Uncategorized

Why Medicare Isn’t the Problem, It’s the Solution

• 200

By ROBERT REICH

I hope when he tells America how he aims to tame future budget deficits the President doesn’t accept conventional Wasington wisdom that the biggest problem in the federal budget is Medicare (and its poor cousin Medicaid).

Medicare isn’t the problem. It’s the solution.

The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That’s almost two and a half times the average of other advanced nations.

Yet the typical American lives 77.9 years – less than the average 79.4 years in other advanced nations. And we have the highest rate of infant mortality of all advanced nations.

Medical costs are soaring because our health-care system is totally screwed up. Doctors and hospitals have every incentive to spend on unnecessary tests, drugs, and procedures.

You have lower back pain? Almost 95% of such cases are best relieved through physical therapy. But doctors and hospitals routinely do expensive MRI’s, and then refer patients to orthopedic surgeons who often do even more costly surgery. Why? There’s not much money in physical therapy.

Your diabetes, asthma, or heart condition is acting up? If you go to the hospital, 20 percent of the time you’re back there within a month. You wouldn’t be nearly as likely to return if a nurse visited you at home to make sure you were taking your medications. This is common practice in other advanced countries. So why don’t nurses do home visits to Americans with acute conditions? Hospitals aren’t paid for it.

America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.

Meanwhile, administrative costs eat up 15 to 30 percent of all healthcare spending in the United States. That’s twice the rate of most other advanced nations. Where does this money go? Mainly into collecting money: Doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policy holders.

A major occupational category at most hospitals is “billing clerk.” A third of nursing hours are devoted to documenting what’s happened so insurers have proof.

Trying to slow the rise in Medicare costs doesn’t deal with any of this. It will just limit the amounts seniors can spend, which means less care. As a practical matter it means more political battles, as seniors – whose clout will grow as boomers are added to the ranks – demand the limits be increased. (If you thought the demagoguery over “death panels” was bad, you ain’t seen nothin’ yet.)

Paul Ryan’s plan – to give seniors vouchers they can cash in with private for-profit insurers — would be even worse. It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.

So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.

Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced.

Let me say it again: Medicare isn’t the problem. It’s the solution.

Robert Reich served as the 22nd United States Secretary of Labor under President William Jefferson Clinton from 1992 to 1997.  He blogs regularly at Robert Reich, where this post first appeared.

Categories: Uncategorized

Tagged as: , ,

200 replies »

  1. I guess this is my first visit here and I always love it. I am going to be a frequent visitor here. Love your writing style. Thanks for this wonderful tips. Even though I am not very good with writing I can see where you are going with the suggestions.

  2. Student Discounts, ASE certified, AAA approved
    http://garysservicecenter.com
    We understand motor vehicles are not immortal. They would soon break down and be requiring a decent auto repair service. That’s the reason why it’s necessary to send the auto to an established support center to obtain the best results.
    Auto Repair, Car Repair

  8. seattle dentist, seattle best dentist, downtown seattle dentist
    http://www.thebestdentistseattle.com
    The Best Dentist Seattle – A Directory of Dental Professionals and Services In Seattle, Bellevue, and King County
    find dentist seattle, best seattle dentist

  9. Thanks for the article. It will be interesting to see how this all shakes out in the coming months. Time will tell.

  12. Secure Paper Shredding, Document Shredding
    http://www.proshred.com/georgia/services
    PROSHRED provides paper shredding services in Ga for business, medial, financial, legal, office at home and residential shredding requirements. Call for a free estimate.
    Paper Shredding

  13. dentist Nepean, Merivale dentist, Adel Sidaros
    At our practice, we believe that excellent dental care is achieved by offering patients choices. We endeavour at all times to inform and educate you, so you can select a course of treatment that suits your needs and lifestyle.
    http://merivalemalldental.ca/
    dentist ottawa, cosmetic dentist ottawa

  14. first aid kit, survival kit, doomsday prepper, prepping supplies
    http://outdoorsandsurvivalguide.com
    Tactical survival gear-Survival and Prepping are in huge demand and this is your chance to prepare yourself and your family from doomsday! Outdoors and survival guide will help you find the right tool, kit, gear, equipment, first aid and food for you to be prepared!
    outdoor survival guide, survival and prepping, wilderness

  15. fencing panels, garden fencing, lattice wooden fence panels
    http://www.farmac.co.uk
    Farmac Timber & Building Resources present you with a variety of fencing products – fence panels, lattice, gates, timber posts and materials, fence supports and fixings, and much more. Based in Pudsey, Farmac deliver to Leeds, Bradford, Halifax, Wakefield and Huddersfield.
    wooden fencing, wood fence panels

  16. Money Mailer Direct Mail, direct advertising, online direct advertising
    http://moneymailercarmichaelfairoaks.com
    Direct mail made easy. Complete direct mail services nationwide. Letters, postcards, coupons, mailing house, printing, mailing lists, bulk mail.
    direct advertising help, moneymailercarmichaelfairoaks.com

  17. click here, medisoft v19, document for medical billing software
    http://issuu.com/insurancebillingsoftware/docs/medisoft_v19_info
    Medisoft Software can serve to help you handle the transformations. With Medisoft v19, you can take benefit of several features that are created to minimize manual entry and minimize the complexness of ICD-9 to ICD-10 mapping. With this release, medicinal office and clinics will be able to:.
    website, more info

  18. ac service Pasadena, air conditioning contractor Friendswood, air conditioning service League City
    Need immediate air conditioning or heating service-repair? Call Vanderford Air today at 281-724-7578. Free estimates for a/c replacement.
    http://vanderfordmechanical.com
    air conditioning repair Pearland, HVAC service Galveston

  19. styvesphotos.com, Stevesphotos, photographers ottawa
    Professional Portrait photographer Ottawa executive photography. headshots. commercial business portrait corporate event photographer real estate Call Steve (613)8638519 for
    http://styvesphotos.com
    photographers ottawa website, professional photographers ottawa

  26. cheap auto insurance, best insurance Jacksonville Fl, FL Home Quotes
    FLHomeQuotes.com – Free online FL homeowners insurance quotes. Call Matt Moss for a FAST Florida home quote and start saving on your Florida home insurance now!
    http://flhomequotes.com
    flhomequotes.com, auto insurance Jacksonville Fl

  27. online real estate laguna beach, Old Newport Realty, real estate laguna beach
    Old Newport Realty | Newport Beach Real Estate | (949) 298-4888
    http://oldnewportrealty.com
    oldnewportrealty.com, real estate for sale

  28. Rice Camera Technologies, best industrial camera, affordable industrial camera
    Rice Camera Technologies Home Page, supplier of CCD, CMOS, and infrared cameras for military imaging, scientific, and Industrial inspection, Unique IR, Military Cameras, hyperspectral, machine vision, megapixel, CameraLink, GigE Vision, and NIR-SWIR imagers
    http://ricecamera.com
    industrial camera, ricecamera.com

  29. Money Mailer Direct Mail, online direct advertising, direct advertising
    Direct mail made easy. Complete direct mail services nationwide. Letters, postcards, coupons, mailing house, printing, mailing lists, bulk mail.
    http://moneymailercarmichaelfairoaks.com
    moneymailercarmichaelfairoaks.com, direct advertising help

  30. make money online fast, passive income opportunities, passive income opportunity
    http://youtu.be/mRIu_ZO3h6s
    How to get unlimited $20 bills stuffed in your mailbox or Paypal account, without having to pay a dime, and without selling a thing!
    make money online free, ways to make money online

  32. online wholesale clothing women, wholesale clothing women, cheap wholesale clothing women
    http://wholesalelookup.com
    Wholesale Dropshipper Directory. Are you are searching for the right product and supplier for your online store or brick and mortar storefront, but just have not been able to find it? Are you looking to make a large profit from selling products online, but can
    wholesalelookup.com, wholesale lookup

  33. myob hints, creating a new payroll category
    http://youtu.be/M9s1mtY4UXw
    In this video we will look at how to create a new payroll category in MYOB and assign individuals to that new category.
    myob payroll category, myob tips

  34. head shot photographer Dana Point, quality Photographer Dana POint, Jack Randall Photography
    Jack Randall provides professional wedding, engagement, portrait and event photography to all of Orange County, including Laguna Beach, Newport Beach and Dana Point as well as San Diego. We commonly shoot St. Regis Monarch Beach, Montage and the Ritz-Carlton.
    http://jackrandallphotography.com
    jackrandallphotography.com, head shot photographer Dana Point online

  35. veterinary hospitals scottsdale, near veterinary hospitals scottsdale, hopianimalhospital.com
    http://hopianimalhospital.com
    Scottsdale Veterinarians, Scottsdale Animal Hospital, Hopi Animal Hospital
    hopi animal hospital, affordable veterinary hospitals

  37. cheap boat rental, ozarks boat rental, Iguana Water Sports
    http://iguanawatersports.com
    Boat rental lake of the Ozarks- Call Us 1-888-773-2199 Iguana Water Sports rental offer Lake of the Ozarks boat rentals at the Lake of the Ozarks. Make your trip to Lake of the Ozarks condo rentals even more enjoyable. There are many choices for boat rental at Lake of the Ozarks. It includes Lake of the Ozarks Boat Rentals, Lake of the Ozarks vacation rentals, Lake of the Ozarks vacation rental, ozarks vacation etc.
    best ozarks boat rental, iguanawatersports.com

  38. find Health Insurance Agency, Triangle Health Plans, get health insurance
    http://trianglehealthplans.com
    Instant Health and Life Insurance quotes for Raleigh NC and all of North Carolina. Long Term Care, Vision and Dental Insurance too.
    trianglehealthplans.com, Health Insurance Agency

  39. cheap party magician, Birthday Party Magician, jmmagic.com
    http://jmmagic.com
    John Measner Magic |birthday, john measner | Birthday Party Magician
    John Measner Magic, professional Birthday Party Magician

  40. High Traffic Academy, Web, Money, Massive, Dave Wood, BIM, Blog, Traffic
    I’ll show you exactly what I did to earn $710K in less than 30 days. Right now this pulls $12,485 per DAY on average. And it wasn’t a “launch” of any kind… No JV partners. No affiliates. Heck, we didn’t even have a website or our own product… And we spent exactly $0 on marketing! Average, ordinary folks are making thousands DAILY after watching this training and the best part is it’s 100% FREE and there is nothing for sale. Model this for YOUR business and prosper. It WORKS.
    http://www.bimtrafficsystem.com
    Dave Sharpe, Vick Strizheus, Empower Network, Big Idea Mastermind, Online, Cash, Fast, Earn

  41. find hotel palm springs, indianwellsresort.com, luxury hotel palm springs
    Indian Wells Resort is one of the best hotels in Palm Springs California. A true boutique hotel with luxury accommodations, golf vacations, and restaurant… 1-888-714-0060
    http://indianwellsresort.com
    Indian Wells Resort Hotel, best luxury hotel

  42. find divorce lawyer, professional lawyer riverside ca, California Mediation Solution
    http://californiamediationsolutions.com
    Divorce Attorney and Certified Divorce Mediator, Laura Rosauer, in Riverside, CA providing mediation for a more affordable divorce solution that keeps you out of court. Even with complex custody issues, mediation from an attorney can save you time and money.
    californiamediationsolutions.com, divorce lawyer riverside ca

  43. POlar heating Inc, cheap ac repair show low az, showlowheatingandairconditioning.com
    Heating & Air conditioning Services, Air Conditioner Repair & Install Furnace Repair & Install Polar Heating Inc. in Show Low, Pinetop, Lakeside, Snowflake, Taylor, Heber
    http://showlowheatingandairconditioning.com
    ac repair show low az, ac repair services

  45. Deep Confessions, learn internet marketing ebooks, Learning About Marketing with Ebooks
    http://www.mambofestival.eu/?p=221
    Today people are constantly looking for ways to go into business for themselves. A new mode of business that people are going into is internet marketing.
    free internet marketing ebooks, free internet marketing ebook library

  46. kick start your online internet business, free internet marketing ebook library, free internet marketing ebook giveaway
    http://buraqinspirations.com/?p=138
    When you read through a marketing ebook, you can also learn strategies for connecting with your customers through social media.
    learning about marketing with ebooks, learn about marketing for your business, internet marketing ebooks

  48. free internet marketing ebook library, virgilio clemente jr, learn internet marketing
    Find everything you need to learn Internet marketing techniques with a set of free internet marketing ebooks. Providing needed information at the touch of a button or click of a mouse, these free ebooks will bring you up-to-date on a variety of topics. They cover areas you may not have considered in your marketing plan, and are an essential tool for the Internet entrepreneur who wants to take their business to the next level.
    https://www.youtube.com/edit?ns=1&video_id=SeJL_E_dfAc
    internet marketing ebooks, free internet marketing ebooks, learn internet marketing made easily

  49. guide will, ranked grandmaster player, shokz guide, video, shokz, animoto
    http://youtu.be/3rfN0VM_Omg
    The Shokz StarCraft 2 Guide is a detailed coaching guide by top ranked Grandmaster player Shokz. Earn your position in the Masters league as you learn the to…
    how …, starcraft2video game, slideshow, gamer, starcraft II, Starcraft 2 game guide

  50. Charlotte Video Production Company
    http://www.youtube.com/watch?v=MTH-BZqnfwE
    We’re very proud of the video production work we’ve done through the years here in Charlotte, NC and here’s a collection of our very best stuff. Please visit our website, lensflare.tv if you’d like to find out how we can create some amazing media for your business.
    Video Production Company Charlotte

  51. asburytrans.com, your trucking companies, trucking companies in california
    http://asburytrans.com
    Asbury Transportation is a flatbed trucking company in Southern California. Serving California, Nevada, and Arizona since 1922. Give us a call! 1-800-ASBURYT
    best trucking companies in California, Asbury Transportation

  52. professional massage tables, click here Massage Tools, massage tables
    http://massagetoolsreview.blogspot.com
    I consider Massage-Tools to be one of the leaders of The massage table industry. They only sell the same tables they use at their own spa insuring only the best for you and your clients.
    reviews of massage tables, massage table

  53. federal way medical office cleaning, federal way janitorial services
    Veltex Services is a janitorial company bringing high quality service to all of our customers. We service the Federal Way, Tacoma, WA areas.
    http://www.veltexservices.com
    federal way building cleaning services, federal way cleaning services

  54. jacksonville fitness center, mma, jacksonville fitness
    http://jacksonvillemartialart.com/faq/
    Jacksonville martial arts classes for kids and adults serving the 32246 and 32216 areas of Jacksonville, FL. Get in fighting fit shape using MMA, Muay Thai, Submission Wrestling and Brazilian Jiu Jitsu!
    jacksonville martial arts, jacksonville muay thai, jacksonville kids martial arts classes

  56. Massage Tools, massage table, click here
    These tables are Extravagant, strong, peaceful, safe and protected– Craftworks have actually become the greatest selling transportable massage table without a doubt. A traditional appeal with unyielding strength, these tables outshines all others. When you see the appeal and feel the remarkable quality of this massage table, you’ll comprehend why. This tables consist of extraordinary products and unrivaled workmanship. Your clients get the massage you suggested. You can count on this table for the life of your profession. Crafted with only the finest choice materials.
    http://massagetoolsreview.blogspot.com
    professional massage tables, massage tables

  57. professional massage tables, massage tables, massage table
    http://massage-tools.tumblr.com
    I consider Massage-Tools to be one of the leaders of The massage table industry. They only sell the same tables they use at their own spa insuring only the best for you and your clients.
    click here Massage Tools, reviews of massage tables

  58. jacksonville fitness, jacksonville kids martial arts classes
    Jacksonville martial arts classes for kids and adults serving the 32246 and 32216 areas of Jacksonville, FL. Get in fighting fit shape using MMA, Muay Thai, Submission Wrestling and Brazilian Jiu Jitsu!
    http://jacksonvillemartialart.com/classes/
    jacksonville fitness center, jacksonville martial arts

  59. reviews of massage tables, click here Massage Tools, professional massage tables
    http://www.squidoo.com/massage-tables-and-tools
    I consider Massage-Tools to be one of the leaders of The massage table industry. They only sell the same tables they use at their own spa insuring only the best for you and your clients.
    massage tables, massage table

  60. massage table, professional massage tables, massage tables
    A timeless beauty with unyielding strength, these tables outperforms all others. When you see the appeal and feel the remarkable quality of this massage table, you’ll comprehend why. This tables include exceptional items and unequaled craftsmanship. Your clients get the massage they deserve. You could depend on this table for the life of your job. Crafted with just the finest pick products.
    http://massage-tools.tumblr.com
    Massage Tools, click here

  62. video production, Click Here, LensFlare
    LensFlare Creations is a brand-new upcoming video manufacturing company based in Charlotte, NC they concentrated on offering the highest quality cutting-edge media feasible. The team at LensFlare Creations are incredibly enthusiastic about what they do.
    http://www.zimbio.com/Video+Production/articles/vmundQckalP/LensFlare+Creations+Review?add=True
    video production company Charlotte, Charlotte Video Production Company

  63. video production company Charlotte, Charlotte Video Production Company, video production
    LensFlare Creations is a new upcoming video production business based in Charlotte, NC they focused on providing the highest quality innovative media possible. Their work ethic, creativity, and precise focus on information, allows them to deliver products far beyond your expectation. The team at LensFlare Creations are extremely passionate about what they do. Making sure everything is perfect from begin to end.
    http://www.squidoo.com/lensflare
    LensFlare, Click Here

  64. live sex, sexcams, cammen, webcams, sex cams, sex cam, sexcam, webcam
    http://www.webxcam.nl
    webXcam.nl – de beste amateur webcam sex met lekkere vrouwen die thuis op zoek zijn naar kerels, om te genieten van deze live sexcams. Wil jij terug webcammen met je cam ?
    webcammen, cam, cam sex, webcam sex, cams, webcamsex, camsex, sexcammen

  65. gold, money, goldbars
    http://connie.kbgoldintro.com/goldbars/
    EVERYONE’S BEEN WAITING FOR…
    When they first see Karatbars, several
    people have said, “This is the program I’ve been
    waiting for!” Find out why…
    People are Investing in their furtures!
    grams, karatbars

  66. Public records, Background Check, Arrest Records
    Our instant nationwide search system will check thousands of sources, public databases, and proprietary search databases and let you download and view the records reports within minutes.
    http://www.governmentrecordsusa.org/
    Death Records, Birth Records

  68. adult cam, live sex, camsex, cammen, webcam sex, sex cam, sex cams, adult cams, cam
    hot cam ladies with sexcams want sex today ! XXX webcamsex for men.
    http://www.webxcams.eu
    cam sex, sexcam, adult webcams, adult webcam, webcam, webcams, webcamsex, cams, sexcams

  70. Racing {video games|games}
    Racing video games are entertaining and for all ages. You do not require a driver’s license to drive a Lamborghini. Our website has a complete selection of racing games for Xbox, PS3, Wii and other game consoles
    http://www.topbestracinggames.com

  71. PS3 simulation {video games|games}
    http://www.ps3simulationgames.com
    Simulation video games are amazing and packed with thrills especially simulation games for PS3 simply because of the excellent color and heart bounding thrills you get from the games. Go to our site and we promise that you will not be disappointed.

  72. PS3 {video games|games}
    PS3 is no doubt one of the most popular brand in video game industry. PS3 by Sony is famous of the vivid color and supreme quality of their video games. Visit our website and you will be surprised to find our best collection of PS3 games available in the market.
    http://www.bestps3videogames.com

  76. review site, make money
    Chris Farrell is one of the most respected
    and successful internet marketers in the industry today.

    Chris Farrell has been voted the Number 1
    Internet Marketing Coaching Program – by IMReportCard.

    Chris began online in 2008.
    And he came from having no previous experience.

    Within 6 months – he was having many $250/days.

    Within 9 months he had his first $1000/days.

    In August 2010 – Chris made over
    $1million in sales…in 24 hours – with Affiliate dot com
    http://a07674tgph1mew79pku5r75r67.hop.clickbank.net/?tid=SP1
    LEARN the internet, business opportunity

  77. CaliforniaWaterBirth.com, Homebirth Santa Rosa CA, Midwife Santa Rosa CA
    http://www.youtube.com/watch?v=I8QEtNSMnFE
    Santa Rosa CA 707-341-6030
    Looking for a midwife ?
    Constance Rock (L.M., CPM) and California Water Birth is the place to call for a great homebirth or waterbirth in Santa Rosa CA area. Constance has had the honor of attending over 1000 births, as well as the privilege of having over 20 apprentices, many who are now licensed and even working as Santa Rosa midwives alongside her. Please call now for a FREE consultation and a great water birth in Santa Rosa 707 341-6030. CaliforniaWaterBirth.com
    WaterBirth Santa Rosa CA, Santa Rosa CA Midwife

  78. hall county heating and cooling, hall county hvac repair
    Hall County Heating and Air: Quality residential & commmercial heating and cooling services since 1997. Licensed & insured. NATE certified and Better Business Bureau A+ rated. Emergency service, preventive maintenance & tune-up, system monitoring & replacement, conversion and retrofitting. Lifetime warranty on Trane equipment, 100% guarantee on all work. Call for free estimate. Use coupon code PDQ1 for extra savings: (678) 794-1476
    http://www.youtube.com/watch?v=YtIVG5LcpV0
    hvac repair hall county, hall county heating and air

  82. virgilio clemente jr, free internet marketing ebook library, instant download
    There are plenty of things that you need certainly to keep in mind before you obtain one, as it pertains to acquiring free website marketing e-books. While free website marketing ebooks are already beneficial in the feeling that you don
    http://paytay.com/articledetail.php?artid=158921&catid=88&title=Guaranteeing+the+grade+of+Free+Internet+Marketing+eBooks
    Guaranteeing the grade of Free Internet Marketing eBooks, free ebooks, kick start your online business

  83. emergency plumber phoenix, plumbing
    Have pipes leaking under your home that you cannot fix? It might be time to call a plumbing consultant. A consultant can come to your home,
    and tell you the best way to get your pipes repaired, and keep them from leaking. You will not have to worry about leaky pipes or puddles under your house any longer
    once you repair your plumbing the way the consultant tells you to.
    http://youtu.be/YuJBvTIkfEc
    plumber in phoenix, pipes

  84. live wallpaper, apps
    The best Xmas Live Wallpaper. Christmas Mood Live Wallpaper apps looks great on phone or tablet. 200 hand selected high quality HD themes you will love. Way cool. Have a look/
    http://bit.ly/xmas-live-wallpaper
    christmas apps

  85. British Broadcasting Corporation, Search, bbc.com, bbc.co.uk
    Breaking news, sport, TV, radio and a whole lot more. The BBC informs, educates and entertains – wherever you are, whatever your age.
    http://bbc.co.uk
    BBC, BBC iPlayer, BBCi

  87. ft. wayne remodeling contractors, remodeling contractors fort wayne
    Great Lakes Improvements of Indiana have been Fort Wayne Remodeling Contractors for over 20 years.  We are 2nd generation family owned & operated. We are fully licensed & insured.  Great Lakes Improvements of Indiana specializes in exterior remodeling: replacement windows, entry doors, patio doors, roofing and seamless gutters. Call us for your free estimate: (260) 483-3100
    http://www.youtube.com/watch?v=RIh5uaJhoqQ
    fort wayne remodeling contractors

  88. ft. wayne remodeling contractors, remodeling contractors fort wayne
    Great Lakes Improvements of Indiana have been Fort Wayne Remodeling Contractors for over 20 years.  We are 2nd generation family owned & operated. We are fully licensed & insured.  Great Lakes Improvements of Indiana specializes in exterior remodeling: replacement windows, entry doors, patio doors, roofing and seamless gutters. Call us for your free estimate: (260) 483-3100
    http://www.youtube.com/watch?v=RIh5uaJhoqQ
    fort wayne remodeling contractors

  89. roofers tri cities wa, roofing contractors tri-cities wa
    Broderick Construction & Roofing have been quality Roofing Contractors in the Tri-Cities, WA area for 23 years including Kennewick, Pasco and Richland, WA. We are fully licensed, insured & bonded and family owned & operated.  We are full service roofing contractors. No job is too big or small. Call for free estimate: (541) 567-2183
    http://www.youtube.com/watch?v=45hupu5YAfk
    roofers tri-cities wa, roofing contractors tri cities wa

  90. maryland solar installers, solar installers maryland, maryland solar panels
    Advanced Solar Technologies is a premiere Maryland Solar Contractor providing quality solar panels and installation in Charles County, Maryland. We are fully licensed, insured & bonded. We are highly skilled solar design and installation experts and our solar systems will last 25+ years with minimal maintenance. 24/7 Emergency service; Best Price Guarantee. Financing available. Call us for a free, no obligation site and energy analysis:  (443) 262-8212 with coupon code: PDQ1 for extra savings.
    http://www.youtube.com/watch?v=q-SSUtDL7ng
    solar panels maryland, maryland solar

  92. Carmel roofing contractor, Carmel roofing contractors
    http://www.youtube.com/watch?v=LANsszyDWzc
    Ace Roofing has served the Carmel, Indiana area for over 25 years. Family owned and operated providing the finest in roofing for residential and commercial properties. We are a fully licensed and insured Carmel Roofing Contractor. Over 25 years of roofing experience. Call for Free Estimate: (317) 626-6741
    Carmel roofing

  93. Frederick County VA plumbers, plumbers Frederick County VA, plumbers in Frederick County VA
    Ned Willson Plumbing are licensed & experienced Plumbers in Frederick County, VA. We are fully licensed, insured and bonded as a Master Plumber and Plumbing Contractor and have 30 years of experience. We provide quality plumbing services for both residential & commercial properties. We specialize in retro-fitting old to new plumbing, remodeling and new construction. All work is guaranteed. Use coupon code: PDQ1 for extra savings. Call for a free estimate: (540) 888-4919
    http://www.youtube.com/watch?v=f7fD9KwmfjA
    Frederick County VA plumbing, plumbing contractors in Frederick County VA

  94. remodeling contractor everett wa, everett wa remodeling contractor
    http://www.youtube.com/watch?v=RvlQa-_lC4I
    Aloha Restoration & Construction company has specialized in remodeling and
    restoration services for the Everett, WA area for over 20 years. We are family owned & operated and are fully licensed and bonded. 24/7 Emergency Service: 206-356-5099
    everett wa home restoration services, remodeling contractors everett wa

  95. hvac northern virginia, northern virginia heating repair, hvac repair northern virginia
    http://www.youtube.com/watch?v=fW_dLu0hjbw
    JBB Heating & Air Conditioning is a reliable HVAC contractor that has been providing quality heating and air conditioning services for Fairfax County and the Northern Virginia area for over 25 years. We are family owned & operated and are fully licensed & insured. We install, service, repair & maintain all Heating and Air Conditioning systems for residential and commercial properties.24/7 emergency service; same day response to urgent calls. All work is 100% guaranteed. We never charge extra for weekend or holiday calls. Please call: 703-368-9626 with Coupon code: PDQ1 for a special discount on your first service call.
    heating repair fairfax, furnace repair fairfax

  99. MAKITA 18 – Volt LXT902 CORDLESS
    http://typesofsaws.org/makita-lxt902-cordless-9-piece-combo-kit-review/
    The Makita 18 – Volt LXT902 Cordless 9 Piece Combo Kit is a fantastic tool kit all in one! In fact, they have been described as a great set of tools with everything you need to get the job done right. This Combo Kit has been created to help you get your project done faster with better results.
    MAKITA 18 – Volt LXT902 CORDLESS 9 PIECE COMBO KIT

  100. kitchen and bath remodelers prince william va, prince william remodelers, kitchen remodeling prince william va
    http://www.youtube.com/watch?v=MksKI_Zgt8Y
    Quality Design Build has been providing quality Kitchen and Bath Remodeling in Prince William, VA for 24 years. We are a Class (A) full-service remodeling contractor with a wide range of experience. We are family owned and operated. We specialize in full kitchen and bathroom remodeling. All work guaranteed. Call us today for a free estimate: (571) 292-1025
    kitchen and bath remodeling prince william va, bathroom remodeling prince william va

  101. roofers in asheboro nc, asheboro roofing, roofing companies asheboro nc
    http://youtu.be/MKlMPH-c9zY
    Ace Roofing are licensed Roofing Contractors in Asheboro, NC providing quality roofing services for both residential and commercial properties. We are fully licensed and insured and locally owned & operated. We are A+ rated with the Better Business Bureau. We are full service roofing contractors providing a lifetime guarantee on all of our work. Call us today for your free estimate: (336) 308-4312
    roofing contractors asheboro nc, asheboro roofing contractors

  102. andropausia
    En los hombres alrededor de los 40 anos de edad comienza la andropausia o menopausia masculina, que es cuando el cuerpo empieza a producir menos testosterona.
    http://laandropausia.org

  104. plumbers in hickory nc, Hickory NC bathroom remodeling, Hickory NC plumbing remodeling
    http://youtu.be/ZFq5hIlmpyo
    Miller’s Plumbing and Drain Cleaning are quality Hickory, NC Remodeling Plumbing Contractors providing full bathroom remodeling and kitchen remodeling for over 21 years. We are family owned & operated. We also provide full plumbing services and free estimates and emergency service.Satisfaction guaranteed. Please call: (828) 310-9393.
    Hickory NC plumbing remodelers, Hickory NC remodeling plumbing contractors

  107. watch ufc 150 free online, watch ufc 150 online free
    WATCH UFC150 FREE ONLINE is something that every UFC 150 fan would love to do. Are you one of those who just can not wait to August 11th to witness the extravaganza which is UFC150 Henderson vs Edgar 2.
    http://www.squidoo.com/ufc-150-big-events-online
    watch ufc 150 henderson vs edgar 2 free online live and replay, watch ufc150 free online

  110. online reputation, david cannell reputation management
    davidcannell.soup.io bigcontact.com/davidcannell david cannell reputation management this is a great site
    http://www.davidcannell.soup.io
    david cannell, reputation management

  111. panasonic vacuum cleaner parts
    http://panasonicvacuumcleanerparts.blogspot.ca/
    Since the time the company was established and to this very day, its vacuum cleaners have seen a lot of development. The first vacuum cleaners Panasonic used to produce were the ordinary canister models, which have now evolved to the Panasonic platinum lines.
    panasonic vacuum cleaners

  112. Hawaii Vacation Rentals, Maine Vacation Rentals, Kauai Vacation Rentals
    http://beachesandpeaches.com/ar/maine-vacation-rentals.php
    Find the best vacation rental for your next trip. Whether you are looking for Ocean City Vacation Rentals,Kauai Vacation Rentals or other relaxing locations, learn more about how to get the best value out of your vacation.
    California Vacation Rentals, Cheap Vacation Rentals

  120. Work from home
    https://www.facebook.com/pages/Arbonne-Reviews/366114376755234?sk=app_106878476015645
    Arbonne Independent Consultants achieve success in 2 ways:

    1. Through retail profit on sales of products purchased at discounted prices from Arbonne.

    2. Through commissions, overrides and bonuses paid on an Arbonne Independent Consultant’s product sales volume and the sales volume of other Arbonne Independent Consultants on their team.

    Full-time or part-time income?

  121. wordpress blog, my money blog, Membership Site
    http://imstitute.com/go.php?offer=autox34&pid=4
    There’s a Better, Faster and Easier Way to Create a Profitable Membership Site. An easy-to-use WordPress plugin that allows you to turn any blog into a powerful membership site in just minutes from now.
    money blog, WordPress Plugin

  122. wordpress blog, money blog, WordPress Plugin
    http://imstitute.com/go.php?offer=autox34&pid=4
    There’s a Better, Faster and Easier Way to Create a Profitable Membership Site. An easy-to-use WordPress plugin that allows you to turn any blog into a powerful membership site in just minutes from now.
    my money blog, Membership Site

  123. how to reduce tummy, how to get abs, Get A Flat Stomach
    http://www.amazon.com/gp/product/B007XK7NA0
    Get A Flat Stomach by avoiding these foods and by using these lean body workouts. Are your abs not showing because of fat build up? You are right to be concerned about belly fat because your health is at risk. Here is the solution. “The Truth about Six Pack Abs” is probably the best known, Get a Flat Stomach solution in the world, with over 439,000 readers in 163 countries to date.
    flat stomach, how to get a six pack

  128. Florida, Miami
    {Imagine the|Think of the|Think about the|Suppose the} {kids|children|youngsters|little ones} {all|just about all|almost all|most} {being|becoming|getting|staying} {happy|pleased|content|satisfied} {and|as well as|and also|along with} {enjoying|taking pleasure in|experiencing|savoring} {life|existence|lifestyle|living}, {splashing|spilling|playing|splattering} {on the|around the|about the|for the} {beach|seaside|seashore|beach front}, {playing|actively playing|enjoying|taking part in} {in the|within the|inside the|inside} waves-life {just|simply|merely|only} doesn’t {get any|have any} {better|much better|far better|greater}.
    http://www.miamipackages.me/
    packages, travel

  129. restaurant fans, exhaust fan kitchen, Restaurant Exhaust Fans
    Buy a new or replacement fan for your commercial restaurant kitchen. Exhaust fans constructed with heavy gauge aluminum. Direct drive motors and belt drive motors are weather-tight. Exhaust Fans and Make-Up Air Fans Fast and Easy! Compare Today!
    http://www.restaurantexhaustfans.com/
    kitchen exhaust fans, kitchen exhaust

  130. How To Start a Business From Home, small business, home business
    Start your money machines by re-investing a small amount of your earnings and creating your business via outsourcing, to take advantage of new market opportunities, while you are employed. In fact you can even do it for free.
    http://www.amazon.com/dp/B005IIY3ZM
    Become Rich, make money from home

  131. home based business that actually works, best home based businesses
    http://mailmasterx.com
    Register to see how easy it is to find local businesses that wants your help
    a home based business that works

  132. Dentist Colchester
    {Dentist Colchester} {-|–|:|*} {video|video clip|movie|online video} {on|upon|about|in} {two|2|a couple of|a pair of} {friends|buddies|pals|close friends} {talking about|referring to|discussing|speaking about} {their|their own|their particular|his or her} {teeth|tooth|the teeth|enamel} {and how|and just how|and the way|and exactly how} {one of them|one of these|one|one too} {had|experienced|acquired|got} {such a|this type of|this kind of|a real} {terrifying|frightening|horrifying|scary} {experience|encounter|expertise|knowledge} {from|through|coming from|via} {her|the woman’s|the girl|your ex} {last|final|previous|very last} {dentist|dental professional|dental office|dental practice} {that she|that they|she} {has not been|is not|hasn’t been|will not be} {back|back again|again|rear} {since|because|given that|considering that}.

    {She|Your woman|The lady|The girl} {now has|presently has|is now offering|presenting} {bleeding|blood loss|hemorrhaging|hemorrhage} {gums|gum area|nicotine gums|gum line} {and|as we
    http://youtu.be/Bii98CzyM-E

  135. war of warcraft
    {Basics|Fundamentals} About {one|1|a single|one particular} of {Best|Greatest|Very best|Finest|Ideal|Most effective} {Pc|Computer} Games Ever

    {World|Globe|Planet} of Warcraft {contains|consists of} {a variety of|a number of|many different|various|a range of|several different} mechanisms for player versus player (PvP) play. Players on player versus {environment|atmosphere} (PvE) servers can opt to “flag” themselves, {making|creating|generating|producing} themselves attackable to players {of the|from the|in the|with the} opposite faction.[36] {Depending on|Based on|According to|Determined by} the mode {of the|from the|in the|with the} realm, PvP combat {between|in between|among|amongst} members of opposing factions is {possible|feasible|achievable|attainable|doable|probable} at {almost|nearly|virtually|practically|pretty much|just about} any time or {location|place} {in the|within the|inside the} game world-the only exception {being|becoming|getting} the {starting|beginning} zones, {where|exactly where} t
    http://games.tiscali.cz/world-of-warcraft-8245

  136. trading stock market, how to stock trading, Stock Trading How To
    Like to become a more confident and profitable stock trader? If so, using a tool like, Stock Market Mastery Software, allows you to gain the upper hand when trading the stock market. You don’t really need to do all the analysis with this method, as your smart software will alert you and tell you what to do and when to do it.
    http://www.amazon.com/gp/product/B007QEHI5I
    stock trading, stock market trading

  137. overdraw bank, overdraw archery, two, overdraw arrow rest, overdraw rest, overdraw english, compound bow overdraw, overdraw harmonica
    overdraw.de is your first and best source for all of the information you’re looking for. From general topics to more of what you would expect to find here, overdraw.de has it all. We hope you find what you are searching for!
    http://overdraw.de/
    2 overdraw, overdraw dictionary, overdraw fee meaning, overdraw 3d, overdraw graphics, overdraw two worlds, overdraw bow

  139. web, affordable
    Rock solid affordable web hosting services. 4-domain & 6-business tool package incl Autoreponders, blogger builder, Video producer, conference sys, prospecting sys, marketing academy. 7 day trial.
    http://bearnbee.hostthenprofit.com/htp/
    services, hosting

  140. fire Rush Limbaugh
    http://www.change.org/petitions/clear-channel-communications-fire-rush-limbaugh
    He disrespects Women:
    Student: Rush Limbaugh ‘slut’ comment out of bounds

    Read more: http://www.politico.com/news/stories/0312/73530.html#ixzz1nwLl9sIP

    The Georgetown University law student who was called a “slut” by Rush Limbaugh for testifying on Capitol Hill about women’s access to contraception condemned the conservative radio host Thursday night for remarks “outside the bounds of civil discourse.”

    Read more: http://www.politico.com/news/stories/0312/73530.html#ixzz1nwLtO8fy
    Rush Limbaugh

  142. cr8traffic, Hampshire SEO
    SEO Hampshire, UK. for a professional, successful solution to getting traffic to your website, sales for your businees, and profits to your bottom line. Best Hampshire SEO.
    http://www.cr8traffic.com
    SEO hampshire

  145. business liability insurance, insurance, general liability insurance
    http://www.cageneralliability.com/
    California General Liability Insurance Brief, insurance quotes and rates comparison
    insurance quotes, liability insurance, commecial liability insurance

  147. los cabos, news, san jose del cabo
    http://visitloscabos.net/
    News, information, tips and more from the Los Cabos area, which includes Cabo San Lucas, San Jose del Cabo, The Tourist Corridor & surrounding locations.
    information, cabo san lucas

  149. job opportunities, employer jobs, job listings, employment opportunities, new jobs, job openings, technology jobs, jobs
    Hound is the first job consolidation service in the employment industry to seek to include every job that exists and not charge employers to post jobs on its site.
    http://employers.hound.com/lcjobpostingmain.php
    employment resources, post a job, direct employer, sales jobs, job aggregator, career and job search, transportation jobs, job seekers

  150. familie, themenaufstellung, systemische aufstellung, systemaufstellung
    http://www.evahelle.de/familienstellen/
    Die systemische Aufstellung nimmt Bezug auf Ordnungsmuster z.B. im Verhalten von Familienmitgliedern, Kollegen am Arbeitsplatz, befasst sich aber auch mit drängenden Problemen oder Themen
    naturheilpraxis eva helle m�nchen, familiensystem, familienstellen, familienaufstellung

  151. self managed super, self managed super funds, smsf estate planning, retirement, smsf
    http://www.smsfmembers.com/
    There are more than 470,000 Self Managed Superannuation Funds (SMSF’s) in Australia, this figure is increasing by 30,000 per annum.
    self managed super fund, superannuation fund, super …, allocated pension

  153. autolink machine, get, autolink buildin, auto, autolink building software, backlinks, autolink, autolink, how to get backlinks, autolink building tool, per month, 5k
    Get reliable autolink building software Machine which will rise and keep your sites or post on number one on search engines.
    http://www.iamtotallyempowered.com/how-to-get-5k-35k-backlinks-per-month
    35k, 5k, monthes, software, auto, 35k, makes, tool, autolink building machines, do, machines

  155. door to door delivery, door to door marketing, door hangers
    Door to Door Delivery – Door Hangers – Flyers – Postcards – Design – Printing – Distribution – Cheap Advertising
    http://www.thedoordeliveryguys.com
    door hanger delivery, door hanger printing

  156. Phoenix legal jobs, legal job board in Phoenix, Law Jobs in Phoenix AZ, Phoenix Law jobs
    Phoenix Law Jobs – Search Law Jobs in Phoenix AZ. Find Phoenix law jobs, Phoenix legal jobs on PhoenixLawjobs, the best legal employment job board in Phoenix on PhoenixLawJobs.com.
    http://phoenixlawjobs.com
    Phoenix AZ Law jobs, legal employment in Phoenix, Phoenix Attorney jobs

  159. gold silver prices, silver price history, silver price today
    Click here to view today’s gold and silver prices, gold price history, silver price history, graphics, charts and important factors that influence the price…
    http://goldsilverprices.co
    gold price history, gold prices today

  160. Medicare Solutions can help you find the best medicare drug plans to fit your life and budget. With a list of providers, health plans listed by state and commonly asked questions, Medicare Solutions is the leader for assistance with medicare supplement.

  161. certainly like your web site but you have to check the spelling on quite a few of your posts. Many of them are rife with spelling problems and I find it very troublesome to tell the truth nevertheless I’ll surely come back again.

  162. I think one of the hardest parts is finding the right medicare plan. I have been doing research for the last few months. I just wanted to make sure I was making the right decision. Recently I came across this site medicare . It does a great job matching you up with the right plan. After trying different sites this is the best one that I’ve encountered. Very user friendly.

  163. Unquestionably believe that which you said. Your favorite justification seemed to be on the web the easiest thing to be aware of. I say to you, I certainly get annoyed while people think about worries that they just do not know about. You managed to hit the nail upon the top and defined out the whole thing without having side-effects , people can take a signal. Will probably be back to get more. Thanks

  164. yes, most medical studies are, who ever pays the bills has an agenda and majority of the time it shines through.

    Not big on the Donald for Pres, I think he’s better on TV, 4 yours without the apprentice sounds like hell.

    Yes I have done considerable business with “The Poor”

    Racial disparities exist is a meaningless statement. If there is unequal opportunity based on race that is a serious problem, if there are unequal results based on poor personal decisions that is a different argument.

    “Most people who tote “look at all the alcohol and fast food sold in low income areas” have never even set foot in those neighborhoods and if they had would know that fast food chains directly target low income areas because they know that they can make a profit with their dollar menu which every fast food chain has.”

    So your not saying those people are wrong, in fact your proving they are correct, you just rather blame the fast food company for holding a gun to the poor and forcing them to eat there?

    “Do you really think big corporations have the little man’s heart in their best interest?? ”

    If the little man doesn’t worry about his heart why should the big evil corporation? If people are going to seek out and find this food why is the corporation wrong for giving it to them. There are fast food joints that go out of business every day in poor neighboorhoods so obviously the poor are able to exercise choice, why do you place all the blame on the corporations, besides that beng what your told to do? People should be allowed to eat what they want, if once a week I want to break my vegan tofu diet and have some roach coach tacos that is my right, your saying poor people are to stupid and weak to be allowed to have those choices so your going to take them all away from them. Why don’t you just lock them all up in towers and tell them how to live….oh thats right you already tried that.

    ” Instead of sitting in your office reading audits you should take to the street and actually talk to some poor people.”

    I have spent more time in the streets and housing developements then you will ever see. Peering out your ivory tower doesn’t mean you have seen poverty.

    I rather spend my time helping people come up not just sustain, I’ll continue spending time working on music and real estate, feed them for a day or a lifetime difference. Apparently you rather have them dependent on you for life, best way to keep their vote right?

  165. Really, the institute of medicine is a propaganda study?? Interesting…you must also be a supporter for Trump as president too..
    Do I weep* at every poor welfare story out there? No, I know there is welfare fraud committed on a daily basis, but I also have worked with the poor directly (which I don’t think you have). From the outpatient clinics to the ER (and, yes, racial disparities exist), so forgive me if I take what you say with a grain of salt. Most people who tote “look at all the alcohol and fast food sold in low income areas” have never even set foot in those neighborhoods and if they had would know that fast food chains directly target low income areas because they know that they can make a profit with their dollar menu which every fast food chain has. Do you really think big corporations have the little man’s heart in their best interest?? Instead of sitting in your office reading audits you should take to the street and actually talk to some poor people. Hey, maybe you should volunteer at a soup kitchen or at a homeless shelter? What do you say? Really get out there and see how the lower half live (I’m betting you won’t).

  166. you are the problem Vanessa, apologist that wheep at every sob story and propoganda study that crosses your path.

    ” it is cheaper to buy high fat content and high calorie food for their family (actually I should say that is all they can afford) than fruits and vegetables.”

    BS, only an idiot would believe this. Look at all the alcohol and soda sold in low income areas, compare that to the price of water. Look at all the fast food sold in those same neighborhoods, a trip to KFC is more expensive then some fresh pruduce.

    Yes I am such a great guy I pay taxes so entire armies of people can do nothing 8 hours a day but sign people up to take more of my taxes. Speaking of facts, you wouldn’t know one if it hit you upside your head, our public assistance programs have a problem of to many ineligibile people signing up and getting benefits they are not entitled to becuase the process has been made so easy. Medicaid alone has over 10% of its enrollees covered without propoer documentation because the rules are so lax. Ready any of the GAO audits.

    Its people like you that enslave these people to their welfare.

  167. Please review the Institute of Medicine report on Unequal Treatment in America and maybe you will bite your tongue the next time you feel like speaking of “society’s supposedly neglected” as well as racial disparities in America.
    It’s not a hidden fact that certain races receive sub-optimal care.
    For the poor, and I’m talking poor Nate….less than $18,000/yr (for some reason I think your views of the poor are very clouded) it is cheaper to buy high fat content and high calorie food for their family (actually I should say that is all they can afford) than fruits and vegetables. If you had $20/wk to buy food with what would you buy Nate?
    You comment that there are all these wonderful programs for the poor and all they have to do is sign up for them, right? How many poor do you think are literate, Nate? How many applications do they have to read and sign? How many multiple times must they be denied by medicaid before they finally give up? But let me guess….you are such a great guy that you will personally take the time to help all these people fill out those applications….

    Institute of Medicine (2003). Unequal Treatment. Washington, DC: National Academy Press. http://www.nap.edu/openbook.php?record_id=10260

  168. Dr. Reich– I love your blog and have been reading it for years. Americans need the type of clear-headed economic information that you provide.

    Regarding Ryan’s Road to Ruin, what about the issue of medical bankruptcy? Americans are more likely to go bankrupt because they can’t pay their medical bills — than for any other reason. The American Journal of Medicine posted a story about this recently.
    http://amjmed.blogspot.com/2011/04/ryans-medicare-overhaul-would-it.html

    Medicare for all!

  169. I am in the MEDICARE FOR ALL camp. But it must be a modified Medicare from the present with-1) Much more emphasis on jail for fraud (fines don’t work) 2) Much more emphasis on individual and institutional prevention. 3) Much more emphasis on death with dignity – not profiteering off the prolongation of death

    Dr. Rick Lippin
    Southampton,Pa

  170. Paolo –

    One important factor that I didn’t mention is that the average annual claims cost per Medicare member is far higher than the average claims cost for the under 65 population. Any comparative analysis of administrative costs needs to adjust for that. Alternatively, one would need to look at administrative costs per insured person instead of as a percentage of premiums. It’s also hard to assign a cost of capital charge to Medicare. I believe the Council for Affordable Health Insurance (CAHI) has also written on this topic.

  171. “Office rent, I believe, is part of the General Services Administration budget. The list goes on. If you factor in all the costs associated with running Medicare that are handled by other government agencies, Medicare’s fully allocated administrative costs are more like 7%-8% of spending than 3%.”

    Barry – do you have any source for these numbers? An additional 5% to Medicare’s budget is about $25 billion. That’s a lot of billions. Given that the entire General Adminstration budget is only about $30 billion, it is pretty hard to believe that most of it is going to assisting Medicare.

  172. I only step in here to laud the accuracy of Godwin’s Law: “As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches 1.” But it takes special cleverness to bring in the Eichmann trial: I’ve not seen “the banality of evil” used to describe those who disagree with universal health coverage, until now. Give this thread one more day, and we’ll have images of gas chambers and ovens.

    Health is in indissoluble unity with wider culture. The ” we spend more for health care but get less for it” sound bite, useful as it is for growing the Democratic voter base of government employees, is a classic instance of assigning causation to the loosest of correlations.
    The “health care system” is only to blame for poorer health in the US if the material human behaviors are under the control of the health care system. If that’s your premise, then the entire culture will need to be managed by the government. This vision seems deeply satisfying to some.

  173. What I always found funny is those that society supposedly neglicted, those that can’t be expected to take responsibility for their healthcare or diet, are always able to figure out how to qualify for assistance. Be it EITC, food stamps, SS disability, etc etc, they can nail that just right, make as much as possible but not to much, or do what ever is needed, but ask that they count calories or follow up on an office visit your racist and suppress them.

  174. Steve –

    This quote is from the IRS website:

    “The Earned Income Tax Credit or the EITC is a refundable federal income tax credit for low to moderate income working individuals and families. Congress originally approved the tax credit legislation in 1975 in part to offset the burden of social security taxes and to provide an incentive to work. When EITC exceeds the amount of taxes owed, it results in a tax refund to those who claim and qualify for the credit.”

  175. “If you have insurance. Without insurance follow up is poor. I am aware of at least one study of pediatric trauma patients showing that the uninsured have worse outcomes, presumably because of worse follow up care.”

    Do you think a study paints a true picture? Studies are done with purpose, they are also paid for by someone with an agenda. That is why we have studies saying Medicare is more efficient and we have lower life expatancy becuase of our healthcare system. With a little thought and research its clear the studies are worthless but its still noise out there.

    Why do uninsured have worse follow up care in the first place. Before you can answer that though why do they not have insurance in the first place? There are only 5 million people that can not get insurance. All the rest either already have access to free insurance programs like Medicaid or they make enough to buy insurance and choose not to buy it.

    Should we be surprised that someone that has access to insurance but doesn’t take it also makes poor health decisions? Is the problem our insurance system or people that make bad decisions? Follow up is poor becuase the people are bad at follow up.

    How do you solve problems directly and solely related to poor decison making by the minority? The left wants to destory a system that works great for 80% of the nation because 15% make bad decisions. Its the same thing they do with education, the crashed education to accomodate the lowest level. Why not let the 80% enjoy an incredible system like they have instead of creating a terrible system that benefits no one?

    Payroll taxes are 7.? lets say 8%. Someone making $20,000 would have $1600 of payroll taxes? All the tax credits far exceed the small amount of payroll taxes.

  176. First I didn’t say it I cut and pasted it. Second its a fact supported by endless studies and statistics. Third its a valid rebuttal to the argument that other nations have higher life expectancy.

    Nice selective quoting by the way, would the extra line have taken to much space.

    “but comparing nearly all-white Europeans to the United States which has a substantial black minority, a race known for its lower life expectancy, then ”

    Pointing out the statistical fact that blacks in all nations have shorter life expecatancy is not racist no matter how badly simple minded liberals want it to be. Typical of the left, you can’t deal with the fact so you just try to distract.

    “Why dont payroll taxes count?”

    Steve you mkust be one of those people that don’t file taxes. If you pay no taxes and get a tax credit back which is payment over and above any payments made what part of zero aren’t yopu getting? If your sole income earner with a spouse and couple kids the government pays you to exist. With earned income child tax credit and everything else they have a negative tax bill. ZERO

  177. “See as how 40%+ aren’t paying federal taxes in the first place your Robin Hood Analogy doesn’t really work.”

    Why dont payroll taxes count? Revenue received by the federal government from payroll taxes is now about the same as received from income taxes.

    “Indeed, the U.S. system probably is the best at what Don Berwick calls rescue care.”

    If you have insurance. Without insurance follow up is poor. I am aware of at least one study of pediatric trauma patients showing that the uninsured have worse outcomes, presumably because of worse follow up care.

    Steve

  178. Margalit –

    It’s a fact that poverty is correlated with lower life expectancy whether we’re talking about low income white people, African Americans, Native Americans or Hispanics. I don’t think it’s legitimate, though, to attribute that lower life expectancy to the quality of the U.S. healthcare system. It’s also a fact that Americans have the highest obesity rate in the world by a considerable margin at over 30%. Only the UK and Mexico are within shouting distance in the low 20’s. For most of the rest of Europe, it’s between 10% and 15% while in Asia, it’s generally in the low to mid single digits. Even within the U.S., this varies quite a bit among the states as diets and cultures are different and diverse in different regions. On the positive side, the murder rate has declined a lot in the last 15-20 years and, as auto safety improves, traffic deaths are down sharply as well. Both are making a positive contribution to the decline in premature deaths and neither has much to do with the quality of the healthcare system.

    The bottom line is that it’s bogus to use life expectancy and infant mortality statistics as indicators of healthcare system quality. Indeed, the U.S. system probably is the best at what Don Berwick calls rescue care. Other countries do a better job in primary care. The two biggest problems with our system are that it costs way too much and we don’t cover everyone (yet). I’m quite sure that fear of litigation among physicians is a much bigger issue in the U.S. than it is elsewhere and, I suspect but can’t prove, that patient expectations are higher here (meaning more expensive to fulfill) especially as it relates to end of life care, diagnostic imaging and, possibly, prescription drugs. We also have the problem of paying much higher prices for most services, tests and procedures than payers in other systems do. Brand name drugs cost more here too though generics are actually cheaper.

  179. Nate, sorry buddy, but you are not getting away with this one.
    You initiated discussion on the race issue here: “black minority, a race known for its lower life expectancy”. I have not the slightest idea what made you say that, and even less of an idea why Barry agreed. So I asked if life expectancy in a continent mired in violence and poverty is your indicator for people’s life expectancy in the US.
    If you think race is not pertinent to your arguments, than you shouldn’t bring it up with clockwork regularity.

    I would also suggest that you look up the definition of “fruits of one’s labor”. It implies actual labor.
    I suggest you check out some actual fruits too, like apples and oranges and how they get to your table.
    Then we can talk about contributions to society, which involves a bit more than paying whatever taxes are left after all the loopholes have been successfully employed.

  180. Liberals envision cadilliac private plan coverage, coverage for everything with little to no out of pocket, for everyone, they just never bother to envison how it would be paid for. This is the exact same thing they did with Medicare. First dollar coverage for every senior even though that isn’t what they needed and don’t worry about paying for it, let someone 50-60 years figure it out.

    Liberals should be required to fix medicare before they are allowed to pass any more insurance reforms.

  181. Medicare for all might be a solution, but as rates are paid now it would mean that most doctor visits would be in VA-like settings. Right now, most doctors’ offices cannot pay the overhead on Medicare and Medicaid fees. If fee structures under non-government (“commercial”) insurance dropped that far, there would be nowhere to get the money to make up for the big financial holes left by Medicare and Medicaid. No doctors outside of large multispecialty or hospital systems would stay in business, other than certain procedure-heavy specialists (who make a great deal more money). Everyone would be cared for by large institutional clinics.

    Some people may be satisfied with this, but many wouldn’t. It would be better for those who currently cannot afford insurance, and that would be good. It would be worse for many who are currently under Medicare/Medicaid, because their doctors get much of their pay for the services they perform for those Medicare/Medicaid patients by other, commercially-insured patients. This is cost-shifting.

    What would that medical world look like? I suspect that under that system the government would allow Medicare patients to see private doctors outside of the large clinics if they could afford the extra fees. Current law does not allow doctors to receive Medicare fees and simultaneously bill patients the balance of the office/service fees. So patients who want to buy more time or service from the doctor cannot do so if the doctor takes Medicare fees. The doctor has to “opt out” of Medicare entirely, and the patient is unable to recoup any of that doctor’s fees from Medicare. I think there would be enough backlash from a VA-like Medicare-for-all system that the government would have to allow balance billing. So doctors would have a financial incentive to open practices catering to those who could afford the supplemental fees. You would have a two-tiered system, with a very evident division between the haves and the have-nots.

    I am not suggesting that this is a bad thing. It’s a matter of opinion. It could end up meaning that there is universal health insurance. I don’t think that’s what Progressives envision, however. I think Progressives picture everyone going to the same sorts of doctors and hospitals, and that being affordable under a government program. I don’t think that would happen without a bottom-up rebuilding of our system with a Swedish or similar model. Just expanding Medicare to everybody won’t accomplish that.

  182. rbar, you must be from a different generation then me, the three or four versions of Robin Hood I remember all entailed Robin Hood stealing the tax collections back from the king’s men and returning them to the common folk. See as how 40%+ aren’t paying federal taxes in the first place your Robin Hood Analogy doesn’t really work. A more correct comparison would be barbarians raiding the civilized working people and stealing the fruits of their labor. If 40% of our population would contribute to society we wouldn’t have these problems.

    “But I do know this – when I reach eligibility it can’t turn me away.”

    Actually Mike you don’t know. Try being covered by your employers plan and see what they tell you. It use to be as soon as you hit 65 you got full Medicare, then the government couldn’t afford that promise so they changed the rules and now employer coverage is primary. 20 years from now you think they won’t change the rules more? It took only 5-7 years after passage before Medicare broke its promise to providers to pay them a fair price for services. The reason Medicare’s 40+ trillion in debt is not on the books is becuase you are not promised Medicare, there is no commentment to anyone beyound today that Medicare will be there, otherwise all that liability would be on the books.

    “Meanwhile some 50 million people in the US are SOOL if they need care.”

    Again no idea what your talking about. 50 million are uninsured for some part of the year, at any one time there is not 50 million uninsured. After that around 15-20 million are already eligible for coverage and just haven’t enrolled, once they need coverage they just need to sign up. Why is it you liberals can never get your facts strait?

    “So, Barry, Americans of African descent ought to see whatever life expectancy they have in the US as a major success for our health care system, when compared to life expectancy in Africa?”

    So white people are suppose to do what? Its not white people shooting them in gang wars and force feeding them junk food. Their health is their issue, if you race baiting liberals have a problem with that then round them all up into gated towers and control their lives…oh thats right you already tried that.

    Like Barry showed with Liberals its never about actually fixing problems or caring for people its all about money and control with them, disgusting, all of them.

  183. “This has been disproven so many time you have to know your lying when you type this. ”

    Nope. It just depends on whether you want to look at expenditures per capita or by total expenditures. If private insurance takes over Medicare and has increased expenditures, we might find those more important.

    “Medicare skimps on admin and because of that they have a 10%+ fraud rate, that is $700+ per year, where is that factored in Robert?”

    You always forget the extra expense incurred by providers from having to comply with private insurance paperwork and changes in billing. Additionally, most of that fraud and waste seems to come through the private contractors hired by CMS. Perhaps the govt should run this directly.

    http://www.gao.gov/new.items/d10844t.pdf

    “Private insurance already delivers Medicare benefits cheaper then Medicare can,”

    My broker will not even give me a price quote for someone of Medicare age. What would you charge to insure a 68 y/o with diabetes, hypertension and obesity, one of my typical patients? Given that private insurance pays 20% to 300% more than Medicare, note all of the docs who come here and say that they have stopped taking Medicare patients, how does private insurance pay less?

    Steve

  184. There is no doubt that the current “system” produces a large, confusing bureaucracy that is rather counterproductive to patient care. Just go into any US hospital and look at the amount of paperwork and, yes, billing clerks. Canada has proven that one can do private delivery of healthcare with a single payor.

    I am not sure whether Barry Carrols analysis is correct, but adjustments to improve medicare could be easily made if there is enough political traction to work against interest groups and “death panel” demagogues (i.e. consevatives incl. , by his own admission, Nate). In particular, the fee schedule need to be looked at. There are studies indicating that certain complex surgeries are overused because they are better paid (including medicare, which is not such a bad payor gor hospital care). but it will not happen with a pseudoliberal centrist and corporate interest peddler in the white house, and republicans who, as a whole, moved towards market libertarianism (without any social libertarianism) and now barely hide their reverse Robin Hood schemes.

  185. Medicare might be more efficient, or maybe it is even no better than private insurance, as an insurance company.

    But I do know this – when I reach eligibility it can’t turn me away. Meanwhile some 50 million people in the US are SOOL if they need care.

    Reich makes some economic arguments for Medicare, but he never really states the most important one, the ethical argument.

    You can argue the economics of insurance systems all day long, but the bottom line is if you defend a system that allows 50 million people (or one person) to remain shut out of the system you have crossed a moral and ethical line and elected to wage class warfare.

    There is a war being waged against the lower half of US society, and the insurance system is one component of that war.

    We get a glimpse in these comments of the minds of good soldiers and bureaucrats in the war against the lower and middle classes. We see people who no doubt sleep well at night in the tight security of their circular arguments, oblivious to the death and misery that they cause, or justify, every day.

    To read the comments here is to witness the banality of evil.

    Former Secretary of Labor Robert Reich is hardly a flaming leftist, but he was as left as was allowed to be part of the Clinton administration, and compared to the right wing Obama administration, he is a breath of fresh air and public ethics.

  186. Government is the problem. It terrorizes people into believing survival is impossible without the government.

    Government is the problem.

  187. “The correct analysis, as you suggest, would compare Asians in the U.S. with Asians in Asia, Scandinavians in the U.S. with those in Scandinavia, Germans in the U.S. vs. Germans in Germany.”

    So, Barry, Americans of African descent ought to see whatever life expectancy they have in the US as a major success for our health care system, when compared to life expectancy in Africa?
    Not to mention that we don’t really have American Germans or American Scandinavians anymore.

    I do agree that the health care system is not the sole reason, and perhaps not even the main reason, for the US life expectancy, or infant mortality numbers.
    I suggest factoring in the large disparities in American society as opposed to, say, European societies (US Gini is in high 40s and Europe is around 30).
    So the problem is, was, and will continue to be, poverty (whichever color you want). Fix that and you fixed health care.

  188. Nate –

    To add to your comments about Medicare’s administrative costs, when people first apply for Medicare, they do so through the Social Security Administration, not CMS. CMS only has about 4,600 employees while SSA has more than 60,000. The revenue to fund CMS is collected or borrowed by the Department of the Treasury. Office rent, I believe, is part of the General Services Administration budget. The list goes on. If you factor in all the costs associated with running Medicare that are handled by other government agencies, Medicare’s fully allocated administrative costs are more like 7%-8% of spending than 3%. Add in the fraud rate which you peg at 10% and you’re up to at least 17% for administration and fraud. Throw in below cost payment rates for many services, tests and procedures which get shifted to a still viable private insurance market and overall costs growing faster than GDP, and it doesn’t look like a sustainable model to me.

    As many times as you and others point out the flaws in the analysis around life expectancy and infant mortality in the U.S. vs. other countries, we still hear the same BS over and over. The correct analysis, as you suggest, would compare Asians in the U.S. with Asians in Asia, Scandinavians in the U.S. with those in Scandinavia, Germans in the U.S. vs. Germans in Germany. The fact is that a given person’s health status is determined 40% by personal behavior, 30% by genetics, 20% by socioeconomic status and environmental factors, and only 10% by the quality of healthcare than one can access.

  189. I have to call out nate for his admittedly relevant, but spectacularly racist dismissal of the issue of health disparities in the US.

    Another way to say what he’s saying is, “sure, if you look at the whole population we’re not taking care of them, but the only ones who COUNT are the white folks, and they’re just fine.”

    Seriously, you can write that blacks are “a race known for its lower life expectancy” without comment? Yes, there are many many social determinants of health that impact non-whites in this country disproportionately and thus impact life expectancy, but that’s PART OF THE PROBLEM, not an exception to be dismissed. This post makes me sick to my stomach.

  190. This one needed its own post so Robert doesn’t miss it;

    http://www.nytimes.com/2009/09/22/science/22tier.html?adxnnl=1&adxnnlx=1302710847-rbuCAF2H0dKLCY/sz3xtKA

    But a prominent researcher, Samuel H. Preston, has taken a closer look at the growing body of international data, and he finds no evidence that America’s health care system is to blame for the longevity gap between it and other industrialized countries. In fact, he concludes, the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis.

    Americans pay more for health care partly because they get more thorough treatment for some diseases, and partly because they get sick more often than people in Europe and other industrialized countries.

    An American’s life expectancy at birth is about 78 years, which is lower than in most other affluent countries. Life expectancy is about 80 in the United Kingdom, 81 in Canada and France, and 83 in Japan, according to the World Health Organization.

    This longevity gap, Dr. Preston says, is primarily due to the relatively high rates of sickness and death among middle-aged Americans, chiefly from heart disease and cancer. Many of those deaths have been attributed to the health care system, an especially convenient target for those who favor a European alternative.

    But there are many more differences between Europe and the United States than just the health care system. Americans are more ethnically diverse. They eat different food. They are fatter. Perhaps most important, they used to be exceptionally heavy smokers. For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world. Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.

    Like the say read the whole article, as it completly tears apart your argument. When I have time I’ll educate you on your other numerous errors. In the mean time could you explain where in your 3% admin cost for Medicare the budget of CMS is included. Also staff time of Congress when working on healthcare related bills. printing and research. Medicare cost is spread all throughout the federal budget, the 3% refers to a minute portion directly linked to Medicare but leaves out all oversight and management, expenses that are included in the private insurance numbers.

  191. Another difference in life expectancy relates to race/ethnicity. For example, in the United States, the expectation of life at birth for whites is six years higher than for African Americans. However, the difference in life expectancy at age sixty-five is less than two years.

    Read more: Life Expectancy – world, body, cause, time, human, The Measurement of Life Expectancy, Life Expectancy at Birth, Circa 2001 http://www.deathreference.com/Ke-Ma/Life-Expectancy.html#ixzz1JQ5x024q

    Ethnic diversity causes lower life expectancy
    European countries have longer average life expectancy than the United States, but comparing nearly all-white Europeans to the United States which has a substantial black minority, a race known for its lower life expectancy, then you are comparing apples to a mixture of apples and oranges. It’s a meaningless comparision.

  192. All the more reason to not listen to Labor Secrataries and journlist and listen to people that actually work in the field and know what they are talking about.

  193. maybe I shouldn’t have used we in such a general sense.

    people that do insurance for a living and work with this stuff day in and day out instead of writing and pontificating about it know the cost.

  194. you have to go to the CMS data and look it up. First thing you need is the bill broken down by revenue codes

  195. We do?
    What is the audited, direct cost incurred by, say, Mass General for a hip replacement, itemized for technical component, professional component and facility, with no margins built in?

  196. ” we should first know what the real costs are to deliver that care. And we don’t. We know what we are charged,”

    Margalit we do some cost plus reimbursement for hospitals now, not nearly as much as I would like but the numbers are known.

  197. I somehow don’t believe it’s a good idea to counteract fiction with more wishful thinking.
    Yes, Mr. Ryan’s plan is not even remotely attached to reality, but if we are serious about fixing this mess, we first need to understand it.

    Medicare, and its poor cousin Medicaid, are indeed not negotiating prices with hospitals and doctors. They are dictating those prices. There could be savings associated with negotiations between Medicare and drug manufacturers, but that’s about it.
    As long as hospitals and doctors have a release valve by which to shift their desire to make profits from Medicare to a private insurance market, we will achieve very little other than miserable care for the elderly and the poor by having Medicare, and its poor cousin Medicaid, reduce reimbursements. I don’t even know if any reductions in Medicaid fees are even possible without getting into negative numbers.

    Medicare for all, including those currently relegated to its poor cousin Medicaid, may very well be a good suggestion, but it has to be for all, from day one. And that is not going to happen any time soon.

    I do agree that there are savings possible from administrative simplifications and reductions in medication prices paid, but in order to reduce what we pay for all other care, which is the bulk of the expenditures, we should first know what the real costs are to deliver that care. And we don’t. We know what we are charged, but we have no idea what the costs are to the provider, excluding embedded profit margins, arboretum constructions, enormous salaries for the few and miscellaneous bloat built in for a rainy day.

  199. What a bunch of BS, pure partisan BS.

    “And we have the highest rate of infant mortality of all advanced nations.”

    Might this have ANYTHING to do with the way infant mortaility is measured? The NHS lets them die under 22 weeks, we spend millions to save them. That skews both your per capita spending and infant mortality rate.

    How many unhealthy illegal South American immigrants are breaking into these other countries to have babies, again skewing both numbers.

    “Yet the typical American lives 77.9 years – less than the average 79.4 years in other advanced nations.”

    Why don’t you break down how an asian American life expectancy compares to an Asian, a black to a black and so on? Because when you do the difference disappears.

    “It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.”

    This has been disproven so many time you have to know your lying when you type this. Medicare is no where close to private insurance on administrative cost, if you had any idea what you where talking about you would know they are considerably higher. Then again this isn’t about facts its about politics.

    “Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure.”

    Do you not understand math or just that dishonest? Robert you’re comparing 3%, which is low, your leaving out half their expenses, of $7000+ to 5% of $3500. Let me help you out there, $210 is more than $175. Even using your bogus numbers you’re wrong. You don’t buy stamp, pay salaries, or office space as a percent of premium so why does the left always compare admin efficiency as a %, because it’s the only way they look close. Incredibly dishonest but effective. Medicare skimps on admin and because of that they have a 10%+ fraud rate, that is $700+ per year, where is that factored in Robert? That alone is 400% of the total cost of private admin. Funny how you always forget that piece of the equation.

    “allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors,”

    ??? What country do you live in, Medicare and Medicaid don’t need to negotiate they just tell doctors and hospitals what they will be paid and this is already done. You want to cut Medicaid reimbursements even lower?

    “Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year.”

    When done by far left liberal propagandist that don’t know anything about healthcare. When done with even a token effort at accuracy fraud alone increases your cost 10%. Private insurance already delivers Medicare benefits cheaper then Medicare can, that is as true of an apple to apple comparison you can get.

  200. Thanks for sharing this. Reich is right on. The system needs to start small with the docs, hospitals and other health care professionals. Trying to fix this nationally is going to leave out the ones who need the Medi programs the most. Looking forward to what Obama has to say about the topic later this afternoon. Reich always gives great insight – a follow-up from him would be superb.