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Gibonius
 
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Originally Posted by Rapier View Post
Deregulation would allow more risk-adjusted pricing rather than a combination of that and government mandate.
And would allow more people to be fucked by their insurance company. Wonderful trade off there.
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For those with expensive preexisting conditions and can't afford treatment, technically stuff like that isn't covered under "health insurance" because they already have it and the prognosis is known to be expensive. If you want to "cover" these people, call it what it is: a subsidy. And don't pretend it will cut costs.
No one has ever pretend actually covering sick people will lower costs, but dropping them is unethical. Either they need to be subsidized by healthy people through health insurance, or through government programs. There's really no other options.
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When Governor Romney instituted "health reform" in Massachusetts, costs exploded, which is why health care is so expensive in MA right now. When I said "buy insurance across state lines", I mean being able to buy policies that don't conform to state guidelines. Some states are ridiculous and mandate chiropractors be covered by insurance and other stupid regulations that do nothing but drive up costs.
The voters of those states are welcome to move or fix their laws.

What you're talking about would lead to a rush of companies moving to states without much consumer protection, and then consumers getting fucked. Well, the sick ones anyway. Healthy people will be ok, but health insurance that only works when you're healthy is not so good.

Example: Eight states don't mandate coverage for diabetics. If my employer (in GA, which mandates coverage under group plans) buys a plan from one of those states, they're no longer required to cover me, and I'm fucked and have basically no options.
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Right now, health insurance is mainly regulated at the state level, and in some states, it's cheaper than in others. That being said, it probably makes more sense to try and make reform at the state level rather than the Federal.
The price in each state is mostly determined by the providers, not the insurance companies. The cost of an MRI (etc) can vary wildly across the country, and utilization of procedures varies wildly across the country. Addressing everything at the payment (insurance) level without addressing the provider level won't fix anything.


Basically everything you're saying is coming straight out of insurance company boardrooms. I mean that literally too, they've spent a lot of money to put this message into the conservative community to get drones repeating it. But the consumer does not stand to benefit from these measures. At least, if you think you might ever get sick or injured, which appears to be why people purchase health insurance.
Old 02-25-2010, 06:16 AM Gibonius is offline  
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Rapier
 
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And would allow more people to be fucked by their insurance company. Wonderful trade off there.
Who says better pricing allows more people to get fucked by the insurance companies?

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No one has ever pretend actually covering sick people will lower costs, but dropping them is unethical. Either they need to be subsidized by healthy people through health insurance, or through government programs. There's really no other options.
I agree that certain conditions should be subsidized. But the question is to what extent, and which conditions are eligible for subsidy? And if they accept the subsidy, should the state be allowed to mandate how they live their life (in order to reduce the burden on the state's finances)?

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The voters of those states are welcome to move or fix their laws.

What you're talking about would lead to a rush of companies moving to states without much consumer protection, and then consumers getting fucked. Well, the sick ones anyway. Healthy people will be ok, but health insurance that only works when you're healthy is not so good.

Example: Eight states don't mandate coverage for diabetics. If my employer (in GA, which mandates coverage under group plans) buys a plan from one of those states, they're no longer required to cover me, and I'm fucked and have basically no options.
Yes, but 90% of diabetics have type 2 diabetes, in which medical research suggests there is a strong correlation (if not causation) between that and obesity, hypertension, and high cholesterol, which, for the vast majority of people in the US, a lifestyle choice.

Do we cover them? And do we cover people with illnesses of affluence as well? Should the young subsidize the old? Where do we draw the line and how much flexibility do we allow insurance companies in determining coverage for a specific individual?

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The price in each state is mostly determined by the providers, not the insurance companies. The cost of an MRI (etc) can vary wildly across the country, and utilization of procedures varies wildly across the country. Addressing everything at the payment (insurance) level without addressing the provider level won't fix anything.
I'm not too familiar about the accounting practices used in the medical industry (specifically at the hospital level), but from what I can see, it results in bandages costing 10 dollars a pop and hospital stays consuming 6k a night at the nominal price (which is then bargained down but only by insurance companies). What I never see is a price list until they actually bill you the invoice.

Inova, an organization that manages hospitals, recently lobbied Virginia to prevent a competing hospital from opening up in Loudoun County for obvious reasons. To me, the insane political rent seeking that results from too much government regulation of health care at all levels is a problem of government, not the private sector.

The system is set up right now to favor employer based health insurance and makes it incredibly expensive, if not outright uneconomical, to acquire it at an individual level. And not having health insurance while incurring a physical accident can be financially disastrous with current accounting practices in hospitals.

Reform is needed, but to me, deregulation, not more regulation, seems to be the answer.

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Basically everything you're saying is coming straight out of insurance company boardrooms. I mean that literally too, they've spent a lot of money to put this message into the conservative community to get drones repeating it. But the consumer does not stand to benefit from these measures. At least, if you think you might ever get sick or injured, which appears to be why people purchase health insurance.
I'm not a "conservative", however nebulous that term may be. I'm a libertarian. And I believe that less regulation, not more, will produce a more efficient health care system that will lower costs and improve care for the vast majority of Americans.

And when I mean less regulation, I mean at all levels of the health care sector from insurance, to hospitals, board certification. Debt forgiveness for medical students would be okay, though, but that's really an issue of our education system (which needs reform too).
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Old 02-25-2010, 10:54 AM Rapier is offline  
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#17  

BigFuzzyArchon
 
 
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Originally Posted by Rapier View Post
Get your facts straight.

Total defense spending (including the costs of fighting our "overseas contingency operations") came to 651 billion dollars. 505 for general DOD spending, 146 for overseas contingency operations. That equates to roughly 4.5% of GDP and 18% of all Federal spending.

no, those aren't the only things that make up all of our national security spending. If you want to get technical it really isn't $1 Trillion its about $965 Billion but at this point that isn't that big of a difference.

http://www.warresisters.org/pages/piechart.htm
Old 02-25-2010, 11:34 AM BigFuzzyArchon is offline  
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Rapier
 
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Originally Posted by BigFuzzyArchon View Post
no, those aren't the only things that make up all of our national security spending. If you want to get technical it really isn't $1 Trillion its about $965 Billion but at this point that isn't that big of a difference.

http://www.warresisters.org/pages/piechart.htm
Get your facts straight:

http://www.gpoaccess.gov/usbudget/fy11/pdf/summary.pdf

Page 30 and 31:

Defense spending accounts for 650 billion dollars in the 2009 fiscal year. An additional 146 billion for prosecuting overseas contingency operations. So if you really want to split hairs, we spent just under 800 billion dollars a year on "defense" in 2009. This was out of a budget of 3.53 trillion dollars, or 22.5% of the Federal budget.

Your amusing website uses outdated numbers and erroneous accounting assumptions about FICA and intragovernmental holdings of the US national debt to arrive at that outrageous figure.
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Old 02-25-2010, 12:05 PM Rapier is offline  
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Tom Kazansky
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Quote:
Originally Posted by BigFuzzyArchon View Post
no, those aren't the only things that make up all of our national security spending. If you want to get technical it really isn't $1 Trillion its about $965 Billion but at this point that isn't that big of a difference.

http://www.warresisters.org/pages/piechart.htm

Lol, brilliant unbiased source.
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Old 02-25-2010, 12:13 PM Tom Kazansky is offline  
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Gibonius
 
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Originally Posted by Rapier View Post
Who says better pricing allows more people to get fucked by the insurance companies?

The regulations are what requires insurance companies to actually cover certain groups of people, and prevents insurance companies from dropping policy owners once they get sick. You remove the regulation, you're going to end up with more people who either cannot buy insurance at all, or who don't get covered once something happens.

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I agree that certain conditions should be subsidized. But the question is to what extent, and which conditions are eligible for subsidy? And if they accept the subsidy, should the state be allowed to mandate how they live their life (in order to reduce the burden on the state's finances)?

Yes, but 90% of diabetics have type 2 diabetes, in which medical research suggests there is a strong correlation (if not causation) between that and obesity, hypertension, and high cholesterol, which, for the vast majority of people in the US, a lifestyle choice.

Do we cover them? And do we cover people with illnesses of affluence as well? Should the young subsidize the old? Where do we draw the line and how much flexibility do we allow insurance companies in determining coverage for a specific individual?
I'm fine with charging people extra money for engaging in optional behaviors with negative correlations to health. That's included in this bill, actually. Well, so long as they don't use BMI as a metric of fatness.

Personally, I think people with long term illnesses should be getting tax credits related to their income levels. If you're loaded, you don't need the help. But that's a politically untenable solution, since people apparently would rather try to shoehorn sick people into the for-profit insurance model. Or they just don't care what happens to sick people.
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I'm not too familiar about the accounting practices used in the medical industry (specifically at the hospital level), but from what I can see, it results in bandages costing 10 dollars a pop and hospital stays consuming 6k a night at the nominal price (which is then bargained down but only by insurance companies). What I never see is a price list until they actually bill you the invoice.
That's not related to regulation though, that's related to the employer based healthcare system primarily. Removing regulation isn't going to fix that problem.
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Inova, an organization that manages hospitals, recently lobbied Virginia to prevent a competing hospital from opening up in Loudoun County for obvious reasons. To me, the insane political rent seeking that results from too much government regulation of health care at all levels is a problem of government, not the private sector.
That's a pretty basic zoning issue. You can't just let hospitals spring up wherever, so obviously the government at some level is going to have to approve them. I don't see how that's something you can deregulate. We can try to minimize corporate influence though.
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The system is set up right now to favor employer based health insurance and makes it incredibly expensive, if not outright uneconomical, to acquire it at an individual level. And not having health insurance while incurring a physical accident can be financially disastrous with current accounting practices in hospitals.
Certainly. This bill addresses those issues. But I've never seen anyone explain how "deregulation" would lead to the death of the employer based system.
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Reform is needed, but to me, deregulation, not more regulation, seems to be the answer.

I'm not a "conservative", however nebulous that term may be. I'm a libertarian. And I believe that less regulation, not more, will produce a more efficient health care system that will lower costs and improve care for the vast majority of Americans.
If your only concern is cost, deregulation would be appealing. If you actually care about treating sick people, it doesn't work out so well.
Old 02-25-2010, 01:39 PM Gibonius is offline  
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Rapier
 
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The regulations are what requires insurance companies to actually cover certain groups of people, and prevents insurance companies from dropping policy owners once they get sick. You remove the regulation, you're going to end up with more people who either cannot buy insurance at all, or who don't get covered once something happens.
Some regulation says that insurance companies need to cover a certain group. Other regulation says that insurance companies need to provide x, y, and z to every person they cover. If you deregulate some parts and not others, of course you're going to screw a lot of people over because you distort incentives to provide a reasonable product to the market.

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I'm fine with charging people extra money for engaging in optional behaviors with negative correlations to health. That's included in this bill, actually. Well, so long as they don't use BMI as a metric of fatness.
It shouldn't be included in the bill. The insurance companies should already look for things like that. And the smarter ones probably already do, unless government regulation forbids it. The more you know about any specific individual, the better you can accurately gauge that individual's personal liability if you're insuring them.

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Personally, I think people with long term illnesses should be getting tax credits related to their income levels. If you're loaded, you don't need the help. But that's a politically untenable solution, since people apparently would rather try to shoehorn sick people into the for-profit insurance model. Or they just don't care what happens to sick people.
All these additional tax credits just bloat the tax code even more. We should simplify the tax code and just add a generous standard exemption for individuals plus additional amounts for those with dependents. But that's really another story.

At some point, we have to decide how much money we're spending on people who require much more health care than others. To be honest, I really don't give a damn about another person's expensive preexisting condition. And I certainly don't want to be taxed to pay for it.

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That's not related to regulation though, that's related to the employer based healthcare system primarily. Removing regulation isn't going to fix that problem.
You can't say "deregulation wouldn't affect this". The fact is there are numerous pieces of regulation and they all have different effects that amplify each other. One thing's for sure, a hospital's services is very cost opaque. In fact, in no other part of the economy is such opacity present. There's a reason for that, and I would wager that government is a big part of that reason.

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That's a pretty basic zoning issue. You can't just let hospitals spring up wherever, so obviously the government at some level is going to have to approve them. I don't see how that's something you can deregulate. We can try to minimize corporate influence though.
Why can't we let hospitals spring up wherever? Hospitals are surely a good thing, aren't they? And if somebody is willing to pay for the property, construction, maintenance, operations....etc etc then to hell with the zoning boards. And I'm not trying to curb corporate influence. I'm trying to curb the power of government that makes corporate influence so...influential. Ultimately, it's the government's call. And they fucked it up.

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Certainly. This bill addresses those issues. But I've never seen anyone explain how "deregulation" would lead to the death of the employer based system.
The employer based system arose because of a WWII-era tax credit in which price and wage controls instituted by the Federal government made pay raises for workers prohibitively expensive, so companies lobbied for a tax credit for providing health care insurance. That's why we have employer based insurance today, because of some piece of regulation passed over 60 years ago.

Eliminate the tax credit for corporations or extend the same benefits to individuals. That's why it's much cheaper to get insurance from a company than purchase an individual plan. It's not about "adequately sized risk pools", it's about the company being given a tax credit while the individual doesn't get one.

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If your only concern is cost, deregulation would be appealing. If you actually care about treating sick people, it doesn't work out so well.
You say this, and yet we don't really know what would happen. What I do know is that I'd rather deregulate and deal with the abuses of the private sector instead of regulate and deal with the tragedies of government power.
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Old 02-25-2010, 02:20 PM Rapier is offline  
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astriy
 
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You say this, and yet we don't really know what would happen. What I do know is that I'd rather deregulate and deal with the abuses of the private sector instead of regulate and deal with the tragedies of government power.

This is just incomprehensible. I wonder what tune you'd be singing if you got cancer and had to stop working and having your insurance company jack-up the cost of your plan to a point where you have to decide between paying the insurance or your mortgage and you not being able to do anything about it because of your now pre-existing condition? Will you still be saying "beats government healthcare" while your family is going broke?
Old 02-25-2010, 03:53 PM astriy is offline  
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Gibonius
 
Trimming some stuff for focus:
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Originally Posted by Rapier View Post
Some regulation says that insurance companies need to cover a certain group. Other regulation says that insurance companies need to provide x, y, and z to every person they cover. If you deregulate some parts and not others, of course you're going to screw a lot of people over because you distort incentives to provide a reasonable product to the market.
You're just sort of waving the magical utopian libertarian wand at this problem and saying it'll go away.

Specifically: how are sick people going to be guaranteed care if we remove the laws that force insurance companies to cover them?

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At some point, we have to decide how much money we're spending on people who require much more health care than others. To be honest, I really don't give a damn about another person's expensive preexisting condition. And I certainly don't want to be taxed to pay for it.
Health care...for healthy people? What good is that, exactly? Your strictly selfish attitude is common among people who think they're invincible for some reason, but anybody can get sick and then you're hosed in the system you envision. I don't really want to live in a country where "Fuck ya'll" is a operative byline. We're too well off to ethically ignore the hardships of others in this country.
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You can't say "deregulation wouldn't affect this". The fact is there are numerous pieces of regulation and they all have different effects that amplify each other. One thing's for sure, a hospital's services is very cost opaque. In fact, in no other part of the economy is such opacity present. There's a reason for that, and I would wager that government is a big part of that reason.
Companies are going to maximize profits in whatever framework they're given. Companies have developed this system of price opacity under the current regulatory framework, but they could change it tomorrow if they actually wanted to. They just don't, it's more profitable for them to not tell anybody the prices and have different prices for every consumer. Pulling the regulatory rug out is not going to automatically fix this problem, since you're not going to have a whole new crop of companies show up. You're going to have all the same problems for a significant length of times, and a whole mess of new ones since consumer will have no protections.
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Why can't we let hospitals spring up wherever? Hospitals are surely a good thing, aren't they? And if somebody is willing to pay for the property, construction, maintenance, operations....etc etc then to hell with the zoning boards. And I'm not trying to curb corporate influence. I'm trying to curb the power of government that makes corporate influence so...influential. Ultimately, it's the government's call. And they fucked it up.
Hospitals require infrastructure (roads, power, water, etc), create a lot of traffic, noise, even air traffic in some cases. It's not like you can just plop one down where ever, it has to be part of some growth plan to actually work effectively. I know in Libertopia this stuff all just happens efficiently somehow, but in Real Life not so much.

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Eliminate the tax credit for corporations or extend the same benefits to individuals. That's why it's much cheaper to get insurance from a company than purchase an individual plan. It's not about "adequately sized risk pools", it's about the company being given a tax credit while the individual doesn't get one.
That's in this bill.

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You say this, and yet we don't really know what would happen. What I do know is that I'd rather deregulate and deal with the abuses of the private sector instead of regulate and deal with the tragedies of government power.
You also don't care what happens to sick people apparently.

Your blasť attitude about corporate abuses in health care is really just mind boggling for anyone who has ever actually had to deal with illness. A serious illness or accident is already one of the worst things that can happen in life, and having your insurance company fuck you because the government won't protect you makes a terrible situation ever worse.

This just isn't a situation where laissez-faire capitalism works.
Old 02-25-2010, 04:21 PM Gibonius is offline  
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Rapier
 
Well, we're at a fundamental disagreement on this issue. I simply don't believe in a positive right to health care.

Do I want people to get sick? No. But am I willing to pay for their treatment if they do? No. And this isn't about me envisioning a libertarian utopia. This is about looking at a heavily regulated sector of the economy and saying it's probably ailing because it's so heavily regulated, not because it's not regulated enough.
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Old 02-25-2010, 09:32 PM Rapier is offline  
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Jason
 
What ever happened to the days when you could go to the doctor, who you knew by name, and pay the bill in cash on your way out? Everything that has been added to that system has just caused costs to spiral out of control. I'd introduce a bill to remove every line regarding health care from the entire history of law... if I could sell myself out enough to get nominated and elected by one of the sellout parties that is.
Old 02-25-2010, 09:38 PM Jason is offline  
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#26  

Gibonius
 
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Well, we're at a fundamental disagreement on this issue. I simply don't believe in a positive right to health care.

Do I want people to get sick? No. But am I willing to pay for their treatment if they do? No. And this isn't about me envisioning a libertarian utopia. This is about looking at a heavily regulated sector of the economy and saying it's probably ailing because it's so heavily regulated, not because it's not regulated enough.

I can reassure myself with the fact that your vision has about no chance of ever happening, since the majority of Americans are not so cold-hearted as to base policy around the idea of "Why should I care if other people get sick and have their lives ruined?"

The interesting extension is that apparently you don't think that scenario could play out for you, or simply don't care for some reason. Anybody can get sick, and even if costs decrease dramatically, close to no one can pay for cancer treatment (etc) out of pocket. But that's the system you want. Selfish AND shortsighted, good combination for determining national policy.
Old 02-25-2010, 11:20 PM Gibonius is offline  
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:ninja:
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Originally Posted by Rapier View Post
Get your facts straight.

Total defense spending (including the costs of fighting our "overseas contingency operations") came to 651 billion dollars. 505 for general DOD spending, 146 for overseas contingency operations. That equates to roughly 4.5% of GDP and 18% of all Federal spending.

So nearly one fifth of the money spent by government is on military and war... but spending half that on healthcare is simply too much money! I don't understand the logic.
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Old 02-26-2010, 05:44 PM :ninja: is offline  
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Jason
 
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So nearly one fifth of the money spent by government is on military and war... but spending half that on healthcare is simply too much money! I don't understand the logic.

Because spending for national defense is a constitutional imperative for the federal government. Has been since the beginning. Spending on health care for everyone would be a whole new thing. Health care has generally been considered more of a personal responsibility than something the government should be doing... at least up until Medicare in 1965.
Old 02-26-2010, 05:50 PM Jason is offline  
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AnasSplenium
 
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I can reassure myself with the fact that your vision has about no chance of ever happening, since the majority of Americans are not so cold-hearted as to base policy around the idea of "Why should I care if other people get sick and have their lives ruined?"

The interesting extension is that apparently you don't think that scenario could play out for you, or simply don't care for some reason. Anybody can get sick, and even if costs decrease dramatically, close to no one can pay for cancer treatment (etc) out of pocket. But that's the system you want. Selfish AND shortsighted, good combination for determining national policy.

I think you are greatly mislead and there are a lot more people than you think. I certainly don't care. Everyone with any kind of respectable job already has satisfactory coverage, and they do not want expensive change.

I'm already paying into systems that will give me nothing back like social security. How bout one more? SOUNDS GREAT.
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Old 02-26-2010, 06:12 PM AnasSplenium is offline  
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