Must read....the downfall of Merck

Anonymous

Guest
http://www.nejm.org/doi/full/10.1056/NEJMp1209249

Why invent new drugs when the credibility of the results is questioned. It all started with Vioxx....

A Randomized Study of How Physicians Interpret Research Funding Disclosures

Aaron S. Kesselheim, M.D., J.D., M.P.H., Christopher T. Robertson, Ph.D., J.D.,
Jessica A. Myers, Ph.D., Susannah L. Rose, Ph.D., Victoria Gillet, B.A.,
Kathryn M. Ross, M.B.E., Robert J. Glynn, Ph.D., Steven Joffe, M.D.,
and Jerry Avorn, M.D.
 




http://www.nejm.org/doi/full/10.1056/NEJMp1209249

Why invent new drugs when the credibility of the results is questioned. It all started with Vioxx....

A Randomized Study of How Physicians Interpret Research Funding Disclosures

Aaron S. Kesselheim, M.D., J.D., M.P.H., Christopher T. Robertson, Ph.D., J.D.,
Jessica A. Myers, Ph.D., Susannah L. Rose, Ph.D., Victoria Gillet, B.A.,
Kathryn M. Ross, M.B.E., Robert J. Glynn, Ph.D., Steven Joffe, M.D.,
and Jerry Avorn, M.D.

Merck is not going anywhere...they have more money than God and can keep buying companies until the next ice age...

they don't even care if their snake oils even have clinical benefit these days...

They have learned to game the system, just like President Hopey/Changey has...

Endless amounts of payors, patients, and clinicians to fleece with their marketing ploys...
 








Around the time of vioxx Merck decided that it would be a "marketing" company rather than a "research and development" company. Merck lowered its standards in everything from the science to promotion to the reps it hired. This now is the result.
 




Merck is not going anywhere...they have more money than God and can keep buying companies until the next ice age...

they don't even care if their snake oils even have clinical benefit these days...

They have learned to game the system, just like President Hopey/Changey has...

Endless amounts of payors, patients, and clinicians to fleece with their marketing ploys...

You really should get out more.....

Health Care’s — and Romney’s — Kodak Moment
September 2, 2012
By GoozNews

Every reputable budget analyst recognizes that dealing with the long-term budget deficit depends on holding government health care costs in check. One line in Republican presidential candidate Mitt Romney’s speech last night not only ignored that reality, it posed a direct threat to efforts already underway to return to fiscal sanity.

The threat wasn’t in his repetition of his campaign’s factually challenged claim that the president’s “$716 billion cut to Medicare to finance Obamacare” will hurt today’s seniors, which has been panned by numerous fact-checking organizations. The $716 billion will come from reductions in scheduled payment increases for insurance companies and health care providers – not cuts in services. Its repeal will increase costs for seniors by making them pay more for drugs and preventive services.

Rather, the irresponsible part came when Romney charged that imposing those cuts would “depress innovation – and jobs – in medicine.” When did spending more on health care become innovative? When did pouring a greater share of the economy and the government’s tax take into caring for the sick turn into a jobs program?

This is silly, indeed, dangerous talk that needs to be challenged by every organization that claims to be concerned about the nation’s long-term fiscal health. More health care spending isn’t a solution. It’s the problem.
If it isn’t a problem, why would Romney and his vice presidential pick Paul Ryan even bother to turn Medicare over to private insurers while providing seniors with a capped grant – so-called premium support or a voucher – to buy their plans? If at the same time Romney-Ryan guarantee that health care providers’ revenue stream will stay on the same old upward trajectory to insure jobs and new technology, premium support becomes nothing more than a prescription for either bankrupting future seniors or forcing many of them to forgo “innovative” care they can’t afford.

For decades the nation has defined innovation in health care by the new drugs, new medical devices and fancier imaging, operating and testing machines that come on the market. Companies always charge higher prices for their latest wares even when there is little evidence that they improve outcomes. Other than changing demographics, technological change has become the number one driver of rising health care costs.

It has reached the point where some hospitals and private firms are spending over $100 million to install “proton beam” cyclotrons to deliver radiation treatment for cancer, even though there is zero evidence that these complexes do any better at targeting tumors than the last generation of advanced radiation equipment.

Despite our huge investment in advanced health care technology, improvements in public health have slowed to a crawl. This declining return on investment – a concept you’d think Romney would have learned in business school – is one of the biggest reasons why Americans spends 50 percent more per person on health care than any other country, yet lag sadly behind when it comes to basic measures like longevity and infant mortality.

And despite spending $2.7 trillion on “sick care,” the population is getting sicker. Why? Because technology has no effect on an uncontrolled obesity epidemic that is driving rates of diabetes – the most costly chronic condition – skyward. Obesity is also closely associated with heart disease and cancer, two other expensive chronic conditions that dominate health care spending. True innovation would come from reducing the number of people who get those chronic conditions, not in coming up with ostensibly better ways of treating them.

Researchers from the Wharton School and the Philadelphia Veterans Affairs Medical Center said as much this week in the New England Journal of Medicine. They compared the U.S. health care system to the Eastman Kodak Company, which for a century was the most innovative firm in photography.

The firm failed, they argued, because its managers didn’t realize they weren’t in the film making business. They were in the image making business. When a new way of making images – digital photography – came along, they didn’t adapt and went bankrupt.

“The analogous situation in health care is that whereas doctors and hospitals focus on producing health care, what people really want is health,” they wrote. “Health care is just a means to that end — and an increasingly expensive one. . . In the future, successful doctors, hospitals, and health systems will shift their activities from delivering health services within their walls toward a broader range of approaches that deliver health.”

In other words, the next wave of innovation in health care will come from providers who figure out how to take the level of reimbursement they already receive and deliver better outcomes at lower cost.

Romney likes to talk about competition in health care. But he doesn’t want to talk about what that really means. If he were truly a savvy business leader, Romney would be on the forefront of this coming revolution. But based on what we heard last night, he sounded more like a Kodak middle manager seeking to prop up a dying industry.
 




I enjoyed reading your post and I am a supporter of anyone other than Obama so you know where I stand on political issues. The only concern I have with your entire post is that you assume that every patient is receiving some "technologically advanced" treatment everytime they go to the doctors. This is simply not the case and what will eventually happen, in a free market, is that more and more technology will enter into the marketplace and drive costs down.

Case in point, Cleveland Clinic, which is president quoted as being a pioneer in the healthcare field, and they are, as I used to live 20 minutes from them. Well guess what, they now have robotic nurses that go around the hall ways delivering simple medications and even injections. However, they continue to turn record profits year after year while also giving out free healthcare to the less forutnate and lower income. The Cleveland Clinic continues to excel with this business model and I can guarantee you that they have all of the latest technology.

I believe your point that the latest advances in medicine, on the tech side, have increased healthcare spending quite a bit but not to the levels that you indicated. What it boils down to, healthcare, poverty, unemployment, etc is personal responsibility. You should know this more than anyone, what is the typical demographic when you walk into a doctor's office? Obesity bottom line. People continue to look to others for help when they should look in the mirror and decide that they need to change their lifestyles. Now don't get me wrong, there are people out there with conditions that they can't help but as long as patients continue to look to others for healthcare advice, healthcare providers will continue to make more and more money off of them.

Imagine this country where every citizen worked out regularly, dieted right, didn't smoke or drink, etc doctors would all be out of jobs.
 




Your post about infant mortality is nonsense. Let me guess, you are comparing that to our european neighbors? Well guess what, in the USA when babies are born deceased they are counted as deaths. In Europe if babies are born deceased not all of them count as deaths. If babies are born dead and are premature they are not counted in the numbers. Europe has established a "length" that babies have to meet in order to qualify as deceased. Get your facts straight. If you like it over there so much than why don't you move there.
 




I enjoyed reading your post and I am a supporter of anyone other than Obama so you know where I stand on political issues....
Imagine this country where every citizen worked out regularly, dieted right, didn't smoke or drink, etc doctors would all be out of jobs.

a) Not just technology, even medicines:

http://gooznews.com/?p=3843#more-3843
Healthcare economists focused on a different aspect of the new study, namely, how much each additional year of life is worth. Philipson’s team assumes a value of $150,000 to $360,000.“Are American taxpayers willing to pay $150,000 in added taxes to purchase an added life year for some poor person?” asked health economist Uwe Reinhardt of Princeton University. “Does the urge to cut government spending on Medicare and Medicaid suggest Congress is willing to purchase added life years for anyone who cannot purchase it with his or her own money at a price of $150,000 per year?

http://gooznews.com/?s=statins&paged=2
The latest study on statins and heart disease, which appeared in the New England Journal of Medicine website yesterday and in all the major papers this morning, is worth a second look, not because of what it says about heart disease, which is mildly interesting at best, but because of what it reveals about profit-driven medical research and how it contributes to making the U.S. health care system the most bloated and wasteful in the world.



b) anyone but Obama--so that leaves only Mitt-and what are his policies? The same as we have right now or maybe he will put Romneycare in place? Who knows? He flips every other day. But, the Republican platform is clear-business as usual and no evaluation systems (ie no death panels).

c) every citizen takes care of themself? cannot and will not happen. All those issues that you raise remain as free will choices. Diseases will still set in, yes at lower numbers but cancer doesn't just inflict those who smoke. Your position also doesn't take into account that people will often chose not to acquire insurance to cover their potential liabilities; whether it be health/car/life. So, if no law to 'force/penalize' them, what? BTW: think of the numbers when you have religions preaching that you not use contraception or abortion~who pays for the unwanted children?

the human condition is: there will always be less fortunate people. How we help or don't help them says more about us then it does about them.
 




Your post about infant mortality is nonsense. Let me guess, you are comparing that to our european neighbors? Well guess what, in the USA when babies are born deceased they are counted as deaths. In Europe if babies are born deceased not all of them count as deaths. If babies are born dead and are premature they are not counted in the numbers. Europe has established a "length" that babies have to meet in order to qualify as deceased. Get your facts straight. If you like it over there so much than why don't you move there.

get off your band wagon and stop listening to the Fox News.

BTW:
The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. Many countries, including the United States, Sweden and Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States Centers for Disease Control (CDC) researchers,[10] some other countries differ in these practices. All of the countries named adopted the WHO definitions in the late 1980s or early 1990s,[11] which are used throughout the European Union.[12] However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[10][13][14] The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.[14]

http://en.wikipedia.org/wiki/Infant_mortality_rate

http://www.cdc.gov/nchs/data/databriefs/db23.htm
The main cause of the United States’ high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States.
 




I won't disagree that our healthcare industry isn't bloated or that corporations have a great deal to do with this as politics and profits are becoming one of the same. But I also wouldn't argue that the department of education, the department of energy, the department of agriculture, the department of defense, the 140 welfare programs created under this administration since day one that attempt to tackle poverty rates (I thought that what welfare, WIC, SNAPS, etc were for?), etc. You and I will never know the true number that Americans pay for healthcare out of their own pocket. Fact of the matter is I just recently had blood work done and I am 30 years old. Do you know the last time I had blood work done? When I was 19. I haven't done anything out of the ordinary except workout, eat right, and enjoy alcohol in moderation. Knock on wood I have been in great health. I believe that everyone can achieve this and I do not come from a silver spoon in mouth either.

B) A true leader doesn't bring his or her agenda to the table and say "Take it or leave it" unlike what we have experience with Obama. This could be an entire post all together with what he has done to bypass congress. Romney said it right, I do not have to have an agenda because I want to hear what both sides of the isle have to say and than we can come to an agreement (Let me guess you will say that he took the easy road with this comment)

C) I believe we had a shot up until the last two adminstrations. Now do not get me wrong, government assitance has historically been higher when a republican has been in office. But the state of this country now doesn't allow the mindset of personal accountability or responsibility to set in. I mean you see it on here every day, people that make 150K delivering coffee and bitching about how much work they have to do. This society has become babied. I believe there is hope for everyone to take personal responsibility. As far as controlling costs, forcing people to buy insurance isn't the answer. Simply allow competition for health insurance across state lines and you would put an immediate dent in controlling the cost. It won't solve the problem but it is better than forcing 30 million people to buy insurance.
 




Obama has nothing to do with the innovation at Cleveland Clinic, nor over at Mayo. Given competition and reduced insurance payment these clinics and other will look for ways to be more efficient and keep their top ranking. It's Business 101. It has nothing to do with the government nor any politicians.
 




"Despite our huge investment in advanced health care technology, improvements in public health have slowed to a crawl. This declining return on investment – a concept you’d think Romney would have learned in business school – is one of the biggest reasons why Americans spends 50 percent more per person on health care than any other country, yet lag sadly behind when it comes to basic measures like longevity and infant mortality

This debate will never end with you. The above post was from you bascially saying that spending in the USA on healthcare is through the roof compared to anyother country and it hasn't given us the best results. I wouldn't disagree with you. (By the way I do not put much insight into Wikipedia claims). Bottom line, the USA and Europe have different ways of reporting data and that data is interpreted in many various ways (I also don't prescribe to much that the WHO says). If infant mortality is higher in the USA than that is on the individual and the government shouldn't attempt to curb costs because of individuals that probably have no business giving birth to a child, i.e. drug addicts, welfare receipients, etc are causing it to rise. It is not that the USA has worse healthcare than anyother country, and yes we may spend more on healthcare, but is it fair to assume that the majority of our spending all relates to longevity and infant births? Absolutely not. Do you know how much it cost my wife and I to have our child? 0 dollars because of the hospital system, that is Catholic by the way, and they continue to boost record profits, add divisions year after year, etc.

This entire issue comes back to the individual and them taking responsibility for their own lives. If they do not want to take that responsibility than so be it..

These individuals that fit the model of having high risk pregnacies should be offered an incentive that every year that they do not have children they receive a government check. That would solve the majority of premature births in this country because they shouldn't be having children in the first place.
 




BTW, I would love to know the percentage of premature births that come from illegal immigrants. Guess what they are not counted in the Census' population totals but are counted in our infant mortality rates. I highly doubt Europe has the same issue with illegal immigrants like the USA does well maybe Germany with the influx of Muslims.
 








You really should get out more.....

Health Care’s — and Romney’s — Kodak Moment
September 2, 2012
By GoozNews

Every reputable budget analyst recognizes that dealing with the long-term budget deficit depends on holding government health care costs in check. One line in Republican presidential candidate Mitt Romney’s speech last night not only ignored that reality, it posed a direct threat to efforts already underway to return to fiscal sanity.

The threat wasn’t in his repetition of his campaign’s factually challenged claim that the president’s “$716 billion cut to Medicare to finance Obamacare” will hurt today’s seniors, which has been panned by numerous fact-checking organizations. The $716 billion will come from reductions in scheduled payment increases for insurance companies and health care providers – not cuts in services. Its repeal will increase costs for seniors by making them pay more for drugs and preventive services.

Rather, the irresponsible part came when Romney charged that imposing those cuts would “depress innovation – and jobs – in medicine.” When did spending more on health care become innovative? When did pouring a greater share of the economy and the government’s tax take into caring for the sick turn into a jobs program?

This is silly, indeed, dangerous talk that needs to be challenged by every organization that claims to be concerned about the nation’s long-term fiscal health. More health care spending isn’t a solution. It’s the problem.
If it isn’t a problem, why would Romney and his vice presidential pick Paul Ryan even bother to turn Medicare over to private insurers while providing seniors with a capped grant – so-called premium support or a voucher – to buy their plans? If at the same time Romney-Ryan guarantee that health care providers’ revenue stream will stay on the same old upward trajectory to insure jobs and new technology, premium support becomes nothing more than a prescription for either bankrupting future seniors or forcing many of them to forgo “innovative” care they can’t afford.

For decades the nation has defined innovation in health care by the new drugs, new medical devices and fancier imaging, operating and testing machines that come on the market. Companies always charge higher prices for their latest wares even when there is little evidence that they improve outcomes. Other than changing demographics, technological change has become the number one driver of rising health care costs.

It has reached the point where some hospitals and private firms are spending over $100 million to install “proton beam” cyclotrons to deliver radiation treatment for cancer, even though there is zero evidence that these complexes do any better at targeting tumors than the last generation of advanced radiation equipment.

Despite our huge investment in advanced health care technology, improvements in public health have slowed to a crawl. This declining return on investment – a concept you’d think Romney would have learned in business school – is one of the biggest reasons why Americans spends 50 percent more per person on health care than any other country, yet lag sadly behind when it comes to basic measures like longevity and infant mortality.

And despite spending $2.7 trillion on “sick care,” the population is getting sicker. Why? Because technology has no effect on an uncontrolled obesity epidemic that is driving rates of diabetes – the most costly chronic condition – skyward. Obesity is also closely associated with heart disease and cancer, two other expensive chronic conditions that dominate health care spending. True innovation would come from reducing the number of people who get those chronic conditions, not in coming up with ostensibly better ways of treating them.

Researchers from the Wharton School and the Philadelphia Veterans Affairs Medical Center said as much this week in the New England Journal of Medicine. They compared the U.S. health care system to the Eastman Kodak Company, which for a century was the most innovative firm in photography.

The firm failed, they argued, because its managers didn’t realize they weren’t in the film making business. They were in the image making business. When a new way of making images – digital photography – came along, they didn’t adapt and went bankrupt.

“The analogous situation in health care is that whereas doctors and hospitals focus on producing health care, what people really want is health,” they wrote. “Health care is just a means to that end — and an increasingly expensive one. . . In the future, successful doctors, hospitals, and health systems will shift their activities from delivering health services within their walls toward a broader range of approaches that deliver health.”

In other words, the next wave of innovation in health care will come from providers who figure out how to take the level of reimbursement they already receive and deliver better outcomes at lower cost.

Romney likes to talk about competition in health care. But he doesn’t want to talk about what that really means. If he were truly a savvy business leader, Romney would be on the forefront of this coming revolution. But based on what we heard last night, he sounded more like a Kodak middle manager seeking to prop up a dying industry.

Great Post! Romney, et al, are very naive to assume that Seniors will pay the additional premiums above the "voucher" or "capped grant" (a rose by another name). My parents cannot afford it, period. In fact, remember the "doughnut hole", every year HCPs either switched them to generic drugs or used the PAP for them. So it is very likely that hospitals, physicians, and other healthcare providers (including us) will receive a revenue DROP if the Ryan/Romney plan is adopted.
 




a) Not just technology, even medicines:

http://gooznews.com/?p=3843#more-3843
Healthcare economists focused on a different aspect of the new study, namely, how much each additional year of life is worth. Philipson’s team assumes a value of $150,000 to $360,000.“Are American taxpayers willing to pay $150,000 in added taxes to purchase an added life year for some poor person?” asked health economist Uwe Reinhardt of Princeton University. “Does the urge to cut government spending on Medicare and Medicaid suggest Congress is willing to purchase added life years for anyone who cannot purchase it with his or her own money at a price of $150,000 per year?

http://gooznews.com/?s=statins&paged=2
The latest study on statins and heart disease, which appeared in the New England Journal of Medicine website yesterday and in all the major papers this morning, is worth a second look, not because of what it says about heart disease, which is mildly interesting at best, but because of what it reveals about profit-driven medical research and how it contributes to making the U.S. health care system the most bloated and wasteful in the world.



b) anyone but Obama--so that leaves only Mitt-and what are his policies? The same as we have right now or maybe he will put Romneycare in place? Who knows? He flips every other day. But, the Republican platform is clear-business as usual and no evaluation systems (ie no death panels).

c) every citizen takes care of themself? cannot and will not happen. All those issues that you raise remain as free will choices. Diseases will still set in, yes at lower numbers but cancer doesn't just inflict those who smoke. Your position also doesn't take into account that people will often chose not to acquire insurance to cover their potential liabilities; whether it be health/car/life. So, if no law to 'force/penalize' them, what? BTW: think of the numbers when you have religions preaching that you not use contraception or abortion~who pays for the unwanted children?

the human condition is: there will always be less fortunate people. How we help or don't help them says more about us then it does about them.


Agree with everything you said except B, we have Death Panels NOW! The insurance companies play God everyday, in fact a 17 year old girl died a few years ago because Cigna denied a liver transplant. The profit motive is too strong so they will continue under what ever Romney plans to do.
 




I won't disagree that our healthcare industry isn't bloated or that corporations have a great deal to do with this as politics and profits are becoming one of the same. But I also wouldn't argue that the department of education, the department of energy, the department of agriculture, the department of defense, the 140 welfare programs created under this administration since day one that attempt to tackle poverty rates (I thought that what welfare, WIC, SNAPS, etc were for?), etc. You and I will never know the true number that Americans pay for healthcare out of their own pocket. Fact of the matter is I just recently had blood work done and I am 30 years old. Do you know the last time I had blood work done? When I was 19. I haven't done anything out of the ordinary except workout, eat right, and enjoy alcohol in moderation. Knock on wood I have been in great health. I believe that everyone can achieve this and I do not come from a silver spoon in mouth either.

B) A true leader doesn't bring his or her agenda to the table and say "Take it or leave it" unlike what we have experience with Obama. This could be an entire post all together with what he has done to bypass congress. Romney said it right, I do not have to have an agenda because I want to hear what both sides of the isle have to say and than we can come to an agreement (Let me guess you will say that he took the easy road with this comment)

C) I believe we had a shot up until the last two adminstrations. Now do not get me wrong, government assitance has historically been higher when a republican has been in office. But the state of this country now doesn't allow the mindset of personal accountability or responsibility to set in. I mean you see it on here every day, people that make 150K delivering coffee and bitching about how much work they have to do. This society has become babied. I believe there is hope for everyone to take personal responsibility. As far as controlling costs, forcing people to buy insurance isn't the answer. Simply allow competition for health insurance across state lines and you would put an immediate dent in controlling the cost. It won't solve the problem but it is better than forcing 30 million people to buy insurance.

Romney lied to you, he has an agenda, to get elected by any means necessary so that he can maximize the return on the $100's of millions of dollars Addelson, Rove, Murdoch are spending to get him elected.
 




Great Post! Romney, et al, are very naive to assume that Seniors will pay the additional premiums above the "voucher" or "capped grant" (a rose by another name). My parents cannot afford it, period. In fact, remember the "doughnut hole", every year HCPs either switched them to generic drugs or used the PAP for them. So it is very likely that hospitals, physicians, and other healthcare providers (including us) will receive a revenue DROP if the Ryan/Romney plan is adopted.

And if the Romney/Ryan plan is not adopted? ACA is loaded with policies that will by its very nature drop revenues. It's supposed to be "affordable" afterall....and if you believe that....
 




Great Post! Romney, et al, are very naive to assume that Seniors will pay the additional premiums above the "voucher" or "capped grant" (a rose by another name). My parents cannot afford it, period. In fact, remember the "doughnut hole", every year HCPs either switched them to generic drugs or used the PAP for them. So it is very likely that hospitals, physicians, and other healthcare providers (including us) will receive a revenue DROP if the Ryan/Romney plan is adopted.

The impact of your parents not paying will result in some combination of the following:

They will avail themselves of proactive medicine less frequently. Worsening their health if models of poverty versus health that are well-established for lower income citizens hold true.

They will show up at emergency rooms more often and once they are declared bankrupt, those emergency healthcare fees will be shifted to the state budget deficit. In fact, a large portion of Medicaid payments in the states are related to payments for older retired citizens.

Their health will be worse and they will die sooner than they would have otherwise.

It is appropriate for all healthcare consumers to feel some financial pain from excessive healthcare price increases - including the young and well-insured. But a voucher system without any collective means to pressure providers into doing what is needed to contain costs will not reduce costs and will not provide much value to the elderly, especially those with marginal finacial situations.

Everyone should examine the situation for senior's medical care that started the entire Medicare system 50 years ago. And there is more to society than payments and deficits and profits - regardless of what the absurdly rich capitalists that are going to pull the strings of government desire. When the salaries of healthcare providers are connected to the real value that they deliver, perhaps we can get value based. Perhaps start with the salries of the pharma execs who as far as anyone can tell have ridden this industry into the ground while lining their own pockets.
 




The impact of your parents not paying will result in some combination of the following:

They will avail themselves of proactive medicine less frequently. Worsening their health if models of poverty versus health that are well-established for lower income citizens hold true.

They will show up at emergency rooms more often and once they are declared bankrupt, those emergency healthcare fees will be shifted to the state budget deficit. In fact, a large portion of Medicaid payments in the states are related to payments for older retired citizens.

Their health will be worse and they will die sooner than they would have otherwise.

It is appropriate for all healthcare consumers to feel some financial pain from excessive healthcare price increases - including the young and well-insured. But a voucher system without any collective means to pressure providers into doing what is needed to contain costs will not reduce costs and will not provide much value to the elderly, especially those with marginal finacial situations.

Everyone should examine the situation for senior's medical care that started the entire Medicare system 50 years ago. And there is more to society than payments and deficits and profits - regardless of what the absurdly rich capitalists that are going to pull the strings of government desire. When the salaries of healthcare providers are connected to the real value that they deliver, perhaps we can get value based. Perhaps start with the salries of the pharma execs who as far as anyone can tell have ridden this industry into the ground while lining their own pockets.

It is extremly funny how the insurance companies come under attack. No matter what article you read or left or right wing radio or TV show you subscribe to the fact of the matter is that "big insurance" operates on a 4-6% profit margin while "big tobacco, big alcohol, big pharma operate on 20-50% margin and "combat to commerce" oh I am sorry defense spending both in the private and public section can reach 100-400% margin.

I am almost to the point where I do not want to debate any social issue anymore. I feel guilty when I don't read into all of them. I am almost at a point in my life where I should just vote for the next American Idol, as more do than the presidency, rather than vote for a Romney/Obama ticket...