You are misreading "self-evident truth that all are created equal." This simply meant no one should be entitled to be king by right of birth. Our forefathers never intended nor thought possible equality of life. Equality and happiness were not guaranteed as a right in the Constitution; only the freedom to pursue them was guaranteed.

No matter what ism, there will always be those who get better doctors, better treatment, and the best technology available. If you want the best health care here in the USA, become President.

The only problem with health care here in the USA is the socialism already mandated by the federal government. And, I believe you will find the reason for the $5 prescription is because we are with our $500 prescription subsidizing the socialist health care system.

The Constitution just might be the most well thought out document ever written. I firmly believe the genius found in those few pages will never be equaled.

Sadly, it was annulled by the founders' descendants with what was supposed to be a temporary federal income tax for the funding of WWI. It is still with us 90 years hence. A review of history will show the Constitution was read with original intent until that time.

With this new found power of the purse, it became convenient for politicians to argue and expand the meaning of the Constitution for the sole purpose of satisfying their desires and the wants and wishes of their favorite constituents. Thus, we now have cradle-to-grave politicians.

Our forefathers not only feared such a centralized government but they feared any large institution with unchecked power. They would be the first to nix the idea of a federalized education system, a federalized health care system, etc. They intentionally saw the role of the federal government as very limited and via the Constitution tried to assure it remained limited.

Their genius was knowing a free people and a free market system would in itself -- with no directed funding or mandates from a government -- make the best use of resources in the most efficient manner.

Bottom line: there was no problem with health care here in the USA until politicians mandated there be a problem. Doctors in all communities charged according to the means of the patient, and a majority of the hospitals were non-profit institutions to which the wealthy contributed money for lavish buildings and the latest technology (provided a plaque was attached with their name).

The more the government is involved, the less we have to be involved with one another. Lose your job? The government has your check. Need daycare? Ask Uncle Sam. Hollywood elites and their ilk are nearly all lefties because it assuages their guilt. Power to the government liberates them from having to get personally involved.

The Founding Fathers knew full well the evils of government. The Bill of Rights, in fact, was never meant to have any sway over state and local governments. None. It was entirely aimed at the Federal Government. They knew well the corrupting influence of power and wanted power over our lives to be as close to the governed as possible.

The health care system could be healed by getting lawyers out of the system, by reducing governmental involvement to the absolute minimum, and by ending illegal entry to the country. What's happened is that the government has broken both our legs and is now offering a wheelchair. If we take it, we will never walk again.

There are more pharmaceutical lobbyists in Washington than there are Congresspersons. These Big Pharma companies have tons of money to contribute to the campaigns of our elected officials.

If you put all the 100,000 pharmaceutical reps in the United States in one place, they'd make a medium-sized city. Their job is to influence the prescription writing habits of medical doctors by "educating" them while supplying them and their staffs lunches (and pens, and pads of paper, and other office supplies) for free.

One of three commercials on TV in the U.S. is a drug ad.

This country has well trained doctors, and takes more medications than anyone, yet we rank 37th among industrialized countries in health care. Why? Because we focus on sickness instead of health. The system is geared towards pouring vasts sums of money into crisis care, and very little into prevention and true health care.

Nearly a quarter of the Medicare budget is for diabetes, a disease that is often preventable and manageable through diet and lifestyle changes, especially "early" changes (when folks are younger).

Half of the bankruptcies in the United States are due to medical bills.

Labels: Health Care

I graduated college back in 2000 and went to work for a software company, one of the products that I worked more with was a PIM and e-mail synchronization tool for handheld devices. It was manufacturer agnostic, meaning that it could sync any Palm, Windows Mobile, or WAP device to the information on any Exchange, Domino, or standardized mail server.

I was talking with a friend of mine who works for a large storage company and was intrigued to hear that he's looking for a device to replace his BlackBerry. Turns out that corporate policy is changing and his company will no longer be allowing new users to purchase and use a BlackBerry on the corporate server.

A BlackBerry is a staple in most corporations these days. It is a fairly versatile device, but it does one thing really well and that is get push e-mail: when a message arrives on the server, it is pushed to the device instantly. So if you are at your desk or sitting on the beach, a message arrives on your device right when it hits the server.

BlackBerry Enterprise Server is a middleware product. You have to have a dedicated server to handle all of the BlackBerry traffic. The server communicates with the Exchange or Domino Mail server. So, for example, I send this e-mail to your corporate account. It travels across the net and gets to your corporate server. The BES (BlackBerry Enterprise Server) has monitoring on your mail server, which intercepts the message and triggers a copy to be sent to RIM's headquarters in Canada and then it is sent over the cellular networks to your device where you get it instantly if you are within a coverage area.

So, the total cost of ownership for this service is expensive. You have to purchase the BES, a moderately powerful server to handle the software, whatever costs you incur to have an extra server on the network, and then you must purchase a license for every device, buy the devices themselves, and subscribe to a data plan for each device.

Microsoft announced Direct Push technology for Exchange some time last year. Basically the Exchange Mail server has the functionality built in to talk to phones and/or hand-held devices over a network (wireless or cellular). When mail hits the Exchange box, there is no middleware. But the Exchange box has network connections that make it just like you are on the local network, and pushes the message instantly to the device where you get it.

When I was working with this technology, we had a trigger if the device was offline to send an encrypted text message to the device to synchronize and securely download the message over the data network. I'm not sure about the specifics on how Direct Push Active Sync works these days, but it is similar.

The key point here is that the push capability is built-in to MS Exchange. It supposedly offers very robust functionality. You can send a command to "kill" the device if it is lost or stolen. It will wipe all data from the device with the command. I assume RIM has this, too, but am not sure. But the interface is 100% Microsoft so it is familiar to people. And any Exchange administrator can handle it as it is basic functionality built-in to the software that they are supposed to be experts on.

Using Microsoft Exchange instead of BlackBerry's middleware dramatically reduces the cost of ownership. You need no additional box or software for it and no additional licenses for clients. You can purchase any Windows Mobile or Palm device to use. They have the ability to wirelessly sync in real time built-in to their default mail clients. You don't have to purchase any software other than the device. The other key here is that a Palm or Windows Mobile device has additional functionality and the ability to run other third-party applications such as CRM for sales forces, native opening and editing of office documents, and so on.

Plus, most people carry a BlackBerry in addition to a mobile phone, so there's no need for the extra data service on the BlackBerry if they already have it on their phone. Most U.S. cell carriers charge less per month for device data than for BlackBerry data.

As companies discover that they can save money while getting the same functionality, we may see a trend away from BlackBerry.

There are rumors that the iPhone will have Active Sync technology built into the mail client in a near-term firmware update. People are always impressed by some of the things I can do with my Treo. The unbelievable screen on the iPhone has got to be even better. And don't discount Jobs's vision to the future to go after business users or come out with a more reasonably and competitively priced device.

Since at least one leading large Technology company appears to be moving away from BlackBerry, others might be thinking about it as well.

I'm not sure what to make of Scot's piece. He compares a "tricked out" Dell model to one of the Macs and comes away with the Dell costing some $650 more than the Mac, due to it needing a faster processor. Scot's analysis is good and he has the data right, I'm just not sure that most people would consider needing the top-end processor at Dell to be equivalent to the Mac in question. Technically, yes, the specs didn't line up without Dell's top choice, but I've never met anybody who needed the $3,500 Dell M170.

Most people are probably like me in that they look at the hands-on stuff more than the internals of a new machine. I wanted a 17-inch screen, separate 10-key number pad because I do so much with numbers in the stock market, and a general coolness and appeal. These days, nearly any computer can do what you want it to do as far as the internals go. None come with tiny hard drives anymore, for instance, and the slowdown in my work happens more often in my brain than in the computer's processor. So far, I haven't been able to upgrade that!

So, my own quick analysis of paying $1,400 for my HP Pavilion dv9000 17-inch when the MacBook Pro 17-inch costs $2,800 seems to support the idea that Macs cost twice as much by the way most people approach it. Also, had I taken the time to gather a few rebates from electronics stores, I could have paid less than $1,400 for the HP. That's never an option for Macs, as far as I know. Do they ever go on sale?

I think you missed the point that I was making. I didn't address just the very top of the Mac line-up. I addressed several parts of it, including the low end.

It's true that if the PC you have to have or can afford to have fits in between the market positions of Apple's models, then you'll be able to find something that costs only a little less (or a little more) than the corresponding Apple model -- and that flexibility may hold extra value for you. But that extra value is not transferrable to everyone. It's about your personal preference. And it also works in both directions.

It's also not an apples to apples comparison about absolute, or intrinsic, value. Most Mac users have no trouble at all picking out a model that suits them. It's not like Apple has too few models (though I do wish they had a few more). The point is that to get at the true value question you have to review comparable hardware on both sides. Otherwise, all you're comparing is price.

The only way to get at value is to level the playing field. When computer experts dissect the level of hardware in comparable products, what you find is that sometimes the Apple hardware has more value, and sometimes PC hardware does.

There is another important factor. When you look at this over time, the value fluctuates again. Computer value is always changing. So any one snapshot in time is only one data point. That's all my story delivered. Were I to do it again now, the results might change. The point is this: It used to be true that Macs were more expensive than PCs. It's just not true any longer.

By the way, my article was just about the hardware vs. the hardware. I have more coming up about the software and the real world experiences of using both Windows and Mac hardware. As a long-time Windows expert, I think I have a far more objective viewpoint on this than most people writing about it. The honest truth is that Macs have picked up a good deal of steam on the software front.

And, you won't want to believe this, but Macs are far, far less problematic than Windows PCs -- even the best Windows PCs. Literally, this is true: If you count up the number of times that your Windows PC won't play the DVD, gives you an error message, freezes, requires a reboot, won't connect to the Internet, and so forth -- things that Windows users have learned to endure as if they're just the cost of using a computer -- and compare those same types of maladies on the Mac, the results are surprising:

You are three or four times more likely to experience a stop-everything-and-fix-it-or-give-up-on-it problem on a Windows PC than you are on a Mac.

I'm not saying Macs don't have issues. They do. It just happens a lot less frequently. I was surprised by how less frequently. OS X in particular has made the Mac far more reliable.

Michael Moore is a certified nutball, right up there with Al Gore. Please do not put any stock in anything the man says. Of course our health care system is broken. The deterioration started in the Lyndon Johnson era, with the implementation of his "Great Society." Any idea how people were cared for in the pre-Medicare era? It was called charity and all doctors practiced it. In fact, before LBJ, a medical doctor was an upper middleclass profession. With the "Great Society" came an infusion of government money, along with all the bureaucratic redtape. It's been downhill ever since, made even worse with Bush's Prescription Drug Plan.

I also refute the claim from one of your readers [Robert J. Manna in Rome, Georgia, whose comments appeared on Wednesday] who says there is no emphasis on "health care," only crisis and treatment. Every day there is news about the benefits of eating right, exercising, forgoing processed foods, etc. There are constant reminders to have one's breasts or prostate examined. Mostly we ignore it and then look for a scapegoat when something goes wrong.

I'm very sorry about your mother's horseback riding accident, but even that was preventable and shouldn't be a burden on taxpayers. Hopefully people that love your mother will do all they can to help. Beyond that, hopefully her church, horseback-riding friends, etc., will step up. Sucking on the teat of the government is anti-American and anathema to freedom.

There are a few things everyone should keep in mind.

First, former Colorado Governor Dick Lamb caused a huge controversy when he said "Old people must realize they have an obligation to die." In his review of medical costs he found that the greatest percentage of medical dollars are spent on old people within six months of their death. Does an 85-year-old with a pacemaker really need a new hip? Should a 70-year-old with a catastrophic stroke really be put on a ventilator in ICU for 3 weeks?

Second, we should all own up to our responsibility to carry health insurance. I hear about the excessive cost but for most people it's about the monthly cost of a new car. There are an awful lot of luxury cars on the road. Am I to believe someone can afford a Porsche but not health insurance?

Third, malpractice suits need to be limited. [Bad stuff] happens. Sometimes babies are born unhealthy through no fault of the doctor. Sometimes operations go wrong. And, yes, sometimes doctors make mistakes. Unless it's something egregious, the doctor shouldn't have to pay for an act of God.

We've become a nation of moaners and groaners. It's always someone else's responsibility, someone else's fault. We think there's a free lunch out there somewhere and we're missing it.

Why do the wealthy and powerful come to the U.S. when they're sick if they have such great health care in their socialized medicine country? Castro was almost killed by his Cuban doctors -- they had to bring in one from Spain to correct the damage.

Michael Moore tells stories from his personal viewpoint, the truth be damned.

The fact is free competition provides the best quality at the best price for every product, including health care. Doctors should develop a "patient outcome" index that shows how well they diagnose and treat diseases and a "patient satisfaction" index that shows what patients think of the care they've gotten, and compete on those. They don't want to be judged but they do want to be free to charge whatever they think is fair. I say, let the market decide.

I'm a physician practicing medicine in Canada who recently returned to Canada after four years of critical care medicine fellowship at Boston's Harvard Medical School.

When I first went to Boston six years ago I (and many of my peers) had a "grass is greener" perception of medicine in the U.S. But after four years of taking care of patients and seeing how other physicians practice medicine in several of the top U.S. hospitals, I have come to the conclusion that the quality of the medical care that patients receive in the U.S. and Canada are very, very similar.

About 1-2% of U.S. patients do get better necessary care, about 20-30% of U.S. patients believe they are getting better care when it is more or less the same, and 5-10% of U.S. patients don't get the care they should because they are uninsured.

Similarly, about 20% of Canadian patients believe they would get better quality of care in the U.S. than in Canada, but I think this is just a perception. Some patients do get better treatments in the U.S. through access to certain innovative treatments that are not yet accepted as standard of care and may not yet be available in Canada. Also there is better access to elective non-urgent treatments in the U.S. But the vast majority of patients in Canada get the basic medical care they need.

Both the U.S. and Canadian systems are far from perfect and both have areas in which they excel. Both suffer from the problem that health care in not cheap and patients want the best possible care for the least amount of money. The major problem with the Canadian system is that a lot resources are spent on acute care (emergency room patients, urgent surgeries, critically ill patients) and there is less left over for elective non-urgent cases.

Thus, a patient will get his chopped-off fingers reattached "for free" (there's no wait because you can't afford to wait), but the patient who needs that same operating room for his cataract surgery might wait nine months because it is not urgent.

By the way, I have read in comments about SiCKO that people wait nine months in Canada for bypass surgery. I have to say that that is absolutely not true. In Toronto, if someone needs cardiac bypass surgery they will get it ASAP -- within a few weeks. In Canada, everyone has medical coverage, in the U.S. that's not the case. In the U.S., if you have good insurance you will get the treatment you need, especially elective non-urgent treatments in a more timely manner.

There are two areas that compound the cost of health care in the U.S:

⇒ The existence of for-profit HMOs and,

⇒ The prevalence and threat of lawsuits

The Canadian healthcare system is administered by the government. It is not the most efficient system, but it is far, far less expensive. Furthermore, it is efficient for patients in that they do not have to think about getting health care, deciding what kind of health care coverage (deductible, cap, in-network/out-of-network, etc.), or worrying about whether they have coverage when they need treatment.

An article in the New England Journal of Medicine showed that health care administration is more than three times more expensive in the U.S. than in Canada:

"In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada."

The reason for this difference as outlined in SiCKO is that HMOs must make a profit and you, the consumer, are paying for your health care and for the profit of HMOs.

The threat of lawsuits is actually more damaging to medicine than the prevalence of lawsuits in the U.S. One reader [Hans Burkholder, whose comments appeared on Wednesday] mentioned a malpractice premium of $300,000 in Florida.

This year I will pay about $5,000 Canadian dollars for malpractice coverage for practicing critical care medicine and I never have to worry about my premiums going up because of any malpractice claims brought against me. But the biggest reason I chose to return to Canada to practice medicine is because of how the threat of lawsuits has negatively impacted the way physicians practice medicine in the U.S.

As your surgery resident contributor mentioned, doctors in the U.S., out of an unnecessary fear, order "reams of unnecessary tests." The system is plagued by frivolous lawsuits which have actually changed the way physicians practice. Extra tests mean extra time and effort wasted for the patient and add significantly to the cost of delivering health care in the U.S. There is something wrong when after 11 years of medical training, against your better judgment, you spend your days compelled by fear to order a test that you know is not necessary and which you wouldn't even order on your own mother.

Years ago an economics major friend argued with me that health care dictated by a free market system would be more efficient and cheaper. HMO's are the U.S. health care system's free market and the courts of law are the system of checks and balance. Because of their own self interests, neither of these systems has helped to reduce costs or improve efficiency.

Finally, I am very glad to hear that the health care system worked for you and your mother. I'm sure it makes the exorbitant bill much easier to swallow.

You say wouldn't buy it above $25/share yet you make no reasoning for 25. Jim Cramer makes these claims all the time, "don't buy company X under 100." But Jim Cramer is more suited as an entertainer than an intelligent and rational investor. My question is why $25? Why not $30? Why not $23? Do you see my point? Your $25 seems like an arbitrary number, there's really no real analysis behind it. I mean, I have no idea if you think this is a 50-cent dollar, a 30-cent dollar, or an 80-cent dollar. If I'm buying a shipping company for half of its ship's scrap value, it's clearly a 50-cent dollar or cheaper, but I have no idea about your reasoning behind Starbucks. Any explanation would be quite helpful.

Labels: AAPL, Health Care, SBUX

I'm a chiropractor and I know the health care system in the U.S. needs help. In fact, it's not "health care" at all....it's sickness and crisis care. There's little emphasis on research into true health care and wellness.

Well over of 75% of the problems that plague Americans today are preventable. However, little is done to teach people the lifestyle changes that will promote wellness. There's big money in crisis care, and chronic disease, but we need to make the system less about money, and more about what's best for people. We need to end the medical monopoly that clearly isn't working.

A recent study showed that people who chose D.C.s (chiropractors) as opposed to M.D.s (medical doctors) as their primary care providers had 85% lower medication costs, had 60% fewer hospital admissions, and 62% fewer outpatient surgeries and procedures.

A major answer to decreasing medical costs in the United States is looking towards the diet and lifestyle of cultures that know best...the Okinawans, for one. They live long, prosperous, healthy lives with little need for drugs or major medical interventions.

• Don't smoke
• Excercise three times a week

The general trend is for hospitals to get more, and physicians to get less. As a surgery resident, I follow the surgical literature. Reimbursements for many surgical procedures are now half of what they were in the late 1980s, and that is in real dollars, not adjusted for inflation. In the late 1980s, Medicare paid a surgeon about $4,000 for doing a CABG (Coronary Artery Bypass Graft), now it pays about $2,000. The same is true for many other surgical procedures as well. Even though the pay for surgeons has been cut, things such as office costs and malpractice costs have skyrocketed.

Malpractice costs vary enormously from state to state. For surgeons, Florida is the most expensive with annual malpractice costs of $300,000 per year. Minnesota, on the other hand, has a malpractice rate of $10,000 per year for surgeons.

All of this has led to several trends in surgery. Surgeons are retiring at a younger age than they used to. If you were working back in the 1980s and now you're doing the same procedures but for less money, retirement looks appealing. The other trend is that surgeons are demanding money from hospitals for being on call for their ERs. Doctors cannot unionize to stop pay cuts from medicare/insurance. However, hospitals have a strong well-funded lobby, and have been able to secure pay increases from medicare. Since an increasing proportion of ER patients seen by surgeons are self-pay (i.e. no-pay -- or a liability since they may sue you) they are trying to obtain reimbursement for being on call.

The medical system in this country is broken. Everyone expects to get a Cadillac but only wants to pay for a Buick. All the doctors are afraid of the lawyers, and therefore order reams of unnecessary tests.

I'm not sure that socialized health care is the answer. I lived in Canada until I was in my early 20s. The health care system there has problems and is not the panacea that folks like Michael Moore would have us believe.

If I were installed as dictator for life, I would make several changes to the American health care system:

• I would modify the legal system in the following ways:
  • Cap pain and suffering pay-outs
  • Make the suing lawyer and client responsible for the defendant's legal costs and missed working time if the lawsuit is deemed to have been frivolous
  • Limit who is allowed to testify as an expert witness to true experts in the field
• I would limit the insurance companies' ability to deny claims or disenroll patients.
• I would institute a single central claims assessing agency to which all hospitals and physicians would submit claims. This claim would then be evaluated and approved or denied. If approved, the insurance company would have a strict timetable to make payment. As things now stand, they send you endless forms or denials. This way they keep the money in the bank longer and therefore have a higher working capital.
• Every citizen would have a magnetized card with their entire medical history on it in a centralized database. Every hospital would use the same software and would log every patient visit into the database. There a large number of drug seeking patients in the system. They go from hospital to hospital complaining of things like back pain. An expensive battery of labs and radiographic studies are performed -- mostly to keep the lawyers at bay. The patient is then sent home with the narcotic they were looking for to begin with. With a centralized system, you could look in the computer and see that those tests had all been done a week ago at the hospital down the street. You would then save the system the costs of repeating all those tests.

I don't exactly consider Michael Moore an expert on health care but rather a film producer whose only goal is to make money. I congratulate him for his ability to make money but do not for an instant believe any of the messages he tries to deliver in any of his entertaining films. Singers should sing, actors should act, politicians should politic, environmental experts should be environmental experts, investors should invest and each needs to understand that their stage is not the other.

That stated, I pray for your personal situation with medical challenges. Medical insurance is important to have and hopefully your family will find assistance in dealing with such a large bill.

CNN confirmed that all of our statistics in "Sicko" are the correct numbers from the sources we cited. Although CNN still prefers to use older World Health Organization statistics, we will stick to using this year's Bush administration stats and more recent U.N. data.

I feel there are aspects of the U.S. medical system that need changing. For one thing we do need a system where the rates insurers pay for medical procedures and medications is available to all. I bet the $2 million you refer to regarding your mother is an uninsured cost. I suspect the insured costs would be closer to $200K or $300K. This is still a lot but a lot less and more manageable to many. I recently had surgery where the doctor's bill was over $5,000 but where the price paid by the insurance company was about $500.

On the other hand, I lived in England and used the U.K. medical system, have had a number of experiences while traveling in other foreign countries, and have friends who have been assigned to jobs in Canada. In all these experiences the level and speed of medical service available in the U.S. is far superior to that available abroad.

I was in Norway last week with my wife and we both had bad head colds. I tried to buy simple cold medications like Coricidin HBP, Sudafed, Dextromethorphan (Robitussin DM) and we were told at the apothecary that we needed a doctor's prescription for each of these U.S. over-the- counter medications. Likewise when I lived in the U.K. and got the flu, it took three visits to my assigned doctor along with a threat to do physical harm to the doctor on my last visit before I got medication which worked to suppress my cough and allow me to sleep and win my battle with the virus.

My friend Jim moved to Toronto, Canada with his wife and two children. The care there for his ill son was so poor and his condition was deteriorating so rapidly that he drove his family to Buffalo to get proper care for his child. His child's health was so poor that he was admitted and in intensive care for two days before he was released from the hospital. Jim feels that if he had stayed in Canada that his son would have died. From that point on, Jim drove to Buffalo for medical care.

I suspect in other countries the following saying fits well: "A person who doesn't know, doesn't know what he doesn't know." My experiences say socialized medicine stinks and I want no part of it.

In his film, Moore mentions that Cuban medical care compares favorably to U.S. medical care. I bet if there is a non-biased body out there that it would say the level of care in the U.S. is much higher than in Cuba.

Labels: Health Care

Labels: GOOG, Health Care, Japan