Considering a single payer model for health reform

The Patient Protection and Affordable Care Act is in the process of being rolled out, however many questions remain.

Will it guarantee universal coverage? Will it stand up to the many court challenges? The private insurance industry will receive an estimated 400 billion in taxpayer money to subsidize the purchase of these plans. Is this the best way to spend our money?

Many of us in the health field remain skeptical of the program. The Physicians for a National Health Plan estimate that approximately 23 million people will remain uninsured. Many more will find themselves underinsured with high co payments and deductibles. They will have insurance coverage that still leaves them at risk of financial ruin in the event of serious illness. Medical expenses are now a leading cause for personal bankruptcy, often occurring in families that have health insurance. It simply does not offer them adequate coverage.

America spends $2.4 trillion a year on our health care expenditures, more than any other advanced country. Yet this higher spending does not translate into better health status. Americans have a lower life expectancy, higher infant mortality and poorer access to care when compared to most industrialized nations. In a 2002 report, the Institute of Medicine estimated that eighteen thousand patients die annually due to a lack of health insurance.

Where does all the money go? The private insurance health plans consume approximately thirty percent of their expense in administrative costs, profits and CEO salaries. These costs do not directly benefit the patients, instead keeping insurance unaffordable for many Americans.

One reform proposal gaining momentum across the nation is single payer health. Vermont recently passed a single payer plan after their legislature commissioned Harvard economist Dr. William Hsiao. His analysis determined that a single payer model would be 25% cheaper than continuing the current model that depends heavily on private insurers. In signing the bill, Vermont Governor Peter Shumlin emphasized health care as a right, not a privilege; a feeling shared by many of us working in the front lines of health care.

Under a single payer plan, physicians and other health care institutions would operate independently and collect payments from a single entity, which would significantly reduce the expense and challenges of collecting from a variety of payers. It would also reduce the administrative costs and the profits that motivate major insurers. This model was not seriously considered during the national health reform discussions. The tide is turning however; recent surveys of physicians have found 59% favor a national health insurance plan. As we continue to move forward on the path of reform, it is crucial we understand where we have been and consider all our options, including the single payer model.

Aldebra Schroll is a family physician.

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  • cool

    The ceo of united health made 100 million last year the private guys are going nowhere. If every insurance paid like medicare i am all for it. But they are so powerful it will never happen. Medicare let’s run my lab pays via direct deposit requres
    No prior authentication. And pays the highest in ny for e and m codes. Trash docs all u want for six figure salaries but in the end it still less less than 10% of expenditures

  • Pamela Wible MD

    Great Aldebra! I’m in favor of almost anything that simplifies and reduces costs while enhancing the patient-physician relationship. It is time for disintermediation (removal of the middle man) to medicine. Decrease the administrative burden and allow docs to get back to work actually practicing medicine.

    Pamela L. Wible MD

  • Umdnjay

    Ummmm a single payer is still a middleman.

    • Pamela Wible MD

      Yep, single payer still a middleman. Agreed.
      Remove no-value or low-value added intermediaries.

  • solo fp

    Single payer already exists. Medicare/ Tricare have mostly the best fees, with the exception of a 2 PPO plans in my area. The rest of the plans all pay around $56 for what Medicare pays $70. The insurance plans have a take it or leave it attitude. Somehow they know the price point with the $56 and keep the docs chasing the carrot and doing more free work outside of office visits. Free work, such as prior auths and phone calls helps keep the insured patients healhty and helps save the insurance companies money. Most docs are afraid to leave the current system.

  • Skeptical Medical Consumer

    Let’s not stop at Single Payer, let’s go ALL THE WAY…let’s go to SINGLE PROVIDER. That is all you high paid medical experts all become employees of the government at government salaries, utilizing governement provided facilities, in locations the government tells you to work from, in specialities the government says they need you in. The government will pay you a nice salary, provide you with reasonable benefits and a modest retirement.

    Think about all the underserved areas in the country who would then actually have doctors, nurses, hospitals and clinics. Think of how many more real doctors we could have instead of all these boutique doctors peddling bad boob jobs and weekly lipo.

    Yeah, I like that ideas as much as I like single payer. How about it, doc, you REALLY willing to make that sacrifice for “the good of your patients”?

    …didn’t think so.

    • Janet

      Sign me up. Fed salary and benefits???? Along with the usual decreased workload and you have a winner. VA physicians in primary care see less than 15 a day at our local clinic. Most private practice docs need to see 30 a day to keep afloat.

      • pj

        Sign me up too!!

        The only reason I dont move to Canada to practice is the weather….

        As you move south from the north pole over our continent, the weather improves but the gov’ts get worse.

        • Alice

          The government is worse to the south? And you want more of it?

          • pj

            from north to south- canada , usa, mexico.

            You refer to the US? Al, you know my feelings on our gov’t.

  • Tom Garvey

    Actually, just as Medicare is an existing model for single payer, there is an existing model of single provider in this country. It’s called the VA. And, as per the recent study in Annals of Internal Medicine, their outcomes are as good as or better than Medicare in matched populations (except for the most high-cost procedures), and their costs and paperwork are better. They have the most extensive and smoothly-running EMR in the world with instant nationwide access throughout the system (HIPAA, SCHMIPPAA!), they are heavily-weighted towards primary care and prevention, and they have high satisfaction among providers and patients. (And before someone rolls out a horror story about some experience they had with the V, remember that the plural of anecdotes is not data.)

    As for my gut feeling, I have no love for bureaucracies, but I have spent far too much time as both a doctor and a patient with a serious illness struggling with insurance and hospital billing bureaucracies to believe they are somehow less malignant outside of the government. In our current system, we will die of a thousand paper cuts.

  • Alice

    I am against single payer…it spreads out care, but is still hurtful…thankfully, in the few countries that have the private sectors good health outcomes have helped up their stats…so we rely on stats to build a case that is skewed (I.e. look at the quote in the article about bankruptcy…it is true…but you need to understand that people quote “medical” bills as the cause of their filing because it is what they are counseled to do…judges approve easier…if you dissect it you find that medical bills are often much less than their extravagances they ran up…but they cite medical for an easier write off). It is bothersome because we build a case for single payer proclaiming it prevents medical bankruptcy from being filed…so just like an autopsy…we assume before actual dissection…then it is revealed we assumed wrong.

    But even if it is true is it being suggested we should accept lesser care because some people were bankrupted? I know, I know…you believe that assumption to…..yeah waiting lists, old equipment, and doctor shortages all serve great care.

    I’m sold….sigh….but doctors seem to prefer government money over private insurance forms….they altruistically tell us we will get better care while they eye the Canadian doctors boasting about their good, government salaries. It is said for every one American doctor that goes there (they do need doctors in areas the current doctors do not want to go to) 19 Canadian doctors come here.

    I live four hours from the province of Ontario, three hours from Windsor and the cash paying Canadians with home equity loans and high charge card bills are at Cleveland Clinic getting care on their dime. I guess they wanna live and possibly bankruptcy for medical bills may not be as easy there…an assumption..but if true it is another hole in the single payer mantra.

    • Jeff Taylor

      You’ll be able to buy as much extra private insurance as you like, Alice. But don’t deny a decent level of care for everyone.

      • Alice

        I am not denying care…and why should I pay then pay again?

        We have the money for care…just need some accountability.

        What bothers me is when people and doctors turn this debate into an altruistic venture…as if they are so charitable….not true…haven’t found one supporter of it that does charitable work with the impoverished.

        So tell me again how uncharitable my opinion is. I believe strongly in working in the ghetto on all sorts of levels from basic needs to education.

  • buzzkillersmith

    The economic term for single payer is monopsony. Quoting from the Wikipedia article on monopsony, “As the only purchaser of a good or service, the monopsonist may dictate terms to its suppliers….” Dictate terms.
    Frying pan and fire stuff, fellow docs. Would putting ourselves at the mercy of the government to an even greater extent make things better or worse for us, even granting that the current situation, at least in primary care, is pretty horrible? Would you rather accept beatings from Uncle Sam or from corporations, or from both? What would be best for our pts? I don’t count myself among those with the answers. I am skeptical of those who do say they know.

  • solo fp

    England has a single payer with private insurance available. Germany and Canada also have a similar setup. I have patients who are immigrants/first generation American citizens. They tell me that in England, Canada, and Germany docs are paid a flat salary. You don’t have to round on weekends/holidays, as the money is the same. A lot can be taken care of by phone. As long as you meet your quarterly quotas, you get your salary. Lawsuits are handled through the government, and the government picks up the tab for the payout and the malpractice insurance. Patients wait 4 weeks or longer for routine exams, unless they opt to private pay or have private insurance by paying extra.

    • Alice

      Ummm…..I lived there and it isn’t that way under UK socialized care. There are only a few countries with true single care. Because most of my family and all of my husband’s family are still there he revisits often. Last time his family member called the GP in at midnight to show off how, supposedly, great their care is there. The GP was not amused…claimed it could have been taken care of at the office, and said he would now be tired the whole next day. He was not paid anything for that visit, and many want house calks eliminated. Indeed, socialized care is wonderful for treating the mundane…ailments that would most likely heal on their own. But my seat in the arena is of a mother of a child with cancer. I do not know one parent here who would chose socialized care over our care (and as I shared my kids and I are in the ghetto a lot. I chat with the moms….my head is not in the sand). As my doctor at Cleveland Clinic shared…he doesn’t know anyone with a serious problem who has been denied care. Either do I.

      When I lived there GP’s were paid by how many patient’s were on their roster. But I believe you are correct about the heralded single payer Canada. David Cameron the PM tried in vain to give the GP’s more of a role, but the budget was cut across the board. The consequences of those budget cuts on the health of the people is incredible. They were (or are) implementing no chemo if the patient was not expected to live more than five years, the elderly are denied care (my mother in law said she could have one cataract removed…not two…she died with one bad eye…she was declared too old). Neo natal units do not have the budgets to keep very premature babies alive…the government will allow chemo, but only private insurance pays for the anti nausea drugs. But there is accountability. My sister in law was required to get tested every single week to see if she was sneaking a cig before she could get her prescription….amidst other items to keep the money flowing only where it would he beneficial.

      The government control will prevent a lot of bad faith lawsuits…so some doctors who live in fear of malpractice think it is great…..I wish they would consider the populace instead of themselves. Sure some are naively, well intentioned….but, again, from where I am sitting…socialized care terrifies me.

  • Jan

    As someone who runs my own business and can’t get a health insurance plan because of pre-existing conditions, I must say that I am starting to resent paying taxes so others can have health care when I can’t afford it for myself. Let me keep my medicare taxes and I could afford my own insurance… or better yet, let me buy into Medicare at a fair rate. Holding on for 6 months to get on the PCIP.

  • Alice

    Since the government already controls almost half of healthcare spending…and poorly in many states…why woukd we encourage more of that!

    • pj

      Alice, we have gone back and forth via email alot on this, but one point here- I see far too much of the private insurers “copying” what medicare and medicaid do.

      In the US, we have the worst of both worlds- huge amts of $ flowing into the pockets of ins. executives, marketing costs, etc, but little to no “value added” since the private co’s reflect – really, they call it “mirroring” internally, what the gov’t payors do.

      Why doesn’t the 30 % figure mentioned by the OP, bother you?

      • Alice

        The 30% of employees who may get dumped and placed in state aid because of Obamacare??? That was a brilliant move. Declare a mandate to help pay for health care for all…then issue waivers…then fine employers less than it would cost them to insure their employees, and tax Cadillac plans. Then the solution is more people needing insurance and less tax dollars.

        Why would you mind if Medicaid or Medicare is the model of insurers? I thought you want single payer with the government running the show? Let’s see…Medicaid payments are getting cut…we have the Medicaid Recovery Act to take assets upon death…now Medicare payments will go down, care denied via patient panels that will resemble Scrooge accountants, and probably a type of Medicare Recovery Act may become essential to pay for all of it. Assets will not be worth keeping at some point because socialism does not encourage capitalism…but someone has to pay for all of this healthcare. It simply can’t be sustained.

        As Medicare payments are cut won’t private insurance pay more? Doesn’t that help patients? I do not understand the vilification of private insurers when promotion of the government is the answer? How do patients gain? Didn’t the state of Arizona just decide to deny payment on organ transplants? And you want more of this?

        • pj

          What???? I have trouble following your reasoning.

          For one thing, “As Medicare payments are cut won’t private insurance pay more?”

          Why in the world would that occur????

          • Alice

            Second party payments.

  • Tom Garvey

    Massive change is coming whether we want it or not. The choice is not reform or status quo. There is no status quo but a downward spiral. Even one’s individual situation is great right now, the ground is falling out from under all of us. Doctors’ autonomy, dignity, and pay (outside of a few specialties, high-profile hospitals and boutique practices) are withering. The cost of care is exploding. The trend of diminished access and quality for a growing majority and spectacular access and quality for a dwindling few will accelerate again once the effects of the Patient Protection and Affordable Care Act boil away like piss on a forest fire. There will be more government intervention. Unless there is concerted and sustained effort by patients and medical professionals that intervention will simply protect the profits of the insurance companies and maybe drug companies.

    So, for those who don’t like the alternatives offered, I ask, what do you think should be done? The ‘patient’ is crashing! I know you don’t like the side effects of the potential treatments. Neither do I. I would love to hear some fresh ideas, but until I do, I am convinced that the only way to save this ‘patient’ is single provider or single payer, and we can tinker with the details such as supplemental private insurance or private providers all you want.

    Note: If you do not care about quality, cost, or access to care for anyone other than yourself and/or a few very privileged people, then we should be having a deeper debate about morality (as well as economics, epidemiology, and infectious disease), and we are wasting time debating healthcare systems.

    • Alice

      The patient is crashing? How’s that? Right now the vast majority have insurance, and 70 million qualify for Medicaid (which is known for long waits….so you are promoting more government care for everyone when the states are messing up Medicaid and doctors dropping it? And a Medicare overhaul is coming. But private insurance will save them. When the government pays less to save their budget, private secondaries pay more…the private secondary will be gone [or limited] costly if single payer comes in).

      It boggles my mind that people want a system with less checks and balances because we know the government does a much better job at policing the free market than they do themselves.

  • Alice

    I like O’Rourke from WSJ:

    “There is no virtue in compulsory government charity, and there is no virtue in advocating it. A politician who portrays himself as “caring” and “sensitive” because he wants to expand the government’s charitable programs is merely saying that he’s willing to try to do good with other people’s money. Well, who isn’t? And a voter who takes pride in supporting such programs is telling us that he’ll do good with his own money — if a gun is held to his head.”–P. J. O’Rourke

  • Alice

    Health Care Turning Point
    By Roger M. Battistella 
    Snippets about single payer

    Mr. Battistella concentrates his salvos on “single payer” health care, the state-run medicine that prevails in the rest of the Western world. Hospitals are owned by the government; doctors are public servants; and care is funded by taxes but rationed by limiting procedures that don’t meet politically determined criteria. It is an approach particularly unsuited to medicine, given the biological variability of disease, the profusion of treatment options and the diverse needs of individual patients: What works and what doesn’t simply cannot be the same for everyone. “The sheer complexity of real world conditions,” Mr. Battistella writes, “surpasses the capacity of experts and their analytical models, regardless of how brilliant or sophisticated they are.”

    It is true that “single payer” is not a popular idea at the moment. But the current structure of American health care is already delivering single payer on the installment plan. This year, government health spending, mostly through Medicare and Medicaid, surpassed private health spending for the first time—even without ObamaCare, which may well bring the public share to 70% or more. And Mr. Battistella discounts the many ways in which our mix of private- and government-paid health insurance suits members of the political class: They always have a handy villain to blame (e.g., private insurance companies) when something goes wrong—even if the government is already calling most of the shots (e.g., archaic regulations) and even if the actual source of the trouble is the same central planning that distorts single-payer systems (e.g., Medicare’s price controls).

    Mr. Battistella confesses that he finds it “hard to carry on a conversation with true believers,” because their idea about health care is “too deeply rooted in ideology.” They simply don’t want to think about practical solutions, where markets do their best work. There’s no convincing some people—especially the supposed pragmatists now pushing for de facto single payer in Washington.

  • pcp

    “single payer” health care, the state-run medicine that prevails in the rest of the Western world

    Not true. Canada, Australia, and the UK are the only Western countries with single payer health care.

    • Alice

      No, Korea has single payer, many have forms of it…it morons:) UK is labeled socialized.

      • Alice

        Oops, morphs…not morons….we have to distinguish because single payer needs defined by private (Canada), or government (UK)..hence, socialized. France is going broke over this method both individually and governmental budgetary….on and on….huge cuts in the UK……but the doctors get paid, and deal with government bureaucracy instead of insurers or both. Progress for the masses?
        According to the NY Times doctors here out earn their foreign peers….but I am sure they would not mind a cut in salary……..let me say I want you to keep doctors earning more as a reward for shorter waiting lists, drugs I may need, services, and newer machines that do not leak, or can diagnose better.

        • pcp

          I didn’t think Korea was in the Western world.

          GPs make more in the UK than in the USA.

          • Alice

            No GP’s do not make more in the UK. Break it down…you have to figure other peripherals into the equation. Go to the NY Times or I have the chart, but do not know how to post the graphic. I can get the URL.

            Well…you left countries off when the article mentioned them so I was clarifying that single payer plays out differently, but I do not see the grand success without a free market component.

        • pj

          Wasn’t the NYT article flawed? Such comparisons commonly leave out other benefits Docs have in other nations- a more balanced med mal legal system, gov’t pensions, more flexible working arrangements and hours, etc.

          • Alice

            No, it isn’t flawed. Canada had to up the pay of docs in certain areas to lure them in. Reading the UK papers and what the Royal Colleges are begging Parliament to consider…budget cuts…the PM trying to give GP’s more control and less bureaucracy (he lost that one for now). The patient loses…and I guess I thought they are the reason the establishment exists?

            I like this chart because salary alone is not adequate. If a doctor were to move to the UK they would pay about $12 for a gallon of gas (I know you get a bit more than the American gallon), but still things are pricey in Europe, so a true comparison takes these into account.

            And remember….as if you could forget…you are a doctor……..patients tend to think you just want easier money…an easier life (yes…I have been reading the old book…Kill As Few Patients As Possible…I needed the laugh…I like this doctor’s writing and think literary doctors are doing much good)……okay…I will be nice and end with a quote we can both agree upon:

            There are three kinds of lies: lies, damned lies and statistics.”. Mark Twain

  • BobBapaso

    A single payer won’t reduce costs. It still protects the system from free market forces.

    We need to help everyone get a Healthcare Savings Account. Then costs will come down to what the services are worth in the current economy. The government would have to help the poor at first. But in time half the population would die with a surplus in their accounts. An inheritance tax on that could eliminate the need for any other taxpayer support.

    • Alice

      Didn’t the new legislation put limitations on these?

  • Alice

    How Much do Family Practioners Make in Other Countries?


    • pcp

      Thanks for the reference.

  • Tom Garvey

    I’m spending way too much time on this.

    Why does anyone care what doctors in various other countries make? Our country is richer than most other countries. Our firemen make more than theirs do to, but we don’t have free market firemen (luckily). Whatever system we have, you can argue for whatever wages you want. However, I do think those graphs are a little deceptive since doctors’ work in this country, is increasingly done, in part, by lower-paid mid-level providers like PAs and NPs. It is the natural tendency of markets to push wages downward, partly by deskilling the work.

    Speaking of markets, we do not have a true market in healthcare. We have a market in health insurance. And the consumers are the employers, who pick a limited number of healthcare plans to offer their employees. Also a real market requires good information. Insurance contracts or intentionally unintelligible.

    Also, BTW, why do I say the ‘patient’ is crashing? Because the cost of care continues to shoot up. The ‘coverage’ created by the reform law is often not worthy of the name (for instance, see Despite the Dem’s rosy predictions, costs will spiral out of control. It is simply impossible to cut costs, improve access and care, pay the medical system fairly, and maintain the millions of insurance bureaucrats, their CEOs, and shareholders. The sickest, most expensive patients will be fobbed off on the state. PPACA is modeled on Massachusetts. The insurance plans being spawned are cruel jokes, and the government is in an autophagic orgy trying to pay for the bloated program (Obamneycare?). As we go, so the rest of you will go too.

    Health saving account? What bureaucracy do you envision to create and enforce the definition of ‘health’? Police the accounts against fraud, etc? I haven’t studied it very much, but it does seem to me like another version of the same problem.

    I don’t think there can be a true market for health. For a market to have a positive effect, among other things, need must be matched to ‘demand’–which means purchasing power. In healthcare, often those who have the most need have the least money. Anything you do to try and cram that into a working market system will create all sorts of hangers-on and unintended consequences.

    Anyhow, I have to see patients in the morning. Goodnight.

    • Alice

      I think doctors go on doctor only boards and listen to their peers in other countries puff and blow tripe about how great it is to work for the government…their wages, no lawsuits, etc. (it isn’t as much truth as boasting… because most countries view us as elitist….sorta the insecure hospitalist:). Using your example of firemen with good wages and benefits ….American doctors start to think there is easy money to be made without realizing the very reason they could be lured there is because the doctors there do not want the jobs they offered (and many have no other opportunities…immigrating here is rough and impossible for some). There is truth that a perception remains that civil servants are paid more than their private sector counterparts, are harder to fire, and the great benefits. So it may be your gain and our loss at times, because I believe that overall in the grand scheme of things more patients are harmed. We may be elitist minded…but at this point….with the cards on the table…if given free reign to where I would want treated for cancer it would be right here….and few would disagree with that.

  • Hashitoxicosis

    The issue is Alice,
    Private insurances are purely profit oriented. They underpay doctors, decline to approve tests and insist on pre-approval for even simple treatments. The pre-approval process is rigged in a way where my staff member needs to spend 45 min to one hour for one pre-approval- often we find it easier to give-up and let the patient be symptomatic than get medications pre-approved.
    Strict control of private insurance is needed, which limits the percentage of non-patient care expenses. A standardized list of test indications for which pre-approval is not needed also will be helpful

    • Alice

      The issue is Alice [end quote]

      I like that:). But if you read more carefully you would see I am not against some regulation (quoting Teddy Roosevelt that sometimes the capitalists need policing… Ayn Rand promotion from me….I like Milton).

      There is a pre approval process with the government to, and up until a few years ago a slightly higher rejection rate over private insurers. My daughter is a nurse and yesterday her employer announced the shutting down of their nursing homes…mass lay offs….says their budget will lose a million a year per nursing home. So private insurers did that? Sounds to me like the consequence of a move towards single payer, and a government that is taking in less than they can afford to keep paying out. A government that borrows funds from Social Security or Medicaid.

      The bottom-line is exactly what you have shown….make life easier on you…patients are secondary.

  • Jonik

    * Private insurance is adversarial—it must grow by eternally charging as much as possible for services, and providing as minimal services as possible in return.
    * For Profit insurers have motive and inclination, and virtual permission, to favor drugs made by their pharm investment properties over others that may be cheaper, safer and more effective—and to do as little as possible to check their own drugs for safety and effectiveness.
    * For and Non-profits spend heaps of “customers’” health care money on non-health-related things—from advertising to jets and CEO bonuses, to lobbying and campaign gifts. There is zero health justification for mandating that anyone provide revenues for that. Of that $400 billion the govt will give to insurers to administer what should be administered by the public, how much will go to those non-health related things? How many patients are not treated because the health money was diverted?
    * It’s rarely, if ever, noted that, under the health law, those who buy insurance from private insurers will give to those insurers twice…once “at the pump”, so to speak, and again via income taxes.
    * That insurers use our health care money for lobbying and campaign gifts is bad enough, but, that providing revenue for that is to be govt mandated may be a bigger constitutional problem than the Repug angle re/ commerce.
    One may be a source of funding for lobbying for laws that one opposes thus undercutting ones’ right to Redress of Grievances as one may be funding the cause of the grievance. Sounds like a joke. It’s not.
    One may be providing funding to insurers for campaign gifts to candidates one opposes…thus undercutting basic voting rights.
    * And, for profits invest billions in health-damaging industries, including cigarette manufacturing, pesticides, GE crops, oil, coal, gas fracking, military weapons and on and on. This explains institutionalized “nice” campaigns to address every health threat under, and including, the sun (our “lifestyle” and “behavior”, drinking, “smoking”, bad diet, lack of exercise, obesity, germs, bugs, “faulty” genes, etc.) with barely a word said about even the most ubiquitous, notorious, and harmful industrial health threats or the lax regulatory system that enables and approves it all. Insurers are the largest investment bloc on Wall Street. The health law must be added to the matter of the Obama administration’s handouts to Wall Street.

    Private health insurance isn’t just an unconscionable waste of money, it’s bad for everyone’s health, scientific integrity, and even our environment.

  • Jonik

    Too many tolerate the term “affordable” in this health care legislation. “Affordable” refers to buying a commercial product…not receiving a tax-paid, public-administered public service. “Affordable” is a word from TV commercials. It says nothing to qualify itself….for instance, as to what percent of ones income it represents.

    As we do not have “affordable ” free speech, or right to vote, or right to redress of grievances, etc etc…it is absurd to think of such a basic thing as health care as “affordable”.

    • Alice

      Free speech isn’t free? Are you suggesting health care is a right? If one is against the free, but heavily regulated, insurers where do we go? To the government?

      If America goes the way of let’s say Greece….will we be exceptional? We are one of the few countries not going down the socialism spiral. The UK just voted in a neo con in an effort to not sink into the sea. Space doesn’t allow a summation of the countries like Cuba that are saying socialism does not work. Let’s learn from them.

      This thread is irritating….a segment of doctors want an easier way to make money and do not seem to mind bartering away the care of their patients. The average patient reads this and thinks doctors just want to show up for work….get paid like a civil servant….and get more golf course time in. Or they think romantically single payer would be wonderful….partly because a portion of doctors can be intimidating whiners:)

      Doctors are just having acclimation problems. And if it did not hurt so many people a part of me would like to see a few of them eat their words when the lucratic job they desired becomes a ball and chain and they become the victims of government pay cuts…..that will surely hurt their patients. Wanting an easy check with better benefits will be costly to your patients….but, hey, we are expendable. And so are you….eventually, you will be served the same slop….oh yes, I forgot the majority of UK doctors purchase private insurance in an effort to get better care….yep, docs run from the same care they promote for us.

  • Alice

    I was rushed last night when I posted….sorry about the jackhammer post:). Dealing with cancer clouds all I see as far as health care and my daughter’s future care. What I failed to ask is why more doctors are not interested in the physician led Health Care Compact Alliance? Yes…it follows a type of Federalism that gives power to the states via block grants…but that is a strength. It means a state like Florida can tailor more care for the elderly. It helps doctors stay in charge, better able to care for their patients.

    Much better to allow each state to decide than a one size fits all Federal program that I think will hurt patients, amd ultimately doctors.

  • Tom Garvey

    When we are talking about specialty care, such as oncology, you may well be correct that our system delivers the best care–for those of us who have excellent insurance, enough money to travel to top flight cancer centers, and the resources to deal with the insurance bureaucracy. (All of that would describe my own experience as a cancer patient.)

    However, for primary care, at least, the socialized systems completely outclass ours in patient outcomes. I am a primary care doc. I do not know whether my own professional life would be better or worse under a directly-paid-for-by-government system (at least for primary care). But the clinical evidence is overwhelming that the majority of my patients would be healthier.

    • Alice

      I think that is an honest answer….but…but…what about the AMA’s recent change of heart (why did it take them so long? Dr. Tevi Troy wrote about it this week…maybe in the WSJ?).. I listened to Dr. Tim Allen also…really interesting.

      I guess I have to ask how basically healthy people are healthier via single pay? We know with single payer the wait to see a specialist often doubles. Isn’t that flustering for you as a doctor who desires to get his patients good care? Time does mean something. A delay in treatment caused my daughter’s cancer to spread to her lymphs…we are on the brink of operation number three…so it is an emotional topic for me…even with this error I prefer our system…our error was human from a doctor who did read the lab notes….not bureaucratic).

      Won’t primary care find themselves limited when treating the elderly? Restricted? I was reading something from Dr. Kevin Fleming about single payer that said something like a million people in Canada are stuck in the limbo zone between GP and specialist. I think the average wait is a bit over 18 weeks. I find that alarming. How can I desire this type of system?

      What if the lock in for fee for service affects you right out of business? Doctors are dropping Medicaid….depending on what country we duplicate the private market is still involved (thankfully), but it can play on reimbursements.

      If innovation, newer drugs, less research happens that affects patients at your level.

      Glad you are well….cancer is certainly a terrifying word…you may want to read the new book by another Boston physician, Emperor of all Maladies….it’s very good.

  • Bajak

    Oncologists, in general, in the USA ought be facing license revocations for their apparent ignorance about, or intentional ignoring of, industrial carcinogens in so many corners of everyone’s life….especially, because of the notoriety of the problem, the cigarette arena.
    Just try to find an oncologist who even humanely warns his or her patients about carcinogenic radiation in typical cigarettes from certain still legal phosphate fertilizers. Just try to find an oncologist who’ll say anything in public about cancer-causing dioxins in smoke from typical (not all) cigarettes from residues of chlorine pesticides. And try to find an oncologist who’ll warn or raise a finger about the also carcinogenic dioxins from chlorine bleached cigarette paper.
    It’s probably not as cynical as..well, they just want an endless and profitable supply of cancer victims to treat. It’s probably just that they dare not upset the interests they work for and are otherwise associated with…namely, chlorine-drenched pharmaceuticals, and health insurers that invest billions in all sorts of chlorine industries…including cigarette manufacturers.
    If an oncologist ever set foot on the issue of chlorine in cigarettes, and dioxins therefore in the smoke and in the fatty tissues of millions of unwitting Guinea pigged smokers, they’d never play golf, or get invited to dinner, or get a promotion, in their town again.

    Easy to search about this. Simply google up “dioxin chlorine” and “dioxin cigarette smoke” or “dioxin cancer” and etc…and take it from there.

    How does everyone feel about having an oncologist who, by silence or distraction, serves the most cancer causing industries on earth…i.e. radiation and chlorine-dioxin?

  • Tom Garvey

    You are unfairly blaming oncologists. They are neither educated nor empowered to address the root causes of the diseases they treat, and I am very grateful for the work they do. The real culprits are the polluters/manufacturers, regulators, politicians, and journalists. Or would you blame firemen for the acts of arsonists?

    • Alice

      I thought the post was a heads up. I remember watching my daughter drink radiation and my knees went weak….because I knew the consequences. But cancer patients are desperate….most do not understand….they drink poison thinking it is helpful…..maybe it will be….maybe not. The question of whether ignorance is bliss comes into play.

      We can dance around warning labels, but after reading both of these posts you realize that killing the messenger is not beneficial. I am going to research what the original post shared.

      I appreciate this type of point-counter-point.

  • Tom Garvey

    Thanks for the kind wishes. My heart goes out to you and your daughter.

    What I want in a system is as few non-doctors/profit-seekers between me and my patient as possible. I don’t see single-payer or socialized medicine as a full solution, but as a way to eliminate just some of these hangers-on. Then we would still have to push forever for quality.

    Most of my time as a primary care doc is spent taking care of patients who are not ‘basically healthy.’ I take care of the common, but often very serious diseases–diabetes, COPD, CAD, etc. I feel very limited by the current system. I took a giant pile of pre-approval forms with me to fill out during my vacation. (Why can’t I send them a ridiculous form that they have to fill out in order to send me a ridiculous form?) The 15 minutes I have for planning, executing, documenting, and billing for most encounters is a joke. If I don’t use exactly the right magic words on the orders, my patients are charged for the most routine blood tests. And sometimes, they must choose between paying for prescriptions or paying for gas.

    So, in our system of private insurance, I see not only the clumsy hand of government bureaucracy, but the greedy and clumsy hands of multiple private bureaucracies now mandated and subsidized by the government. Each one has its own nonsensical rules and procedures, its unintelligible website and impenetrable telephone barricade, and each one with its own payroll of bureaucrats whose only real function is to suck away more resources.

    When you talk about 18 month waits for specialists in Canada, I agree. That’s outrageous. But I do not think that longer wait times are inherent in their system versus ours. That sort of thing already exists here for some people, and I think it’s what’s coming for the whole middle class in this country with or without single payer or socialized medicine. The very few will get good, timely care with easy access to specialists and diagnostic studies, and the rest will get McDonald’s care–huge deductibles and tiny caps with Byzantine requirements for even the simplest test–all reshuffled every time the poor sop loses their lousy job and gets a new one.

    Like a profoundly sick patient, the problems of healthcare are immensely complicated. You can blame problems in Britain on their socialized medical system, but I think it’s important to remember that their system has been administered by politicians hostile to its very existence since Thatcher came in. Whatever system we have, be it federal or state-based, as long the politicians in Washington and the State Houses are beholden to corporate lobbyists, it’s going to stink. Driving the insurance companies out of ‘the temple’ (at least out of all but catastrophic coverage and luxury care) is just the beginning of reform.

    Honestly, I don’t know much about the Health Care Compact Alliance, and I promise to look into it. I like the idea of decentralizing decision-making (at least that which is not based on firm scientific evidence), but I am worried that devolution of power to the states in an era of multinational corporations is often just a way to divide up potential resistance to privatized pillage into more manageable bites. The devil and the angels are in the details.

    Anyhow, be well, and best wishes for your daughter.


    • Alice

      I can understand the headache of the middleman, but think of having to tell a patient you cannot help them as many GP’s do under socialized medicine,…where limitations and wait times, and denials are part of the landscape. Newer expensive drugs are not available…sometimes patients are refused to pay themselves…no out pocket because it goes against the ideology the system is built on.

      I agree about states being in control…no perfect system…but better to have 50 states offering variables than one huge behemoth. I think Georgia signed on to the alliance…Texas looks probable…maybe TN…hmm…can’t remember…but doctors are enthusiastic about it.

      I really believe that even with the headaches it is a terrible mistake to remove the free market component from our care. In the UK my brother in law was on a waiting list after his heart attack. Told at least four months…he got his private insurerer to order the test…it took two weeks.

  • Tom Garvey

    Just one more thing–single payer etc aside, health outcomes cannot solely be credited to or blamed on the healthcare system. I can talk to my diabetic patients about diet, exercise, and rest until I’m blue in the face. But I am powerless against their long commutes to lousy, unsafe, underpaying jobs that demand long hours without overtime compensation, that they can’t leave because jobs are scarce and their spouse was laid off and they have kids and a mortgage and gas and so on.

    • Alice

      Agreed….and if we get single payer it doesn’t encourage patients to do any better….and they feel entitled to more care because they feel they paid for it so they use as much as they can. If we look at France the citizens pay 25% for health care, then they have copays…then they have the usual taxes we pay. Think about that…if a person makes $60,000 a year that is $15,000 off the top then the rest….even if that is 20% another $12,000 in taxes….close to half a check gone in taxes and they cannot sustain their system.

  • Bajak

    Well, it’s not uncommon that forest fires are started by those who want the paid job of putting them out.

    The firemen analogy is off a bit. At least fire fighters know what they are fighting…i.e., fire. It seems that too many oncologists don’t want to know that they are fighting the effects of exposures to industrial chemicals, radiation, or other toxins and endocrine disruptors. And so, in deference to the powerful businesses involved with those substances, too many oncologists, and other doctors, dismiss it all by simply, and quite unscientifically, blaming “smoking”….the behavior of the uninformed person hit with those substances.
    A doctor must be on the patient’s side…not on the side of the poisoners…or their insurers and investors.
    This system tolerates health insurers investing billions in cigarette manufacturing AND the tobacco pesticide makers (some being pharms), and just about all the other worst health-damaging industries on Wall Street. The system AND the patients are sick.

    • Alice

      They tolerate the tobacco industry because the government makes more off their sale than the tobacco industry.

  • Jonik

    Please. It’s not “the tobacco industry”. That’s the industry’s favored name for itself…as if it ‘s just providing a traditionally-used natural plant product. Geronimo never smoked what today is foisted off as “tobacco”. Lucky for him, the pesticides and other industrial contaminants weren’t made yet.
    One can say “cigarette industry” or “smoking product industry” if one wishes to be kind to them. But, since any number of cigarettes may not contain a shred of tobacco, and since, even if they do, it’s absurd to describe the highly-adulterated, highly-processed end products as “tobacco”.
    Might as well call the hand-gun industry “the iron ore industry”.
    If one really wants to describe and discredit the cigarette manufacturers, describe typical (very non organic) products as “Pesticide Pegs”, “Dioxin Dowels”, or “Radiation Rods”….and demand putting references to THAT on the labels of adulterated products.
    Google up the terms. Easy. “Pesticides tobacco”, “dioxin cigarette smoke”, “dioxin cancer”, “dioxin fetal damage”, “dioxin chlorine”, “chlorine pesticides”, “radiation tobacco” etc. Some good references available at “Fauxbacco”. Google it up.
    Once it’s widely understood that what the corporatocracy and the cigarette industry calls “tobacco” is Quite Another Thing Altogether, maybe we can get somewhere. If one means pesticide-contaminated tobacco, say it. If one means plain unadulterated tobacco, ditto. Otherwise understanding is impossible.

  • Alice

    Geronimo probably smoked more than tobacco…but I think this is splitting hairs. Taken one step further this conversation goes into legalizing marijuana because it’s organic?

    Hey…I am who thinks some conversations online can become toxic!

    • Jonik

      Re/ Geronimo: That was just a way of making distinction between tobacco (what Geronimo and all smokers used for some ten thousand years, and the industrial chemical-laced stuff that came along in the early-mid 1900s.

      Re/ Marijuana: Re-legalization of cannabis, hemp and marijuana, would go a long way to solve a lot of problems, not the least involving the fact that cannabis needs no pesticides. The Good Example of pesticide-free and chlorine-free hemp agriculture and processing would have been quite harmful to the petrochem-pharm-chlorine-pesticide cartel. That’s one (utterly illegitimate) reason we got some 70 years of Reefer Madness atrocities.
      Incidentally, by blaming “smoking” and “tobacco” for every disease under the sun, that identical toxic-carcinogenic cartel remains protected from suits and indictments for their deadly part in the cigarette industry.

      Further, as relates to Single Payer, if those industries took a well-deserved, long-overdue, civil and criminal hit for the harms they’ve caused (perhaps especially via typical cigarettes), that would bode very badly for the for-profit health insurers that invest billions in those health-damaging industries. Single Payer would sever that harmful conflict-of-interest.

      • Alice

        Hmm….so you want everything natural? Removing the pharmaceuticals will cost a whole lot of lives. Sure they want profit…that is what drives innovation. Is it foolproof…no….is anything…no. My girlfriend died at home refusing to get chemo, or even an operation claiming she would not let a surgeon have her breast…she was 42 years old. Maybe some poison would have kept her alive to raise her four children? It helped my mom thirty years ago and she turned 83 years old.

        To go single payer means you entrust the government to run the healthcare industry, not just regulate. The same government with a Drug Czar who is relying on the Rand Study to show that decriminalizing marijuana does not lessen crime.

        You probably know pharmaceutical companies have developed marijuana in a pill form. Safer than smoking. Are you sure you want to penalize them out of existence?

        • Jonik

          - One beauty of re-legalizing marijuana is that one can be freed from profiteering, routinely rule-breaking and generally untrustworthy, and eternally adversarial corporations. One can grow it on the windowsill. Patented marijuana pills don’t cut it.

          - No. I don’t want everything natural, as if it’s even possible to define that word. But it is important to have The Government…i.e, We The People…not private businesses in charge so that that ol’ Profit Motive doesn’t create problems in drugs and everything else. Few businesses build Better Mousetraps. They build cheaper-to-make, more-profitable-to-sell mousetraps…and worker rights and environmental concerns and consumer rights, and even law, be damned.

          If anyone thinks The Government is separate from We The People, that’s too bad. Those who speak of how bad government is don’t ordinarily say it’s bad because of so much NON-governmental private corporate corruption is going on. OUR government seems to be largely gone anyway. Corporate govt is in charge, We the people are out. Only a corporate entity would say yippie to that.

  • Tom Garvey

    @Bajak, I don’t understand why you think that doctors are on the side of the poisoners. I find it offensive. I have had many extremely severe and permanent side effects from cancer treatments. My doctors have been horrified by them. But they aren’t magicians. They are balancing the risks and benefits of a primitive science (although it’s a lot better than it was 30 years ago when I first encountered it). During my most recent bouts, I went in as a patient and doctor, with my eyes wide open. There was no other known way to do it.

    Oncology is one of the most emotionally and intellectually demanding jobs in existence with a high rate of burnout and suicide. Don’t blame them for the enemy they fight.

    • Jonik

      No offense meant to oncologists and other medical professionals who know about and condemn the ubiquitous industrial carcinogens that affect so many. Maybe there are more out there than we know, but the commercial media sure doesn’t report anything.
      One heroic champion, Dr. Samuel Epstein and his Cancer Prevention Coalition(easy to Google up), is invisible in mainstream media, and, pretty much, even in medical journals.
      What we DO see in media and med journals are the oncologists in the cancer “cure” industry where never will we hear a word about pesticides, chlorine and dioxin, radiation or about organic and natural alternatives to all that. As a test, I once called every cancer “cure” facility in Philadelphia to see what they offered about preventing or minimizing exposures to industrial carcinogens. Not One had any such material. Not One could suggest where to get such information.
      That’s sickening…literally.

  • Tom Garvey

    @Bajak: PS: Once we have gotten to the oncologists, it’s too late to talk about the exposures that caused the cancer. You’re blaming a trauma surgeon for not being a vocal gun control activist.

    • Jonik

      There are differences between a trauma surgeon treating gun shot victims, and oncologists treating victims of exposures to industrial carcinogens:
      1) The trauma surgeon doesn’t ignore the bullet, but it’s the rare oncologist who acknowledges the presence of the pesticides and dioxins.
      2) Everyone knows about, fears and avoids run-ins with guns and bullets. The topic is on TV news every two minutes. Relatively few know about, say, pesticide residues and dioxin-creating chlorine in typical cigarettes.
      3) There are laws galore about gun use, but it is absurdly, outrageously, “legal” to contaminate typical cigarettes with some of the worst industrial carcinogens on the planet. It’s hard to see how this CAN be legal in light of international laws about experimenting upon people with known harmful or untested substances without Informed Consent….not to mention laws against reckless endangerment, creating a public health disaster, and even mass murder.


      • Alice

        Your point is well taken….but I think the vast majority of people know they are drinking and smoking poison? When I drink a Diet Coke I know I am taking a risk, plastics are messy….research on it conflicts (i.e. the wise Jerome Groopman’s article), on, and on, and on. Is the question one of a complete ban of anything that can possible harm, or education, or knowledge with the freedom to use it at your own risk?

        So your point is about comparison in labeling (pharmacies could do a better job here…researchers have introduced a no nonsense label that resembles food labeling…but it usually takes regulation to bring change…sigh). Education? Not prohibition? Because in truth when treating cancer nothing is concrete. How I wish medical school graduates could use a crystal ball….my doctor wishes he had one…but until then I think most doctors are doing what they can ( but another point is unnecessary treatments for government money. CT scans being one of them…Medicare money influencing decisions).

        Just how far do you want to go with bans? Yes, guns can be lethal…chemo…lethal…but both are useful too.

        • Jonik

          Bans on “smoking”, as opposed to bans on poisoning typical smoking products to prevent so-called “smoking related” diseases, are as unjust as banning women from walking down streets as a way to prevent rapes and muggings.

          A lot of problems can be solved with Just One Ban—a ban on any government legislator or regulator, or judge, having any economic links (personally, in the family, and up to ten years in the future) with any of the industries affected by legislation, regulation, or court decisions. There would be no dioxins in cigarette smoke, for instance, if the broad chlorine cartel didn’t have its private tentacles in the pockets of public officials. And we wouldn’t have Reefer Madness. And on and on.
          Just because such a ban defies the “reality” of the current privatized-corporatized-corrupted system doesn’t mean it should be abandoned as a goal.

          • Alice

            What if this ban kills people? Do you have stats on how many people chemo helps or hurts? I was reading a book that said chemo has never helped one single person. That was too far reaching for me.

            Not sure how much you are battling for patient rights, education, or MJ freedom? I do think Jon Stewart had a good response about a state that legalized medical use of MJ. He said the healthiest state suddenly became the sickest.

            So if the pharmaceutical companies release a non-toxic form of MJ will you be in their corner? Just trying to get to the root of the problem:)

  • Tom Garvey

    @Alice: There are already people to whom I (effectively) have to deny treatment. That is the purpose of insurance companies.

    Also, co-pays have been studied systematically. They generally do not result in better outcomes. I think the problem with risk behaviors has more to do with the way our society has built itself than with individual motivations. One fat, physically inactive, toxin-guzzling person is an idiot. A country of them is a sociological/public health phenomenon.

    I hear you saying that France is in trouble due to the amount they spend on healthcare. What does that mean for us, though? Is France in worse trouble than we are? We spend much more than they do, and our results are worse by nearly any measure. All systems have to wrestle with the difficult question of what medicine ought to do versus what it can do, since the latter is rising exponentially, but I don’t know that France’s balance is particularly bad.

    • Alice

      Well….I like straight talking…understandable…but if we all get moving we may need less doctors?

      Rationing is a given…money limited…but how we obtain funding is important…the mandates are pragmatic but could be unconstitutional (not so sure the Supreme Court isn’t injecting their own ideologies and making the Constitution fit that….I am against lifetime appointments).

      Vermont is appointing a panel. Obamacare has appointed patient panels with more power than Congress. I much prefer having regulated private insurers over government because government polices itself poorly…this leads to more errors as we see in other countries.

    • Alice

      But France employs the free market, big copays, heavy taxation, and the private sector involvement brings stats of success up. There is more online, but Health Care Economist said this (and a lot more…they compare different countries). I should add that I support copays because of abuse of Medicaid, and unnecessary ER visits, etc.

      However, France utilizes more market-based ideas than most people realized. Copayment rates for most services are 10%-40%. About 92% of French residents have complementary private health insurance.

      In essence, the French system avoids widespread rationing because, unlike true single-payer systems, it employs market forces. Even the OECD says that the “proportion of the population with private health insurance” and the degree of cost sharing are key determinants of how severe waiting lists will be.

  • Alice

    Thought this article today in the news about Vermont pointed out some…cons…about single payer from a writer for Forbes who was raised in Canada:
    ******‘A Terrible Path’

    Vermont is going down “a terrible path,” says Sally Pipes, president and chief executive officer of the Pacific Research Institute.

    “We can expect a doctor shortage in Vermont’s future. Already, doctors have retired early and others are planning on closing their practices in anticipation of ObamaCare. We’ll see the same thing there as a generation decides not to go into medicine because they don’t want to become civil servants,” says Pipes. “Businesses forced to bear the cost will not expand, some will leave, and the state will have trouble attracting new ones. This will decrease the tax base at a time when the demands on health care there are becoming greater. And if the businesses go, then the taxpayers will have to pick up the bill,”

    She points to Canada as an example of the problems of monopolistic government-run approaches.

    “I grew up in Canada, where they have government-run health care, and I saw what it did there. People have trouble seeing doctors, the lines for treatment are long and it hurts the economy,” Pipes said. “In Canada, they pay 10.4 percent of gross domestic product (GDP) for health care. That’s what the country has decided it can afford, and that’s why it takes 18.2 weeks to get treatment from a specialist. Some 17 percent of Canadians are waiting to see a primary care doctor because no one wants to be a primary care doctor—they are paid the least out of all physicians there.”

    Pipes says the cost problem is just one of the concerns about Vermont’s plan.

    “By telling the people that the government-run health care is ‘free,’ they will overutilize it since they don’t pay directly. This will cause the state to ration health care, increase taxes, and institute price controls to offset the increased demand,” Pipes says. “I hope this doesn’t foreshadow what’s in store for the rest of America.”

    Pro’s are here:

  • Alice

    Hmmm……do you think we are a Republic? Democracy? What do you think of judges who overrrule the will of the people?

    • Jonik

      Judges aren’t the only ones who over-rule the will of the people…so do legislators and regulators and cops and the works.
      Majority considers itself to be environmentalist….yet most court and legislative decisions favor what are known as “earthrapists”…big oil, coal, gas, logging, “development”, and the rest.

      On the other hand, the “will of the people” can be sculpted by massive extensive PR on mainstream media…to the point that we have Popularity Contest Ballot Initiatives galore for or against what the mainstream insufficiently-informed voters are told to be for or against. Anti-smoking votes are pre-ordained to win because…uh…the majority has been told that something called “smoking” is bad. Anti gay rights votes usually suffer because, well, gays or gay rights supporters don’t and may never be a majority. And etc.
      Can’t go wrong asking the majority to vote against the rights of any minority.

      But..funny…there’s no ballot questions about—
      -Shall cigarettes be contaminated with deadly industrial substances?
      - Shall international law violations by the Bush Administration (and now by the Obama Adm.) be prosecuted?
      - Shall illegal “wars” in Afghanistan, Iraq, Libya etc be funded and permitted?
      - Shall dangerous and untested substances be permitted in foods and smoking products and other products?
      - Shall criminal Wall Street bankers and brokers etc be allowed freedom to walk the streets and continue their crimes?
      Even WITH mainstream media on the side of the bad guys here….the public knows better. So, of course, such questions will never be put to a vote test.

    • Jonik

      The USA is a Corporatocracy…and judges, mostly, are part of it….allowed to be funded by private corporate entities, allowed to have income to themselves and families from investments in private business interests, and even allowed to preside over cases where, for instance, their religious or personal bias against “sinful” smoking isn’t even questioned. Due Process? Not a chance. Constitutional Democracy. (as importantly distinct from pure democracy…i.e., majority rules)..adios.

      Or is the term “Criminalocracy” more fitting?

  • Jonik

    It’s too difficult here to find which comment to respond to.
    One thing in parting…re/ abuses in the Medicaid system. It wasn’t clear if that meant abuses by administrators, or by low income and poor patients.
    If by administrators…full power of law should come down on their heads.
    If by the poor, desperate, frightened, generally abandoned, sick, unemployed, powerless, un-represented patients…geeze …seize their yachts, I say.

    • Alice

      I was going to respond, but if you wre parting I certainly do not want to chat with myself….too bloody boring:). Although, at times you spoke in third person as an observer….I wish you would stay, but I am wiling to continue the conversation privately. You can click on my pic, and my twitter account gives my email address.

  • Alice

    Guess organic is problematic too…

    Blame Organic Industry for Ecoli Outbreak

    If ever there was an argument for the organic industry to buckle down and finally start field testing, this is it: The E. coli outbreak in Europe has now resulted in at least 44 deaths and over 3,700 illnesses. The outbreak was caused by bean sprouts originating from an organic farm in Germany.

    Rest of article at RealClearScience:

  • Jonik

    The latest ( June 30 news) is that they traced the e-coli to seeds from Egypt.

  • Alice

    So do you forresee the possibility of bad marijuana seeds?

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