Must-Read Health Care Story of the Day

Mayo Clinic is part of this analysis as well:
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http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
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We know what the problems are. We know how to fix them. The only barrier is graft.

“We’re getting quantity, not quality.”
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Ah, we’re paying more and not getting better service. Sounds like capitalism at work to me. Isn’t the goal to make as much money as possible?
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Until we switch the goal from “getting rich” to “helping sick people” we’ll get nowhere.

Does this matter any longer? KT’s last post indicates “health care reform” has become a euphemism for insurance company welfare. Feh.

with medical errors now estimated to be our eighth leading cause of death,
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Uh, scary. KT, or anybody, how does this stack up against the rest of the civilized world?

[...] Swampland blog links to a story in Time about the Mayo Clinic’s plan to offer better health care for a [...]

FO: Please read the story. One thing that is interesting is that the Mayo Clinic is not fee-for-service medicine. Docs, for instance, work on a salary. One question I have is whether a lot of what they do would work as long as docs are paid per visit and procedure they do.

Karen, it is nice that Mayo Clinic has found a way to do some good, but the problem remains:
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This reform is a sham!
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Most hospitals don’t have the resources to do the scale and scope that Mayo does, besides Mayo is a major trauma center. That makes a big difference.
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Now if everyone were able to go to Mayo, how long do you think it would take them to be overwhelmed. I think there are probably a lot of hospitals who have equally glowing stories, but how many fail to get coverage, and how many in the Mayo service area have had to choose between life of bankruptcy.
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Nice fluff peice, and worthy of attention, but again, I ask you, Karen:
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How many calories does spin have? Can I eat it? Will my wife eat it? Can we solve world hunger with spin? Will the health care problem now go away?
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Ka-ching. No sale…

Karen:
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Do you know that a doctor’s pay is only a small part of the cost of health care?
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My brother in law, (I have several, we are all in our 50s and beyond), had to go to a therapeutic clinic that had some 200 patients and no resident doctors. He was charged $4000 / day. Where did the money go that his insurance paid?
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To figure it out, do the math. Figure out how much the bldg and overhead is per day, how much the staff (On call doctors charge separately) gets per day, and then, the real cost of the medical supplies (no, NOT $2 per cotton ball!), and then you realize:
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Much of the money goes to the shareholders in the clinic!

Getting people (and product) on salaries instead of pay per service is such a no-brainer.
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Also studying what works is a no-brainer. The next time someone tries to claim to you that Republicans are “fiscally responsible”, simply point to Jon Kyl’s little baby temper tantrum over studying what medicine works. “Baaahhh, baby no no like comparative effectiveness”.
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The VA is getting big into evidence-based treatments, at least on the psychology side; it is little wonder that they are one of the good guys too (salaries as well!). For instance, evidence based PTSD therapies like Cognitive Processing and Prolonged Exposure have resulted in some Vietnam Vets who have been coming in for weekly hand-holding type “treatment” for 20+ years being able to move to monthly or even quarterly maintenance appointments.
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If this was done out in the piece-rate for fee world, a patient moving from weekly to monthly appointments is basically a 400% pay cut for a doctor. Quantity is the wrong incentive.

what complete BS….
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Mayo has better outcomes/dollar because it has a completely different set-up — its closer to the VA (and Britain’s National Health Service) than how the US health care system in general is set up.
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In short, if you go to the Mayo Clinic, the doctors who treat you are employed by the Mayo Clinic. They’re on salary, and there is no “choice of doctor”. Its essentially “socialized medicine” with the Clinic itself assuming the role of the state.
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Grunwald (and Karen, and Dartmouth, and their ilk) all go out of their way to ignore the structural difference that Mayo (and Kaiser Permanente) have that all them to operate more “efficiently”. Instead, they try to make it appear as if you can achieve the efficiencies that a “socialized medicine” structure brings by coming up with better treatment modalities.
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HERE’S A FREAKING CLUE — THAT’S WHAT HMOs ARE DOING TODAY — DECIDING WHAT TREATMENTS WILL BE AVAILABLE FOR WHICH DISEASES, AND WHICH TESTS ARE APPROPRIATE FOR WHICH SYMPTOMS. And its pretty obvious that HMOs are a ‘mega-fail’ situation.
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So stop spreading the lie that the solution to health care reform is “better data” — its not. Insurance companies already have all that data, and already have those “efficiencies” in place — and the health care system is still a mess.
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(this is not to say that there aren’t ways that MEDICARE could operate more efficiently, but Medicare is a separate and distinct issue from the question of health care reform for all americans..)

I just want to pat myself on the back for having typed this before beuiung made aware of Grunwald’s article.

It’s easy to forget that Medicine as a field is fraught with wishful and/or magical thinking. Between people who seek treatment for every twitch or people who insist that their herbalist knows better than their doctor there are lots of bad decisions available to those who insist on making them themselves. Add to that the amount of uncertainty contained with ‘mainstream’ medicine and we are forced to realize that there’s not necessarity a single ‘right’ answer to every question.
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People on both the left and right exploit the uncertainty. The example from the left that forcing people to pay will result in inadequate care is balanced on the right by the insistence that actually confining payment to treatment that can be shown to work is some totalitarian conspiracy.
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There are no easy answers and,as I keep harping on, the people who are concerned about where the money is supposed to arrive from have legitamate concerns that need to be addressed.

Getting people (and product) on salaries instead of pay per service is such a no-brainer.
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well, yes and no. Its a no-brainer if you are willing to concede that something along the lines of britain’s national health service is the way to go. But unless its a “single payer/salaried doctor” model, the “salaried medical personel” model means that consumers lose any real “choice” of doctor — the company that is paying the salaries decides which doctors you get to see.
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And “choice of doctor” is one of those things that people don’t want to give up.
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That’s why Karen’s presentation is so fundamentally dishonest — she leaves out the very real changes that would have to happen in order for the efficiencies she thinks are possible to achieve.

Skip this article and just read the New Yorker piece.
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Gawande takes out all the issues related to insurance by looking only at Medicare treatment. The situation is simple. In instances where doctors focus on maximizing how much money they make, costs go up (triple)with no patient benefit. Docs who get their own CAT scanners order a lot more CAT scans. The most cost effective coverage is an engaged PCP. The best way to ensure that is to find mechanisms to separate care decisions from revenue flow.
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This isn’t news. If you watched the British system segment of Sicko you already know this.
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This isn’t about health care. It’s about the insurance companies keeping their government subsidized oligopoly. And it looks more and more like “health care reform” is going to consist of increasing that subsidy.

53_3: i realize the doctor’s pay is only a small part, but the number of procedures that get done–needlessly–is a huge part. as i have noted here before, and as grunwald notes in the story, there are studies that suggest 30% of what is spent on health care is on unnecessary (and potentially harmful) treatment. yet the financial incentives in fee-for-service medicine encourages more. that’s why one of the most important parts of health reform is changing that reimbursement system, and tying compensation more closely to outcomes than to inputs (how many procedures get done).

jayack: i agree the new yorker piece is great at defining the problem, which is why i’ve recommended it several times here in the comment section, but i also think grunwald has done a terrific job showing what a solution might look like.

There’s alot of data here suggesting the “public option” is wanted by the majority of Americans in all demographics. So why is it always framed like it would be a “battle” to get done? Like it’s “off the table”? When a politician or “expert” tries to claim otherwise, why aren’t they challenged with this?
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http://www.huffingtonpost.com/bob-cesca/my-face-was-ripped-off-an_b_216993.html

I were just writin’ a flamin’ letter t’ me congressional representatives, tellin’ ‘em tha’ if th’ health care reform bill tha’ passes be anythin’ li’ th’one currently in conference, I’ll be votin’ Republican next time ’round. Might as well…we don’t seem t’ be able t’ use th’ majority Democratic House an’ Senate (an’ WHITE HOUSE!) t’ accomplish anythin’ substantial. If we’re goin’ t’ be held hostage t’ corporate interests, it mi’ as well be above-board wi’ th’ people who be make no claims t’ be in any other corner!
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Not tha’ this be unexpected, mateys – they all be politicians, an’ they all be beholdin’ t’ money. I be ri’ disappointed, tho, an’ angry, too!
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YARR!

PS – if me recent experience wi’ th’ end o’ me Uncle’s life in Seattle be any ways representative, once ye enter th’ hospital, ye be not HAVIN’ yer doctor no more. Ye be havin’ wha’ be called a “hospitalist” – a doctor who be specializin’ in hospital care. Th’ one we were “blessed” wi’ called me aunt on ‘er cell phone in me uncle’s room t’ tell ‘er – OVER TH’ PHONE – tha’ me uncle were terminal an’ there be nothin’ else t’ be done fer’ ‘im. Thar were no one thar bu’ me t’ catch ‘er when she fell – no nurse, no social worker, no nothin’.
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Ye be havin’ no choice wha’soever, once ye be leavin’ th’ confines o’ yer primary care office fer other treatment. Ye be confined too by th’ “preferred provider” system – ye either pick a doctor tha’ yer insurance co’ works wi’, or yer reimbursement is drastic reduced an’ yer on yer own fer th’ rest.
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This be a long way o’ sayin’ tha’ “doctor choice” be another one o’ those myths tha’ don’t be reflectin’ reality no more. Yer insurance company makes yer choice, mates, wi’ yer primary care doc, wi’ referrals, and wi’ hospitals, too!
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YARR!

53_3: i realize the doctor’s pay is only a small part, but the number of procedures that get done–needlessly–is a huge part. as i have noted here before, and as grunwald notes in the story, there are studies that suggest 30% of what is spent on health care is on unnecessary (and potentially harmful) treatment.
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Karen, why are you continuing to shill for the insurance companies? Seriously.
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All that you are saying is that the traditional “fee for service” model of health care delivery is inefficient. But except for medicare, “fee for service” is no longer the prevailing model for payment of health care services. Instead, insurance companies demand gatekeepers, who are severely restricted in what they can prescribe in terms of drugs, therapies, and tests.
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Moreover, while there are clearly savings that can be achieved in Medicare, we ALREADY KNOW that the “private insurance/HMO” model for delivery of Medicare is MORE EXPENSIVE than traditional “fee for service” Medicare delivery. In other words, the system that you are flogging — the one that supposedly can achieve efficiencies through better data — DOES NOT WORK in terms of saving money. The HMOs have the data — its what they base their treatment modalities and drug formularies on.
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So why do you continue to pretend that there are savings to be achieved through “effiencies” that don’t require a wholesale reorganization of the medical care delivery system?

53_3
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Docs who are motivated by money rather than providing the best patient care order more procedures, and find ways to make money from doing so. Kickbacks. Providing the procedures themselves. Stuff like that.
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This is independent of the cost imposed by the presence of a for profit gatekeeper whose interests lie in denying service requests. But it is still a major issue in cost containment.
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None of this is anything new. We have seen different versions of government supervised health care operating in the rest of the OECD for decades. It works better there. Cheaper, with better patient outcomes. As KagroX tweeted today, people understand this. The public option polls in the mid 70s. Republican opponents in the low 20s. This is entirely about the degree to which the insurance companies and big Pharma can dictate how US health care systems will operate. Broder will be pleased to know that this corruption is bipartisan.

Grunwald (and Karen, and Dartmouth, and their ilk) all go out of their way to ignore the structural difference that Mayo (and Kaiser Permanente) have that all them to operate more “efficiently”. Instead, they try to make it appear as if you can achieve the efficiencies that a “socialized medicine” structure brings by coming up with better treatment modalities.
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plukasiak, I read the article differently. It outlined all the benefits to evidence-based medicine that emphasizes quality over quantity, and then showed that Mayo’s system is not sustainable under the current economic structure of America. Even a non-universal system of socialized medicine is more efficient, yet it’s still not compatible with the status quo.
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Between people who seek treatment for every twitch or people who insist that their herbalist knows better than their doctor there are lots of bad decisions available to those who insist on making them themselves. Add to that the amount of uncertainty contained with ‘mainstream’ medicine and we are forced to realize that there’s not necessarity a single ‘right’ answer to every question.
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People on both the left and right exploit the uncertainty. The example from the left that forcing people to pay will result in inadequate care is balanced on the right by the insistence that actually confining payment to treatment that can be shown to work is some totalitarian conspiracy.
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Paul Dirks, personally I think it makes sense to leave the possibility of some non-evidence based treatment open. And countries like Canada and Britain use plenty of new medications and treatments – that’s why American seniors can find their medicine at Canadian pharmacies. But if a treatment or medication has been shown to be no more effective than a cheaper option – i.e. if the evidence has already been gathered and analyzed – then it makes no sense to pay the extra money. This isn’t merely a hypothetical case: a lot of widely-prescribed newer pharmaceuticals are used instead of generics that are just as effective.

Docs who are motivated by money rather than providing the best patient care order more procedures, and find ways to make money from doing so. Kickbacks. Providing the procedures themselves. Stuff like that.
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While physician “greed” doubtless plays a role, i think that’s an oversimplification. There is a demand for “efficiency” throughout medical systems that results in inefficient medical care. If a hospital buys a new piece of equipment, there is a drive to optimize its economic return — the hospital will promote the availability of the new equipment to the relevant doctors, highlighting all of its potential uses — and there are both subtle and no-so-subtle incentives for doctors to prescribe the use of the equipment.
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and a specialist who buys new testing equipment will justify its “overuse” not based on greed, but on greater efficiency. For instance, based on the “old” tests, the doctor can prescribe the right level of medication 75% of the time — but the new test makes it possible to prescribe the right meds 90% of the time. The greater accuracy results in fewer followup visits, and a more efficient use of the doctors time….

plukasiak, I read the article differently. It outlined all the benefits to evidence-based medicine that emphasizes quality over quantity, and then showed that Mayo’s system is not sustainable under the current economic structure of America.
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you imagined that last part — while the article pointed out the problems with the current system, it made no effort to suggest that the Mayo system would not be sustainable. Indeed, the whole point of the article is to present the FALSEHOOD that “More Data + Less Care = Lower Cost + Better Health” (that the title of the piece.
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Thats a lie — but one that the insurance companies are happy to have promulgated by people like Karen. The fact remains that INSURANCE COMPANIES ALREADY HAVE THE OUTCOME DATA AVAILABLE, AND BASE THEIR TREATMENT MODALITIES ON THAT DATA, and insurance costs remain ridiculously high.
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Grunwald DOES NOT MENTION the real reason that Mayo can operate so “efficiently” – its doctors are salaried (not to mention that the prestige of the Mayo clinic makes it possible to get “the best” doctors to work for less than they would otherwise — a stint at the Mayo clinic is also good on ones resume.)

jayack:
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A case in point is that many of the shareholders at that clinic are doctors. My brother in laws’ case is one where there isn’t unnecessary treatment going on. His case points to the fact that we are massively overcharged for treatment – regardless of whether it is unnecessary or not!.
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I’m with pirate wench here, and I think that Karen is reaching for straws trying to justify the current process as legitimate! Mayo’s solution won’t make a dent. Period.

As punctuation on that last point, how much per day does the average hospital charge?
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Doctors charge separately!

Karen:
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How many calories does spin have?

you imagined that last part — while the article pointed out the problems with the current system, it made no effort to suggest that the Mayo system would not be sustainable. Indeed, the whole point of the article is to present the FALSEHOOD that “More Data + Less Care = Lower Cost + Better Health” (that the title of the piece.
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Thats a lie — but one that the insurance companies are happy to have promulgated by people like Karen. The fact remains that INSURANCE COMPANIES ALREADY HAVE THE OUTCOME DATA AVAILABLE, AND BASE THEIR TREATMENT MODALITIES ON THAT DATA, and insurance costs remain ridiculously high.
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plukasiak, so you’re saying that HMO medicine is perfectly efficient, and basically treatment modalities would not at all be changed in a single-payer system. I just disagree with that. Insurance companies benefit from expensive health care that prizes quantity, because then they can expand their businesses and extract more revenues and profits. They just keep raising premiums and growing their businesses. Extremely expensive individual procedures like transplants don’t fit this model, but more widely used procedures do. Insurance companies can’t increase their profit percentage indefinitely and to an unlimited extent, but they still need/want to grow their businesses. Increasing expenditures and thus premiums and thus profits is the obvious solution.
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It’s what I would do if I were an HMO executive and, well, a horrible person.

plukasiak, so you’re saying that HMO medicine is perfectly efficient, and basically treatment modalities would not at all be changed in a single-payer system.
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no, what I’m saying is that “better data” is meaningless in the face of real, systemic reform — and we already have the “data” to prove that. The private insurance industry already does these studies in order to contain their own costs, and restricts what health care providers can do — yet insurance costs continue to skyrocket.
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The insurers are trying to promote the idea that “savings” can be achieved with greater efficiency THROUGH THE PRIVATE INSURANCE INDUSTRY. We know that’s a lie — we know that it doesn’t work in their own HMO systems, and we know that the HMO approach is more expensive when it comes to Medicare delivery. Its a diversionary tactic — one that Karen and her ilk are buying hook, line, and sinker.

I think basically this whole idea of cost savings in this manner is misleading. It is true that it will save some money, it is a drop in the bucket compared to where the real costs are.
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The point is that this is a shell game between the insurance companies, who charge us and pay the hospitals, doctors, and labs directly. What we don’t see is what goes on with the $4000 / day room charge like my brother in law got.
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When you look at a hospital, go look at the buildings, the art, the ostentatious nature of the design, the constant construction*, all the things that don’t directly have to do with treatment, and, on top of that, what the shareholders get.
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It is there where the real costs are!
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FYI, hospital construction is much, much, much more expensive than your typical home construction. Our hospital has had construction going on for more than five years continuously and I assure you, it is not cheap!

KT:

As I read the reports of the Baucus Beltway Bend-over, “reform” will only make coverage a little less unaffordable for millions – not unlike being a little less dead. Nothing at Mayo is going to assure universal coverage or preclude insurance weasels collecting premiums, then denying coverage as a profit enhancing strategy, so I say again – feh.

KT:
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There is a problem with Grunwald’s answer to the question “Why are US health care costs the highest in the world?”
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Grunwald tries to answer that question by telling a nice story, the moral of which is “To solve the US’s cost problem, providers need to be more like the Mayo Clinic“.
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The problem with that answer is that it doesn’t really account for the skyrocketing rate of costs’ rising over the past decade-and-a-half in the United States.
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John Buckley and Robert Van Giezen, two economists in the Division of Compensation Data Analysis and Planning at the US government’s Bureau of Labor Statistics compiled this data on the increase in per capita health care expenditures from 1993 to 2002:

Table 11.
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Year…Per capita amount…Private expend…Insurance expend
1993…$3,381…………..$1,895………………….$989
1994…$3,534…………..$1,922…………………. –
1995…$3.698…………..$1,993………………….$1,078
1996…$3,847…………..$2,061………………….$1,119
1997…$4,007…………..$2,161………………….$1,171
1998…$4,179…………..$2,285………………….$1,243
1999…$4,402…………..$2,411………………….$1,319
2000…$4,670…………..$2,550………………….$1,422
2001…$5,021…………..$2,716………………….$1,545
2002…$5,440…………..$2,941………………….$1,679
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SOURCE: Centers for Medicare and Medicaid Services, National Health Expenditures Survey.

So what’s the rate of increase?
Well, in order to calculate that, we’ll need to do some basic math…
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First, we subtract the starting cost ($3,381) from the end cost ($5,440) for a difference of $2059 more per person (in 9 years’ time).
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Next, we divide that difference ($2059) by the starting cost ($3,381) to get .61 (00.608991422656…)
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Finally, we multiply the result of that division (.61) by 100 to get the final percent, which is…Holy Crap!! 61 percent!!
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If we were to apply Grunwald’s answer to the problem of cost to the data, we would then be saying that, over a nine year period of time in our nation during relative economic health, US health care providers became less and less like the Mayo Clinic, i.e. had “Less Data” and “More Care”…at a rate of %61 percent per decade!
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How is that possible, KT?
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What changed? How could a cost increase at a rate of 61 percent over that time due solely to those factors?
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It’s a nice story, KT, and it puts the debate about what health care should look like into better focus, but as a means for people to understand what the current inflationary insanity of costs mean –and therefore what the different proposals being floated actually do to solve that cost inflation problem– it’s just a nice story.
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If this were about oil price inflation, how would we explain to readers in common sense terms why the cost of gasoline went up by two-thirds over nine years during economic good times?
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If this were about milk or eggs or fast food cheeseburgers, how would we explain that, in 1993 the average cost of cheeseburgers per person was $3.00, but in 2002 it was $4.83 (61 percent higher)?
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If the rate inflation as measured by the consumer price index over that period is less than 10 percent, what profound change took place over that time?
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People know that prices rise, but we also know from common sense that prices don’t skyrocket by themselves, unless some force or catastrophe is manipulating prices into the stratosphere at wild rates.
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We can’t effectively answer the question “How do we get out of this mess we’re in?” without first answering the question “What happened to get us in this mess?”
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Unless we’re prepared to accept the idea that providers everywhere were all pretty comparable to the Mayo Clinic, KT, and then all radically changed their provision methodologies to be less cost (and outcome) efficient by 61 percent over nine years, Grunwald’s conclusions get us nowhere!
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Please, please, please can you help the discussion –not by telling another story, for God’s sake– by getting a real answer to the question imbued in that data that’s staring us all in the face:
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How do we best explain a 61 percent rate of increase in the cost of health care from 1993 to 2002?
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In simple terms, what happened and what do we now need to do the opposite of?
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What’s the answer, KT? Who knows?
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Thanks so much for reading and considering this, and thank you so very much for covering this issue with the depth of attention that it deserves.

And what about those of us who cannot afford health insurance of any kind? Join us, won’t you, for a fun and instructive night on the town in the Third World.
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New make-up, old circus, same clowns.

“How do we best explain a 61 percent rate of increase in the cost of health care from 1993 to 2002?”
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Super-sized corn syrup.
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I think that looking at delivery models as the means to reform cedes too much ground to Our Owners from the get go. Beside the obvious problems with the profit model, our real problem is the disease model.
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A wellness model is the only way we’ll avoid being bankrupted by our epidemics of obesity and co-morbid disease and the cost of ever-more expensive treatments. But, obviously, those things are what make Our Owners in the insurance and pharmaceutical industries rich and why they’re making sure to take away the possibility of any universal system:
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Here are five critical reforms that only a universal system can accomplish:
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1) Pool risk and cost as broadly as possible, creating the lowest average cost per person for healthcare.
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2) Allow for a simple administrative system with a single database of records, one set of rules and one payment processing system.
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3) Create a level competitive marketplace for all health care providers and pharmaceutical sellers.
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4) Allow for an emphasis on wellness, preventative and primary care.
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5) Give the public-at-large control over the features of the healthcare system.
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That’s the only sort of reform that can really address the root of skyrocketing health care costs. So we’re just jerking-off here. Our Owners will never allow us to take away their health care system. It may make us sick but it also makes them rich.

The problem isn’t that people get too many procedures. Most people I know don’t go to the doctor enough. They gut out illnesses and injuries because getting care is too damned expensive. Obviously we don’t want unnecessary procedures but most people should be getting more care at less cost.

I have a first-hand recent story about the wonders of the Mayo clinic.

Our receptionist’s husband had been ill for over a year and no one could fully diagnose his entire problem. The Mayo found out the root cause and treated him. And by the way, he was in intensive care for six weeks because he truly needed to be. So, it’s not as if the Mayo will ever put cost saving about a human life.

The big thing is that all the specialists conferred that enabled them to see the entire picture.

So how do we burst the health care inflation bubble?
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Not with state-by-state “Health Insurance Exchanges”, that’s for sure.
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Scarecrow at FDL’s Oxdown Gazette notes the absurdity of this profoundly corrupt idea:

…notice what’s missing? There’s no robust public plan that consumers can choose as an alternative to the private plans that would be eligible for purchase in the “exchange.”
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As I’ve said over and over, a public “exchange” is not a plan; it’s a market place where you choose between plans. It’s not one of the products, and it’s definitely not a public option product. You can only buy private plans in this exchange. So there’s no meaningful choice. Why is this so hard to grasp?
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So what do we have left?

1. The insurance companies get the federal government to mandate that everyone must purchase insurance. (Insurance companies 1, consumers 0)
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2. There are only private insurance plans available. (Private Insurers 2, consumers 0)
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3. The federal government gets states who feel like it to create an exchange to help consumers shop for — and insurance companies sell — their private insurance. (Private insurers 3, consumers 0) [And insurance companies get an extra point in states that don't like federal intrusion]
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4. The federal government then subsidizes consumers to help them pay the full premiums charged by the private insurance plans. Insurers win! 4-0!

Does this look familiar? Well, yes, because this is exactly what the private insurers proposed months ago, and are now salivating about. But that deal excluded what Obama and some Democrats proposed: a robust public plan option to compete with the private industry.
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The so-called “bipartisan” proposal is exactly what the private industry developed to kill meaningful competion and avoid the possibility that consumers might actually leave the private insurance system and choose the public option.

I beg to differ…actually, this is John McCain’s plan, except with mandates, and without lifting the employer tax break on employee health insurance.
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Either way, this plan is a solution to industry concerns, not mine and not yours.

wow guys, KT blogs about a story, and you guys foam at the mouth
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Actually, you guys have convinced me. We need healthcare reform desperately in this country. I had no idea so many people don’t have access to meds. The rants in here prove it.

spob:
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I hadn’t realized that taking the time and trouble to reformat US Bureau of Labor Statistics report data into text that would fit into these table-less WordPress textboxes constituted “foaming at the mouth”.
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Although in today’s news media environment, I suppose that the practice of referring to actual data might appear to be a symptom of something psychologically wrong…

“Karen, why are you continuing to shill for the insurance companies? Seriously.”
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That’s not the only comment. SZ, you are being overly sensitive. There is mouth-foaming in here. You are not one of the mouth-foamers. OK?

Thanks for the clarification, spob, much appreciated.

FT said: “And what about those of us who cannot afford health insurance of any kind? Join us, won’t you, for a fun and instructive night on the town in the Third World.”
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Man, I lived there for six years in my 20s. Good times!
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Will Durst once said:
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“Just because I believe a society should be based on how it treats its least fortunate not its most fortunate. And that makes me a commie pinko yellow rat bastard?”
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And SZ, you’ll have to forgive Spob–he’s accustomed to his party having the market cornered on outrage and “populist” anger.

go soak your head