For the first time in generations, the US Congress has passed a bill reforming our nations health care system.
Historical Attempts
This lofty goal has eluded reformers ever since Teddy Roosevelt attempted it during his 1912 run for president. A national health insurance program was proposed by FDR as part of Social Security, and the effort was continued by his successor Harry Truman in the 1940s, but stiff opposition by conservatives derailed the effort. Lyndon Johnson managed to get limited reforms enacted with the passage of Medicare in 1965, although this national health insurance program is only available to those over 65 years old (and a few others in certain circumstances). Despite nearly universal support today, conservatives vehemently opposed Medicare at the time, claiming it would be the start of government takeover of the health care system. In fact, Sarah Palin almost quoted verbatim the fear mongering speech by Ronald Reagan to the AMA in 1961 that opposed the creation of Medicare.Rep. John B. Larson (D-CT), the Chairman of the Democratic Caucus in the U.S. House of Representatives writes that the top 10 immediate benefits of the bill will be:
Prohibit pre-existing condition exclusions for children in all new plans;
Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool;
Prohibit dropping people from coverage when they get sick in all individual plans;
Lower seniors prescription drug prices by beginning to close the donut hole;
Offer tax credits to small businesses to purchase coverage;
Eliminate lifetime limits and restrictive annual limits on benefits in all plans;
Require plans to cover an enrollee’s dependent children until age 26;
Require new plans to cover preventive services and immunizations without cost-sharing;
Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions;
Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs.The health care reform expert Karoli adds:
1.Adult children may remain as dependents on their parents’ policy until age 26
2.Children under age 19 may not be excluded for pre-existing conditions
3.No more lifetime or annual caps on coverage
4.Free preventative care for all
5.Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online. While these will not be cheap, they’re still better than total exclusion and get some benefit from a wider pool of insureds.
6.Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50% of what they pay for employees’ health insurance.
7.The “donut hole” closes for Medicare patients, making prescription medications more affordable for seniors.
8.Requirement that all insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.
9.Authorizes early funding of community health centers in all 50 states (Bernie Sanders’ amendment)
The group meets and individuals are taken aside for private assessment. Private charts aren’t shared with the group. The ground sets ground rules not to share information outside the group. For more information about the centering model of health care:
http://www.centeringhealthcare.org/
It’s for pregnant women now, but a goal is to expand it “across the life cycle.”
@Gainesville Resident
your father must have also worked outside the Feds. I believe that if it is totally Fed, only part of Medicare (like hospitalization?) is available to retired employees. But if they also paid for Medicare in private jobs, they might have more options available to them.
Cindy, thanks for the link, I will read up on it. This will add to my knowledge and I appreciate it.
@Moon-howler
Wolfie, as I understand it, doctors were not happy with the AMA and there appears to be some rift going on as a result of the endorsement. I also understand that doctors have been having some misgivings about AMA for some time and before the health care debate. So I think it is safe to say that the AMA probably does not speak for doctors like they once did but I may be mistaken.
And here is a link with information–
http://www.forbes.com/2009/08/17/obamacare-doctors-ama-business-healthcare-obamacare.html
MH, the short answer is yes.
First, the AMA doesn’t represent all doctors. I think current estimates are between 15-20% of active doctors are in the AMA. The few doctors that I have as personal friends and not use in a professional capacity won’t join them because the organization to them smells like a union.
Second, general practice is a money losing profession. The WPost reports that family practice (GPs) make on average $173K. To put that in perspective, oncologists make $335K, radiologists 391K, and cardiologists 419K. To further put that in perspective an IT worker in the national capital region can make 80-160K without having to have a degree (or advanced degree on the higher end), be licensed by the state or hold malpractice insurance (self employed will probably be insured for E&O, etc.).
From the same WPost article; The disparity results from Medicare-driven compensation that pays more to doctors who do procedures than to those who diagnose illness and dispense prescriptions. In 2005, for example, Medicare paid $89.64 for a half-hour visit to a primary-care doctor in Chicago, according to a Government Accountability Office report. It paid $422.90 to a gastroenterologist who spent about the same amount of time performing a colonoscopy in a private office.
Compensation rewards specialization and not being a generalist. And, I’m ok with that. Do you want your ticker looked at by a guy that got a C in general anatomy or a gal that’s spent 5 years in a dedicated program after med school and a few years in a fellowship concentrating only on that one specific ailment? Specialization costs money and time.
Now, that’s not to say we don’t need generalists but you get into the same problem you see in any industry. We are paying more for Worker B than Worker A. Worker A wants a bigger cut of the pie but consumers don’t want to pay it (remember, how many people here WANT to give insurance companies more money?). So, the supply-side begins to decrease as it’s an uninteresting and under compensated field. What will fill the gap especially if it takes 8-12 years to train a new doctor (and I haven’t even touched on loan repayment)? More doctors? Nope. I can (if I was a doctor) do 2 boob jobs a day for 4 days a week and make 2x as much as the GP slaving over sick people 12 hours a day for 6 days/week. Bonus points also for not seeing a lot of flu or for dealing mostly with cash and not insurance.
So, some will say, lets just up the reimbursement rate to those GPs afterall they provide a valuable service. And, as I said above if you up Worker A do you take from Worker B? Worker B will rightfully think – wait I used to make more money for less work. Now I’m working more for less – how’s that fair to ME? So, do we lose some of those specialists that decide to go John Galt? How long does it take to make a new specialist?
So, lets say we up A without effecting B. Where do we come up with more money for A? Under our traditional system HCIs negotiate a fee schedule with these docs and will up premiums to customers when A wants a pay raise. So, Customer A, B and C pay more to the insurance company to pay A his raise. Now, replace customer A B and C with Taxpayer X Y and Z. Those taxpayers may NEVER see a doctor because they’re healthy as a horse but they have to pay for everyone else’s health insurance. So, XYZ gets no benefit but has to pay for everyone else. XY or Z refuse to pay and want to pocket the money into a savings account to save up for a Jaguar – nope, can’t do that. Even though he’s elected NOT to consume a resource he’s somehow run afoul of the new insurance mandate and faces jail for non-compliance.
You want real reform at the GP level? Let providers other than doctors provide GP services. Nurse practioners or PA’s have sufficient education and training for doing most GP functions. Why not allow the free market use those persons and let them set up shop and provide services?
And, as a nation we MUST get off this notion that because I have a cough or a sneeze that I *must* goto a doctor. Self-rationing of care will do more to drive down HCI costs than anything else. With the moral hazard of HCR instead we’ve gone the other direction and made it clear that regardless of your situation you can get coverage and the govt (taxpayers) will pay for it.
So, I’m gonna fatten myself up into a turkey and get my govt insured lap band and body sculpting done so I can look like I was in my 20s again. 😉
Why not? it’s your money.
OK Rez. I may have something mixed up then – or really just be talking about the hospitilization part of medicare – as both my parents have been in and out of the hospital in the past 2 years. My father only briefly worked in private industry, so really probably 98% of his career was working for the feds. My mother really stopped working when they got married many many years ago. Although, I’m then confused as to what they are saying about their doctor bills or prescriptions being very low cost to them. Well, I admit I know next to nothing about medicare.
What Rez says above is pretty much the explanation I heard too. I think a lot of doctors don’t agree with AMA says on a wide range of subjects, from what I’ve heard. I know though Obama and others liked to say the AMA was behind healthcare – but that didn’t necessarily mean all the doctors were.
I didn’t realize it was that low. I knew not all doctors were in the AMA – but I actually would have guessed 60-70% were. Wow, that’s really low!
I like this part of the Forbes article Rez posted:
“An online straw poll on the doctors-only Web site Sermo.com found that 94% of 10,500 physicians polled oppose the bill. While the sample isn’t scientific, and may have attracted an anti-AMA crowd, it’s gotten attention as a vote of confidence against the group.”
While the poll isn’t scientific, i think those numbers are very telling….
Already, 11 states are planning to file suits over this.
“Republican attorneys general in 11 states warned that lawsuits will be filed to stop the federal government overstepping its constitutional powers and usurping states’ sovereignty.”
“In addition to the pending lawsuits, bills and resolutions have been introduced in at least 36 state legislatures seeking to limit or oppose various aspects of the reform plan through laws or state constitutional amendments, according to the National Conference of State Legislatures.”
Of course, VA is among those states. Read the whole story at http://www.comcast.net/articles/news-politics/20100322/POLITICS-US-USA-HEALTHCARE-STATES/
Here’s something else from that article:
“President Obama had promised to consider tort reform during a conciliatory speech at the same June meeting, though the bill has not turned out to have any. ”
Does anyone know if tort reform (of any kind) is what was passed yesterday?
I’d like to know the answer to that – to see if Obama kept his promise (well, to be fair, he only said he would “consider it”).
It will be most interesting to see what happens with those lawsuits.
@Gainesville Resident
Oh I know that my mother-in-law that had survivor benefits from Federal retirement as well as her mother in the same situation, did not pay out of pocket either although they had the Federal insurance. I don’t know how it works either. i just know that when they paid me, there was only an amount for Part B (whatever that is–I assumed it was hospitalization).
Cindy,
Maternity care is outrageous in this country. Infant mortality and maternal mortality are one of the highest for an industrialzed nation such as ours. I could go on and on about we could and should save money, but obstrectics is a cash cow. My first child cost over 10,000 dollars to have, my second child, 2,300. Now THAT is cost savings. One out of three women have a c-section, it is becoming an epidemic. The WHO says 10% c/s rate is acceptable. We are at 30%.
I spent two hours this morning talking with a client who is a well-respected physician in a challenging specialization. He practices in an area vital to everyone. This person spent many, many years in school and in training before he earned a dime as a doctor. His wife worked to help pay for this training, and then he returned the favor for her to complete her education. This man was almost in a panic today and considering ways to expand a part-time consulting business he has that does not involve treating patients.
Moon asked what else are the doctors going to do. For the doctors who have already finished their education and are now practicing, the answer for many is build up an investment portfolio and retire as quickly as they possibly can. Younger people will increasingly not subject themselves to the sacrifices necessary to become doctors and then suffer diminished compensation, increasing patient loads, worsening malpractice insurance costs and the threat of more torts.
I’ve spent a lot of time around physicians, both clients and otherwise. I taught finance for eight years at Johns Hopkins University’s Business School, including in the continuing education program the JHU Medical School runs for medical professionals. Virtually all of the doctors I know are very concerned. Some said they are advising their own children to choose another profession. I have not heard one say they approve of what the AMA is doing regarding health care reform.
Aside from the financial and economic problems yesterday’s bill is going to create, my greatest concern is what will become of the quality of health care in the United States as current doctors exit, and young people chose not to enter. The government is driving people out of the profession and my fear is that the supply of qualified doctors in the not-too-distant future will be dramatically less than we need. We will likely see “gated community” type health care emerge as the very wealthy create a private system outside the emerging health care system this bill will give us. Even the currently affluent middle class will not be able to afford anything comparable to the health care they receive today.
Quotes from comments at Coyote Blog (http://www.coyoteblog.com/coyote_blog/2010/03/well-my-health-insurance-policy-just-became-illegal.html) too good not to share:
#
Roy:
1865 just got reversed.
Then, by force of arms, a unilaterally imposed right to some person’s productivity became illegal. Now, by representative vote (opposing, as far as I can telll, the majority popular opinion) people gained the right to demand another person’s time (productivity, life) at a reimbursed rate that person cannot negotiate.
What makes some people believe slavery will work better this time around?
March 21, 2010, 11:04 pm
#
zero wolf:
“slavery will work better this time around because we have a kind, caring, well-educated priestly/governing class overseeing it. because these godlike creatures are immune to the foibles and frailties of normal humans, you may rest assured they will ensure the new slavery…er, “system” is *guaranteed* to be fair to all.”
“no, they’re not covered by that particular health plan. why do you ask?”
How many more people will actually seek services than were seeking them before??
I hear all the time how crowded the emergency rooms are, as people use it for regular visits instead of using a PCP (Primary Care Physician). How many people will this move from the ‘going to die because you went untreated’ to the ‘we have an anti-biotic for that TB you have’.
It is hard to tell how they dynamics will change. We can now put a little more personal responsibility onto people and hold them accountable. Nobody said that healthcare is free – nobody said that health services are free. What they say, is that everyone can get affordable health insurance.
For all the naysayers – obviously, you have not witnessed someone down on their luck getting diagnosed with an ailment while they have no insurance – it is devastating that they have to spend their retirement funds so that they can finance getting expensive healthcare (and after having insurance all their lives).
@cindy b As a healthcare professional, the privacy and dignity of each individual patient is paramount for me. As a patient, the idea of having to hear the icky details of another person’s bodily issues sounds repugnant to me, and I would much rather feel “alone” than share intimate details of my own. I would fear the day that this model of group care became the standard of care across the life cycle.
Does anyone know how the mandate is going to work? Suppose someone goes to the emergency room and reports no insurance? Will that be reported to the Feds? If not, then how is overcrowding at ERs change in any way?
Will doctors and nurses be part of the IRS reporting system to report people not in compliance with the law?
Somethings are nice to talk about, but the implementation is almost impossible. And if it is impossible, how will the savings come to any fruition if there is no way to report people?
I wondered that myself, Rez. Right now, hospitals can’t turn anyone away in an emergency, so this idea that people are just dying in the streets for lack of healthcare is a joke. Were they planning on revoking that requirement that hospitals care for emergency patients regardless of insurance? Since Democrats have sworn up and down that illegal immigrants won’t be able to buy the insurance, will they now be forced to prove citizenship before CPR can begin?
Marin, I hope boob jobs aren’t covered under the new plan. (unless for medically necessary reasons) I did notice you chose that job for yourself. snicker 🙄
It sounds like it is all boiling down to money and that doctors are the ones society values as the money makers. I will have to ponder…..
@Emma
I invisioned the health department setting… not sure if it would be far off?
A couple of responses to previous posts:
Censored — I never posed the question of single-payer to these docs per se. However, I did once ask the older and most experienced doc what he thought about changing his debating opponents on reimbursement and treatment issues from insurance company types to bureaucrats in D.C. His simple answer: ” I’d quit. That would be a problem on the shoulders of the other two younger guys.” The context of the discussion was a public option which could cause insurance companies to quit the field — an objective stated publically by some Democrats, e.g.. the public option being a waystation on the way to a single-payer system.
The article I read which included the company specializing in sell offs of medical office equipment was directed specifically at doctors leaving the profession altogether. That is what the company owner was addressing. You have a point that there might be some office consolidations involved because of the current economy, but that was not the crux of the article.
Poor Richard — Good point about trying to find a doctor who will take Medicare. Moreover, I just heard something last night on the radio which stated Walgreens will no longer take Medicare prescriptions. I have a strong hunch that, in terms of medical care availability, we may be headed for the worst aspects of the Canadian and British single-payer systems without even actually having a single-payer system. That older doctor in my response above? I once joshed him about the House bill possibly turning him into a civil servant rather than a private practice physician. He replied that he already was a civil servant in a way. Most of his patients are on Medicare. I haven’t been able to ask him about the provision in the current Senate bill which lowers Medicare payments to doctors. That provision was part of the argument that the bill would reduce medical costs and the deficit. Of course, it is just more of the usual double talk put out by the politicians, since it is likely that those payments will be moved back up via the “adjustments” being sent to the Senate. Lies, lies, and more lies. If our medical profession ever gets to the point where the docs are imitating the politicians, we are all dead at an early age — IMHO.
GR — One of the younger doctors in our family has already had his patient face time reduced to an almost ridiculous level by the new, computerized record keeping demands put on all physicians. I would wager that he spends as much time on the computer as he does in examining patients. You have to add to that the time he spends in the hospitals with his own patients. I cannot imagine how he will keep his sanity if the patient load is expanded as promised by this health care bill without an accompanying expansion of the number of care givers. I wager that this will become a real problem for him because he practices in a blue collar town with unemployment over 15 % and a very large number of poor and working poor. I would not be surprised if the increased work load did not eventually force him to look for a place with different demographics in which to practice, if just to retain his sanity and his family life. The other young doc sought out a clinical position where he did not have to pull shifts in the local hospitals in return for privileges. I think he saw that as a way to retain some semblance of a personal life. However, I bet he will soon see that clinic stuffed to the gills with patients and his face time down to a couple of minutes each.
Just an interesting aside in all this. My daughter used to work for a doctor in a situation where that doctor, in return for hospital privileges, had to pull shifts in the hospital ER. The darn funniest thing I ever heard of. If this doctor treated a patient in the hospital ER, somehow he had to assume that person as a patient in his own office. Many of the patients in the ER were immigrants taking advantage of the free care. When they came to the doctor’s office, they apparently thought that his treatment was also paid for by somebody else. The problems became so acute that the doc had to start demanding payment up front. It was a “Lay your money on the counter here, son; and then I’ll take you into the consulting room.” He didn’t like to do things that way, but the guy was left holding the cost bag all the time. And he was a specialist with far more training and experience, plus far more specialized equipment, than a family practice doc.
And for all: Maybe you saw this and maybe not. You all know that Great Britain has a single-payer system. A couple of weeks ago, a young man with some serious medical complications was in one of that country’s top teaching hospitals. He was thirsty and asked the nurses for water. He didn’t get any. He was really in need of water, so much so that he actually picked up the bedside telephone and called the police. The police came. The man’s mother arrived. The mother was asked to step out of the room. She came back an hour later, just to be told that her son had died. Died of what? Well, among other things, dehydration. That’s right. DEHYDRATION. The nurses ignored his requests for water. Big investigation going on. In the meantime, all nurses are being asked to sign a declaration that they will always do their duty and pay attention to the needs of the patients. Or something similar to that. All you folks demanding a huge government role in our medical system. Is this what you had in mind? Bob Pugh, I think you are right on the money with your #67.
Rez, I don’t know how the mandate will work but as I understand it, it won’t kick in until 2016. Maybe I dreamed it.
Emma, I would think that the HIPAA (???) rules would have to change before anyone could do group icky. I sort of agree with you re icky. I know that Reston has gone to all private rooms because of the HIPAA privacy issues.
HIPAA is already taken lightly, because it has never been enforced in any meaningful way, and complaints generally go nowhere.
Example: A young adult family member who takes Adderall goes to her clinic to get her refill. The clerk calls out, “Miss XXX, your AMPHETAMINE is ready.” As my relative walks up to the counter, the clerk again calls out, “Do you have any questions about your AMPHETAMINE?”
Needless to say, she was a little uncomfortable walking out of the clinic alone carrying her bag of AMPHETAMINE. Outrageous.
I have seen the example above just about everytime I am at the doc’s office.
“Nobody said that healthcare is free – nobody said that health services are free. What they say, is that everyone can get affordable health insurance.”
If everybody gets “affordable” health insurance, on what basis is the risk analysis formed? If there is no restriction to prior condition, why get it at all, until one is sick?
I have seen hipaa taken very seriously in hospitals with both my mother and my husband. Maybe they were just putting on an act for me. Who knows.
Cargo, you just made a real strong case for the mandated coverage. Otherwise people would wait until they got sick, I would think.
@Moon-howler
And if is cheaper to not get the mandated coverage but to wait until you need it, even if you pay some penalty, how does that keep costs down? That is the house of cards in this bill. it all falls apart without enforcement.
Pinko, on your #23 about “baby killer.” That was sort of an inside joke that I tossed at Moon because I know she is a contemporary. When the troops came home from Vietnam, some were actually accosted in the streets, spat upon, goaded into fights, and called names like “baby killer.” That was really something since most of the troops did not start the war and were not career military. Many were draftees who had answered their country’s call just like their fathers, grandfathers, and great-grandfathers before them. And then along came John Kerry and his phony meetings in Michigan where people often posing as Vietnam vets claimed that some of us were not only baby klllers but torturers and murderers and vicious monsters all around. All that hurt very badly. I, for one, have never forgotten and find it really hard to forgive. Those wounded Marines of which I spoke in a previous post — Mrs. Wolverine’s “kids.” When my medevac plane finally reached its destination, all the wounded were carried in stretchers into the hospital receiving area. The guy next to me was in a full body cast. All I could see were his eyes and his mouth. An officer got up and wlecomed us home. Then he told us that, when the time came that we were ambulatory and able to go on liberty, we should NOT wear our uniforms because we would be called names and goaded into fights — by our fellow Americans. I remember looking around and thinking that I must be in a dream. I wasn’t really in an American military hospital surrounded by young kids with ghastly wounds and missing limbs. I must be part of the army of Attila the Hun. Pinko, you never forget that. Could be why I am so adamantly against bad behavior in my own contemporary political ranks
@Moon-howler
I was kind of hoping thigh reduction would be covered.
@Emma Not being a healthcare professional, I know I’m not communicating this concept well. From my understanding, there is privacy and dignity in the assessment, and the sharing part is no more intimate than a support group. If I find more information that explains it better, I’ll post it.
@Wolverine
Wolverine, your story really struck me. I can’t even begin to imagine what it feels like to serve your country and be reviled like that after.
All I can say is we need to make sure that kind of thing never happens again. Whether we are for or against a war, we should respect those who fight for us.
War crimes must be addressed, yes. But most soldiers are not war criminals. They are those making as many sacrifices as they can to protect us.
Thank you for your service.
You know, I know it happened but I never saw or heard it happen. I saw it on the news. I think there was less of that vile behavior towards returning Vietnam vets in the south than other place. I was VERY good to a vet or 2, as I recall.
@Wolverine
Wolverine, there are times in our history that I would hope we never see again and what you describe was not only accurate but brought back a sadness that I haven’t felt for some time. And many of the leaders of this anger toward our troops was fueled by people in Hollywood starting with Jane Fonda. I, unfortunately, do not believe that similar occurrences could not recur.
@Moon-howler
Except for the whole unconstitutional part of the mandates…….
The answer to problems caused by over-regulation and government control is not more regulation and government control.
Actually, my doctor in his examining room has this big article posted about how physicians are having to spend more and more time doing paperwork and as a result getting less and less time to actually spend with patients. So I’m guessing my doctor agrees with the article or he’d never have posted it in his examining room. I go to a family practice in Haymarket and my doctor does seem like he’s often a bit rushed, but then again I’ve only had to go there for very routine things like a yearly physical.
Anyway, what you write is interesting about one of the younger doctors in your family – and his feelings about the reduced face time he’s already experiencing as far as seeing his patients. Also, as you say because of the demographics of where he works, his workload may increase more than other places, and as you say force him to locate to a place with different demographics. That would obviously be an unintended effect of healthcare reform, and would actually be sort of what we call a “positive feedback loop” in that now you’d be down one doctor – so the rest of the doctors would see even higher workload – and it might just get worse and worse!
Your story about that doctor your daughter worked for is really interesting too. That’s prett bad when you have to demand payment up front like that – just to avoid getting stuck holding the bag on costs – with that crazy policy that once you see the patient in the ER they become your patient!
I hadn’t even thought about that – but that’s an excellent point. If they don’t enforce it (that everyone has to have health insurance) things are doomed for sure. The whole system is going to depend on healthy people buying health insurance. That’s the whole theory behind how costs will be kept down. If healthy people feel like they don’t need to buy into it, and there’s no enforcement, there’s going to be big big problems with the costs!
I was young when the Vietnam vets returned – but I remember reading about it in the newspapers about how poorly some of them were treated by members of the public upon their return. I didn’t know any Vietnam vets personally – or never really met any (that I know of) at the time – so I don’t have any personal knowledge of it either – other than what I remember reading in the newspapers at the time. It was definitely awful, and absolutely uncalled for. Someone else mentioned Jane Fonda – and yes, she and people like her were a big part of the problem and probably fueled that behavior. Not one of the better moments of US history – in terms of how we treated returning Vietnam vets.
@Rick Bentley
It’s very difficult to win popular support when the “popular support” says NO to everything
discussed.
@Bob Pugh
Bob,I didn’t understand a lot of what you said about the GAO, but I’ll take your word for it and it’s one more thing we have to work on. As far as tort reform and malpractice insurance costs
it is my understanding that the congress will do that next in health care reform.
@cindy b
Cindy, I agree with you, Why waste all this energy on fighting change — put it towards solutions and common sense. This Bill will give the Congress a base to work on and make future improvements. This is just the first step!
Growl, Bear. How are things up north? You have brought us some wise remarks.
I have mixed feelings about tort reform. I think some of the awards you read about are absurd. On the other hand, if some idiot left me paralyzed, I would want millions. Perhaps its whose ox is being gored.
@Moon-howler
Moon,The North is not much different from the South ,Same Political Nuts,different state.
Governor and staff more concerned with their own agendas. As far as tort reform ,If we don’t give the doctors some help with their mal-practice Insurance they will never be able to reduce their rates or the number of “cover their rear” tests they perform.
Maybe they could add an amendment for everyone except Moon-Howler LOL