complord said:

Which brings up an interesting point. What exactly is the goal of healthcare reform? Sure we can lower GDP spent on healthcare by switching to socialized medicine, but we could accomplish the same feat outlawing all medical treatments that cost more than $50. But it won't improve the quality of care.

Is the goal to lower costs of healthcare, to give every person in the nation some amount of medical insurance, or to improve the quality of care? Its hard to imagine that any law, any program, or any government entitlements program that can accomplish all three. And when people start thinking that the government is going to lower the cost of healthcare by lowering the quality of healthcare, that's why people are freaking out (IMHO).

complord said:

Which private insurance companies have been trying to do for decades - although in an attempt to increase profits. Insurance companies, including Medicare, already pretty much dictate what they will pay the provider. This obviously has led to ever increasing cost of care here in the US, not the opposite. The providers compensate by pushing high-margin procedures, not by bringing down overall costs or prices. So how is another insurer, even a government sponsored one, entering this going to change things? What will be different?

Anyway, there is a basic difference here that makes the Wal-Mart model falls apart if you try to apply it to healthcare. Healthcare does not work like retail or manufacturing. The government is not buying the "product" from the doctor, then selling it to the patient through their "insurance company.". Rather, the patient goes to the doctor with an agreement that the government will pay. It would be like you going down to the Colgate factory, picking up a tube of toothpaste, and having the factory bill Wal-Mart. Wal-Mart would have considerably less control over how much the factory will charge for toothpaste when they don't control the "product" anywhere along the supply line. Especially if Colgate has to give toothpaste to everyone who comes through the door, whether they have an agreement with Wal-Mart or not.

complord said:

But as I also touched on, if the providers know what the government is going to pay, there is an incentive to push the high-margin procedures and encourage overutilization. (One of many reasons, including that the patient often wants everything .) The balance is not necessarily struck by insuring everyone, particularly if the government is not the only payer.

complord said:

Right, but how does the government influence this in our culture, which does not practice as much preventative medicine? The lack of preventative care in this country has as much, if not more, to do with social and cultural factors than it does with doctors not trying to get their patients to take more personal responsibility for their health before the problem arises. In fact, a good chunk of doctors are all for preventative measures, even though they don't get paid for them.

complord said:

Yes, but they also "ration" care and/or refuse certain treatments to different people (the government doesn't pay for dialysis for someone over 65, for example). Will that fly in the US?

Sounds like you advocate pure socialized medicine with a single government payer? If so, that essentially comes down to all healthcare providers being employed by the government (perhaps not directly, but essentially). Not saying it's a bad thing, only that to do that here, we wouldn't be "reforming;" we'd be "demolishing and rebuilding."

We already ration. Here is an excellent article on the NY Times regarding it.

"The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally."

Also, something that many who point the finger at the big bad rationing English fail to mention is that DESPITE rationing, or perhaps (as you allude to) because of it, they have better health care than us and greater longevity.

The New Yorker article goes in-depth into cost vs. quality . The big culprit is (surprise) profit-seeking physicians, not patients seeking additional care or tests because their insurance is footing the bill.

"Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care."

And unless the trend in profit-seeking physicians is reversed, this is what we can look forward to if everywhere becomes like McAllen:

"In a few cases, the hospital executive told me, he’d seen the behavior cross over into what seemed like outright fraud. “I’ve had doctors here come up to me and say, ‘You want me to admit patients to your hospital, you’re going to have to pay me.’ ”

“How much?” I asked.

“The amounts—all of them were over a hundred thousand dollars per year,” he said. The doctors were specific. The most he was asked for was five hundred thousand dollars per year.

He didn’t pay any of them, he said: “I mean, I gotta sleep at night.” And he emphasized that these were just a handful of doctors. But he had never been asked for a kickback before coming to McAllen."

Man - everyone should read that New Yorker article. It makes it pretty clear that doctors who are involved in the profitability of the hospitals theya re affiliated with are definitely driving up cost. I'm not sure if the patients really wnat all these tests - theya re told to take them by doctors: so what are they going to do? Refuse treatment?

The problem with the insurance for rpofit model is that there is often a conflict between the best interest of the insuracne companies shareholders and the best interest of their patients.

SiddGames said:

Of course we already ration. It's the method of rationing that you have to pay attention to.

In American, we ration just about everything based on the "almighty dollar." If you can pay for it, there is no reason you shouldn't have it, right? Private security companies, package delivery services, private schools and personal generators are just a few examples of how people with means get themselves "better" or "more" services than the public options. (And how people who don't really have the means will ruin themselves economically in pursuit of the associated status.) That's the heart of capitalism, after all. The necessary (and inevitable) economic rationing is based on what an individual can pay for.

When I ask "will that fly in the US," I am referring to the system of rationing used in socialized medicine, which is based on a mixture of need and outcome formulae. It may work great (depending on whose stats you look at), but philosophically , it would be a nightmare in the US because, in general, we don't think that way. Leaving aside the emotional "socialism is not a democracy" stupidity of comparing an economic system to a political system, the idea of socialized medicine leaves people thinking that they cannot get what they want, even if they can pay for it. People see it as the sickest people with the poorest prognosis would not be able to get the medical resources they want/need, regardless of their means to pay. This is not something that "computes" with most Americans. Further, Americans hate being told what they "must" buy. We'll go into debt spending money we don't have on houses and cars at unreasonable or short-sighted terms, but ask us to pay and extra $25 a month in taxes for improved public works and we freak out.

Keep in mind that this goes straight to the heart of the question "is healthcare a right or a privilege?" If it's a privilege, then the capitalist model of rationing works just fine. If it's a right, then a better rationing system that measures its success in equity and/or quantity of "positive" outcomes needs to be introduced.

The problem is that we want healthcare to be a right, but we still measure success of the system in profit (ultimately). The public attitude needs to change, and the current reforms are not taking the hard, and unpopular, stance that if you want healthcare to be an accessible right, we have to make a public commitment to making it so, and ability to pay cannot create an "elite class" of healthcare recipient.

jmccarthy said:

Really good article here:

http://www.realclearpolitics.com/articles/2009/08/20/call_for_a_doctor_mr_president_97956.html

which references that excellent New Yorker piece again. Ktom talks about containing teh costs of care above - and its getting clearer and clearer to em that we need to be talking about doctors and their compensation here. I love the idea of reducing compemsation for procdeures that rpove to be unnecessary. Thsi sin't just baout defenive medicine - that New Yorker article makes clear that the county in Texas capped malpractice settlements, yet their doctors still assess more expensive procedures and bill higher than their counterparts in El Paso.

I think a government option is a start, I think insurance reform is mandatory - but we need to be talking about doctors and their relationships to the hospitals and testing centers need to be monitored as well.

complord said:

Sorry, Jesse, but you're going to need to back that statement up with a source. Where are you getting your information that the "hospitals, clinics and pharma dictate what they are going to charge and the government says fine"? I work in heathcare and I can tell you point blank that it doesn't work that way. It's not like a hospital sends the government a bill and they simply pay it, regardless of what is charged. What a hospital charges is not what the government (whether Medicare or Medicaid) actually pays. Medicare has its own schedule of reimbursements and that's what they pay. In fact, healthcare providers contract with Medicare the same as any other insurance payer. The choice largely comes down to accepting Medicare patients or not accepting Medicare patients, but if you do (and most healthcare providers feel they must simply because that's how most people over the age of 65 are covered these days), you are accepting Medicare's fee schedule (with some regional variation). The provider can send Medicare a bill for $100, but when the government only sends a check for $75, the billing cycle is done. And if you send a bill for $150 next time, you're still only going to get a check for $75. Medicare and Medicaid (aka, the government) dictate how much they will pay the provider, not the other way around (unless you're dealing with a service that they pay a percentage of charges, which isn't how Medicare is working in most cases these days.)

Neither Medicare nor private insurance pay 100% of charges. And private insurance usually pays a higher percentage of charges than Medicare does.

Now, keep in mind that until recently, Medicare's fee schedule has largely been a "fee for service" schedule. You can't make Medicare pay more for an office visit by increasing the charge on the bill, but you can schedule 3 office visits in a month instead of 1 with 2 phone calls as follow-up. And the fee schedule is not particularly equitable across all services (in general, specialist visits are compensated at a higher rate than primary care, even though the patient probably spends more time with the primary care physician than the specialist). There are certainly ways to "game" the system - although you run dangerously close to fraud if you do. (BTW: Medicare/Medicaid is moving away from a "fee for service" schedule toward a "block payment" schedule.)

But the fact remains; Medicare dictates how much it will pay for a given service (whether that payment makes sense or not), although the provider dictates how many services a particular patient receives, or if they want to work with Medicare at all.

This is from wikipedia and the source link follows the quote:

By the design of the program, the federal government is not permitted to negotiate prices of drugs with the drug companies, as federal agencies do in other programs.

http://www.azstarnet.com/news/163911

That is for Medicare Part D. Now for hospitals and clinics. I think I see the disagreement we are having. Yes, Medicare only pays for part of the cost for health care and yet Medicare still keeps rising in price since its inception. Now, part of this is the aging population but the other factor to this is that hospitals and clinics can charge whatever it pleases. I'm saying the problem starts with you , the hospitals and clinics, and the government does nothing to stop this. In a health care system that makes sense the government would say that if a CAT scan is needed, fine, you can only charge X and we will only pay X and no run over costs will go to the patient . That doesn't happen in the US. Medicare pays a percentage up to a total dollar amount and the rest gets charged to the patient. So their Medicare gets vaporized by a CAT scan that costs way too much and they have to pay for the nurses, doctors, and drugs used themselves. This is insane. Even with this insanity people on Medicare/Medicaid like the service they are getting from the government which shows how messed we are culturally when it comes to health care.

The bottom line, which I believe everyone can agree with, is that making money from illness is amoral and illogical.

complord said:

Stag Lord, I'd suggest to you healthcare is not a "right". As another has said:

No health care is a "right," in the sense of intrinsic/basic human rights like life, liberty, and the pursuit of happiness. It is a moral duty for us to attempt to provide reasonable health as widely and fairly as possible. It is not a "right," nor can it ever be. Health care requires one person to provide a service (which they spent great time, effort, and money to make available) to another person, and often to expose themselves and their families to the risk of lawsuits that can render them and their dependents financially poor. No "right" can require another person to perform a service for you. You have no "right" to another person's skill and labor. If you did, then it would be a right to own a slave.

Claiming a "right" to health care makes slaves of health care professionals (indeed, the party in power has proposed many policies placing demands upon health care professionals). Even worse, socialized health care also enslaves citizens to labor in order to pay for the health care of others and puts the decisions and control over an entire population in the hands of a few people with the power to use force, fines, or imprisonment against you. What better way to exert control than to make every last citizen dependent upon you for their very health and life?

Sorry - we disagree.

You can't have a "pursuit of happiness" if you don't have health. And health is no a commodity like paste or hammers. It literally is a life and death issue. Now I am not saying that doctors don't deserve compensation for their efforts - and certainly under even the govenment option, this is not a concern. what I am saying - is that the insurance for profit model that we are working under wiht health care is broken and needs to go. A government option, with lower costs and overhead is the best bet (since single payer seems to eb a non starter) to driving down cost and getting folks off the insurance treadmill.

~ Just think of all the money the government option will save by not having to provide huge CEO bonuses.

I just don't get why people are so afraid of a governemnt plan, but they are happy putting their lives in the hands of merciless insurance companies.

On the "healthcare is a right" issue: It might help to distinguish between a moral right and a sociopolitical right. Sure, we have a right to the "pursuit of happiness" (I always thought it was really smart not to say that we have a right to actual happiness), but only in as far as our pursuit does not interfere with the pursuit of others. You know, the old "it makes me happy to punch you in the face, so I am well within my rights to do so" thing. So if healthcare is a "moral right," due to every person because they are human, at what point are you guilty of human rights violations for not going to medical school?

I totally get Artaban's position that being healthy is not a basic human right, although we have a general moral responsibility to tend to the sick, because that cannot be demanded without taking away (time, talent, energy, happiness, etc.) from someone else. If I have a moral obligation to try, you do not necessarily have a moral, human right for me to succeed. But I also get Stag's position that it should be the responsibility (and goal) of a society to provide healthcare of sufficient quantity and quality to address the major health needs for the maximum number of its citizens as possible (a mark the US is falling far short of).

So, in the best Bill Clinton you can manage, I'd say that whether or not healthcare is a "right" depends on what you mean by "right."

complord said:

Keep in mind that not being permitted to negotiate prices is not necessarily the same thing as paying whatever that price is. As an extreme example (full of hyperbole), if you have a policy of "not negotiating with terrorists," does that mean you give the terrorists everything they demand?

complord said:

Couple of things here: Medicare does not pay a percentage for most services. That is, Medicare does not say "we'll pay 70% of that," and send a check for $70 to the guy who charges $100 and a check for $140 to the guy who charges $200 for the same thing. There is some regional variation in the actual dollar amount, but they typically say, "we'll pay $70 for that service." So the guy who "arbitrarily" charges $200 isn't going to get more from the government than the guy who "realistically" charges $100. In addition to the aging population, the costs for Medicare continue to rise because that $70 paid for every service. So volume tends to be the way that hospitals, clinics and physician offices can get more money out of Medicare. It's also worth noting that the "$70 paid" is set by the government through a political process and, as such, is very vulnerable to lobbying and other aspects of the political process. One of the reasons primary care doesn't get as much for reimbursements as specialists do is because their lobbyists aren't as good.

Pass through costs also tend to be limited to drugs, biologicals and devices, not services. If a physician charges $100 for an office visit and Medicare reimburses $70, they cannot typically bill the patient for the additional $30. Pharmacists can, though (assuming they pass federal guidelines allowing them to do so).

There is another aspect here that is not being considered. It really isn't all unbridled greed on the part of providers. Legally (and morally), if someone shows up at a hospital or clinic, they must be treated regardless of their ability to pay. And it costs something to provide that care. If they can't pay, it's not like the government, a private insurance company, an employer or anyone else is stepping up to cover the costs for indigent care or the uninsured/underinsured. So the provider eats that cost, which must then be reflected in what the provider charges paying patients (including Medicare, private insurance, etc.). That's how we subsidize care right now. But think about that: Let's say it costs the provider $100 to provide a particular service. They charge $125 for it. But every 4th patient, who they are legally obligated to treat, can't pay (for whatever reason; there are a lot of reasons and they are all legitimate). So the hospital has spent $400 to provide that service 4 times and has collected $375 for those 4 services (which they never do; almost no one pays 100% of charges). Economically, what's going to happen?

This is why a single payer, universal system is seen to have promise. Everyone is covered, so the provider doesn't have to eat costs for people who can't pay for services. The pressure then falls to the provider to make sure that what they are reimbursed is in line with their costs, because revenue is known, one way or the other.

I'm not saying hospitals, clinics and other providers are without fault. I'm saying it is not all the fault of providers because the system we have created feeds on itself to keep getting larger and larger. Critical mass will eventually be reached. There are a lot of factors here and reform isn't going to come by concentrating entirely on "the other guy's" responsibility for this mess. There needs to be a change in attitude on all levels, government, provider and patient . No one-sided solution is going to work (but it's what everyone seems to be going for, reform that requires the other guy to change the most).

complord said:

True, but remember that it works both ways. While the provider should not be taking advantage of the illness to make money, the illness is not an excuse for the healthcare system (as it currently exists and is funded) to bear the entire cost of care. It is illogical to think that it will survive under it's own bureaucratic and political weight.

I can't really argue with any of that.

If you don't agree that people have the right to at least basic medical care so that they don't have to worry about accidents out of their control I'm not sure you are morally suited to be in a society. Society is much more than following rules, working and spending.

Kevin, you are retreading ground I already covered. The problem is that hospitals, clinics and pharmaceuticals charge way too much for their services because they are trying to make more profit than last quarter. If you take the profit out of it the system doesn't reach that critical mass you are talking about. Also, if everyone is covered costs can, and will, go down because there will be no more excuses for uninsured patients (illegal immigrants will always be an issue). Also, with profit out of the mix the only reason to raise rates on procedures and medicine is because it costs more.

Single payer works. All countries with single payer health care in the Western world have lower health care costs and better health care overall. Nobody in this thread has denied this yet you keep railing against the solution to our problems. The reason single payer won't pass is because, like has been said in this thread, people don't understand it. I'm not sure how simpler I can make it....

I agree with Complord. It's a really simple issue to address. Doubly so when you understand that the uninsured are taken care of and those that can afford insurance are already paying for their emergency medical costs.

I don't want to ignore any problems that will come up from universal coverage. We're facing a large Primary Care Giver shortage right now and that'll only get worse should everyone, or close to everyone, become insured. That's going to be a problem we'll have to face. The alternative is a system where 60% of bankruptcys stem from healthcare costs, insurance companies dump customers when they start actually using the coverage, and where state and local governments bankrupt themselves trying to fix the problem while we have an incoherent approach to health care.

That's my larger point, universal coverage or health care is an enormous task and requires a strong nationwide approach. There's more to this than providing coverage for everyone, there's also issues of our food supply and work environments, issues of consumption tax (like it wouldn't be an awful idea to tax soda and other items more heavily so as to dissuade people from consuming them but to also use that money to pay for the health problems that come from such consumption), and a myriad of other issues that need to be addressed in a coherent way. This issue is much larger than universal coverage.

As a side note, I'll be going to a forum tonight to have fun with some of the wingnuts protesting. I went to one a few weeks ago and it was pretty funny to see old white people on Medicare not only be overtly racist in a lot of ways but completely ignorant about where their medical coverage came from, and when they did know they were simply hypocritical.

complord said:

Actually, what I'm disputing is that hospitals and clinics are "always" charging way too much for their services in an attempt to make more profits than last quarter. In many cases and for many services, they are charging what they have to for individual services in order to break even on the whole (depending on their patient and payer mix), in an attempt to compensate for services that go unpaid or underpaid. You seem to be taking a stance that it is all about profit and greed on the part of the providers. I am saying that the way the system is currently set up, even providers that operate on "not-for-profit" principles (a whole other discussion...) can have trouble covering costs because of the uninsured, underinsured, indigent and other non-payments due to the fact that providing care is the law, but paying for it isn't.

In short, you are placing 100% of the blame for the current state of affairs at the feet, and on the greed, of the providers - with some over-generalizations and misconceptions on the economics of healthcare and how it is paid for. I am trying to show that the system can work against the provider, even when they are not motivated by greed. Take that "4x$100 cost to 3x$125 paid" example. The options for the provider at that point are to either increase the charge to $133 per service, somehow get a 5th procedure done, or to deny the 4th non-paying individual treatment just to break even - no profit involved!

(In a perfect world, the provider could also figure out a way to lower the cost for them to provide the service to $94, but due to the politicking I mentioned earlier, this option doesn't work too well in our system because payers - including the government - argue for a lower reimbursement if the provider manages to lower costs, creating an ever-escalating "do more with less" cycle. I'm not saying providers shouldn't be trying to reduce their costs, only that there isn't much incentive to do so in our current system.)

So no, I don't think I'm retreading ground you have already covered; I'm filling in detail I feel you missed in an attempt to show that not all providers should be painted with the same greedy, unfeeling, profit-motivated-patient-be-damned brush you seem to be using. In fact, it is easy to read what you have posted so far and draw the conclusion "the current system would work just fine if hospitals, clinics and pharmaceutical companies weren't so greedy," which I don't think is true (nor do I see all providers as inherently greedy as you seem to). Our endpoints are similar, but the profit-motive of the providers is not the only contributing factor.

complord said:

So in my last post, when I said "This is why a single payer, universal system is seen to have promise. Everyone is covered, so the provider doesn't have to eat costs for people who can't pay for services. The pressure then falls to the provider to make sure that what they are reimbursed is in line with their costs, because revenue is known, one way or the other," I was railing against a single payer system? Seems to me I was supporting the general idea, just filling in details to point out that the need for reform, and its ultimate success, does not depend solely on curbing the greed of providers. I was trying not to demonize the people that will ultimately be taking care of your illness.

It should also be noted that a single payer system is not even being given the opportunity to pass in the current round of healthcare reform. It isn't even an option being discussed - although perhaps the desire is for a government insurance company to drive all private insurance companies out of business and become a single payer. But as is, the current bills and discussion call for a government insurance option in addition to even Medicare and Medicaid.

Obviously, providers are responsible for a lot of the current situation, but it's not like the system was set up well in the first place to avoid what things currently look like. I actually agree with you that for anything to really work, we probably need to tear the whole thing down and start from scratch. But I think you are making it too simple; the economics of healthcare are much more complex than you are making them out to be.

I agree that 100% of the blame doesn't lie at the feet of providers. I focused on them because you were defending them, I apologize if that is the impression I gave. I totally understand that insurance providers are very complicit in this endeavor to constantly shoot for the moon when it comes to profits. Insurance companies are part of the problem mainly when it comes to medical bankruptcies. 8 out of 10 medical bankruptcies are for someone with insurance. Wall Street actually rates insurance companies with lower claim rates as better insurance companies and thus get more money to their share holders. This is all a vicious cycle though. Insurance companies deny coverage and thus the provider is left with a patient that got service but doesn't pay. So now the providers jack up all the prices on procedures to pay for these people who are going bankrupt on them. Now, the insurance companies see that prices have gone up so the premiums go up and less services are now covered because how expensive they are. On top of that private hospitals want to make a profit so they will deny patients and jack up prices to get more money from insurance/government. These patients then get dumped at county hospitals which the taxpayer has to pay for. It keeps going until the critical mass you mentioned. I feel no sorrow for private providers or insurance companies.

I was directing that last part to the thread as a whole and I noticed I put a 'you' in there. Sorry about that. Yes, single payer is and probably never will be an option because of all the money that will be lost an entire sector of the economy destroyed. Politics as usual, we get what the lobbyists want and not what the people want.

Stag Lord said:

Stag, what a very narrow view of human happiness you've exhibited. I must say it stands in direct opposition to the teaching of the Catholic Church, as it elevates health to the status of an ultimate value. The lives of the saints, and great figures of many/most other religions have clearly demonstrated that happiness can be found in the midst of suffering and physical pain. Buddhism is built on the belief that life is pain, yet that pain can be transcended, and is not the be all and end all.

So here we see some of the dysfunction of our culture laid bare...we are a culture that can't handle pain, and it even shows in our medical spending. There is a drug diversion officer that spoke at our school last fall, and he pointed out that 99% of medical painkillers are consumed by the Western world.

I feel sorry for anyone that thinks their happiness is dependent on physical health or "painlessness". They're never going to be happy. I have a medical condition that means I have to deal with pain on average of 3-4 days a week. You get used to it, and it doesn't eclipse the joy I find in most days. I could medicate the discomfort away, but I don't want to run the other health risks (among them chemical dependence) daily pain meds would bring. I take the medication that prevents my joints from deforming, and consider with gratitude that they only cost me $100 every three months. I don't feel entitled to them by any means.

I know some very happy people who are paralyzed or lost limbs.

As for why so many don't trust gov't run healthcare, it could have to do with the current flaws in such systems. Tell me, is your confidence or acceptance of government healthcare based on actual experience with it? Because my wariness does stem from exposure to it.

complord said:

Playing God again, are we, Complord? Where did I ever say people shouldn't receive help for "accidents out of their control"? Didn't you hear me mention a "moral duty" to do what I/we REASONABLY can to help others' health?

And "lower healthcare costs" are easy to come by when your country is less populous, or has a much lower life expectancy. Recall we ARE the third most populous nation on earth, after all.

I'd just point out a little bit of wisdom LiquidIce once mentioned in a thread, and suggest that we not conflate "better health" (of someone in another country) with "better healthcare". Firstly, the term "health" probably means something very different to everyone on this board. One might define it as "quality of life" (and indeed there are people who've foregone good health habits even knowing they shorten their lifespan by doing so--ex. smokers and diabetics who won't change their diets), while another might measure health purely in terms of lifespan. Life expectancy in Cuba is lower than the national U.S. average. Still, some consider Cubans to generally be healthier.

Is that "health" a result of the Cuban medical system, or does a large part of it have to do with the fact that they walk/bike from place to place rather than drive and have a tropical climate that doesn't force them inside to a sedentary lifestyle, as in colder northern climes? Is it heavily influenced by diet? Red meats and lard are almost absent from the Cuban diet, according to one website. Nutrition is a component of health given little relative consideration by Americans. And I'd also echo an observation made by a friend of mine in healthcare...Why is it that most fastfood chains are American in origin, even overseas? Can you think of a popular German or Swedish fastfood chain?

Ah - I should know to tread more warily on matters of morality when you are in the room Artaban!

Of course you are correct. One can find happiness and meaning in life, even if you are sick, maimed or crippled. Many spiritual people find comfort in faith. But Jesus' teachings in scripture are quite clear on this point - we all have a duty to feed the hungry, clothe the naked and tend to the sick. It is my firm conviction that an enlightened adn compassionate society has an obligation to ensure that it is meeting the needs of its citizens.

Now - one can argue that medicaid already covers the worst off - and so ti does. And if you aren't enrolled in medicaid, or you don't qulaify, but have no insurance, emergenecy rooms are available. But clealry this system is not working. As has been demonstaretd already - the costs are getting passed on to the rest of society, its threatening our entire economy, and even many of those who do have some sort of insurance face bankruptcy due to medical emergencies. The system sin't working - and I place little faith in capitalism or corporations to provide solutions for the benefit of society. By their nature - they can't. Going back up thread a bit - i seriously question the wisdom of health insurance being a for profit proposition at all.

I'm not sure what having more people means when we are talking about percentages and not total money spent. Also, comparing a third world dictatorship on a Caribbean island to America is a joke. One thing Cuba does have over us is happier people but that could also be that the secret police have killed all the unhappy people.

Stag Lord, I probably shouldn't bring this up but it is just so tempting: If we are a nation founded on Judeo-Christian principles how come universal health care isn't in the Constitution considering Jesus talked about helping the sick?

On another note, Ted Kennedy died today which is sad even though he was a controversial figure to put it lightly. One of the major proponents of health care reform died before he could see it come to light which is unfortunate.

I recall Age of Enlightenment Philosophy and Neo-Classical ideas were a major influence on the Founding Fathers as well as Classical Liberalism, but also remember Judeo-Christian is a large bucket.

Complord is tweaking me about an old argument we had about the religous convictions of the Founders and how much of a role those beliefs played on our founding documents.

Stag Lord said:

Considering the "Jefferson Bible," that must have been a really interesting discussion.