This is a very tough question and there are no good answers. I support a single-payer system and I do believe there needs to be some limits to coverage in the case of limited life extension treatments. We simply can't cover everything under a single-payer system, especially expensive treatments that prolong life for a very limited time with no hope of recovery. I also think the example you give is one that illustrates clearly how easy it is to make errors in setting these guidelines. Children are probably much more likely to recover miraculously than a 75 year old smoker. 6 months is also a far more significant extension to their life than it is to a 75 year old life (being a 10% extension to the 6 year old's life). Finally, giving parents time to prepare for the unexpected early death of a child is certainly very significant. Family of a 75 year old smoker would have been much more prepared for the death. Any guidelines we develop will not be perfect, but they can be much better than your example. It would need to be upon policy makers to ensure that there are checks and balances in the system to continually evaluate and improve guidelines such as this.

The other question you raise is also tough. I am inclined to lean in the egalitarian direction for pragmatic reasons, however I am also somewhat troubled by it. I don't t see any moral problem with allowing people who can afford to pay out of pocket for non-covered treatments to do so, in fact I see a problem in preventing them from doing so. The risk with that approach is that by allowing this the single-payer system and coverage could be degraded. I would only support allowing this kind of supplemental coverage and treatment if we have very stringent ways to prevent this from degrading the quality of care that everyone receives. It would defeat the purpose of a single-payer system to start moving to the attitude that everyone should have supplemental coverage.

While you raise tough questions, I do not think they are questions that cannot be answered. I think they can if we dedicate very smart people to finding the best solutions. Our current system is extremely broken. While we may not be able to design a perfect system, we can design one that is far better than the system we have today.

drmick3, please see the post by Jonas above. He is starting an experimental forum for discussion that will hopefully test out some new ideas for how to organize the discussion. To get involved you can contact him at jonaslehtonen@gmail.com.

I am glad to see the MPAA is not pushing excessively rigid copy protection technology in this document. They have adopted positions promoting copy protection technology that seriously restricts fair use by the consumer many times in the past.

The transition from physical media to virtual digital media delivered over the internet will happen during Barack's administration. It will be important to preserve rights of the consumer to fair use and backup of their digital media. It will also be important to do something to ensure consumers who purchase protected media in a format that becomes obsolete when a company abandons it are compensated in some way.

The issues we will see around DRM technology will reach a peak in the coming years as the masses complete the transition to the world of digital media. Media companies will try to impose as many restrictions as possible on the use of this media in an attempt to find ways to get consumers to pay multiple times for the same content. Please keep the consumer in mind when dealing with these issues over the next several years.

This document says nothing about the rampant abuse and fraud in the H1-B visa system. This problem is dramatically affecting American IT professionals. Please strictly and diligently enforce the rules around H1-B visas. Companies found abusing the program should face heavy fines, be prevented from participating in the program at all in the future, and executives setting the abusive policies should face applicable charges in court.

Usually when a company claims that there are no American workers to fill their technology positions the truth is that there are no American workers willing to take a job at the below-market salary levels they are offering these positions at. If companies offered the positions at market level salaries they would quickly find many qualified applicants.

Another example of techniques used by companies to avoid hiring Americans is inflated job descriptions. In some instances job descriptions are easily found requiring years of experience with a particular technology that exceed the life of the technology. They know that nobody can possibly have the experience they are "requiring" and thus they can easily avoid hiring an American if they want.

Technology jobs are some of the best jobs available to Americans. Preserving these jobs for the American work force is critical. We already face enough competition against outsourcing, etc. We should not need to compete against H1-B workers for jobs we are qualified to fill. That is not the intent of the H1-B program and it should not exceed the bounds of its intent.

I totally agree.

I have been very disappointed in the bailouts our government has been handing out in recent months. They have been seriously lacking in demands, concessions, accountability, oversight, and transparency. It is somewhat concerning that Barack has chosen to appoint Mr. Geithner who has been deeply involved in the fed during this process. While I am concerned I plan to withhold judgement until we see what actions are taken by Mr. Geithner under Barack's leadership. I sincerely hope he will behave differently in the new administration than he has currently while Bush, Paulson and Bernake have been leading the way. Europe has provided a much better example of driving hard bargains and protecting taxpayer's money.

The institutions we have been bailing out have been in an extremely weak position. Our government has been the party with leverage at the bargaining table. Yet they have rolled over and handed out money with loose "desires" rather than solid mandates. It is no surprise that the money has not been used as congress claims to have intended. It should not be a surprise to our congress either despite their posturing to the contrary. Corporations are very good at taking full advantage of any wiggle room they are given. Without clear mandates they will do as they please. We can also say the same of the Bush administration in its record of dealings with congress (in fact they go a step further and often ignore mandates in the case of signing statements).

We need fully enforceable mandates with serious consequences if we are going to conduct bailouts in the future. We also need to revisit the bailouts that have already happened and make them stronger where possible. We need to lead the world in looking out for our citizens and sadly we are not. Instead, we are mortgaging the future of our children to save the country from the greed of the recent past. Even sadder yet, we are allowing many of the leaders of our greediest financial institutions to remain in their positions of power with little consequence. Let's call for Barack to correct these errors and move forward with a strong message to wall street in a language they will understand that there are consequences to be had for creating this crisis and that never again will we allow a crisis to be created by their greed.

Is anyone else having trouble posting to this thread? I have been trying to post a comment for a couple days and keep getting a message that says "This comment is currently in moderation" and it still has yet to show up here.

I agree vinnie, no more tax breaks for the rich!

This is a very detailed document and I am not an expert in all of the nuances but I fully support making our country as green as possible. I think we need a high profile cabinet position to champion the environment and green issues. I would like to see Barack consider appointing Al Gore to such a position if he would accept it. Al has worked tirelessly to champion environmental issues and would make a wonderful leader of green policy.

I am glad to see our governors very concerned with the energy issue. I support everything they are asking for, however I would also ask for more. I would like to see Barack take Al Gore's green energy challenge and offer Al a position of leadership in implementing this green energy strategy. Al has been doing everything he can to address the failings in our climate change and energy policy for a long time. He has expertise, experience, and relationships that few others do. Please consider working with Al to make his dream a reality. Our children and grandchildren would have a brighter future to look forward to.