If only all of that lobbying money had gone into treating the sick and injured, what a better world it would be.

Who cares what doctors and patients think about healthcare? That's just a bunch of "special interests." We should all just listen to Assclown Reich and let Uncle Bammy handle all the tough details. IF we listen to any patients on healthcare, it should, of course be ONLY those who can't afford it. The rest of us who pay for our care and theirs have no opinions of value, obviously.

This column is essentially self-parody of big government liberalism pushing a welfare state on a population that never wanted it (to the extent that they even understand the implications).

RR lists ~$30M in lobbying spend. That sounds like about enough to cover the helicopter costs for a few months at the medium-sized hospital in my community. Hardly enough to make the world much better, healthcare wise. If it saves us from more Gov-administered healthcare, I'll call it a bargain, the best I ever had.

What's wrong Natty-J, you work in the insurance industry?

I have great insurance, which my company pays for out of pocket. We still pay a national insurance giant just to administer the plan, and those incompetent morons still fight every charge and deny valid claims all the time.

Insurers are fucking everybody on both ends: hospitals, doctors, and citizens who need health care.

Why so much love for them, and why so much hatred for a national public insurance option?

-Jamobey

There is no way I am rushing into this with a yes until I know more.

I am disturbed by the following...how Obama's plan will give free healthcare to illegals. We can't even afford them in CA (the teacher's Cadillac health plans a lone are bankrupting the state) much less EVERYBODY. I want citizens who have paid into the system to come FIRST. There has to be boundaries when you have entitlements.

Second, I don't want him to rush into this. Rushing into a complex program is wrong. It's the same way he pushed his massive spending which hasn't done much yet.

This what I am afraid will happen. I pay for my own health care. I get more bills every time I use it...but with Obama's plan, I am betting, I'll have to pay MORE taxes (and no I earn a modest income) yet still get no benefits. So what else is new? Paying for more benefits for others you do not get to see. And it doesn't solve the crux of the problem.

Doctors think about medicine the same way that auto executives think about running American car companies and the same way that bankers think about finance.

They do not see systemic risk or market externalities, and they will tend to maximize profits in the system they are given rather than try to reform the system to minimize cost. They locally optimize to prevent lawsuits, to maximize billable events, and to see as many patients as possible.

The AMA should be at the table, but should not drive reform.

Why do you suppose Big Pharm/Insurance wants to kill the public option? If their profits are reduced, the wingnuts arguing against the public option will see their standard of living go up. It's disturbing to watch the wingnuts parrot the talking points. It's like watching someone stick a needle in their eye.

The real breakage here is that our laws that allow large moneyed interests to buy influence. It's the 21st century; we should really work on changing this.

American Healthcare costs twice as much as any other capitalist democracy in the world, with no benefit to us in health or longevity. Our healthcare costs have been outpacing inflation for decades and are now bankrupting businesses, pension plans and citizens at an alarming and increasing rate.

As even Obama admits "Big American Health" is too big to fail, it must be reformed... The easiest way to fix our system, without destroying it and starting from the ground up, is to find the greatest areas of waste and eliminate them. This will buy us time and allow a less painful progression towards a state of the art, 21st Century healthcare system.

The two most glaring defects of our current system are: The fact that one third of all healthcare money is skimmed off the top by paper pushers in the insurance industry; and the fact that 80% of what remains is spent "selling hope" to the terminally ill, and their family members as they make end of life decisions on how they want to spend the time they have left.

The solution to the 30%/paperwork problem is simple streamlining... Outlaw the "pre-existing conditions" and eligibility/protection issues, and standardize rates that can be charged down to simple age and dependant status. Insurance that is open and affordable to all. The yuppies and fitness freaks will wig-out at the thought of sick kids and obese/smoking white trash sharing their coverage, but by reducing the business overhead to a manageable 5%, the cost of their premiums should remain stable (the highest rates in the world!).

The real savings will occur when doctors are required to provide full disclosure, of precisely what a full-on end of life grind in the hospital actually means, compared to a peaceful death at home (with home hospice) or at an inpatient hospice facility. Doctors love to whine about how little Medicare pays, but the truth is, the end of life grind is the jackpot at the end of the Medicare providers rainbow/quarter.

Many feel giving (false) hope to the dying is a "unfortunate necessity" in healthcare, and perhaps this is true, but failing to fully disclose the unpleasantness, pain and futility of end of life heroics, is perhaps the greatest "tolerated sin" in healthcare today. Doctors and nurses need to stop talking about hypothetical "miracles that might happen" and focus on "the quality of life" for patients during their last few months of life.

These two steps are not only doable... They are ethical, sane, and realistic solutions for healthcare in 2009.