I find myself in some degree in agreement with zamfir on this. If you look at what has been going on, you see production being systematically pushed up with more and more 'flexibility' being required of employees. At the same time wages have been held in place and benefits pushed back. All of this has subjected our middle class workforce to the big squeeze. Ordinarily this would cause people to push back. But that has been thwarted by a simultaneous offering of across the board EZ credit. That employee has been told "not to worry", shop, shop, shop. Do your patriotic duty and use that credit card. He has also been told that this big era of prosperity will allow his family also to own a house, since everybody 'knows' that home prices are going to continue to go forever due to this amazing economic expansion brought on by such policies as 'supply side economics' and such amazing strategies as raising tax proceeds by a policy of constantly lowering tax rates. The bottom line here is that they convinced people that this magic was working and was going to continue to work forever. These people were duped NOT ONLY by the mortgage scammers, but ALSO by the political scammers who where benefiting from this whole thing by making everybody FEEL rich even if they were in debt up to the fifth generation. Its easy to say that these people deserve to be thrown under the bus. But they are much more victims than many people seem to recognize. They are mostly not sophisticated citizens. They simply believed what their government and surrounding culture was telling them and they ended up getting shafted. I personally have an alt-A mortgage on my home because I didn't and don't qualify for a conventional mortgage. I don't have any problem, because I carefully planned ahead of time how I would manage the payments and how I would deal with unexpected eventualities like the current financial mess. But many people are just not that sophisticated to figure these things out. They make the mistake of believing those they should supposedly be able to trust. Thank God, I personally don't know anyone in this kind of situation, but I know of cases and I simply think it is extremely sad and I feel for these people. They trusted their government and the businesses they were dealing with and both let them down in an extremely cruel and systematic way. It is just so sad.

The problem is that just about any living wage job you can invent can be exported just as quickly as those that are already gone. The point comes where you can't invent jobs fast enough to stay ahead of those that can invent ways to move them offshore. How can Americans compete with workers in countries were living standards are way below ours? How can Americans compete with foreign companies who have no probem intimidating their employees with brutal force? I don't know what the solution is here. But wide open free trade certainly isn't. It is actually a mirror image to our own internal economic disaster and was invented largely by the same people who promoted the deregulation that fostered it.

The fact that businesses are "out for themselves" doesn't bother me all that much as long as its done in an ethical way. What really disturbs me is the number of high level corporate executives who are so "in it for themselves" that they are not acting as good stewards for their business. That in and of itself is a major ethics issue. And to make matters worse, they use the concept of corporate citizenship to promote their personal self interest.

Perhaps a better way might be via a time-out where someone on the administrative side would distill the relevant content out of a useful thread and re-present it with perhaps some well thought questions to guide a more focused discussion on the topic in question. This could form a framework to enable use to drill down through discussions to ferret out more useful ideas and relevant information.

But certainly this whole thing is on the right track. We shouldn't be concerned about contributors possibly not having expertise, because there is just as much need for questions as there is for answers. Many times it is the person who asks the right question who can lead us to a solution, just as much as the person who thinks they have the right answer. And we are all learning as we are contributing. This whole process is just so beneficial to us all. We just have to find a way to structure it in a manageable way going forward. Its never really been done before, but we are doing it! What a privilege it is to be a part of this!

I really thing that PAs and NPs are among the most underrated health care professionals. We really need more of these people and we need to make better use of them in order to free up whats left of the rapidly disappearing MDs and DOs for the more serious stuff. And of course, we need to staunch the decline of MDs and DOs by fixing our broken health care system. But PAs and NPs can really help by effectively triaging patients with minor complaints on a day to day basis. In most cases I am completely satisfied with just seeing the PA. He often provides me with all the help I need, but also is able to recognize situations where I really need a prompt follow up with the MD.

The reality is that spot testing is showing almost 50% of the population to be deficient and the resulting health care costs going forward are enormous. Experts in the field are declaring this to be a major public health problem and it needs to be addressed soon or it will result in even more devastating financial pain for our country.

References:
http://www.jhu.edu/~gazette/2008/18aug08/18vitamind.html
http://www.prohealth.com/library/showarticle.cfm?LIBID=14114

A big factor in health care costs is the expense of the drugs used in treatment. While I understand the need for continued research and development of new drugs on the part of the pharmaceutical companies, the current system for FDA approval is too heavily weighted in the direction of new wiz bang drugs. Often there is research out there indicating potential efficacy of off-patent drugs or other substances in treating specific diseases or conditions, but since our current drug development model is geared toward high profit patent drugs, these opportunities have no viable path to approval and low cost treatment options are passed by in favor of far more expensive and often less effective approaches.

These are really excellent points. Appropriate preventative action would not only lower consumer health care costs, they would also make a huge impact in dealing with our government's medicare and medicaid obligations. We need to find ways to promote healthy exercise. Perhaps those things that contribute to healthy exercise should receive some sort of tax incentive, perhaps via Federal Income Tax deductions or credits. We also need to find ways as a nation to promote healthy eating habits. We know which food ingredients are toxic. Perhaps they should be subject to additional taxation, not only to discourage their consumption, but also to discourage their inclusion in foods in the first place. It is maddening to find otherwise healthy foods in the grocery store that are loaded with unnecessary and unhealthy ingredients and sometimes not even be able to find healthy alternative products. We also face a known epidemic of Vitamin D deficiency in this country according to respected researchers at Johns Hopkins and multiple campuses of the University of California. Researchers are indicating that this problem is feeding the epidemic of metabolic syndrome and cancer rates as much as diet or exercise issues. There needs to be a national policy to make sure that everyone gets their Vitamin D levels checked and stabilized at a healthy level just as their blood pressure, blood sugar, and cholesterol levels are monitored and addressed. These are three key areas that are not being adequately addressed, and they represent a huge opportunity to lower health care costs in both the long and short term.