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14 Sep 2009 20:14

Part of the issue with the healthcare debate is that no one realizes that everyone has healthcare now... it is called the emergency room. The problem is that it is ineffective and overly expensive way to administer medicine. The taxpayers pay for it one way or another. So, some recognition that people with no other option go to the emergency room rather than a "regular" doctor, who could have been seen a lot earlier and given better, targeted treatment earlier in a disease, would go a long way to help the "debate."

I would also point out the Tuskegge Syphillis Study as a reason that some people fear a government take over of healthcare.

Subject shift: Best bumper sticker during election time: "Cuthulu for President: why always choose the lesser evil?"
Dude17
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14 Sep 2009 20:48

Bala Verde wrote:I think damages or compensations in other countries are much much lower.


I don't really know, but I think most other countries will award compensation but not punitive damages. Punitive damages can be very high in relation to actual compensatory costs.
"If you're going through hell, keep going." - Winston Churchill
User avatar elapid
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The real driving cost..

15 Sep 2009 18:44

scribe wrote:...you have to have some checks on authentic malpractice. I am not sure what solution is...

But the real driving cost of medical care in America is the lack of prevention, from healthy diet to identifying disease and treating them in much earlier stages.


Agree. Also a lot of overhead costs of many, profit-motivated insurance companies. Insurance company admin adds nothing to quality of care and costs a lot, including the admin expenses of doctors, hospitals, and HMOs negotiating prices and reimbursement with multiple insurance companies.
Rupert
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15 Sep 2009 20:11

BroDeal wrote:That is a good thought. There is a reason why other sites that allow discussion of politics restrict it to a politics forum

I tend to agree. Though such a forum might be interesting here with all the people across the planet.

Appreciate this has turned into more of a health care discussion, as I know we have some physicians on here, and I would assume, a fair amount of health conscious people. I've also dealt with a lot of health care bureaucracy in the last two years after my father had a major stroke. Even though he has Medicare and private insurance, it's been an absolute nightmare, driving my parents to the brink of insolvency.

Dude17 wrote:Part of the issue with the healthcare debate is that no one realizes that everyone has healthcare now... it is called the emergency room. The problem is that it is ineffective and overly expensive way to administer medicine. The taxpayers pay for it one way or another.

This is what is indeed lost on people. They don't see it as a cost, as they don't see it as a tax because it's not coming directly from the government. But taxpayers (that would be working people) absolutely, positively, definitely pay for it. You pay for it in rising costs of your own health care as the hospitals have to get their money somewhere to stay in business, plus all the ancillary costs associated with that; and you'll pay for it later in the fact that Medicare, Medicaid and other costs go up, driving deficits higher and higher.

It's a pretty viscous spiral we're stuck in.

Rupert wrote:Also a lot of overhead costs of many, profit-motivated insurance companies. Insurance company admin adds nothing to quality of care and costs a lot.

Well, that's the system we set-up. Our country believed for a while, and many still do, that competition should exist in the private sector on nearly every level. So the theory would be that as this happens, the system will take care of itself when people can no longer afford to pay, and this will lower the costs. And those companies that are too top heavy and greedy won't survive.

The problem is we've been living in this theory for many years now, and not seen it happen. There's been no correction in this "market" at all, with costs outpacing inflation for decades. It's only gotten worse, and worse, with no indication it's going to improve on it's own what so ever.

Compounding all of this of course is that major insurers and health care powers are so connected to politicians that they are able to essentially bribe them with campaign funding and other perks. As such, little change comes from either party. This is why we need open elections in primaries, and to eliminate tax-deductions from political contributions of any kind, essentially eliminating the two-party system, or turning the parties into clubs. We also need total campaign finance overhaul, and to make lobbying a crime. :mad:
User avatar Alpe d'Huez
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20 Sep 2009 06:41

In my opinion, the only reasonable way to run health insurance is a government system. What I don't understand is how a free market of health insurances should be superior. Let's think where one can make a difference in the bottom line:

First of all, the actual insurance bureaucracy shouldn't eat up more than a few percent of the premiums. So, not much to save there. The way to make an insurance profitable is (i) to deny claims, (ii) to pick out low-risk customers or (iii) to have a better model for 'likelihood of claim'/'insurance premium' than your competitor. (ii) and (iii) are more or less the same.

Now, this is how car insurances, home insurances etc. will compete against each other. Premiums there will depend on the amount of insurance and they will be adjusted individually based on risk or risky behavior.

Health insurance, as proposed by Obama, will work differently. First of all, he doesn't want a cap on yearly or lifetime payments. I.e. everybody is insured up to a virtually infinite amount and every reasonable procedure should be approved for everybody. Second, premiums should not depend on lifestyle, risky behavior or pre-existing conditions. Everybody is supposed to pay a premium not based on those factors, but based on their income (the remainder is made up by subsides).

If that is the system we will get in the future (it is the one Obama was talking about), then there cannot be much meaningful competition between different insurance providers anyway. The only difference would be marginally different operation costs of the bureaucracy and the profit margin. It will be a very homogenous market with very few players, an oligopolistic industry. The greatest danger will come from price fixing or other type of collusion. Very tight oversight will be needed and maybe a government option.
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20 Sep 2009 12:11

Galic Ho wrote:People should stick to cycling. Firstly Bush did not create the global financial crisis. The republicans could have addressed the main issue in the senate but didn't. The initial work began when Carter was President and solidified by Clinton. Look up Freddie Mac and Fanny Mae and their business dealings. Makes Enron look like a model of virtue and honesty. Obama did not and has not solved the global financial problems, though he claimed he had a few weeks back. How big of him. I know teenagers with better grasps of macroeconics than the US president. Look at the debt level. Four times higher than last year...good work Obama! Broke companies collapse...they aren't pumped up with billion of taxpayer funds. Secondly Obama is a great orator and can deliver a very moving public address. Thats about as far as his skills go. In a one on one debate with no prompts or pre-written speeches most people on this forum would trounce him. He's a con man, like our PM down under. Any fool saw this coming. Oh wait, not the US of A and the man who will save the world. Spare me. We've heard this before in cycling. Self annointed saints who can't back their promises up. They quickly falter, project, spin and distract when challenged. Obama said what he needed to get elected. You think Sarah Palin was stupid...she has nothing on Joe Biden. You don't get much lower in the intellectual stakes.

Health care. Michael Moore films aside (Sicko) most people know the US health care system is in shambles. Clinton could have fixed it, heck Hilary tried, but alas the payoff from the pharmaceutical giants was too appealing. Glad I'm not american or sick. As for Ted Kennedy being mentioned on this thread. Check out the dailmail.co.uk for a realistic idea of how he's viewed outside the US. As a coward, drunkard, womaniser and supporter of terrorism. Obama promised the world. He was never going to be able to deliver half of what he claimed was possible. Always a good precedent when the man who wants to be president can't provide a birth certificate and uses his law degree and connections to avoid having to prove he was born in the US. But hey at least he isn't a gun totting uber religious Alaskan. One thing rings true about politics, people deserve who they elect. They can always say no. Oh and in true democracy...everyone votes.


I will just step in with this. I was in the industry on the non-conforming side, and to those who think this was a government problem and not one with the market, I assure you that you have no idea what you are talking about. If you think Freddie and Fannie's business dealings were unethical and poorly done, you should see the books of Wachovia, Goldman Sachs, Lehman, Bank of America, GMAC, Barclays, Citi Group, well, just about everyone involved. Their "business dealings" on with non-conforming loans (the stuff Fannie and Freddie DON'T buy-which is the GREAT majority of non performing loans.) make Fannie and Freddie look like a model of intelligence. Sorry, but I assure you that you have absolutely no idea what you are talking about. The great majority of foreclosures were on loans NOT on Fannie and Freddies books in any way. The problem is that very few people understand how the market worked. I do, and can tell you that the blame game is much broader than your characterization. You also left out Reagan, Bush I and II from your list of Presidents.

Compound that with an unregulated derivatives market that allowed AIG to offer up credit default swaps with ABSOLUTELY NO REQUIREMENT that they be backed by actual MONEY, and you have a MASSIVE MARKET failure. This is what happens when governments DON'T regulate enough and allow assholes who need 13% return on investment to run amok in the financial industry.

Oh, and one more thing about "Socialism." We have had a mixed economy in the US with Socialist structures for over 100 years and have somehow managed to provide the greatest prosperity for the greatest number of people in history. Again, most people THINK they know what they are talking about, but unfortunately they don't.

Now, we should just leave politics alone here because I spend enough time posting about cycling, you don't want to get me started on politics...
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20 Sep 2009 13:40

Cobblestones wrote:In my opinion, the only reasonable way to run health insurance is a government system. What I don't understand is how a free market of health insurances should be superior. Let's think where one can make a difference in the bottom line:

First of all, the actual insurance bureaucracy shouldn't eat up more than a few percent of the premiums. So, not much to save there. The way to make an insurance profitable is (i) to deny claims, (ii) to pick out low-risk customers or (iii) to have a better model for 'likelihood of claim'/'insurance premium' than your competitor. (ii) and (iii) are more or less the same.

Now, this is how car insurances, home insurances etc. will compete against each other. Premiums there will depend on the amount of insurance and they will be adjusted individually based on risk or risky behavior.

Health insurance, as proposed by Obama, will work differently. First of all, he doesn't want a cap on yearly or lifetime payments. I.e. everybody is insured up to a virtually infinite amount and every reasonable procedure should be approved for everybody. Second, premiums should not depend on lifestyle, risky behavior or pre-existing conditions. Everybody is supposed to pay a premium not based on those factors, but based on their income (the remainder is made up by subsides).

If that is the system we will get in the future (it is the one Obama was talking about), then there cannot be much meaningful competition between different insurance providers anyway. The only difference would be marginally different operation costs of the bureaucracy and the profit margin. It will be a very homogenous market with very few players, an oligopolistic industry. The greatest danger will come from price fixing or other type of collusion. Very tight oversight will be needed and maybe a government option.


There was a great Frontline episode a couple of years ago where they went and looked at healthcare in various countries around the world. The great thing about this episode is that a lot of the concerns about the different models being thrown around have already been answered, in other countries! Here's a link (There is also a text overview if you don't want to watch it):

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
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20 Sep 2009 14:05

The way the elite have secured their position throughout history is by keeping the rest under their boot. Make good education, legal justice and healthcare for the rich, keep the rest stupid and unquestioning with mind numbing entertainment and religion. Similarly stop certain countries developing by supporting regimes that supress growth and properity.

Of course there's uproar about the healthcare plan, from the elite but the US can't call itself a civilised country until it puts something like this in place like most other civilised countries run with a modicum of compassion. It's a shameful situation as it currently stands.

Ironically this is not pressure from where you might think, it's actually pressure from big corporations whose health plans are costing them a fortune and of course big business and US government are bedfellows.
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20 Sep 2009 14:22

Cobber wrote:There was a great Frontline episode a couple of years ago where they went and looked at healthcare in various countries around the world. The great thing about this episode is that a lot of the concerns about the different models being thrown around have already been answered, in other countries! Here's a link (There is also a text overview if you don't want to watch it):

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/


Oh, there's no doubt different ways of dealing with health insurance work around the world. I myself have experienced both a single-payer system and a private/government hybrid for more than 20 years of my life. :D

I think the first step in the US is to stop running health insurance like car or home insurance. Once that step is done, is shouldn't matter much whether it is administered by government or private companies. Government would probably be the saner choice, since then it would operate under administrative law, not contract law.

One question which interests me is: if you could enroll an average person in Medicare, what premium would be needed? What about the VA healthcare? Why not calculate that number and then open one (or both) for everybody?
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20 Sep 2009 15:07

Cobblestones wrote:Oh, there's no doubt different ways of dealing with health insurance work around the world. I myself have experienced both a single-payer system and a private/government hybrid for more than 20 years of my life. :D

I think the first step in the US is to stop running health insurance like car or home insurance. Once that step is done, is shouldn't matter much whether it is administered by government or private companies. Government would probably be the saner choice, since then it would operate under administrative law, not contract law.

One question which interests me is: if you could enroll an average person in Medicare, what premium would be needed? What about the VA healthcare? Why not calculate that number and then open one (or both) for everybody?


+1... I agree completely. This is actually a really good idea. Calculate a number, and then put it to a nationwide referendum.

I have also experienced 2 very different healthcare systems - socialist (Australia) and private (US). (Un)fortunately, I was really healthy in Australia where healthcare was free, and then moved to the US, threw my back out and married someone who needed a liver transplant..... :mad:

Another thing that the US population as a whole needs to come to terms with is where they think healthcare should fall with regards to necessity. In my opinion, it should not fall in the same category as car insurance, because that is not essential (you can take public transit - and yet there are mandates for auto insurance). It definitely does not fall in the same category as cable TV, cell phones etc. as these are definitely luxuries. I believe that healthcare falls in the same category and police, public sanitation and potable water - absolutely an essential component of a civilized society.

Edit: one more thing. With auto insurance, there are discounts for safe drivers etc. With healthcare, I think there could be the same types of incentives built in (ie. discounts for non-smokers etc), but it would be much easier to implement this with taxes on specific products (tobacco, alcohol and maybe fast food).
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20 Sep 2009 15:49

Cobber wrote:With healthcare, I think there could be the same types of incentives built in (ie. discounts for non-smokers etc), but it would be much easier to implement this with taxes on specific products (tobacco, alcohol and maybe fast food).


Precisely. Since it would be a pain to adjust premiums to healthy lifestyle, the much easier way would be to tax unhealthy stuff (alcohol, tobacco, soda, fast food etc.) Now, of course, one has to make sure that those taxes go to health insurance.
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23 Sep 2009 05:39

User avatar usedtobefast
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23 Sep 2009 08:57

This has turned into a very good thread.

Thoughtforfood wrote:Compound that with an unregulated derivatives market that allowed AIG to offer up credit default swaps with ABSOLUTELY NO REQUIREMENT that they be backed by actual MONEY, and you have a MASSIVE MARKET failure. This is what happens when governments DON'T regulate enough and allow assholes who need 13% return on investment to run amok in the financial industry.

But you're only talking about half the picture. We screwed it up on both ends, in the worst way. First by letting this go on it's own to get to where it was because we believed the conservative doctrine that the government should get completely out of the way. Then, reversing that course entirely by bailing the failures out, and basically opening up the vault to the Treasury - in essence a total complete reversal, to near total government control.

This, to me, is why the GOP in this country is in shambles. The so called neoconservatives were the ones who adopted no regulation as a model of success. That government should get out of the way of flowing money, but a total failure of that system was not acceptable, and could thus be justified to have the government intervene in their eyes. This is why what we are seeing now is mostly obstructionist activity on the Republican's part with no real ideas, as the foundation of their ideas collapsed and was wholly contradicted when they supported all the bailouts. And now we're seeing someone like Peter Schiff run for Senate as a Republican in a very Democratic state (Conn) with a very good chance of winning - because he's quite unlike this pseudo neocon model, and has been highly critical of his own party for some time, at one point calling many of the Republicans "a bunch of losers".

Interestingly enough, Art Laffer, who lost the famous 1 penny bet with Schiff on the housing bubble, agreed with Schiff that the bailouts were going to be a disaster, and the market would have collapsed, but resurrected itself on it's own, and gotten rid of the worst offenders, with sound investment buying up the good assets. Instead, we insured that the same people who screwed it up are still in charge, with mostly tax payer money funded by debt. And we all did this, everyone it seems, all while screaming for change.

Oh, and one more thing about "Socialism." We have had a mixed economy in the US with Socialist structures for over 100 years...

Yes, completely true. Surprising that people don't realize this, or accept it. And this is across the board. Not just welfare and the National Park service. It goes all the way to government contracts with huge corporations, and specific tax breaks, incentives, and rule changes. All in order to better the nation. We definitely live in a mixed economy, and have for over a century.

Cobber wrote:Another thing that the US population as a whole needs to come to terms with is where they think healthcare should fall with regards to necessity. In my opinion, it should not fall in the same category as car insurance, because that is not essential...

Excellent post Cobber. I think that's something else lost on people.

I think as a nation we have to decide that. All while understanding as previously noted, that everyone is already covered - one in seven people just do so by going to the ER for basic care.

Strangely enough, I think Joe "You Lie" Wilson represents the far-right quite accurately when he was reportedly looking into finding ways for hospitals to turn people in need away from the ER who don't have insurance, or can't pay. As cruel as this may sound, it coincides I think with extreme conservatism. The thinking that by doing this, the costs will be driven down, and people will be motivated to find insurance on their own by working at better jobs, or bonding together on their own, etc. Thus people would in theory pay less for health care, and lower taxes as their Medicare/Medicaid taxation would go down, thus more money being funneled into the economy. The same applies to welfare and food stamps. Cut everyone off, and they'll be forced to find it on their own, and learn to educate themselves, etc. and the rest of us can have our money to do what we want with it. Even more strange, as popular as he is in his own district, it's also a district that has a higher than normal amount of citizens with no health care living in poverty.

And yes, in case you're wondering, Joe Wilson voted "yes" on the bailouts.
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23 Sep 2009 14:14

Alpe d'Huez wrote:But you're only talking about half the picture. We screwed it up on both ends, in the worst way. First by letting this go on it's own to get to where it was because we believed the conservative doctrine that the government should get completely out of the way. Then, reversing that course entirely by bailing the failures out, and basically opening up the vault to the Treasury - in essence a total complete reversal, to near total government control.


What is extremely frustrating to me is that the oversight that was supposed to be there wasn't. Look at the whole Madoff mess. Warnings were given to the SEC years in advance of the final blow up, but they did nothing. Bank regulators didn't do their job. Basically, the limited oversight that was supposed to be there was out to lunch. Would that oversight have stopped the excess? Probably not all of it, but a good portion of it.


Strangely enough, I think Joe "You Lie" Wilson represents the far-right quite accurately when he was reportedly looking into finding ways for hospitals to turn people in need away from the ER who don't have insurance, or can't pay. As cruel as this may sound, it coincides I think with extreme conservatism. The thinking that by doing this, the costs will be driven down, and people will be motivated to find insurance on their own by working at better jobs, or bonding together on their own, etc. Thus people would in theory pay less for health care, and lower taxes as their Medicare/Medicaid taxation would go down, thus more money being funneled into the economy. The same applies to welfare and food stamps. Cut everyone off, and they'll be forced to find it on their own, and learn to educate themselves, etc. and the rest of us can have our money to do what we want with it. Even more strange, as popular as he is in his own district, it's also a district that has a higher than normal amount of citizens with no health care living in poverty.


There are people who think that way, but they miss all the implications of following those policies. "Hey, no welfare, no food stamps, you're on your own! We're not paying for you. Pick yourself up by your bootstraps!" and such. Okay, so, you want a class of people, who are poor, not vested in the system and who have nothing to lose? Wow, that usually works out well.

And yes, in case you're wondering, Joe Wilson voted "yes" on the bailouts.


Surprises me not at all. If Wilson wants to say whatever about the president, that's his right. He was a douche for interrupting the President who was in the middle of addressing the Congress.
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23 Sep 2009 19:43

Part of the argument Schiff and a few others are making is this interesting thought - regulation (or lack there of) isn't the root of the problem. The root of the problem is that over the last decade we sold everyone on the idea that you didn't have to do anything with your money, just buy more houses, go further in to so called equity debt, and your money would magically grow. All while the actual physical growth of the nation remained flat. When people got sucked up into that belief, and tossed all their money into something they knew nothing about at all, against their logic, they shouldn't have acted with such surprise when it collapsed (something he predicted, actually).

A corollary to that is that over the last 20 years or so working people's wages in the US have remained fairly flat, but their health care costs have gone up, with the incomes in the upper .1% making all the real money. So a lot of people are frustrated that hard work doesn't pay anymore. Couple that with all the get-rich books and seminars out there, plus people's willingness and desire to buy crap they don't need, and you've arrived to where we are.

The guys at JibJab really hit it with this video.
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23 Sep 2009 23:22

i am going to "big box mart":eek:
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24 Sep 2009 00:36

A personal example of how much waste there is in healthcare....

So today, I hope, my wife and I have finally resolved a problem we have been having with out insurance company. 3 years ago, I changed jobs and thus insurance companies. 2.5 years ago, my wife had to go to the emergency room. The hospital accidentally billed my old insurance company, and they rightfully denied it. They then contacted us and we informed them of their mistake, and they successfully billed my new insurance. My new insurance saw that the hospital billed my old insurance, claimed they shouldn't have paid, and asked for their money back. The hospital refunded them, then billed me. We have spent the last 2.5 years getting letters from insurance companies clarifying our coverage, have had conference calls with the hospital and both insurance companies and have spent probably more than 50 hours on the phone trying to resolve this. The other day, we heard from a collection agency who was threatening action. Today, our insurance company "discovered" that they had actually paid that bill 2 years ago, and the hospital had lost the record and that we were being re-billed for an already paid amount. So problem solved (I hope).

Now, the "hilarious" thing is that this bill was for only $500. How much money do you think was wasted trying to collect $500? I would argue several thousand.
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24 Sep 2009 03:24

Cobber wrote:A personal example of how much waste there is in healthcare....

So today, I hope, my wife and I have finally resolved a problem we have been having with out insurance company. 3 years ago, I changed jobs and thus insurance companies. 2.5 years ago, my wife had to go to the emergency room. The hospital accidentally billed my old insurance company, and they rightfully denied it. They then contacted us and we informed them of their mistake, and they successfully billed my new insurance. My new insurance saw that the hospital billed my old insurance, claimed they shouldn't have paid, and asked for their money back. The hospital refunded them, then billed me. We have spent the last 2.5 years getting letters from insurance companies clarifying our coverage, have had conference calls with the hospital and both insurance companies and have spent probably more than 50 hours on the phone trying to resolve this. The other day, we heard from a collection agency who was threatening action. Today, our insurance company "discovered" that they had actually paid that bill 2 years ago, and the hospital had lost the record and that we were being re-billed for an already paid amount. So problem solved (I hope).

Now, the "hilarious" thing is that this bill was for only $500. How much money do you think was wasted trying to collect $500? I would argue several thousand.


it would be funny if it was Monty Python. "that parrot is not dead!"...
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30 Sep 2009 12:51

scribe wrote:It's a problem for sure. At the same time, you have to have some checks on authentic malpractice. I am not sure what solution is.

But the real driving cost of medical care in America is the lack of prevention, from healthy diet to identifying disease and treating them in much earlier stages.


I think you hit the nail on the head here...I am probably not in line with most on this forum..but will give my views...maybe not even eloquently.

I don't want a nationalized public option or socialized plan. And this is why...I already pay a lot of taxes for "others" to utilize. From food stamps, to other social programs. Now, I came up with the bare minimum...but my family made me work very hard to get an education...which I took all the way through post graduate work. The main problem in America is that too much of the population (and I live in rural america) sit on their collective butts doing nothing for themselves or their children. They have no respect for education, either formal or at home...hence a nation where 40% of high school graduates can't even point to Washington DC on a blank map!! This is fact...not my opinion. I am raising my kids the same way...education and hard work are what makes a person successful in life. No comment has made me more upset than the Hillary Clinton comment that it takes a village to raise a child...bull crap!! It takes 2 hard working and caring parents!! I would't trust a village in this day and age to raise my kids at all. I emphatically do not want the government to be involved in health care. They have done such a crappy job in every other thing they get involved in. For example...the mission of the DOE in the late 70's was "to reduce/eliminate the US dependence on foreign oil. 30 years later the DOE is a huge money sink, and they have done nothing about the US dependence on foreign oil. Absolute poppycock!!

I have no problem with my tax dollars going to help people who have had bad luck and are really down in the dumps...but that is where it ends. I feel like I am subsidizing abject stupidity in our country and I want it to stop. I also get sick and tired of the "morality" issue. Take it a bit further...everyone in the developed world should give up all the creature comforts (phones, cars, stereos, etc.) in order that we send every available dime we earn to the 3rd world to that we can all be just. Somehow, I just don't see that happening.

Lastly, I think the Amish have it right...give nothing to social security...and expect nothing back. Take care of themselves...strong families!
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30 Sep 2009 13:07

How about this...to show that I am not a total right wing nut job...how about to qualify for any federal entitlement assistance you first have to pass a drug test? Fail...no assistance. And since Obama is so interested in National Service...if you receive federal assistance there should be some sort of service requirement. Sounds fair to me.

I hope you guys will still discuss cycling with me!!
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