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Tags Affordable Care Act , donald trump , health care issues , health insurance issues

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Old Today, 01:32 PM   #2161
Travis
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My mom has a problem. No doctors. She has Medicaid and a private supplement. But there are no family doctors around here anymore. We used to have so many but they've all retired and new doctors are now all specialists. All the existing family doctors are full and are not taking new patients.

As a result my mom has to drive three hours one way to see a doctor in Chowchilla.

This is a trend that started well over a decade ago but has become almost a crisis.
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Old Today, 01:33 PM   #2162
marplots
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Originally Posted by Planigale View Post
Relevant to this discussion, the survival benefits of being Canadian.
http://www.bbc.co.uk/news/world-us-canada-39410236
Up to ten years more life that seems attributable to UHC.
It probably just seems like ten years longer.
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Old Today, 01:46 PM   #2163
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Originally Posted by TraneWreck View Post
Here's a good article on a gross middleman in the pharma industry that serves almost no purpose and drives prices up:


http://www.esquire.com/news-politics...et-healthcare/

Part of the reason we spend 2x as much as every other functioning nation is that we have an endless list of parasites on the system each maximizing their own profit.
The rules forbidding the government from using its bulk-purchasing power to negotiate the best deals strikes me as utterly insane as well.
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US 16.4% of GDP of which 48.2% is public expenditure - 7.9% of GDP is public spending
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Old Today, 01:49 PM   #2164
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Originally Posted by CapelDodger View Post
It's not that budget is going one way instead of another. US military spending and US healthcare are determined within their own ideological bubbles, independently.
Yes they are. But my point and I think it is a fair one. How can we afford all this other stuff and not healthcare? In the end, we should measure the effectiveness of our society and government based on the quality of life of our citizens as a whole.

I was half joking earlier about losing a war to Canada. But given that the quality and the lengths of life of Canadians as well as Europeans seem to be significantly better I'm starting to think we should have lost in 1776 or 1812.

I've been proud to be an American my whole life but why? A shorter expected lifespan and less vacation time and a higher probability of dying in a war?
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Old Today, 02:13 PM   #2165
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Originally Posted by Travis View Post
My mom has a problem. No doctors. She has Medicaid and a private supplement. But there are no family doctors around here anymore. We used to have so many but they've all retired and new doctors are now all specialists. All the existing family doctors are full and are not taking new patients.

As a result my mom has to drive three hours one way to see a doctor in Chowchilla.

This is a trend that started well over a decade ago but has become almost a crisis.
This is probably a downstream effect of population migration. Sounds like your mom may be in a relatively rural environment.

In and of itself, UHC doesn't solve this. If there's not enough patients in a region, there won't be enough doctors. Supply and demand.

In BC, the province has attempted to address this through the Single Payer model by distorting the market in the following way: regions are designated into service levels, and regions identified as having low service levels, the province enhances the fee for service remuneration.

For example, an eye exam in the GVRD (population 2 million) pays a GP $100; the same exam in Pouce Coupe (population 739) the GP can bill $130. (these are not real numbers, just an illustration).

Generally, the MDs do not 'move' to these communities. They seem to circulate on a tour, sort of like locums. One day a week in each town, for example, with a 10 or 20 town rotation.
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Old Today, 02:31 PM   #2166
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Originally Posted by Travis View Post
My mom has a problem. No doctors. She has Medicaid and a private supplement. But there are no family doctors around here anymore. We used to have so many but they've all retired and new doctors are now all specialists. All the existing family doctors are full and are not taking new patients.

As a result my mom has to drive three hours one way to see a doctor in Chowchilla.

This is a trend that started well over a decade ago but has become almost a crisis.
I think I will stick with my doctor. You only have to have the annual physical to keep in the books. I can go find someplace for blood work and bring it to him. That would take care of 2018. If he takes Medicare I will make it to 2019 with him. Otherwise a new doctor search. We have tons as we are the state capitol in a farm state.
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Old Today, 03:00 PM   #2167
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Originally Posted by acbytesla View Post
Yes they are. But my point and I think it is a fair one. How can we afford all this other stuff and not healthcare? In the end, we should measure the effectiveness of our society and government based on the quality of life of are citizens as a whole.
That's a value judgement which I share.

Quote:
I was half joking earlier about losing a war to Canada. But given that the quality and the lengths of life of Canadians as well as Europeans seem to be significantly better I'm starting to think we should have lost in 1776 or 1812.
That is an argument which spans the two subjects. When Britain ramped up recruitment for the Crimean War, in the 1850's, Parliament was appalled to discover how many recruits had to be rejected. It led to changes in healthcare over the following decades, with the strategic importance of a fit male population being a large part of the argument. Not as large a part of the motivation, of course : that was more to do with value judgements. But politics is the art of the possible.

Quote:
I've been proud to be an American my whole life but why? A shorter expected lifespan and less vacation time and a higher probability of dying in a war?
I've avoided pride in nationality, but I've an enormous regard for the society that's been created here through the efforts of others. The US is a great enterprise, built from many great and small enterprises, and a marvel in itself.

Nil desperandum. I'm in my sixties and was politically aware by the time homosexuality between consenting adults was decriminalised. So much social progress has been made in my lifetime, on sexism and racism as well, that the dying gasp of the old world that Trump represents can do no permanent harm. The demographic imperative will not be defied.
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Old Today, 03:15 PM   #2168
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Originally Posted by Travis View Post
My mom has a problem. No doctors. She has Medicaid and a private supplement. But there are no family doctors around here anymore. We used to have so many but they've all retired and new doctors are now all specialists. All the existing family doctors are full and are not taking new patients.

As a result my mom has to drive three hours one way to see a doctor in Chowchilla.

This is a trend that started well over a decade ago but has become almost a crisis.
It's a problem in the UK as well. "General Practice", and general practitioners, have lost much of the esteem they once had.
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Old Today, 03:19 PM   #2169
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Originally Posted by Tero View Post
I think I will stick with my doctor. You only have to have the annual physical to keep in the books. I can go find someplace for blood work and bring it to him. That would take care of 2018. If he takes Medicare I will make it to 2019 with him. Otherwise a new doctor search. We have tons as we are the state capitol in a farm state.
Could you expand on the relevance of "farm state"? I ask as a foreigner.
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Old Today, 03:22 PM   #2170
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Originally Posted by Travis View Post
My mom has a problem. No doctors. She has Medicaid and a private supplement. But there are no family doctors around here anymore. We used to have so many but they've all retired and new doctors are now all specialists. All the existing family doctors are full and are not taking new patients.
.....
If her problem is specific, can she go to a closer specialist? Will Medicaid pay for it? I suspect they might recognize that making a sick person travel for hours round trip isn't a great idea. Are there nurse practitioners in your area? Visiting nurses? If her problem is serious and chronic, would she be better off moving to a place where she could get routine care?
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Old Today, 03:27 PM   #2171
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Originally Posted by blutoski View Post
This is probably a downstream effect of population migration. Sounds like your mom may be in a relatively rural environment.
No doubt, but Travis did say "anymore". There's a change.

Quote:
In and of itself, UHC doesn't solve this. If there's not enough patients in a region, there won't be enough doctors. Supply and demand.
The capitalist model fails in such cases, of course.

Quote:
In BC, the province has attempted to address this through the Single Payer model by distorting the market in the following way: regions are designated into service levels, and regions identified as having low service levels, the province enhances the fee for service remuneration.

For example, an eye exam in the GVRD (population 2 million) pays a GP $100; the same exam in Pouce Coupe (population 739) the GP can bill $130. (these are not real numbers, just an illustration).

Generally, the MDs do not 'move' to these communities. They seem to circulate on a tour, sort of like locums. One day a week in each town, for example, with a 10 or 20 town rotation.
You say BC has "attempted to address this" : is it working? Would Travis's mother still have to drive three hours each way to see a GP in BC?
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Old Today, 03:37 PM   #2172
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Originally Posted by Bob001 View Post
If her problem is specific, can she go to a closer specialist? Will Medicaid pay for it? I suspect they might recognize that making a sick person travel for hours round trip isn't a great idea. Are there nurse practitioners in your area? Visiting nurses? If her problem is serious and chronic, would she be better off moving to a place where she could get routine care?
I imagine Travis and his family have given some thought to this, and looked into the options available.

Nurse paractioners have their place : demarcation in health-care has been an issue pretty much throughout civilisation. They can take strain from a GP, but they can't replace them.
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Old Today, 03:41 PM   #2173
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Originally Posted by CapelDodger View Post
Could you expand on the relevance of "farm state"? I ask as a foreigner.
We have most of the income from farm products, food processing and export of those to China and Japan. The rest are services and such and a small amount of not food industry. The capital is under 300 000 people. Out further West is Wyoming that has less than a million people. And some roads, a nice Interstate so you do not have to stop. Just drive right to California. Well, Utah or Idaho first.

Farmers think themselves important. Businessmen. Fine. But then vote Republican and exclude themselves from healthcare.

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Old Today, 03:42 PM   #2174
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Originally Posted by CapelDodger View Post
Could you expand on the relevance of "farm state"? I ask as a foreigner.
I'd guess it would be that in such areas, the facilities are more concentrated in the few urban parts.

In a more urban state, these might be more distributed.
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US 16.4% of GDP of which 48.2% is public expenditure - 7.9% of GDP is public spending
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Old Today, 03:43 PM   #2175
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Originally Posted by Travis View Post
My mom has a problem. No doctors. She has Medicaid and a private supplement. But there are no family doctors around here anymore. We used to have so many but they've all retired and new doctors are now all specialists. All the existing family doctors are full and are not taking new patients.

As a result my mom has to drive three hours one way to see a doctor in Chowchilla.

This is a trend that started well over a decade ago but has become almost a crisis.
The other crisis is the increasing rarity of hospitals to serve smaller or rural communities. If you live in a city, you have your choice of hospitals. If you live in a rural area...good luck getting yourself to the closest hospital before you bleed to death. Hospitals are enormously expensive to run, and without government aid the smaller ones fail without the population to sustain them. Not as many people in an area means less need for a hospital overall, but when a person needs a hospital they usually need it pretty damn bad.
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Old Today, 03:53 PM   #2176
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Originally Posted by CapelDodger View Post
That's a value judgement which I share.

That is an argument which spans the two subjects. When Britain ramped up recruitment for the Crimean War, in the 1850's, Parliament was appalled to discover how many recruits had to be rejected. It led to changes in healthcare over the following decades, with the strategic importance of a fit male population being a large part of the argument. Not as large a part of the motivation, of course : that was more to do with value judgements. But politics is the art of the possible.

I've avoided pride in nationality, but I've an enormous regard for the society that's been created here through the efforts of others. The US is a great enterprise, built from many great and small enterprises, and a marvel in itself.

Nil desperandum. I'm in my sixties and was politically aware by the time homosexuality between consenting adults was decriminalised. So much social progress has been made in my lifetime, on sexism and racism as well, that the dying gasp of the old world that Trump represents can do no permanent harm. The demographic imperative will not be defied.
I've been immersed in politics and government since as young as I can remember. My mother and father recounted countless times to me the story of when they met JFK on a White House tour.

I was 10 when I worked on an initiative campaign. In high school I went to the American Legion Boys State and Boys Nation. There's a famous picture of Bill Clinton while at Boys Nation meeting JFK. Boys State and Boys Nation are summer camps that focus on developing civic minded leaders. I worked as a volunteer for Senator Henry Jackson and later for Senator Warren Magnuson and was employed by 2 city mayors. I grew up being proud of my nation and it's role in WWII and then the Marshall plan when we helped Europe rebuild to building the Interstate Highway System to the Apollo mission. There was a time when Americans were united even though we may hold differences. When discussions were civil and when the future and opportunities seemed bright. You didn't have to be genius or even go to college and you still could count on making a good wage. For America anything was possible regardless of your circumstances. ( That is if you're a white heterosexual male) You would expect a better future for our children.

Well that America has been disappearing for most of the country at an ever accelerated rate. I can't even hold the office of the President with any respect when they're is a lying turd residing there.
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Old Today, 03:55 PM   #2177
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Originally Posted by CapelDodger View Post
No doubt, but Travis did say "anymore". There's a change.


The capitalist model fails in such cases, of course.


You say BC has "attempted to address this" : is it working?
My impression is that it's working based on the metrics they have used to define it. There's room for debate as to whether, for example, a 30% increase in accessibility is 'success'. In other words, if the target was 50%, a 30% increase would represent failure, while also being an improvement.

There are other strategies being employed, such as paying for MD education tuition + living expenses, in exchange for a commitment to practicing in low service areas. (I call that the "Northern Exposure" strategy).


Originally Posted by CapelDodger View Post
Would Travis's mother still have to drive three hours each way to see a GP in BC?
Impossible to say unfortunately. Not enough information, and too many uncertainties.


ETA: I just realized the question may have been more general, as in "Does anybody in BC have to drive 3 hours to see a GP?" - in which case the answer is yes, tens of thousands of British Columbians are still that remote. Technically, though, they probably don't live in 'towns' and probably are not road access, so would not be able to drive anywhere either. Just as an example, I have a relative who lives on an island in the Inside Passage, she is a 6 hour boat sail to the nearest connected road. She'll die in that cabin; she's made her choice.
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Old Today, 04:32 PM   #2178
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Originally Posted by Travis View Post
My mom has a problem. No doctors. She has Medicaid and a private supplement. But there are no family doctors around here anymore. We used to have so many but they've all retired and new doctors are now all specialists. All the existing family doctors are full and are not taking new patients.

As a result my mom has to drive three hours one way to see a doctor in Chowchilla.

This is a trend that started well over a decade ago but has become almost a crisis.
Originally Posted by blutoski View Post
This is probably a downstream effect of population migration. Sounds like your mom may be in a relatively rural environment.
Originally Posted by CapelDodger View Post
It's a problem in the UK as well. "General Practice", and general practitioners, have lost much of the esteem they once had.
CapelDodger is correct. It has less to do with population migration and much, much more to do with the incentives. Specialists get paid a lot more than generalists. Over the last decade or so, there's been a definite shift away from general practice to specialty practice. This actually presents a lot of problems from a clinical side, although that's not really pertinent to this discussion at the moment.

If it were a population shift, you'd expect to see a reduction in bot generalists and specialists. That's not what Travis is identifying.

In more urban areas, there tends to be more generalists available overall, so it's not as obvious as in more rural areas... but the trend is still there. As a country, we have far, far more specialists than is necessary per capita. This is not limited to the US, although it's probably worse in the US because of how doctors are compensated.
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Old Today, 05:03 PM   #2179
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Originally Posted by blutoski View Post
My impression is that it's working based on the metrics they have used to define it.
Sod anybody's self-serving "metrics", does anybody's Mum have to drive three hours each way to see a GP?

Quote:
There's room for debate as to whether, for example, a 30% increase in accessibility is 'success'.
Two hours is no doubt better than three, but not materially so.

Quote:
In other words, if the target was 50%, a 30% increase would represent failure, while also being an improvement.
The failure in question is real, and involves people driving three hours each way to see a GP.

Quote:
There are other strategies being employed, such as paying for MD education tuition + living expenses, in exchange for a commitment to practicing in low service areas. (I call that the "Northern Exposure" strategy).
Do they cumulatively work? Not to perfection, obviously, but have they kept GP's in districts where "supply and demand" would dictate otherwise?

Quote:
ETA: I just realized the question may have been more general, as in "Does anybody in BC have to drive 3 hours to see a GP?" - in which case the answer is yes, tens of thousands of British Columbians are still that remote. Technically, though, they probably don't live in 'towns' and probably are not road access, so would not be able to drive anywhere either. Just as an example, I have a relative who lives on an island in the Inside Passage, she is a 6 hour boat sail to the nearest connected road. She'll die in that cabin; she's made her choice.
There's rural and there there's the British Columbian experience. If only tens of thousands have to drive three hours to a GP it's a result.
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Old Today, 05:05 PM   #2180
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Originally Posted by jimbob View Post
The rules forbidding the government from using its bulk-purchasing power to negotiate the best deals strikes me as utterly insane as well.
It's a ridiculous rule. Want to make a guess who lobbied for that?
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Old Today, 05:13 PM   #2181
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Originally Posted by Emily's Cat View Post
It's a ridiculous rule. Want to make a guess who lobbied for that?
Take a guess who actually put it through....
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Old Today, 05:19 PM   #2182
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Originally Posted by Travis View Post
My mom has a problem. No doctors. She has Medicaid and a private supplement. But there are no family doctors around here anymore. We used to have so many but they've all retired and new doctors are now all specialists. All the existing family doctors are full and are not taking new patients.

As a result my mom has to drive three hours one way to see a doctor in Chowchilla.

This is a trend that started well over a decade ago but has become almost a crisis.
This same problem occurs in countries with NHS also.

Doctors In Canada: Numbers Increase, But Rural Practices Still A Struggle Says Report

Analysis: GP shortages 'crisis' and rural NHS in Wales

And so on...
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Old Today, 05:31 PM   #2183
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Originally Posted by acbytesla View Post
Well that America has been disappearing for most of the country at an ever accelerated rate. I can't even hold the office of the President with any respect when they're is a lying turd residing there.
Nor should you. Any more than you should let the office of President define the US. Trump isn't the first to demean it, he's just the most brazen, and lot of that comes down to opportunity - Twitter, for instance. Who knows how past Presidents might have presented themselves if they had instant access to the internet?

I firmly believe that the Trump phaenomenon represents a last gasp, not a new awakening. It's a failing of the younger generations to have left politics to their parents, but if a wake-up call is required this is it.
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Old Today, 05:38 PM   #2184
CapelDodger
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Originally Posted by jimbob View Post
The rules forbidding the government from using its bulk-purchasing power to negotiate the best deals strikes me as utterly insane as well.
It interferes with the free market, don't ask how exactly, and in some circles that equates with inefficiency.
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Old Today, 05:54 PM   #2185
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Originally Posted by CapelDodger View Post
It interferes with the free market, don't ask how exactly, and in some circles that equates with inefficiency.
It is part of the Private can do it better then Public misbelief that certain people view the world with.

As a result, in their opinion, private insurance can negotiate better rates than can Government run Medicare, and so they banned Medicare from doing so, and forced them to accept the insurance groups to negotiate on their behalf.

Not quite as bad as forcing them to pay full prices with no negotiating power at all, but still very jacked up in you ask me.
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Old Today, 05:56 PM   #2186
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Originally Posted by CapelDodger View Post
It interferes with the free market, don't ask how exactly, and in some circles that equates with inefficiency.
Same BS with unions, using collective public power interferes with the billionaires' ability to grab all the profits for themselves. Corporate monopolies, not so much.
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Old Today, 06:03 PM   #2187
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Originally Posted by CapelDodger View Post
Nor should you. Any more than you should let the office of President define the US. Trump isn't the first to demean it, he's just the most brazen, and lot of that comes down to opportunity - Twitter, for instance. Who knows how past Presidents might have presented themselves if they had instant access to the internet?

I firmly believe that the Trump phaenomenon represents a last gasp, not a new awakening. It's a failing of the younger generations to have left politics to their parents, but if a wake-up call is required this is it.
There are still great people in America but fewer but fewer of them in government. The politicians work for just a select few at the expense of everyone else. We have two corporate parties these days. The GOP and the GOP light.
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Old Today, 06:26 PM   #2188
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Originally Posted by acbytesla View Post
There are still great people in America but fewer but fewer of them in government. The politicians work for just a select few at the expense of everyone else. We have two corporate parties these days. The GOP and the GOP light.
Both of which cut their political teeth in the 60's and 70's. There are undoubtedly still great people in the US, and great social advances have been achieved by non-governmental means in recent decades, but the political system has been shunned. Trump, Clinton, Sanders - it's a gerontocracy.

The generations that grew up with the internet need to grow into their role. Leave it to your parents and look what happens.

You know that the same way I do, I suspect. You just aren't as keen to blame the younger generations.
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Old Today, 06:51 PM   #2189
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Originally Posted by PhantomWolf View Post
It is part of the Private can do it better then Public misbelief that certain people view the world with.
Such people are always with us, but I remember when they took charge again with the Thatcher victory in '79. We got so drunk, and I still remember snatches of that very night.

Quote:
As a result, in their opinion, private insurance can negotiate better rates than can Government run Medicare, and so they banned Medicare from doing so, and forced them to accept the insurance groups to negotiate on their behalf.

Not quite as bad as forcing them to pay full prices with no negotiating power at all, but still very jacked up in you ask me.
Medicare proves the pont that once something is given it's politically uncomfortable to take it away again. The battle against Medicare was lost, and the Obamacare battle after it. There's no replay option.
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Old Today, 07:00 PM   #2190
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Originally Posted by CapelDodger View Post
Both of which cut their political teeth in the 60's and 70's. There are undoubtedly still great people in the US, and great social advances have been achieved by non-governmental means in recent decades, but the political system has been shunned. Trump, Clinton, Sanders - it's a gerontocracy.

The generations that grew up with the internet need to grow into their role. Leave it to your parents and look what happens.

You know that the same way I do, I suspect. You just aren't as keen to blame the younger generations.
Are you kidding? Goodness, I'm not looking for the generation that thinks tweets and snapchats are insightful. Let them stare at their phones, and let the rest of us decide who should lead us.

Oh, wait.... Yeah, maybe you've got a point. Never mind. Let the pipsqueaks decide.
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Old Today, 07:13 PM   #2191
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Originally Posted by CapelDodger View Post
Both of which cut their political teeth in the 60's and 70's. There are undoubtedly still great people in the US, and great social advances have been achieved by non-governmental means in recent decades, but the political system has been shunned. Trump, Clinton, Sanders - it's a gerontocracy.

The generations that grew up with the internet need to grow into their role. Leave it to your parents and look what happens.

You know that the same way I do, I suspect. You just aren't as keen to blame the younger generations.
I only blame them for their lack of involvement. Frankly, I blame my generation. We're supposed to do better for our children.
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Old Today, 07:23 PM   #2192
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Baby boomers are America's worst generation.
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Old Today, 07:25 PM   #2193
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Originally Posted by Tony Stark View Post
Baby boomers are America's worst generation.
As one, I shamefully must agree.
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