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Author Topic: This is reform?  (Read 3498 times)
Finnegans Wake
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« on: Aug 18, 2009 at 08:16 »

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Steelerdipwad
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« Reply #1 on: Aug 18, 2009 at 10:02 »

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« Reply #2 on: Sep 10, 2009 at 11:44 »

I don't think people understand what they are asking for when they ask for the government to take over our health care. Free is certainly not free.

And we have to think about this in a pragmatic fashion. Do we want a small portion of the population dealing with a lack of quality health care or everyone dealing with a lack of quality health care? Some people seem to think because someone doesn't have insurance that they can't get care which isn't true. I would say 50% of the people that come into our ER are uninsured and don't pay a dime...nor are asked to pay a dime. These people use the ER as their primary care center. Second, when there is a procedure that the ER can't do...there are hospitals much like ourselves who are given governmental $$$ to take care of the uninsured. If they do not qualify there are always spin down programs and they pay pennies on the dollar for care. The system might be broke...but compared to Canada and England we are the mecca of quality medical care.

How to contain costs?

1) Malpractice Reform
2) Incentivize the young and healthy to buy health insurance to spread the risk
3) We have a civic duty to purchase health insurance...those that can not financially do so can be subsidized through taxation on unhealthy foods and non essential items.
4) Insurance should be for serious illness and injury. If you choose to go to the doctor for a sore throat...you should plan on paying for it just like you pay for gas, groceries etc. Insurance should be meant to protect a family from catastrophic loss...not a 75 dollar office visit.
5) Incentivize those on Medicaid and Medicare to participate in wellness, and for living healthy lifestyles. And there must be consequences for those who abuse the system. The ER should not be a place for those on governmental funds to treat a sore throat or a runny nose. This costs tax payers around $500 as opposed to $75. But, it's done everyday. Those who use the ER to seek narcotics should lose rights to governmental funds.
6) Lower regulation...and you lower our need for staff which = lower overall costs.

Demand the government fix it's current systems before taking over others. Medicaid, medicare and most VA hospitals are broken...and broken badly.

The fact is free markets lower costs and improve services. Lets just fix what we have.
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« Reply #3 on: Sep 10, 2009 at 12:02 »

I don't think people understand what they are asking for when they ask for the government to take over our health care. Free is certainly not free.

And we have to think about this in a pragmatic fashion. Do we want a small portion of the population dealing with a lack of quality health care or everyone dealing with a lack of quality health care? Some people seem to think because someone doesn't have insurance that they can't get care which isn't true. I would say 50% of the people that come into our ER are uninsured and don't pay a dime...nor are asked to pay a dime. These people use the ER as their primary care center. Second, when there is a procedure that the ER can't do...there are hospitals much like ourselves who are given governmental $$$ to take care of the uninsured. If they do not qualify there are always spin down programs and they pay pennies on the dollar for care. The system might be broke...but compared to Canada and England we are the mecca of quality medical care.

How to contain costs?

1) Malpractice Reform
2) Incentivize the young and healthy to buy health insurance to spread the risk
3) We have a civic duty to purchase health insurance...those that can not financially do so can be subsidized through taxation on unhealthy foods and non essential items.
4) Insurance should be for serious illness and injury. If you choose to go to the doctor for a sore throat...you should plan on paying for it just like you pay for gas, groceries etc. Insurance should be meant to protect a family from catastrophic loss...not a 75 dollar office visit.
5) Incentivize those on Medicaid and Medicare to participate in wellness, and for living healthy lifestyles. And there must be consequences for those who abuse the system. The ER should not be a place for those on governmental funds to treat a sore throat or a runny nose. This costs tax payers around $500 as opposed to $75. But, it's done everyday. Those who use the ER to seek narcotics should lose rights to governmental funds.
6) Lower regulation...and you lower our need for staff which = lower overall costs.

Demand the government fix it's current systems before taking over others. Medicaid, medicare and most VA hospitals are broken...and broken badly.

The fact is free markets lower costs and improve services. Lets just fix what we have.


Most of that is what Obama said last night.  My main gripe is that an inordinate amount the health care dollar is spent on the administrative side of things.  Let's get the patient care we're already paying for.
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« Reply #4 on: Sep 10, 2009 at 12:10 »

I agree with what you've posted, Doc, but those ER visits by the uninsured just spread hidden costs.  As you say, free ain't free.  And per 5) we would do better to have the uninsured covered and going to GPs.

I agree that Medicaid and Medicaire need overhauled, but private insurers are still pitting profits versus care and coverage: that's an untenable model, morally and fiscally.  

Also on points 3) and 5), there was an article by Michael Pollan ("Omnivore's Dilemma") about how we spend so much more than other countries... but that much of that cost is due to downstream effects of diet.  Obesity, diabetes, heart disease...  all very much on the rise due to the elephant in the living room, and NO ONE, R or D, is addressing that very basic cause.  One quick fix would be to eliminate Farm Bill subsidies for commodity crops (corn, soy, etc.) which make up the basis of 90% of industrialized "food."  The high cost of cheap food, as a recent Time cover put it.  

My football analogy for Obama's speech is this, BTW:  he fair catches the kickoff with coverage teams 30 yards upfield.  Calls a time out.  Is heckled by drunken oafs.  First play from scrimmage... PUNT!

I don't agree that free markets lower costs and improve services in healthcare.  How can that be possible with these generous CEO pay packages and profits for shareholders?  Doesn't that money directly siphon from patient care?



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« Reply #5 on: Sep 10, 2009 at 12:27 »

I was actually encouraged by what Obama said last night. Though it does concern me about taxing higher premium insurance plans as a means to reduce costs to consumers. It seems like it will lead right down the road to eventually the only game in town being government run healthcare. I just don't want that. But, like I said, I did like what he said last night.
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« Reply #6 on: Sep 10, 2009 at 12:37 »

I agree with what you've posted, Doc, but those ER visits by the uninsured just spread hidden costs.  As you say, free ain't free.  And per 5) we would do better to have the uninsured covered and going to GPs.

I agree that Medicaid and Medicaire need overhauled, but private insurers are still pitting profits versus care and coverage: that's an untenable model, morally and fiscally.  

Also on points 3) and 5), there was an article by Michael Pollan ("Omnivore's Dilemma") about how we spend so much more than other countries... but that much of that cost is due to downstream effects of diet.  Obesity, diabetes, heart disease...  all very much on the rise due to the elephant in the living room, and NO ONE, R or D, is addressing that very basic cause.  One quick fix would be to eliminate Farm Bill subsidies for commodity crops (corn, soy, etc.) which make up the basis of 90% of industrialized "food."  The high cost of cheap food, as a recent Time cover put it.  

My football analogy for Obama's speech is this, BTW:  he fair catches the kickoff with coverage teams 30 yards upfield.  Calls a time out.  Is heckled by drunken oafs.  First play from scrimmage... PUNT!

I don't agree that free markets lower costs and improve services in healthcare.  How can that be possible with these generous CEO pay packages and profits for shareholders?  Doesn't that money directly siphon from patient care?





I hear ya and totally respect that moderate view.  I would agree with some of that.  Our current free market system isn't working...that is very obvious.  Insurance companies are a problem for both the patient and the provider.  There has to be competition.  What I fear from government competition is that this will lead to only one option...the government.  How can a private insurance company compete with an entity that prints money?  Also, many providers won't even deal with medicaid and medicare because of low reimbursements.  In many areas of the country the reimbursement for an office visit is around $32.  Family docs might get a few extra bucks for a strep test or some blood work but it's not much.  So, if the average FP sees 26 patients a day at 40 bucks a patient he is making about 5K/week in a 5 day work week.  The problem?  The overhead is absurd due to red tape and regulation.  Most offices need at least 4-5 employees, lights, supplies, office space etc.  Pocketing 30% of that reimbursement is the norm.  So, that FP will see about 1500/week if he were to only see medicaid or medicare.  78K per year might sound like "enough" to most.  But, when you consider the fact that most didn't work for 12-16 years during training and the fact that they are now 200K in debt...I think those numbers are very low.  78K per year is about the national average in Canada for a family doc.  When it comes to my health...I want to attract the best and brightest.  78K/year won't do that...especially not with all the malpractice worries we have to deal with.

If you really want to cut costs...you need malpractice reform.  I would say about 80% of the tests I order are to cover my butt.  I need about 20% to make a decision and the other 80% for show.  I have to protect my license and ability to earn.  With multimillion dollar decisions being common place I have to order a CT for that belly I could probably observe.

As for those that if they had insurance they would go to the GP...welp that doesn't happen much around here.  I deal with sore throats and sniffles all the time in the ER.  These people are on the government dollar.  I work a small ER with little to no wait...so they come here to get in and out faster.  I see constant abuse and misuse of dollars by those who we are supposed to help.
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« Reply #7 on: Sep 10, 2009 at 13:21 »

I don't think people understand what they are asking for when they ask for the government to take over our health care. Free is certainly not free.

And we have to think about this in a pragmatic fashion. Do we want a small portion of the population dealing with a lack of quality health care or everyone dealing with a lack of quality health care? Some people seem to think because someone doesn't have insurance that they can't get care which isn't true. I would say 50% of the people that come into our ER are uninsured and don't pay a dime...nor are asked to pay a dime. These people use the ER as their primary care center. Second, when there is a procedure that the ER can't do...there are hospitals much like ourselves who are given governmental $$$ to take care of the uninsured. If they do not qualify there are always spin down programs and they pay pennies on the dollar for care. The system might be broke...but compared to Canada and England we are the mecca of quality medical care.

How to contain costs?

1) Malpractice Reform
2) Incentivize the young and healthy to buy health insurance to spread the risk
3) We have a civic duty to purchase health insurance...those that can not financially do so can be subsidized through taxation on unhealthy foods and non essential items.
4) Insurance should be for serious illness and injury. If you choose to go to the doctor for a sore throat...you should plan on paying for it just like you pay for gas, groceries etc. Insurance should be meant to protect a family from catastrophic loss...not a 75 dollar office visit.
5) Incentivize those on Medicaid and Medicare to participate in wellness, and for living healthy lifestyles. And there must be consequences for those who abuse the system. The ER should not be a place for those on governmental funds to treat a sore throat or a runny nose. This costs tax payers around $500 as opposed to $75. But, it's done everyday. Those who use the ER to seek narcotics should lose rights to governmental funds.
6) Lower regulation...and you lower our need for staff which = lower overall costs.

Demand the government fix it's current systems before taking over others. Medicaid, medicare and most VA hospitals are broken...and broken badly.

The fact is free markets lower costs and improve services. Lets just fix what we have.


Most of that is what Obama said last night.  My main gripe is that an inordinate amount the health care dollar is spent on the administrative side of things.  Let's get the patient care we're already paying for.


I absolutely agree.  There is a crushing amount of red tape...all set up to "protect the public".
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« Reply #8 on: Sep 10, 2009 at 19:00 »

I'm gonna have to get the sis to post on this.  She & my dad are independent pharmacists, and what the insurance companies do to them is criminal.  Such as the $30K in retroactively denied claims they just got noticed on.

I don't know enough about all this stuff to effectively argue, but I know that competition among insurance companies and pharmaceutical companies most certainly has not driven down costs.
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« Reply #9 on: Sep 10, 2009 at 19:22 »

I'm gonna have to get the sis to post on this.  She & my dad are independent pharmacists, and what the insurance companies do to them is criminal.  Such as the $30K in retroactively denied claims they just got noticed on.

I don't know enough about all this stuff to effectively argue, but I know that competition among insurance companies and pharmaceutical companies most certainly has not driven down costs.

And that's where one set of rules, streamlined, in the form of single payer, would reduce admin costs and this kind of confusion.  (BTW, nice stress for your father, in the other news, eh?  Related?)

We can have private providers, a public administrator, spend more than other countries to ensure better care, but lower current costs due to inefficiencies in the system.  'Cept that 'Bama punted.
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« Reply #10 on: Sep 10, 2009 at 19:51 »

And that's where one set of rules, streamlined, in the form of single payer, would reduce admin costs and this kind of confusion.  (BTW, nice stress for your father, in the other news, eh?  Related?)

I'm sure it didn't help!!
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« Reply #11 on: Sep 10, 2009 at 19:57 »

I'm gonna have to get the sis to post on this.  She & my dad are independent pharmacists, and what the insurance companies do to them is criminal.  Such as the $30K in retroactively denied claims they just got noticed on.

I don't know enough about all this stuff to effectively argue, but I know that competition among insurance companies and pharmaceutical companies most certainly has not driven down costs.

And that's where one set of rules, streamlined, in the form of single payer, would reduce admin costs and this kind of confusion.  (BTW, nice stress for your father, in the other news, eh?  Related?)

We can have private providers, a public administrator, spend more than other countries to ensure better care, but lower current costs due to inefficiencies in the system.  'Cept that 'Bama punted.

Nothing about the government reduces admin costs.  All it does is reduce care and increase inefficiency.  The government needs to fix medicaid, medicare and the VA hospitals before it touches the rest of it.
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Finnegans Wake
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« Reply #12 on: Sep 11, 2009 at 08:59 »

I'm gonna have to get the sis to post on this.  She & my dad are independent pharmacists, and what the insurance companies do to them is criminal.  Such as the $30K in retroactively denied claims they just got noticed on.

I don't know enough about all this stuff to effectively argue, but I know that competition among insurance companies and pharmaceutical companies most certainly has not driven down costs.

And that's where one set of rules, streamlined, in the form of single payer, would reduce admin costs and this kind of confusion.  (BTW, nice stress for your father, in the other news, eh?  Related?)

We can have private providers, a public administrator, spend more than other countries to ensure better care, but lower current costs due to inefficiencies in the system.  'Cept that 'Bama punted.

Nothing about the government reduces admin costs.  All it does is reduce care and increase inefficiency.  The government needs to fix medicaid, medicare and the VA hospitals before it touches the rest of it.

I understand that.  I recommend a streamlining of those programs, too.

But the admin costs of Medicaid is something like 2%, whereas private insurers run closer to 30% (factor in not just admin and paperwork inefficiency, multiple claims re-files, but also profits, advertising, and several million bucks in lobbying efforts).

Believe me, I have over a decade of experience with state government in procurement, so I see the very grist of spending waste and inefficiency.  I've seen agencies close up, or close enough, and know the boondoggle of bureaucracy.  Lazy assed state workers who spend their day on their cell phones and eating chips.  I've also seen some pretty good programs with dedicated workers.  I've seen agencies with no concept of the dollar, and mostly where I've worked we've done the opposite, and saved the state millions of dollars, getting better pricing than you'd think for IT, services, goods.  It does work both ways, but it depends on the system in place, management, and mindset. 

The point is, if the government program under single payer were designed intelligently, paperwork burden shifted out to more IT efficiency, the multifariousness of varying price points by provider would be eliminated and a single set of data would cut admin time dramatically.  Doctors would be able to trim admin staff, and you wouldn't be doing the back-and-forth paperwork nearly as much.  Even if it were 5 times as inefficient as Medicaid, it would save money overall.  Basically, the government would be a payment agency: tax money in, payments to private providers out.  No bullshit paperwork and waiting for patients. 

Cost containment would be the big issue, and tort reform/unnecessary testing would still need overhauled, I agree.  Single payer would need to find a way to incentivize healthy behaviors, but universal coverage would alleviate ER burdens.  I still believe that other government policy -- like Farm Bill subsidies -- needs examined in light of a cohesive food policy, of which this country has none.  I'm not saying we need to tax Doritos, but we sure as hell don't need to indirectly subsidize them (and Coke and Pepsi and every other cheap snack).

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« Reply #13 on: Sep 11, 2009 at 11:11 »

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« Reply #14 on: Sep 11, 2009 at 23:58 »

I'm gonna have to get the sis to post on this.  She & my dad are independent pharmacists, and what the insurance companies do to them is criminal.  Such as the $30K in retroactively denied claims they just got noticed on.

I don't know enough about all this stuff to effectively argue, but I know that competition among insurance companies and pharmaceutical companies most certainly has not driven down costs.

And that's where one set of rules, streamlined, in the form of single payer, would reduce admin costs and this kind of confusion.  (BTW, nice stress for your father, in the other news, eh?  Related?)

We can have private providers, a public administrator, spend more than other countries to ensure better care, but lower current costs due to inefficiencies in the system.  'Cept that 'Bama punted.

Nothing about the government reduces admin costs.  All it does is reduce care and increase inefficiency.  The government needs to fix medicaid, medicare and the VA hospitals before it touches the rest of it.

I understand that.  I recommend a streamlining of those programs, too.

But the admin costs of Medicaid is something like 2%, whereas private insurers run closer to 30% (factor in not just admin and paperwork inefficiency, multiple claims re-files, but also profits, advertising, and several million bucks in lobbying efforts).

Believe me, I have over a decade of experience with state government in procurement, so I see the very grist of spending waste and inefficiency.  I've seen agencies close up, or close enough, and know the boondoggle of bureaucracy.  Lazy assed state workers who spend their day on their cell phones and eating chips.  I've also seen some pretty good programs with dedicated workers.  I've seen agencies with no concept of the dollar, and mostly where I've worked we've done the opposite, and saved the state millions of dollars, getting better pricing than you'd think for IT, services, goods.  It does work both ways, but it depends on the system in place, management, and mindset.  

The point is, if the government program under single payer were designed intelligently, paperwork burden shifted out to more IT efficiency, the multifariousness of varying price points by provider would be eliminated and a single set of data would cut admin time dramatically.  Doctors would be able to trim admin staff, and you wouldn't be doing the back-and-forth paperwork nearly as much.  Even if it were 5 times as inefficient as Medicaid, it would save money overall.  Basically, the government would be a payment agency: tax money in, payments to private providers out.  No bullshit paperwork and waiting for patients.  

Cost containment would be the big issue, and tort reform/unnecessary testing would still need overhauled, I agree.  Single payer would need to find a way to incentivize healthy behaviors, but universal coverage would alleviate ER burdens.  I still believe that other government policy -- like Farm Bill subsidies -- needs examined in light of a cohesive food policy, of which this country has none.  I'm not saying we need to tax Doritos, but we sure as hell don't need to indirectly subsidize them (and Coke and Pepsi and every other cheap snack).



In an ideal world...your ideas make sense.  They are obviously well thought out.  The problem...the government has a terrible track record.  And if we can't learn from the mistakes of the Canadian and British health care systems I don't know what to say.

In order for a government run program to work...something serious would have to change on many levels including management.  Incentivizing employees much like a for profit entity needs to be the cornerstone.

Obviously, I have a vested interest and I am going to be swayed by my own family's needs.  What I know is this...once again the top 5% wage earners will be footing this bill.  If the Canadian and British payment for physicians is any indication...physicia ns here will take about a 40-50% pay cut.  Not to mention we will be hit with higher taxes.  So, we went to school...bought houses...planned our childrens colleges...made sacrifices for 12-16 years...for what?  For the government to steal our services?  For us to be basically bullied into government employment?  It's not right.  I know we won't get a whole lot of sympathy but what motivation is there to strive anymore?

I like the thought of multiple entities competing...but real competition.  If the government wants these companies to compete against non profit co-ops great!  New rules...new world...no more insurance companies or drug companies running unchecked.  Lets re-write the rules...add new competition and let the insurance companies fight it out.  
« Last Edit: Sep 12, 2009 at 00:03 by DocLogic77 » Logged

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« Reply #15 on: Sep 12, 2009 at 09:38 »

But wait.  We're ALREADY paying tone and a half, two, three times more for healthcare than other Western countries.  So I am not suggesting cutting doctors' pay at all, nor do I think that would be feasible.  And since we are ALREADY paying this -- we don't all see it, but it's taken out of our wages invisibly in the form of employer-provided healthcare -- we're not really looking at adding to the top earners' tax burden.  Government has a terrible track record in certain areas, but not others, and it's an overgeneralization to say the government could not act as a payment administration system.

And again, single payer does NOT mean doctors are working for the government.  Hospital systems remain private and use cost containment measures as they do now; it's just who they would receive money from.  Instead of a morass of insurers, all haggling different rates and refusing to pay for some procedures until the 7th time it gets billed, SP would be one payer, one rate, no bullshit.   

Laissez faire capitalism is great... unless profit undercuts the concerns of doctors and patients.  When companies can and do drop people who are "too sick" to be coverable, at will, and tell Congress they will continue to do so... and will continue to not pick up people with "pre-existing conditions"...  the system is broken.  Time to really fix it.
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« Reply #16 on: Sep 12, 2009 at 17:59 »

I don't believe that it's simply where hospitals will get their money from (private/M'care/M'caid v. single payer)

If the single payer follows M'care and M'caid, it means a significant reduction in reimbursement (as doclogic mentioned early on).  Private don't reimburse well but gov't M'care is far below private.

So while there will be one rate, my guess is it will be much closer to the M'care reimbursement rate.  Which affects things like available capital to expand hospital wings/bed, purchase new equipment, hire additional physicians to meet an increased demand, etc. 

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« Reply #17 on: Sep 12, 2009 at 20:35 »

I don't believe that it's simply where hospitals will get their money from (private/M'care/M'caid v. single payer)

If the single payer follows M'care and M'caid, it means a significant reduction in reimbursement (as doclogic mentioned early on).  Private don't reimburse well but gov't M'care is far below private.

So while there will be one rate, my guess is it will be much closer to the M'care reimbursement rate.  Which affects things like available capital to expand hospital wings/bed, purchase new equipment, hire additional physicians to meet an increased demand, etc. 



Exactly...we already know what the government feels physician services are worth.  That won't increase with them taking things over.  Who do you want taking care of your health?  You'll see a migration much like you have seen in Canada and in England.  The best minds will go elsewhere.  Research will slow to a crawl...fewer people will apply to medical school and access will be limited due to lower reimbursements to hospitals and providers.  Seriously, do you think people will want to put in the kind of time, money and work it takes to become a physician for 70-80k/year?  Why not become an engineer, business owner, lawyer or the numerous other professions that take less time and money.  Will it be worth 12-16 years of your life, long long hours and the stress of getting your head kicked in during training?  It makes no fiscal sense no matter how much you love taking care of patients.
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« Reply #18 on: Sep 17, 2009 at 04:52 »

The best minds will go elsewhere.  Research will slow to a crawl...fewer people will apply to medical school and access will be limited due to lower reimbursements to hospitals and providers.

For that reason, if Barack Obama's health care plan passes, Pittsburgh's economy will be directly -- and severely -- impacted. Sure, it won't be the 1980's all over again, but whatever positive momentum has been built since 2000 will be lost. This is one of many reasons why I oppose the President's plan. Does there need to be health-care reform? Yes. Is this the way to do it? No.
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« Reply #19 on: Oct 22, 2009 at 08:15 »

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Does there need to be health-care reform? Yes. Is this the way to do it? No.

That's pretty much it.  But there are too many people saying that nothing needs to be done, at least down here in my very "red" neck of the woods.  Something really needs to change, but there is clearly a lot of debate about exactly what that "something" is.
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We have traded Christ for the religion of Christianity.
Steelerdipwad
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« Reply #20 on: Mar 19, 2010 at 07:36 »

The wife and I are going down Saturday to the rally. If you live within driving distance of Washington, and you are as firmly against this trillion dollar mess, then you need to come down and e-mail as many of your like minded friends as you can. If you don't stand up for yourself now because you have an 8 o'clock tee time, or some other excuse, then don't complain later when your healthcare is a disaster.

If you're gonna take Metro, leave early because they most likely won't have enough trains running again. It's on the west steps (where they have the innauguration)
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"Fanatics are picturesque. Mankind would rather see gestures than listen to reason." - Friederich Nietzsche
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