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What makes the US healthcare system so expensive? Why is the US so expensive compared to Canada?There are a long list of reasons but here's a start.1. Americans won't permit or accept healthcare rationing. America spends much more for care in the last 6 months of life than any other country. By a lot.Walk through any ICU and you'll routinely see some people in vegetative conditions with virtually no chance of getting better. Yet they are receiving a full court press with anything and everything that can be done from the standpoint of medical technology.Some of the push for this care comes from families who are adamant against witholding or withdrawing care. But doctors are also guilty of over treatment. We all know some crazy doctors who believe that miracles can happen daily in the ICU regardless of how hopeless the situation may be.The expense is enormous and American families are divorced from it. If the patient is uninsured, the costs are absorbed by the treating hospital and the doctors. If the patient is insured, the deductible has been met and the rest is paid for by insurance or via the taxpayers (Medicaid/Medicare). 28% of Medicare costs involve the last 6 months of life. That is a ton of money.You won't see this in any other country with a national health service. Elderly patients don't get started on dialysis in the NHS in England. They die of kidney failure. You won't see 75 or 80 year olds getting quadruple bypass surgery either. Cancer patients in Canada and England routinely don't get $10,000 a month drugs for cancer treatment that prolongs life by several months (on average). The drugs either aren't available at all like in Canada where some cancer drugs never get approved, or they are made virtually unavailable through a lottery in England.Americans are often overtreated. NHS patients are often under-treated.End-Of-Life Care: A Challenge In Terms Of Costs And QualityCancer drug lottery still rife I'm proof that a new wonder drug beats skin cancer. So how can the NHS let thousands like me die?Wait Time For Cancer Drugs In Canada Exceeds U.S., Europe2. Americans pay much more for pharmaceuticals than anyone else in the world. The American government under pressure from the Big Pharma lobby refuses to negotiate discount rates for Medicare. So Americans pay 30% to 300% more than Canadians for the identical drug made in New Jersey or California.U.S. Consumers Foot the Bill for Cheap Drugs in Europe and Canada3. There is gigantic waste and fraud in Medicaid and Medicare programs. Billing is electronic and payment is automatic. Auditing is very expensive and apparently very rarely occurs. It's so lucrative and easy to skim hundreds of millions of dollars per scheme that organized crime is now involved. There are reasonable estimates that the fraud is $120-180 billion a year. This are astronomic numbers.Comments are frequently made about how efficient Medicare/Medicaid are because they have such low administrative costs compared to insurance companies. (It's pretty difficult to scam insurance companies for large amounts of money.) But the administration of Medicare/Medicaid includes the Department of HHS and also various law enforcement arms of the federal government. That's not cheap. And it's apparently not very effective either.And while every state struggles with Medicaid fraud, the Office of the Inspector General says the five topping the list are California, Texas, New York, Ohio and Kentucky. The good news is that states recovered $1.7 billion in fraudulent payments in 2011. The bad news is the government had to spend $208 million to do it.Medicare And Medicaid Fraud Is Costing Taxpayers Billions4. Americans demand immediate access to technology. We want the ability to get an MRI or PET scan tomorrow or that latest diagnostic test and treatment reported on CNN. That kind of access is incredibly expensive both in overhead to build the facilities and purchase the machines let alone the costs of the procedures. In no other country does this happen. Many small American cities have more MRI scans and PET scans than exist in entire provinces of Canada. In Canada and England there is a waiting list for these kinds of tests and they are often not approved because the yearly budget runs out of funds.We Americans want these tests sometimes even when they are considered not necessary for good health. We ask our doctors to rule out the 1 in 10,000 event. It's human nature to want the latest and greatest of everything. But its never free and this kind of medical care costs a tremendous amount of money.More than half of lower-back MRIs ordered at two Canadian hospitals were inappropriate or of questionable value for patients—and family doctors were more apt than other specialists to order these unnecessary tests, according to newly published medical research from Alberta and Ontario teams.The findings are important because in some parts of the country, MRI tests for the lower back account for about one-third of all MRI requests. Across the country, wait times for MRIs are long and patient access is limited.Requests for lower-back MRIs often unnecessary: studyOur friends in Canada and England accept rationing of healthcare sevices. Americans give no indication that they are willing to. Look at the uproar over the IPAB (called by some death panels) in the ACA law.5. The wasteful practice of defensive medicine. In American there are enormous numbers of unnecessary tests and scans that are performed by a doctor to cover his/her ass just in case of a lawsuit. It's impossible to practice in America without facing the threat of litigation. I and every doctor answering honestly will admit to ordering defensive tests.I've seen estimates of $600+ billion a year in unneeded tests and procedures done primarily to avoid litigation. That's a lot of money that could otherwise go to insuring the uninsured. Opponents to tort reform quote very small numbers because they only use the cost of defending lawsuits in their equation. But that's a drop in the bucket compared to what doctors in America waste so that no one will accuse them of "missing something".Defensive Medicine: A Cure Worse Than The Disease
What is the most heartbreaking thing you have seen in the United States?Veterans that are on deaths door vehemently fighting and arguing that they need to go to the VA that is forty-five minutes away.I'm a firefighter/paramedic. I work in the north end of a pretty urban/suburban county in Florida. Being Florida we have a very elderly population and we run a lot of medical calls. The VA is in the south end of the county a good fortyish minutes away. These men and woman have laid their life on the line and/or at the very least entered into a binding agreement with the US government with regards to healthcare. Apparently the government likes to cut costs by refusing to pay for non-essential treatment that is performed outside the VA. I've had patients that were having heart attacks, strokes, breathing crises insist they be transported to the VA. These patients in severe medical distress wanted to bypass a hospital that was five to ten minutes away and drive by six others while on their way to the VA. With what could have been their last breaths they were insisting we drive them forty minutes to the VA. Why? Because being on a limited and fixed income they were terrified that the VA would deem their emergency non-critical and refuse to pay. Many of them knew from experience that if the VA deemed their case a non-emergency they'd refuse to pay. The extremely high bill could then potentially become their responsibility. They preferred to risk death than risk the government reneging on their agreement and possibly making them destitute.EDIT; It was suggested by somebody that perhaps they should have lived closer to the VA. The state of Florida has about a half dozen VA hospitals that can provide emergency care by my count. Florida is pretty much god’s waiting room. I'm pretty sure they can't all live within a ten minute drive of a VA hospital that provides emergency care. The county in which I work is one of the most densely populated and elderly in the state. It also happens to be a peninsula, and guess what they built at the bottom of it? Guess what is also a very expensive area of the county to live in? I'm sure a veteran on a fixed income and scraping by to make ends meet could find some place reasonable to live nearby. God forbid they stray too far from home in order to visit family or drive to Disney. Looks like a pretty expensive neighborhood to me.
How long would you want to have your life support system on for?My mother, at the terribly young age of 42, was on life support for the last ten days of her life. It was unbearable, for both of us. All she could do was lie there, swollen and immobile, huge beautiful dark eyes looking up at me, hitting the bed weakly with her pale hand, as she pulled her eyebrows together, (I'm sure this was her way of swearing, as she was so fond of doing) and unable to use her voice to communicate, all the while too drugged up to write a coherent sentence. For three solid years after she died, I dreamed of her every night. Every night without fail. And in every single one of those dreams, she had no voice. Twenty-seven years have gone by, and my dreams of her are far and few between, now. But to this very day, she still makes her appearances in absolute silence, and I am still bothered by the fact that she was robbed of her final words. Being conscious and on life support is the absolute worst torture I can imagine happening to me in my lifetime. If I were unconscious, and it was something temporary, and for a short time - like waiting for a transplant, say...then ok. But to be conscious on it only to extend my life for a few more tortuous days? Or to survive that way as a vegetable permanently?? I don't even know why society permits such abomination.
Which country's healthcare system can be emulated in India?Thanks for asking me, ‘Which country's healthcare system can be emulated in India? ‘.I was in the Govt service (Defence) for more than three decades before I entered the private health care. With experience in both the sectors, I think I am qualified to answer this question.Before I discuss which system is better for India, its better to start with a brief history of health care in India to give orientation and ground for appreciating the ground reality.The first medical institution in India was founded in 1664 by the British East India Company, and it stands today as the proud Govt General Hospital (GGH), Chennai. Surprisingly, this hospital is younger to Taj Mahal by about 30 years only.Govt General Hospital (GGH), Chennai. ( Source: Google)The first medical college in India was started in Calcutta (1835) followed by the Madras Medical College (1835).BTW, I want the readers to know that the 2nd oldest Eye hospital to establish in the world after London, is Eye Hospital, Chennai, and not in Germany or France or America!!!These two medical colleges-Calcutta and Madras- formed the mother colleges to provide instruction in modern medicine, and their alumni went on manning the future medical colleges established gradually in various cities across India over a period of time.In the hospitals attached to the medical colleges, treatment was always free and till the early sixties, higher specialty treatment was available only in the medical college hospitals. Mighty MGR was treated in Govt.General Hospital (GGH), Madras, when he was near fatally shot at. Medical treatment in private was confined to only OP cases.This brief introduction is meant to let the readers appreciate that even the rapacious colonial masters considered health care is the responsibility of the state. The policy of free treatment has been in continuation till now albeit in such a diluted fashion that now the health care in govt hospitals is considered a mere tokenism.It will be of interest for the readers to know that in British India, there were two classes of doctors- The Indian Medical Service( IMS) on par with the ICS in status with even higher remuneration, and the lower qualified licentiates. Dr. Ronald Ross of malarial Parasite cycle fame, the second to win the Nobel Prize (NL) in the category of Medicine and physiology (1902), belonged to the Indian Medical Service (IMS). ( We for some unfathomable reasons do not count him among the NLs from India though the Nobel committee records him from India, officially ( born in Almora).The Bhore Committee:Abhorred by the discriminating two types of quality in medical care, in 1945, the Bhore committee strongly recommended to abolish the licentiate system and bring in uniformity in medical education across the country such that the basic medical qualification for practice of modern medicine remains only MBBS. This committee also recommended primary health care centres and secondary care centres at the district headquarters, and various other reforms that paved the way for expansion of healthcare, medical colleges and district hospitals and various specialties immediate post-independence.Till 1975 the products of these institutions were treated on par with the British qualified doctors, and the doctors qualified before 1975 could straight away register with the General Medical Council (GMC) of great Britain without exam (PLAB) and could practice anywhere in the commonwealth. Following introduction of bridge courses to grant MBBS to the graduates of integrated system ( ayurvedic and other licentiates) and ever falling standards, the GMC derecognized Medical Council of India in 1975. Instead of improving the standards we retaliated by derecognising diplomas of Royal Colleges (FRCS & FRCP), the craze for which only increased after that.The Deterioration of Govt Hospitals:The high quality medical manpower thus produced also has a flip side. After the mid-sixties, when the medical institutions started showing signs of deterioration due to failure of administration to improve the infrastructure commensurate with time, and poorer remuneration of doctors ( purchase power of doctors salary reduced nearly 10 times by the sixties compared to 1917), these highly competent doctors found themselves not fitting into the dated hospitals and started to see greener pastures away from govt. service. Slowly but surely many ambitious and talented doctors started quitting the govt. service to enter lucrative private practice. This is the beginning of flourishing of private practice. It gradually started to acquire commercial tones from the early eighties while the government hospitals showed further decline in the scope and quality of medicare both due to lack of leadership at the helm and over crowding with patients who could not afford private care.Importance of InvestigationsWith rapid strides in medicare and introduction of new gadgets and investigations, the domain of clinical medicine has gradually receded back giving way to objective investigation dependent diagnosis and medicare. This is one of the causes for growing trust deficit between doctors and patients. But patients have to understand that early diagnosis is lifesaving often and it is sometimes intense investigation dependent. By the time the diagnosis of cancer stomach can be made clinically, the patient has passed beyond the stage of operability / cure. Only sophisticated investigations offer hope of early diagnosis and pave way for effective treatment.Since the answer is becoming too big, I will rather try to be more concise.The National Health Service (1948) in the UK is considered one of the ideal health care services on the earth. More patients have trust in the NHS doctors and the services than those who decry them.It offers stratified health care where a General Practitioner is the entry level medicare provider and the patient gets referred if the disease/ condition falls outside the GP’s expertise. A specialist cannot be approached by walking in, like in India. Patient has to patiently wait for his/ her turn for treatment/ procedure while emergencies are immediately attended. The waiting for knee replacement can run to months while it can be fixed in less than a week in India.Though the quality of care is high, this waiting time for procedures can be frustrating. ( One Indian family known to me returned back to India when the waiting for a D&C was told six months).The doctors in UK are well paid and fall into the 2nd highest social strata with such income after entrepreneurs and business houses. But these days many NHS doctors find the job highly stressful and I heard from friends in NHS expressing frustration at the working conditions due to ever increasing complexity of managing of patients in advanced years with multi co-morbid diseases, and lack of say in the matters that affect the doctors. Yet NHS continues to be popular. Private healthcare though exists in Britain, its not the main player and only the rich can afford.The American system is highly evolved in so far as providing treatment with cutting edge technology is concerned but quite costly to the point that patients sometimes choose to suffer the disease rather than go to a hospital. Without insurance, it’s difficult to bear the costs of American medical treatment. A profession of ‘billing’ has emerged from this complexity of American system, which, honestly I, an outsider, found too complex to bother to know about. The system is lawyer and litigation oriented. No prescription comes without extreme investigation. No one wants to miss any and that ‘you-never know-syndrome works to the hilt.I have seen their hospitals. Simply superbly maintained and meticulously managed. There is a lot to learn from their attention to the minutest detail.Now coming to India. When the govt has failed to introduce such facilities as required and in demand, the private sector has evolved to fill the vacuum and take care of the needs of population. Many good hospitals have come up to provide contemporary medicare at a fraction of what it costs abroad. Be it liver transplant or bone marrow transplant India has the expertise widely available, if I may say, more wider and accessible than the America. No frustratingly long waiting lists unlike the West. India even started attracting medical tourism.But Indian private care suffers from the following.Lack of institutionalism. With rare exceptions, a consultant in private works almost unsupervised/ unaudited unlike in govt sector where the treating physician cannot do things the way he wants. This lack of scrutiny or overseeing has given rise to suspicion and dubious practices.Though insurance is becoming popular, most families end up spending from pocket and the burden can be quite heavy and sometimes almost make the patients bankrupt following the treatment of major diseases. This is not the fault of doctors. Medical equipment are imported and costlier than they are abroad and their maintenance is very costly. Gadgets become obsolete in about a maximum of 5 years.Many patients do not buy insurance or budget for medical treatment like they do for education and weddings etc. leading to despair, and find the doctors soft target to attack to vent out their frustration. Its no solution at all.Reforms in Govt HospitalsThe existing Govt hospitals are to be expanded with establishment of more peripheral treatment centres especially cancer centres across the nation and augmenting the strength of specialist doctors with built in performance based incentives.With the existing salaries and work culture of staff, quality in govt hospitals is a mirage. Hire and fire system and delegation of powers to the deans with autonomy only will bring in changes.The existing system is highly bureaucratic and inefficient to give desired results. The deans with supporting young hospital management guys as administrators shall be given powers and made responsible for omissions and commissions. And the selection of deans shall be confined only to those with outstanding annual performance reports and not based on seniority alone.The private hospitals shall have some kind of peer audits and regulation to check if they are following established norms of practice. Ethical and transparent billing shall become the norm.We are evolving but the recent move by the govt to introduce bridge courses and allowing vaids of other systems to practice modern medicine is an ill-conceived move which will sure to destroy what little we have achieved in the medical care.Instead of exploring ways to increase the penetration of the available medical expertise through better infrastructure and performance based incentives, government is trying to tinker with the system, which can do irreparable damage to the health of profession itself. In the sixties integrated system guys were there who were later conferred MBBS and this half baked guys were the weakest links in the chain. I have known such guys and their below par competence.Accreditation of hospitals through agencies like NABL etc shall be made mandatory for all the corporate hospitals and NABH norms shall be applied for all the private and govt labs. Drug control shall be more stringent. These are the pressing needs not bridge courses to ayurvedic vaids and exempting exams to pathetically trained foreign qualified doctors who could not clear the national exam. Their pass rate at 7–13% speaks of volumes of their quality. Exempting them from examination amounts to promoting quackery on one side and killing the majesty of noble profession. If people have complaints about quality of doctors, to avoid them, they shall support quality measures.Politicians come and go but its the systems which remain in place and guie the society.How much it costs annually per head for free health care?It needs about 5–6 thousands per head per year to provide primary care for every individual in the society .And it can go up much higher if tertiary and quaternary treatments are added. The govt just doesn’t have that kind of money and for that matter no govt on earth can afford nearly 8 trillions rupees /annum to provide high quality free treatment for 1.3 billion people.My viewCulturally, Indians abhor long waiting and queuing up at the government clinics for minor ailments. Primary care for trivial ailments may be left as it is going on now- part private and part public with choice left to the patients.Secondary and tertiary care and trauma care require urgent attention. It shall be fully augmented at all levels in taluks and cities and govt shall ensure quality through new additional recruitment, implementing modern well established norms of management and adequate funding. While insurance base shall get expanded for those wanting private care.Quaternary care shall be such, part of the costs shall be borne by the beneficiary. If it has to be free, cost overruns will destroy the quality to make it dysfunctional. No govt can spend tens of lakhs of rupees per patient.
How can the UK honestly view their healthcare as better than that of the US?I understand the American attitude but we are a bit on the arrogant side of health care. We think we're the best at everything. Each system has their strengths but the USA is built on ability to pay.I have had the fortunate experience of living in both the USA and UK. I have spent the better part of 50 years with good Blue Cross insurance in the USA and now I'm under the NHS in Scotland. I've found that I have received good care under both systems. What's the difference? For one thing, when I visited the doctor in the USA I had to pay a co-pay of 25 dollars plus the fact that I also paid about 100 dollars out of my paycheck every month though my employer paid the bulk of it. When I had a problem last week in Scotland I received a phone consultation with the doctor who made an appointment for me. I got in at 3:40 that same day. The doctor thought it would be good for me to get an x-ray so he contacted the hospital radiology and made an appointment then and there. I went to the hospital and had my x-ray done. I was out and on my way home by 4:15. The cost? Nothing. If I had needed a prescription it would have cost me nothing.Now I know what you're thinking. Nothing is free. That's true. I pay taxes to cover my NHS care. However in the USA when I was caught up in a layoff I lost my employer provided health care. To keep that care I would have paid 800 dollars a month and that coverage was limited to a year. In current dollars health insurance paid for under the same Blue Cross policy would be fifteen hundred or more dollars a month.So what are my taxes to pay for this socialised medicine? My payroll taxes (of which NHS is only a portion) amount to much less than half what my health care alone would cost me in the USA.Conservatives in the USA complain and resist socialism. It is anathema to them. And the propaganda from the right paints all these horror stories that are extreme or overblown cases that you can find even more examples of in the USA. We Americans tend to love our Medicare and VA hospitals. That is socialized health care. The USA has plenty of social systems in place that we take for granted. Every government has some form of socialistic programs. Most western nations have established national health care because its citizens want it. And I know of no countries with national health care that have remotely considered it a mistake. Once established they have never gone back. It is only a matter of time before the USA adopts some form of it. It's possible it will start as state programs in California or other large states. It is a much more cost effective system. And everyone qualifies no matter what their income status.Who in the USA would not want it? Doctors for starters. Pay for them would not be in the millions. Pharmaceutical companies also since the national system would negotiate competitive prices. And some conservatives would rather have no coverage and die than have socialized medicine.The British like their NHS and I can't complain at all. It's their choice to keep it and it serves them and me well. If Obama had managed to sell the idea to America you would have bitched and moaned but in the end you would have used it and gotten used to it. Then you would have never given it up.Now that I'm retiring it is the NHS that will keep me in Scotland rather than returning to the USA. The troubles we're currently experiencing with the NHS are the result of the conservative government's penchant for cutting budgets when they really should be increasing taxes.In short, the USA has some of the best health care in the world but it comes at an extreme cost and neglects those without adequate funds. The UK has very good health care but a far superior system. There is more to health care than technology alone.
As of 2016, should the Affordable Care Act be judged a success or a failure and why?I have trouble coming up with a decent analogy that describes the situation with the ACA and the U.S. healthcare system. The system is so bad and yet the fix, though not simple, is obvious. U.S. health care and the ACA fix is kind of like the patient walks into the E.R. with a life threatening bullet wound, the bullet is lodged close to the patient’s heart but, for some reason, the doctors only put a bandage, the ACA, over the entry hole and send the shooting victim home without surgery. What was really needed was heart surgery to remove the bullet however some of the doctors think that even the bandage is more treatment than the patient needs; so the compromise was nothing more than a bandaid and the patient, the U.S. healthcare system is now dying.There are a lot of people lying about what is going on with U.S. healthcare. We are told that the ACA is some kind of socialist program designed to ruin a perfectly good free market based system of healthcare. On the other hand, others are saying that the ACA band aid is somehow going to fix one of the worst health care systems in the developed world. (U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries - Forbes).The U.S. healthcare system is a uniquely twisted American approach to providing a service via middlemen and the politician’s response to those who say it needs improvement is a microcosm of the problem of the poor political leadership of the U.S. The ACA is trying to fix something that cannot be fixed. The ACA never had a chance of success.There is No Profit Motive to Provide Good Service to the PatientLet’s put to rest the B.S. that the U.S. healthcare system is some kind of capitalist free market system serving patients. Under the existing system of U.S. healthcare, regardless of ACA or no ACA, a patient that walks into a doctor’s office is most likely not the paying customer. The paying customer for healthcare is most likely either an insurance company or the government but almost never the person receiving the service. In other words, the paying customer for healthcare in almost every case is a middleman, whether it is Humana, or Aetna, or Medicare or whatever. The middlemen customer’s demand determine costs and services provided. The patient is nothing more than a transaction. No wonder U.S. healthcare is so bad.A patient walks into the doctor’s office or a hospital and the very first piece of information that the patient provides, sometimes even before what is wrong with them or what hurts, is health insurance information. Why is that? Why does the doctor want to know what health insurance you have before they treat you? The doctor needs to know who the paying customer is so he or she will know what treatments will be paid for. The patient is not the customer; the tail is wagging the dog.For example, personally for a long time I needed a drug called to fix my genetic high cholesterol problem, but my doctor didn’t bother to prescribe it or even tell me about it because he knew my insurance would not pay for it and no way could I afford it. Instead he prescribed which is the generic and drug that only marginally addressed my condition. Finally after 3 years of additional damage to my pulmonary system, , a generic for came out, but it would be another year before the generic was cheap enough so that I got what I needed and only after Pfizer made $130 billion over charging for the drug.Why the ACA is Nothing More than a Bandaid over a Bullet HoleBefore the advent of the ACA, a very high number of Americans did not have healthcare insurance. Either the insurance was too expensive, there was no employer to provide it, or the patient had a preexisting condition that the insurance companies would not cover. One symptom of this problem is the scandalously high infant mortality rate in the U.S. Basically, impoverished women are having babies without the services of a obstetrician because they cannot pay for it. The ACA set about trying to fix the access to healthcare through the current private and government insurance system. By making healthcare insurance mandatory, the ACA attempts to change the statistics of healthcare allowing insurance companies to accept higher insurance risks and insure pre-existing conditions without losing money. Thus, theoretically, more people are insured. In cases where patients simply cannot afford health insurance, the ACA has the government step in to subsidize insurance. The ACA does not attempt to improve the quality of the U.S. healthcare system. If you had a choice of where to break your leg and receive care for it then you are better off breaking it in Cuba and going to the hospital there, than the U.S. ACA or no ACA; you will almost alway be more likely to have a better outcome for the most common injuries and illnesses in another country. Also the ACA does not lower the incredibly high cost per patient in the U.S. which is double the amount spent by countries known to have the best healthcare in the world.The Health Insurance Companies Make Everything WorseAll insurance companies, doesn’t matter what kind, make their profits through something called float. Everything else, the administrative overhead and claim payments are a wash verses premium payments from clients. Float is simply the interest earned on the money while it sits in the insurance company’s bank account before it is paid out to claims.For an insurance company, managing float, i.e., lengthening the amount of time that money spends in the company’s bank account, is everything. Even lengthening the float a few hours can make a huge difference in the profitability of an insurance company. While this business model may be OK for car or life insurance, having the management of float determine what treatments a patient will get is just nutty, but that is basically what is going on.The middleman is a U.S. phenomenon. We buy our cars from a dealer and it is illegal in many states to sell cars without the dealer middleman. We buy our cell phones from a network instead of directly from Apple or Samsung because the AT&T or Verizon middlemen have manipulated the politicians and FCC to create a system that forces us to into a technology that is more primitive than in countries like South Korea. So it is no surprise here in the U.S. that actuaries instead decide what health care is available and at what cost.Remember the float is what counts. The more money floating in the bank account the better. The insurance companies are not motivated to reduce the cost of healthcare. Quite the opposite actually. The more money things cost the better it is for them. As long as the actuarial tables predict the costs accurately, insurance companies will gladly pay.The Political System Does Not Serve the PeopleYou think these idiots in Congress do not understand the problem? Think again, insurance companies, mostly health insurance companies have donated $15 million to politicians during the current election cycle. That is only the part that we know about and does not include PAC money. Any solution that Congress comes up with is going to have insurance companies involved, guaranteed by our corrupt political system. We either going to have the extremely poor pre-ACA health care system or something with a bandaid like the ACA.A Modest ProposalSpain and Italy do not have the best healthcare systems in Europe. Yet, they are miles, miles better than the U.S. system and at 1/3 the cost per patient, with better service, more and better doctors, nurses, and hospital beds per capita and there has been less than 1% inflation of per-patient costs for a decade in those countries (What Makes Spain's Health Care System The Best?). We should emulate them. Imagine your health insurance premium at 1/3 what it is now and not inflating. Walk into any doctor, no fees; maybe they ask you your name and lookup your healthcare history; that is all. The only difference is that you write that check to the government not an insurance company.The barriers to this solution are getting past the political marketing financed by the insurance companies. The people must for an end to political corruption and forcing the U.S. political system back to serving the people instead of serving the corporations. Basically, we have one group of politicians working together to make the U.S. government fail where other governments succeed brilliantly, while the other group of politicians sit idly by like so many sheep as wolves tear apart one of their number and watch it happen. The American people are SOL as long as that is going on.
What do Liberals/Democrats want to see happen to guns? What laws/restrictions do they want passed and why?I am a liberal. I voted for Dukakis, for God’s sake. I am so far left that Bernie Sanders does not go far enough.Image: USNewsI don’t need to restrict firearms. There are tens of millions of other liberals to ask for that. I would like to see:National reciprocity for concealed carry permits. Wait for Heller to be overturned or a new Amendment for a rebuttal. Meanwhile, Heller should be enforced as surely as gay marriage, women’s suffrage and abolition of Black slavery.Allow private sellers access to the National Instant Criminal Background Check System (NICS). You want to require background checks for all firearms sales, including private face-to-face? Then individuals need free access to NICS like licensed dealers and law enforcement have. People should have this choice available to them already.Prosecute those who lie on background screenings. “In almost every case, these people can be prosecuted” (Politifact), but only 0.055% prosecution rate for those who fail. What’s the purpose of screening for prohibited persons such as convicted felons, if those prohibited persons are not prosecuted for breaking federal or state law by lying on forms? In my state, applicants must pay for their own federal background check and fingerprint check and registry. They shouldn’t.Uphold the thousands of existing gun laws against criminals, instead of penalizing law abiding citizens with new ones. If a violent felon is convicted to 15 years for illegal possession of a firearm, why are they now out to commit more crimes? (FAMM - Families Against Mandatory Minimums) Yes, keeping people out of the system saves money and may be good for families. So how does making more gun laws to break and creating millions more criminals with the stroke of a pen help? If you are willing to release a non-violent felon who illegally possessed a firearm because we should care about the impact on their families (FAMM), why do you want to jail a non-violent gun owner simply because he has a magazine that holds over 10 rounds?Increase penalties for use of a firearm in crimes. Sorry FAMM, and I do care about impacted family members of convicted criminals (FAMM - Why Should I Care?). As a liberal, I would increase social supports for underprivileged families so women and children do not need to be dependent on or stay with criminals, have convicts imprisoned within more reasonable distance of their homes, and allow/encourage family visits. With accommodations and family friendly events, even. If they don’t agree using an illegal handgun in commission of a robbery means an extra ten years on top of the robbery charge, perhaps criminals shouldn’t use guns or rob people.Free or affordable firearms handling and safety training to promote safer handling and storage of firearms, to avoid being a burden to exercise a Constitutional right, for the same reason people argue against requiring voter IDs for inner city minorities.Require secure storage of firearms to prevent access by unauthorized persons when not ready for immediate use. You sleep with your loaded handgun to be ready for a home invasion? I do. You keep an AR-15 or shotgun at hand at the computer? Sometimes. But I put them in the safe when I shower or leave home, because I’m the only one allowed to touch my guns. I have the keys for my safes and locks. I have private home security and various kinds of gun owner and liability insurance, too. If you can afford a $400 firearm and $18 a box for ammunition, you can afford a lock if one doesn’t come with your gun, or you can buy a small safe or clamp style cover for the trigger housing or action. Note: not electronic smart guns that fail when you need it.AR15 Lock, IC-Lock Ejection Port Gun Lock $27Image: ic13arms, eBay (I am not a representative or stakeholder of IC-LOCK.)Life Jacket Locking Firearm Safety Case LJ3 Shotgun Case $15.99Image: eBay (I am not a representative or stakeholder of Life Jacket.)I’ve taken time off work, and paid thousands of dollars to travel thousands of miles to go to the classes, taken the tests (100%), shot on the range (90-ish?), passed the federal background checks (in addition to all other background checks and random drug tests to be an education and health care worker), paid the fees, yet can carry a concealed weapon in only 33 states, and not my home state. What other Constitutional right does not apply nationwide?In my state at the time I first got my permit to acquire a firearm, state certified Hunter Education classes or other state approved firearms training (e.g. armed law enforcement or military service) were required prior to applying for a permit. The cost for the classes was normally $100, but the fee was waived due to a donation or grant. I was trained for free. Hell, if some donor is willing and able to shell out $100 per student, why can’t they give an extra $10 for a gun lock or $40 for a pistol safe? I bought my own 14 rifle safe and a pistol safe, but that was my choice.[Fun fact: at my hunter education class (2008), I noticed the older brother of a high school classmate in attendance. Purely by coincidence while looking at a sex offender registry much later, there he was. His listing is still current. Two counts, Sex Assault III, 2001. He’s a convicted felon and wouldn’t pass a background check.]Note I did not say, promote ownership of firearms. There may be firearms in 4 out of 10 homes in the US. Your children and loved ones are around guns accessible from other homes or while in other homes, regardless of lack of guns in your own home, vault like security for firearms you do own, or legal status of firearms in your community. Widespread firearms handling and safety training will have a societal benefit, even if it is as simple as children learning Don’t touch! Tell an adult! if they see a firearm unattended.
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People also ask
Does a power of attorney have to be signNowd in California?In California, a power of attorney must either be acknowledged in front of a notary or signed by two witnesses. While either method of validation will work, consider doing both. By signing in front of a notary, you expel any doubt as to the validity of the principal's signature.
Who can override a power of attorney?If the court finds the agent is not acting in the principal's best interest, the court can revoke the power of attorney and appoint a guardian. The power of attorney ends at death. If the principal under the power of attorney dies, the agent no longer has any power over the principal's estate.
Is power of attorney valid without notary?But even where law doesn't require it, custom usually does. A durable power of attorney that isn't signNowd may not be accepted by people with whom your attorney-in-fact tries to deal. The notary public watches you sign the durable power of attorney and then signs it, too, and stamps it with an official seal.
How much does it cost to signNow a power of attorney?What is the normal fee for notarizing a Power of Attorney? It will vary based on your location, but most notaries charge between $15 to $25 for their services.
Does a power of attorney need to be signNowd in BC?Under section 17, the attorney must sign the enduring power of attorney in front of one adult witness if they are a BC lawyer or BC notary public. Otherwise the attorney needs two adult witnesses.