Tens of millions of Americans lack health insurance. Extending coverage to them has been a core goal of health reform proposals since the 1960s. President Richard Nixon offered a universal health plan in his first administration, but since then Republicans have hesitated to commit the nation to so costly an undertaking. Is it time to rethink? Should Republicans accept universal coverage as a goal? We posed this question to NewMajority’s contributors.
The healthcare debate isn’t going away any time soon. If anything, despite the hue and cry televised at a number of town hall meetings across the country, the demand for reform will only gain momentum in the future. Universal coverage has been the trend in almost every other industrialized nation, and though many of our European and Asian counterparts have adopted some form of expensive, socialized medicine and inefficient central planning others, like the Dutch, have introduced market reforms designed to rein in costs and spur competition.
In the United States, Medicare costs will continue to squeeze the federal budget, and lawmakers will be faced with tough choices between further tax hikes, means-testing, or other reforms to help keep the program solvent, while rising private insurance premiums will continue to place a heavy burden on small businesses. While our healthcare is quite good, our system of providing it is far from where it should be, distorting costs and incentives and leading to out of control spending in the public and private sectors.
It’s time conservatives made health care reform their own – and not by mounting defenses of Medicare or by retreating to the status quo.
Employer provided insurance in the American system is anything but an example of the free market. Fifty different sets of regulations in fifty different states not only makes purchasing insurance on a national market impossible, it creates localized monopolies that drive up costs and create barriers to exit for consumers and barriers to entry for competitors. Employee provided coverage also creates a disconnect between the consumer of healthcare and their healthcare decisions, and that disconnect leads inevitably to higher spending.
Even worse, since employee coverage is the only affordable option for most Americans, health insurance is no longer portable, making mobility in the workplace far riskier than in other industrialized nations. Employee provided health insurance also places a huge financial burden on American companies, making them less competitive in the global economy, and stagnating wages for American workers.
Medicare is a huge, bloated government run healthcare entitlement which will eventually run out of money without major tax hikes or similarly decisive reforms. Yet, RNC chairman Michael Steele, laying out the case for a Senior’s Health Care Bill of Rights, wrote in Monday’s Washington Post,
The Republican Party’s contract with seniors includes tenets that Americans, regardless of political party, should support. First, we need to protect Medicare and not cut it in the name of “health-insurance reform.” As the president frequently, and correctly, points out, Medicare will go deep into the red in less than a decade. But he and congressional Democrats are planning to raid, not aid, Medicare by cutting $500 billion from the program to fund his healthcare experiment. The president also plans to cut hospital payments and Medicare Advantage, all of which will mean fewer treatment options for seniors.
According to the Pacific Research Institute, since 1970, the per-patient costs of all healthcare apart from Medicare and Medicaid have risen from $364 to $7,119, while Medicare’s per-patient costs have risen from $368 to $9,634.” And, since 2000, private “per-patient out-of-pocket costs have risen only 35% since 2000, while Medicare’s per-patient costs have risen 59%.”
This is not a fiscally sound program, and conservatives are wrong to defend it or any other entitlement with a politically inspired Bill of Rights. Imagine a future debate over Social Security and the ensuing Senior Citizens Retirement Bill of Rights. Indeed, Steele’s own argument could be used against him by replacing “senior citizen” with “47 million uninsured”, the common number touted by proponents of the public option.
Defending one entitlement to postpone another might make some political sense, but it puts Republicans on a poor footing to help enact the kind of healthcare reforms that conservatives should be pushing for.
Specifically, conservatives need to push for choices in healthcare, and the two steps most needed to create real healthcare markets are 1) ending huge tax subsidies for employer provided benefits and 2) replacing state-by-state regulations with one national regulator. These will open the door to a much more competitive insurance market, and much lower costs for individuals. Beyond this, there are other ideas conservatives should consider that could help to rein in costs and increase results.
Health savings accounts. Rowan Callick, writing in The American in 2008, discussed Singapore’s health care model which relies heavily on personal health savings accounts to reign in costs. While the Singaporean health care model itself may be too drastic a reform for the American public, finding ways to put the health care consumer back in charge of their own healthcare decisions is a reform that liberals and conservatives can both agree on. Rationing healthcare is necessary, but forcing the consumer to self-ration is the best way to contain costs. Interestingly, even though Singapore has largely socialized healthcare coverage beyond each individual’s own contribution to their Medisave accounts, Singapore’s government spends far less per capita on healthcare – $381 per person, or roughly one seventh what our government spends. The conservative Heritage Foundation ranks Singapore second on their Index of Economic Freedom, right after Hong Kong. The United States ranks 6th.
Vouchers. While Singapore’s health model rids itself of health insurance altogether, the Dutch have adopted an entirely market-based approach and have used smart regulations and government cost-subsidies to allow low income citizens and those with pre-existing conditions to still afford health insurance. Unlike the highly monopolized American system, the Dutch rely on fierce competition to keep costs low. They attain universal coverage but avoid the major government involvement that defenders of a public option are calling for. The government still plays a role, through cost subsidies and reinsurance programs that help level the playing field if one insurer finds itself with a disproportionate number of high-cost customers. Nevertheless, though the Dutch government involves itself very directly in health care, it still spends less per capita then the United States.
Reinsurance. In an article in the Los Angeles Times this April, Harold Luft argued that public and private entities can work together to provide better, cheaper insurance. Rather than setting up a public option to compete against the private market Luft argues that we should “allow private insurers to voluntarily buy into an expanded public pool. This would enable insurers to partner — rather than compete — with a public healthcare plan. This publicly chartered insurance would have the scope to offer bundled payments to physicians and hospitals that volunteer to come together and provide high-quality care to their patients. They would determine among themselves how to allocate resources. Public oversight of the plan would ensure transparency and fairness, and the operational aspects could be contracted to private intermediaries, just as Medicare does today. Medicare could also adopt such a bundled payment approach, reducing its costs while enhancing quality.” Whether or not Luft is right that this would actually reduce costs, it’s an example of a form of government partnership that avoids pitting government monopoly against natural markets. And one way or another, government will be involved in healthcare. The question is how.
In the end, simply doing nothing and playing the role of obstructionist and defender of the status quo is not an option. It may result in short term victories, but as long as meaningful reform doesn’t take place, the war will eventually be lost. Conservative implementation of universal healthcare is possible. Limited government can work to provide this very basic safety net, open up competition, choice, and portability of insurance, and lift major burdens on American business without creating a vast new entitlement. Beyond this, Republicans need to realize that healthcare reform is a moral concern. The problem, as John Avlon wrote earlier this week, “is that Republicans have allowed themselves to be painted as somewhere between agnostic to uncaring on the issue of healthcare reform.” It’s time to make healthcare reform a conservative goal, and this will never happen by defending the status quo or by writing a phony Bill of Rights to defend the already burgeoning entitlements we have now.
To read other contributions to this symposium, click here.
33 responses so far
1 liv&win // Aug 26, 2009 at 1:38 pm
Appologies for the double post. I think it is important to re-present this which was posted in another thread
The most cogent report on US health care and reform I have ever read. By a democrat.
http://www.theatlantic.com/doc/200909/health-care
2 balconesfault // Aug 26, 2009 at 1:44 pm
Singapore’s government spends far less per capita on healthcare – $381 per person, or roughly one seventh what our government spends
Average Singapore Physician Salary: $ 3,843/month (2005 US constant dollars – net monthly income).
Average US Physician Salary: $ 8,189/month
That’s one place to start when wondering how Singapore does it.
3 barker13 // Aug 26, 2009 at 3:36 pm
Re: Liv&Win // Aug 26, 2009 at 1:38 pm (#1) –
Yes, by all means folks, click on L&W’s link and read Goldhill’s piece.
Then… head on over to the “NM Symposium Part 2 Universal Coverage: Right Goal, Wrong Principle?” thread and consider the points I made. (And as well as getting my comments you’ll get a digest version of the Goldhill piece’s highlights.)
Re: Balconesfault // Aug 26, 2009 at 1:44 pm (#2) –
“Average US Physician Salary: $ 8,189/month”
Hmm. OK. Without getting into self-employment vs. salaried employment… let’s just stick with Balc’s number.
OK. $8,189 X 12 = $98,304
Hmm… doesn’t sound all that outrageous to me.
(*SHRUG*)
How’bout the rest of you…???
Balc… didn’t you once note that you’re a six figure guy with over $1,000,000 in assets? (Correct me if I’m confusing you with someone else.)
In any case… so, Balc… what do you believe an “appropriate” average salary for a PHYSICIAN should be… and while you’re at it, just for comparison sake… share with us if you will what you believe a kindergarten teacher should make and what a long haul trucker should make and what a carpenter should make and what an engineer should make.
(Hey… unless I have a compare/contrast “baseline” how the heck can I believe you’ve put any thought into the answer – right… fair enough?)
* E.D. Kain — How familiar are you with the views and proposals of myself and the other regulars here on NM? You might want to do a bit of thread browsing so as to give yourself an idea of the breathe and depth of views here. (Just a suggestion…)
BILL
4 sinz54 // Aug 26, 2009 at 3:53 pm
balconesfault: That wouldn’t explain it. America’s health care costs are roughly seven times that of Singapore, while America’s doctor salaries are a bit more than twice that of Singapore.
The real answer is that Singapore imposes compulsory savings, price controls–AND supply controls. That is, they force every worker to contribute to a government fund via payroll tax (similar to how we fund Social Security). It’s a lot easier to do that in Singapore, because their top marginal tax rate is only 28% to begin with.
And in Singapore, when prices charged by hospitals rise in some locale, they automatically build more hospitals in that locale to drive the price down by increased supply there. That would be impossible to replicate in America, with our separation of powers between the Federal government and the states. That works in a small island but it won’t scale up to the U.S.
5 ottovbvs // Aug 26, 2009 at 6:30 pm
“A new survey commissioned by the AARP asks respondents to what degree they support or oppose “[s]tarting a new federal health insurance plan that individuals could purchase if they can’t afford private plans offered to them” — a public option, in other words. The results are interesting, though not necessarily surprising to those who have been closely following the debate.
All: 79 percent favor/18 percent oppose
Democrats: 89 percent favor/8 percent oppose
Republicans: 61 percent favor/33 percent oppose
Independents: 80 percent favor/16 percent oppose”
………any questions?
6 ottovbvs // Aug 26, 2009 at 6:33 pm
barker13 // Aug 26, 2009 at 3:36 pm
“OK. $8,189 X 12 = $98,304
Hmm… doesn’t sound all that outrageous to me.”
….Heh mastermind…….that’s the average…..so it includes those thousands of interns earning about 45 k while the complete the last two years of their medical education……want to know what the median is?
7 ottovbvs // Aug 26, 2009 at 6:53 pm
“OK. $8,189 X 12 = $98,304
Hmm… doesn’t sound all that outrageous to me.”
……….Ok Baarking just for you here’s a link to median incomes by medical specialty in 2007(median btw means half earned above this figure and half below it which makes it a much more reliable guide than averaging)……as you’ll see the median for specialisations is $350-500 k and that means if you’re a reasonably successful radiologist, oncologist or orthopaedic surgeon with say 15 years of seniority you’re making $750-$1million a year……if you’re outstanding you’re going to be making well over a million!!!
hhp://www.aafp.org/online/etc/medialib/aafp_org/documents/press/charts-and-graphs/median-income-by-specialty.Par.0001.File.tmp/MedianIncome2007.pdf
8 ottovbvs // Aug 26, 2009 at 6:55 pm
……Sorry……dropped some characters off the url
http://www.aafp.org/online/etc/medialib/aafp_org/documents/press/charts-and-graphs/median-income-by-specialty.Par.0001.File.tmp/MedianIncome2007.pdf
9 barker13 // Aug 26, 2009 at 9:10 pm
So, E.D. Kain, are you another one of Frum’s “contributors” who won’t engage in a back and forth discussion with posters?
I dropped by “The League of Ordinary Gentlemen” and you seem to welcome feedback there.
Join us! (Ignore Ottovbvs – just skip over his comments – and you’ll be fine.) (*WINK*)
BILL
10 sinz54 // Aug 26, 2009 at 9:18 pm
ottovbs asks: “any questions?”
Just one:
Why should ANYONE believe a push poll from AARP, a known advocate of ObamaCare, over the VERY different results being reported by Gallup, Rasmussen, and ABC News?
http://online.wsj.com/article/SB20001424052970204313604574330442429438938.html
http://www.rasmussenreports.com/public_content/politics/mood_of_america/america_s_best_days
http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/august_2009/voters_say_they_know_health_care_bill_better_than_congress
http://www.realclearpolitics.com/epolls/other/president_obama_job_approval-1044.html
http://www.gallup.com/poll/122255/Amid-Debate-Obama-Approval-Rating-Healthcare-Steady.aspx
If you want to play games with polls, you’re going to lose big.
Don’t even bother trying to foist a poll sponsored by an ADVOCATE or
11 sinz54 // Aug 26, 2009 at 9:20 pm
the rest of my post got cut off accidentally.
Don’t bother trying to foist a push poll from an ideological advocate (or an ideological opponent for that matter).
One more thing: If those Blue Dog Dems thought that ObamaCare was popular with the constituents in their own states and own districts, they would be rushing to get it passed.
They know it’s not. And THAT is the main reason they’re dragging their feet.
12 ProfNickD // Aug 26, 2009 at 10:21 pm
If you want to substantially lower the salaries of physicians, as some posters here are suggesting, then you will receive treatment relative to that lower salary.
In other words: if you want to pay Yugo salaries to physicians, then you can’t reasonably expect Mercedes S-class treatment.
There is no free lunch — it’s clear that a lot of people want to get “free” medical care, while simultaneously expecting that medical care to be the best in the world. Sorry, it doesn’t work that way. If you want to pay nothing, or very little, for a service then you will receive that level of service and not the level of service had you paid more.
13 balconesfault // Aug 27, 2009 at 4:27 am
There is no free lunch — it’s clear that a lot of people want to get “free” medical care, while simultaneously expecting that medical care to be the best in the world. Sorry, it doesn’t work that way. If you want to pay nothing, or very little, for a service then you will receive that level of service and not the level of service had you paid more.
I agree in part. You certainly can’t expect taxpayer funded Universal care to provide the best of the best of everything to everyone.
The question I see is whether there is a benefit to society of providing a certain level of service to everyone, regardless of circumstance.
14 barker13 // Aug 27, 2009 at 7:33 am
Re: Balconesfault // Aug 27, 2009 at 4:27 am (#13) –
Balc. Why the dance? Why ignore my question (post #3) which came in response to YOUR post #2?
Hey… YOU brought up physician salaries…
(*SHRUG*)
And now, in response to Profnickd (post #13) you seemingly say “nevermind” to your OWN previous comment (#2).
(*SNORT*)
Balc, do you really believe that a combination of ignoring reasonable questions and moving the goal posts is your best tact?
(*SNORT*)
BILL
15 E.D. Kain // Aug 27, 2009 at 10:13 am
Sorry – didn’t mean to not respond. Just a very busy day of coding at my other site, plus busy day at the office, plus getting over a cold. So. Let’s see.
Regarding physician salaries – I think it’s a moot point. If we had fewer barriers to entry in the medical practice we’d have more low-cost providers doing quality work. For instance, “barefoot doctors” and nurses who could set bones, sew stitches, and tell people that it’s just a cough and it will go away with rest and chicken soup and bad television. They wouldn’t need expensive medical school or nearly as high of malpractice insurance, and yet most people’s day-t0-day needs could be met by seeing them. This would also create more competition for regular doctors who would have to lower the cost of their services in order to compete. Obviously there are still problems in how medical malpractice suits are handled, but I don’t see any simple way of reforming that at all.
Also, I’d say freeing up competition in the drug business would be a good way to drive down costs. The drug market is far too protected.
Beyond this, putting health care financial decisions back in the hands of consumers will naturally drive down costs because people will have much more of an incentive to be stingy. HSA’s are very good at this, providing both incentive to save and incentive to get the proper, needed medical care.
16 liv&win // Aug 27, 2009 at 11:30 am
RE ed-kain, Lets start with what we want, and then build something that provides that. Reasonable access to quality health care at an affordable price that is free from government AND insurance company bureaucracy and provides choice of providers.
You comment above illustrates one of the points I have been making, and that is, health reform must include some method of (a) decreasing the cost of medical school, (b) providing incentives to get more primary care physicians to practice, (c) remove artificial limits set by doctors regarding who can do what, and let nurses (nurses, nurse practioners, medical assistants) do more direct care on the dozens of procedures that they are fully capable of doing, and (d) begin an educational framework in schools which discusses health reform, specifically, 1, educating the next generation on basic medical issues, 2. educating them on self-care (diet, nutrician, exersize, coping skills, first aid and where to get help when they need it.
This is the start of consumer oriented changes which will positively affect both supply and demand and will result in lower costs of primary care.
As you may know, the resulting system I am proposing is a two-tiered along the lines of primary care and all other care. Primary care would organized regionally into medical homes where all a consumer’s primary health care needs can be addressed: medical (pediatric, internal and geriatric medicine), nurses, urgent care, dental (oral health – cleanings), vision (exams and prescription issuance), hearing (exam and prescription issueance), mental (all basic, non-severe counciling), and chiropractic/accupuncture. There would be no insurance and limited government intrusion. This would be organized regionally and the consumer would pay into their regional district which would hire and pay the salary directly for the primary care providers. Highly limited adminstration, limited malpractice, no middleman, drastically reduced costs.
In the secondary program, health care would be provided similarly to Medicare supplements. Every specialist and every hospital would be available to every consumer. This would be an insurance based system and also provide full portability and guaranteed issue coverage. We would identify, through quality assessments, who the best, second best, third best, specialists and facilities are and pay them more for quality. A podiatrist, right out of internship would be paid at Medicare rates. With training, education, experience and quality outcomes, that podiatrist could earn 1.2, 1.4, 1.6, 1.8 or 2.0 times Medicare. The best get paid the most, rather than the current system, where they all get paid the same. The consumer can design a plan with a large array of deductibles and out of pocket cost limits, and could choose which level of care his plan is going to reimburse (1.0, 1.2, 1.4, etc.) The consumer that could afford the 1.0 plan could still see the 2.0 doctor (if he could get in), but the insurance he purchased would leave him with non-reimbursed out of pocket costs. This is fair, effective and transparent. More importantly, it is at least a serious discussion on how to provide reasonable access to quality health care at an affordable price that is free from government and insurance company bureaucracy and provides choice of providers.
We need to start thinking about solving problems, not creating new ones.
17 barker13 // Aug 27, 2009 at 7:46 pm
Re: Ed-Kain // Aug 27, 2009 at 10:13 am (#15) –
“If we had fewer barriers to entry in the medical practice we’d have more low-cost providers doing quality work. For instance, “barefoot doctors” and nurses who could set bones, sew stitches, and tell people that it’s just a cough and it will go away with rest and chicken soup and bad television. They wouldn’t need expensive medical school or nearly as high of malpractice insurance, and yet most people’s day-t0-day needs could be met by seeing them. This would also create more competition for regular doctors who would have to lower the cost of their services in order to compete.”
I totally agree. More nurse practitioners. Definitely!
“Obviously there are still problems in how medical malpractice suits are handled, but I don’t see any simple way of reforming that at all.”
Just in general, I believe we should rely more on criminal law and less on civil tort actions. For example, if a doctor – or indeed anyone – acts in a manner that violates the simple “smell test” of criminally irresponsible vs. just a plan old mistake… well… off to jail you go my friend and a suitable “fine” goes directly to the injured party.
Otherwise… where we’re talking mistakes… awards have to be reasonable and “guilt” has to be more a matter of fact and analysis than emotion or courtroom storytelling skills.
Me? I’d like to see us move to a modified “loser pays” system, similar to what the Brits have. Couple this with stricter criminal enforcement and I believe the public interest is served. (*SHRUG*)
“Also, I’d say freeing up competition in the drug business would be a good way to drive down costs. The drug market is far too protected.”
Not quite sure what you’re talking about here – what you’re specifically referring to or proposing.
In any case… me… I’d INCREASE patent protections in both length and severity – meaning I tend to favor the “inventor” over the widget maker who just follows instructions to mix up a formula another has worked to perfect. I’d also like to hear what international experts have to say about the FDA in terms of are they simply being “safer than safe” with regard to how long drug approvals take OR are they doing more harm than good in gumming up the works when it comes to getting cutting edge drugs approved and on the market.
Oh… and I’d regulate pharm advertising much more heavily than it is now. I’m not even sure that prescription drugs should be “advertised” as such. (I’m not saying the public should be kept in the dark, only that one should have to do the actual research and perhaps the government – in cooperation with the pharm companies and academia – would be acting in the long term public interest by insuring via regulation that folks who were interested in prescription medications be basically steered towards their doctors and authoritative sources focusing on info, not glitz; info, not marketing.
Thanks for responding, Ed!
BILL
18 barker13 // Aug 27, 2009 at 7:55 pm
Re: Liv&Win // Aug 27, 2009 at 11:30 am (#16) –
“…decreasing the cost of medical school…”
Yeah. I’m sympathetic. HOWEVER…
(*SHRUG*)
Government doesn’t exactly have the best record for decreasings costs/spending on… er… anything.
Take away the actual specific military equipment and military training component of the facilities and compare West Point, Annapolis, Colorado Springs, and New London, CT. to both their private and public peers… I’m not confident in guessing their costs per pupil are lower; in fact, I’d guess they’re higher. (I might be wrong… I’m just throwing it out there.)
“…providing incentives to get more primary care physicians to practice…”
Such as…??? It’s my understanding that it’s all the governmental and insurance company regulation that ALREADY exists which make most doctors who leave medicine or retire early do so. Government would have to promise to get out of the way; the “other side” wants MORE government involvement.
(*SIGH*)
Anyway, I’ll address the rest of your post later, L&W; looks like you have some interesting ideas worth exploring.
BILL
19 barker13 // Aug 27, 2009 at 11:07 pm
Re: Liv&Win // Aug 27, 2009 at 11:30 am (#16) –
“Primary care would organized regionally into medical homes where all a consumer’s primary health care needs can be addressed: medical (pediatric, internal and geriatric medicine), nurses, urgent care, dental (oral health – cleanings), vision (exams and prescription issuance), hearing (exam and prescription issueance), mental (all basic, non-severe counciling), and chiropractic/accupuncture. There would be no insurance and limited government intrusion. This would be organized regionally and the consumer would pay into their regional district which would hire and pay the salary directly for the primary care providers. Highly limited administration, limited malpractice, no middleman, drastically reduced costs.”
“Organized regionally” by whom…??? Under what authority…???
“…their regional district…”
Huh…??? Again, first I need to understand what you’re talking about with these “regional organizations.” Who is running them? Under whose authority (sponsorship? ownership?) are they being created…???
“…hire and pay the salary directly for the primary care providers.”
I’m still confused about “who” (or “what”) it is you see as the “owner” or control mechanism.
Next… what if doctors don’t WANT to work for a “regional district…???” What if a doctor chooses to remain a sole practitioner?
“In the secondary program, health care would be provided similarly to Medicare supplements. Every specialist and every hospital would be available to every consumer. This would be an insurance based system and also provide full portability and guaranteed issue coverage. We would identify, through quality assessments, who the best, second best, third best, specialists and facilities are and pay them more for quality. A podiatrist, right out of internship would be paid at Medicare rates. With training, education, experience and quality outcomes, that podiatrist could earn 1.2, 1.4, 1.6, 1.8 or 2.0 times Medicare. The best get paid the most, rather than the current system, where they all get paid the same.”
So government is setting prices…??? Ultimately all doctors work for the government and accept whatever payment the government decides is adequate based on a rating formula decided upon by… er… government?
Perhaps I’m just tired… but I’m not sure I’m understanding your proposal fully.
BILL
20 liv&win // Aug 28, 2009 at 2:12 pm
Hi Bill, first, is there a quick way to follow all these threads so I can know when you post a question directly to me? Just wondering.
Organized regionally” by whom…??? Under what authority…??? “…their regional district…”
Well, that has to be determined. I start with the premise that health care is largely local. If you separate primary care from specialty/facility care, I would say that all primary care is local, and most specialty/facility care is local.
That being the case, I see this as being organized as a private/public partnership with local government, citizen committees and provider committees. Don’t take this analogy too deep, but my idea is not too dissimilar to school districts where there is govt, PTA and teacher representation.
Under what authority? Well, that is a very detailed question. My first comment is that who is the target audience and what current legislation exists that needs to be addresses? Remembering that my implicit goal is universal coverage, everyone would be part of this new arrangment. And the authority would have to be granted to the states to grant it to the local government or government enabled organisation. So, in my community (13000 people) we could pull this off ourselves. In a large metropolitan area, it would be too unweildly and non-local to use the large city government, so I would want them to authorize local cooperation.
Next… what if doctors don’t WANT to work for a “regional district…???” What if a doctor chooses to remain a sole practitioner?
Freedom baby. Yes, they are free to do what they want. But my plan is designed to give them a huge incentive to join. To wit, first, our monthly contribution includes a kicker for new primary care doctors. If they practice in a primary care setting, and stay for 5 years, we’ll reimburse the cost of their education. Also, since there is no insurance mechanism, the estimated 30+% of time doing administrative tasks not directly associated with patient care are eliminated. Next, for the new doctor especially, but for any that joins, we will be essentially guaranteeing something close to 2000 patients, right away, from the local community. The doctor doesn’t have to hang a shingle, and hope to make enough to make his payments. Most of that “business stuff” is eliminated. Next, we are paying a flat salary from day one. That is going to appeal to many. There are practice benefits too. If your patient roster is based on who is in your local community, not what insurance they have, this primary care doctor has the opportunity to be your doctor for as long as you live there. that is a benefit to the patient and the provider. Also, if the patient agrees to all this, he will also agree to not sue for medical errors. We will greatly reduce the need for malpractice insurance. Like you said somewhere eles, criminal complaints might be a better way to address this. There is also openness. We won’t hire or keep a doctor who is bad in terms of quality. We fire em. The bottomline, is that there is enough encentive to to the doctor to work for less. We are paying him close to the same net, saving on the gross.
“In the secondary program, health care would be provided similarly to Medicare supplements. Every specialist and every hospital would be available to every consumer. This would be an insurance based system and also provide full portability and guaranteed issue coverage. We would identify, through quality assessments, who the best, second best, third best, specialists and facilities are and pay them more for quality. A podiatrist, right out of internship would be paid at Medicare rates. With training, education, experience and quality outcomes, that podiatrist could earn 1.2, 1.4, 1.6, 1.8 or 2.0 times Medicare. The best get paid the most, rather than the current system, where they all get paid the same.”
So government is setting prices…??? Ultimately all doctors work for the government and accept whatever payment the government decides is adequate based on a rating formula decided upon by… er… government?
Well, the truth is this, we need to start somewhere. We can’t get to where you and I would generally want to go without interim steps. The truth is that medicare seems like a good place to “price” things. Also, there is a little political reality here. Specialists and facilities are different animals than primary care providers. I have anntedotal evidence from my father-in-law who is a retired doctor. Doctors group into pecular subsets. They are by no means similar throughout. Internists have a very different personality than do surgeons. On and on down the line. So its a little like hearding cats.
Medicare rates give everyone a very distinct understanding of the costs. We start with entry level rates and work up from there. It is easy to understand, rather than making someone “know” that the laws of supply and demand are working. Medicine just doesn’t work that way. Doctors control supply and demand to a large extent. Controlling their fees is perfectly logical. It is the way things are done now.
As for now, my other explicit goal is to reduce costs, NOW. So this is one way to get it done. And I don’t decimate an entire industry to make it happen either. I reduce the size, yes. I reduce the labor force, yes. But my plan provides reasonable access to quality health care at an affordable price while eliminating (ok, dramatically reducing) government and isurance company bureaucracy while mainting choice of providers. More questions please
21 barker13 // Aug 28, 2009 at 4:44 pm
Re: Liv&Win // Aug 28, 2009 at 2:12 pm (#20) –
“…is there a quick way to follow all these threads…”
I don’t know. Not that I know of. I do it the old fashioned way… I click and scroll. (*WINK*)
“…a private/public partnership with local government, citizen committees and provider committees. Don’t take this analogy too deep…”
(*GRIN*) You read my mind with the “don’t take this analogy too deep” line. (*CHUCKLING*)
Obviously you realize what this “sounds” like. I’m just not a big fan of mandatory “partnerships.”
“…my idea is not too dissimilar to school districts where there is govt, PTA and teacher representation.”
Now I KNOW I don’t like the idea! (*LAUGHING OUT LOUD*)
I live in a relatively wealthy and sophisticated school district. Let me tell you… they’re not exactly a model of cost conscious efficiency.
Perhaps we’re talking past each other… perhaps I’m not fully “getting” what you’re trying to get across to me… heck, perhaps we simply disagree! (*GRIN*) (*SHRUG*) Hmm… let me keep reading…
“…my implicit goal is universal coverage…”
So is mine; universal coverage prefaced with universal PAYMENT… universal LIFE-LONG CONTRIBUTIONS and LIFE-LONG PERSONAL RESPONSIBILITY.
(*WINK*)
“…everyone would be part of this new arrangement…”
Christian Scientists too…??? (*SHRUG*) Hey… partly just throwing it out for “effect,” but it is a serious consideration; what do we do when “pragmatism” runs into… er… Constitutional protections?
(Anyway… let’s leave that aside for now; just throwing it out for purposes of future reference.)
“If they practice in a primary care setting, and stay for 5 years, we’ll reimburse the cost of their education.”
Very generous… with MY money. (*RUEFUL SMILE*)
Hmm… sounds like more market distortion – more social engineering with government picking winners and losers – to me. Plus… philosophy aside… it just sounds like cost shifting to me – moving the money around; instead of education loans being paid off out of high salary you’re talking education loans being paid off courtesy of taxpayer (oops… “regional membership”) largess. Either way the high costs of medical school remain – you’re just shifting how they’re shouldered. Ultimately, either via direct payments or via premiums, we’re still spending the same money. (*SHRUG*)
“…since there is no insurance mechanism…”
(*HEADACHE*)
I write “headache” not to signify a critique of your viewpoint, but because once again I’m confused. I’m sorry, L&W, I just can’t seem to keep a clear picture of your overall proposal straight in my head; it’s just too broad and complicated. I’m sure it’s me and not you. Still… it is what it is.
“…administrative tasks not directly associated with patient care are eliminated…”
So you say… but I’m not seeing it. (*SHRUG*) Again… returning to YOUR analogy of the school district… talk about your frigg’n bureaucracy…!!! Regardless of “who” or “what” the actual medical practitioners “working for,” it seems to me to be a pie in the sky dream to assume that anything “government related” is going to be LESS bureaucratic. (*SHRUG*)
(Are you following me…???)
“…for the new doctor especially, but for any that joins, we will be essentially guaranteeing something close to 2000 patients, right away, from the local community.”
Well… (*PAUSE*)… only if we assume your plan is smoothly put into play with a minimum of opposition from the EXISTING structure and the existing doctors who paid off their student loans decades ago. (*WINK*)
“…we are paying a flat salary from day one…”
(*SIGH*)
L&W, I hate to come across as overly negative, but again… returning to YOUR analogy of a school district… what you propose sounds suspiciously like the way we pay TEACHERS and other school employees. (*SHRUG*) No accounting for supply and demand. No accounting for ever changing realities. It sounds like a recipe for mediocrity. (*SHRUG*)
“We won’t hire or keep a doctor who is bad in terms of quality. We fire em.”
(*SMILE*)
Sounds good in practice… BUT… we’re back to the “we.” Who is this “we?” And again… going back to the school district model… heck, going to the government model overall… it hasn’t worked the way you propose anywhere else government is involved – why would your proposed health system be any different?
I don’t know, L&W… it sounds pretty utopian to me. (*SHRUG*)
Anyway, L&W, what I like and appreciate about this discussion is that we’re HAVING this discussion! We’re actually going back and forth over DETAILS!
(Of course we’re mainly alone… but, still… I retain hope that others will join our model…)
I still like my plan better. I use broader brush strokes, focus more on concepts vs. “flow charts,” and perhaps because of this I’m fairly confident in saying that I believe my plan is both simpler and easier to follow.
“My plan” is all over this website. (*WINK*) (*GRIN*) I’ve outlined it time and again in thread after thread. Funny thing… I don’t recall many (any!) of my fellow posters responding to it in the way I regularly respond to others’ posts – this exchange with L&W being an excellent example of what I’m referring to.
We need to LISTEN to each other more. We also need to CRITIQUE each other SPECIFICALLY.
Folks… if any of you (and I know there ARE a few of you!) are truly interested in reaching some sort of theoretical consensus on broad outlines of “reform,” then we’ve got to “define” the specifics of “reform” in terms of concepts we like and don’t like, concepts that we’d compromise on vs. what we wouldn’t compromise on.
THEN… when we’re done… David Frum can distill our wisdom, claim it for his own and…
(*HUGE FRIGG’N GRIN*)
Just KIDDING, David! Just throwing it out to see if you’re paying attention… (Not that we’d ever know!)
BILL
22 liv&win // Aug 28, 2009 at 6:42 pm
“…my idea is not too dissimilar to school districts where there is govt, PTA and teacher representation.”
Now I KNOW I don’t like the idea! (*LAUGHING OUT LOUD*)”
I am laughing too. I know the paradigm is hard to imagine. And perhaps it is totally unworkable. But let me try to clarify.
“So is mine; universal coverage prefaced with universal PAYMENT… universal LIFE-LONG CONTRIBUTIONS and LIFE-LONG PERSONAL RESPONSIBILITY.” So far so good! We be brothers!
“I live in a relatively wealthy and sophisticated school district. Let me tell you… they’re not exactly a model of cost conscious efficiency. ”
No perhaps they are not the model of efficiency, but having a sophisticated school district is a major factor in the quality of life, and the sense of community your home town has. In any event, my analogy was a 60,000 foot view of what might be a similar, community-based, public service (education or health care) model.
“…everyone would be part of this new arrangement…”
Christian Scientists too…???
Here’s the thing…primary care IS different than just about all other health related care. It is relatively finite, it is limited in scope, it is not complicated (generally speaking), it is routine.
Part of my inspiration is from Henry Kaiser (kaiser steel) who was one of the first to hire doctors directly to take care of the primary care needs of his workers and their families. It was a benefit to him (productivity was enhanced) and a benefit to the workers (health costs were taken care of and care was convenient). But we don’t all work for major employers and those of us that do, don’t typically share many commonalities. But we all live somewhere and we all can band together in our community.
“but it is a serious consideration; what do we do when “pragmatism” runs into… er… Constitutional protections?” Like Medicare eligible have alternatives? Not that I am throwing Medicare out as a model, (we’ve been there done that, right
), but I don’t see that as being a problem. There is still choice of providers. All that we are doing is, on a community basis, pre-paying for primary health care.
“Hmm… sounds like more market distortion – more social engineering with government picking winners and losers – to me. Plus… philosophy aside… it just sounds like cost shifting to me – moving the money around; instead of education loans being paid off out of high salary you’re talking education loans being paid off courtesy of taxpayer (oops… “regional membership”) largess. Either way the high costs of medical school remain – you’re just shifting how they’re shouldered. Ultimately, either via direct payments or via premiums, we’re still spending the same money. (*SHRUG*)”
Well, you have a point, but consider this. There is a goal of increasing access. We have a shortage of primary care doctors and nurses. Money is a major factor in a doctors decision to practice primary care. We need to increase the number of primary care doctors. How do we do this? We pay them well, give them persistency rewards and hope to hang on to them. Look, let’s say it takes a doctor 7 years to repay his loans. For the next 30 years, he is charging a fee which is essentially based on him paying off that loan time and time and time again.
think of this…if the average take-home salary of a primary care doctor is $150,000. And the optimum practice size is 2000 patients. What is the cost to just pre-pay the doctor? That is $6.25 per person per month. Perhaps this makes better sense. That is 6.25 with no deductibles, no coinsurance, nada. The average gross income is more like $300,000, but with payroll and rent and insurance and the 30+% of him time spent filling out insurance paperwork, he nets $150,000. We save, he wins.
“So you say… but I’m not seeing it. (*SHRUG*) Again… returning to YOUR analogy of the school district… talk about your frigg’n bureaucracy…!!! Regardless of “who” or “what” the actual medical practitioners “working for,” it seems to me to be a pie in the sky dream to assume that anything “government related” is going to be LESS bureaucratic. (*SHRUG*) ”
Yes, I am with you. But, optimistically speaking, this is an entirely new paradigm, with which comes the opportunity to re-write the rules. Most of the admin grunt work is very effectively addressed in electronic medical records. I don’t know if you have been able to check these out, but my doctor uses them. I get my care from a group, so all my records are integrated. they are not simply Word docs on a computer, but very sophisticted software that does a lot of nifty things. All kinds of reports can be generated by whatever adminstrative need there is, with a little programming and the ability to push the F9 button. More cool is that all lab tests, including x-rays are digitized. I get a x-ray at the remote lab, and instantaneously, my primary care doctor gets notified and can see the x-ray. Lab results are done the same way. When he writes a prescription, he asks me which pharmacy I want to use, then instantaneously send the electronic prescription to that pharmacy. If I need a referral to a specialist, he can pull up the schedules of each specialist in the group, and refer me to the one that has the most immediate availablility. If time is urgent, he has authority to slot me in anywhere at anytime. Obviously, by re-writing the rules, and letting technology do its thing, we can reduce the administrative bueaurocratic BS dramatically.
“Well… (*PAUSE*)… only if we assume your plan is smoothly put into play with a minimum of opposition from the EXISTING structure and the existing doctors who paid off their student loans decades ago. (*WINK*)” Again, primary care doctors are a different breed than most other doctors. My vision has something in it for everyone. As my dad says (the consumate salesman), I don’t know what their hot button will be, but I have a bunch of answers for whatever turns them on.
“We won’t hire or keep a doctor who is bad in terms of quality. We fire em.”
(*SMILE*)
Sounds good in practice… BUT… we’re back to the “we.” Who is this “we?” And again… going back to the school district model… heck, going to the government model overall…”
Well, Bill, you can’t fire em now. Do you know what it takes for a doctor to get his license suspended? Do you know what it takes to find out about malpractice claims and other complaints?
Bill, I like your ideas. I just think that I have a stronger sense of what people want. They want low cost coverage that is simple to understand within a system that is designed to protect their interests. I don’t think there is any other way to explain why 80% of the people (or was it higher) are very satisfied with their health insurance/care. their employer pays a large percentage of the cost, and it is pretty straight forward coverage.
“Folks… if any of you (and I know there ARE a few of you!) are truly interested in reaching some sort of theoretical consensus on broad outlines of “reform,” then we’ve got to “define” the specifics of “reform” in terms of concepts we like and don’t like, concepts that we’d compromise on vs. what we wouldn’t compromise on.”
I agree. My ideas start with a goal. reasonable access to quality health care at an affordable price, which also reduces (ok, I have said eliminates) government and insurance company bureaucracy and provides a choice of providers. In broad outlines, I think my concept addresses that. But there are also a lot of data points that need to be addressed. Call them system shortcomings, call them human behavioral tendencies, call them philosophical concepts…but they need to be addressed. Some of these i have tried to address: access, quality and cost. Perhaps there are more data points that I didn’t address, but I am certain I addressed a lot of them.
Did I respond to your comments Bill?
23 barker13 // Aug 28, 2009 at 9:49 pm
Re: Liv&Win // Aug 28, 2009 at 6:42 pm (#22) –
“There is a goal of increasing access.”
Yes.
Where the discussion gets… er… interesting… is when we start debating the price. (*GRIN*) What price am I willing to pay to meet this goal? What price are you willing to pay? What price are we ALL willing to pay. There lies the heart of the discussion. (*WINK*)
“Do you know what it takes for a doctor to get his license suspended? Do you know what it takes to find out about malpractice claims and other complaints?”
Yes. And frankly that’s probably a good thing. Still, as you know and as we agree, when it comes to “bad” doctors, my response is that we make it easier to take their licenses and indeed make PRISON the response to a certain level of depraved indifference/incompetence as opposed to simply passing on the cost of a monetary award to an insurance company.
In other words, L&W, we’re not all that far apart where I UNDERSTAND you… (*GRIN*)… it’s where I’m genuinely confused that I’m not so sure we’re not far apart.
(If that makes any sense; it’s certainly an unwieldy sentence!) (*HUGE FRIGG’N GRIN*)
“Bill, I like your ideas. I just think that I have a stronger sense of what people want.”
Yeah. I don’t really give a flying f–k what “people want.” (*CHUCKLE*) Me…??? I’m just laying out what I feel is the best rough blueprint for a system that would work and give the most bang for the buck at the lowest cost in personal freedom.
(*SHRUG*)
I mean, L&W… what the people “want” is a free frigg’n lunch.
What the people “want” is for someone else to do the heavy lifting.
We need our scumbag politicians – the ones with enough brains to understand simple reality – to EXPLAIN to “the People” why they can’t have what they want in this case and why in light of economic reality and the traditions and ideals of our nation the “Barker Plan” is the only way to go.
(*WINK*) (*SMILE*)
“They want low cost coverage that is simple to understand within a system that is designed to protect their interests. I don’t think there is any other way to explain why 80% of the people (or was it higher) are very satisfied with their health insurance/care. their employer pays a large percentage of the cost, and it is pretty straight forward coverage.”
Yes. I understand! And I want to rub our old Farberware Percolator (buried in a cupboard somewhere no doubt) and have a Genie come out (looking like 30 year old Barbara Eden) and grant me my three frigg’n wishes…
(*SHRUG*)
L&W. If we’re going to go to the trouble of proposing “solutions”… (*SIGH*)… why not at least stick theoretically to what would be the best solutions regardless of political viability. Anyway… that’s what I’d like to do. (*SHRUG*) That’s what I’m doing.
“Did I respond to your comments Bill?”
You tried! You gave it a game effort! (*WINK*) I’m sorry to say, however… (*SIGH*)… no… I’m still not clear on the model. As I keep on saying… it’s probably me.
You’re used to my writing style. Take out the (*SMIRKS*) and the (*HUGE FRIGG’N GRINS*) and no doubt you’ve noticed that I have a fairly meticulous approach to writing – laying out the groundwork, the concepts, and then filling in details as I go in as linear a fashion as possible.
You’re throwing too many unfleshed-out concepts at me and I’m just not able to connect them in such a way as to make out the forest for the trees. I apologize. I’m NOT trying to be difficult – really, I’m not.
ANYWAY… glad you like my proposal – at least in theory.
I’d sure as hell like to hear others’ reactions to my basic “plan.” I’m open to criticism and disagreement… I’d just like the criticism and disagreement to be specific.
BILL
24 liv&win // Aug 29, 2009 at 12:54 pm
Bill, I thought about it last night. Here is another paradigm which may help you understand my proposal. I didn’t previously use this because there is often a knee jerk reaction from many…but, here it goes. Primary care, as I have described it above, is provided by community-based HMOs which hire the doctors, not unlike Kaiser Permanente. Never been to a Kaiser clinic? You walk in, give the receptionist your card…lab is over there, x-rays are over there, pharmacy downstairs, mental health upstairs, the nurse practioner does her thing, your PCP does hers. If you need anything that is provided in that building, and you got it. Kaiser clinics are largely primary care only and are unbelievably easy and cost efficient. The list price for an office visit at Kaiser is 50% what it is at my private PCP charges.
Bill, I do appologize. I have been in theoretic mode for so long on this issue. I am eager to run my proposal around the block. But theory has to meet reality…
Kaiser is not all that different from Cleveland Clinic and other well regarded, low cost, high quality operations.
And of course, in my paradigm, specialty and facility care is private where insurance plans, similar to medicare supplements (highly regulated, uniform specific plans from A-F).
As I pointed out, if you wanted to hire a primary care physician to serve the needs of you and 1999 of your neighbors, the cost of the salary is $6.25 per person per month.
I know this isn’t what YOU want, but I am certain if I tried to sell this, I would have a lot of people who would much rather pay $6.25 per month and never have to be concerned about access or cost, than the alternative.
I would add, that this has a very dramatic impact on the cost of the insurance for specialty and facility care. The two biggest impacts are on administration and insurance costs. Relative to administration, by doing a paperless primary care model, more than 80% of the claims/admin/paperwork is eliminated than a comprehensive insurance plan. Admin costs are further restricted, because the claim payment is based on a scheduled fee, versus fee-for-service. I don’t want to get bogged down in this area, but by eliminating primary care claims, and administering a fee scheduled plan, administrative costs can be reduced to 6% from 20%. This alone can fully counteract the inflationary part of the cost of care.
25 liv&win // Aug 29, 2009 at 2:09 pm
Bill, where was your proposal posted, I can’t find it.
26 barker13 // Aug 29, 2009 at 2:56 pm
Re: Liv&Win // Aug 29, 2009 at 12:54 pm (#24) –
“Primary care, as I have described it above, is provided by community-based HMOs which hire the doctors, not unlike Kaiser Permanente.”
Ahh… yeeesss… BUT… Kaiser Permanente EXISTS!
(*GRIN*) (Do you see my point….???)
WHO is it “providing” the “community-based HMOs…???” (*GRIN*) That’s the question! And even if you give me an off-the-cuff answer… that answer would be just that – simple words – not actual ACTION by a real “organization” willing and able to provide these “community-based HMOs.
In other words… what you’re giving me is a mixture of speculation and ultimately mandate. (*SHRUG*) If no one – no private organization – steps up to the plate… well… then we’re left with GOVERNMENT.
(*SHRUG*)
Again, L&W… I oppose government owned/run healthcare.
(But I do like your use of the word “paradigm” in your first paragraph, second sentence!) (*WINK*)
“Kaiser is not all that different from Cleveland Clinic…”
Like Kaiser… Cleveland Clinic… er… EXISTS. (*SHRUG*) (See where I’m coming from…???)
“As I pointed out, if you wanted to hire a primary care physician to serve the needs of you and 1999 of your neighbors, the cost of the salary is $6.25 per person per month. … I know this isn’t what YOU want, but I am certain if I tried to sell this, I would have a lot of people who would much rather pay $6.25 per month and never have to be concerned about access or cost, than the alternative.”
It’s not so much a question of “what I want” as it is this simple reality, namely…
L&W. “You” are doing nothing. (*SHRUG*) By that I mean unless you’re about to reveal a big surprise to us all, you’re not some multi-billionaire with the resources to put his plan into actual action on the “testing” level in the real world.
Again, L&W, with respect, like the libs you’re quick to say what “others” should be creating and what “others” should be spending their money on… and that’s ALWAYS an easy call. (*SMILE*)
Now you might respond that I’m doing the same thing, demanding people pay (*LOOK OF SHOCK*) for their OWN health general health care out of pocket… but my call is in line with societal norms for pretty much EVERYTHING we need – food, shelter, clothing…
(*SHRUG*)
“I would add, that this has a very dramatic impact on the cost of the insurance for specialty and facility care. The two biggest impacts are on administration and insurance costs. Relative to administration, by doing a paperless primary care model, more than 80% of the claims/admin/paperwork is eliminated than a comprehensive insurance plan. Admin costs are further restricted, because the claim payment is based on a scheduled fee, versus fee-for-service. I don’t want to get bogged down in this area, but by eliminating primary care claims, and administering a fee scheduled plan, administrative costs can be reduced to 6% from 20%. This alone can fully counteract the inflationary part of the cost of care.”
(*GRIN*)
L&W. Let me leave you with something hopefully more palatable than my constant “nitpicking” on your plan.
How’bout this… we institute “The Barker Plan” and then you start pounding the pavement looking for investors to start up “Live and Win Clinics, Inc.” and I’m sure Americans will flock to you.
(*WINK*)
No. Seriously! I’m NOT being a wiseass. I’m being serious. Just as under my plan Americans would be free (and be WISE) to utilize “groups” such as as Kaiser and Cleveland, so too would it make sense for them to spend THEIR money utilizing YOUR ideal facility.
L&W. When you think about it… our two “plans” are more complimentary than in conflict.
(*WINK*)
BILL
27 barker13 // Aug 29, 2009 at 3:11 pm
Re: Liv&Win // Aug 29, 2009 at 2:09 pm (#25) –
Try browsing “Obama’s Big Idea: Bankrupt Medicare Faster.”
BILL
28 barker13 // Aug 29, 2009 at 6:15 pm
L&W and the rest of my fellow New Majorians… (*WINK*)
http://online.wsj.com/article/SB10001424052970203706604574376981533298534.html
How many different articles about the failures of EXISTING federal “health care” initiatives do we need to be exposed to?
(*SHRUG*)
BILL
29 liv&win // Aug 30, 2009 at 12:43 pm
Hey Bill, I don’t take your posts in any way other than what I am sure they are intended, honest and intelligent comments.
I understand the WHO dilemma. I haven’t totally figured that however
I guess I do approach this as if I were president…which I admonished someone about once here on NM.
If Kaiser and Cleveland do exist are effective and are supported by the market, why don’t more exisit? I don’t know exactly, but I do know, often times people need a swift kick in the @ss to change what they’ve been doing.
I know our proposals are not much different.
30 liv&win // Aug 30, 2009 at 12:46 pm
I saw that article also, Bill. I laughed at yet another health care program run by the govt. More shit against the wall.
31 barker13 // Aug 30, 2009 at 1:13 pm
Re: Liv&Win // Aug 30, 2009 at 12:43 pm (#29) –
“…I guess I do approach this as if I were president…”
(*ROFLMAO*)
I’ll “see” your presidential “bid” and “RAISE” you…
(*GRIN*) (*DRUM ROLL*)
I – William R. Barker, Legend In My Own Mind – approach these matters placing myself in the role of… umm… a godlike, all knowing, all seeing, all wise Being always ready, willing, and able to give… umm… “THE” answer.
(*WINK*)
* Hey, Sinz… for your peace of mind… if that “hole in the Ozone” ever gets too big… no doubt my ever expanding ego will fill it in!
(*ROFLMAO*)
L&W. It’s ALWAYS great chatting with you!
** Hey… Midcon… where’s Midcon been…??? (Brutus…??? You around, Brutus…???) (Franco…???)
BILL
32 caltha.palustris // Sep 3, 2009 at 12:13 pm
EDK,
Great writing!
However, I’d like to know if the following has been measured against inflation since 1970? …can it be found in the PRI’s study?
33 caltha.palustris // Sep 3, 2009 at 12:19 pm
Also, did Mr. Jeffrey Anderson compile the PRI study…if not does the study have a title…as I’d like to review it..
Thanks, and again a great read!
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