Insurance Does Not Equal Health Care: Specious Arguments by 'Free-Market' Opponents of Colorado Single Payer Bill
Paralysis around health care reform is exacerbated by specious rhetoric surrounding Single-Payer health care. Lazy media fail to look behind corrupted rhetoric, while corporate interests spin the debate to serve their bottom lines.
Media Blackout on Single-Payer Healthcare, a report by FAIR reveals that proponents of single-payer health care reform have been virtually shut out of the debate, despite polls showing strong public support - 59-to-32 over a privatized system in a New York Times/CBS survey (January 2009). In the week prior to President Obama's health summit, two of only three mentions of single-payer on TV outlets were by guests who strongly oppose it.
The Single-Payer discussion has been preempted - declared off the table by Congress before public discussion even begins, stifled by media blackouts, and dismissed without consideration as 'politically unfeasible' - shorthand for lack of political will to stand up to monied corporate lobbies.
So, with concerted opposition by the insurance lobby and Republicans, as well as heavy lobbying against the Colorado Guaranteed Health Care Act by Democratic Governor Bill Ritter, it is testament to strong grassroots support that a state bill to create a Single-Payer model of reform made it through 2 committees to a brief 1-1/2 hour window of debate on the House floor, where it ultimately fell short by 1 vote.
When Rep. John Kefalas introduced the Colorado Guaranteed Health Care Act (HB 1273) in February, he cited the unsustainable costs of private individual and small group insurances. Public insurances, too, experience higher costs as a result of privatization and multiple categories of coverage - e.g., Colorado Medicaid has approximately 20 different categories of coverage, each with different means testing, reauthorizations, etc., substantially increasing administrative costs and waiting lines. A universal single-risk-pool insurance billing system would streamline administrative costs for all.
The unsustainable U.S. for-profit health insurance bureaucracy regularly denies, delays or reneges on claims, often coming between doctor and patient. A proposal for systemic reform, HB 1273 would create a Health Care Authority, stipulating a two-year timeline for establishment of Single-Payer financing of health care in Colorado. The measure proposes guidelines for quality care, incentivizing best practices based on outcomes, addressing deteriorated primary care infrastructure, establishing educational incentives, and retraining displaced workers, etc.
In addition to 18% of Coloradans who are uninsured, Rep. Kefalas cited a Colorado University School of Medicine Report revealing that 36% of Coloradans are underinsured - many who delay seeking treatment, and fill the ranks of those experiencing 50% of personal bankruptcies due to large medical bills. With health care access compromised to over 50% of Coloradans, a Republican opponent of the bill asserted that "most health care problems have been solved," and that "80% of Coloradans are satisfied with their insurance," therefore not justifying major reform.
Aside from parallels drawn by Republicans to allegedly inferior Canadian and British health care (the documentary Sick Around the World counters that notion) and Rep. Spencer Swalm's obscure association of the bill with the former Soviet Union, opponents predictably invoked "free market" solutions, "competition" and "choice." Corrupted rhetoric from the right holds that people want "choice" of minimum benefit insurances, instead of the full choice of health care providers permitted by Single-Payer insurance. The bill's sponsor held that quality-centered health care would restore competition among providers, where it belongs, instead of among for-profit insurances.
There is willful cognitive dissonance among Republicans who deny the administrative savings with Single Payer insurance, and argue that providing comprehensive health care for all has driven up taxes inexorably in other countries, where people "cannot get the care they need" - unsupported by the facts. The U.S. averages twice the spending per capita on health care and has worse outcomes than other industrialized nations.
Allegations of "socialized medicine," "rationed care," and warnings that the bill would "open the floodgates to the world's sick," were leveled by a Colorado Springs Republican. Existing rationed care that renders many with minimal or no health care access, is facilely dismissed - as long as it affects others. One ultraconservative legislator has opposed universal health care, protesting, "I do not want to stand in long lines."
Seemingly counterintuitive, the more that have barrier-free access to necessary health care, the less cost and the better access for all. Rep. Amy Stephens further maintained that doctors would balk at having "to treat everybody" and would exit the state to make more money elsewhere.
An oft-used argument to foreclose debate around the Colorado Single-Payer bill by both the Democratic governor's office and Republicans has been the notion that the 208 Colorado Blue Ribbon Commission for Health Care Reform studied the Single Payer proposal in depth in 2007 and rejected it. Nevertheless, we who attended the 208 Commission meetings witnessed a swift dismissal, from the moment the Lewin Group presented its evaluation of the cost savings with the Single Payer plan - "That can't be!" exclaimed Commission Chair Bill Lindsay, an insurance broker. With no serious follow-up, the Commission early on dismissed the Single Payer proposal as"politically unfeasible." See Evaluation of the 208 Commission's Final Draft Recommendations.
Only 1 of 5 health care reform proposals evaluated by the Lewin Group for the Commission - the Colorado Health Services Single Payer model - demonstrated cost savings for businesses, families, providers, hospitals, and a net savings of $1.4 billion for the state, as well as the ability to provide comprehensive health care for all Coloradans. The Lewin findings mirrored those of more than 20 previous federal and state studies of the Single Payer model of health care reform.
The CHS proposal was met with an effective media blackout by Denver's large print media. Some Democrats continue to permit them to define the terms of the health care reform debate.
Paraphrasing Winston Churchill, "Americans do the right thing after exhausting all other possibilities," Rep. Kefalas cited the need for cost relief for businesses, families and providers, as well as Polls demonstrating that people want major health care reform, not more bandaids. Finally, he cited Nelson Mandela's statement: "Many things seem impossible until they are done."
The word from congressional leaders in Washington is that a Massachusetts-style Mandate is the preferred congressional model of health care reform. If so, U.S. health care will continue its downward spiral of rising costs and decreasing health care access. True economic recovery demands serious health care reform - not further capitulation to the insurance/pharmaceutical lobbies that wrote Medicare prescription drug reform for their own profit.
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Simple solution...
Create a public program in competition with the private program, make it unfunded, but tied into the medicare/medicaid program. By unfunded, I mean that it would have to break even, not take tax revenues.
Hand in hand with that, we should make insurance cooperatives legal again (Mutual of Omaha used to be a insurance co-op I believe). Imagine an insurance company owned by the insured!
The "For profit is best," folks don't have a reasonable arguement against that.
34 comments and 21 from PaceboStudmand and SelenickMagick ....why would someone defend the current healthcare system we have now so passionately..............hhmmmm
Also interesting that PaceboStudmand (placebo stud man Doctor???) joined Huffpost in Jan 2009. Wonder if the health care industry decided they needed to hire PR folks for the "liberal," sites to shout down progressive ideas.
Bingo
I don't know if my earlier comment posted, but if it did, I apologize to PaceboStudmand, I read his earlier posts, and they don't indicate a corperate shill.
I am just tired of finding PR people on this site...
SeleniickMagick and I are NOT defending the current system at all. We are simply saying that the Canadian and European models that have been put forth as examples of great health care are NOT great for everyone, namely myself, and her daughter, both of us living with the congenital birth defect Spina Bifida. The Universal Health Care systems are great, if you have the luxury to wait for sometimes up to 4-6months for treatment, but if you need absolutely necessary medical care, you may not be so lucky.
I used to live in New Zealand where universal health care is not, as Placebostudman calls it, "a utopian fantasy." It is real, just as it is in Canada, England, France, Sweden and other countries where the idea is to provide health care to people, not use illness and other medical needs as a profit generator for shareholders or corporate executives.
The goal of for profit hospital corporations is not to provide quality health care; it is to provide the bare minimum to avoid lawsuits and generate profits. I've see the memos and directives from one of these corporations firsthand in which the CEO and others demand that costs be cut or people will be fired. All they care about is profits and bonuses. Quality health care is far down their list of priorities. Every department is considered a "profit center" just like every department at a car dealer or a retail store.
The idea that the government would somehow do a worse job is ludicrous. I spent several days in a for profit hospital a couple of years ago. I couldn't get anyone to tell me what was wrong with me until I tracked down one of the doctors and demanded to know what was going on. He gave me a simple explanation and I checked myself out. The first thing they wanted when I checked in was cash up front; they couldn't have cared less about what was wrong with me.
If you've followed my story at all throughout the weeks and months I've been here, you'll see that I have debunked the myth that Canada, England, France, Sweden and other countries" have universal health care. They Have very good coverage of most HEALTHY non-institutionalized people. But, there is little to no evidence that these countries do as well treating their disabled, the most critically needy patient's health care needs. At least not without institutionalizing the majority of them. The simple fact that the United Nations makes a distinction between institutionalized and non-institutionalized disabled, and only keeps statistics about the non institutionalized patients makes me wonder if they're hiding something. Unlike here in the USA, there is not the stigma of being institutionalized, or not being overly dependant on others. They have a different philosophy behind their care, and I wonder if the USA would accept the reduction in dignity and self respect when more people are institutionalized under the Universal Health Care model that are used in the countries you mention
Wait, so you are saying that because countries with universal health care keep the really sick people in hospitals until they get better, as opposed to throwing them out in the street if their insurance runs out, they provide worse care?
One of us is stupid here...
Thats all b.s. I live in a country with national healthcare and all that you say is fantasy.
All you all talking about is fantasy and b.s. All lies you have just made up.
All Obama has to do is go to Europe and see how its done. The wheel has been invented already and it works. All those doubts and questions about how a proper health care system works are answered already.
The question is, will Obama dare to confront the health insurance cartels ? if he proceeds like with the Wall Street cartels, then I think some cosmetic watered-down small improvement in health care will result.
I hope he goes all the way. Will he have the courage to do it when the moment comes ?
I take it you are a super healthy Charles Atlas mutant who has been screened to eliminate any possibilty for genetic mutation that could lead to cancer or MS or ALS or Parkinson's? Because, if you're not, and end up being diagnosed with one of those illnesses, or any one of a number of other long term chronic medical conditions such as a disability, then I suspect you may find that The European system (and there really is no unified European system by the way) is not all it's cracked up to be.
Sure, it's great if you're only worried about a broken finger, a stubbed toe, or jock itch, but if you're one of the 19.3% of the US population who are non-institutionalized disabled, then you might not find it as forgiving a system as you think
Its OK, there is long term care for the disabled. My mother has been treated for about 10 years for two serious disabilities and we are happy with the coverage. As you well indicate, there is no unified European health care - it varies from country to country.
The good thing is that no matter how lenghy your disability or illness is, by law you have coverage.
cheers !
A few years ago the California Legislature passed a state single-payer system, but Gov Schwartznegger vetoed it. Health care would then have been disconnected from employment in Calif, so that people could choose to move to a new place (within Calif) and not worry that they couldn't make changes because they'd lose their health ins. Care would have included chiropractic and acupuncture as well as physical therapy and massage. The program, covering everyone, would have actually saved the state billions of dollars in the first several years over what Calif currently spends on medical programs in the conventional, current healthcare mode, in which healthcare is abysmal.
Note to the fact that medical error, hospital and physician caused death, is the 4th or 5th leading cause of death in the USA. The current system is so far from working it is absurd. Here's a gov't link on the subject, but search for for current info: http://www.ahrq.gov/qual/errback.htm
You bring up a good point. Shouldn't we be worried about reducing or eliminating medical error, doctor/hospital related death, or neglect that leads to more hospitalizations, BEFORE we consider just how much we're going to pay for something? What happens when we settle on a price now, then these reforms are put into place, and those reforms force the reformers to raise costs. Won't that lead us to believe they were disingenuous, and should have thoight of that BEFORE asking us to pay?
I don't know, maybe I'm weird that way, but I tend to prefer to know what I'm paying for BEFORE I agree to pay for anything. Especially if I know that what I am paying for is already planning to be upgraded. I'd rather wait and get the upgrade and pay 10% more than pay now, and pay 25% later to get the upgrade.
You're ignoring the well-documented fact that medical errors, overmedication, neglect, etc are products of the existing system, and have only been increasing in the last 30 years, not getting better. The only way to stop these abuses is to remove the middle-man profit motive which creates them in the first place.
If we move to a single-payer system, the structure of the system itself would improve healthcare even if no other changes were made, because evidence-based medicine would be the rule instead of the current system, e.g. the loading up of people with insurance on pharmaceuticals they may or may not need, while others without insurance do not get vital meds that would vastly improve their quality of life and productivity as members of society.
Evidence-based medicine is a conservative approach that uses many different modalities, such as starting with sports-medicine chiropractic for repetitive-stress injuries (which I can attest to) instead of the surgeries that are less than 50% effective, or nutritional therapies for depression (I also have experienced) instead of side-effect ridden antidepressants. Evidence-based medicine costs less to provide.
Your comment also ignores the fact that it would cost less to provide expanded care to everyone than it would cost to continue the current system, in which there are vast disparities of care. This research was already done in conjunction with the Kuhl initiative in Calif that I referenced above.
HR 676 National Healthcare For All is the way to go for the following reasons:
1. By eliminating the profit given to insurance companies by employers and employees in premiums and co-pays more money can go to treating and preventing diseases and injuries.
2. By promoting prevention and healthy lifestyles, people would not go to the Emergency Room when they get sick or injured when often it is too late and very costly.
3. Computerizing records and claims would save money and expedite care.
4. Everyone in and nobody out is the morally right thing to do for the richest nation on Earth.
5. With one payer the government, we have one set of forms, one list of approved drugs, standardized regional boards for fees and treatment protocols
6. Using tax money will be less costly and shared by a larger risk pool.
7. Companies and individuals won't have the economic burden or risk bankruptcy because the government is paying for their care and negotiating fees with providers an pharmaceutical providers.
8. If we eliminate the tax cuts for the rich under the Bush administration, stop the war in Iraq and wasteful Defense spending we will have plenty of money to pay for healthcare for all..
9. By cutting the bureaucracy and profits to for profit insurance companies, we can provide universal health care, not health insurance for all.
10. We can improve the quality of life and no long be ranked 37th in the world by the WHO.
2. How do you promote prevention of genetically based diseases and disabilities such as childhood cancer/lukemia, or any one of the number of disabilities that currently exist which people are BORN with? The only way I know how is through amniosentesis and genetic screening which will lead to more people being encouraged to abort, so that their child does not become a drain on the system, when their care spans 20, 30, 40 or more years.
5. One list of approved drugs? Great, just great. So what happens then, when someone is allergic to the only approved drug that is listed for a certain ailment? There are numerous people who are allergic to one drug or another, and those allergies cause often excruciating side effects, for which we will likely be put on another drug to cure the symptoms of said allergy.
simple issues with simple fixes... so is that your arguement for continuing as it is?
2. Lupis, parkinsons, altzheimers, all genetic diseases which can be treated once diagnosed. If you get treatment early, the disease can be stopped in it's tracks, if you wait, the damage is irreversable. Heck, even lukemia death rates are lower if you know the genetic problem is there and monitor. So if we had a prevention vice "wait for someone to get sick, then treat," system, costs would be lower and people would live longer, healthier lives.
5. One list does not mean one drug per disease, I am going to assume you didn't know this (vice that you did but just want to make a straw man argument). Right now the drug companies bribe doctors to suggest their drugs work on problems the drugs are not approved for, the drug companies make more money, and who cares if people die because they are effectivly on an expensive placebo. Having a list that docs need to use for a disease means patients get a proven treatment for what they are diagnosed with.
#4. Freedom of choice is one of those "Great American Traditions" and IF you remove choice with regards to health care then you have JUST LOST the ENTIRE argument with regards to Roe V Wade since THAT particular argument rests ENTIRELY on the issue of CHOICE.
#5. I have a whole HOUSE FULL of people who are severely allergic to BOTH 'cillins and sulfa drugs (in simple terms... they are DEATHLY allergic to MOST antibiotics) . Are you going to be responsible for EVERY death that results from only certain drugs being available?
#7. How, SPECIFICALLY, will you provide coverage to the tens of thousands of Americans who do not live IN the US? Reciprocal agreements won't do the trick because there is NO world standard of COSTS with regards to medical care AND there is no WORLD currency.
#10. How, SPECIFICALLY, will you deal with the specific medical needs of the nearly 20% of the US population that is disabled when those NEEDS are vastly different than "average"?
4. There is no freedom of choice regarding social security, medicaid, medicare, unemployment insurance, need I go on?
5. So what is a doc going to use? We are talking about the pharma industry using paid shills to advocate doctors using drugs on problems the drugs are not proven to help. Giving someone an expensive placebo probably won't provide the best outcomes.
7. The same way France does.
10. Better than private insurance, specifically, medicare would pay for treatments.
The more I read the naysayers about universal health care, the more I wonder about the human psyche. At it's base level there seems to be an underlying hatred of everyone else that fuels gut level reactions to things.
It's like if someone walked up to you tomorrow and said; "Hey, I want to make sure you and your family are all covered medically. Rather than you paying $368 a month to a private company that has a CEO that makes millions of dollars a year as long as your health care claims are denied, I want to make sure you get the care you need when you need it. All you need to do is add $54 dollars to your federal taxes, and no longer pay the 368 dollars a month. That's a savings to you of $314 dollars a month and a savings of $1,235 dollars a month to your employer. Isn't that awesome? it's good for everybody."
And you say; "Wait - you mean everybody gets this benefit? Heck no! I don't want 'fill in the blank of whatever creed, sexual preference, socio-economic standing, race of gender you don't like. to have access to this! I'd rather cut off my nose to spite my face! So what if it will better my health care and save me money!"
You're wrong. You want to know what the naysayers are saying? I am one of them, so I'll tell you. We are saying, "We are dying under the current system, because the medicine and technology that is being provided is substandard to poor. Considering this now, what are the people in control of quality control going to do to GUARANTEE that the levels of care will not go down, in the rampant mass exodus toward lowering cost?"
If someone can answer that honestly and forthrightly, then I'm sure many naysayers would be happy to rethink their position. But, because there IS a history of humanity cutting services, rather than improving quality of service to cut costs, across the board in so many industries, what is to make us doubt that the health industry won't do the same?
Until we have a guarantee that CARE will not be cut or rationed for the people who need it most, I don't have a problem paying more because I know what I'm getting. I DONT know what I'll be getting when costs are cut as care is cut, and as a member of the 19.3% of the US population who is disabled, that is something I worry about, when my neighbor is only worried about making sure he only has to pay $10 for his jock itch cream
I think this is two different topics. There is a lack of access to healthcare services in this country, with many utilizing (inappropriately) emergency medical services as primary care, because they cannot afford anything else.
I'm a physician, so I'm not going start an argument with you over the quality of care you have received. However, I am going to ask you to elaborate on your blanket statement of "substandard to poor" care that you've received.
If you are dying under the current system, wouldn't a change be a good thing?
Right now half of our medical care dollars go to paperwork (I used to work in a hospital in the accounting department). This is because for profit insurance can save money by denying coverage, so they deny every claim that has a missing dot on an "i". The hospital has to re-send the form, and if further treatment is involved the insurance company has the added bonus of the savings from a patient dying before they can get care.
My concerns are linked more to the fact that we currently have TWO problems with this entire discussion...
First this discussion, as it is currently framed, is dishonest at best. It is blatantly dishonest to call this discussion a discussion about CARE when the ONLY things being discussed are those related to MONEY. It is even more dishonest to continue to say that the discussion is about CARE when EVERY time that someone asks specific questions related to ACTUAL CARE they are (falsely) accused of being "a shill for the insurance companies".
Second, I need REAL answers to REAL questions. WHY should I buy a "pig in a poke"? There has been NO ACTUAL CARE discussed... Would you buy anything ELSE "sight unseen"? Of course not... and yet you actually EXPECT people to "buy" health care reform sight unseen. I wouldn't buy windows for my house without first measuring the size of the opening FOR the window... Health care is a LOT more important than windows... and I'm NOT buying it without KNOWING what I am getting FIRST.
People are more concerned with the price of the warrantee (which is what insurance is) than they are about the fact that the mechanic only has leaded fuel or deisel to put into his high performance car.
If you are lucky enough to be able to afford your health insurance, you already are, in fact buying that which you cannot see, or know. Until you make a claim you cannot know if it will be paid or not. It is very likely that you would be denied for any number of reasons. Too many people have been through this for anyone to not be aware of the problems with health insurance. It does not mean health care. We have the most expensive health insurance in the world, We do not have the best health care in the world by a long shot.
I am trying to figure out whether you are a Canadian (as your profile says) arguing about the US system to save us from what you have, or a US resident trying to avoid a Canadian system.
You need to pick one persona and stick with it.
Great article. Single payer is the only sustainable option yet it is not even made part of the debate. We should all follow Colorado's example of grassroots pressure and get Congress to pass national single payer. If you want to use your vote strategically on this issue please join our voting bloc at:
http://www.votingbloc.org/Health_Bloc.php
I'll disagree with you that it is the ONLY sustainable option. The threat of underfunding by future governments is real. It's not reasonable to expect to have an Obama and majority Congress in office forever. Recession is also no friend of single payer system. Also we cannot assume that all procedures will be covered by a single payer plan. I think people will try to go outside of the single payer plan to cover procedures not covered by the single payer plan. In principle I'm in favor of single payer, but I'm not convinced it is the best possible plan. Also, if a single payer plan is going to be a big medicare plan, reimbursement rates are not exactly spectacular, and some colleagues have opted out for these reasons. I read an article recently in the Annals of Internal Medicine that was intriguing, called EMBRACE for Expanding Medical and Behavioral Resources with Access to Care for Everyone Health Plan. http://www.annals.org/cgi/content/full/0000605-200904070-00113v1 . I don't want to have to continue fighting for Universal Health Care for the next 20 or 30 years with the possibility of future hostile governments setting us back every time there is a change in regime. It seems that the EMBRACE plan allows for insurance companies to make a moderate amount money, without sacrificing necessary care for everyone. But, I''m still looking for more details.
Thank you. Right on Target!
There are really only two constituencies that should matter in this discussion - doctors and patients. Why the media and the politicians are blind to that escapes me.
A single payer health care system is not the end of all of the problems in the American health care system, it is the beginning of the solution. Look at the issues that the provider community focuses on, coordinated care, payment reform, medical homes, information infrastructure. None of these has a chance in the fragmented and fractured patient delivery system that characterizes the American mix of public, private and no health care plans.
I administer a $100 million employer sponsored benefit plan. I see every day the money that is spend spending money. That is money that could be spent on health care. People who fantasize about the horrors of a single payer bureaucracy, should spend some time dealing with American health care bureaucracies. We have too often spent months trying to figure out who should pay, not how much or what for, but simply who should pay. That is not efficient. That is not money spent on health care. That is waste by design.
But, shouldn't we be planning 2 or 3 steps ahead of the game? Once we do figure out who pays, then we need to figure out what we're paying for, and it's only when we figure out what we're paying for that we can determine how much we're going to pay. If more people knew what they were paying for up front, then maybe, just maybe, more people (or corporations, or governments, whoever) might be more willing to step up to the plate and offer to pay. But, right now, people are not taking responsibility for who is going to pay for it, simply because there are those of us who have absolutely NO clue what we are paying for, other than knowing we are paying to have someone else pay for some unknown undisclosed quantity of care is likely to change at any given moment BY the person who is paying, because the person who pays is not willing to pay more for something that only a minority of people use, and therefore said medication/procedure is deemed cost ineffective.
It is more than a little disingenuous to call a discussion about the COST of health care a "health care" discussion. WHY is it impossible to have so much as a smidgen of honesty with regards to this discussion? "Oh but saving money will improve health care" you say. Let's be honest... IF the only thing that changes is who is paying for the policy there will be NO CHANGE in the QUALITY OF CARE that people receive.
In order to IMPROVE CARE we must do several things... Things like getting rid of the incestuous relationship between the FDA and drug companies. ADDRESSING the fact that almost 20 percent of the US population has VERY DIFFERENT medical NEEDS than the "majority"... AND HOW specifically we are going to MEET those needs without infringing on THEIR rights to things like LIFE & LIBERTY. No matter HOW you want to slice the apple the REALITY is that people WILL wait longer for care than they are waiting today.
I KNOW how badly people want to BELIEVE that universal medical coverage will be a utopia in which "everyone" is treated the same medically the sad reality is that IF we WANT to avoid the problems that OTHER countries have with regards to universal coverage (and whether you ADMIT it or not there ARE problems with MOST "universal coverage" schemes) we MUST ADDRESS the problems BEFORE we "craft" what may or may NOT "work" in the US.
So tell me then....and be honest....what will happen when this country reaches its utopian fantasy goal of universal health care coverage, only to realize that more people are dying, because no one thought to do anything...not one single thing...about the fact that the FDA, a government agency, will continue to put dangerous or even deadly ingredients in our drugs, that will kill many of us. This article title is misleading. I thought there actually WAS going to be a discussion about how to improve the level of care. But, again, I've been proven right in my belief that, so long as health care is free or virtually free, no one will give one iota of thought to the fact that our care is so abominable. Reducing costs, removing the insurance industry, and all the ideas I';ve heard so far won't do one lick of good to raise the US standard of CARE, it will only FEEL better because it is cheaper. But it will not change the medicine and technology issues that are currently being faced by millions of people in this country.
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