Talk:Healthcare reform in the United States/Archive 2

arguments-for-and-against X
It should be split up sections for each of the various issues, or be liquidated into sections on each topic, and incorporating into the existing article--eg: Scientus (talk) 05:09, 16 September 2009 (UTC)
 * costs, incorporating both topics of entitlement/assurance and efficiency
 * status quo
 * waste
 * cost under single payer, models of the developed world
 * cost effect of other changes
 * cost to whom?
 * conflicts of interest / moral hazard
 * accountability
 * monopoly (patents); monopsony/buying power

What kind of coverage of the Shona Holmes incident is appropriate in this article?
A big block of text was recently cut from the article on Shona Holmes, and pasted into this article. This poorly carried out cut and paste does not comply with policy, because it doesn't credit the original contributors who drafted this text, back at Shona Holmes.

The contributor who performed the cut and paste recently nominated the Shona Holmes article for deletion -- their third attemp in the last three months. In this most recent afd they argue: "The main point of this article is already in ... health care reform in US ... Which means this article is useless and should be deleted."

This contributor spent so little effort at performing a meaningful merge that they didn't even bother to remove the other article's reference section. This contributor spent so little effort at performing a meaningful merge that they didn't even make sure they included the body of all the references

I don't think any serious contributor to this article will think that they sections this contributor thoughtlessly pasted on the Canadian reaction and the Local (Hamilton Ontario) reaction are appropriate in an article on American health care reform.

Note: I am not saying this contributor has knowingly lapsed from WP:POINT or knowingly lapsed from good faith. But I think even stripping out the superfluous double references section, and the three sections on reactions to the Shona Holmes ad, the Shona Holmes section would still be too long to fit in this article. Geo Swan (talk) 17:37, 23 September 2009 (UTC)


 * After several attempts to collapse the section, it occurred to me that Shona Holmes's saga isn't a common argument either for or against reform, nor is it a description of a common strategy in the healthcare reform debate, but rather is simply one person's story that's gotten a lot of minor media coverage especially in Canada. While I respect the sensitivities of many Canadians w.r.t. some of the slights and misrepresentations about the Canadian system that've been thrown around by a number of commentators and healthcare-industry advocates in the US, Ms. Holmes's story is irrelevant to this article in that it is a minor scuffle which doesn't have anywhere adequate WP:WEIGHT to include here. I've removed the section. ... Kenosis (talk) 18:26, 23 September 2009 (UTC)


 * Thanks for the quick reply. My own guess would have been that the appropriate size ranged from zero coverage to a couple of sentences, or a short paragraph.  I think her ad turned out to have stirred a much bigger controversy here in Canada than it did in the States.  Thanks again!  Cheers!  Geo Swan (talk) 19:16, 23 September 2009 (UTC)


 * No problem. Yes, we seem to have become somewhat inured in the US to the use of anecdotal horror stories such as this. Again, I'm sensitive to the wish of many Canadians for their country not to be misrepresented in this sort of way by television and other media advocacy in the US. But this story simply doesn't carry sufficient weight to present in any detail in this particular article, which is already quite complex without detailed stories of individuals. ... Kenosis (talk) 19:26, 23 September 2009 (UTC)


 * How would you feel about changing the passage: "if Shona Holmes's account was accurate" to "if Canadian Shona Holmes's account of undergoing grain surgery at the Mayo clinic was accurate"? Feel free to say it is too much. Or alternatively, how would you feel about just putting "Canadian" in front of her name?  I already took the liberty of changing "Holmes" to a wikilink to "Shona Holmes".  Cheers!  Geo Swan (talk) 21:01, 23 September 2009 (UTC)


 * As I mentioned, I removed the section. IMO, If it's reinserted, it should be extremely brief. ... Kenosis (talk) 22:12, 23 September 2009 (UTC) ... The wikilink makes good sense to me. ... Kenosis (talk) 08:54, 24 September 2009 (UTC)


 * It might make more sense to include a brief description of it (with a wikilink) in Comparison of Canadian and American health care systems instead. That's where these sorts of 'stories' have tended to surface, and perhaps a brief section there about 'invalid comparisons' or some such might do the job of informing readers who've heard 'something' but want more facts (and who can remember the woman's name?!) without giving it undue weight. Flatterworld (talk) 15:58, 28 September 2009 (UTC)
 * Prehaps that would work, but the story has gotten very little treatment here- as mentioned before- and I would not support any description about it here. The Squicks (talk) 06:54, 29 September 2009 (UTC)


 * An alternative might be to mention it (with a Wiki-link to the original article) in the article on Health care reform debate in the United States. There is some overlap between that article and this one, but to the extent that a story became part of the debate (or a distraction from it), without touching on actual reform, the mention might fit better there than here.TVC 15 (talk) 20:04, 4 October 2009 (UTC)

External links - Interest Groups
I added a 'see also' link to List of healthcare reform advocacy groups in the United States, but I'm thinking we should merge our section with theirs. The list is probably useful for several articles, so I can see the point of keeping it separate - no reason to try to keep duplicate lists updated. btw, there are two types of groups from what I've seen: stand-alone groups not affiliated with anyone or anything (independent), and those with a 'parent' group such as AARP, the AMA or whatever (associated). (Note: some are less 'independent' than others, as in astroturf groups.) Anyone else have any thoughts on this? Flatterworld (talk) 19:39, 24 September 2009 (UTC)
 * I went ahead and merged this article's links with List of healthcare reform advocacy groups in the United States. I left the 'Interest groups' line with a link so the list would be easy to find, and to avoid links being re-added by people not used to the separate List concept. Hope this helps. The tag on External links had been there since August and I didn't want it to appear this article was being ignored/neglected when it's such an important resource right now. (Many thanks to all who are working on it!) Flatterworld (talk) 15:51, 28 September 2009 (UTC)
 * Please see WP:MOS and External_links. While it's only a guideline, there should be a fairly clearcut overriding reason to divert from the generally accepted practice of not using internal WP inks in the "external links" section. ... Kenosis (talk) 03:01, 7 October 2009 (UTC)
 * If you feel that strongly, then the better alternative is to not list any 'advocacy groups' at all. The List is already in the See also section - the only reason for including it here was to AVOID an ever-growing list of 'really important - honest!' advocacy groups. Listing some and not others gives them undue weight, and afaik none is 'definitive'. Dmoz has a fairly extensive list already (looks like 60 interest groups, 17 think tanks) - External_links - which is why it's included. Flatterworld (talk) 01:58, 8 October 2009 (UTC)
 * I have now removed all the groups. The attempt to get rid of 'conservative' and 'arguments against reform as proposed' links was transparently disingenuous (ooh!ooh! they're policy institutes! ooh!ooh! they're not primarily about healthcare! ooh!ooh! they're not non-profit - so who cares? We're talking about ideas and concepts here, remember?) This is indeed why certain articles list the relevant Dmoz category along with whatever official links exist and ongoing coverage from responsible news media. An encyclopedia's purpose is NOT to imply some groups (and their issue positions) are more important/relevant/better than others. If anything, 'single-payer' groups belong with the single-payer article, etc. Flatterworld (talk) 17:29, 9 October 2009 (UTC)
 * jftr, I would point out that MasteroftheWatch added Conservatives for Patients' Rights as the 'token conservative group' to the list - which was the final straw as to why I deleted the entire section. Reading the article, it's clearly set up as a straw man argument - ooh!ooh! connect them with the Swift Boat Veterans et al so the implication is that everyone against health care reform as proposed is wicked!wicked!wicked! May I remind you: this is an encyclopedia. If you're off on some partisan campaign, please go elsewhere. Flatterworld (talk) 17:39, 9 October 2009 (UTC)
 * Sad to see the list go. The title of the List of healthcare reform advocacy groups in the United States doesn't suggest the presence of  other groups that may have presented some insights on this issue, and the included list of projects within larger groups doesn't link to their work on healthcare.  I don't see this as a purely conservative/liberal or Democratic/Republican issue; it affects everyone, although much of the 'air war' is driven by competing financial interests (e.g., insurance companies vs. hospital corporations and PhRMA).  The NewsHour on PBS reported that in Holland most babies are delivered at home by midwives, with basic follow-up care provided in-home by visiting nurses to obviate the number of doctor visits.  Infant mortality and spending are both much lower than in the U.S.  This is the kind of perspective that vanishes from the lobby-driven debate, which tends to favor the most profitable program regardless of its effect on "beneficiaries" (or victims, as the case may be and too often is).  Some have pointed this out, e.g. some Cato authors call the AHA and AMA cartels that monopolize vital services for their own profit while killing and bankrupting patients, and it would be helpful to link to their relevant pages.  A free encyclopedia (WP) is the best place to show that sometimes it is better to spend _less_ not more.TVC 15 (talk) 21:19, 9 October 2009 (UTC)

Lobbying money
The article could be updated with this article which states how much has been spent on lobbying in 2009. Smartse (talk) 13:08, 4 October 2009 (UTC)

Sections and Related articles on Current Debate in desperate need of overhaul
The related sections (really all sections) in this article and all related articles on the current healthcare debate desperately need to be overhauled and expanded. There is practically nothing in this article about the ongoing major events around the current debate, a subject area that is absolutely required.

The main discussion around generating an overhaul effort is on the talk page on the main article: Health care reform debate in the United States

For now, for this overhaul effort, please discuss anything not pertaining specifically to this article on that talk page.

NittyG (talk) 05:01, 27 October 2009 (UTC)

McCarran–Ferguson Act
I added:


 * McCarran–Ferguson Act United States federal law that exempts health insurance companies from the federal anti-trust legislation that applies to most businesses.

...in the see also section, in the hope that others may add this section to the main body. I am really quite surprised this is not on this page. Reversing this law is the stick that Obama and the democrats have been using on the health insurance industry after he health insurance industry came out with an industry funded study saying that rates would go up.

Therefore: Health_care_reform_in_the_United_States "Some conservatives advocate free market reforms such as breaking up state monopolies on insurance and licensing and allowing consumers to purchase health insurance licensed by other states." is not fully correct, democrats have been threatening this also. Ikip (talk) 07:43, 28 October 2009 (UTC)

Multiple issues pretaining to article
This article is both too long and is too technical, therefore not following the WP:Technical standard.

The Health_care_reform_in_the_United_States section needs a seperate article (that is NOT Tort reform).

The following Templates can correctly be placed on the article.

Template:restructure Template:condense Template:Very long Template:technical

Overall articles pretaining to healthcare in the United States are formed up in an unorganized manner with lots of Duplication.

Objective: FIX

Spitfire 19 (Talk) 15:50, 6 November 2009 (UTC)


 * This is a very complicated topic that's also currently in a very real state of flux. A number of editors have done a lot of work to try and bring some organization to the topic, but there isn't an easy fix.  Specifically, a number of sub-articles have been created to simplify this one, such as Uninsured in the United States, History of health care reform in the United States, Health care reform debate in the United States, Health care reform in the United States presidential election, 2008, Obama administration health care proposal and Public opinion on health care reform in the United States.  It isn't perfect, but those sub articles have helped a lot.  One problem we have is editors who haven't taken the time to figure out the structure, and who want to dump everything in this article.  (It should summarize everything, but we are getting too much detail.)


 * At this point, I think the most useful thing we could do is create a subarticle for the content of the "Current reform advocacy" - it's getting disproportionately long, and the material doesn't really fit under existing Health care reform debate in the United States section that it points to.


 * But I do think there's going to be a limit to how much clean up we can do before the dust settles on the current legislative debate. EastTN (talk) 17:57, 6 November 2009 (UTC)


 * I've created the article I suggested above. EastTN (talk) 20:38, 6 November 2009 (UTC)

Patient Protection and Affordable Care Act
The name of the current Senate bill, the Patient Protection and Affordable Care Act, does not have an article at the moment. That bill is technically an "amendment in the nature of a substitute to H.R. 3590" and was proposed in the Senate on November 18, 2009. 72.244.207.125 (talk) 07:41, 22 November 2009 (UTC)


 * H.R. 3590 &rarr; (AS or Amendment Substitute) is expected to be the vehicle for the Senate health care bill - the  Patient Protection and Affordable Care Act . IGNORE all the previous Tax Code language since the substitute amendment will replace it anyway.


 * You can also see this draft amendment at the democrats.senate.gov site. 68.237.235.127 (talk) 11:09, 22 November 2009 (UTC)

Healthcare Market size vs. Costs
Is the cost of comparable goods any different in teh united states than overseas? Is it perhaps that people in the U.S. buying the same things as people overseas and then more goods and services in addition? When one claims the costs of healthcare are different than overseas, shouldnt there be a basket of goods and services being compared rather than an outcome? Mrdthree (talk) 17:13, 4 December 2009 (UTC)

What I want to research is whether a basket of healthcare goods and services in the United States is actually cheaper than that same basket of healthcare goods and services in other countries. If not, why not? Mrdthree (talk) 17:19, 4 December 2009 (UTC)

Bias
Once again we find a substantial liberal bias on Wikipedia. I have begun to clarify and edit the opposition's arguments on the page. For instance, a counterargument for socialized medicine was found in an argument regarding the constiutionality of government-run health care which itself wasn't even phrased right to being with. I also found a disturbing lead sentence in the Public Opinion section. It states "Survey research in recent decades has shown that Americans generally see expanding coverage as a top national priority, and a majority express support for universal health care." This simply isn't true. To make matter's worse, the sourced sited was written "by a liberal perspective" and in fact was listed so in the title of the article. If this doesn't prove a pro-socialist or at least a pro-liberal bias on Wikipedia than I don't know what the hell does. 66.45.155.16 (talk) 18:05, 29 August 2009 (UTC)


 * Poor choices of wording on one article hardly indicates that Wikipedia as a whole has a 'liberal bias'. If you disagree with the wording of an article, discuss it and work out a solution. Falcon8765 (talk) 18:54, 29 August 2009 (UTC)
 * I read a source yesterday that actually did say that the majority of Americans surveyed DO regard that Health Care Reform is the nation's top priority and the top issue for them was extending coverage to all Americans. It was actually you that changed the RIGHTS issue to refer to constitutional rights when the book is actually about individual rights. Its pretty impossible to know what an entire book says on this issue but I am inclined to think that you were wrong to make reference to constiutional rights (which people acquire by living in a state which gives a constituional right) and individual rights which are personal to each and everybody. I have raised the problem that this edit causes in the next section. Because I now doubt that the author was referring to constitutional rights I am going to delete that addition you made as wrong.--Hauskalainen (talk) 07:59, 30 August 2009 (UTC)

Lobbying
Here is an article from the Washington Post on this. I put in a lobbying paragraph in the underlying debate article but leave it here for you to decide if it belongs in the main article.Washington Post - Nice Summary of Contributions to Key Folks

— Preceding unsigned comment added by Farcaster (talk) 04:18, 31 August 2009 (UTC)

lieberman and aetna
article states that lieberman has received $110k from aetna in 2009. cites secondary source instead of opensecrets.org. couldn't find anything on opensecrets.org that corroborated this number. can someone else find it? if so can we link to that instead? —Preceding unsigned comment added by 128.32.115.2 (talk) 20:02, 23 December 2009 (UTC)

Fraser Institute
Tom, in the U.S., and even more in the U.K., students are taught to write essays in which they give the argument for one side, the argument for the opposing side, the reasons for and against each side, and a conclusion about which side they think is right.

Did you ever learn to write essays like that? Nbauman (talk) 16:03, 30 December 2008 (UTC)


 * Yes, of course. When I deleted the link I did so with an edit summary that said "Link removed (not valid)" I guess (from your comment above) that you have mistakenly believed that I am saying the claim is not valid. I meant that the link was not valid because it is not working. And it is STILL not working even though you added it back!  Maybe we should add in a link to the surveys done for the Commonwealth Fund data which I think also showed that Canadians had longer waiting times.--Tom (talk) 12:20, 31 December 2008 (UTC)


 * It's working now. Maybe they're using an unreliable Objectivist ISP. Nbauman (talk) 18:25, 4 January 2009 (UTC)


 * This is puzzling. I am referring to this one (listed as link number 84 in the list I checked a minute ago). For me it is STILL not working. And I have cleared my cache so this is not a false negative. http://www.fraserinstitute.org/admin/books/files/HowGoodHealthCare2006.pdf . Maybe you are reading a version stored in your cache! Try opening it on another PC or using another browser application or using Adobe Reader directly /i.e. not via your browser application).--Hauskalainen 21:02, 4 January 2009 (UTC)


 * I apologize. You're right. I changed the link to the current link . Although now I have to check it to make sure it makes the same claim that the 2006 report made.


 * The reason I'm taking all this trouble is that I always make a special effort to include the viewpoints that I disagree with. These people are widely quoted and it's important to know what they say, as well as the reasons they're wrong. Nbauman (talk) 21:23, 4 January 2009 (UTC)


 * Glad we got it sorted! I too am interested to follow the arguments of those I disagree with. Then I very closely follow the evidence trail and check whether the interpretation is correct. On the question of waiting times for example, did the interviewers rely on reported waiting times in countries with reported wait times (like the UK or Canada)? If so, how did they count wait times for people in countries without recorded wait times (e,g, in U.S.)? Did they follow the trail of all people who are diagnosed as need a particular treatment and how long it took for them to get it? Or did they just ask those who have received a particular treatment and how long they had been waiting? The two methodologies could deliver very different results. If there are people who need treatment and cannot afford it yet, they are waiting too, but they get included in one method of counting but not in the other. I think we should know.--Hauskalainen 02:09, 5 January 2009 (UTC)

Link rot (see WP:DEADLINK which states "Do not delete factual information solely because the URL to the source isn't working any longer. WP:Verifiability does not require that all information be supported by a working link, nor does it require the source to be published on-line.") is very bad, and we have a way for dealing with it. Either search it up on www.archive.org (see WP:WAYBACK) or better yet add it to webcitation.org (see WP:WEBCITE) and add it in the reference.

By the way. The Wayback Machine has copies from 2007 and 2008 for this link, see http://web.archive.org/web/*/http://www.fraserinstitute.org/admin/books/files/HowGoodHealthCare2006.pdf and heres the last one of this http://web.archive.org/web/20080409061041/www.fraserinstitute.org/. Nsaa (talk) 15:44, 10 January 2010 (UTC)


 * The 2006 report can still be found on the Fraser site at: http://www.fraserinstitute.org/commerce.web/product_files/HowGoodisCanadianHealthCare2006.pdf.

A 2008 update is at: http://www.fraserinstitute.org/commerce.web/product_files/HowGoodisCanadianHealthCare2008.pdf

I think it may have taken me at least 45 seconds or more to locate these, but trying to find where they originally fit into the context of the article seems to be a longer task which I'll leave to someone else. Cheers... Fat&amp;Happy (talk) 20:42, 10 January 2010 (UTC)


 * Why do so many websites move stuff around WITHOUT making a proper redirect ... ? Thanks for the updated links. It must be worked in by people familiar with the topic (have the time doing it). Nsaa (talk) 22:29, 10 January 2010 (UTC)

New source of information
In checking to see if anyone else has done more accurateöy the rough calculation I made in the previous section about the rise in GDP allocated to government as a result of heath care reform, I stumbled by accident across this piece http://www.thestatisticaltruth.com/ which is a re-look at the statistics as they pertain to health care. There are some interesting graphs here that I have not seen before and and some editors may wish to look at this more deeply and perhaps incorporate some of the data into the article with references back to the reliable sources. --Hauskalainen (talk) 04:20, 26 January 2010 (UTC)

"Government Takeover of Health Care"
An appeal for more information and help to add more meaningful information to the article

Republicans continue to claim that the bills before congress represent a government takeover of the health care system. This is clearly a serious claim because it is repeated over and over again but I do not really understand the substance behind it.

I believe that this article should look at the substance behind the claims. What are the elements of the bills that make it possible to make such a claim? I am sure something must have been said to substantiate them, otherwise it is just a chant without substance. I don't suppose for one minute that this has no substance so we should detail in this article the elemts of the reform proposals that do represent a substantial shift towards government taking over the health care system. Can I suggest that some editors who know the substance of the claim details them here. Then we can perhaps break it down into the major areas and detail the elements that support and refute the claim. Then we can add this detail to the article.--Hauskalainen (talk) 17:49, 25 January 2010 (UTC)

To kick things off, here is Representative Tom Price on the government takeover of health care and below I have tried to draw out the list he says comprises the GTOHC (sorry its such a mouthfull)


 * Government-run insurance
 * Higher taxes
 * The Individual Mandate
 * The Employer Mandate
 * Washington to define what qualifies as health insurance
 * Expansion of the Medicaid entitlement

and "Countless (undefined) provisions that set Washington bureaucrats firmly between you and your doctor" (which I think we have to ignore unless someone can set out what they are). He also says that the bills do not ban taxpayer funding of abortion (which is true because at the moment the law only allows taxpayer funded abortions to save the life of the mother - does he want to ban that?), and that the bills do not do anything to deal with "lawsuit abuse" (which is true but perhaps it is because Obama is concerned not to override the genuine concerns and legal interests of people who are injured through medical malpractice or insurance malpractice, or perhaps because he has heard that legal reforms would make only a marginal impact on costs - which I think I read is 2-4% of total costs-). Also, its not clear to me how the absence of medical malpractice provisions or a new ban on taxpayers funding abortions when the life of the mother is at stake means that there is a "government takeover of healthcare. Forgive me, but I just don't get it!

I am not sure that Government-run insurance could qualify as a government take over because as I understand it this is refering to a public option allowing people to choose a government insurance plan rather like Medicare instead of being forced to buy private insurance. If everyone chooses the government plan then that would be a take over by consumer choice and not government choice. The other elements seem like fair claims to be government interfering more in health care. --Hauskalainen (talk) 18:30, 25 January 2010 (UTC)

It's mostly conservative propaganda and readily discredited by those responsive to a fact-based argument. In the UK, my understanding is that doctors are employees of the government. They have a budget and an administrative rationing scheme, apparently. They are paid salaries. That is government run healthcare. We are nowhere near that. To keep the cost of covering those with expensive pre-existing conditions down, we must mandate that all pay in to capture the low cost young folks presently opting out of health insurance. Otherwise, premiums would go up significantly. Medicare covers like 45% of healthcare spending in the U.S. and is wildly popular with seniors, so fears are overblown. Doctors are reimbursed at rates the government determines, but across services the doctor decides are necessary. Expanding Medicaid would give access to healthcare to more folks that don't take advantage of it. It might actually give the doctors more revenue.Farcaster (talk) 19:34, 25 January 2010 (UTC)

Mmm. The issue is not to just declare it to be propaganda. If there is a government takeove of health care we need to know where it is happening, why it is happening, and how each side comes to reckon it is a good or a bad thing. In a way the article does this because it looks at the elements of reform, but the issue I am trying to pin down (because it is not very clear to me) is why republicans argue it is a government take over. As far as I can see, yes, the government is declaring what must be covered and restricting how insurers can avoid covering individuals risk. To what extent is that a government takeover? Yes the government is taxing some things to make coverage more afffordable for the middle classes. Is that a government takeover or just a redistribution of wealth from the richest to the poorest? Yes the government is making it obligatory for people to be insured (but I am not sure that one can really say that there is an employer mandate). There is a tax on certain employers who do not cover their employees health insurance needs to some extent (what is the extent in the bills? I don't reall know. And why are the very smallest employers exempt? That to me is a puzzle.) But even if there is a mandate, the mandate is to obtain insurance cover, rather like insurance for cars. That is not regarded as a government take over of the car insurance industry, so why is mandating buying health care insurance a government take over of health care? I have this feeling that people are believing in this "mantra" of a government takeover not because it is real but because it is repeated so often. Is this like Nazi propoganda? (You know, if you are going to tell a lie it had better be a big one and if its repeated loudly and often enough, people will just believe it). Or is it really more susbstantial than this? The issue for us as Wikipedians is not to put out our opinions (as you kind of did above) but to lay bare the opinions of experts and others and let our readers decide.

I don't quite agree that the British NHS is run by the government. Rather a lot of the NHS is run by quangos (or more properly, Non-departmental public bodies) which have been established by parliament but run at arms length from government. The most popular and most used part of the NHS is the GP service which is actually run by doctors as private business partners choosing freely to work under contract with a local NHS Quango (a primary care trust) and paid according to the work they certify that they do. Nobody forces GPs or surgeons to work for the government and nobody forces people to use the NHS. Rationing is an emotive term as some people think that the there is no rationing in the US health care system, when clearly there is. The issue is that allocation of resources in the UK PUBLIC HEALTHCARE SYSTEM is allocated according to need within the resources available. In the UK PRIVATE HEALTHCARE SYSTEM (there is one) the resources are allocated according to the ability to pay, much as it is in the US. One can flit from one to the other, so there is plenty of free choice. As to the work of NICE (which actually makes relatively few "resource allocation" -your "rationing" -choices), it, like much of the rest of the NHS, is actually run by clinicians and not by government bureaucrats. I have been served by the NHS and similar systems for years and I have never had a bureacrat interfering in my health care nor that of my family. Its strange where people like Rep. Tom Price get this idea. It seems to me to be another of those often repeated mantras - if people in the U.S. are told over and over again that the NHS is dirty, provides only a minimal service, and probably kills more people than it helps, then a good percentage of them will come to believe it, even though the opposite is actually true. The fact that the NHS provides free care at less than half what Americans pay each year for health care and that most people in the UK love the NHS and would not change it for anything is hardly ever reported. Wikipedia has been able to change this incorrect perception to some extent (see for example Health care in the United Kingdom and Socialized medicine).

We need to look at the retoric and the reality of the claims that the bills before congress represent a government takeover of health care. Clearly there is some reality here, but it would be useful for the public to see the retoric and look at the issues and then let them decide for themselves whether the retoric has any substance. This may not be the article to do this. It may need an article of its own because I suspect that it could get quite sizeable.--Hauskalainen (talk) 20:28, 25 January 2010 (UTC)

Thanks for the description of the UK system, which is among the best systems I've seen. (Within North America, both Canada and Mexico have better systems than the USA.) In reply to Farcaster's comment about mandates, and the confusion surrounding them generally, you might watch Keith Olbermann's comment.  Farcaster, the argument you made above is essentially the adverse selection argument advanced by Paul Krugman and Hillary Clinton, and first rejected but then embraced by Barack Obama. Krugman's _other_ work, unrelated to healthcare, won him a Nobel Prize, but he has sacrificed his integrity on this issue - not just a difference of opinion, but rather he started twisting his facts too. In reality, insurance companies have always worked in the margin between adverse selection and risk aversion: most people will pay more than their actual risk to avoid the remote risk of being bankrupted. That is how auto insurance, fire insurance, life insurance, and travel insurance have always been sold. At the _state_ (not federal) level, automobile _liability_ insurance is required, to cover liability for injuries a driver might cause _to other people_. Personal injury law has always been a state matter, and driving is a privilege (not a right) subject to state regulation. Premiums vary based on risk (and, sadly, political power, with the young being forced to subsidize the old, due to the fact that the young are less likely to vote). Certainly premiums for bad drivers are not subsidized with the goal of keeping them on the road. In contrast, the federal bills would take over at a federal level the payment for and content of health insurance policies nationally, doubling [revised: increasing by 50%] at a single stroke the percentage of GDP controlled in Washington, while still subsidizing corn syrup and taxing vaccines. The supposed 'beneficiaries' are more like cattle in a feed lot: pumped full of unhealthy chemicals and then 'treated' for someone else's profit; hospital infection rates show an industry so cynical that yes, they do continue to spread infections by not washing their hands and yes, it does double their revenues by keeping people in the hospital longer. While auto insurance companies do generally pay claims, health insurers are notorious for abandoning their customers precisely when those customers are too weak or sick to fight for their rights. Certainly when the US spends twice as much as the UK, for worse results, the answer cannot be to force people to spend even more. Salesmen for the current bills try to focus attention on needy patients, but the patients are frequently the biggest victims; the provider lobbies are the real beneficiaries. BTW, the bit about premiums would be laughable if it weren't so sad: the insurance lobby always says premiums will go down if everyone is forced to buy insurance, but that never happens; insurers made the same promise when lobbying for mandatory auto insurance, but of course premiums went up instead of down; insurers repeated that promise when lobbying for mandatory health insurance in Massachusetts, but premiums there are now the highest in the country (even higher than neighboring New York, which has guaranteed issue and community rating, thus proving that mandates themselves drive higher premiums).TVC 15 (talk) 21:43, 25 January 2010 (UTC)

Re TVC 15'a comments. You make lots of points but the only one that I see that seriously comes abywhere near the claim that this is a "government take over of health care" is the bit where you say that the percentage of GDP controlled by the government will double. Where does that doubling estimate come from? It sounds interesting, but I suspect that some of it is either spurious (the taxpayer picking up the tab for the uninsured poor which ought to relieve the pressure on insurance premiums who currently pay this as a hidden tax via hospitals picking up and passing on the unfunded costs in the EMTALA legislation), or misleading (people choosing the government insurer - again, not a takeover), or it was that even more bizzare claim that if the government collects premiums through the exchange and passes this on the insurers, the money in and out will be treated as if it was income and expenditure of the government (instead of it just acting as an agency). Sure, some taxpayer funds will be used to subsidize insurance purchase, but it will be up to the recipient to determine to which insurer that money goes. It is hardly a government takeover. The argument also has an implicit assumption that government being responsible for a big slice of GDP is inherently bad. In the UK and Canada, and in fact in most of the rest of the advanced world, health care money flows through the hands of government or into the hands of parties not controlled by goverment but designated by them, but people generally think that this is a good idea in those countries. There is no inherent reason why this should automatically be bad unless you ignore all logic and merely say "non-government is good and government is bad". I know that I am straying into debating with you, but that is not what I want to do. I really do want to stay focussed on the issue of why Republicans say this is a "government takeover" and whether there really is a government take over of any kind, what it is, and to what extent it exists.--Hauskalainen (talk) 22:34, 25 January 2010 (UTC)

I don't mind your "straying into debating" with me, but I do object to your falsely imputing specific assumptions to me. The doubling estimate reflects the fact that medical spending and federal government spending are approximately equal, hence giving the federal government control of medical spending would double the total spending they control. [Revised: the 50% increase reflects the relative shares of GDP, federal spending vs. the sum of federal spending + non-federal medical spending.] Whether you think that is good or bad is a matter of opinion, not really an assumption either way, but you should by now be able to observe some specific issues (e.g. the enormous increase in diagnostic radiation, profitable for providers but dangerous for patients; the number of hospital infections, profitable to providers but lethal to patients). A more general observation is, European voters tend to be more cynical (or sophisticated, depending on your POV) than American voters, but (perhaps because of that) American "healthcare" is certainly much more cynical than European healthcare. At least in this country, you cannot impute any purity of motive to healthcare providers, or assume that money given to them will in any way benefit patients. The insurance mandate without a public option would empower the federal government (1) to order the citizenry to pay an unlimited amount of money to a private industry that can lobby (and now advertise without limit!) in favor of the policy, without even requiring any of that money get spent on actual medical care; (2) dictate exactly which corporations will be eligible to participate in that bonanza (hint: the list will look a lot like AHIP membership, campaign donors, and big advertisers); (3) decide what will be subsidized (mammograms that do more harm than good) and what will be taxed (vaccines, which reduce costs and thus reduce the provider lobbies' revenues). The "recipient" (conduit would be a better word) of subsidies will certainly not have a free choice over what to do with the money; it will all be required to go to one of the pre-selected provider lobbies. I think you're sincere but remote: for example, you continue to think the insurers are "subsidizing" the uninsured through EMTALA and other means, despite the demonstrable fact that the insurers avoid paying wherever they can, and in reality the self-paying uninsured and the taxpayers are the only ones subsidizing anyone else. Also, note that EMTALA would continue to subsidize some people (hardship and religious objectors who opt out of insurance, illegal aliens, etc.) even with an insurance mandate, which is part of why CBO says a mandate wouldn't have much effect on cost-shifting.TVC 15 (talk) 23:52, 25 January 2010 (UTC)

I was not "falsely imputing" but I was forced into speculating because you gave no source for your claim leaving me to wonder what it relates to. I am still puzzled. Your saying that "The doubling estimate reflects the fact that medical spending and federal government spending are approximately equal, hence giving the federal government control of medical spending would double the total spending they control" seems like gobbledegook. It does not give any references or any means to judge whether any of the things you say are true or how the bills will double the spending by government. Please provide us with references. Are you saying that Federal spending on health care is matched by State and local spending on health care? If so, where does that figure come from? Why would the bills result in a "doubling at a single stroke the percentage of GDP controlled in Washington" (with citations please); and what is the basis for the statement "giving the federal government control of medical spending " come from? Why would the bills "give the federal government control of medical spending"? Subsidies could go to private insurers - there is no pushing of anyone into the public option. Even if the federal government was chosen by the public as their insurer and it worked along the lines of Medicare, people would still go to the provider of their choice which in all likelihood would be a private provider. I still do not understand the basis for these claims. Please be more explicit and give us some numbers and details of where you got them.--Hauskalainen (talk) 00:23, 26 January 2010 (UTC)

I have provided citations for you previously (starting with the Declaration of Independence and the Constitution) but you stopped appreciating them and besides I am not your research assistant. If you look at the difference between your wording and mine, you will see the root of your misunderstanding. You seem distracted by the superficial difference between direct spending and mandating other people's spending; "the provider of their choice" will be chosen from a lobby-driven list of the most overpriced providers, i.e. AHIP and associated lobbies, for example babies being delivered in hospitals (with risk of infection) by AMA rather than at home by midwives (cheaper and usually safer). However, you do have a point about doubling: I checked the numbers again and, partly as a result of the current bailouts, federal speinding is already a much larger share of GDP than it was just a decade ago. So, the increase would be around 50%, which is still huge. The U.S. has a federal system, based on a philosophical skepticism about centralized power; the current lobby-driven debate has proved the skepticism well founded. The lobbies necessarily favor the most overpriced "services," because those have the biggest mark-up from which lobbying money can be drawn: vaccines are cheap and reduce provider revenue, so they don't have much lobbying power and they get taxed; meanwhile, "services" that rational consumers would not buy (because they do more harm than good) are sold by lobbyists to taxpayers as a captive market. Although I don't mind debating, as I've said before I have no particular interest in it, and you would learn more from doing your own reading rather than demand strangers do your homework for you.TVC 15 (talk) 00:44, 26 January 2010 (UTC)

OK. No references to support even your toned down assertion. So you don't want to be constructive. I await other editors who will be.--Hauskalainen (talk) 02:25, 26 January 2010 (UTC)

Note to other editors. Even using the one reference TVC 15 did give, it is clear that to raise the govt share of GDP from its present 43.47% of GDP to 65.205% (the 50% TVC claims will happen) around 21.735% of present GDP ($14,728bn from TVC 15's chosen source http://www.usgovernmentspending.com/us_20th_century_chart.html)would need to be shifted to the government. This is about $3,200 Bn a year. According to the congressional budget office, the increase in taxation needed to fund the Senate Bill over 10 years is $403 billion (and for the House Bill the similar figure is 461 Bn over 10 years).http://www.kff.org/healthreform/upload/housesenatebill_final.pdf In other words, the average annual cost over 10 years is in the order of $40bn and not the £3,200bn needed for TVC 15 to be correct. TVC 15's "fifty percent" increase is wrong by a factor of about 80 or eight thousand per cent!!!!!!! Or in other words the government share of GDP will rise by 40bn per year on average over ten years which at today's GDP of $14,728bn represents a rise in the government share of GDP by 0.27% from 43.47% to 43.71%, a far cry from the 50% increase which TVC 15 claims will happen. Personally I doubt that anyone would notice it, yet it would be a great advance in coverage and security for the American people because no longer could people go bankrupt getting ill and the sick will be able to get affordable coverage. It certainly is not "the government taking over one sixth of the American economy" (another common matra of Republicans). --Hauskalainen (talk) 03:16, 26 January 2010 (UTC)

Alas, Hauskalainen, you've reverted from analysis to your usual bombast. The Congressional Budget Office numbers refer to the Congressional budget, not the unfunded federal mandates the legislation would impose on individuals, employers, and states. You also lose sight of the forest for the trees, focusing on the current TARP year share of GDP rather than the underlying structural share of GDP. If your goal is to obfuscate and mislead, or preen before a supposed virtual audience of "other editors," then go ahead and grandstand with exclamation points(!!!!!!). If your goal is to learn something, then go back and read the numbers more carefully. My error was to hope, naively, that you were actually interested in constructive dialog. At least, to your credit, you do sometimes research facts and contribute something.TVC 15 (talk) 07:01, 26 January 2010 (UTC)

Note Editors. Note how TVC 15 says that the states are unfunded but actually reading the kff.org analysis shows that the budget does include MOST (but, yes, not quite all) of the costs imposed on the states through medicaid expansion (the House bill for example covers them 100% until 2014 and by 91% of them thereafter). Most people have effective health insurance of one form or another and so the bills mandates that all people should have health insurance is not a major change for them. Those people who will be effected by the mandates are therefore those who do not have health insurance currently. That will be the middle class working poor who are not eligible for medicaid and who currently flood the emergency rooms, students and other young people who are not on their parents policies currently and who are playing russian roulette with their health, those working for miserly employers that do not contribute anything directly to their employees health needs, the sick who have already been cut off by their insurance company and who now cannot get insurance, and of course the very rich who are so wealthy they don't have to worry about insurance. Apart from the latter group who undoubtedly will pay more in taxes, most of the others make considerable gains under the bill. And again TVC 15 has provided no figures. We clearly need to get these claims of politicians (Republicans as well as Democrats) out into the open and examine them to let the reader determine whether the politicians claims stand up to critical analysis.

Hauskalainen, you want numbers? Here are some numbers: the number of Americans with access to care who are killed by medical errors is estimated from 44,000 to hundreds of thousands each year., making medical error "far more deadly than inadequate medical insurance." You talk about the uninsured "playing Russian roulette with their health" but given the standard of care and infection rates at U.S. hospitals in fact anyone who even visits this country is to some extent playing Russian roulette with their health, the only difference being whether they are also forced to pay in advance. Your reference to "miserly employers" is particularly misguided: picture tbree employers, Company A spends $13,000 per employee annually on health insurance, while Company B spends the same amount providing continuing educational opportunities for employees and their families, and Company C gives employees the same amount in extra cash and lets them decide what to do with it; the employees of company B will live longest, while the employees of company C will be richest; the worst off are the employees of company A, whose earnings were diverted by their employer to the AMA. You assume (contrary to basic economics) that employer-sponsored healthcare is paid for by generous employers; in fact it is paid for by employees, whose wages are partly diverted by paternalistic employers to inefficient uses. Likewise you refuse to observe what happened in Massachusetts, where mandating insurance led to _more_ emergency room visits not fewer. You insist that almost everyone will be either unaffected or make gains, but that is incorrect. Spending needs to come _down_, but the current bills would cause spending to _increase_, making almost everyone worse off except the provider lobbies sponsoring the bills. Fulminating about the precise (and at this point unknowable) precentage by which the proposed federal mandates would increase the federally-controlled share of GDP, whether 51% or 32% or 68% or whatever, is losing sight of the forest for the trees: the point is, the mandates lock in huge spending on one industry, with recipients determined by a lobby-driven Congress. Maybe you should consider the opinions of the people whose benefit you purport to be fighting for: 57% don't want these bills, and before you call everyone ignorant, consider that college graduates opposed the bills sooner and by a wider margin than the general population.TVC 15 (talk) 20:51, 26 January 2010 (UTC)

I have no idea what infection rates have to do with whether or not there is a government takeover of health care. Republicans claim this. Factcheck.org said there is no government take over of health care because Congress did not go down the socialized medicine route (which allegedly would be a government take over, though if the British system is any example, it would be a medical professional takeover of the health care system). Not even is taking away the role of the insurance companies (which would have happened had their been a single payer insurer). So where is the government take over? Its not directing the hospitals to do, and neither is stopping the selling of minimum insurance plans (though buying this would mean a person would still have to pay a fine if he or she did not have adequate coverage from elsewhere. I only mentioned miserly employers who don't provide health care because I have a relative in the U.S. who used to work for just such an employer. Not providing group insurance makes it very expensive for the employee to get insurance on their own. Like others, my relative took the risk and did not have insurance, but thankfully she got another job just in time to get health care coverage about a year before ill-health struck. --Hauskalainen (talk) 22:27, 26 January 2010 (UTC)

Saying you "have no idea" does not really enhance your persuasiveness. As for whether there is a takeover, the word has more than one reasonable meaning; you can agree with one source's definition or another, but if your argument comes down to semantics you should tone down the moral pretense. When Daimler took over Chrysler, it did not mean that Mr. Daimler returned from the grave personally to design, build, and repair every Chrysler automobile; rather, it meant Daimler corporation took over the authority to decide what designs would be approved and built, and what repair warranties would be provided, and the related financial decisions. You do have a point though about the individual insurance market; then-Senator Obama campaigned on offering people the option to purchase insurance (private or public) on exchanges, and that was a very popular idea because everyone is familiar with stories like your example. However, the Congress passed lobby-driven bills that increase cost without really increasing benefits (actually mandating coverage for procedures that do more harm than good, while continuing to tax vaccines). Obama then "changed his mind" to support the lobby-driven bills, using false arguments that have been disproved and rejected, which is why his approval on this issue has dropped so dramatically.TVC 15 (talk) 22:59, 26 January 2010 (UTC)

Where is your WP:RS for this argument? What specifically is it in the health care coverage rules that conservatives regard as a "government takeover of health care"? Should we include Sen Enzi's objection to a rule change for insurance to stop insurers preventing a woman with a pre-exisiting violent husband from getting medically reimbursed if her husband beats her up and she has to get treated for her wounds? (that was on the grounds that this would prevent other people from getting insurance if I remember rightly).--Hauskalainen (talk) 02:08, 27 January 2010 (UTC)

If you are interested in reading further, you might start with these:, , , ,. Factcheck.org's claim that it isn't a takeover is based on a narrower definition of "takeover" than is used by other (maybe most) participants in the debate. My comparison to Daimler Chrysler was an attempt to help you understand something that you said you had no idea about, but perhaps you meant you did not want to have any idea about it, in which case the effort to explain was wasted. Sources for the remaining points (e.g. Obama's reversal) can be found in the debate article, unless somebody deletes them. The "takeover" accusation belongs in that article rather than this one, so for further discussion I suggest going there instead:Health care reform debate in the United States.TVC 15 (talk) 05:50, 27 January 2010 (UTC)

At last you gave me something to get my teeth into.

Here, using your examples are the arguments in support of there being a "government takeover of health care"

1. Insurers will evolve into subsidized public utilities seeking to game the political process

"The concern from the right isn't that the Obama approach will literally nationalize for-profit health insurers. Rather, it is that for-profit health insurers will continue evolving into heavily subsidized firms that function as public utilities, and that seek advantage by gaming the political process. Profits, including profits governed by medical loss ratios, can and will then be cycled into political action, which leads to the anxiety concerning a "corporate takeover of the public sector." (Reihan Salam in the Natiomnal Review (Reihan Salam in Natiomnal Review)

2. Many of the current plans that are legal will become illegal reducing peoples choice

This breaks Obama's promise that if you like your health care plan then you can keep it. Forcing people to buy plans which have better coverage (which perhaps they don't want) is a form of taxation and a denial of theie freedom to choose to what is right for them."Michael Cannon of Cato

3. The passing of the bills before congress will soon see public expenditure exceed private expenditure

"measures include adding more middle-class kids to the children’s health care program (known as SCHIP), along with expanding Medicaid eligibility..(has already shifted expenditures so that)..as of 2007 the federal government controlled 46% of every health care dollar spent compared to 44% in 1993. The House Bill (will mean that)..the government takeover of health care would be greatly accelerated. ..the government could control more than 50% of all health care spending – even before most of the major spending provisions in the House bill are implemented."[ http://blog.heritage.org/2009/11/04/the-government-takeover-of-health-care-in-pictures/ Conn Carroll, Heritage Foundation]

But it is noticeable that you have come up with points that are being made by pressure groups who try to influence politicians, but none of the quotes come from politicians themselves.

Point 1 is not an argument that I have not heard any politician make. As it is politicians who are presenting their political message to the world and who have the final say over the direction of policy and who have been the most voiferous that there is a "government takeover of health care" I think you really must provide a mainstream politician making that argument for it to be considered seriously.

Point 2 almost falls into the same category. Tom Price in the example I gave in this section did, to his credit, allude to the government determining what was and what was adequate insurance (to avoid paying a fine) but he did not put in so stark a term as Cannon did, making clear that current insurance policies do meet the standard that Congress thinks is adequate in the bills that they have passed. We should detail I think what it is that Congress has done to determine what is inadequate in current insurance so that WP readers can see this more clearly. What do you think?

Point 3 also falls into the same category as Point 1.

So please, come back with examples of mainstream politicians making these arguments. Its all well and good proving references from people that most people in the mainstream of society do not listen to, but it is the politicians who are chanting "government takeover of heathcare" and it is the politicians who must explain to the people what they mean by this. Otherwise they are chanting empty rhetoric.

Right at the beginning of this thread I did give some examples from one politician who was at least prepared to state what he meant by a "government takeover of heath care". Unless you can provide additional arguments from decision makers in Congress I will just have to insert this one set of arguments on its own as what the politicians mean by the phrase.

—Preceding unsigned comment added by Hauskalainen (talk • contribs) 09:50, 28 January 2010 (UTC)

Setting up automated archiving for this article
In accordance with the recommended procedure for establish archiving at User:MiszaBot/Archive_HowTo, I'd like to establish a procedure for archiving this page. I'll kick off by suggesting that we archiving for all threads where there has been no activity in the last 90 days but retaining always the last 5 threads (the deault value). --Hauskalainen (talk) 07:04, 20 February 2010 (UTC)

Reorganization
I just made a fairly extensive rearrangement of the article, as so:
 * Costs
 * Effectiveness (or at least, comparison to other countries)
 * History
 * Public policy debate (now split up into several subheadings which likely need fine-tuning)
 * Federal proposals during the Obama administration

In these edits I did not delete any sources (except, which I'd previously tagged as not very clearly informative to the point made), and removed only a little bit of redundant or uninformative wording. I hope this helps. Mike Serfas (talk) 08:18, 28 February 2010 (UTC)

Deletion of Text confusing government intervention, survival rates for cancer and other issues
The article carried the following text...

Opponents of government intervention, such as the Cato Institute and the Manhattan Institute, argue that the U.S. system performs better in some areas such as the responsiveness of treatment, the amount of technology available, and higher cure rates for some serious illnesses such as colon, lung, and prostate cancer in men. Both males and females in the United States have better cancer survivor rates than their counterparts in Europe. The Cato study also found that Americans are less likely than citizens of other countries, such as Cuba, to abort fetuses with disabilities and other medical problems; the group views this a complicating factor towards these calculations.

This block of text can be criticized on all sorts of levels...

1. The text equates lower survival rates for cancers with "government intervention". But this is not what the EUROCARE-4 data shows. In fact it shows the reverse. The survival rates for cancers in Europe are much higher in the more affluent Northern European countries such as Sweden, Finland and Denmark where in fact government is much MORE involved in health care delivery than is the case in the Southern European states. In fact, survial rates in Northern European countries are much closer to the US survival rates (if one uses the data published in the Telegraph).

2. The US data is highly skewed and may not reflect the national picture. The US SEER cancer registries that cover just 26% of the US population, and almost half of them are from the relatively affluent state of California (http://seer.cancer.gov/registries/data.html). A large slice of the rest are either from rural states. The vast majority of US states are not even covered in this collection of registry data! It is therefore highly misleading to make comparisons between the sets of data and draw the conclusion that Cato does.

3. About 15% of the American public are uninsured and a disproporionate number of them are uninsured because they are uninsurable due to illness. Do all the people who are uninsured in the areas covered by the US registries ever get to appear in any of the US registries? In other wprds are the registries representative of the population catchment area or just the insured persons in the catchment area?

4. The argument made by Cato about five year survival rates are not very meaningful when taken out of context. (And by extension it also applies to the argument in para 1 above). In the countries of southern Europe, as with Japan, the incidence of diseases of the heart and circulatory systems are much lower than in Northern Europe. People tend to live longer and therefore get to old age with less of a problem. In such people, cancer becomes the disease more likely to kill you. It might be that the average of getting a cancer diagnosed in Northern Europe (perhaps due to better screening) is 65 compared to say 75 in Southern Europe. But how meaningful is to be still alive at age 70 (and perhaps die aged 72) compared to the Southern European who on gets diagnosed with cancer at aged 75 and dies at age 77? According to the Cato interpretation it is better to be the person in Northern Europe than the person in Southern Europe because the 5 year suvival rates are higher! One simply cannot make that kind of value judgement based on the limited knowlege of the 5 year survival rates.

5. Cato selectively refers to cancers. But cancers are an area where the U.S. does better. But it does far worse on areas such as diseases of the heart and circulation, and areas such as diabetes and obesity which are highly amenable to prevention and cure by the health care system. Would it be equally fair to say therefore that lack of government intervention in the health care system leads to worse rates of heart disease and diabetes? Of course not! But neither is it right to make the argument that Cato and the Manhattan Institute do about cancer.

6. The abortion issue is based on this text from Cato. ".. Michael Moore cites low infant mortality rates in Cuba, yet that country has one of the world’s highest abortion rates, meaning that many babies with health problems that could lead to early deaths are never brought to term." That may well be true. It is though a moral argument about whether it is fair on the child to be forced to lead a life which will lead to an early death. Mothers in Western Europe will often abort a fetus on such grounds, but their abortion rate does not come close to that of Cuba. I am inclined to think that the extensive free pre and post natal care given to children under the age of five in Europe is more likely to be the reason for the lower infant mortality in Europe. But until we have an impartial study on the issue we will never know. Cato's supposition is not more valuable or true than my own.

7.  Just because there are 5 times as many MRI units in the U.S. compared say to France does not mean (as the text implies) that the U.S. system is performing better than France or that American have better access to MRI as a diagosis aid than do the French. It could equally mean that the U.S. system is performing worse because it has over invested in such technology and that over investment is under-utilized or worse still over-utilized when cheaper technologies could be as effective. Most industries apply technology to do things cheaper, but in America there is plenty of evidence that investment in technology has greatly added to costs in the U.S. because of lack of incentives to do things cheaper and the of use the investment in high tech as a selling point to patients to walk into your hospital and not into a another one that does not have this.

8. Cato and the Manhattan Institute are not neutral sources. It is wrong to cite THEM for this kind of statistical nonsense because they have a clear incentive to misrepresent statistics for their own purposes. And clearly they do.

For these reasons I intend to delete this paragraph.--Hauskalainen (talk) 03:27, 1 March 2010 (UTC)

Protection
Given the current situation, I think it's in the article best interests to at least semi-protect it for a while 68.200.252.231 (talk) 21:54, 21 March 2010 (UTC)

YPLL and DALYs
I noticed that Hauskalainen added back a paragraph that I'd deleted while revising the section tagged for cleanup:


 * Another metric used to compare the quality of health care across countries is Years of potential life lost (YPLL). By this measure, the United States comes third to last in the OECD for women (ahead of only Mexico and Hungary) and fifth to last for men (ahead of Poland and Slovakia additionally), according to OECD data. Yet another measure is Disability-adjusted life year (DALY); again the United States fares relatively poorly. According to Jonathan Cohn, health care scholars prefer these more "finely tuned" statistical measures for international comparisons in place of the relatively "crude" infant mortality and life expectancy.

I'd deleted this because
 * From what I could tell, the sentence needing a citation actually traces back to a simulation:
 * So actually once calculated, what would health care spending as a fraction of the GDP look like in the US compared to other countries if we did the simulation and let those other countries pay their health professionals like we do, and it turned out we were third from the bottom in OECD fraction. Only Turkey and Portugal were lower than us.
 * Since otherwise we were dealing with fairly basic hard data, I didn't think this was very important.


 * The DALY statement doesn't actually compare the U.S. to Europe, nor does the source give data in DALYs, so again it seemed like we could do without it. Also, I have a poor opinion of DALYs, because in most (but not all) publications they are modified by an arbitrary social weighting that sets the life years of young adults to be most important.  When such weighting is used, the results have been to find that diseases of adults are surprisingly important...  I think that if we discuss DALYs, we should discuss the range of critical opinion about them also - but that's even more space devoted to a paragraph that tells us nothing about whether U.S. health care is good or bad. Mike Serfas (talk) 05:24, 1 March 2010 (UTC)

Thanks for better explaining your delete. I may have to go back to the article history but I feel pretty confident that these texts did at one time have a solid foundation. This may take a little time. Please bear with me. If I recall correctly the DALY data came from the WHO Health care report 2000. I'm not too sure but the YPLL is from the same or a similar source.--Hauskalainen (talk) 05:56, 1 March 2010 (UTC)

...effect on the rising costs...
The article contains this sentence:

The two bills are also similar in that neither would have much, if any, effect on the rising costs experienced by most Americans who currently have private health insurance.

The references listed to support it were:

http://www.kaiserhealthnews.org/Daily-Reports/2009/November/02/Public-Option.aspx

http://www.latimes.com/news/nationworld/nation/la-na-health-age9-2009nov09,0,2196213.story

http://www.npr.org/templates/story/story.php?storyId=120723411

http://archive.salon.com/opinion/feature/2009/11/19/public_option

I have carefully read these and none seem to support the statement. The first is about utilization of a public option (which is not even in the senate bill). It says nothing about effects on the cost of private plans.

The second indicates that "age-discrimination" in pricing will still be allowed (although now with limits on the ratio). This says nothing about the plans effect on the overall cost of private health insurance.

The third article discusses whether health care will be affordable enough that a mandate to purchase insurance will be reasonable (and not too unpopular). It does not address the issue of the impact of the bills on affordability.

Finally, the last article laments the watering down of the public option. I see no statement (supported or otherwise) about the effect of the bills' on the cost of private insurance.

I have removed these references. Please do not replace them without explaining here how they support the statement. I would be very happy to see some other references which do support the statement added. Wpegden (talk) 20:50, 21 March 2010 (UTC)

Life expectancy
I have changed

"Life expectancy in the United States is 78.11 years, lower than the 78.67 years for the European Union." to "Average Life expectancy in the United States is 78.11 years, lower than in some other countries."

First, we are talking about AVERAGE Life expectancy an not Life expectancy since not everybody dies in the US with 78.67 years. 78.67 compared to 78.11 for all of the EU is basically NO DIFFERENCE. Compared to specific countries like, let's say Japan that has an average life expectancy of 82 years (I think). That would be nearly four years more. But is it really? 3 Problems:

1. When is there a difference? 10 Years? 1 Year? One day? Statistics would tell you, you would have to do a kind of test (say T-Test for example) to see if there is really a significant difference. Then you would have to know the sample size and the standard deviation

2. Average life expectancy is highly influenced by child mortality. You want to increase the average live expectancy in a third world country a lot? Forget health care for adults, just do vaccinate children and provide health care for child birth!

3. Even if a T-Test would say that there is a difference between average life expectancies then this could easily be based on living conditions, food/eating habits (Japan!) or plain genetics.

I think the link between average life expectancy and health care should be handled very very carefully.

Yoyo —Preceding unsigned comment added by 66.108.142.23 (talk) 03:25, 22 March 2010 (UTC)

Duplication with Patient Protection and Affordable Care Act
It is counter to Wikipedia practice to have a mass duplication of the listing of provisions of the bill, forcing editors to keep track of changes in two places and confusing readers.

We have a whole article on this stuff. Clearly, we should have a short (1-paragraph) summary of what the bill does, and refer to the other article for a detailed year-by-year listing. I made a stab at the 1-paragraph summary of the most visible provisions of the bill, other people may have other opinions. Please feel free to improve.

But a detailed listing of the bill provisions simply does not belong here.

— Steven G. Johnson (talk) 18:37, 27 March 2010 (UTC)
 * No it's not a duplication. See below. ... Kenosis (talk) 18:43, 27 March 2010 (UTC)


 * I've removed the one-paragraph summary (which was largely unsourced and read like someone's opinion anyway) and replaced it with most of the material in the section above, sourced to Reuters "fact-checking" service, point by point, with some additional sourcing for points not covered by the Reuters article, as is being laid out in the section above. I've included a see-also to the articles on both bills. Better to start with a bit too much sourced material and gradually reduce it to WP:SUMMARY. Perhaps obviously, the whole article will need parsing down into WP:Summary style, which I expect will take time. But it seems to me this article is a reasonable place to present material from both the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, at least unless and until a place is found for such material. ... Kenosis (talk) 18:43, 27 March 2010 (UTC)


 * We have plenty of sources in the main article, but if you want to add a few sources here, then fine. Mass duplication of the list, however, is clearly counter to WP practice.  If you don't like a summary, then just link to the other article.  — Steven G. Johnson (talk) 18:49, 27 March 2010 (UTC)


 * Regarding the fact that there are two bills, there are two possibilities: (1) Mention the amendments from the reconciliation bill in the main article on the main bill; this is what we have now. (2) Have a single separate article on the provisions of both bills.  Either options seems fine, but having two articles with a mostly redundant list is (a) insane (b) counter to WP practice and (c) makes no sense here anyway as this article is already super-long and is not specifically on the 2010 reforms.  — Steven G. Johnson (talk) 18:51, 27 March 2010 (UTC)
 * These things take time, of course, and a lot of cooperative work among many editors. But for now, a one-paragraph summary (the content of which participants can argue endlessly) of complex major legislation will not suffice, especially given the level of detail in which the article deals with the long run-up to its passage. .... Kenosis (talk) 19:01, 27 March 2010 (UTC)


 * Of course a one-para summary does not suffice. That's why we have a whole article on the subject.  I'm not saying that a 1-para summary is all WP should have, but it's all we should have here.  Regarding the level of detail on the long run-up to its passage, that's probably also not appropriate here given that we have a whole article on Health care reforms proposed during the Obama administration.  — Steven G. Johnson (talk) 19:03, 27 March 2010 (UTC)


 * (If you want to cooperate with other editors, please do so on a single article, not fighting other editors by having two redundant articles containing the same material. Also note that this article is already insanely long; standard WP practice is to break up long articles into short ones on specific subtopics, with the longer article pointing to the specific ones with a short summary.  Please cooperate with WP practice and with other editors.  — Steven G. Johnson (talk) 19:10, 27 March 2010 (UTC))
 * I can readily see this "discussion" is beginning to go nowhere pretty quickly. However, this summary certainly will not do. Nor will this one. It will be necessary, in the end at least, that the presentation in the article be in accordance with WP core content policies. ... Kenosis (talk) 19:18, 27 March 2010 (UTC)


 * So just link to the main article, and hash out here what the summary should say until editors can agree. If you look at pretty much any article summarizing the provisions of the reforms, the main provisions are exchanges and coverage for pre-existing conditions, mandates for individuals to get insurance and for large businesses to provide it, expanded subsidies (including Medicaid expansion), Medicare cost controls, and increased taxes on high incomes, with a net deficit decrease according to CBO projections.  See e.g. here, here, or here

I agree with Kenosis. This is encyclopedia for average peoples. To have a good rating on search engines we need average peoples to like it, and make links to it. The more links we get to the article the better it rating on google etc. Also if you have talk to a grandmom that 63 years old you would understand me. This is better to have it all in one place, because it all very relevant to healthcare in America and this is what peoples want to know. If we make whole article as links to other places, then it is no point having it at all. Innab (talk) 19:28, 27 March 2010 (UTC)


 * (a) The whole of WP works by having relatively short, specific articles that link to other articles for specifics on subtopics and related topics; please learn to cooperate with WP structure. (b) If your grandmother could click on the link to get here, surely she can click on a clearly labeled link to the details of the 2010 reform.  (c) Regarding the point of this article, the article is on Health care reform in the United States, not on 2010 Reforms: the whole point of having a general article like this is to give the big picture, summarize events over the years, and give pointers to specific articles for more detail on specific events.  (d) Regarding search engines, your comment makes no sense; I'm not saying that we shouldn't have a good, detailed article on the 2010 reforms somewhere, just that massive details don't belong here.  — Steven G. Johnson (talk) 19:34, 27 March 2010 (UTC)
 * This is not a duplication of article. The Patient Protection and Affordable Care Act  has much more information then just provisions. This is just a bries summary for someone without PhD, and if they need more info about Patient Protection and Affordable Care Act they can click on the link. This is perfectly normal to have a common paragraph in both artcles because they are very similar and related to same document. We are trying to make article better by adding to it, and you are trying to remove all content from it. Innab (talk) 19:47, 27 March 2010 (UTC)
 * Also other articles health care reform debate in the United States, Uninsured in the United States on same subject have a lot of same information because they all are about the same subject. This is obviously normal. Specialy for MIT: This is not a database normalization, this rather warehouse denormalization for search speedup by average folks. Innab (talk) 19:53, 27 March 2010 (UTC)
 * I'm not claiming the whole article is a duplicate. I'm claiming that the detailed listing of provisions is largely duplicate, which is obviously true, nor is it merely a "brief summary".  And I agree that there is a lot of other redundancy in the health-care articles; when this is identified, editors should try to fix it with a merge process &mdash; such inadvertant duplication as a part of the natural growth of articles is quite different from the situation here, when you are insisting on duplicating information intentionally.  — Steven G. Johnson (talk) 20:07, 27 March 2010 (UTC)
 * It's not a duplication. I thought this much had been made adequately plain already in the above comments. The present listing of provisions and when they take effect, all from Reliable sources, already includes provisions from both major bills even at this very early stage of section development. To substitute instead a brief summary that fails to deal with specifics is completely counter to the direction the article has already taken for quite some time now. ....... The article is 116 kB long without this material, and 126kB long with it, not exactly an inordinate expansion in light of the fact that the just-passed legislation now properly relegates a very large percentage of the other 116kB, with its numerous proposals, counterproposals and charts and such, to what should henceforth become a much more concise "History" section. Perhaps it would be useful at this point to begin reducing and summarizing the history, and allow the provisions from both bills to be fully articulated in order of when they take effect. At some point perhaps a new article will bring together the provisions of both bills and a briefer summary will suffice in this article. But the proposal to just put this combination somewhere else, (e.g., Health care reforms proposed during the Obama administration as suggested above, is IMO very insufficient justification for the removal of reliably sourced material that reflects in proper chronological sequence what current legislation provides. For now, this article is as reasonable a place as any to provide material from both bills, at its present level of specificity, even if it's partially duplicative of what's at the articles on each bill individually. ....... The one brief summary paragraph Steven G. Johnson composed and proposed to use instead may well be a suitable addition to the other material, at least as a starting point from which other editors can weigh in and build upon and/or revise, provide reliable sourcing, etc.. ... Kenosis (talk) 20:50, 27 March 2010 (UTC)
 * This discussion goes nowhere. But I have ask 6 people around me what article they prefer and they definetely prefer to see more information. For sake of search engine rating and value to average people, please leave it in. Innab (talk) 20:26, 27 March 2010 (UTC) P.S. If you think article is too long, shorten up Public opinion, Lobbying,President's plan 2010,Congressional proposals etc. - it is all not that valuable anymore. But future of the reform is major part of this article.


 * I'm not suggesting that the information be deleted from Wikipedia, I'm suggesting that it be consolidated in one place, in accord with existing Wikipedia practice. See WP:SS.  — Steven G. Johnson (talk) 21:09, 27 March 2010 (UTC)

Another point worth raising, it is a violation of the GNU licensing to just copy and paste from one article to another. Much of the text in the sections under discussion are exactly the same as the other article. I also know they originated on the other article because I authored a large portion of them. :) The stuff here needs paraphrased or the original authors credited in the history. In regards to saying its not duplicated, just look at the too. A large part is obviously directly copied from that page. &mdash;Charles Edward (Talk 21:11, 27 March 2010 (UTC)
 * These are vertabim copied from what I authored on the article about the bill, other items are also.
 * Members of Congress and congressional staff will only be offered health care plans through the exchange or plans otherwise established by the bill (instead of the Federal Employees Health Benefits Program that they currently use).[18]
 * Investment income of individuals earning $125,000 annually or couples earning $250,000 annually will be subject to Medicaid Payroll withholding.[9]
 * Medicare Payroll withholding increases from 2.9% to 3.8% on all earned income.[9]
 * A new excise tax goes into effect that is applicable to pharmaceutical companies and is based on the market share of the company; it is expected to create $2.5 billion in annual revenue.[9]
 * Most medical devices become subject to a 2.9% excise tax collected at the time of purchase.[9]
 * Health insurance companies become subject to a new excise tax based on their market share; the rate gradually raises between 2014 and 2018 and thereafter increases at the rate of inflation. The tax is expected to yield up to $14.3 billion in annual revenue.[9]
 * The qualifying medical expenses deduction for Schedule A tax filings increases from 7.5% to 10% of earned income.

&mdash;Charles Edward (Talk 21:15, 27 March 2010 (UTC)

In the larger discussion I agree with steve here, this article should be about the reform and the debate. Not a catalog of the contents of this particular bill. This article is already violating WP:Length for its length. Something needs cut, this seems like a good place to start.&mdash;Charles Edward (Talk 21:18, 27 March 2010 (UTC)

I renamed Provisions section to Future of the Reform. Now everybody will see why is it here. Article name Health care reform in the United States and future of the reform is major and logical piece here. If you think article is too long, shorten up Public opinion, Lobbying, President's plan 2010,Congressional proposals etc. - it is have many outdated statements, not that valuable anymore and full of duplications. But Future of the Reform is necessary here. Innab (talk) 21:20, 27 March 2010 (UTC)
 * That still doesnt address the licensing violation. Check out Copying within Wikipedia &mdash;Charles Edward (Talk 21:20, 27 March 2010 (UTC)


 * Charles, I don't think we need to get into copyright issues here. Information in WP articles is never explicitly attributed to particular editors except by looking at the page history, and things are commonly moved from one article to another (although a note in the edit comment "copied from article X" would be good).  See Merge and delete for more information about good practice here.  At issue is the more basic principle of WP:SS - details should go in subarticles and be summarized in the parent article.  Here, we already have a subarticle on the main bill.


 * The question of the title of the section is irrelevant. The question is the content.  To the extent that the content is a long list of the provisions of the 2010 reform, a long list that already appears in another article specifically on the main bill, the content should be replaced with a short summary and a link to the more detailed subarticle.  See WP:SS.


 * (If the main objection is that there are two bills, we could instead have a subarticle on the 2010 reform package. The main thing is to consolidate the work on provisions to one place.  As a practical matter, however, the reconciliation bill makes only relatively minor amendments that can be noted as needed in the article on the main bill.)  — Steven G. Johnson (talk) 21:23, 27 March 2010 (UTC)


 * I don't fully disagree, but content directly copied from one article to another has to be attributed at minmum with a edit summary notice of the copy, which did not occur here.. I would also point out that a fair number of items in the lists here are wrong, and have been fixed on the article but not here. &mdash;Charles Edward (Talk 21:26, 27 March 2010 (UTC)


 * Charles, we really appreciate your contributions to the bill description. Not sure how to show credit to you on wiki article. But if you think any part violates your copyright, then please remove it. We did not write the original bill, so here is plenty people who can quote it.Innab (talk) 21:30, 27 March 2010 (UTC)


 * Oh I am sorry! Please don't think I am upset about that. Don't really matter to me. Copy whatever of mine you want. It was the other editors I was thinking of. &mdash;Charles Edward (Talk 21:34, 27 March 2010 (UTC)
 * I was one of the authors on that article also, so no problems with me :-) Lets wait until someone else complains about wiki copyright. Innab (talk) 21:42, 27 March 2010 (UTC)

Avoiding unnecessary splits See WP:SS. Quote: "Editors are cautioned to not immediately split articles if the new article would meet neither the general notability criterion nor the specific notability criteria for their topic. Instead, editors are encouraged to work on further developing the main article first, locating sources of real-world coverage that apply both to the main topic and the subtopic. Through this process, it may become evident that subtopics or groups of subtopics can demonstrate their own notability and help justifying splitting off into their own article. If information can be trimmed, merged, or removed, these steps should be undertaken first before the new article is created."Innab (talk) 21:38, 27 March 2010 (UTC)
 * I propose we shorten up Public opinion, Lobbying, President's plan 2010,Congressional proposals etc. - it is have many outdated statements, not that valuable anymore and full of duplications with sub-articles. Let me know if you have problems with that. But Future of the Reform is necessary here. Innab (talk) 21:46, 27 March 2010 (UTC)


 * In this case, the article has already been split, so the section in WP:SS about avoiding unnecessary splits is irrelevant. Given that we have already had a specific subarticle on the 2010 legislation for some time time, WP:SS (and common sense) indicate that we shouldn't be maintaining a redundant detailed list of provisions here, copied from another article, but instead should have a short summary.  — Steven G. Johnson (talk) 21:58, 27 March 2010 (UTC)
 * My experience is that it'll get messed around and very non-redundant quickly enough. In the meantime, it's neither redundant of the article on either bill nor with any other article. For the moment it's only closely paralleling what is at the Patient Protection and Affordable Care Act section on the provisions of the bill. It's sourced, its progeny is on the talk page history and article history as to from where the original form was derived, and it's already begun to get copyedited. ... Kenosis (talk) 22:22, 27 March 2010 (UTC)
 * For the volume of original "Patient Protection and Affordable Care Act" this is very brief summary :-) Innab (talk) 22:14, 27 March 2010 (UTC)

I have to agree with Steven G. Johnson's view on duplication. It does not make sense to include anything more about the new law than a very brief summary - maybe one or two paragraphs at most. The entire "Future of the reform: Provisions of the legislation signed in March 2010" of this article is too much duplication of the "Patient Protection and Affordable Care Act" article. The article would better conform to Wikipedia standards if it had a more tightly defined scope. For example, it should provide background on the arguments for and against reform at all, perhaps political context, and so forth. --MeatheadMathlete (talk) 01:00, 28 March 2010 (UTC)
 * What's more, this article should include more than just reform efforts since January 2009. Health care reform has been going on for years.  In fact, in addition to this newest law (and the "reconciliation bill" that amended it), this article should provide some *brief* information about HIPPA, COBRA, and Medicare Part D - those were all significant health care reforms.  It would probably even be appropriate to provide a *brief* section about the failed "Hillarycare" effort.  Notice that I said all these area some be covered with *brief* sections - that's because each section should have a link to the longer article focused on each change (or attempted change). --MeatheadMathlete (talk) 01:00, 28 March 2010 (UTC)


 * Way too much detail on the specific provisions of PPACA. I came to this article to get overview of HCR in the US with regards to PPACA and get a list of trivial provisions like "The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates". This strikes me was WP:UNDUE and are better left for the PPACA article. Rillian (talk) 13:04, 28 March 2010 (UTC)

Ok, I did multiple clean ups on whole article trying to keep it length close to WP:Length standards. I hope this helps, but feel free to put back anything you think is necessary. Things that I removed was extra summary of sub-articles, old projections, really old citations (except, of cause, of the ones in the History of reform efforts). I also think that many of the things in the Public policy debate section belongs now to history section. If anybody objects, let me know. Innab (talk) 19:00, 28 March 2010 (UTC)
 * Just wanted to share great news: wiki healthcare reform article got into 2nd position on google for "healthcare reform" and on 6th for both "health reform" and "health care reform". Also this article "Health care reform in the United States" on 8th position today on google search for "healthcare reform" up from about 30th position several days ago. According to Google AdWords the "health reform" search got 673,000 searches in February, "health care reform" got 550,000 and "healthcare reform" got 165,000. Thanks you all for your contributions! Innab (talk) 17:23, 29 March 2010 (UTC)