I agree, Philip. I work in a nonprofit community mental health clinic and the system is so thick with waste, fraud, and abuse you can cut it with a knife. At this point I don't care about the details of the reform, we just need something. Even a bad bill will force us to take a second look at our system. But if NO bill is passed I have a great fear we'll be looking at more of the same.

(BTW, anyone else bothered by Brown's supporters chanting "41! 41! 41!"? When can we finally see some bipartisanship & cooperation in politics???)

I have to admit, like you, I'm ambivalent. I think the current bill is a nightmare, especially with some of the mental health initiatives that were snuck in, but at the same time, not having any reform and no public option is also a disaster. The whole system in D.C. is badly broken.

Ambivalence aside, poor legislation steeped in special and corporate interest giveaways is not health care reform.

It's just the same old Washington DC insider politics that seldom are capable of solving any problem until it has become a huge cumbersome crisis that needs to be bailed out with massive infusions of tax payer money.

Let's take a painful trip down memory lane to the saving and loan, bank, mortgage, Wall Street, energy, and auto industry debacles; mentioning just a few industries our government has done a such great job of reforming and regulating in the recent past.

Now some actually expect our government is magically going to do a better job with health care.

I would say personally from an opinion stand point after seeing exactly how government now provides social services and health care (Medicare/Medicaid), it's definitely a case of going to the same corrupt and defunct body again and again, and somehow expecting a different result this time around.

Lots of conflicting thoughts here too. One is that why do we need 60 senators to support a bill when the constitution calls for a simple majority unless the president vetoes the bill.

Second, only in America would corporate largess for the pharmaceutical and insurance companies be passed off as health care reform.

Finally, I'm sick of Obama's attempting to please everyone. When FDR came in the American people got a New Deal and he pissed off a lot of business leaders. Obama is not willing to piss off anyone and so the American people are getting a Raw Deal.

It is only going to be when the SHTF for a large portion of Americans-when they are frightened out of their wits and unable to keep healthcare for themselves-that there will be enough drama to push Obama to quit attempting to walk the middle ground.

The rich don't care-they have private doctors. The House and Senate? They already have their coverage-so in the end who really cares about the regular citizen?

No one cares about health reform-except those who make cash from stock in pharma.

Something...good or bad...must be passed.

If it is bad people will go bananas breathing down the necks of the house and senate members. I'm for showing up on the sidewalks in front of their houses.

If we luck out and get a good plan of reform-then awesome.

This is a pee on tree match and we are the losers. Obama needs to grow up and quit kissing the hind portions of those around him.

I completely share SteveBMD view - the deal at hand is better than the status quo, and at least with some plan on the table, it can be re-worked and fine-tuned while starting to help the 40-million without insurance.

I hold citizenships in both Canada and the USA, and the main thing preventing me from considering the US as a legit option for career/life relocation is health care. I don't like the prospect of for-profit health care that is not guaranteed. I view helath care as a right, not a privilege. We have our problems with universal care in Canada, but it's a system I cherish and am very proud of, not just for what it does for me, but what it does for my fellow citizens.

If Obama can't get a half-baked bill passed, methinks the USA simply is not a nation that will ever accept anything approaching a universal health system. That's really too bad because a lot of people will die needlessly, for nothing more than socio-economic reasons.

Even here in Australia it was depressing to hear of the vote for the republican senator knowing it would stymie even the piecemeal health reform your country is attempting.

There is a series running on BBC (British Broadcasting Commision) World Service radio called "health of the nation" about the US health system. It tallies with what I've gleaned from various sources over many years - unless the USA can stop lobbyists paying politicians, there will never be serious health reform so Americans can get what all other developed nations' people get - universal health cover that in GDP terms is about half the price the USA currently pays.

This suggests the political bill to allow for health care should first be to ban/limit lobbyist payments to politicians. Of course that has less chance of success than a health bill itself. Sad.

Also hearing some of the hysteria from mainly Republican party and the health insurance industry about so called "socialised medicine" systems in other developed nations being supposedly worse - is infuriating because it is just empty and false propaganda.

American colleagues who know about the health system here in Australia for instance note how much simpler and fairer it is and how Australian doctors are free from much of the red tape that occupies American doctors' time. We earn similar despite the total national health bill so much cheaper.

The current bill was a debacle and it's not so easy to just undo a bad bill so I think it's best this one failed.

There are so many problems with the US health care system some of which are cultural, like over utilization. People in other countries generally are not stupid enough to think they should take their active toddler or unhappy teenager to a psychiatrist, people in other countries aren't as likely to stay fat and take pills to deal with the side effects of obesity like lipitor and high blood pressure drugs and diabetes meds. People in other countries might be as likely to file fraudulent disability claims to make a living because of the job market, still it's a big problem here.

Forcing individuals to get insurance hasn't improved anything in Massachusetts and would have been a debacle for the rest of the nation. So who knows, at least people are really thinking about the problem now.

Some simple legal reforms like the one I'm always pushing, making law that says that if you have health insurance your medical bills are the legal responsibility of the insurer and dropping all mandatory insurance requirements would go a long way towards weeding out unnecessary health care utilization and lowering costs of needed health care.

To stop so many people from filing invalid social security disability claims, workers compensation claims, and long term disability claims, we need to pass incentives to encourage businesses to hire workers in the US at a living wage so then these workers can afford to by products and services produced here and pay for all but the most catastrophic health care out of pocket.

...People in other countries generally are not stupid enough to think they should take their active toddler or unhappy teenager to a psychiatrist, people in other countries aren't as likely to stay fat and take pills to deal with the side effects of obesity like lipitor and high blood pressure drugs and diabetes meds.

Hmmm...people in other countries (Like Australia) their Aborigines have the worst life expectancy rate of any indigenous population in the world.

There are problems everywhere it seems. It also appears that there are those "stupid enough" to let parts of their populations go medically unprotected as well. All countries have troubles. I say Americans need to manage America.

Thanks

Well, the US pays for 90% of all medical research done throughout the world, and this research amounts to 30-50% of our health care dollar. To honestly believe we will still have a high level of research and medical breakthroughs with a universal health care situation is naive for it is doubtful that these costs will be a large part of universal health care.

If you look at Great Britain or Canada, they fund 3-5% of all medical research. Perhaps this is why they use far fewer health care dollars than we do. Perhaps they should be encouraged to pay their fair share of research costs?

I don't think non-Americans comment on this issue with any sense of enjoyment or jingoism or even ignorance, but rather do so with a true feeling of curiosity and bemusement. And incidentally, the medical research line and all countries have problems lines of counter-argument are lame non-sequiturs, they just do not speak to the issue of a failure to create a fair, equitable system of health care.

I really think this issue boils down to one of rights vs. privileges. Bad bill or not, the democratic will of Americans seems hesitant to treat health care as a right. Or maybe it is a question of bad leadership on Obama's part. Or both.

It's not like this is a new issue. FDR has been mentioned in this discussion, and reviewing his long forgotten Second Bill of Rights, the idea of health care as right was clearly articulated by him years before Obama was even born. To quote two articles from President Roosevelt's January 11, 1944 message to the Congress of the United States on the State of the Union, in proposing a Second Bill of Rights:

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The right to adequate medical care and the opportunity to achieve and enjoy good health;

The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;

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The political will has always been there. It's just been laying dormant for several decades.

Lots of good points here. The current system is a mess and I see huge incentive for people to not work and chase disability. I am not sure anything in life that requires it be placed on the back of another individual is a "right". You may think it is the best way to live but demanding that someone pay for something else you are getting is not a "right". No place in the constitution or Bill of Rights does it say anything about this such "rights". That being said I would support universal health care for catastrophic health problems for all run by a single payer. There needs to be a 3-5k per year deductible before anyone gets anything for free. I treat Medicaid pts on a daily basis and have for 20 years. 2nd even 3rd generation who have never even considered their healthcare should cost or mean anything to them. I have never seen such an entitled wasteful group of people in my life. Just giving people anything in the end results in them seeing no value in in it. Make people pay for some of it through work programs or out of their own pockets and you will see a huge amount of waste taken out of the system including lots of needless procedures done purely for financial gain by Drs.

Lili - I know Americans are a very proud and patriotic people, and the USA has led the world on so many things, particularly cutting edge science, that many Americans find it hard to fathom just how much more sensible and better off other nations' health systems are.

But it is true. I've talked with American colleagues at conferences for the past 2 decades - they who travel and meet doctors from all over the world seem to all agree that we outside the USA have cheaper and fairer more equitable health care.

It is actually long past a stage of embarrassment for the USA. One day hopefully you will get a fair cost-effective health system that doesn't siphon off huge money to private vested interests and beauraucratic red tape. (this is not to say there aren't some pockets of very good health care systems for some groups in the USA - they're just not universal as in other countries)

As for Australia's aborigines you are quite right, it is a national disgrace for our country. The analogy is with the first peoples of the Americas, the clash between ancient and modern cultures and the long term effects of racism, conquest, disposession and what the sociologist Emil Durkheim called anomie - the loss of functioning cultural norms that effects the surviving individuals of that culture. Fixing it for our aboriginal population is going to be a long and hard road. I know a bit more from my son who is a school teacher in a remote aboriginal community deep in the outback.

A whole new way of economic thinking is in order
on a vaster more simpler basis in the United States, if health care reform is to work. TOday's health care as a system is eaten up with greed and outright expolitation of patients, that is including and even by doctors at total expense of patient's health, such is, a substantial reality in today's medical world . As long as profiting, and money oriented goals exist across the wide expanse of health care as weighty interfering aims of health care practioners; this situation being from manufacturers, insurance companies, pharma companies to the medical profession itself, the results: health care exists no longer on any sane or solid grounds, and as such might as well simply continue to go down the tubes. Getting back to early twentieth century perception of the role the doctor and patient relationship takes on, where money hardly existed as any participatory element in how medical practice was conducted, certainly not the insane degree as it is today---getting back to that era's ideas would be beneficial for today's medicine. The APA resignation letter of Loren Mosher and his indictment of how the pharma companies have taken over psychiatry to the spiralling downward drop of standards in the field is a salient example of the above ills that plague medicine today.