or we're just smart enough to realize that the day we get nationalized healthcare, you can forget about ever having a cure for cancer or aids or what have you - Josh Betz

Josh, do you seriously think that you get cancer research through the hospital system? - Scoble, Alex Scoble

watching Newshour and it makes me sick to think the mcliarpants are gonna carry the day with their shrill brute selfishness. it really underscores the essence of American movement and bedrock conservatices: they dont give a damn about anybody else but them and theirs. makes me sick to think we are not going to get reform cuz of the nasty curs. Feh! - Thom Kennon

I don't normally get involved with political topics but I can't help it when it comes to health care. I'm Canadian and our health care is a joke, you don't want any part of it. The reason most Canadians are against Obama's plan is that we'll have no where to go if we get really sick. Canadians put up with 8 hour waits for simple care because its "free" but we flock to the U.S when we're really sick. I knew people who are now dead because of the the system. If you need to see a specialist in Canada, you'll wait months. The U.S has the best health care in the world, why do you think Kings and Queens from other parts of the world come here for treatment. - Justin Luey

Cancer research, for example, is good and all, but we need to be focusing on prevention. - Nick Humphries

According to WaPo columnist Steven Pearlstein, you're also a "political terrorist" if you get in the way of consensus on health care reform. - Garmon Estes

As if cancer research wasn't already funded by the government. Without the NIH, where would we be? The profit margins on anti-cancer drugs aren't exactly making pharmaceutical companies obscenely rich. Anyway, nothing Obama is proposing will prevent the Saudi Arabian sheiks and European royalty from getting state-of-the-art care in Rochester, MN. And Canadians can still come if they're willing to pay cash. - Victor Ganata

I am sorry you feel that way. Unfortunately, sometimes in a two-party system, when one side doesn't like the way that a particular problem is being addressed, whether it's from the perception that it's being pushed through too hastily, or with too many hangers-on or "pork," the alternative that some choose to express is, "what we have now is better than what is being presented." Here in Spain they have a saying, that translates loosely to, "better the devil you know than the devil you don't." It seems like people without insurance (which certainly doesn't describe union workers) or who have insurance that they would like to see detached from their employers, and otherwise reformed; well some will say they are satisfied, but if they are like most of the people I know, they only mean it as when THAT is compared to the thousand page bill that is currently in the Congress' (specifically the super-majority Democrat's) hands. In the years that I have lived over here, I have seen many Spaniards, usually famous, and therefore newsworthy, who choose to get their health care in the U.S., rather than trudge through the system here. - midnightgolfer

But it's not mutually exclusive. The 80% who like their current insurance aren't necessary averse to health care reform. And it's all perspective. The U.S. health care system is definitely better than the average developing country, but it's definitely broken in a lot of ways. Nothing is perfect. I think people are at least aware enough that just because they really like their insurance now doesn't mean they'll necessarily have their insurance in the next year or so, given the current state of the economy. - Victor Ganata

Josh, that first comment reminds me of a somewhat famous Paul Tsongas gaffe - he claimed that it was America's health care system that produced the treatment that (at that time) saved his life, but in fact it came from Canada. The fact is, medical innovations come from all over the world... (edit: cite here: http://www.sociology101.net/reading... ) BTW, re-reading that reminded me that in fact, it was a cancer treatment! (I had thought that it was some kind of heart surgery or something...) - Andrew C (✓)

Good god. FIrst of all, we're not getting Canada's health care or socialized health care. The current program on the table lets you keep your insurance if you want to. But you may not because there will be competition. Second of all, I just spent Mon-Friday in the hospital and anyone who is happy with their health care in this country hasn't been in the hospital lately. - Erin @queenofspain

Justin: I'm sorry you feel like but that is not my experience of health care here in Canada at all, nor of most people judging by the reports seen recently. There is an issue of waiting times but they are a problem wherever you go. - WoH: Professor MOTHRA

The portion of our healthcare system that is already government funded is problematic, so it's not hard to see why there are concerns about moving further in that direction. Safety net hospitals--those that provide care to low income, uninsured, under-insured, at-risk populations--play a crucial role in community health, but struggle to stay afloat in the face of late and absent payments. I truly don't believe that anyone is against good health care--that would be like coming out against literacy, or taking a firm stand against safety--but given what we know about how the portion of healthcare that is already government funded works (or fails to), it seems wise to proceed with caution. - Kathy Fitch

But the private system is in itself broken, and its brokenness overflows onto the public system, exacerbating the problems they already face. - Victor Ganata

No doubt that the whole thing is overdetermined--the issues and the causes thereof are many and complicated. I've been on lots of sides of the thing: a unionized higher ed worker with utterly fabulous benefits, a stay at home mom staring the possibility of COBRA in its very expensive face, a part of an organization having to provide the insurance to its workers, a part of an organization charged with turning around failing safety net hospitals. There aren't easy answers. Our government is *all over* health care already--virtually no aspect of it is untouched by government influence and regulation. Finding our way toward improvements ("solutions" is perhaps too much to hope for) is a great big job. And it will be messy. - Kathy Fitch

Here's a quote from Rep. Mike Ross, one of the Blue Dogs, bragging about how he stalled the bill: "If it had been based on Medicare rates, I can assure you that it would have eventually ended up resulting in a single payer-type system, because Medicare has really good rates, because they're negotiating for every senior in America. Private insurance companies could not have competed with that." -- protecting his constituency from "really good rates", what a stand-up guy. - (dot)lizard kelly

Well--good rates don't change the actual costs, that's the thing. Medicare doesn't cover actual cost. That cost will have to be covered, though. - Kathy Fitch

@WorldOfHiglet - agreed! I'm Canadian and proud of our health care system. There's waiting times for non-essential procedures, but never anything for a life-threatening condition. No-one in Canada is punted off the plan for a "pre-existing condition" or recission. - Matt M (inactive)

A system not based in profit would go a hell of a long way towards controlling costs. - (dot)lizard kelly

I expect to profit when I provide a product or service. Seems like most of us do. Research and development, medications, blood products, sutures, medical and surgical expertise, specialized machinery and folks to operate it-it all costs. Who in that chain should not profit from the product or service they provide? Even not-for-profit organizations do need to make a profit, it's just that they roll it back into the development of the organization rather than distributing it to stakeholders. I like profit! I don't like a $50.00 aspirin, though! ;-) - Kathy Fitch

And that is why, Holden, you are a worthy God. ;-) (When did that happen, by the way? I must have been sleeping.) - Kathy Fitch

Hah--well please let us know if you have any urges toward flooding us all out and starting over with a better class of humans. - Kathy Fitch

No fee schedule--public or private--actual covers the prices anyone charges, although Medicare really is one of the better payers. But since the prices aren't at all subject to market forces, how do we figure out what a fair price is? Basically it's arbitrarily set, although I realize Medicare's RBRVS system (which most private payers tend to adapt to their fee schedules to anyway) tries to be sensible about it. I definitely agree that it's going to be complex and messy, but I think reform is definitely needed. But when one side starts off with nothing but inflammatory falsehoods, how are we supposed to take them seriously? - Victor Ganata

Victor, yes, the inflammatory falsehoods part is really a key factor for me. Following the money behind the "grassroots" movement to disrupt and block reform leads to a who's who of the most corrupt health profiteers. - (dot)lizard kelly

That's the crux of it, isn't it, Victor? It's like death and taxes--impossible to talk about it any calm or reasonable fashion because it's an inherently emotional thing. Pushing through a huge new model--so huge that no given individual seems to be conversant with it in its entirety--seems like a really bad idea to me, just on the basis of sheer logic. Even smaller things that seem easy by comparison--making it so docs can practice without being totally crushed by malpractice insurance, for instance--turn out to be impossibly complicated. It's disheartening, to say the least. - Kathy Fitch

The problem is, as Kathy points out, the government is already massively involved with health care. With Titles XVIII and XIX and with EMTALA, that pretty much sets the stage for everyone else. And no one is seriously considering abolishing Medicare, Medicaid, or anti-patient dumping laws. Even many hard-core anti-reformists like Medicare a lot, so where does that leave us? - Victor Ganata

Holden, I will keep an inflatable dinghy handy and watch for animals wandering by in pairs, just in case. - Kathy Fitch

Relatively speaking, a public option is nowhere near as radical as Title XVIII and Title XIX were at the time. Single-payer, now that would be pretty radical. The thing is, I'm getting the sense that the most vociferous and most violent opposition is coming from people who have the least sense of how all the pieces fit together, egged on not-so-surreptitiously by the people who have the most to lose should reform happen, and who don't give a crap about the average American. - Victor Ganata

Yup--and on the flip side, wholesale embrace seems to flow mostly from a "this should be better, dammit" space, which is understandable, but not so useful. It matters what happens here, but it's just so darn big. Just go look at all the active bills concerning XVIII and XIX at any given time! Mind boggling! When things are that huge, people are going to default to emotion, no matter which side they might champion. Fear is a powerful thing. - Kathy Fitch

And we're just talking about how we pay. Quality is a whole separate issue. - Kathy Fitch

Ok, I've read all the comments and I definitely don't have the insight of everyone else, especially the specifics of what the national health care plan look like at this point. But I do have a couple things I want to mention. 1) It would not be like Canada's system, it would be more like France (mixed public and private) 2) I live in MA, and next year I'm off my mom's insurance (I'm unemployed and 25) so the state is going to change me money to punish my lack of insurance. That's a state issue, but it's basically further punishing those who can't afford insurance. Which leads me to 3) My aunt and uncle don't always have insurance. During a time they had no coverage my aunt had to have an MRI. The hospital charges like $1,000 to the insurance company covering someone, but like $2,500 to an individual. The only way my aunt could afford was by pre-paying on a credit card and getting a small discount. - Heather

Cry me a river, srsly - LANjackal

"I expect to profit when I provide a product or service. Seems like most of us do." ... like the police, Kathy? Or is it possible that certain areas of life are not well served by a market paradigm? - Andrew C (✓)

Yes, precisely like the police, who get paid for their work--who profit from it, as should all who work for a living. Is it possible to work for no pay? But of course, I do it all of the time. I call it volunteering or doing pro bono work, and I think it's important. I love psychic income. Unfortunately, no one lets me write psychic checks to cover the bills. - Kathy Fitch

Just because a system is non-profit doesn't mean the people who work there don't get paid. - Andrew C (✓)

Yes, I believe I pointed that out above. Not for profit enterprises must actually generate a profit in order to meet payroll, pay vendors, build, secure loans, etc. "Profit" is not the enemy, and shouldn't be conflated with "profiteering," which is a whole different ball of wax. - Kathy Fitch

It seems to me the health insurance system of the US has tremendous perverse incentives which are basically inevitable results of trying to provide it via a open market. Healthy people willing to gamble may find it advantageous to not get insured, and insurers have huge incentives to dump sick people - both those who have individual plans and those who have small enough employers that the insurers can and will dump the entire group plan. - Andrew C (✓)

And non-profits don't need to make a _profit_, they just need to cover costs. - Andrew C (✓)

Ah, it's splitting hairs, Andrew. They need to make money. A hospital's costs include things like new machinery. To cover that cost, they have to make money--there has to be some gain after all current costs are covered. They roll that profit back into the organization, and then they might be able to afford, say, a decent MRI machine. In any case, not all hospitals are not-for-profit ventures. There are some great investor owned hospitals in the world. - Kathy Fitch

I'm relatively fine with for-profit hospitals. I am mostly unconvinced that for-profit health insurance is workable. - Andrew C (✓)

Seems like we're about to get a chance to compare, doesn't it? I can't pretend to know what will happen. It's going to be an interesting ride. There have been some actual studies that correlate lower quality of care (fewer qualified staff, higher rates of errors) with free market forces in healthcare. If the concern is constantly the survival of the institution, then perhaps the health of the patient can't be a priority. What's not clear to me is that publicly funded institutions fare much better. They, too, fear for their survival, sometimes month to month. - Kathy Fitch

The reason pubicly funded institutions and most health care delivery institutions (like where I work) struggle is that there is a huge number of people who aren't insured. This drives costs up for everyone as we just try to break even and what the reform really is trying to address. We're talking about adding about $100 billion a year to a >$1 trillion dollar a year industry. This is not a government takover. On the "profit" thing, I do have issues with for profit insurance companies who's policies emphasize profit growth to keep their shareholders happy - how to do it? restrict payment for claims. - Carey Lumeng

While I am not opposed to health care reform, I am opposed to having the government run health care. We'll end up with mediocrity, just like our government run education system! - Darren

None of the proposals currently on the table intend to implement a government-run health care system. This is a strawman that we really need to stop bringing up if we intend to have fruitful discussions about what direction we need to go. - Victor Ganata

Healthcare isn't perfect, there is many things that can be done to help, however, having the government take it over is the worst thing that can happen. The good thing is most Americans are waking up to Obama and his nonsense, hence his poll numbers dropping. I would also bet that most who still support him, have not read any of the bill. The truth is, the government does not run anything well. Social security and medicare are nearly broke, we have a deficit that we can possibly never repay, so having another entitlement program is ridiculous. - Spencer

The statement that rings truest to me is that profit is ok but profiteering isn't. :-) - Mathew A. Koeneker

The revenue that you have to reinvest in your infrastructure isn't usually referred to as profit, though, is it? And neither are wages paid in fair compensation for labor provided. I realize it's semantics, but I think it would be pretty evil if fire fighters and police actually derived profit from their work, although I'm all for them receiving fair compensation for the difficult and dangerous work they do protecting us. - Victor Ganata

CapEx is a sound investment usually and not one that I would refer to as profit. I would actually like for first responders to get a little extra compensation much as I would for teachers as these are industries where going the extra mile should in my opinion be rewarded. I just become enraged at "for-profit" healthcare companies as they do derive their profits not only from the argument of economies of scales and vertical domination of the market va their "in-house" pharmacies. What a racket? - Mathew A. Koeneker

I'm in my 20s, employed, I've got health insurance from my employer, and I haven't been to a hospital since I was young (and only once then). However, even I am wary of the pain that I will have to go through if I lose my job; I'm sure COBRA would be too costly. Besides, it wouldn't matter even if I did find a new job (not easy to do right now), thanks to pre-existing condition rules that will block off the part of the insurance I'd actually use. Food for thought: Take your current situation, assume you lose your job, and figure out if your insurance will be there when something bad happens. Hope for the best, but be prepared for the worst. - A. Karl Kornel from twhirl

I'm in my 20s and got laid off. COBRA's $145/mth, which has been OK for me. I'm not saying it'll be the same for everyone else, but I'm ok - LANjackal from IM

Everyone misses the key --- the what's-mine-is-mine crowd who "want gummint off their backs" (but i bet they like the interstate highway system, a standing army, state colleges, subsidized cotton, regulated utilities) and the humanists (who believe people all deserve a basic right to food, health, shelter, safety). And the key is this: fee for services. This is the single most important thing that needs to change. And the current bill(s) don't attack and solve for this in a meaningful, structural longterm way. But reform is required, for many of the reasons peeps cite here and elsewhere --- for longterm economic security, global competitive advantage & a healthy populace equitably treated. - Thom Kennon

I am not for "Obamacare." I am for having a discussion on things that need changing and making those changes. I don't care how it's done, but these things need doing. 1) Stop dinging people for pre-existing conditions 2) Stop over-charging for prescription drugs 3)Stop giving care that isn't effective or necessary (restless leg syndrome, overactive bladder, etc. We've gotten to the point where nothing is normal; everything is a condition 4) Lower awards in malpractice cases 5) Give further help for advance directives (not a requirement) 6) Do not encourage recission for sick people 7)Change standards of practice so doctors are paid for outcomes, not services performed Right now we are incentivizing doctors to do more, because that's how they make more money These things have been suggested by policy experts and physicians, and even by people like Kaiser and Mayo We are arguing over the color of the life preservers - Francine Hardaway

Glen, what you said happens now. Except, one, the 23 yo bureaucrat might not be in DC, he or she is wherever your insurance company is headquartered. And two, under Obama's proposal, you can keep your current health insurance if you think it's good enough. - Andrew C (✓) from Android

I'm conservative, but I'll be honest, the 66% COBRA subsidy under the ARRA has been a lifesaver. Just FWIW - LANjackal from IM

Francine, yes, everything that takes away from worker productivity has been labeled a condition. The question is, who gets to decide what is effective treatment? Researchers? Clinicians? Insurance companies? Government officials? I do agree that incentives should be geared towards outcomes with objective measures rather than volume of procedures performed but the problem is that the final outcome is always, without exception, death, and again, who gets to decide what outcomes are worth paying for, and which aren't? These are all questions that don't have easy answers. The problem is that the loudest voices of opposition don't even want us to ask these questions and try to change things. - Victor Ganata

I'm thinking of profit in more basic terms--the amount of money left after expenses have been subtracted from income. It seems natural to me that folks object when the portion that might actually be left, there, is quickly sucked up by the government, which isn't exactly renowned for efficiency and ethics. - Kathy Fitch

I'm not making an argument here, but really just posing a series of philosophical questions: *Do* people have a basic right to healthcare? If so, where do we draw the line? A basic right to immunizations, to health education, to emergency care, to open-heart surgery, to hip replacement, to orthodontia, to treatment for acne or eczema? The difficulty of drawing those lines is one source of the angst here, and the ability to fund it all is another. It's an ethical dilemma of huge proportions. How does lifestyle play into it? Do we offer less support for self-inflicted issues, and who decides what counts as self-inflicted? Quite a thicket, seems like. - Kathy Fitch

I think people have a basic right to health care, both on ideological and pragmatic grounds. The ideology is down to what's right and wrong; the pragmatic argument is that society is not well served by having the poor suffer from treatable problems. I can see drawing the line for trivial and cheaply solved problems like usual teenage acne, paper cuts, etc. I can also see drawing a line for extraordinary costs. Every insurer, whether nationally run or private, for-profit or not, draws such lines. - Andrew C (✓)

Offering carrots and sticks for healthy lifestyles can only go so far. Who knew tobacco was carcinogenic back in the 1940s? Or asbestos? I think the idea that people willingly lead unhealthy lifestyles _because they plan to fall back on health insurance_ is ludicrous; everyone prefers to live a healthy life rather than get by with massive surgeries or other catastrophic interventions. - Andrew C (✓)

When people are in need of new organs, the health care system already does judge them on behaviors, like not allowing alcoholics to get new livers. But I think preventative medicine, at a basic level like annual check ups, screenings for high risk patients, vaccines, visits with a nutritionist, that kind of stuff, is totally reasonable to offer everyone. I mean before I got back on my mom's insurance I had to pay $84 to pee in a cup to check if I had a UTI. The antibiotics would have cost less then that, or been free at Walmart (of all places). - Heather

Very true, Heather. Already, we must make these calls, and already we aren't so hot at it. If we have a right to healthcare, why shouldn't we have the right to a new kidney or lung or heart, even if our lifestyles in some measure caused those organs to fail? The junk food junkie might be the best teacher or counselor in the community, the drinker might be on point of composing the most moving piece of art imaginable, the smoker might live just long enough to invent something that saves many. We just don't know. If we think we have a "right" to treatment because being human is inherently valuable, how in the heck do we say, "well, this human is more inherently valuable than that one?" If you have to earn something, it's not a right at all. - Kathy Fitch

Teenage acne, by the way, is not at all trivial to the ones who suffer from it, and it's hugely expensive to treat. Check the prices on something like Doryx, for instance. Might seem like a purely cosmetic issue, but of course it has social implications, and mental health implications, as well. http://dermnetnz.org/acne... A friend of mine always used to say that the definition of "minor" surgery is "surgery on someone else." Just so, it seems, with many health afflictions. - Kathy Fitch

To those of you concerned about a single-payer option and the elimination of Employer Insurance, the President clarifys those concerns in this video. http://www.youtube.com/watch... - Sharon McPherson

Of course you're right Erin. I have Parkinson's Disease and Fibromyalgia that is going untreated because the Government Run Medicare system says my husband's $500 per wk pay check puts us over the threshold to receive assistance, although our monthly expenses amount to $2400. And my young grandchildren are desperately in need of Dental Care because the State Run Florida KidCare program is denied by every dentist in West Central Florida, and when we do find dentists outside of our area who will take Florida KidCare, they are refused treatment because they are too young . But because I have concerns, and as yet unanswered questions, about The President's Proposed Health Care bill and won't fall immediately inline with what you, the DNC, Nancy Pelosi and the President tells me I should, I am a "big, fat, evil, don't want to care about me, lying mcliarpants". - Sharon McPherson

Sharon, the problem is that the opposition isn't addressing any of the issues you raise. They are lying about "death panels". Let's address the real issues, please. - Tom Talbott, Jr

The US is the only country in Western World that doesn't have some sort of nationalized system (and it is arguably one of the worst). I am confused at anyone who thinks that a corporation is going to operate in the best interest of the customer. It operates in the best interest of the share holders - it must. It is time to consider some government control, so people don't have to pay +$500 for "mostly covered". - Jeff Waite