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US: 47% Republican, 43% Democrat (Politico/GWU 9/19-22)

Topics: National , poll

Tarrance Group (R) and Lake Research (D) for Politico/GWU
9/19-22/10; 1,000 likely voters, 3.1% margin of error
Mode: Live telephone interviews
(Tarrance release)

National

State of the Country
30% Right Direction, 63% Wrong Track (chart)

2010 Congress: Generic Ballot
47% Republican, 43% Democrat (chart)

Congressional Job Approval
28% Approve, 66% Disapprove (chart)

Obama Job Approval
46% Approve, 51% Disapprove (chart)

Favorable / Unfavorable
Mitt Romney: 45 / 28 (chart)
Mike Huckabee: 49 / 25 (chart)
Sarah Palin: 44 / 49 (chart)
Barack Obama: 54 / 44 (chart)

 

Comments
Farleftandproud:

Not bad for likely voters, and not bad for polling voters to give strong favorables to a bullshiter like Huckabee. I mean he isn't a bad person, so perhaps I could see why some would have a favorable opinion of him. A lot of people may like Obama personally, but just not approve of him as president.

I think my opinion of Huckabee was alright when he ran for president, but after a year on Fox news, he started to buy into the death panel theory, and when someone is struggling to pay a huge percentage of their income into health care expenses, by him calling Obama's ideas a train wreck was ridiculous.

I have heard all the excuses about why our health care system is great and Canadians have to wait and wait for some surgery and longer in the waiting rooms; no doubt there are problems with a national health system, and perhaps a better alternative is cutting costs in half per person, yet still buying into an insurance plan. That is still a step up from the barbaric system we have now. It is better to wait and have the luxury of getting care than to either go uninsured or in some cases pay 1/3 of people's income in hospital bills or insurance.

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Field Marshal:

Single payer will never happen in this country, thankfully. Its a terrible system and the American people would revolt if they tried it here. Most people who advocate for it have no idea what they are advocating for and have never seen it in action. Only extremists are touting a single-payer type system.

4 point movement in favor of the GOP since the last poll.

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Stillow:

farleft - Huck usually has good favorable ratings.

...oh and tel lthe guy who needs bypass surgery to wait 18 months for his operation. Or tell the lady with breast cancer she'll need to wait 12 months before treatment can start.

The American HC system is the best system the world has ever seen and has provided the highest quality care for the maximum number of people than is found in any other country. Our for profit system has produced the best doctors o nthe planet and the best medical technology in existance.

...and wanting g'ment to ruin that for everyone is a train wreck...and Huck is nto the only one saying that....millions upon millions of americans agree with him.

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Paleo:

"the American people would revolt if they tried it here."

Just as they did with Medicare?

"The American HC system is the best system the world has ever seen and has provided the highest quality care for the maximum number of people than is found in any other country. Our for profit system has produced the best doctors o nthe planet and the best medical technology in existance."

And the private health insurance has contributed to that in what way? Other than by driving up costs by being an unnecessary middleman?

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Paleo:

"A new AP poll finds that Americans who think the law should have done more outnumber those who think the government should stay out of health care by 2-to-1."


http://www.google.com/hostednews/ap/article/ALeqM5gSXIViw_RWvU3uweKkhKfhAVGgqgD9IF4ET80

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Stillow:

Also according to politco...now only 38 percent feel Barry deserves re-election.

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Farleftandproud:

Yeah, Stillow and Field Marshall probably would like to privatize medicare. I think they are both wrong, and that single payer will happen in a few places in this country once it will save costs. It may not even be free, but the costs would be be less. Of course the health care law should have done more, and the killers of the public option are the ones I think who are the true losers in the end. It would have benefitted more people than medicaid ever would, and if you read the fine print, married people making too much for medicaid get screwed with the highest expenses. A public option would have been a great alternative for someone who is with a company with high premiums or is self employed.

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Field Marshal:

Just as they did with Medicare?

Medicare is not a socialist health care system. Its just a different third-party payer. A single-payer is and people in this country won't stand for it, i guarantee that.

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Field Marshal:

I think they are both wrong, and that single payer will happen in a few places in this country once it will save costs.

No it won't. No state will have single-payer because it would mean the states confiscation of private property (hospitals and delivery) and the moving of doctors to government workers which will also never happen, thankfully.

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Paleo:

Medicare is single payer.

The dirty little secret in U.S. politics is that the public is, progmatically, far more to the left than they are philosophically. Health is one example, as the poll I cited indicated. Taxes are another. But Democrats in Washington are either too intimated by the villagers and the right-wing media, or too much in the pocket of corporations and wall street, to take advantage of that.

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Paleo:

"No state will have single-payer because it would mean the states confiscation of private property (hospitals and delivery) and the moving of doctors to government workers"

Untrue. Neither is a requirement for singly payor.

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Stillow:

Let me get this straight. We're going to be "gifted" with a health care plan we are forced to purchase and fined if we don't, written by a committee whose chairman says he doesn't understand it, passed by a Congress that hasn't read it but exempts themselves from it, to be signed by a president who smokes, with funding administered by a treasury chief who didn't pay his taxes, to be overseen by a surgeon general who is obese, and financed by a country that's broke.

What the hell could possibly go wrong with this plan?

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Bukama:

Insurance companies operate on tight, tight margins. Last year the average margin was 3.4%, so their profits are hardly the reason medical insurance costs so much. The insurance industry is a dog, from an investment standpoint, earning between 3 and 5% margins. Compare Oil companies, at 8 or 9%, or soft drink companies with 20 to 30% margins.

But indirectly, insurance companies are part of the reason health care costs so much in America. With the vast majority of people divorced from the process of evaluating the cost of medical care, they are no longer effective price shoppers. This situation is aggravated by medicare and Medicaid, where individuals don't even directly pay the premiums for the insurance. let alone the medical treatment they receive.

I think the government should provide emergency care. Emergency means it is necessary treatment and the individual can't afford the necessary treatment. There could be a sliding scale to avoid people driving themselves into bankruptcy to qualify for care - but no one should get tax-subsidised care that can afford to pay for it while maintaining a reasonable standard of living.

This would make people price shoppers again. They could ride uninsured, and be picky in health care choices, and knowing that a serious disease or accident will reduce their standard of living (a reasonable choice some people might make). Those that choose insurance would select policies just like they choose auto or home insurance - best value for the money. For private insurance, I like the Kaiser model - less cost, restricted choice of hospitals and doctors. I wish their were other networks competing with Kaiser.

P.S. I don't use Kaiser, but I would if I didn't have employer subsidized insurance.

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Field Marshal:

Medicare is single payer.

How do you figure? Medicare's business model is the EXACT same as private insurance. There is no difference in that its a third-party biller. The only slight difference is that they have significantly more pricing power.

Clearly you have no idea what a single-payer system is.

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Paleo:

I'm afraid you're the one who has no idea:

"Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs."

http://www.pnhp.org/facts/what-is-single-payer

"Medicare in the United States is an example of a single-payer system for a specified, limited group of persons within a country."

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Field Marshal:

Bukama,

Kaiser is the illustration that eliminating private insurance will do anything for costs. Kaiser is basically its own single-payer system (much closer to single-payer than Medicare is for sure). They have been able to keep health care inflation a few points below the standard in the industry through their model.

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Field Marshal:

Paleo,

I didn't see where you got that medicare quote as its not on the page you cited. However, under that definition, private insurance could also be considered a single-payer. What we are talking about is a single-payer Government run health care system that does not allow private insurance plans similar to Canada and Sweden.

France, Germany, UK are hybrids that are slightly closer to single-payer than private.

From that clearly biased and misinformed website: “The NHI program would compensate owners of investor-owned hospitals, group/staff model HMOs, nursing homes and clinics for the loss of their clinical facilities, as well as any computers and administrative facilities needed to manage NHI."

So they are advocating the seizure of private hospitals. Good luck with that. Luckily, we live in American where extremists like the people who wrote that website are mostly marginalized to the far-fringe.

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seg:

Paleo:
I agree that single-payer does not REQUIRE "single-owner." However, as every business knows, being a supplier to only one company makes you that company's slave. Obamacare will markedly reduce the already low level of competition in medical care. As happens in all heavily regulated business, crony-capitalists will thrive and the number of competitors will be driven down every year, mostly because of the cost of regulatory compliance, but also because of barriers to entry helpfully suggested by panels populated by representatives of a few large vendors. The same problems will further enervate hospitals and clinics. Obamacare will also inevitably destroy health insurance, as the dems well know. You will get your single payer system as a temporary emergency “reform” when health insurance collapses, probably immediately after the gov refuses the rate increases needed to cover vastly increased costs.

You will celebrate and feel vindicated when that happens. “They should have done single-payer from the start,” you will say. As the saying goes, “Be careful what you wish for. You may get it.” At first, you will be as proud as liberal Canadians still are. Cost will rise even as services and quality decline (see Post Office, U.S.). Eventually, everyone but libs will realize that we are being served by the most rigid, politicized HMO you can imagine. It will be like the VA system: availability of medicines and treatments always substandard compared to the private system. Except that there will be no private system to be substandard to. Physicians will become clock watching time-servers. Their reduced productivity and needs to improve diversity will lead to strong efforts to reduce med school admissions requirements, physician pay, and the number of specialists. You will be like the British, who are mostly happy with their system because it is “free” at the point of contact and because, except for the wealthy, they mostly are unaware of just how bad the system really is. Oh, sure, there are bad administrators and doctors who can be embarrassed and transferred but somehow not fired, but if only we could weed them out, it would be a great system.

I would much prefer to see any system that produced real competition. The benefits of competition are clearly show by plastic surgery and Lasik surgery, which get better, faster, and cheaper every year with no cost containment at all except a vigorously competitive market. Because of insurance paid for by employers and government but not the consumer, we do not have that market now and we have not for many decades.

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Field Marshal:

Seg,

Great post but i would disagree with you on one point; where you state there will be no private system. I guarantee you if a single-payer is installed, which i still think is a virtual impossibility given the degree of private ownership and constitutional restrictions (I know, when has that ever stopped a libie?) most of the good doctors will start their own independent practices that will cater to the rich who can afford it. In the end you will go from 75% of the country getting the best health care in the world at high prices to 10% of the country with the rest getting substandard care.

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CompCon:

The total cost of US healthcare is $2.5 trillion per year. The total federal revenue from individuals is $2 trillion per year. In order to pay for a single payer system, you would have to raise taxes across the board by 125%.

What politician in his right mind is going to tell the country that everyone taxes are going to more than double so that we can get inferior healthcare with 18 month waiting lists for surgery, higher cancer fatality rates, and an average 20 hour wait for the emergency room?

On top of that, everything the government does adds a minimum of 25% to the cost of what it can be done in the private sector. That would add another half trillion dollars per year to our healthcare bill and even higher taxes (they would have to increase by 150%).

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Aaron_in_TX:

Problem is that health care is not a rational market. It's quite the opposite. De-regulating the market will never fly. People don't want a return to unregulated health care where alcohol could be termed "medicine."

You DON'T want to shop for a bargain wrt health care. The question is not "what doctor is cheapest?" the question is "what doctor is best?" Cost is a secondary factor when the health problem exceeds a manageable level.

It might work for things like teeth cleaning, but it won't work for chronic illness care, emergency care, or serious illness like cancer.

Part of our problem and the reason other countries get better outcomes even with single payer is that the people themselves are fundamentally healthier. They don't eat all the garbage we put in our bodies, don't have the obesity issues. In GB they do to some extent, probably why their system doesn't work quite as well.

In my opinion, health care should be viewed as a public service except for cosmetic-type things. We still think of it as a way to get rich, ie: why few med students want to be on the front line as general practitioners. They all want to specialize where the money is 2 or 3X better.

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Georgia Joe:

It is interesting to read the thread on health care. The United States does have the best health care in the world available in a limited number of places and to a limited number of people. The real issue, however, that you all miss is that we spend double what the rest of the world spends on health care per capita. Our health care system is a far larger burden on our economy than is our tax system. Health care spending is a larger share of GDP than federal taxes and growing at a much more rapid rate with no mechanism to gain control. Without getting control of health care costs, our businesses will become uncompetative and governments and individuals will be bankrupted.

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Aaron_in_TX:

Health insurance is indeed not a great return on investment, but pharmaceuticals do get returns in the 15-20% range, as well as medical device manufacturers.

We have this screwed up system where some entities (hospitals) are non-profit, but others are uber-profit (pharma).

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Aaron_in_TX:

"we spend double what the rest of the world spends on health care per capita."

I hit on that a little bit with the comment on the health of our population.

A lot of our problem is cultural. We have luxurious care and believe that people are entitled to it. In other countries they do not utilize the system as much for little problems like we do, and doctors are more inclined to look holistically at their patients.

Ie: doctors in America rarely consider that depression or stress can be a major driver of various problems. They are only just training them to consider that.

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Field Marshal:

We have this screwed up system where some entities (hospitals) are non-profit, but others are uber-profit (pharma).

Yes, but if liberal theories are correct, eliminating the profit motive would help decrease costs. Why haven't we then seen non-profit hospitals take out the for-profits if that is the case? If the theory holds, non-profits would be much cheaper than for-profits and take all their business.

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seg:

Aaron_in_TX:
Outcomes in different country are often bananas to oranges comparisons. In the US and most countries race has a huge effect on outcomes. Therefore, you must compare whites to whites, blacks to blacks, and Asians to Asians. Low-income Asians are far healthier than affluent whites or blacks. Affluent blacks are less healthy that working class whites.

"Indians" in Canada are far less healthy than whites in Canada.

If that is done, I think you will see remarkable closure.

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StatyPolly:

Kaiser aside, I think the majority of private policy holders have PPO. And carriers fight like hell to get costs of care down. It's called "negotiated rates", and if a doctor or a hospital does not agree, they're out of the network. I have Blue Cross of CA, for example, and they're always in flux as to which hospital is on and which is out. I know a few doctors who are not in BCC Preferred Provider network (top notch experts with long waiting lists) but few providers can afford not to be, at the risk of losing something like 40% of the market. So most providers bitch and moan about low compensation, but begrudgingly join BBC PPO. And the rates are about a third of providers' stated rates. So you can argue that insurance co's actually do help keep medical costs down.

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Georgia Joe:

Once again, you are all missing the point. A new study out today by Hewitt states that costs for the average employer based plan will increase almost 9% from 2010 to 2011 and insurance costs will have doubled since 2001. Other than gasoline, I can't think of any other item in our economy that has doubled in cost in 10 years.

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StatyPolly:

Georgia Joe, that's because we use more healthcare than before. If you compare the exact same services and procedures, or apples to apples, you'll find that costs actually go down over time.

What drives costs up are new drugs, equipment, etc.. And not the least, evergrowing malpractice insurance.

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Georgia Joe:

You are partially correct. Malpractice is only a minor issue, most studies indicate it adds about 2% to costs and has remained relatively stable. Drugs are a huge issue. In a recent meeting with insurance brokers, they indicated that over use of prescription drugs is the fastest contributor to the growth of spending. I spent years on the board of a large integrated health care organization. Your premise about costs going down is wrong. Costs of most products and services increased every year. Unfortunately, we always found savings in two places, shortening hospital stays and driving more patients through a doctor's office at a reduced payment.

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BH:

"Medicare is single payer."

Medicare is also unfunded to the tune of 50-90 trillion dollars.. and even greater dirty little secret.

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seg:

Georgia Joe:
It is instructive that the greatest cost driver (drugs) was largely ignored in Obamacare because of a brazen political payoff. Constant political meddling and payoffs are the second biggest problems with government control of medical care. The biggest are inefficiency and poor delivery of services.

Insurance and government can reduce costs by denial of services and squeezing individual vendors. Both follow both services, but they are ultimately unsuccessful because of political pressure. The only way they can reduce cost substantially is by fooling us into thinking no better care is possible (see British system).

The government and insurance companies have every right and motivation to deny coverage of expensive treatments. However, I vehemently object to government using costs to suppress approval of treatments and drugs. In my view, they have no right to manipulate FDA approval or panel findings of efficacy of treatment on the basis of cost. Both are already happening and will happen with increasing frequency as Obama folks are appointed to boards and panel.

We kid ourselves when we say cost cannot be considered. We also kid ourselves when we try to make health care completely egalitarian by denying expensive care to the rich. That is a dog in the manger attitude (if I can't have it, nobody gets it). Worse, it ignores the reality that in every society known to history the rich/politically connected will always get the best the system has to offer. When the government rules the system, the difference is that the rich will use their superior political connections to get the government to pay for their extraordinary care.

For example, Ted Kennedy most likely had the government pay for his desperate measures to find treatment for himself, measures that will not be applied to us proles under Obamacare.

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Field Marshal:

Our costs are directly related to two things: the United States is the R&D driver for all new medical technology and pharma drugs, and medicare. We produce a HUGE disproportionate amount of both in this country and are basically carrying the rest of the world. 75% of new drugs come from the US or are funded by US consumers. 80% of medical tech also comes from here.

Sure, single-payer sounds nice and glamorous (to some, not to actual people who have used it like myself) but i bet if you asked the question to people who support if it they thought it was okay to basically stop advancing our medical technology, they would say no.

Medicare is subsidized by private insurance which is why its technically not single payer. In other words, medicare patients see the same doctors and stay at the same hospitals as private insurance patients. The only thing in this country that comes close to mirroring single payer is the VA system. And ask how many vets would approve of the state of that system!

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Georgia Joe:

Seg, other than attacking the reform bill, I'm not sure what point you are trying to make. The cost of our health care system as it is operating today and the trend that it is on is unsustainable. The political dialogue today is doing a great disservice to our future. The President did not frame the debate well and the Republicans have demogogued the issue. The public knows we have a problem, but the reform bill has been created as a false enemy. The enemy is the current system that is on course to bankrupt us all. The reform bill is a model that has been proposed by mostly Republicans for the past 30 years while Democrats have been pushing for single payer. The current debate is going to lead us to wasting years battling over the current bill rather than really attacking one of the most serious threats to our economic health.

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Field Marshal:

Georgia Joe,

The public knows we have a problem, but the reform bill has been created as a false enemy.

You mean just like Medicare and SS will?

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CompCon:

Georgia Joe, "The public knows we have a problem, but the reform bill has been created as a false enemy."

Nope - the enemy is the "reform" bill. This bill is 5% healthcare and 95% corruption, graft, payback, bribery, and liberal social engineering and the majority of the voters know it. It is not just a bad bill - it is a desructive and dangerous bill. This bill will kill people in the name of liberal "progress".

Some progress. Roll back our healthcare system to 3rd world standards and kill people. That's progress - Pelosi, Obama, and Reid style.

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Bukama:

With respect to pharmaceutical companies, the reason they have higher margins is because they are the one part of the health care system that is constantly producing (or trying to produce) new products/services.

A doctor or hospital (or insurance co.) is providing overwhelmingly a standard treatment or service. Some may provide the standard better than others (and be able to charge more), but generally, their is little opportunity to earn outsized profits beyond what the market will bear.

Drug makers invest a huge sum in R&D, in the hopes of generating a blockbuster drug - 1 out of 1000s of failed attempts every year. Our Patent system creates the ability to earn outsized rewards precisely to encourage such innovation. I think as a society, we want to encourage that level of risk taking in innovation.

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Georgia Joe:

CompCon: You tirade is an example of the type of commentary that is confusing the debate. The reform bill is more a Republican piece of legislation than Democratic. It is modeled on Romney care, a long standing Heritage Foundation plan and legislation proposed by Bob Dole and Howard Baker among others. You clearly know very little about the bill or you are getting your information from Rush and Sarah Palin. The uninformed scare tactics don't help inform they simple show ignorance.

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Georgia Joe:

Bukama: you are absolutely correct about the drug company margins. The real question is regarding their ability to drive consumption in the United States by advertising prescription drugs. I believe we are only one of two industrialized countries that allow drug advertising. The other issue regarding pricing is the Companies ability to sell to US customers at one price, but sell to the remainder of the world at a discount. Do we really need to pay full fair when many in the medical field believe that advertising is driving over consumption of prescription drugs?

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seg:

Georgia Joe:
I think great changes are necessary for our insurance system (not medical system). That in no way requires that I support Obamacare. I very strongly believe that Obamacare takes the worst features of our present system and makes them worse still. It will bend the cost curve, but in the wrong direction.

I am not sure the present system is truly "unsustainable (much that is "unacceptable" is accepted every day). However, I am convinced that Obamacare is unsustainable for the reasons I have listed.

My positive message is that I think the Libertarians are right on this one: too much government meddling has created an unwieldy monster, starting with the post WWII tax deduction for CORPORATE payment of health insurance cost. Like the tax deduction for interest payments, it has distorted the sector it was intended to promote and made it "unsustainable." Each wave of meddling has further eroded the effects of markets, with the usual effects thereof.

I believe that our society should make it possible for all Americans to receive at least a minimum level of health care. It should be done using market forces to the maximum extent possible. There should be NO government panels or NICE equivalents, no federal regulation of insurance, etc. Each patient should bear a portion of the costs they incur based on ability to pay. But never zero.

The insurance should not mimic a HMO. It should cover only the most serious problems. The poor should NOT have the same freedom to waste money on doctors as the rich enjoy. Sorry.

Each patient should have complete freedom to chose the medical treatment they want, whether you or I or the FDA or a panel of physicians approve or not. The only restrictions should be that it is actually a form of medical care, not a trip to Cancun.

The patient should have maximum freedom to make bad choices rather than having "experts" make blanket bad choices for everyone. Since I work with epidemiologists and academic physicians I have great respect for them and no belief in their infallability. Medical experts have been appallingly wrong appallingly often.

The FDA should have limited ability to remove drugs from the market. It is a close call whether they currently do more harm than good. Their infinite degree of chicken-sh*ttiness drives up the cost of medical astronomically and keeps drugs away from those who need them longer even than European countries. They should be required to balance opportunity costs against costs of detrimental effects of medicine. I think the results would surprise you.

The same problem is true with state and federal regulation of insurance: it ignores the cost of the regulation itself. A hard look at state regulations would reveal that many are meant to protect monopolies and oligopolies within the state.

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