The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Health Care Reform Surrealism

Posted by Alan on March 12, 2010


It’s finally happened. The health care reform has at last officially passed into the Twilight Zone. How else to explain the idea under serious consideration in the Senate to make student loan reforms a part of the health care reform package. Yes. Really.

Follow this down the rabbit hole:

The Obama Administration wants to remove banks from the student loan process. This would apparently shift money in the program that currently goes to overhead and/or bank profits to tuition payments, helping more students for the same amount of spending. (I’m surer the issue is far more complicated than this, but this is a health care reform blog so this description will do). Legislation to implement these reforms has passed the House, but has stalled in the Senate due to a Republican filibuster. Sound familiar? The way around this dilemma is for Democrats to pass student loan reform through the reconciliation But to do that appears to require combining the student loan and health care reform bills into a single piece of legislation.

A fair question at this point might be, “Huh?”

Reconciliation, you’ll recall, allows passage of spending and tax bills with a simple majority. Reconciliation is the path the Senate will take in passing the clean-up legislation the House is demanding in exchange for passing the Senate’s health care reform bill. And there’s the rub.

It seems the reconciliation process can be used but once per year (or maybe session – I’ll edit this post once I find the answer). Which means that if reconciliation is used to pass the health care reform clean-up bill it would no longer be available to get the student loan reform legislation through the Senate. Or vice versa. So the solution is to combine the two into one bill.

This legislative mash-up may make sense from a parliamentary perspective, but it makes no sense to the general public. Instead, it will smack  of legislative trickery, something that has already soured much of the population on the current  health care reform bill. By adding to the through-the-looking-glass surrealism of the legislative process, combining student loan and health care reforms will only confirm to voters the feeling they have that Washing, D.C. is a reality-free zone.

Of course, such Carroll-esque lawmaking has been done before. The law that allows employees to keep their employer’s coverage after they leave the company is referred to as COBRA – which stands for the Consolidated Omnibus Budget Reconciliation Act (of 1985). In the past I’ve focused  on the “R” in COBRA standing for reconciliation. But it appears the “O,” for omnibus, is just as significant. That legislation addressed more than continuity of medical insurance coverage. Which means there’s precedent for asking one reconciliation bill to carry disparate legislative burdens.

Just because there’s precedent, however, doesn’t mean this strange development to an already strained legislative process is any less, well, strange.

49 Responses to “Health Care Reform Surrealism”

  1. Dyck said

    Just to leave one parting comment:

    Like other blogs the comments seem to be from people who need to vent. And I suppose this is a legitimate purpose. But, to find a voice in my government process is what I want… not an appeasement… not just a little ego trip when I engage with another. I don’t see change in others or myself as a result of bantering about how things are, or why. It is ultimately negative and wasteful (except for venting) and doesn’t help us really know one another or gain human connection.

    Like when it’s election time we get mail wanting our opinions along with a donation… do they think we’re that stupid? Are we?

    All the problems I encounter need to exist because in the suffering that goes with them are the lessons I must learn. Suffering is the great teacher. And the suffering doesn’t stop until I have really learned (not in my head but in my behavior). What lessons are here for me now? I don’t know… maybe they’re about greed or selfishness or compassion or attachments or having images or what’s important and what’s not, or knowing myself, or love, etc…

    What my experience informs me is that all ‘problems’ are really ‘opportunities’ and all have silver linings– light that wants to emerge. That’s what I’m interested in knowing more about and pursuing. I want to learn my lessons and move on to realize fullness and my awesome human potential.

    A secret thought of mine is that our society (maybe the world) has come to a place where it needs to learn about sharing and generosity (and our connections to one another and the earth) as the way out of our ‘mutual’ problems. Or, the suffering must increase, in ways we probably can’t imagine, to a point where we are then able to learn this.

    • “This is politics; this isn’t a question of faith and morals,” said Sister Simone Campbell, executive director of Network, a national Catholic social activism lobby. “We are the ones who work every day with people who are suffering because they don’t have health care. We cannot turn our backs on them, so for us, health care reform is a faith-based response to human need.”

      Why do not the Catholic Bishops join ranks with the nuns who work in the 600 Catholic Hospitals nationwide? Could it possibly be that the Bishops–like so many Americans–are insulated from the actual flesh and blood consequences of a system Uwe Reinhardt (arguably the nation’s leading healthcare economist) told me in an interview he considers “cruel”?

      I know my frequent postings on Alan’s wonderful blog have struck many of you as unseemly and self-serving, but I can’t help but believe that those who want to stop this far from perfect reform effort–knowing full-well that it will be years if not decades before any politician ever attempts to change the status quo–are against it for lofty philosophical reasons far removed from the reality of human suffering.

      It’s sort of like the mentality of soldiers. The first thing to go in the fox holes are lofty notions of “fighting for freedom” or “democratic ideals”. In the end you fight for your buddies and your own life. Abstractions are the province of Bishops and the like; what is real is left to the nuns on the ward.

      • Jim Thornton said:

        “I can’t help but believe that those who want to stop this far from perfect reform effort–knowing full-well that it will be years if not decades before any politician ever attempts to change the status quo–are against it for lofty philosophical reasons far removed from the reality of human suffering.”
        – – – – – – – – – – – – – – – – – – – – – –

        Were those words said BEFORE your unfortunate financial disability and subsequent “epiphany”, and not AFTER, they may have carried more weight. Considering the actual evolution of that apparent “epiphany”, your words ring hollow.

        Accusing those of us who are opposed to the current iteration, and arrogant manner of possibly successful passage of this HCR plan, of being a philosophical abstraction unrelated to the real world we experience is as arrogant an assumption as are Pelosi’s words.

        You do not know us; you do not know whom among us donate many tireless hours to helping those less fortunate, in time and money, those who coach ball games, help raise money for boys and girls clubs, who help to build schools, PUBLIC schools, who help to raise money through many selfless efforts for those suffering from Alzheimer’s, Parkinson’s, or to help “Special Needs Students”, or who are providing long term care to the parents, or aunts and uncles, or others; in short, you words are simply a reflection of the angst one might expect from someone who is apparently suffering (certainly not quietly and not with respect for those who are still moving forward in their lives in spite of their personal problems), and you are continuing to strike out with stark and unjustified accusations of others perspectives.

        I am reminded of the reasons that those in the past have provided as their “rationalizing” for the socialist revolutions they fomented.

      • Rick said

        “Are against it for lofty philosophical reasons far removed from the reality of human suffering”

        Poetic words Jim, but the fact is we don’t have the money for what you want!

    • dave said

      Surreal indeed, instead of Obama educating our clueless citizens of the mess that is American health care, he fails to use the words UNSUSTAINBLE, UNFAIR, INEFFICIENT, AND DEADLY. Had the dems used these words over and over, to bang it into our heads, he would have been honest, and would have the trust of middle America. But he failed to do that and now has lost middle America, by that I mean the political center who elected him.

      As for comments about how rotten these anti government types are, and how great the govt. has been over the years building the interstate highways, dams, hospitals, etc. what you fail to mention is that the govt has grown too big, to cumbersome, to inefficient, and to ineptly managed. The right wingers only have to wait for another bomb to drop about how crappy the federal govt is, then they just say SEE!

      Did you know that according to a study in Health Affairs, that 70% of the uninsured children in this great nation currently qualify for existing govt. health care programs? BUT THEY DONT SIGN UP!

      That 34% of all the research money for drugs comes from govt, usually out of research universitys, but that the govt. fails to negotiate lower prices for drugs for its members in medicare and medicaid, they do get a discount in the VA program………..curious isnt it?

      That in some states, medicaid does not cover flu shots or other basic care, because the states are allowed to dictate what it covers and what it doesnt cover. States also determine eligibility. States also are responsible for enforcement thus making the states the cops for fraud.

      A comment was made that fannie and freddi were not responsible for the financial melt down, and that Ms. Korn resigned when congress failed to heed her advice to monitor the derivatives markets like she asked. Well my friend, CONGRESS made that decision, not Ms. Korn. Congress failed to oversee wall street and its greed. Congress failed to regulate and do its job. In fact congress ramped UP the subprime borrowing through fannie and freddy adding gas to the fire. CONGRESS FAILED.

    • Dyck said:

      “Just to leave one parting comment:”
      – – – – – – – – – – – –

      Just like a “Post and Run” guy; they never stick around to be held accountable for their “crime”. There oughta be a law! 🙂

  2. Nosedoc said

    This is from the Op-Ed Page of today’s NY Times, and I think it sums up the frustration many political moderates like myself have been feeling over the last several months.

    http://www.nytimes.com/2010/03/16/opinion/16pewen.html?ref=opinion

    There are few things worse than having the stars aligned to accomplish great things only to allow arrogance and greed (feel free to add other vices) doom the endeavor to failure.

  3. Alison said

    I think the avenue now surfacing that allows it to pass without an actual vote on the bill but voting on the process is frightening on a whole different level. I am now officially afraid for my country.

    • Alison, you find bureaucratic political wrangling frightening but not this?

      http://www.healthpolicy.ucla.edu/NewsReleaseDetails.aspx?id=50

      I suspect you are not one of these 2 million Californians. How many people who post on this blog have any worries whatsoever about their own health insurance situation?

      It is very easy to be “scared for your country” over trivial matters when you have the luxury of not being “scared for the health of your family members.”

      • Dyck said

        Jim, I really wake-up to your Q. …people with no worries about HC costs.

        I suppose I am one. And I am wrestling with my deep intention– to see others and feel what they feel and acknowledge them. Early in my business I asked the question, what is right to charge for my repair and remodeling? I never came up with an answer.

        But I come up with a reaction to the often quoted sales mantra “don’t leave money on the table” as insensitive and predatory. Being careful to not be a ‘do gooder’ I actually feel pain of others who are hurting. I sense and feel hurting of humiliation, desperation, shame, sickness, hunger and hurting, depression… and on and on.

        So, I have gotten ‘active’ in the system to voice my disgust and abhorrance to how we treat people from the perspective of government, big corporations, institutions. We human predators Look at others as wallets or workers (what is useful to us) and this seems profane and shallow and adolescent.

        It seems we (maybe just me) needs to wake up to what life is and what is my role.

      • Alison said

        I dont remember ever sharing the position of myself or my family members in regards to healthcare. While you are assessing everyone do me a favor and bypass me. Thanks.

      • Nosedoc said

        Once again, Jim, many of us view the number of uninsured and under-insured as a symptom rather than the disease. The disease is the high per capita cost of insuring the public, and without addressing the issue of over-consumption of services, any reform proposal will fail miserably, leaving a horrendous financial disaster, worse than the one we are in now, in its wake. While I hold the health insurance industry with about as much esteem as you do, I believe that the industry’s pursuit of profits are probably a relatively small part of the overall problem compared to our insatiable thirst for more health care (than we need per person).

        • At the risk of causing Spencer’s carotids to go spastic with more talk of “me, me, me”, I don’t think that many Americans have “an insatiable thirst for more health care.”

          I am a guy, and we guys–or so the conventional wisdom has it–try to avoid doctors at all costs.

          I went to a doctor last October after returning from a 5 day trip in the Frank Church River of No Return Wilderness Area for Backpacker magazine and developed an open, weeping lesion on my groin, which the doctor thought was Rocky Mountain Spotted Fever.

          I would not have gone to the doctor at all if the symptoms, as they usually do, just disappeared after a couple weeks, but they didn’t and I did.

          He sent me for tests, prescribed various antivirals, antibiotics, antifungals, etc. Then he sent me to a dermatologist, who did a biopsy, prescribed various cremes, more pills, etc. All the tests came back negative. None of the magic potions worked. After another month, the thing went away.

          That’s the only time I have gone to the doctor, save mandatory time-wasting prescription refill visits, in the last four years.

          Insatiable thirst? I don’t know. But once I got on the carousel, it definitely took me around on a number of spins, which all ultimately proved a waste of time and money.

          The insatiable thirst, in my experience, is partly driven by patients, but overwhelmingly driven by service providers–especially in the last six months of life.

          People who have signed living wills, absolutely do not want extensive end-of-life emergency interventions, etc. are nonetheless routinely dragged into hospitals and subjected to no shortage of these costly procedures–the administers claiming they are practicing “defensive medicine” so some second cousin twice removed won’t be able to sue–and meanwhile, the specialists rack up their country club dues as the patient goes tube-ridden into that good night.

          There is insatiable thirst; and there is also unconscionable force feeding of care to people who only want some intravenous morphine, versed, and sleeping medications–who only want to die in some comfort, most likely at home in their own beds. But the hospital system as set up now does not make this an easy option.

          Spencer, rather than replying to your latest gibe below, let me say here: you are correct. I do care about myself and my family. But after 26 years writing for magazines, it has long since become abundantly clear to me that nothing about me is terribly unique–that problems affecting me also affect millions and millions of other people in the same boat. Yesterday, California announced that another 2 million residents of that state have lost their health insurance, the vast majority because of job loss.

          I hope that all 2 million of them will take your excellent and obviously well-intended advice to go out and start their own businesses and make successes out of themselves. After all, we who are under Medicare age must work hard to make sure you beneficiaries of socialized medicine keep receiving all the government care you thirst for!

          Again, I hope this has not caused your carotids to spasm. If so, try gently rubbing the sides of your neck, then call a specialist and make an appointment on the government dole. It looks like you won’t have to share any of that money with me for quite a while!

      • Oh I have very serious concerns about my own health care insurance solutions, should this abortion of a HCR Bill be passed, and in the frighteningly “screw the public’s concerns” attitude and manner in which the Queen of Arrogance Nancy Pelosi intends to do it.

        “It is very easy to be “scared for your country” over trivial matters when you have the luxury of not being “scared for the health of your family members.”

        Just cannot help yourself, can you Jim Thornton. When I consider all of your posts on this blog it becomes apparent that, unlike many others who post here, yours are all about YOU. It would appear that you couldn’t care less about anyone except YOU. Oh, and you say “your family”, but really Jim, honest now, it is simply all about YOU. Think I’m being harsh? Gimme a break; compared to the insults you have hurled at so many others, my comments to you are tame.

        Alison, right on! Don’t let Jim Thornton or anyone else here intimidate you with their own “crying in their beer” tears. There are 18 Million Americans suffering as is Mr. Thornton. I know a few myself (who are at an age where they will never be able to make up their losses, and they aren’t crying about it, some have even (OMG, perish the thought!) started their own businesses! Imagine, in these tough times, out of work, insurance, and money, and they are creating their own successes! Good for them!

  4. JimK said

    Rants from the Left or Maybe the Center, but Definitely not the Right

    While this post strays from the Healthcare argument, I get the feeling from reading the posts here that many of the contributors believe the government is inept and that if the Federal Government would just get out of the way the United States will return to its heyday, which existed prior to the introduction of Federal Regulations and programs.

    I find this particular Libertarian bent amusing since I seriously doubt that anyone posting here actually lived at the time our current regulatory scheme began. Now while I may be wrong, it is my understanding that the current trend towards government regulation began in 1907 with the passage of the Pure Food Act. The Pure Food Act passed to placate the American public who were alarmed by Upton Sinclair’s expose on the meat packing industry. If you were alive and prospering prior to this period, you have every right to demand a return to these halcyon days.

    I also believe that a number of those posting here probably were the indirect beneficiaries of government programs such as the G.I. Bill or from benefits their parents gained through Union participation. Of course, it is equally possible that a number of contributors here were “born on third base and believed they hit a triple.”

    What I find equally amusing if not downright hypocritical, is it appears everyone who writes here was outraged by the Bush deficits, yet I do not remember this outrage when Bush and the Republicans were in control.

    The Tea Party movement was non-existent, could this be because the Tea Party movement is really just a shill for Dick Armey and his corporate sponsored Freedom Works organization. No, that could not be the case, the Tea Party advocates are much too sophisticated to be scammed by anyone with corporate ties.

    Without the Federal Government, the Interstate Highway System would not exist and it is doubtful that the internet would have achieved the widespread use it enjoys today, and no, I do not believe that Al Gore invented the Internet.

    I also read the constant refrain that Fannie Mae and Freddie Mac, and by implication the Community Reinvestment Act (CRA), were the primary culprits in the mortgage meltdown and resulting financial crash.

    Anyone who followed the crash knows better. Fannie and Freddy did purchase mortgages that would not meet prior standards but this was a reactive move. They were losing market share in the secondary mortgage markets. Prior to the meltdown the secondary mortgage market had doubled and the new entrants into the field were not subject to the CRA rules. These were primarily scam artists who originated mortgages and then unloaded them as fast as possible. They were able to unload these shoddy products with the assistance of the rating agencies who ignored the actual risk involved and rated the Mortgage Backed Securities as Triple A. This even though it is well documented that employees at the agencies knew these ratings were false.

    The true culprit for the meltdown was the sale of derivatives and counterparty risk. The major derivative for the current financial crisis is the Credit Default Swap. Warren Buffet, in the early part of this decade labeled these products as Weapons of Mass Destruction. Even prior to Buffet’s warning, the former head of the Commodity Futures Trading Commission (CFTC), Brooksley Born recognized the risk in unregulated derivatives. During her tenure as Commissioner Ms. Born had proposed a rules change on the Federal Register. Ms. Born’s proposed rule change required greater transparency in the Derivatives market. Under pressure from Alan Greenspan, Larry Summers, and Securities Exchange Commission (SEC) Chairman Arthur Levitt Ms. Born abandoned her proposal to regulate the derivatives market and she resigned as Chairman of the CFTC. Just a side note from anyone who does not remember, Alan Greenspan admitted he was wrong about the “magic of the markets.”

    Subsequent to Ms. Born’s proposal Long Term Capital Management (LTCM), a Hedge Fund, which relied heavily on the use of derivatives in the foreign currency markets failed and the government intervened to bailout the counterparty’s to LTCM’s risky bets. AIG failed for much the same reasons that caused the financial breakdown of LTCM.
    Having seen the implications of an unregulated derivatives market, one would think that these financial geniuses’ would have seen the Ms. Born had raised a legitimate point, however these true believers in the magic of the market ignored the then recent events and proposed even less regulation through their endorsement of the Commodity Futures Modernization Act (CFMA).

    Under the CFMA, individual States were prohibited from investigating or bring State level actions against insurance companies who were engaged in the practice of trading derivatives. As means of evading insurance margin requirements, the derivatives known as Credit Default Swaps were labeled Swaps and not insurance. This distinction was necessary to remove oversight of the derivatives market from State regulators.
    Prior to the enactment of the CFMA, a number of States had laws that outlawed what “Bucket Shops.” Bucket Shops were essentially gambling houses where investors could bet on the direction of the market. Bucket Shops were prevalent in early 1900’s and it is widely accepted that they were instrumental in contributing to the financial panic of 1907. The creation and use of Credit Default Swaps was essentially a return to the Bucket Shops of the early 1900’s.

    To address a more specific point raised here and that is the so-called “Doc Fix” price controls. While it is true that the “Doc Fix” was included in the Medicare Sustainable Growth Act (SGA) of 1997, it is also true that since 2003, on five separate occasions, Congress overrode the SGA mandated reimbursement rates. Another side note, it is worth noting that when Clinton left office in 2001 we had a budget surplus.

    It is also worth noting during the 80’s, the Reagan Administration implemented the present structure for Medicare reimbursements. It was under the Reagan Administration that Medicare implemented Diagnose Related Groups (DRG). Again, the purpose of DRG’s was to assist in the reduction in Medicare reimbursements. The implementation of DRG’s helped reduce the rate of medical inflation. This method is probably no longer effective because of the intervention of special interests such as AMA.

    One final note on Reagan, although he did cut taxes early in his Administration he also raised taxes on two separate occasions. It is my own personal opinion that the 1986 Tax Code changes, which eliminated interest deductions for consumer loans and credit cards, was partially responsible for the destruction of much of today’s home equity.

    Jim Kirk

    • Rick said

      “Anyone who followed the crash knows better. Fannie & Freddy did purchase mortgages that would not meet prior standards but it was a reactive move”

      In 1999 Fannie began the program that eased credit requirements on loans purchased from banks. People below underwriting standards were now able to purchase homes. The intention was to increase the number of minority and low income homeowners.

      • Jimk said

        The attached analysis by the Federal Reserve Bank of Dallas gives a detailed analysis of sub-prime loans and the CRA. However, feel free to stick to the FOX analysis.

        http://www.dallasfed.org/ca/bcp/2009/bcp0901.cfm

        • Rick said

          “However feel free to stick to the Fox analysis”

          How did Fox get into this?

          Is my 1999 info regarding Fannie incorrect? If so explain!

        • Jimk said

          Okay the FOX thing was a cheap shot and in fairness to FOX, after the Healthcare Summit one of their correspondants in an interview with Senator Thune, challenged Senator Thune when he resorted to Republican talking points.

          However, getting back to your question, I am not disputing the fact that lending standards were lowered in 1999, I am disputing the fact that Fannie Mae and Freddy Mac were responsible for the financial collapse in 2008. There were two primary causes for the financial collapse, the Credit Default Swaps held by AIG, and a 2004 decision by SEC Commissioner Cox to relax the margin requirements for investment banks. The SEC move was made at the behest of then Goldman Sachs CEO Henry Paulson.

        • Rick said

          JimK

          Thanks for agreeing Fannie eased credit score requirements in 1999 on mortgages it purchased. If credit score requirements would not have been lowered those default swaps you refer to would not have housed most sub-prime mortgages. I do not contend Fannie & Freddy were the only culprits, however I do feel there is a good case for recognizing them as prime movers.

        • JimK said

          Rick

          I will agree that Fannie and Freddy were partially responsible for the financial crisis by perpetuating faulty lending practices.

          However, the predominant cause for the financial meltdown was the finance industry’s greed and stupidity. The industry had deluded itself into believing that their packaged Bonds such as Collateralized Debt Obligations (CDO) and Mortgage Backed Securities (MBS) were structured in a manner that eliminated risk. In the CNBC documentary “House of Cards” Kyle Bass, a Houston based hedge fund investor explained how he examined the aforementioned Bonds and concluded that these securities would fail. Mr. Bass’ basic finding was that the industry created their computer models to hedge against risk based on the premise that housing prices would continue to rise in perpetuity. Mr. Bass realized the absurdity of this conclusion and purchased Credit Default Swaps, which ultimately netted his firm three billion dollars.

    • Jim, perhaps you and I live on different planets from those who gave your amazing history lesson a thumbs down. The idea that unfettered capitalism is always self-correcting is ludicrous. Perhaps over a long enough time span, this might be the case. But as last night’s 60 Minutes interview with Micheal Lewis showed, Wall Street insiders scammed us all–and probably themselves, as well.

      I don’t mean to sound too profane here, but these little business owner popinjays who continue to spout their Any Rand absurdities in the face of overwhelming evidence to the contrary remind me of rape victims who fall in love with their rapists.

      Wake up, you guys. You have been more victimized by “free market” lunacy than you even know, just as you have benefited significantly more from “socialism” than you are willing to concede.

    • Jim K said:

      “I also believe that a number of those posting here probably were the indirect beneficiaries of government programs such as the G.I. Bill or from benefits their parents gained through Union participation. Of course, it is equally possible that a number of contributors here were “born on third base and believed they hit a triple.”

      Jim Thornton said:

      “I don’t mean to sound too profane here, but these little business owner popinjays who continue to spout their Any Rand absurdities in the face of overwhelming evidence to the contrary remind me of rape victims who fall in love with their rapists.”
      ____________________________________________

      It occurs to me, after reading both “Jim’s” all round condemnations of “…indirect beneficiaries of government programs…”, and suggestion that “…a number of contributors here were “born on third base and believed they hit a triple.”, and that “…these little business owner popinjays who continue to spout their Any (sic) Rand absurdities in the face of overwhelming evidence to the contrary remind me of rape victims who fall in love with their rapists.”, are surprisingly demeaning, insulting and cavalier to almost all who post here (was anyone left out?), except for the two “Jim’s”.

      C’mon fellahs, no one can be as perfect as you two seem to think you may be.

      Jim K, not all who post here who are opposed to Obama’s HCR plan meet all of your denigrating characteristics (others whom I have read here, and me, for example…not on one count).

      Jim Thornton, not all of us who are business owners are “little popinjays” (and it is AYN, not “Any”…were there really that many?), in fact, I’ll wager that the vast majority of those of us you characterize as “Popinjays” employ a lot of people, pay for their days off, sick pay, pay them well, etc. Nor is your POSTING (I don’t give a damn what you think) that you think of us, who are business owners, being akin to “Rape victims who fall in love with their Rapists” appropriate to suggest; in fact, it is so insulting that it suggests that you no longer have control of your emotions, and probably shouldn’t be posting here or anywhere until you can act with more maturity. I don’t care how depressed you may be, how broke you may be, or how down on “the system” you may be, you just insulted not only us, but women who have been Rape Victims, Men who have been Rape Victims, and I am frankly stunned that you have so little respect for the others who post here (except, it would appear, Jim K), that you waste your time telling us all what a bunch of shits (means “SHITS”) we are.

      I think both of you are behaving like truly ignorant and rude PITA’s (PITA means “Pain In The Ass”) who appear to have no tolerance for others perspectives; having been the subject of a particularly acerbic criticism of yours, Jim K (with which I agreed), suggest that you follow your own advice, or be more thoughtful about where and at whom you “throw stones”.

      • JimK said

        Spencer

        Other than my comment about “third base” how is being an indirect beneficiary of the GI Bill or someone’s parents Union participation derogatory? Many of the Middle Class gains of the 50’s and 60’s were directly attributable to schooling provided by the GI Bill. In addition, it was also this point in time when Union membership increased the standard of living for many Americans. These gains made the lifestyle of the “Baby Boomers” possible.

        In addition, in case you do not recall I am opposed to the current Healthcare Proposal.

        Jim Kirk

        • Jim,

          I’ll accept your points, and yes I do remember that you aren’t in favor of the current HCR proposal; it seemed to me that you were being a bit too critical of those who were the beneficiaries of some of America’s so called entitlements (I don’t consider the GI Bill, and other Veteran’s rights to be entitlements, they earned it). Some may think that they were born on third base and believe that they hit a triple, but I’m not sure if that should be considered not qualifying to voice an opinion, or perhaps I misunderstood you; if so, then I’m glad that I did.

        • JimK said

          Spencer

          I was one of those beneficiaries, my father used the GI Bill to further his education and through the additional education he attained we were able to move from a low-income environment. I am 58 and I do not think my situation is unique among people of my generation. Although I am far from rich, I am comfortable and in much better position then many people in our country. My point about people “born on third base” was that these are people who were born into a position of privilege, have no idea of ever being without feels like, and hold in contempt anyone who has not achieved their status or shares their views.

          My other point was that there is much government-bashing going on here and I just wanted to point out certain instances where government programs were a success and the times when the government abdicated their responsibilities.

          Notwithstanding my above remark on the success of certain programs, I based my remark on Libertarians on my own previously held endorsement of this philosophy. At one time when asked what form of government I believed, I responded by stating that I was a Libertarian. This view was colored by the fact that anytime the Federal Government held a particular view on how the individual States should be governed, the Federal Government would essentially blackmail the States into accepting their programs or else risk losing Federal dollars. I have attached a link to an article from yesterday’s NYT on the growing debate over State’s Rights.

          While I still believe in some of the Libertarian philosophy, particularly their viewpoint on American interventionism, I also realize that I have never lived under a truly Libertarian government. As an aside, for anyone interested in the growing power of the Federal and State Governments at the expense of individual liberty I recommend “Attention Deficit Democracy” by James Bovard.

          Mr. Bovard castigates both political Party’s and provides ample evidence that while the Republican rhetoric endorses the philosophy of State’s Rights they are firm believers in the power and authority of the Federal government when it suits their agenda. He cites several Supreme Court decisions to make his point but two recent decisions stand out. The two that stand out are as follows:

          Kelo V New London, where the Liberal Justices endorsed the right of local municipalities to seize land from individual property owners for the benefit of another private entity;

          Atwater v City of Lago Vista, where the Conservative Justices upheld the right of law enforcement to arrest an individual based on the discretion of the arresting Officer.

          In both cases, Justice O’Connor gave a scathing dissent and in my opinion when future historians view the current and recent records of the Supreme Court, decisions Justice O’Connor will rank as one our greatest Justices.

          Finally, in my 58 years, I have learned that the more I learn the less I know. I attempt to inform my opinion by researching as much as I can about a particular issue such as healthcare and ultimately come to the conclusion that there are no simple solutions to any of the major issues facing our country today.

          As to Healthcare reform, while I do not have an answer to the healthcare debate, I do believe the focus on the insurance companies is a “red herring.” The insurance companies are healthcare intermediaries, and the real problem is the growing lack of Primary Care Physicians. The current reimbursement structure rewards specialization and penalizes Primary Care Physicians. The income disparity between PCP’s and Specialists is between 300 and 400K annually.

          My apologies for the lengthy reply.

          http://www.nytimes.com/2010/03/17/us/17states.html?hp

        • No apologies necessary, Jim.

          I appreciate the detailed and educational background.

          Spence

  5. Billy B said

    The whole QWERTY myth was debunked a long time ago. http://www.reason.com/news/show/29944.html

    • Billy B said

      That was supposed to be under Jim Thorton’s post. I put it in the wrong spot – sorry.

      • Billy,

        Thanks for the link.

        I thought it was going to suggest that the QWERTY arrangement was NOT designed to slow down typing.

        As far as the Newsweek reference, I will say that the metaphor I used–hamhanded as it may have been–was nevertheless something that I independently derived. I had not seen the QWERTY business cited in reference to other dysfunctional systems.

        Which only makes one remember the wisdom of Ecclesiastes in both this small matter and the much larger matter that the healthcare reform controversy itself will seem some distant day:

        8 All things are wearisome,
        more than one can say.
        The eye never has enough of seeing,
        nor the ear its fill of hearing.

        9 What has been will be again,
        what has been done will be done again;
        there is nothing new under the sun.

        10 Is there anything of which one can say,
        “Look! This is something new”?
        It was here already, long ago;
        it was here before our time.

        11 There is no remembrance of men of old,
        and even those who are yet to come
        will not be remembered
        by those who follow.

  6. Dyck said

    Alan,
    I know it’s useful. But, simply reporting and bashing of news in your article is a downer for me. Isn’t there more we can do, like searching for the silver lining?

    What do I need as an American right now? Confidence in my government! What single thing would bring confidence(for me)? Health Care Reform. But… (7 requirements to pass HC reform)

    1. It must be FAIR and equitable to all (no mandatory or punishments) and yet provide a safety net to those in trouble.
    2. It must apply to ALL Citizens, including all government.
    3. It must not favor big business or any special benefactor interest.
    4. It must honor the patient first and push toward non-assembly line medicine.
    5. It must allow complete choice of all citizens to have their lifestyles and care for their own health.
    6. It must not interfere with consequences of imprudent lifestyle or unsatisfactory choices or lack of personal responsibility.
    7. It must have a short implementation and not be mired down w rules.

    ps, ‘Dyck’s 5 Steps to HCR’ maybe not polished, but it fits these criteria. See it at http://bit.ly/9wmOLT
    blog: 7 Requirements to Pass HC Reform http://bit.ly/9TaS5c

  7. Nosedoc said

    Doing things the usual way, rather than the right way:

    http://finance.yahoo.com/news/Senators-resist-Obama-over-apf-1010764305.html?x=0

    We all know, even the most liberal-minded among us, that this monstrosity of a bill will truly condemn our economy to financial ruin because it fails to address the most fundamental problem with health care in the U.S., and that is to reduce the per capital cost of delivering it. Many of us prefer not to admit this, however.

  8. No offense taken, Spencer. I did, after all, suggest at once point that you might want to consult a proctologist.

    I know that you imagine I am angry and that my “rants” here are nothing but the irrational spewings of an out-of-control rage-a-holic. I think this probably has some truth to it–aren’t we all, to some extent, aggravated to think that those in what we perceive to be the “other camp” are pulling a fast one on us? And shouldn’t that provoke at least a little bit of bile, perhaps peevishness, even the odd moment of outright irascibility?

    You can rest assured that I am not red-faced and spittle-spewing 24/7, that my resting heart rate is a reasonably sedate 38 beats per minute upon awakening, and that I spend most of my waking hours in a state somewhere in between ennui and borderline excitement, with only occasional spikes of joy, lust, greed, jealousy, fear, excitement, despair, and anger. Of all these spicier emotions, anger is perhaps the least prevalent one in my temperament.

    I do concede, however, that I enjoy a could verbal scrap, and I am guilty of occasionally aiming a jab at my opponent’s nose.

    To understand the vehemence with which I support MY opinion, I have had to acknowledge that those who disagree with me do so with the same level of vehemence–and, hard as it is for me to believe, the same degree of conviction that they are correct in their views.

    I think this is what both sides conclude in the end: that it’s extremely frustrating to see someone so obstinately denying the Truth that is right in front of their eyes!

    When the jury acquitted O.J. Simpson, I think the majority of white Americans simply could not understand this. The majority of black Americans, at least those living in urban environments where cops do not always “serve and protect” in a way we white suburbanites are accustomed to, these folks had no problem thinking, “Mark Furman lied about saying the ‘N’ word. He probably lied about a lot of other things, too.”

    So here are my questions–and Rick, feel free to chip in here, too:

    1) Do you want this current plan to fail, yes or no?

    2) If it does fail, when do you think reform will be attempted again by the political powers that be?

    3) If the plan fails, and there is a lag between then and the next attempt at reform, what do you think will happen to the population of uninsured or underinsured Americans? Will their population grow or shrink?

    4) Do you acknowledge that the Government currently funds over 50 percent of all health care expenditures in this country today? If so, are we or are we not already a primarily socialized medicine system? If you are against socialism, which part of the current system deserves to be dismantled? Medicare? Medicaid? VA benefits?

    5) At what point do you personally not want to be sustained by heroic high tech medicine? If a significant chunk of our health care expenditures are spent of people in the last six months of life, do you think buying a little additional time at this stage is in the interests of the individuals themselves and/or our country? Do you believe that rationing makes sense in any situation?

    6) Can you suggest an alternative to the current reform other than letting the status quo continue to take us where it’s going to take us? If so, please be specific. Don’t say something general or piecemeal like “tort reform is the answer” or “more competition”. Give me something to hang an actual hat on. Give me reason for hope.

    ———————————————————–

    Rick:

    “why do so many poor people end up pulling their own abscessed teeth”

    Please provide links or proof of this.

    http://alumnibulletin.med.harvard.edu/bulletin/autumn2005/spiral.php

    This is an excerpt from the above link:

    We were particularly struck by the problems people faced getting dental care. Nearly everyone we interviewed had lost several teeth; some had even resorted to pulling them out themselves to stop the pain. Similarly, mental health treatment was an issue for almost everyone. Ironically, the system wouldn’t provide even a few dollars for a doctor’s visit or medications to manage hypertension or diabetes until those conditions reached a critical point, such as causing kidney failure or irreversible disability. Only at this end stage would people become eligible for Medicare benefits.

    “chemotherapy drugs or a heart valve etc etc”

    Hopefully a doctor will post some info on this as I have none, and you probably have nothing to back up this assertion.

    Au contraire. This is also from the Harvard Medical School Alumni paper:

    Our interviews with uninsured people supported the Institute of Medicine data: Being uninsured absolutely matters when you are trying to obtain all the health care you need. While it is true that hospitals by law must diagnose and treat immediately life-threatening illnesses and injuries and respond to the imminent delivery of a baby, this mandate excludes many conditions. Over and over again we found the uninsured had difficulty getting preventive services; controlling chronic diseases, such as diabetes and asthma; or even managing serious but not emergent conditions, such as Gina’s gallbladder disease.

    “Why is the uninsured death rate so much higher than the insured death rate”

    More responsible life style?

    From Annals of Internal Medicine

    Differences in Control of Cardiovascular Disease and Diabetes by Race, Ethnicity, and Education: U.S. Trends From 1999 to 2006 and Effects of Medicare Coverage
    J. Michael McWilliams, MD, PhD; Ellen Meara, PhD; Alan M. Zaslavsky, PhD; and John Z. Ayanian, MD, MPP

    Conclusions from abstract:Results: Disease control improved significantly between 1999 and 2006 for all 6 measures (P < 0.001). These trends did not differ by race or ethnicity or by education (P ≥ 0.185 for group–time interactions), except that white–Hispanic differences in glycemic control widened (P = 0.042). Black–white differences in systolic blood pressure were smaller among adults age 65 to 85 years than among adults age 40 to 64 years (reduction in difference, 4.2 mm Hg; P = 0.009). Black–white differences in hemoglobin A1c levels were also smaller after age 65 years (reduction in difference, 0.7%; P = 0.005), as were Hispanic–white differences (reduction in difference, 0.7%; P = 0.007) and differences between less and more educated adults (reduction in difference, 0.5%; P = 0.033).

    Limitation: Data were cross-sectional, and estimates may have been biased by coincidental events at age 65 years, such as retirement, that may affect disease control.

    Conclusion: Control of blood pressure and glucose and cholesterol levels has improved since 1999 for adults with cardiovascular disease and diabetes, but racial, ethnic, or socioeconomic differences have not narrowed significantly. Medicare coverage after age 65 years is associated with reductions in these differences.

    “why doesn’t everyone just drop their insurance”

    Responsible people?

    Jim, on that first post you stated “make health care an American right” How to you reconcile that with your other statement “cut cost and ration care with single payer”

    Uwe Reinhardt, the Princeton University health care analyst that I think Alan knows told me that the very very rich love the status quo, because even the most expensive treatments, drugs, and other inteventions are well within their means to pay for. As long at there's competition to develop the next generation of marginal improvements on current healing arts, cost doesn't matter to these guys. I am sure Michael Milkin would say to spend billions to cure prostate cancer even if targeting some of these funds to help, say, pandemic asthma in inner cities would do a lot more good for a lot more individuals.

    There is a relatively tiny number of people who can afford and want access to the absolute best and most expensive care money can buy.

    There is a relatively huge number of people who are just hoping to reasonably good care they can afford.

    And there is a significant minority–46 million Americans and counting–who would be happy to be covered at all.

    It seems that the rich always get richer, and the poor get poorer–in both money and in health. But does the discrepancy really have to be SO great? Where has gone any sense that we are all country men–that what is good for all of us helps make our nation stronger, which, in turn, makes us as individuals stronger, too.

    The genius of Rush Limbaugh and Gordo Gecko and their greed is good lie is it gives the successful an excuse to turn their backs on those less fortunately. It converts selfishness into a virtue, calling it compassionate conservatism–makes people think offer a leg up to somebody else will weaken the helped, who will not feel pride in going it alone.

    What merde as our french colleagues would say!

    The alliance between Jesus and Fiscal Conservatism is too much for me to understand. And so I will not subject you to my ruminations at how this paradox has come to be.

    • Rick said

      I’m going to give you another thumbs up for this one Jim.

      You appear to be a policy uptopian wonk and I’m only a big picture financial realist. WE CANNOT AFFORD WHAT YOU WANT, as explained a few weeks ago.

      The abscessed teeth you referred to were from poor dental care. Do you feel us tax payers also owe free dental care to everyone?

      I’m sure many people used as examples are not angels and had everything to do with their plight. We can only afford to help those that cannot help themselves.

      It appears you have done a great deal of research on the subject of health care. Were you this conscientious researching the background of people used as examples? If so, I would really like to see that.

      • Nosedoc said

        Rick, I prefer to say that “WE DO NOT HAVE THE MONEY TO PAY FOR WHAT YOU WANT” rather than use the AFFORD word, so it doesn’t get turned around with the line, “We cannot afford not to…” Let’s REALLY address the areas of waste and pointless consumption of goods and services (and there are LOTS of them) and then we can find out just what we can truly afford.

        As for the abscessed teeth–which should not occur, regular personal dental care (just like personal health care) has to be the priority. A huge percentage of people do not have dental coverage, and by brushing twice daily, flossing at least a few times a week, and having teeth cleaned by a capable hygienist once or twice a year at a relatively modest expense, they are able to avoid having to deal with dental caries and gum disease. Dental abscesses are the result of a cascade of neglect, starting in one’s own bathroom. If our population at large were to take better care of their teeth, then dental insurance would be very affordable for everyone, and those with issues like dry mouth from rheumatologic disease or post-radiation therapy that make dental disease inevitable, would be more easily ‘absorbed by the system’.

        • Rick said

          “I prefer to say that “WE DO NOT HAVE THE MONEY TO PAY FOR WHAT YOU WANT”

          You’re correct, I’ll use that wording from now on.

          Thanks

    • Rick said

      Jim, regarding your six questions:

      Yes, I want the current proposal to fail. As stated before CBO graded it on 10 years of income and only 6 years of expenses and w/o the doc fix. My primary concern is the solvency of this country. Without solvency health care reform is moot.

      The balance of the questions I’ll answer in a way you think naive. Government got us into this mess via price controls of years past. Let the magic of the market handle it and get government out of the way. I have competed in the market for over 50 years and I’m not sure you have that same market experience to appreciate what it can do.

      • James S. Thornton said

        Rick–see your quotes and my questions/responses:

        Yes, I want the current proposal to fail. As stated before CBO graded it on 10 years of income and only 6 years of expenses and w/o the doc fix. My primary concern is the solvency of this country. Without solvency health care reform is moot.

        I don’t think this 10 year income, 6 year expenses chestnut–so often quoted by those against reform–is actually correct. Alan, can you weigh in here?

        Moreover, you seem to cite the CBO when it boosts your arguments, but denigrate it when it conflicts with your arguments. According to the latest CBO estimates I saw, Obama’s plan will cut, not add to, the deficit. The status quo, on the other hand, will make things much, much worse. If solvency is truly your big concern, what would be so horrible about returning the tax rates on the top earners to what these were during the Reagan years–and actually PAYING for some of the lunacy that Bush-Cheney thrust upon us during their credit card shopping spree? Where was your concern for solvency during the 8 years of that administration?

        The balance of the questions I’ll answer in a way you think naive. Government got us into this mess via price controls of years past. Let the magic of the market handle it and get government out of the way. I have competed in the market for over 50 years and I’m not sure you have that same market experience to appreciate what it can do.

        Did you vote for Bush-Cheney? When Cheney said, “Reagan taught us that deficits don’t matter,” were you up in arms? Do you think that the meltdown of Lehman Brothers and the near meltdown of the other “too big to fail” investment banks were or were not an example of letting the free market operate? Do you believe that laissez faire capitalism, devoid of any government regulations, is truly the way to go? Would you vote against the re-imposition of the Glass-Steagall Act and other post-Depression measures that did not eliminate all boom and bust cycles since the 1930s but prevented the major collapse we just endured in 2008?

        The free market (or whatever bastardized version of this our current lobbyist-thick/tilt the playing field for my corporated client system it is we actually have), I will acknowledge works well in some areas, including even types of health care. Lasik eye surgery and various cosmetic procedures, for instance, have dropped significantly in price over the past years. Not surprisingly, these are not covered by insurance.

        But it’s more than just the fact that the consumer has to pay for these things directly.

        Elective procedures and “do this or your child will die” interventions are not the same. We may just have to agree to disagree here, but I don’t believe unfettered capitalism works particularly well for “goods” that are life and death by nature.

        • Rick said

          “According to the last CBO estimates I saw, Obama’s plan will cut not add to the deficit”

          CBO graded Obama’s plan on the assumptions given to it. My understanding is that those assumptions given were to grade it on 10 years income and 6 years expenses without the doc fix.

          “The status quo, on the other hand, will make things much much worse”

          The status quo will be much better than the financial result of Obamacare.

          “returning tax rates on the top earners to what they were during the Reagan years”

          I’m not sure but I think Reagan cut the top tax rate from approx 70% to 29%. Actually that tax cut increased government revenues, but Congress continued to increase spending. Top tax rates were increased during Bush I & Clinton. Bush II cut federal income tax rates and as a result government tax receipts again increased, but spending increased much more. Our problem is one of over spending not under taxing.

          “Where was your concern of solvency during the 8 years of that administration?”

          If I would have been a visitor to this site during that time you would have seen me bitching about all the spending.

          “The meltdown etc etc”

          Prime movers of that were the two government sponsored entities Fannie Mae & Freddie Mac. Franklin Raines CEO of Fannie Mae reduced credit score requirements for mortgages purchased by Fannie Mae.

          “Glass-Steagall Act etc etc”

          The repeal of Glass-Steagall was not the prime mover of the meltdown, as Fannie & Freddy were.

  9. Alan,

    I think your commentary, again, is excellent.

    I’m reminded by your comments about “Reconciliation”, and “Omnibus”, of the damage that can occur during an OBRA (Omnibus Reconciliation Act), such as we experienced in OBRA ’93. OBRA ’93 was the result of Budget differences that occurred in the 1993 Congress. California had already implemented its Public/Private Partnership for Long Term Care, as had New York. Henry Waxman (House) and Daniel Patrick Moynihan (Senate), both Democrats agreed in conference committee to include in OBRA ’93 language that made it illegal for any state that had not received a Medicaid Waiver by May of 1993 to implement a Public/Private Partnership for Long Term Care. Four states had them, 20 more wanted them and were prevented from doing so by these two highly suspect individuals. Neither stood to suffer any political ramifications because their states were protected. Denying a Medicaid Waiver to the other 46 states was apparently thought to be a budget saving machination.

    I had been working with the Robert Wood Johnson Foundation, creator of the Partnerships on having a Partnership implemented in WA State. I’d spent the better part of three years doing so after I was finished with work for the day, got to know our State Legislators very well, and had run the campaign for the House Health Care Chairman for three successful terms. The OIC (Insurance Department), DSHS, and legislature seemed to finally be in agreement on how we would do this immense job, and provide great coverage to WA State citizens, and protect those of low income and/or assets.

    Waxman and Moynihan destroyed those hopes. While I never had any respect for Waxman, having observed him for some time, I had great respect for Senator Moynihan, and then knew the feeling of seeing a once admired American crumble and fall off his pedestal. He was just as duplicitous and disingenuous as any other “run of the mill” politician, in my opinion. The RWJF worked for years to try to determine what Waxman’s problems were with a Partnership he wanted to have exist in California. They never found out. Waxman has continued to refuse to alter his language (never admit you’re wrong?), and there are now in excess of 30 states that have passed “Enabling Legislation” but cannot be granted a Medicaid Waiver.

    Our system of reconciliation, particularly when both Houses of Congress are the same party, can only lead to true corruption of democratic ideals, and a genuine screwing of the public. That the Ds are again up to their old tricks in attempting to lump Student Loans with HCR surprises me not. They may very likely succeed, again to the detriment and total ignoring of the wishes of the Electorate (Wishes? They don’t even know about it! Arrogance, arrogance, arrogance).

  10. Rick said

    “make access to health care an American right”

    Jim, I’m sure you are aware of the fact that no one may be turned away from health care in this country.

    • Really?

      So why do so many poor people end up pulling their own abscessed teeth? Why is the uninsured death rate so much higher than the insured death rate?

      It may be true that ER’s can’t turn you away, but if you are not insured and lack the money to pay for, say, chemotherapy drugs or a heart valve replacement, you are maintaining straight-faced that you will get these just by asking?

      Emergency care is one thing–a quick patch job and back on the street (assuming Hospital A doesn’t first dump you over at Hospital B). But is it really true anybody can get longer term care for chronic conditions? If so, why doesn’t everyone just drop their insurance and go this route, then pay the minimum requirement (say, $10 a month) to keep creditors off your back till you die and the slate’s wiped clean?

      Since somebody must be paying someway for the indigent, isn’t socialism already here? Why the big fuss at just taking it all the way?

      • Rick said

        Here we go again Jim!

        “why do so many poor people end up pulling their own abscessed teeth”

        Please provide links or proof of this.

        “chemotherapy drugs or a heart valve etc etc”

        Hopefully a doctor will post some info on this as I have none, and you probably have nothing to back up this assertion.

        “Why is the uninsured death rate so much higher than the insured death rate”

        More responsible life style?

        “why doesn’t everyone just drop their insurance”

        Responsible people?

        Jim, on that first post you stated “make health care an American right” How to you reconcile that with your other statement “cut cost and ration care with single payer”

      • Jim,

        At the risk of seeming to be asking a question that perhaps I shouldn’t, it occurs to me that your anger may be so great that you might benefit from speaking to a “professional”.

        I would truly be saddened to see one as clearly depressed and unhappy as you become just another “statistic”.

        It’s just a thought.

  11. Strange, perhaps, but not in my opinion a bad thing. One could argue, with some rationality, that a college education not only significantly ups the odds of higher life time earnings, but with this, better health (as data shows again and again that those who can afford high quality medical care fare much better than those who can’t.)

    Here is a metaphor for a bunch of dysfunctional systems in the US today: the QWERTYUIOP keyboard. As I am sure you know, Alan, the arrangement of keys on the typewriter keyboard was originally designed to prevent typing speeds from getting too high, thus jamming the mechanics of early type writers.

    Today, with computers, there is no jamming risk whatsoever, and many arrangments of the alphabet have been shown to be much faster and easier to type with. Alas, the status quo is so entrenched (almost like our inches and feet and lb measurements which are clearly nonsensical compared to the metric system) that few, if any, people want to change. It becomes a vicious circle. Keyboard manufacturers won’t change things without a significant demand for the better product; without a better product widely available, kids learning to type use the current QWERTYUIOP configuration; the status quo continues with no relief in sight.

    Ditto with our current system of employment-based health insurance, begun as a way of circumventing price controls in the olden days, and around which a huge entrenched bureaucracy of vested interests has grown like strangler figs anxious to suck every unguarded penny from the doctor-patient transaction.

    Many hospitals today–their actual architecture–seem to follow this same inefficient pattern. They began as somewhat rational buildings, but grew with new wings and skyways and jury-rigged annexes to the point where you need a GPS to find your way from the lobby to the doctor’s office. I have seen gerbil tube extravanganzas laid out more rationally than this mess that evolves over time.

    The Congress has reached a similar point of spectacular ineptitude: many good people, I am sure, but penned in by archaic rules and party rules and the corruption of special interest money–all of which has lead to a virtual paralysis.

    I say why on earth should private banks be allowed to suck money out of student loan moneys, where the need to educate our people is clearly a public good? Ditto, I believe, for private insurers and all the other fatted-tics that have appended their rasper organs on the national health.

    To me, it’s always boiled down to a clear notion: throw out the QWERTYUIOP keyboards and non-metric system; raze hospital mazes that bewilder all visitors; take Occam’s razor to the Gordian Knot of congressional archania; make access to health care an American right, and cut costs and ration via a single payer system; get rid of all of the leeches who add nothing to the public weal save for angry ideology that the answer to laissez faire’s obvious failings is to laissez faire even harder till the “free market” fixes everything.

    One way or the other, those blood-engorged leech-ticks someday will explode.

    • Jim,

      I’ve been reading your “madder than hell and not going to take it anymore” posts here for some time, and it seems quite clear that you really don’t like living in the US. I strongly doubt that many will agree with you that we need to change to socialized form of government in order to rid the country of all of “all of the leeches who add nothing to the public weal save for angry ideology that the answer to laissez faire’s obvious failings is to laissez faire even harder till the “free market” fixes everything.”

      It also seems clear that the most angry person posting on these issues, is yourself. I realize that you’re in a real “pinch”. However, it is quite apparent that living in a socialized system is your desire, so with that thought in mind, think about moving to Canada. It is close, would be inexpensive relative to other socialized countries to which you may prefer moving and living, and I think would offer you a real possibility for happiness, or something close.

      Your gain would be clear. The gain to all of the “leeches who add nothing to the public weal save for angry ideology that the answer to laissez faire’s obvious failings…” who believe in a “Free market” is that you won’t need to throw and we won’t need to respond to the eloquent, articulate, slap-in-the-face insults those with whom you disagree, those of us who post on this blog along with you.

    • Mark said

      Jim if I could write you an Rx it would be for two cuts at Mineos’ on Murray. It always brought some temporary piece of mind to me and still does when I get back for a visit. Granted too much pizza and you would become a large user of the system that you despise.

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