US Doctor Shortage to Improve Under New Laws

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Health overhaul likely to strain doctor shortage

http://news.yahoo.com/s/ap/20100328/ap_on_he_me/us_med_healthbeat_primary_care

By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer ? 1 hr 4 mins ago
WASHINGTON ? Better beat the crowd and find a doctor.
Primary care physicians already are in short supply in parts of the country, and the landmark health overhaul that will bring them millions more newly insured patients in the next few years promises extra strain.

The new law goes beyond offering coverage to the uninsured, with steps to improve the quality of care for the average person and help keep us well instead of today's seek-care-after-you're-sick culture. To benefit, you'll need a regular health provider.

Yet recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a field losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack. ...
Not enough doctors in the land of the free? Who'd a thunk it|?
 
Mar 2009
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Not enough doctors in the land of the free? Who'd a thunk it|?
But is it still the land of the free however? The less freedom to practice, the less doctors?

Refer article on recent poll among physicians after the passing of the Healthcare Reform Bill (View full PSI survey results (PDF)):


Yesterday, athenahealth and Sermo released our Physician Sentiment Index (PSI). With over 1,000 physicians polled, the national survey is thought to be the largest of its kind. While many of the findings will come as no surprise to physicians in practice, the messages are nevertheless alarming. Key findings include:
  • 64% cited the current healthcare climate as somewhat or very detrimental to their delivery of quality care
  • Only 22% are optimistic about the ability of the American physician to practice independently or in small groups
  • 59% are of the mind that the quality of medicine in America will decline in next five years; only 18% believe the quality of medicine will improve
  • The majority (54%) strongly disagree/disagree that more active government involvement in healthcare regulation can improve outcomes; less than a quarter feel otherwise
  • A shift from fee-for-service to pay-for-performance gives hope to almost half (49%) who think it will have a very/somewhat positive impact quality of care but; but 53 percent believe pay-for-performance will have a negative/very negative impact on the effort required to get paid
 

myp

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Being the land of the free has nothing to do with doctor shortages (not that we are as free as we used to be.) Most parts of the world are in similar situations, especially as the baby boomer generation ages. This problem existed before this legislation, but the mandate will surely add additional strain as the article says- just another argument that many against this bill used, but the current administration had to have their way. Reform that would have helped increase the supply and hence, reduce strain was quickly thrown aside because it was from Republicans or people who didn't support the mandate.
 
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Being the land of the free has nothing to do with doctor shortages (not that we are as free as we used to be.) Most parts of the world are in similar situations, especially as the baby boomer generation ages.
I don't agree. The rest of the developing world has been restricted for a very long time. Their physicians have moved to the United States where they could practice freely and earn top dollar for their specialist knowledge. There is only so much medical fee money that can circulate in the system, and the Government through its regulations is claiming a share of it that will mean less for physicians. Also more regulations, greater bureacracy. So being less free is obviously going to demotivate those physicians coming from abroad to specialize in the can-do land of the free. The stresses and strains of a heavily regulated medical system may also mean that physicians will choose to retire earlier, and students may elect to choose different professions, perhaps accounting or other professions where they can be more in control of their destinies.
 

myp

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I don't agree. The rest of the developing world has been restricted for a very long time. Their physicians have moved to the United States where they could practice freely and earn top dollar for their specialist knowledge. There is only so much medical fee money that can circulate in the system, and the Government through its regulations is claiming a share of it that will mean less for physicians. Also more regulations, greater bureacracy. So being less free is obviously going to demotivate those physicians coming from abroad to specialize in the can-do land of the free. The stresses and strains of a heavily regulated medical system may also mean that physicians will choose to retire earlier, and students may elect to choose different professions, perhaps accounting or other professions where they can be more in control of their destinies.
Ok, maybe my phrasing was misleading because that is not what I meant. As a champion of freedom, I do believe more freedom would mean better choices and a better market for doctors and consumers alike. I am saying the opposite of what you have interpreted in that the shortage is not the result of what some may have seen as a lack of regulation. A freer market would lead to a greater supply of doctors- this could be established through more competition and easing certain licensing laws.
 
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I disagree with you both. To make such an assertion you first must define "freedom". Freedom has never meant the absence of controls. It usually means the absence of controls you dislike. A constitution is intended to limit the extent to which the state can impose on people, whereas the regular law restricts the ability to which people can impose on each other. True freedom in an organized society can never exist because of conflicting values. Sauce for the goose is often soup from the gander and ne'er the 'twain shall meet. A society without rules is not free at all, it is a jungle with even day to day survival a matter of questionable chance. Why else do you think Somalia fails to prosper? If you truly want freedom from formal authority move there and report back in a year. You are free to shoot at your neighbour if you wish, just as free as he is to shoot at you.
 

myp

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I disagree with you both. To make such an assertion you first must define "freedom". Freedom has never meant the absence of controls. It usually means the absence of controls you dislike.
Of course not. The state is run on coercion, which is essentially the opposite of freedom. The less coercion, the more freedom.

A constitution is intended to limit the extent to which the state can impose on people, whereas the regular law restricts the ability to which people can impose on each other. True freedom in an organized society can never exist because of conflicting values.
The state is still coercion though. A stateless society is in reality the most free.

A society without rules is not free at all, it is a jungle with even day to day survival a matter of questionable chance.
I completely disagree here. What people seem to forget is that in an anarchy, people still have ethics and morals. They are not the creation of the state. It is not like today's law abiding citizens would certainly become murderers in that situation and as such the anarchic chaos we often see portrayed in movies is misguided.

Why else do you think Somalia fails to prosper?
It is not fair to compare Somalia to Western states. The only fair comparison to itself before the government was overthrown in 1991. In comparison, Somalia is not doing as bad as perhaps the media suggests. Local communities have grown to a sense of self rule. If you want an outside comparison, look at the rest of Africa, which is probably closest in terms of culture, etc. While a lot of Africa has established states, Somalia is still more educated, peaceful, etc. than a lot of those states.

Furthermore, Somalia is the result of a failed state- of a coercive, distorted distribution of power. Most anarchists believe in an intellectual movement by the people to reject the state, not simply the collapse of one. Perhaps over time we will see what really happens with Somalia and if the people choose to actively reject a national authority and if so, how that leads to future growth and development.

Note that I am not an anarchist, but the idea that Somalia disproves the anarchist ideology from being legitimate is just absurd. Perhaps Dirk could add more to this as he is an anarchist.
 
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Of course not. The state is run on coercion, which is essentially the opposite of freedom. The less coercion, the more freedom....

All of which has what to do with doctors in the US? The notion of 'the state is coercive therefore anarchy is a choice' is about as useful as mile per gallon debates of a car in a vacuum. We do not live in a frictionless world and the points you argue are meaningless in a world of friction. Freedom within society without rules and laws is not possible in this life.
 

myp

Jan 2009
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All of which has what to do with doctors in the US?
Just responding to your questioning of the definition of freedom.

The notion of 'the state is coercive therefore anarchy is a choice' is about as useful as mile per gallon debates of a car in a vacuum. We do not live in a frictionless world and the points you argue are meaningless in a world of friction. Freedom within society without rules and laws is not possible in this life.
You can not argue a point by simply saying it is so. I have given you logos supporting my argument in my last post. Besides, no one is saying anarchy means not rules and no laws, most anarchists recognize the FACT that morals and ethics would still exist. Furthermore, there is a school of anarchism that suggests a system of law and order would naturally form without a state- Somalia is actually an example of that, where there are many tribes which do have guidelines.
 
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Originally Posted by chuck schmidt
All of which has what to do with doctors in the US?
Just responding to your questioning of the definition of freedom.
How? You say, “more freedom would mean better choices”. What does that mean vis a vis the discussion in the link? I presume that we are discussing among realistic “possibles”, not a hypothetical exchanging of the US form of republican government for something like anarchism?

Originally Posted bychuck schmidt
The notion of 'the state is coercive therefore anarchy is a choice' is about as useful as mile per gallon debates of a car in a vacuum. We do not live in a frictionless world and the points you argue are meaningless in a world of friction. Freedom within society without rules and laws is not possible in this life.

You can not argue a point by simply saying it is so.
First, sure I can. Sometimes Internet comments are so simplistic or lacking in reality, substance or relevance that doing so is appropriate. I am not doing so in this case. Your comment that,
“The state is still coercion though. A stateless society is in reality the most free.”
does not appear to address the topic in the link, and is in itself a statement standing bare.

Second, my statement contains its own logic. You can argue the definitions and effects of “friction”, but the presence of societal friction explains the conclusion that societal freedom needs rules. That’s not the topic, hence little explanation or discussion

If you are suggesting that every post needs an authority, nawwwwwww. This isn’t school.

I have given you logos supporting my argument in my last post.
You say that you have ‘given me "logos"’? I don't understand the term “logos”?

Besides, no one is saying anarchy means not rules and no laws, most anarchists recognize the FACT that morals and ethics would still exist. Furthermore, there is a school of anarchism that suggests a system of law and order would naturally form without a state- Somalia is actually an example of that, where there are many tribes which do have guidelines.
Huh? I don't think you have argued the issue. Abstract notions of anarchy and coercion do not address the issues of health care and too few doctors. You may recall instructing me in the past not to post entire articles? In deference to you I have posted only the first three paragraphs to get people started so it may be a bit vague, but I have difficulty seeing how that morphs into a highly technical discussion of anarchism?

You have previously stated your opinions on how the new scheme will not work well from a market perspective. But the new plan is now in, so I am seeking debate on ‘what is’, not on ‘what might have been’.

What freedoms are lacking and how are they affecting doctor availability?
 
Apr 2009
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Disunited Queendom
Let's clarify a few things:

* Anarchism doesn't necessarily mean no rules

* Hyper-capitalism doesn't qualify as anarchism - DEFINITELY not on its own

* Anarchism is a practicable concept

* Anarchism does not automatically mean free markets, just as the reverse is not true

* I fail to see how more doctors would participate in a system that even the current ones wouldn't support (they don't support the current system, either, btw)

* Most anarchist movements are socialist movements, arising from the theories of Bakunin, Malatesta, Goldman, Kropotkin and other such far-left political philosophers

* I suggest you stop equating my and myp's ideals - they are very different worlds
 

myp

Jan 2009
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How? You say, ?more freedom would mean better choices?. What does that mean vis a vis the discussion in the link? I presume that we are discussing among realistic ?possibles?, not a hypothetical exchanging of the US form of republican government for something like anarchism?
I am referring to better choices for consumers as well as doctors in the market. More flexibility for doctors would almost certainly mean more doctors as well.

First, sure I can. Sometimes Internet comments are so simplistic or lacking in reality, substance or relevance that doing so is appropriate. I am not doing so in this case. Your comment that,
?The state is still coercion though. A stateless society is in reality the most free.?
does not appear to address the topic in the link, and is in itself a statement standing bare.
Well you can't just say something is true by claiming so- that is a logical fallacy. The whole anarchism thing was a spin-off of our discussion, perhaps we should discuss it elsewhere as it isn't completely on-topic.

Second, my statement contains its own logic. You can argue the definitions and effects of ?friction?, but the presence of societal friction explains the conclusion that societal freedom needs rules. That?s not the topic, hence little explanation or discussion
We can discuss it elsewhere, but from what I understood, I disagree with your friction theory.

You say that you have ?given me "logos"?? I don't understand the term ?logos??
It's a rhetorical style of persuasion centered around the use of facts and/or logic.

Huh? I don't think you have argued the issue. Abstract notions of anarchy and coercion do not address the issues of health care and too few doctors. You may recall instructing me in the past not to post entire articles? In deference to you I have posted only the first three paragraphs to get people started so it may be a bit vague, but I have difficulty seeing how that morphs into a highly technical discussion of anarchism?
I did not bring up the anarchism topic- you brought up Somalia. But you are right in that the anarchism debate isn't on-topic to this thread, so we can let it go and discuss it elsewhere.

You have previously stated your opinions on how the new scheme will not work well from a market perspective. But the new plan is now in, so I am seeking debate on ?what is?, not on ?what might have been?.
That is just being close-minded, don't you think? By that logic, when the new plan was still not passed, those against it could have used the same argument, saying that is just hypothetical, let's talk about what is, not what might be.

If you want to focus on "what is" with this new bill though, it is just what I have said before- it is not sustainable, it is not Constitutional, it is freedom-restricting, and it adds more regulations to the market which will worsen the doctor shortage.

What freedoms are lacking and how are they affecting doctor availability?
The health care industry, even before this legislation, was one of the most regulated in the United States. This bill, adds further regulation. Part of this includes added bureaucracy and dealing with state bureaucracies for payments, etc. Many doctors/pharmacies had even before this bill stopped accepting medicare and other forms of government payment due to inefficiency on the state's end. This only adds to that.

Furthermore, certain licensing laws could be eased to allow for more doctors in the market and competition can be increased by ending the "favorites" game through certain subsidies and operating regulations.
 
Apr 2009
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Disunited Queendom
We can discuss it elsewhere, but from what I understood, I disagree with your friction theory.

I don't disagree with the premise. There is clearly social friction. But he's going all liberal on us with that "social contract" rubbish. I'm just surprised he hasn't used the term yet! No, authoritative institutions are not necessary to deal with this. It's a classic justification, but it's firstly extremely one-sided and secondly, it's not the reason the state exists. The state exists to protect power and rich people.
 
Jan 2010
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The health care industry, even before this legislation, was one of the most regulated in the United States. This bill, adds further regulation. Part of this includes added bureaucracy and dealing with state bureaucracies for payments, etc. Many doctors/pharmacies had even before this bill stopped accepting medicare and other forms of government payment due to inefficiency on the state's end. This only adds to that.

Furthermore, certain licensing laws could be eased to allow for more doctors in the market and competition can be increased by ending the "favorites" game through certain subsidies and operating regulations.

Way back in the 60's I remember discussions about how there are too many rules so first we get rid of what's there. It just isn't going to occur in a world of human beings. Its all that people can do to agree on what is needed now let alone goring many more oxen getting rid of old baggage. That kind of logic needs specifics. What? Why? In the meantime people in the world's wealthiest country are dying for lack of the same universal health care that the rest of the western world takes for granted. Do you realize how inhuman and hypocritical that makes America look? As I have opined in the past, the perfect is the enemy of the possible. I am sure people who finally have health care will thank you for finally cleaning house if you start a year from now.
 
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I disagree with you both. To make such an assertion you first must define "freedom". Freedom has never meant the absence of controls. It usually means the absence of controls you dislike.
Totally agreed, so maybe I should rephrase my reference with saying that there will be considerable less freedom available after the implementation of the new Health Care Reform Bill, than before.

Furthermore, and MYP has contributed a thread about this. There is the possibility that the new Health Care Reform Bill may be in conflict with the Constitution, in so far as it is trying to dictate to the States in an area that may not be included in the powers of the Federal Government. I genuinely hope that all of the States will test the validity of the Federal Government legislation and to check how much power the Federal Government has in legislating laws like these, that maybe outside their sphere of power, i.e. the boundaries between State and Federal Government.
 
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myp

Jan 2009
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Way back in the 60's I remember discussions about how there are too many rules so first we get rid of what's there. It just isn't going to occur in a world of human beings. Its all that people can do to agree on what is needed now let alone goring many more oxen getting rid of old baggage. That kind of logic needs specifics. What? Why?
I already gave you some quick specifics and generally those opposed to mandates and excessive regulation do have their own ideas.

In the meantime people in the world's wealthiest country are dying for lack of the same universal health care that the rest of the western world takes for granted. Do you realize how inhuman and hypocritical that makes America look?
That is an extremely weak argument. Not only is it your opinion, but others may see the freedom restrictions you impose in order to do these things as just that: inhumane.

As I have opined in the past, the perfect is the enemy of the possible. I am sure people who finally have health care will thank you for finally cleaning house if you start a year from now.
You can not look at sob stories to push an argument. They exist on both sides (government health care horror stories on the other side) and they do not serve as a proper reflection on the entire market. Look at the overall effect to EVERYONE. Mandates such as the one just passed hurt a lot of people as well. Not only that, but there is a matter of principle and what the role of government should and should not be. You can not make your argument by simply saying you are right or that you are humane because those opposed to your views would claim the same about themselves. Show me some facts or logic that supports what you claim instead of just saying it.
 
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That is an extremely weak argument. Not only is it your opinion, but others may see the freedom restrictions you impose in order to do these things as just that: inhumane.

Inhumane to provide Americans with the same universal health care as the rest of the western world? Human life and health are an extremely weak argument? About on the level of stepping on garden slugs, perhaps? Nothing compared to the glory of semantics from well educated college students. Wine and words should both mellow with age. I am waiting with baited breath to hear the horror stories of man's inhumanity to man hidden behind good health for all Americans! Please supply popcorn. :giggle:

The state exists to protect power and rich people.

Is that an immutable rule for which people are disgraced or imprisoned for disregarding or disobeying
 

myp

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Inhumane to provide Americans with the same universal health care as the rest of the western world?
Why do you always have to compare things with the rest of the Western world? Who says the rest of the Western world is right? Let me remind you that we were the first to try a republic and it was the rest of the Western world that followed us, not the other way around.

Human life and health are an extremely weak argument? About on the level of stepping on garden slugs, perhaps? Nothing compared to the glory of semantics from well educated college students. Wine and words should both mellow with age. I am waiting with baited breath to hear the horror stories of man's inhumanity to man hidden behind good health for all Americans! Please supply popcorn. :giggle:
No one is saying health care is a bad thing or that we don't want everyone to have health care. Most sane people would. The problem is that a mandate is not the way to do it. What I was referring to as potentially inhumane is that mandate- which REQUIRES one to buy insurance even if they don't want it.

Furthermore, what about the trillions that it will surely add to the debt that the future will have to pay? It is generational theft, which may also be considered inhumane by some. On top of that, government has its own interests, you need to remember that. The bigger the bureaucracy gets, the more power it has and the more harm it can cause. The reason I said sob stories aren't good arguments is because they exist on the other side- go to any other Western country (since you think they are a good example) and you will find sob stories about how the government wouldn't cover certain treatments or interfered in some way that hurt someone.
 
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Why do you always have to compare things with the rest of the Western world? Who says the rest of the Western world is right? Let me remind you that we were the first to try a republic and it was the rest of the Western world that followed us, not the other way around.

What's the relevance in comparing 2010 to 1776? The nation could operate warships much more inexpensively then too. Are you suggesting we mothball the sub fleets and re-commission four-deckers?

No one is saying health care is a bad thing or that we don't want everyone to have health care. Most sane people would. The problem is that a mandate is not the way to do it. What I was referring to as potentially inhumane is that mandate- which REQUIRES one to buy insurance even if they don't want it.
I don't necessarily agree with mandating health care either, but other jurisdictions are finding it workable. Or are you suggesting that America is too wise and powerful to learn from others? Perhaps its a sign of how seriously US health care has deteriorated? At some point you have to trust that your leaders have done right even when you don't necessarily agree. No plan will receive the approval of 330,000,000 people.

Once again I repeat the point you ignore: perfection is the enemy of the possible. The plight of 20,000,000-40,000,000 Americans without health coverage has obviously reached a national point of criticality. The private sector could have kept their mandate forever. Unfortunately their computers started telling them some years ago that statistically people would always trade money for life and health, especially for their families, so the money pit was potentially bottomless. The old guard who used to recognize ethical barriers to profit taking were eased out and the new, aggressive, computer oriented capitalist thinkers replaced them. The industry always knew that the curve had to have an end point somewhere, and they gambled that they could make enough to make it work. The most optimistic believed that they could find a level at which to plateau that would be long-term sustainable. Unfortunately the greedy profit takers out-voted the cautious plateau seekers and they lost - or have they? They are still here and still have a place. They are just no longer trusted with control. Too many Americans died and were bankrupted.

Furthermore, what about the trillions that it will surely add to the debt that the future will have to pay? It is generational theft, which may also be considered inhumane by some.
Inhumane? Theft? Pure hyperbole. America has the biggest military and lowest gasoline prices in the western world. Suck it up and start paying as much for a gallon of gas as (ie) Canadians or Brits and many things will be affordable. Bring home the military and put half of the carrier battle groups into short term mothballs. There are more options than multi-generational debt. They just don't all permit current vested interests to keep their licenses to print money for corporate coffers.

On top of that, government has its own interests, you need to remember that. The bigger the bureaucracy gets, the more power it has and the more harm it can cause.
Nobody said America has to remain the worlds largest democracy, but as long as it is it needs a big government. Cut the country in half at the Mississippi if you want? Or let Dixie go free? Or cut something like the military instead of leaving 10% of Americans without adequate health care. A healthier population is better for the nation than the world's most powerful military unless there are crisis nobody is telling us about. I seem to recall we all lived just fine when the USSR had one just as big? Why is everybody else's smaller and America's bigger now? You know the guns or butter arguments. Money spent on armaments is fully consumed. There is no real investment return, just consumption and maintenance expense. Investing in healthier people produces less down-time and a more productive work force. This in turn reduces crime and other brakes on the economy. A domestic win-win instead of an international win-lose.

The reason I said sob stories aren't good arguments is because they exist on the other side- go to any other Western country (since you think they are a good example) and you will find sob stories about how the government wouldn't cover certain treatments or interfered in some way that hurt someone.
Those kinds of sob stories exist but they are internal to the argument. One of the big issues in the current debate is how health insurers act as profit takers and deny health coverage for purely profit reasons. A properly working state insurer may operate with internal inefficiencies, but it will not seek always to increase profits at the expense of coverage. Government will have to get awfully inefficient before inefficiency overcomes profits as a cost factor.

The biggest efficiency in the state system is that when health coverage becomes a problem voters can make it a direct issue with leaders. Not so with private corporations. Why do you think America hears so many complaints about Canadian health care woes? When people have a problem it becomes news and an issue that can be resolved. Media bashes leaders, leaders demand answers and get them. In America the same attempts at resolution has just been met with corporate arrogance and reference to insurer property rights. The problem is now solved for the insurance corporations - they were tried and found wanting and no longer have the same worries.
 
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myp

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What's the relevance in comparing 2010 to 1776? The nation could operate warships much more inexpensively then too. Are you suggesting we mothball the sub fleets and re-commission four-deckers?
Who is comparing 1776 to 2010? I am simply saying that just because the rest of the Western world does something does not mean its right. There could be better alternatives (and I think there are.) Being a copy-cat doesn't produce better things- it never has and it never will. The European systems aren't perfect either.

I don't necessarily agree with mandating health care either, but other jurisdictions are finding it workable. Or are you suggesting that America is too wise and powerful to learn from others?
I am saying that perhaps America can find a better way, as it did with government. I believe we had that way and we have lost it. And as for being workable, why don't you take a look at their budgets and then tell me how workable it is over the next 100+ years.

Perhaps its a sign of how seriously US health care has deteriorated?
And as it has deteriorated, government has also meddled in it more. Coincidence? I think not. The majority of hospitals have major public funding today as opposed to not 20 years ago. What is in the market today is not something made in a free market.

At some point you have to trust that your leaders have done right even when you don't necessarily agree. No plan will receive the approval of 330,000,000 people.
I do not believe in the idea of acting "for the greater good." Historically it has only led to tyranny and chaos. As for 300,000,000 people (not sure where you got the extra 30 million)- of course they all won't, but the lack of government keeps things in the people's hands. Government just makes them do things. Besides, what happened to the Constitution?

Once again I repeat the point you ignore: perfection is the enemy of the possible. The plight of 20,000,000-40,000,000 Americans without health coverage has obviously reached a national point of criticality.
That does not mean the government has to provide health care. In fact, the sharp rise in that uninsured number happened during the same time as significant increases in government meddling in the market. The government made things as bad as they are and yet you want to trust them to now fix the same problem they helped create?

The private sector could have kept their mandate forever. Unfortunately their computers started telling them some years ago that statistically people would always trade money for life and health, especially for their families, so the money pit was potentially bottomless. The old guard who used to recognize ethical barriers to profit taking were eased out and the new, aggressive, computer oriented capitalist thinkers replaced them. The industry always knew that the curve had to have an end point somewhere, and they gambled that they could make enough to make it work. The most optimistic believed that they could find a level at which to plateau that would be long-term sustainable. Unfortunately the greedy profit takers out-voted the cautious plateau seekers and they lost - or have they? They are still here and still have a place. They are just no longer trusted with control. Too many Americans died and were bankrupted.
You realize that the majority on insurance companies make NO profit on premiums right? Furthermore, what do you think has given them so much market power? Ever think that government restrictions such as not being able to buy across state lines has severely limited choices for consumers to the point where some states only have 1 insurance company? Competition always brings prices down- why not pass reform that increases competition instead of just the consumer base?

Inhumane? Theft? Pure hyperbole. America has the biggest military and lowest gasoline prices in the western world. Suck it up and start paying as much for a gallon of gas as (ie) Canadians or Brits and many things will be affordable. Bring home the military and put half of the carrier battle groups into short term mothballs. There are more options than multi-generational debt. They just don't all permit current vested interests to keep their licenses to print money for corporate coffers.
Just because one thing is bad or evil, does not justify you to create another evil or bad thing. By that logic, if leader A killed 500 innocent people, it would then be ok for his predecessor leader B to kill 250. Not only that, but bringing in other expenses is nothing more than a red herring in terms of debate.

Nobody said America has to remain the worlds largest democracy, but as long as it is it needs a big government.
Who says that? We were fine for a couple hundred years and with improved communications today, it would be even easier to manage a larger country.

Those kinds of sob stories exist but they are internal to the argument. One of the big issues in the current debate is how health insurers act as profit takers and deny health coverage for purely profit reasons. A properly working state insurer may operate with internal inefficiencies, but it will not seek always to increase profits at the expense of coverage. Government will have to get awfully inefficient before inefficiency overcomes profits as a cost factor.
Again, most insurance companies make nothing from premiums- that money is set aside for potential periods of heightened sickness when they would have to pay out a lot of money. A Fed govt insurer has the inflation machine to cover excessive costs- in the end we still pay for that, as well as the extra bureaucracy cost, and any interest on debt incurred.

The biggest efficiency in the state system is that when health coverage becomes a problem voters can make it a direct issue with leaders. Not so with private corporations.
With private companies consumers can stop buying their product and they would go under. There are also things like consumer reports. With government, everyone isn't even elected- a lot of the people in charge of the health care plan, etc. will be appointed.

Why do you think America hears so many complaints about Canadian health care woes? When people have a problem it becomes news and an issue that can be resolved.
And you don't see private sector problems get complaints and be in the news too? Search for "Toyota" on any major news site and you'll find at least a handful of articles from over the last month.

Media bashes leaders, leaders demand answers and get them.
Hitting the pocketbook is more effective then threatening votes. Incompetent leaders have won elections in the past, I think we can both agree on that.

In America the same attempts at resolution has just been met with corporate arrogance and reference to insurer property rights. The problem is now solved for the insurance corporations - they were tried and found wanting and no longer have the same worries.
This legislation is actually extremely corporatist. The insurance companies and big pharma supported it for the most part- youtube and you'll even find some commercials from them for it. Why? Because the government just gave them 30 million new contracts with guaranteed payment and no cost cuts.
 
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