50 million people are without healthcare and many more undercovered, is that not rationing? In our service oriented nation I would for all our sakes that the person doing the servicing is not sick.

Give me a break. Travel the world. Learn what you're trying to talk about. You sound like a teenager.

Hear hear, or else someone who's afraid they are going to get euthanized! Larry Lindsey hit it on the head this am on CNBC. Scarcity must be rationed. Who does it, the govt or some cranky $35,000 a year HMO clerk under pressure from management flying around the country in their jets with their seven figure salaries? I recently started a business. My partner/fiance, myself and one of my employees have pre-existing conditions. Find private insurance for a growing business that has hired 5 employees in the last three months? get serious, it ain't happening. Not ONE QUOTE even, ay ANY PRICE.

And go back to Against the Gods, and what is risk in the first place. You INSURE against the unforeseen. You FINANCE what is expected. We are not talking about INSURANCE anymore, the days of major medical plans only are gone baby gone. We are talking about how to FINANCE and manage the nations health care. And the system now is broke broke broke. My two brothers are MD's and opted for academic careers rather than deal with the cr*p that is the insurance system. Full disclosure: I was able to retire early on money I made in an Insurance stsrt-up. Health and major chunks of the P&C inudstry should be nationalized. Now.

Every one uses the UK health system as the "gold standard" of free medical care. Anyone who has had experience with it including the Bris and anyone else in Europe know that it is a terrible system. Why doesn't anyone cite Germany, France, Switzerland, Belgium, Italy,Spain and on and on. I spent 35 years as a pharma execdutive and everyone knows the British system stinks. I agree there is much that can be done by the individual patient by giving him access to someone other than the MD and or letting him get some maintainence drugs on his own with minimal supervision.

Another question no one has asked is why are there 23 beta blockers on the market for example. Most drugs like these are whats called "me too too late." Even thought the pharma company has missed the market by coming out with the 15th rendition of a drug with marginal or no improvement, they still had to invest enormous sums to get the FDA approval. They just wanted to get an oear in the competitive water and will never recoup a profit. We are paying for this in the cost of their other drugs. Finally many of the drugs we take for granted in the US were on the market overseas for years before they were licensed into the US. Ex. motrin, loressor. Yet the pharma companies had to redo all the studies as if the drugs were just discovered. Why can't the US accept Swedish or British data and thereby lower the cost of getting these drugs to market.

The current system is already rationing.
And, it's not just the people without insurance or without the money to make all the copays.

I know several people in the US with "good" insurance plans and plenty of money who waited years fighting with insurance companies to get their needed surgeries.

The biggest problem is for people, like my wife, who cannot buy insurance because of a preexisting condition. If we ever lose our jobs long enough to lose COBRA (or not be able to afford it), we will learn what rationing really is...

Our experiment in health care in this country is a lot like social Darwinism; survival of the fittest. Without any changes, you better hope that you aren't below the middle of the pack.

Perhaps suggestions on how to improve the proposals or avoid "rationing" would be more productive than saying it can't work.

Good point. When i was in Germany, i obtained otc products that you would need a prescription for in the u.s. Time to break up the u.s. drug cartel.

I believe we already have rationing. Some people have extensive health care and some people have none. A single-payer system would provide a minimum level of care for everyone, and still allow those financially able to go to a specialist or out of the country for specialized or more expensive treatments. I would prefer such a system to the current have/have not rationing we now have.

I'm surprised healthcare plans don't offer the option for medical vacations. Almost everthing else in the country has been outsourced, why not med care?

Mr. Willy.
Is that how you talk down to teens or just everyone...quality.
James has an excellent thought on possible meds solution.
However this teeny brain has difficulty with why a specialty graduate
incurs 300k+ w/interest in student loans. Also mystifying is
that our mighty problem solving nation is unable to ramp up
General Practice physicians in order to meet supply.
Being an inquisitive teen I probably shouldn't push to hard, you
might not let me borrow the car. But know this, if you continue to make it inaccessible... I'll just take it, but hey you got insurance.

Fifteen years ago my Ca Blue Cross health insurance cost $2760 per year. I did not need preaproval, many doctors and hospitals accepted my plan and we seldom had to challenge their decisions. Now we pay $11,000, Many providers will not accept our coverage, and we have to appeal decisions on a regular basis. Medicare and insureres limit your access to expensive madications and supplies, and your doctor doesn't tell you because he may be capitated and make more money the less he spends. Also, even if you have good coverage, Medicare requires that their patients receive the same level of care as private insurance patients, so your provider limits services to you ,rather than subsidizing Medicare patients.

Doctors have full time people in their offices whose only job is to negotiaate with insurance companies. Speaking of insurance companies, they take 6-10% of your premiums. What value do they add to your care? Their goal is to deny you service and abandon you when you get sick. We have the most expensive healthcare in the world and yet we are not in the top twenty for many measures of health. We don't cover all citizens and we allow people to be driven into bankruptcy by medical bills. If you want to find out about healthcare in other countries see these videos before you speculate how effective they are.

http://www.experiencefestival.com/forum/Video-Viewing/xxIOScgO-W0

American healthcare is technologicaly advanced, but often poorly coordinated and very expensive. What is it that you think are the parts of this system you want to preserve?

So, he's right: there is endless demand for free health care.

On the other hand: We ration health care already, we're just not up front about it and frankly, it's a little random. It did not discuss the problem of spending hundreds of thousands of dollars on end of life care for 1 person when the same money could provide vacations and/or health solutions in hundreds younger patients.

The other issue that is totally missed here is that most of the chronic diseases outlined here are modified through *lifestyle* changes, not through drugs or the medical system. The FDA food pyramid is a nightmare in that regard (a diet too high in grains/processed food being a major cause of both diabetes and heart disease), but I have to admit I also get impatient with the idea that since Freddy doesn't want to get his butt off the couch to exercise, that I get to help pay for his 2nd double bypass surgery.

What it boils down is we have an expensive system in part because we ask our oddly and expensively trained doctors to "fix" everything for us. We want to pop pills instead of eating right and exercising. And please, please don't make us grapple with the difficult decision such as whether it's right to perform expensive surgery on 91 year olds. When you ask others to fix all your problems for you, it's bound to be expensive.

"Also mystifying is
that our mighty problem solving nation is unable to ramp up
General Practice physicians in order to meet supply. "

You are aware that US medical schools deliberately control the number of students admitted each year to keep salaries up, right?? I have read that there have been years when the Federal government has paid medical schools not to train physicians. Vet schools do this too, so I'm not singling medical schools out.

There's also zippo reason for a medical student to obtain a 4 year degree to go to medical school, and I'm pretty sure there's a year or two we could shave of med school, too. In short there's no reason for physician training to be the intensive, expensive 12 year process that it is and indeed in other countries it is not so long. The AMA does a fabulous job of ensuring that seeing a "real" doctor will be rare experience.

Also, American doctors have worked very hard to keep a monopoly on prescription writing. A high school friend of mine is a pharmacist in Germany and she is allowed to give out drugs for minor aliments that would be prescription only here.

Amy,
Thanks very much for following up on that point. I was aware of the AMA involvement. The thoughts you have for unraveling some possible solutions
are sensible and authentic. Legislative history recognizably shows lthat dollar denominated influenceve beyond what is justifiable has taken its toll on our heath system. Seemingly an open public network that provides many alternatives, real solutions and ways in which they may be paid for (the real controversy) by all participants is much warranted.

I'm an American health care exile living abroad in Riga a good part of the year. I can't live in the US with my Latvian fiance without health insurance, which is completely unaffordable in the US for the self-employed. Full coverage (25 GBP deductible with no co-pays) expat health insurance costs $2550/year; for just in-patient coverage with a travel option which includes visits to the USA of up to 90 days, $1813 with the same deductible. in the US such a policy doesn't even exist.

I have a friend in London making a fortune (15000 GBP/month), while in France he was un or under-employed as a doctor (and got an American MBA as a result). Why? The French government sees to it that medical schools churn out doctors who compete with each other and hold down costs. In France Hippocrates meets Adam Smith; the govt sets the reimbursement rate and patients choose their clinic or doctor at more or less that price, whether or not they have insurance. I paid 60 euros for a visit with a great orthopedist in Paris who in NY would have cost 4 times as much for a less attentive shorter visit. In provincial Albi, near Toulouse, the waiting period for a triple bypass is 8 days. How do I know? A patient's wife told me.

My mother needed treatment for a dislocated shoulder while visiting me in Lecco, Italy in 1996. No forms, no credit cards, caring personable doctors and never a mention of money. Health care in Italy is a fundamental human right, even for foreign tourists.
When a Swiss friend visiting Hawaii about the same time had an emergency, the first question was about a credit or insurance (he had insurance).
In Utah, First Aid at Alta wouldn't even look at my friend's injured daughter without a $500 deposit and a credit card. This is barbarism, plain and simple.

Three years ago an American friend of mine living in Tallinn had an asthma attack requiring an ambulance, 6 days in the hospital and major treatment. The bill for a foreign resident contributing to Estonia's social security system: 65 euros. Estonia's GDP per capita at the time: $14000, less than 1/3 the US.

In the US we have the worst of both worlds, collectivism with central planning by insurance co. accountants and and predatory capitalism with no free market, but a rigged cartelized market with no anti trust rules except those made by the insurance-big pharma-AMA cartel.

Both the US and UK should outsource their health care to France.
It is an obscenity that a relatively poor country such as Estonia has a better health care system than the USA.

I want Obamacare to use predatory pricing to compete with private insurance and raise the supply of doctors to lower costs. A new national health plan should include government financing the medical education of tens of thousands of students who sign up to work at a fixed salary for the government health service where the patients most need them to work. So we'll raise the supply of doctors who are debt-free and more motivated to treat patients and do research, instead of feeling they have to make tons of money to pay off debt. I prefer to be treated by doctors motivated altruistically by service, not their next Mercedes. That's the way medical care, which is a fundamental human right, should be.

If you want to know how to run a health care system, travel. France, Central and Northern Italy, Holland, Estonia, Canada, Finland....take your pick. Abstract economist's theory can't compete with empirical data and personal experience--come and need treatment where I've lived or needed it, and you'll see.

Yours truly,


Lester Golden

Statins may not be the wonder drugs they are portrayed to be in this article.

A family member of mine suffered ALS-like symptoms from taking statins (Zocor). Researching the problem lead me to the People's Pharmacy, a site run by two Duke University Medical Center faculty -- a pharmacologist and his wife, a medical anthropologist. The following is a blurb from their website on statin drugs:

"We can think of few diseases that are more dreadful than ALS (Lou Gehrig's disease). Losing muscle control to the point of total paralysis takes an incredible toll on the patient and the family. We speak from personal experience. A beloved member of our family died from ALS many years ago, so this is not an academic exercise for us.

Several years ago we started hearing rumors about an association between cholesterol-lowering drugs called statins and ALS. At first we rejected this as gossip, rumor and innuendo. We talked with Duane Graveline, MD, about cases he was collecting (see below) and we talked with Beatrice Golomb, MD, about her own research in this matter. We also interviewed Ralph Edwards, MD, Director of the World Health Organization's drug-monitoring center in Uppsala, Sweden about a link between statins and ALS-like syndrome. Extended interview with Dr. Edwards (August, 2007): http://www.peoplespharmacy.com/2007/08/02/extended-interv-3/

Many cardiologists and other physicians could not swallow this idea. Nevertheless, many patients have reported a connection between taking a statin-type medicine and the development of ALS-like symptoms (see comments below). And now there is a new publication from Beatrice Golomb, MD, and her colleagues (Amyotrophic Lateral Sclerosis-Like Conditions in Possible Association with Cholesterol-Lowering Drugs: An Analysis of Patient Reports to the University of California, San Diego (UCSD) Statin Effects Study, Drug Safety, Aug. 8, 2009) http://adisonline.com/drugsafety/pages/currenttoc.aspx

We suspect that there may be individuals who are highly susceptible to muscle pain and weakness brought on by statins. This could be as many as 10 percent of those who take such drugs. There may be a much smaller group that is susceptible to a far worse reaction called ALS-like syndrome.

The FDA has dismissed our concerns and concluded that there is no connection. We certainly hope the FDA is right. If the agency is wrong, however, a terrible tragedy could be unfolding because people in authority have ignored the early warning signals of danger."

Much more info here: http://www.peoplespharmacy.com/2009/07/31/statins-and-als/#

Lester, your experience in other countries is revealing. I took away the feeling that every country takes better care for less. Now the Adam Smith in me wants to turn the coin over and ask: What is in it for the Doctors who perform for these very reasonable sums? I am prone to fabricate my own answer to this: subsidies. The token charge made at the point of service is to prevent the national pastime from becoming hypochondria! Please tell me I'm wrong!

Dang, and here I was wishing for an argument about some of the statements I made earlier. ;)

The fact is that there is no "safe" drug including aspirin. Your points on Statins are well stated and are rational concerns. I've also read concerns that certain statins can induce mental issues (forgetfulness, mental "fog"), where none existed before.

The sad part is that, from what I've read, the actual beneficial effect that most statins may have is to simply raise the levels of vitamin D in the body, a vital nutrient. Vitamin D is something that could be easily, cheaply, and much more safely achieved either through supplements or simply consistent outdoor/sun time.

... is better than no health care at all.

I agree about the clinics -- good idea.

But the fact is, every developed country except the US has government-subsidized health care. And most of them spend much less than we do in the US AND have better health-care statistics.

Check out this link

http://www.americanthinker.com/2009/08/obamacare_and_me.html

Single payer would work if the game isn't rigged and the goverment can negotiate prices like the private industry can without incredibly byzantine pricing schemes (usually based on AMP and a mix of almost incomprehensible rebate policies) currently in place for our largest single payer entities - Medicare and Medicaid. However, a public option would be a start. The for-profit industry needs to stop whining, in some parts of the country it is already competing with relatively affordable quasi NPOs (Kaiser comes to mind).

The bigger issue is why why insist on keeping a vital national concern part of the free market. Some things just don't belong there. Despite the best efforts of our last administration, the majority of our military operations are government run, so is the planning of most of our infrastructure and our domestic security (such as police and fire) at a combinations of federal, state, and local levels. Talk of privatizing those essential services is still relegated to the crazy corner.

Pharma is a little more complicated, not even fully committed social democratic states have nationalized biopharma industries. However, it isn't fair that Americans shoulder the brunt of the cost for Pharma to generate profits in the open market. More investment in public private partnerships in this area may be necessary to offset lower drug prices if we ever get the courage to do it.

For someone who doesn't have any health insurance or is dropped because of pre-existing conditions, a government plan would make sense. At least the person would be covered for healthcare.
So you Republicans can keep your private system with all the profit mongering going on by the insurance companies. Some of us want another choice. We'll go with USPS and you can keep your FedEx.

sez more about narrow weallths ideology and where you sit.
It's O.K. though, your honesty shines through...thanks

Apologie for the delayed reply. Why the US gets less for more:
1. A cartelized, uncompetitive insurance mkt. in which states have laws restraining out of state insurers from competing.
2. A cartelized limited supply doctors mkt in which the AMA prevents incompetent drs from being disciplined and limits supply.
3. The gangsters of big pharma lobby to prevent the govt from negotiating bulk discounts and allowing cheaper imports from obviously safe countries like Canada and France.

Other countries have made single payer work for 35-50% less as a % of GDP. It's a blatant fallacy to say it couldn't work in the US, if we used the same combination of market mechanisms and disintermediation that Holland, France, Germany....take your pick.....use. I, for one, don't want to wait 11 years until I'm 65 to get the health care our seniors get. Take back the 30% of our 16% of GDP now going to insurers, unnecessary admin and overhead and negotiation-free Big Pharma, and single payer is affordable. There's a long menu of options available, from the health savings accounts in Singapore, to the market based French reimbursement system, to choose from. What is truly nuts it to choose to do nothing, which is both barbaric and economically suicidal.

Lester Golden

"On the other hand: We ration health care already, we're just not up front about it and frankly, it's a little random. It did not discuss the problem of spending hundreds of thousands of dollars on end of life care for 1 person when the same money could provide vacations and/or health solutions in hundreds younger patients."

This is basically the "death panel" issue that so many insist does not exist. Yes there is rationing by the market. In my opinion it is better done there than by government so people have some control and can choose their priorities and not be chosen for. This also eliminates the possible waste and corruption of government and preferential treatment of the politically connected.

The prescription drug problem is real. Why should we all pay $100+ every time we get a cold to go get the same meds we are always prescribed. The docs are adament about retaining this drug dealing monopoly, but it is critical to lowering healthcare costs. This is a reform worth pursuing. Government takeover of the healthcare industry is not. They have done enough harm. People bemoan the high cost of insurance, but that is what quality care costs. Even if you took out the 6-7% profit of the insurers most people would still think it costs too much and demand subsidies.. Those with demands need to remember that someone always foots the bill and they are forcibly taking the fruits of others labor.

Why not demand a government takeover of housing and food while we are at it? These are necessities and getting more expensive by the day. The rate at which Americans will relinquish their freedoms is frightening.

Your numbers vastly overstate the problem. Most estimtes put the uninsured at 10 - 15 million less than your estimate when you do not count the people in this country illegally. Some of those uninsured also choose to be, This is a very low rate and no reason to increase the size and power of the federal government unless that is really your goal. I think there are other affordability issues that could be addressed that make more sense and do not increase the power of the feds. Breaking the prescription drug monopoly of doctors would be an excellent start. Allowing greater insurance co. competition would also be beneficial. Why not start with these and see what progress can be made without creating a massive new nanny bureaucracy to lord over us (and creating it without almost no public discourse by ramming it through congress without many congressman even reading the bill). A lot of you on here also talk about the inefficiences of insurance companies (profits, marketing, compensation). The government is notorious for inefficiency so why would you think they would do any better. Remember the $50 hammers and $500 toilet seat covers?
Believing the government is really here to help could be very dangerous to your health.

Also - when did the wants of individuals in this country become the responsibility of other taxpayers? This is a very slippery slope, and time we quit going down it. The country is already broke and can't prossibly pay the obligations of previous entitlements.

Thanks for the time and responses Amy. Good work.

I look at it this way:
If the government requires insurance companies to provide coverage, then people will only buy insurance when they need it. The insurance companies know this, so they get the government to require everyone to buy health insurance all of the time to spread the risk and guarantee profits. It's a tax that's paid to the insurance companies instead of to the government and it's an inflated tax. The choice is between Mussolini style fascism and socialism.
We would be somewhat better off, I think, if the people who claim to do certain jobs actually DID those jobs: like represent the interests of the actual people who elected them.

Yes, I remember the 500 dollar toilet seats and 50 dollar hammers. They were custom-made devices to fit government specs, which were really written by the contractors themselves because the government employees were too lazy to do their jobs, charged at cost of machining plus 4% to the government. They have been replaced by $500,000 American Flags in front of insurance companies that inflate their expenses with landscaping, marble halls, and corporate Jaguars, as well as 1.7 million dollars per day in lobbying money.

I agree. Why NOT start talking about a government takeover of housing and food. Such as the Dairy industry's hold on the USDA and outlawing of farm-processed foods. How about the National Electrical Code, written by electrical contractors to include the most expensive ways to build a house under the guise of 'safety'. It is illegal in most places now to build a house yourself and install minimal or no electrical wiring.
Let's talk about Monsanto's genetically modified foods that you don't even know you are eating because farmers aren't allowed to label their foods "GMO free" or "rBGH" free.
Let's talk about the food pyramid, which is based in processed grains where the farmer gets 2 cents on the dollar for every dollar spent by the consumer, but the farmer can't grind the grain and sell it as food without massive investment in processing, paperwork, and certifications which are only viable for large, centralized facilities that set up with government subsidies.
Let's talk about an education system where almost all of the decent paying jobs require a college education, but that college education doesn't even teach how to do specific jobs: those skills are learned AFTER college.
Let's talk about the ACTUAL cost of going to the hospital if you don't have insurance. You receive a bill for some but-number with lots of zeros after it. If you have insurance, the insurance company negotiates the bill down to a 10th of the original. If you don't have insurance, you file bankruptcy or pay for the rest of your life.
Let's talk about all of the new 'competition' in hospitals, which are being built in the exurbs of cities to guarantee that poor people who don't have enough money for a car can't show up in the emergency rooms.
Let's talk about 'Grandma': who is declared 'mentally unfit' with a wink and a nudge so that she can get into the 'rationed' Nursing home.
Let's talk about doctors who are Mad as Hell because they are taking the blame for the high cost of care when the high cost is what's making corporate shareholders (who obviously have insurance) even richer than they already are.
Let's talk about revolution when people are fed up with the lies and the profits from their pain.