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Paul Abrams

Paul Abrams

Posted: September 23, 2010 01:27 AM

Today, September 23, 2010, President Obama and congressional Democrats freed approximately 300 million Americans from the absolute dictatorship of insurance companies over their healthcare. The other, approximately 50 million Americans were freed in 1965 with the passage of Medicare (aka, "medical care for the aged under the Social Security system").

Republicans such as Ronald Reagan declared in TV ads that Medicare would enslave both doctors and patients, with government compelling physician relocation and making decisions that doctors should be making about healthcare. Neither, of course, occurred -- indeed, so unobtrusive is the government hand that many Republican Tea Party members have screamed to "keep government out of my Medicare." The administrative cost of Medicare is less than 5% of total expenses, and that means that more than 95 cents out of every Medicare dollar goes to pay for... wait for it... healthcare!

Nonetheless, the "Young Guns" (who are more like aged rightwing radicals) will propose, if Republicans take control of Congress, that Medicare be privatized into a "voucher" system providing people with money that will cover increasingly small percentages of private premiums and jack up the premiums for the rest of us as high-risk, expensive, patients are added to the below 65-year-old pool.

All the same tired, worn, absurd lies have been made about "Obamacare." It almost worked to derail the entire program, and it certainly reduced the benefits that could have been provided at an even lower cost. But this law planted a giant stake in the ground. The tectonic tensions that remain because of Republican Tea Party lies and control of the dialogue will have to be corrected. That is reserved for another day.

Today, insurance companies can no longer drop your coverage when you become ill. They can no longer exclude your children from coverage under your policy due to a pre-existing illness, real or imaginary. Parents, as of today, also have the right to include their children up to age 26 under their insurance policy. Insurance companies can no longer impose annual or lifetime limits on coverage.

And, small businesses will receive a tax credit (i.e., dollar-for-dollar, not just a deduction) for paying for healthcare for their employees, immediately impacting up to 16.6 million people. Moreover, these small businesses can receive direct help to provide PREVENTATIVE CARE, such as immunizations, in their health insurance policies, similar to benefits big companies sometimes provide their employees. It limits non-direct healthcare expenditures to 20-25%, with a requirement to report those percentages and refund to enrollees any amounts that exceed that limit. (Note: This is still more than 4X higher than Medicare's administrative costs).

Before today, an insurance company had dictatorial powers. It could, and often did, the following: exclude children from coverage, drop coverage once a person became ill, refuse to insure someone in the first place if they had pre-existing illnesses, refuse to include children 18 and over under their parents' insurance.

No more.

To Republicans, 9/23/10 is a day of infamy. To the American people, including many Republican voters who will benefit, it is a day of freedom and justice. (Incidentally, our Preamble talks about Liberty and Justice, and so does our pledge of allegiance. This law achieves both.)

But, this is the law the Republican Manifesto pledges to destroy. And, while they are at it, throw Medicare overboard as well -- despite the American Medical, Nurses and Hospital Associations and AARP (i.e., our doctors, nurses, hospitals and elderly -- people who just might know a bit more about these matters than "Young Guns"), favoring both this law and opposing the replacement of Medicare with vouchers.

Vote them in, and they will vote this out. And, if they do not get their way, they will shut down the government until the administration caves.

Republicans fight to maintain the absolute dictatorship of insurance companies over peoples' lives, and, when they are not doing that, apologize to oil companies.

Oh, yes. There is then John Boehner, the man who would be Speaker of the House. He not only wants to repeal this (he now pays a tanning booth tax to maintain his tan), he also wants cigarette companies to be able to enslave your children to the ill-health of smoking... and, just to be certain of support, handed out tobacco lobby checks to his fellow Republicans on the floor of the House of Representatives, forever disgracing him and the House itself.

And, Americans are seriously considering trusting these people with their livelihoods, healthcare and retirement?

 
 
 
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05:00 PM on 09/24/2010
We have passed from one dictatorship, the companies, to another, the government.
06:10 PM on 09/24/2010
Only government can be a dictator. Government can force you into what it wants you to do. Private companys cannot. If you dislike one company, take you business to another. There is no dictatorship in the private free market.
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Paul Abrams
06:02 PM on 09/25/2010
Really? So, when you are sick and your insurance company finds you once had a zit as a teenager that you forgot to tell them about that was removed in a dermatologists office, and they drop you, you are "free" to go find another private company that will, now, insure you? Or, when all insurance companies tell you your toddler's asthma is a pre-existing condition so none of his medical care can be covered under your insurance...what are you going to do? Or, when you lose your job, and have no health insurance, you come into the emergency room for your illness, you get treated but cannot pay, and so the cost of that emergency room visit gets passed on to increased premiums for those who do have insurance, whereas, if you had insurance, you would have sought earlier and less expensive care, that is not "forcing" others to pay for you?

By the way, I forgot to mention this: I have a bridge for sale. Want to buy it? I'll give you a really good price.
04:33 PM on 09/24/2010
So when it turns out that ObamaCare is a good thing, are they going to change the name?
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LibRule
Peace on, Republicans!
02:25 PM on 09/27/2010
LOL! Don't miss much, do you? They are already building most of it into their new contract on America. :)
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LibRule
Peace on, Republicans!
02:05 PM on 09/24/2010
What kind of fools are we that we would choose to put health in the hands of companies trying to make a profit? This insanity has to be stopped, not reformed. If we cannot go to a public plan (like virtually every other major country in the civilized world), health insurance needs to be non-profit only by law. Of COURSE the insurance companies are jacking your rates- they are trying to scare you into voting for more of the same- and judging by the responses it seems to be working on the easily scared who can't seem to step back and ask why they are defending such a deranged system. And if this works for you, we can continue to pay more than 7 times more than any other country in the world for healthcare- goodness knows, the CEOs need to make their millions!
06:23 PM on 09/24/2010
There is nothing wrong with profit. There is nothing wrong with free enterprise. The government and "non-profits" also have capital costs, even if they are allowed to ignore them on their books. Profit is a cost of capital. Just because the government doesn't explicitly recognize its capital cost and doesn't have an accounting category called "profits", doesn't mean it doesn't raise and use capital or earn profits (or better yet, losses). By ignoring capital and profit, the government hopes to show its books and budgets in a more favorable light. The cost of raising taxes is the cost of capital. The IRS is a provider of capital to the Feds.

Profit also means that one's income is higher than one's expenses. If any instituition, govt, non-profit or for profit constantly loses money they will be out of business. Non-profits are allowed to make a profit. They need to use surplus from a good year to cover a down year.

Government can mask its red ink. If it loses money it can just get more from the tax payers. If a private company loses money it goes out of business.

If you think a company is not a good health care provider the private market will allow you to choose another provider. If you think none of the current providers is good or efficient, then YOU can start your own company and provide better service at a lower cost. That's the beauty of the free market.
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LibRule
Peace on, Republicans!
02:20 PM on 09/27/2010
Thank you for the lesson on profits. It was so rudimentary as to really not be worth saying, but I guess you felt it had to be gotten off your chest. I stand by "What kind of fools are we that we would choose to put health in the hands of companies trying to make a profit? "
You need to look up Wendell Potter. For-profit insurance companies are out to - surprise! - make a profit. They will choose to do so over your health. Period. There was an article last week about a Canadian lady that had a very fatal bone cancer of the hip and spine. Canada sent her to the Mayo clinic where a VERY experimental surgery saver her life. It NEVER would have been covered by an insurance company here. If you think the free market is so great, let's bring it back to police and fire departments- and let's start in your neighborhood.
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NotStarvingArtist
"Art is the signature of civilizations."
12:22 PM on 10/17/2010
Really? Do you seriously think that any individual who doesn't like the current providers of healthcare can start their own company and provide better service at a lower cost? Have you ever tried to start up a business in a market that is already saturated with major players? Puleeeze, get real! And since relatively few people buy their insurance themselves, rather than through their employers, they really have even less ability to influence the profitability of any insurance company.
12:19 PM on 09/24/2010
How can anyone defend a repeal of this law. Do you actually think that insurance companies dropping someone's coverage when they get sick is a good practice. That is like if you house is on fire and the the fire insurance company comes while still on fire and cancels the policy because the house is on fire. Come on people think.

http://themiddleamericanvoice.blogspot.com/
06:40 PM on 09/24/2010
Midle Man:

Your comments show a lack of knowledge about the working of the private market (health care or otherwise). You also imply a lack of understanding of just how the various European systems work. And there is not one, but many variations of health care in Europe.

It is an urban myth that companies drop patients when they get sick. I am sure that there are cases. How many? The few that can be documented are blown out of proportion and used as a whip on the industry. Too many dropped patients and a free market company would lose customers and go out of business. Besides, the get sued for millions. That's a deterrent to the practice.

When the government will be in charge of health care it won't drop coverage. It just won't agree to pay for the proceedure. and you won't get to sue to get the denied coverage it it isn't on the approved list. A perfect example is NICE in Great Britain. NICE is the governmental committee charged with approving the proceedures to be paid for. Many of the denied proceedures are the high-cost, cutting-edge cancer drugs and proceedures provided by private insurers in the US, but denied by NICE in GB. You may get some sort of cancer treatment in GB, but it won't be cutting-edge. For instance, look at the rate of prostate cancer survival in the US v. GB. The US is FIRST in prostate cancer survival.
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Paul Abrams
06:09 PM on 09/25/2010
We spend twice as much per patient as the UK. If they decided to double their expenses per patient (doesn't matter if private or public), then they could provide even better care than we do. And, in many areas, they DO provide better care.
I, however, am at a disadvantage when I talk about this. You see, I have actually worked in the UK health care system. Have you?
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NotStarvingArtist
"Art is the signature of civilizations."
12:28 PM on 10/17/2010
Where is your proof that it is an urban myth that companies drop patients when they get sick? Do you have access to insurance company records so that you can compile actual statistics to prove your position? And how many people would have to die because their coverage was dropped would it take before you considered it to be significant? If it were your Mother, sister, brother, etc. who died, would you care if they were only a small percentage of the people covered by insurance companies, or would you be furious that they were dropped?
11:29 PM on 09/24/2010
Seriously? You destroy your whole case when you state that it is an urban myth, but you are sure there are some cases. Let us say it happened once, then all this law did was to prevent it from happening again and you therefor should not get so anger over such a preventative measure. Again you destroy your argument when you talk about to many dropped people then that company would be out of business. You are misunderstood about private insurance, if a company accepts your premiums and then cancels you when you get sick, then there is nothing but profits for the insurance company, and since there are limited competition within states you really have no choice in the matter. As far as your point in Europe it is again almost silly. It does not matter the rates for one fact only and that is if you are considered uninsurable in the United States you can not afford medical treatment. At least you got a shot at survival in Europe which is better then being uninsured here.
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Paul Abrams
06:11 PM on 09/25/2010
Middle man, just remember this one fact when you are talking to friends about health care in the US vs. other countries. We spend about double per patient as they do. If you take any of their systems, and double the amount of money going into it per patient, it would provide everything we do, and then some.
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Tim303
11:41 PM on 09/23/2010
"This should be repealed. Your kids don't need inhalers. Asthma IS a preexisting condition."
10:53 PM on 09/23/2010
Here's a new one: a friend was hospitalized for gastrointestinal symptoms (doctor's orders). Many tests were run; they have not yet found what is wrong. But the insurance company has denied the claim because they didn't find anything, ergo, she wasn't sick and didn't belong in the hospital. Great. Now we're supposed to second-guess our doctors and decide for ourselves whether or not we need to be in a hospital? Not to mention, not all her test results are in yet - how do they know she is "not sick"? I recognize that this is just a dodge, and eventually they will pay it, but it's a new game now that they can't play the old ones. Public option, people!
09:15 PM on 09/23/2010
If the costs weren't so much, and you could actually get insurance when you are over 60, maybe the "free market" would be a good thing. Personally, I have parents that are in their 70s. If there was no medicare, there would be NO insurance for them. That means that for every medical related item, they would be paying out of pocket. I'm not a genius, but with the ridiculous costs of health care, it seems my folks would be screwed. They are not broke, in fact they are doing OK, but if there was no medicare to help with Mom's breast cancer, or Dad's skin cancer, they would have been destitute years ago. Well, I guess my older brother is the most well to do out of the kids, maybe he can just pay for everything? Then again, after all 4 kids chip in, maybe my folks would be able to pay for the next visit to a doctor, but what do we do when the kids are broke and Mom and Dad still need medical care? I surely don't know, but the damn costs of medical care MUST come down. Is this by design? Only the rich being able to live and go to the doctor?
Chauncey1186
Yeah, I'm a soshulist - so what?
09:54 PM on 09/23/2010
If we totally took health insurance (which provides no postive healthcare outcomes) out of the mix then costs would come down since there would be very few who could afford $300 for an aspirin. The free market forces would bring the costs back down to a reasonable level. Way back when (70 years ago) there was no such thing as health insurance....until someone figured out how to make a profit out of it, then someone else figured out how to make a buck out of the insurance industry by charging $300 for an aspirin. And so it goes.

I'm thinking your elderly parents remember a time when they didn't need an insurance card to visit the doctor - in fact they probably remember a time when the doctor came to visit them. I'm not advocating chickens for checkups, but we have to get the middle man (health insurance companies) out of the business of our health. Cigna, Blue Cross and all the others provide NO healthcare service whatsoever - they are in the business of gambling that you don't get sick, and when you pay them premiums, you are gambling that you will.
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Paul Abrams
01:12 AM on 09/24/2010
There is a basic problem with medical care that is quite different, say, from buying a car. Your parents earned their money, whatever it was, in the 1960s and afterward to about 2000/2005. If they wanted to buy a care in the 1970s, they bought a 1970s-priced car with their 1970s wages. But, most of their medical expenses will be in 2020 and thereafter. Unless they have enough extra money and could invest it--and if there had been no George W Bush Administration who destroyed whatever they had--to make excellent returns, they would be purchasing 2020 medical care, with 1970/80s wages. That won't cut it. Moreover, all this presumes that they paid no insurance during that period, saved their money, and never needed medical care.
That is why medical care for seniors must be an intergenerational transfer expense. Today's wage earners pay for today's medical care. And, even that has problems since wages have risen at a far lower pace than healthcare costs. But, to pay for today's healthcare with wages from the 1970s is a huge mismatch.
And, that, of course, assumes one could have paid for it one's self contemporaneously. Most people cannot, and could not. So, unless there is a large risk pool, and we all realize that someone will get sick, and I put my money in just in case it were me, then we can get much closer to paying for those who need it, when they need it.
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bllnsinchnge
peace, markets, freedom
08:36 PM on 09/23/2010
And, Americans are seriously considering trusting these people with their livelihoods, healthcare and retirement?

YOU trust any government with those? Medicare is a huge ripoff to the taxpayers. 100 billion a year in fraud!

http://www.google.com/url?sa=t&source=video&cd=2&ved=0CDsQtwIwAQ&url=http%3A%2F%2Fwww.cbsnews.com%2Fvideo%2Fwatch%2F%3Fid%3D5419844n&ei=Z_KbTNuxL4T6lwfMpu3zCQ&usg=AFQjCNGN49EyqcsiHo4T-_WxpRqIkbcBtw
09:22 PM on 09/23/2010
I trust a government elected by the people more than I trust corporations looking to make a buck off of the people.

Your link is broken
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bllnsinchnge
peace, markets, freedom
12:49 AM on 09/24/2010
The link was a recent youtube of 60 minutes on medicare.
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Ronald Sloan
10:13 PM on 09/23/2010
Even it the public option had 500 billion in fraud it would still
be cheaper then what we have now.
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bllnsinchnge
peace, markets, freedom
12:50 AM on 09/24/2010
single payer would have been the best of the three bad choices we have had.
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dsws
No owning ideas. Limit only commercial use.
07:25 PM on 09/23/2010
"And, if they do not get their way, they will shut down the government until the administration caves."

Don't count on it. If it comes to that, my quatloos are on Obama to squish them like a bug. It didn't work against Bill Clinton, so the conventional wisdom doesn't call for caving.
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John Mainstream
I'm a Clinton Democrat that is now an independent.
06:30 PM on 09/23/2010
We needed a bill that provided health care to every American, regardless of ability to pay. What we got was a mandate from Washington that every American and business must get insurance, or get fined.
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dsws
No owning ideas. Limit only commercial use.
07:27 PM on 09/23/2010
... with the government paying for it if they choose the second-cheapest option on the exchange, and letting them keep the difference if they go for the cheapest.
10:20 PM on 09/23/2010
What we got is a bill that provides health care for ALMOST every American, but most of the provisions go into effect in 2013, I believe it is. The system had to include time to put everything in place, so as the article states, several VERY GOOD provisions go into effect today -- forever putting an end to the way insurance companies take advantage of their clients -- and other provisions for the rest of Americans will go into effect in a couple of years.

Democrats, if still in power in Congress, plan to work to correct the flaws in the health care bill as they are able to get the votes thru Congress. The bill was not PERFECT as it was passed the first time -- almost no MAJOR PIECE OF SOCIAL LEGISLATION is -- they all have to be fixed over time. This is what happened with Medicare and Social Security -- they didn't cover everybody in the beginning either, and now both programs are credited with keeping our parents and grandparents in the middle class, and out of poverty

If you stay home on election day, or vote for Republicans, they will try to privatize Social Security and hand out a few vouchers in place of health care to every family. The vouchers won't be enough to pay for anybody's annual insurance costs. WE KNOW WHAT WE MUST DO -- VOTE DEMOCRAT, so we can fix healthcare and eventually get our PUBLIC OPTION.
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John Mainstream
I'm a Clinton Democrat that is now an independent.
06:27 PM on 09/23/2010
Now that health insurance companies are jacking up premiums under Obamacare, over a million jobs will be lost in 2011 because of this.
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dsws
No owning ideas. Limit only commercial use.
07:28 PM on 09/23/2010
They're jacking up premiums less than they would have under business-as-usual, but not so much less that they'll have to fire a million insurance bureaucrats.
08:21 PM on 09/23/2010
No they were jacking up premiums anyway, nice try though, they just have a convenient scapegoat now. The new law has nothing to do with current rate increases. That one million jobs figure, also false. Please try and provide any legitimate justification for that, with citations please.
05:47 PM on 09/23/2010
Dear Mr. Abrams,
Your figure of 5% for Administration costs is WRONG! WRONG! WRONG!
It is less than 1% to Manage MediCare. That means that 99% goes to Healthcare.
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Paul Abrams
09:16 PM on 09/23/2010
I thought I said "less than 5%". 1%--even better! Thanks for the info!!
12:20 PM on 09/24/2010
Both 5% and 1% are incorrect. It is difficult to compare, dollar for dollar the amount of overhead. My educated guess is that the administrative costs for Medicare at at least as much as for the private sector. The public sector is a notoriously inefficient economic institution. When one looks at all of the other public sector/private sector comparisons, the private sector wins.

Here's one large cost that is ignored and misunderstood in the public sector: profit. Profit is essentially the cost to raise capital. Medicare is a beneficiary of the governement's ability to tax. It receives whatever it needs to pay it's claims and to invest in the initial startup or any other capital cost it pays for. Medicare doesn't need to account for its capital costs as capital. A private business does and has to report its profit on its disclosure forms. That does not mean that there is no cost of capital for Medicare. It does have an implicit cost to raise capital. It means that the cost of capital to Medicare is hidden in the vastness of the government from the cost of the IRS to collect taxes to the cost of Congress to pass funding bills and enforcement bills.

Medicare loses money on its operations. The government supplies the rest and it would be treated as capital if it were a private company. The government ignores its caoital costs because it can. Your comparison of 1% or 5% is incorrect.
05:43 PM on 09/23/2010
As I have been blogging for a weeik now, Dems need to pass an ammendment to the Healthcare bill that would require any Insurance Company that wants to be listed on the Exchange to have covered all children under the current law for a period of two years before they can be eligible. The Dems should hire that ex Insurance CEO, now turned whistleblower, to find other loopholes to patch, at the same time.

We need to copy and paste this into as many other blogs and Facebook groups and Twitters as we can, to get the word out.
08:22 PM on 09/23/2010
Public option or medicare buy in in the lame duck session perhaps? We can hope
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09:00 PM on 09/23/2010
This is a possibility -- if all the politicians who voted in favor of the mandatory-purchase-of-health-insurance will give up their ownership of health insurance stock. Otherwise, not so much.
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rougebaisers
05:15 PM on 09/23/2010
Nonsense. Their game plan will simply change with the aid of putrid politicians.
RACVC
Forever Young - B. Dylan
06:03 PM on 09/23/2010
Disagree.
At least the patient has a greater say now. That shifts the balance of power.
04:54 PM on 09/23/2010
I'm all for extending Medicare for all and negotiating with a pool of 300 million. You want to see health care costs come into line and drug prices fall overnight? That's how you do it. The lost productivity and sap on our small businesses is more than enough reason to move towards Medicare for all. We're paying for people without coverage right NOW because they're going to emergency. How much more disposable income would people have if their health care costs were cut and how much happier and healthy would the population be if they didn't have to stress over paying for their house or paying for their cancer treatment? That sheer level of increased disposable income would flood the economy, it would allow people to pay off credit cards and lines of credit, get caught up on their mortgage, etc.
06:13 PM on 09/23/2010
While you are obviously in favor of having the government run health care as a monopoly, you believe that the government monopoly would be favorable to you. On the issue of prices it seems (superficially) that lower prices would be favorable to you.
What about the other effects of monopoly: limited choices, poor service, waiting lines? The most important reason why markets work and the range of goods and services in the US is so vast is because there is a significant amount of choice. A government monopoly would severely restrict those choices.
How much more disposible income would there be if we restricted the prices paid for houses? Why don't we have one market for houses, let the government run it and restrict the price one could pay? Let's use the same reasoning used for health care: housing is a necessity, many people can't afford it and if we had only one buyer in the market, then the prices would be lower and we would all benefit, is that how it goes? I sure hope you would see that the housing market would collapse and then the only remedy would be for the government to step in, build it itself, dictate prices and ration it, kinda like the Soviet Union.
07:09 PM on 09/23/2010
You make it sound so crazy and extreme but every single other Western industrialized country has made for-profit health care illegal. Basic health care is covered by the whole as they all pay in, anything over and above that is provided for by private health insurance plans. They do it that way because it works, it provides ACCESS to health care for all citizens, it's far, far cheaper and it's benefits speak for themselves.
08:33 PM on 09/23/2010
There would be no loss in competition or quality of care. It would not be a "Government run system" it would be a paid for by government system. Everything would be the same EXCEPT insurance companies could not essentially dictate costs by making arbitrary decisions based on profit. Medicare works essentially like this. With the services being provided at more or less market rates with the fed footing the bill with reasonable co-pay. Seems like if it works in every other industrialized nation it should be able to work here. The U.S. is not the fore front of health care like everyone seems to think. In fact we are rated by the World Health Organization (as of 2000) as 37th. Somehow I don't think we have gotten much better in the last ten years.