Down the Drain

Good article, Kat. Thanks.

Government spending may very well get us over the hump with infrastructure projects and the like. But healthcare, no matter what the President says, is speedbump in the whole economy situation - not a crisis. No one lost their jobs because the healthcare system was screwed up. Passing it now is reckless at best. Yes, they have to pass it now, because the supermajority may not last long - but it is fiscally reckless to do this now. All of the rest of the government spending? Go for it. If my taxes give a man a well-earned job - it WILL help the economy stabilize.

Yeah lets not actually put money back in the hands of those who earned it, to spend as they see fit..... what a terrible thought. I mean the government living within its means.....what idiocy!

Spend! Spend! Spend!

Yglesias apparently thinks basic laws of economics should be suspended so the Democrats can pass some more programs. Remember deficit spending is stimulative in the short run but hurts growth in the long run. I agreed with the need for a stimulus package as a relatively short term measure, but that does not justify deficit spending to pass every program one might like.

And look at the source, a reliable partisan hack at a far left site like ThinkProgress. Look at the headline "Nelson: Bad Economy Means We Should Wreck Economy, Destroy Planet, Let Health Care Languish". This is not the way reasonable people discuss issues.

I have trouble thinking that something that costs 10% more every year is not a problem in an economy where wages are stagnant or shrinking. In fact if you think it is not a crisis I would have to judge you as irrational or dependent on the status quo.

No one lost their jobs because the healthcare system was screwed up.

Really? That 's not what the fine people of Alabama would tell you...
Free Republic - Toyota to build 100,000 vehicles per year in Ontario (Americans too illiterate to train)

The factory will cost $800 million to build, with the federal and provincial governments kicking in $125 million of that to help cover research, training and infrastructure costs.

Several U.S. states were reportedly prepared to offer more than double that amount of subsidy. But Fedchun said much of that extra money would have been eaten away by higher training costs than are necessary for the Woodstock project.

He said Nissan and Honda have encountered difficulties getting new plants up to full production in recent years in Mississippi and Alabama due to an untrained - and often illiterate - workforce. In Alabama, trainers had to use "pictorials" to teach some illiterate workers how to use high-tech plant equipment.

"The educational level and the skill level of the people down there is so much lower than it is in Ontario," Fedchun said.

In addition to lower training costs, Canadian workers are also $4 to $5 cheaper to employ partly thanks to the taxpayer-funded health-care system in Canada, said federal Industry Minister David Emmerson.

"Most people don't think of our health-care system as being a competitive advantage," he said.

Tanguay said Toyota's decision on where to build its seventh North American plant was "not only about money."

Looks like quality affordable health-care and education are things that investors take under consideration before plunking heir money down... I'd say that a few thousand jobs that ended up in Canada in part due to the cost of our health-care system.

Sure, lets wait until everything is hunky dory again before we start tackling the problems that are... ah, well... getting worse every day. And when will that be? Maybe Ben Nelson and friends think these problems will magically solve themselves if only we start ignoring them. Good grief, no wonder the country is so dumbed down, it starts at the top!

The issue is being mis-framed. We have problems with energy, emissions and health care, but the solutions being proposed have more downside than upside.

A transition to "green energy", thereby reducing emissions and foreign energy dependence, is achievable in an economically viable format. But, denying the usefulness of natural gas and nuclear as part of the solution is short sighted and ideologically based, as opposed to practically driven. The remainder of a "green energy revolution", or evolution, can best be accomplished in an economically healthy way by public-private cooperation in coordination with incentives for private investment, competition and profit, as opposed to government control.

The health care "reform" we about to get is an economic time bomb. Through mandates, failure to control underlying health care cost, fines and taxes, its most likely effect will be to remove a significant percentage of discretionary spending from the pockets of consumers in a consumer driven economy, while further beaurocratizing the health care industry.

We have done a good job of identifying problems and a remarkably poor job of crafting practical solutions.

No middle ground here. If you don't spend like crazy, tackle every problem in sight, to hell with the grand kids, you are a slobbering insensitive dolt who only wants to spend money on the wars he creates.
Or, you want to hunker down ignore real problems in health care, national defense (wars), economy and not to try to fix anything since things will fix themselves after awhile and let them eat cake.

I have trouble thinking that something that costs 10% more every year is not a problem in an economy where wages are stagnant or shrinking.

Ah, I see you are referring to the college tuition problem!

Obviously we need a tax-payer funded, mandatory, 100% opt-in with a public option Higher Education Tuition Reform Act. It must be passed NOW! No time for reviews or cost reduction analysis or measures, as this is a CRISIS.

p.s. - the bill must contain a minimum of 2,200 pages.

The misspending and misconduct by Congress is legendary this year. That it ironically is happening at a time where reform is overdue and restraint is obviously in order as well, is just adding insult and injury to insult and injury. Support for Lysenkoist "global warming" political-quasi-religion policy mischief and other follies simply follow perversely from the already-perverse insistence on "tax and tax, spend and spend, elect and elect" and buy the votes of those whose votes and minds and souls are so very cheap.

"Government spending may very well get us over the hump with infrastructure projects and the like."

Wiser people were willing to give ObamaCo and the Congre-Dems a chance, risky as it was to do that.

What have ObamaCo and the Congre-Dems done? The wrong things. They're not only too inept, and elitist and out of touch with reality as well as the mainstream public, but they're recklessly ambitious with taking over the private sector here, there, everywhere if they could do it, misspending and borrowing like crazy, avoiding all overdue real reforms as well as sensible "stimulus" measures such as listed by people like Zandi before they even began exercising their post-election power, and seeking extremist as well as wrongful and repellent political goals such as with energy and environmental political policy goals.

"Yglesias apparently thinks basic laws of economics should be suspended so the Democrats can pass some more programs."

Maybe he's just aping hacks like Krugman, who predictably have already expressed such thoughts.

Yeah lets not actually put money back in the hands of those who earned it, to spend as they see fit..... what a terrible thought. I mean the government living within its means.....what idiocy!

What a load of crap, Leonidas. We've not been spending OUR money, but our childrens'. Since REAGAN ushered in the "borrow and spend" Republican strategy, we've gone from $1 trillion in debt that Carter and ALL other presidents before him accumulated, to over $12 trillion today. And as I've pointed out lots of times, and love to do so again, THE NATIONAL DEBT IS A REPUBLICAN CREATION. Every Democratic president has lowered it. Every Republican president since Reagan has massively increased it. (note how tiny is the blip contributed to date by Obama, and all of it trying to staunch the bleeding from the GOP-created meltdown and the GOP wars.)

Now it's almost impossible to get control of it, thanks to Republicans. Every taxpayer owes over $235 A MONTH in interest on the debt. Your debt. Republican debt. That's how much of your tax dollars go to paying for the mess your team created, and that doesn't pay down ONE DIME of principle. Now add the $2,000 a year freebie you get as a government handout for having employer-provided government subsidized health care and HOW MUCH TAX ARE YOU PAYING? I'll bet it's next to nothing. That's $4820 a year. For smeone making $32,000 a year and in the 15% tax bracket, 100% of their taxes go to interest on the debt and the federal share of their health insurance. That is the fact, Leonidas. We're screwed, and it's almost entirely the fault of the irresponsible REPUBLICAN handling of the economy.

Remember deficit spending is stimulative in the short run but hurts growth in the long run.

Yes, DaGoat. If only Reagan and both Bushes had ever figured that out.

No one lost their jobs because the healthcare system was screwed up.

I can't believe you said that. Millions have lost their jobs because their employers couldn't compete while paying so much for health insurance, even with the government subsidy. I myself lost employees when I could no longer afford the 40% increases in health insurance. Employees who couldn't afford their own insurance had to quit and seek employment elsewhere. In Detroit, there's more health insurance cost in a new Ford than there is steel. Industry after industry has shut down and we've gone from 40% of our GDP coming from manufacturing to 10%, largely because we can't compete with countries that have single payer health care (or labor or environmental regulations). Now consider the alternative to fixing it now. Within 10 years, private insurance cost will double. The $2,000 we subsidize now, becomes $4,000. The share that the taxpayer doesn't pick up is $8,000 a year, but will be $16,000. That's $8,000 a year employees WON'T be getting in salary. The total insurance cost employers and employees pay, for a family, is now >$12,000 a year and within 10 years will be $25,000 How many companies can afford their insurance costs to double? How many individuals?

But, denying the usefulness of natural gas and nuclear as part of the solution is short sighted and ideologically based, as opposed to practically driven.

tidbits, you're right about natural gas, wrong about nuclear. Nuclear is already not cost competitive with wind, even without considering the cost of decommissioning plants. You're being sold a bill of goods on that. Nuclear power 8-11 cents a kWh and rising. Wind, 5 cents and falling. And that's even with TAXPAYERS paying for insuring the nuclear plants because insurance companies won't (purportedly the "risk experts"). See Price Anderson Act for this nugget.

On health care, has anyone looked at the Republican plan, which all Republican reps voted for? What a cynical bit of baloney. For those who haven't read it, it simply avoids federal expense by forcing the states to cover "high risk" individuals. We call that "unfunded mandate" and the GOP is famous for it.

Now it's almost impossible to get control of it, thanks to Republicans.

And the obvious solution is to triple the deficit in one year of democratic control of the Whitehouse... Brilliant!

Spend! Spend! Spend! Don't stop must spend more, its all the fault of the Republicans, they are making us Spend!.

"We've not been spending OUR money, but our childrens'."

Our childrens', too. Tell that to Pete Stark, who denied it -- while he and others refuse to reform entitlements and continue to support spending and borrowing this year that dwarfs all before it.

With his children accompanying him, he said:

"I can assure you these guys aren’t going to have to pay for it in the future..."

"Spend! Spend! Spend!"

It's not as if we are confident they would restrain themselves, reform entitlements, or say "no" [gasp].

Remember deficit spending is stimulative in the short run but hurts growth in the long run.

Yes, DaGoat. If only Reagan and both Bushes had ever figured that out.

No argument from me on that. Hey maybe we should have elected a president committed to "change".

"THE NATIONAL DEBT IS A REPUBLICAN CREATION"

GreenDreams, all I can say is that your reality shield looks almost as resilient as Father_Time's. We've been over this before: the only setup that curbs the debt is a Democratic president with a Republican congress, which is why I've always seen the Republicans as good defenders that can't be trusted with the ball. Anytime either party gets the house, the senate, and the presidency, they go on a spending rampage. A far more meaningful graph would include unfunded mandates in it, because the Democrats do a better job with them (see Medicaid and the Social Security act of 1965) than the Republicans.

You're also blaming all health insurance increases on the health insurance companies. As I've stated before, that's just scapegoating. Just as gas stations don't have complete control over gas prices, health insurance companies don't have complete control over health costs. They're only one member of the gang -- the others are getting coddled.

I have to agree with the prospects of wind, solar, and bio-diesel (even if you didn't mention that last one), because even uranium is a limited resource.

Well. I am glad there is someone around here who can hoist the Republican numbers people on their own petard. My abilities just don't go in that direction. Stick around, GreenDreams, and don't disappear on us again.

"Toyota to build 100,000 vehicles per year in Ontario (Americans too illiterate to train)"

Don..... Come on... You are being just like the current adminstration on this one.
You are quoting the loss of potential jobs as job losses.
Show me an actual statistic that shows loss of a PRESENT job from healthcare.

"THE NATIONAL DEBT IS A REPUBLICAN CREATION. Every Democratic president has lowered it."


That's not true, Green. We went over this earlier in the week. It is not simply "a democrat president". The times when the debt was turned around and lowered were with a Democrat President and a Republican majority Congress. Every single time. Just about all others mixtures had debt stagnation or debt increase.

that's revisionist history. Every Republican voted against Clinton's economic policy and had they the votes to kill it, we would have been in worse shape. Instead, we had 8 years of relative peace and prosperity.

As for insurance companies, I am right to blame them. Medicare negotiates better rates with providers including doctors, drugs and hospitals. The GOP fights to PREVENT negotiation.

Look, the Republicans are sycophants to the rich and the corporate interests. Democrats "pander" to the majority. That's called Democracy. That said, I'm not pleased with Obama selecting Summers and Geithner, nor all the bailouts. However, there is no credible economist who thinks cutting government spending in a recession is a good idea. Remember the bailout was passed by Republicans and signed by Bush.

I do admit, sadly, that the Dems are just as good at selling out to the corporados and corruption is rampant on both sides of the aisle. But the GOP is committed to militarism and wealth redistribution upward, despite the fact that it is these exact two things that have brought down every single empire in history. And they have brought us down too.

thanks Kathy. I really wish the other side could see through their own talking points. No one has denied that the GOP philosophy, ie Reaganomics, is defined by Milton Friedman's mantra "privatize, deregulate, cut social spending." The result is always widening wealth gap, privatizing profit and nationalizing debt. It's a recipe for disaster and the GOP still bows down to the mantra despite the global failure of that philosophy.

Jefferson, as I commented above, the policies Clinton enacted were opposed by Republicans. The Dem Congress successfully scaled back Reagan's plans which according to his own OMB and GAO would have made the debt and deficits higher. I admit that Dems went along with the deficit spending started by Republicans, because apparently the public was not worried about either one. Now you want the Dems to be the ones who cut back popular programs. Ironically, the GOP talks about Dems offering freebies and goodies and "a free pony" when in fact the GOP started this deficit driven slide, and still push that.

The difference between the parties is that the Dems tend to focus on people, environment, labor, regulation, education and social issues; the GOP focuses on business and tax favors to the rich. It's profit over people for the GOP, and that shows in the health care debate.

I admit that Dems went along with the deficit spending started by Republicans, because apparently the public was not worried about either one.

Since we can agree on this, why can't we agree that increasing deficit spending is undesirable and expect both parties to stop it? GD, much of your defense of Democrats rests on claiming Republicans are just as bad, which is really no defense at all. The main difference is the Democrats support programs you like and the GOP doesn't. Unfortunately both are over-spending.

DaGoat, as I pointed out, no credible economist believes cutting government spending in a recession is a good idea. It's frustrating that politics trumps common sense, but consider the politics for a moment. How convenient it would be for the GOP if they get to rack up massive debt, greatly pleasing their Wall St. base by shoveling money taxpayer money into their pockets, then insist that the Dems cut social programs and other spending, gutting popular programs and hence losing the elections to the "give me my free pony" Republicans.

As for "programs I like," those happen to be the things I think are important to future generations: infrastructure, regulating out of control corporations, protecting workers and communities, education, health and environment. The GOP appears to be all about selfishness and greed. Their programs are designed to gut regulations, cut taxes for the rich, cut spending on everyone else, send jobs and investment overseas and generally pander to the corporados. No one here has refuted or even argued with my assertion that GOP economic policy is accurately summed up by Milton Friedman (and Reagan) like this: "privatize, deregulate, cut social spending." In every single case in world history in which that policy has been implemented, the result is the same, privatize profit, nationalize debt, widen wealth gap. That is EXACTLY the goal of the GOP.

THE NATIONAL DEBT IS A REPUBLICAN CREATION

Trying the Big Lie in capital letters is still a lie, GD.

First, that chart you referenced was national debt as a percentage of GDP, not just the national debt itself.

Second, even trying to take your position and make it not a lie fails, as the chart clearly shows that the national debt as a percentage of GDP for Eisenhower and the Nixon/Ford administrations were lower than when they took office. I am 100% sure they were all Republicans.

And if you talk about the national debt itself, not as a pct of GDP, then the only President since 1940 that can make the claim the national debt was lower the day he left the office than the day he assumed the office is Harry Truman.

So to you, too, I say if you cannot read and interpret figures, charts and tables correctly, you should not try, as you are again be-clowning yourself.

Yes, debt as a % of GDP is the relevant number, just like it is for businesses, AR. Businesses view debt as a % because some debt is reasonable, but too much is too much. We have way too much. As for Nixon and Eisenhower, I DID say the the GOP has been fiscally irresponsible "since Reagan." You're talking about a time when I was a Republican, when it actually meant fiscal responsibility, states rights, individual rights, smaller and less intrusive government. That is not the case any more. At all.

As for "big lie," these numbers are from the white house. You can download the spreadsheets they are based on, and believe me, every detail is backed up. The "big lie" is that Republicans are businesslike and fiscally responsible. They aren't

"DaGoat, as I pointed out, no credible economist believes cutting government spending in a recession is a good idea. "

And as I've pointed out in posts long gone, there aren't any real "credible" economists. They're mostly philosophers, with very little science backing them up, which is why they're close to useless in predicting economic change.

I would think that cutting corporate welfare payments, breaking up the banks, and cutting off the bailout money would help tremendously once the slackers got out of bankruptcy court. They bubbles that are being (re)created right now are rather scary for those who are watching.

when it actually meant fiscal responsibility, states rights, individual rights, smaller and less intrusive government. That is not the case any more. At all.

You will get no argument from me on that point.

"the policies Clinton enacted were opposed by Republicans"

That's not necessarily true, Green. The President makes the budget and it is approved by Congress. If the GOP truely opposed Clinton's policies, then the budget would not have passed. I'm just giving credit to both parties here - where it belongs. Clinton was an excellent executive. But, in the GOP's defense, if Clinton would have had his way with Universal Healthcare, do you think he would have kept the surplus he had at the end of his term? Not likely.
Actually, that would have been the BEST time to do something like healthcare reform. But the GOP screwed up and didn't acknowlege it as a problem, and chose the status quo.
Right now, however, when the economy sucks and the debt is already up around 7-9 TRILLION, it is the absolute worst time to do healthcare. I only want Congress to get the deficit down and keep the "popluar programs" that we absolutely cannot do without - doing away with all of the "fluff".

As far as the difference in parties go. I do not agree.
The GOP benefits from one set of corporate sponsors, and the DEMs benefit from another set of corporate sponsors. Neither give a darn about people.

I agree with you about the bubbles being recreated. I agree we need to break up any business that is deemed "too big to fail". We should never again allow companies to exceed our ability to shrug off their failure. And I totally agree with eliminating corporate welfare. ALL of it.

Jefferson, just like Obama, Clinton had to do all he could the first year, and that's when the economic changes were passed, by Democrats, with no Republican support. Look it up. The GOP said it would result in financial ruin. They were wrong. It is THEIR policies that create and deflate the house of cards.

BTW, the debt is now >$12 trillion. Our disagreement, the major one, on health care, is that you think the private insurance mess we have now will ultimately cost less (for what reason I cannot fathom). I believe the only way out of our health care cost crisis is to learn from the successful models, as Taiwan did when revamping their system. That means single payer nonprofit medicine. It costs LESS, not more. But you'll see. You're young enough to see private insurance double in 10 years (last doubling was 9 yrs) so it's FOUR times what it was when Bush entered office. Then 10 years later, it will double again, to EIGHT times what it was.

Oh yeah, you already have government health care. Never mind. That's OUR problem, not yours.

I just don't know, Green. You can't just put the praise only upon our party. The repubs have done some good, but just not in healthcare. We'll just have to agree to disagree about the Clinton Administration. The major reduction in military spending (after the cold war) helped Clinton's overall picture. We simply did not need the bases we had after the cold war. That was begun with GHW Bush and a democratic Congress - and it continued under Clinton and a republican congress (in 96). It's good to walk into office with that kind of financial burden off of your bottom line.

And I've seen the charts. When Dems/Dems hold both branches the trend has historically been downward in terms of debt. But only when Repubs hold Congress and Dems hold the Whitehouse, has the trend REVERSE from upward to downward. We are currently in the biggest upward debt swing since WWII.

And I do NOT have government healthcare. I have to pay a monthly fee just like you do for my family. It's approximately the same as Blue Cross elsewhere for family coverage. I am covered, but they are not since they do not live at least 50 miles from a military treatment center (base).

Why the nasty little jab, bro?

And I KNOW all about health plans since I was born. My father had an awesome plan at his job. There was only ONE bill that showed up. His insurance paid 80%, no questions asked. Prescription medicine was cheap, and most doctors cared about CURING you, not just TREATING you. Doctors did not have to worry about being sued for practicing their craft, unless they purposely or neglegibly did something fatal.

Why is healthcare so expensive now?
1. LAWYERS and million/billion dollars lawsuits.
2. Insurance company greed.
3. Pharmaceutical greed.
4. Unionization of healthcare workers.
5. Breakup of payments - doctor bill, x-ray bill, aspirin bill, hospital bill, sheet cleaning bill, etc.

And you know what? Instead of tackling the above problems, the democrats just want to scrap the whole thing and put in place a massively expensive public healthcare plan. All they had to do is address the problems that made it get so expensive in the first place. The republicans have failed to do that as well.
Now all we have to look forward to is a health plan with questionable performance and efficiency (or availability) and high taxes. YAY! I already pay 50% of my pay in taxes of some sort. I've had enough.

I'd like to add to JD's list, except that I like tracing back to laws.

McCarran-Ferguson, which gave the AMA way too much power and created the near monopolies that health insurance companies have in every state. It's purpose was to increase doctors salaries, that is, to drive up medical costs. I think it worked!
ERISA pre-emption, which has been misconstrued to prevent all lawsuits against health insurance companies and employers who have ERISA plans.
Laws against buying medicines from other countries.
Laws that prevent people from forming arbitrary groups for the purpose of purchasing health care and health insurance.
And of course I couldn't leave out the tax "subsidy" for getting insurance through your employer, the one that you have mentioned on several occasions.

Jefferson, I sit corrected. Figured you and your family had military health care. Your #1 reason for health care rise is lawyers and malpractice? Why? That's only 0.5% of health care cost. Plus the states that have capped malpractice settlements have seen their malpractice insurance rates go UP, not down, just like every other state. So that would be a nice bit of profit enhancement to the insurance biz, but current experience is that it does not help reduce health care cost, and even if it did, it's 0.5%. I agree with 2,3 and 5. But unionization? My mom's a nurse. My sister is a nurse. I was married to one. Man, painting their piddling salaries and benefits as a demon in the system is just unfathomable.

As for what the Dems are doing, again I point to the Taiwan government. They studied every major health care system and concluded that single payer with 100% enrollment was the way to deliver health care to their citizens for the lowest cost. There is no other way to deal with insurance co and drug co greed, and the GOP has PROTECTED their profits by forcing Medicare to NOT negotiate. JD, would you invest in a company that directed its staff NOT to negotiate because it would be unfair to vendors? What a colossal disconnect with business reality.

Prof, I agree with your list.

That's ok about the healthcare misunderstanding. For most in my situation, your assumption would have been correct.

Is that really true about the .5% of healthcare costs being from malpractice settlements? I can possibly agree that the actual amount given out is .5%, but that may not reflect the actual amount the insurance companies pass on to their customers because of it.

Regardless, the crap that goes down with fraud and lawsuit abuse is wrong, and should be regulated. Lawyers and Insurance companies are rolling in the dough through other people's misfortunes. I'm not stupid enough to say that businesses should not make lots of money - I'm glad they do. But healthcare is not a commodity and human health should not be thrown into the purely unfettered capitalism ring. I don't give a hoot if someone cannot make money providing healthcare.

That still leaves Pharmaceutical greed, Insurance Greed, Doctor/Healthcare worker issues, and billing dishonesty. I'm convinced, through my research, that those items are at the core of the 1000% cost increase since the 70's. Neither party in Congress has even begun to address those. That's what is so darned frustrating.

As for single payer.... I'd rather have that than the mess they are throwing us in this Baucus/Pelosi mess. It doesn't address the core problems. Either go ahead with single payer, or scrap the poor excuse that is being presented now and atttempt REAL reform.

I agree with you about the current bill. I'm not happy with it, but will await a final bill to see what gets fixed. Some things did get fixed. Medicare can negotiate lower prices for drugs for one thing. But so much has been done to appease the insurance industry that real cost controls have been crippled. For the reform to provide the competition that will bring down prices, everyone has to be able to choose the public option. Only if the insurance industry's current customers are at risk will they feel the need to keep prices down; even those in employer paid plans. I'll be looking for that in the final bill. Without a "robust public option" the insurance companies will continue down the same path they're on now and we all lose.

Green,

Good to see eye to eye on that. But you have to admit that massive restriction on all of those entities would have cost about 3/4 trillion dollars less, right?

Well as I noted, cracking down on victims through "tort reform" doesn't pay off. The highest estimate I've seen of that is 2%, with most research supporting the 0.5% figure. Let me amplify that point. Even if it's 2%, I assume you don't think all malpractice claims are fraudulent or frivolous. What do you think? Half? One third? Even assuming it's as high as half, that knocks the savings from tort reform to nearly nothing. Furthermore, it's estimated that only 3% of those who were entitled to sue actually did. Scary number. You sure you want to shine a light on whether wronged patients are the cause of our problem?

I'm not sure how you intend to restrict pharma profits or insurance. Government price fixing? Windfall profit tax? The latter won't work either because the poor insurance industry "only" makes 4% profit. But that's after all expenses, including lobbying, all those obnoxious ads and massive executive salaries and perks. If their profit is taxed more, they just "lower" their profit by taking more off the bottom line. I'm sure the CEO and officers will be glad to oblige.

Unionization? You mean pay the nurses, orderlies, cooks and housekeeping staff LESS? You must think they're living large. But you know better. You see a lot of those people driving away in a Lexus?

As for your last item, that's a tough one. You may be surprised to learn that it is ALSO part of the insurance industry problem. The surgeon doesn't bill the patient for anaesthesia so his insurance is not responsible for mistakes by the anaesthesiologist. Same with all the other bits. Everyone bills separately so no one is seen as a "subcontractor".

GreenDreams, the estimates of the benefit of tort reform I've seen you cite have focused on direct costs such as malpractice insurance premiums or settlements rather than the indirect costs of preventive medicine. A doctor who covers his ass by egregiously over-testing and over-treating should theoretically have low malpractice premiums, so your calculus would foresee very low potential savings.

As for paying nurses less, yes. The median staff RN hereabouts makes $103K (per salary.com) in total compensation, and nationally they average nearly $90K. Many of them doubtless are driving away in a Lexus.

How to put pressure on their earnings? Or pharma profits? Or executive bonuses? The only way that ever really works: competition.

Yes, Dr. J, but analysis of "defensive medicine" (not preventive as you said) has not concluded that this is a major issue. Doctors order more tests for example, because patients want them, and because they either have no diagnosis or are unsure of it. You have evidence to the contrary? And as I noted, capping judgments in the three states that have done so did not even freeze malpractice rates, let alone lower them. Apparently you need to adjust the "greed" variable in your calculus.

As for competition, well free market is what we've had all along. It would appear not to work the way you think it should.

BTW, do you love the GOP plan? It garnered 100% support from GOP legislators. May I assume that is your favored alternative?

In my calculus, greed figures in with 100% weight for everyone. Moaning about it is a waste of time, and policies that hinge on people not being greedy may work in some alternate universe but have no use in ours.

Defensive medicine is a cultural problem, and I'm not imagining reforming the tort system makes it go away by itself, or quickly. But we need a system that does a better job of the costs and benefits of treatment X, including the pressures you cite--patients want them, etc. Tort reform is an important piece of the puzzle, but it's only one.

As for competition, well free market is what we've had all along.

Hogwash. The government completely dominates the market. It already pays for half of Americans' care directly and heavily distorts the market for the other half. What exactly are you imagining the market is "free" of?

"price fixing or windfall profit tax?"

Neither. (And this is when I start to sound like a democrat)
I support placing a cap on the profit margin of insurance and pharmaceutical companies as part of comprehensive healthcare reform package. I also support limiting bonuses within these companies, and mandate a portion of the un-capped profit to go to the truly needy among us.

As far as unionization, I'm for organized labor and belong to one of the biggest ones in the nation (not SEIU). I just believe that unions do not belong in certain industries - healthcare is among them. Have the government regulate pay in this industry and provide some sort of greivance procedure without the union. Healthcare workers can not and should not be allowed to strike - it's unethical - and without striking power a union isn't really anything but a scam.

And for the last one. Outlaw multiple billing. One bill comes to the patient. Make it law.

Good luck trying to gain traction for "capping profit margins". There would be special tea parties just for that. Besides, as I pointed out, profit is malleable. Need a lower profit? Raise your costs. How about replacing those company limos with private jets for all the execs. Or a tropical paradise "retreat" for meetings? Or heck, why not just another round of bonuses?

That's where regulation comes in. I'm talking about profit margin caps for healthcare entities ONLY here by the way. Government oversight can keep the profits from being lied about or manipulated. This is a semi-government "take-over" with free market left in place.

And I attended the Tea Parties. If this fixes the problem, I don't care how the companies see it.