To use a phrase out of President Obama’s own dazzling speaker repertoire, adding a few amendments to a fundamentally flawed health-insurance reform bill is like putting lipstick on a pig. Sure, it might look a little prettier, but it’s still a pig and you might not want to kiss it. Improving access to insurance is only one part of the health-care reform equation. Reducing costs is another, and this bill looks only at reducing Medicare costs to the government, not at reducing the health-care costs that individuals and families will pay. Beyond that, it does nothing to improve the delivery of care.
Simply providing increased access to insurance will not “bend the curve” of overall health care spending, although it may push those costs away from government and on to individuals and families (through higher taxes and higher prices on premiums, procedures, prescriptions, and devices). In fact, simple economic theory tells us that if all we do is give more people insurance, then more people will get more medical care, which will cost more money. Yes, I’ve heard all of the rhetoric about the long-term savings that are realized from better preventative care, but the data don’t support that theory. Just because people have access to medical care doesn’t mean that they are healthier or that they require less costly medical care in the future. Even among the insured, we have seen an increase conditions like obesity that lead to chronic disease.
Access to better managed care, through some managed care plans, has proven effective in reducing the overall cost of treating chronic illness, but I have not seen compelling data to support the idea that access to insurance has reduced the incidence of chronic illness. Moreover, having insurance does not preclude one from using the emergency room as the primary care physician, especially when there is a shortage of primary-care docs. I have outstanding health insurance, but recently found myself in the emergency room when my son’s pediatrician would not see him (he had just turned 19), and I couldn’t find a primary-care physician who could take on a “new patient” with less than a three-week delay. His condition required more care than the CVS minute-clinic could provide, although he did not need the ER. He needed a good primary care doctor, and even in a major metropolitan area, none could be found in the necessary time frame.
A review of data for people over 65, all of whom have health insurance, shows that when they have access to more care, they endure more medical visits and procedures, which costs more money, but does not necessarily lead to improved outcomes. The folks at Dartmouth have been studying this for years, and their data shows that having access to more specialists and medical facilities increases Medicare costs, but does not improve outcomes. I’d encourage you to read Shannon Brownlee’s insightful book, Overtreated: Why Too Much Medical Treatment is Making us Sicker and Poorer, to understand how overtreatment is costing us more money, but not improving health-care outcomes.
While the bill does include a few provisions that could be effective in reducing Medicare waste, fraud, and abuse, none of these provisions will reduce personal spending on health care. Sure, saving the government money may reduce the tax increases that many of us will soon suffer, but it will not reduce our personal spending on health care. And the only way to really reduce waste, fraud, and abuse is by hiring more government auditors and investigators, the cost of which is not included in the CBO score for the current bill. And speaking of CBO scoring, I sure hope that everyone understands that the 10-year cost estimate is based on a bill that collects money for 10 years, but provides services for only 6. The cost estimate for the next 10 years looks shockingly different.
Like 55 percent of Americans surveyed recently through the Gallup Poll, I believe that we need to scrap this bill and start over. In the area of insurance reform, we need to focus on catastrophic coverage that would prevent Americans from bankruptcy in the event of a medical catastrophe. Catastrophic-care coverage, with low premiums and high deductables, would allow people to have the insurance they need to cover the high cost of unexpected events. This, after all, is what insurance is supposed to be for. We could even provide a government loan program to help people manage costs incurred in meeting the high deductable for events that ultimately qualify for catastrophic coverage — sort of a Direct Loan program for health-care costs.
I guess one could say that the best thing about the current bill is that it allows individuals and families to opt out of insurance coverage until they need it. Since insurance companies would not be allowed to deny coverage based on preexisting conditions, but individuals and families will be penalized only at the rate of only 2.5 percent of their annual income if they do not have insurance, it makes sense for families earning under around $500,000 per year to forego insurance coverage until they get sick. Clearly insurance coverage costs most middle-class families far more that 2.5 percent of their annual income, so the current bill serves as a disincentive to purchase insurance. Bravo, Mr. President!
But most importantly, we need to do a better job of putting patients in a position to make informed decisions about what tests and procedures they want … and for which they are willing to pay. Currently, we have a system in which the doctor, who is paid on a fee-for-service basis, is also the primary source of information, and sometimes the ultimate decider, about which service the patient should receive. At the same time, the patient generally pays the same copay regardless of which test or treatment option is selected. If I am going to pay the same amount of money for an X-ray or a CAT scan, I’ll probably go for the CAT scan, and the physician will certainly push me toward that test if she thinks it will offer her better protection against potential lawsuits and if she or the hospital will enjoy a higher reimbursement rate for the procedure. A young resident may not even know about the low-tech option since his or her training is likely to be biased toward the latest and greatest technology.
The elimination of unnecessary care is not care rationing, but in this country, we have allowed people to believe that what they want is what they deserve, even when it isn’t what they need. We must empower consumers to make good decisions by providing them with more information about the options they have, which includes also providing them with accurate information about the cost of each of those options. And if they don’t win damages in court for suffering from the very risks about which they were warned in advance, people may actually take decision making a bit more seriously. It is good to support comparative effectiveness studies, as long as we are willing to embrace what the experts tell us and as long as we understand that an individual may need a treatment plan that deviates from the general practice standard. Comparative-effectiveness studies, if used as a floor for acceptable practice standards that protect physicians from medical malpractice suits, could be quite helpful. However, I worry that insurance companies might use comparative-effectiveness studies to deny coverage for certain tests and treatments, despite solid medical justification for a deviation from the standard given a particular patient’s condition or medical history.
Moreover, I’m worried that we won’t embrace the results of comparative-effectiveness studies if they do not support what we believe or want to believe. While men might be very willing to accept the American Cancer Society’s new recommendations about PSA testing and routine digital prostate exams, we should remember that women did not react with the same level of enthusiasm when an expert panel recommended, based on empirical studies, that annual mammography is not necessary for most women under the age of 50. We must be willing to accept the findings of comparative-effectiveness studies even when we don’t like them and even when the data do not support what good marketing and PR efforts have forced us to believe.
And we do need to be honest about the fact that spending hundreds of thousands of dollars on people in their 90s may not be one of our better investments, especially when the 90-year-old person may want nothing more than pain management and the chance to die at home, surrounded by friends and family. It can be impossible for a family or a patient to stop a doctor or hospital from doing more stuff to a dying person, even when the dying person accepts his or her fate and doesn’t want any more procedures. If Granny, who is suffering from multiple chronic illnesses, wants an intervention to treat one of them, then we shouldn’t should stop her from having it. But most of the time what Granny wants is better days at home, not more days in the hospital. While baby boomers may be in the search for eternal life, the greatest generation is generally willing to accept the fact that death is part of life, and something that each of us will face. The problem is that families don’t always make the best decisions when they are in a time of emotional duress.
Of course, we cannot have an honest conversation about cost if we don’t take a genuine stab at reducing the practice of defensive medicine. It is a ridiculous waste of time and money to do more pilot studies about tort reform. We don’t need more studies, but instead need an efficient system to reward damages to those who are the victims of medical negligence, but not to those who, unfortunately, suffer the fate that they were warned about when they signed the consent form for a procedure in the first place. People have to understand that when they are told about the risks of medical procedures, those risks are real, and that they may suffer a negative outcome. Medical procedures are inherently risky, so we can’t keep pretending that medicine is practiced in a zero-risk environment. And we can’t keep rewarding patients — and their lawyers — who sadly suffer from the outcomes that they were warned about in the first place. Medical malpractice is not the same thing as medical risk or even human error. Doctors sometimes make mistakes, especially when they are dealing with very sick patients who have multiple confounding conditions and who don’t do a very good job of communicating honestly or accurately about their current medications or conditions.
And by the way, it is dishonest to say that the current bill reforms Medicare or cuts Medicare costs when it doesn’t include the very necessary “doc fix” that ensures primary care physicians appropriate payment for the care they provide. Until the health insurance reform bill makes permanent — and pays for — the “doc fix” (which this year was conveniently inserted into the armed services appropriation bill rather than the “must pass” health care bill because of its high cost), nobody should vote yes for this bill. If we increase the number of insured, but don’t compensate primary-care doctors fairly for their services, there will never be enough doctors to treat patients, even if patients have insurance to pay for care. Already many primary care doctors find that they cannot afford to participate in Medicare due to the extremely low reimbursement rates. Medicare harms primary-care doctors, yet rewards specialists and surgeons who are the very ones who drive up health care costs. We have too many specialists, and too few primary-care docs. Every year, Congress has to pass a separate provision in some other piece of legislation to provide reasonable reimbursements to primary-care physicians. Yet the health insurance reform bill does not make an honest attempt to permanently fix this problem. Why not? Because the cost of this fix, alone, makes the health insurance reform bill dead on arrival.
So instead of putting some lipstick on this pig, let’s scrap the bill and start over, this time listening to the American people and delivering to them a bill that would reasonably increase access to insurance (defined in the traditional sense, to protect against the unexpected), that improves health care delivery, and that reduces costs, over the long term, to the government, to individuals, and to families. And let’s be honest about the fact that we might not be able to tackle all of these problems in a single piece of legislation, or within a single presidential term … or even two.
19 Responses to Putting Lipstick on the Health-Reform Pig
tridaddy - March 5, 2010 at 9:01 am
This opinion piece is correct; but like a spoiled child who thinks he must win at everything or get what he wants when he wants it, I’m afraid our representative gov’t bodies are more interested in the ends than the means that get us there. If this bill passes in any of its current form, we and generations to come will be strapped with a giant monkey on our backs that will be next to impossible to alter. Power and self importance is a corrupter.
kffdn - March 5, 2010 at 9:42 am
Well-written and well-informed.
livefreeordie2 - March 5, 2010 at 9:59 am
Overall, an excellent piece. There are some areas where you are simply incorrect – such as suggesting that Medicare rewards specialists and surgeons when the truth is they are reimbursed only a tiny fraction of their services are worth – but for the most part, you are right on target. Unfortunately, you are using logic, which seems not to apply to supporter of government care, and in the end, this isn’t about health care at all. The only thing this is about is “fundamentally changing” the US into a European style socialist nation where every action of the citizenry is controlled. Why not logical? Take the debate over pre-existing conditions. People will look at you with a straight face and bemoan the unfairness. When you tell them that what they are asking for is to be able to live without paying for car insurance until after they have an accident, it doesn’t register. As you said. . . it’s supposed to be insurance. When I was younger, it was called “major medical.” It has been morphed into the idea that the patient really shouldn’t have to pay for anything ever. That, combined with the tremendous (and tremendously expensive) advances in medicine, the longer life expectancy, and all the unnecessary testing that must be done because of law suit craziness, easily explains why health care costs are increasing so dramatically. Another example of the illogic of those who want universal health care (and make no mistake – this bill is simply an incremental step according to Obama) is the notion that everyone should always have health care – that somehow it is a right. Those in my generation – boomers – are obsessed with “rights.” The truth is, if it costs me money for you to have a right, then it ain’t a right. Think about it. Think about the Bill of Rights. There’s no right that a person has that requires another person to do something or to pay something. If the left succeeds in making health care a right, then medical professionals become slaves and hospitals become plantations. If you are sick, then treatment is your right and since the doctor then must treat you whether you pay or not (or your right is violated), then the doctor is a slave. More crazy logic. Obama is going to increase the “covered” rolls by 30 million people and increase the quality of care. And while this is happening, costs are going to decrease. Does anyone really believe that? Our President says it with a straight face. More people getting better care for less money. It’s a lie. Obama knows it as do the democrats that support the bill. But people believe it.But the point is that you can argue about health care this and that all day, but at the end of that day, it has only to do with control. If the government takes control of health care, then despite the US Constitution, they will be able to control every aspect of human behavior in the name of “reducing health care costs.” They scoff at the notion of death panels while they will clearly happen in the name of “efficiency.” Everything you do, every place you go will be controlled by the government. The only way to save health care and to save liberty in this country is to do away with any government involvement in health care. And do away with anything but catastrophic health care insurance. Everyone should pay for their own medical care. And those who have nothing, let families and charities take up the slack. That system worked very well in this country for nearly 200 years. People need to take responsibility for themselves and that includes health care. It’s called freedom.
mhutcheson - March 5, 2010 at 10:04 am
Neither “correct” nor “well-informed,” imho. Ms. Jones has simply put lipstick on the Republican pig of stalling until the American public gets tired of hearing about health care reform, and until Mr. Obama can be accused of ineffectiveness. Of course, I could be wrong. Ms. Jones may simply be politcially naive in thinking that scrapping the current bills would actually lead to new negotiations and better legislation. But given her stint in the Bush administration, and the years she has spent as a lobbyist, I doubt she’s politically naive.
11142568 - March 5, 2010 at 10:12 am
I am sure that there are flaws in the bill that is now under consideration. But for the first time we are within sight of actually passing a health care bill, a goal that eluded many past presidents. It is likely that after the November elections, the democratic majorities in House and Senate will vanish or be diminished. The Republicans have consistently resisted any kind of health care legislation. So it is better to get this done now if possible. When medicare passed, it initially only covered relatively few, but over time, it was amended to add coverage. If we are ever going to get any kind of national health system, we need to move now, despite the imperfections. Later on, we can add features. It is a scandal that almost alone among the industrialized countries, we have very little by way of a national health system. Peter Baker
dogood1776 - March 5, 2010 at 10:27 am
11142568,So, it is an appropriate goal to simply pass a bill?
jdm0007 - March 5, 2010 at 10:33 am
Great piece. As you can see from the blog that any reasonable article will be dismissed as a Republican plot. Then these same people claim the Republicans always engage in namecalling and devisive speach. If you are a clear thinker you can see who it is who is devisive and who is the problem in this country today. Smart people know that in a 2000+ page bill there is massive amounts of hidden mischief. That fact alone is good reason to stop this bill. There is not amount of lipstick that you can put on this bill and make it kissable.I loved a sign in the Chicago rally the other day that the news media never reported. Out of little ACORNS mighty Marxists grow. This is what we have in the Chicago mob in the Whitehouse.
cwinton - March 5, 2010 at 10:50 am
Unfortunately for livefreeordie2 and others more libertarian minded the cow is already out of the barn. We are now bedeviled by armies of accountants and lawyers who are basically sycophants for government regulation (and making a lot of money in the process). In my youth, there was a huge outcry to prevent federal government expenditures for education since accepting the money meant regulation would follow. We were assured there would be no strings attached. Hah. Now we are seeing lunacies like NCLB and crippling accountability regulation that take enormous amounts of personnel and money out of the classroom. The entire financial system, as events have just shown, is a “free” enterprise myth, propped up by government agencies. Many of those now so eager to espouse “conservative” causes owe their paper wealth to the system of government expenditure we have built up since the great depression. Eisenhower was concerned, with good reason given the stupid wars we’ve become entangled in since, about the impact of government expenditure for the military-industrial complex, which in many ways led to massive government expenditure for other “worthy” causes that could be argued were for the good of the country. Like those interstate highways? Well, if the government owns them, it has to regulate them. Like having credit? Well, if the banks need the federal reserve, as they evidently do, the government needs to regulate them. Like stock investments? Well, if corporations are going to be recognized entities like citizens, then they will have to come under government rules of civil society. Don’t want your contributions taxed? Well, if you allow tax exemptions for one thing, you can bet there will be a long line at the door of people wanting tax exemptions for heaven only knows what else. Like cheap food? Better keep NAFTA then. Don’t like the current health care situation (and who does, except for the insurance companies)? Better grind your teeth then, since anything Congress comes up is unlikely to help. We can already see the freight train of Social Security bearing down on our children and the political reality is that Congress can’t deal with that. The point is that much as we might like to we can’t turn back the clock, but some honest fiscal reality would help (Bush’s “off budget” war comes to mind). It’s ironic that the only presidency for my life time that even tried to be fiscally responsible was Clinton’s, who was villified (and not without reason), but who at least understood the virtue of living within one’s means.
emwhite - March 5, 2010 at 11:58 am
The perfect is the enemy of the good. This piece and its apologists are either ingenuously or disingenously opposed to a bill that might just make it past the huge amounts of money being spent to kill it to give us a start on improving our disgraceful present health system. “Start over” is another term for “kill it for a generation.” Of course the bill is not perfect. That allows for the smoke screen of argument designed to stop all reform. CHE readers should be smarter than to be taken in by such argument.
stand4freedom - March 5, 2010 at 1:44 pm
To 11142568 (PBaker) and emwhite, yes, you’re right: perfect is often the enemy of the good. But evil, and socialism are also enemies of “the good”, and this health bill is full of both (evil & socialism). I’ve often used that very phrase, “Don’t let the perfect get in the way of the good”, but I’ll tell you what, whoever said earlier that we will have a 10 ton monkey strapped on our back for generations if this bill passes was right on target. This bill is so bad it scares me to death to think of what we are about to do to this country. Yes, we, the patient, have an ailment–health care does have some serious problems that need to be remedied. But I ask you in good conscience, “Do you take an ailing patient into the hospital, and, in the name of “doing something,” force cyanide down their throat and then exclaim to those against what you’re doing that they are part of a ‘vast right wing conspiracy’ or ‘small minded’ or ‘just stuck in the past’??? COME ON–PEOPLE WAKE UP! This bill is bald-faced, freedom destroying, economy sinking, socialism. Our President has the audacity to stand up yesterday and say “America just can’t wait any longer for reform”!! WHAT???? America, by overwhelming numbers does not want this bill and reports being satisfied (85%) with their coverage, and this President has the audacity to pretend he’s doing what America wants him to do? These are sad days indeed. And yes, I too find it interesting that the liberals, Democrats, and progressives–those of you who are always touting “tolerance”–are only tolerant of those who agree with you…ironically, many (not all) of you are among the least tolerant I know–don’t believe me–just watch what some of you will say in response to this posting…just because I don’t like the same horrible health care bill that you adore. Its ok, I believe in a country where you have the right to disagree with me…even if you don’t believe I have that right. God Bless this great nation that our founders were wise enough to create, where freedom and prosperity have reigned for over 200 years, and where like no other nation on earth, a person can accomplish almost anything they can dream–without the need to apologize for their success….so far.
innocentpasserby - March 5, 2010 at 3:14 pm
The piece seems to me primarily an attack meant to muddy the waters and stall action without much substance to go on, riddled as it is with contradictions, inaccuracies, and half-truths. For instance, one paragraph begins, “I guess one could say that the best thing about the current bill is that it allows individuals and families to opt out of insurance coverage until they need it” and then ends with a sneering “Bravo, Mr. President!” Well, which is it? And: “[W]e need to do a better job of putting patients in a position to make informed decisions about what tests and procedures they want,” yet “[those same patients] won’t embrace the results of comparative-effectiveness studies if they do not support what [they] believe or want to believe.” This is not a “moreover,” as Ms. Jones presents it, it’s a “however,” and a rather large one (besides being unsupported by more than a single anecdotal example). Later, “It can be impossible for a family or a patient to stop a doctor or hospital from doing more stuff to a dying person,” and then, a few sentences later, “The problem is that families don’t always make the best decisions when they are in a time of emotional duress.” So is it families who decide, or not? And what of the health-care directives that many people have in place now? These contradictory claims (both unsupported by any real evidence) actually seem to tend toward support for government rationing of health care for the elderly, which might give pause to some of the antigovernment rhetoric in posts above. (One can only assume, as an aside, that none of these posters are or intend ever to be on Medicare.)Then there are the unsupported claims about the supposedly huge costs of “defensive medicine” (opening with the classic rhetorical bid for assent without thought, “of course,” and impatiently exclaiming that “we don’t need any more studies”). Or the claim that most Americans reject the current bill, repeated in the current Republican discourse ad nauseam without the qualifier that opposition comes from both the right (who think the bill does too much) and the left (who think it does too little, mainly by excluding the massively popular public option). I can only conclude that this column is another (inevitably rather confused and confusing) attempt simply to discredit and stall, without much to offer in the way of constructive suggestion.For my money, health care is indeed a fundamental right in a properly functioning society, and, guess what, insurance (in any form, and however administered) is socialism. Risks and benefits are redistributed across a pool of payers/claimants, no matter how you slice it. It’s absurd to imagine that every individual in the United States could possibly save up enough to meet every contingency that might arise, so we agree that we will pool some funds to pay for those who need them while many if not most of us get less back than we put in. The only issue for me beyond that is whether a large portion of those funds should go into private profit or whether it makes more sense to take the profit out of the system. Cars, fast food, cellphones, okay, my life or death, not okay.
ledzep - March 5, 2010 at 4:15 pm
“take the profit out of the system”Sorry, but that’s not on the table politically, either, innocentpasserby – that’s far more utopian than anything Auer-Jones said. And again, for those who read “start over” as “stall for another generation,” why is that? Why is it that conservative ideas for health care are so politically impossible? Oh, maybe it’s because liberals oppose them! Could that be it? When the reform on the table is a government mandate for citizens to buy insurance, mostly from for-profit insurance companies, then I find it hard to take seriously the charge that the opposition is pandering to the vested interests of the status quo. The reform guarantees, through the power of the state, business for the insurers. And yet you continue to think that only conservatives could possibly be in bed with the special interests. Right.
redanlew - March 5, 2010 at 5:21 pm
Live Free or Die 2: We will pay taxes to cover medical care. Just as we do for roads, schools, prisons etc. To use inflammoarty words like “slaves” and “plantations” is simply inflammoatory rhetoric.
teacher11 - March 5, 2010 at 6:24 pm
Any bill that requires so many bribes to get enough votes to pass has something seriously wrong. A good start on a rewrite would be to eliminate all special provisions for states, organizations – such as unions, and exemptions – such as for the legislators who think it is such a wonderful bill. If it is good enough for me, it is good enough for EVERYONE. Then let’s see who will vote for it. The legislators voting for it should have to live under it.
suomynona - March 5, 2010 at 8:37 pm
ledzep,The reason no one takes conservative ideas for health reform seriously doesn’t have much at all to do with liberal opposition, in my view. The reason is, rather, that the most empowered and influential conservatives have decided almost monolithically that it’s both easier and more gainful politically to obstruct and critique the ideas on the table than to propose their own ideas in a serious way. I’m struck by your use of the phrase ‘serious conservatives’–no doubt a deliberate way of distancing yourself from the demagogues–because I do think there are some out there who would fit that bill. In fact, I find much of your commentary here quite good. Trouble for conservatives is, the power centers of the political right have chosen to ignore ideas in favor of demagoguery. And in many ways, sadly, it works. Your ‘death panels,’ your ‘socialism,’ your ‘government takeover of health care,’ your last-ditch efforts to make it look like the Democrats are ramming this thing through, as though they haven’t dicked around with it trying to garner substantive input from Republicans (some of which is actually in the bill itself!) for a year now: there’s a finite amount of time and space involved in passing legislation, and all this bullshit from conservatives takes up most of their share of time and space.All this ‘scrap the bill’ stuff is an appalling political ploy. Just thinking about the sheer amount of labor and money that goes into these debates, both in the chambers and the individual offices, between the lobbyists and the special interests, between the reporting and the op-eds, etc., a decision to ‘just scrap the bill’ would be nothing more than a catastrophic waste of money and effort that conservatives would turn around and use as a political football. Everyone on the left and the right knows this. And everyone ought to know that starting over from the beginning on this thing would be like a ten-time four-hour marathoner stopping a few strides before the finish of his eleventh marathon under the impression that he can start again next year and somehow knock an hour and a half off his time. We all know how these things work; we’ve all seen it happen (or not happen) plenty of times before. What silliness it is to think the idea of turning back after all the vetting and all the discussion and all the hard work would be a good idea. It’s not like this is some quickie bill that will be haphazardly passed. That notion is a talking point, and an absurd one.
mdmartinsen - March 6, 2010 at 2:28 am
Very solid assessment and many comments that ring true, regardless of your lean (though a couple just can’t recognize the sarcasm they are wound so tight), but Teacher 11 hit the nail on the head and pounded it flush with his/her view that if it needs to be bribed into passage??, and if it is what we need, then ALL should be covered by it. This is not the health care system we want in place for Americans, I hold hope that it will be realized before it is too late.
suomynona - March 6, 2010 at 8:32 am
Can someone really argue with a straight face that this bill is being bribed INTO passage? Unless this bill has particularly more pork than most of the bills, major or minor, that go through Congress, I’m highly skeptical of that argument. It’s pretty clear and on record that the most overt bribing and financial strongarming being done with regard to this bill is coming from the insurance lobby and has brought Republicans in line lock-step. Hundreds of millions of dollars, just like every other time health reform gets on the table, pushing the usual suspects into the ‘no’ position. There are over 30 senators in favor of adding the public option right now, let alone supporting the bill as it is. Is anyone seriously trying to argue that a majority in the sentate and the house doesn’t support this bill on substantive grounds? And for those citing public opinion polls about being for or against the bill: were you born yesterday, or have you just failed to notice that a public opinion poll can be engineered to reflect virtually any conclusion? Enough with the cheap populsim; this isn’t a straight democracy. We elect officials to do these things precisely because of how fickle we are as a mob, particularly when hundreds of millions of dollars are being spent on influencing our generally underinformed views.
hccbrandonlibrary - March 10, 2010 at 8:14 am
I agree that this article is well written and informed. HOWEVER, that being said, having seen chances for health care coverage destroyed in the Nixon and Clinton presidencies, I’m reluctant to urge our legislators to NOT accept the pig with the lipstick. Lets face it, this country has been bought and sold.
dank48 - March 12, 2010 at 1:56 pm
Best government money can buy.