If the public option has enough members the “negotiation” could be more like making an offer they can’t refuse. They can say, we’re paying Medicare plus 5. Sign up at that rate or you lose access to all our members. If the membership is high enough, providers will have to sign up.

That last if is a big if. It will take a fairly large chunk of members to constitute such a critical mass.

Where it will face particular difficulty is with large specialty practices that often represent a practical monopoly in many areas. If 80% of the cardiologists in an area are part of one group, they can dictate prices in any negotiation. That’s a big part of the reason why specialty costs are such a big driver of runaway health costs. (The other major factor is how RVRVU’s are set but that is a very complex subject.)

That is what happens when you get your software from Ned Flanders.

SG, where are you? We need you to get on the messaging here. Nobody liked the name public option, but robust public option is a whole lot worse. It sounds like a huffing politician ready to burst out of his suit.

Since Sg is not around, let me *** up the Option name for you.

From now on it shall be known as The Robust Scarlett Johansson Option.

Who could refuse to vote for that, or stand up for it, for that matter.

The Republicans, and their Robber Baron Patrons have looted the country, and shipped all the good blue collar jobs to China, so college graduates can either look for jobs in Government, or starve.

That is the reality of what the Republicans have wrought.

You’re being way too pesimistic, things change and we have to change with them especially when we are on an unsustainable path. It’s time to move into the 21st. Century and bring new fields of green technology into the forefront and any scientist who wants a job can get one in the environmental field right now and probably for years to come. It’s a good field for engineers as well.

I would stay away from financing however.

Makes no sense.

Its not that simple. And its not about getting rich. I wouldn’t advise someone to do it for the money in the first place.

To begin with we are talking here about the top 10% cohort, IQ 125+, etc. They could do a lot of things, and succeed at most of them. But these are the folks that make the wheels turn. (I was counting the staff the other day at the surgery clinic where my wife had outpatient surgery – one surgeon, three nurses, one lab tech, two front desk clerical folks. One surgeon clinic – at least 6 other direct jobs.)

Its a life trade-off – a number of years of fairly intense post-graduate education and training, with the prospect of making a probably OK (but to be determined by some future Congress) income, as what is to all intents and purposes a government employee. In the large, a projected environment where they have many fewer choices than today.

If you really have a vocation for it, fine. I think for most people its a combination of vocation, social status (and all the things that come with that), and materially better than average income. Probably not so different than the motivations for many to go to law school.

I may be being overly fey – been looking at too much macro economic data. But there is a huge, huge problem coming with paying for providing health care for boomers, and I suspect that the government is going to be under incredible pressure to constrain costs.