Good News/Bad News: CBO on Baucus Bill

The much-anticipated CBO score is here. I’ve just begun to read it. The good news/bad news seems to be that it reduces the deficit by $81 billion over 10 years, but leaves 25 million uninsured (one-third of them illegal immigrants). Will post more soon.

UPDATE: Jonathan Cohn gives us the comparisons to the House bill:

That’s significantly lower than the projections from the House bill, which would result in 97 percent of legal residents and 94 percent of people living here. In raw numbers, it’s the difference between 25 million people remaining uninsured (Senate Finance bill) and 17 million (House bills) ten years hence.

Of course, those numbers involve a lot of uncertainty. Their significance is that they correspond to a particular level of benefits and financial assistance, at least in the calculations of the CBO. And this is something we’ve known for a while: The Senate Finance bill isn’t as generous or as protective as it ought to be.

But the fact that the measure would actually save money means, or should mean, there’s a bit more money to throw at the program–ideally, by raising a little more money in taxes and/or offsetting savings. The difference between covering people at the level of the Senate Finance bill and covering nearly all legal residents* is maybe $150 billion over ten years. That’s not a lot of money in the grand scheme of things.

UPDATE2: Wonkroom compares latest version to the original Baucus bill.

Related Topics: congressional budget office, Congress, Health Care
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  • trifecta55

    Unacceptable. Seriously. In 10 years, there will still be 25 million without coverage? All for the sake of protecting the interests of those who give Baucus money, and hire his staffers as lobbyists? DOA.

  • freeinpa

    “but leaves 25 million uninsured (one-third of them illegal immigrants).”

    Can’t be Joe Wilson was harangued because he called Obama a liar when he said illegals would not be covered.

    Who is calling out the President on this for spreading falsehoods about the HC bill.

    And can’t wait for squeezing fraud out of Medicare.

  • Ivy_B

    How come deficit reduction has to be the centerpiece of this bill when there was nothing but crickets when Bush trashed the surplus he inherited and created the basis for this huge deficit?

    As to the coverage, no one begins to answer the real question as noted in today’s Daily Howler …

    SUAREZ: Even with universal coverage, the Netherlands spends less than half what the United States spends per person on health care. While spending half the money, the Netherlands gets better results. The Dutch have longer life expectancy and lower infant mortality. The average Dutch citizen spends about 7 percent of income on health care, and they seem satisfied with the system. The annual Euro Health Consumer Index puts the Netherlands in first place in a survey of patient satisfaction across Europe.

  • deconstructiva

    That’s a dealbreaker, sorry (not you, KT). The point of this HC crap is get access for all. Baucus still doesn’t get it; Schumer and Rockefeller do (with their PO versions). Actually, KT, I had wondered if you were taking today off …to get back to work on that book perhaps?

  • freeinpa

    Simple answer GO live in the NETHERLANDS

  • rustyreturns

    “The good news/bad news seems to be that it reduces the deficit by $81 billion over 10 years, but leaves 25 million uninsured (one-third of them illegal immigrants)”.

    .
    Karen, please tell me that you are not so ignorant, un-informed not to know that there is no way in hell that Congress will pass a bill with over 500 BILLION in Medicare CUTS?
    .
    I am truly not trying to be disrespectful here, but this is a fact, and you have to know it.
    .
    Lindsay Graham just said on Tee Vee that “hell will freeze over first before those in Congress will vote to cut that much from Medicare. He cited case after case when various bills have been proposed in Congress to cut Medicare, that it was voted down.
    .
    Now for the illegals. A precedent has already been set by the Supreme Court that “all persons” must be included in any bill which provides for some type of service. Example, when Texas attempted to cut off funding for schools and the education of illegal’s children. The constitution clearly states that “all persons are equal in the eyes of the law when it comes down to things like education or other services that are to be used for the people of this country”.
    .
    So, Congress is saying they will exclude over 12 million people, but they can’t do it. We will be funding health care for illegals and their children, period. No matter how much Obama wants to say they will not be able to apply for health care benefits, ILLEGALS WILL BE ABLE TO APPLY.
    .
    Take out of the CBO projection’s 500 billion in Medicare cuts, and ADD over 12 million illegals into the mix and you have a bill that will exceed in my estimations over 2 TRILLION dollars.
    .
    How on earth can we create the largest entitlement program in mankinds history?

  • rustyreturns

    Perhaps if we could somehow round up all the illegals in the US, and pay for people like IvyB to migrate to the Netherlands, then perhaps we could afford to offer health care for all that remain.

  • arbitrarystring

    I have a better idea, Freeper: Why don’t you go live in Somalia?

  • http://phd9.blogspot.com Paul Dirks

    How come deficit reduction has to be the centerpiece of this bill when there was nothing but crickets when Bush trashed the surplus he inherited and created the basis for this huge deficit?
    .
    Because GWB’s trashing the budget doesn’t make it right (It just makes republicans dishonest)
    .
    Two things are true. First, whatever bill emerges can be modified if 6 years from now we realize that it’s not performing as advertised. Secondly, unless it’s revenue neutral over the long haul, it will be guaranteed to fail over the long haul. It would be better if seventy years from now, we weren’t still debating how we’re going to pay for our health care system.

  • rustyreturns

    “Who is calling out the President on this for spreading falsehoods about the HC bill”.

    .
    Come on freeinpa. Call Obama a LIAR.
    .
    He lied then, and he continues to spread lies about this folly A.K.A. Health Care Reform!

  • stuartzechman

    KT:

    The much-anticipated CBO score is here.

    O Huzzah!
    .
    The CBO score is here!
    .
    I can’t wait for you to read it, and report the most key, important finding of all:
    .
    By how much and when does the CBO say that the cost of health care per year to America will be reduced from its 2007 level of $2.2 trillion, if we pass into law the Baucus bill?
    .
    By how much and when does the CBO say that the astronomical price tag of $7,421 per person (according to US Dept of Health & Human Services http://tinyurl.com/rcru3c ) will come down to what the rest of the world pays, if the Baucus plan is implemented?
    .
    By how much and when does the CBO say that the insane, nation-bankrupting 16.2 percent of our country’s wealth (GDP) being thrown away on mediocre health care will come more into line with France or Japan or Italy or England or Germany’s 10 percent or lower, once the Baucus bill’s prescriptions are fully realized?
    .
    The deficit-reduction numbers are grand, sure, but that’s a drop in the bucket compared to the $2.2 trillion a year the United States spends on unexceptional health care.
    .
    Let’s even say that the bill, if passed, will be deficit-neutral over the next decade. So what?
    .
    Even if health care reform as currently envisioned will truthfully not contribute a dime to the deficit, who ever said that the goal of this was to come out spending the same idiotic amount on health care that we do now, KT?
    .
    So I eagerly await the fruit of your diligent reporting labors, KT:
    .
    If the Baucus bill becomes the law of the land, what does the CBO say about what will become of the crazy $7,421 per person price tag of American health care?
    .
    In 2013, will the price of health care in the US be less, the same or even more money than it is now…and what will happen to base insurance premiums and Medicare & Medicaid as a result?
    .
    Thanks so much in advance for this awesome reporting, KT (I’ll read the report, too)…

  • http://phd9.blogspot.com Paul Dirks

    Rusty keeps his own set of facts in his back pocket, in caae the real ones aren’t to his liking.

    “all persons are equal in the eyes of the law when it comes down to things like education or other services that are to be used for the people of this country”
    .
    Since you used quote marks, that would indicate that the phrase appears elsewhere and you’re quoting it. Care to cite your source?
    .
    hint (It’s near your back pocket……)

  • arbitrarystring

    but leaves 25 million uninsured (one-third of them illegal immigrants).

    .
    Let’s for the moment leave aside any debate over whether or not illegals should be included. If the plan on the table specifically intends to exclude them, doesn’t it muddy the waters to include illegals in the number of people the plan will miss? If we’re trying to gauge how effective the bill will be, we need to compare it against its intended goal.

  • freeinpa

    rustyreturns

    I know he is a liar and you know he is a liar, it’s just the liberals who think only Fox News and Rush lie.

  • freeinpa

    arbitrarystrin

    Sounds like somebody needs a nap (and his meds)

  • http://twitter.com/ktumulty Karen Tumulty

    because we are still paying for their treatment, when they show up at emergency rooms.

  • deconstructiva

    …what’s with rusty’s unprovoked ad hominem against Ivy?

  • rustyreturns
  • freeinpa

    Judge Napolitano, I believe

  • gysgt213

    My constant complaint is that the media coverage of the entire effort to reform health care and the effort not to reform health care has been a complete muddy mess.

  • rustyreturns

    Those who HAVE health care insurance are paying for “when they show up at emergency rooms”. People who do not have insurance do not pay anything towards the cost.
    .
    Please be more specific, KT.
    .
    Now, every tax payer will pay, most notably those of us with “cadillac” plans, and seniors giving up over 500 BILLION in Medicare CUTS

  • arbitrarystring

    Fair enough. I just personally think that we should consider that separately from the matter of how effectively the bills cover the people they intend to cover.

  • stuartzechman

    Thank you so very much for responding to commentary, KT.

  • stuartzechman

    500 BILLION in Medicare CUTS
    .
    Do mean cuts in benefits to seniors, or cuts in over-payments to mediocre providers/inefficient private insurers?
    .
    Actually, I’d like to look it up myself…
    .
    …where in the CBO report does it mention this, Rustydog?
    .
    What page number?

  • gysgt213

    “Those who HAVE health care insurance are paying for “when they show up at emergency rooms”. People who do not have insurance do not pay anything towards the cost.”
    .
    That’s not entirely true Rusty. The federal government has a special program that reimburses hospitals for treating the unisured. That is taxpayer money. So even if a person does not have health insurance if they are paying taxes to the federal government they are paying something. It might not be their fair share. But so be it. You like this way because you don’t want to do anything to make sure they have insurance. Correct?

  • fhmadvocat

    freeinpa,

    Why is it so important that “illegals” not be covered? It is because the Republicans want to cut off their noses inspite of their faces?

    Let’s see, for Republicans is makes for sense to have to pay for an illegal getting care in the emergency department (which happens now) than for an illegal to pay his or her own insurance and to see a primary care physician. Yea, these guys are bright!

    Somehow, Republicans think, if illegals aren’t covered, they won’t get medical care, or it will be provided for free. Boy, talk about genius! Every time, an illegal goes to the hospital and receives care, it is pay for, either directly with our tax dollars, or indirectly through our insurance premiums.

    I would like the illegal to at least cover some of his or her costs, or at least see a primary care physician so it costs you and me, directly or indirectly less money. But clearly you would rather he or she go directly to the emergency room and then you and me pick up all of the costs, directly or indirectly.

  • spob

    KT, first of all, the “treatment” that they receive at emergency rooms, on a macro-level, is almost certainly not as costly as the treatment that they would receive under a regime of treating all of their medical issues. Second of all, Congress could simply pass a law that deported any illegal who showed up for emergency care once that illegal was stabilized.

  • fhmadvocat

    rusty,

    You seem to be missing the point about illegals. YOU AND I ALREADY PAY FOR MEDICAL CARE FOR ILLEGAL ALIENS, DIRECTLY OR INDIRECTLY. Therefore, whether they are covered under this bill is irrelevant. Republicans don’t care, either, they simply want a “us vs. them” argument to rally Conservative hatred of immigrants.

  • freeinpa

    fhmadvocat:

    Here is a wild concept I know liberals don’t like. Note the IL in front of LEGALS. They are breaking the law. Enforce the law and medical expenses go to zero.

    That’s the problem with liberalism- moral relativism.

  • http://phd9.blogspot.com Paul Dirks

    Thanks.
    http://www.law.cornell.edu/supct/html/historics/USSC_CR_0457_0202_ZO.html
    It is indeed interesting reading. Do you now care to state that your in favor of illiteracy. It would appear that way to me……

  • http://phd9.blogspot.com Paul Dirks

    Standard Republican logic. Deny any and all benefits to any and all Americans on the off chance that someone else might inadvertantly benefit as well. Better to have people die in the streets, except for the inconvenience of having to dispose of the corpses or step over them…..

  • http://twitter.com/ktumulty Karen Tumulty

    I have FOUND the Death Panels. Or not. Please read the post above this one.

  • cidelson

    What a relief we won’t be covering people who are “illegal.”

    Too bad that won’t stop them from contracting communicable diseases, and since they won’t be “covered” will be more likely to pass those viruses and diseases on to those of us who are not “illegal”.

    And too bad that some of those people will end up getting care in more expensive emergency rooms when they delay getting care when they get sick because they are not covered for primary care.

    And too bad that will drive up healthcare costs for everyone.

    Yes, it’s more important that we adhere to rightwing fundamentalism and deny health coverage to people because they are “illegal” — even though that is inhumane, foolish from a health policy standpoint, and increases overall healthcare costs.

  • rustyreturns

    http://www.nhpf.org/library/background-papers/BP_MedicaidDSH_09-14-04.pdf
    .
    I assume you are talking about DSH, gysgt. You may want to read this report I cite above.
    .
    The estimation is that DSH covers approximately 23 Billion in un-insured and that includes illegals.
    .
    I am not able to find what the actual costs are overall, we assume that some of these costs or have been told that anyone who has insurance is also paying for part of these costs through pass throughs.
    .
    Using stuart’s figures that it costs every individual approximately $7400 in the US, whereas in other countries it is only about 1/2 of that cost, or a savings of approximately 736 billion dollars.
    .
    One could then preclude that those of us who are insured are spending about 700 billion dollars in pass throughs or increased costs we pay for our insurance.
    .
    The government or tax payer is funding about 23 billion.

  • rustyreturns

    No, I am in favor of passing legislation that requires ICE to deport anyone in this country who resides here illegally, PERIOD.
    .
    I am in favor of securing our borders and preventing the illegal passage of those into this country illegally.
    .
    Once we take these steps, then we can provide for those within our borders who are legally here, and provide them with all the necessary basics of life.

  • xxception

    This entire debate is ignoring the fact that study, after study has found that people who do NOT pay for their health insurance take VASTLY more resources from the healthcare system than those that do.

  • Matt

    Nothing short of great news for the president. The bill generally hits the mark as far as bottom line goals and paints the GOP into a dangerous corner in opposing a bill that would significantly reduce the deficit.

    http://www.political-buzz.com/

  • rustyreturns
  • choska

    Okay, spob and Rusty, you win. Feel free to elect only Republican nominees who are willing to deport any and all illegals.
    .
    The problem is that too many businesses, including those owned by Republicans, depend on illegal immigrants to work for them. Your politicians say they are for deporting every illegal immigrant they can find, but they don’t actually do anything about it.
    .
    Stop complaining to us. Pick up the phone and talk with Cornyn and McCain. They are your enemy. They are the ones who are weak on immigration. There is a 5th column of people in the GOP who aren’t doing everything they can to deport every illegal they can find.

  • johnnie1984

    Rusty and Free:

    Just wondering, do you two get paid to post comments here? It seems to me, with your harsh tone and views that are generally incompatible with most of the readers here, you are trying to accomplish either of two things: one, honestly trying to persuade and alter people’s opinion; two, you are being paid and continue your work even though it makes no progress – in fact, might even calcify your opponents even more.

    The first option doesn’t make sense to me. You’re smart – not intellectual and able to grasp the collective human environment, but quick and sharp – nevertheless, smart. Yet, you’re clearly out of place here, you would feel much more at home posting on other sites, so you get combative – understandable, but that tone never works to persuade. So if you are honestly trying to sophisticate us, you haven’t yet noticed it’s not working, but you’ve been doing it for quite some time and people as smart as you don’t not often notice things like this. Which means you’ve most likely noticed it, but continued your efforts undeterred expecting a different result. Thus, you might be insane.

    I don’t think you’re insane – could be, but not likely. That leaves us with option two. You’re quick and sharp; have quick access to what most people would consider obscure reports; and you have significant amount of time on your hands. This sounds like to me a mid-level clerk with some talent and a hard-working attitude, willing to do anything to get ahead. I think you’re being paid.

    Either that or you just like harsh, political conversation – stirring people’s feelings, people who have an intuition about something, but don’t quite have the sophistic ability to defend their ideas quite you. It might even make you feel good to show your perceived intellectual superiority – I guess this then would be option three.

    So what is it? Are you insane, being paid, or just a plain dick?

  • johnnie1984

    “sophistic ability to defend their ideas quite you.” There should be a “like” in between “quite” and “you”. Oops.

  • xxception

    johnnie1984………..so, it’s not possible they merely have a different opinion and enjoy engaging in debate? You have perfected the Democrats art of denegrating the opposition so you don’t have to engage their thoughts. Good job. *sarcasm fully intended*

  • freeinpa

    I won’t speak for Rusty, but nearly every topic or comment I post is met with name calling, derision and an arrogant condenscening attitude. And your response perfectly reflects that attitude.

    You seem to think what liberals on this site write passes for some civil, sophisticated intellectual exchange. With a few exceptions,stuartzechman and Paul Dirks, to name two, are in large part gaseous windbags who throw temper tantrums because the world doesn’t agree with them and give them everything they want. Typical liberal fare.

    I don’t get paid to write (here), nor insane, although trying to reason with liberals could be described as insanity and my name is not dick. I am an independent who works when I need to or have to, read non-stop and stand by my principles.

    So, here, as most parts of your life its no runs, no hits only errors. Don’t worry Mommy will be home soon.

  • freeinpa

    Not to worry: I have been called worst things by better people.

  • freeinpa

    The goal on the deficit is precarious at best. Trusting 500+ politicians (of either party) to eliminate fraud and abuse out of Medicare and reduce senior citizen coverage in rural areas will be a stretch. Dealing with the unions who will lose gold-platted plans won’t be easy either. And let’s face they can’t truly predict 10 months out let alone 10 years.

  • freeinpa

    We could move all the uninsured to Chicago and they could die of natural causes (Chicago style)

  • johnnie1984

    I think you should re-read what I wrote. You only got one thing correct: I called you two dicks. Yup, guilty as charged.

    “every topic or comment I post is met with name calling, derision and an arrogant condenscening attitude. And your response perfectly reflects that attitude.”
    -An insult, but you then return the favor. Way to be the bigger man/woman.

    “You seem to think what liberals on this site write passes for some civil, sophisticated intellectual exchange.”
    -Never said this, in fact, never even hinted at it. My whole topic was you two.

    “so, it’s not possible they merely have a different opinion and enjoy engaging in debate? You have perfected the Democrats art of denegrating the opposition so you don’t have to engage their thoughts. Good job. *sarcasm fully intended*”
    -Two things: one, this isn’t a debate; there is no conversation, no precise meaning, nothing that would constitute a civil conversation between people. In fact, you completely assumed my positions to be liberal and I never said anything about myself – NOTHING; two, I never wasted the time engaging their thoughts because, if you read my post, I don’t think it will do any good. I would have to be insane, paid, or a dick.

    “Not to worry: I have been called worst things by better people.”
    -I’m sure you have and I wouldn’t be surprised if it happened frequently.

    Now, if you’ll excuse me, Mommy is calling me downstairs for dinner.

  • gysgt213

    Well, there you go with the name calling card.

  • gysgt213

    Boy that was fun reading.

  • freeinpa

    It was hardly worth reading the first time. But I will help you out here since you have trouble following your own post.
    “You seem to think what liberals on this site write passes for some civil, sophisticated intellectual exchange.”
    -Never said this, in fact, never even hinted at it. My whole topic was you two.” Well yeah you did. You refer to the postings o ftwo people with conservative views and how they do not hold up to the standards you seem to believe others have here.

    “so, it’s not possible they merely have a different opinion and enjoy engaging in debate? You have perfected the Democrats art of denegrating the opposition so you don’t have to engage their thoughts. Good job. *sarcasm fully intended*”
    Not my post!

    “”Not to worry: I have been called worst things by better people.”
    -I’m sure you have and I wouldn’t be surprised if it happened frequently.

    And I am perfectly happy with that. I do not need the approval of others to make my life work.

    Now, if you’ll excuse me, Mommy is calling me downstairs for dinner.”

    And make sure she gives you your meds. I believe you will need them.

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  • johnnie1984

    “You refer to the postings of two people with conservative views and how they do not hold up to the standards you seem to believe others have here.”

    When did I mention standards that others have? Just wondering. Cause mommy just lost her job and now we don’t have any insurance, so we can’t afford my meds – this causes me to often black out and forget things.

    I’ve gone back through my post a few times now, and I find no mention of standards; i find me saying that your views aren’t really compatible with most people here – maybe that’s what you mean. Yet, I did mention you having more sophistic ability than others which would seem to elevate you above any conventional standards. Man, I am totally confused now. This was way more than anticipated. I just wanted to know if you were being paid to post and felt I should mention that your behavior seems to hint at you being a dick. Should’ve known it would become more than that.

    Free Indiana University of Pennsylvania

  • dvd320

    So many people want the illegal insured. True when they show up in the ER we pay for their care… so why do we not deport them at that time?

  • ceryan83

    The citizens of the U.S. are losing the war against the corporations for control of the government. The healthcare bills are just another battle lost, really. Why was single payer off the table?

    You can be sure that the devil is in the details of the bill…for example, the Medicare/Medicaid will not negotiate for better prescription drug prices, because Big Pharma claims it needs to price gouge in order to “remain innovative.” What baloney..

  • xxception

    It appears as if many of you don’t like seeing the profit motive at work in healthcare. What incentive do you believe pharma companies and any other that produce the latest greatest medical technology will have to further advance their fields if the profit motive is removed? Or, do you believe they should only have as much profit as YOU deem them to need?

  • hippooath

    If simple profit motives were the only reasons why healthcare is nervous about healthcare improvements they wouldn’t spend millions elicit special treatment from our political system. Pharma companies don’t really innovate anymore; in order to avoid their cash cows from running out of steam they make small changes to existing drugs, call them something else with minimal improvements to continue making absorbent amount of money on them, or try to sell their drugs for a broader set of treatments – a cure for ‘cancer’ when it’s only meant to take care of your ‘thinning hair’.

    Any good business model is a give and take between producer and consumer. They make a good product, we buy it and if it doesn’t work as advertised we have either legal options or simply the right to stop buying it. But when an industry corner what we need with bad products that we’re more or less forced to buy simply to survive; well then I’d like the same bargaining chip at the table as companies who can spend that much money to continue the money flow their way.

    The argument that we won’t get the greatest medical technology is quite silly because they’re not all made in USA, some of the ‘great’ drugs out there are made in other countries under different policies. There’s something fundamentally wrong when someone can make 200% profit on some products because we’re afraid that it’ll kill their ability to re-brand pretty much the same product as something else.

    I’m all for companies making a lot of money, but not for us consumers to first pay a lot to buy the stuff we need and then for them to get special treatment on our tax dime behind our backs.

  • xxception

    hippooath…..you are absolutely WRONG that pharma companies don’t innovate anymore. Also, they don’t have unlimited protection for ANY drug they develop, ONLY NEW ones. If you ran a company that developed a new product potentially worth millions, would you give away the permission to make that product or recoup your r&d costs and turn a profit?

    “The argument that we won’t get the greatest medical technology is quite silly because they’re not all made in USA, some of the ‘great’ drugs out there are made in other countries under different policies.”

    Another fallacy. All medical technology is not MADE in the USA, but the vast majority of it was researched and developed in the USA. Who is going to take the lead to develop this technology if we take away the profit motive? Are we gonna wait for France or China to develop something and then hope they share the technology with us? No thanks, i’d rather be the innovators.

    Also, there is an economic principle at play here. I forget the name of the principal, but in short it states that as a society becomes larger and more successful, the cost of it’s medical care as a % of it’s net worth INCREASES. Why? Because you can make a factory more efficient and produce 200 widgets in the time you formerly could produce 100, but during that same amount of time, a hear surgeon will STILL only be able to operate on a few people a day. You cannot efficiently manage the manpower required for surgeries and what not so that they require less LABOR as you can in other industries.

  • xxception

    Also, the protection for any new drug they produce is only for 7 years at which time any company that produces drugs may make a generic version.

  • piper1

    What utility are you suggesting the insurance companies provide?
    .
    What is the connection between cutting out the insurance companies as middlemen profiting from denying claims and the profit margins of drug makers?

  • hippooath

    True – but it only takes incremental improvement of a drug to make it different enough to call it a new drug. The basic research of that drug is already done and the improvements are usually a matter of molecule manipulation in the form of the drug ‘working’ longer. Other then marketing the ‘new’ drug, it is more or less paid for. And with a minimal cost to the manufacturer for the ‘new’ and improved drug, yet it doesn’t stop the drug company for charging as if it was ‘new’. As I said, making money is all nice and well, but please do it operating under normal marketing principles.

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  • ceryan83

    xxception:

    It’s my understanding that the term of patents is 20 years in the U.S:
    http://www.uspto.gov/web/offices/pac/mpep/documents/2700_2701.htm#sect2701

    Could you provide a link for your claim that prescription drugs have a 7-year patent?

  • zc421

    I think people are entitled to timely, effective, efficient health care.

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