Michael Merritt I can't help but think you're at least partially responding to me. :D After all, I essentially just compared the two and concluded that the result of claim denial was the same, no matter who is doing it. Also, by the definition you cite, isn't there also a claim to be made that the government wouldn't be rationing health care, either? It wouldn't be happening "during wars, famines, or other national emergencies," so how can it be rationing?

Jeb It looks like Bailey cherry picked a definition that suited him. Following are definitions of ration(ing) from other sources. from Wordnet

restrict the consumption of a relatively scarce commodity, as during war

Websters Unabridged

1. A fixed daily allowance of provisions assigned to a soldier in the army, or a sailor in the navy, for his subsistence. 2. Hence, a certain portion or fixed amount dealt out; an allowance; an allotment.

Free dictionary

1. A fixed portion, especially an amount of food allotted to persons in military service or to civilians in times of scarcity. 2. rations Food issued or available to members of a group. tr.v. ra·tioned, ra·tion·ing, ra·tions 1. To supply with rations. 2. To distribute as rations: rationed out flour and sugar. See Synonyms at distribute. 3. To restrict to limited allotments, as during wartime.

Rationing in the context of the health care debate has been used to make people fear arbitrary refusal of service at the hands of government. At present we have arbitrary refusal of service of service at the hands of private insurers and of course for inability to pay. It is a much tougher sell to explain why you think that the former is worse than what we have now than to simply decry 'rationing' and to deny the 'rationing' that we currently employ. In the end it is partisan politics as usual.

Patrick Glenn Jeb, I'm not sure the alternative definitions you provided make your case, either. Based on the meme I'm seeing from liberals/progressives, there's really two questions being raised: 1. Does the market ration in a general sense? 2. Do U.S. insurance companies practice a type of rationing by the manner in which they pay out reimbursements, etc.? The answer to the first question is no. Although you can find a small minority of economists who will refer to market-based allocations of (limited) resources as "rationing," the great majority do not agree with that analogy. And let's face it, that's what liberals/progressives are doing when they repeatedly refer to market allocations as "rationing": exploiting a poor analogy, beating it like a dead horse, because they think it's useful to their agenda(s). In that sense, Michael was quite right to call out liberals/progressives for distorting the meaning of the word rationing, but then again many ideological battles are rooted in disagreements about basic assumptions (such as defining terms). So, I understand that cuts both ways. Anyway, rationing has long been understood to refer to GOVERNMENT or other coercive authority restricting allotments, not the "invisible hand." Rationing is what people in power to do other people who are not in power. Human coercion is the very essence of rationing. Refering to price mechanisms as "rationing" is anthropomorphizing the market. The Britannia definition is perhaps cherry picking, but that's because it includes only the best and most literal definition of rationing. But your alternative definitions also refer to goods/services being "dealt out" and restricted. The market doesn't do those things except perhaps in a metaphorical sense and I don't think we should base health insruance reform around poetic license. Saying that insurance companies are "rationing" is less of a stretch, but it still seems like an imprecise use of the word. When an insurance company denies (or restricts) a claim, there's two main possibilities: a). the denial/restriction is legit - i.e. the policy holder is not eligible for all of what he wants/needs, based on the contractural agreement; or b). the insurance company is denying/restricting the claim in violation of the contract. In neither case is it "rationing," although the insurance company should be forced to comply and/or be penalized in the latter case. Would you consider it rationing if your cable company did not give you all 350+ channels, if you haven't paid for them? I'm not aware of that many cases of health insurance companies maxing out on claims for a given year (like, I think, the flood insruance companies have run into), but if they did, then perhaps you could make the case that they would have to ration - i.e. they're not paying out on all ELIGIBLE claims, etc. But the insurance company wouldn't be able to utilize this power for long, as they'd be out of business, and its policy holders would go elsewhere. Under single-payer, consumers are stuck in the government plan, which can ration with impunity (at least until the law is repealed).

wilky Not sure that health care is limited or a fixed amount Jeb. Yet anyway. Once the government gets a hold of it its going to be inevitable. You got to control costs, that seems to be the whole point of this "crisis." It is a tougher sell government over private. When the private sector screws up you can always appeal to the government. When the government screws up, who you gonna complain to. They can just pass a law to squash you complaint. You know the play this game. Think of Kennedy and how he got laws changed to cover his wants with relation to sitting a senator in the event of a premuture opening in '04, and recently tried to change it back when he realized he may not make it through his term and leave the Dems one seat short of 60. ========== Not directed at Jeb ========== Libs. Rightfully wants government out of the bedroom, but advocates government involvement in the rest of my life. Go figure.

Tully When the private sector screws up you can always appeal to the government. When the government screws up, who you gonna complain to. Bingo. Specifically, you can refer to the courts. But with government, there's this little thing called "sovereign immunity," and you're stuck petitioning Congress for redress. Good luck with that. That's not to say there is no problem with insurance companies illegitimately denying contractually covered services, but you have some legal recourse. Our major health care problem is cost. To understand cost problems, look to the determinants of supply and demand. Health care is expensive because demand is very high and supply is limited. Feeding more money into the demand side is not going to reduce cost -- quite the opposite, as it will increase demand without increasing supply. To control cost you have to increase supply or reduce demand or some combination thereof. Since demand for health care is strongly inelastic (in short, it's not gonna reduce, period) we will have to increase supply quite a bit to flatten out cost growth. That applies in ANY health care system, including the NHS. We can gain some one-time efficiencies in various ways, but we're not going to reduce demand that way, and when those savings have been fully realized excess cost growth over and above the rate of GDP growth will resume. If Congress were serious about health care reform they'd be pouring funding into training more primary care physicians, reducing barriers to primary care practice for PA's and Nurse Practicioners, and building up open-door primary care clinics. They'd be reforming the tort system. Etc. All of these things are notably absent from HR 3200. The legitimate conclusion is that they don't intend to really reform health care in any meaningful way, just shift around who's in charge and how the pie is divvied up.

Jeb First, all of this assumes a single payer system ala Canada or UK which simply will not happen in the US regardless of the fears of some on the right or the hopes of some on the left.

Saying that insurance companies are “rationing” is less of a stretch, but it still seems like an imprecise use of the word. When an insurance company denies (or restricts) a claim, there’s two main possibilities: a). the denial/restriction is legit – i.e. the policy holder is not eligible for all of what he wants/needs, based on the contractural agreement

Using that logic then government based insurance would not likely ration either. They would simply set up a guidelines as to what is covered and what is not covered under their policy like they do with Medicare and private insurers do now. Does Medicare ration?

Patrick Glenn Jeb, Medicare comes closer now to actually rationing than the other alleged culprits but, yes, the long-range concerns about potential rationing do assume either a single-payer system or a government-option that ultimately leads to single-payer. Until then, we wouldn't get full-fledged government "rationing," although 10 years from now many Medicare recipients might feel like they're victims of rationing. Really, they'll have been gamed by the system. Right now, though, I can think of a couple of reasons why Medicare would come closer to meeting the definition of rationing, and I'm suspect there's more reasons as well. 1. Obviously, it's run by the government. With an assist from wilky (above), there's no higher recourse when they deny a claim and they can change the rules anytime. 2. I realize the current system has a distorted market, but there is at least some room in which to shop around for different packages at different prices. In contrast, everyone is forced to pay into Medicare. In turn, it is funded not just by payroll taxes and limited premiums, but also by general revenues. Therefore, the purchaser-insuror relationship is even less market-friendly and therefore less equal than it is under the current private plans (which have themselves been distorted by government failure).

Jeb

Not sure that health care is limited or a fixed amount Jeb.

At any given time there are a limited number of doctors, nurses, hospital beds, etc, etc

To control cost you have to increase supply or reduce demand or some combination thereof. Since demand for health care is strongly inelastic (in short, it’s not gonna reduce, period) we will have to increase supply quite a bit to flatten out cost growth.

Here we agree.

The legitimate conclusion is that they don’t intend to really reform health care in any meaningful way

There are multiple problems with our health care system. Dealing with one (the uninsured) does not while failing to deal with the other (supply) does not indicate lack of desire for reform. It does indicate prioritizing one problem over the other.

If Congress were serious about health care reform they’d be pouring funding into training more primary care physicians, reducing barriers to primary care practice for PA’s and Nurse Practicioners, and building up open-door primary care clinics. They’d be reforming the tort system. Etc

Again we agree.

Jeb

the long-range concerns about potential rationing do assume either a single-payer system or a government-option that ultimately leads to single-payer

Which, I reiterate, simply will not happen here. I am willing to bet on this. Is anyone willing to set stakes and take me up on that bet?

Patrick Glenn @Jeb I hope you're right. A public option is beginning to look like a bit of a longshot, but we're far from out of the woods yet. Until single-payer/public-option is off the table, opponents must be vigilant, including pointing out the perils of centralized (govenment) rationing and planning of health care. Even if single-payer/public-option are defeated, there are other rationing/planning threats - e.g., comparitive effectivess models/panels for Medicare. As for your proposition, Jeb, that's a bet I would be very unhappy to win regardless of how high the stakes. But, no, I don't think it will happen, either - but that's because people are fighting against it - not because the progressives don't want it. If we get a "progressive" public-option, though, that will lead to single-payer over the long-run, unless the law were to be repealed at some point. That would be a difficult bet to set up: the bills being kicked around would not be implemented for like 5-6 years, then it would take maybe 10+ years for the public option to destroy the private health insurance market (although boutique supplemental insurance would probably still be available, if they don't go Canadian on us). The pay-off date would have to be like year 2030.

Jeb @Patrick Glenn Do you really think that if a public option were to survive in the ultimate bill that it would turn out more like Canada than like France? We have a decades long real world experiment showing that there can simultaneously be a public option to cover some basic level of care along side a private system to provide additional options and this can and does happen without rationing. Given this I think that the public option leads to single payer leads to rationing hypothesis is far from a given. Again I am genuinely surprised by how few people on any side are seriously addressing the issue of supply.

Jeb

Even if single-payer/public-option are defeated, there are other rationing/planning threats – e.g., comparitive effectivess models/panels for Medicare.

From what I have heard those models or panels would determine what drugs/procedures/whatever Medicare would cover. This would in no way prevent any Medicare recipient to buy supplemental insurance to cover what Medicare will not or they could pay out of pocket for treatment if they had the means. Unless these models/panels limit the number of procedures and do not allow outside access to said procedures that would lead to economic (or self) rationing which you have earlier denied to be real rationing.

Interested

Jeb :

the long-range concerns about potential rationing do assume either a single-payer system or a government-option that ultimately leads to single-payer

Which, I reiterate, simply will not happen here. I am willing to bet on this. Is anyone willing to set stakes and take me up on that bet?

Really? Like the cries and screams on the left when limits are put into place on abortions? That it's just one more step towards overturning Roe vs Wade? or the cries and screams on the right when limits are put into place on gun control? That it too is just one more step towards banning weapons outright? Or how about Tax A is a Sunset Tax? It's just another step towards more taxation. Are you actually going to say with a straight face that proposals set forth by the Left are not with the ultimate goal of Universal Health Care? Or that however far they get towards that goal now can again be advanced with additional steps in the future? You cannot possibly be that naive. btw - If Canada had a sufficient public option - their High Court would not have overturned the ban on Private Insurance.

Jeb

Are you actually going to say with a straight face that proposals set forth by the Left are not with the ultimate goal of Universal Health Care?

Certainly the goal is universal health care. If you mean single payer then some want it, but it will not happen in the US in the foreseeable future, just as Roe will not be overturned in the foreseeable future.

Interested Single payer is what will finance universal health care. Once you get to Single payer the Ultimate Liberal wet dream is a step away.

Jeb

Single payer is what will finance universal health care

???

Interested

Jeb :

Single payer is what will finance universal health care

???

did I stutter?

Tully Does Medicare ration? Yes, it does, though mostly indirectly. When Medicare fails to pay providers enough to justify them accepting new Medicare patients, that is rationing. When Medicare allows lowest-cost treatments to go through unquestioned but audits providers who utilize any higher-cost treatments, it is rationing. When Medicare establishes formularies that will pay for some drugs but not for others, it is rationing. And so on. Ask a doctor about how easy it is to unknowingly commit a career-ending and bankrupting felony under Medicare rules -- they run to over 110,000 pages, more than five times as long as the US tax code. The sheer weight and threat of those arcanely incomprehensible rules is itself a form of rationing, heavily discouraging providers from stepping a single millimeter out of the safe path of the designated cookie-cutter treatment. Those who have Medicare Advantage have a LOT more wiggle room there, as their care is handled differently, by private insurers. Guess which part of Medicare Obama wants to toss under the bus in order to pay some of the tab of "reform?" Uh huh. Medicare Advantage. From what I have heard those models or panels would determine what drugs/procedures/whatever Medicare would cover. This would in no way prevent any Medicare recipient to buy supplemental insurance to cover what Medicare will not or they could pay out of pocket for treatment if they had the means. Not exactly. If it IS a covered treatment area and Medicare denies the specific treatment you want for a specific condition because it's not the Medicare-approved one, your supplemental will not cover it. As far as your secondary insurer is concerned, it's not their problem because Medicare has a covered treatment, even if that treatment is no good to YOU or is not the one YOU want. Medigap policies cover things that Medicare does not cover at all. Understand the difference? Again I am genuinely surprised by how few people on any side are seriously addressing the issue of supply. Addressing supply has little immediate and visible impact, and the "debate" is being controlled by pols who require shiny trophies for their bases. Thus we get "supply side" arguments from one side that we can quickly increase supply by addressing inefficiencies, by freeing up supply-side resources for more care. That argument ignores the fact that THE most critical supply shortfall is in professional personnel that take many years to train. Enabling providers to function with fewer office clerks will indeed free up some money, but does not make new primary care doctors appear out of thin air. OTOH, it won't make things instantly worse, but a little bit better until the efficiencies are absorbed. The other side simply ignores the supply issue with the implicit assumption that throwing more money at the problem from the demand side will automatically increase supply. Same dodging of the real issue from different angles. Once again, that won't make resources instantly appear when those resources require most of a decade or more to be generated. In the short term such a demand-side approach will actively make things worse. Still no fairy dust or magic wands. No free lunch. If systemic reform does not BEGIN on the supply side, any gains will be short-lived and illusory.

Jeb

Yes, it does, though mostly indirectly...

If the things you list are rationing then private insurers and the market also ration.

Not exactly. If it IS a covered treatment area and Medicare denies the specific treatment you want for a specific condition because it’s not the Medicare-approved one, your supplemental will not cover it.

Wouldn't that depend on the supplemental? That is a policy of the gap insurances rather than a Medicare policy.

Addressing supply has little immediate and visible impact, and the “debate” is being controlled by pols who require shiny trophies for their bases.

That and it would anger some powerful lobbies.

Jason Arvak The accusation that everyone who opposes single-payer or "public option" health care is beholden to "powerful lobbies" is deeply dishonest and abusive, Jeb. I would have expected better from you. As for addressing supply, I addressed it some time ago when you first brought it up and you just blew me off. So don't pretend you're the only one trying to talk about it. To refresh your memory, I will summarize by saying that supply shortage of GPs is not caused primarily by simple lack of available medical school slots as your prescription assumed, but rather by the lure of specialization where doctors are both better paid and less vulnerable to out-of-control medical malpractice lawsuits. When conservatives ask that tort reform be incorporated into health care reform (a request that is always dismissed out-of-hand by progressives), they ARE addressing supply problems.

Tully If the things you list are rationing then private insurers and the market also ration. Private insurers can't throw providers in federal prison and/or bankrupt or harass them out of practice over minor diagnostic quibbles, and the consumer enters into their contracts voluntarily. If they change the contract, the consumer can opt out or enforce the original or change insurers. Wanna try that with Medicare? Good luck. The only choice in Medicare is traditional or Medicare Advantage, and both are under that federal legal thumb. Also, if a private insurer pays part but not all of a treatment cost, you can pay the rest out of pocket without a problem. Your insurer won't care, they're simply bound by their contract and if you want to pay more on top of their reimbursement, that's your business. If a Medicare provider takes Medicare assignment for a treatment, taking anything more than the Medicare-approved pay and co-pay can get them charged with felony fraud. This really is a bullshit claim, that private insurers "ration" by simply fulfilling their contracts. No, consumers "ration" themselves by their choice of coverage. If you can't understand the distinction between government edict and private contract further explanation is useless. Wouldn’t that depend on the supplemental? That is a policy of the gap insurances rather than a Medicare policy. NO. BY LAW, Medicare itself determines what forms allowable Medigap policies may take. Medigap coverage policies ARE Medicare coverage policies -- the allowed and allowable content and coverage of Medigap policies are standardized coverages determined and dictated SOLELY and DIRECTLY by Medicare itself, BY LAW. The only discretion on the part of Medigap insurers is which standardized Medigap policy or policies they may choose to offer. If it's called Medigap, it must conform to Medicare policy EXACTLY.

Jeb

did I stutter?

??? = What on earth did you mean by that?

The accusation that everyone who opposes single-payer or “public option” health care is beholden to “powerful lobbies” is deeply dishonest and abusive, Jeb.

I did not say that. I thought that it was clear in context that both sides are beholden to or afraid of "powerful lobbies" and that is part of the reason that neither address some issues. Do you disagree?

I will summarize by saying that supply shortage of GPs is not caused primarily by simple lack of available medical school slots as your prescription assumed, but rather by the lure of specialization where doctors are both better paid and less vulnerable to out-of-control medical malpractice lawsuits.

1) I argued for multiple causes of the shortage of GPs. Number and location of medical school slots was one important factor, not the factor. More important is the ridiculous amount of debt carried by the average graduate. If you owe $500,000+ you cannot afford to be a town GP regardless of malpractice insurance rates. 2) Our primary disagreement is over the relative importance of these factors. 3) My gripe on this point was not that no one was talking about this. It was that FEW even recognize supply as a problem and that no one with the power to address the problem directly appears to have it anywhere on their agenda. I don't think that is much in doubt.

If it’s called Medigap, it must conform to Medicare policy EXACTLY.

Medigap plans have a variety of requirements in order to qualify, but is it not legal to have health insurance supplemental to Medicare that is not "Medigap" insurance. Some retirement plans for instance continue to provide health insurance, though that practice is fading fast. Am I misunderstanding the law. BTW As I have made clear in other threads single payer is not my preferred option.

Jeb Tully, I could support loosening restrictions on Medigap and offering another tier of supplemental Medicare insurance with even less restrictions.

Jason Arvak

I did not say that. I thought that it was clear in context that both sides are beholden to or afraid of “powerful lobbies” and that is part of the reason that neither address some issues. Do you disagree?

If, as appears to be the case, I failed to notice that your allusion to "powerful lobbies" includes tort lawyers as well as the usual insurance company boogeymen, then I apologize.

1) I argued for multiple causes of the shortage of GPs. Number and location of medical school slots was one important factor, not the factor. More important is the ridiculous amount of debt carried by the average graduate. If you owe $500,000+ you cannot afford to be a town GP regardless of malpractice insurance rates.

I'm familiar with the student debt problem at a personal level. I think there are changes that could legitimately be made to the training process and some subsidies that could be offered to those who agree to become GPs (like loan forgiveness programs for lawyers who serve 10 years in public service jobs) that would be a good component of health care reform.

2) Our primary disagreement is over the relative importance of these factors.

I don't think you have the information to support that claim, since you've never asked nor have you justified a claim of importance. But more importantly, I don't think it is necessary to resolve this issue if you would be willing to concede that supply is far from a complete solution to the problem AND that even addressing supply alone has to include tort reform as a component.

BTW As I have made clear in other threads single payer is not my preferred option.

Do you concede the analysis (offered many times by many people) as to how "public option" collapses inevitably into single-payer anyway? If so, perhaps you'd be willing to join in advocating a compromise that addresses supply and demand at the same time by enacting subsidized co-ops and subsidized GP training while avoiding further cuts to Medicare payment rates as advocated by the Obama administration (which undermine the supply of GPs).

Interested

Jeb :

did I stutter?

??? = What on earth did you mean by that? Quite well aware of what you intended - and as I asked - did I stutter? Here is the logical path towards the Universal Nightmare you desire so much. Public Coops are enacted for Health care - (they'll fail in every business sense which makes the Left break out in song & dance). Public Coops become Public Insurance Private Insurance is regulated out of business Public Insurance becomes Single payer Insurance Single Payer Insurance favors community run hospitals for profit hospitals are regulated out of business Community run hospitals are then fully funded by single payer insurance Federal Gov't takes over responsibility of running the community hospitals, private doctors will not receive any payment unless part of the community option. Universal Nightmare transformation complete. BTW As I have made clear in other threads single payer is not my preferred option.

I realize that the preferred option is to soak the rich to pay for everyone else (despite the fact that they already do pay for far more than they should). Fortunately that Liberal dream is just a pin-up on a wall - Single Payer is a much more likely scenario.

Interested tweaked up those blockquotes - i'm sure you can pick it out though

Jason Arvak

Public Coops are enacted for Health care – (they’ll fail in every business sense which makes the Left break out in song & dance).

This is false. There are some successful co-ops operating already, including HealthPartners here in Minnesota. If properly configured and given moderate government support, there is no reason that co-ops could not provide a compromise solution. Of course, to purists of both left and right, compromise is ruled out on spec. :rolleyes:

Interested If If If Write that eye rolling moment down - it'll come back to haunt you.

Interested Here you go Jeb What voters think of public Health Care. http://s.wsj.net/public/resources/images/NA-BA144_OVERLO_G_20090831184054.jpg

Jason Arvak No, thanks, Interested. I am pretty confident that compromise is better than purism, intransigence, and exaggeration.

Jeb

If, as appears to be the case, I failed to notice that your allusion to “powerful lobbies” includes tort lawyers as well as the usual insurance company boogeymen, then I apologize.

The list is considerably longer, but those two are on it.

Do you concede the analysis (offered many times by many people) as to how “public option” collapses inevitably into single-payer anyway?

No, I do not and neither do I concede that single payer leads inevitably to rationing. I am not opposed to coops as part of a plan. I support subsidizing GP and nurse training as well as expanding the role of nurses.

Interested

Jason Arvak : No, thanks, Interested. I am pretty confident that compromise is better than purism, intransigence, and exaggeration.

So confident you don't want to count on yourself? That's oozing with confidence Jason.

Doomed This is false. There are some successful co-ops operating already, Because a couple succeed does not mean the model itself is successful. Additonally if they were a rousing success they would be cropping up all over the country. The basic premise of The democratic health care reform movement is flawed to the core. Simply adding 45,000,000 more patients to the rolls of people demanding goods and services is going to result in higher pricing by doctors and hospitals. Why? Its simple economics 101. More demand....higher prices. Supply and Demand. The very fact that their are now 45,000,000 more people demanding a set amount of goods and services is going to result in price controls and government intervention and rationing. It has to. The pure physics of it has been altered. So we can all pretend the democrats are not offering rationing and price fixes but thats simply not going to be the case. They dont have to offer it. It will just happen.

Tully This is false. There are some successful co-ops operating already, including HealthPartners here in Minnesota. If properly configured and given moderate government support, there is no reason that co-ops could not provide a compromise solution Apples and oranges. As I pointed out previously (and extensively) what Conrad proposed by "co-op" is NOT what the few extant and succesful health care co-ops are. While there are indeed a few (namely TWO) succesful integrated HC system co-ops, those models bring nothing new to the table in either a competitive or financial sense that cannot be done now without any tweaks, and provide no additional value that is not already available, as evidenced by Health Care Services Corporation. The only new thing would be government subsidy and (necessarily) de facto government control, despite being "member owned." I note that for most of their plans HealthPartners has much the same pre-existing-condition exclusions as any coverage. Yes, I know this is not true for a select few of HP's large-employer plans, namely those associated with state government. One notes that said plans are themselves essentially government-funded and guaranteed, which takes us right back to those subsidies. Since I'm not a Minnesota taxpayer I am happy for those who have that coverage, but like MCR/MCD it relies on offloading any excess plan costs onto the taxpayers directly and indirectly via units of government AND onto their other members in other plans, and is NOT representative of the bulk of HP's plan offerings. Again, the HP/GHC models are not what is being referred to as "co-ops" by the proposers of same in Congress. Conrad's "co-ops" are NOT integrated-system co-ops such as HP/GHC. What Conrad proposes is essentially a government-subsidized mutual insurance plan along the lines of HCSC but backed by government, NOT an integrated-system co-op such as GHC or HP. (HCSC also has the same pre-existing-condition exclusions as any other insurer.) Once again, zero additional value is brought to the table, only a government-backed plan that would inevitably undercut private insurers who cannot offload excess risk onto the taxpayers. In the long run, not sustainable without some form of rationing. A variant of Gresham's Law applies -- if available to all, such a "co-op" would tend to drive private insurers out of business as surely as a "public option." GIANT. WOODEN. BADGER. The Democrats are trying to sneak up on nationalization of private health insurance without having to fly the take-over flag, as they know it will not fly in bright light. Eating the rich remains as popular as ever as aproposed financing solution. There are still not enough rich to feed everyone, they're still tough and gamy, and to a large extent they're wary and wily critters who have the ability to run away.

Jay_C Rationing will Definitely occur if Illegals are added to the mix (or not explicity excluded in the text of the legislation)… http://hotair.com/archives/2009/09/07/obamateurism-of-the-day-112/