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You are here: MacNN Forums > Community > MacNN Lounge > Political/War Lounge > Poll On Obama Care and options

View Poll Results: Most preferred if you had a choice that excludes zero medical coverage
Poll Options:
Obama Care As Is 0 votes (0%)
State Single Payer 1 votes (20.00%)
Federal Single Payer 3 votes (60.00%)
Highly Regulated Private 1 votes (20.00%)
Voters: 5. You may not vote on this poll
Poll On Obama Care and options
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Athens
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Jul 3, 2012, 03:11 PM
 
Just a little poll on what would be most preferred if you had a choice that excludes zero medical coverage

Option 1 Obama Care as it stands, requirement to have private medical insurance through work or personally and if you don't you get fined. The running of Medicare, Medicad, VA beside private delivery.

Option 2 State run Single Payer model (Similar to Canada, private delivery, public insurance) through tax dollars, end of Medicare, Medicaid and VA as it is today.

Option 3 Federal run Single Payer model, private delivery, public insurance but national through tax dollars end of Medicare, Medicad and VA as it is today.

Option 4 Private insurance, private delivery but highly regulated, every one still required to have insurance like Obama Care, but private insurance to run at cost for medical coverage making the gravy on additional insurance products like home insurance, auto insurance, life insurance. (Similar to the Swiss)

Something else to discuss, should Medicare and Medicaid and Va be independently run systems or should the government just pay private insurance companies for those people that would otherwise be on Medicare and Medicaid systems.
Blandine Bureau 1940 - 2011
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Athens  (op)
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Jul 4, 2012, 02:50 PM
 
I am surprised how many have voted for a Federal single payer system. Any one want to say why they prefer that one?
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besson3c
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Jul 4, 2012, 11:54 PM
 
Originally Posted by Athens View Post
I am surprised how many have voted for a Federal single payer system. Any one want to say why they prefer that one?
I haven't voted yet, but it would probably cost less to do it that way since data sharing and facilitating stuff across state lines could be better handled.
     
Buckaroo
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Jul 5, 2012, 03:47 AM
 
The choices are lacking. How about complete repeal of the law in 2013.
     
besson3c
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Jul 5, 2012, 03:56 AM
 
Originally Posted by Buckaroo View Post
The choices are lacking. How about complete repeal of the law in 2013.
This thread is about what you'd replace it with.
     
Big Mac
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Jul 5, 2012, 04:15 AM
 
You're missing choices there, Athens. Such as:
Partial Repeal
Full Repeal and Replace
Full Repeal Without Replacement
Full Repeal/Privatization With Common Sense Minimal National Regulation
(Repeal ObamaCare, Medicare and Medicaid, subsidize privately owned regulated plans for low-incomes/pre-existing conditions ONLY!)

You seem to be missing any truly market based solutions. And to me, highly regulated private is equivalent to ObamaCare.

My plan (for those who haven't seen it): I advocate for the last one listed. Get both the states and especially the federal retards out of their destructive war against US medicine. Supersede state regulations that prevent people from buying health insurance across state lines. Substitute state laws for a very simple, streamlined federal statute without the thousands of pages of corruption. Here are five bullet points of my proposed federal statute:
1) Encourage private ownership of health plans for all - get employers out of the stupid practice of providing health insurance, instead they can provide bonuses to employees that they can then use individually toward their own private plans.
2) Encourage but don't mandate major medical/catastrophic only plans, coupled with HSAs. If people want fuller plans they can pay their own premiums to it.
3) Provide subsidies for low-income Americans and those with preexisting conditions to purchase private plans.
4) Preserve consumer protection that prevents insurers from unjustly cutting insured who get sick.
5) Repeal ObamaCare, Medicare and Medicaid. Supersede/replace all state and federal statutes that prevent nationwide competition in health insurance plans.

I bet all of that can be done in under 100 pages. That's an American solution, one that regulates fairly with the least impact and lets the private market operate, greatly alleviates budgetary strain on the state and federal level and relieves the American people of the burden of government command and control health care. As opposed to a colossally corrupt monstrosity ObamaCare that grows government enormously, burdens medicine at all levels, makes people subject to IRS abuse and incompetence in yet another area of their lives and serves as a backdoor to single payer.
( Last edited by Big Mac; Jul 5, 2012 at 04:44 AM. )

"The natural progress of things is for liberty to yield and government to gain ground." TJ
     
besson3c
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Jul 5, 2012, 04:17 AM
 
It's not enough to just repeal, it's time to start talking replacement plans (since we all seem to agree that the status quo blows chunks).

If you care about the debt you should care about discussing replacements, and not just making life more difficult for Obama.
     
besson3c
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Jul 5, 2012, 04:31 AM
 
Besides, your answers to this poll will imply an Obamacare repeal pretty clearly anyway.

Let's make this thread about more than Obamacare bitching and with actual solutions? The only right wing proposal in here I can think of off the top of my head worthy of discussion is ebuddy's.
     
ghporter
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Jul 5, 2012, 07:08 AM
 
At the moment, it's hard to say which of these options I would prefer, since it is almost impossible to get a handle on what the AHA actually does. Too much rhetoric about what people want us to think it does gets in the way of understanding what the statute actually is written to do.

For the moment, I (reservedly) like having the government set rules that insurance companies have to follow instead of building on the existing Medicare infrastructure to cover everyone. The federal government has a poor track record for managing Medicare, in part because it is a federal bureaucracy that uses outside entities to do the actual work, but has a huge job and insufficient internal and external oversight. Medicare needs to be rebuilt, from scratch in my opinion, but making it possible for everyone to have effective health care access doesn't belong as part of that at all.

Further, while many pundits have said this or that about how the Act will either be wonderful or horrible, neither has addressed the major economic impact of moving the currently uninsured away from the current "wait until you're too sick to put anything off, then go to the emergency room" model. Taxpayers foot the bill for those folks waiting until their cold turns into pneumonia and earns them a 4 week stay in the hospital, and by shifting things around so that people can get seen by a doctor before they get that bad off should cut costs across the board. I'm looking forward to my county health agency not paying so much for caring for people who are not insured because they make too much to qualify for Medicaid but not enough to afford health coverage...

At the bottom line, I think that ANYTHING is better than leaving our broken health care funding system as it was when AHA was passed. I have no illusion that it is "very good," let alone perfect, but changing the paradigm was essential, and whether you like the way it was changed or not, it remains to be seen whether or not the change was as effective as it should have been. I'll call it a start.

Glenn -----OTR/L, MOT, Tx
     
Chongo
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Jul 5, 2012, 07:01 PM
 
One thing we do know, PPACA gives the Sec of HHS too much power.
     
Athens  (op)
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Jul 6, 2012, 01:13 AM
 
Originally Posted by Big Mac View Post
You're missing choices there, Athens. Such as:
Partial Repeal
Full Repeal and Replace
Full Repeal Without Replacement
Full Repeal/Privatization With Common Sense Minimal National Regulation
(Repeal ObamaCare, Medicare and Medicaid, subsidize privately owned regulated plans for low-incomes/pre-existing conditions ONLY!)

You seem to be missing any truly market based solutions. And to me, highly regulated private is equivalent to ObamaCare.

My plan (for those who haven't seen it): I advocate for the last one listed. Get both the states and especially the federal retards out of their destructive war against US medicine. Supersede state regulations that prevent people from buying health insurance across state lines. Substitute state laws for a very simple, streamlined federal statute without the thousands of pages of corruption. Here are five bullet points of my proposed federal statute:
1) Encourage private ownership of health plans for all - get employers out of the stupid practice of providing health insurance, instead they can provide bonuses to employees that they can then use individually toward their own private plans.
2) Encourage but don't mandate major medical/catastrophic only plans, coupled with HSAs. If people want fuller plans they can pay their own premiums to it.
3) Provide subsidies for low-income Americans and those with preexisting conditions to purchase private plans.
4) Preserve consumer protection that prevents insurers from unjustly cutting insured who get sick.
5) Repeal ObamaCare, Medicare and Medicaid. Supersede/replace all state and federal statutes that prevent nationwide competition in health insurance plans.

I bet all of that can be done in under 100 pages. That's an American solution, one that regulates fairly with the least impact and lets the private market operate, greatly alleviates budgetary strain on the state and federal level and relieves the American people of the burden of government command and control health care. As opposed to a colossally corrupt monstrosity ObamaCare that grows government enormously, burdens medicine at all levels, makes people subject to IRS abuse and incompetence in yet another area of their lives and serves as a backdoor to single payer.
Ah so you pretty much picked option 4.
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Athens  (op)
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Jul 6, 2012, 01:19 AM
 
Originally Posted by ghporter View Post
At the moment, it's hard to say which of these options I would prefer, since it is almost impossible to get a handle on what the AHA actually does. Too much rhetoric about what people want us to think it does gets in the way of understanding what the statute actually is written to do.

For the moment, I (reservedly) like having the government set rules that insurance companies have to follow instead of building on the existing Medicare infrastructure to cover everyone. The federal government has a poor track record for managing Medicare, in part because it is a federal bureaucracy that uses outside entities to do the actual work, but has a huge job and insufficient internal and external oversight. Medicare needs to be rebuilt, from scratch in my opinion, but making it possible for everyone to have effective health care access doesn't belong as part of that at all.

Further, while many pundits have said this or that about how the Act will either be wonderful or horrible, neither has addressed the major economic impact of moving the currently uninsured away from the current "wait until you're too sick to put anything off, then go to the emergency room" model. Taxpayers foot the bill for those folks waiting until their cold turns into pneumonia and earns them a 4 week stay in the hospital, and by shifting things around so that people can get seen by a doctor before they get that bad off should cut costs across the board. I'm looking forward to my county health agency not paying so much for caring for people who are not insured because they make too much to qualify for Medicaid but not enough to afford health coverage...

At the bottom line, I think that ANYTHING is better than leaving our broken health care funding system as it was when AHA was passed. I have no illusion that it is "very good," let alone perfect, but changing the paradigm was essential, and whether you like the way it was changed or not, it remains to be seen whether or not the change was as effective as it should have been. I'll call it a start.
I agree with you on the Medicare, and I personally don't think at the federal level it could ever be cost effective because of how the federal government runs things. That's why my vote went to a state run system.

What is going to be interesting is how the medical providers coop with so many new people. The US like Canada already suffers doctor shortages and like us red tape and regulations make it hard for immigrants with medical backgrounds to practice. North America is not producing enough doctors, has not for a long time now. The demand is going to increase and poaching from state to state is going to leave some places with real problems.
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Athens  (op)
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Jul 6, 2012, 01:20 AM
 
Where did the poll go with this new horrible forums....
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Athens  (op)
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Jul 6, 2012, 01:21 AM
 
Ah yay, BB editor much better then the rich text editor, now where is the poll lol
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Athens  (op)
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Jul 6, 2012, 01:24 AM
 
Ok it was lost, I re-added it, people will have to vote again sadly.
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ebuddy
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Jul 6, 2012, 07:43 AM
 
Originally Posted by Athens View Post
Ok it was lost, I re-added it, people will have to vote again sadly.
This may have been an opportunity to revamp the poll to include the missing options; namely one that indicates private-run with minimal regulations since those are what has severely distorted the provider-to-patient relationship. The reason health care providers charge what they do is because they can. Giving more people health insurance (while still leaving most of the "uninsured" without insurance) does nothing for the root cause of the problem.
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Athens  (op)
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Jul 6, 2012, 10:30 AM
 
The missing option was excluded on purpose, I wanted to keep the debate on the 4 options only. We already have threads that go into more general discussion. I don't think the high costs are related to regulations. They might play some part but I think its the overall fragmentation of the risk pool, the numerous and fragmented insurance options and care of the uninsured that play the biggest factors in cost.

Free Market Model

Lots of different insurance companies
- > Spread out risk pool, through selective insurance, excluding those with current conditions a insurance company can cherry pick healthy people to profit from.
(Sick people end up on the government funded system or no insurance at all, tax payers pay or hospitals pay)

-> Complex insurance options, lots of configurations allows for the ability to find loop holes of non coverage for conditions when those healthy people become sick
(insurance company saves money, but some one else pays down the line for this insured person who is not being insured for a condition)

-> Because of both lots of insurance companies and lots of insurance packages designed to be complicated to make it easy to exclude ppl from coverage the administrative work on the delivery side is increased by a lot.
(Hospitals and doctors have to figure out if a person is insured, for what, what conditions are placed on this insurance and ultimately get approval from the insurance company)

-> Requirements of co-pays, high deductibles, and user fees are designed to discourage usage of medical system. Attempt to save insurance companies money
(People don't go to the doctor as often as they should or leave problems until later to save on money resulting in bigger more expensive problems, if the insurance company can't find a hole to exclude coverage they end up paying more when they do. When they find a hole or make one up, the person ends up not being covered)

-> Fraud occurs by those that can't afford insurance costing either the insurance company or the care delivery companies money.
(I'm sure a lot of money is also spent trying to prevent fraud as well)

-> Insurance companies not only need to make a profit but they also need to market themselves so part of the premiums people are paying are for profit (expected in a business) and advertising costs to sell the products (expected in a business) so part of the costs not factored in with American health costs is the money that does not go into health itself but promoting health care and making money.
(This is why that even though the US overall spends twice as much in health dollars as other countries, it does not actually mean twice as much is going into care. Part of it is going to profits and advertising as well)

Single Payer Model

Large risk pool, both the healthy, sick, rich and poor are part of a single pool which lowers the costs overall
(With different insurance companies cherry picking healthy people leaving sick people for the federal government you end up with Insurance companies making good profits with low costs while the tax payer is footing almost 100% of the cost of sick people with out healthy people putting back into the costs to reduce it. You end up with a very unbalanced system and its a real bad deal for the tax payer. Real good deal for the private insurance companies)

Less complex insurance system. With a single payer you remove a lot of the administrative work right off the top. Its easier dealing with one payer then a dozen. And most single payer systems really have two options for packages. Basic mandatory and extended.
(Items under extended for a extra fee to the subscriber of the insurance would be private rooms, TV access, upgraded meals, eye exams, and so on. While the critical stuff, emergency care, doctor visits are under the basic option. Less work for administrators because they know what is covered and what is not. Billing becomes easier, patient registration becomes easier and less work. Generally effort isn't required to get permission for something unless its something really out of the ordinary and not listed or covered. Generally under single payer models every one is covered to so care providers do not lose nearly as much. There is no fraud outside of illegal immigrants or out of state people (assuming the single payer is a state model not a federal model)

Sadly even under a single payer model user frees and co-pays cold be part of it. So the very fact its single payer does not change this possibility. For those that don't have it people would make more use of the medical system preventing serious and expensive conditions from not waiting. If it is part of the system this expensive waste would continue so this is the same under both systems.

Single payer systems are break even or subsidized, meaning no wasted health dollars on profit or advertising. This takes off a large cost of the medical costs from the top as well.
(Because healthy and rich people make up the same insurance pool, the direct cost to the tax payer is greatly reduced because the risk is spread out more)
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Athens  (op)
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Jul 6, 2012, 10:38 AM
 
What would be a interesting break down to see, and I don't think there is one or if its even possible to come up with a number. But I would love to see a comparison between actual health dollars spent between Canada, UK and the United States. I don't mean what is currently counted as spent per person because that includes administration, profit, advertising. But dollars on only the health care itself.

The 3 countries are similar enough but different enough it would be a interesting comparison.
United States (Free Market Insurance and Free Market Medical delivery plus Government single payer for a limited group)
Canada (Single Payer Government Insurance and Free Market Medical Delivery)
UK (Government Run insurance and Government run Delivery with private options for the wealthy)

I would bet that the UK would beat out Canada and the US in such a comparison of actually dollars spent on providing care.
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ebuddy
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Jul 8, 2012, 06:48 AM
 
Originally Posted by Athens View Post
Single Payer Model
Large risk pool, both the healthy, sick, rich and poor are part of a single pool which lowers the costs overall
(With different insurance companies cherry picking healthy people leaving sick people for the federal government you end up with Insurance companies making good profits with low costs while the tax payer is footing almost 100% of the cost of sick people with out healthy people putting back into the costs to reduce it. You end up with a very unbalanced system and its a real bad deal for the tax payer. Real good deal for the private insurance companies)
The average profit margin of a health insurer in the US is 3.3%. You and few others would entertain similar ventures at such a meager profit. This is why most health insurers are diversified into many other insurances and market vehicles. The problem is the cost of health care, not health care insurance. All a single-payer model does is merely add another insurer to the problem while doing zero to actually address the exploding costs of health care. The problem? What you're calling a "Free Market Model" in the US is anything, but free. The US system is already, majority government-managed care which continues to severely distort the provider-consumer relationship. If your goal is to merely enlarge risk pools, you can accomplish this much more easily than creating a monolithic single-payer model by simply allowing the consumer to shop their insurers across State lines giving them the choice of more than 1300 insurers as opposed to perhaps the 3-5 currently available in their State or the 1-2 available to their employer. i.e. if you believe the size of the risk pool is critical to cost-saving, there's a much simpler, more efficient way of addressing that phenomena. Requiring everyone to pitch into your care is what is already enabling the providers to charge what they will. They charge what they do because the consumer is disconnected from the cost of health care. Your solution does nothing for the systemic solvency problem, creates greater imbalance, and perpetuates increasing costs.

  • We need HSAs and compatible HSA insurance plans (including and in many cases encouraging a catastrophic-only provision) that can be tailored more effectively toward individual needs. You can contribute your plan "premiums" to your HSA, your employers can donate to the HSAs, a relative or others can donate to your HSA, and the government can means-test their contribution to your HSA should you need aid. Annual HSA plan savings can be rolled over to subsequent years encouraging a more shrewd consumer and placing providers in the position of having to compete instead of guaranteed clientele under the currently distorted, primarily government-managed system.
  • Insurers can be chartered by State creating jurisdictional competition among the States competing for charter-status as opposed to insurers trying to manage their model in accord with the regulations of 50 different States, manipulating minimum coverage requirements in give-aways to this lobby or that with little to no regard for what the collective actually needs including treatment for restless leg syndrome, massage therapy, and EDS to name a few.
  • Some Tort reform would go a long way toward limiting the health care expenditures on unnecessary testing and treatment.


Less complex insurance system. With a single payer you remove a lot of the administrative work right off the top. Its easier dealing with one payer then a dozen. And most single payer systems really have two options for packages. Basic mandatory and extended.
(Items under extended for a extra fee to the subscriber of the insurance would be private rooms, TV access, upgraded meals, eye exams, and so on. While the critical stuff, emergency care, doctor visits are under the basic option. Less work for administrators because they know what is covered and what is not. Billing becomes easier, patient registration becomes easier and less work. Generally effort isn't required to get permission for something unless its something really out of the ordinary and not listed or covered. Generally under single payer models every one is covered to so care providers do not lose nearly as much. There is no fraud outside of illegal immigrants or out of state people (assuming the single payer is a state model not a federal model)
You're welcome to poll any provider in the US whether the government payer (Medicare/Medicaid) is less an administrative burden to them or more. Statistically, it is the latter. While I support the right of States to engage a single-payer model, we've yet had a solvent example of it and health care costs did not decrease. Under what is typically deemed a single-payer model, you are managing health care at the Federal level with resources distributed according to logged "needs" that quickly become antiquated leaving you with Provinces/States perpetually whining for more funds from the centralized health care authority; unable to meet the needs of their regional phenomena. The result? Clinics closing, doctors leaving the profession, nursing shortages, etc... Another unfortunate byproduct of this phenomena is a system that does not encourage advancement. Catastrophic-only coverage and HSAs for fundamental care encourages the consumer to save by shopping and bolsters competition for clientele placing the patient in charge of their health care needs and the provider in the position of having to compete which includes the cutting-edge services they can tout.

Sadly even under a single payer model user frees and co-pays cold be part of it. So the very fact its single payer does not change this possibility. For those that don't have it people would make more use of the medical system preventing serious and expensive conditions from not waiting. If it is part of the system this expensive waste would continue so this is the same under both systems.

Single payer systems are break even or subsidized, meaning no wasted health dollars on profit or advertising. This takes off a large cost of the medical costs from the top as well.
(Because healthy and rich people make up the same insurance pool, the direct cost to the tax payer is greatly reduced because the risk is spread out more)
There is currently nothing about government-subsidized health care that is "break even" and it is defined by its wasted health dollars. There's a profit-motive no matter which way you cut it. It just depends on what is considered profitable to the cigar-chomping bureaucrat on any given day.
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Jul 8, 2012, 04:01 PM
 
I wouldn't use US medicare as a example of less administrative costs for a care provider because its just ONE more insurance organization to deal with. If it was the ONLY one then the overall administration from the health provider would be less. But US Medicare also does a lot more then pay bills, it also runs facilities if im not mistaken.

As for lower prices, when you are negotiating with a single insurance organization as the only organization then prices do come down. This is not the case with use medicare because its just one of many insurance organizations and prices are setup differently between all of them plus the no coverage price. If the insurance company says its only paying $50.00 per patient visit take it or leave it, patient visits are going to be $50.00.

3.3% Profit, + what percent for advertisements + what percent is on administration + what percent for fraud... Are we up to 10% waste now, perhaps 15%. What is 15% worth on the total cost of medical costs in the US. Its a pretty penny im sure.
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Jul 12, 2012, 12:53 PM
 
Would be nice if more of the critics of the Affordable Healthcare Act would would provide suggestions on how to move forward with expanding health care coverage, so that everyone has access to quality affordable healthcare. There are no credible alternatives being suggested. The suggestion to 'block grant it to the states' or 'let the states decide' are not real alternatives. First, there's too much of that being said by politicians already, simply because they have no idea how to improve our healthcare system or their ideas are already being put to use in the Affordable Healthcare Act. Healthcare is also a national issue. States do not have unique healthcare issues. Healthcare needs to be universal so that when a person moves or travels around the country, they can expect to receive the same care with the same guidelines

Cheers !
     
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Jul 13, 2012, 09:58 AM
 
A lot of things would be nice Sandman.

It'd be nice if proponents of the Affordable Health Care Act actually read the legislation and could speak knowledgably about what's in it. It'd be nice if they actually understood the criticisms being lodged against it on a vastly bipartisan basis by everyone up to and including health care providers (i.e. everyone, but the health insurers looking forward to the mandate of new customers). You speak of affordable and accessible as if ObamaCare isn't going to leave some 20+ million people uninsured or drive health care costs through the roof. Good show.

Instead of the little hit and run post not directed towards the only one who apparently disagrees with you in this thread, it'd be nice if you had at least read my response in which I provided a wealth of credible alternatives that not only tackle the exact same problems as ObamaCare supposes to, but much more inexpensively and efficiently. You'd have seen how coverage can be expanded and how it is to be properly addressed as a national issue, on a national level. While health care needs do vary based on demographics that can differ wildly from state to state, there are a wealth of national-level solutions you're just not paying any attention to. Why? Because most of them have been offered by (R)s and you and the party of "no" in the Senate have blocked every last one of the 35+ health care initiatives passed to it from the House.

What you would not have seen in my post or anyone else's is your mention of "block-granting it to States" and other bits of nonsense you apparently weren't confident enough to stand behind.

Thanks and have a great weekend!
ebuddy
     
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Jul 13, 2012, 10:32 AM
 
Have a good weekend
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