Yet another reason to despise the ambulance chaser

[Gene DeMambro]

These are the same circular arguments we keep having, year after year after year. Continuing screeds about tort refrom continue to be nothing more than business protection reform. Unconvinced otherwise. All full of sound and fury, signifying nothing and an incredible time waster.

Hava a good weekend,
Gene

[Bill Glasheen]

These are the same circular arguments we keep having, year after year after year. Continuing screeds about tort refrom continue to be nothing more than business protection reform. Unconvinced otherwise. All full of sound and fury, signifying nothing and an incredible time waster.

Hava a good weekend,
Gene

No, Gene, TORT REFORM. Would you like me to type slower? God knows I can't dumb it down any more for you.

You studying law or something?

Tort reform refers to proposed changes in the civil justice system that would reduce tort litigation or damages. Tort is a system for compensating wrongs and harm done by one party to another's person, property or other protected interests (e.g. reputation, under libel and slander laws). Tort reform advocates focus on personal injury in particular.

***

In Commonwealth countries, those initiating liability lawsuits must pay court costs as well as the legal expenses of defendants should they lose, thus greatly reducing the number of such cases. On the other hand, there are proposals to replace tort compensation with a social security framework that serves victims without respect to cause.

The nice thing about Obama's humiliating health care reform (sic) failure is the potential opportunity to pry the trial attorneys off the cahones of their Democrat puppets.

Don't think I'm bashing the honorable legal profession, Gene. I have family members who are attorneys and we all think alike on this matter. We collectively have it out for the whores and sociopaths who trash whatever profession has any money associated with it. For them it isn't about justice, Gene; it's about Sutton's law.

Ambulance chasers - 1900

Lawyer jokes from 1900. Top-hatted lawyer to workman falling off scaffolding: "Take this card, my man, and if you're not killed call on me and I'll recover big damages for you."

- Bill

References: Wikipedia

[Valkenar]

The nice thing about Obama's humiliating health care reform (sic) failure is the potential opportunity to pry the trial attorneys off the cahones of their Democrat puppets.

Yup, that's pretty much the conservative credo. Make the president fail at any cost so we can get back to the glory days of starting bad wars, ignoring corporate malfeasance and putting the ten commandments back where they belong: in schools.

[IJ]

I don't think the failure is humilitating because time has ended, and one person can't herd a bunch of stupid cats who want to spend the nation's last penny on broken healthcare so they can retain their seats another term. Like Rome, we'll get what we deserve.

"These are the same circular arguments we keep having, year after year after year. Continuing screeds about tort refrom continue to be nothing more than business protection reform. Unconvinced otherwise. All full of sound and fury, signifying nothing and an incredible time waster."

THIS I don't get, however. We know there are good alternatives to the current tort system. One is the vaccine compensation system, which was designed to keep tort from destroying our vaccine supply. Since the tort system is about absurd payouts for individuals apparently injured rather than what's best for the whole, you get a situation where a million people are vaccinated much to everyone's benefit, and then one person has an injury or PERCEIVED injury) then in the court of opinion of a few laypeople huge damages are levied against the drug maker. That threatens the supply and safety of us all, and it's stupid, so the law made manufacturers immune and created a fund to compensate those injured. It's been working well since 1988.

http://www.hrsa.gov/vaccinecompensation/

I challenge the sanity of anyone who thinks that mega settlements to punish well intentioned vaccine makers who make lifesaving products which simply aren't risk free is a better alternative to this more reasonably decided, cautiously funded pooled-risk solution.

This is perfectly analogous to the situation where liability is placing OB's beyond the reach of many communities. Who can seriously think that tort against OB's is better for the collective when we can't get OBs anymore?! There ought to be a separate system for taking care of people potentially injured by malpractice, or good practice, as the case may be, that isn't pursued by people incentivized to collect insane payouts, but rather, fairly compensate injured people OR merely take care of people who through no fault of their OB have birth injury.

Meanwhile, I think it is perfectly reasonable to hold hospitals and doctors accountable for injuries due to preventable problems by payers not reimbursing for them (of course, I think it's reasonable to provide payment when people get sick despite documented best care by the institution). People should be made whole for their injuries, too, but we waste so much of their funds on the process and fees it's not optimal for them, nor has this system really prompted systems change--it's just ineffective. Or fair: if everyone called Johnson, Sleazy and McGreedy for every injury they suffered and obtained compensation at the going rate, the system would fail overnight hurting everyone to supposedly heal individuals. It's a tragedy of the commons. Just ask people whether they'd prefer the current vaccine system or one in which an unexpected rare injury would be compensated at the whims of a few individuals involved in a tort with possible unavailability of these needed products down the line to get their best impression over tort reform. Asking them when they're ready to scalp their doctor because of a hospital complication isn't the best time.

[Bill Glasheen]

The nice thing about Obama's humiliating health care reform (sic) failure is the potential opportunity to pry the trial attorneys off the cahones of their Democrat puppets.

Yup, that's pretty much the conservative credo. Make the president fail at any cost so we can get back to the glory days of starting bad wars, ignoring corporate malfeasance and putting the ten commandments back where they belong: in schools.

What are you smoking, Justin? Can you pass that bogart? Must be some good schit...

Those of us who actually do give a damn about health care and don't give a damn about either party (because neither represents me) actually want to improve health care. What the party in charge needs to do is get their heads out of their buttholes and agree that a Democrat-only program does not equal better health care.

Justin, you have no idea how close this country came to letting a bunch of idiots in a smoke-filled room destroy one of this country's better institutions. Granted the health care system needs reform. But we don't need what one political party will ram down our collective throats.

Take all this politics and shove it. Throw everything that was done in the trash. Clean slate. Let's get started.

Or not... We could always get into blaming everything on Bush. But God knows that dog just won't hunt any more.

- Bill

[IJ]

You know what else doesn't hunt? The Obamocalypse. If healthcare is one of our better institutions, we're toast. The "system" is like a fancy airplane in a free fall--about to run out of cash, terribly inefficient, ineffective at delivering care in many ways--it's a crisis. You can view this as a bullet dodged all you want, but there's another one aimed right between our eyes no one is doing anything about. As for republican health care initiatives, remember the one either Bush floated, or that was detailed in the contract with America? Me neither.

[Bill Glasheen]

If healthcare is one of our better institutions, we're toast. The "system" is like a fancy airplane in a free fall--about to run out of cash

That's Medicare, Ian. You know... the GOVERNMENT system. That's the one about to crash and burn - right about the time when I'm supposed to be on it. That's what you get with a system built on a Ponzi scheme.

Meanwhile... The commercial system isn't as broken as you make it out to be. The private system is self-limiting. And by law, commercial insurance companies won't run out of cash. (They don't rob Peter to pay Paul. They're required to use your premiums to pay claims, and they're required to have reserves.)

Bush

There you go again... Bush isn't president.

Primum non nocere, Ian. No change is better than that 2000 page piece of cr@p that was coming down the pike. Not even Massachusetts - a state that mandated universal coverage - wanted any of that. Why else would they elect Scott Brown to replace Teddy Kennedy?

As for Medicare, I'd be a lot better off with a private option. That was proposed by that other party, you know. Meanwhile... I'll just have to go buy a BCBS Medicare extended policy.

- Bill

P.S. Did you know that Bush was responsible for the damn Yankees winning the World Series last fall? I mean really...

[Bill Glasheen]

I realize this thread has been meandering a bit. But I couldn't resist the opportunity to share this news.

By Russ Zerbo February 5, 2010

The democrat-controlled Virginia Senate passed the Virginia Health Care Freedom Act this week that — if passed by the Republican-controlled house — would make it illegal to force Virginians to purchase healthcare as well make it illegal to fine Virginians for not doing so.

****

Yes, Obama, Virginians feel THAT strongly about their libertarian roots.

I leave you with some quotes of Thomas Jefferson. In addition to being a graduate of the College of William and Mary (above), he was author of the Declaration of Independence (does it show???) founder of the University of Virginia, and author of the Virginia Statute of Religious Freedom (from which the Constitution penned the ideas of church/state separation).

Thomas Jefferson:

A democracy is nothing more than mob rule, where fifty-one percent of the people may take away the rights of the other forty-nine.

Thomas Jefferson:

No man has a natural right to commit aggression on the equal rights of another, and this is all from which the laws ought to restrain him.

Thomas Jefferson:

I never submitted the whole system of my opinions to the creed of any party of men whatever, in religion, in philosophy, in politics or in anything else, where I was capable of thinking for myself. Such an addiction is the last degradation of a free and moral agent. If I could not go to Heaven but with a party, I would not go there at all.

Thomas Jefferson:

A wise and frugal government, which shall leave men free to regulate their own pursuits of industry and improvement, and shall not take from the mouth of labor and bread it has earned -- this is the sum of good government.

Thomas Jefferson:

I have no fear that the result of our experiment will be that men may be trusted to govern themselves without a master.

- Bill

[Glenn]

As for republican health care initiatives, remember the one either Bush floated, or that was detailed in the contract with America? Me neither.

There you go again... Bush isn't president.
P.S. Did you know that Bush was responsible for the damn Yankees winning the World Series last fall? I mean really...

This attempt to change the subject totally misses Ian's point and you know it Bill. A Bush not currently being president does not change the fact that neither one of them (nor Reagan for that matter) introduced anything to try to reform healthcare when they were president, demonstrating that there is no interest in the Republican party in any health care reform. And you can't blame Obama for their failures to do anything, he wasn't president then.

a Democrat-only program does not equal better health care

Granted the health care system needs reform. But we don't need what one political party will ram down our collective throats.

At least Obama made the effort to try to fix it. Given that no Republican president/congressperson is likely to ever introduce any kind of health care reform, they're making too much money off the current broken system, the only way reform will ever happen is if the Democrats force through a Democrat-only program.

As for Medicare being broken, not even Republicans are willing to back that up. They objected to it when it was first proposed, using the same ridiculous arguments that it would destroy free America, make us socialist, blah blah, none of which happened. But when a Dem senator got fed up with the Republicans spouting that nonsense about the current health care reform bill he introduced a bill to eliminate Medicare, and the Republicans voted against it as he knew they would. So I guess they do see a use for government run health care options after all.

[Bill Glasheen]

I can't believe people are STILL blaming everything from sunspots to the heartbreak of psoriasis on Bush. Obama screws the pooch and Bush blah blah blah...

But you know what? This one is just way too easy.

As for republican health care initiatives, remember the one either Bush floated, or that was detailed in the contract with America? Me neither.

This attempt to change the subject totally misses Ian's point and you know it Bill. A Bush not currently being president does not change the fact that neither one of them (nor Reagan for that matter) introduced anything to try to reform healthcare when they were president, demonstrating that there is no interest in the Republican party in any health care reform.

Wrong, betadine breath!

Let's go back to the Nixon administration. This from Science Policy

HMO Legislation May Reshape American Medicine

by Daniel S. Greenberg and Philip M. Boffey

The most significant health legislation of the 1973 congressional session was signed into law by President Nixon on December 29. It authorizes a federal program to foster development of health maintenance organizations (HMOs), a form of medical care that could spark profound changes in the shape of American medical practice and of medical schools as well.

This from Wikipedia

Consolidated Omnibus Budget Reconciliation Act of 1985

The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, is a law passed by the U.S. Congress and signed by President Reagan that, among other things, mandates an insurance program giving some employees the ability to continue health insurance coverage after leaving employment.

This from CNN

Bush signs landmark Medicare bill into law

President Bush: 'Giving older Americans better choices'

Monday, December 8, 2003 Posted: 1:23 PM EST (1823 GMT)

WASHINGTON (CNN) -- President Bush on Monday signed into law landmark Medicare reform legislation that includes prescription drug benefits and has sparked a bitter fight between opponents and supporters.

Speaking at DAR Constitution Hall in Washington, Bush characterized the measure as "the greatest advance in health care coverage for America's seniors since the founding of Medicare."

Backers say the $400 billion Medicare Prescription Drug Modernization Act will provide much-needed help for the nation's 40 million senior citizens to buy medications; critics say it is a giveaway to drug makers and insurance companies and a prelude to the dismantling of the program.

"Our government," Bush said, "is finally bringing prescription drug coverage to the seniors of America."

Oh my, but how the bubble gets burst.

• Hillarycare? Failed!!!
• Obamacare? Failed!!!
• Nixon? Reshaping American medicine. Ever heard of Kaiser Permanente? Any HMO from any health insurance company? The days of "traditional" insurance are over. Health care costs a fraction of what it would have cost had this reform not happened. Furthermore, health insurance now covers preventive medicine (e.g. a mammogram) - a novel concept at the time. Now we've come to expect it!
• Reagan? Helping people temporarily keep their health insurance coverage when laid off and in-between jobs. God do we need that now!!
• George W Bush? Landmark reform legislation. Seniors get drug coverage. Furthermore, they no longer have to pay AWP (average wholesale price). Or as insurance companies call it, "Ain't what's paid!" And... the government now picks up most of the tab. A senior on fixed income no longer has to choose between paying the electric bill or paying for medicine that keeps her out of the hospital. How cool is that?

Those God damned do-nothing Republicans!

You really should have known this, Ian. I'm disappointed in you.

- Bill

[IJ]

Forgive me, Bill. I was talking about systemic reform, in the semi recent past. You were talking about libertarianism and how we're too focused on Bush, because he hasn't been president for a year or so. So then you bring up a law from BEFORE I WAS BORN and Bush's senior drug plan and how that's paid for by the government, the same one running a ponzi scheme two sentences ago! Again, forgive me, for I was confused.

Let's point something else out: preventing Virginians from having to purchase healthcare insurance is totally F'ing retarded in an entitlement state. We all know that with EMTALA and Medicaid people HAVE to get treated when they come to an ER, regardless of ability to pay; we know people get on government Ponzi funds, that you despise, when their healthcare bills bankrupt them (takes about 5 minutes). So plenty of people don't play ball and purchase insurance when their risk is lowish, because they know they'll be caught by a safety net if things go south. They're freeloaders or ignoramuses. Only in a libertarian state that offers you freedom AND the opportunity to die without care when your bad decisions come due, will a free market sensibility have a chance of prevailing and EVEN THEN, as demonstrated by data on healthcare choices people make when copays are adjusted, people don't always make good decisions. Here, Virginia has embraced the feelgood half of a logical whole--reminds me somewhat of the Californian fruitloops who passed the proposition preventing property taxes from going up with home value more than a percent a year or something, WITHOUT any corresponding drop in services/expenditures. Now I pay huge bills as a new comer and the state is still bankrupt.

You know what else is moronic and antifreedom? Insisting that people have helmets on their heads or seatbelts or most applicable: car insurance. Because we know that risking huge financial liabilities while driving, just like health liabilities the state will have to absorb, shouldn't result in anyone being forced to have their freedoms tampered with.

If you want to avoid those problems, you have to ensure people pay into the system, because the public system will save their butts when they need it. It's like paying for military--we can't have people opting out of THAT because we all know the services will be their when they need them, and not for free!

[Glenn]

I can't believe people are STILL blaming everything from sunspots to the heartbreak of psoriasis on Bush. Obama screws the pooch and Bush blah blah blah.

No Bill, you're the only one who keeps taking those sidetracks.

Nixon was before my time, and the value of HMOs is debatable. I'll grant you the Reagan one, even if laid off people cannot afford COBRA it was still a step in the right direction. However what Bush signed was the Part D privatization of the Medicare drug program that was a boon for drug and insurance companies, criticized at the time and the cause of serious problems for the elderly since (for example the "doughnut hole" issue).

A senior on fixed income no longer has to choose between paying the electric bill or paying for medicine that keeps her out of the hospital. How cool is that?

Seniors appear to disagree with you on this one:

The Medicare drug law achieved its primary goal of providing drug coverage to most seniors who previously lacked it,” said Kaiser President and CEO Drew E. Altman, Ph.D. “But the survey found a significant number of seniors in Part D plans paying sizable amounts out-of-pocket for their medications and delaying or not filling their prescriptions for cost reasons.

(http://todaysseniorsnetwork.com/seniors_paying_more.htm)

Compared to 46% overall, 53% of Medicare beneficiaries who responded said prescription drugs are either not affordable or not covered, reflecting the inability of the privately administered Part D drug benefit to negotiate with big drug companies for lower prices and the dangers of the "donut hole" period when prescriptions are not covered.

(http://todaysseniorsnetwork.com/Seniors ... o_high.htm)

[Bill Glasheen]

I can't believe this discussion is still going.

1) Dr. Ian... WE DON'T WANT ANY FUKING "SYSTEMIC" CHANGE!!! And why?

• It's an excuse for socialists to try to institute a government-run system. Yes, Ian, government suks at running health care. They suk so bad that all the money I gave them for my Medicare is GONE and I won't have health care coverage waiting for me when I retire.
  
  If a commercial insurance company had done this, we'd have every Congressional liberal rioting in the streets with Michael Moore and members of moveon.org, demanding the heads of all those "fat cat bureaucrats" But government gets away with this because we expect them to fuk things up. It's what they do.
• Any "systemic" reform like the 2000 page bill to nowhere will be filled with pork. Can you say oink?
• "Systemic" reform is also associated with unethical dealmaking. Remember that sweetheart deal to bring the Senator from Nebraska on board? I don't blame you for wanting this, Glenn. Your state was going to get out of taxes that the other 49 were going to have to pay. What's not to like about that?

2) Ian and Glenn (and NOT Bill) brought up Republicans doing nothing on health care. He went back as far as Reagan. Well, Dr. Ian, I trumped you. I went all the way back to Nixon and went forward. I showed how Nixon, Reagan, and Bush all came up with dramatic reforms in our health care system. In hindsight, Nixon's efforts were indeed systemic.

I know, Ian, because I was there. I know what traditional insurance covered, and what it didn't. The reason why I was hired by BCBS to form a research unit was to get the stodgy old Blues out of the anachronistic world of indemnity insurance and into the world of managed care.

The problem you have, Ian, is you can't admit you were wrong. Go back and see what you wrote, and then go see how you got rejected like a school girl trying a flat-footed shot against Shaq.

You can do it, Ian. Say it. I ... was ... wro ...wrooo ... <gasp> wroooonnng!

3) Here we go again. Honey, hide the kids!

BUSH!!!



Yes, boys and girls. It was George W Bush who instituted a revolutionary change in how we treat our seniors in the health care system. But here's the thing, Ian. It wasn't just that we were getting more government money. Bush the drunken liberal spender in fiscal conservative clothing actually did something very smart here. He did what commercial insurers do even better. He applied the bargaining power of numbers to the table and got seniors prices for their drugs that holders of commercial insurance policies get every day. (In my world, we call that "allowed amount.") Even if it was an ASO (administrative services only) model, that saves billions in pharmacy costs for our seniors. Frankly I could have settled for that and nothing more. But to keep the socialists happy, he went even further and threw some more Medicare fund money into the pool.

Does this bloat the Medicare budget? Yes and no. It does save us lots of ER and hospital visits. Eventually though the seniors are going to get old enough to get sick and die of something, so you are just delaying the inevitable. But creative thinking along these lines just might help keep people healthy and productive long enough to work beyond 65, keep paying for commercial insurance a few years longer, and keep paying taxes (and Medicare money) into the system.

It was a step in the right direction. You Bush bashers have nothing to whine about.

Meanwhile, what do we have from Obamacare? I leave you with this SNL video (embedded in the article). Enjoy!

Obama's Accomplishments

And finally... Before doing any more "reform", I demand that my insurance company cover this benefit.

Cialis for three-ways


- Bill

[Bill Glasheen]

One final thought on "systemic change."

Anyone engaging in such needs to take some systems engineering. Obama can't design his way out of a community rally. Drastic change like what they were proposing would have totally screwed up an already taxed primary care system.

Before ANYTHING can be done, we need more primary care practitioners. Lay the groundwork (as industry is doing now as a back-end run around the AMA) and more of the uninsured will be able to enter the system without totally throwing it in chaos.

A good case study of what NOT to do can be shown by what happened to AOL when they changed the online browsing model on a dime. Back in the day, your ISP charged you by the minute to surf the web. In a move to steal market share, AOL announced that its customers would be able to do all the surfing they wanted for one flat fee. That is now the business model. They were forward-thinking. It was a bold move.

Except...

Their systems couldn't handle the sudden capacity change. AOL customers were in constant wait mode while their servers got ground into failure mode. And consider that this was in the days of 1200 baud modems. (My Verizon FIOS transfers information several orders of magnitude faster than that.) In short, they created a customer service disaster.

Know what happens when you tell the uninsured they can all now go to the doctor? Things are already bad enough with the AMA limiting the number of MDs graduated from medical schools. And financial incentives are such that the best and brightest want to go into specialty care. We don't need more specialists; we need more family doctors who work like hell to keep you away from hospitals and specialists. And then you're going to double PCPs' patient-visit volume? I don't think so.

NPs and PAs are already slowly filling the hole that the AMA hasn't (yet) covered. They'll likely be the big winners when capacity is increased. They're also the quickest to get into practice from BS/BA to on-the-job. It would take a generation for the AMA to turn their ocean liner around.

FWIW, not all doctors belong to the AMA, just like not all lawyers are bloodsucking trial attorneys. I'm not bashing whole professions. I'm just pointing out the obvious.

- Bill

[IJ]

Yikes Bill. Do you not get it? The system has to change, Mr. "We don't want systems fixes." The costs are rising far too fast; insurance prices are climbing and messing with the economy and the number of people who can afford private insurance is dropping. The uninsured are rising. They end up on government programs sooner or later. So something has to be done, or the private system will just be for the wealthy while everyone else ends up on spotty government systems and by and large gets fragmented and ineffective care with EMTALA guaranteed salvage (too expensive too late) when things go seriously wrong. You can watch that happen (that appears to be our national plan) and say that ANYTHING else is basically surrendering to French socialists, but that's nonsense. Systematic change does not have to mean government run. You're a creative guy, figure that out. But one thing that's obvious is that when the government PAYS for so much healthcare already (but that part we love and cherish and protects our elder voters, so it's not socialist or evil, in a cognitive dissonance way) can control the way healthcare is delivered by forcing inefficient regions with low quality care to mimic systems that work in low cost highly effective regions. THAT would require a major systems overhaul but wouldn't be "government run."

I'm super pleased you liked Nixon's reforms a generation ago. I didn't bring them up. I didn't think they're relevant. What is obvious to everyone else is that the system you cherish is currently (now) in freefall, and SINCE then, despite this amazing systems fix (that says exactly WHAT about our current dilemma, Bill? You know, the topic??), the people who've tried to overhaul the system have been Democrats with silence during Bush administrations (that was my point a few posts ago). You bring up the important exception of the Bush drug plan, and I happened to receive an email today from someone unaware of this discussion on the deficit.

Here's the CNN interview with Fareed Zakaria it contained (skip to bolds if desired):

Budget fixes are simple -- and unthinkable

Editor's note: Fareed Zakaria is an author and foreign affairs analyst
who hosts "Fareed Zakaria GPS" on CNN U.S. on Sundays at 10 a.m. and 1
p.m. ET and CNN International at 2 p.m. and 10 p.m. CET / 5 p.m. Abu
Dhabi / 9 p.m. HK

New York (CNN) -- The solutions to America's long-term budget deficits
are surprisingly simple, but they're politically unthinkable in
today's Washington, says analyst Fareed Zakaria.

America's failure to deal with its growing budget deficit is hurting
its image internationally, according to Zakaria. President Obama
proposed a $3.8 trillion budget Monday, projecting a deficit of more
than $1.5 trillion this year and nearly $1.3 trillion for the 2011
budget year.

Zakaria, author and host of CNN's "Fareed Zakaria: GPS," spoke to CNN Wednesday.

CNN: So the president released his budget this week, projecting
deficits almost as far as the eye can see. What do you make of it?

Fareed Zakaria: The real problem is not the current deficits that the
president has projected. These deficits are to a large extent
inescapable because of the financial emergency we find ourselves in,
the rescue of the financial system, the stimulus package to jump-start
the American economy. But it's worth understanding why this gets us to
10 percent of GDP, the worst deficit since World War II.

And it is because, as the president points out, the budget was broken
in the first place. It was broken by three decisions made during the
Bush administration.

The first was to have massive tax cuts, which was a decision made in
the wake of the Clinton surpluses.

The second decision was to have a massive new entitlement program --
prescription drugs for the elderly -- which took the fastest growing
part of the American population and joined it to the fastest-rising
costs in American health care, which is prescription drugs. It was
therefore a marriage made in budgetary hell.

And the third, of course, was to have two wars that were going to be
funded without any tax increases, the first time in modern American
history that that decision was made. ... A partial exception was
Vietnam, which produced an economic catastrophe in the 1970s.

And then you add to it the fact that we were in a financial and
economic crisis and needed to spend money to get out of it, and you
have the current budget problem.

CNN: Right now the United States has a triple-A credit rating and the
dollar is the reserve currency for the world. Do you think America's
financial stability is threatened in the short term?

Zakaria: Not in the short term. These are understandable choices
America has to make. The entire industrialized world is facing very
similar budget deficits. We have probably five years to try to bring
our budget into some kind of manageable situation. And if we can't do
it within five years, it suggests two things. One is that the trends
at that point become so deep that fixing them at that point becomes
very difficult. And the second thing is that it becomes a signal to
the world that we really cannot get control of our budget. And at that
point, I do think that America's reputation, its credibility, its
ability to borrow vast amounts of money all will come into jeopardy.

CNN: Do you think that President Obama should have taken more dramatic
steps to curtail spending?

Zakaria: If he were to cut spending at this point, the economy would
quite likely go into a second recession, a double-dip, and then
frankly everything collapses. If you don't have growth, you have no
prospect of getting out of this budgetary situation. ... But he must
in a year begin really to address the serious issues that make up the
budget crisis that we have.

The most significant one is health care costs. ... Obama's health care
plan, while it has some cost control measures, is mostly about
expansion and adding to the costs. ... There has to be a much, much
more serious focus on costs.

The second is a number of sacred cows in the federal budget which are
very large but which frankly make no sense. We have a $250 billion a
year hole in the federal budget because employers are given a tax
deduction for health care plans. This is actually bad for health care,
because it is one of the factors that contributes to these out of
control costs, because it's an invitation to have inflation in the
system.

CNN: Are there other large "sacred" budget items?

Zakaria: Another is the deduction of mortgage interest, which is taken
in America as some kind of great measure that has enabled Americans to
own homes, whereas we have the same rate of home ownership as Britain
and Canada, neither of which have interest deductions for their home
mortgages.

What it is really is a subsidy for homeowners to take on debt. ... We
take on more debt than people in other countries and we can see that
has been part of the distortion of the market that has produced the
financial crisis that we've just gone through.

That deduction is a hundred billion dollars. When you hear people
talking about freezing this or that federal program, there you're
talking about hundreds of millions of dollars, occasionally a billion
dollars. But the real big money is in all these middle class
entitlements that are regarded as sacred cows.

And the third part is taxes. You're not going to bring the budget into
balance unless you talk about tax increases. The only real question is
what kind of tax increases. If we were to have a modest value added
tax, the kind we have in Europe, it would probably raise $150-$250
billion a year. It would discourage excessive consumption, it would
encourage savings. ...

CNN: So if the solutions are so simple, why aren't they happening?

Zakaria: If you take those three things -- health care, middle class
entitlements and taxes -- we have effectively solved America's budget
crisis. So the good news here is that we have a $14 trillion economy.

There's more than enough money to have a very substantial federal
budget, moderate taxes (we are still at the low end of the
industrialized world in terms of taxes as a percentage of GDP). So it
really is worth thinking about how strange it is, that a fairly
sensible set of discreet measures could put us back into a situation
where we would be the envy of the world in terms of our fiscal
condition.

The steps I outlined are economically simple and sensible and yet
they're political dynamite.

If we were to raise the retirement age on Social Security, modestly
and on a sliding scale so that it was phased in. If we were to trim
the benefits very slightly ... the program would be solvent for the
next 75 years. And yet think about it. That simple commonsensical fix
is politically absolutely impossible in Washington today.

CNN: Why do you think that is?

Zakaria: Because we have a political structure in Washington today,
that if one side proposes any solution to these problems, the other
side does not ask itself: How can we have a compromise that solves
this problem?

Instead they think: How can we demagogue this issue to fundraise, to
win votes, to scare people, to polarize the political climate and gain
advantage from it? It's almost that the entire strategy now is how can
we take any proposal that anyone makes and turn it into a fundraising
opportunity for our extreme wing.

And if you do that, you're never going to actually solve the problems
of the country because every proposal can be demagogued.

CNN: You just came back from Davos. What's the view of world leaders
of this American budget problem?

Zakaria: There is great unease not just about the numbers ... the real
unease is about the sense that Washington is no longer working, that
you cannot count on the United States to be able to make hard
decisions, to sort its own internal affairs out. One European CEO said
to me, what worries us more than anything else is that problems you're
facing now are the same problems you were facing 10 or 15 years ago.

They don't seem to go away. In other words, we keep kicking the can
down the road."

I've highlighted the key causes he identifies of recent problems, and the section indicating Obama's plan won't fix it all, and a section about how political division and obstructive a-holism in Washington is keeping us from doing much about it. That's nifty how it's smart on Bush's part to apply the government's purchasing power to the drug plan (isn't that how the entire government system works, and why medicare and medi-cal reimbursements are lower?), and everything wrong with the bill is someone else's fault. Oh, and I belong to the AMA, because I read JAMA at home--doesn't mean I support all their endorsement or am a blood sucker myself.

Oh: flat footed girls vs Shaq? Tons of goofy bouncing faces? Really?