Free Markets, Free People

Health Care

A Closer Look At European Health Care

We continue to hear how wonderful it is as compared to the horrible US system.

But is it? One of the fundamental truths of any health care system is you have infinite demand meeting finite resources (beds, doctors, availability, etc). Whatever system a country has, that truth doesn’t change.

So, regardless of system, there is going to be some sort of rationing. It is unavoidable and inevitable.

Now add a desire to control and cut costs associated with the provision of health care to the mix (the promise of every one of these government systems). On the one side, as European nations have done, access to health care is expanded to include everyone. On the other hand, these same nations attempt to control health care costs.

The result? Very mixed. France is always held up as the exception to the rule that government health care can’t be both good and inexpensive. But a closer examination seems to indicate that it isn’t an exception at all:

A World Health Organization survey in 2000 found that France had the world’s best health system. But that has come at a high price; health budgets have been in the red since 1988.

In 1996, France introduced targets for health insurance spending. But a decade later, the deficit had doubled to 49 billion euros ($69 billion).

“I would warn Americans that once the government gets its nose into health care, it’s hard to stop the dangerous effects later,” said Valentin Petkantchin, of the Institut Economique Molinari in France. He said many private providers have been pushed out, forcing a dependence on an overstretched public system.

Why have private providers been “pushed out”? Because government has provided health care “cheaper” than do private providers (and obviously at a loss given the deficit). Notice I said “cheaper”. That doesn’t necessarily mean “better”.

And the same thing is being seen in other European health care systems which are considered “models” of government run health care:

Similar scenarios have been unfolding in the Netherlands and Switzerland, where everyone must buy health insurance.

“The minute you make health insurance mandatory, people start overusing it,” said Dr. Alphonse Crespo, an orthopedic surgeon and research director at Switzerland’s Institut Constant de Rebecque. “If I have a cold, I might go see a doctor because I am already paying a health insurance premium.”

Cost-cutting has also hit Switzerland. The numbers of beds have dropped, hospitals have merged, and specialist care has become harder to find. A 2007 survey found that in some hospitals in Geneva and Lausanne, the rates of medical mistakes had jumped by up to 40 percent. Long ranked among the world’s top four health systems, Switzerland dropped to 8th place in a Europe-wide survey last year.

Dr. Crespo’s point is simply an astute observation of human nature. If something doesn’t directly cost the user, why would the user ration the use of such a benefit?

The use, however, still costs someone or something. The doctor must be paid, the institution must be paid, etc. So in the end, the only way to control costs is to cut payments. Eventually, the incentives to enter the health care field become less attractive (unless you like long hours, overrun waiting rooms, minimal time with patients, being second-guessed by a bureaucracy and making much less than a private system allows for compensation) and there are fewer that enter the field. Hospital beds then drop, hospitals merge and there are fewer specialists available to serve the population as Switzerland is discovering.

And then there’s the lack of innovation to face.

Bureaucracies are slow to adopt new medical technologies. In Britain and Germany, even after new drugs are approved, access to them is complicated because independent agencies must decide if they are worth buying.

When the breast cancer drug Herceptin was proven to be effective in 1998, it was available almost immediately in the U.S. But it took another four years for the U.K. to start buying it for British breast cancer patients.

The promise that has been made in the US is health care reform will return the decision making to the doctor. But that’s simply a false promise given the priorities of the reform we’ve been promised. It is to cut cost and make care “affordable” to all. Somewhere is a bureaucracy in waiting which will decide what “affordable” means – and it won’t include your doctor.

So you can expect innovation to begin to slow. Why invest billions when a bureaucracy will decide whether or not it’s a medicine or treatment worth the cost. The same bureaucracy will also decide what it will pay for your innovation. Of course, if the innovator can’t recover the cost of development and make a profit as incentive toward more innovation, the probability exits the developer will simply stop such research.

“Government control of health care is not a panacea,” said Philip Stevens, of International Policy Network, a London think-tank. “The U.S. health system is a bit of a mess, but based on what’s happened in some countries in Europe, I’d be nervous about recommending more government involvement.”

Words of wisdom most likely to be ignored by our legislators here. And the unfortunate thing is it will not only destroy an excellent health care system here, but, given the level of government spending forecast, tank the rest of the economy as well.

~McQ

[HT: Carol D]

More Health Care Lies

I don’t use the “L” word very often but in this case it seems completely appropriate.

The question:

Would a government-run health plan upend the employer-based health insurance system used by 160 million Americans?

The Democrats claim the answer is ‘no’.

Here’s their rationalization:

Sens. Edward Kennedy, D-Mass., and Chris Dodd, D-Conn., say their plan would preserve employer-sponsored insurance coverage and create an affordable public option for those who need it.

“The … bill virtually eliminates the dropping of currently covered employees from employer-sponsored health plans,” Kennedy and Dodd said in a letter to members of the Health Committee, one of two Senate groups working on health reform.

The bill includes a “pay or play” provision that would require employers to provide adequate coverage for their workers or subsidize a system that will.

“Pay or play” would require companies to pay the government $750 per full-time worker per year ($375 for part-timers) if they don’t offer health coverage, or if they offer “qualified” coverage but pay less than 60% of workers’ premiums. Small businesses that employ fewer than 25 workers would be exempt.

The Congressional Budget Office, which analyzed the legislation, estimated that by 2019 the same number of workers would be covered by employer-based plans as would otherwise be the case under the current system.

“It tracks what we’re seeing in Massachusetts,” a senior Democratic aide on the Senate Health Committee said on a conference call with reporters.

I’ve put the lie in bold. Why is it a lie? Anyone out there have a $750 a year health care plan? Anyone? I don’t know of a plan for an individual that costs only $750. If there is, then there’d be no reason for any of this nonsense would there?

And Kennedy and Dodd (and the Democrats), the supposed “experts” on health care know that very well. This is pure disingenuousness on their part. This is a blatant attempt to launch a lie to get them past a very important sticking point in the public perception of the bill.

But the average – average – individual health care insurance cost in the US is almost $4,000. And then there’s the cost of administering it.

Hypothetical – you employ 100 people. Let’s say your company pays full health care coverage at the national average (for simplicity sake, assume they all have individual policies). You have two people who administer the coverage at $35,000 each. Your total cost each year to cover your employees is $470,000.

If you pay the federal government $750 per employee a year, your total cost is $75,000. But you can let the two people you’ve had administering your health care program go, saving $71,500 (includes -$1,500 for 2 less employees). Total cost of “pay or play” for you? $3,500 the first year ($73,500 vs. $470,000 every year afterward). In reality, however, it is a net savings of $466,500. You don’t have to be a very good businessman to figure out that one do you?

And remember – these figures only involve “individual” coverage. Family coverage is much more costly, but I see nothing from our two Senate experts which even addresses that. So obviously, the cost of the health care of 100 employees could be vastly more than my simplified example.

No wonder we see corporations coming out now to back this sort of a program. For the vast majority of them, $750 per employee is a huge savings not to mention getting them out of the health care provision and administration business. They’ll pay it gladly. If you like your doctor or your plan, tough beans. You’re going on the government plan. And, of course, the administration will be more than happy to blame your problem on “greedy corporations.”

When they do, just consider the lie and the incentive it provides and then lay the blame precisely where it belongs. Not that it will do you any good where it concerns your present doctor and plan.

Just another step along the road to single-payer brought to you by two lying Senators and backed by the CBO.

~McQ

Government Run Health Care – “Anecdotal” or Indicators of a Systemic Problem?

A couple of quick examples of real world problems with government run health care. South Africa:

KwaZulu-Natal health MEC Dr Sibongiseni Dhlomo has issued an ultimatum to striking doctors, calling on them to return to work on Friday or face the music.

Addressing the media in Durban on Friday, Dhlomo said notices had been sent to all hospitals calling on all striking doctors, dentists and pharmacists to resume their duties no later than 08:00.

The department was also preparing a court interdict to force the striking health professionals to end the strike, he said.

“We as the department of health are designated as an essential service provider and therefore find the action of these health professionals [is] disrupting service delivery and compromising patients’ lives,” said Dhlomo.

He said the department had been more than reasonable in dealing with the unprotected strike.

“This situation is untenable, we cannot continue to put the lives of our people in danger and the government will act,” he said.

Dhlomo said people had died due to the unavailability of doctors, although he was unable give the number of people who died as a result of the strike.

A recent example you’re probably more familiar with from Canada:

A critically ill premature baby is moved to a U.S hospital to get the treatment she couldn’t get in the system we’re told we should emulate. Cost-effective care? In Canada, as elsewhere, you get what you pay for.

Ava Isabella Stinson was born last Thursday at St. Joseph’s hospital in Hamilton, Ontario. Weighing only two pounds, she was born 13 weeks premature and needed some very special care. Unfortunately, there were no open neonatal intensive care beds for her at St. Joseph’s — or anywhere else in the entire province of Ontario, it seems.

Canada’s perfectly planned and cost-effective system had no room at the inn for Ava, who of necessity had to be sent across the border to a Buffalo, N.Y., hospital to suffer under our chaotic and costly system. She had no time to be put on a Canadian waiting list. She got the care she needed at an American hospital under a system President Obama has labeled “unsustainable.”

And this one:

In 2007, a Canadian woman gave birth to extremely rare identical quadruplets — Autumn, Brooke, Calissa and Dahlia Jepps. They were born in the United States to Canadian parents because there was again no space available at any Canadian neonatal care unit. All they had was a wing and a prayer.

The Jepps, a nurse and a respiratory technician flew from Calgary, a city of a million people, 325 miles to Benefit Hospital in Great Falls, Mont., a city of 56,000.

Great Falls was better equipped to handle their case than was Calgary? People like to dismiss these as “anecdotal”, but they continue to describe a system in which decisions have been made that end up endangering the lives of children. It is inevitable when the primary focus of “reform” is “lowering cost”.

Doctor’s strikes. Limited if not completely unavailable neo-natal care. The refusal of the system, based on cost concerns only, to provide certain care that places the lives of those on the margin in jeopardy.

Is that what we have to look forward too?

~McQ

[HT: Micaela S]

Busting Medicare’s “Low Overhead Advantage” Myth

One of the favorite arguments of the government health care crowd is the supposed Medicare low overhead argument – i.e. Medicare is more efficient than private insurance because its overhead is so much lower than private administrative costs.

It goes like this:

But the administration of Medicare is a miracle of low overhead and a model, despite all the fraud and abuse, of what government can do right. Three percent of Medicare’s premiums go for administrative costs. By contrast, 10 to 20 percent of private-insurance premiums go for administrative costs. Roll that figure around on your tongue. When you swallow and digest it, you’ll understand that any hope of significantly reducing health-care costs depends on a public option.

Right now, the Medicare average is 3% and private insurance averages 12%. But Tom Bevan points out, some of that difference is an apples and oranges comparison:

But here’s the catch: because Medicare is devoted to serving a population that is elderly, and therefore in need of greater levels of medical care, it generates significantly higher expenditures than private insurance plans, thus making administrative costs smaller as a percentage of total costs. This creates the appearance that Medicare is a model of administrative efficiency. What Jon Alter sees as a “miracle” is really just a statistical sleight of hand.

Furthermore, Book notes that private insurers have a number of additional expenditures which fall into the category of “administrative costs” (like state health insurance premium taxes of 2-4%, marketing costs, etc) that Medicare does not have, further inflating the apparent differences in cost.

However, when you make an apples to apples comparison, Medicare comes out much worse than private insurance:

But, as you might expect, when you compare administrative costs on a per-person basis, Medicare is dramatically less efficient than private insurance plans. As you can see here, between 2001-2005, Medicare’s administrative costs on a per-person basis were 24.8% higher, on average, than private insurers.

So, contrary to claims of Alter, Krugman, and President Obama, moving tens of millions of Americans into a government run health care option won’t generate any costs savings through lower administrative costs. Just the opposite.

Make sure you click through and check out the real Medicare administrative costs as compared to private industry.

Then there’s waste fraud and abuse. Did you happen to catch that little hand wave at “fraud and abuse” in the first quote touting Medicare’s efficiency? What, pray tell, is one of the primary jobs of an administive system? Would you imagine it to be the elimination of fraud and abuse – or said another way, to ensure that the company pays legitimate claims and avoids fraudulent and unnecessary payments?

How efficient is a system which is awash in both fraud and abuse? And, without profit, what incentive do they have to eliminate it?

John Stossel takes that part of the “Medicare efficiency” myth apart:

But there’s a bigger point – the connection between “low” administrative costs and staggeringly HIGH levels of fraud and waste. As Michael Cannon at the Cato Institute and Regina Herzlinger at Harvard Business School have pointed out, much of the 10 to 20 percent of private insurance administrative costs goes to preventing fraud. Private insurers, you see, care about whether or not they lose money. Medicare, with its unlimited claim on the public purse, does not. It’s only taxpayer money, after all.

The results are predictable, but breathtaking nonetheless: an estimated $68 billion (with a B) in outright Medicare fraud every year (About $3 billion in Miami-Dade county ALONE.) On top of that, according to well-respected Dartmouth researchers, roughly a third of Medicare’s total $400 billion annual spending goes to procedures which were medically unnecessary.

That’s, on average, 68 billion every year. Imagine a private insurance company surviving with loss figures like that. But as Stossel points out, without an incentive to eliminate fraud and abuse, it continues year after year after year, with politicians and Medicare administrators tut-tutting but never really doing anything about it.

That is the reality of Medicare’s efficiency. It is also the probable model any future health care insurance run by the government. Efficiency is an illusion brought about by a statistical sleight of hand and ignoring the systemic waste, fraud and abuse of Medicare.

~McQ

CBO, Entitlments, Health Care Reform and the Deficit

One more time into the breach. The CBO has issued a warning to Congress about entitlement spending. Again. Here’s a key paragraph:

Almost all of the projected growth in federal spending other than interest payments on the debt comes from growth in spending on the three largest entitlement programs–Medicare, Medicaid, and Social Security.

Most of you know that Medicare and Medicaid have an unfunded future liability of 36 trillion dollars. That’s about 3 times the annual total GDP of the US economy. And they are the very same type of “public option” program – i.e. government insurance – that the left says is so very necessary and crucial to real “health care reform”.

In other words, the left’s argument is that adding at least 47 million (presently uninsured), plus the possibility of adding 119 million who are shifted to the public option from private insurance (private insurance, btw, doesn’t have any effect on the deficit whatsoever since we, the private sector, are paying for it) will somehow make the deficit picture better?

I’m obviously missing something here.

With the public option, we’re adding a new entitlement (47 million who presently supposedly can’t afford insurance, meaning taxpayers will subsidize theirs). Assuming it is set up originally to be paid for by premiums, at some point, like Medicare and Medicaid, and every other government entitlement program I can think of, it will pay out more than it takes in. How can it not? It is a stated “non-profit” program and it will include subsidies. At some point, another revenue stream is going to be necessary as it burns through the premiums with its payouts.

Well, say the proponents of government involvement in your health care, we’re going to save money by doing preventive health care. Yes, preventive care is the key to lower costs because a healthier population is one which visits the doctor less. While that may seem to be at least partially true (you’d think a healthier population would, logically, visit the doctor less) the part that is apparently missed when touting this popular panacea is the cost of making the population healthier (and the fact that the assumption of less visits isn’t necessarily true) doesn’t cost less – it costs more:

If health care providers can prevent or delay conditions like heart disease and diabetes, the logic goes, the nation won’t have to pay for so many expensive hospital procedures.

The problem, as lawmakers are discovering to their frustration, is that the logic is wrong. Preventive care — at least the sort delivered by doctors — doesn’t save money, experts say. It costs money.

That’s old news to the analysts at the Congressional Budget Office, who have told senators on the Health, Education, Labor and Pensions Committee that it cannot score most preventive-care proposals as saving money.

So with that myth blown to hell, we’re now looking at a government plan which will add cost to the deficit by subsidizing the insurance of 47 million and (most likely) many more, plus a plan to use a more costly form of medicine as its primary means of giving care.

But, back to the entitlement report – or warning. The CBO says that unless entitlements are drastically reformed (that means Medicare, Medicaid and to a lesser extent, Social Security) we’re in deep deficit doodoo:

The most frightening findings in this report are the deficit and debt projections. In this year and next year, the yearly budget shortfall, or deficit, will be the largest post-war deficits on record–exceeding 11 percent of the economy or gross domestic product (GDP)–and by 2080 it will reach 17.8 percent of GDP.

The national debt, which is the sum of all past deficits, will escalate even faster. Since 1962, debt has averaged 36 percent of GDP, but it will reach 60 percent, nearly double the average, by next year and will exceed 100 percent of the economy by 2042. Put another way, in about 30 years, for every $1 each American citizen and business earns or produces, the government will be an equivalent $1 in debt. By 2083, debt figures will surpass an astounding 306 percent of GDP.

The report also finds high overall growth in the government as a share of the economy and of taxpayers’ wallets that provides an additional area of concern. While total government spending has hovered around 20 percent of the economy since the 1960s, it has jumped by a quarter to 25 percent in 2009 alone and will exceed 32 percent by 2083. Taxes, which have averaged at 18.3 percent of GDP, will reach unprecedented levels of 26 percent by 2083. Never in American history have spending and tax levels been that high.

Here’s the important point to be made – these projections do not include cap-and-trade or health care reform.

Got that? We’re looking at the “highest spending and tax levels” in our history without either of those huge tax and spend programs now being considered included in the numbers above. Total government spending, as a percent of GDP is now at an unprecedented 25%. And they’re trying to add more while this president, who is right in the middle of it, tells us we can’t keep this deficit spending up forever.

Fair warning.

~McQ

Axelrod Floats A Healthcare Middle Class Tax Trial Balloon

Over the years, one of the purposes the sunday news shows have come to serve is a venue from which to launch political trail balloons and see how well they float.

Some get shot down immediately. Some take flak but survive. And other sail right on through with very little notice. David Axelrod appeared on “This Week” with George Stephanopoulos and launched one concerning taxes and health care. Axelrod first said that Obama still believes taxing health benefits is not the way to pay for health care (although during the ABC informercial, he essentially said that if it happened, it would be a compromise (and obviously not a show stopper for him)).

Stephanopoulos pushed a little harder on funding through taxation:

I pressed Axelrod on whether Obama will draw a line in the sand and veto any bill that funds health care reform with tax hikes for people making under $250,000 a year — despite a pledge Barack Obama made during the 2008 presidential campaign not to raise taxes on the poor and middle-class.

“One of the problems we’ve had in this town is that people draw lines in the sand and they stop talking to each other. And you don’t get anything done. That’s not the way the president approaches us. He is very cognizant of protecting people — middle class people, hard-working people who are trying to get along in a very difficult economy. And he will continue to represent them in these talks,” Axelrod said.

“But they’re also dealing with punishing health care costs, and that’s something that we have to deal with.”

Classic. He could have simply said “we’re open to compromise and if that’s what it takes to pay for it, then yes, we’ll raise taxes on the middle class in a New York minute.”

But instead he had to do the “we’re here to protect the middle class, but …” and then tell us how they really weren’t there to protect them in this particular case.

So to those of you who believed Obama when he said that 95% of Americans won’t see their taxes raised by a single dime – well, that’s no longer necessarily the case – if you let this trial balloon float away unimpeded (not that it will matter really – if they pass health care it has to be paid for somehow and there is no possible way only the richest 5% are enough to pay for that boondoggle).

~McQ

Health Care – Plans To Exempt Unions, Tax Others

No “gold plated” care for you – unless you’re in a union.

Yes, friends, it’s payback time in the health care legislation world. Bloomberg reports:

The U.S. Senate proposal to impose taxes for the first time on “gold-plated” health plans may bypass generous employee benefits negotiated by unions.

Senate Finance Committee Chairman Max Baucus, the chief congressional advocate of taxing some employer-provided benefits to help pay for an overhaul of the U.S. health system, says any change should exempt perks secured in existing collective- bargaining agreements, which can be in place for as long as five years.

The exception, which could make the proposal more politically palatable to Democrats from heavily unionized states such as Michigan, is adding controversy to an already contentious debate. It would shield the 12.4 percent of American workers who belong to unions from being taxed while exposing some other middle-income workers to the levy.

This is how they manage to get at your health care plan. Baucus wants to tax any health care benefit that is more costly than those provided federal employees. Those costs are about $4,200 for individuals and $13,000 for families. The claim is they again want to go after the “rich” who have “gold plated” plans. And the example in the Bloomberg article is the $40,543 in health benefits paid to Lloyd Blankfein, chief executive of New York-based Goldman Sachs Group Inc., the fifth largest U.S. bank.

Of course that threshold will also affect people much lower on the financial totem pole than Lloyd Blankfein. For example:

It can also affect companies such as Henderson, Nevada- based Zappos.com, where workers’ $11 per hour pay is supplemented by employer-paid health insurance plans worth about $7,500.

So immediately you have an $11 an hour employee liable for $495 at 15% of the difference. But remember, your taxes won’t go up by a dime. Not a single dime.

Why the desire to exempt unions? Well it gets a favored constituency off their back, is a measure of payback for their support and union members can then enjoy their “gold plated” coverage while $11 an hour workers pay the freight. Don’t believe unions have gold plated coverage. Try this example:

Sandra Carter, a retired Pacific Bell Telephone Co. technician from Stockton, California, said her health benefits, worth about $12,000 per year, were negotiated by the Communications Workers of America. She is unmarried with no children, meaning her individual coverage exceeds benefits paid to federal workers by about $7,800. If that amount were taxed at the 15 percent marginal rate, she would owe $1,170.

“I can’t afford the taxes I pay now,” said Carter, who said she suffers from diabetes. “Why should I get taxed on a benefit that keeps me a functioning person?”

Gee Ms Carter, why should anyone? Why is it any business of the government to limit the coverage to $4,200 and tax the rest. Who is Max Baucus, or anyone, to arbitrarily set the insurance limit at $4,200 for individuals and $13,000 for families and punish those who have better plans through taxation?

I would guess, however, Ms Carter is fine with unions being exempted and also fine with others being taxed in her stead.

Most unions, of course, see themselves as the exceptions deserving of such exemptions:

Anna Burger, secretary-treasurer of the Service Employees International Union, said in an interview that workers have often traded salary increases for better benefits in agreements.

Taxes “shouldn’t be taken from the backs of workers who have bargained away wages and other things for their benefits over the years,” Burger said.

But it is ok if others who’ve negotiated the same sort of exchange privately get nailed, eh Ms Burger? It’s not the principle, it’s the exception which is important here apparently.

To their credit, some unions are actually standing on principle:

“Either way, we are against a tax on health-care benefits in whatever form it takes,” said Jacob Hay, spokesman for the Laborers’ International Union of North America. The union represents 500,000 workers, largely in the construction industry.

Special interest democracy – political payback – so blatant now that you don’t even have to wonder if it is being done. Democrats are shameless in their pursuit of it. If you’re in a favored group, your ship has come in.

~McQ

Questions and Observations #2

For new readers the title is that for which the shortened “QandO” stands. This is the second in a series of questions and observations.

  • In the “you can’t make this up” department, China will block the sale of Hummer for “environmental concerns”.  I guess that’s their nod to the rest of the world after flatly refusing cut CO2 emissions in the future.
  • Ezra Klein is suddenly for smaller government, specifically the elimination of the Agriculture Committee. Of course the only reason he’d like to see it given the deep 6 is because it has, in Klein’s opinion, badly weakened cap-and-trade by extracting “a truly mind-boggling array of tax breaks, exemptions, and straight subsidies”. I guess Klein would like to temporarily make government smaller to make it larger.
  • Yes, Michael Jackson is dead – but for heaven sake, do we have to devote every minute of the news day to running “Thriller” vid and spreading rumors about the possible cause of his death? Is this what “news” organizations have become?
  • Apparently we’re still stalking the North Korean ship enroute to either Singapore or Burma. For those who are waiting for us to confront it and board it, that’s not going to happen. The “tough” UN resolution only provides for boarding if the North Koreans agree. And, while we can demand that they then go to the nearest port for inspection, the North Koreans can refuse that as well. The plan, it seems, is to convince the refueling port the NoKos pull into to refuse to refuel the ship. Then, when the NoKo ship runs out of fuel, put it under tow and then inspect it. As I understand it – they can then inspect it legitimately. Amazing.
  • Waxman-Markey, aka cap-and-trade, survived an earlier test vote that moved the bill to the floor for a 5pm vote. As I recall the margin was 5 votes. It is a job destroyer in the middle of a recession. The Center for Data Analysis of the Heritage Foundation figures it will cost 50,000 jobs in the transportation equipment sector alone. Their data for other sectors is available here.
  • House liberals have staked out a bit of ground on the health care bill saying they will not vote for it if it doesn’t include a public option – period. That is actually good news as the public option does seem to be in trouble. Any bill showing up without it will most likely not get the 80 members of the Congressional Progressive Caucus to vote for it. Add in the Republicans and the Blue Dogs, and it may be in very serious trouble without just the sticker shock of 1 to 3 trillion dollars of cost.
  • Mark Sanford? He should resign. The affair is between he and his family. He should resign because he was derelict in his duty and he misappropriated government funds to pay for his trip to Argentina.  Kinda like Bill Clinton should have resigned, not for the affair, but for lying under oath to a grand jury and attempting to obstruct justice.

~McQ