Wow that's some crazy stuff. I didn't know it was that bad.

Its a shame really (referring to the 2nd last paragraph) that doctors have to worry so much about malpractise when they're doing the best they can. I hate those ambulance chasing attorneys that go after good people like doctors. If you cured the guys cancer but accidentally cut out his appendix or something, get ready to be sued.

The Iraq war.

I'm pretty sure most people were for that at the time. 

Either way, the Mass thing may just be because of how badly their own plan has worked.

Problem is... this bill... as stated by the whitehouse will EXPLODE out spending per GDP for healtchare.  This plan makes that worse.  Not better.

They're elected, just like everybody else.

6 year terms.

Judges who run for office are told they are not alowed to make any political comments... so all you can really run on is your record... and well your opponents negative record.   Republicans and Democrats still "rule the roost" due to the fact that you still need money to run.

Or rather... Republicans rule the roost.  There isn't a single democrat on the Ohio Supreme court... an odd thing considering Ohio is pretty much THE SWING STATE when it comes to elections where Republican and Democrat are on the ballet.

In a funny way Ohio is the most important state in the country.  Yet oddly the national politicians still avoid coming through on the promises it gives them.

Yeah, I pretty much knew that the US government wouldn't have the stomach to make the changes that need to be made going into this whole health reform morass. Too much money at stake, and you can see how effective it is to raise the bogeyman of socialism in US politics, even when there's hardly anything socialist about this reform bill.

As I understand it, this bill is all about expanding access, not controlling costs. Not necessarily a bad thing, but I think most people would like to see costs go down before access is expanded.

It's actually expanding costs and INCREASING prices.  The American Medical Assosiation disliked the bill, said it would actually hurt more people then it helped and end up costing the country more money. 

The AMA changed their position in about the middle of this year due to a promise made by house democrats.  They would roll back medicare prices.  So the doctors would get paid more for every treatment they performed on a medicare patient.  In otherwors... they bribed them.

It's why i'm not a big fan of healthcare reform, with how the US government works... there is no way the needed changes could be made.

Plus, it's just so complicated an issue.  Non-profit insurance isn't any more cheaper then for profit insurance in many cases it's more expensive.   How is it that non-profit insurance companies can't have lower prices?

Additionally, you've got the fact that most technological breakthroughs in healthcare happen in the US.  How much of that is because of our broken system?  We spend more on healthcare scientific development then the rest of the world combined.

When we fix the problem will healthcare spending still outpace the rest of the world combined?  Will healthcare technology development slow down?  How will this effect healthcare treatment in the future?

How worse is the US care really?  Of all the "lists" done like ones by the WHO they don't really take into account any actual healthcare factors.  It's all based on cost and things like crude death rate, which ignores things like crime, lifestyle etc..  Things like Infant mortality rate are biased based on different reporting methods... etc.

I wish they could dedicate a lot of time to real questions rather then petty bickering and trying to make the other side of the argument look like boogeymen who want to kill people (on both sides they do this.)

It'd also be nice to see them build the health care bill in a very pragmatic way - pass one piece of legislation that is confirmed to help the system out like ensuring nationwide competition for insurance. Once that is done, move on to area two.

We don't need a 2000 page bill for healthcare. We need 100, 20-page bills that do what is needed. That way we can roll back, and optimize the areas that effect the quality and cost of healthcare.

But instead, this bill is just a political mess to ensure favorites are played and that dems look good by expanding our costly healthcare.

Patience will be a killer for this sort of thing. All the more need to ram it through now, imperfect as it is, then it can be tweaked later. If the bill fails, then it'll be decades again before the political capital is mustered to try, and some of the stuff in the bill is stuff we definitely need (like stopping very predatory industry practices that encourage denial of care, and regulating prescription drug prices)

Its imperfect, but ultimately the choice is do it now, or in 25 years (or so).

mrstickball's idea would have a better impact, because the components of this bill are pretty much all common sense stuff, but together it makes it something that the fearmongers can easily point to and demonize with their demagoguery

It really can't be tweaked later.

Government programs are pretty much never tweaked even when there are obvious ways to fix things.

That's why most legislation gets bogged down in changes small little bits of dialogue senators are upset with because they know to tweak it later is near impossible even if there are huge loopholes that are obvious.

Here's the problem, Khan:

If you pass a large bill like this, the areas that need fixed will NOT be fixed.

Look at other government programs:

• Social Security
• Public Education
• Welfare
• Medicare

All were passed under sweeping changes, but have taken decades to actually fix when something has gone wrong. President Johnson was the one that enacted welfare laws for his 'great society'. It took 30 years later, under Clinton, until major issues with Welfare (such as the requirement of working after so much welfare has been given to able-bodied people) was passed. Social Security is still largely unfunded and being used to fuel government, instead of helping those that put income in the system. Public education has so many entrenched groups, there is no way that it can be reformed easily. Likewise, Medicare was passed without understanding that the 2% taken out of paychecks would NEVER be enough money to fund actual medical care decades down the road. Now we cannot enact meaningful MC reform without cuts - cuts that have to take place, or MC will continue to be underfunded, if not unfunded.

That is why you can't propose sweeping legislation. It needs to be much smaller and focused on specific areas to have any effect. Thats not saying that a bill that effects a lot of things cannot be enacted, but that if its designed to implement an entire new feature....It rarely works. You can't enact legislation worth hundreds of billions of dollars and hope it is efficient or works at all from the get go. Its not the way business or industry works. Business and industry work with start ups, and tweaks to ensure growth. Likewise, the government could enact small, meaningful reforms to ensure that things are a little bit better 2 years from now, and do that for the next 20 years - rather than pass a bill in 1 year, and spend the next 19 years trying to make it work.

Ultimately, my belief on healthcare is this:

Make it affordable first. Ensure that the cost of insurances is managable for businesses, people, governments, and whomever else needs it. Drive the price down to where almost anyone can afford it. Then look to make it universal. If you do that, then when the universality comes, the engines will make sure it stays cost-effective and works well, as you'll have a higher number of people naturally on insurance since its more affordable. If you do it ass-end first, you get a smelly bill. Remember: government healthcare costs between $7,000-$9,000. Thats private/public hybrids (medicare) and competely public arenas (VA). Private care is far less. If you add 31 million people to that $7,000-$9,000 insurance plan...Your not making the situation any better.

I know I didn't work a whole long time for the inner workings of healthcare, but when I worked as a medical transport officer, the one thing I always felt was this:

Our system is not ready to handle universal healthcare, and not by a long shot. Most facilities I went to were poorly staffed. I caught nurses sleeping under desks because they were forced to work 16 hour double shifts. I read trade magazines for nurses as I was interesting in the field. Many hospitals are begging for nurses and doctors, and are willing to pay tens of thousands of dollars in bonuses to come to their hospital. In a world of supply and demand, there is too much demand as is. If you add another 31 million people, there will be rationing, higher prices, and lower quality of care. That is regardless of how you cut it.

As stated, I think you need a very pragmatic approach:

• Enact reform to ensure competition between every insurance company out there. Make plans compete nationwide so that BCBS has to go head-to-head with private firms. Insurance companies will be forced to make less money as they try to stay alive in a more competitive environment.
• Tort reform. Doctors can't get sued every time something dumb happens. A significant amount of money is required for doctors to carry malpractice insurance. It can be big money....That is all wrapped up in the cost of a doctors' visit.
• Education reform. What kind of education does it require to become a worker in the healthcare field? As I stated, it takes ~12 years of education and clinicals to become a medical doctor. At most colleges, this means a $100,000 burden for every doctor. That cost is translated to patients. I believe that we need to end the stranglehold the doctors' unions have on the healthcare field, and make it more comeptitive - nurses can take some responsibilities from doctors that could greatly lower costs (nurses make about 1/3rd that of doctors in the US, yet a doctor is required to sign off on most medications and perform many kinds of checkups....Again, that is a huge cost for skills that most nurses have). I believe there is a lot of credentialed BS in the medical field. I knew LPNs that could do RN jobs, RNs that could do MD jobs, yet absolutely could not unless they had a paper that said they paid tens of thousands of extra dollars for college. We need a more flexible system.
• Medicare reform. Medicare needs to cover the most desperate, not everyone that paid in the system. This would be really, really hard, but it needs to be done. Every American pays into this system, and only a few can benefit. Either this needs to be removed as an income tax and used more as a welfare program, or something needs to happen to ensure that every geriatric patient isn't on this (and many, MANY were when I had to fill out their paper work).

Those would be 4 areas I would tackle, by parsing up (especially education) into various sub-groups, and fixing them one part at a time.