The discussion got a little heated in another thread, with many participants claiming that the U.S. "has the best healthcare in the world", and that "government involvement in healthcare will both erode quality and increase costs".

In the interest of just putting the facts out there, consider these. There are are myriad of sources of facts regarding healthcare on the internet that anyone can check. I used studies done by Forbes magazine, the World Health Organization and The World Bank.

Maybe the best way to present my findings are in a series of brief statements. Any of these can be fact-checked and more extensive explanations provided.

-- In almost any of the studies done recently, the U.S. doesn't come close to being the healthiest country in the world. The Forbes article had us ranked 11th healthiest in the world. Their criteria included" life expectancy, infant motality, physician density, TB frequency, air and soil quality and access to healthy water and sanitation. The top countries in the Forbes study were Iceland, Sweden, Finland, Germany and Switzerland.

-- The U.S. is well down the list in life expectancy and we experience relatively high infant mortality. We ranked 50th in life expectancy and 26th in infant mortality among the industrialized countries.

-- Notwithstanding the results, the U.S. has by far the highest cost healthcare system in the world. Whether measured as per capita expenditures or as a percentage of GDP, the U.S. spends well more than twice the amount of the average of developed countries. On the WHO listing, our expenditures were 50% greater than the country with the second most expensive healthcare system (Switzerland). But in "bang for the buck" Switzerland won out, being ranked as being the 2nd healthiest country in the world by Forbes. The U.S. spends more than 2-1/2 times more on a per capita basis than the median average of the 14 most developed countries.

-- The U.S. was the only country included in any of the surveys that had a private healthcare system. All other countries had some form of government insurance or single-payer system. The analysis by the WHO indicated that the private system in the U.S. largely explained the high cost of healthcare in the U.S. The study by the WHO indicated that the high costs in the U.S. were mostly the result of the rising costs of medical technology, prescription drugs and particularly the high administrative costs resulting from the complex and multi-layered multiple payer system in the U.S. The WHO also noted that having almost 20% of it's population uninsured also contributes significantly to high costs. They note that "conditions among the uninsured that could have been prevented or treated inexpensively in the early stages often develop into health crises" and treatment at that stage becomes dramatically more expensive. WHO estimated that costs in the U.S. were in the range of 30-34% higher than necessary as the result of excessive administrative costs and profit for the providers.

-- The WHO noted that "the U.S. was the only country in the developed countries in the world except South Africa which does not provide health care for all of it's citizens." Their study noted that "the hodge-podge of multi-layered private companies that pay for healthcare insurance in the U.S. add dramatically to costs". They note in their study that the profit-driven "non-system" in the U.S. results in significant gaps in coverage, further adding to costs as the uninsured seek emergency room treatment.

-- The U.S. ranked next to last among the industrialized countries in the number of it's citizens who die while experiencing some form of disability. Only Denmark ranked lower.

-- The WHO study measured "fairness in financing", where the U.S. was ranked as the lowest (least fair) in distributing the contributions which fund healthcare across the population. The existence of healthcare "haves" and "have nots" was attributed to the absence of any central control of a system with a huge number of profit-driven providers.

-- One final study done by the WHO was a survey of citizens in the most industrialized countries, seeking to determine how satisfied the residents of the countries were with the healthcare provided to them. Most of the countries ranking high on the scale of having the best healthcare systems also had the most satisfied citizens. The satisfaction of the higher-rated countries was often in the 70-80% range among the healthiest countries. Notwithstanding the amount spent on healthcare in the U.S., our residents registered among the least satisfied with their healthcare, with only 41% of the U.S. survey participants registering satisfaction..
--------------------------------
As I said, there is a wealth of analytical information available on the internet. Everyone should take the time to do their own research on how our system of healthcare stacks up. Knowing that the expense of our system of healthcare is growing at a rate that is a multiple of inflation, and that the number of U.S. citizens that are uninsured is growing (a recent study says that 14,000 people per day are losing their health insurance, either because their employers stops offering it or because they can no longer afford it), makes our understanding of the situation important as we follow the reform legislation that is making it's way thru Congress.

Here is a link which refutes the assumption that the US has the best healthcare system in the world. Far from it.... http://www.huppi.com/kangaroo/L-healthcare.htm

The statistics are old, but I suspect they haven't changed much in the last 10 years or so.

a question and a conclusion..
The assumption is: everything stated is 100% correct.

The question is: does anybody think/believe the legislation being proposed addresses the issues in the 100% correct list?

The conclusion: based on the fact it is a partisan rush reform, that most likely will not include a plan, timing, responsibilities or measures there is no way to expect correlation for the reform to solve the stated problems with the system.

Commentary:
All the bail outs to date lack a plan, timing, responsibilities or measures, therefore they have no idea if it is working, going to work or not or when.

There are no individuals in the 545 that have the business ability to cause the needed reform....only lawyers that can wordsmith the feel good (we hope) document. None of them will be around when it is implemented, stated to take at least 10 years.

The effectiveness of the US Government is more broken than ANY other aspect affecting our lives. Acknowledged to be infiltrated with die hard partisans (both parties) who are incompetent. Is there information some of you are privy to that leads you to believe these same incompetents will miraculously get one right, this time.... FOR THE FIRST TIME?

I anxiously await the education that is hopefully forthcoming.

btk

Kahuna, I don't believe the American people and many of the posters here have a huge disagreement about the status of our health care or the need for reform. The crux of the issue for most people seems to be the Obama administration's overzealous and in some cases, suspicious rush for the government takeover of the entire system and its implications for citizens and taxpayers.

Why is medical tort reform, a major driver of medical costs, not a part of a comprehensive reform by Congress and the president? Tort reform would reduce insanely outrageous medical malpractice insurance our medical professionals must carry. Further, it may reduce current "defensive medicine" practices such as the superfluous, expensive and often unnecessary testing that now significantly escalate costs for doctors, patients, taxpayers and insurance companies.

The Pew Hispanic Center says there are 11.9 million "unauthorized immigrants" in the United States. The Federation of American Immigration Reform 2004 study says the annual cost for their medical care in California alone is $1.4 billion. Gee, could that be part of their financial problem?

Richard Wolf in USA Today wrote, "One thing is clear: Undocumented immigrants are driving up the number of people without health insurance. The Pew Hispanic Center estimates that 59% of the nation's illegal immigrants are uninsured, compared with 25% of legal immigrants and 14% of U.S. citizens. Illegal immigrants represent about 15% of the nation's 47 million uninsured people — and about 30% of the increase since 1980."

It is obvious that the cost of providing medical care for illegal immigrants is another driving factor influencing out of control costs for medical care. The current Obama plan exacerbates the problem by including all uninsured illegal aliens. The same Obama plan wants seniors to accept death, avoid costly testing and medical procedures and counsels them to "die with dignity". I believe many think "the plan" is mercenary cost cutting and shabby treatment for American senior citizens who have contributed so much to this country in so many ways. I feel empathy with the crying eagle icon I use. I have said before that I do not oppose inclusion of medical treatment on a true emergency basis for anyone. I do not believe illegal entries should be given a free ride at the expense and disadvantage American taxpayers. I suspect I am not alone in that belief.

There are many controversial absurdities in the Obama plan that hurt doctors, seniors and citizens. That is why I suggest to you that while your research is interesting, it is misdirected from the point of contention. That point being that the need for health care reform is not the issue......the plan being fast tracked by Congress and Obama is the issue. For the record, a Republican plan has recently been announced. I understand that one component is Tort Claim reform. That being said, from what I've seen of it, I'm not sure it is significantly different in many regards, than the Obama plan. My confidence level is not elevated by the GOP's late entry. More politics. I hope the interest of the American people rises above the instinct to play for votes, lobbyists, unions and special interests.

There are many other criticisms of the Obama plan that have been expressed by TOTV contributors. It's about the plan not the need for reform.

Thank you for your enlightening research.

xxxxxx

xxxx

Originally Posted by cabo35

Kahuna, I don't believe the American people and many of the posters here have a huge disagreement about the status of our health care or the need for reform. The crux of the issue for most people seems to be the Obama administration's overzealous and in some cases, suspicious rush for the government takeover of the entire system and its implications for citizens and taxpayers.

Why is medical tort reform, a major driver of medical costs, not a part of a comprehensive reform by Congress and the president? Tort reform would reduce insanely outrageous medical malpractice insurance our medical professionals must carry. Further, it may reduce current "defensive medicine" practices such as the superfluous, expensive and often unnecessary testing that now significantly escalate costs for doctors, patients, taxpayers and insurance companies.

The Pew Hispanic Center says there are 11.9 million "unauthorized immigrants" in the United States. The Federation of American Immigration Reform 2004 study says the annual cost for their medical care in California alone is $1.4 billion. Gee, could that be part of their financial problem?

Richard Wolf in USA Today wrote, "One thing is clear: Undocumented immigrants are driving up the number of people without health insurance. The Pew Hispanic Center estimates that 59% of the nation's illegal immigrants are uninsured, compared with 25% of legal immigrants and 14% of U.S. citizens. Illegal immigrants represent about 15% of the nation's 47 million uninsured people — and about 30% of the increase since 1980."

It is obvious that the cost of providing medical care for illegal immigrants is another driving factor influencing out of control costs for medical care. The current Obama plan exacerbates the problem by including all uninsured illegal aliens. The same Obama plan wants seniors to accept death, avoid costly testing and medical procedures and counsels them to "die with dignity". I believe many think "the plan" is mercenary cost cutting and shabby treatment for American senior citizens who have contributed so much to this country in so many ways. I feel empathy with the crying eagle icon I use. I have said before that I do not oppose inclusion of medical treatment on a true emergency basis for anyone. I do not believe illegal entries should be given a free ride at the expense and disadvantage American taxpayers. I suspect I am not alone in that belief.

There are many controversial absurdities in the Obama plan that hurt doctors, seniors and citizens. That is why I suggest to you that while your research is interesting, it is misdirected from the point of contention. That point being that the need for health care reform is not the issue......the plan being fast tracked by Congress and Obama is the issue. For the record, a Republican plan has recently been announced. I understand that one component is Tort Claim reform. That being said, from what I've seen of it, I'm not sure it is significantly different in many regards, than the Obama plan. My confidence level is not elevated by the GOP's late entry. More politics. I hope the interest of the American people rises above the instinct to play for votes, lobbyists, unions and special interests.

There are many other criticisms of the Obama plan that have been expressed by TOTV contributors. It's about the plan not the need for reform.

Thank you for your enlightening research.

This is the first time I ever used those funny little icons but in this case...

Originally Posted by cabo35

...It's about the plan not the need for reform....

No disagreement here, Cabo. As much as anything, I was putting some information out there for many of the people who post here whose analysis of the current situation regarding healthcare is hasn't gone beyond what we have is OK with them and whatever we do, any form of government involvement is a bad thing.

If I had my 'druthers, the Congress would take a good long time considering all the reforms that should be included in their legislation. And definitely, whatever bill they pass should not add to the deficit and national debt. My greatest fear is that the various members of the 435, responding to their own interests and special interests will cobble together a bill which creates a system as confusing, ineffective, inefficient and expensive as the one based on a myriad of private insurance companies that we have now.

Some of the things that I wouldn't resist if they were included in the proposed reform legislation would include...

• Significant tort reform
• Some sort of single payment system the could be designed and regulated by the government. I don't mean a system where the government makes the payments. Rather, I mean the establishment of a system or procedure with the objective of simplifying and standardizing the claim payment process, thereby reducing the overhead costs of healthcare insurance.
• The creation of some sort of "healthcare claims appeals" court or central adjudication process. Americans shouldn't be subjected to the whim and/or profit motivation of an army of privately-employed claims adjusters making the decision of what gets paid for and what doesn't. Whatever system we have should be consistent for everyone.
• Means testing for Medicare and VA benefits
• Healthcare insurance for all American citizens, whether they can afford to pay for it or not. That means that if someone can't produce citizenship or insurance documentation at a hospital emergency room they don't get treatment. More specifically, after the first illegal immigrants die on the stairs to hospitals, there will be be lot more of of those who entered the country illegally heading home. Note that I said "or insurance documentation". I mean that if employers want to hire illegal immigrants because they work hard and cheap, if they want to keep them here they should provide them with healthcare insurance. Of course, another alternative would be to secure our borders--but that's another whole different debate.
• A tax on the richest Americans to help pay for the program(s)
• Some serious regulation on what medical research gets paid for by the government or by individuals thru their insurance premiums. We shouldn't be paying for rocket science when a fast train will do. If medical research beyond that is desired, it should be funded privately. (If you want a pattern of what I mean, consider stem cell research. Stem cell research can be deemed to have significant potential--it's just that the government won't pay for it. If the potential of the research is so great, let private money pay for it.)
• Negotiation, probably by the government, of more reasonable prices for prescription drugs. Why should Americans be required to pay substantially more for the same drug that companies sell elsewhere in the world for far less? We all know the stories of our neighbors going to Canada or Mexico or Europe to buy drugs made here in the U.S. for deep discounts. Why? Along with that, some serious reductions of the period for which drug companies can prevent the introduction of generic drugs with their patents and copyrights.
• A hard look at whatever legislation further reduces payments to doctors. Medicare payments authorized by Congress have already been reduced to the point that about 40% of the doctors in the U.S. refuse to treat Medicare patients--and that number is growing! Maybe even take a long look at paying doctors who practice in the areas of greatest need more than those in areas where the doctor-patient ratio is already too high.
• Government regulation of the coverages, benefits and co-pays on company-provided health insurance. Just because a group of employees are represented by a particularly powerful union or work for a generous employer, shouldn't mean that they get "Cadillac" healthcare coverage at little or no cost while other U.S. citizens have no insurance or coverage that is less than "basic". The healthcare insurance playing field should be leveled--or at least the "tilt" reduced somewhat. If employers want to provide better than standard coverage for competitive purposes or because it is the result of a union contract, those benefits over and above a standard package should result in a tax on the employer.
• If after all the other stuff I like has been done, if the government wants to offer Medicare coverage to citizens instead of private insurance that may be available to them, that would be OK with me. There is a caveat however. The premiums of Medicare to those of less than "senior" age would have to be increased to cover the actual cost of healthcare treatment for those that choose the that option. Premiums for seniors should remain low, as they have paid into the funding for both Social Security and Medicare thru payroll taxes during their working years.
• Finally, whatever national healthcare insurance or standards that are created should apply to all members of the Congress and all government employees. The Congress and government employees should not be permitted a different, better or cheaper plan than that available to the citizens they represent or work for.

That's certainly not a complete list of stuff that I wouldn't mind seeing in reform legislation, just a few that I though of on a warm Sunday morning here in The Villages.

sector take care of the implementation.
NO government run anything in the new reform.

btk

As I read the posts of those of you who are disenchanted with President's health insurance proposal, here are some of the prominent objections and concerns: 1) How this complex, huge plan has been thrown together and is being pushed at a too rapid pace. 2) That it is incomplete, less than the 100% solution, with glaring omissions like tort reform. 3) That it will probably allow illegal immigrants to be included in the 'gravy train' (my words). 4) That it will actually increase health care costs for the 'average already tax-burdened citizen.

IMHO the first three don't take enough account of our history. The last one I think is speculative and is more convincing to those who have lost most or all faith in our ability to operate as an efficient nation.

Not to belabor the history thing, but the nature of our political system is fickle and fleeting. Opportunities for real progressive action and change are too rare, with the diversity, self-centeredness and lack of vision of many of our leaders. But the health insurance 'stars are finally crossing'- the system is terribly broken, the future is frightening, a leader who was widely ridiculed has been replaced by one who seems to be representing the concerns of the people, etc. That scenario has been repeated many times in our nation's history and when it happens we've had our best opportunity to progress.
The current administration started well before the election assembling what they believe is the best health insurance plan they can come up with and one they can get approved. There were extensive meetings and some understandings reached with health care providers, insurance company and pharmaceutical companies. The result is not just 1000 pages of drivel. I believe it is not 100% complete and purposely omits certain things, especially comprehensive tort reform, because if included, that might be the ingredient that would prevent it's passage. I don't think a 100% solution is in any way possible, even theoretically.
I also believe the President is correct in thinking the chance of passing the best an most comprehensive plan shrinks each day, as momentum decreases, and opponents amass more money and influence to block it, very often for shamefully selfish reasons. I fully support the President's speed of promoting even a less than perfect plan because if it doesn't get done soon, it will not get done or will become another Rube Goldberg boondoggle.
Our history is all about immigrants, legal and illegal. They have always been with us. When we say "give us your poor..." we have meant it, (I love that about us), and most of those people became productive members of our society is a short period of time. I'm proud of my ancestors who came here with nothing. Today the new illegals make a major contribution to our economy, collecting poverty wages and working dependably at jobs we vets don't want. I'm not in favor of a wholesale opening up our borders, but I am willing to accept the way things are, those who are here and allow them to receive some care which may prevent many from simply ending up in emergency rooms and shelters, completely on the dole.
As for the last objection, I think it's time to suspend our belief the worst is what we'll get. If the plan is designed to be deficit free, paid for by current fund reallocations and a surtax on those with annual incomes over $1 million, I can live with that. I've suggested elsewhere that, I can't come up with a better formula, I haven't read anyone's suggestion which seems better, so I support this one.
But to me, this job just needs to get done. If it improves things even somewhat, it could be the stepping stone to even more progress, real tort reform for example.
I think it's time to stay positive and supportive.

Originally Posted by billethkid

...NO government run anything in the new reform...

Again, no argument here. Other than my thought that Medicare could be offered to people less than 65 as an option, the things I listed that I'd like to see in the proposed reform legislation are a lot of standard-setting and regulation, but doesn't have the government actually doing anything more than they're doing now.

Originally Posted by ijusluvit

...I don't think a 100% solution is in any way possible, even theoretically.... I also believe the President is correct in thinking the chance of passing the best an most comprehensive plan shrinks each day, as momentum decreases, and opponents amass more money and influence to block it...if it doesn't get done soon, it will not get done or will become another Rube Goldberg boondoggle.
... I think it's time to stay positive and supportive.

Even though my inclination is for our elected representative to take care in designing the reforms being considered, I recognize the threat of the myriad of special interests influencing the process and the individual members of Congress with their money. That's a terrible thing to admit--but that's the way it is.

So in response to your thoughtful post...

Why is it that people will analyze and theorize things to death but totally fail to consider two or thee simple truths?

I hear people taking quite a few pot shots at our health care system and frankly I never here BO say anything good about America in general... ever.

Just about every government program you can think of is bankrupt and ended up costing 10 times more than they told us it would.

There is more than meets the eye going on in the health care industry that is very positive. None of it has anything to do with government.

BO's plan will kill jobs and devastate delivery of health care.

Just a few simple questions.

When has a government social program ever lowered costs and raised standards?

What is it about the federal government that gives so many so much faith in their abilities?

Why do we so depend on politicians and bureaucrats (many of which are self serving liars) for our solutions?

Originally Posted by Villages Kahuna

The discussion got a little heated in another thread, with many participants claiming that the U.S. "has the best healthcare in the world", and that "government involvement in healthcare will both erode quality and increase costs".

In the interest of just putting the facts out there, consider these. There are are myriad of sources of facts regarding healthcare on the internet that anyone can check. I used studies done by Forbes magazine, the World Health Organization and The World Bank.

Maybe the best way to present my findings are in a series of brief statements. Any of these can be fact-checked and more extensive explanations provided.

-- In almost any of the studies done recently, the U.S. doesn't come close to being the healthiest country in the world. The Forbes article had us ranked 11th healthiest in the world. Their criteria included" life expectancy, infant motality, physician density, TB frequency, air and soil quality and access to healthy water and sanitation. The top countries in the Forbes study were Iceland, Sweden, Finland, Germany and Switzerland.

In all circumstances, the countries mentioned are highly restrictive in their immigration policies, rarely take political asylees (except Sweden) and are geographically small (the largest, Sweden, is equal to California). The health condition of foreign visitors, students, temporary employees, asylees and many others (including border-jumpers) is not checked until they apply (if ever) for green-card "permanent resident" status. Their "pre-existing conditions" impact all health statistics.

-- The U.S. is well down the list in life expectancy and we experience relatively high infant mortality. We ranked 50th in life expectancy and 26th in infant mortality among the industrialized countries.

We also have the worst diet and sedentary lifestyle, and high intentional infant mortality. You can't legislate what folk eat or make them exercise

-- Notwithstanding the results, the U.S. has by far the highest cost healthcare system in the world. Whether measured as per capita expenditures or as a percentage of GDP, the U.S. spends well more than twice the amount of the average of developed countries. On the WHO listing, our expenditures were 50% greater than the country with the second most expensive healthcare system (Switzerland). But in "bang for the buck" Switzerland won out, being ranked as being the 2nd healthiest country in the world by Forbes. The U.S. spends more than 2-1/2 times more on a per capita basis than the median average of the 14 most developed countries.

the other 13 "developed countries" have high tariffs and other trade-protective mechanism to protect their economies and have positive balance-of-payments ratios. That affects all economic ratios, includeing health care to everything else.

-- The U.S. was the only country included in any of the surveys that had a private healthcare system. All other countries had some form of government insurance or single-payer system. The analysis by the WHO indicated that the private system in the U.S. largely explained the high cost of healthcare in the U.S. The study by the WHO indicated that the high costs in the U.S. were mostly the result of the rising costs of medical technology, prescription drugs and particularly the high administrative costs resulting from the complex and multi-layered multiple payer system in the U.S. The WHO also noted that having almost 20% of it's population uninsured also contributes significantly to high costs. They note that "conditions among the uninsured that could have been prevented or treated inexpensively in the early stages often develop into health crises" and treatment at that stage becomes dramatically more expensive. WHO estimated that costs in the U.S. were in the range of 30-34% higher than necessary as the result of excessive administrative costs and profit for the providers.

WHO only compared medical-to-medical costs and did not factor other economic conditions. We can solve half the uninsured problem by resolving the illegal immigration factor.

-- The WHO noted that "the U.S. was the only country in the developed countries in the world except South Africa which does not provide health care for all of it's citizens." Their study noted that "the hodge-podge of multi-layered private companies that pay for healthcare insurance in the U.S. add dramatically to costs". They note in their study that the profit-driven "non-system" in the U.S. results in significant gaps in coverage, further adding to costs as the uninsured seek emergency room treatment.

The largest uninsured group in emergency rooms are illegal aliens. The citizenry issue is one thing - the "everybody here, legal or not" is another.

-- The U.S. ranked next to last among the industrialized countries in the number of it's citizens who die while experiencing some form of disability. Only Denmark ranked lower.

The USA is also has the greatest ethnic "melting pot.' The disability factor includes wounded veterans and those with genetic conditions. The former have protected just about everyone else, and the latter is due to our propensity to accept more of the world's desperate.

-- The WHO study measured "fairness in financing", where the U.S. was ranked as the lowest (least fair) in distributing the contributions which fund healthcare across the population. The existence of healthcare "haves" and "have nots" was attributed to the absence of any central control of a system with a huge number of profit-driven providers.

"Fairness in funding" is highly subjective.

-- One final study done by the WHO was a survey of citizens in the most industrialized countries, seeking to determine how satisfied the residents of the countries were with the healthcare provided to them. Most of the countries ranking high on the scale of having the best healthcare systems also had the most satisfied citizens. The satisfaction of the higher-rated countries was often in the 70-80% range among the healthiest countries. Notwithstanding the amount spent on healthcare in the U.S., our residents registered among the least satisfied with their healthcare, with only 41% of the U.S. survey participants registering satisfaction..

Again, let's compare sizes. Florida residents may be very content with their coverage, while residents of Nevada may not. That would be the equivalent of Germans and Greeks in a European study. We seem to keep forgetting the USA is geographically as large as all of Europe (excluding Russia).
--------------------------------

As I said, there is a wealth of analytical information available on the internet. Everyone should take the time to do their own research on how our system of healthcare stacks up. Knowing that the expense of our system of healthcare is growing at a rate that is a multiple of inflation, and that the number of U.S. citizens that are uninsured is growing (a recent study says that 14,000 people per day are losing their health insurance, either because their employers stops offering it or because they can no longer afford it), makes our understanding of the situation important as we follow the reform legislation that is making it's way thru Congress.

When government keeps imposing higher overhead upon US employers, making them less competitive than the foreign goods/services providers who receive "most favored nation" trading status despite having nationalized, socialist-run industries, something has to give to keep the business doors open so they can keep employees. In this, we are our worst enemy.

Originally Posted by Villages Kahuna

No disagreement here, Cabo. As much as anything, I was putting some information out there for many of the people who post here whose analysis of the current situation regarding healthcare is hasn't gone beyond what we have is OK with them and whatever we do, any form of government involvement is a bad thing.

If I had my 'druthers, the Congress would take a good long time considering all the reforms that should be included in their legislation. And definitely, whatever bill they pass should not add to the deficit and national debt. My greatest fear is that the various members of the 435, responding to their own interests and special interests will cobble together a bill which creates a system as confusing, ineffective, inefficient and expensive as the one based on a myriad of private insurance companies that we have now.

Some of the things that I wouldn't resist if they were included in the proposed reform legislation would include...

• Significant tort reform
• Some sort of single payment system the could be designed and regulated by the government. I don't mean a system where the government makes the payments. Rather, I mean the establishment of a system or procedure with the objective of simplifying and standardizing the claim payment process, thereby reducing the overhead costs of healthcare insurance.
• The creation of some sort of "healthcare claims appeals" court or central adjudication process. Americans shouldn't be subjected to the whim and/or profit motivation of an army of privately-employed claims adjusters making the decision of what gets paid for and what doesn't. Whatever system we have should be consistent for everyone.
• Means testing for Medicare and VA benefits
• Healthcare insurance for all American citizens, whether they can afford to pay for it or not. That means that if someone can't produce citizenship or insurance documentation at a hospital emergency room they don't get treatment. More specifically, after the first illegal immigrants die on the stairs to hospitals, there will be be lot more of of those who entered the country illegally heading home. Note that I said "or insurance documentation". I mean that if employers want to hire illegal immigrants because they work hard and cheap, if they want to keep them here they should provide them with healthcare insurance. Of course, another alternative would be to secure our borders--but that's another whole different debate.
• A tax on the richest Americans to help pay for the program(s)
• Some serious regulation on what medical research gets paid for by the government or by individuals thru their insurance premiums. We shouldn't be paying for rocket science when a fast train will do. If medical research beyond that is desired, it should be funded privately. (If you want a pattern of what I mean, consider stem cell research. Stem cell research can be deemed to have significant potential--it's just that the government won't pay for it. If the potential of the research is so great, let private money pay for it.)
• Negotiation, probably by the government, of more reasonable prices for prescription drugs. Why should Americans be required to pay substantially more for the same drug that companies sell elsewhere in the world for far less? We all know the stories of our neighbors going to Canada or Mexico or Europe to buy drugs made here in the U.S. for deep discounts. Why? Along with that, some serious reductions of the period for which drug companies can prevent the introduction of generic drugs with their patents and copyrights.
• A hard look at whatever legislation further reduces payments to doctors. Medicare payments authorized by Congress have already been reduced to the point that about 40% of the doctors in the U.S. refuse to treat Medicare patients--and that number is growing! Maybe even take a long look at paying doctors who practice in the areas of greatest need more than those in areas where the doctor-patient ratio is already too high.
• Government regulation of the coverages, benefits and co-pays on company-provided health insurance. Just because a group of employees are represented by a particularly powerful union or work for a generous employer, shouldn't mean that they get "Cadillac" healthcare coverage at little or no cost while other U.S. citizens have no insurance or coverage that is less than "basic". The healthcare insurance playing field should be leveled--or at least the "tilt" reduced somewhat. If employers want to provide better than standard coverage for competitive purposes or because it is the result of a union contract, those benefits over and above a standard package should result in a tax on the employer.
• If after all the other stuff I like has been done, if the government wants to offer Medicare coverage to citizens instead of private insurance that may be available to them, that would be OK with me. There is a caveat however. The premiums of Medicare to those of less than "senior" age would have to be increased to cover the actual cost of healthcare treatment for those that choose the that option. Premiums for seniors should remain low, as they have paid into the funding for both Social Security and Medicare thru payroll taxes during their working years.
• Finally, whatever national healthcare insurance or standards that are created should apply to all members of the Congress and all government employees. The Congress and government employees should not be permitted a different, better or cheaper plan than that available to the citizens they represent or work for.

That's certainly not a complete list of stuff that I wouldn't mind seeing in reform legislation, just a few that I though of on a warm Sunday morning here in The Villages.

The list is impressive, but in general indicates the government is the only solution. So far, there has been nothing concrete, proven workable, presented in HR 3200 - just a bunch of theoretical concepts with none having any record of trial or success.

I agree that immigration, border security and all that involves is worth a debate, as the predominate group filling this "uninsured" population are illegal aliens (yeah, "undocumented" is a lousy descriptive), followed closely by foreign long-term visitors who get rolled into most statistics. Fix this problem and the largest argument for changes to the health care system goes away, as this population impacts costs to a disparate degree.

When the economy is booming, competition for employees (recruiting and retention) solves the health care insurance issue. When domestic employers find themselves behind the business 8-ball due to government-directed business advantages given to foreign providers/suppliers of almost everything, to increase the domestic employers' cost-of-doing business will have only two results: 1) the employer goes under; or 2) wages are decreased to equalize the cost of government-directed employee compensation. There is no free lunch here.

It's always easy to tax the richest, but it's always only a starting point. This is one place where "trickle down" really happens.

The only "significant tort reform" that may reduce "defensive medicine" is blanket immunity from damages. There is no partial or cap that works, as already found where in place. Is that what folk really want?

So, for the most part, the problem is not the health care industry - it's everything which impacts the health care industry and every other industry in this country. Until the externals which impact the industry (and all others) are fixed, we are just applying an unproven and untested and highly expensive action (not even a solution) just for the sake of "change."

Don't get me wrong. I have no problem fixing anything that is broken. What I do have a problem with is saying we'll buy an expensive "fix" when we have no proof that these "fixes" have worked anywhere or will work on any scale or magnitude. It's like saying I don't like my car, so give me a new way to get around (Beam me up, Scotty) that has never been tried and charge me 100 times what the car costs to get it.