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pay bonuses to hospitals that improve patient results after heart failure, pneumonia, and surgery. There’s a program that would impose financial penalties on institutions with high rates of infections transmitted by health-care workers. Still another would test a system of penalties and rewards scaled to the quality of home health and rehabilitation care. Other experiments try moving medicine away from fee-for-service payment altogether. A bundled-payment provision would pay medical teams just one thirty-day fee for all the outpatient and inpatient services related to, say, an operation. This would give clinicians an incentive to work together to smooth care and reduce complications. One pilot would go even further, encouraging clinicians to band together into “Accountable Care
Organizations” that take responsibility for all their patients’ needs, including prevention—so that fewer patients need operations in the first place. These groups would be permitted to keep part of the savings they generate, as long as they meet quality and service thresholds. The bill has ideas for changes in other parts of the system, too. Some provisions attempt to improve efficiency through administrative reforms, by, for example, requiring insurance companies to create a single standardized form for insurance reimbursement, to alleviate the clerical burden on clinicians. There are tests of various kinds of community wellness programs. The legislation also continues a stimulus-package program that funds comparative-effectiveness research—testing existing treatments for a condition against one another—because fewer treatment failures should mean lower costs.
790:
Arizona to about 96 percent in
Alabama. In 31 of the 39 states supplying market share information, the top carrier had a market share of a third or more. The five largest carriers in the small group market, when combined, represented three quarters or more of the market in 34 of the 39 states supplying this information, and they represented 90 percent or more in 23 of these states. Thirty-six of the 44 states supplying information on the top carrier identified a Blue Cross and Blue Shield (BCBS) carrier as the largest carrier, and in all but 1 of the remaining 8 states, a BCBS carrier was among the five largest carriers. The median market share of all the BCBS carriers in the 38 states supplying this information was about 51 percent, with a range of less than 5 percent in Vermont and Wisconsin and more than 90 percent in Alabama and North Dakota...the median market share of all the BCBS carriers in 38 states reporting this information in 2008 was about 51 percent, compared to the 44 percent reported in 2005 and the 34 percent reported in 2002 for the 34 states supplying information in each of these years."
1366:. This relates to moral arguments for health care reform, framing healthcare as a social good, one that is fundamentally immoral to deny to people based on economic status. The motivation behind healthcare reform in response to the medical-industrial complex also stems from issues of social inequity, promotion of medicine over preventative care. The medical-industrial complex, defined as a network of health insurance companies, pharmaceutical companies, and the like, plays a role in the complexity of the US insurance market and a fine line between government and industry within it. Likewise, critiques of insurance markets being conducted under a capitalistic, free-market model also include that medical solutions, as opposed to preventative healthcare measures, are promoted to maintain this medical-industrial complex. Arguments for a market-based approach to health insurance include the Grossman model, which is based on an ideal competitive model, but others have critiqued this, arguing that fundamentally, this means that people in higher socioeconomic levels will receive a better quality of healthcare.
412:
738:
accounted for 43 percent of total spending, while the costliest 25 percent...accounted for fully 85 percent of spending...These high-cost beneficiaries, compared with beneficiaries in the bottom 75 percent in terms of their spending, were slightly older, more likely to suffer from chronic conditions, such as coronary artery disease and diabetes, and more likely to die in a given year." Such concentration offers opportunities to focus on key ailments and treatment approaches. Peter Orszag wrote in May 2011: "The truth is that constraining future health care costs will require a variety of approaches, but in particular it will mean improving the information that providers have about their patients and best practices, and the incentives that providers are given to deliver better care, especially in expensive cases."
1380:–Healthways Well–Being conducted a survey and found that the uninsured rate is going down. 13.4 percent of U.S. adults are uninsured in 2014. This is a decrease from the percentage at 17.1 percent in January 2014 and translates to roughly 10 million to 11 million individuals who gained coverage. The survey also looked at the major demographic groups and found each is making progress towards getting health insurance. However, Hispanics, who have the highest uninsured rate of any racial or ethnic group, are lagging in their progress. Under the new health care reform, Latinos were expected to be major beneficiaries of the new health care law. Gallup found that the biggest drop in the uninsured rate (2.8 percentage points) was among households making less than $ 36,000 a year.
427:
782:
combined, represented three-quarters or more of the market in 19 of the 34 states supplying information, and they represented more than 90 percent in 7 of these states. Twenty-five of 37 states supplying information identified a Blue Cross and Blue Shield (BCBS) carrier as the largest carrier offering health insurance in the small group market, and in all but one of the remaining 12 states, a BCBS carrier was among the five largest. The median market share of all the BCBS carriers in the 34 states supplying information was about 34 percent, with a range from about 3 percent in
Vermont to about 89 percent in North Dakota; in 9 of these states BCBS carriers combined for half or more of the market."
536:
system reform (e.g., whether the government or private insurers process payments) is considerably less important yet gathers a disproportionate share of attention. Gawande argued that dramatic improvements and savings in the delivery system will take "at least a decade." He recommended changes that address the over-utilization of healthcare; the refocusing of incentives on value rather than profits; and comparative analysis of the cost of treatment across various healthcare providers to identify best practices. He argued this would be an iterative, empirical process and should be administered by a "national institute for healthcare delivery" to analyze and communicate improvement opportunities.
1217:
the part of service providers (mainly doctors and hospitals) to process payments. For example, the
Cleveland Clinic, considered a low-cost, best-practices hospital system, has 1,400 billing clerks to support 2,000 doctors. Further, the insurance companies have their own overhead functions and profit margins, much of which could be eliminated with a single payer system. Economist Paul Krugman estimated in 2005 that converting from the current private insurance system to a single-payer system would enable $ 200 billion per year in cost savings, primarily via insurance company overhead. One advocacy group estimated savings as high as $ 400 billion annually for 2009 and beyond.
930:
1008:
has reported that $ 13.5 billion of processed
Medicare fee-for-service claim payments for fiscal year 1999 may have been improperly paid for reasons that ranged from inadvertent error to outright fraud and abuse." Fewer than 5% of Medicare claims are audited. CBO reported in October 2014 that it is difficult to quantify healthcare fraud related to government programs. CBO reported that: "According to HHS, since 2009 the HEAT Medicare task force has filed criminal and civil charges against more than 1,700 defendants who falsely billed the Medicare program for more than $ 5.5 billion." However, false billing is a partial measure of fraud, as much of it is undetected.
544:
to improve medical decision making, reduced tobacco use and obesity, reforming the payment of providers to encourage efficiency, limiting the tax federal exemption for health insurance premiums, and reforming several market changes such as resetting the benchmark rates for
Medicare Advantage plans and allowing the Department of Health and Human Services to negotiate drug prices. The authors based their modeling on the effect of combining these changes with the implementation of universal coverage. The authors concluded that there are no magic bullets for controlling health care costs, and that a multifaceted approach will be needed to achieve meaningful progress.
556:
870:
of small awards, offsetting any reduction in large awards. A New York study found that only 1.5% of hospital negligence led to claims; moreover, the CBO observed that "health care providers are generally not exposed to the financial cost of their own malpractice risk because they carry liability insurance, and the premiums for that insurance do not reflect the records or practice styles of individual providers but more-general factors such as location and medical specialty." Given that total liability is small relative to the amount doctors pay in malpractice insurance premiums, alternative mechanisms have been proposed to reform malpractice insurance.
442:
1417:
countries ranging from $ 3,365 (Argentina) to $ 27,810 (Australia). An MRI averaged $ 1,121 in the U.S. versus $ 280 in France. The reasons for these differences are driven by higher prices per unit of service, rather than a higher volume of usage. In other countries, governments intervene more forcefully in setting prices. In countries such as Canada and
Britain, prices are set by the government. In others, such as Germany and Japan, they're set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail.
705:
to $ 147 billion. The CDC identified a series of expensive conditions more likely to occur due to obesity. The CDC released a series of strategies to prevent obesity and overweight, including: making healthy foods and beverages more available; supporting healthy food choices; encouraging kids to be more active; and creating safe communities to support physical activity. An estimated 25.6% of U.S. adults in 2007 were obese, versus 23.9% in 2005. State obesity rates ranged from 18.7% to 30%. Obesity rates were roughly equal among men and women. Some have proposed a so-called "
1063:
gives politicians enormous power to dictate the content of every
American's health plan – a power that health care providers inevitably capture and use to increase the required level of insurance" and state that providers were successful in persuading legislators to include an additional 16 benefit mandates in the required benefit package during the first three years after the coverage mandate was enacted. They also say that by prohibiting the use of health status in pricing, the Massachusetts law "further increase premiums for the young and healthy" and, as the result of
400:
1247:
doctors feared malpractice suits if they refused; and doctors and hospitals wanted to maximize revenues. One study indicated that changing incentives may have reduced cost growth. From 2006 to 2010, the share of workers with deductibles exceeding $ 1,000 grew from 10 percent to 27 percent. Increased out-of-pocket expenses have made patients and physicians more cost conscious. Further, a combination of prior notification, higher patient co-payments and restrained reimbursements may have contributed to slowing cost growth.
759:, which is a series of budgetary reforms. His January 2010 version of the plan includes the transition of Medicare to a voucher system, meaning individuals would receive a voucher which could be used to purchase health insurance in the private market. This would not affect those near retirement or currently enrolled in Medicare. A series of graphs and charts summarizing the impact of the plan are included. Economists have both praised and criticized particular features of the plan. The CBO also partially scored the bill.
632:
320:
1618:. 2 bar charts: For both: From bottom menus: Countries menu > choose OECD. Check box for "latest data available". Perspectives menu > Check box to "compare variables". Then check the boxes for government/compulsory, voluntary, and total. Click top tab for chart (bar chart). For GDP chart choose "% of GDP" from bottom menu. For per capita chart choose "US dollars/per capita". Click fullscreen button above chart. Click "print screen" key. Click top tab for table, to see data.
946:
are excluded from individual income and payroll taxes. Although both theory and evidence suggest that workers ultimately finance their employment-based insurance through lower take-home pay, the cost is not evident to many workers...If transparency increases and workers see how much their income is being reduced for employers’contributions and what those contributions are paying for, there might be a broader change in cost-consciousness that shifts demand.
1358:
because of lack of medical care were estimated in a 1997 analysis to be nearly 100,000 per year. A study of the effects of the
Massachusetts universal health care law (which took effect in 2006) found a 3% drop in mortality among people 20–64 years old - 1 death per 830 people with insurance. Other studies, just as those examining the randomized distribution of Medicaid insurance to low-income people in Oregon in 2008, found no change in death rate.
1055:
denouncing the whole concept." According to the article, however, "ealth-policy experts . . .say there is a good reason for the mandate." Proposed reforms would prohibit health insurers from denying coverage to individuals with pre-existing medical conditions. Insurers said that, to keep premiums from rising for everyone, it is necessary for healthier people to pay into the insurance pools to balance out the cost of these higher cost individuals.
1437:
Gibbs said
President Obama is supportive of importing drugs, provided safety concerns related to the drugs can be addressed. This is because drugs manufactured outside the country may be held to different standards. According to Bloomberg News, drugmakers agreed in June 2009 to contribute $ 80 billion over 10 years, largely to help the elderly afford medicines, in return for staving off other profit-endangering proposals such as drug importation.
709:" to provide incentives for healthier behavior, either by levying the tax on products (such as soft drinks) that are thought to contribute to obesity, or to individuals based on body measures, as they do in Japan. A study released in October, 2010 had a similar cost estimate, of $ 168 billion, nearly 17% of U.S. medical costs. This is an estimated $ 2,400 per obese person. The study was performed by researchers at Cornell and Emory universities.
982:
6.1% of the variation is attributable to the combination of benefit design and plan type (e.g., PPO, HMO, etc.). The employer's industry and regional variations in health care cost explain part of the variation, but most is unexplained. The researchers conclude ". . . that analysts should not equate high-cost plans with Cadillac plans, . . . ithout appropriate adjustments, a simple cap may exacerbate rather than ameliorate current inequities"
1156:
restrictions in cases where quality of life cannot be improved. He also recommended that a budget be established for government healthcare expenses, through establishing spending caps and pay-as-you-go rules that require tax increases for any incremental spending. He has indicated that a combination of tax increases and spending cuts will be required. All of these issues would be addressed under the aegis of a fiscal reform commission.
596:, as corporations pay for benefits rather than wages. Bloomberg reported in January 2013: "If there’s a consensus among health economists about anything, it’s that employer-provided health benefits come out of wages. If health insurance were cheaper, or the marketplace were structured so that most people bought health coverage for themselves rather than getting it with their jobs, people would be paid more and raises would be higher."
921:'If you're just coming in to have your blood pressure checked and your pulse taken, you really don't need to see a doctor, and you might not need to see a nurse, either,' says David Barrett, president and CEO of the Lahey Clinic in Burlington, Mass. "There are three-stripe military sergeants with two-year degrees who can provide excellent primary care. There's absolutely no reason to force all primary-care providers to have an M.D."
1086:, said that a coverage mandate would not be necessary within a single-payer system and that even within the context of current system she was "troubled by the notion of an individual mandate." She described the Massachusetts mandates as "a windfall for the insurance industry" and wrote, "Premiums are rising much faster than income, benefit packages are getting skimpier, and deductibles and co-payments are going up."
564:
and Germany (both at 11.6% of GDP). The United States spent $ 8,233 on health per capita in 2010, two-and-a-half times more than the OECD average of $ 3,268 (adjusted for purchasing power parity). Following the United States were Norway and Switzerland which spent over $ 5,250 per capita. Americans spent more than twice as much as relatively rich European countries such as France, Sweden and the United Kingdom.
900:
2% of medical school graduates choose primary care as a career. An amendment to the Senate health bill includes $ 2 billion in funds over 10 years to create 2,000 new residency training slots geared toward primary care medicine and general surgery. Writing in Forbes, a physician argued that this is a "tiny band-aid at best," advocating full loan repayments and guaranteed positions upon graduation.
331:
912:
Price Waterhouse advanced several strategies for addressing the nursing shortage, including developing more public-private partnerships, federal and state-level grants for nursing students and educators, creating healthy work environments, using technology as a training tool, and designing more flexible roles for advanced practice nurses given their increased use as primary care providers.
713:
were incurred by the smoking group. However, because of differences in life expectancy (life expectancy at age 20 was 5 years less for the obese group, and 8 years less for the smoking group, compared to the healthy-living group), total lifetime health spending was greatest for the healthy-living people, lowest for the smokers, and intermediate for the obese people."
376:. Key reforms address cost and coverage and include obesity, prevention and treatment of chronic conditions, defensive medicine or tort reform, incentives that reward more care instead of better care, redundant payment systems, tax policy, rationing, a shortage of doctors and nurses, intervention vs. hospice, fraud, and use of imaging technology, among others.
669:
malpractice/tort reform. He described how the U.S. faced a cost problem with agriculture, with nearly 40% of household disposable income absorbed by food costs in 1900. With a central oversight panel (the U.S.D.A.) and many pilot programs, the U.S. was able to vastly improve the productivity of its food production and reduce these costs over time. He wrote:
850:
counterparts; U.S. clinicians are more likely to fear litigation which may be due to the teaching of defensive strategies which are reported more often in U.S. teaching programs. Counting both direct and indirect costs, other studies estimate the total cost of malpractice "is linked to" between 5% and 10% of total U.S. medical costs.
1067:, drives more comprehensive health plans out of the market. The conclusion they draw is that "he most sweeping provision . . . is an 'individual mandate' that makes health insurance compulsory. Massachusetts shows that such a mandate would oust millions from their low-cost health plans and force them to pay higher premiums."
1012:
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
1047:
current pay or play proposals are limited in their ability to increase coverage among the working poor. These proposals generally exclude small firms, do not distinguish between individuals who have access to other forms of coverage and those who do not, and increase the overall compensation costs to employers.
615:
the IMAC) that facilitate such change over time. And ultimately, without a structure in place to help contain health care costs over the long term as the health market evolves, nothing else we do in fiscal policy will matter much, because eventually rising health care costs will overwhelm the federal budget.
1007:
reported that $ 54 billion in "improper payments" were made to Medicare ($ 24B), Medicaid ($ 18B) and Medicaid Advantage ($ 12B) during FY2009. This was 9.4% of the $ 573 billion spent in these categories. GAO reported in 2000: "The Department of Health and Human Services’ Office of Inspector General
877:
Administration and members of Congress; CBO concluded that "the evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect, either positive or negative, on economic efficiency." Empirical data and reporting have since shown that some
869:
Others have argued that even successful tort reform might not lead to lower aggregate liability. For example, the current contingent fee system skews litigation towards high-value cases while ignoring meritorious small cases; aligning litigation more closely with merit might thus increase the number
857:
put medical malpractice costs at 2 percent of U.S. health spending and "even significant reductions" would do little to reduce the growth of health care expenses. A 2009 CBO report estimated that approximately $ 54 billion could be saved over ten years by limiting medical malpractice lawsuits. A tort
781:
number of licensed carriers in the small group market per state was 28, with a range from 4 in Hawaii to 77 in Indiana. The median market share of the largest carrier was about 33 percent, with a range from about 14 percent in Texas to about 89 percent in North Dakota. The five largest carriers, when
712:
However, in contrast to yearly costs, lifetime costs can be highest among healthy people, who live longer. One study in the Netherlands indicated that: "Until the age of 56, yearly health costs were highest for obese people and lowest for healthy-living people. At older ages, the highest yearly costs
642:
refers to when a patient overuses a doctor or to a doctor ordering more tests or services than may be required to address a particular condition effectively. Several treatment alternatives may be available for a given medical condition, with significantly different costs yet no statistical difference
614:
Their support of the IMAC proposal underscores what most serious health analysts have recognized for some time: that moving toward a health system emphasizing quality rather than quantity will require continual effort, and that a key objective of legislation should be to put in place structures (like
571:
The Centers for Medicare and Medicaid Services reported in 2013 that the rate of increase in annual healthcare costs has fallen since 2002. However, costs per capita continue to rise. Per capita cost increases have averaged 5.4% annually since 2000. Costs relative to GDP have risen from 13.8% in 2000
1416:
provides a comparative annual survey of costs for drugs, devices and medical services across countries. According to their 2013 report, the U.S. pays considerably more than other countries in 22 of 23 categories. For example, the average cost of a hip replacement in the U.S. was $ 40,364, with other
1246:
During 2009, Medicare spent $ 11.7 billion for medical imaging, such as CT scans and MRI's. From 2005 to 2009, usage of scans grew at an annual rate of 14%, but may have slowed since due to a combination of changing incentives and saturation of usage. Initially, demanding patients insisted on scans;
1229:
determined that some 31 percent of U.S. health care dollars, or more than $ 1,000 per person per year, went to health care administrative costs. Other estimates are lower. One study of the billing and insurance-related (BIR) costs borne not only by insurers but also by physicians and hospitals found
1038:
Reforming or restructuring the private health insurance market is often suggested as a means for achieving health care reform in the U.S. Insurance market reform has the potential to increase the number of Americans with insurance, but is unlikely to significantly reduce the rate of growth in health
1011:
According to CBS News, Medicare fraud accounts for an estimated $ 60 billion in Medicare payments each year, and "has become one of, if not the most profitable, crimes in America." Criminals set up phony companies, then invoice Medicare for fraudulent services provided to valid Medicare patients who
899:
The American Academy of Family Physicians predicts a shortage of 40,000 primary care doctors (including family practice, internal medicine, pediatrics and obstetrics/gynecology) by 2020. The number of medical students choosing the primary care specialty has dropped by 52% since 1997. Currently, only
865:
explained why tort reform was omitted from the Congressional health care reform bills then under consideration: "When you go to pass a really enormous bill like that, the more stuff you put in it, the more enemies you make, right?...And the reason tort reform is not on the bill is because the people
797:
argued that allowing interstate competition would create a "race to the bottom," in which "he states with the weakest regulations – for example, those that allow insurance companies to deny coverage to victims of domestic violence – would set the standards for the nation as a whole. The result would
704:
reported that approximately 9% of healthcare costs in 1998 were attributable to overweight and obesity, or as much as $ 92.6 billion in 2002 dollars. Nearly half of these costs were paid for by the government via Medicare or Medicaid. However, by 2008 the CDC estimated these costs had nearly doubled
673:
Medicare and Medicaid currently pay clinicians the same amount regardless of results. But there is a pilot program to increase payments for doctors who deliver high-quality care at lower cost, while reducing payments for those who deliver low-quality care at higher cost. There’s a program that would
535:
further distinguished between the delivery system, which refers to how medical services are provided to patients, and the payment system, which refers to how payments for services are processed. He argued that reform of the delivery system is critical to getting costs under control, but that payment
496:
described aspects of the Obama administration's strategy during an interview: "In order to help contain cost growth over the long term, we need a new health care system that has digitized information...in which that information is used to assess what’s working and what’s not more intelligently, and
1436:
Congressional proponents argue that drugs manufactured overseas by U.S. companies could be imported and purchased more cheaply in the U.S. Drug manufacturers argue that certain foreign countries have price controls, which they recoup by charging higher prices in the U.S. Whitehouse spokesman Robert
1216:
The payment system refers to the billing and payment for medical services, which is distinct from the delivery system through which the services are provided. The over 1,300 U.S. health insurance companies have different forms and processes for billing and reimbursement, requiring enormous costs on
1093:
reported that the number of people seeking emergency room care and the cost of emergency room visits increased after the 2006 mandates went into effect (comparing 2005 to 2007). The number of visits increased by 7% during that period, while costs rose by 17%. State officials cautioned that it was
920:
wrote: "Lately, some policymakers have argued that instead of having a primary-care doctor, more people—especially young, healthy patients with simple medical needs—should see a nurse or physician assistant who administers routine care and kicks more complex problems up to a doctor when they arise.
849:
lawsuits are a major driver of medical costs. A 2005 study estimated the cost around 0.2%, and in 2009 insurer WellPoint Inc. said "liability wasn’t driving premiums." A 2006 study found neurologists in the United States ordered more tests in theoretical clinical situations posed than their German
817:
Gawande argued: "Our fee-for-service system, doling out separate payments for everything and everyone involved in a patient’s care, has all the wrong incentives: it rewards doing more over doing right, it increases paperwork and the duplication of efforts, and it discourages clinicians from working
543:
in December 2007 examined 15 federal policy options and concluded that, taken together, they had the potential to reduce future increases in health care spending by $ 1.5 trillion over the next 10 years. These options included increased use of health information technology, research and incentives
1192:
has concluded that increased use of health information technology has great potential to significantly reduce overall health care spending and realize large improvements in health care quality providing that the system is integrated. The use of health IT in an unintegrated setting will not realize
1110:
wrote: "A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States." There is also disagreement as to whether federal
1098:
reported that Massachusetts had "the most expensive family health insurance premiums in the country." Premiums in Massachusetts increased by 40 percent from 2003 to 2008, compared to a national average increase of 33%. The report did not break out the amount of the increase since 2006, but as the
967:
Employer-provided health insurance receives uncapped tax benefits. According to the OECD, it "encourages the purchase of more generous insurance plans, notably plans with little cost sharing, thus exacerbating moral hazard". Consumers want unfettered access to medical services; they also prefer to
945:
One factor perpetuating inefficiencies in health care is a lack of clarity regarding the cost of health insurance and who bears that cost, especially employment-based health insurance. Employers’ payments for employment-based health insurance and nearly all payments by employees for that insurance
563:
Health spending accounted for 17.6% of GDP in the United States in 2010, down slightly from 2009 (17.7%) and by far the highest share in the OECD, and a full eight percentage points higher than the OECD average of 9.5%. Following the United States were the Netherlands (at 12.0% of GDP), and France
981:
in December 2009 found that high-cost health plans do not provide unusually rich benefits to enrollees. The researchers found that only 3.7% of the variation in the cost of family coverage in employer-sponsored health plans is attributable to differences in the actuarial value of benefits. Only
903:
Physicians wrote a NYT Op Ed in May 2011 stating that doctors typically graduate with an average of $ 155,000 in debt from Medical school, with over 80% owing debt of some type. This drives some doctors into higher paying specialties as opposed to primary care. As specialists, they prescribe more
825:
One option involves an integrated series of healthcare providers charging a premium or flat fee to patients to participate in the network, rather than a fee for each individual service. This modifies the doctor's incentive from ordering more services to solving the problem efficiently (i.e., more
609:
President Obama has proposed an "Independent Medicare Advisory Panel" (IMAC) to make recommendations on Medicare reimbursement policy and other reforms. Comparative effectiveness research would be one of many tools used by the IMAC. The IMAC concept was endorsed in a letter from several prominent
1357:
There are health losses from insufficient health insurance. A 2009 study found more than 44,800 excess deaths annually in the United States due to Americans lacking health insurance. More broadly, estimates of the total number of people in the United States, whether insured or uninsured, who die
1333:
estimated that 16 million U.S. adults were underinsured in 2003. The underinsured were significantly more likely than those with adequate insurance to forgo health care, report financial stress because of medical bills, and experience coverage gaps for such items as prescription drugs. The study
1062:
has asserted that the Massachusetts law forcing everyone to buy insurance has increased costs: "Premiums are growing 21 to 46 percent faster than the national average, in part because Massachusetts' individual mandate has effectively outlawed affordable health plans." They say that "the mandate
1016:
said in an interview: "Clearly more auditing needs to be done and it needs to be done in real time." 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
985:
Premium tax subsidies to help individuals purchase their own health insurance have also been suggested as a way to increase coverage rates. Research confirms that consumers in the individual health insurance market are sensitive to price. It appears that price sensitivity varies among population
911:
The American Association of Colleges of Nurses cited studies estimating that a shortage of registered nurses would reach 230,000 by 2025 as America ages, with over 135,000 open positions during 2007. An additional 30% more nurses would have to graduate annually to keep up with demand. A study by
453:
A variety of specific types of reform have been suggested to improve the United States health care system. These range from increased use of health care technology through changing the anti-trust rules governing health insurance companies and tort-reform to rationing of care. Different overall
1284:
According to 2009 World Bank statistics, the U.S. had the highest healthcare costs relative to the size of the economy (GDP) in the world, even though estimated 50.2 million citizens (approximately 15.6% of the September 2011 estimated population of 312 million) lacked insurance. In March 2010,
881:
One option proposed includes specialized healthcare courts rather than the jury system. Such courts exist in other disciplines. In administrative health courts, an expert judge would decide cases based on best medical practice, writing an opinion that is subject to appeal to an appellate health
789:
reported in 2008 (using 2007 data for the most part) the following statistics: "The median number of licensed carriers in the small group market per state was 27. The median market share of the largest carrier in the small group market was about 47 percent, with a range from about 21 percent in
1399:
An estimated 3%–10% of all health care expenditures in the U.S. are fraudulent. In 2011, Medicare and Medicaid made $ 65 billion in improper payments (including both error and fraud). Government efforts to reduce fraud include $ 4.2 billion in fraudulent payments recovered by the Department of
1233:
Advocates of "single-payer" argue that shifting the U.S. to a single-payer health care system would provide universal coverage, give patients free choice of providers and hospitals, and guarantee comprehensive coverage and equal access for all medically necessary procedures, without increasing
1046:
Since most Americans with private coverage receive it through employer-sponsored plans, many have suggested employer "pay or play" requirements as a way to increase coverage levels (i.e., employers that do not provide insurance would have to pay a tax instead). However, research suggests that
1054:
reported that while requirements to purchase health insurance were central to proposals in both the House and Senate, these coverage mandates were "under fire from both ends of the political spectrum, with some liberals saying the penalties are too harsh for those who refuse and conservatives
687:
proposals state that most of its savings would be from providing preventative care to the uninsured. Canadian physicians, who provide universal health care including preventative care, found that they could lower their total health care expenditures by 40% simply by increasing appropriate and
668:
Gawande wrote that Obamacare contains a variety of pilot programs that may have a significant impact on cost and quality over the long-run, although these have not been factored into CBO cost estimates. He stated these pilot programs cover nearly every idea healthcare experts advocate, except
1628:
Emanuel, Ezekiel; Tanden, Neera; Altman, Stuart; Armstrong, Scott; Berwick, Donald; de Brantes, François; Calsyn, Maura; Chernew, Michael; Colmers, John; Cutler, David; Daschle, Tom; Egerman, Paul; Kocher, Bob; Milstein, Arnold; Oshima Lee, Emily; Podesta, John D.; Reinhardt, Uwe; Rosenthal,
1159:
Rationing by price means accepting that there is no triage according to need. Thus in the private sector it is accepted that some people get expensive surgeries such as liver transplants or non life-threatening ones such as cosmetic surgery, when others fail to get cheaper and much more cost
1155:
has also argued that some form of rationing is inevitable and desirable considering the state of U.S. finances and the trillions of dollars of unfunded Medicare liabilities. He estimated that 25–33% of healthcare services are provided to those in the last months or year of life and advocated
821:
Gawande quoted one surgeon who stated: "We took a wrong turn when doctors stopped being doctors and became businessmen." Gawande identified various revenue-enhancing approaches and profit-based incentives that doctors were using in high-cost areas that may have caused the over-utilization of
737:
The CBO reported in May 2005: "Medicare spending is highly concentrated, with a small number of beneficiaries accounting for a large proportion of the Medicare program's annual expenditures. In 2001, the costliest 5 percent of beneficiaries enrolled in Medicare's fee-for-service (FFS) sector
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During April 2012, nine physician groups identified 45 tests that were commonly used but that provided no proven benefits to patients or could actually be harmful. This was done at the urging of a Dr. Howard Brody, who published this recommendation in a 2010 article. The nine groups (medical
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The cost of insurance has been a primary motivation in the reform of the US healthcare system, and many different explanations have been proposed in the reasons for high insurance costs and how to remedy them. One critique and motivation for healthcare reform has been the development of the
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too early to determine if the state's new coverage mandate had failed to reduce the emergency room use, but several physicians and policymakers said that it was unlikely that a coverage mandate alone could solve the problems of emergency room crowding and overuse. In August 2009
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President and CEO Denis Cortese has advocated an overall strategy to guide reform efforts. He argued that the U.S. has an opportunity to redesign its healthcare system and that there is a wide consensus that reform is necessary. He articulated four "pillars" of such a strategy:
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argues that U.S. healthcare is rationed, based on income, type of employment, and pre-existing medical conditions, with nearly 46 million uninsured. He argues that millions of Americans are denied coverage or face higher premiums as a result of pre-existing medical conditions.
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Massachusetts reforms are often taken as a model for national reform, "advocates on various sides of the issue said the report underscores the urgency of including cost controls in any large-scale federal or state overhaul." Karen Davenport, director of health policy at the
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are avoidable or wasted. This included: unnecessary services ($ 210 billion annually); inefficient delivery of care ($ 130 billion); excess administrative costs ($ 190 billion); inflated prices ($ 105 billion); prevention failures ($ 55 billion), and fraud ($ 75 billion).
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President Obama further described his plan in a September 2009 speech to a joint session of Congress. His plan mentions: deficit neutrality; not allowing insurance companies to discriminate based on pre-existing conditions; capping out of pocket expenses; creation of an
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care spending. Careful consideration of basic insurance principles is important when considering insurance market reform, in order to avoid unanticipated consequences and ensure the long-term viability of the reformed system. According to one study conducted by the
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Proponents of health care reform argue that moving to a single-payer system would reallocate the money currently spent on the administrative overhead required to run the hundreds of insurance companies in the U.S. to provide universal care. An often-cited study by
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of the highest medical costs are now in states where tort reform had already caused malpractice premiums and lawsuits to drop substantially; unnecessary and injurious procedures are instead caused by a system "often driven to maximize revenues over patient needs."
651:(CBO), the cost of healthcare per person in the U.S. also varies significantly by geography and medical center, with little or no statistical difference in outcome. Comparative effectiveness research has shown that significant cost reductions are possible. Former
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overall spending. Shifting to a single-payer system, by this view, would also eliminate oversight by managed care reviewers, restoring the traditional doctor-patient relationship. Among the organizations in support of single-payer health care in the U.S. is
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In addition, the number of employers who offer health insurance has declined and costs for employer-paid health insurance are rising: from 2001 to 2007, premiums for family coverage increased 78%, while wages rose 19% and prices rose 17%, according to the
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pay through insurance or tax rather than out of pocket. These two needs create cost-efficiency challenges for health care. Some studies have found no consistent and systematic relationship between the type of financing of health care and cost containment.
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The annual rate of cost increases slowed during 2010 and 2011. The causes are disputed, ranging from recession-related delays in visiting doctors to more long-term trends in moderating insurance premiums and reduced spending on structures and equipment.
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expensive treatments. About $ 2.5 billion/year would be required to make Medical school free, which the writers estimated at one-thousandth the total annual healthcare costs. Making medical school free would help address the shortage in their view.
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have each separately noted that health care rationing is not a choice, but an economic necessity. All health care resources are finite and have to be allocated in some way or other. The issue is which way is the most sensible way to do it.
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have found that the United States spends more per-capita than other similarly developed nations but falls below similar countries in various health metrics, suggesting inefficiency and waste. In addition, the United States has significant
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court. There would also be a requirement of full disclosure by hospitals, and all facts would be fed back into the health care system so providers learn from their mistakes. Such an approach has been opposed by trial lawyer lobbyists.
1171:(R-IA) makes similar arguments claiming for example that people like the late Senator Edward Kennedy received health care in the U.S. that would have been denied in countries which have government controlled health care, a claim that
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would cost much less. However, preventive care is typically provided to many people who would never become ill, and for those who would have become ill, it is partially offset by the health care costs during additional years of life.
1024:, citing approximately $ 110 billion in unauthorized payments of all types, including Medicare and Medicaid. President Obama has directed his administration to reduce these payments by $ 50 million annually by 2012, less than 1%.
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found that underinsurance disproportionately affects those with lower incomes — 73% of the underinsured in the study population had annual incomes below 200% of the federal poverty level. However, a study published by the
1103:, has argued that "before making coverage mandatory, we need to reform the health insurance market, strengthen public health insurance programs, and finance premium subsidies for people who can’t afford coverage on their own."
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The U.S. had 2.3 doctors per 1,000 people in 2002, ranking 52nd. Germany and France had approximately 3.4 and ranked in the top 25. The OECD average in 2008 was 3.1 doctors per 1,000 people, while the U.S. had 2.4.
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One application of healthcare technology is the creation of registries or databases to relate treatments to outcomes. Useful treatments could be identified and those less useful could be avoided to reduce costs.
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effective care such as prenatal care, which could save the lives of many fetuses and newborn children. Some places, like Oregon for example, do explicitly ration Medicaid resources using medical priorities.
1392:, asserted that 20% to 30% of health care spending is waste. He listed five causes for the waste: (1) overtreatment of patients, (2) the failure to coordinate care, (3) the administrative complexity of the
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are reaching retirement age, which combined with significant annual increases in healthcare costs per person will place enormous budgetary strain on U.S. state and federal governments, particularly through
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stated: "Nearly thirty percent of Medicare's costs could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level of low-cost areas."
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spending (Medicaid provides long-term care for the elderly poor). Maintaining the long-term fiscal health of the U.S. federal government is significantly dependent on healthcare costs being controlled.
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that the current exclusion of insurance premiums from compensation represents a $ 200 billion subsidy for the private insurance industry and that it would likely not exist without it. In November 2009,
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Deductibles (the amount a person pays before insurance begins to cover claims) have risen sharply. Workers must pay a larger share of their own health costs, and generally forces them to spend less; and
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for individuals and small businesses; tax credits for individuals and small companies; independent commissions to identify fraud, waste and abuse; and malpractice reform projects, among other topics.
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Both Mayo Clinic CEO Dr. Denis Cortese and Surgeon/Author Atul Gawande have argued that such panel(s) will be critical to reform of the delivery system and improving value. Washington Post columnist
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subgroups and is generally higher for younger individuals and lower income individuals. However, research also suggests that subsidies alone are unlikely to solve the uninsured problem in the U.S.
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in outcome. Such scenarios offer the opportunity to maintain or improve the quality of care, while significantly reducing costs, through comparative effectiveness research. According to economist
5432:"Key Issues in Health Reform: The federal government’s role in financing and delivering health care; Lowering the rate of growth of Medicare spending; Advance care planning for serious illness,"
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4758:
430:
5408:"Public Health Insurance Plan: Should some uninsured Americans be able to enroll in a newly created, publicly administered health plan as the nation works to expand health insurance coverage?"
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reform package that includes caps on jury awards of $ 500,000 for punitive damages and $ 250,000 for "pain and suffering" damages would lower liability insurance premiums by about 10 percent.
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Some conservatives advocate free market reforms such as breaking up state monopolies on insurance and licensing and allowing consumers to purchase health insurance licensed by other states.
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1167:(R-GA) argued that the reform plans supported by President Obama expand the control of government over healthcare decisions, which he referred to as a type of healthcare rationing. Senator
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outlined his strategy for reform. He mentioned electronic record-keeping, preventing expensive conditions, reducing obesity, refocusing doctor incentives from quantity of care to quality,
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healthcare. He contrasted this with lower-cost areas that used salaried doctors and other techniques to reward value, referring to this as a "battle for the soul of American medicine."
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The proportion of workers with employer-sponsored health insurance enrolled in a plan that required a deductible climbed to about three-quarters in 2012 from about half in 2006.
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Patients that are fully insured have no financial incentive to minimize the cost when choosing among alternatives. The overall effect is to increase insurance premiums for all.
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336, no. 11 1997) "concluded that almost 100,000 people died in the United States each year because of lack of needed care—three times the number of people who died of AIDs."
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896:, cardiologist Arthur Feldman cited various studies that indicate the U.S. is facing a "critical" shortage of doctors, including an estimated 1,300 general surgeons by 2010.
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can incur over half a million dollars in hospital bills in a few months, which must be borne by all other health care consumers, when the same diagnosis at stage one with
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Medicaid recipients could also be provided with tax credits or subsidies to purchase their own private insurance, reducing incentives for them to remain in the program.
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5420:"Health Insurance Reforms: Should there be a new federal law and regulations to broaden coverage and make the market work better for individuals and small businesses?"
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Roland Brilla; Stefan Evers; Angela Deutschländer; Katja Elfriede Wartenberg (2006). "Are neurology residents in the United States being taught defensive medicine?".
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for treatment of conditions rather than specific services, better identifying and communicating the most cost-effective treatments, and reducing defensive medicine.
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The U.S. is facing shortages of doctors and nurses that are projected to grow worse as America ages, which may drive up the price of these services. Writing in
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lists Medicare as a "high-risk" government program due to its vulnerability to improper payments. Estimates of Medicare fraud or "improper payments" vary. The
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Establish mechanisms for improving the healthcare service delivery system over the long-term, which is the primary means through which value would be improved.
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Doctors are typically paid for services provided rather than with a salary. This provides a financial incentive to increase the costs of treatment provided.
387:, which originated in the Senate and was later passed by the House of Representatives in amended form on March 21, 2010 (with a vote of 219–212). President
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estimated that taxing employer-provided health insurance (which is presently exempt from tax) would add $ 215 billion per year to federal tax revenue.
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One July 2012 proposal advocated that consumers of healthcare always have "skin in the game" such that their costs rise as more services are provided.
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that BIR among insurers, physicians, and hospitals in California represented 20–22% of privately insured spending in California acute care settings.
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1564:. Click the sources tab under the chart for info on the countries, healthcare expenditures, and data sources. See the later version of the chart
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in which we’re paying for quality rather than quantity while also encouraging prevention and wellness." He also argued for bundling payments and
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Politicians on the right tend to be fearful of democratically elected governments becoming involved in rationing decision. Former House Speaker
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Health insurance premiums for employer-provided family coverage 1999–2014. The 3% increase in 2014 was tied for lowest over the 16-year period.
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5754:
3833:""Health Care Fraud: Schemes to Defraud Medicare, Medicaid and Private Health Insurers" U.S. Government Accountability Office, July 2000 (PDF)"
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1315:
1256:
1043:, if not implemented on a systematic basis with appropriate safeguards, market reform has the potential to cause more problems than it solves.
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who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on. That is the plain and simple truth."
218:
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2850:"GAO-09-363R Private Health Insurance: 2008 Survey Results on Number and Market Share of Carriers in the Small Group Health Insurance Market"
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57:
20:
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magazine said was "dangerous" and went on to say that "The reality is that America, like Britain, already makes extensive use of rationing.
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1281:(Medicaid provides free long-term care to the elderly poor). The fiscal and human impact of these issues have motivated reform proposals.
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Increased use of preventive care (e.g., regular doctor visits) is one way of reducing health care spending. Official budget scores of
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care to more cost-efficient care). The provider network would also purchase insurance for catastrophic (extremely high cost) cases.
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During February 2010, President Obama updated his reform proposal, with modifications to the bills that had passed as of that time.
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5145:. How Money, Power, and the Pursuit of Self-Interest Have Imperiled the American Dream. Cornell University Press. pp. 39–77.
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commented that the high costs paid by U.S. companies for their employees' health care put them at a competitive disadvantage.
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signed the reforms into law on March 23, 2010. Reuters and CNN summarized the reforms and the year in which they take effect.
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5396:"Individual Mandate: Congress is now weighing different versions of a requirement that individuals obtain health insurance,"
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has also recommended that President Obama engage someone like Cortese to have a more active role in driving reform efforts.
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2210:"Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis"
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Wilper, Andrew P.; Woolhandler, Steffie; Lasser, Karen E.; McCormick, Danny; Bor, David H.; Himmelstein, David U. (2009).
4826:"Health Insurance Premiums Rise 6.1% In 2007, Less Rapidly Than In Recent Years But Still Faster Than Wages And Inflation"
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Critics have argued that the healthcare system has several incentives that drive costly behavior. Two of these include:
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societies) developed the lists after months of analyses and reviews of the medical literature by expert committees. The
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Several studies have attempted to explain the reduction in the rate of annual increase. Reasons include, among others:
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3883:"How Initiatives to Reduce Fraud in Federal Health Care Programs Affect the Budget | Congressional Budget Office"
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Higher unemployment due to the 2008–2012 recession, which has limited the ability of consumers to purchase healthcare;
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Meredith; Sharfstein, Joshua; Shortell, Stephen; Stern, Andrew; Orszag, Peter R.; Spiro, Topher (September 6, 2012).
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1941:
1325:. Even for those who are employed, the private insurance in the US varies greatly in its coverage; one study by the
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mandates would be constitutional, and state initiatives opposing federal mandates may lead to litigation and delay.
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1000:
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reported in 2002 (using 2000 data) the following statistics regarding insurance competition in state markets: "The
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Standard Option. One indicator of the consequences of Americans' inconsistent health care coverage is a study in
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that concluded that half of personal bankruptcies involved medical bills, although other sources dispute this.
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editorial board wrote: "Eliminating needless care is not rationing. It is sound medicine and sound economics."
4633:"The cost of health insurance administration in California: estimates for insurers, physicians, and hospitals"
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Medicare: More Effective Screening and Stronger Enrollment Standards Needed for Medical Equipment Suppliers
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Cathy Schoen, Stuart Guterman, Anthony Shih, Jennifer Lau, Sophie Kasimow, Anne Gauthier, and Karen Davis,
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1238:(PNHP), an organization of some 17,000 American physicians, medical students, and health professionals.
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4011:"The Economics of "Pay or Play" Employer Mandates: Who Gets What From Employer "Pay or Play" Mandates,"
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2900:
2275:"In the Balance: Some Candidates Disagree, but Studies Show It's Often Cheaper To Let People Get Sick,"
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be to afflict the afflicted, to make the lives of Americans with pre-existing conditions even harder."
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2383:"CDC-Recommended Community Strategies and Measurements to Prevent Obesity in the U.S.- July 24, 2009"
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Preventing obesity and overweight conditions presents a significant opportunity to reduce costs. The
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Washington Post-Ezra Klein-21 graphs that show America’s health-care prices are ludicrous-March 2013
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How Does the Benefit Value of Medicare Compare to the Benefit Value of Typical Large Employer Plans?
4140:"Bay State health insurance premiums highest in country: Rein in health costs, Massachusetts urged,"
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1864:"Bending the Curve: Options for Achieving Savings and Improving Value in the U.S. Health Spending"
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reducing inappropriate preventative care measures. A single uninsured cancer patient diagnosed at
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Washington Post-Ezra Klein-Why an MRI costs $ 1,080 in America and $ 280 in France-March 15, 2013
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In December 2011 the outgoing Administrator of the Centers for Medicare & Medicaid Services,
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Centers for Medicare and Medicaid Services-Statistics, Trends and Reports-Retrieved June 9, 2013
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Focus on value, which he defined as the ratio of quality of service provided relative to cost;
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Craig, David M. (January 1, 2014). "Health Care as a Social Good". In CRAIG, DAVID M. (ed.).
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4117:"ER visits, costs in Mass. climb: Questions raised about healthcare law's impact on overuse,"
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Justice and the FBI in 2012, longer jail sentences specified by the Affordable Care Act, and
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Health insurance premiums paid on behalf of workers are increasingly offsetting compensation.
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273:
153:
5342:"Bloomberg-McCain Charges Democrats Pandering to Drugmakers on Import Ban-December 11, 2009"
5215:"Republicans Darkest Fears Realized: ACA Causes Number of Uninsured to Drop Across All Ages"
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Medicare Fraud and Abuse: DOJ Continues to Promote Compliance with False Claims Act Guidance
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3742:""High-Risk Series: An Update" U.S. Government Accountability Office, January 2009 (PDF)"
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2511:"Lifetime medical costs of obesity: prevention no cure for increasing health expenditure"
2382:
2291:"CDC Home Page-Economic Consequences of Overweight and Obesity-Retrieved October 6, 2009"
2277:
1960:
892:
835:
399:
5141:
Ehrenreich, John (January 1, 2016). "The Health of Nations". In Ehrenreich, John (ed.).
4735:
3185:
1507:
838:
costs (insurance and lawsuits, for example) are significant and should be addressed via
7200:
7188:
6906:
6896:
6873:
6856:
6252:
5996:
5991:
5863:
5526:
5164:
5120:
5076:
5064:
4991:
4964:
4932:
4803:
4097:
3986:
3056:
2537:
2510:
2339:"CDC Home Page-Health Consequences of Obesity and Overweight-Retrieved October 6, 2009"
2236:
2209:
2004:
1787:
1393:
1071:
955:
335:
5168:
1607:
1508:"Reuters-Factbox-U.S. Healthcare Bill Would Provide Immediate Benefits-March 19, 2010"
7943:
7099:
6451:
5949:
5868:
5853:
5154:
5110:
5054:
4996:
4924:
4870:
4851:
Cathy Schoen; Michelle M. Doty; Sara R. Collins; Alyssa L. Holmgren (June 14, 2005).
4674:
4656:
4183:
4010:
3684:
3566:
3048:
2542:
2241:
1873:
1650:
1561:
1326:
1064:
540:
4936:
4164:
4039:
2596:
2290:
1630:
1565:
7859:
7706:
7412:
7232:
6242:
6083:
6066:
6061:
5900:
5146:
4986:
4978:
4916:
4860:
4646:
4552:
4143:
4120:
4064:
3676:
3646:
3598:
3402:"American Association of Colleges of Nurses-Fact Sheet-Retrieved September 7, 2009"
3159:
3044:
3040:
2777:
2645:
2532:
2522:
2231:
2221:
1642:
1611:
1377:
1270:
1168:
1095:
1090:
693:
644:
5013:
A 1997 study carried out by Professors David Himmelstein and Steffie Woolhandler (
4330:
3454:"Long-Term Budget Outlook and Options for Slowing the Growth of Health Care Costs"
3060:
1813:
1269:
and significant impending unfunded liabilities from its aging demographic and its
7568:
7344:
7242:
7014:
6314:
6247:
6016:
5937:
5883:
4681:
4618:
4584:
4473:
4017:
3973:
3970:
3794:
3775:
3708:
2527:
2338:
2193:
1920:
1870:
1144:
1040:
639:
593:
474:
301:
5380:
Centers for Medicare and Medicaid Services-National Health Expenditure Data-2012
4829:
3963:
3808:""White House Reports Billions of Improper Payments in 2009" CNN, November 2009"
8038:
7938:
7321:
6456:
6446:
6441:
6436:
6108:
5971:
5905:
5435:
5423:
5411:
5399:
5384:
5018:
4070:
3934:
3667:
3562:
1894:
1756:
1692:
1389:
1330:
1286:
1059:
977:
941:
has described how the tax treatment of insurance premiums may affect behavior:
874:
689:
631:
620:
527:
306:
5453:
5150:
4888:
4651:
4632:
3680:
3108:
8435:
7019:
6319:
6128:
5763:
5068:
4982:
4828:(Press release). Kaiser Family Foundation. September 11, 2007. Archived from
3428:
3134:
2694:"Washington Post-Robert Samuelson-Paul Ryan's Lonely Challenge-February 2010"
1164:
1079:
961:
5124:
3865:"Medical Fraud a Growing Problem: Medicare Pays Most Claims Without Review,"
3839:
873:
In 2004, the CBO studied restrictions on malpractice awards proposed by the
861:
In August 2009, physician and former Democratic National Committee Chairman
7326:
7298:
6353:
5000:
4928:
4874:
4865:
4852:
4693:
4660:
4074:
4006:
3688:
3586:
3554:
3294:"Feldman-Washington Post-Ten Things I Hate About Healthcare Reform-Sept 09"
3052:
2953:"Beyond Obamacare: How to Fix Our Enormous, Inefficient Health-Care System"
2849:
2825:
2546:
2361:"WebMD-Retrieved October 6, 2009-Obesity Costs U.S. $ 147 billion per year"
2245:
2226:
1654:
1293:
1140:
1133:
950:
794:
656:
532:
493:
470:
388:
5449:
CBO-Key Issues in Analyzing Major Health Insurance Proposals-December 2008
4920:
4245:
3787:
3741:
1646:
845:
How much these costs are is a matter of debate. Philip Howard argued that
7603:
7134:
6471:
6373:
6113:
5976:
5732:
5366:
Time Magazine-Steven Brill-Why Medical Bills Are Killing Us-February 2013
4715:
Washington Post-Samuelson-Curbing the Costs of High-Tech Health-July 2012
4302:"NYT-Leonhardt-Healthcare Rationing Rhetoric Overlooks Reality-June 2009"
3729:"Subsidies and the Demand for Individual Health Insurance in California,"
2901:"NYT-Leonhardt-In Health Reform, A Cancer Offers and Acid Test-July 2009"
1376:
Another concern is the rate of uninsured people in the US. In June 2014,
1017:
networks, which should assist Medicare in identifying fraudulent claims.
1013:
862:
846:
839:
504:
4788:
http://www.economist.com/media/globalexecutive/coming_gen_storm_e_02.pdf
4596:
3882:
3661:
Gabel, Jon; Pickreign, Jeremy; McDevitt, Roland; Briggs, Thomas (2009).
2644:. Roadmap.republicans.budget.house.gov. January 26, 2011. Archived from
1752:"Remarks by the President to a Joint Session of Congress-September 2009"
1615:
635:
Medicare spending per person varied significantly across states in 2006.
6466:
6272:
6098:
6093:
6011:
2406:"Washington Post-U.S. Obesity Epidemic Continues to Grow-July 17, 2008"
610:
healthcare policy experts, as summarized by OMB Director Peter Orszag:
5385:
Slate's online guide to the health care reform bill. – By Timothy Noah
4467:"Evidence on the Costs and Benefits of Health Information Technology,"
2487:
1956:"Washington Post-Sarah Kliff-Healthcare spending slowdown-August 2012"
829:
461:
reported in September 2012 that approximately $ 750B per year in U.S.
7955:
7948:
5051:
Health Care as a Social Good: Religious Values and American Democracy
3907:
2800:"Newt Gingrich-LAT Times-Healthcare Rationing-Real Scary-August 2009"
2484:"CNN-Obesity Care May Cost Twice Previous Estimates-October 15, 2010"
1557:
4500:
1921:"OECD-Health Data 2012-How Does the United States Compare-June 2012"
1533:"CNN-Timeline-When Healthcare Reform Will Affect You-March 23, 2010"
6138:
6088:
4950:
4501:"Newsweek-The Hospital That Could Cure Healthcare-December 7, 2009"
4276:"NYT-President Obama-Why We Need Healthcare Reform-August 15, 2009"
4087:
4085:
4083:
4066:
Massachusetts' Obama-like Reforms Increase Health Costs, Wait Times
4034:
4032:
4030:
4028:
4026:
3915:
3641:
3603:
3590:
1302:
1278:
916:
4906:
2620:"Bloomberg-Orszag-Cost Sharing is No Way to Fix Medicare-May 2011"
1554:
Link between health spending and life expectancy: US is an outlier
706:
437:). 11.2% for Canada in 2022. 16.6% for the United States in 2022.
4962:
4327:"Peter G. Peterson on Charlie Rose-July 3, 2009-About 17 min in"
4080:
4023:
3702:"The Price Sensitivity of Demand for Nongroup Health Insurance,"
3376:"Forbes-Bruce Bartlett-Health Care Costs & Reform-July 2009"
2720:"Forbes-Bartlett-Paul Ryan's Budgetary Holy Grail-February 2010"
2668:"Roadmap for America's Future-Charts & Graphs-February 2010"
2509:
van Baal PH, Polder JJ, de Wit GA, et al. (February 2008).
885:
5374:
5107:
To Live and Die in America: Class, Power, Health and Healthcare
5025:, Vicente Navarro, September 2003. Retrieved September 10, 2009
3964:"Health Insurance Market Reforms: What They Can and Cannot Do,"
3958:
3956:
3902:
3900:
3898:
3896:
3541:"Economic Survey of the United States 2008: Health Care Reform"
3075:"CNN-Tort reform could save $ 54 billion,CBO Report Says-Oct 9"
2458:"WSJ-Another Thing Big in Japan-Measuring Waistlines-June 2008"
1670:"How the U.S. Health-Care System Wastes $ 750 Billion Annually"
778:
572:
to 17.9% by 2009, but remained at that level in 2010 and 2011.
403:
Life expectancy vs healthcare spending of rich OECD countries.
4853:"Insured But Not Protected: How Many Adults Are Underinsured?"
3987:'Fundamentals of Insurance: Implications for Health Coverage,"
3008:"Bloomberg-Malpractice Lawsuits are Red Herring in Obama Plan"
4887:
Dale Yamamoto, Tricia Neuman and Michelle Kitchman Strollo,
3953:
3893:
3660:
2132:"Peter Diamond-Healthcare and Behavioral Economics-May 2008"
1627:
374:
health care reforms proposed during the Obama administration
4587:, America's Health Insurance Plans, has some 1,300 members.
3946:
3930:"Whitehouse-Improper Payments Elimination and Recovery Act"
3642:"Do I have a "Cadillac Plan"? An Explainer health care FAQ"
2826:"GAO-Letter to Honorable Christopher "Kit" Bond-March 2002"
2091:
1906:
1887:"President Obama's Plan – February 2010-Whitehouse Website"
1769:
1705:
1603:
1118:
upheld the individual mandate provision as Constitutional.
1058:
Arguing against requiring individuals to buy coverage, the
746:
4907:
Himmelstein DU, Warren E, Thorne D, Woolhandler S (2005).
3559:
Crisis of Abundance: Rethinking How We Pay for Health Care
2927:"Atul Gawande – Testing, Testing-New Yorker-December 2009"
501:, which reward doctors for teamwork and patient outcomes.
422:. $ 6,319 for Canada in 2022. $ 12,555 for the US in 2022.
2972:
RCP-Roth-The High Cost of Medical Malpractice-August 2009
2875:"Paul Krugman-Afflicting the Afflicted-February 25, 2010"
786:
774:
5175:
4951:"An Economic Analysis of the Consumer Bankruptcy Crisis"
4111:
4109:
4107:
3663:"Taxing Cadillac Health Plans May Produce Chevy Results"
3620:"Congress Is Split on Effort to Tax Costly Health Plans"
3490:"NYT-Singer-Why We Must Ration Healthcare-July 15, 2009"
2055:"What Republicans Misunderstand About Health-Care Costs"
1810:"Denis Cortese Interview on Charlie Rose Show-July 2009"
1631:"A Systemic Approach to Containing Health Care Spending"
1580:"America's inefficient health-care system: another look"
1178:
379:
The first of these reform proposals to be passed by the
3618:
Herszenhorn, David M.; Robert Pear (October 12, 2009).
4577:
4354:"Time Magazine-Ethics: Rationing Medical Care-Sept 09"
3912:
CBS-60 Minutes-Medicare Fraud-A $ 60 Trillion Business
3617:
2670:. Roadmap.republicans.budget.house.gov. Archived from
2207:
2067:
1784:"Charlie Rose-Peter Orszag Interview-November 3, 2009"
1022:
Improper Payments Elimination and Recovery Act of 2010
1020:
During July 2010, President Obama signed into law the
765:
4630:
4619:
Costs of Health Administration in the U.S. and Canada
4104:
4059:
4057:
4055:
4053:
3727:, Jose J. Escarce, Kanika Kapur, and Jill M. Yegian,
3429:"Newsweek-The Doctor Won't See You Now-February 2010"
3320:"Forbes-The Doctor Drought-Marc Siegel-December 2009"
1241:
626:
4134:
4132:
4130:
3797:, GAO Report to Congressional Committees, April 2002
3533:
2508:
1425:
4487:"Smart Health-Care Strategy Hidden in 'Cliff' Deal"
4384:"LA Times-Gingrich-Healthcare Rationing-Real Scary"
3280:"Costly Medicare Mistakes You Can't Afford to Make"
2165:"Gawande-Testing, Testing-New Yorker-December 2009"
1688:"Remarks by the President to the AMA-June 15, 2009"
1106:Addressing the issue when it was proposed in 1994,
830:
Medical malpractice liability costs and tort reform
5105:Chernomas, Robert; Hudson, Ian (January 1, 2013).
4909:"Illness and injury as contributors to bankruptcy"
4759:"Buffett says economy recovering but at slow rate"
4050:
3857:
3351:"Opinion | Why Medical School Should Be Free"
2314:"WSJ-Cost of Treating Obesity Soars-July 28, 2009"
2000:"Slowdown in Rise of Healthcare Costs May Persist"
1404:—volunteers trained to identify and report fraud.
1309:
971:Some have proposed an "excise tax" for high cost '
732:
5290:
5241:"Rate of uninsured Americans is dropping: Gallup"
5232:
4621:, Woolhandler, et al., NEJM 349(8) Sept. 21, 2003
4127:
3098:RCP-Roundtable on Health Reform Costs-August 2009
2642:"Republican Website-Roadmap for America's Future"
2057:. January 14, 2013 – via www.bloomberg.com.
1342:(PPO) plan in 2007 was more generous than either
8433:
7167:Native American recognition in the United States
5184:"SURVEY: UNINSURED RATE DROPS; HEALTH LAW CITED"
5053:. Georgetown University Press. pp. 85–120.
4800:"Charlie Rose-Peter Orszag Interview Transcript"
4597:"The Health Care Crisis and What to Do About It"
4489:. January 8, 2013 – via www.bloomberg.com.
3927:
2981:
2185:Physicians for a National Health Program (2008)
1835:
1833:
1831:
1599:
1597:
1471:"House sends health care overhaul bill to Obama"
1183:
801:
5483:
5267:"Health Official Takes Parting Shot at 'Waste'"
5181:
5104:
4040:"Insurance Mandates Draw Flak From Both Sides,"
3591:"Health Care Financing, Efficiency, and Equity"
3515:"The Economist-Stemming the Tide-November 2009"
3426:
3349:Bach, Peter B.; Kocher, Robert (May 28, 2011).
2107:"Washington Post-Paging Dr. Reform-August 2009"
592:Increasing healthcare costs also contribute to
4631:Kahn JG, Kronick R, Kreger M, Gans DN (2005).
4077:on August 27, 2009 (accessed October 16, 2009)
3483:
3481:
1446:
1338:in 2008 found that the typical large employer
1316:Health insurance coverage in the United States
1257:Health care reform debate in the United States
716:
604:
449:, compared amongst various first world nations
7564:Greenhouse gas emissions by the United States
5748:
5469:
5390:Washington Post's Ezra Klein on Health Reform
5036:"Study calls wide Mass. coverage a lifesaver"
4965:"Health Insurance and Mortality in US Adults"
4624:
2572:
2570:
2432:"NYT-Leonhardt-The Way We Live-Fat Tax-Aug 9"
2208:Hogg, W.; Baskerville, N; Lemelin, J (2005).
1842:"The New Yorker-The Cost Conundrum-June 2009"
1828:
1594:
1432:Prescription drug prices in the United States
886:Addressing the shortage of doctors and nurses
353:
21:Healthcare reform debate in the United States
5444:President's Proposal Summary – February 2010
4818:
4020:Employment Policies Institute, November 2007
3731:Health Services Research 39:5 (October 2004)
3256:. CBSNews.com. March 5, 2009. Archived from
1997:
1571:
1485:"CNN-Obama Signs Health Bill-March 23, 2010"
1407:
179:Health Care and Education Reconciliation Act
5182:ALONSO-ZALDIVAR, RICARDO (March 10, 2014).
4203:Seelye, Katharine Q. (September 26, 2009).
3611:
3478:
3364:NationMaster.com-Retrieved December 4, 2009
3001:
2999:
2997:
2593:"CBO-High Cost Medicare Beneficiaries-2005"
2025:
5762:
5755:
5741:
5476:
5462:
5206:
5140:
4673:Physicians for a National Health Program.
4253:"Supreme Court upholds individual mandate"
4073:, Reprint of article that appeared in the
3348:
3154:
3152:
2567:
1991:
1499:
418:. Public and private spending. US dollars
385:Patient Protection and Affordable Care Act
360:
346:
7177:Federally recognized Alaska Native tribes
4990:
4864:
4719:
4650:
4528:"Krugman-One Nation, Uninsured-June 2005"
4299:
3602:
2898:
2536:
2526:
2429:
2235:
2225:
2068:Peter Orszag, Director (August 4, 2009).
2019:
1577:
1454:House passes historic healthcare overhaul
1348:Federal Employees Health Benefits Program
1227:Canadian Institute for Health Information
1128:Healthcare rationing in the United States
994:
975:' insurance plans. A study published in
818:together for the best possible results."
741:
4557:Physicians for a National Health Program
4408:
4093:"Should Health Insurance Be Mandatory?,"
3005:
2994:
2563:. April 9, 2012 – via NYTimes.com.
2403:
2104:
1414:International Federation of Health Plans
1236:Physicians for a National Health Program
1205:
1151:Former Republican Secretary of Commerce
928:
747:Privatize Medicare with a voucher system
678:
630:
554:
515:Pay for and align incentives with value;
454:strategies have been suggested as well.
440:
425:
410:
398:
7228:List of counties and county equivalents
5371:Health Care Reform in the United States
5291:Phipps, Jennie L. (February 21, 2013).
4859:. Suppl Web Exclusives: W5–289–W5–302.
4525:
3229:
3206:
3149:
2946:
2944:
2924:
2872:
2778:"Cato-A Free Market can fix healthcare"
2617:
2561:"Opinion | Do You Need That Test?"
2162:
1839:
1262:International comparisons of healthcare
1196:
8452:Healthcare reform in the United States
8434:
5339:
5238:
5212:
5136:
5134:
5100:
5098:
4202:
4188:: CS1 maint: archived copy as title (
3487:
2950:
2746:"CBO-Ryan Roadmap Letter-January 2010"
2579:"Opinion | A Choice, Not a Whine"
2576:
2481:
1396:, (4) burdensome rules and (5) fraud.
5736:
5457:
5340:Jensen, Kristin (December 11, 2009).
5048:
5019:The Inhuman State of U.S. Health Care
4915:. Suppl Web Exclusives: W5–63–W5–73.
4667:
4351:
4273:
4225:
3765:U.S. Government Accountability Office
3585:
3553:
3547:
3427:Mary Carmichael (February 25, 2010).
2311:
2082:from the original on February 3, 2017
1505:
1179:Better usage of healthcare technology
469:During a June 2009 speech, President
5264:
4756:
4409:Cummings, Jeanne (August 22, 2009).
4226:Davey, Monica (September 28, 2009).
3636:
3630:
3184:. Physiciansnews.com. Archived from
2941:
2618:Bratton, William J. (May 24, 2011).
2455:
2430:Leonhardt, David (August 12, 2009).
2258:Nicholas Kristof (October 17, 2012)
1667:
1121:
1027:
989:
445:Health spending per capita, in US$
5131:
5095:
4725:
3962:Linda J. Blumberg and Len Nichols,
3032:Clinical Neurology and Neurosurgery
2873:Krugman, Paul (February 25, 2010).
2105:Ignatius, David (August 20, 2009).
1547:
1074:opinion blog "Room for Debate" the
766:Insurance company antitrust reforms
123:America's Affordable Health Choices
13:
4802:. November 3, 2009. Archived from
4413:. Dyn.politico.com. Archived from
4300:Leonhardt, David (June 17, 2009).
3928:Katelyn Sabochik (July 22, 2010).
3326:. December 4, 2009. Archived from
2982:Philip K. Howard (July 31, 2009).
2456:Wang, Shirley S. (June 13, 2008).
2404:Reinberg, Steven (July 17, 2008).
1608:Health resources - Health spending
1383:
1242:Reduce costs of imaging technology
627:Comparative effectiveness research
117:Affordable Health Care for America
79:Social Security Amendments of 1965
14:
8468:
6573:Director of National Intelligence
5359:
5265:Pear, Robert (December 3, 2011).
4970:American Journal of Public Health
4329:. Charlierose.com. Archived from
4274:Obama, Barack (August 15, 2009).
4207:. Prescriptions.blogs.nytimes.com
2951:Howard, Philip K. (May 7, 2012).
2899:Leonhardt, David (July 7, 2009).
2482:Stobbe, Mike (October 15, 2010).
1938:"OECD Health Data 2012-June 2012"
1812:. Charlierose.com. Archived from
1668:Fung, Brian (September 7, 2012).
1578:Kenworthy, Lane (July 10, 2011).
1426:Importation of prescription drugs
1292:Further, an estimated 77 million
663:
599:
372:There were a number of different
6729:Government Accountability Office
5597:Saint Vincent and the Grenadines
5415:Policy Brief, November 10, 2009.
5333:
5322:
5311:
5284:
5258:
5213:Easley, Jason (March 10, 2014).
5042:
5028:
5007:
4956:
4943:
4900:
4881:
4844:
4792:
4781:
4750:
4708:
4686:
4612:
4590:
4570:
4545:
4519:
4493:
4479:
4455:
4429:
4402:
4376:
4345:
4319:
4293:
4267:
4219:
4196:
4150:
4095:"Room for Debate" opinion blog,
3999:
3979:
3921:
3230:Gawande, Atul (August 1, 2011).
3207:Gawande, Atul (August 1, 2011).
3006:Nussbaum, Alex (June 16, 2009).
2925:Gawande, Atul (August 1, 2011).
2260:"Scott’s Story and the Election"
2163:Gawande, Atul (August 1, 2011).
1840:Gawande, Atul (August 1, 2011).
1082:, former editor-in-chief of the
1001:Government Accountability Office
550:
416:Total healthcare cost per person
329:
318:
5427:Policy Brief, October 21, 2009.
5403:Policy Brief, January 13, 2010.
5015:New England Journal of Medicine
4526:Krugman, Paul (June 13, 2005).
3875:
3825:
3800:
3781:
3778:, GAO-05-656 September 22, 2005
3758:
3734:
3717:
3695:
3654:
3579:
3507:
3488:Singer, Peter (July 19, 2009).
3446:
3420:
3394:
3368:
3357:
3342:
3312:
3286:
3272:
3246:
3223:
3200:
3174:
3127:
3101:
3089:
3067:
3022:
2975:
2963:
2918:
2892:
2866:
2842:
2818:
2792:
2770:
2738:
2712:
2686:
2660:
2634:
2611:
2585:
2553:
2502:
2475:
2449:
2423:
2397:
2375:
2353:
2331:
2305:
2283:
2267:
2252:
2201:
2179:
2156:
2124:
2098:
2075:Office of Management and Budget
2061:
2047:
1980:
1948:
1930:
1913:
1879:
1856:
1802:
1776:
1744:
1712:
1680:
1661:
1635:New England Journal of Medicine
1506:Smith, Donna (March 19, 2010).
1452:Noam N. Levey and Janet Hook, "
1420:
1340:preferred provider organization
1310:Insurance cost and availability
1084:New England Journal of Medicine
1005:Office of Management and Budget
733:Address expensive chronic cases
8372:Separation of church and state
6588:National Reconnaissance Office
6531:President of the United States
5439:Policy Brief, August 20, 2009.
5239:Howell, Tom (March 10, 2014).
4728:"World Health Statistics 2009"
3045:10.1016/j.clineuro.2005.05.013
2577:Brooks, David (July 3, 2012).
2312:Mckay, Betsy (July 28, 2009).
1621:
1582:. Consider the Evidence (blog)
1525:
1477:
1463:
582:Rising out-of-pocket payments;
499:accountable care organizations
405:US average of $ 10,447 in 2018
199:Obama administration proposals
1:
3994:American Academy of Actuaries
2984:"Health Reform's Taboo Topic"
2028:"Healthcare Costs and Budget"
1440:
1250:
1184:Automation of patient records
924:
802:Reform of doctor's incentives
6734:Government Publishing Office
6202:Technological and industrial
5722:United States Virgin Islands
5484:Healthcare in North America
5293:"How big is Medicare fraud?"
5038:. Boston Globe. May 5, 2014.
4953:, 99 NWU L. Rev. 1463 (2005)
4857:Health Affairs Web Exclusive
4765:. SFGate.com. Archived from
4757:Funk, Josh (March 1, 2010).
4352:Elson, John (May 15, 1989).
3595:NBER Working Paper No. 13881
2780:. Cato.org. October 21, 2009
2528:10.1371/journal.pmed.0050029
2214:BMC Health Services Research
1101:Center for American Progress
757:Roadmap for America's Future
16:Proposed health care reforms
7:
8206:Women's reproductive health
7172:Federally recognized tribes
7035:Public utilities commission
6939:Public Health Service Corps
6842:Code of Federal Regulations
6724:Congressional Budget Office
6578:Central Intelligence Agency
6484:Water supply and sanitation
5911:Declaration of Independence
4463:Congressional Budget Office
4038:Janet Adamy and Greg Hitt,
3712:Congressional Budget Office
2187:"Single Payer System Cost?"
1193:all the projected savings.
1190:Congressional Budget Office
939:Congressional Budget Office
855:Congressional Budget Office
717:Eliminate unnecessary tests
702:Centers for Disease Control
649:Congressional Budget Office
605:Independent advisory panels
394:
10:
8473:
8457:Presidency of Barack Obama
7384:Red states and blue states
7289:City commission government
7284:Council–manager government
4583:November 11, 2009, at the
4472:February 19, 2012, at the
4016:November 26, 2007, at the
2486:. NBC News. Archived from
2070:"OMB Director Orszag-IMAC"
1429:
1364:medical–industrial complex
1313:
1254:
1209:
1125:
1031:
647:and research cited by the
539:A report published by the
431:Health spending by country
286:Third-party payment models
98:Medicare Modernization Act
18:
8393:
8219:
8092:
8024:
7677:
7673:
7664:
7612:
7477:
7468:
7364:
7335:
7312:
7251:
7218:
7209:
7152:
7140:Comparison of governments
7115:
7078:
7055:
6971:
6951:
6882:
6820:
6742:
6665:
6523:
6514:
6510:
6501:
6223:
6214:
6159:
6119:Post-Cold War (1991–2008)
5960:drafting and ratification
5933:Articles of Confederation
5846:
5780:
5771:
5697:Saint Pierre and Miquelon
5615:
5489:
5151:10.7591/9781501703591-004
4732:World Health Organization
4652:10.1377/hlthaff.24.6.1629
3969:January 12, 2015, at the
3707:October 12, 2011, at the
3681:10.1377/hlthaff.2008.0430
3543:. OECD. December 9, 2008.
2595:. Cbo.gov. Archived from
2293:. Cdc.gov. March 28, 2011
2192:December 6, 2010, at the
1998:Annie Lowrey (May 2013).
1408:International comparisons
834:Critics have argued that
242:Health insurance exchange
8159:Prescription drug prices
7279:Mayor–council government
7269:Coterminous municipality
7259:Consolidated city-county
7025:Agriculture commissioner
6675:House of Representatives
6583:National Security Agency
6233:Contiguous United States
5717:Turks and Caicos Islands
5442:President Barack Obama,
4983:10.2105/AJPH.2008.157685
4895:Kaiser Family Foundation
4606:New York Review of Books
3793:August 24, 2006, at the
3353:– via NYTimes.com.
2581:– via NYTimes.com.
2341:. Cdc.gov. March 3, 2011
2026:Yuval Levin (May 2013).
1336:Kaiser Family Foundation
1323:Kaiser Family Foundation
1076:single-payer health care
1034:Health insurance mandate
325:United States portal
142:American Health Care Act
41:Healthcare reform in the
30:This article is part of
8244:Criticism of government
7589:Social welfare programs
7182:State-recognized tribes
6167:Outline of U.S. history
5879:Continental Association
4763:San Francisco Chronicle
4675:"What is Single Payer?"
4476:Pub. No. 2976, May 2008
4044:The Wall Street Journal
4005:Richard Burkhauser and
3725:Melinda Beeuwkes Buntin
3077:. CNN. October 12, 2009
2462:The Wall Street Journal
2318:The Wall Street Journal
1720:"Summary of Obama Plan"
1402:Senior Medicare Patrols
1212:Single-payer healthcare
488:In November 2009, then-
8306:Environmental movement
8149:Health insurance costs
8044:Educational attainment
7569:Federal Reserve System
7527:Science and technology
7030:Insurance commissioner
6568:Intelligence Community
6263:minor outlying islands
6026:Civil rights movement
5647:British Virgin Islands
5169:10.7591/j.ctt1h4mjdm.6
4866:10.1377/hlthaff.w5.289
4680:June 16, 2009, at the
4576:The trade association
3985:Uninsured Work Group,
3774:June 23, 2008, at the
2227:10.1186/1472-6963-5-20
2033:National Review Online
1869:March 4, 2016, at the
1223:Harvard Medical School
1114:On June 28, 2012, the
995:Address Medicare fraud
948:
934:
742:Market-based solutions
694:preventative screening
676:
636:
617:
560:
450:
438:
435:Gross domestic product
423:
408:
381:United States Congress
336:Health care portal
292:All-payer rate setting
247:Nationalized insurance
209:Reform advocacy groups
8132:Immigrant health care
7647:Transportation safety
7642:Transportation policy
7632:Public transportation
6702:President pro tempore
6558:Executive departments
6327:National Park Service
5982:Territorial evolution
5587:Saint Kitts and Nevis
5143:Third Wave Capitalism
4921:10.1377/hlthaff.w5.63
4913:Health Aff (Millwood)
4638:Health Aff (Millwood)
3188:on September 28, 2011
3096:Realclearpolitics.com
1732:on September 10, 2009
1657:– via CrossRef.
1647:10.1056/NEJMsb1205901
1535:. CNN. March 23, 2010
1487:. CNN. March 23, 2010
1430:Further information:
1314:Further information:
1206:Payment system reform
943:
932:
853:A 2004 report by the
755:(R) has proposed the
685:universal health care
679:Preventive strategies
671:
634:
612:
558:
459:Institute of Medicine
444:
429:
414:
402:
262:Canadian vs. American
154:Healthy Americans Act
8301:Environmental issues
7966:Political ideologies
7865:Indigenous languages
7065:List of legislatures
6862:separation of powers
6563:Independent agencies
6489:World Heritage Sites
6124:September 11 attacks
6047:Spanish–American War
5987:Mexican–American War
5943:Confederation period
5874:Continental Congress
5188:The Associated Press
4417:on February 27, 2012
4364:on November 22, 2009
3640:(October 14, 2009).
3182:"Physiciansnews.com"
2970:Realclearmarkets.com
2758:on February 16, 2012
2674:on December 19, 2011
1197:Treatment registries
1050:In October 2009 the
148:Medicare for All Act
8144:Health care finance
7637:Rail transportation
7403:Imperial presidency
7125:State constitutions
7070:List of legislators
7020:Auditor/Comptroller
6993:Lieutenant governor
6719:Library of Congress
6610:Diplomatic Security
6253:Indian reservations
5916:American Revolution
5602:Trinidad and Tobago
5497:Antigua and Barbuda
4806:on January 11, 2012
4553:"PNHP-Single Payer"
4507:. November 26, 2009
4170:on January 21, 2012
4063:Michael F. Cannon,
3889:. October 20, 2014.
3869:The Washington Post
3845:on January 26, 2021
3813:. November 18, 2009
3521:. November 19, 2009
3466:on December 3, 2011
3408:on October 11, 2011
3330:on January 23, 2013
3300:. September 6, 2009
3298:The Washington Post
2988:The Washington Post
2726:. February 12, 2010
2700:. February 12, 2010
2698:The Washington Post
2648:on January 30, 2010
2599:on January 27, 2012
2410:The Washington Post
2278:The Washington Post
2144:on December 2, 2011
2111:The Washington Post
1961:The Washington Post
1790:on January 11, 2012
1760:. September 9, 2009
1616:10.1787/8643de7e-en
1556:. May 26, 2017. By
1052:Wall Street Journal
893:The Washington Post
836:medical malpractice
173:Affordable Care Act
160:Health Security Act
8254:affirmative action
8227:Capital punishment
8186:Poverty and health
8181:Physician shortage
8154:Health care prices
8084:Standard of living
7767:standard of living
7574:Financial position
7201:Hawaiian home land
7189:Indian reservation
7162:Tribal sovereignty
7005:Secretary of state
6874:United States Code
6790:Territorial courts
6762:Associate Justices
6647:Inspector generals
6134:War in Afghanistan
5997:Reconstruction era
5864:Stamp Act Congress
5537:Dominican Republic
4532:The New York Times
4306:The New York Times
4280:The New York Times
4232:The New York Times
4098:The New York Times
4047:, October 10, 2009
3976:, November 1, 1995
3918:, October 25, 2009
3723:M. Susan Marquis,
3494:The New York Times
3260:on August 10, 2003
2905:The New York Times
2879:The New York Times
2436:The New York Times
2005:The New York Times
1944:on April 13, 2012.
1394:health care system
1116:U.S. Supreme Court
956:The New York Times
935:
637:
561:
483:insurance exchange
451:
439:
433:. Percent of GDP (
424:
409:
219:Insurance coverage
129:Baucus Health Bill
8429:
8428:
8389:
8388:
8385:
8384:
8355:National security
8064:Income inequality
7944:Statue of Liberty
7747:income inequality
7660:
7659:
7652:Trucking industry
7464:
7463:
7460:
7459:
7391:Foreign relations
7379:Electoral College
7360:
7359:
7148:
7147:
7100:District attorney
6947:
6946:
6774:Courts of appeals
6497:
6496:
6210:
6209:
6151:COVID-19 pandemic
6104:Feminist Movement
5950:American frontier
5869:Thirteen Colonies
5730:
5729:
5619:other territories
5194:on March 10, 2014
4977:(12): 2289–2295.
4832:on March 29, 2013
4599:By Paul Krugman,
4443:. August 20, 2009
4390:. August 16, 2009
4388:Los Angeles Times
4333:on March 19, 2012
4147:, August 22, 2009
3947:National Archives
3638:Beam, Christopher
3572:978-1-930865-89-1
3115:. August 26, 2009
2806:. August 16, 2009
2804:Los Angeles Times
2092:National Archives
1968:on March 12, 2016
1907:National Archives
1874:Commonwealth Fund
1816:on March 22, 2012
1770:National Archives
1706:National Archives
1562:Our World in Data
1473:. March 22, 2010.
1460:(March 22, 2010).
1458:Los Angeles Times
1327:Commonwealth Fund
1153:Peter G. Peterson
1122:Rationing of care
1065:adverse selection
1028:Coverage mandates
990:Government action
541:Commonwealth Fund
475:bundling payments
463:health care costs
370:
369:
150:(2021, H.R. 1976)
44:
8464:
8409:
8402:
8289:African American
8171:Health insurance
8059:Household income
7929:National symbols
7860:American English
7833:Federal holidays
7742:household income
7675:
7674:
7671:
7670:
7475:
7474:
7413:Anti-Americanism
7337:Special district
7264:Independent city
7233:County executive
7216:
7215:
7010:Attorney general
6969:
6968:
6958:Federal District
6541:Executive Office
6521:
6520:
6512:
6511:
6508:
6507:
6268:populated places
6248:federal enclaves
6243:federal district
6221:
6220:
6084:American Century
6067:Great Depression
6062:Roaring Twenties
6022:Women's suffrage
5901:Halifax Resolves
5894:Founding Fathers
5889:military history
5854:Pre-colonial era
5778:
5777:
5757:
5750:
5743:
5734:
5733:
5687:Saint Barthélemy
5617:Dependencies and
5490:Sovereign states
5478:
5471:
5464:
5455:
5454:
5354:
5353:
5351:
5349:
5337:
5331:
5326:
5320:
5315:
5309:
5308:
5306:
5304:
5288:
5282:
5281:
5279:
5277:
5262:
5256:
5255:
5253:
5251:
5245:Washington Times
5236:
5230:
5229:
5227:
5225:
5210:
5204:
5203:
5201:
5199:
5190:. Archived from
5179:
5173:
5172:
5138:
5129:
5128:
5102:
5093:
5092:
5086:
5082:
5080:
5072:
5046:
5040:
5039:
5032:
5026:
5011:
5005:
5004:
4994:
4960:
4954:
4947:
4941:
4940:
4904:
4898:
4897:, September 2008
4885:
4879:
4878:
4868:
4848:
4842:
4841:
4839:
4837:
4822:
4816:
4815:
4813:
4811:
4796:
4790:
4785:
4779:
4778:
4776:
4774:
4769:on March 6, 2010
4754:
4748:
4747:
4745:
4743:
4734:. Archived from
4726:WHO (May 2009).
4723:
4717:
4712:
4706:
4705:
4703:
4701:
4690:
4684:
4671:
4665:
4664:
4654:
4628:
4622:
4616:
4610:
4609:, March 23, 2006
4594:
4588:
4574:
4568:
4567:
4565:
4563:
4549:
4543:
4542:
4540:
4538:
4523:
4517:
4516:
4514:
4512:
4497:
4491:
4490:
4483:
4477:
4459:
4453:
4452:
4450:
4448:
4433:
4427:
4426:
4424:
4422:
4406:
4400:
4399:
4397:
4395:
4380:
4374:
4373:
4371:
4369:
4360:. Archived from
4349:
4343:
4342:
4340:
4338:
4323:
4317:
4316:
4314:
4312:
4297:
4291:
4290:
4288:
4286:
4271:
4265:
4264:
4262:
4260:
4249:
4243:
4242:
4240:
4238:
4223:
4217:
4216:
4214:
4212:
4200:
4194:
4193:
4187:
4179:
4177:
4175:
4169:
4163:. Archived from
4162:
4154:
4148:
4144:The Boston Globe
4136:
4125:
4124:, April 24, 2009
4121:The Boston Globe
4113:
4102:
4089:
4078:
4061:
4048:
4036:
4021:
4003:
3997:
3983:
3977:
3960:
3951:
3950:
3944:
3942:
3925:
3919:
3904:
3891:
3890:
3879:
3873:
3863:Carrie Johnson,
3861:
3855:
3854:
3852:
3850:
3844:
3838:. Archived from
3837:
3829:
3823:
3822:
3820:
3818:
3812:
3804:
3798:
3785:
3779:
3762:
3756:
3755:
3753:
3751:
3746:
3738:
3732:
3721:
3715:
3699:
3693:
3692:
3658:
3652:
3651:
3634:
3628:
3627:
3615:
3609:
3608:
3606:
3587:Glied, Sherry A.
3583:
3577:
3576:
3551:
3545:
3544:
3537:
3531:
3530:
3528:
3526:
3511:
3505:
3504:
3502:
3500:
3485:
3476:
3475:
3473:
3471:
3465:
3459:. Archived from
3458:
3450:
3444:
3443:
3441:
3439:
3424:
3418:
3417:
3415:
3413:
3404:. Archived from
3398:
3392:
3391:
3389:
3387:
3372:
3366:
3361:
3355:
3354:
3346:
3340:
3339:
3337:
3335:
3316:
3310:
3309:
3307:
3305:
3290:
3284:
3283:
3276:
3270:
3269:
3267:
3265:
3250:
3244:
3243:
3241:
3239:
3227:
3221:
3220:
3218:
3216:
3204:
3198:
3197:
3195:
3193:
3178:
3172:
3171:
3169:
3167:
3156:
3147:
3146:
3144:
3142:
3131:
3125:
3124:
3122:
3120:
3105:
3099:
3093:
3087:
3086:
3084:
3082:
3071:
3065:
3064:
3026:
3020:
3019:
3017:
3015:
3003:
2992:
2991:
2979:
2973:
2967:
2961:
2960:
2948:
2939:
2938:
2936:
2934:
2922:
2916:
2915:
2913:
2911:
2896:
2890:
2889:
2887:
2885:
2870:
2864:
2863:
2861:
2859:
2854:
2846:
2840:
2839:
2837:
2835:
2830:
2822:
2816:
2815:
2813:
2811:
2796:
2790:
2789:
2787:
2785:
2774:
2768:
2767:
2765:
2763:
2757:
2751:. Archived from
2750:
2742:
2736:
2735:
2733:
2731:
2716:
2710:
2709:
2707:
2705:
2690:
2684:
2683:
2681:
2679:
2664:
2658:
2657:
2655:
2653:
2638:
2632:
2631:
2629:
2627:
2615:
2609:
2608:
2606:
2604:
2589:
2583:
2582:
2574:
2565:
2564:
2557:
2551:
2550:
2540:
2530:
2506:
2500:
2499:
2497:
2495:
2490:on July 30, 2020
2479:
2473:
2472:
2470:
2468:
2453:
2447:
2446:
2444:
2442:
2427:
2421:
2420:
2418:
2416:
2401:
2395:
2394:
2392:
2390:
2379:
2373:
2372:
2370:
2368:
2357:
2351:
2350:
2348:
2346:
2335:
2329:
2328:
2326:
2324:
2309:
2303:
2302:
2300:
2298:
2287:
2281:
2271:
2265:
2256:
2250:
2249:
2239:
2229:
2205:
2199:
2183:
2177:
2176:
2174:
2172:
2160:
2154:
2153:
2151:
2149:
2143:
2137:. Archived from
2136:
2128:
2122:
2121:
2119:
2117:
2102:
2096:
2095:
2089:
2087:
2065:
2059:
2058:
2051:
2045:
2044:
2042:
2040:
2023:
2017:
2016:
2014:
2012:
1995:
1989:
1984:
1978:
1977:
1975:
1973:
1964:. Archived from
1952:
1946:
1945:
1940:. Archived from
1934:
1928:
1927:
1925:
1917:
1911:
1910:
1904:
1902:
1891:
1883:
1877:
1860:
1854:
1853:
1851:
1849:
1837:
1826:
1825:
1823:
1821:
1806:
1800:
1799:
1797:
1795:
1786:. Archived from
1780:
1774:
1773:
1767:
1765:
1748:
1742:
1741:
1739:
1737:
1731:
1725:. Archived from
1724:
1716:
1710:
1709:
1703:
1701:
1684:
1678:
1677:
1665:
1659:
1658:
1625:
1619:
1601:
1592:
1591:
1589:
1587:
1575:
1569:
1551:
1545:
1544:
1542:
1540:
1529:
1523:
1522:
1520:
1518:
1503:
1497:
1496:
1494:
1492:
1481:
1475:
1474:
1467:
1461:
1450:
1271:social insurance
1169:Charles Grassley
1096:the Boston Globe
1091:the Boston Globe
645:Peter A. Diamond
362:
355:
348:
334:
333:
332:
323:
322:
321:
40:
27:
26:
8472:
8471:
8467:
8466:
8465:
8463:
8462:
8461:
8447:2010s in health
8442:2000s in health
8432:
8431:
8430:
8425:
8412:
8405:
8398:
8381:
8367:Opioid epidemic
8284:Native American
8264:intersex rights
8215:
8211:Life expectancy
8201:Medical deserts
8191:Race and health
8088:
8074:Personal income
8020:
7924:National anthem
7757:personal income
7722:Economic issues
7656:
7608:
7456:
7356:
7345:School district
7331:
7314:Minor divisions
7308:
7247:
7205:
7144:
7130:Statutory codes
7111:
7074:
7051:
6961:
6956:
6943:
6878:
6835:civil liberties
6816:
6807:Other tribunals
6786:District courts
6738:
6697:current members
6680:current members
6661:
6595:Law enforcement
6493:
6206:
6155:
6146:Great Recession
6017:Progressive Era
6007:Native genocide
5938:Perpetual Union
5926:Treaty of Paris
5884:United Colonies
5842:
5767:
5761:
5731:
5726:
5620:
5618:
5611:
5485:
5482:
5362:
5357:
5347:
5345:
5338:
5334:
5327:
5323:
5316:
5312:
5302:
5300:
5297:Retirement Blog
5289:
5285:
5275:
5273:
5263:
5259:
5249:
5247:
5237:
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5223:
5221:
5211:
5207:
5197:
5195:
5180:
5176:
5161:
5139:
5132:
5117:
5109:. Pluto Books.
5103:
5096:
5084:
5083:
5074:
5073:
5061:
5047:
5043:
5034:
5033:
5029:
5012:
5008:
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4886:
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4835:
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4809:
4807:
4798:
4797:
4793:
4786:
4782:
4772:
4770:
4755:
4751:
4741:
4739:
4738:on May 25, 2009
4724:
4720:
4713:
4709:
4699:
4697:
4692:
4691:
4687:
4682:Wayback Machine
4672:
4668:
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4625:
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4595:
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4585:Wayback Machine
4575:
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4508:
4499:
4498:
4494:
4485:
4484:
4480:
4474:Wayback Machine
4460:
4456:
4446:
4444:
4437:"Economist.com"
4435:
4434:
4430:
4420:
4418:
4407:
4403:
4393:
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4381:
4377:
4367:
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4320:
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4308:
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4284:
4282:
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4268:
4258:
4256:
4255:. June 28, 2012
4251:
4250:
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4236:
4234:
4224:
4220:
4210:
4208:
4201:
4197:
4181:
4180:
4173:
4171:
4167:
4160:
4158:"Archived copy"
4156:
4155:
4151:
4137:
4128:
4115:Liz Kowalczyk,
4114:
4105:
4090:
4081:
4062:
4051:
4037:
4024:
4018:Wayback Machine
4004:
4000:
3984:
3980:
3974:Urban Institute
3971:Wayback Machine
3961:
3954:
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3938:
3926:
3922:
3905:
3894:
3881:
3880:
3876:
3872:, June 13, 2008
3862:
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3846:
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3795:Wayback Machine
3786:
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3776:Wayback Machine
3763:
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3749:
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3722:
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3709:Wayback Machine
3700:
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3287:
3278:
3277:
3273:
3263:
3261:
3252:
3251:
3247:
3237:
3235:
3234:. NewYorker.com
3232:"NewYorker.com"
3228:
3224:
3214:
3212:
3211:. NewYorker.com
3209:"NewYorker.com"
3205:
3201:
3191:
3189:
3180:
3179:
3175:
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3163:
3158:
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3094:
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3080:
3078:
3073:
3072:
3068:
3027:
3023:
3013:
3011:
3004:
2995:
2980:
2976:
2968:
2964:
2949:
2942:
2932:
2930:
2929:. Newyorker.com
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2296:
2294:
2289:
2288:
2284:
2280:, April 8, 2008
2272:
2268:
2257:
2253:
2206:
2202:
2194:Wayback Machine
2184:
2180:
2170:
2168:
2167:. Newyorker.com
2161:
2157:
2147:
2145:
2141:
2134:
2130:
2129:
2125:
2115:
2113:
2103:
2099:
2085:
2083:
2066:
2062:
2053:
2052:
2048:
2038:
2036:
2024:
2020:
2010:
2008:
1996:
1992:
1985:
1981:
1971:
1969:
1954:
1953:
1949:
1936:
1935:
1931:
1923:
1919:
1918:
1914:
1900:
1898:
1889:
1885:
1884:
1880:
1876:, December 2007
1871:Wayback Machine
1861:
1857:
1847:
1845:
1844:. Newyorker.com
1838:
1829:
1819:
1817:
1808:
1807:
1803:
1793:
1791:
1782:
1781:
1777:
1763:
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1750:
1749:
1745:
1735:
1733:
1729:
1722:
1718:
1717:
1713:
1699:
1697:
1696:. June 15, 2009
1686:
1685:
1681:
1666:
1662:
1641:(10): 949–954.
1626:
1622:
1602:
1595:
1585:
1583:
1576:
1572:
1552:
1548:
1538:
1536:
1531:
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1490:
1488:
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1478:
1469:
1468:
1464:
1451:
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1434:
1428:
1423:
1410:
1386:
1384:Waste and fraud
1373:
1318:
1312:
1259:
1253:
1244:
1214:
1208:
1199:
1186:
1181:
1145:David Leonhardt
1130:
1124:
1070:Writing in the
1041:Urban Institute
1036:
1030:
997:
992:
927:
888:
832:
804:
768:
749:
744:
735:
719:
681:
666:
640:Overutilization
629:
607:
602:
594:wage stagnation
553:
518:Cover everyone;
397:
366:
330:
328:
327:
319:
317:
312:
311:
302:Fee-for-service
287:
279:
278:
252:Publicly-funded
232:
224:
223:
194:
186:
185:
181:
69:
42:
23:
17:
12:
11:
5:
8470:
8460:
8459:
8454:
8449:
8444:
8427:
8426:
8424:
8423:
8418:
8411:
8410:
8403:
8395:
8394:
8391:
8390:
8387:
8386:
8383:
8382:
8380:
8379:
8374:
8369:
8364:
8363:
8362:
8352:
8351:
8350:
8340:
8335:
8330:
8325:
8323:Mass shootings
8320:
8315:
8314:
8313:
8311:Climate change
8308:
8298:
8293:
8292:
8291:
8286:
8281:
8276:
8271:
8266:
8261:
8256:
8249:Discrimination
8246:
8241:
8240:
8239:
8229:
8223:
8221:
8217:
8216:
8214:
8213:
8208:
8203:
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8119:
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8098:
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8089:
8087:
8086:
8081:
8076:
8071:
8066:
8061:
8056:
8051:
8046:
8041:
8039:American Dream
8036:
8030:
8028:
8022:
8021:
8019:
8018:
8013:
8008:
8006:Transportation
8003:
7998:
7993:
7988:
7983:
7978:
7973:
7968:
7963:
7958:
7953:
7952:
7951:
7946:
7941:
7939:Mount Rushmore
7936:
7926:
7921:
7916:
7911:
7910:
7909:
7904:
7899:
7894:
7889:
7879:
7874:
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7867:
7862:
7852:
7847:
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7649:
7644:
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7609:
7607:
7606:
7601:
7596:
7591:
7586:
7581:
7576:
7571:
7566:
7561:
7559:Federal budget
7556:
7551:
7546:
7545:
7544:
7539:
7534:
7529:
7524:
7519:
7514:
7509:
7504:
7499:
7497:Communications
7494:
7489:
7478:
7472:
7466:
7465:
7462:
7461:
7458:
7457:
7455:
7454:
7449:
7448:
7447:
7442:
7437:
7427:
7426:
7425:
7420:
7418:exceptionalism
7415:
7405:
7400:
7399:
7398:
7396:foreign policy
7388:
7387:
7386:
7381:
7371:
7365:
7362:
7361:
7358:
7357:
7355:
7354:
7353:
7352:
7341:
7339:
7333:
7332:
7330:
7329:
7324:
7318:
7316:
7310:
7309:
7307:
7306:
7301:
7296:
7291:
7286:
7281:
7276:
7271:
7266:
7261:
7255:
7253:
7249:
7248:
7246:
7245:
7240:
7235:
7230:
7224:
7222:
7213:
7207:
7206:
7204:
7203:
7198:
7197:
7196:
7186:
7185:
7184:
7179:
7174:
7164:
7158:
7156:
7150:
7149:
7146:
7145:
7143:
7142:
7137:
7132:
7127:
7121:
7119:
7113:
7112:
7110:
7109:
7108:
7107:
7097:
7096:
7095:
7093:Chief justices
7088:Supreme courts
7084:
7082:
7076:
7075:
7073:
7072:
7067:
7061:
7059:
7053:
7052:
7050:
7049:
7048:
7047:
7037:
7032:
7027:
7022:
7017:
7012:
7007:
7002:
7001:
7000:
6990:
6989:
6988:
6977:
6975:
6966:
6949:
6948:
6945:
6944:
6942:
6941:
6936:
6931:
6930:
6929:
6927:National Guard
6924:
6919:
6914:
6909:
6904:
6899:
6888:
6886:
6880:
6879:
6877:
6876:
6871:
6870:
6869:
6864:
6859:
6854:
6844:
6839:
6838:
6837:
6830:Bill of Rights
6826:
6824:
6818:
6817:
6815:
6814:
6809:
6804:
6803:
6802:
6800:list of judges
6797:
6795:list of courts
6783:
6782:
6781:
6779:list of judges
6771:
6770:
6769:
6764:
6759:
6748:
6746:
6740:
6739:
6737:
6736:
6731:
6726:
6721:
6716:
6714:Capitol Police
6711:
6710:
6709:
6704:
6699:
6689:
6688:
6687:
6682:
6671:
6669:
6663:
6662:
6660:
6659:
6654:
6649:
6644:
6643:
6642:
6637:
6635:Secret Service
6632:
6627:
6622:
6617:
6612:
6607:
6602:
6592:
6591:
6590:
6585:
6580:
6575:
6565:
6560:
6555:
6550:
6548:Vice President
6545:
6544:
6543:
6538:
6527:
6525:
6518:
6505:
6499:
6498:
6495:
6494:
6492:
6491:
6486:
6481:
6476:
6475:
6474:
6469:
6464:
6459:
6454:
6449:
6444:
6439:
6428:
6427:
6426:
6421:
6416:
6411:
6406:
6401:
6396:
6391:
6386:
6381:
6376:
6371:
6366:
6361:
6356:
6351:
6346:
6336:
6335:
6334:
6332:National Parks
6324:
6323:
6322:
6317:
6312:
6307:
6302:
6292:
6287:
6285:Extreme points
6282:
6277:
6276:
6275:
6270:
6265:
6260:
6255:
6250:
6245:
6240:
6235:
6224:
6218:
6212:
6211:
6208:
6207:
6205:
6204:
6199:
6194:
6189:
6184:
6179:
6174:
6169:
6163:
6161:
6157:
6156:
6154:
6153:
6148:
6143:
6142:
6141:
6136:
6126:
6121:
6116:
6111:
6106:
6101:
6096:
6091:
6086:
6081:
6080:
6079:
6069:
6064:
6059:
6054:
6049:
6044:
6043:
6042:
6037:
6032:
6024:
6019:
6014:
6009:
6004:
5999:
5994:
5989:
5984:
5979:
5974:
5972:Federalist Era
5969:
5968:
5967:
5965:Bill of Rights
5962:
5952:
5947:
5946:
5945:
5940:
5930:
5929:
5928:
5923:
5913:
5908:
5906:Lee Resolution
5903:
5898:
5897:
5896:
5891:
5886:
5881:
5876:
5871:
5866:
5856:
5850:
5848:
5844:
5843:
5841:
5840:
5835:
5830:
5825:
5820:
5815:
5810:
5805:
5800:
5795:
5790:
5784:
5782:
5775:
5769:
5768:
5766: articles
5760:
5759:
5752:
5745:
5737:
5728:
5727:
5725:
5724:
5719:
5714:
5709:
5707:Sint Eustatius
5704:
5699:
5694:
5689:
5684:
5679:
5674:
5669:
5664:
5659:
5654:
5652:Cayman Islands
5649:
5644:
5639:
5634:
5629:
5623:
5621:
5616:
5613:
5612:
5610:
5609:
5604:
5599:
5594:
5589:
5584:
5579:
5574:
5569:
5564:
5559:
5554:
5549:
5544:
5539:
5534:
5529:
5524:
5519:
5514:
5509:
5504:
5499:
5493:
5491:
5487:
5486:
5481:
5480:
5473:
5466:
5458:
5452:
5451:
5446:
5440:
5436:Health Affairs
5428:
5424:Health Affairs
5416:
5412:Health Affairs
5404:
5400:Health Affairs
5392:
5387:
5382:
5377:
5368:
5361:
5360:External links
5358:
5356:
5355:
5332:
5321:
5310:
5283:
5271:New York Times
5257:
5231:
5205:
5174:
5159:
5130:
5115:
5094:
5085:|journal=
5059:
5041:
5027:
5023:Monthly Review
5006:
4955:
4949:Todd Zywicki,
4942:
4899:
4880:
4843:
4817:
4791:
4780:
4749:
4718:
4707:
4685:
4666:
4645:(6): 1629–39.
4623:
4611:
4589:
4569:
4544:
4518:
4492:
4478:
4454:
4428:
4411:"Politico.com"
4401:
4375:
4344:
4318:
4292:
4266:
4244:
4218:
4195:
4149:
4126:
4103:
4101:, June 4, 2009
4079:
4071:Cato Institute
4049:
4022:
3998:
3978:
3952:
3935:whitehouse.gov
3920:
3906:Ira Rosen and
3892:
3874:
3856:
3824:
3799:
3780:
3757:
3733:
3716:
3694:
3675:(1): 174–181.
3668:Health Affairs
3653:
3629:
3624:New York Times
3610:
3604:10.3386/w13881
3589:(March 2008).
3578:
3571:
3563:Cato Institute
3546:
3532:
3506:
3477:
3445:
3419:
3393:
3382:. July 3, 2009
3367:
3356:
3341:
3311:
3285:
3271:
3245:
3222:
3199:
3173:
3148:
3137:. Medscape.com
3135:"Medscape.com"
3126:
3100:
3088:
3066:
3039:(4): 374–377.
3021:
2993:
2974:
2962:
2940:
2917:
2891:
2865:
2841:
2817:
2791:
2769:
2737:
2711:
2685:
2659:
2633:
2610:
2584:
2566:
2552:
2501:
2474:
2448:
2422:
2396:
2374:
2352:
2330:
2304:
2282:
2266:
2263:New York Times
2251:
2200:
2178:
2155:
2123:
2097:
2060:
2046:
2018:
1990:
1979:
1947:
1929:
1912:
1895:whitehouse.gov
1878:
1855:
1827:
1801:
1775:
1757:whitehouse.gov
1743:
1711:
1693:whitehouse.gov
1679:
1660:
1620:
1593:
1570:
1546:
1524:
1498:
1476:
1462:
1444:
1442:
1439:
1427:
1424:
1422:
1419:
1409:
1406:
1390:Donald Berwick
1385:
1382:
1371:Uninsured rate
1369:
1352:Health Affairs
1331:Health Affairs
1311:
1308:
1287:Warren Buffett
1267:underinsurance
1255:Main article:
1252:
1249:
1243:
1240:
1210:Main article:
1207:
1204:
1198:
1195:
1185:
1182:
1180:
1177:
1126:Main article:
1123:
1120:
1089:In April 2009
1072:New York Times
1060:Cato Institute
1032:Main article:
1029:
1026:
996:
993:
991:
988:
978:Health Affairs
926:
923:
887:
884:
875:George W. Bush
831:
828:
815:
814:
811:
803:
800:
767:
764:
748:
745:
743:
740:
734:
731:
724:New York Times
718:
715:
680:
677:
665:
664:Pilot programs
662:
628:
625:
621:David Ignatius
606:
603:
601:
600:Best practices
598:
590:
589:
586:
583:
580:
552:
549:
528:The New Yorker
523:
522:
519:
516:
513:
396:
393:
368:
367:
365:
364:
357:
350:
342:
339:
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314:
313:
310:
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307:Global payment
304:
299:
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285:
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206:
204:Public opinion
201:
195:
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188:
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184:
183:
176:
169:
168:
167:Latest enacted
164:
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145:
138:
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126:
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108:
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55:
47:
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36:
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15:
9:
6:
4:
3:
2:
8469:
8458:
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8453:
8450:
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8440:
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8422:
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8408:
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8326:
8324:
8321:
8319:
8316:
8312:
8309:
8307:
8304:
8303:
8302:
8299:
8297:
8296:Energy policy
8294:
8290:
8287:
8285:
8282:
8280:
8277:
8275:
8272:
8270:
8267:
8265:
8262:
8260:
8257:
8255:
8252:
8251:
8250:
8247:
8245:
8242:
8238:
8237:incarceration
8235:
8234:
8233:
8230:
8228:
8225:
8224:
8222:
8218:
8212:
8209:
8207:
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8199:
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8147:
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8142:
8138:
8135:
8133:
8130:
8128:
8125:
8123:
8122:Prenatal care
8120:
8118:
8117:Birth control
8115:
8113:
8110:
8109:
8108:
8105:
8103:
8100:
8099:
8097:
8095:
8091:
8085:
8082:
8080:
8077:
8075:
8072:
8070:
8067:
8065:
8062:
8060:
8057:
8055:
8054:Homeownership
8052:
8050:
8047:
8045:
8042:
8040:
8037:
8035:
8032:
8031:
8029:
8027:
8023:
8017:
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7999:
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7989:
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7908:
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7848:
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7838:
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7814:
7813:
7812:
7809:
7807:
7804:
7802:
7799:
7795:
7792:
7790:
7787:
7786:
7785:
7782:
7778:
7777:working class
7775:
7773:
7770:
7768:
7765:
7763:
7760:
7758:
7755:
7753:
7750:
7748:
7745:
7743:
7740:
7738:
7737:homeownership
7735:
7733:
7730:
7728:
7725:
7724:
7723:
7720:
7718:
7715:
7713:
7710:
7708:
7705:
7703:
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7648:
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7538:
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7530:
7528:
7525:
7523:
7520:
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7517:Manufacturing
7515:
7513:
7510:
7508:
7505:
7503:
7500:
7498:
7495:
7493:
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7488:
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7484:
7483:
7480:
7479:
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7471:
7467:
7453:
7450:
7446:
7445:Third parties
7443:
7441:
7438:
7436:
7433:
7432:
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7428:
7424:
7421:
7419:
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7414:
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7409:
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6853:
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6843:
6840:
6836:
6833:
6832:
6831:
6828:
6827:
6825:
6823:
6819:
6813:
6812:U.S. attorney
6810:
6808:
6805:
6801:
6798:
6796:
6793:
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6791:
6787:
6784:
6780:
6777:
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6772:
6768:
6765:
6763:
6760:
6758:
6757:Chief Justice
6755:
6754:
6753:
6752:Supreme Court
6750:
6749:
6747:
6745:
6741:
6735:
6732:
6730:
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6686:
6683:
6681:
6678:
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6672:
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6658:
6657:Public policy
6655:
6653:
6652:Civil service
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6641:
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6345:
6342:
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6340:
6337:
6333:
6330:
6329:
6328:
6325:
6321:
6320:Sierra Nevada
6318:
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6313:
6311:
6308:
6306:
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6301:
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6297:
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6293:
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6286:
6283:
6281:
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6274:
6271:
6269:
6266:
6264:
6261:
6259:
6258:insular zones
6256:
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6140:
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6131:
6130:
6129:War on Terror
6127:
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6120:
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6115:
6112:
6110:
6109:LGBT Movement
6107:
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5783:
5779:
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5774:
5770:
5765:
5764:United States
5758:
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5608:
5607:United States
5605:
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5459:
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5447:
5445:
5441:
5438:
5437:
5433:
5430:Susan Jaffe,
5429:
5426:
5425:
5421:
5418:Susan Jaffe,
5417:
5414:
5413:
5409:
5406:Susan Jaffe,
5405:
5402:
5401:
5397:
5394:Mark Merlis,
5393:
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5219:Politicus USA
5216:
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5160:9781501702310
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4836:September 13,
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4441:The Economist
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4228:"Nytimes.com"
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4205:"Nytimes.com"
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4091:The Editors,
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3582:
3574:
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3564:
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3556:
3555:Kling, Arnold
3550:
3542:
3536:
3520:
3519:The Economist
3516:
3510:
3495:
3491:
3484:
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3255:
3254:"CBSNews.com"
3249:
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3203:
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3177:
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3110:
3109:"YouTube.com"
3104:
3097:
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2362:
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2340:
2334:
2319:
2315:
2308:
2292:
2286:
2279:
2276:
2273:David Brown,
2270:
2264:
2261:
2255:
2247:
2243:
2238:
2233:
2228:
2223:
2219:
2215:
2211:
2204:
2198:
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2188:
2182:
2166:
2159:
2140:
2133:
2127:
2112:
2108:
2101:
2093:
2081:
2077:
2076:
2071:
2064:
2056:
2050:
2035:
2034:
2029:
2022:
2007:
2006:
2001:
1994:
1988:
1983:
1967:
1963:
1962:
1957:
1951:
1943:
1939:
1933:
1922:
1916:
1908:
1897:
1896:
1888:
1882:
1875:
1872:
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1600:
1598:
1586:September 11,
1581:
1574:
1567:
1563:
1559:
1555:
1550:
1534:
1528:
1513:
1509:
1502:
1486:
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1418:
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1405:
1403:
1397:
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1374:
1372:
1367:
1365:
1359:
1355:
1353:
1349:
1345:
1341:
1337:
1332:
1329:published in
1328:
1324:
1317:
1307:
1304:
1300:
1295:
1290:
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1276:
1272:
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1237:
1231:
1228:
1224:
1218:
1213:
1203:
1194:
1191:
1176:
1174:
1173:The Economist
1170:
1166:
1165:Newt Gingrich
1161:
1157:
1154:
1149:
1146:
1142:
1138:
1135:
1129:
1119:
1117:
1112:
1109:
1104:
1102:
1097:
1092:
1087:
1085:
1081:
1080:Marcia Angell
1077:
1073:
1068:
1066:
1061:
1056:
1053:
1048:
1044:
1042:
1035:
1025:
1023:
1018:
1015:
1009:
1006:
1002:
987:
983:
980:
979:
974:
969:
965:
963:
962:The Economist
958:
957:
952:
947:
942:
940:
931:
922:
919:
918:
913:
909:
905:
901:
897:
895:
894:
883:
879:
876:
871:
867:
864:
859:
856:
851:
848:
843:
841:
837:
827:
823:
819:
812:
809:
808:
807:
799:
796:
791:
788:
783:
780:
776:
771:
763:
760:
758:
754:
739:
730:
727:
725:
714:
710:
708:
703:
698:
695:
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686:
675:
670:
661:
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654:
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646:
641:
633:
624:
622:
616:
611:
597:
595:
587:
584:
581:
578:
577:
576:
573:
569:
565:
557:
551:Cost overview
548:
545:
542:
537:
534:
530:
529:
520:
517:
514:
511:
510:
509:
506:
502:
500:
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448:
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401:
392:
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382:
377:
375:
363:
358:
356:
351:
349:
344:
343:
341:
340:
337:
326:
316:
315:
308:
305:
303:
300:
298:
295:
293:
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283:
282:
275:
272:
270:
267:
263:
260:
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238:
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228:
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210:
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197:
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190:
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180:
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174:
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166:
165:
161:
158:
155:
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149:
146:
143:
140:
139:
135:
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130:
127:
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118:
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110:
109:
105:
102:
99:
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90:
87:
84:
83:
80:
77:
76:
72:
71:
65:
64:
59:
56:
54:
51:
50:
49:
48:
45:
43:United States
38:
37:
33:
29:
28:
25:
22:
8338:Human rights
8318:Gun politics
8269:Islamophobia
8259:antisemitism
8127:Hospice care
8069:Middle class
8049:Homelessness
8026:Social class
7986:Social class
7850:Human rights
7840:Homelessness
7752:middle class
7717:Demographics
7692:Architecture
7599:Unemployment
7579:Labor unions
7327:Town meeting
7304:City council
7299:City manager
7040:State police
6902:Marine Corps
6892:Armed Forces
6867:civil rights
6847:Constitution
6419:Southwestern
6414:Southeastern
6404:Northwestern
6399:Northeastern
6364:Mid-Atlantic
6354:Great Plains
6072:World War II
5955:Constitution
5859:Colonial era
5838:2008–present
5712:Sint Maarten
5692:Saint Martin
5434:
5422:
5410:
5398:
5346:. Retrieved
5335:
5324:
5313:
5303:November 28,
5301:. Retrieved
5296:
5286:
5276:December 20,
5274:. Retrieved
5270:
5260:
5248:. Retrieved
5244:
5234:
5222:. Retrieved
5218:
5208:
5196:. Retrieved
5192:the original
5187:
5177:
5142:
5125:j.ctt183p79j
5106:
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5014:
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4902:
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4883:
4856:
4846:
4834:. Retrieved
4830:the original
4820:
4808:. Retrieved
4804:the original
4794:
4783:
4771:. Retrieved
4767:the original
4762:
4752:
4740:. Retrieved
4736:the original
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4688:
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4636:
4626:
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4604:
4592:
4572:
4560:. Retrieved
4547:
4535:. Retrieved
4531:
4521:
4509:. Retrieved
4504:
4495:
4481:
4457:
4445:. Retrieved
4440:
4431:
4419:. Retrieved
4415:the original
4404:
4392:. Retrieved
4387:
4378:
4366:. Retrieved
4362:the original
4357:
4347:
4335:. Retrieved
4331:the original
4321:
4309:. Retrieved
4305:
4295:
4283:. Retrieved
4279:
4269:
4257:. Retrieved
4247:
4235:. Retrieved
4231:
4221:
4209:. Retrieved
4198:
4172:. Retrieved
4165:the original
4152:
4142:
4119:
4096:
4075:Detroit News
4065:
4042:
4007:Kosali Simon
4001:
3989:
3981:
3945:– via
3939:. Retrieved
3933:
3923:
3886:
3877:
3867:
3859:
3849:November 14,
3847:. Retrieved
3840:the original
3827:
3817:November 18,
3815:. Retrieved
3802:
3783:
3760:
3750:November 13,
3748:. Retrieved
3736:
3719:
3697:
3672:
3666:
3656:
3645:
3632:
3623:
3613:
3594:
3581:
3558:
3549:
3535:
3523:. Retrieved
3518:
3509:
3497:. Retrieved
3493:
3468:. Retrieved
3461:the original
3448:
3436:. Retrieved
3432:
3422:
3412:November 11,
3410:. Retrieved
3406:the original
3396:
3384:. Retrieved
3379:
3370:
3359:
3344:
3332:. Retrieved
3328:the original
3323:
3314:
3302:. Retrieved
3297:
3288:
3274:
3262:. Retrieved
3258:the original
3248:
3236:. Retrieved
3225:
3213:. Retrieved
3202:
3190:. Retrieved
3186:the original
3176:
3164:. Retrieved
3139:. Retrieved
3129:
3117:. Retrieved
3112:
3103:
3091:
3079:. Retrieved
3069:
3036:
3030:
3024:
3012:. Retrieved
2987:
2977:
2965:
2957:The Atlantic
2956:
2931:. Retrieved
2920:
2908:. Retrieved
2904:
2894:
2882:. Retrieved
2878:
2868:
2856:. Retrieved
2844:
2832:. Retrieved
2820:
2808:. Retrieved
2803:
2794:
2782:. Retrieved
2772:
2760:. Retrieved
2753:the original
2740:
2728:. Retrieved
2723:
2714:
2702:. Retrieved
2697:
2688:
2676:. Retrieved
2672:the original
2662:
2650:. Retrieved
2646:the original
2636:
2624:. Retrieved
2613:
2601:. Retrieved
2597:the original
2587:
2555:
2518:
2514:
2504:
2492:. Retrieved
2488:the original
2477:
2465:. Retrieved
2461:
2451:
2439:. Retrieved
2435:
2425:
2413:. Retrieved
2409:
2399:
2387:. Retrieved
2377:
2365:. Retrieved
2355:
2343:. Retrieved
2333:
2321:. Retrieved
2317:
2307:
2295:. Retrieved
2285:
2269:
2262:
2254:
2217:
2213:
2203:
2196:
2181:
2169:. Retrieved
2158:
2146:. Retrieved
2139:the original
2126:
2114:. Retrieved
2110:
2100:
2090:– via
2084:. Retrieved
2073:
2063:
2049:
2037:. Retrieved
2031:
2021:
2009:. Retrieved
2003:
1993:
1982:
1970:. Retrieved
1966:the original
1959:
1950:
1942:the original
1932:
1915:
1905:– via
1899:. Retrieved
1893:
1881:
1858:
1846:. Retrieved
1818:. Retrieved
1814:the original
1804:
1792:. Retrieved
1788:the original
1778:
1768:– via
1762:. Retrieved
1755:
1746:
1734:. Retrieved
1727:the original
1714:
1704:– via
1698:. Retrieved
1691:
1682:
1674:The Atlantic
1673:
1663:
1638:
1634:
1623:
1584:. Retrieved
1573:
1549:
1537:. Retrieved
1527:
1515:. Retrieved
1511:
1501:
1489:. Retrieved
1479:
1465:
1457:
1448:
1435:
1421:Other topics
1413:
1411:
1398:
1387:
1375:
1370:
1368:
1360:
1356:
1351:
1319:
1294:Baby Boomers
1291:
1285:billionaire
1283:
1260:
1245:
1232:
1219:
1215:
1200:
1187:
1172:
1162:
1158:
1150:
1141:Peter Singer
1139:
1134:Barack Obama
1131:
1113:
1105:
1088:
1069:
1057:
1049:
1045:
1037:
1019:
1010:
998:
984:
976:
970:
966:
954:
951:Peter Singer
949:
944:
936:
915:
914:
910:
906:
902:
898:
891:
889:
880:
872:
868:
860:
852:
844:
833:
824:
820:
816:
805:
795:Paul Krugman
792:
784:
772:
769:
761:
756:
750:
736:
728:
723:
720:
711:
699:
682:
672:
667:
657:Peter Orszag
638:
618:
613:
608:
591:
574:
570:
566:
562:
546:
538:
533:Atul Gawande
526:
524:
503:
494:Peter Orszag
487:
479:
471:Barack Obama
468:
456:
452:
447:PPP-adjusted
389:Barack Obama
378:
373:
371:
257:Single-payer
198:
156:(2007, 2009)
24:
8343:Immigration
8274:LGBT rights
8176:Food safety
8011:Video games
7604:Wall Street
7584:Public debt
7487:Agriculture
7423:nationalism
7135:Uniform act
7057:Legislative
6964:Territorial
6922:Coast Guard
6917:Space Force
6667:Legislative
6462:Red (South)
6452:Mississippi
6374:New England
6310:Appalachian
6280:Earthquakes
6177:Discoveries
6172:Demographic
6114:Vietnam War
6057:World War I
6052:Imperialism
6002:Indian Wars
5977:War of 1812
5682:Puerto Rico
5592:Saint Lucia
5542:El Salvador
5348:January 12,
5344:. Bloomberg
4810:January 12,
4700:January 12,
4601:Robin Wells
4562:January 12,
4537:January 12,
4511:January 12,
4447:January 12,
4421:January 12,
4394:January 12,
4368:January 12,
4337:January 12,
4311:January 12,
4285:January 12,
4237:January 12,
4211:January 12,
4174:November 6,
4138:Kay Lazar,
3996:, July 2008
3990:Issue Brief
3941:January 12,
3887:www.cbo.gov
3525:January 12,
3499:January 12,
3470:January 12,
3438:January 12,
3386:January 12,
3334:January 12,
3264:January 12,
3238:January 12,
3215:January 12,
3192:January 12,
3166:January 12,
3141:January 12,
3119:January 12,
3081:January 12,
3014:January 12,
3010:. Bloomberg
2933:January 12,
2910:January 12,
2884:January 12,
2858:January 12,
2834:January 12,
2810:January 12,
2784:January 12,
2762:January 12,
2730:January 12,
2704:January 12,
2678:January 12,
2652:January 12,
2626:January 12,
2622:. Bloomberg
2603:January 12,
2494:January 12,
2467:January 12,
2441:January 12,
2415:January 12,
2389:January 12,
2367:January 12,
2363:. Webmd.com
2345:January 12,
2323:January 12,
2297:January 12,
2171:January 12,
2148:January 12,
2116:January 12,
2086:January 12,
1901:January 12,
1848:January 12,
1820:January 12,
1794:January 12,
1764:January 12,
1736:January 12,
1700:January 12,
1539:January 12,
1517:January 12,
1491:January 12,
1014:Eric Holder
863:Howard Dean
847:malpractice
840:tort reform
525:Writing in
505:Mayo Clinic
237:Free market
182:(H.R. 4872)
175:(H.R. 3590)
162:(H.R. 3600)
125:(H.R. 3200)
119:(H.R. 3962)
68:Legislation
8436:Categories
8377:Xenophobia
8166:Disability
8107:Healthcare
8016:Visual art
7961:Philosophy
7907:television
7897:newspapers
7887:journalism
7877:Literature
7789:attainment
7440:Republican
7435:Democratic
7408:Ideologies
7369:Corruption
6934:NOAA Corps
6857:preemption
6852:federalism
6467:Rio Grande
6369:Midwestern
6349:West Coast
6344:East Coast
6187:Inventions
6099:Space Race
6094:Korean War
6077:home front
6012:Gilded Age
5677:Montserrat
5672:Martinique
5667:Guadeloupe
5522:Costa Rica
5299:. Bankrate
4696:. PNHP.org
4694:"PNHP.org"
2521:(2): e29.
1972:August 29,
1441:References
1251:Motivation
1132:President
925:Tax reform
793:Economist
690:stage four
531:, surgeon
297:Capitation
111:Superseded
19:See also:
8360:Terrorism
8137:Rationing
8034:Affluence
7981:Sexuality
7949:Uncle Sam
7855:Languages
7784:Education
7727:affluence
7687:Americana
7614:Transport
7512:Insurance
7502:Companies
7482:By sector
7374:Elections
7015:Treasurer
6973:Executive
6912:Air Force
6884:Uniformed
6707:President
6524:Executive
6295:Mountains
6228:Territory
6216:Geography
6040:1954–1968
6035:1896–1954
6030:1865–1896
5992:Civil War
5833:1991–2008
5828:1980–1991
5823:1964–1980
5818:1945–1964
5813:1917–1945
5808:1865–1917
5803:1849–1865
5798:1815–1849
5793:1789–1815
5788:1776–1789
5781:By period
5662:Greenland
5577:Nicaragua
5552:Guatemala
5250:March 10,
5224:March 10,
5198:March 10,
5087:ignored (
5077:cite book
4742:August 2,
3908:Joel Bach
3162:. CBO.gov
3160:"CBO.gov"
2385:. Cdc.gov
2220:(1): 20.
1558:Max Roser
1273:programs
1078:advocate
953:wrote in
753:Paul Ryan
655:Director
492:Director
274:Universal
214:Rationing
131:(S. 1796)
73:Preceding
8416:Category
8112:Abortion
7976:Religion
7934:Columbia
7892:internet
7828:Holidays
7823:Folklore
7794:literacy
7732:eviction
7622:Aviation
7594:Taxation
7549:Currency
7542:by state
7452:Scandals
7322:Township
7080:Judicial
6981:Governor
6744:Judicial
6630:Marshals
6503:Politics
6457:Missouri
6447:Columbia
6442:Colorado
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917:Newsweek
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