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2. I mean great, particularly if you want to lower your blood pressure.
   As such, proper control in weight and intakes of sugar and cholesterol rich foods should be avoided.
   ” The goal here is to allow your forearm muscles to work ‘ but not to overdo it to the degree that your blood pressure spikes.

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3. A basic conundrum: Finite resources, infinite demand.

   To shrink the pie, one must either:

   1) Ration access to patients – especially for non emergency and elective services. BTW, whoever plays the payer ( private insurance or the government ) will wear the black hat with the patient when they deny something based on lack of medical necessity. This includes as the Mad MD shares tough calls on who gets what, when and where. Can someone say, ” hospice”?

   2) Reduce unit cost reimbursement to providers – all payer legislation, global budgets, ( oh, and watch a generation of docs retire, fold their tents and our best and brightest go into something other than medicine ) Perhaps UK docs will come here as former Commonwealth docs flood to the UK to accept better levels of reimbursement than their own countries – creating huge nursing and provider shortages

   3) Reduce units consumed by patients through PCP directed medical homes, compliance based designs, clinical oversight, population health improvement and performance based remuneration for all. Must invert the pyramid to restore primary care.

   Having consulted and handled private and public health purchasing across the UK, Continental Europe and the Middle East for many SMEs and large multinationals, the private system is alive and well – everywhere. There is no getting around the perpetuation of a two-tiered system. It will always exist as long as someone is willing to pay for the ability to access care faster than a public system would otherwise accommodate.

4. ” we can estimate what national health care expenditures will be next year, inefficiencies included.”

   That’s not good enough, government can’t raise taxes effective next month. If they are off 20% then where does the extra money come? What if we are mid recession where does it come from?

   Look at Medicare’s history of projections, if private insurance was half as bad as government at projecting cost they would all be out of business.

5. Margalit –

   Even if Medicare were a single payer system that covered the entire population, it would not be any easier to accurately predict healthcare costs a year in advance than it is under the current system. If you had that model and tried to make it work within a fixed budget, what do you think would happen if the money ran out by the end of November? The answer is that there would be a supplemental appropriation because we’re not going to let people go without care just as we won’t let people die on the steps of the ER just because they’re uninsured and can’t pay.

   Canada imposes global budgets on hospitals but it rations care, especially for non-life threatening procedures and diagnostic testing. Moreover, a recent article in Health Affairs found that poor people who had complete access to care in Canada with no coinsurance required still had worse medical outcomes than middle income and wealthier people while they consumed more care in the process. So, aggressively and expensively addressing poverty as you would like still won’t produce equal medical outcomes just as throwing a lot of money at poor school districts in New Jersey as our State Supreme Court requires us to do doesn’t come close to equalizing education outcomes either.

   Regarding Medicare Advantage plans, PPACA is gradually phasing out the extra payments over the next several years. Humana, the 2nd largest MA insurer after United, is confident that it can continue to grow and prosper in the Medicare market while earning its target pretax profit margin of 5%. Several years ago, it developed a strategy it calls its “15% solution” which is intended to deliver the standard Medicare benefit package to seniors for 15% less cost than regular Medicare can do it. Strategies include less fraud than regular Medicare, better discharge planning and care coordination, better case management generally and more cost-effective provider networks.

   Finally, there are circumstances under which it is appropriate to pay different providers different rates for the same service, test or procedure. For example, even within the same group practice, a relatively new doctor is likely to be willing to charge less in order to build his practice and gain experience while a 20 or 30 year veteran will charge more.

   Also, even within a tax financed system like Germany’s, to calculate the cost of insuring a particular individual, the Central Fund will use as many as 80 separate factors to calculate the premium to be paid to the sickness fund or insurer that covers that person. People in the U.S. don’t want and wouldn’t trust a one size fits all system. We like to have choices here even if it costs a little more.

6. So as a tax payer, I am supposed to pay more for each Medicare beneficiary to private corporations because…… ???
   We’re looking to cut Medicare expenses, but somehow now I have to pay for memberships in the Silver Sneakers club for active seniors? Does this have anything to do (again) with keeping the same percentage in profit, but from a larger amount?

7. “If physicians are all going to be government contractors can we all look forward to public health center quality care or VA before it became a national scandal?”

   Why? Every physician that is not operating on a cash only model, which very few do, is currently a contractor with Medicare and with private insurers. Physicians treat members and the payer pays according to contract terms. Medicare has one contract with everybody (although actual fees vary) and private insurers have different contractual fees. The only difference would be that the doctor at Partners and the solo practitioner across the street would be paid the same amount for the same service. Is that a bad thing?
   I don’t see any public health centers or VA models being necessary as long as physicians are not employed by the government.

   As to employer self funded insurance (or not), from a consumer POV, there is no difference. I pay X number of dollars per month and the “system” takes care of all my medical expenditures. The high deductible plans, which you seem to favor, are more insurance-like, if the employer doesn’t fund the deductible, but since according to you, most do, we are back to prepaid.

   Barry, I agree that the lack of a fixed budget makes this an open-ended entitlement. But if we had Medicare for all, is there any reason not to have a fixed budget (a reasonable one)?
   The fact that variations in care exist is not necessarily a risk. We know they exist and we can calculate and project their effect. Unless there is some sort of new plague coming our way, we can estimate what national health care expenditures will be next year, inefficiencies included.

   Although I do agree with Dr. Emanuel on most things, I do not agree that small private practice, particularly for primary care, is either inefficient or incompetent. I actually think that primary care should be provided in the most disaggregated and independent form possible, so it maintains an alignment of interests with patients instead of whoever owns the medical complex.

8. “It is prepaid medical services. There is really no risk involved in medical care if you look at it at a national level.”

   Margalit –

   That’s not true. Medicare is an open ended entitlement. Bills come and taxpayers pay them. It does not operate within a fixed budget determined in advance. Medicaid works similarly though both the federal and state governments share the cost. There is also plenty of risk even at the national level. Practice patterns vary enormously whether it’s managing patients with diabetes, heart disease or asthma. There are regional differences in determining under what circumstances to recommend back surgery, hip and knee replacement surgery, heart surgery, etc. Lots of care is either unnecessary, defensive in nature, money driven or an attempt to satisfy patient expectations. Total costs are growing faster than the economy and have been for a long time which is why the system is unsustainable. Even if Medicare were the single payer for the whole system, cost growth would still be unsustainable. Potential administrative savings, which are the single payer approach’s biggest advantage, are substantially overstated, in my opinion and would probably be more than offset by increased fraud in any case. Lower prices per service, test or procedure without a large commercial insurance sector to shift costs to would probably endanger the viability of much of the hospital sector. A single payer approach, according to Dr. Zeke Emanuel, would lock in most of the practice pattern inefficiencies of the current system and probably stifle innovation as well. It’s not the answer. Maybe the Vermont legislation will prove that for us eventually.

9. ” Which contracts are easier to work with? Which entity allows you more autonomy and has less red tape?”

   You don’t work with Medicare, you do things the way they tell you or you go to jail or lose access to all their members.

   If physicians are all going to be government contractors can we all look forward to public health center quality care or VA before it became a national scandal?

   “What we call health insurance is not insurance. It is prepaid medical services.”

   Again Margalit, there is so much you don’t know. Again most private insurance is self funded, on those cases, which are the majority, the insurance doesn’t kick in until 50K, 100K, or 200K in claims on a single person. How is that prepaid medical services? Now when your genious president passed PPACA caping deductibles and OOP he has turned it into prepaid services, why did you vote for him again?

   ” all pretending to assess and manage risk, which only exists because we fragmented the pool into thousands of artificial sub-pools, is illogical. And expensive.”

   In this system you and Quack dream of, how do individuals pay for their hospital stays and large dollar care without insurance and pools?

10. “I thought that the “private” version of Medicare, i.e. Medicare Advantage is even more expensive.”

    Do you try to be this obviolous to facts or do you really live under a rock? Have you never compared traditonal medicare benefits to Medicare Advantage? Hint, its cost more becuase you get more.

    Don’t vote because your ignorant of the basic knowledge you need to make an informed vote.

    What’s with you liberals and your apple to orange comparisons?

11. “hatred of insurance, I assume you feel the same way about life insurance, auto insurance, homeowners insurance”

    What we call health insurance is not insurance. It is prepaid medical services.
    There is really no risk involved in medical care if you look at it at a national level. It’s an expenditure that can be estimated and budgeted just like other budget items (except wars).
    So eliminating all the little inner pools of insurance, all pretending to assess and manage risk, which only exists because we fragmented the pool into thousands of artificial sub-pools, is illogical. And expensive.
    The actual medical care is what it is, at least for now. The surrounding paper shuffling and data crunching and busywork can be eliminated.

    I don’t go as far as Dr. Vickstrom, and I don’t really think physicians should be civil servants, but they should be government contractors. If that sounds onerous, just remember that most physicians are already operating that way both for government contracts and private contracts. Which contracts are easier to work with? Which entity allows you more autonomy and has less red tape?

12. ‘Until you can reconsile the fact single payor Medicare is more expensive then everything else you should refrain from voting.”

    Interesting. I thought that the “private” version of Medicare, i.e. Medicare Advantage is even more expensive.

    I wonder how expensive Medicare would be if it included all the healthy people currently paying into private insurance. What was the MA excess? 14%?

    Is this the new conservative idea of how to run a democracy “don’t vote because we know better”?

13. “you don’t need health insurance to live, you need healthcare.”

    True, true. All the more reason to get rid of health insurance. Time to change the paradigm.

    “Health Insurance exist becuase healthcare is so expensive, health insurance didn’t make healthcare prohibitivly expensive. You can thank government for that.”

    Ultimately, we can thank supply and demand for that. Once again, I argue we should change the paradigm of supply and demand. Also health insurance does its part in jacking up the price of said health care.

    “You are still ignoring the fact that 80% of private healthinsurance is non profit so your argument based on profit motive is BS.”

    “Non-profit” in the way the Blues are? I suppose it depends upon what “is” is then…

    Nate, you say I don’t know what I’m talking about all day long, but the fact remains I’m a doctor. I deal with this junk all day, every day. Our “system” is failing. I comprehend that just fine.

14. you don’t need health insurance to live, you need healthcare. Health Insurance exist becuase healthcare is so expensive, health insurance didn’t make healthcare prohibitivly expensive. You can thank government for that.

    You are still ignoring the fact that 80% of private healthinsurance is non profit so your argument based on profit motive is BS.

    These aren’t assumptions, your making wild and false claims apparently based on a complete lack of comprehension, instead of getting your facts straight you bury your head in the sand chanting falsehoods. Self funded plans don’t have profit motives and they are 50% of all private insurance. Next majority of the fully insured carriers are non profit so they also don’t support your argument.

15. When you are arguing over assumptions, logical proof has nothing to do with the argument. The current medicopolitical reality is unsustainable and a failure. Time to create a new one.

    I don’t hate insurance, I just think it shouldn’t exist or should exist on a (really) non-profit model. And no, this doesn’t apply to other kinds of insurance. We don’t need them to live.

    AAMOF, I already live on a civil servant’s salary. I am one, and proud of it.

16. At least you admit facts and reality have nothing to do with your thought process. Now if only we could take away people like you right to vote the rest of us would be ok.

    Curious though, this ilrational hatred of insurance, I assume you feel the same way about life insurance, auto insurance, homeowners insurance? They should all be non profit or not exist at all?

    And when is it you propose providers live on civil servant salaries? $50,000 a year and a pension.

17. “If providers really think that insurers consume 30% of the premium dollar and provide no value added, there is nothing stopping them from assuming the insurance function.”

    First, I’m a physician, not a provider.

    Second, yes there is something preventing me from assuming the insurance function: I want to do something real, substantial and honest with my life. I have no desire to get money for nothing.

18. @Mssrs. Carol and Ogden,

    I’m a doctor, not an insurer. I do something real with my life, not shuffle other people’s money around, while taking a cut off the top. I don’t need to pull dubious numbers out of my rectumAhem.

    Which brings me to the point. The Ryan plan is just tinkering with the current system, which is the bastard child of socialism and capitalism. The current system is not working for most people, although it is working for insurance company executives and their shareholders. I am arguing for revolution, not incremental change. No profit motive in medicine for starters, and that includes all players. Take medicine to a civil service model like police, firefighters, etc. We can dispute this, but is ultimately something that is not provable either way. I speaks to your basic assumptions concerning resource management. You all seem to think bleeding off resources to third parties that neither provide nor consume medical care is a good idea. I don’t. You can spew insurance “facts” at me until you are blue in the face, but it won’t change my mind that for-profit, third-party insurance costs too much by its very existence. The insurance companies cannot distract me from the fact that they exist.

    In the interest of intellectual honesty, I should concede that I would be OK with private insurance if they made no profit, and their executives were paid civil service compensation, and that they were regulated to the point to which they provide all the benefits which the government would have provided had it done the job. I’m OK with highly regulated, supplemental private insurance to cover beyond the basics what socialized medicine doesn’t cover.

19. If providers really think that insurers consume 30% of the premium dollar and provide no value added, there is nothing stopping them from assuming the insurance function. Become an insurer, estimate your claims costs, quote a premium and capture what you think are massive profits currently going to insurers. Oh wait, that’s been tried. It turns out that assuming actuarial risk is not so easy and it’s quite possible to go broke quickly if actual claims costs materially exceed estimated claims costs. Insurers are, in fact, a lot better at assuming actuarial risk than providers are because they have better data and better analytics. If you can do it on a huge scale like Kaiser, it can work, at least in some markets but even their premiums are about in line with their competitors’.

    I think what doctors in particular really want is to be able to practice medicine as they see fit with no accountability, oversight or utilization review and they want their fees to be paid promptly and without question. That might be OK in a world of infinite resources but that’s not the one we all live in.

20. 36 million enrolled in traditional Medicare

    “A four month “Nightline” investigation into Medicare fraud makes one thing perfectly clear: this is a crime that pays and pays and pays. The federal government admits that a staggering $60 billion is stolen from tax payers through Medicare scams every year. Some experts believe the number is more than twice that.”

    That works out to $1,666.66 per Medicare enrollee per year. Private insurance only cost around $3600 total per year. Private insurance admin at most would be $720. According to ABC news and the government half of what Medicare loses on fraud alone. How can you ignore these facts and continue to insist government care would be cheaper? Oh thats right if you liberals, socialist, and communist took over everything you would click your heals and make all the fraud go away. Why you can’t do that now I will never understand but we shouldn’t worry about facts when we have dogma

21. Wow the inteligence on here drops to zero on the weekend. Think through some of these comments….for the first time apparently.

    “Private insurance in this country is subsidized by Medicare.”

    ? how, Medicare through cost shifting and administrative complexity increases the cost of private insurance for the population it serves. Now if your saying private insurance premiums are lower then they would be if they covered people over 65 that is true but that is not a subsidy.

    No Medicare does not take the sickest, how many premature babies are covered by Medicare? What’s with you and margalit making all these obviously false comments, decided the truth and facts were to inconvienent to argue with? Are you really that clueless to how Medicare works Quack?

    “After you pay a deductible each benefit period, Original Medicare will cover you in full for days 1 to 60 that you are in a hospital. For days 61-90, you pay a daily coinsurance. Medicare pays for up to 60 additional hospital days in your lifetime with a high daily coinsurance, after you have used up your 90 days of hospital coverage in a benefit period.
    After you use up your 60 lifetime reserve days, Medicare will no longer pay for any coverage until you start a new benefit period.”

    Well Quack how does Medicare cover the sickest people when it cuts off hospital stays? And those expensive Rx, is that Medicare that covers all of those?

    Its becoming very clear that you and Margalit don’t care aqbout the facts or a system that actually works all you care about is the politics and destroying the country. If you just need to make crazy baseless BS up to support the argument and get your political change so be it, you don’t care how poor the outcome, as long as it is more government power.

    Name a socialized system that is so much better then ours that doesn’t have private insurance…..

    ” If private insurance took over Medicare patients, the cost of private insurance would sky rocket and the actual care delivered to that population would fall thru the floor.”

    Once again Quack, BS that has been disproven. Private Insurers already deliver Medicare, exact same benefits, cheaper then Medicare does.

    What else would you like to make up?

22. Yes Margalit I have actual numbers. Every time I process a claim with a PPO discount I know for a fact I saved them money. When I audit a hospital bill I know for a fact money has been saved. When I write a new piece of business and reduce their premium 10% I know for a fact I saved them money.

    You don’t seem to grasp that not all insurance is written by carriers.

    You also can’t seem to get your head around the concept that it could be far worse then it is now.

    “If employers wanted to slash their health care expenditures, they should support single payer.”

    And there is the home run of ignorance. You admit just above you have no grasp of how insurance works yet somehow your ideological certain single payor would save money. If this was true then Medicare wouldn’t be the most expensive health insurance system in the world now would it?

    Until you can reconsile the fact single payor Medicare is more expensive then everything else you should refrain from voting.

23. Good one.

24. The many socialized health care systems around the world that deliver care at a fraction of the cost of our own argue conclusively against this. The socialized, civil-service systems are much cheaper than our own. Face it.

    Private insurance in this country is subsidized by Medicare, which takes the oldest, sickest and most costly patients off the books for private insurance. If private insurance took over Medicare patients, the cost of private insurance would sky rocket and the actual care delivered to that population would fall thru the floor. Once again, private health insurance in this country is ultimately parasitic, and it’s profitability highly subsidized by Medicare.

25. Unless you have actual numbers to prove that the cost to insureds has been reduced, all we have is the ever increasing cost curve. Could it be that, as you argued here many times, 5% of more money translates into larger profit? And could it be that all those bureaucratic activities you describe, indeed decrease the portion spent on actual care, but do very little for the overall cost to consumers?

    If employers wanted to slash their health care expenditures, they should support single payer.

26. “have done nothing to reduce cost and I would venture a guess that they may have contributed to the rising of costs.”

    How can you come off as lucid some days then say completly stupid things like this? Nothing really, PPOs don’t reduce billed charges? Utilization review? Bill audits?

    What’s increased cost is government and clueless liberals making statements like nothing has reduced cost then passing laws based upon that warped view.

    “There is no one in the medical complex, including private insurers, that would benefit from lowering costs.”

    Sorry for the bluntness but you managed to raise the bar on stupidty over your last comment with this one.

    Employers wouldn’t benefit from lower cost, I’m sure they would be shocked to hear that. Most plans are self funded and sponsored by employers, over 50% to be exact so wouldn’t all those people hired by those plans benefit from succesfully lowering cost? That would be TPAs, PPO, UR, etc etc.

    Can’t wait to hear what you come up with next.

27. ” how do we justify spending all the money on shareholders, executives, physical plant, staff time and secretaries?”

    Because even when paying for shareholders, executives, and everything it is still cheaper then paying civil servants. I’ll point this out to you again, evil private insurance “cost” $360 to $720 per person per year. Medicare cost $700 to $1050.

    Civil Servants don’t save money and this has been proven time after time for 30 years.

28. “..why not wish for Fairy Guardians that keep us healthy with their magic wand?…….. You want individuals to determine what care they will and will not get only with the consultation of their doctor…. you propose to eliminate all cost control.”

    First of all, all the cost controls that supposedly exist today, have done nothing to reduce cost and I would venture a guess that they may have contributed to the rising of costs. There is no one in the medical complex, including private insurers, that would benefit from lowering costs. Everybody has a nice last resort release valve called patient empowerment, where any unpalatable extras are passed on to employees or other insureds.
    The only group that will benefit from lowering costs are people and the government, both as a payer and as a representative of citizens.

    The biggest damage is probably the destruction of general practice, first by gross underpayment and then by pitting GPs against their patients in various gate-keeping roles, which is about to get infinitely worse now. Even your “beloved” NHS, after trying this industrialized type of medicine, is now turning to its GPs to fix the problems.

    If I had to choose someone to trust with health care, I would much prefer a gazillion disparate professional PCPs, who are empowered to be the guardians of health care, to corporate medicine, corporate insurance, government committees or anything else that is large, monopolistic, powerful, for-profit and therefore sooner or later largely corrupt and never interested in individual people. I am not comfortable being a population.

29. Which again brings me to my point: how do we justify spending all the money on shareholders, executives, physical plant, staff time and secretaries? Why not just replace them all with a few civil servants and be done with it? If the money is not going to provide actual health care, why is it going in the first place?

30. “…the cost to run CMS, Congress, Treasury, collection, buildings, and countless other cost”

    We have to run those anyway, so might as well use them. It’s called “economies of scale”.
    How much does it cost the system just to process claims today? Including all payers, all middlemen, all providers (including time on the phone).
    How much goes to marketing? How much goes to benefit design? How much goes to shareholders and other profits (including hospitals)?

31. “And I believe insurance companies take 30 cents of every dollar for admin/profits,”

    Can’t say I am surprised your opinion is based on ignorance of the facts but no they don’t take 30 cents. 50% of private group insurance is ERISA self funded plans, that would be what 50% of 80% or 40% of all insured people? Overhead in self funded plans is around 10%. That would be roughly $360 a year per person. Medicare loses $700 per person per yer in fraud.

    ” It would certainly be worth the savings, in my mind.”

    What savings, you haven’t demonstrated where a single penny would be saved. I have demonstrated how poor civil service work does increase cost on the other hand. So you are suggesting we pay considerly more for worse service and poorer results. No thanks.

    “instead of the 5 cents of Medicare.”

    Besides doing an invalid comparison, use dollars not percent, you can’t even get the numbers right. Medicare pays private insurers a little under 5% to perform the work they do, not included in your invalid argument is the cost to run CMS, Congress, Treasury, collection, buildings, and countless other cost.

    “Certainly it would go a long way towards a more just and merciful society.”

    Maybe if the left could get the basic facts right they wouldn’t be in such a rush to socialize everything. Do you care about the actual results, in which case you should care about the facts going in, or just the politics of it?

32. Well, our civil service functions much better than many countries I have visited or lived in. It’s not really that bad if you are not into instant gratification and customer service. It would certainly be worth the savings, in my mind.

    With regards to fraud and tax cheats, that is a law enforcement problem, not one to shill out huge amounts to private companies. And I believe insurance companies take 30 cents of every dollar for admin/profits, instead of the 5 cents of Medicare.

    What I would like to see is primary care, nursing homes and medications socialized, with high-ticket interventions (like open heart surgery and ICUs) privatized. If everybody could be provided with a basic level of care, private insurance for major medical would not be that big a burden. Certainly it would go a long way towards a more just and merciful society.

33. “Civil servants could do with this with minimal expense: no shareholder dividends, no multimillion dollar executive salaries, no profits to third parties which add no value.”

    Like how civil servants efficently run DMVs, accessor office, turn pikes, and everything else. What’s their success on tax collection, mid to high 70s?

    Medicare and their civil servants thougth they could be smart and save 1-2% on admin fees, and pay for it 5 times over with fraud. Is that what you hope happens?

34. “Democrats want the government in the exam room and Republicans want corporations to be there. I don’t want either.”

    Why stop there Margalit, why not wish for Fairy Guardians that keep us healthy with their magic wand? Its more praticle then your sound bites.

    Who do you want to pay for this? You want individuals to determine what care they will and will not get only with the consultation of their doctor. Yet you want someelse to pick up the bill for this. Obviously you have not given any thought at all to the consiquences of this system. Our problem with healthcare today is cost and you propose to eliminate all cost control.

35. “Democrats want the government in the exam room and Republicans want corporations to be there. I don’t want either.”

    Very well said, Ms. Gur-Arie!

36. @Nate,

    “It’s not insurance companies billing 10 times cost for hospital services, $10,000 a month for life saving drugs, bilking public health programs for 10% in fraud, ordering redundent test, killing thousands with preventable errors, etc etc.”

    Much of this is probably true. But that is not the job for insurance companies. This sort of thing should be taken care of by a civil service board of physicians. They are in a position to know what is and is not necessary; what is and is not correct; not insurance company executives and their secretaries. Civil servants could do with this with minimal expense: no shareholder dividends, no multimillion dollar executive salaries, no profits to third parties which add no value. In my daily dealings with insurance companies, they just reflexively say “no” to everything I order. Period. Where is there value added in that?

    BTW, 35% of my income actually does go to taxes. Could I pay less? I’m sure I could, but I consider it my patriotic duty to pay my taxes, especially when I DON’T like it. Would I prefer that it not go to sustaining fossil fuels, slaughtering innocent people across the globe, corporate welfare and (unnecessary) welfare the poor? Yes, of course. But I do it anyway because it’s patriotic.

    Anyone here every read Maj Gen Smedley Butler?

37. Sure not what you sound like when your comming forward hand outstretched demanding money. It’s not insurance companies billing 10 times cost for hospital services, $10,000 a month for life saving drugs, bilking public health programs for 10% in fraud, ordering redundent test, killing thousands with preventable errors, etc etc. You question the value added benefit of insurance, they minimize, counteract, and eliminate all of the above, there is your value.

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39. Dr. Determined,
    You’d be surprised, but I do agree “about being realistic and clarifying what quality of life means for a person, not the family members more often than not in prolonging life”.
    This is what it should be and this is where it should stop.
    Democrats want the government in the exam room and Republicans want corporations to be there. I don’t want either.

40. @DeterminedMD

    Wow. I largely agree with you post, regarding resources and their allocation. You make a very concise and poignant argument.

    With regards to political parties, while I do not defend the Democrats, remember that the Republicans have been just as evil, carrying political water for the filthy insurance companies, the ultimate parasites in the medical field. The insurance companies are the very definition of “no value added.”

41. What a lame interpretation to what I wrote, at least that is how I interpret your reply, Ms G-A. It is not about asking people to “commit mass suicide at the appointed time”, but it is about being realistic and clarifying what quality of life means for a person, not the family members more often than not in prolonging life.

    This is a sizeable part of Medicare expenses. Your comment above reinforces why this debate is both absurd and annoying to those of us who are championing for change and hope. Not these partisan bylines and echo rhetoric that both parties are guilty of. People in DC are the textbook illustrations of selfishness, greed, and lack of clarity and concern for the pubilc. And as I wrote earlier, you vote for the same, lame, out of touch representatives, you have no right to complain, you are part of the problem.

    Prolonging life just because there is technology that allows some chance does not infer entitlement and unfettered access. That is what cost is about. But, as most do here, focus on what is best for party and personal interest first. Politics and health care are oil and water. That is why I detest so much how the Democrats have cruelly, carelessly, and cluelessly dug such a canyon between physicians and patients.

    I’m done at this thread and site for now until a whopping link intrigues me to come back. Not that most of you really care though.

42. “Ah, Margalit, you just begged the question: who owns the money? And before you answer, it doesn’t matter what you think, because most of the people who posses it think they morally own it. ”

    People thought that they “morally” owned lots of other things that they are not entitled to own any longer. Of course the new question that begs to be answered is what does “morally” mean?

    It does matter what I think because we chose to live in a democracy. And there is a price for individuals to pay. Sometimes, when the government decides to go to war, it may ask you to contribute your life for the common good or go to jail. Sometimes it may ask you to contribute a few dollars for the same purpose, or go to jail.
    Once we agree that government has a right, conferred to it by virtue of representing the majority of citizens, to ask you to contribute as needed to the common good and to the preservation of the system as we know it, then you have to agree that government has a right to ask you to also contribute money. For some reason, folks seem to be uniquely attached to money more than anything else, and the more you have the more attached you become. Must be addictive somehow. Is there an ICD-9 for that?

    Yes, minorities deserve protection from majorities, and people should have a basic right to enjoy the fruits of their labor without the State ripping those from their clutched little hands. I have never heard of anybody driven into destitution by taxation, and I have never heard of wealthy individuals driven into the middle class by taxation either.

    The argument for progressive taxation is that without the environment, services and labor of others in this country, you would not have been able to earn your fortune. The country provides you peace, tranquility, infrastructure and trained labor. The more you exploit these features and the more money you make, the more you have to pay back, so the country can continue providing the same to you and to future generations.

    For those contending that boomers are selfishly bankrupting their grandchildren because they refuse to commit mass suicide at the appointed time, may I suggest that those selfishly refusing to respond to the needs of the country, whatever those may be at the moment, are damaging future generations in a much more horrific way.