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Archive 1

Rationing

I think this topic merits some additional discussion. This is a key part of how countries all over the world keep costs in check. The basic question of how much to pay to extend life (quantity or quality) is a critical question that may merit its own section. Here is a an interesting article on this topic.Peter Singer - Healthcare rationingFarcaster (talk) 21:30, 16 July 2009 (UTC)

Add criticism from Wendell Potter

The former health care executive Wendell Potter turned whistleblower who testified in the US Senate against the business practicises of the Health Inusurers should be integrated in this article. MaxPont (talk) 08:30, 23 July 2009 (UTC)

Hyperbole

...has become such a feature of this debate that it deserves a section. I suggest something like:

The health care reform debate in the United States has taken an Orwellian turn whereby Obama's health care reform policies are equivocated with Nazism.[1][2] Another widely reported source of hyperbole is Sarah Palin:

"... my baby with Down Syndrome will have to stand in front of Obama's 'death panel' ...", 7/31/09, together with "Stop making things up.", 7/26/09.

In August 2009 (after talk radio was alleged to have inspired the abusive disruption of Congress members' town meetings on health-care reform), Bill Mann wrote in The Huffington Post :


  1. ^ Barney Frank Confronts Woman At Town Hall Comparing Obama To Hitler
  2. ^ Town Hall Crazies Go Through the Ideological Rabbit Hole
  3. ^ Bill Mann, Here's How You Can Strike Back Against Right-Wing Cable, Radio, The Huffington Post, August 18, 2009

Of course, as has already been pointed out, a discussion of POV cannot be POV itself. So, reliable sources must be found. But, what's not reliable about video of the events in question? And, doesn't showing hyperbole on both sides ("Sieg Heil on Your Dial") suffice for objectivity? I'd say make this section. -65.246.126.130 (talk) 20:48, 21 August 2009 (UTC)

Public protests regarding reform debate

There seems to be a rather vehement disagreement between users regarding whether the text should refer to "Tea Party protesters" or "teabaggers". While "Tea Party protesters" references a single, well-identified group, currently holding rallies on a 33-city tour of the Western United States, "teabaggers" is most often heard as a pejorative. Strongly recommend AGAINST using the term "teabaggers" in this article or its companion, as it would violate WP:NPOV.
Note: I for one will only seriously consider points made in Discussion pages of the articles in question, rather than edit comments which have been used most recently as attacks against editors.Alan (talk) 17:31, 31 August 2009 (UTC)

Agreed. "The term "teabaggers" not only lends itself to perjorative uses, but also links to a disambiguation page. Tea Party protester is more clearly defined, and is the term that should be referred to in the text. --JayJasper (talk) 17:36, 31 August 2009 (UTC)

I'd like to move the second paragraph currently in the intro into the body. That sort of detail shouldn't be in the lead; I was thinking just the first sentence would remain and we can add some other content about what is in the body.Farcaster (talk) 04:30, 2 September 2009 (UTC)
Thinking it over, Farcaster has a good idea. I see no reason why we shouldn't do that. Although, good luck trying to keep the article stable given the never ending army of sockpuppet vandals. The Squicks (talk) 04:33, 2 September 2009 (UTC)
I agree with Farcaster's idea as well. The paragraph in question belongs in the article, but not in the intro.--JayJasper (talk) 16:25, 2 September 2009 (UTC)

Barbara Wagner

All this and not one word why Palin called it the ‘death panel’ over associating what happened to Barbara Wagner in Oregon and Palins' down Syndrome Child. Oregon which already has a single payer plan. She was also referring to Rahm Emmanuel brother statements that works with him.

http://www.facebook.com/note.php?note_id=113851103434&id=24718773587&ref=mf

http://abcnews.go.com/Health/story?id=5517492

--OxAO (talk) 05:05, 2 September 2009 (UTC)

Thanks for the article and comment. This debate is going to become increasingly important; I recently added an article on Healthcare rationing in the United States where you could expand on this line of argument if you wish (balancing it with the concept that we have finite resources and critics argue we must make tough decisions about rationing care for those we cannot save.)Farcaster (talk) 22:15, 2 September 2009 (UTC)

Needed additions

-74.162.147.56 (talk) 05:19, 2 September 2009 (UTC)

NPOV section-check requested

I've nominated the section Health_care_reform_debate_in_the_United_States#Debate_about_political_organizing_methods to be checked for neutrality. I took out some obvious POV commentary, reduced inappropriate blockquotes to inline quotes (under 50 words per WP:MOS), and moved the selected quotes to after the section summary paragraph. I would appreciate feedback from other editors. Thanks. ... Kenosis (talk) 16:18, 10 September 2009 (UTC)

Farcaster has taken the approach of separating out liberal/progressive and conservative arguments into subsections, e.g. here and in several folllow-up edits. Hopefully that takes care of it--so I'll now proceed to remove the POV-check-section template. ... Kenosis (talk) 16:23, 10 September 2009 (UTC)
From my own personal view, I see no problem for the section.
From the point of view of Wikipedia, which is generally required to have a liberal/left-wing bias, I see several problems=
1)The teaparty protesters are not labeled as 'teabaggers' ('teabagging scumbags' would be even better)
2)Given that the Center for Media and Democracy are on our side and they are our friends, there's no reason to label where their funding comes from.
3)Allegation from them, since they are our friends, must be treated as objective fact rather than just allegations.
4)The teabaggers must be labeled, as a matter of objective fact, as corporate shills and morons.
3)Americans for Prosperity must be labeled as astroturf as a matter of objective fact.
4)Wendell Potter's name should be followed by , hero of the ages,
5)Phil Kerpen's name should be followed by , the merciless,
6)Ben Smith is too friendly to conservatives in his writings, so his comments must be deleted.
/sarcasm The Squicks (talk) 17:15, 10 September 2009 (UTC)

Proposal. The article should be deleted.

This article should be deleted. Reasons

1. It is not encyclopaedic. Anything that is reported by anyone saying anything could be regarded as valid content for an article about DEBATE, whether there is any truth in what is said or not. Thus quite inappropiate content that is not factually verifiable can end up in Wikipedia.

2. It is a fork from Health care reform in the United States.

3. The article is being used to play out debate. Wikipedia isnot a mirror.

4. Its content cannot be defined. Where does it end?

5. Wikipedia is not a link farm. But this is how the article is being used. To link people to outside web sites where political argument is being played out.

6. Its just a horrible mess. There is a section about publicly funded health care (by which I assume means government as a collective for the people) - but the reforms currently being discussed in the US are not fundamentally for public funded health care (though some do argue for it, it is disingenuous to make out that this is what the debate is about). Its also messy because it categorizes positions as being conservative/libertarian or liberal. But who is to say which of these arguments fall into these camps? I see American politics as an outside oberver. In other countries there is a strong party line and parties publish their beliefs in a manifesto which they put before the electorate as a program for political development. The differences are clear and in those countries one can with certainty say what a part line is. Amercian politics is much looser than this. So for example, you can have some Democrats who regularly vote with Republicans on certain issues and there are some Republicans who vote with the Democrats. I don't think you could categorize the UN declaration of Human Rights as being either a liberal or conservative view. Also, there seem to be some differences between some libertarians and some conservatives, so lumping them together as one homogenous group is also wrong.

So I am going to propose that the article should be deleted.--Hauskalainen (talk) 14:50, 8 October 2009 (UTC)

Agreed insofar as it's a mess and there's far too much overlap between this and Health care reform in the United States. Maybe it would be helpful to become familiar with WP:CFORK. The distinctions between content forks (permitted) and POV forks (not permitted) are important and can be quite intricate. While in need of improvement and possibly a merge in the future, this article doesn't stand out to me as necessarily being a POV fork. ... Kenosis (talk) 15:49, 8 October 2009 (UTC)
Disagree as I favor showing the whole ugly mess that characterizes what is, in fact, the health care reform debate in the United States. The article's growth will slow considerably soon, and consolidations can be made. What ever happened to the Hyperbole section? Any article on the topic of a strident political debate should have one. -MBHiii (talk) 18:35, 8 October 2009 (UTC)
Disagree The article will probably improve, eventually.Jimmuldrow (talk) 11:54, 9 October 2009 (UTC)
Strongly Disagree
1) The positions and arguments advanced by those for and against reform in the U.S. are relevant, and can be reliably sourced. It is not Wikipedia's place to determine who's right, but we can help the reader understand who's saying what.
2) This is not a POV fork of Health care reform in the United States. There was a good bit of discussion by the editors working on that article - and others in this area - about how best to organize the material in an understandable and reader-friendly way. Throwing it all into one article simply was not working - it was too long and waaaaay too confusing. A consensus developed that the Health care reform in the United States article should be a higher-level summary, and that the detailed "look at the life expectancy here . . . yeah, but look at the wait time there . . . no, look at the administrative costs . . . so they say, but when you include government workers to admin cost is really . . . " back and forth should be spun off separately. (The same decision was made for the history of reform efforts, data on the uninsured, and public polling on the issue.) Looking back at it, that was a very good decision. There's more than enough material here for a stand-alone article. If anything, we should do more pruning in the main article.
3) That's the fault of the editors - pretty much all of the editors, as far as I can see. U.S. editors who are partisans on both sides, and non-U.S. editors who don't like what partisans in the U.S. are saying about their particular health care system. The fix is for more editors to be willing to "write for the enemy."
4) That's not that hard. It should include arguments advanced by notable groups or individuals supporting or opposing health care in the U.S. - that can be reliably sourced as such.
5) I don't see the link farm. I do see some sloppiness in the sourcing (and no, the side of the "angels" - whichever one that may be - is not better about their sourcing than the "other" side). We should make sure sources are reliable - not for proving the point, but for establishing what the argument is and who is making it - and provide full citation information. Random web links aren't good enough.
6) Yeah, it's messy. U.S. politics is messy. We can and should do more to better organize the material, but throwing it all back into Health care reform in the United States is not the answer. Frankly, this - and the article turning into a debate forum - is not the fault of the subject matter, it's the fault of us as editors. EastTN (talk) 14:52, 9 October 2009 (UTC)

If this article is so great, why is there NO mention of the merits or otherwise of creating a self-supporting government insurer for the individual market (which is the subject of a major debate cutrrently)? And why does it focus almost exlusively on the public funding of health care? This could imply that the reform debate currently envisages a shift the funding of health care away from insurance and onto taxation (which is absolutely NOT what the bills currently in passage thru the Congress do). The withdrawal of the huge public subsidy currently received by Medicare Advantage insurers also is not even mentioned, yet the removal of this subsidy is a key part of all the bills. These issues are mentioned in other WP articles but not this one. IMHO this particular article is a crock of brown stuff misinformation put up by people wishing to influence public opinion and not inform it. It should be deleted. I will not even try to rescue it. --Hauskalainen (talk) 23:02, 28 October 2009 (UTC)

Please go through the appropriate deletion nomination process. Thank you. The Squicks (talk) 00:42, 29 October 2009 (UTC)
Given the opinions above I don't see the point. But it does not change anything I have said. With nothing about the public option or the fact the Medicare Advantage insurers are getting huge state subsidies currently (and that reformers want to undo that) this article is misleading. It would be more helpful if you did something useful by adding this information if you want the article preserved.--Hauskalainen (talk) 22:34, 29 October 2009 (UTC)
I'm comfortably certain that the article is incomplete in that it does not include all of the notable arguments that have been made for and against reform in the U.S. I suppport bringing more aspects or sides of the debate into this article (with the usual caveats that they be appropriately sourced and neutrally presented). But that's a recipe for improving the article - not for deleting it. The article is not a content fork of anything, and I do firmly believe that the arguments being made on this issue constitute an appropriate encyclopedia topic. I do think there may be a valid scope issue here. It seems to me that it may make sense to focus this article on the broader arguments for and against health care reform writ large, and put more detailed arguments regarding specific policy initiatives (such as an individual coverage mandate, a public option, or income-base premium subsidies) in articles on those specific strategies or initiatives. If we try to make this article cover both the global arguments for and against report and the detailed arguments on specific elements of reform, I'm afraid it may become too unwieldy. EastTN (talk) 19:44, 9 November 2009 (UTC)

This article is an embarrassment

First off, good job to those who started this article and who do take the time to write it. But it is amazing that such an important topic has such a dismal article. This is unacceptable for wikipedia's standards on such subjects. Even articles on events that continue to unfold, such as the events surrounding the Death of Michael Jackson, are far more clear, well organized, and thorough. I am aware that this is a convoluted topic, but that is what wikipedia is best at clarifying.

I only have so much time to work on this, but will do what I can. So far I have done a minimal adding of "see also" and "main article" links that point to this article. This article needs to be drastically expanded, and the following articles among many more need to complement each other:

Major Articles:

I think that the following articles should be combined into this one. If not, they should also be overhauled and made complementary to this article:

Some Specific Health Care Proposals:

Some Minor Articles:

NittyG (talk) 04:42, 27 October 2009 (UTC)

Nitty, the reason we have so many articles is that we're trying our best to get the material organized - there's simply too much content for a single article to handle. Certainly there's room for improvement, but I don't think combining articles is the way to go. Conceptually, the way we got to the current organization is this:
1) The "parent" article on reform was Health care reform in the United States - originally, it was the home for all of the material on health care reform. It was becoming waaaaay too long and complicated, though.
2) We then began moving material out of that article, turning it into a summary with the details in sub-articles. Each of the sub-articles began as a way to handle a major subtopic that was originally covered in the parent article. The primary sub-articles spun out were:
Those all seem reasonable to me, especially when you consider that whatever happens this year, tinkering around with the U.S. health care system is likely to continue for decades. A "history" article is going to continue to make sense going forward, and grouping reforms by administration seems to be as natural an approach as any. The one article that is the most awkward, but I still think makes sense, is Health care reforms proposed during the Obama administration. It's intended to cover all the many specific policy initiatives that are under discussion, and which are picked up in different combinations by the various legislative proposals. That's different from the Obama administration health care proposal, and we really did need to move that material out of the main article. I can see some of those ultimately spinning out into individual sub-articles, as has already happened with Healthcare rationing in the United States.
Having an Article on each of the major legislative proposals seems to make sense, and is likely to be reasonable in the future regardless of which one is ultimately adopted. Covering the legislative history of health care reform is not a bad thing for an encyclopedia to do.
Prescription drug prices in the United States has been around forever, and seems to be a reasonable stand-alone topic.
I understand your concern, but I really don't see combining these articles as helping. A better approach might be to give the reader a high-level road-map to this constellation of articles. The sidebar template named Health care reform in the United States was intended to do that, but there may be a better way. Or perhaps we need to provide multiple road-maps for the reader. I could see adding a well-structured footer navigation template as well, and perhaps an "outline" article that also shows the overall structure of these articles. My sense is that if the reader starts with the main article Health care reform in the United States and follows the links down, it works pretty well. Where it gets confusing is if a reader starts with one of the other articles - then it's a lot less clear how all the articles fit together. Some well-structured hatnotes might help as well. EastTN (talk) 20:09, 9 November 2009 (UTC)
EastTN - thanks a lot for the detailed response, it was really helpful. Sorry for the delay... This will take a lot of time to go through, and I would need a solid block of time to devote to it, which I may take soon, and actually begin the work.
Just some random thoughts in the meantime... As you noted, perhaps from the perspective of those working on the articles they make sense, given the progression that you outlined. But to someone who comes in wanting to know about the healthcare debate, it is all over the place. The ideas about connecting the articles to each other is an essential part of what I had in mind. Indeed, I went around and added the basic hatnotes.
What I want is essentially this - someone should be able to go to one article, and be able to find a basic outline of the current healthcare debate, and it should be constantly updated as events unfold.
Is there an example of an outline article that you can provide that we can compare with?
I'll have to go through all the articles and really understand how they should all fit together, then begin the work to make it all clear.
NittyG (talk) 06:44, 14 November 2009 (UTC)

Organizing overhaul?

A group of wikipedians need to revamp this and all related articles (most listed above) to meet appropriate quality standards. There is only so much I can do myself - I may take some time to at least go over some articles and do some basic revamping and reorganizing, but we should figure out how this can be done systematically. How can we make an organized effort at an overhaul? Are there any forums that can point to articles that are in desperate need of attention?

NittyG (talk) 04:42, 27 October 2009 (UTC)

I just nominated this for Wikipedia:Article Collaboration and Improvement Drive It only needs 4 votes by Nov 3, and I am the only one who has cast 1. Please at least vote there. We should generate as many votes as possible to get peoples attention. NittyG (talk) 05:43, 27 October 2009 (UTC)

I just started a WikiProject proposal page: Current Health Care Reform in the United States. If you would like to engage in this overhaul effort, please go to the proposal page, sign your name and add to the discussion. NittyG (talk) 06:33, 27 October 2009 (UTC)


OK. I have made changes to the header to make the article more up to date. There are no active proposals regarding single payer so I have moved this section way down. I have added the references to mandates and new taxes as well as the subsidies. I also added reference to the public insurance option which is clearly a disputed element as is the removal of subisidies to insurers providing Medicare Advantage plans. I am short of time right now but hopefully some editors with more time than me can develop sections to cover these points. I will leave the update needed flag at the head of the article until these are done.--Hauskalainen (talk) 21:47, 3 December 2009 (UTC)

POV (November 2009)

I like that both sides of the issue is covered here, but it looks like we've had some Obama supporters here writing more "they claim"s and "it is argued"s to the free market side than in the Obama care side. Also, at least one section has more arguements in favor of Obama care than the free market, which isn't balanced as there are just as many arguements against it if not more than there are for it. PCHS-NJROTC (Messages) 00:50, 9 November 2009 (UTC)

The number oof arguments for each side are similiar. 20 for public and 17 for free market.Spitfire19 (Talk) 15:32, 9 November 2009 (UTC)
Maintaining a neutral point of view isn't simply a matter of counting the number of arguments - we have to handle the arguments on both sides in an evenhanded way. The section makes it crystal clear that we're talking about arguments being advanced by advocates on each side, so there's no real need to constantly be throwing in weasel words on either side. EastTN (talk) 16:26, 9 November 2009 (UTC)
What is the POV tag for the Rationing of care sub-article about? Does someone want to give equal weight to pro-death panel opinions? If not, then what?Jimmuldrow (talk) 06:57, 16 November 2009 (UTC)
Again, what specific concerns need to be addressed here for the Rationing of care sub-section?Jimmuldrow (talk) 13:45, 13 December 2009 (UTC)

"Free market"

Saying that patents and other monopolies are part of a "free market" is absurd. [1] End of sentence.Scientus (talk) 21:11, 10 November 2009 (UTC)

Medicare Fraud

The text below was removed twice. Care to explain? This is drawn from a 60 minutes piece that seemed well-researched to me. What is the POV element here? What is the other side of the argument that is neglected?

Addressing Medicare fraud

An estimated $60 billion per year is paid out by Medicare for fraudulent purposes. Criminals set up phony companies, then invoice Medicare for fraudulent services provided to valid Medicare patients who never receive the services. These costs appear on the Medicare statements provided to Medicare card holders. The program pays out over $430 billion per year via over 1 billion claims, making enforcement challenging. Its enforcement budget is "extremely limited" according to one Medicare official. U.S. Attorney General Eric Holder said in a interview: "Clearly more auditing needs to be done and it needs to be done in real time." Various federal agencies including the FBI, the Department of Health and Human Services, and the Department of Justice have task forces engaged in addressing this issue. The Obama administration is providing Medicare with an additional $200 million to fight fraud as part of its stimulus package, and billions of dollars to computerize medical records and upgrade networks, which should help Medicare catch more phony charges.[98]Farcaster (talk) 05:35, 12 November 2009 (UTC)

Sorry, Medicare fraud is a serious issue and must be addressed. The main problem is the last clause "which should help Medicare catch more phony charges.", I think a authority should be cited on this opinion. also

Its enforcement budget is "extremely limited" according to one Medicare official. U.S. Acitettorney General Eric Holder said in a interview: "Clearly more auditing needs to be done and it needs to be done in real time." Various federal agencies including the FBI, the Department of Health and Human Services, and the Department of Justice have task forces engaged in addressing this issue.

is written without good context, and needs more facts to make a resounding point. For example: what is the ratio of enforcement money to discovered fraud? I have heard 1:37, but it needs a authoritative source. Also might be nice to be more specific of how this is conduced, through automated billing I presume.
WP:NPOV is more than covering multiple points of view, if fact that is more related to WP:UNDUE. Scientus (talk) 21:59, 12 November 2009 (UTC)

Intro

Hi H: This section seems like it might belong in separate section below the summary. It has a bit too much detail I think for an overview and doesn't capture the content of the article well enough yet...I'm trying to help. Perhaps this could go into the body or an overview section outside the intro? There is also some detail about the assault on a women and its effect on insurance which should be cited and in the body I think.

"Various legislative proposals under serious consideration propose fining larger employers who do not provide a minimum standard of health care insurance and mandating that people buy health This is the first time that the Federal government has mandated people to buy inurance although all states in the union currently mandate the purchase of auto insurance. The legislation also taxes certain very high payout insurance policies (so-called "Cadillac policies") to help finance subsidies for poorer citizens. These will be offered on a sliding scale to people earning less than four times the federal poverty level to enable them to buy health insurance if they are not otherwise covered by their employer. The issue of concentration of power by the insurance industry has also been a focus of debate as in many states very few large insurers dominate the market. Legislation which would provide a choice of a not-for-profit insurer modeled on Medicare but funded by insurance premiums has been a contentious issue. Much play has been made to changes to the Medicare Advantage scheme which will reduce public subsidies given to private insurance plans selling such plans by forcing insurers to compete and which it is estimated has increased the profitability of private insurance companies selling these products. No cuts are made to guaranteed coverage benefits in the bills before congress. Democrats have largely supported these changes to Medicare Advantage and Democrats have largely criticized them. Certain proposals include a choice of a not-for-profit insurer modeled on Medicare (sometimes called the "government option"). Democratic legislators have largely supported the proposed reform efforts, while Republicans have criticized the government option or expanded regulation of healthcare."Farcaster (talk) 20:21, 4 December 2009 (UTC)

suppressing problems in the bill is not NPOV

Hauskalainen and Loonymonkey - your edits suppressing problems in the current bill are not neutral; rather, you are biasing the summary in favor of the bill. For example, procedures that "do more harm than good" are not "health promotion services," they are provider revenue enhancers; that is not synthesis, it is the cited opinion of the NY Times (read the source link you deleted [2]) among others. Likewise the proposed excise tax on medical device and drug makers includes vaccines; if you want to give Republicans credit for pointing out that fact, OK, but it's not a partisan issue and Democrats have not denied it. Also, "inadequate coverage" is not a neutral term at all; as the WSJ link you deleted points out, customers whose policies are perfectly adequate (at least in their opinion and under prior law) can be penalized because they provide less coverage than the new standard dictates; a policy with a $2,500 deductible provides slightly less coverage than a policy with a $2,000 deductible, but calling it "inadequate" is in the eye of the beholder and certainly not neutral.[] Even if you insist on believing in "reform at all costs," that is not an argument for suppressing what those costs actually are. Even the NY Times, which has supported the reform effort up to now, called these latest amendments "follies" and wrote "This sorry episode does not bode well for reform efforts to rein in spending on other procedures based on sound scientific evidence of their potential benefits and risks for patients."[3] (That was in the NY Times source that you deleted, calling it synthesis on my part, when in fact the specific language was a direct quote from US News[4]. And, Loony, I don't appreciate your accusing me of "hiding" editorial comments in a reference; I'm not sure how one can "hide" something by publishing it on the Web, and it was merely an accurate summary of the linked piece.) Including only the good points of the bill, while suppressing the bad parts, is not a neutral summary. You seem to accuse me of bias for adding the bad parts to the summary, but in fact those parts are needed for balance and NPOV. If you are going to cover a national debate in a serious way, you have to acknowledge valid points made by three of the nation's most prominent news publications and at least one of its two major political parties. (I say at least one because in addition to the Republicans many Democrats have raised some these criticisms and more, although the specific source Loony complained about credited only the Republicans, so I have adjusted the article text accordingly. If someone wants to make the presentation more neutral by quoting a Democrat saying the same thing, that would be an improvement. Or we could just say critics, without limiting it to one party, but Loony might revert again.)TVC 15 (talk) 06:18, 7 December 2009 (UTC)

No TVC 15, I am not surpressing anything.

1. You are using the classic tactic used by opponents of reform of pointing out exceptions and pretending they are generalizations. The vast majority of preventative medicine IS preventative and a positive thing for the patient. The issue of the effectiveness of mammography in people under 50 is something that the American public has only just woken up to and is having difficulty reconciling with the experience of people under 50 who have have survived a long time having had their "breast cancer" (which may never actually have been fatal) supposedly cured. We Brits have long known about this issue and the NHS follows long known clinical research and does not routinely offer mammograms under the age of 50. The heart searching going on in America went on the UK several years ago and the same dilemma has still not been resolved satisfactorily and people can get NHS mammograms under that age if need be. Nevertheless the case you give is an EXCEPTION as most preventative services have demonstrable benefits. Your position reminds me of the economist John Goodman who uses extreme cases to make general points. He argues for instance that in some countries people in the wait years for treatment. Well there are always exceptional cases like that - for example, in the UK years ago, someone could be on a wait list for hip operation but is so overweight that they have to lose 150lbs before the operation). In the real world, there are people like my own 74 year old mother who broke a hip and had a replaoement hip operation TWO DAYS AFTER. Goodman's argument that only people in the US have a right to health care because people there have a right to dialysis is quite extraordinary. It is about the only health condition where the government mandates treatment and pays for it - yet again the insurers in the U.S. managed to rid themselves of the risk of covering a whole class of high spending individuals - the other group being seniors of course. Quite simply, exceptions do not make the rule. And the rule is that preventative treatments are mostly not harmful.

2. The Wall Street Journal article was an opinion piece. So its not in the right class of reference. The author even admits that the policy was a "bare bones policy". One only to see that the U.S. has the dubious distinction of being the only industrial country where people with insurance go bankrupt due to health problems IN SPITE OF HAVING HEALTH INSURANCE to realise that many people's insurance policies offer INADEQUATE COVERAGE (the words you deleted). The simple fact is that many people in the US do have inadequate coverage and the removal of Caps and the lowering of co-pays are actions intended to address that very issue. Insurance companies are not stupid. If the law lets them avoid paying out, they will use every trick in the book to avoid doing so.

Your edits are clearly partisan and aimed at denying truths. I will have no hesitation whatsoever in removing those edits when you go over the line. And I will be glad to take the issue to dispute resolution if you continue to insist that you are correct.--Hauskalainen (talk) 14:00, 7 December 2009 (UTC)

In addition to the NPOV problems outlined above, I would point out that these edits were fundamentally wrong because they were misplaced. That section is simply listing the stated elements of the bill. It is not the place to add editorial opinion about those elements, whether for or against. There is a section for adding opinions from the right and left on the bill to this article, but it must be treated carefully to avoid turning those sections into a coatrack. And obviously, we should never state opinion as fact (as was done in the above mentioned edits) wherever it appears. --Loonymonkey (talk) 19:36, 7 December 2009 (UTC)

Hauskalainen, as usual you view everyone who disagrees with you as "partisan" (which party anyway?) and "against reform." You have the luxury of British and Finnish healthcare, yet you act as if you WP:OWN this article on the American debate, and a reform process that has been hijacked by provider/client lobbies. Study after study has shown that routine physical exams in asymtomatic patients provide no benefit, they merely increase costs; the routine mammography story is only the latest example in a long line: it is part of the RULE, not the EXCEPTION. At this point the U.S. does more than 60 million CT scans annually, each with the radiation of 1,000 X-rays; it is equivalent to X-raying the entire population 200 times annually,[5][6], which is one reason why cancer rates and health costs are increasing, yet if your doctor owns a CT-scanner it is very likely that you will be prescribed "health promotion" services such as scanning whatever the doctor might conceivably be able to justify scanning. Loonymonkey, the summary of elements of the bill must be WP:NPOV, not a sales pitch listing only "goodies" when some do more harm than good, and others involve penalties. Given that the US already spends much more per capita on medical care than any other country on earth, while living shorter lives than Canada, the UK, and Finland, how can the solution be to force us to spend even MORE? You might not care since you don't have to pay it personally, but consider what happens to the global economy if the U.S. diverts yet more of its resources to domestic consumption rather than other priorities. Funding for education and research is already being reduced to pay for medical insurance, even though education is a better predictor of longevity than insurance, and even though American research used to contribute to global innovation promoting health around the world. As I keep trying to explain to Hauskalainen, this isn't a partisan issue. It's a reality vs. lobbyist issue. With six medical lobbyists for every member of Congress, the process is difficult enough already without some people trying to use WP as an additional sales tool. The difference between reporting and marketing is, marketing insists on only positive "messaging" while reporting requires pros and cons. Loonymonkey, you wrote on your page that "the burden for obtaining consensus is on you." There isn't consensus for including a list of sales points without counterpoints, so if you don't want the section to become a coatrack then perhaps it would be simpler to say that comparisons and criticisms of the bills have been published and link to them.TVC 15 (talk) 20:37, 7 December 2009 (UTC)

P.S. On "health promotion services," the issue has been studied for years and the results are always the same; "The annual physical examination remains a popular format with both patients and providers, despite the lack of evidence that either a comprehensive examination or laboratory screening tests are indicated for healthy adults."[7] (See also [8].) This is why Medicare and most insurance policies don't currently pay for them. Although these "services" have no benefit for patients, they are a HUGE benefit for providers, who get to sell all sorts of tests and follow-up visits. Perhaps it depends on the definition of "service," i.e. whom is one trying to serve. If the latest round of the bill is enacted, then resources will be pulled out of things like education (proven to increase longevity) and forced into what you insist on calling "health promotion services" that are consistently proven not to promote health. More people will pay more and die sooner. Hauskalainen, since you insist on calling me a partisan opponent of reform, I must quote Sarah Palin and ask why do you hate Americans? Why do you want us to die sooner and poorer?TVC 15 (talk) 20:57, 7 December 2009 (UTC)

update - I've removed that bit for now, hopefully we can agree on a WP:CONSENSUS version that comports with reality.As noted on the WP:CONSENSUS page, the natural process is for people to make changes towards consensus, but unfortunately Loony is a proud reverter; if you thought the U.S. News and NY Times quotes were in the wrong place, you should simply have moved them, rather than deleting them.TVC 15 (talk) 23:36, 7 December 2009 (UTC)
2d update - I've added a new paragraph, farther down, so hopefully that should address Loony's objection about placement. Hauskalainen, you accuse me of aiming to "deny truths," a false accusation for which you should apologize; as you can see from the sources, the facts are accurate and well sourced.TVC 15 (talk) 23:59, 7 December 2009 (UTC)
3d update - my recollection of the number of CT scans was actually low, so I've updated it above, with sources. Hauskalinen and Loonymonkey, this article is about a debate in a mostly overweight country that subsidizes corn syrup while taxing vaccines. For every one person who goes without treatment, several are over-treated with overpriced CT scans and X-rays that cause them to spend more and die sooner. Vaccines are by far the most cost-effective public health measure in the history of medicine (with the possible exception of fluoridated water), yet the proposed bills would actually increase the tax on vaccines. There are plenty of ways to improve on the current system, but the lobby-driven debate is mainly about increasing revenues for the same industries that created the current situation. If you keep pushing the current bill and suppressing its obvious problems, you aren't helping the article or the debate.TVC 15 (talk) 07:13, 16 December 2009 (UTC)
Please see WP:NOTAFORUM. This article is about the debate. It is not the place to engage in debate. Your recent additions had very severe POV problems. You cannot state one side's opinion as fact (as you did when you wrote "Republicans point out that..."). Also, you cannot synthesize facts as in the case of stating what is in the bill and then digging up some research about specific procedures. Criticism is fine, but it must come from reliable third-party sources, not yourself. And finally, you grossly misrepresented that editorial. The full quote was "The first week of debate on the Senate’s health care bill was a depressing mixture of foolish posturing by members of both parties and blatant obstructionism by Republicans. If this is the best the Senate can do, we are in for very rough going." You took the last sentence out of context and made it sound as if it were about the medical procedures rather than the "foolish posturing....and blatant obstructionism" That's completely incorrect. --Loonymonkey (talk) 07:32, 16 December 2009 (UTC)
Also, please do not edit-war. If you do not yet have consensus to add material, don't repeatedly revert every time someone removes it. That sort of behavior is disruptive. --Loonymonkey (talk) 07:36, 16 December 2009 (UTC)
[outdent] Loony, perhaps you haven't had time to read the whole NY Times editorial, because you seem to be jumping from the first sentence to one in the middle (which you call the "last sentence"). Rather than falsely accusing me of quoting a whole sentence out of context, please actually read the context:
"Since she had not mentioned the much-maligned task force, Senator David Vitter, a Louisiana Republican, offered an amendment to her amendment that directed the government to ignore the task force’s most recent mammography recommendations. With the Vitter language inserted, Senator Mikulski’s amendment was approved by a vote of 61 to 39. A rival Republican amendment that would have left decisions on mammograms mostly to private insurers after consultations with medical groups was then rejected.
This sorry episode does not bode well for reform efforts to rein in spending on other procedures based on sound scientific evidence of their potential benefits and risks for patients."[9]
That is exactly how it is used in the article, so it is not synthesis, and was not misrepresentation (gross or otherwise). Regarding "Republicans point out that," how would you prefer to phrase pointing out the obvious? You previously insisted on giving Republicans credit for it, what more do you want?TVC 15 (talk) 07:43, 16 December 2009 (UTC)

Additions by SJRSIMAC

Superb additions with the comparatives tables! Thanks for your hard work!Farcaster (talk) 22:19, 26 December 2009 (UTC)

Accountable care organizations

Discussion of "global payments" or "accountable care organizations" (now an incoming redirect) could probably be expanded into a full section or subarticle. -- Beland (talk) 21:01, 6 January 2010 (UTC)

Withdrawal of support

The section was entirely anti-reform. It contained a conservative polling organization with no offset. Please balance and re-introduce. You could explain how Obama built an unprecedented 60 Senators behind the bill, but there recently was a high-level defection in Nelson. Who cares what Ahnold thinks; he is not in the Senate.Farcaster (talk) 07:33, 19 January 2010 (UTC)

The CNN poll showed 57% opposition, compared to Rasmussen's 55%. I'll add CNN since you object to Rasmussen, but the only way I know of balancing 57% opposition is to report (as Rasumussen does) around 40% support. Since you want Senators rather than Governors, I'll add Snowe too.[10] Maybe for balance you should add a section on "opponents who've changed their mind and decided to support the current bills," if you can find any. Also, with regard to your comment that "Obama built an unprecedented 60 Senators...", if you check his WP biography I think you'll find he's no longer a Senator, he's President now. Harry Reid is the Senate Majority leader.TVC 15 (talk) 08:43, 19 January 2010 (UTC)

Public opinion (which according to many polls is declining) is notable here. Calling the section "Withdrawal of support" is a little bit loaded, though and it's really not clear what the opinion of uninvolved celebrities has to do with any of this. As for the people actually voting on this, a lot of what you cite as "withdrawal" is simply the sort of horse-trading and vote counting that goes along with any big controversial bill. Are you also going to add a "Withdrawal of opposition" section for those that got behind the bill after various concessions and compromises were made? If not, why? (and for the record, I think either such section is pretty weak structure for an encyclopedic article).
While we're on the subject, I'm not sure why you keep attempting to claim that Nelson withdrew his support for the bill. He voted for the bill (which, in the end, is probably a much better indicator of "support" than a couple out-of-context quotes ). The quote you cite makes it pretty clear that, while discussing the political miscalculation of bringing such a bill up now, he still supports it conditionally. He said he would (note the future, not present tense) withdraw his support if the final version has a public option (which is highly unlikely at this point). Rather than edit-war and declaring "no it's not!" to legitimate objections, try discussing this stuff first and gaining consensus. Remember, in content disputes, the burden for consensus is on the editor seeking to add material, not those removing it. --Loonymonkey (talk) 16:35, 19 January 2010 (UTC)

I've changed the section title for balance. Senator Nelson called the bill "a mistake" and "a bad bill" and said he'll vote against it if it continues to include a public option; the House bill has one and the Speaker of the House has said she couldn't pass a bill without one, and the Senate bill that got 60 votes also had one, so Nelson is opposed to the current bills. I do wish you would read more before deleting, but perhaps the two functions involve opposite instincts; at least it is refreshing to see you've found the discussion page. Regarding deletions, I did have to delete the bit about Obama passing a stimulus plan, since it had nothing to do with the subject of the article and (as I stated above) he is no longer a Senator; the Congress passed it, and the President signed it. Anyway some of the editors on this page seem to view this as 'let's do something nice for Obama and save healthcare from those ignorant Tea Partiers', which is a ridiculous oversimplification that shows remote inattention. If you take a moment to read this [11] and this [12] (bonus points for this [13]), you may begin to understand that Obama has done himself and his party no favors by 'changing his mind' and campaigning against the plan that got him elected. (Of course, now that Loonymonkey got the article on Obama's plan deleted, that information is harder to find.) The fact that the Massachusetts Senate race is even close should tell you something, in addition to the Democrats' loss of two Governors' races last year. Likewise it's puzzling why you would call the Governor of California an "uninvolved celebrity;" here in this country, governors tend to work closely with their states' Congressional delegations, and even appoint replacements if a representative or senator can't continue in office.TVC 15 (talk) 18:30, 19 January 2010 (UTC)

Update: Boston.com reports Coakley actually LOST the MA Senate race, and by 7 points.[14] That's a really wide margin but, in Coakley's defense, it's 10 points narrower than the national margin against the healthcare "reform" she had promised to vote for.TVC 15 (talk) 03:07, 20 January 2010 (UTC)

Hauskalainen, the Ben Nelson speech that you linked to as evidence of support is from December, when he voted for the bill. The quote that you deleted is from January, and belongs in this section on changes in support and opposition.TVC 15 (talk) 22:21, 20 January 2010 (UTC)

The web site of the senator would have been updated had he really changed his opinion. I am afraid that the text in the article you quote from quite neatly fits the alternative interpretation that Nelson did not like the bill which was originally presented nut decided to vote for it after the abortion and public option clauses were amended. That fits the text and his own statement on the personal web site. Therefore I do not accept the interpretation you wish to make. I see no evidence that he would now change his vote if the same legislation he previously voted in favor of was presented before him again. To do this would be an admission that he had made a mistake and I see no evidence of this from him. --Hauskalainen (talk) 02:40, 21 January 2010 (UTC)

Nelson's waffling all over the place now, probably because the bill he voted for is even more unpopular in his state than it is in the rest of the country, but we might as well omit him because otherwise the article might get distracted into the ever-changing statements of a single senator from a sparsely populated state. BTW, since you seem to think opposition to the bill is a function of ignorance, it might interest you to know that college graduates opposed it sooner and by a wider margin than the general public; you can read all about it in the newspaper that, since these bills were announced, has become the most widely read in the country.[15]TVC 15 (talk) 07:11, 23 January 2010 (UTC)

"Arguments" section needs clean-up.

For stylistic and NPOV reasons, I've combined the "Liberal arguments" and "Conservative arguments" into one section, but left all of the paragraphs in place. Reading through it though, it's pretty apparent that this whole section needs some serious clean-up. It's not a collection of arguments in the Health care reform debate so much as it is just random collection of quotes about the current bill (almost every single one of which is negative). It's primarily a coatrack of quotes slamming the Senate bill. There's the obvious WP:NPOV and WP:WEIGHT issues that this raises, but more to the point, what is this section meant to convey? Before we can fix it, we should agree on what it should be, if anything. Is it supposed to be summarizing arguments for and against the current bill? (if so, it fails because it's so lopsided) Is it even supposed to be about the current bill or Health care reform in general? (if about the current bill, we should lose the historic stuff, if about Health care reform in general we're giving too much weight to the current bill). Also, there is a section further down the article giving arguments for and against the current bill. This is clearly redundant so we either need to merge this section into that section or remove the overlap (depending on, again, whether we even need this section. --Loonymonkey (talk) 00:48, 25 January 2010 (UTC)

Instead of only deleting and complaining, why don't you try contributing something? For organizational and NPOV reasons, the article has always included arguments from liberal and conservative sources; as the debate has progressed, liberal sources have turned increasingly against. (Conservative sources were always against.) The new sections on post-passage tactics have to do with electoral political strategy rather than substantive policy; these are two different parts of the debate, so they are in separate sections. When one side has more and better arguments than the other, NPOV does not require suppressing those arguments to make the debate seem more ambiguous than it really is.TVC 15 (talk) 02:40, 25 January 2010 (UTC)
(sigh) really, please back off from the battleground mentality. First of all, I didn't delete any of the quotes, it was an organizational question. Whether any particular paragraph belongs or should be deleted has nothing to do with what I'm discussing here. As for one side having "better arguments" that may be your opinion, but it's hardly WP:NPOV. I'm pretty familiar with your point of view (and your feelings about me personally) but I'm hoping to get input from other editors here. --Loonymonkey (talk) 03:41, 26 January 2010 (UTC)
Alas America is deeply polarized between liberal and conservative camps, and this polarization affects nearly every debate. This article has always made a point of including expressly liberal and conservative sources. You recently deleted the liberal category (leaving the conservative category - perhaps that was an oversight?), even though you had left it previously. Since it's been part of the structure for so long, you might consider discussing _before_ deleting it. As for whose arguments are better, or at least winning, that question is decided by hundreds of millions of people; I am only one. Somehow you don't (want to) understand that a fair trial does not always result in a hung jury, or a level playing field does not always result in a tied game, or pick your metaphor for a debate in which one side persuades more people than the other. In reply to your comment regarding my feelings about you personally: my sadness at your unwillingness to contribute, and my frustration at your insistence on deleting and tagging instead, are not really germane to the article. One thing I will say for you though: you have taught me to appreciate Hauskalainen, who at least does some research.TVC 15 (talk) 09:18, 26 January 2010 (UTC)
Yes, leaving the "Conservative" section was a mistake. I meant to merge the two sections. As for the rest, well....I actually bet a friend of mine that you were incapable of responding without going into a long attack rant against me personally. Looks like I won. --Loonymonkey (talk) 22:08, 26 January 2010 (UTC)
Actually, you lost. My reply to your personal comment was about the same length as your comment, and not a "long attack rant." At least you managed to admit a mistake - first time I've seen you do that - and I hope your bet was that if you lost you'd start contributing instead of deleting.TVC 15 (talk) 23:07, 26 January 2010 (UTC)
In this case distinguishing between the arguments on both sides is quite useful. Whether the best terms for describing the two sides are "liberal" versus "conservative", "Democratic" versus "Republican", "Pro" versus "Con" may be worth discussing, but there are generally two widely recognized sides to this debate. EastTN (talk) 20:20, 26 January 2010 (UTC)
I fully agree. Arguments for and against are a necessity here and there's no problem with dividing sections into "Democratic" and "Republican." The problem is in arbitrary designations like "Liberal" and "Conservative" which don't really have anything to do with the argument so much as the person making the argument. It gets particularly POV when these designations are based simply on the opinion of the editor adding the quotes, yet stated factually (such at the New York Times). And obviously using ridiculous language like "Proud liberal..." and "Other prominent liberals...." has nothing at all to do with the arguments being made (and really, is just bad writing. We try not to spoon-feed the readers here). --Loonymonkey (talk) 22:17, 26 January 2010 (UTC)
The "proud liberal" label that you object to was added primarily because without it Hauskalainen deleted Bob Herbert saying he had no place among liberal arguments, so it was about spoon-feeding Hauskalainen not the reader generally. Another reason was because of your "who" tags, to help you see that your question had already been answered in the text (rather than repeating every person's name in every sentence). If Hauskalainen will leave Bob Herbert in without the label, that's fine with me. However, "Democratic" and "Republican" are not necessarily better labels, because those happen to be the names of the two largest (but certainly not the only) political parties, and they should only be applied to arguments endorsed by those parties. Also, as I recall, Michael Moore supports the Green Party, which campaigns for single-payer healthcare (their nominee for President in 2008 was Cynthia McKinney, who had previously been a Democratic Representative in Congress, but she campaigned against both the Democrats and Republicans in 2008). So, switching to Democratic and Republican labels would impute arguments to the parties that they have not endorsed, and would assign people to parties that they are not members of.TVC 15 (talk) 23:12, 26 January 2010 (UTC)
You're putting the horse before the cart there. You're saying we can't call it a Democratic and Republican section because Michael Moore doesn't fit in there. But why do we need a Michael Moore quote at all (as opposed to the thousands of other pundits that have commented). Or more to the point, why would we even need to divide arguments into two sections based on the perceived ideology of the person making the argument (which are often arbitrarily and incorrectly applied, as mentioned above). The root issue is what is the purpose of this section. What are we trying to convey with this? If we decide what the section should be, we can easily make the text conform to that, but right now it's just a jumble of quotes with no clear purpose. That's the coatrack issue described above, in that the section is primarily just a collection of quotations against the current proposals with none in favor. --Loonymonkey (talk) 23:38, 26 January 2010 (UTC)
[outdent] The horse always goes before the cart; if you look at some old photos, you'll see that. Also, if you read the text, you'll see it does contain arguments in favor, e.g. Krugman. Your removal of the liberal/conservative labels reduced the degree of organization; prior to that, there were two clearly identified sections to organize what most people would call the two sides of the debate.TVC 15 (talk) 00:36, 27 January 2010 (UTC)
So I mistyped the metaphor. Not really that big of a deal. But now we're getting somewhere. Contrary to what you say, this was not divided into "two sides of the debate." Both sections (liberal and conservative) were primarily quotes against the legislation (or reform in general). I have no problem with, and would actually favor, dividing this by position, arguments for and arguments against. That's what I suggested above. If you and other editors feel this is appropriate then we can begin reorganizing it to conform to that. This would mean that the "against" section would contain many of the quotes already in this section and the "for" section would need to be created (there is very little in the way of "for" in this section as noted above). Is that what you favor?--Loonymonkey (talk) 20:31, 27 January 2010 (UTC)
"For" and "Against" works for me. If absolutely necessary, I would not object to an "other views" section for the miscellaneous stuff. EastTN (talk) 22:23, 27 January 2010 (UTC)

Republican Ideas

Needs stand points of conservatives not just of Obama. Richiebf (talk) 01:41, 11 March 2010 (UTC)

Feel free to offer a proposed alternative in your sandbox, maybe? Debate isn't what is needed in this discussion text, action is needed. 142.192.200.200 (talk) 17:46, 13 March 2010 (UTC)

Is it constitutional? The commerce clause

My personal belief is that this new healthcare reform is constitutional...but I am aware of the contentious debate on this issue. As the article currently states, "The government argues that this is covered under the Commerce Clause, whereas detractors argue that this is wrong. As of 2010, this matter is still before the courts."

There certainly should be a sub-section of this article that examines this issue, fairly describing the various points of view on this issue. However, we would need to take care to prevent this from becoming a right versus left flameware. RK (talk) 13:41, 22 December 2010 (UTC)

move big chunks to PPACA article

Roughly the second half of this article is really about PPACA's legislative history and not about the health care reform debate in general. In the period before PPACA was passed it made sense to keep this history in this article because there were a lot of proposals floating around, but now I believe it's time to move it over. The first half of the article should stay here because it is about the health care reform debate in general and could apply equally to some future legislation. Any thoughts? --Nstrauss (talk) 19:30, 9 March 2012 (UTC)

Agreed. Move it there please. WP:BOLD

This Wiki Entry is a Mess of Partisan Platitudes.

In preparation for writing an article on the subject of PPACA, I started reading this wiki entry. I made it to the section describing Medicare Advantage as a "scheme" when I could no longer keep myself from making corrections.

Medicare (dis)Advantage?

In addition to being an unwieldy string of awful clauses, the mentioned sentence evinced a complete lack of understanding concerning Medicare Advantage and its intentions. I left most of the awful structure of the sentence intact, but I had to correct the more egregious errors.

Against my better judgment, I left the idiotic ending of that sentence mostly untouched. The sentence seems to suggest that insurers profiting from the sale of Medicare Advantage was an unforeseen consequence--rather than the entire point.

You don't have to agree with Medicare Advantage, but if you're going to pretend to discuss it, you should probably have the barest inkling about it--to say nothing of insurance or health care. The Bush administration intended to use the profit motive to increase efficiency. That is the entire point of privatization. I'm not suggesting you have to agree with it. I am, however, suggesting you shouldn't call it a "scheme" and then promptly demonstrate you haven't the slightest clue.

I'll probably go back and rewrite it again to read: "Much debate surrounded Medicare Advantage and the insurers profiting from its sale." Not only is that a better sentence, but it also stops short of pinning my partisan credentials to the page.

The Rest of the Story

The difference between that sentence and the rest of this horrible article is one of degree, rather than category. I suppose trashing the whole thing and starting over is out of the question. As it stands, the article reads mostly as liberal pandering punctuated with conservative rejoinders.

Although the article contains facts, the authors lack the understanding of the central issues required to arrange those facts cogently. Most of what is written here seems culled arbitrarily from MSNBC or Fox. A real reference might have discussed aspects of central planning and market forces and how they relate to things like the Medical Loss Ratio, mandated benefits and extraordinary compulsions for insurers, this one compiles disjointed quotes into a useless pile of propaganda.

I suppose that's just how Wikipedia works.

Or is it? — Preceding unsigned comment added by Stuntpickle (talk • contribs) 05:33, 22 April 2014 (UTC)

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Deletion of much of the ObamaCare text

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PROPOSED ARTICLE DELETION

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PROPOSED ARTICLE MERGER

This article has only dated material about Health care reforms proposed during the Obama administration. There needs to an article about the Health care reform debate in the United States that is current and relevant. Is anyone interested in updating this article?

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