(8-11-09): "Of NICE and Men" (WSJ) - How Britain rations health care

[JLB123]

Meet Britain's "Death Panel" and learn why some people will still buy private insurance in Britain, just so they won't have a pol decide if they should go blind or die.


Of NICE and Men

Speaking to the American Medical Association last month, President Obama waxed enthusiastic about countries that "spend less" than the U.S. on health care. He's right that many countries do, but what he doesn't want to explain is how they ration care to do it.

Take the United Kingdom, which is often praised for spending as little as half as much per capita on health care as the U.S. Credit for this cost containment goes in large part to the National Institute for Health and Clinical Excellence, or NICE. Americans should understand how NICE works because under ObamaCare it will eventually be coming to a hospital near you.

The British officials who established NICE in the late 1990s pitched it as a body that would ensure that the government-run National Health System used "best practices" in medicine. As the Guardian reported in 1998: "Health ministers are setting up [NICE], designed to ensure that every treatment, operation, or medicine used is the proven best. It will root out under-performing doctors and useless treatments, spreading best practices everywhere."

What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. For example:

In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs -- including Sutent, which costs about $50,000 -- that would help terminally ill kidney-cancer patients. After last year's ruling, Peter Littlejohns, NICE's clinical and public health director, noted that "there is a limited pot of money," that the drugs were of "marginal benefit at quite often an extreme cost," and the money might be better spent elsewhere.

In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: "When treatments are very expensive, we have to use them where they give the most benefit to patients."

NICE has limited the use of Alzheimer's drugs, including Aricept, for patients in the early stages of the disease. Doctors in the U.K. argued vociferously that the most effective way to slow the progress of the disease is to give drugs at the first sign of dementia. NICE ruled the drugs were not "cost effective" in early stages.

Other NICE rulings include the rejection of Kineret, a drug for rheumatoid arthritis; Avonex, which reduces the relapse rate in patients with multiple sclerosis; and lenalidomide, which fights multiple myeloma. Private U.S. insurers often cover all, or at least portions, of the cost of many of these NICE-denied drugs.

NICE has also produced guidance that restrains certain surgical operations and treatments. NICE has restrictions on fertility treatments, as well as on procedures for back pain, including surgeries and steroid injections. The U.K. has recently been absorbed by the cases of several young women who developed cervical cancer after being denied pap smears by a related health authority, the Cervical Screening Programme, which in order to reduce government health-care spending has refused the screens to women under age 25.

We could go on. NICE is the target of frequent protests and lawsuits, and at times under political pressure has reversed or watered-down its rulings. But it has by now established the principle that the only way to control health-care costs is for this panel of medical high priests to dictate limits on certain kinds of care to certain classes of patients.

The NICE board even has a mathematical formula for doing so, based on a "quality adjusted life year." While the guidelines are complex, NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn't adjust for either overall or medical inflation.

Proponents argue that such cost-benefit analysis has to figure into health-care decisions, and that any medical system rations care in some way. And it is true that U.S. private insurers also deny reimbursement for some kinds of care. The core issue is whether those decisions are going to be dictated by the brute force of politics (NICE) or by prices (a private insurance system).

The last six months of life are a particularly difficult moral issue because that is when most health-care spending occurs. But who would you rather have making decisions about whether a treatment is worth the price -- the combination of you, your doctor and a private insurer, or a government board that cuts everyone off at $22,000?

One virtue of a private system is that competition allows choice and experimentation. To take an example from one of our recent editorials, Medicare today refuses to reimburse for the new, less invasive preventive treatment known as a virtual colonoscopy, but such private insurers as Cigna and United Healthcare do. As clinical evidence accumulates on the virtual colonoscopy, doctors and insurers will be able to adjust their practices accordingly. NICE merely issues orders, and patients have little recourse.

This has medical consequences. The Concord study published in 2008 showed that cancer survival rates in Britain are among the worst in Europe. Five-year survival rates among U.S. cancer patients are also significantly higher than in Europe: 84% vs. 73% for breast cancer, 92% vs. 57% for prostate cancer. While there is more than one reason for this difference, surely one is medical innovation and the greater U.S. willingness to reimburse for it.
* * *
The NICE precedent also undercuts the Obama Administration's argument that vast health savings can be gleaned simply by automating health records or squeezing out "waste." Britain has tried all of that but ultimately has concluded that it can only rein in costs by limiting care. The logic of a health-care system dominated by government is that it always ends up with some version of a NICE board that makes these life-or-death treatment decisions. The Administration's new Council for Comparative Effectiveness Research currently lacks the authority of NICE. But over time, if the Obama plan passes and taxpayer costs inevitably soar, it could quickly gain it.

Mr. Obama and Democrats claim they can expand subsidies for tens of millions of Americans, while saving money and improving the quality of care. It can't possibly be done. The inevitable result of their plan will be some version of a NICE board that will tell millions of Americans that they are too young, or too old, or too sick to be worth paying to care for.

Printed in The Wall Street Journal, page A14



http://online.wsj.com/article/SB124692973435303415.html

[foxyladi]

this is what a lot of us are afraid of.

[JLB123]

this is what a lot of us are afraid of.

And this is why we will stop this Obamanation.

[TheTaoOfBill]

http://www.inthenews.co.uk/thebigissue/news/health/patient-satisfaction-$1085847$1085847.htm

Patient Satisfaction
Wednesday, 16 May 2007 09:08
[More patients are expressing satisfaction with NHS care]
More patients are expressing satisfaction with NHS care
Patients are becoming increasingly satisfied with the care they receive from the NHS, according to a new survey.

More than 80,000 patients from 167 acute and specialist NHS trusts in England were questioned on how they viewed the NHS.

Nine out of ten patients rated their NHS treatment from 'good' to 'excellent' in the study conducted by the Healthcare Commission (HC).

Just two per cent of patients thought their care was 'poor' and waiting times for planned admissions and cleanliness were found to have improved in the last year.

But the report also found a number of areas that need improvement.

HC chief executive Anna Walker warned that a minority of trusts are "letting the rest down" on issues including helping patients eat. She also warned that a "significant majority" of patients had not been given single sex accommodation.

http://www.hi-mag.com/healthinsurance/article.do?articleid=20000137961&adname=his_breaking_news

The public is more satisfied with the NHS than at any time since 1984, according to the latest British Social Attitudes report.

The report, by the King's Fund, said that over half (51%) of people are "very satisfied" or "quite satisfied" with the NHS, up 17% since 1997. Thirty per cent of people are "dissatisfied", down from 50% in 1997.

The highest ratings come from people with recent experiences of the NHS, followed by those who have a friend or relative in recent contact, suggesting that the government's PR efforts need to be concentrated on people without regular contact. Almost 70% of those with recent experience are satisfied with inpatient care, falling to 43% for people without it.

Dentistry has the biggest gap in satisfaction. While 65% of people with recent personal experience are happy, this is over double the rate of those with no recent experience (25%). An independent review team is currently investigating why 1.2 million fewer people have seen an NHS dentist during the past two years.

GPs gained the highest satisfaction levels (76%) and satisfaction with outpatient services has returned to 1983 levels at 60%. However, satisfaction with inpatient services has fallen from 74% in 1983 to 49% now, reflecting concern about the quality of medical treatment and nursing care.

John Appleby, co-author of the research, said: "This is a good news story for the NHS. The public seem to acknowledge and appreciate the increased spending of recent years which has enabled improvements in staffing and waiting times.

"But NHS experience shows that as one problem or public concern is dealt with, another takes its place. Satisfaction with inpatient services has been falling in recent years, linked in part to the view that the quality of medical treatment and nursing care in hospital are in need of improvement."

[TheTaoOfBill]

And this is why we will stop this Obamanation.

No you won't.

You can claim Obama's numbers are falling all you want. But no matter how low they get they still won't be as low as anyone in the republican party.

The republicans are going to be out of the count for a long time. I can't wait for Obama care to pass.

[JLB123]

No you won't.

You can claim Obama's numbers are falling all you want. But no matter how low they get they still won't be as low as anyone in the republican party.

The republicans are going to be out of the count for a long time. I can't wait for Obama care to pass.

That's not going to happen. Congress has a 14% approval rating, the lowest in history. Obama was the only thing that was propping them up, and now he is in a free-fall.

This country has buyer's remorse, and Obama is leading the Democrat Party off of a cliff.

[JLB123]

And hot off the presses..... :D


Support for Congressional Health Care Reform Falls to New Low
Rasmussen Reports ^ | 08/11/2009 | Scott Rasmussen



Public support for the health care reform plan proposed by President Obama and congressional Democrats has fallen to a new low as just 42% of U.S. voters now favor the plan. That’s down five points from two weeks ago and down eight points from six weeks ago.

A new Rasmussen Reports national telephone survey shows that opposition to the plan has increased to 53%, up nine points since late June.


(Excerpt) Read more at rasmussenreports.com ...

[karate kid x]

In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs -- including Sutent, which costs about $50,000 -- that would help terminally ill kidney-cancer patients. After last year's ruling, Peter Littlejohns, NICE's clinical and public health director, noted that "there is a limited pot of money," that the drugs were of "marginal benefit at quite often an extreme cost," and the money might be better spent elsewhere.

well, then get $50,000 and buy the damn drug yourself, then

[JLB123]

The public is more satisfied with the NHS than at any time since 1984, according to the latest British Social Attitudes report.

The report, by the King's Fund, said that over half (51%) of people are "very satisfied" or "quite satisfied" with the NHS, up 17% since 1997. Thirty per cent of people are "dissatisfied", down from 50% in 1997.

Wow, what a step backwards that would be for Americans!

89% of Americans are satisfied with their healthcare according to CNN.


That is probably because we don't have a Death Panel, like Britain.

[JLB123]

well, then get $50,000 and buy the damn drug yourself, then

Good idea. Ration care, and only let the rich live.

That'll sell.

[joeysky18]

The good thing about UK healthcare is everyone can see a doctor. The healthcare is available to all UK citizen. You can make an appointment to see a GP.

The bad thing about it is after the initial consultation if there is a requirement to see a specialist or a surgery, you will have to wait for a long long time.

I'm on a waiting list to see an orthopeadic for a knee injury. And the waiting list is 18 weeks. I figure by the time it's my turn to see him either my body finds a way to sort it out or I have ruied my knee. When I told my GP that I have a private insurance, he wrote a referral letter to an orthopeadic that has a private pracitce, and I will see him next week.

The postman that has a route around my neighbor had back pain since last December. He got to see his GP in January. By February, he had blood coming out in his urine. After 8 weeks of waiting, he finally had an ultrasound in April which revealed a small tumor in his bladder. He was on 22 weeks waiting list to see a specialist! He finally got to see a surgeon in June (which was ealier than scheduled). Right now, he is on a waiting list for the surgery. And it's August, almost a year since he got his first symptom.

He doesn't know when he will get the surgery. He still has backpain which getting worse and worse. He still has the blood in his urine. The only thing the doctor gave him is Ibuprofen for the backpain and told him to drink lots of water. God knows how big is the tumor now.

These are just my personal experiences. The cases like these are everywhere. Yes, it's an affordable healthcare for everyone. But most people will have a private insurance to cut the que.

[Spang]

"Insurance companies already decide if you're worth the cost." - Don Millard

[karate kid x]

Good idea. Ration care, and only let the rich live.

That'll sell.

With no government healthcare, you'll still have to pay $50,000 and buy the damn drug yourself anyways

[JLB123]

The good thing about UK healthcare is everyone can see a doctor. The healthcare is available to all UK citizen. You can make an appointment to see a GP.

The bad thing about it is after the initial consultation if there is a requirement to see a specialist or a surgery, you will have to wait for a long long time.

I'm on a waiting list to see an orthopeadic for a knee injury. And the waiting list is 18 weeks. I figure by the time it's my turn to see him either my body finds a way to sort it out or I have ruied my knee. When I told my GP that I have a private insurance, he wrote a referral letter to an orthopeadic that has a private pracitce, and I will see him next week.

The postman that has a route around my neighbor had back pain since last December. He got to see his GP in January. By February, he had blood coming out in his urine. After 8 weeks of waiting, he finally had an ultrasound in April which revealed a small tumor in his bladder. He was on 22 weeks waiting list to see a specialist! He finally got to see a surgeon in June (which was ealier than scheduled). Right now, he is on a waiting list for the surgery. And it's August, almost a year since he got his first symptom.

He doesn't know when he will get the surgery. He still has backpain which getting worse and worse. He still has the blood in his urine. The only thing the doctor gave him is Ibuprofen for the backpain and told him to drink lots of water. God knows how big is the tumor now.

These are just my personal experiences. The cases like these are everywhere. Yes, it's an affordable healthcare for everyone. But most people will have a private insurance to cut the que.

Do you live in the UK?

[joeysky18]

Do you live in the UK?

Yes I do.

[JLB123]

With no government healthcare, you'll still have to pay $50,000 and buy the damn drug yourself anyways

Not if your private insurance covers it.

Please address the other drugs and treatments that Britain's Death Panel denies their people.

[karate kid x]

Not if your private insurance covers it.

Please address the other drugs and treatments that Britain's Death Panel denies their people.

Well then you can get private insurance instead

[JLB123]

Yes I do.

And you are getting good care through your insurance, but you have personally seen the horrile coverage of Britain's Single Payer system?

[JLB123]

Well then you can get private insurance instead

Not for long, if Obamacare is passed.

[JLB123]

"Insurance companies already decide if you're worth the cost." - Don Millard


Yes, and there are thousands of them to choose from, with thousands of different costs and coverage.

It's called "freedom".

[Spang]

Yes, and there are thousands of them to choose from, with thousands of different costs and coverage.

It's called "freedom".

And they aren't going anywhere. If you don't want Obama's health care plan once it's made available, you won't have to take it. You'll have choices.

[JLB123]

And they aren't going anywhere. If you don't want Obama's health care plan once it's made available, you won't have to take it. You'll have choices.

Really?

Do I still have to pay taxes for the public plan that I am not using, since I choose to remain private?

[Spang]

Do I still have to pay taxes for the public plan that I am not using, since I choose to remain private?

Have you ever been able to choose where your taxes ended up?

[JLB123]

Have you ever been able to choose where your taxes ended up?

You said I have a choice...

Do I have a choice on what healthcare I choose, and what health care I have to pay for or not?

[Spang]

You said I have a choice...

Do I have a choice on what healthcare I choose, and what health care I have to pay for or not?

You don't get to choose where your taxes go.

[karate kid x]

Really?

Do I still have to pay taxes for the public plan that I am not using, since I choose to remain private?

No, it is payed for by premiums

[JLB123]

You don't get to choose where your taxes go.

So I have to pay twice?

And get less?

When I go to the post office I buy a stamp or pay shipping charges. When I go to UPS I don't have to pay the USPS shipping charge and the UPS shipping charge, do I?

[JLB123]

No, it is payed for by premiums

AKA: Taxes

Once again, look at your paycheck and see if it says "Medicare Premium" or "Medicare Tax".

Premiums are voluntary.

[Spang]

So I have to pay twice?

No.

[JLB123]

No.

Explain....

Will I have to pay taxes for Obamacare which I don't choose, and also pay for my own private insurance that I do choose?

[Spang]

Explain....

Will I have to pay taxes for Obamacare which I don't choose, and also pay for my own private insurance that I do choose?

You pay your taxes like your supposed to. Where your taxes go is not up to you. It never was, it never will be.

[JLB123]

You pay your taxes like your supposed to. Where your taxes go is not up to you. It never was, it never will be.

But I'm no paying for Obamacare now, so I will have to pay twice then, right?

How does that keep private insurance competitive when Obama will make me pay twice?

[Spang]

But I'm no paying for Obamacare now, so I will have to pay twice then, right?

You pay your taxes once a year like everyone else.

[JLB123]

You pay your taxes once a year like everyone else.

But I won't be using Obamacare, so tell me again how my private insurance will compete when I have to pay twice for healthcare?

[JLB123]

You pay your taxes once a year like everyone else.

How does it make you feel, as a young student, that you will have to pay off the largest debt and deficit in history?

[karate kid x]

AKA: Taxes

Once again, look at your paycheck and see if it says "Medicare Premium" or "Medicare Tax".

Premiums are voluntary.

I hope you realize that the bill hasn't been passed yet, and that it's not medicare and medicaid

[JLB123]

I hope you realize that the bill hasn't been passed yet, and that it's not medicare and medicade

Really?

So where does it say it is a premium and not a tax, like you have been saying?

[Spang]

How does it make you feel, as a young student, that you will have to pay off the largest debt and deficit in history?

I'm not a young student.

[JLB123]

I'm not a young student.

About Spang
Location
East Tennessee
Interests
Video Production
Occupation
Employed Student
Political Ideology
Fake American

[Spang]

About Spang
Location
East Tennessee
Interests
Video Production
Occupation
Employed Student
Political Ideology
Fake American

That's right, I'm a student with a job.

[JLB123]

That's right, I'm a student with a job.
And your age is.....?

[Spang]

And your age is.....?

30.

[Kbentleyis]

I have found, sometimes, you can never teach the youth. Their minds are set and see no further than the comfort of their surroundings.

Unfortunately, many of them voted for BHO. Free college, free health care... free freee freeeee.

I see no further argument on my part, BHO said he's going to pass a health care plan, no matter what--democracy at it's best. If he can't get all the dems, he'll do a reconciliation vote.

I'm hoping I can afford all of the future burden of federal and state taxes. I don't want to lose my home.

[JLB123]

30.

Ya, sure....

:rolleyes:

That's still a youngster.

The older you get the more wise you will become, and you will shed your liberal ways.

[Spang]

Ya, sure....

:rolleyes:

That's still a youngster.

The older you get the more wise you will become, and you will shed your liberal ways.

Compared to senior citizens, I am young. Compared to college students, I'm old. Also, I will never be a conservative.

[JLB123]

Compared to senior citizens, I am young. Compared to college students, I'm old. Also, I will never be a conservative.

If you educate yourself you will be.

[Spang]

If you educate yourself you will be.

Okay.

[jlynne]

If you educate yourself you will be.

I don't think there are many American colleges that teach critical thinking skills much less counterarguments to mainstream liberal ideology. The more educated someone claims to be the more they are able to regurgitate the liberal texts they've read and the less able they are to explain why they agree with those texts.

[Wyoming Dem]

Here's the deal from my prospective...If you are under 35, you have not paid in enough of anything to have a choice...simple as that. Do any of you younger guys here have any idea what we "mature" folks have paid in? I can only give an estimate of what I have paid in to Social Security, Taxes, blag, blah, blah and it's well over two million dollars (probably closer to 3 million)...that's right..two million dollars so frankly, I feel that WHAT I THINK should be done with MY MONEY and what health care I will have is not your business or the governments and the point being made about having no say so how our taxes are spent??? DAMN STRAIGHT AND WE ARE SICK AND TIRED OF IT.

And...Most of us here were registered Democrats for more years than you have been alive. As one ages, you are more liklely to become socially liberal and fiscally conservative and that is exactly what I am. And as regards the Democratic Party...If they ran Jesus Christ for POTUS they would never get my vote ever again. (Well...I am an atheist so that's probably a bad analogy...) I don't care who they run, including Hillary Clinton, Bill Clinton or whoever else, NEVER, EVER will I vote Democratic again and they will not get one penny of my money. I will probably never vote again anyway and I won't have to live here under this lunatic Congress and the enbarrasing fruitloop who is POTUS and really would not care what they do other than caring about what happens to my friends and family because of this moron and his unscrupulous crew.

Below, this this is for Karate Kid:
Originally Posted by karate kid x
Why are you picking on the postal service? you pay them $.50 to come to your house, pick up some piece of crap you wrote, and fly it across the country in a plane.

Oh no...you opened up a can of worms....When I am living in Cowley, Wyoming... I HAVE NO HOME MAIL DELIVERY OR PICK-UP...none...nada...zilch. I am one of 12 ranches in my immediate area that receives no services form the USPO at all. Until about 5 years ago, we were MADE to purchase a P.O. Box so that we could get our mail at the P.O.. I wrote a letter to the Postmaster General (and you just had to know that was coming, right?) and asked why we, as citizens who pay our taxes, were required to pay for something that everyone else gets for free??? Consequently, I received a nice letter from the PO General & now we do get the smallest size P.O. box at no cost (it was not the 7.00 dollars, it was the principle...) Apparently,
Quote:
"“Neither snow, nor rain, nor heat, nor gloom of night, stays these couriers from the swift completion of their appointed rounds.”

does not cover..
Quote:
"Sorry...you live too far out."

So I have to drive a long way, every day to get our mail in all kinds of weather, something which the P.O. refuses to do. So that's why I pick on the P.O. which is broke and getting broker by the minute and does a mediocre job most of the time, getting letters and parcels from Point A to Point B in a timely fashion. I use Fed Ex almost exclusively for most of my mail, including letters, which I don't often have to send and I pay my bills on line and have requested paperless billing from everyone and I can talk to anybody else on the phone or have them fax stuff to me. If it is government it's FUBAR and that is an absolute fact. Aren't you sorry you asked?

[foxyladi]

i,m glad he asked.W.X.D i loved your response as always.:thumbsup::thumbsup:

[mack20]

If you educate yourself you will be.

Disagreeing with you does not make someone stupid.

[CGP]

It's very easy to pick and choose articles to satisfy one's agenda. Everyone does it. And this thread is no exception. I could go and find a million articles about how American private insurance companies ration care and effectively have their own internal "death panels". Would that convince opponents of anything "public" that for-profit health care has its own problems? No. And this article about NICE doesn't prove anything to me either.

It's interesting in the health care debate that any plan to effectively manage limited resources is labelled as "catastrophically bad", and yet in everyday life any organization which paid no attention to managing limited resources would be labelled "catastrophically bad". Do you see the inconsistency? In almost all aspects of business and government, wisely managing limited resources is seen as good organizational practice. But when it comes to health care, opponents of reform suddenly regard the sound managment of limited resources as a fundamentally bad thing. Illogical.

[JLB123]

Disagreeing with you does not make someone stupid.

Yep, merely ignorant.

Agreeing with me makes them informed and intelligent, however.

[JLB123]

It's very easy to pick and choose articles to satisfy one's agenda. Everyone does it. And this thread is no exception. I could go and find a million articles about how American private insurance companies ration care and effectively have their own internal "death panels". Would that convince opponents of anything "public" that for-profit health care has its own problems? No. And this article about NICE doesn't prove anything to me either.

If you aren't satisfied with your private insurance, guess what? You just change it.

It's interesting in the health care debate that any plan to effectively manage limited resources is labelled as "catastrophically bad", and yet in everyday life any organization which paid no attention to managing limited resources would be labelled "catastrophically bad". Do you see the inconsistency? In almost all aspects of business and government, wisely managing limited resources is seen as good organizational practice. But when it comes to health care, opponents of reform suddenly regard the sound managment of limited resources as a fundamentally bad thing. Illogical.


The resources are not limited in private insurance. You get what you pay for.

Resources are limited in the government option, because they cannot manage things properly. Just look at Medicare.

[Wyoming Dem]

FUBAR...every single thing the Government touches is fUBAR. The Federal Government Bureaucracy is a self-feeding beast that grows exponentially via the amount of paperwork it creates. Filled with cronyism, self-promotion, territorialism like nothing else and never any indication that any department knows what another is doing. Do I want to trust my health care to the bumbling fools who pay 23,000 for a toilet seat? (and that sort of belies the Governments credibility when it comes to running anything economically) or the morons who continue to pay benefits to dead people, people who don't exist or in some cases to animals....) And I don't need some GUY setting at a desk deciding if I am "medical treatment worthy". I have GREAT health insurance but many in my family do not...they have Medicare/Medicaid and it is a FUBAR CLusterF**k. The Government will have a really hard time saying with a straight face (well, maybe not, the current Administration has lieing
to the Public almost down to a science) that they can manage health care better than the system we have... HYSTERICAL
http://www.lifeshore.com/smiley/data/media/3/3D_emoticon_S150.gif

[PA_Voter]

No you won't.

You can claim Obama's numbers are falling all you want. But no matter how low they get they still won't be as low as anyone in the republican party.

The republicans are going to be out of the count for a long time. I can't wait for Obama care to pass.

Are you forgetting about Independents, or don't we count?

[foxyladi]

Yes I do.

thanks JOEYSKY18

[mack20]

Yep, merely ignorant.

Agreeing with me makes them informed and intelligent, however.

Well I certainly disagree with that lovely assessment.

[JLB123]

Well I certainly disagree with that lovely assessment.

Then you will need to pay close attention so you may find enlightenment.

[TheTaoOfBill]

If you educate yourself you will be.

That's why the college grads voted for conservatives.

Oh wait...they voted for Obama.

[mack20]

Then you will need to pay close attention so you may find enlightenment.

I'll pass, I have no interest whatsoever in being "educated" by you.

[PA_Voter]

That's why the college grads voted for conservatives.

Oh wait...they voted for Obama.

Oh wait... And the college grads are being taught by whom? That's right, it appears Liberal Dems have a monopoly on academia, don't they? Let's take Ayers as one brilliant example!

[mack20]

Oh wait... And the college grads are being taught by whom? That's right, it appears Liberal Dems have a monopoly on academia, don't they? Let's take Ayers as one brilliant example!


So only the non college graduates are smart enough? Or is it just that all people under 35 are too stupid to actively participate in politics?

[CGP]

If you aren't satisfied with your private insurance, guess what? You just change it.
^ No, insurance choices are restricted by who your employer has a deal with.


The resources are not limited in private insurance. You get what you pay for.
^ So a for-profit company has unlimited resourses? Of course not. All companies have finite resources and they ration those resources to prevent bankruptcy and to maximize profit margins - rationing and managing finite resources is common to all businesses and all industries. Actually, in relation to health care insurance, if you actually have to use it you get far more in return than what you actually paid for. Insurance premiums are nothing compared to what a health insurance company will have to pay if a patient requires major medical treatment.


Resources are limited in the government option, because they cannot manage things properly. Just look at Medicare.
^ Resources are limited in the govt option for the same reason they are limited in private insurance plans - because resources are not unlimited. Medicare actually works very well for millions of people. Just because opponents of reform slam Medicare as a failure doesn't make it so - I wonder how many of those same critics actually have Medicare & would voluntarily surrender it today because it's so "bad"? Probably none.

[tracker]

Meet Britain's "Death Panel" and learn why some people will still buy private insurance in Britain, just so they won't have a pol decide if they should go blind or die.

Obama and many dems are liars and if they can't forsee this sort of thing or worse happening here, then they shouldn't be in office.

[foxyladi]

Yes, and there are thousands of them to choose from, with thousands of different costs and coverage.

It's called "freedom".

hillarystamp!