I just heard on NPR

[flacaltenn]

That's mutually exclusive thought. I can't agree. Medical breakthroughs may have actually been greater without health insurance companies ever existing.

My mother isn't the only person over 75 to tell me she probably wouldn't be alive if not for Medicare.

Voluntary participation in Medicare for all at a rate based on age is one solution. Though the single payer option would remove a lot of expensive cars from the garages of insurance executives, so there's all those jobs in detailing that will be lost if some of the extreme profitability is shaved off the bureaucracies we pay to track health care expenditures.

I'll not argue Medicare as I support it, however we are way beyond that

If we actually want a solution to the high cost of medical services we must reduce the cost of delivery

Anyone who knows anyone who works in a clinic can tell you why the cost is so high

Problem is, to actually reduce that cost, it would likely cost a lot of those people their jobs. Yet, it is the solution.

1/2 the folks in a GP med office are for rules compliance, insurance and billing. Doctors are just now realizing that they can work free - er and more efficiently by offering contracts direct to patients. That's the way to go here for general care.

If my doctor would give me the same discount as he gives Aetna -- I'd pay him cash and 10% more. He has lower overhead and our visit isn't micromanaged by 3 layers of insurance and govt... I'd even pay them monthly on subscription.. Pick up a Catastrophic Coverage plan and your 1/2 way there.

 

[AVG-JOE]

That's mutually exclusive thought. I can't agree. Medical breakthroughs may have actually been greater without health insurance companies ever existing.

My mother isn't the only person over 75 to tell me she probably wouldn't be alive if not for Medicare.

Voluntary participation in Medicare for all at a rate based on age is one solution. Though the single payer option would remove a lot of expensive cars from the garages of insurance executives, so there's all those jobs in detailing that will be lost if some of the extreme profitability is shaved off the bureaucracies we pay to track health care expenditures.

I'll not argue Medicare as I support it, however we are way beyond that

If we actually want a solution to the high cost of medical services we must reduce the cost of delivery

Anyone who knows anyone who works in a clinic can tell you why the cost is so high

Problem is, to actually reduce that cost, it would likely cost a lot of those people their jobs. Yet, it is the solution.

Absolutely.

It's apples and oranges. Delivery of service, and the bureaucracy that tracks premiums in and benefits out. Both need fixin', each in their own way.

 

[Luddly Neddite]

for those who might have forgotten --

California Obamacare premiums: No ?rate shock? here

 

[thewanderer]

Pop23, I agree with a lot that you (and others) are saying. What we call "health insurance" always drives up the price of health care. Of course, what we call health insurance isn't really insurance at all, which is exactly why it drives prices up.

One of the very devious things that politicians deliberately did with this whole debate was use the terms "health care" and "health insurance" interchangeably. They are not synonymous, but they have been deliberately and persistently represented to the public as though they are. And it worked-I see and hear people discussing this issue all the time confusing the two.

Making sure everyone has affordable health insurance is relatively easy. Bringing down the cost of health care is also simple, but much more painful. This is a smoke and mirrors game in which the politicians have convinced half of America (the half that worships at the church of democrat) that they have solved health care by providing a solution to health insurance. What they have actually done is speed up the process of what we call health insurance becoming unworkable, (which is probably not a bad thing.) It was headed that way anyway-if you take the time to analyze what we call health insurance from an economic perspective, you will see that premiums were going to keep going up and coverage was going to keep going down even if their had never been any such thing as the ACA. But the ACA has sped that trend up.

One of the key points that people seem to quickly forget is that medical offices and hospitals are in business to make money. And they should be. Someone took the economic risk to start the business. The providers are paying off mountains of personal school debt. BTW, part of the reason that going cash is not a perfect solution either has to do with the other economic bubble that we've allowed to grow into frightening proportions...the higher education bubble. It costs way too much to produce a doctor now for them to just "make less money" in the words of our probable next president.

Anyway, insurance money is easy money. Yes you have to follow a bunch of ridiculous rules and documentation requirements and call the insurance company to resolve denials, but which do you think is easier, collecting a $2500 hospital bill from the insurance company or from an individual patient? It ain't even close.

If we went cash but for catastrophic coverage it would absolutely bring costs down, but it wouldn't be a perfect solution. It might be the best solution we've got, but it wouldn't be perfect.

First, medicine is much more technologically dependent today than it was 50 years ago. Unless we go to a system in which the government somehow subsidizes the maintenance or access to medical technology that we have now (which is just paying for it a different way), we are going to have less access to a lot of the testing/treatment technology that we have become accustomed to. When costs go down, so do revenues. And administrative costs don't reflect all of the money used by the insurance driven model we have now.

Second, if we don't also pop the education inflation bubble and make it cheaper for people to become doctors, you can forget about maintaining quality. Taking on $275,000 in med school debt and giving up a decade's worth of your life in potential earnings is worth something. If the financial rewards aren't there to make it worth it, new grads ain't going to be what they used to be. They'll major in finance instead, and be out in four making the same money.

Third, the model would work fine for both routine primary care and for the other end of the spectrum in catastrophic care. The middle is where it would be a problem. Non-life threatening but still fairly expensive procedures or conditions. Hip replacement surgeries. Pain management. Things like that. If the catastrophic policy covers those things, fine, but then it really isn't that limited and probably won't bring costs down that much. If it doesn't cover those things then I think we'll have a huge gap in health care services and those services will become scarce, even if any given patient has the money to pay out of pocket. Why specialize in orthopedics if only 15% of the population can afford your services?

 

[editec]

That we're fixin' to see a slew of new advertising from, of all people, the Health Insurance Industry.


Say we're gonna see new cultural icons join the ranks of Mayhem, Flo and the Geico Gecko.
Insurance Mascot Mayhem! Here Mayhem, Flo, the Gecko, Caveman, and the Aflac duck clash! PARODY - YouTube
Say the Health Insurance industry is having to scramble to change their image from a "**** You - Denied!" bureaucracy protected by layers of government and a lack of competition to one of the choices young people can investigate on their li'l smart-phones.



Weird.

It seems that it sometimes takes reams of government paperwork to inspire a little competition in a stuffy old industry.

Millions of Americans (mostly young) who formerly had no insurance must now purchase it.

I presume they INS companies are hoping to capture that market.

 

[dblack]

Pop23, I agree with a lot that you (and others) are saying. What we call "health insurance" always drives up the price of health care. Of course, what we call health insurance isn't really insurance at all, which is exactly why it drives prices up.

One of the very devious things that politicians deliberately did with this whole debate was use the terms "health care" and "health insurance" interchangeably. They are not synonymous, but they have been deliberately and persistently represented to the public as though they are. And it worked-I see and hear people discussing this issue all the time confusing the two.

Making sure everyone has affordable health insurance is relatively easy. Bringing down the cost of health care is also simple, but much more painful. This is a smoke and mirrors game in which the politicians have convinced half of America (the half that worships at the church of democrat) that they have solved health care by providing a solution to health insurance. What they have actually done is speed up the process of what we call health insurance becoming unworkable, (which is probably not a bad thing.) It was headed that way anyway-if you take the time to analyze what we call health insurance from an economic perspective, you will see that premiums were going to keep going up and coverage was going to keep going down even if their had never been any such thing as the ACA. But the ACA has sped that trend up.

One of the key points that people seem to quickly forget is that medical offices and hospitals are in business to make money. And they should be. Someone took the economic risk to start the business. The providers are paying off mountains of personal school debt. BTW, part of the reason that going cash is not a perfect solution either has to do with the other economic bubble that we've allowed to grow into frightening proportions...the higher education bubble. It costs way too much to produce a doctor now for them to just "make less money" in the words of our probable next president.

Anyway, insurance money is easy money. Yes you have to follow a bunch of ridiculous rules and documentation requirements and call the insurance company to resolve denials, but which do you think is easier, collecting a $2500 hospital bill from the insurance company or from an individual patient? It ain't even close.

If we went cash but for catastrophic coverage it would absolutely bring costs down, but it wouldn't be a perfect solution. It might be the best solution we've got, but it wouldn't be perfect.

First, medicine is much more technologically dependent today than it was 50 years ago. Unless we go to a system in which the government somehow subsidizes the maintenance or access to medical technology that we have now (which is just paying for it a different way), we are going to have less access to a lot of the testing/treatment technology that we have become accustomed to. When costs go down, so do revenues. And administrative costs don't reflect all of the money used by the insurance driven model we have now.

Second, if we don't also pop the education inflation bubble and make it cheaper for people to become doctors, you can forget about maintaining quality. Taking on $275,000 in med school debt and giving up a decade's worth of your life in potential earnings is worth something. If the financial rewards aren't there to make it worth it, new grads ain't going to be what they used to be. They'll major in finance instead, and be out in four making the same money.

Third, the model would work fine for both routine primary care and for the other end of the spectrum in catastrophic care. The middle is where it would be a problem. Non-life threatening but still fairly expensive procedures or conditions. Hip replacement surgeries. Pain management. Things like that. If the catastrophic policy covers those things, fine, but then it really isn't that limited and probably won't bring costs down that much. If it doesn't cover those things then I think we'll have a huge gap in health care services and those services will become scarce, even if any given patient has the money to pay out of pocket. Why specialize in orthopedics if only 15% of the population can afford your services?

Probably the best assessment of the situation I've seen on this board. Too bad so few get it, and too bad so many succumb to the bamboozlers peddling ACA.

 

[Pop23]

Pop23, I agree with a lot that you (and others) are saying. What we call "health insurance" always drives up the price of health care. Of course, what we call health insurance isn't really insurance at all, which is exactly why it drives prices up.

One of the very devious things that politicians deliberately did with this whole debate was use the terms "health care" and "health insurance" interchangeably. They are not synonymous, but they have been deliberately and persistently represented to the public as though they are. And it worked-I see and hear people discussing this issue all the time confusing the two.

Making sure everyone has affordable health insurance is relatively easy. Bringing down the cost of health care is also simple, but much more painful. This is a smoke and mirrors game in which the politicians have convinced half of America (the half that worships at the church of democrat) that they have solved health care by providing a solution to health insurance. What they have actually done is speed up the process of what we call health insurance becoming unworkable, (which is probably not a bad thing.) It was headed that way anyway-if you take the time to analyze what we call health insurance from an economic perspective, you will see that premiums were going to keep going up and coverage was going to keep going down even if their had never been any such thing as the ACA. But the ACA has sped that trend up.

One of the key points that people seem to quickly forget is that medical offices and hospitals are in business to make money. And they should be. Someone took the economic risk to start the business. The providers are paying off mountains of personal school debt. BTW, part of the reason that going cash is not a perfect solution either has to do with the other economic bubble that we've allowed to grow into frightening proportions...the higher education bubble. It costs way too much to produce a doctor now for them to just "make less money" in the words of our probable next president.

Anyway, insurance money is easy money. Yes you have to follow a bunch of ridiculous rules and documentation requirements and call the insurance company to resolve denials, but which do you think is easier, collecting a $2500 hospital bill from the insurance company or from an individual patient? It ain't even close.

If we went cash but for catastrophic coverage it would absolutely bring costs down, but it wouldn't be a perfect solution. It might be the best solution we've got, but it wouldn't be perfect.

First, medicine is much more technologically dependent today than it was 50 years ago. Unless we go to a system in which the government somehow subsidizes the maintenance or access to medical technology that we have now (which is just paying for it a different way), we are going to have less access to a lot of the testing/treatment technology that we have become accustomed to. When costs go down, so do revenues. And administrative costs don't reflect all of the money used by the insurance driven model we have now.

Second, if we don't also pop the education inflation bubble and make it cheaper for people to become doctors, you can forget about maintaining quality. Taking on $275,000 in med school debt and giving up a decade's worth of your life in potential earnings is worth something. If the financial rewards aren't there to make it worth it, new grads ain't going to be what they used to be. They'll major in finance instead, and be out in four making the same money.

Third, the model would work fine for both routine primary care and for the other end of the spectrum in catastrophic care. The middle is where it would be a problem. Non-life threatening but still fairly expensive procedures or conditions. Hip replacement surgeries. Pain management. Things like that. If the catastrophic policy covers those things, fine, but then it really isn't that limited and probably won't bring costs down that much. If it doesn't cover those things then I think we'll have a huge gap in health care services and those services will become scarce, even if any given patient has the money to pay out of pocket. Why specialize in orthopedics if only 15% of the population can afford your services?

Probably the best assessment of the situation I've seen on this board. Too bad so few get it, and too bad so many succumb to the bamboozlers peddling ACA.

I'm gonna disagree - to a degree with the mid expenses. The cost would come down substantially even with hip replacements. That's what banks are for. We seem to want to live forever, feeling like we did at 21 and not have to pay for the privilege.

Choose the hip or the caddy.

 

[thewanderer]

I'm gonna disagree - to a degree with the mid expenses. The cost would come down substantially even with hip replacements. That's what banks are for. We seem to want to live forever, feeling like we did at 21 and not have to pay for the privilege.

Choose the hip or the caddy.

Pop, again I agree with a lot of your sentiment. My objection is that most of those with whom I converse who advocate going to a cash system (with catastrophic coverage) seem to think that there would be no negative repercussions from going cash, that we would have access to everything we have now only the price would be lower so that middle and upper class people could pay out of pocket.

That wouldn't be the case. It would change, and it would change to the point that I'm not sure most people would be o.k. with it. There would be a significant portion of care being delivered under our current system that would not be being delivered under a cash system. not a majority, but a significant portion. Supportive care, orthopedic surgeries, psychiatric care, and a lot of testing procedures come to mind immediately.

I don't know if you are a relatively young person or an unusually realistic older person, but your attitude regarding what level of comfort you are entitled to is not shared by many.

Even with that, forget about my hip replacement example and let's give an example as per above. What if you have a child born with special needs that would put her in a position of needing supportive care for an extended period of time? Nothing that would be covered by a catastrophic policy, but something that would be beyond the means of all but the wealthiest families on an extended basis. For most people it's one thing to tell grandpa to cash in his bonds if he wants a hip replacement; it's another to let a special needs child suffer.

And I've already weighed in on what would happen across the board for the expensive technology that we've all come to take for granted.

I know a little bit about this subject as I am a provider myself who has owned both cash and insurance practices and who is now getting into corporate wellness. I think you'll agree with me that the biggest problem we have is that we create too much lifestyle-related disease and need too much care to begin with, regardless of how it's paid for. And yes, making the consumer directly financially responsible is the best incentive to reducing the amount of unnecessary disease, but it wouldn't solve the entire problem. I honestly believe that the workplace is the best place to fight this trend, as employers have motive and leverage to strongly encourage employees to change their behavior.

Cash may be the best option we have, but it's not perfect. It will have some negative consequences too.

On of the things that I think we sorely need to do is have a frank and extended national conversation about what we do feel that people are entitled to in the way of health care in a civil society. For all the talk about health care, this has not happened yet. One side tacitly assumes one point of view and the other does likewise. If we establish that point, everything else becomes a lot easier to figure out.

As for me, I'm not a fan of enabling poor lifestyle choices at all, but as a provider it is tough for me to know how much good the medical field is capable of doing and know that some people don't get the care that they need for conditions created by no fault or choice of their own.

 

[midcan5]

Geckos don't blink, but the ads are interesting because the voice is not American. Not only are Americans outsourced but so are their voices. Ads are fascinating pieces of Americana, the recent Walmart ad with presumably normal people is an interesting comment on American shoppers. Last evening there was an ad for Obamacare, a mother and her daughter and the benefits of the ACA. Change is hard for people, we've come to accept Social security, medicare, and welfare provisions, eventually the ACA will too be the way of the land. America needs to get back to a can do mentality and away from this whining and gnashing of teeth mentality.

 

[mudwhistle]

That we're fixin' to see a slew of new advertising from, of all people, the Health Insurance Industry.


Say we're gonna see new cultural icons join the ranks of Mayhem, Flo and the Geico Gecko.
Insurance Mascot Mayhem! Here Mayhem, Flo, the Gecko, Caveman, and the Aflac duck clash! PARODY - YouTube
Say the Health Insurance industry is having to scramble to change their image from a "**** You - Denied!" bureaucracy protected by layers of government and a lack of competition to one of the choices young people can investigate on their li'l smart-phones.



Weird.

It seems that it sometimes takes reams of government paperwork to inspire a little competition in a stuffy old industry.

NPR could start playing music that people listen to when they aren't high. Every song is so bad that you have to be stoned to appreciate it.

 

[thewanderer]

we've come to accept Social security, medicare, and welfare provisions, eventually the ACA will too be the way of the land. America needs to get back to a can do mentality and away from this whining and gnashing of teeth mentality.

Yes, we accepted all of those programs and they are bankrupting the country. Social Security and Medicare aren't even solvent themselves and are unsustainable in their current form.

We can click our heels and say, "I think I can, I think I can" all we want, but that won't change the math.

Not trying to be rude and I may be misinterpreting your comments (I apologize if I am), but I think one of the most damaging problems we have is our "team" mentality when it comes to politics. This is my team's law. We won. Nah, nah, nah to the other side, and no matter how big a mistake it is, I will support it, defend it, and promote it.

Both sides do this, BTW.

 

[AVG-JOE]

Geckos don't blink, but the ads are interesting because the voice is not American. Not only are Americans outsourced but so are their voices. Ads are fascinating pieces of Americana, the recent Walmart ad with presumably normal people is an interesting comment on American shoppers. Last evening there was an ad for Obamacare, a mother and her daughter and the benefits of the ACA. Change is hard for people, we've come to accept Social security, medicare, and welfare provisions, eventually the ACA will too be the way of the land. America needs to get back to a can do mentality and away from this whining and gnashing of teeth mentality.

​

It's going to be interesting when we look back after 2020, eh? I wonder what history will make of all the whining, since it will be fully documented here on USMB.

 

[AVG-JOE]

NPR could start playing music that people listen to when they aren't high. Every song is so bad that you have to be stoned to appreciate it.

You say that like it's a bad thing...

 

[flacaltenn]

Geckos don't blink, but the ads are interesting because the voice is not American. Not only are Americans outsourced but so are their voices. Ads are fascinating pieces of Americana, the recent Walmart ad with presumably normal people is an interesting comment on American shoppers. Last evening there was an ad for Obamacare, a mother and her daughter and the benefits of the ACA. Change is hard for people, we've come to accept Social security, medicare, and welfare provisions, eventually the ACA will too be the way of the land. America needs to get back to a can do mentality and away from this whining and gnashing of teeth mentality.

​

It's going to be interesting when we look back after 2020, eh? I wonder what history will make of all the whining, since it will be fully documented here on USMB.

Even tho the Unions have a temporary exemption -- THEY are whining this very week..

This is CLEARLY Corporate Welfare on steroids.. And it won't SURVIVE til 2020 for all those community organizers to be our "healthcare navigators"..

Won't have to wait much more than a couple election cycles and an employment crisis topped with insurance defaults by individuals of a MASSIVE scale..

 

[KissMy]

All the big corporations & unions got a break & compliance delay on Obamacare. Us regular folks & small business owners got a 200% rate increase & no compliance delay. I guess government must think we don't count. So they are going to get a big **** YOU from me on election day.

 

[dblack]

All the big corporations & unions got a break & compliance delay on Obamacare. Us regular folks & small business owners got a 200% rate increase & no compliance delay. I guess government must think we don't count. So they are going to get a big **** YOU from me on election day.

This sort of thing is where our government is headed in general. We're abandoning universal rights and rule of law in favor of state granted privilege. Everybody gets a different deal depending on what group they belong to and how much political influence they wield.

 

[Grandma]

I was cleaning out my dads filing cabinet last year & came across doctor bills & checks written from the late 70's & early 80's before the EMTALA & PPACA. A doctor visit including shots or medicine was $2. Now it is 100 times higher. We had no insurance company or government between the doctor & patient. Now it's a disaster.

In the 1970s the average doctor's office visit (no shots) was $35.

 

[AVG-JOE]

All the big corporations & unions got a break & compliance delay on Obamacare. Us regular folks & small business owners got a 200% rate increase & no compliance delay. I guess government must think we don't count. So they are going to get a big **** YOU from me on election day.

This sort of thing is where our government is headed in general. We're abandoning universal rights and rule of law in favor of state granted privilege. Everybody gets a different deal depending on what group they belong to and how much political influence they wield.

This is amazingly insightful, but it's not fate.

 

[Pop23]

I'm gonna disagree - to a degree with the mid expenses. The cost would come down substantially even with hip replacements. That's what banks are for. We seem to want to live forever, feeling like we did at 21 and not have to pay for the privilege.

Choose the hip or the caddy.

Pop, again I agree with a lot of your sentiment. My objection is that most of those with whom I converse who advocate going to a cash system (with catastrophic coverage) seem to think that there would be no negative repercussions from going cash, that we would have access to everything we have now only the price would be lower so that middle and upper class people could pay out of pocket.

That wouldn't be the case. It would change, and it would change to the point that I'm not sure most people would be o.k. with it. There would be a significant portion of care being delivered under our current system that would not be being delivered under a cash system. not a majority, but a significant portion. Supportive care, orthopedic surgeries, psychiatric care, and a lot of testing procedures come to mind immediately.

I don't know if you are a relatively young person or an unusually realistic older person, but your attitude regarding what level of comfort you are entitled to is not shared by many.

Even with that, forget about my hip replacement example and let's give an example as per above. What if you have a child born with special needs that would put her in a position of needing supportive care for an extended period of time? Nothing that would be covered by a catastrophic policy, but something that would be beyond the means of all but the wealthiest families on an extended basis. For most people it's one thing to tell grandpa to cash in his bonds if he wants a hip replacement; it's another to let a special needs child suffer.

And I've already weighed in on what would happen across the board for the expensive technology that we've all come to take for granted.

I know a little bit about this subject as I am a provider myself who has owned both cash and insurance practices and who is now getting into corporate wellness. I think you'll agree with me that the biggest problem we have is that we create too much lifestyle-related disease and need too much care to begin with, regardless of how it's paid for. And yes, making the consumer directly financially responsible is the best incentive to reducing the amount of unnecessary disease, but it wouldn't solve the entire problem. I honestly believe that the workplace is the best place to fight this trend, as employers have motive and leverage to strongly encourage employees to change their behavior.

Cash may be the best option we have, but it's not perfect. It will have some negative consequences too.

On of the things that I think we sorely need to do is have a frank and extended national conversation about what we do feel that people are entitled to in the way of health care in a civil society. For all the talk about health care, this has not happened yet. One side tacitly assumes one point of view and the other does likewise. If we establish that point, everything else becomes a lot easier to figure out.

As for me, I'm not a fan of enabling poor lifestyle choices at all, but as a provider it is tough for me to know how much good the medical field is capable of doing and know that some people don't get the care that they need for conditions created by no fault or choice of their own.

People all say they want a solution to the high cost of health care, but they really don't. They actually simply want to find something to complain about.

The solution is to put the system back to what it needs to be. Medicine.

Eliminate all the middle men, all or at least most of the paperwork and put doctors back doing what they do best.

We can rebuild from there with a clear understanding of the mistakes that got us to this point.

 

[dblack]

I'm gonna disagree - to a degree with the mid expenses. The cost would come down substantially even with hip replacements. That's what banks are for. We seem to want to live forever, feeling like we did at 21 and not have to pay for the privilege.

Choose the hip or the caddy.

Pop, again I agree with a lot of your sentiment. My objection is that most of those with whom I converse who advocate going to a cash system (with catastrophic coverage) seem to think that there would be no negative repercussions from going cash, that we would have access to everything we have now only the price would be lower so that middle and upper class people could pay out of pocket.

That wouldn't be the case. It would change, and it would change to the point that I'm not sure most people would be o.k. with it. There would be a significant portion of care being delivered under our current system that would not be being delivered under a cash system. not a majority, but a significant portion. Supportive care, orthopedic surgeries, psychiatric care, and a lot of testing procedures come to mind immediately.

I don't know if you are a relatively young person or an unusually realistic older person, but your attitude regarding what level of comfort you are entitled to is not shared by many.

Even with that, forget about my hip replacement example and let's give an example as per above. What if you have a child born with special needs that would put her in a position of needing supportive care for an extended period of time? Nothing that would be covered by a catastrophic policy, but something that would be beyond the means of all but the wealthiest families on an extended basis. For most people it's one thing to tell grandpa to cash in his bonds if he wants a hip replacement; it's another to let a special needs child suffer.

And I've already weighed in on what would happen across the board for the expensive technology that we've all come to take for granted.

I know a little bit about this subject as I am a provider myself who has owned both cash and insurance practices and who is now getting into corporate wellness. I think you'll agree with me that the biggest problem we have is that we create too much lifestyle-related disease and need too much care to begin with, regardless of how it's paid for. And yes, making the consumer directly financially responsible is the best incentive to reducing the amount of unnecessary disease, but it wouldn't solve the entire problem. I honestly believe that the workplace is the best place to fight this trend, as employers have motive and leverage to strongly encourage employees to change their behavior.

Cash may be the best option we have, but it's not perfect. It will have some negative consequences too.

On of the things that I think we sorely need to do is have a frank and extended national conversation about what we do feel that people are entitled to in the way of health care in a civil society. For all the talk about health care, this has not happened yet. One side tacitly assumes one point of view and the other does likewise. If we establish that point, everything else becomes a lot easier to figure out.

As for me, I'm not a fan of enabling poor lifestyle choices at all, but as a provider it is tough for me to know how much good the medical field is capable of doing and know that some people don't get the care that they need for conditions created by no fault or choice of their own.

People all say they want a solution to the high cost of health care, but they really don't. They actually simply want to find something to complain about.

The solution is to put the system back to what it needs to be. Medicine.

Eliminate all the middle men, all or at least most of the paperwork and put doctors back doing what they do best.

We can rebuild from there with a clear understanding of the mistakes that got us to this point.

I'd really love to see just that kind of reset. But it's hard to imagine finding much agreement on a 'clear understanding of the mistakes' we made. That's really the crux off the political dysfunction. We can't even agree on what problem should be solved.