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Is it possible to have a reasonable health care discussion?


I doubt it. Most here think all conservatives are evil corporate drones hell bent on destroying the world. But I'll try. Here are a few points about health care. (1) It is not free, no matter who pays. Government provided does not mean free. (2) Many things affect the cost, but insurance only spreads the cost - it does not lower it. (3) If something of value is provided to 50 million people at no cost to them, someone else is going to have to pay. (4) Government health programs always involve rationing and limits on types of treatments as pressures mount to control costs.
Now, with the proposals before the Senate, it should be noted that people will lose the ability to pick their own doctor, they will be assigned one. They will not be able to see a specialist unless the Government approved doctor authorizes it. They will only be able to get the treatment/tests that he approves. Then there is the issue of wait times. In Canada it is not uncommon to wait a year for a mammogram or an MRI, and several months for angioplasty. People do die waiting for treatment that they would have gotten immediately in the US. Rationing is also a concern. Obama himself brought this point up when he talked with the woman about her mother needing a pacemaker. Obama said maybe it doesn't make sense to do that for a person of her age, maybe she should just be given pain medication. There you have it from the source - if we determine you are not worth treating, then just go home and die quietly. Sure, private insurance companies can and do deny treatment, but there are other companies to go to. Who do you turn to when it's the government? Another great point is the plan to allow companies to ditch their benefit plans and opt for an 8% payroll tax instead. Of course this tax will ultimately be paid by the workers, and the company will get an immediate cost reduction by dumping their plan. So if you think you will keep the coverage you have, guess again - it will disappear fast. In fact, within 5 years as stated in the legislation, everyone will be in the government plan.
I would prefer just fixing what we have. Prohibit insurance from denying coverage for people if they are covered by another plan. Losing your job should not end your insurability. Reduce lawsuits that drive up costs. Reduce regulations and paperwork that do the same. Increase enrollment at med schools. Focus on what is driving up the cost - lack of supply, defensive medicine due to lawsuits, high insurance costs, lengthy government reviews and regulations (concerning drug development). And don't forget the abuse of the system by millions who opt for 'free' treatment at ER's instead of paying for insurance and private treatment.


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The #1 mechanism to ration health care is.... price. It's a fundamental piece of Economics 101. The existing system rations. It just does it by price.

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Ok, I just read your various discussions of this, below.

You know the price system rations scarce goods, you just don't like SAYING that it does. Because "ration" is a word you want to stick on any government health program, but not on your own dear system.

In sum, you don't LIKE the truth - that there are scarce resources, access to them must be limited, and you prefer the method whereby the dollars in your pocket are used to sort out who gets the scarce treatment, and who doesn't.

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There is a difference. Ferraris are also 'rationed' by your definition. Under the current system, no one is barred from any procedure. If they have insurance, it pays. If not, they pay. Under Obamacare, you simply won't be able to get the treatment, regardless, if they deny it. This is how it works in the UK. That is rationing.

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That is incorrect, as is most of your post; and no, it will clearly not be possible to have a reasonable discussion.

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I wouldn't think so with someone proud to call themselves a Marxist. Marxism/Stalinism/Communism lead to the deaths of scores of millions of people around the world. That says a lot about you.

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And not knowing the difference between the three says that you know fuck-all, not that this was a new discovery.

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And you thinking there is a difference says a lot about you. I doubt the countless millions killed care much if the murderer was a Che style Marxist, a Castro style Communist, or Stalin himself.

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Oh, I am sure you are correct that it would not matter, but since Guevara and Castro were self-styled leninists and did not "kill millions of people", misguided as they were, and Stalin -- who did -- was a stalinist and a grade-A totalitarian genocidal asshole (as did Mao, the famed maoist), I think I stand by my earlier assessment of you being an ignorant fool.

Communism is to capitalism as democracy is to tyranny.

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Clever -

How if you can keep your present Insurance under what Obama is suggesting is your healthcare going to be rationed? Keep in mind the Public option does not replace your current insurance plan. You are free to keep it if you so choose.

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It is doubtful that you will be able to keep your present insurance. In the Senate bill, it has a 5 year timeline for all plans to phase out. Also any plan changes push participants into the gov't plan. Fortune ran a piece on this, if I find the link I'll post it. In addition, since there is the option of paying 8%, few companies would want to keep paying the much higher costs of their current system, so they will phase them out.

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JSfox - even people who choose to keep their existing insurance will be affected. The public option doesn't replace your plan - true. BUT the House bill DOES say that all companies which today self-insure through ERISA will be subject to new government oversight after a 5-year grace period. So hundreds of millions of people that are under current employer provided plans will be affected.

So this isn't just a case of adding a public option and the existing plans remain "status quo".

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ERISA is flawed and doesn't look out for the health care consumer at all.

What this provision does is give private insurers five years to get their act together and quit killing their clients or else ALL Americans become eligible to enroll in the public option. If private insurance companies can continue to make a profit while following new regulatory structures designed to protect us from them,

Health insurance companies should be under new government regulations and oversight, just like the meatpacking industry from a century ago. I see nothing in the current legislation that should give any real conservative a moment's pause.

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I'm not sure why you are bringing up insurance companies. The ERISA issue I wrote about has to do with large companies that self-insure.

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Yes, and ERISA gives them zero protection from fraudulent insurance company practices. Nothing in the current legislation forces anyone to change a single thing about their coverage except the price and performance.

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Their employers self-insure them, so what do the insurance companies have to do with it?

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The employers provide group coverage from private insurance companies. They aren't self insured or at least I am not understanding the context or your comment.

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That opinion piece seems fairly short on facts and makes liberal use of the word could and maybe.

He also doesn't connect the ERISA issue that is being decided in the court case to anything in the proposed legislation, so I am not so sure this is the Chicken Little ruling this article makes it out to be.

I am willing to keep an eye on ERISA changes in the final conference committee bill, but I am willing to bet this is another case of people who don't want reform at all making a mountain out of a mole hill.

For what it is worth, self insured businesses appear to make up a pathetically small amount of the whole and with a strong public option, those small business who can't afford coverage with private insurers today have someplace to go.

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The number of people whose employer relies on the ERISA pre-emption has been quoted in the 125-150 million range.

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Thanks for this.

I must ask, is your rationale about ability to achieve specific doctors/treatments based only on your premise that public option is mimicing same tenets as other countrie's programs and processes?

Or is this based on knowledge of actual legislation to be proffered to Congress and approved by President Obama?

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It is based on an analysis of the latest Senate bill as detailed in Fortune mag.

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Can you provide link and/or actual bill number - which source (i.e. committee) this report references?

Thanks.

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Does that mean if I move to the UK, I will get a free ferrari from NHS?

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No one is barred? Um, what about the 43 million who can't afford healthcare in our current system? Can they buy a Ferrari too?

And about your loss of choice argument. I think Jason does a better job below, but here's my take and analogy: Many countries with universal coverage have a hybrid system or are moving that way. Meaning all possess coverage and access to care; however private practices exists to fill in the gaps, alleviate waiting times, or just provide coverage to those who wish.

It's almost like the school system. Everyone can go to public schools, but some may prefer to go to private school. This opens another can of worms in my thinking, but the point is that good coverage is guaranteed to all by the public system--but some can choose otherwise.

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Then maybe ,as I suggested, we should focus on LOWERING the COST of medical treatment. Why is everyone so obsessed about insurance? That does not lower cost. Address the root issues, and the insurance issue will go away.

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Insurance is only one small piece of a much larger package of reforms. It seems you are more concerned with insurance than the parts of the bills that address costs in other ways such as medical IT infrastructure and eliminating wasteful practices with dubious results.

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You are right to say that lowering the cost of healthcare is one of the problems. Problem is that even if costs are lowered, there will still be those without access to healthcare because it is still too expensive. The self-employed (I have a friend who has to buy her own coverage--it's completely unreasonably astronomical in price). The poor. Those with the pre-existing conditions (There's one person who comments on TPM who lost her coverage because she went through menopause. Is that crazy or what?).

But how do we lower the cost? One way is leverage. Another is competition. But competition doesn't seem to be working, does it? I'm open to other ideas.

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I think increasing the supply of doctors will lower costs, as will allowing NP's and Pharmacists to diagnose and treat minor ailments. Reducing the malpractice awards that are so insane - Edwards personally made over 50 million dollars by suing doctors claiming that lack of a c-section caused CP. There is no medical evidence to support his claim, but he won the cases anyway. With drug companies, if they follow FDA procedures and don't commit fraud in their application process, they should be immune from lawsuits for FDA approved drugs. Why destroy them for something that was no ones fault?

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Malpractice suits and the resultant high-cost practitioner insurance is a problem, but may be just a drop in the bucket compared to the whole system's costs (If someone has numbers please say what they are--I've no time to research at the moment).

But how can you regulate it? Blanket caps could let egregious offenses go under-punished. A tiered cap system based on reasonable punitive damages would have to scale with inflation/deflation(!) and also be based on somebody's idea of what 'reasonable' means. What would be the caps for, for example, leaving scissors next to some poor sap's spleen verses a hospital systematically giving the wrong drugs to patients to save money?

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I think in your examples, the hospital should face CRIMINAL sanctions - those responsible go to prison. The doctor should be forced to take some remedial training for a minor mistake, be suspended for a major mistake, and be de-licensed for repeat offenses. This protects society, which is the goal. It does not compensate the victim (neither do most criminal matters), but currently doing that punishes society with higher costs which is not a solution.

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Now, with the proposals before the Senate, it should be noted that people will lose the ability to pick their own doctor, they will be assigned one.
Not true. Nothing currently in the senate significantly changes the current public-private paradigm. It simply better regulates the private insurance companies and give the uninsured and uninsurable a place to go to enjoy the benfits of group coverage.
(3) If something of value is provided to 50 million people at no cost to them, someone else is going to have to pay.
Again, not true. Of the "fifty million" who are currently uninsured, only a small percentage of those will need to be subsidized. Most are self employed or small business owners who can't afford private coverage outside of a group benefits plan.

Again, none of the bills currently in the senate do anything other than give those people a place to band together to realize the same strength in numbers that other group plans receive. There is no "government plan" currently being suggested in the senate legislation. At worst, the public option is a nonprofit collective that allows those without coverage to be covered at a reasonable rate.

The status quo is clearly not an option, so rather than make untrue claims about plans you obviously have not read, perhaps you could tell us what plans the republican caucus have offered for debate. Oh wait, that's right, our party doesn't seem to care that the health insurance companies are killing hundreds of thousands of people each year due to lack of regulation.

Kind of like the meatpacking industry in the last century.

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Your information does not match what has been published about the Senate bills. Here is a link

http://money.cnn.com/2009/07/24/news/economy/health_care_reform_obama.fortune/

Read it.

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That review is partisan and flawed. Further, the writer clearly has a bias toward free market ideology and is against anything that is remotely progressive, like our tax system. Claiming that raising taxes on the top earners in America from #6% to 39% is some sort of socialist conspiracy.

There is no all-encompassing bill in the house or senate that works the way this OPINION article suggests. Nor is what is likely to emerge from Conference going to do much more than what I outlined above. There are moderate republicans and democrats who are now driving the discussion, so the resulting legislation will be far from as radical as the write of this hit piece suggests.

Many of the things he speaks about seem to come from HR 676, which is stalled in committee and most likely won't be anywhere in the legislation that makes it to Obama's desk. You might read the actual legislation and come to your own conclusions.

This quote is patently false not to mention absurd:

The bills in both houses require that Americans purchase insurance through "qualified" plans offered by health-care "exchanges" that would be set up in each state.
The writer is referring to the "public option" that would be offered to the uninsured and those small businesses and self employed who can't afford coverage. For most Americans, the only difference they would see is the inability of insurance companies to deny their claims on dubious grounds or cancel their coverage when they have the temerity to get ill and actually need it.

You have something against regulating an industry that is killing people for profit?

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So you admit that many of his points are valid concerning various competing bills, but dismiss his concerns even though you have no idea what will be in the final bill? You support it blindly? And please use more accurate terminology referring to your ideas. I know Progressive sounds better than Marxist, Socialist, Communist but it was Marx that proposed the graduated tax system that you adore.

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Yeah, Teddy Roosevelt was a commie. Explain why these the top marginal tax rates, under republicans and democrats, led to our most prosperous growth on record.

You can't because you are woefully uninformed about a great many things, least of which is what it means to be a true conservative. I have yet to see a single counter proposal from your crowd that doesn't start and end with the word No.

Today's neoconservatives have strayed far from your republican roots.

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So you think that high taxes lead to prosperity? So any nation could simply tax itself to great wealth. Truly a revolutionary economic theory.

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You continue to run in circles, chasing your own tail.

What I said was, we followed a very progressive taxation scheme in this country under both parties for more than four decades and it led to unprecedented growth that has since turned into decline as we altered those policies.

Seems a fairly common sense connection to me as you can't run a 21st century society on fumes or on the backs of the working poor.

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That growth came from the industrialization of the world following world war, not from tax policy. The tax policy almost certainly retarded the growth. It is pretty obvious that confiscatory tax policy does not lead to investment and growth.

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That is not in keeping with the historical record. Our declining revenues and budget deficits didn't start until we drastically changed our taxation and regulation policies to favor capital over labor.

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Again not accurate. Revenues are at an all time high. The problem is/was/will be the escalating gov't spending.

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Not accurate in any way, shape or form. Debt is at all time high, both public and private.

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Wrong on revenue, right on debt. Federal revenues continue to grow, just not as fast as spending.

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Per capita growth isn't real growth. Spending has increased under both parties, that is true, but not as fast as the fraud, waste and abuse by private industry exploited that trend.

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Oh , and debt is not always bad. If I borrow 10 grand and buy an Aston Martin worth 250 grand, I have added to my debt, but have increased my assets much more. If Obama buys cars for 4500 and then scraps them, he is increasing the debt and not increasing the asset base. See the difference?

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Check out the finance market. Debt when used for innovation, to start a company, to build a factory, builds the economy. But financial leveraging schemes in the last couple decades now have lowered the debt-to-economic output. There's leveraged debt on packaged mortgage debt bundled with other debts--none of it which helps anyone except the company who created the scheme (yay deregulation!).

Of course these schemes and companies are now falling like dominoes. This kind of debt was almost nonexistent in the early 80s and now, if the numbers I recently read are correct (I think I'm remembering the book "Bad Money"), about equal to the GDP.

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If you can buy a $250K Aston Martin with only ten grand, you must be getting payola.

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lol. Maybe the loan was for gas and the car was a, um, 'gift'.

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WAIT A MINUTE! I got stuck with this stupid Ferrari, I want an Aston Martin too.

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Sorry you missed out. My Aston drives SWEEEEET!

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Your $250K Astin Martin is worth about $200K as soon as you drove it off the lot. So not only are you still in debt for the original loan of $240K, but the car is only worth two-thirds of that amount.

Sounds like a great deal.

No wonder neocons suck at both government and business. If you decrease the government's revenues and then take on a bunch of new spending by way of no-bid contracts to your buddies then of course it will be red ink as far as the eye can see.

Ignoring the trillion we spent on Iraq while denigrating the billion Barack spent on the Cash for Clunkers thing is a ridiculous argument. I have problems with that program for a number of reasons, but pumping some money into struggling local economies isn't one of them.

I suspect the owners of car dealers agree with me, many of whom are also republican.

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As usual your comments are off the mark. First, in the example, the 'hypothetical' Aston Martin was being purchased for the absurd price of 10 grand. This was to illustrate that taking on debt is not always bad, as you implied. I contrasted this hypothetical example to the very real example of the Gov't buying cars at a greatly inflated price, and then scrapping them, as a perfect example of where debt is not good - money borrowed and then destroyed. I could have gone into the analysis of how little the CARS program is affecting the market for the money being spent. Edmunds estimates an average cost to the taxpayer of 20 grand per car.

Missing in all of this is the original point you keep alluding to that gov't revenues have declined significantly since Reagan changed the tax code. This is not true, as any cursory glance at the budget over the years will show. If spending were at the same level as under Reagan we would be running a 3 trillion dollar surplus right now.

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If you buy unicorn poop at $10/pound (but it is really worth ELEVENTY BILLION/ounce), and have to take a loan out for $10,000, you have totally increased your assets! Ultra sweet!

And people wonder why the economy is completely fucked up. I am bookmarking your "explanation" so that I can just point people there next time they inquire.

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PS: Of course I don't support anything blindly, but I reserve my criticism for what is actually being done rather than what I THINK is being done. This article not only puts the cart before the horse, but it has the horse riding inside.

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...it was Marx that proposed the graduated tax system...

No, it was actually Adam Smith that proposed a progressive tax in Wealth of Nations:

"The subjects of every state ought to contribute toward the support of the government, as nearly as possible, in proportion to their respective abilities; that is, in proportion to the revenue which they respectively enjoy under the protection of the state ....[As Henry Home (Lord Kames) has written, a goal of taxation should be to] 'remedy inequality of riches as much as possible, by relieving the poor and burdening the rich.'" Adam Smith, Wealth Of Nations [emphasis mine.]
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Maybe true for the Senate, but the House bill has proposed to repeal ERISA and require employers that self-insure to be subject to new government appovals after a 5-year grace period. This is what makes Obama's rhetoric about keeping your current plan so insincere. He makes it sound like if you're happy with your plan that you won't be affected. You get to keep your plan and all is fine. But we know that's not the case. Your existing plan will change because it will now be managed by the government

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See my earlier response. I think you may be misinterpreting that particular section.

At any rate, anything truly radical isn't likely to make it through the conference committee. We need health care reform that is smart and measured and focused. The bills I have read seem to do that without a whole lot of new intervention on behalf of Uncle Sam.

The House bills are also more reflective of the majority's base than the conference committee or Senate bills.

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PS: Paragraph breaks are a beautiful thing. You should check into them.

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Was that comment really necessary? The original post wasn't that long.

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Just the typical liberal smugness where he assumes he is smarter than everyone else. Of course, he still works for a living, and the bulldog has been retired 10 years.

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lol! More like an atypical progressive-conservative?

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I must doing something right when conservative republicans call me a typical liberal and liberal democrats call me a typical conservative.

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But, you see, the question is: Are you smug?

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I suppose that part is true.

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Weird how arguing about health care can be fun. I hadn't even meant to be on tpm today.

I've got an idea in my head about writing on here about total American debt: government, financial, and private. Clinton's balancing the budget was partly based on taxes reaped from the economic "stimulus" of massive private debt skyrocketing. But every time I look at the whole debt picture it kind of freaks me out. Can an entire country go bankrupt?

I just hope healthcare reform goes towards balancing the books in a positive way, long-term. Lower costs. More money for things that actually are investments in our economy. 'Cause what we need are investments in our economy.

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Look upstream for one reason our economy is in shambles. I am trying to explain to our host why dismantling our progressive taxation system was largely responsible for bankrupting the country.

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"Stimulus of massive private debt" would be very good subject matter. Most people don't understand that we, the people, bled the credit market dry.

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I must doing something right when conservative republicans call me a typical liberal and liberal democrats call me a typical conservative.
Evidence does not support hypothesis. There is an actual named fallacy for assuming the middle is better than the sides, you know.
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Someone commenting from one of the sides would of course make that claim. Of course, all real progress in this country has been forged in the middle, despite the distraction caused from the sides.

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Yep. Slavery, ended by mutual agreement by the reasonable people in the middle not taking sides. Civil rights, established by great consensus to whom hardly anybody protested. Gay rights, strongest in the moderate parts of the country. Reproductive independence secured by the silent masses who did not join protests. Hell, even the revolutionary war was a triumph of moderation -- all the loony extremes wanted TWO revolutions, not just one, but Washington sure showed them and took the middle road between two and none revolutions.

The argument that just because something is the middle ground is utter and complete bullshit. Worthless. Sometimes, that might happen. Often, it is the only possible way to make anything happen. But it sure as hell does not mean it is right, nor that it results in the best outcome.

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Yeah, slavery was ended by the activists and not by the Union Army and a Civil War that found 800,000 dead on both sides. Yeah, those gay rights sure are moving along the mainstream thirty years after Stonewall. Your grasp of history is pretty weak.

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Your point is...my point?

You can complain about U.S. history, but it is what it is. Hardly anything significant has been achieved by sticking to the middle of the road and avoiding partisanship. That was your argument.

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That just isn't true. Harvey Milk made things happen while the revolutionaries took to the streets. Progress is forged out of the middle via compromise when America's extremes finally get to be too much.

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That just flies flat in the face of objective history.

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Not sure what history you are reading, but I keep giving examples of things that aren't in keeping with your thesis and you keep saying I am wrong without once providing a "radical" example that led to substantive and sustainable change. Our most celebrated progressives were first and foremost consensus builders.

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At least he knows the function of paragraphing.

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Perhaps, but it was hard to read for no reason other than the lack of hitting the return key at the appropriate spot. If someone is going to blog here, they should be able to handle such a minor piece of constructive criticism.

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Hard to read? C'mon. It wasn't that bad. You just like to make smart-aleck comments to people you disagree with.

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No, I always tell people who don't understand how to write for the web and an audience how a simple addition makes it easier on the reader. It has nothing to do with the opinions being written. I was actually trying to make him a better blogger as the old guy was having a bit of trouble.

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When you start thinking for yourself, instead of spouting dogma and party framing/talking points, then we'll have a conversation. There are a lot of different opinions here, some for single payer, some for public option or nothing, some for whatever works, some against the whole damn thing. But when we talk, we try our best to speak the truth (Normally. We all have our opinions and often cling to them when we know we are right, dammit!).

Do some reading, link to a study, just go out on a limb and say what you think. But your "ideas" in this blog are tired and a couple of them are simply incorrect.

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And here is the link I posted to Jason:

http://money.cnn.com/2009/07/24/news/economy/health_care_reform_obama.fortune/

You should read it too before you call me incorrect.

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This is an opinion piece about the July 15 bill that had just cleared committee (article is dated July 24).

There have been a few changes since then as they try to hammer out something that'll get the Blue Dogs on board. There's a piece out yesterday that kind of gives a feel to how the negotiations are playing out: http://www.nytimes.com/2009/08/06/health/policy/06health.html

The article skimps the bills' details, however.

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How about Michael Moore taking sick people to Cuba?

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For me, the bottom line to this nonsense is how many seniors on Medicare are unhappy and demanding a different form of health care? The answer is I can't think of any and I don't know any, including my parents.

Is Medicare government run health care? The answer is yes.

Can they obtain extra insurance if they want? The answer is yes.

As the person who has to deal with my mother's health care, am I satisfied and happy with the quality of care from her doctors? The answer is yes.

So why the conservative hysteria regarding health care reform? The answer is I have no fricking idea.

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You asked in your blog title if it is possible to have a reasonable health care discussion, and your very first comment precludes the possibility? [currently if you want a procedure your insurance may or may not pay for it; you can pay for it if you want it bad enough; under obamacare you are prohibited from getting the procedure]

Bite me, Bulldog.

Ps -- I didn't even read beyond your first post, because you are such a ridiculous hippocrite.

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Way to go - read selective parts and call somebody a hypocrite. I hope he takes a piss on you. You're not worth biting.

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Language, MCB, language....

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Language? I just provided an alternative to biting. I think pissing on you would be more effective than biting you.

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