Originally Posted by The Wonkette

There has been a lot of discussion about contraception, religion, and such in the Election 2012 thread. The New Republic had a long article about the clash between Catholic doctrine and health care, as it applies to the many Catholic hospitals. I'm posting this article in full, because you have to subscribe to the New Republic in order to access the full article. Disclaimer -- I am pro-choice, although I feel abortion should be restricted (not abolished, but restricted) in the 3rd trimester.


[/I]

that is a very inconsistent attitude. Why?

Originally Posted by Lady Vagina

that is a very inconsistent attitude. Why?

Because there is a big difference in my mind between a 6-10-week embryo (which is the stage when most abortions occur) and a 32-week fetus. The requirements for aborting a near-term fetus should be much more stringent. In my opinion, it should include a significant health risk to the mother or a severe fetal abnormality. The requirements for aborting an embryo in the first trimester should only be the desire of the mother to terminate the pregnancy.

Originally Posted by The Rani

Surely you jest!
The struggle between private/public interests exists in every aspect of our society.
Including many which affect our health ... factory farming, natural gas drilling, the tobacco industry, etc etc.

Not jesting. I have received many medical bills that are marked down by the Insurance Co to ~10% of original 'price'. I really have never seen such discounts anywhere else. It appears to me that there is little or no correlation between cost and price in the medical industry.

Here's an interesting point of view:

http://www.latimes.com/health/la-na-...,6657163.story

Reporting from Washington—

Mary Brown, a 56-year-old Florida woman who owned a small auto repair shop but had no health insurance, became the lead plaintiff challenging President Obama's healthcare law because she was passionate about the issue.

Brown "doesn't have insurance. She doesn't want to pay for it. And she doesn't want the government to tell her she has to have it," said Karen Harned, a lawyer for the National Federation of Independent Business. Brown is a plaintiff in the federation's case, which the Supreme Court plans to hear later this month.

But they're collecting unemployment.

Originally Posted by The Rani

As Deb and I both noted, it's not a "discount."
Health care providers know that different insurance companies cover different percentages of charges, and they set their fee scales accordingly.
In that sense, one might argue that insurance companies are the ones driving up the costs.
Medicare is one of the worst offenders.

Still looks like nonsense to me.

Originally Posted by JDG 66

http://www.humanevents.com/article.php?id=50081

...In the course of a few minutes, Sebelius – who will become one of the most powerful officials on Earth, once ObamaCare is fully up and running - concedes that ObamaCare’s funding mechanisms are collapsing, its costs are ballooning out of control, and it has driven the cost of insurance for American families up instead of reducing them, and she has absolutely no idea what it’s going to do to the federal budget deficit...

Putting aside the Senator laying out a set of bizarre numbers never confirmed by Sebelius outside of having to play nice with the wind bag (you obviously haven't experienced one of these committee hearings), his complaints come down to two: the old bug-a-boo hysteria of adding to the federal deficits; and transitory exemptions to large businesses (e.g., McDonalds, Wal-Mart) given that the full program that makes sense for them and their employees will not be in place until 2014.

All that needs to happen is for Obama to win this November's election and the exemptions go away as an argument within a year - no one will even remember them by 2016 when t-baggers are carrying signs, "Keep the Socialist Govt's Hands off My Obamacare!!!"

So what we are left with, what we are always left with, is the Right's fetish/hysteria/fear mongering bug-a-boo of federal deficits.

The Affordable Care Act was past two years ago; in that time, no one's tax rates have gone up. They have actually gone down with the payroll tax cuts.

There are plenty of issues we as a nation need to wrestle with regarding our health care systems. One of the biggest problems in moving forward with that dialogue is that about half the country, like your Senator, are stuck in adolescence and not capable of engaging in an adult conversation on the matter.

Originally Posted by The Rani

...
In that sense, one might argue that insurance companies are the ones driving up the costs.
Medicare is one of the worst offenders.

That assertion seems to be a bit odd when juxtaposed with the quote from your reference -

...Government, on the other hand, is the gorilla at the table. For the most part, it can dictate the amount it is willing to pay for a given service or procedure. Hospitals can take it or leave it. Most have to grudgingly accept government reimbursement rates ...

As a result, hospitals and clinics see low and even negative margins for Medicare and Medicaid patients. A survey by the American Hospital Association found that two-thirds of all responding hospitals lost money on Medicare and Medicaid services in 2004. AHA calculated that Medicare and Medicaid underpaid hospital claims by $25 billion on a cost basis in 2005, up dramatically from just $4 billion in 2000.

I can understand using this to support an assertion of "cost shifting," however, most studies indicate the shift is to private insurers not to the uninsured. Most providers are pretty willing in most cases to negotiate prices (or, more likely, after-the-fact billing) with the uninsured for effective rates substantially less that what is billed to private insurance companies - it's simple a matter of "follow the money" and its pretty well-recognized that the path with the uninsured is usually a quick dead end.

Obviously, that all goes away with single-payer, but that doesn't necessarily resolve the underlying issues your reference mentions of shortage of doctors and nurses. More so the issues that your reference doesn't mention that those shortages do not exist in affluent communities nor the "problem" that health care providers have very strong expectations in this country for highly affluent compensation far exceeding those in other countries (i.e. some believe you all are greedy bastards). However, I believe, single payer would get to those issue quicker than a New York minute.

Then there is this reference of yours -

A 2005 article in the journal Health Affairs noted, “Although largely unintended, Medicare's payment systems have benefited specialized, procedure-oriented care,” such as oncology and cardiac surgery.
But as the saying goes, you get what you pay for: In this case, reimbursement policies have been a central architect of any medical arms race taking place today, encouraging investment in new, intensive and expensive kinds of treatment.

- which has been pretty much discredited as being, at a minimum, a misdirection. Fairly simple to understand when one remembers that Medicare (as well as Medicaid) is about old people where there might just be a little bit more problems with cancer and heart attacks than say healthy 18 year old high school graduates and unlikely much pre-natal or maternity care for grandma.

It has been clearly shown that the majority of the nation's medical costs are with those of a certain age. And the majority of those costs are undertaken in the last two years of life. To attribute that to financial mechanisms like Medicare rather than to the reality of a combination of the basic facts of life (age, sickness and death) and a societal choice to take care of our elderly is, as mentioned, at best, a misdirection of the real issues.

Originally Posted by playwrite

That assertion seems to be a bit odd when juxtaposed with the quote from your reference -





I can understand using this to support an assertion of "cost shifting," however, most studies indicate the shift is to private insurers not to the uninsured. Most providers are pretty willing in most cases to negotiate prices (or, more likely, after-the-fact billing) with the uninsured for effective rates substantially less that what is billed to private insurance companies - it's simple a matter of "follow the money" and its pretty well-recognized that the path with the uninsured is usually a quick dead end.

Obviously, that all goes away with single-payer, but that doesn't necessarily resolve the underlying issues your reference mentions of shortage of doctors and nurses. More so the issues that your reference doesn't mention that those shortages do not exist in affluent communities nor the "problem" that health care providers have very strong expectations in this country for highly affluent compensation far exceeding those in other countries (i.e. some believe you all are greedy bastards). However, I believe, single payer would get to those issue quicker than a New York minute.

Then there is this reference of yours -



- which has been pretty much discredited as being, at a minimum, a misdirection. Fairly simple to understand when one remembers that Medicare (as well as Medicaid) is about old people where there might just be a little bit more problems with cancer and heart attacks than say healthy 18 year old high school graduates and unlikely much pre-natal or maternity care for grandma.

It has been clearly shown that the majority of the nation's medical costs are with those of a certain age. And the majority of those costs are undertaken in the last two years of life. To attribute that to financial mechanisms like Medicare rather than to the reality of a combination of the basic facts of life (age, sickness and death) and a societal choice to take care of our elderly is, as mentioned, at best, a misdirection of the real issues.

There may be more work behind the scenes than envisioned.
But it is clearly a wild card as to whether we ever will really get Single Payer Health Care in this country. The big insurers I'm sure are going to fight it to the last wire. The mandatory health insurance clause of Obamacare as it is commonly now called, is coming up for SCOTUS review soon. If that is struck down, will that mean that laws in almost every state require drivers to carry auto insurance may get struck down eventually as well?

Rant time!

It's been about two years since I went against my better judgment and purchased health insurance. After a lot of comparison shopping in a small cartel of companies offering virtually the same product, the premiums are near $200 a month and so far pretty much nothing has been covered.

First, the insurance agent kept harassing me to get a physical and bloodwork panel done. I guess they wanted to make sure they're not accidentally insuring a sick person. This is one of those $5 chem kits TNT was talking about, and the insurer promised that it would be completely covered.

Nope. I get a bill for almost $150 from the doctor because I had a sniffle when I went in and she decided to prescribe some antibiotics I never filled (why does everyone want antibiotics for a cold?!?). The blood panels were in a perfect range, and even though that was the only time I visited the doctor in that year, they still found it fit to raise my premium by about 12% after 8 months.

Fast forward a bit and move to North Carolina. Forced to get a new policy, so spend another few weeks comparison shopping for the 5% differences among the same few companies. Five and a half months later, I chip a tooth. Head to the dentist recommended by my insurer, they assure me that the basic procedure is covered at the agreed upon rate, and I pay the 30% remainder. The next time I go in for my first cleaning, they tell me I owe the other 70% because my insurer said I'm in a six-month waiting period.

Even better: since they couldn't bill the insurer for the chipped tooth, they threw an "exam" on the bill for $100 and now I can't get my first cleaning until six months from then - or 11 1/2 months from starting the policy. (The "exam" was incidental to the $250 reconstruction procedure, and the total $350 they billed is significantly higher than typical cash prices).

Basically, in two years I've shelled out about $4000 in premiums, and still paid out of pocket at the cash price for $400 in services (that are theoretically covered until you read all the fine print). Any part that the insurers covered was tacked on by the health care provider - because they needed to find something they could bill to them.

The $400 in services is actually a $5 blood test kit, $10 of resin, 10 minutes with a distracted doctor, and 20 minutes of a dentist's actual time and focus. Oh, and about 6-7 hours of sitting in waiting rooms.

Now in two years, this plan that covers preventative & catastrophic care won't be good enough, and I'm looking at being forced in to a deal with a $350-400 monthly premium. Can you hear my excitement?

A 2005 article in the journal Health Affairs noted, “Although largely unintended, Medicare's payment systems have benefited specialized, procedure-oriented care,” such as oncology and cardiac surgery.

But as the saying goes, you get what you pay for: In this case, reimbursement policies have been a central architect of any medical arms race taking place today, encouraging investment in new, intensive and expensive kinds of treatment.

Actually, Rani, as you no doubt know, the above is oversimplificaiton. As you know, when a person is admitted to a hospital (Part A Medicare) the bill is usually paid on the basis of "DRG's" or Diagnosis Related Groups. So ... if a person gets an appendix removed, the hospital gets the Appendix Removal payment. No more, no less. It doesn't matter whether the patient got well fast or slow, the payment is the same.

Now, the outpatient or Part B Medicare is a WHOLE DIFFERENT KETTLE OF FISH!! There, providers get to bill on the basis of procedures (CPT codes), and do so innovatively and with enthusiasm! Part B also applies to a lot of the procedures run in Emergency Rooms since certain conditions have to apply for a patient to be considered NOT an outpatient any more, but an inpatient instead.

Ultimately, behind the curtains, there are all kinds of folks looking for loopholes and inventive ways to bill both A and B. And of course there are other allowances and things like capital expenditure reimbursements that add to hospitals' revenue from Medicare.

Originally Posted by JohnMc82

Rant time!

It's been about two years since I went against my better judgment and purchased health insurance. After a lot of comparison shopping in a small cartel of companies offering virtually the same product, the premiums are near $200 a month and so far pretty much nothing has been covered.

First, the insurance agent kept harassing me to get a physical and bloodwork panel done. I guess they wanted to make sure they're not accidentally insuring a sick person. This is one of those $5 chem kits TNT was talking about, and the insurer promised that it would be completely covered.

Nope. I get a bill for almost $150 from the doctor because I had a sniffle when I went in and she decided to prescribe some antibiotics I never filled (why does everyone want antibiotics for a cold?!?). The blood panels were in a perfect range, and even though that was the only time I visited the doctor in that year, they still found it fit to raise my premium by about 12% after 8 months.

Fast forward a bit and move to North Carolina. Forced to get a new policy, so spend another few weeks comparison shopping for the 5% differences among the same few companies. Five and a half months later, I chip a tooth. Head to the dentist recommended by my insurer, they assure me that the basic procedure is covered at the agreed upon rate, and I pay the 30% remainder. The next time I go in for my first cleaning, they tell me I owe the other 70% because my insurer said I'm in a six-month waiting period.

Even better: since they couldn't bill the insurer for the chipped tooth, they threw an "exam" on the bill for $100 and now I can't get my first cleaning until six months from then - or 11 1/2 months from starting the policy. (The "exam" was incidental to the $250 reconstruction procedure, and the total $350 they billed is significantly higher than typical cash prices).

Basically, in two years I've shelled out about $4000 in premiums, and still paid out of pocket at the cash price for $400 in services (that are theoretically covered until you read all the fine print). Any part that the insurers covered was tacked on by the health care provider - because they needed to find something they could bill to them.

The $400 in services is actually a $5 blood test kit, $10 of resin, 10 minutes with a distracted doctor, and 20 minutes of a dentist's actual time and focus. Oh, and about 6-7 hours of sitting in waiting rooms.

Now in two years, this plan that covers preventative & catastrophic care won't be good enough, and I'm looking at being forced in to a deal with a $350-400 monthly premium. Can you hear my excitement?

Oh Jeez, WHY do perfectly intelligent doctors give out antibiotics for things like colds and the flu, which they perfectly know well are VIRAL diseases???

http://thinkprogress.org/health/2012...-medical-debt/

Lead Plaintiff In Health Care Reform Suit Files For Bankruptcy With Medical Debt


The lead plaintiff in the legal case against the Affordable Care Act filed for bankruptcy after accruing nearly $5,000 in medical debt. According to the Los Angeles Times, plaintiff Mary Brown was uninsured last fall when her husband’s medical bills stacked up to $4,500.That, combined with other debt they had accumulated, led the couple to file for bankruptcy:

Brown, reached by telephone Thursday, said the medical bills were her husband’s. “I always paid my bills, as well as my medical bills,” she said angrily. “I never said medical insurance is not a necessity. It should be anyone’s right to what kind of health insurance they have.

“I believe that anyone has unforeseen things that happen to them that are beyond their control,” Brown said. “Who says I don’t have insurance right now?”

Brown “doesn’t have insurance. She doesn’t want to pay for it. And she doesn’t want the government to tell her she has to have it,” according to Karen Harned, a lawyer for the National Federation of Independent Business.

Brown may be focused on health care choices, but American taxpayers have another concern. Sixty-two percent of people who file for personal bankruptcy do so because of medical bills, placing those debt burdens on the American taxpayer. And while Brown’s husband may have run up his medical bills, others take the less medically responsible road and decline preventive treatment so they can avoid high medical bills in the short term (but risk more problems later).

Other opponents of the Affordable Care Act may argue for a consumer-driven market on health care plans, the fact is that the plans people chose, or their choice not to have one, effects everyone. The Affordable Care Act, on the other hand, may already be slowing health care costs.

Romneycare, seems to be having an impact -

http://www.washingtonpost.com/blogs/...rss_ezra-klein

Study: Romneycare is making Massachusetts healthier

... improvements in “physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity.” The gains were greatest for “women, minorities, near-elderly adults, and those with incomes low enough to qualify for the law’s subsidies.

...The reforms led to more people having insurance, which is to say more people having more opportunities to see a doctor and get early and/or regular treatment for ailments. That led to improvements in health. ...

....“The general strategies for obtaining nearly universal coverage in both the Massachusetts and federal laws involved the same three-pronged approach of non-group insurance market reforms, subsidies, and mandates, suggesting that the health effects should be broadly similar,” they write. “However, the federal legislation included additional costcutting measures such as Medicare cuts that could potentially mitigate the gains in health from the coverage expansions. On the other hand, baseline uninsured rates were unusually low in Massachusetts, so the coverage expansions — and corresponding health improvements — from the Affordable Care Act could potentially be greater.”
...

Nothing like results.

Whether by the election or by the SCOTUS, 2012 is the last chance for the Right to kill this off.

http://tpmdc.talkingpointsmemo.com/2...on.php?ref=fpa

How The Affordable Care Act Could Quash The GOP’s Dream Of Medicare Privatization

What if “Obamacare” not only helped save Medicare from fiscal doom, but also quashed the GOP’s longstanding goal of privatizing the program? It’s too early to know what will ultimately happen, but new evidence suggests that nightmare scenario for conservatives is within the realm of possibility.

In a development with potentially profound implications — both for Medicare itself and for the broader ideological fight between the two parties over the role of government — researchers writing in the New England Journal of Medicine believe that the growth in per patient Medicare costs has slowed, contra earlier projections that spending would soar at an unsustainable rate. More importantly, the researchers believe this trend will hold over time, thanks largely to the Affordable Care Act’s sweeping cost-control policies.
.
.
.
Ironically, the news of the changing trend line comes amid a congressional debate over the future of Medicare. House committees last week cleared GOP-sponsored legislation to repeal the health care law’s Independent Payment Advisory Board, a panel of 15 appointed experts who will be charged with limiting Medicare per-enrollee spending to per-capita GDP growth plus 1 percent — it would do so via provider cuts, which if too steep could restrict access to care. Part of the reason Republicans want to repeal IPAB is that it may render their push for a privatized system irrelevant.

But the kicker is that if the NEJM study’s projections prove to be correct, neither approach may be necessary, and Medicare as we know it will be alive and healthy for the foreseeable future.

Originally Posted by playwrite

http://thinkprogress.org/health/2012...-medical-debt/

Since you're quoting the 62% figure, let's hear the rest of the study it came from:

Overall, three-quarters of the people with a medically-related bankruptcy had health insurance, they say.

"That was actually the predominant problem in patients in our study -- 78 percent of them had health insurance, but many of them were bankrupted anyway because there were gaps in their coverage like co-payments and deductibles and uncovered services," says Woolhandler. "Other people had private insurance but got so sick that they lost their job and lost their insurance."

Originally Posted by JohnMc82

Since you're quoting the 62% figure, let's hear the rest of the study it came from:

Ah, I didn't quote any study; the article apparently did. I was bringing up the karma of being against mandated insurance and then suffering bankruptcy from medical bills. But since you brought it up, let's dive a little deeper.

Her unpaid medical bills added up to $4500. The lowest level plan that one can have under ACA is the Bronze level where your total costs (deductibles, co-pays, everything else) can't exceed $6000 or 40% of the total costs - so that wouldn't of helped. However, she could have been subsidized by the govt and got the Gold level plan that would have cut her total cost in half (40 to only 20%) - greatly diminishing her likelihood to go bankrupt.

But just like the t-baggers who screamed for the socialist govt to keep its hands off their Medicare, I'm pretty sure she would still prefer bankruptcy over the govt subsidizing her health care and preventing her bankruptcy. It's just another clear case of the degree and success of the corporate masters in brainwashing the sheeple to go against their own economic self interest time and time again - see "What's the Matter with Kansas?" But there's hope for society - see "Darwin Awards."

On a different note: did you see my post on the OWS thread concerning how that may be an open source model for the evolution of civilization? I named the post after you ; I thought you might find the article interesting.

http://www.offthechartsblog.org/

New Health Exchange Rules Show Important Improvements


Health reform took a major step forward this week, as the Department of Health and Human Services (HHS) released the final rules detailing the standards for the health insurance exchanges that the Affordable Care Act calls for.

These competitive marketplaces are a centerpiece of health reform and will give individuals, families, and small businesses multiple options of private health insurance plans that meet basic standards. States planning to set up their own exchanges now have much of the information they need to move forward.

While we are still reviewing the new rules, several improvements since HHS’s initial proposals are worth highlighting:

The final rules strengthen the standards for “Navigators” — entities that are supposed to provide, with funding from the exchanges, accurate and unbiased information to consumers about available health coverage options. The final rules require exchanges to develop conflict-of-interest and training standards for Navigators. And, while it was already clear that health insurance companies could not serve as Navigators, the final rules state that associations that include insurers or lobby on their behalf cannot be Navigators either. Meanwhile, Navigators cannot receive compensation from an insurer for enrolling individuals or employees in any health plan, including plans available outside the exchange.

Under HHS’s proposed rules, a family’s income would have to drop by 20 percent from what was on their prior tax return before the exchange would take that decrease into account in determining the amount of help the family would get to pay premiums. Rightly recognizing that this approach would make coverage unaffordable for many families, the final rules allow exchanges to take all income declines into account. As a result, people who need help paying their premiums are far more likely to get the right amount of assistance.

The final rules require exchange governing boards both to include at least one voting member who represents consumer interests and to ensure that insurers and other parties with a conflict of interest do not make up a majority of the board. We hope that states will go beyond these minimum standards and further strengthen consumer representation on their exchange boards.

Like I said, either through the election or the SCOTUS, 2012 is the last chance for the GOP to stop this train. By 2016 election, we'll see t-baggers with signs "Keep the Socialist Govt Hands off my Obamacare!"

Originally Posted by The Rani

Since this has come up a few times on the forum:
Eating Processed Meat and Red Meat Significantly Raises Risk of Death

Dunno what is sadder, the final results of the study, or the comments on that article you linked. Yea, no one likes inconvenient news, but they're just openly mocking research that can help them live longer, healthier lives.

So the mortality risk rises linearly even after the multivariate correction for height, weight, BMI, activity level, veggie consumption, etc... damn! My hypothesis was that meat eaters in general had worse habits - veggies being self-selected for health consciousness and meat eating as the default mode of a processed diet & sedentary lifestyle. There's some correlation there, but not enough to explain the total risk of mortality even after those lifestyle factors are corrected.

Also a bit surprised that chicken fared so differently than beef, but that is good news because one nice steak each week is plenty fine so long as chicken and fish is still on the menu

Originally Posted by The Rani

Since this has come up a few times on the forum:
Eating Processed Meat and Red Meat Significantly Raises Risk of Death

A guy is finishing up his annual exam with his doctor and gets into the following exchange -

P: "Hey doc, will I live until I'm 90 or even 100?"
D: "Do you drink?"
P: "No, never touch the stuff."
D: "Well, then do you eat meat?"
P: "Nope, I've been a vegetarian my whole life."
D: "Okay, then, do you practice any unsafe sex?"
P: "No, never!"
D: "Okay, do you do anything risky in your life?"
P: "Nope, never have, never will"
D: "Well, yea, you might live to an old age, but why bother?"

Originally Posted by The Rani

I wonder what that doc would say about a guy who spends his whole life insulting random strangers on a message board.

If he's my doc, he'd say: "Well done!"

That's how he likes his steaks too.

Originally Posted by The Rani

There's a reason I posted this on the healthcare thread.
Can you figure it out?

P.S. You bring up "cognitive dissonance" a lot. Think along those lines ... if you are able.

Yea, I figured it out -

You're having a bad day.

Buck up buckaroo, this too shall pass.

Originally Posted by playwrite

Her unpaid medical bills added up to $4500. The lowest level plan that one can have under ACA is the Bronze level where your total costs (deductibles, co-pays, everything else) can't exceed $6000 or 40% of the total costs - so that wouldn't of helped. However, she could have been subsidized by the govt and got the Gold level plan that would have cut her total cost in half (40 to only 20%) - greatly diminishing her likelihood to go bankrupt.

Well it ultimately wouldn't matter, would it? The shop shut down and the family's stated income is only $275 - hardly enough for rent and food, let alone health insurance. And even with ACA bronze coverage, it will be easy to rack up $4500 in medical bills... on top of the $4500 in annual premiums.

On a different note: did you see my post on the OWS thread concerning how that may be an open source model for the evolution of civilization? I named the post after you ; I thought you might find the article interesting.

Haven't caught up from spring break, but I think I read the article you're talking about. It was a decent overview, if not kinda clumsy in trying to capture the big picture. As to the open source civilization, I'm all in. Literally all my income and equity, that is. Have I mentioned that the line between labor and capital seems to break down when labor can be fully mobile, and work retains long-term value owned directly by the worker? The financial and monetary institutions will have to reflect this...

Originally Posted by JohnMc82

Well it ultimately wouldn't matter, would it? The shop shut down and the family's stated income is only $275 - hardly enough for rent and food, let alone health insurance. And even with ACA bronze coverage, it will be easy to rack up $4500 in medical bills... on top of the $4500 in annual premiums.

- that's a shame. I wouldn't wish that misery on anyone.

Originally Posted by JohnMc82

Haven't caught up from spring break, but I think I read the article you're talking about. It was a decent overview, if not kinda clumsy in trying to capture the big picture. As to the open source civilization, I'm all in. Literally all my income and equity, that is. Have I mentioned that the line between labor and capital seems to break down when labor can be fully mobile, and work retains long-term value owned directly by the worker? The financial and monetary institutions will have to reflect this...

Let's hope so. I've been at it for more than a couple decades. I still have to plug in to the production side which in my beginning were those entities on the lower-end of capitalization, but mid-career, became nearly always high-intensity (i.e. Hollywood). Now I pick and choose, and generally more on the lower-end because it comes closer (usually) to expressing the art but I know that is a luxury (even if earned).

I don't see it becoming the general model of production as say Justin sees it, but I sure as hell see it as a lot more promising than I did just months ago when first engaging with him on the topic. I'm not sure it has to 'take over' in order to have a profound impact on everyone. If it impacts labor rates at the margin, it could be a tremendous shift in power back to labor.

On the other hand, automation is the honey badger - it don't care if production is centralized or not; it will rip (perhaps, is ripping) labor a new one regardless. I'm not sure what the answer to that is - something along the lines of rewarding demand more than the near-genetic rewarding of production.... but, that makes me sound more of a socialist than even those in Soviet communist party of 60-70 years ago! I'm uneasy with that - inherently, but also for I see no alternative other than catastrophic collapse. One can only hope that the Luddite Fallacy keeps working – so to speak.

This is a very creative cartoon that pin points the need for single payer health care.

Unaffordable co-pays and deductibles, death by a million cuts for insured Americans

Rose Ann De Moro, the head of National Nurses United

wrote eloquently last month in the Huffington Post about the catastrophic collapse of the U.S. healthcare system.

While the ACA had some undeniable positive elements, such as permitting young adults up to age 26 to remain on their parents health plan, and a few limitations on insurance industry abuses, such as barring them from denying coverage due to pre-existing conditions, our health care nightmare is far from over.And, as nurses have reported repeatedly the past year, the economic crisis has great aggravated the suffering with broad declines in health status that are directly linked to job loss, unpayable medical bills, and families having to choose between paying for food, housing, clothing or healthcare.

As to the law itself, despite its name the ACA has done little to actually make healthcare affordable. Out of pocket health costs for families continue to soar largely unabated. Nurses now routinely see patients who have postponed needed care, sometimes even life-saving or life-prolonging care, because of the co-pays and deductibles.