some of Robert Berenson's work on the subject. The fact is that the savings will have to come from somewhere. Providing cheaper preventive care; ordering fewer tests; limiting the use of specialists; reducing hospitals' ability to form cartels; these will all be in play, and they're all likely to take a bite out of physician compensation.

I'm sorry that you find the lifestyle of your profession so stressful. It's important to note, though, that this is partly because professional organizations like the AMA have put barriers into place that restrict the supply of doctors. The current equilibrium is unsustainable, and whether you like the stress:payday tradeoff is irrelevant. It needs to change. Obviously we have to find a way to make that happen safely, but it does need to happen.

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91. SRC on March 23, 2010 1:09 PM writes...

fact is that the savings will have to come from somewhere.

Sure. Denying coverage. That's where they'll come from. Forget the rest.

Think about it. An insurance company wants you alive and healthy to continue paying premiums, and then to croak quickly and cheaply.

The government, however, has zero interest in keeping you alive if you're not working. None. If you're retired, you're a straight-up liability. You pay in nothing, but have a call on a lot of expensive services. The ideal scenario from the government's perspective is that you are handed your gold watch at your retirement party, clutch your chest, and slump to the floor, dead. Perfect.

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92. Hap on March 23, 2010 1:44 PM writes...

"Sure. Denying coverage."

At the moment, though, the government can't, but insurance companies can - hence the other tool you (oops) forgot to mention, namely, excluding people who might get sick (and excluding previously healthy people who do get sick). If the government could exclude people from coverage, it would have, because right now Medicare and Medicaid get only the unprofitable people - those who are likely to require expensive care - while insurance companies take those who are likely to be profitable, for as long as they are so. In addition, much of the pool for Medicare and Medicaid are poor people with little political power, so their leverage is significantly less than people under a gov't system that includes more people (and thus a population more likely to include people with power or to gather people who have none but might find otherwise).

Insurance companies have no less of an incentive to want you to die quickly and cheaply than the government would, but they have an alternative - denying coverage - that the government does not. Whereas if denial of coverage isn't an option (because there is no place else to go, and far greater political pressure not to limit coverage than now, when they already can't), preventative care and other tools that might actually lower costs and make people healthier might actually be employed.

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93. Stiv on March 23, 2010 2:12 PM writes...

#84 tav -

Alternatively, if you don't believe all Americans are entitled to basic health care regardless of means or existing medical conditions you should state that directly. I look forward to hearing your views.

From Derek's silence, it seems likely that this is exactly what he believes. It would certainly be consistent with his previous political postings.

So how about, Derek? No reply to tav's posting means that you believe that not all Americans are entitled to basic health care regardless of means or existing medical conditions. If you believe otherwise, say so.


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94. Lily the Pink on March 23, 2010 3:08 PM writes...

#88 come now

The republicans betrayed their conservative roots during the time period you mention. W was a lousy president, not as lousy as the guy we have now. You are wrong when you say Obama is standing up to principle. He campaigned with vague language "hope and change" and people applied to that what they desired in their heart.

If your car breaks down because the alternator went out, you do not disassemble the car, and replace all the parts. You fix the damn alternator. This monstrocity of a bill does that to our current healthcare system. What needs fixing wasn't even addressed in this bill.

The most frightening thing about this bill, now law, is that those who rammed in through do not care about the consequeces of their actions. We don't have the money to be doing any of this. What good do good intentions serve if they result in making matters worse?

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95. SRC on March 23, 2010 3:14 PM writes...

the government can't [deny coverage]

Sure it can. You misunderstood my point. By denying coverage I meant "not paying for the requisite treatment." Sure you'll have a card that says you have coverage; what that means when you need an expensive treatment is the question.

Consider this: what inputs would you expect to the bodies charged with increasing the efficiency of allocation of medical resources? What outputs from those bodies?

My answer: the inputs are the cost of treatment, the improvement in life expectancy, and the quality of life. The outputs are who receives the requisite treatment and who doesn't.

This is the same for the government as an insurance company. But you can't find a government decision. Which is why Canadians cross into the US to receive cancer treatments that the Canadian government will not pay for, because they consider them cost-ineffective.

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96. k on March 23, 2010 3:18 PM writes...

I propose the following method of lowering
government funded healthcare costs:
Have every teabagger on Medicare, Medicaid,
VA, etc. hand in their cards and allow them
the freedom to purchase their health insurance
on the open market.

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97. Hap on March 23, 2010 4:04 PM writes...

Sorry, I misunderstood. They have that now - though, again, it would be hard to use, depending on the limitations, because more people would likely to be affected by changes, and some of the people would be more likely to have political power than now. Also, preventative care coverage would probably reduce the set of things the government wouldn't cover (because if the preventative care was effective, it would be spending less on acute care). The ability to spread risk that doesn't happen now would also help.

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98. alex on March 23, 2010 4:24 PM writes...

"It's important to note, though, that this is partly because professional organizations like the AMA have put barriers into place that restrict the supply of doctors."

I don't have time to argue over the rest, but this is so demonstrably wrong and on EVERY DAMN FORUM on the internet that it makes my brain ache. For the love of god, the AMA has been lobbying for YEARS to expand the number of training positions to create more doctors. IT COSTS A TON OF MONEY, over $100,000 per doctor per training year. The federal government refuses to open more spots because they don't want to spend the money and they recognize that more doctors = more medicare spending. Please stop perpetrating this meme, it makes baby jesus cry.

See (among a million other references): http://www.aamc.org/workforce/aging-workforce-ad.pdf

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99. AlchemX on March 23, 2010 6:12 PM writes...

@alex#97

Wow, did you forget about the Flexner Report? Basically the beginning of regulated healthcare and spiraling costs starting in 1910. Guess who pushed that into the government's hands? The AMA

The AMA dug itself a hole by using the government to control the market for medical personnel so they could get a pay raise. Now they have kiss the rings of every bureaucrat to get even obvious things done. It's a very expensive hole to get out of, I don't doubt that. The AMA would do better to just abolish government imposed rules and actually let the free market work for once. But then they might face competition and get paid less....uh oh for them. Some people might find out they don't need to go to college for all four years to start med school...uh oh.

Does it really take 11 years of costly education to train a podiatrist to cut my toenails? Probably not.

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100. provocateur on March 23, 2010 6:41 PM writes...

Lilly the pink

what would you do if people don't have the car itself....
do not tell me that you want to cut their taxes so that they can go and buy a car !
please stop making excuses for baby bush!frankly i do not know whom to beleive in this health care bill?But I am sure this too shall pass...

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101. AlchemX on March 23, 2010 7:02 PM writes...

I agree with Lilly the pink in many ways. The conservatives made very few attempts to actually fix anything. Did they try to allow competition across state lines between insurers? nope. Did they try to relax regulations? nope. They put up almost no solutions, they just protect the status quo. They should be blamed for that part. But the healthcare bill is more of the same problem. We've had the government messing with our healthcare for a long time in america. There really hasn't been a free market here for awhile and the spiraling costs are the result. Look at our UNIVERSAL EDUCATION system. We still perform lousy against other students in the world. And we are still going to have lousy, pricey healthcare compared to other countries when we get UNIVERSAL HEALTHCARE.

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102. alex on March 23, 2010 7:05 PM writes...

AlchemX: You're right. The conspiracy began almost 100 years ago. They are cleverly continuing the conspiracy to limit their competition... by lobbying to increase the number of doctors. The only way that would not be continuing the conspiracy would be if they were lobbying to abolish medical licensing. Because that is a totally mainstream view widely considered a realistic option by doctors, politicians and the public.

Also, your tinfoil hat is on a little bit too tight.

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103. AlchemX on March 23, 2010 7:38 PM writes...

@alex

Just saying the AMA handcuffed itself. I think the AMA is learning that government has some bad effects (from your ad). They have to deal with their previous (Flexner) issues. They are sincere in their devotion to expand training. But they don't do much to relax the rules, since it's not in their interest.

I think the AMA had a good idea with the Flexner report. The problem is they used the government to impose it.

I understand a lot of us free-market types just get derided as conspiracy nut jobs these days, with kooky ideas and tin-foil hats like you said. It's hard to argue against this extremely complex system of regulation without just looking plain crazy. It's big, it's been there for a long time, it's not gonna change, people's family's depend on it's existence, I know.

Crazy like Yossarian. The sane are insane in an insane world.

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104. Anonymous on March 23, 2010 8:12 PM writes...

I do not know what is the big deal with the cost"??
Its 940 billion over 10 years i.e. roughly 8 billion a month.
You know the cost of keeping a soldier in Afghanistan/Iraq for 1 year? 1 million

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105. Lilly the Pink on March 23, 2010 8:30 PM writes...

#99 Provocateur

First, I make no excuses for "baby Bush." He did a few things right, a lot of things wrong.

Second, if you "don't have a car" then you need assistance. But just because there are people that don't have cars is no excuse for repossessing everyone else's car, crushing them, melting them down, and building new cars for everyone, and sending the bill to the taxpayers.

Just "doing something" is a stupid way to solve problems. What if we did our jobs that way? We would get fired. Which I hope is what happens to most of this pathetic congress and administration, democrats AND republicans. Our representatives are drunk with power and on a perpetual spending spree. If that doesn't stop, our country is doomed.

I am a conservative science educator, which is rather rare. Liberalism DOES have a proud history in science: Kepler,Galileo, Newton, Darwin, they were all "liberals" by the standards of their day. What has happened in the past 100 years is the growth of "progressivism." Progressives have hijacked the democratic party, and the "liberal" moniker. Progressives believe in the power and ultimate authority of the State. It is "Statiism" that is the ultimate evil in the world today, not capitalism. This healthcare bill is a stealth form of Statism. It is an attempt to grow government and government control. If it actually helped to solve some of the real problems with our healthcare system, I would be all for it. As it stands, I can't support something meant only to grow goverment and run up our debt even higher.

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106. AlchemX on March 23, 2010 8:48 PM writes...

Thanks Lilly for clearing up what is actually liberalism. It's sad that statists are getting by calling themselves liberal. A lot of people bought it hook, line and sinker.

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107. Anonymous on March 23, 2010 9:01 PM writes...

Lilly the Pink
Now a Days everybody is giving a lecture on all the 'isms'.I am an immigrant here and I am very conservative wrt to money.So I think above all, I am a fiscal conservative.Bur do not go ahead and lecture me that the 'conservative party' did somethings right with money.Frankly I did not see it in the last 8 years before Mr 'o' came and the only sane guy I see on the other side is Ron Paul.He makes a lot of sense but the others scare the shit out of me.

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108. come now on March 23, 2010 9:15 PM writes...

Ms. Lilly the Pink,
It's obvious that you are conservative. How about getting your analogies right, though. The new legislation would take a part from a car of those with three cars in the garage, not those with one basic unit of transportation. It's about helping everyone in the country have more opportunity due to easier access health care so adults & children alike can do more, achieve more, improve their lives, and contribute more to the country overall.

What is appalling about those who are so selfish that they don't want to help others in this country is that the origin of this country, it's fantastic growth, it's great advantage for people from any background to achieve great things for themselves and the country. That includes many groups of financially or policially, or religously displaced groups. So many soon forget these roots, soon forget their own backgounds, and what they should be giving back for what opportunities they had been given. I only hope that you folks never have to be subjected to such misfortune, personally, where you could benefit from someone else's generosity.

Sometimes, government must intervene to make things right. Civil rights, voting to minorities and women, equal ownership of property outside of white males, and now, a baseline of access to modern health care.

Thanks President Obama. You stand by your word and your commitment to the country. A man of honor and substance.

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109. Lilly the Pink on March 23, 2010 9:22 PM writes...

# 106

I didn't say what I thought W did right. I will tell you that he did practically NOTHING that could be called fiscally conservative.

He did a good job right after 9-11 of bringing the country together. After that, it was downhill for him. NOTE TO FUTURE PRESIDENTS: Don't start a war unless you are attacked.

Look, we've got to get over this idea that true conservatives support the Bush policies. The guy spent like there was no tommorrow. He never saw a spending bill he didn't like. But just as we shouldn't condemn liberals because some of them are "progressive", we shouldn't condemn conservatives because Bush called himself one.

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110. Anonymous on March 23, 2010 9:32 PM writes...

Lilly the Pink
...but as a voter why should I vote for a party that did exactly against what it is preaching now twice in a row?I like Ron Paul because at least was consistent in what he believed was right even when Bush was running the country.The others had their clams shut thruout and now everybody is giving the country a lecture.

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111. Lilly the Pink on March 23, 2010 9:38 PM writes...

#107 Come now

Thank you for putting into words what the mainstream media and Obama himself will not:
"The new legislation would take a part from a car of those with three cars in the garage."

There is another word for that. It is called "wealth redistribution", AKA Marxism.

You need to find a new mode of transportation. Keep your damn hands off my three cars. I worked my butt off to EARN THEM. There are better ways to help those who take the bus every day than take what is rightfully mine. I'll be glad to lend a hand, hell I might even pitch in to buy the guy a Ford Escort. But if your plan is to give the government authority to TAKE parts off my car, you've lost me and the argument.

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112. bd on March 23, 2010 9:50 PM writes...

Come now

'Socialism for the wealthy and capitalism for the poor'
So if Lilly the Pink is a Goldman Sachs board member, he can take my money and pay himself a good fat bonus.Thats okk because that will 'save the country'.

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113. FarmaFan on March 23, 2010 10:44 PM writes...

Healthcare is not a Right. It is a collection of goods and services that needs to fairly paid for like any other good or service. Rights are concepts. You have a Right to Free Speech. You do not have a Right to a government provided computer to blog paid by the taxes of the very few for the very many.

I actually believe in Universal Healthcare access, but paid by honestly and openly disclosed tax increases/productivity enhancements delivered through the private sector. What government provides, it can take away and that is rather risky for your health.

Also, the Doc Fix has everything to do with this costing exercise. There is no point in "having" coverage if a Doctor won't see you or Walgreen's won't fill your Rx. Even the CBO says this bleeds red ink when combined. The CBO scores what it is given (plan and methodology). You give it good crap, it tells you good crap, but it is still crap in the end. Meet the new crap; same as the old crap.

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114. come now on March 24, 2010 7:18 AM writes...

Dearest Lilly, Ms Pink:

It's now come to what I love the most about conservatives who can only provide verbal attacks and traditional criticism. People with little vision and even less ability to show creativity in making this country better. That is, putting everything they yap, yap, yap against into a catagory, some type of traditional or new made up word or phrase that is intended to scare everyone into submission. Marxism...come on now...
As far as I'm concerned, this debate is over. I don't listen or give any credibility to people who's methods of moving forward is to lump everything into convenience-store publication phrases intended to frighten others into submission.

Bye, Bye Missy.

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115. Puker on March 24, 2010 7:20 AM writes...

I know there are a lot of bench chemists and others on this blog involved in the nuts and bolts of Pharma. If any of you were involved in the development of Phenergan, I want to thank you from the bottom of my heart. It took (2) 50 mg tablets, but they did help me overcome the last line of #107 "Come Now's" comments.

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116. cynical1 on March 24, 2010 8:08 AM writes...

"If we don't believe in freedom of expression for people we despise, we don't believe in it at all."

Noam Chomsky

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117. Grey Haven on March 24, 2010 9:48 AM writes...

#113 Come now...

It is obvious that sexism isn't dead in your world.

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118. alex on March 24, 2010 1:12 PM writes...

Alchemx: Sorry for being a bit overly harsh. It's just annoying to constantly read that there's a doctor conspiracy to limit the number of spots when in fact medical leadership is probably far more aggressive in trying to increase doctor numbers than individual doctors would like.

FWIW, I wouldn't get too stressed out about licensing because every day midlevels expand their scope of practice so things are trending in the way you would like. In twenty years you'll probably have a nurse practitioner taking out your gallbladder because government health care's primary concern is finding the cheapest person to do the job. Though you may find yourself wishing for the good old days. Personally I would quit medicine before tolerating the brand of mediocrity that I saw every day at every VA hospital I have worked in. A bunch of people looking to avoid work and count hours until their shift is done... including the doctors. Nobody takes responsibility for anything. Appalling, but probably where the future is headed.

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119. come now on March 24, 2010 1:18 PM writes...

#116:
It is obvious you carry too many presumptions and assumptions around in your head, just waiting to oooozzzze out when there's nothing more insightful to say.

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120. Irish Rover on March 24, 2010 2:32 PM writes...

Seems Lilly is politically incorrect around here. So is her namesake song. It IS apporopriate for a Pharma blog:

Here's a story, a little bit gory,
A little bit happy, a little bit sad,
Of Lily the Pink and her medicinal compound,
And how it slowly drove her to the bad.

Meet Ebenezer, thought he was Julius Caesar.
So they put him in a home.
And then they gave him medicinal compound,
And now he's Emporer of Rome.

We'll drink a drink a drink
To Lily the pink the pink the pink
The savior of [the savior of] the human race.
She invented medicinal compound.
Most efficacious in every case.

Meet Johnny Hammer had a t-t-terrible s-s-stammer.
He could b-barely say a word.
So they gave him medicinal compound,
And now he's seen, but never heard.

And Freddie Clinger, the opera singer,
Who could break glasses with his voice they said.
So on his tonsils he rubbed medicinal compound,
And now they break glasses over his head.

And Mr. Frears, who had sticky out ears.
And it made him awful shy.
So they gave him medicinal compound,
And now he's learning how to fly.

And Uncle Paul, he was very small. He
Was the shortest man in town.
So on his body he rubbed medicinal compound,
And now he's six foot, but it's underground.

Lily died and went up to heaven.
Oh, the church bells they did ring.
She took with her medicinal compound.
Hark the herald angels sing.

KEY C

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121. Frodo on March 24, 2010 3:03 PM writes...

#118 Come now

Calm down. This whole healthcare episode is, to some people, like watching their house burn down. The problem with "social justice" is that it simply replaces one form of selfishness with another. There will never be true justice on this planet, not while humans are in charge.

True justice is a windmill we all like to tilt at. At our core, we are no different from Australopithecus. We have bigger brains, which just makes us more dangerous to ourselves and everyone else. We hunt, we scavenge, we defend our territories. No amount of intelectualizing will ever rid us of that crocodile brain lurking at the base of our skull.

We should strive to better ourselves, but we must be vigilant that our solutions are not worse than our problems.

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122. Come now on March 24, 2010 6:55 PM writes...

Frodo:
A pompous, monotonous monologue.

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123. Frodo on March 24, 2010 9:10 PM writes...

#121 Come now

Well, now that I read my post, it does sound a bit like an Obama speach. My bad.

You win. Go celebrate.

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124. Stiv on March 25, 2010 7:49 AM writes...

Lilly the Pink:

Keep your damn hands off my three cars. I worked my butt off to EARN THEM. There are better ways to help those who take the bus every day than take what is rightfully mine. I'll be glad to lend a hand, hell I might even pitch in to buy the guy a Ford Escort. But if your plan is to give the government authority to TAKE parts off my car, you've lost me and the argument.


Just checking your consistency: given the chance, you'd immediately get rid of Social Security, Medicare, Medicaid, and the progressive income tax, right?

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125. Lilly the Pink on March 25, 2010 9:08 AM writes...

#123 Stiv

Yes, absolutely. The country did quite well for 150 years without any of those programs.

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126. Lilly the Pink on March 25, 2010 10:21 AM writes...

We have always faced problems, we always will. The solution to a given problem is not always a government program.

Growth of government means loss of individual freedom. If you don't mind that, then I guess big government isn't a bad thing for you.

It is for me.

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127. David L on March 25, 2010 10:27 AM writes...

Why is it that those labeled "progressive" or "liberal" allow themselves the moral high ground and "conservatives" are heartless and immoral? If someone doesn't think we can afford more debt with this healthcare why label them as greedy and not caring about others.

How about this: All the people that want to help others can impose a tax on themselves at whatever rate they feel is appropriate and give to whoever you want. In fact, income tax is only a minimum payment...you can always freely send more.

Why is it that those that profess to want to help others are really more interested in forcing others to help? Politicians raise taxes and they themselves are always caught not paying taxes.

I have a coworker that is from the Hippie generation and she's always going on about "oh those poor people blah blah blah...I wish the govt would do something". I said to her "hey, my neighbor lost his job, he has 2 young children, and he can't pay his health insurance. How about you 'adopt a family' and just write him a check every month to help him out'. Guess what....she's not interested. Really???? I thought she was so concerned! Like I said, she's only concerned that others help, but she's on the moral highground. That's BS in my book. Put your money where your mouth is.

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128. come now on March 25, 2010 12:43 PM writes...

To 125 and 126:

Such traditional concepts and statements. Always looking to the past when things were thought to be better, not forward as to how things can be improved for the country as a whole. The same people still expecting to receive and willinging accept their own "due" (social security, unemployment, medicaid etc), but amongst the loudest to complain about cuts in provisions and/or taxing of benefits if income is too high.

The words, statements, context and content, hidden conveniently in the anonymity of postings across the world-wide-web provide much bemusement. The difference between thee and thou, though, is that thee knows that everyone is a hypocrite.

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129. Theo LeSieg on March 25, 2010 12:48 PM writes...

#127 Come now

I would not could not with a fox,
I could not would not in a box,
I do not like it here or there,
I do not like it anywhere!
I do not like the healthcare plan!
I do not like it, Sam I Am!

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130. Stiv on March 25, 2010 1:18 PM writes...

Lilly the Pink:

Yes, absolutely. The country did quite well for 150 years without any of those programs.

You can't just pick one aspect of society from back then, drop it on top of today, and assume that everything will be swell - it is not possible to have a clue how that would work out.

Instead, you get it all so we'll be glad to put you back in the time period - split the difference and make it 1850. You don't have to pay any income taxes or social security/medicare - lucky you! However, you get small pox and polio and all those other great diseases, no anesthesia and antiseptics for operations, poor health and dental care, and likely a short life span (less than 40 yr in the US). Of course you lose your internet and iPod and facebook account and electricity, your latte and most of your food selection, daily hot showers, and yeah, your three cars in your garage too as well as the paved roads they run on. But you do get the return of human slavery so depending on how lucky you are and what race fate put you in, life could be pretty good or could be wretched. Odds are, though, your life is hard, with much manual labor. If you are a woman you can't vote of course but you can have lots and lots of babies, some of which will die at childbirth.

And of course, the federal government and its 'progressive' taxes had absolutely nothing to do with improving any of the above (hint: for one example, see 'Revenue Act of 1862')

So how's that working out for you? Me, I'd much rather be alive today instead of pining for some distorted past seen through rose colored glasses.

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131. Lilly the Pink on March 25, 2010 1:43 PM writes...

My glasses aren't rose, they are o.d. green.

Oh, 1850 it was a very good year. You forgot to mention the infant mortality rate back then.

At least we hadn't started polluting the environment, putting a hole in the ozone layer, cutting down the rainforests, contaminating the soil with plutonium from above-ground nuclear testing, setting fire to the Cayahoga River, melting the polar ice caps, clubbing baby Harp Seals, and causing global warming :) :) :)

(At least there was whaling in those days. Nothing like a Nantucket Sleigh Ride.)

Our government is growing, our freedoms are shrinking.

Government does not have to grow. All of the technology you mentioned was invented by the private sector. I'm glad you like income taxes, because they are about to skyrocket.

Hey, I don't think government is evil. The single greatest achievment of the 20th century was the United States, the country I love, sticking an American flag into the lunar regolith at Mare Tranquilitatus. That was US government money, US contractors, private and public sector, achieving great things. It IS possible for government to do things right.

You cannot tell me that this healthcare bill was done right. Not when not five minutes ago Fidel Castro called the healthcare bill "A Miracle."

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132. jumping in on March 25, 2010 3:31 PM writes...

To Pink,

How much more evidence of living in the past than reference to some obscure statement by Castro as a way to create impact in debate!

Sorry, if it scares you, but the year is 2010. We aren't in 1960 any more.

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133. Lilly the Pink on March 25, 2010 6:15 PM writes...

#131 Jumping in

Because Castro is still a communist. If the communists of the world like the healthcare (law), there must be something wrong with it.

Sorry that I forgot which century I was in. Old age creeping in. I bet I could be your grandmother.

I keep forgetting you young people think History began the day you were born.

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134. Daen de Leon on March 25, 2010 7:35 PM writes...

I've lived and worked under four healthcare systems now, three of them (UK, Denmark and France) socialized to a greater or lesser extent, the fourth (the US) not.

I've had multiple surgeries and a couple of A&E incidents under two of them (UK and Denmark), without paying an extra penny. I admit that the key word here is 'extra' - both the UK's NHS and Danish health systems are funded by taxes - National Insurance in the UK (not originally regarded as a direct tax) and by direct taxation in Denmark. Both systems are very good (around 90% satisfaction in both cases.

But here's the thing; expenditure on UK and Danish healthcare systems is around 8% and 9% of GDP, while current US healthcare expenditure is around 15%. Why do you insist that government involvement means that healthcare costs will escalate, given that at least two governments with excellent universal healthcare systems are able to keep costs below 10% of GDP?

And anyway, isn't the issue here about a basic human right (the provision of universal healthcare), not the costs involved? I am surprised at the self-centered nature of the debate in the US when it comes to taxes: a country with one of the lowest basic taxation rates and highest GDPs in the world, which currently provides the minimum of support for its citizens, really ought to be able to afford to pay for a bit more towards universal social justice.

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135. Tommy on March 25, 2010 7:43 PM writes...

#133

Just where is it written that Universal Healthcare is a human right? The Constitution? The Magna Carta? The Bill of Rights? Who decided this? If it is a basic human right, why isn't it spelled out in any of the aformentioned documents? Was Jefferson simply not enlightened like we are? Or is it that he lived at a time when the thought of a government "helping us" was anathema?

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136. alig on March 25, 2010 8:14 PM writes...

I am just confused at why this is being done at the federal level. Massachusettes did it at the state level. Auto insurance is handled at the state level. Why does the federal government need to mandate this? Isn't that what the 10th amendment was supposed to prevent?

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137. Daen de Leon on March 26, 2010 4:44 AM writes...

Tommy #134:

Those documents also have nothing to say about universal suffrage, sexual equality, freedom from slavery or the right to receive an education. Regardless of the impact that they had at the time of their writing, and whatever relevance they still hold today, social reforms will, and should, progress in directions which could never have been foreseen by even the most insightful and enlightened of the political philosophers of the past.

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138. Daen de Leon on March 26, 2010 5:09 AM writes...

However ... Adam Smith in "Wealth of Nations" alludes to the improvement in workforce productivity that good health brings:

"[T]hat men in general should work better when ... they are frequently sick than when they are generally in good health ... seems not very probable". (p69)

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139. Anonymous on March 26, 2010 7:16 AM writes...

hey guyz

its not about any ideology or rights issue for me..

I just do not want to vote for the republican party after what they did for 8 yrs.I just dont trust them anymore.For a fiscal conservative like me, the republican party has to prove tome that its worth voting for again(unless the D party screws up).If need be I will keep changing my votes in future elections.In the age of the internet, everybody can make up their own minds, nobody needs lectures!For now, the R party is acting like a bunch of hyperactive kids on steroids who are shouting but do not make a lot of sense (except Ron Paul and Mr. Brown)

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140. Tommy on March 26, 2010 7:27 AM writes...

The D party has been screwing up for 80 years.

Social justice leads to wealth redistribution and loss of personal freedom. I can't wait until the government is deciding which foods I can and cannot eat, because certain ones are costing us too much from a healthcare perspective.

Look, Daen, you seem like a reasonable guy. But do you see where this is headed? The path to Hell is paved with good intentions. Government cannot be trusted with this much power.

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141. Me Me Me on March 26, 2010 10:07 AM writes...

You can read the full article over at Bloomberg but here is a summary:

I'm a proud teabagger and "real" American. I want my country back. Say NO to socialism. Government needs to stay out of my life and keep their hands off my medicare and medicaid. Government needs to help me get a job.

Here are some snips from the article:

Tea Party Advocates Who Scorn Socialism Want a Government Job

March 26 (Bloomberg) -- Tea Party activists, who are becoming a force in U.S. politics, want the federal government out of their lives except when it comes to creating jobs.

More than 90 percent of Tea Party backers interviewed in a new Bloomberg National Poll say the U.S. is verging more toward socialism than capitalism, the federal government is trying to control too many aspects of private life and more decisions should be made at the state level.

At the same time, 70 percent of those who sympathize with the Tea Party, which organized protests this week against President Barack Obama’s health-care overhaul, want a federal government that fosters job creation.

They also look to the government to rein in Wall Street, with almost half saying the government should do something about executive bonuses. Supporters are also conflicted over whether private-enterprise elements should be introduced into government programs like Social Security and Medicare.

“The ideas that find nearly universal agreement among Tea Party supporters are rather vague,” says J. Ann Selzer, the pollster who created the survey. “You would think any idea that involves more government action would be anathema, and that is just not the case.”

The activists say they believe the government is on a path to socialism, although they don’t see all federal programs in that light.

Fewer than 10 percent say the Veterans Administration is definitely socialist, 12 percent identify management of national parks and museums, and 36 percent say expanding Medicare for the elderly, Medicaid for the poor and Social Security amount to socialism.

Many more, 65 percent, say Social Security is either definitely or sort of socialism. Even so, almost half, 47 percent, want to keep it under government control or aren’t sure about privatization, with 53 percent in favor of privatizing Social Security and Medicare.

Republicans may be more supportive of some forms of “socialism” than Tea Partiers, with 56 percent saying Social Security is definitely or sort of socialism while just 45 percent say the programs should be privatized.

Republicans and Tea Party supporters are more united in opposition to a government health-care initiative, with 78 percent of Tea Partiers and 72 percent of Republicans saying it is definitely a form of socialism.

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142. Dan on March 26, 2010 10:32 AM writes...

Derek and all the rest of the dissenters,

Could you please explain why every other industrialized democracy has universal health care except the US, the richest country in the world? I thought we could do anything here, except provide health care for all our citizens I guess. And I am sick and tired of hearing this socialism, Marxism even fascism nonsense. First educate yourself about health care in Japan, Netherlands, Germany, France and other countries. This is a good place to start: http://scienceblogs.com/denialism/2009/05/what_is_the_cause_of_excess_co.php. Are we so addicted to American exceptionalism that we can't learn anything from anyone else? We spend twice as much on health care in the US and have worse outcomes. Why? Obviously there is something very wrong here. I don't know if this law will reduce costs. Probably not. But it does do a lot of good things. Something you may appreciate one day Derek when your child is over 21 and has a major illness. I know I think about that for my children.

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143. Tommy on March 26, 2010 10:47 AM writes...

A woman comes up to me and says "We'll have any kind of sex you want, every night for the rest of your life. All I ask is that you let me make most of your decisions for you."

Every neuron in my brain fires at the first part of her statement. Only half the neurons fire over the second part of her statement.

We are being seduced.

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144. tav on March 26, 2010 10:58 AM writes...

#92 stiv

Since we've heard nothing from Derek, perhaps the more vocal "lilly" will provide the conservative view on how to provide health care for sick and indigent US citizens. I suspect that hidden behind the bluster is the view that health care is only for the healthy or wealthy. Very sad.

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145. Lilly the Pink on March 26, 2010 11:16 AM writes...

I haven't had this much attention paid to me since high school (1955 prom...) Funny.

Guess what, Stiv? We should provide those people with healthcare, yes even government-funded healthcare. This isn't an either-or argument.

This bill trashes our healthcare system for everybody, and attempts to re-make it for a minority. Why destroy it for everyone? Why not just fix the parts that are lacking or broken?

Well, by now you know MY answer. That this isn't about healthcare. It is about growth of government. I'm sounding like a broken record. OH, EXCUSE ME... a defective iPod. Got to stay with the times, you know. After all, history is so old fashioned. What could you learn from it?
---former Soviet Union... modern China... present-day Argentina... Cuba... cough cough ------

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146. Anonymous on March 26, 2010 11:17 AM writes...

"Since we've heard nothing from Derek, perhaps the more vocal "lilly" will provide the conservative view on how to provide health care for sick and indigent US citizens."

According the official RNC talking points the answer is simple:

"Personal Responsibility"

If you insist on rephrasing the question, the follow up answer is:

"Let the free markets decide"

If you still haven't gotten the message by now then try:

"Across the board tax cuts"

And assuming they've got you on the ropes by now, the coup de grace:

A $5,000 tax credit and allow them to buy insurance across state lines.

PS. Shhhhhh. Don't bring up the fact that no insurance company is going to insure the sick or poor for 5 grand. Also don't state the obvious that no insurer in Podunk, Arkansas is going to charge the same low premium to a New Yorker as a Podunker. Talking points are just that. Talking points. Keep your pesky facts to yourself.

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147. Lilly the Pink on March 26, 2010 11:27 AM writes...

---- Venezuela, North Korea, Vietnam, Lao People's Republic -----

...Shining examples of socialism/communism and what happens when people stop being vigilant. I know you all think you are right.

Everybody thinks they are right. Hell, Hitler thought he was right too. Somebody is wrong here, though. History is a valid instructor. Don't just blow off the possibility that there is more going on here than an attempt to provide healthcare to people. Do your own homework.

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148. Stiv on March 26, 2010 11:32 AM writes...

Lilly the Pink
All of the technology you mentioned was invented by the private sector.

Right.......DARPA had nothing to do with the internet, the Federal Government put NO money into the Interstate Road system, NIH grants have never lead to any medicinal advances (ignore the >100 nobel prize winners who received NIH money to further their research), the feds weren't involved in rural electrification...blah blah blah

How is it that a self-described scientific educator would make such a blatently false statement?

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149. Lilly the Pink on March 26, 2010 12:35 PM writes...

This is a blog, Stiv, we're not writing papers here. Do you want citations for everything we write? If you have been following my comments that closely, you will also see that I am no enemy of governments, government money, or government involvement (see #130)

Our society in the US has intricately connected public and private resources. For better or worse, there is little that goes on today that doesn't have some government involement in it. This healthcare thing is a several-orders-of-magnitude leap beyond the norm.

I won't nitpick your comments, deal?

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150. Anonymous on March 26, 2010 12:37 PM writes...

Lilly the Pink:
We should provide those people with healthcare, yes even government-funded healthcare. This isn't an either-or argument.

Hell, yes - now you are talking! (Although it does sound an awful lot like socialism....:-)

For that matter, let's have basic government-funded healthcare for all (the rich can buy supplemental insurance of course).

I would have thought that American businesses and their stockholders would have been jumping out of their boardrooms to get healthcare off their books and onto the government's. yet, I heard nary a peep from them other than the Chamber of Commerce who seems to think that government-funded healthcare is some dastardly plot. Go figure.

BTW, I am no youngun either - FWIW, I remember seeing the Beatles on the Ed Sullivan show...

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151. Lilly the Pink on March 26, 2010 12:54 PM writes...

#150 Anonymous-

Ed Sullivan was great. I just can't get into "American Idol." It seems too artificial. That's also why I don't care much for "Survivor" If you really want some entertainment, dump those 16 schlubs on an island and come back in a year. THAT would be entertaining.

Anyway, we've had creeping socialism since day one. The founders of our country feared that more than a standing army. Yet here we are. Could you have a country that is a pure republic, with just the barest of government involvement in individuals' lives? Sure. But you would have to start from scratch.

This socialist train left the station long ago. Healthcare is a jet engine duct-taped to the back of it. Hold on tight.

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152. Daen de Leon on March 26, 2010 9:58 PM writes...

#139: Tommy,

Is it possible to devise a perfect system of government? No. All human systems are inherently flawed, being devised and executed as they are by human beings. So the question then becomes, what is the best practicable system of government which can be devised to offer the best available balance between individual and society? Obviously, there is no single answer to this question. But coming as I do from the UK, and having worked and lived in a number of European countries, I am quite fond of the European social democratic tradition. Taxes are high, to be sure. But in return you get (especially in Denmark, which I am primarily discussing here) free education up to PhD level, free healthcare and a subsidised public transport network. Crime is low, disposable income is high, people are happy. On the other hand, private automobiles are expensive, second homes are heavily taxed and it is expensive to start and run a business. But the political model is very flexible - a proportional representative model - and political engagement is high - typically in excess of 80% turnout every election, even though voting is not compulsory as it is in, for example, Australia.

I wonder why the US so afraid of the Danish model? If you talk to the average Dane, they will not tell you that they feel any the less free than their US counterparts. They will tell you that they may not trust their government, but they are willing to allow that same government to assume responsibility for certain aspects of society, such as education and healthcare and retirement, because they see it as a universal right, and woe betide any politician that talks about turning them over to the free market.

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153. Chris D on March 29, 2010 4:20 PM writes...

Seriously? Fiscal restraint from BushCo? You'd honestly rather have the incredible lies and bad math of tax cuts for billionaires, and the Medicare drug benefit? And starting an endless war that killed hundreds of thousands of civilians, in a country that had done nothing to threaten us? *Really*?

Republicans could have acted like grown-ups and recognized the need for health insurance reform--they were offered so many opportunities to participate and contribute that I started getting angryat Obama for constantly humoring people who continued to piss on his shoes--and probably we would have a better bill. Instead they went for death panels and Obama with a Hitler mustache, and the current bill is all we could get.

It's not perfect, but at least it's in place and we can start fixing it.

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