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  1. #1
    Administrator U-Ute's Avatar
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    The health care debate thread.

    This thread is here instead of in the health forum because it is intended to be the landing spot for the debate concerning our current health care system, which I'm sure most of us agree is broken to some extent. The broken nature of which is contributing significantly to the budgetary problems our country currently faces.

    To that end, I bring a slightly different look at the problem. Instead of looking at "how do we pay for it", this piece from Time magazine takes a look at "why is it so expensive to begin with".

    While it does lean a bit left in the conclusions it makes at the end concerning Medicare and a single payer system, I think it takes a good deep look into the world of medical charges. It helps answer some of the questions I had when I was looking at the bills coming out of my wife's two trips to the ER last year for kidney stones. It is a lengthy read, but it is worth it whether you are left or right.

  2. #2
    Yeah I liked that Time article. I spent 4 years working across the street from MD Anderson in Houston so I liked his description of the Texas Medical Center glass skyscrapers as reminiscent of Dubai. Sure seems like there's something wrong with that when people are getting fabulously wealthy off the backs of people who are sick and dying and paying tens of thousands of dollars in hope of possibly extending their life a few months in the face of cancer.

    "Rescue" medical care in this country is awesome. I think people who get in car accidents, have heart attacks, have septic shock, etc. in this country generally get amazing care and have really great outcomes. Cancer care is great in this country as well. And this care is legitimately expensive, although not as expensive as hospital charges obviously.

    Why is health care so expensive? Because patients don't ask (and if they ask then nobody knows the answer to the question) "How much is this going to cost?" Patients only ask, "My insurance is going to cover this, right?" Since "somebody else" is paying the costs skyrocket.

    Really there are two ways to fix health care: 1. Price transparency with high-deductible insurance and the majority of costs for the majority of patients paid from health savings accounts OR 2. Single payer government health care, extending basic Medicare/Medicaid type coverage to everyone.

    Option 1 would work if costs and quality/outcomes for every visit and every procedure test were mandated to be posted on the internet by every health care provider and patients paid out-of-pocket (had "skin in the game") for all this stuff. That would bring back competition and price transparency that is now sorely lacking. But I think eventually this country will work itself to Option 2 because that is where public sentiment seems to be in my experience. That's why Obama won the election. People who have no problem paying $1000 for a car repair bill are outraged if they have to pay $1000 for a medical bill. Most people don't want to take personal responsibility for the cost and quality of their own health care -- people want their taxes to pay for it and the government to regulate it tightly. And I do think that probably at the end of the day single payer government funded health care will be the most efficient and cheapest system that we could have.

  3. #3
    I am a universal health care advocate. The tax burden is heavy but, in my estimation, it is worth it. My family greatly benefits from access to universal health care. The article linked below, however, highlights some of the potential problems with the system, especially in smaller or, rural communities:

    A decade of pain: The only foot surgeon in Nova Scotia has waiting list 3,500 names long

    http://news.nationalpost.com/2013/02...00-names-long/

    “I know you have to wait your turn in Canada,” Ms. Berringer says. “I understand that. But sometimes the system doesn’t seem to work for the people that need it.

    “I am kind of back to full circle, back to Dr. Glazebrook, and he has a 3,500-person waiting list. I have waited over 10 years to see him and I’m not getting any younger, you know.”

  4. #4
    Quote Originally Posted by tooblue View Post
    I am a universal health care advocate. The tax burden is heavy but, in my estimation, it is worth it. My family greatly benefits from access to universal health care. The article linked below, however, highlights some of the potential problems with the system, especially in smaller or, rural communities:

    A decade of pain: The only foot surgeon in Nova Scotia has waiting list 3,500 names long

    http://news.nationalpost.com/2013/02...00-names-long/

    This is foot surgery. It is also commonplace for those that need serious cardiovascular procedures such as stents, bypasses, etc. to face long waiting lists as well. I have had discussions with many US doctors over the years that have told me it isn't uncommon for them to perform these type of procedures on wealthier Canadians that have been put on 6+ month waiting lists that are concerned about dying before it is their turn. Cancer care in Canada is below US standards as well.

    Universal healthcare works great for basic, primary care type of conditions such colds, flu, broken bones, etc. As you get older and need more specialized care, there are a lot of problems such as those mentioned in this article. I'm not sure many of us will be singing the Universal Healthcare model works great for me tune as we get older and find fewer specialists (oncologists, cardiologists, etc.) and need access to newer and potentially lifesaving procedures and technology.

    I fear it will only be the very wealthy that will be able to afford access to top notch care in a universal healthcare system. The rest of us will have such a big tax burden, we will not have the income or means to pay for our own private insurance if we prefer.

    I don't pretend to have all the answers as to how to fix the spiraling healthcare cost problem. It is a complex, multifaceted issue for which there are no easy answers. Unfortunately, I am pretty sure Obamacare has ironically accelerated the pace of rising costs considerably. I have read articles just in the past few weeks stating that insurers in many states are raising premiums 15-50% this coming year to be able to cover the costs associated with the requirements and regulations in this bill.

    I would have preferred an incremental approach implementing some of the ideas already mentioned rather than the huge Obamacare overhaul and associated costs we will now be facing. Obamacare or not, tort reform and caps on punitive damages should have been a part of any healthcare reform bill IMO. While by no means the only problem contributing to out of control healthcare costs, doctors practicing defensive medicine and ordering thousands of unnecessary tests and procedures each year doesn't help the situation.
    Last edited by #1 Utefan; 04-01-2013 at 05:28 PM.

  5. #5
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by CardiacCoug View Post


    Really there are two ways to fix health care: 1. Price transparency with high-deductible insurance and the majority of costs for the majority of patients paid from health savings accounts OR 2. Single payer government health care, extending basic Medicare/Medicaid type coverage to everyone.
    You're right. I think. What's interesting (and frustrating/funny) is that people seem to want the choice that (1) would give them, but they don't want to pay for that choice or take responsibility for their own healthcare. Obamacare will push us towards (2), I think, and we'll be there in 20 years or less. Maybe 10.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  6. #6
    Here is an interesting tidbit. There are ~10 million people in Michigan. We are expecting that by the end of 2014 roughly 11% of all those in Michigan will be on some sort of individual health plan (IE they don't get their insurance from work). The health care exchanges are going to be a BIG game changer.

    To put that in perspective. The Health Plan I work for has about 450k members of which 5k of them are individual plans (1%). If things hold up expectations then ~45k more members will be moved to Individual plans

  7. #7
    Sam the Sheepdog LA Ute's Avatar
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    MRD, what impact do you see health care exchanges having on the insurance markets? Here in CA the system is shaping up as a very intrusive one (no surprise).

    Meawhile, here's a interesting blog post on the "volume to value" trend:

    Divided Healthcare Nation

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  8. #8
    Quote Originally Posted by LA Ute View Post
    MRD, what impact do you see health care exchanges having on the insurance markets? Here in CA the system is shaping up as a very intrusive one (no surprise).
    As I said before they are going to be a gigantic game changer. The subsidies by the feds and state will drive how successful those exchanges are. I would expect more and more companies to just provide a subsidy and their employees go to private (and public) exchanges.

  9. #9
    I watched a report on 60 minutes about six months ago, or so, and they were talking about concierge systems and how they work. Apparently, an average cost of an MRI test, as priced through a hospital and paid by risk transfer (some type of insurance), is approximately $10,000. When the same procedure was priced through a concierge system that operated on a cash basis for patients the cost was $300, for the same tests/procedures (I know that repetition is redundant, but I think this point deserves some attention). Now when I ask about medical service I always ask about cash pricing. It has made sense to pay some expenses from my pocket (MSA) and disregard annual deductible limits.

    I have been happy so far with my concierge/cash approach, and have persuaded my family physician to accept cash payment for a 40% across the board reduction in cost. The only problem is that this discount does not extend to tests or procedures outside of his office, so it is an incomplete approach. Still, it's the health insurance companies driving this chaos. I also wonder what impact on the economics is produced by the legal sysytem and it's effects on doctors, hospitals and care.

    I wonder if a true free market existed in health care what would be the result?

  10. #10
    Living in the past ... FMCoug's Avatar
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    I am self employed with a $ 6000 deductible. Just brought my wife come from getting some outpatient surgery. This is gonna hurt.

    But I am a middle class white guy so I have obviously got too much money anyway.

  11. #11
    Sam the Sheepdog LA Ute's Avatar
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    Why become a doctor?

    Recently, I was having a discussion with a colleague about being a doctor. She confided in me that if someone asked her about becoming a doctor, she would tell him or her to become a nurse practitioner. After reading the emotional open letter to our policymakers in Washington DC, it may sound like a reasonable suggestion. After all, why go into this much debt and spend so much time in training if your prospects are not much better? More recently, the New York Times article points out job prospects for radiology trainees are thinning, meaning the well known “ROAD” (Radiology, Ophthalmology, Anesthesiology, and Dermatology) to success may soon become a road to nowhere if there are no jobs....

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  12. #12
    Quote Originally Posted by LA Ute View Post
    It is totally asinine when people say it's as good or even preferable to be a nurse practitioner or physician assistant instead of a physician. Completely ridiculous. What the hell kind of person wants to be subordinate and only take care of patients under the supervision of somebody else for an entire career?

    I see these surveys with unhappy doctors and I honestly don't get it. Most people I work with love their job and really what's not to like? It's very meaningful and important work, great income, 100% job security unless you commit a crime. These whiny doctors who complain about their job are idiots.

  13. #13
    Quote Originally Posted by CardiacCoug View Post
    It is totally asinine when people say it's as good or even preferable to be a nurse practitioner or physician assistant instead of a physician. Completely ridiculous. What the hell kind of person wants to be subordinate and only take care of patients under the supervision of somebody else for an entire career?

    I see these surveys with unhappy doctors and I honestly don't get it. Most people I work with love their job and really what's not to like? It's very meaningful and important work, great income, 100% job security unless you commit a crime. These whiny doctors who complain about their job are idiots.
    Fully agree. It isn't for everyone, but i wouldn't do anything different for many of the reasons stated by cardiac, and several others he hasn't listed:

    Live just about anywhere you could desire.
    Many other pathways for a career besides clinical work.
    Instant excuse for any traffic violation.
    “Man cannot discover new oceans unless he has the courage to lose sight of the shore.”
    André Gide

  14. #14
    Quote Originally Posted by Jarid in Cedar View Post
    Fully agree. It isn't for everyone, but i wouldn't do anything different for many of the reasons stated by cardiac, and several others he hasn't listed:

    Live just about anywhere you could desire.
    Many other pathways for a career besides clinical work.
    Instant excuse for any traffic violation.
    Yep. I saw some survey recently that said something like 70% of physicians say they were underpaid and believe they would have made more money in a non-medical field. Made me wonder what kind of fantasy world those docs are living in.

    Another huge intangible benefit of being a physician is being able to help family members and friends with health problems and figuring out the health care system and which docs to see. I could go on and on about how happy I am with my career. From time to time I have undergrad students who want to hang out with me and when I tell them how great my job is they usually say something like, "Really? Every other doctor is telling my how horrible it is and how much they regret their career choice." I find it totally bizarre how negative a lot of docs are. Just proves that no matter how good people have it it's still easy for so many people to wallow in misery.

  15. #15
    Quote Originally Posted by sancho View Post
    I'm sure 99% of the country would happily take on $200,000 in low interest debt in return for a 6 figure salary.
    So why don't more people do it?

    It was a career path I considered, but decided it wasn't worth it, the 200k debt not even factoring into the decision.

  16. #16
    Ok, I'm done being contentious. I just read part of the article linked and what I read it was talking about going into debt and all that not being worth it anymore.

  17. #17
    Quote Originally Posted by sancho View Post
    I hear these kinds of sentiments from doctors regularly. And the doctors I hear them from are all very wealthy. Med school is still one of the surest paths to wealth that we have. I'm sure 99% of the country would happily take on $200,000 in low interest debt in return for a 6 figure salary.
    I agree with your sentiment, but with one correction: that debt is not low interest. Student loans for med school are around 7-8%, depending on the type of loan. That interest starts to accrue from day 1 of school, and some don't start paying it off until 6-10 years later when they're done with residency. That's a lot of money.

    I agree with you, though, still a pretty good investment.

  18. #18
    Healthcare is an interesting market, because when people need it, they're far less likely to shop dispassionately, as you might when you're evaluating a purchase of a dishwasher, for example.

    "My mother has breast cancer, and I've found a place that offers 40% off radiation treatments this month!" It doesn't quite work that way, neither does it work for emergencies, like who does price shopping for bypass operations while they're in a medical helicopter?

    When there's something wrong with your body, you entire being, your existence, is at stake. And when we see the same level of distress in others, we empathize, which is why Reagan signed the law that mandates emergency rooms treat people who need emergency care, regardless of their ablity to pay. This single law has caused a great distortion in the whole market, with attendant cost shifting, the cat-and-mouse games people play when they go to the ER, etc.

    If we wanted to truly incentivize the free market in healthcare, give hospitals the ablity to turn people away who don't have insurance or enough $$$$ on the spot to pay for their treatment. Sure, this will result in some people dying on the front lawns of emergency rooms, but it will send the message to everyone else that they need to have insurance, and THEN the cost shifting problem will start to evaporate.

    The biggest problem with this is it's totally against what Jesus taught, and when it comes down to it, Americans have a hard time being brutally Darwinistic.

    It's hard - and maybe unrealistic - to fully apply the free market to healthcare.

  19. #19
    Quote Originally Posted by Ma'ake View Post
    Healthcare is an interesting market, because when people need it, they're far less likely to shop dispassionately, as you might when you're evaluating a purchase of a dishwasher, for example.

    "My mother has breast cancer, and I've found a place that offers 40% off radiation treatments this month!" It doesn't quite work that way, neither does it work for emergencies, like who does price shopping for bypass operations while they're in a medical helicopter?

    When there's something wrong with your body, you entire being, your existence, is at stake. And when we see the same level of distress in others, we empathize, which is why Reagan signed the law that mandates emergency rooms treat people who need emergency care, regardless of their ablity to pay. This single law has caused a great distortion in the whole market, with attendant cost shifting, the cat-and-mouse games people play when they go to the ER, etc.

    If we wanted to truly incentivize the free market in healthcare, give hospitals the ablity to turn people away who don't have insurance or enough $$$$ on the spot to pay for their treatment. Sure, this will result in some people dying on the front lawns of emergency rooms, but it will send the message to everyone else that they need to have insurance, and THEN the cost shifting problem will start to evaporate.

    The biggest problem with this is it's totally against what Jesus taught, and when it comes down to it, Americans have a hard time being brutally Darwinistic.

    It's hard - and maybe unrealistic - to fully apply the free market to healthcare.
    Exactly this (I think I've posted almost an identical description before). As long as the mandated ER provision is in place, universal/single payer health care will be the eventual outcome.

    Healthcare is incredibly complex and virtually every physician, outside her own area of expertise, is poorly equipped to make her own personal acute health care decisions. The lay public is even worse off to the extent that individuals can rarely make TIMELY informed Heath care decisions despite best attempts to explain benefits risks, etc. The huge market for quackery and health care fraud is further evidence that self educated health consumers tend to make VERY POOR decisions with their discretionary health care spending even in non-acute settings.

    there are however some very generalize able and easily learned lifestyle modifications and preventive care actions that could be incentivized effectively in a single payer system with substantial reductions to the largest contributors to overall costs (I.e diabetes/cardiovascular disease/effective cancer screening programs).

  20. #20
    Even if you had time, How would you price shop procedures? It's not like you can call around and say, yeah, I'm a 1978 Caucasian from Buffalo, what would you charge to replace my starter... and what if you used aftermarket parts? Complications arise during surgeries, things turn out to be worse than originally thought, procedures change on the fly. You may have multiple providers working on you (anesthesia etc), are you going to try to price shop all of them?

    Most patients don't have the knowledge of what's wrong with them to do something like that. Regardless, if I have someone call me and they have a high IQ of what's going on and what they need to do a price comparison, I'm going to do my own assessment. That costs additional money, even if you bring your labs/x-rays etc.

    Also, how variable do you think healthcare prices are? As variable as washing machine prices?

  21. #21
    I'm not sure why a patient would have to try to bargain shop a service or procedure. There are referral networks operating now, whether it's physician or provider facilitation, it's a referral service. Concierge networks would presumably operate in the same way. So if you are now part of a gatekeeper system or hmo or whatever, you would instead be a part of a concierge network where cash is king. Your primary would still refer to specialists. The only difference is that insurers would be out of the picture, mostly.

  22. #22
    It's a clear sign to me that the system is broken that I'm having a huge internal debate as to whether to take my dehydrated toddler who has been vomiting and having diarrhea for the past 36 hours to the ER. His ashen cheeks and sunken eyes are convincing in the affirmative, but it's unfortunate that getting him an IV will set us back an arm and a leg.

    Like many here, we have an independent high deductible HSA plan. The total bills for an ER visit for a head wound Mpfunk had about 6 months ago came back at around $1,800 out of pocket cost for us. And people complain that lawyers overcharge for their time! We were in ER for maybe 40 minutes.
    "Well-behaved women seldom make history." - Laurel Thatcher Ulrich

  23. #23
    Quote Originally Posted by Mrs. Funk View Post
    It's a clear sign to me that the system is broken that I'm having a huge internal debate as to whether to take my dehydrated toddler who has been vomiting and having diarrhea for the past 36 hours to the ER. His ashen cheeks and sunken eyes are convincing in the affirmative, but it's unfortunate that getting him an IV will set us back an arm and a leg.

    Like many here, we have an independent high deductible HSA plan. The total bills for an ER visit for a head wound Mpfunk had about 6 months ago came back at around $1,800 out of pocket cost for us. And people complain that lawyers overcharge for their time! We were in ER for maybe 40 minutes.
    Take him to urgent care. Much cheaper and get him some pedialite

    Sent from my SGH-T999 using Tapatalk 2
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  24. #24
    Quote Originally Posted by Mormon Red Death View Post
    Take him to urgent care. Much cheaper and get him some pedialite

    Sent from my SGH-T999 using Tapatalk 2
    We called about 6 urgent cares. None will place an IV on a 19-month-old. The ER is our only option if we have to take him tonight. Believe me, the urgent care was our first choice. And we're all over the Pedialyte. I do appreciate your response. Thanks.
    Last edited by Mrs. Funk; 02-27-2013 at 08:22 PM.
    "Well-behaved women seldom make history." - Laurel Thatcher Ulrich

  25. #25
    Quote Originally Posted by Mrs. Funk View Post
    We called about 6 urgent cares. None will place an IV on a 19-month-old. The ER is our only option if we have to take him tonight. Believe me, the urgent care was our first choice. And we're all over the Pedialyte. I do appreciate your response. Thanks.
    Get a teaspoon dropper. Give 5 ml of the pedialyte every 10 minutes, until no vomiting for an hour, then give 10 ml every 10 minutes until no vomiting for an hour, then give 20 ml every 15 minutes. If they vomit at any time start over at 5ml every 10 minutes. Keep doing that even if he is vomiting.

    By following this protocol, you can successfully hydrate almost 90% of infants without using an IV.

    Good luck!
    “Man cannot discover new oceans unless he has the courage to lose sight of the shore.”
    André Gide

  26. #26
    Quote Originally Posted by Jarid in Cedar View Post
    Get a teaspoon dropper. Give 5 ml of the pedialyte every 10 minutes, until no vomiting for an hour, then give 10 ml every 10 minutes until no vomiting for an hour, then give 20 ml every 15 minutes. If they vomit at any time start over at 5ml every 10 minutes. Keep doing that even if he is vomiting.

    By following this protocol, you can successfully hydrate almost 90% of infants without using an IV.

    Good luck!
    Thanks for the advice. (And sorry for the threadjack.) The severe active vomiting was more yesterday. He's kept some liquids and a popsicle down recently so the immediate danger is lessened. Today has been 14 diarrhea blowouts. 7 loads of laundry today alone. Ugh.
    "Well-behaved women seldom make history." - Laurel Thatcher Ulrich

  27. #27
    Sam the Sheepdog LA Ute's Avatar
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    Jenkins: Yes, Hospital Pricing Is Insane, But Why?

    It's a short but interesting piece:

    "What is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?" Mr. Brill asks. But his question is rhetorical since he doesn't exhibit much urge to understand why the system behaves as it does, treating its nature as a given.

    In fact, what he describes—big institutions dictating care and assigning prices in ways that make no sense to an outsider—is exactly what you get in a system that insulates consumers from the cost of their health care.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  28. #28
    Living in the past ... FMCoug's Avatar
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    I've been thinking about this lately and am wondering if we're debating something where the ship has already sailed. Health care is so institutionalized at this point, with the costs totally separated from the consumer, that it's basically like dealing with the government. Is fighting with (insert insurance company here) any different than dealing with (insert government agency here)? Should it just be gov't / single payer and be done with it? I honestly don't know ... not trolling or proposing one thing or another. I just think that most people equate medical stuff (insurance, bills, etc.) about the same as dealing with the IRS or the like.

  29. #29
    Sam the Sheepdog LA Ute's Avatar
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    Here's an interesting perspective from Walter Russell Mead:

    "The world is in the early stages of a golden age of biotech innovation, one that has the potential to revolutionize everything from health care and manufacturing to energy production. And the biotech revolution will build on and add to the infotech revolution that has been shaking the world for the last 50 years. The 21st century will be more different from the 20th than the 20th was from the 19th. And the 22nd century will be something else again, if we don’t kill ourselves en route.


    "VM never gets tired of pointing this out for one very simple reason: wonks who don’t keep the innovative dynamism of our age at the forefront of their minds as they think up new policies are likely to do more harm than good. Trying to build elaborate models for the future of healthcare based on today’s delivery systems and economic models is as futile as trying to build a national transportation model in 1830 based on the success of the Erie Canal...."
    The whole blog post is worth reading.
    Last edited by LA Ute; 03-28-2013 at 11:30 AM.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  30. #30
    So Obamacare is going to cost a lot more than thought. Its nice that the hardest hit states are the ones who voted for Obama.

    But that increase won't be felt evenly across the country because the study forecasts that some states will feel more pain than others. Among the hardest-hit will be Ohio, where claims costs will jump by almost 81%, and California, with a 62% increase.
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

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