That ultra-liberal newspaper "Wall Street Journal" gives some options for people like Rush Limbaugh who would rather leave the country than live with health care reform: Web Link

Last night Al Sharpton expressed the views of many people who are now experiencing hubris "First of all, then we have to say the American public overwhelmingly voted for socialism when they elected President Obama," Sharpton said. "Let's not act as though the president didn't tell the American people - the president offered the American people health reform when he ran. He was overwhelmingly elected running on that and he has delivered what he promised." Web Link Friedrich von Hayek told us where this Socialist path leads in his 1940s book---The Road to Serfdom.Web Link Not a pretty picture

Where will they put all the new hospitals? Where will they find all the doctors? Will we see the U.S. equivalent of Mao's Barefoot Doctors?

Unfortunately, moderates are at risk politically right now. Which, by definition, would be anyone who dared to vote across party lines. That would include Republican Cao (Louisiana) and 39 Democrats. Those 39 Democrats no doubt voted the way they did because the bill was unpopular back home, and, they will probably lose anyway despite their no votes-- either in the primaries or the general election. I'm guessing the congressional class of 2011 will be split almost right down the middle. That was the odd thing about the 2008 election -- everyone was voting goodbye to George W. Bush, but, they weren't all agreed on what they were voting for. I wonder how long the traditionally moderate American people will be able to stay that way in the face of the increasingly strident and partisan party extremes? Are we going to become like the one of the historic Mediterranean countries that used to swing dramatically from far left to far right and back again? The healthcare issue always seems to bring out the very worst aspects of our politics.

"The bill passed, and we should make every effort we can to make it succeed" Paul, Could you please explain that statement? Would you include a serious analysis of the real costs? The CBO estimate was based on what was provided to them...fantasy in, fantasy out. Would a downgrade of Treasury bonds help us out? Would tort reform be helpful? Above all, please explain how this health bill will benefit your business over the next ten years.

James, Paul can answer for himself, but, it will be a better situation for small business owners that want to provide a significant health insurance package to employees, and, already have or would like to hire some employees with adverse health histories. For example, maybe one of your best employees has had breast cancer. You can't afford to insure everyone because of the cost of this one person. These situations are very common. The largest single cause of bankruptcies is unaffordable, unpayable healthcare costs. The reason older employees find it so difficult to get full-time work with health insurance is healthcare cost. Maybe you have a family member used to be virtually unemployable and is about to become employable? The fact is that healthcare insurance costs affect the labor market in this country in all kinds of ugly ways, and, this bill should help level the playing field somewhat. It isn't perfect, but then, in healthcare, nothing ever is.

Anon, As a medium-sized employer, in this area, I can assure you that health care is a real cost, but it is not determinative. I look at the total cost to hire a new employee. This is sometimes referred to as "full time equivalent" or "FTE". It works this way: I decide if we need a new employee, at (say) the total cost of $100k. If I had no overhead costs, like health insurance and social security and workman's comp, I would just offer the new employee a $100k salary. However, since this is not the case, I just subtract the costs of the government mandates, and offer the resulting salary to the new employee. Essentially, I do not pay for the mandates, the new employee pays for them. I simply look at that FTE figure, and determine if it pencils, or not. If I cannot get the job done for $100k, I look outside this country to get the job done. This is happening more and more. I hope that helps.

We really don't need insurance, we need health care, and we had health care better than anyone else because the system worked better than any other. This bill creates no new facilities, no new workers. It may level the playing field, but Job's transplant took nothing from me, and just might lead to development of cheaper anti rejection medicines for us all. If this bill indeed eliminated copay, that one item might double the patient load. I would suggest that California, to carry her new burden for this, resurrect one of Arnie's ideas and tax punitive damages at 98%, with that tax going to medical.

Well said James. BTW, Paul, the "sea change" was, in fact, a massive bill of nearly 3,000 pages, passed "by a whisker" by Dems only, to the cries of 70% of the American people screaming they don't want it..and heading into the Court system today.. The "sea change" was a massive reach of power by this Federal Admin, against a majority of the States AND American people, and against the powers invested in the Fed govt in our constitution. Yes.."sea change"..I think I would watch out for the coming tidal wave. Ok, back to work trying to figure out how to make as much money off govt health care as I can before it all collapses. ( sorry, taxpayers, I fought this with everything I had, but I am a practical person...if I couldn't beat 'em, I may as well join 'em) Guarantee you I am not the only one.

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Sea change? Hardly. As Robert Reich points out Obamacare is similar to the proposals made by REPUBLICANS back in 1994. Thanks to the histrionics by folks like Rush, the GOP stuck itself in a corner where it was unable to negotiate a package without losing support. Walter if our current health care is so great then why are rates of infant mortality higher and longevity lower than in other first-world countries? Why are nearly one in five people without insurance? Why, by the way, do you think we'd need huge numbers of new hospitals? The population hasn't changed.

The USA has the most honest reporting of infant mortality rates in the world-- many of the cases we report would not be counted as infant mortality in other developed countries. In terms of longevity, we have historically had higher obesity rates and smoking than other developed nations such as Japan. Obesity rates in other developed countries are now reaching our levels, so longevity is declining--- look at Scotland where life expectancy for males is like Russia-- 57yrs. Obesity is a behavioral/vice problem with a simple cheap solution--- do not be a glutton. Also we have reduced smoking levels to below any other developed country, particularly in CA and particularly in Palo Alto, eg in Stanford it is 4% Given the time delay in the health impact of smoking-- countries with high rates of smoking like Germany, France and Japan will see reduced life expectancy moving forward. As Smoking has decreased in the USA we will see improved longevity. Also we have many immigrants who received very poor prenatal care in their 3rd world lands of birth. The main predictors of longevity are 1/ Prenatal care, mainly good diet, avoiding toxins like lead and mercury, no alcohol or smoking and do not marry your first cousins { a huge problem with SE Asian immigrants in the UK and else where}. 2/Sanitation-- hepatitis leading to liver cancer etc 3/Healthy weight/ physical activity 4/Not smoking Most of these are behavioral and sanitation issues, issues of prevention, not health insurance issues, and not solved by high tech medicine.. A rational approach to understanding longevity statistics is useful

The longevity issue is interesting, but it misses the point, in terms of overall cost reductions. Older people cost the system more money, because they use the system ever more, with each additional year of life. I would add that they cost my pension system ever more...thus increasing my overall cost per new hire. This means that I have to factor these costs against my new hire. This is why I am looking more and more to outsourcing. It would be interesting to know where Paul Losch has his products maunfactured. My guess would be China, like so many others, but I don't know. Paul?

james you bring up an interesting point that few people want to talk about --- longevity is a net economic liability,--- if people died when the reached 65yrs or retirement the economy would benefit enormously. Phillip Morris did a study for gov of Czechoslovakia showing the economic benefits of encouraging smoking ---they proved 1/ you get huge tax revenues from the product 2/ smokers died younger and faster so you have less pension and medical cost than with non smokers, who linger on and develop chronic expensive conditions. Apparently this study informed Chinas view on smoking-- China gets the tax revenues when they smoke and they do not cost China when they stop working as they die soon after-- 60% of male MDs in China smoke--1% or less of MDs at Stanford smoke. I forgot to mention another very cheap intervention-- vaccination of children. As the US government takes over health care we are going to see cold economic trade offs that will make non economists shudder eg-- what is the economic value of a given human life versus the cost. We will line up for out health care as we do at the DMV and Post Office, while driving our governemnt produced GM volt cars and in PA the green police will inspect our garbage-- for who knows what? and ration our health care accordingly? The law of unintended consequences dooms all attempts at social engineering-- the road to serfdom Web Link is paved with good intentions

" OhlonePar, ...Walter if our current health care is so great then why are rates of infant mortality higher and longevity lower than in other first-world countries?" Sharon answers this in more detail than I care to delve. "Why, by the way, do you think we'd need huge numbers of new hospitals? The population hasn't changed." If we don't need more facilities then the whole premise of this bill, that we have millions of people under-served by the current system, is belied.

"The USA has the most honest reporting of infant mortality rates in the world-- many of the cases we report would not be counted as infant mortality in other developed countries." Huh? You mean we in the USA are better at telling a dead infant from a live one? Get real. "Phillip Morris did a study for gov of Czechoslovakia showing the economic benefits of encouraging smoking...this study informed Chinas view on smoking-- China gets the tax revenues when they smoke and they do not cost China when they stop working as they die soon after-- " So we conclude that having private enterprise merchants of death advise communists makes for more efficient death panels? You like that, huh? Is public health evil because it makes for more old people?

The definition of live birth vs dead varies widely between countries. "But the method of calculating IMR often varies widely between countries based on the way they define a live birth and how many premature infants are born in the country. The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[5]Web Link In the USA we make much more heroic efforts to save premature babies lives than in any other country----- if these premature babies later die of complications their deaths are added to infant mortality statistics. In other countries such premature babies are counted as stillborn and not revived or treated. So one way to improve our IMF statistics would to revive so many premature babies---- the practice in other countries. As Clinton said " it is a matter of the definition of what is-- is" or in this matter the definition of what Live Birth is QED

Correction I meant to state-- So one way to improve our IMR statistics would be to NOT revive so many premature babies---- the practice in other countries QED

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No national polls showed support for this bill-38% polled thought it good for them, 48% thought it bad for them. Why would any of us want to make this a 'success' when 62% do not think it is going to be good for them?

"Is public health evil because it makes for more old people?" No, it is not evil. It just costs a lot more. This fact should be recognized. The single payer systems like Canada and England understand this fact. That is why they have developed rules to avoid plugging granny in. I have little doubt that we are heading towards single payer. It doesn't really bother me that much, because people are going to be dealt with, either way, and I understand the political tsunami in favor of 'free' health care, paid by the government. This health care bill will just be an expanded Medicaid system, which we can't afford, and will not afford. Our health system will use rationing and inflation to provide political cover. The net result is that almost everybody will be covered, but with inferior care for the majority, compared to that the majority is getting today. I, personally, buy my own catastrophic insurance policy, but pay out-of-pocket for any event costing less than $50k. Thus far, I have saved a lot of money by doing this. I also ask each doctor what his/her fees will be ahead of time. I have walked away to another doctor several times in my life. My main concern is not health care, per se, but the effect of runaway health/social spending on our treasury bonds ratings. The combination of Social Security and Medicare and Medicaid yields an overwhelming unfunded mandate on our federal and state treasuries. The baby-boomers are like a rat moving through a snake, and they will not be denied until they come out the other end.

What's the definition of success: the efficiency Peter is robbed to pay Paul?

James, As a courtesy to you, I will tell you that I get product from 2 companies in China, and we finish the products in my facility in Fremont. The nature of the business is such that this is the best approach. Some customers we deal with want things made entirely in the States, and what we do makes that a non-starter. There was once upon a time companies in this country that could make what we need. They don't exist any more. Pretty typical, as best as I can tell. I actually investigated outsourcing off shore the entire production process, and concluded it did not make sense. Here is what I do partially outsource: finishing the product by an agency in Santa Clara County that has programs and jobs for people with mental and physical disabilities. They do a great job, love my company, and a few of them even like me! There are plenty of small businesses in this country which have struggled, as mine has, to deal with the cost of health care. Most of them operate here, and cannot just "offshore" what they do. It is disingenuous to imply otherwise.

Paul Losch, [Portion removed by Palo Alto Online staff.] Your basic problem, from the business perspective, is that your products do not have enough 'value added' in them. I am sure you try to add it in, but some things are just not amenable to additional margins, because they do not meet the pressure of supply and demand. Outsourcing is a dicey thing, especially in China. I know, because I already do some of it. China happens to need my technology, at this point, but I am very aware that they want to steal my technology, through reverse engineering. This causes me to build in redundancies that will lead them down the wrong path, long enough for me to iterate to the next level, and making them to continue to deal with me. They are always asking me to bring in their own engineers to my firm. The answer is "no", and it always will be. It's a tough business, and not for dreamers. China is serious business, and I can only suggest that those doing their biz there open their eyes. There is profit to be made, but it comes with a price. Don't be surprised if the world market gets flooded with your products, Paul, despite patents. Back the the health bill: It will go forward, and it will be paid for through major inflation. This is the most regressive tax of all, but it will not affect me, personally. I feel sorry for all those who will need to pay the price, though.

Sharon, Yes, there are slight discrepancies from country to country in assembling statistics, but everyone agrees that the appallingly high IMR in the United States has nothing to do with statistics. Infants die in the United States because our medical system does a rotten job of providing medical care. Precisely because we do not make heroic efforts to save babies. Have the intellectual honesty to admit that.

The best example is Huawei's theft of Cisco's source code for their routers. It was blatant, clear and illegal theft. International IP property laws are difficult to enforce-- so it will continue--we presume that China offered Cisco access to China markets in exchange for dropping the case-- what do we call that? The health care bill is Socialism pure and simple, Al Sharpton was foolish enough to celebrate the reign of Socialism in the USA after the vote. The Road To Serfdom is paved with good intentions---afterward-- you will see the Great Terror Web Link as documented by our neighbor ---Robert Conquest Web Link We are now dinner for the sharks-- the first thing Obama needs to do is to follow the Petraeus doctrine in the Holy Land, the only good thing about his political victory on health care is that he now has the political strength to impose the Petraeus solution to that hornets nest.

SEems that once again Sharon is injecting her middle east doctrine on an unrelated thread. Btw, there is no petraeus doctrine but that is for another thread.

@ Posted by Seriously, a resident of the Barron Park neighborhood Yes we --- kill millions of babies each year, but those do not count in any statistics neither here nor abroad. If you look at the male/female birth rates in China or India you get the picture. Amazing that today's debate in Congress was about tax payers paying abortion, and Viagra for sex offenders If that is the beginning-- what is the end?

Walter, No, the point is people wait to get medical treatment which results in more serious problems and more serious medical care. Right now, hospitals like Stanford treat huge numbers of uninsured people in their emergency rooms for minor problems that can be resolved through a doctor's visit. The cost of those ER visits are tnen passed on to the privately insured through increased costs for *their* treatments. James, Costs a lot more? Really? Then how come countries with nationalized health care have populations that live longer and spend a lower percentage of their GDP on health care? Health care in this country is *already* rationed--by insurance companies. Sharon, Not going to cut it. According to your link, Sweden, Germany and the U.S. all use the same definition of live birth. Sweden, with socialized medicine, ranks third or fourth in lowest infant mortality rate. Germany with its private, but required insurance system (not socialist, but closer to what we'll be doing) is 14th. The United States is 33rd, with an infant mortality rate more than three times that of no. 1 Iceland (with, yes, national healthcare). I mean, speaking of socialism, our IMR is worse than *Cuba's*--it's shameful. So, no, by your own data, it's not a case of differing definitions.

James, Landed costs. Quality of product that goes into finishing our offerings. GM's north of 70% for a something that is not high tech. IP not a KSF, product quality and customer service are. Also, knowing which channels are the best targets for future business. I am sure you had a terrific experience at the GSB.

O/P, In my day there were clinics in poor areas [can I say poor?] that took care of medical needs. My maternal grandmother worked in one in Chicago for years. At any rate, most of the medical problems are cultural, the consequence of dysfunctional relationships. My solution to the indigent patient is for the government that mandates no means test for admission should, ultimately, pay 70% of the reasonable fee for services, and declare that income tax free.I am sure that my wife, a great grandmother [and a great wife, too] is still covered for childbirth.

Walter, In your day, the population spread was quite different. The medical cost issue has been one people have known was coming for decades. Your wife may be covered for childbirth--but that's meaningless, she won't use those services, so there's no cost involved. As for medical problems being the result of "dysfunctional relationships". Well, yeah, if we're talking about a black eye--but, come on . . . you're really going to pretend viruses and bacteria have no part in pneumonia or strep throat? That genetics has nothing to do with gout? That certain thyroid cancers have nothing to do with radiation exposure? This is just wishful thinking on your part, Walter--you have some control over relationships, but not over these other factors. So, if I have perfect relationships I'll never die? Or do I lose a day every time I yell at my spouse?

OhlonePar, Yes it costs a lot more. The CBO report that was used to justify this recent bill was fatally flawed by the removal of the so-called "Drs fix", and assumptions about unrealistic saving from Medicare. Fantasy in/fantasy out. Private insurance companies have lower per patient administrative costs compared to Medicare. I fail to see how expanding Medicare or Medicaid, if that is your concept, would lower costs? One also needs to factor in the thousands of IRS new hires to administer the collection of premiums and prosecution of penalties to all those who are now forced to take insurance. Medicare fraud is rampant, and it is the nature of the beast. If $500B can be taken out of it, then why has it not already been taken out? Again, this fantasy figure was forced upon the CBO as a fact. If you want to compare health care costs, as a fraction of GDP across countries, then you also need to do proper accounting methods, on an equal footing. For example, some socialist medicine countries do not count overhead costs of builidings as part of their health care costs. Their thinking is that these buildings, like offcies and hospitals, are capital investments of the entire society and should not be the burden of the health system, per se. The best way to compare costs between private insurance countries, like the U.S., and single payer countries is to look at comparative tax rates, taking into account the lack of spending on defense issues (e.g. Canada has a higher tax rate, even though it uses the U.S. to protect its borders and thus does not incure a defense cost similar to the U.S.). It was interesting that a Canadian politician recently came to the U.S. to get his important medical needs tended to. If the Canadian system was so good, why did he do that? There are many things wrong with the current bill, but I trust it will go forward, because it is loaded with some upfront goodies. However, the net result will be lower wages, and fewer jobs for most Americans. It also means lower quality health care.

"So, if I have perfect relationships I'll never die? Or do I lose a day every time I yell at my spouse?" [O/P] Pregnancy at 15, multi father families, untrained housekeepers, these are examples of cultural causes of illness. My gout was explained to me as God slowing me down to give others a chance.

Walter Wallis is correct that in another day, most indigent health care costs were handled locally. There was a "county hospital" used by indigent patients, most doctors had some charity patients (informally shared out). There are a lot of reasons this can't work today, chief among them that people are so much more mobile now. Another major reason is the growth of specialized care, and the specialization of hospitals in particular areas (cancer, cardiovascular, neonatal, etc.), and the large capital expenses associated with some of those specialties. It was a better system than what we have now; I just can't see how to make it work in today's environment.

The "socialist" health care bill sounds a lot like what those flaming socialist Republicans Nixon and Eisenhower proposed. Another socialist Republican president who looked for a way to enact universal health care was Teddy Roosevelt. Medicine is a really difficult problem because at the personal level it is a "service". Governments don't do too badly with big projects: dams, roads, etc. Governments generally don't do services efficiently. But then, neither do private enterprises spending taxpayer money. However we discuss the alternatives, lets skip the dumb soundbite stuff and use of the word "socialist", and discuss the proposals on their merits.

The current bill is a gateway to single payer. I have never had any doubt about that. It will be "improved", step by step, as was done in Canada. It is quite approriate to be discusssing socialist medicine. It is our future, like it or not.

"I just can't see how to make it work in today's environment." Precisely my point. While I have ideas, some expounded here, I have not put my money on any of them, making my opinion less compelling. The one major weakness in any socialist system is that nobody loses, nobody wins. When all ideas com from above, innovation dies.

To you people so enthralled with the European systems, I hope you're going to be happy paying the VAT which is bound to come to pay for this mess.

James...well said. I love your point about "overhead". Our public schools don't count their buildings etc as part of their "operating budget", so they can claim to be spending less per student than other places... yet in the private world, the cost of buildings is part of the budget. So when a private school is charging $12000/year, it is covering ALL their costs. The same would be true for health care comparisons. There is also the pesky little problem of outcome measure comparisons, such as time lost from work when ill and/or awaiting surgeries, etc. But, such things don't seem to matter any more. It is all about the "dream", not reality.

We need some form of rational and prudent health care reform, but not the law rammed down our throats is neither rational nor prudent. It needs to be repealed

The more we learn about this "sea change" being a tidal wave, the more we want to repeal it. Rasmussen has us at 60% nationwide wanting to repeal the Health Care "Reform" ( destruction) bill..and Missouri just voted to overturn it by 70% Can any Democrat wonder why this Congress is at the lowest approval in history, and this President unequaled in his "approval" rating drop from election to now? This party keeps ramming anti-people bills down our throats in the name of "protecting" us. Per Pelosi, never forget her comment Web Link that we had to pass the Bill in order to find out what was in it!! Well, those of us who actually READ the bill knew what was in it before it was passed and tried to tell the rest of you. Now, though, you are getting those Medicare letters from your doctors, and those rate increase letters from your private insurances, and those warnings about your "taxes" going up for this, because it wasn't a tax but now it is, from H and R Block, and the truth is setting in.