Remember the old Star Trek shows where money was not an issue? Society was beyond all that. There were replicators and Science was God. Whatever the scientists wanted, they got. No need to beg the government or anyone else for research money. Illness or injury? No big deal. Except of course for some strange virus the Doc would find a cure for in less than an hour.
Well, we are not there yet. Now when we see a story about researchers being on the verge of some new drug that will stop cell degeneration and promise us eternal middle age if not eternal youth it probably means some drug company had to jack up the price of Granny's meds to pay for the research which may or may not pan out. We reach for the stars, nothing wrong with that...but what about what is happening right now?
I am not a demagogue or a partisan and I do believe that the society that the most people feel they have a stake in is the one most likely to succeed. That is why I am concerned at the debate or lack of it when it comes to health care. Democrats blame Republicans for being greedy and Republicans blame Democrats for giving too much to too many who they feel do not deserve it.
In his Jan. 25th article for Newsweek, Robert Samuelson noted something most people are probably oblivious to: We subsidize employer-paid helath insurance by excluding it from income taxes [the 2006 cost to government: an estimated $126 billion]
Below are some depressing numbers:
______________________________________________________________________________________
National Health Expenditures
1960... 1985... 2003
(in billions of current dollars)
Aggregate spending 27... 427... 1,679
Per capita 143.... 1,765... 5,670
(in billions of constant 2003 dollars)*
____________________________________________
Aggregate spending 166... 730... 1,679
Per capita 891... 3,019... 5,670
Share of GDP 5.1%... 10.1%... 15.3%
____________________________________________
Source: National Health Expenditures, Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group; U.S. Department of Commerce, Bureau of Economic Analysis; and U.S. Bureau of the Census
*Adjusted for changes in the Consumer Price Index for all-Urban Consumers, “all items”
The nation’s spending on medical care has been on an unrelenting upward path for a number of decades. In 1960, aggregate health expenditures in the U.S. totaled $27 billion; in 2003, the figure stood at nearly $1.7 trillion — a 63-fold rise. In contrast, the U.S. population grew by only 51 percent. Health expenditures per capita (or per person) rose from $143 in 1960 to $5,670 in 2003 — a 40-fold rise. General inflation pushed up prices of goods and services in the economy by 5-fold. In contrast, the recorded rise in prices for medical care was 12-fold, driven mostly by increases in hospital charges and doctors’ fees.[1] The overall economic dimensions of the growth have been equally impressive, with the share of the economy devoted to health care tripling over the period, rising from approximately 5 percent of gross domestic product (GDP) in 1960 to over 15 percent in 2003.
_____________________________________________________
Inflation and the Rise in Health Care Prices
1960-2003.... 1990-2003
(Percent increase in prices)
Inflation generally
515%..... 41%
Medical care overall 1,232%.... 82%
Medical care services 1,469%.... 88%
Source: Consumer Price Index for All-Urban Consumers, loc. cit.
Consumption of health care by the elderly is larger than for the rest of the population. In 1999, per capita health care spending for the U.S. population as a whole, it was $3,834. For the population under age 65, it was $2,793. For the population age 65 or older, it was $11,089, or nearly four times as high. Even within the aged population, the divergence was significant.
_________________________________________________________________________________________
The above stats are from the ASPE Issue Brief.
When the public rejected the idea of Social Security reform in spite of the obvious problems facing the system, I began to wonder if the American public is dedicated enough to free market economics to face the reality of coming change. I would like to see Republicans embrace a policy of reform, competition and deregulation to help deal with the worsening health care crisis, rather than partisan attacks on Democrats or uselss class warfare.
Perhaps it is time we realized that we can not have everything we want. Perhaps we should work on making the basics of health care more affordable and spend less time thinking about science fiction.
Otherwise we baby boomers might find ourselves facing something akin to Logan's Run. Is your crystal flashing? Is it your time to go to the Carousel?
Update: The National Institute for Pharmaceutical Technology and Education-NIPTE is a collaberation of 11 major universities working to bring down drug prices. At least people are paying attention.
51 comments:
The "problem of the commons" is automatic in a third-party payer arrangement. If the government can't find a way out the mess, we ought to nationalize health-care and cap the costs at no more than 100% of GDP.
buddy:
You are a brave man.
The Democrats say raise taxes [their answer to everything] and the Republicans either deny there is a problem or say it is only a few folks on the fringe. Denial.
interesting:
In 1980 a hospital room was $127 day. A bushel of corn was $3.50.
Today a hospital room in NJ can run up to $5000 a day. I think it is $1800 locally and a bushel of corn is $2.05.
The 'health-savings accounts' plus the huge bureaucratic push to cut administrative costs thru data-efficiency, together, do offer a resistance level at somewhere around something less that a catastrophic percentage of GDP--or so I read in the papers.
fresh air:
I think you are right.
Health savings accounts have not proven to be very helpful to people so far, but it could be that is the way to go in the future.
I think the biggest problem is that the costs have just grown too far too fast.
Although most Americans say the believe in the free market to sort those things out, when it comes to health care, most people feel entitled to pay little or nothing out of pocket. Nothing matches healthcare to bring out the mommy, take care of me feelings in most people. In the mindset of most Americans we feel we should get an endless supply of medical services without seeing the cost of this hit home.
barry:
I agree, but at the same time $20,000 for an appendectomy and two days in the hospital is simply beyond the ability of most people to pay out of pocket.
Maybe the problem is a combination of prices so high we can't pay them and a feeling we should not have to anyway. That leads to a disonnect.
We have lost a sense of reality when it comes to health care.
David:
I said I would like to see a solution that did not entail attacking someone.
This is not about sex change operations, it is not about medicaid, it is not about the Democrats. It is about the escalating costs of health care, which has been rising for decades and is getting to the place where it will be completely out of control if we do not do something to deal with it.
BTW I have a five thousand dollar deductible.
David:
I heard Mort Kondracke and Fred Barnes discuss this one day and Fred said that this was not a crisis. He said it was a problem but that it was overblown. And I like Fred, but that was his perspective. I think a lot of conservatives see it that way. If not where is their program to deal with it, or can it be dealt with?
And you know what? So far you have said it was the fault of sex change operations and people wanting something for nothing. This is one of the leading causes of bankruptcy in the US, this is not just about boob jobs and insurance companies.
Wonder what a pie-charted 1960 health-dollar would look like, next to the same from 2005? Categories to include end-users only; end-use being personal-consumption.
Terrye,
Excellent post.
We do have a big problem in this country and it's only been getting worse in the last five years.
The article you quoted says the problem is mostly due to rising doctors' fees and hospital administration costs. I also hear that the problem is due to: greedy lawyers, greedy insurance companies, and greedy drug companies. I don't know what the truth is. I do know that all that money we're spending has to be going somewhere.
I had a friend who was both a doctor and a lawyer. He claimed the doctors had become too greedy. I used to be a premed. I had several friends who went on to become doctors and who managed to essentially retire by age 45. They made so much money before then that it was no longer necessary for them to work after that point. That seems reasonable to them. I don't know, but if I were dictator I would set things up so that everybody had to produce during their working lives, not just those stuck in the lower-paying jobs.
There is no doubt in my mind that we have a big health-care crisis and a big social security crisis and that we as a nation are in denial. Contrary to the constant anti-Bush hatred we hear, I think Bush is closer in fact to the classical Democratic position than either his detractors or his Republican supporters would like to admit. The Democrats have moved way off toward complete socialism, while the Republicans have the fantasy they can eventually get rid of the government entirely. They can't. I have no doubt that both of our crises will have to be solved by governmental action, but neither the mainstream Democrats nor the libertarian Republicans sniping from the sidelines are helping us at all on this, so I guess the country will have to wait another generation before we start to wake up to the problems.
IOW, who-all spends--or can spend--your health-care dollar (spent by you or your proxy) at the grocery store?
MHA:
There is no way government can carry all these costs. In fact in the not too distant future we will be doing well to keep up the status quo.
I feel bad saying this, but I have wondered about the money Doctors make too. My brother took me around to see some of the doctor's homes he built, and my God they were mansions.
Back when I was a kid {I know I know} doctors did well. But they are basically upper middle class. Today they are in the very top level of income earners. Maybe it was the speicialization or the idea that they deserved it because their costs were so high, but they are definitely making a lot more money than they used to.
I had a friend who became a doctor and paid off her loans in three years, in another three years she had a new home and a portfolio. By the time she was 50, she was wealthy. We don't see much of each other anymore. I am not quite in her class.
In 1980 a hospital room was $127 day. A bushel of corn was $3.50.
Today a hospital room in NJ can run up to $5000 a day.
There is an escalation of facilities going on. I spent some time the hospital back in the 50's, and there were four beds to a room with curtains that could be drawn. Now, everyone gets a private room, or maybe two beds in a room. Old hospitals have been torn down and replaced with upscale versions, there has been a steady drift to the high end of the market.
The same is true of housing in the suburbs. Around here there are old homes, maybe 1200-1400 sq. ft., and folks raised up families of 4-6 in them. Of course, the kids shared rooms and probably beds and there weren't three bathrooms. Our whole idea of personal space has expanded and has assumed greater importance. We could do much more with less if we were willing to compromise on some of the modern luxuries, but we seem incapable of prioritizing things these days.
I feel bad saying this, but I have wondered about the money Doctors make too. My brother took me around to see some of the doctor's homes he built, and my God they were mansions.
That's a good point too. I think that the supply of doctors is artificially constrained through school accreditation and admissions limitations. To some extent nurse practitioners are an attempt to get around that and I think that general idea should be extended. And whatever happened to midwives? I can see having a hospital nearby for speedy treatment of complications, but I don't think every birth needs to take place in a full up hospital environment.
chuck:
I think housing prices are outrageous.
I had a real estate license and this not exactly a booming area but even here I had trouble getting young people to buy within their means.
I was helping a lady clean out an old house and we found some old hospital bills. They were from 1950 or so. If I remember correctly the bill was for an appendectomy and a week in the hospital and it was around $200. I am sure it was not a private room. Of course back then hospitals would keep a woman for a week when she had a baby, now they get them out the door asap.
In this area it is about 1500 to 1800. Still a lot. That is why people do so many outpatient surgeries.
chuck:
I don't even know a midwife. I think liability has a lot to do with that.
In a small town to the south of me the locals sent a young man to med school with the promise that he would practice locally for a number of years.
We call the local doctor here the witch doctor. Don't ask.
chuck,
Nurse-midwives still exist and I can assure you are legal and thriving right there in Utah. My second son was born right in LDS hospital in Salt Lake with a nurse midwife presiding and he is a gem!
Some rough (but close) numbers for your use:
Total US health expenditures - $1,557B
Per Capita - $5,460
Docters Income as % of total expend. - 9%-12% (170K - 220K Avg)
Total Malpractice Claims Paid - $39B
Total Paid As A % of Total Expend - 3%
Total number of licensed physicians - 835K
Total MD's awarded last reported year - 15K
Total RN degrees awarded last year - 31K
Total LLB/JD awarded - 39K
Total attorney's income reported - Reported? - Sue me.
I know it's dumb to say, but a vision of utopia might be USA '50s without the prejudices that created the reaction that threw so much of the baby out with the bathwater.
Take me back to Mayberry! Hell, I'll even be Barney Fife, I don't care. Everything ya need is right there in Mayberry, and all these globalized pricing structures just ain't found the way there yet.
I'm looking at these numbers;
National Health Expenditures
1960... 1985... 2003
(in billions of current dollars)
Aggregate spending 27... 427... 1,679
Per capita 143.... 1,765... 5,670
(in billions of constant 2003 dollars)
and wondering what, exactly, we have received in return for this huge additional expenditure on healthcare.
I guess the first step in coming up with a solution to the problem is coming up with a definition of what the problem is.
Is there some average life expectancy number which we are chasing after, for example?
Assuming the health care problem is "fixed" tomorrow, what measurements will let us know it is fixed? This is mostly a question for terrye, but anyone else can join in.
Total MD's awarded last reported year - 15K
Total RN degrees awarded last year - 31K
Looks to me like there aren't nearly enough nurses relative to doctors, I mean, someone has to do all the work of actually caring for the patients.
Let's see, 835K doctors is about 1 per 320 persons, which doesn't seem all that bad, but it doesn't seem quite right either. At 15K doctors/year that is about 55 years worth of doctors. Do your figures include dentists and such?
Chuck,
Nope - MD's only. How many don't actually go into practice isn't mentioned nor did I dig up the average time spent in further training prior to actual practice.
PeterUK,
I expect that the extension of life expectancy from the 50's up to the 80's also comes at a cost, we older folks get more expensive year by year. Not that I am complaining, mind you, but it does cost and we older farts start to need naptime and all, so we aren't as productive as hardy youngsters old enough to have some experience.
On the other hand, a place like Germany or France where many retire before 55 (numbers?) is just asking for trouble.
If an MD's career is 40 yrs, at 15k/835k we're replacing a 55th of the profession every year, while losing 21k to retirement. Wonder what 25% more new MDs would do to the economics?
Now, *there's* a good gov't program for ya--Uncle Sam buys you the degree, and you work where he sends you, for a set compensation, for a set number of years, in return.
Horrors! Indentured servitude!
Seneca's new find has two great comments on this topic (near bottom): "Is Government Divine?" and "Pity the Poor Hospital Owner".
Terrye
Sorry I wasn't able to respond sooner, but I understand and agree with your addition to what I said. Part of the large cost is due to people not literally feeling the connection between the service and their wallet. The high deductible might be a way some folks would have to pay for more of the routine procedures and that might lead more people to take better care of themselves in the first place.
The increase in cost is partly doctors' salaries, but I've met physcians who are not making what people think doctors make. Specialists make a tremendous amount of money, but pediatricans often don't make outrageous salaries but do a lot of heavy lifting in the healthcare industry.
Part of the increase in cost is due to care in the last 6 months of life which is incredibly expensive. Part is due to the pharmaceuticals. Part is due to procedures being available for things that never were before (treatments for balding, plastic surgery, etc.). Part is due to trials lawyers and the need to practice "defensive" medicine. Part is due to lifestyle choices of people, e.g., there are far too many cases of diabetes that are basically self inflicted wounds. I don't think there is a silver bullet cause, except for the development of technology which allows the wonder procedures but also makes it easier to sue (by enabling the more elaborate distribution of information of all sorts) and makes it easier to sit on the couch and pig out. National health care will lead to waiting lines and people will tolerate that at Micky Ds but not M.D.s Also it won't lead to better medicine.
There is a disconnect, as you said. We want to live forever in youthful vigor and we want it to come at virtually no cost. Solutions to problems involve trade offs or advantages/disadvantages. We are so wealthy and powerful, I think that too often we can "forget" that there are "costs" to our way of life. Eternal vigilance is the price of liberty. Actually I have a book coming out later this year that touches upon this theme in various areas of American life.
Barry,
Au contraire, I believe that people can and will put up with queues for the doctors, provided they believe that everybody is getting the same treatment. That's where we're headed, whether we elect Hillary to sock it to us in two years, or whether we wait another 10 years or so.
After that at some point there will be a story about how the Republican congressmen are opting out of national health and sending their children to private medical care. There will be great outrage, a vast public hue and cry, and the fact that the Democratic congressmen are doing exactly the same thing will be ignored, because they care about the "little people" in flyover country while the Republicans are heartless. By definition.
I don't even wish to weigh in on this. There's a lot of blame the victim mentality going on. All I will say is that it has gone beyond crisis and has become a disaster for many.
Well... why don't drug costs come down over time?
There is supposed to be a learning curve in economics. In other words after awhile prices come down on a product. This does not happen with a lot of meds. They just get higher and higher.
I think the drug companies deliberately keep the patents alive by tinkering with the meds so that they can maximize their profits and use that money to make new drugs. It is a cycle that keeps drug prices inflated.
Buddy & Peter,
I can't think of any government entitlement program that has been eliminated in a democracy. Once the electorate transfers theoretical responsibility for a "problem" to the government they have created eternal life.
Medical care and "social (in)security" are headed towards means testing (where they should have been since inception) but getting there is going have a political cost that politicians will turn away from with great resolution until their socks are in flames.
A capped means tested program would resolve both issues in an economic sense but are simply not feasible in a democracy where the ability to think is not a prerequisite for suffrage. A (un)significant plurality always has the imagination to concoct scenarios where output is unrelated to input and can always find a subset of pols willing to promise to extract additional input from "them".
Something for nothing and passing the buck are the heart of democracy (with open suffrage), we may not have bought a ticket but we're definitely along for the ride.
My bet is that we are at least ten years from imposition of means testing in the US. I'd bet on bottom of the next harsh recession but the valleys seem to be smoothing out over time.
But you Brits have not perfected the illusion of entitlement that allows a voter to feel that he should receive 100% of a service, the value toward which he has contributed only 40%. That's the trick - sell it as "insurance" or an "annuity" and charge the masses a fraction of the cost while promising that "they" (those evil "others") will be wrung out like a wet dish towel to provide the balance.
It really works well politically (as you know).
Until...
PS How on earth is one to assure oneself of an unending supply of clients if one does not promote illegitimacy?
Rick
You are brutal. You seem to hate the recipients of social security and medicaire. Please. Get a clue. Social Security has been in existence for the entire lives of most Americans. One doesn't even think about it. It's just there.
Ah! But people should just KNOW that they are demanding something for nothing. How? Money has been taken out of their paychecks forever, it barely registers in their consciousness. Where were you 40 years ago educating the masses about it? Huh?
Ah! I know the answer to that. The Democrats were in power so your message couldn't get through. That's understandable. But it doesn't make it the recipients fault.
And constantly blaming the people for being stupid and selfish does nothing to advance solutions.
Syl,
Means testing implies hatred? Where?
There is a percentage of the population that cannot care for themselves (for whatever reason). Applying societal resources to care for them appears to me to be a moral duty unworthy of discussion. It just is, as the those unable to care for themselves just are.
I have to leave now but I'll return with a longer response later.
Rick
I have nothing against means testing. I disagree with the characterization of Americans trying to get something for nothing...as if they know that's what they're doing.
I see we still don't have a grip on why costs are so high. Or even if they *are* high relative to services rendered.
In that regard, I recall paying someone's bill at the hospital counter and noticing the charge for a box of kleenex: $10. And that was some 20 years ago. Clearly something wasn't quite right even then, and don't get me started on hospital food.
meaninglesshotair,
I'm hoping that our different understandings of what we will and won't put up with aren't submitted to an empirical test, but it might be (i.e., I don't want socialized medicine as the experiment to test our different predictions). I don't think that Americans, on the whole, will put up with long waits for routine procedures, but I could be wrong. I think Americans prize liberty more than our neighbors to the North or the Euros.
Yet, the amount of GDP that healthcare consumes is going to result in some kind of changes to the system at some point, even if we kick the can down the road for a while longer. I don't think Americans, on the whole, are aware of the entitlement feelings that I described in earlier comments. I think it is extraordinarily difficult for anyone to receive something valuable (like healthcare) which is paid for indirectly (for the most part) and to not feel somewhat entitled to receive it. I think that is human nature. The Canadians and Euros feel entitled to free healthcare, only they do not seem to value liberty to the same degree that Americans do, so they wait or ignore the fact that they have shortages that inevitably accompany anything that is rationed. In that situation equality means some misery for everyone.
Many people don't understand that the health insurance actually means a lower wage than they otherwise would receive, as they don't receive it in the first place. And our educational system does not do a very good job of explaining the nuts and bolts of social security and healthcare.
you can start working 80-100 hours per week for the princely sum of $32,000.
I think the whole internship thing is more like hazing, or an initiation rite, than education. If there are too few doctors to lower the hours, then supply more doctors (sounds simple, I know).
I would also say that many folks in technical/scientific fields work just as hard for just as long, or longer. Some of the technical people may do better than $48K at age 32, some worse, but however you look at it, it is not that bad a salary.
Knucklehead,
One way the demand for more doctors is attempting to be met is to have many functions traditionally undertaken only by MDs be done by other personnel, such as nurses, physician's assistants, etc. In my profession of psychology, the American Psychological Association has been lobbying for years (and is now winning) prescription privileges for psychologists (something I'm against but I'll be on the losing side of that and that's another story). I also suspect we'll do some outsourcing of things that can be done via internet (e.g., reading Xrays by Indian MDs, etc.). Whether this will work is another thing altogether.
The Average Bear does not undergo 4 years of rigorous undergruate school + four years of even more rigorous graduate school for the prospect of making $32K/year...
I was making a comparison to folks in the sciences, not engineering. Someone headed for a research position will be doing just as much work, academic and in the lab, while spending a number of years as post-docs with salaries in the 30K-40K range. Then again, their graduate education will usually be financed by working as a TA or through employment by professors who have grants, so they will not be greatly in debt but will only have suffered from deferred earnings -- more so than the physicians as their professional salaries are likely to be less.
Knucklehead:
How much does a fireman make for running into a burning building? I work in health care and I know plenty of doctors who are not struggling.
I live in a small town and doctors here are not that rich either, but then again there are very few doctors in places like this.
They would rather be specialists and live in a place where they can make enough money that someone like my brother can build them a seven car garage to go with the mansion he just built them in the gated community where they live with other highly paid professionals.
And as for the pregnant woman being delivered whether or not she has money...would you prefer she be turned out to have the baby in the parking lot?
I mean really. This is the kind of attitude that pisses me off. If that woman had wanted an abortion eight months earlier conservatives would have been right there doing everything they could do to stop it.
But hey, once labor starts she and the kid are on their own.
I have a client who was an exercise freak. He worked hard and was a middle class guy. Then he had an accident on a mountain bike. He ended up a quad and on medicaid. It was not his plan. He did not want something for nothing.
The problem with the high costs is not just that people on medicaid get help, it is that the high costs are responsible for people being on medicaid in the first place. Their insurance and other resources only go so far.
Knuck and Terrye,
I think you should both go back and reread what the other has posted. From where I sit it looks like you both are misreading the other and being a bit touchy.
And now I will shut my mouth and go feed the cats.
"I disagree with the characterization of Americans trying to get something for nothing...as if they know that's what they're doing."
The two greatest political frauds committed in this country were whooped through Congress by the same generation and the same party. I've never written about the "Greatest Generation" as such and I never shall. I can't even see it written without laughing. The plea of ignorance that you enter on behalf of those guilty is probably at least partially true but the pols who wrote and proposed Social Security and Medicare knew precisely what they were doing and they played on the ignorance of the electorate as skillfully as if they were concert pianists playing Chopsticks.
If you think me cynical, what do you think of the greasy pols who concocted the Ponzi schemes in the first place and sold them based upon the known ignorance of the electorate? I'm reasonably evenhanded in my condemnation of the phonies and hustlers we pay for governance. I wish I had a 'rent a backbone' concession on Capital Hill but I fear that if I had, I would be bankrupt within a year due to lack of trade. On a need basis a years income would set me up for life.
The people get the government they want - and the government that they deserve. The "health care crisis" has been ongoing since the day medicare passed (over the vociferous objections of the AMA).
The villains in this low drama/farce are not doctors or attorneys (mebbe insurers should get handlebar mustaches) but the main villain is - as you pointed out - the ignorance and gullibility of the electorate. Good hearted, perhaps, but not a group whose decisions provide a positive advertisement for democracy.
Remember, government is about what and how much, and almost by definition no two people will ever agree, and idealists and realists look to each other like they have fish heads. There IS away, however, to come to a complete agreement:
knucklehead:
My point is that for some people the only options are to give care or refuse it because its cost is so high they can not pay.
I mentioned pregnant women because you did.
The truth is this economy requires that many people not make a lot of money. I am not a socialist but I understand that cheap labor and low paying jobs help make the economy run and it is just a fact that people like that will not make enough money to afford high price health care.
My point about firemen is that not everything is about money. Once upon a time doctors did house calls and they absorbed a lot of costs. First do no harm. Now it is a lot more about money.
Once upon a time doctors did house calls
I knew (well, my best friend at the time had cats who were his patients) a vet who was the last known vet in America to make housecalls.
He died thirty years ago.
He wrote a wonderful book called:
All My Patients are Under the Bed
Probably out of print.
And probably neither here nor there. Except that vet costs are going sky high too while health insurance for pets is still a novelty.
So there's something going on independent of our insurance system don't you think?
rick
In a perfect world everyone would know everything and have prescience about all consequences. Read my lips. Social Security has been with us since before most of us were born. We don't even think about it.
It's not that the electorate was blocking govt from changing it, nobody told us until recently it was a ponzi scheme and my god has to be changed. Nobody told us DISASTER COMING DANGER DANGER. And I guess some folks think the soc sec meltdown is akin to overpopulation fears, global warming, and power lines causing cancer.
I'm sure those who implemented it didn't believe it was a bad idea.
the ignorance and gullibility of the electorate. Good hearted, perhaps, but not a group whose decisions provide a positive advertisement for democracy.
Good grief. Do you have any idea how elitist this sounds?
I have news for you. Democracy is for poor as well as rich, stupid as well as smart, doers as well as slackers.
A worthwhile mission to pursue is education. But pointing out cynically how pathetically ignorant everyone else is isn't going to help.
health co-ops--wow--has the ring of truth about it--a mixed entity with distributed ownership and resposibility. really does sound like an idea for rural counties.
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