America's Health Care System

Yup, there are always people who will game the system for their own benefit. Some are in emergency rooms, some are on Wall Street, some are in the halls of Congress.

But for every story like this one from my dear friend Dennis, there are others like this:

http://tinyurl.com/ylbbu96

Larry

And some are in the health insurance industry.

I usually studiously ignore these kinds of discussions but reading this after just getting home from my frustrating shift in the Emergency Dept. tonight required comment. Any ER doc or nurse could write you books full of examples of both the cases you guys illustrate. You can literally multiply these two cases by hundreds of thousands in our country right now.

I took care of one of our "frequent fliers" tonight whose visits when added up had been to the ER over 750 times in the past 8 years. When you consider that I have worked about 1000-1200 days at the same ER over the same time period, you can see that this person has been there almost as often as I have; AND I WORK THERE. Multiply that by $300 to $3000 per visit paid for by tax dollars and add it up.

Larry, I love the Grp5 lights I bought from you, and they look great on my car, but can you see that a large part of the reason for the neglect of the people that your article talks about is the resources wasted by the ones Dennis (the headers I bought from you look equally as nice on my car) alludes to in his quote?

To those of my friends who tend towards the more liberal side-there is not enough resources and manpower to continue to try to give everybody everything they want all the time. When we do people that really need it go wanting as per Larry's article.

To my more conservative friends, one way or another we are going to end up taking care of people who won't take care of themselves. We can do it now or we can do it later. There is no getting around this. And if you don't want to change the system because there would be "rationing" you are kidding yourself. Right now it is the insurance companies (private and governmental) doing the rationing.

To my lawyer friends who resist malpractice reform with the argument that lawsuits improve the safety of medicine in the US- I pay $22.50 of malpractice insurance for every hour I work. Every doctor that works in an ER pays at least this much. That amount is approximately the hourly wage for a skilled ER nurse. Do you think the ER is more safe by having the threat of a lawsuit hanging over the staffs head than it would be if that money was used to have an extra nurse in the ER for EVERY hour that EVERY doctor works?

To my friends that have bad experiences in the ER and dealing with medical matters-yes, there are some bad doctors out there, and mistakes are made. However, most doctors and nurses are trying to do the right thing for the right reasons. Often disappointment and displeasure in the medical experience is due to unrealistic expectations. I can't get them an MRI at 3am in the ER because their knee has been bothering them since they played high school football, I can't give them a prescription for "liquid morphine" because Tylenol doesn't help with their menstrual cramps, I can't tell them why their right shoulder hurt 2 weeks ago but feels better now, I know they have been waiting here much longer with their twisted ankle than the guy that just got here, but he is having a heart attack and I have to take care of him first. And yes I totally agree with you that there should be more doctors and nurses here right now to take care of all these people that have been waiting a long time-could you please tell the hospital administration about your concerns as they are the ones who do the staffing.
One of the first things I try to teach residents is to find out what the patient wants. If it is something that is reasonable, appropriate and within my power I will be happy to help them with it. If it is something that is unreasonable or not doable we save tons of energy and resources by telling them upfront that it can't be done. If people realize the limitations of what can be done, and why or why not, they are much happier with their experience.

I apologize for my whining. I expect much flaming, however this thread caught me at a very frustrating time where all these problems are being used to play politics and nothing is really being done to help the situation.

We now return you to your previously scheduled Pantera content.

Mike MD
Assistant Professor
Department of Emergency Medicine
Emergency Medicine Residency Program
Texas A&M University Health Sciences Center School of Medicine

Well said, Mike.
No flaming from here...
Will

quote:

No flaming from here...

Nor here. Thanks Mike.

Perhaps it comes down to this:

The providing of medical care in the USA is broken. While it offers the best, it provides much less, or nothing, to too many of us.

Is this how we should continue?

Larry

P.S. - Before it became a talking point, something prone to manipulations by both sides, did we hear very much about the failures of government-run Medicare?

I find Mike's post to be one of the more cogent and pragmatic posts I've recently read on the subject. All good observations and after such revelations my first response is let’s do something about it. I do scratch my head a bit when I hear people complain about the absence of healthcare for “x” million people in the US. My observation is exactly that which Mike points out. We pay for it one way or another anyway. We don’t seem to have the political will to pay more so why not get the inefficiency and waste out before we throw more money at it? That’s what we have to do in free market business, at least the ones that want to remain solvent. I’m not a health care professional but do manage businesses and the economics of healthcare is business. It would run better without the level government intervention by people that are more motivated by the politics than their understanding of healthcare and related economics. My observation is things get totally fouled up when authority and decision making gets to far removed from the point where the valued added part of business occurs. So we (US G) take the authority away from someone and then make them accountable for the result? Then let the lawyers work them over and then to make it worse, try to micromanage the piss out of the outcome?

-Makes absolutely no business sense me but it does to bureaucrats. IMO, this is what has happened with healthcare (and many other parts of government for that matter). The call to action is to create proper motivation, incentivization, and provide more control for the health care industry professionals such as Mike that are witnessing the fiasco first hand 80 hours a week. Mike, I have lots of friends that practice medicine. They are typically brilliant folks but not the greatest business people. They’re too busy learning and practicing their trade (and yes defending themselves) because that’s their passion. I think the “real” health care professionals are politically under represented and need to be more proactive in being part of the solution. The most obvious example to me is HMOs. They organized, told a good story (we’ll get cost out) and off they went. Problem is, they didn’t get cost out, they merely reached into the health care professionals pocket to make room for themselves. –Cost is still there with the politicos slamming more in. If the health pros were there first instead, the margin would likely still be in your and the taxpayers pocket instead of the insurers. Take control of your own destiny health care Pros. If you don't have the time or expertise to do it, hire it. In the long run, it would be cheaper than the financial enema you receive with the $22.5/hr malpractice insurance; that's simply appalling. I in no way mean to place blame with this statement, I just think it’s the solution.

BTW, I always resist these kind of posts too. Now the flaming may begin.

Kelly

Well gentlemen. I'm very impressed. You guys have been paying attention.

Carry on.

Exceptional ... well said. I must add that again .. the people who are actually doing the work are the ones taking it on the chin. In my area 2 hospitals actually closed ... they stated it was because of a high volume of people with no insurance ( imigrants ) who they cant refuse or will not refuse emergency room care. Medicade and Medicare is being abused, workmans comp is being abused, and Illegal imigrants are straining our health care system. Restructure Medicade and Medicare, leaglize the 25 million Illegals so they pay into the system .. they are here working already ... and Maybe just maybe the 26k I pay for each employee can be cut in half and the hsopitals can expand, and hire more doctors nurses and help to meet the needs of ALL THE PAYING CUSTOMERS.

But it isnt going to happen, it isnt going to be fair .. our Goverment is going to continue throwing money at problems.

Ron

This is a very intelligent discussion of such a politically charged issue. But we aren't alone with the problem. Some countries (and I don't mean Canada!) manage to offer their citizens decent healthcare, access to doctors and medicine and everyone seems to get along just fine - patients, doctors, hospitals and lawyers. No system can be perfect for everyone all of the time, but what are these countries doing that we can learn from?

quote:

Originally posted by 4NHOTROD:
Well said, Mike.
No flaming from here...
Will

I "ditto" that!

Wow! I am really impressed with the thoughtful, intelligent replies. I do feel a little guilty for putting this out there in light of the fact that I don't have a grand scheme or any great ideas how to fix these problems.

This is an incredibly complicated situation that goes to the core of our belief system in the US. We have to figure out how we are going to come to a resolution that is palpable and safe for all of us. One way or another there are going to be some big societal changes from this problem whether we like it or not. I think this realization has to be the first step in deciding how we are going to proceed as a country.

We can't begin to solve these problems until we decide, as a country, what our belief is about the system of health care. The first decision we have to make is whether health care is a privilege (you can have it if you work hard, earn it and pay for it), or a right (any person living in a society as rich as ours should be able to expect to not have to worry about such a basic necessity as medical care). Do we believe that the more money you have to spend, the better your care should be, and the better the outcomes you can expect from treatment? Or should we all be able to expect the same high level of service as we do from our highway system, firefighters, police officers and other public safety systems? I think it is some kind of poetic justice that one of the systems described above is basically the Canadian system (where many of my family live), and the other is realistically the Mexican system (that living in South Texas I deal with the shortcomings of on a daily basis). How ironic that we are literally and figuratively "in between"?

My best guess on how this is all going to play out is something in the middle, as practiced in the past in the UK (where my wife grew up). Greatly simplified-a basic expected level of care that, if you can afford it, can be enhanced with your own supplemental insurance/money. Does this ensure equal care for all citizens? Absolutely not, but you are guaranteed a certain level of care and freedom from the threat of financial ruin from medical bills. Is there rationing involved? Absolutely, you are not guaranteed the latest wonder drug or procedure.

Even without government intervention I believe we are headed this direction. Many medical specialists are now banding together and building there own for profit hospitals to get out from under the government regulations required when you accept governmental insurance. You get what you pay for at these sites. One of the hottest trends in medicine today is "boutique care" where you pay extra money to have improved access to your physician (and often their home/cell phone number that you are encouraged to use if needed) and longer scheduled appointments in what is usually a nicer, less busy office.

Will this UK type of system fly in the US where we feel like we are entitled to and expect the newest, fastest, most technologically advanced everything available "because we are Americans"? That remains to be seen. There would have to be a change in attitude about the whole system. Whose job is it to tell someone they are not entitled (sorry, I love that word) to the most advanced, specialized treatment available? Unfortunately, I think the only entity that could pull it off would be the government. I think it works in the UK because of different expectations and history of a strong class based societal system.

Why don't we just give in and do it that way? To many people have to much at stake. Many of us are not comfortable turning even a basic level of our medical care over to our government control even though realistically we already do. With exception, and to greatly simplify it, everything in medicine today including private insurance reimbursment rates and approval of procedures/treatments is based on Medicare/Medicaid standards. Do we think multi-billion dollar profit making insurance companies or hugely profitable hospital systems (of which there are more than you might expect) are agreeable to this? Do we believe the people who can't afford extra "boutique care" will accept this inequality? Do we think the many private physicians that would essentially become government employees (even though practically they already are) would accept it? Do we think the lawyers will agree not to sue if the basic accepted care was rendered but the latest state of the art cutting edge treatment was not given? Do we think the politicians up for election are going to be able to tell their constituents, "I'm sorry, you can't have everything but this is the best for all of us in the long run"? I think you can see how big of a shift in societal attitude this would require. I'm not sure we're ready for it, but something is going to happen whether we are ready or not.

To just respond to some of the excellent comments you guys have made:

Larry-Medicare is a great idea, the first problem is that it is going broke. Without a huge influx of money and/or limiting of benefits it is unsustainable. Problem 2 is that it is so laden with regulation and complexity that it is impossible to fulfill all the requirements without using more costly resources. We have to have people (called "coders") whose only job is to look at our charts and determine the proper codes to submit to get paid for the care we provide. If you put in the wrong code you don't get paid. If you get paid for something that wasn't supported by your chart you can be subject to prosecution for fraud and have to pay back 2-3 times the money the government paid you on demand. Sorry, given that I practice Emergency Medicine I am somewhat blissfully ignorant of the many intricacies of the coding/reimbursment particulars. I'm lucky enough to be in a specialty that has people to do it for us. I'm sure some of the other docs on the forum can give you way more info on this than you will ever care to know. Think about the forum discussion we had on the paperwork for "cash for clunkers" and multiply it by all the possible diagnoses and patients that are taken care of every day.

Kelly-some of the worst business people I have ever met are doctors. In 4 years of college, 4 years of medical school and 3 years of residency I never had a class in business. We are trying to change that now in Emergency Medicine by including lectures in our residency program regarding the business aspects of medicine. It is the medical profession's own fault that we got taken advantage of by insurance/lawyers/government. In the past the profession saw itself as a calling. We thought we were "above" the business/legal/political aspects of medicine and let others deal with those aspects of practice since we felt our job was to just take care of the patient. Obviously this was incredibly short-sighted and arrogant or naive of us and we eventually let other people/government/organizations tell us how we had to treat the patient instead of what we knew needed to be done. Unfortunately that genie is out of the bottle. Organized medicine is not that organized, and like everything else today there are huge political forces at work.

Once again, I appreciate all your thoughtful comments. Thanks for listening. I'm glad there are people out there that can see through the political posturing and reactions and realize this is actually important and will affect all of us in the long run.

As Jack says, my 2 cents worth.

I promise not to burden the forum further with too many off topic musings.

Mike

P.S. My wife stumbled on these postings on my computer and said "Oh my God you got started on it again, didn't you".

Not that long ago, when I bought a car or a house I paid 20% down. This meant I had “skin in the game”. I took care of the house. I made money, eventually bought another, better house at 20% down.

About 4 years ago I built a new house. The house we were living in I had invested over $40k in improvements too numerous to go over. The house was in damn good shape.

The person who bought my old house was able to buy it no money down and got $12k back to do with as he pleased.

Right off the bat I would drive by and cars were parked in the front yard. After 6 months, grass was dead, many of the shrubs were dead and much of the fence was knocked over. A year latter the house was empty and the occupants evacuated.

I talked to a neighbor. The occupants defaulted on the loan so they decided to trash the house. They have no “skin in the game”. There is no deposit for them to worry about. Windows were busted out, walls were torn up, brand new counters were destroyed, new carpet was ruined. The house was intentionally left open and was rained to where water filled the basement.

The health department was called 2x for things like a trash barrel of fresh meat left in the garage. The city finally condemned it and forced the bank to fix it up and sell it. Repairs included ripping out the dry wall, repairing mold, replacing windows, new cabinets, appliances, flooring, and more.

We decided to buy a car last year. We bought a Toyata Rav. We have no other loans but with the stock market down, we decided to leave or money invested and bought the car on loan. Despite what is said, interest rates are damn cheap and loans were easy to get either through bank or car dealer.

NOW they do not require or even ask for money down. Instead they almost demand insurance. Insurance if you can’t pay, insurance if you loose your job, etc. All this to protect the bank; all this which did the same job as 20% down. INSTEAD, this adds 20% to the overall price of the car. Much to their disliking we did not take any of them.

You can see where this all is headed. No skin in the game. I have a car with no money down. If I can not make payments, why wouldn’t I trash it? I wouldn’t of course but there is a large percentage who think that way.

Who pays for all this which people trash? YOU, ME!!!

I work my ass off. I work not just to provide for my family but for healthcare. I work so we can all be taken care of. It is a perk of the job. If we (and we are) give out free health care, a HUGE number of people will not only live off the system but find no reason to work or contribute to society. NO SKIN IN THE GAME!

We are heading in the wrong direction and we have lost our way!!!

There is a different problem in our healthcare system too. When I bought my first house, my first car, my first lawnmower, life was manageable. But what happens over time?

I buy another car, a bigger house, a tractor, more lawn accessories, more stuff, more hobbies, more friends, more involved work, more events, etc. I have a half dozen collector cars and I will probably die before I get to them. My father has over 30. I have a dozen R/C airplanes in disarray and I am not sure I will ever get back to them.

We have done the same thing as a society. Look at healthcare in the 1920’s compared to today. If you go in for stitches in 1920, you saw a doctor, he swabbed your arm with alcohol, but a belt in you mouth and put in a couple stitches. Today you get a 4hr wait, you meet a receptionist, fill out 30 minutes of paperwork, escorted to an emergency room, xray of hand, you work with as many as 8 or 10 people in the hospital, stitch kits costing several 100 dollars, with a bill close to $3,000 after spending 8 hours in a hospital.

Is this good care? Perhaps. But the care is like my car collection. It has gotten over done and difficult to manage.

The prime minister of Canada just came here for heart surgery because he can’t get the treatment in Canada. I cannot imagine the insurance process, the procedures, the amount of people involved, etc. The more healthcare becomes free for everyone, the more good care will become difficult to give and the more we will all loose options.

Should the people unwilling to contribute to society be given this same service when they won’t work, smoke, drink, live off government aid? Should we allow them to reduce the quality of healthcare for everyone and increase the cost for everyone? At the same time driving profits and industry from our country!

quote:

Originally posted by comp2: If you go in for stitches in 1920, you saw a doctor, he swabbed your arm with alcohol, but a belt in you mouth and put in a couple stitches.

What is ironic, is the last 2 times I have gotten stitches I waited in the waiting room for 3 hours, waiting room to be seen. When the stitching process began they gave me a shot of pain killer in the stitch area. They were in such a hurry they did not wait for the pain killer to take effect. I was reaching for my belt both times. My we have come a long way!

Time to get my brain going over a cup of coffee. So what the heck, here it goes.

quote:

Originally posted by David B: This is a very intelligent discussion of such a politically charged issue.

Yes, strip out the emotion and reasonable discussion follows. When the name calling begins and emotions take over, rational thought departs the conversation.

quote:

But we aren't alone with the problem. Some countries (and I don't mean Canada!) manage to offer their citizens decent healthcare, access to doctors and medicine and everyone seems to get along just fine - patients, doctors, hospitals and lawyers. No system can be perfect for everyone all of the time, but what are these countries doing that we can learn from?

This is agreed Dave, but I would like to emphasize that just because I am for approaching the problem by first eliminating waste and controlling costs does not mean that I am against everyone having access to healthcare. I don’t mean to infer that you are saying such, because I understand this isn’t your point, but this is typically the way the political battle lines are drawn; if you are for a financially prudent approach then you’re against healthcare for all. That’s nonsense. It’s quite the contrary. If it’s done in a financially tenable way, then it stands a chance of passing on the hill and more people get access at lower cost to we taxpayers.

quote:

Originally posted by ktmike: Wow! I am really impressed with the thoughtful, intelligent replies. I do feel a little guilty for putting this out there in light of the fact that I don't have a grand scheme or any great ideas how to fix these problems.

Nothing wrong with that, just find a way of being part of the solution. It’s always easier to identify the problem than the solution.

quote:

We have to figure out how we are going to come to a resolution that is palpable and safe for all of us. One way or another there are going to be some big societal changes from this problem whether we like it or not. I think this realization has to be the first step in deciding how we are going to proceed as a country.

-The political reality in a two-party system

quote:

We can't begin to solve these problems until we decide, as a country, what our belief is about the system of health care. The first decision we have to make is whether health care is a privilege (you can have it if you work hard, earn it and pay for it), or a right (any person living in a society as rich as ours should be able to expect to not have to worry about such a basic necessity as medical care). Do we believe that the more money you have to spend, the better your care should be, and the better the outcomes you can expect from treatment? Or should we all be able to expect the same high level of service as we do from our highway system, firefighters, police officers and other public safety systems? I think it is some kind of poetic justice that one of the systems described above is basically the Canadian system (where many of my family live), and the other is realistically the Mexican system (that living in South Texas I deal with the shortcomings of on a daily basis). How ironic that we are literally and figuratively "in between"?

My best guess on how this is all going to play out is something in the middle, as practiced in the past in the UK (where my wife grew up). Greatly simplified-a basic expected level of care that, if you can afford it, can be enhanced with your own supplemental insurance/money. Does this ensure equal care for all citizens? Absolutely not, but you are guaranteed a certain level of care and freedom from the threat of financial ruin from medical bills. Is there rationing involved? Absolutely, you are not guaranteed the latest wonder drug or procedure.

Woh, lot to chew on here. First, from a constitutional perspective, I don’t think the inalienable rights of life, liberty, and the pursuit (being the operative word) of happiness was intended to be a guarantee or grant there of to health care, 2.5 kids, fido,and a split foyer house. It was an opportunity to earn it, not be gifted it, and yes, in an increasingly globalized economy, we must be willing to earn our higher standard of living. Others in the world are willing to do more for less because they have less; much less. Best we accept this and move on.

quote:

Will this UK type of system fly in the US where we feel like we are entitled to and expect the newest, fastest, most technologically advanced everything available "because we are Americans"? That remains to be seen.

Certainly not because we are Americans.

quote:

There would have to be a change in attitude about the whole system. Whose job is it to tell someone they are not entitled (sorry, I love that word) to the most advanced, specialized treatment available? Unfortunately, I think the only entity that could pull it off would be the government.

Actually, I think it’s each and everyone of our responsibility to tell ourselves we are not entitled to that. We’re not entitled to have our lives prolonged at increasingly diminished quality of life and at a cost that often exceeds the life’s earnings in the last year of our life, and then place the burden for paying that expense for someone else; say our children for example. We’re simply not entitled to that because it’s unsustainable and will ruin us all. Am I insensitive? Don’t think so. Just lost my mother on December 23rd. She had a chronic condition that made her very susceptible to pneumonia. Landed her in the hospital for the second time in a year and after whipping the pneumonia, developed secondary infections as often happens from the stubborn bugs that live in the hospitals. I’ve had the full frontal view of the public healthcare system and it wasn’t my first time, and it’s not pretty. I had to research everything from her condition to coverage and stand in the face of the physicians and be the proverbial squeaky wheel so they would aggressively treat her instead of merely making her comfortable while she died. The first time around a year ago, it resulted in the bonus round for her and she was able to live independently for another year. After my intervening several times, after 6 weeks, she asked me to let her go, and this time she succumbed. Gut wrenching? Yes. But she was 78 and able to live independently her whole life. I would have liked to have had her longer but hope I can do it as well when my time comes. –So I know fellas. Not trying to spill my guts but I’m not just preaching here.

quote:

I think it works in the UK because of different expectations and history of a strong class based societal system.

I manage a group of businesses for a UK plc and spend quite a bit of time there and hear their opinions. They (at least the ones I run with) don’t think it works; certainly not well. Same carps as here in the US; non-contributing immigrants sucking the financial life out of the system, long waits, poor quality of care, and they would never dream of stuffing their families through the public system. That’s part of the reason the work; for the bennies; just like us. –And the ones I’ve spoken to that are in the public system don’t like it either.

quote:

Kelly-some of the worst business people I have ever met are doctors. In 4 years of college, 4 years of medical school and 3 years of residency I never had a class in business.

And level of educational debt you carry, and malpractice premiums, and long hours, are worthy of mention.

quote:

We are trying to change that now in Emergency Medicine by including lectures in our residency program regarding the business aspects of medicine. It is the medical profession's own fault that we got taken advantage of by insurance/lawyers/government. In the past the profession saw itself as a calling. We thought we were "above" the business/legal/political aspects of medicine and let others deal with those aspects of practice since we felt our job was to just take care of the patient. Obviously this was incredibly short-sighted and arrogant or naive of us and we eventually let other people/government/organizations tell us how we had to treat the patient instead of what we knew needed to be done. Unfortunately that genie is out of the bottle. Organized medicine is not that organized, and like everything else today there are huge political forces at work.

To sort of circle back here (and since I’m now out of coffee and have shaken out most of the cobs) and tag a couple of simple premises; if you don’t have the time or expertise to represent the front line view, you still have the means to organize and to hire it. When I have a business need and not the skill or knowledge to execute it, that’s what I do. Then I try to learn it and institutionalize it so I don’t have to pay for it a second time. Other special interests with a lot less disposable income than the medical professionals manage to do it. People than can identify problems are certain useful but not as much as those that can identify and become part of the solution. –Get in the game everyone.

In my business experience, when we get the shop floor people involved in identifying the solutions instead of saluting mandates our mandates or condescending to them about improvement initiatives we get results. It’s because they see things we don’t because they live in it and have different perspective. It’s also a simple leadership premise. I sincerely believe the same principles apply here. We all need to do our part.

quote:

Once again, I appreciate all your thoughtful comments. Thanks for listening. I'm glad there are people out there that can see through the political posturing and reactions and realize this is actually important and will affect all of us in the long run.

Agreed.

quote:

P.S. My wife stumbled on these postings on my computer and said "Oh my God you got started on it again, didn't you".

Ah Mike, just wish her happy Valentines day and give her a peck on the cheek.

Best Regards,
Kelly

quote:

Originally posted by comp2:
The prime minister of Canada just came here for heart surgery because he can’t get the treatment in Canada.

Just to correct this, it was NOT the Prime Minister, but a Premier (think State Governor) of Newfoundland, one of the least rich provinces in Canada. Some are of the opinion that the sole reason for going to the US for treatment was to politically embarrass the Federal Government into providing more health-care funding to the province. Since no specific details of his procedure have been made public, it remains speculation as to why he sought treatment outside Canada.

Mark

I'm just not sure how Healthcare can ever be a right to have. It may be easy for me to say being fairly healthy and young, but I also don't engage in many risky activities. This isn't like freedoms you can give to populations in 3rd world countries and give them unalienable rights. This is something other people have to provide to others as a service (doctors, nurses) etc. People will never respect medicine and it's importance until they have to pay for it themselves.

One of the biggest reasons health care has become out of reach for so many people is because of the abusers of the system. The answer isn't just giving everyone health care, its cleaning it up with reform, and not just tort reform. You can't help people who can't help themselves.

quote:

because of the abusers of the system.

I'm a firm beleiver of social programs. As long as we can prosecute those that abuse the system.
Unfortunately, that rarely happens.
Will

quote:

I'm a firm beleiver of social programs. As long as we can prosecute those that abuse the system.
Unfortunately, that rarely happens.
Will

Ditto.

quote:

Originally posted by 4NHOTROD:

quote:

because of the abusers of the system.

I'm a firm beleiver of social programs. As long as we can prosecute those that abuse the system.
Unfortunately, that rarely happens.
Will

It should also be set up so it is not easy to abuse. Illegal immigration is something we don't stop. This is not fair to those who are here illegally but it is also not fair to those who come here illegally. In the same boat many of us would probably do the same but it puts them in a bad spot. A system which encourages illegal immigration, healthcare abuses, etc is impossible to enforce.