The US has the best health care in the world?

[Ivan Seeking]

This claim is often made by those who oppose Obama's efforts to reform the medical system.

I worked in health care [tech support and services] for seven years, and my wife has been an X-Ray and CT tech for over thirty years. She has worked everywhere from world-class hospitals, to one-horse hospitals in a town with two street lights. While I don't know what health care is like in other countries, to those who think the system here cannot be signifantly [dramatically] improved, I say you are seriously misguided. From my point of view, the claim is ludicrous! I cannot even begin to tell you how many times my wife [Tsu] has come home either steaming from the ears, or nearly in tears. One example that comes to mind was the time a major hospital at which she worked didn't even have the proper respirators for babies, but they did buy a grand piano and hire a pianist to play in the lobby. What has happened over the last two+ decades is that health care has become more about business than health.

Probably one of the most ridiculous experiences was when my mother was in the hosptial. After a botched surgery that left her crippled, I went down to help out. I then posted this rant in the mentors forum.

Boy, this just keeps getting better. :cry:

Mom had the implant done thursday morning, so I drove down last night anticipating that I could be some help when she gets home [again]. Yesterday she was doing absolutely great and declared the spinal nerve stimulator a raging success. So I expected that today we would pick her up around noon, and I could spend the weekend making food for the week and so forth. Having arrived at 4AM, I was awoke by my dad who was nearly in a state of panic at 8AM. Mom called at 7, and during the night the battery in the power pack for the stimulator went dead! They installed a ten thousand dollar device and put in a dead battery. So she called the nurse who got another battery and put it in, but then the thing wouldn't work. So what I wake up to is this: The stimulator isn't working and we need to go fix it!!!

So I'm laying there trying to make sense of this: Okay, the implant was done yesterday, she's still in the hospital, and I have to fix it???? WTF!!! He explained that the phone number for the technical support was sitting on her bedstand, and housekeeping threw it away so nobody knows who to call. As I'm still shaking my head in disbelief, I asked if we can't call the main number for the company, but of course, all that is heard is a message that they're closed for the weekend, and please enter the desired mailbox number to leave a message. Of course we have no idea who we even need.

We called the pain specialist's answering service, but the primary was off and the secondary gave explicit instruction that he was only to be contacted in the case of an emergency. But this is an emergency, she's in extreme pain we insisted. "I'm sorry, that's not an emergency", she replied. Okay so what is an emergency for a pain specialists? "I'm sorry, I have explicit instructions". So I made sure that we understood: You [a near min wage worker Iamb thinking] are refusing to contact the doctor. Yes she replied. "Well, I could if the nurse called me". So even though the pain specialists is on call mainly for when mom is home, we conceded to call the head nurse. The nurse thinks that she may know who to call by looking up the names in the registry for the day of the implant, since the technical specialist had to sign in. Meanwhile, I managed to fake my way into the mail system at the main number and started scrolling through what turned out to be at least a hundred different names; none of which began with what we knew was the first name of the support specialists - Don.

At about 11AM, while my dad and I are still scrambling for some way to resolve this situation, we get a call from mom saying that the surgeon who did the implant showed up with the support guy, the thing is now working, and "get me the hell out of here".

While at the hospital, the nurse gave mom some paperwork with emergency number needed for the tech support person. I then asked the nurse to write it down on one of my business cards and joked that when they lose the number again they can call me. Well, later and back at home, mom wasn't doing so well, so we wanted to talk with tech support to see if an adjustment can be made. We then discover that we had been given the same phone number that we had at 7AM. We never got the emergency number. By the time we discovered this, the nurse of interest was off duty and had left.

The pain specialist was scheduled to call and check in this evening so we figured that he could help, or at least have the information needed. He never called.

That was only one week. It went on for years and was a freaking nightmare. IIRC, she was taking something like 80mg of morphine a day for about two years!

Here is one study that ranks the US as 37th in the world, in health care.
http://dll.umaine.edu/ble/U.S.%20HCweb.pdf

From my point of view, waving the flag at the expense of people who are suffering terribly, is right up there with 911 and moon hoax conspiracy theories. Honestly, when I hear someone talking about how wonderful our health care system is, I want to hurt someone!

[turbo-1]

It's even worse than you think, Ivan. Medical practices have to hire tons of coding specialists to work through the maze of hoops that the insurance companies set up, and even then, claims are denied over and over again so that the insurance companies can make money off interest on the "float". I would like my wife to retire a bit early, but I have pre-existing medical conditions and could never be insured on my own without disastrous premiums.

Don't get sick and don't get old unless you have a LOT of money.

[maverick_starstrider]

You have to pay for health care in the states. How could it possibly be "the best in the world". Best by what possible criteria? That if you're employed and insured and you walk into a clinic you're going to get better treatment then any other country?

[seycyrus]

There is a logical fallacy here.

The assumption that since mistakes and abuses occur in the present system, they will not occur in the proposed system.

This is a ludicrous claim.

In fact, from my experience with govt. I envision the number of mistakes getting greater, and the abuses getting far worse.

[seycyrus]

And evidently, Barack Obama's Health care system will cure stupidity, and remove beauracracy.

[seycyrus]

You have to pay for health care in the states. How could it possibly be "the best in the world". Best by what possible criteria? That if you're employed and insured and you walk into a clinic you're going to get better treatment then any other country?

You have to pay for food at a fine restaurant ... Does the place with free food for everyone generally have the best food in the world?

[turbo-1]

There is a logical fallacy here.

The assumption that since mistakes and abuses occur in the present system, they will not occur in the proposed system.

This is a ludicrous claim.

In fact, from my experience with govt. I envision the number of mistakes getting greater, and the abuses getting far worse.The insurance companies do not engage in "mistakes and abuses". They intentionally deny and delay payment as long as possible to make money off the interest on their holdings, and the magnitude of the fraud is incredible. A couple of decades ago, banks were required to clear checks on a timely basis to stop them from capitalizing on the "float" - insurance companies are presently exempt and are raking in the dough.

If you think that a government-based program will perpetuate this kind of crap, please link to some legitimate sources to support your claim.

[D H]

You have to pay for health care in the states. How could it possibly be "the best in the world". Best by what possible criteria? That if you're employed and insured and you walk into a clinic you're going to get better treatment then any other country?
Health care isn't free anywhere. Somebody pays for it. You just want that somebody to be someone else. While doctors in other countries might not be as well off as doctors are in the US, they are still receive above-average compensation. Hospitals do not pop out of the ground for free in other countries and they do not have fancy equipment and pharmaceuticals trees from which medical devices and drugs can be plucked au gratis.


If you think that a government-based program will perpetuate this kind of crap, please link to some legitimate sources to support your claim.
I suspect that what the government will do is to deny the request up-front rather than after the fact. In other words, you won't be allowed to receive the medical treatment you (and your doctor) think you need. HMO+. If they do allow the treatment, they won't quibble over the claim as insurance companies do. They'll accept it forthwith -- and then take six months to make good on it.

Have you ever contracted with the government? If you want to do contract work for the government you better have a healthy cash reserve to pay your bills, pay your employees, and pay yourself. The government takes their sweet time to make good on obligations. Those laws that require banks to clear checks on a timely basis -- Who do you think wrote them? Do you really think they would have subjected themselves to those same laws?

[russ_watters]

[title statement] The US has the best health care in the world?

This claim is often made by those who oppose Obama's efforts to reform the medical system.

.....to those who think the system here cannot be signifantly [dramatically] improved, I say you are seriously misguided. Your counterargument does not address your title statement! Saying something is the best does not imply that it cannot be improved. Heck, it doesn't even imply that it is good, much less perfect!

[russ_watters]

If you think that a government-based program will perpetuate this kind of crap, please link to some legitimate sources to support your claim. You cannot provide direct evidence of a prediction, since it hasn't happened yet, so that is an unreasonable request.

One can only say that since government is extremely inefficient with everything it does, it stands to reason that it would be extremely inefficient managing healthcare.

[russ_watters]

You have to pay for food at a fine restaurant ... Does the place with free food for everyone generally have the best food in the world? And, of course, (duh), free isn't free! Someone has to pay for it. In the case of a food bank, the free food is paid for by someone else, but in the case of healthcare, you pay for your free healthcare! :yuck:

So the question really is, does the cost vs quality of Canada's "free" healthcare exceed the cost vs quality of the US's. And that is not a straightforward question, since the quality of the actual care for Canadians is roughly uniformly mediocre (it doesn't vary depending how much you pay for it) whereas the quality for Americans is highly variable, depending on how much you pay for it. At the same time, the cost for "free" healthcare for Canadians varies widely by income, as does the cost for healthcare for Americans - though the cost for Americans is generally higher.

So the answer, in terms of bang for the buck, is probably that if you are poor, the mediocre free (it really is free if you are poor) coverage of Canada is probably better than the bad free coverage for poor Americans. But if you are much above the poverty line, it is probably better in the US.

And since people like anecdotes so much, I have a good example from my own life of a minor surgery I had that went extremely smoothly: Last year, I found what I realized was a growing hernia in my abdomen. I saw my doctor (took a week to get the appointment) and he referred me to a specialist (another week's wait for an appointment). He scheduled surgery for two weeks later because he happened to be moving in the intervening week. The surgery was outpatient and went perfectly. Altogether, I had to live with the hernia for about a month from the time I realized what it was to when I got the surgery. I shudder to think about how long I would have had to wait if I was Canadian. At the same time, the cost out of pocket was about $4,000. I had personal health insurance with a high deductable and moderate coverage, a calculated risk on my part due to my age (33) and general health (excellent). Overall, I'm very happy with how it all went and the level and cost of care I got were highly accessible to a very large fraction of the US population (I was paying $120 a month for my insurance).

The biggest problem I see with health care in the US is that I think the business model of the insurance providers has been allowed by lax legislation to get a little out of hand (turbo-1's point about attempting to deny as much coverage as possible). So legislation and oversight of that needs to be tightened-up. Prescription drug overcharges too (such as the government not being allowed to negotiate drug prices in their own plans). But beyond that, I don't see much wrong with our system. Possibly too much malpractice (too many lawyers), but I've seen conflicting reports on the reality of that issue.

[jarednjames]

I'll be honest, I don't like the idea of requiring medical insurance. I much prefer the British way of the NHS. But it ISN'T free, not by a long shot. You pay it directly out of your wages (not sure what percentage it is, but it's there).
The big difference is, no matter who you are in Britain you are entitled to the same health care (unless you go private of course). Whereas I believe in America it's a case of "patch 'em up and throw em out", or to get it correct, get the patient stable and then they no longer are required to do anything else.
The downside of the NHS is that the people who work end up paying for everyone, the bums who refuse to work, which is wrong. If you can't work for a reason then yes, you should be entitled to it (and income support off the government) but those who refuse to work should get nothing.
Right, rant over.
I wouldn't say America has the best health care in the world, I would like to think it is fairly level over most 'rich' countries, but I suppose like everything, different countries will have their strong aspects in the health system and their weak aspects.

The NHS in Britain currently has exceptionally long waiting lists for seeing doctors and operations. However, in other European countries they are far shorter (I believe 18 weeks). So it depends what you rate it one.

[mgb_phys]

So the question really is, does the cost vs quality of Canada's "free" healthcare exceed the cost vs quality of the US's. And that is not a straightforward question,
The admin costs of US healthcare are roughly twice those in Canada, mainly due to the layers of billing. There are also other hidden costs like unnecessary scans and procedures performed in the US largely to cover hospitals/doctors from liability.
Admin costs in the NHS (uk) are supposedly only 6% - half of Canada's, but real comparisons are always tricky.

since the quality of the actual care for Canadians is roughly uniformly mediocre (it doesn't vary depending how much you pay for it) whereas the quality for Americans is highly variable, depending on how much you pay for it.
Another advantage of 'free' health care is that there is much more incentive for preventative care than in a system where insurance only pays for a hospital visit.
It's like having the insurance cover free breakdown repairs on your car, but having to pay $10,000 for an oil change.

[mgb_phys]

The downside of the NHS is that the people who work end up paying for everyone,
That's not a new problem. One of the grievances in the Magna Carta was inland towns having to pay for the navy. Since they didn't have any boats that needed protecting why should they pay for the navy?

the bums who refuse to work, which is wrong. If you can't work for a reason then yes, you should be entitled to it (and income support off the government) but those who refuse to work should get nothing.
That is one of the problem of the US system. 'Bums' are (in theory) covered by free health care Medicaid, but because it is means tested and tied to a whole range of other benefits it is a hugely complex and expensive nightmare. It also leaves the vast majority of people too rich for free care and too poor to pay - the Daily Mail would be proud!

[jarednjames]

That's not a new problem. One of the grievances in the Magna Carta was inland towns having to pay for the navy. Since they didn't have any boats that needed protecting why should they pay for the navy?

I think that's a slightly different concept. The navy is there to protect the boats AND country (offcoast obviously), the whole country. If there was an attack on the coast, its effect isn't likely to stop there. Hence, everyone should pay. The people who refuse to work, expect to get free health care. They don't want to work, they don't want to pay and yet they expect to get free health care. It would be like you living mid country, refusing to pay for the navy and then expecting them to protect you during an attack.

[Evo]

That is one of the problem of the US system. 'Bums' are (in theory) covered by free health care Medicaid, but because it is means tested and tied to a whole range of other benefits it is a hugely complex and expensive nightmare. It also leaves the vast majority of people too rich for free care and too poor to pay - the Daily Mail would be proud!That's where a misunderstanding of the excellence and availabilty of US healthcare comes in. Just because it takes a bit more time to get to see a specialist through medicaid, it's nowhere near as long as in socialized or government run healthcare.

I had a condition recently (I am recovering from surgery right now). I was referred to a specialist, got in in 3 days. I had a cat scan prior to seeing the specialist and I only waited 2 days for that. When I saw the specialist, he said I should have surgery (elective) and could have surgery the following Tuesday, that wasn't convenient for me, so I scheduled it a few weeks out.

Now tell me that I could have a non-emergency problem in the UK and from the first day I went to the doctor (called that morning and got in within a few hours), was diagnosed, had a cat scan and a biopsy and had surgery all within a week and a half? And it cost me $40 for the specialist, $20 for the regular MD and the cat scan and other dianostic tests were free. For the surgery/hospital, I had a deductible of $150. And I don't pay through the nose in taxes to pay for any of that. My employer pays for it, private medical insurance is a perk.

On one hand, I would be willing to pay some to extend a bit more universal health benefits to the unemployed, but I do not want to give up the excellent health care I have right now. I am not in favor of an all or nothing solution.

[Topher925]

You only need one visit to the hospital to realize that the US health system is FUBAR. It seems to me that its the lower middle class sort of folks who get screwed the worst. If your to poor to afford decent or no health insurance and to wealthy to qualify for medicare/medicaid, your basically screwed. Same goes if your employer doesn't offer medical insurance.

I'm all for trying to fix the problem, but I don't understand how a NHS is going to solve it. The two biggest problems are access and cost. NHS may fix the access problem, but I don't see how it will affect the cost. Lawyers will still make billions off of frivolous law suits and stupid people will continue to smoke and be obese. I don't understand how standardizing everything and taxing the rich is going to be an incentive for people to take care of themselves and create less lawsuits.

[Topher925]

And it cost me $40 for the specialist, $20 for the regular MD and the cat scan and other dianostic tests were free. For the surgery/hospital, I had a deductible of $150.

It sounds like you've got some very nice coverage Evo. Under my plan, the first $1500 of anything comes out of my pocket. I pay 30% of everything else after that.

[jarednjames]

It doesn't, but it means that every person who works pays in to the system, automatically deducted by the government each month. So each person is considered on an equal playing field with respect to the health care system. You can go private if yo uwant but it's expensive. So if you use the NHS, it means everyone, rich or poor, is equal, that is the difference.

[jarednjames]

Now tell me that I could have a non-emergency problem in the UK and from the first day I went to the doctor (called that morning and got in within a few hours), was diagnosed, had a cat scan and a biopsy and had surgery all within a week and a half? And it cost me $40 for the specialist, $20 for the regular MD and the cat scan and other dianostic tests were free. For the surgery/hospital, I had a deductible of $150.

I went into hospital emergency room recently with sever pain in my abdomen. I was seen by a doctor within an hour and had an x-ray and scan within thirty minutes of that, results about another half an hour later and then discharged (although they were lining me up for having my apendix removed that week if required). It depends on what is wrong with you and what the current waiting times are. If people can't afford the operation in america, they don't have it (non-emergency room of course), whereas in the UK, you are queued up. If in that time someone more urgent comes along, they get priority.

The american system seems more like the private system in the UK. If you go private, you don't have all the waiting times and queues of the NHS, which is why you pay large amounts for it. So to compare your insurance system to the NHS isn't truly fair, it should be to the private system as you are paying for both then in the same way you do for private.

[Hurkyl]

You only need one visit to the hospital to realize that the US health system is FUBAR.
One cannot judge a program consisting of 7,569 different facilities employing 5.1 million people (and that's just the hospitals, not the rest of the US health system) by a single cursory glance at one facility.

I am at a loss of words to emphasize how poor such judgement that is.

source (http://www.census.gov/Press-Release/www/releases/archives/facts_for_features_special_editions/004491.html)

[mgb_phys]

The american system seems more like the private system in the UK. If you go private, you don't have all the waiting times and queues of the NHS, which is why you pay large amounts for it.
Not quite, private hospitals in the UK generally don't treat serious cases. They do operations that have a long NHS waiting list (hip replacments) and a lot of orthopedic work (squash and skiing injuries by managers). Often patients that develop complications in private hospitals end up having critical care on the NHS.

This is sometimes used to twist the statistics to 'prove' how much more efficient the private sector is by comparing the average cost of specific procedures but it doesn't take into account the cherry picking of private hospitals only handling the simple cases.

Also in the UK nobody pays for private health care themselves, it is frequently offered as a perk by employers. It's very cheap for employers (<$1000/employee/year) compared to US plans because it is only used for relatively cheap non-critical procedures and it's worth it to minimize staff time off.

[Evo]

It sounds like you've got some very nice coverage Evo. Under my plan, the first $1500 of anything comes out of my pocket. I pay 30% of everything else after that.When I look for an employer, I weigh the benefits package they offer. Luckily my daughter gets the same benefits until she is 24. If we went to a government plan, I'm afraid that I could lose the level of medical care that I am used to.

[cristo]

The US has the best health care in the world?

I'd say that these people would answer no!

2VyNbuWbirU

[Evo]

I'd say that these people would answer no!

2VyNbuWbirURural Kentucky? That's like falling off the face of the planet. That is probabaly the most unrealistic view of America they could find! Talk about ridiculously biased journalism. That is not representative of the US. Kentucky is one of the most rural, uneducated, and low income parts of the country. Of course they have problems, but they are a tiny, tiny portion of the US. All of the locations they cite are unsually poor/uneducated/and not the norm. The problem there is a breakdown of reaching these people, period. The US is huge and yes, there are very bad areas.

To claim that this is representative of the US as a whole is ridiculous.

[Ivan Seeking]

Your counterargument does not address your title statement! Saying something is the best does not imply that it cannot be improved. Heck, it doesn't even imply that it is good, much less perfect!

I also stated explicity that I don't know what health care is like in other countries. Please bother to read the post before responding. I also cited the WHO study that ranks the US as 37th in the world.

It is also made clear that the fallacy is in thinking that the system can't be vastly improved - that it's good enough. Let me tell you what I think after nearly thirty years of close association with medical care in this country: I would rather drop dead now than be a victim of our health care system. That is no exaggeration. I know what goes on in hospitals. Recall for example the man at MLK in LA that called 911 from the ER because his wife was getting no attention. She died in a pool of blood that she vomited while waiting in the ER for someone to help her.

The wonders of modern medicine are truly amazing. The system is horrifying!

[maverick_starstrider]

That's not a new problem. One of the grievances in the Magna Carta was inland towns having to pay for the navy. Since they didn't have any boats that needed protecting why should they pay for the navy?

That's a cool factoid dude.

[Danger]

I have a good example from my own life of a minor surgery I had that went extremely smoothly: Last year, I found what I realized was a growing hernia in my abdomen. I saw my doctor (took a week to get the appointment) and he referred me to a specialist (another week's wait for an appointment). He scheduled surgery for two weeks later because he happened to be moving in the intervening week. The surgery was outpatient and went perfectly. Altogether, I had to live with the hernia for about a month from the time I realized what it was to when I got the surgery. I shudder to think about how long I would have had to wait if I was Canadian. At the same time, the cost out of pocket was about $4,000. I had personal health insurance with a high deductable and moderate coverage, a calculated risk on my part due to my age (33) and general health (excellent). Overall, I'm very happy with how it all went and the level and cost of care I got were highly accessible to a very large fraction of the US population (I was paying $120 a month for my insurance).

Your understanding of our system is severely misguided.
My first hernia was diagnosed by my family doctor, who had me in to see a specialist two days later. With another day, I was in surgery. I stayed awake and watched the operation with a mirror, chatting with the staff, and went home within 4 hours.
A year later, the other side blew out. Diagnosis and scheduling were the same, but they used a different procedure so I had a general and stayed in the hospital for 3 days.
Total cost out of my pocket for the first procedure was $0. The second cost me $21.50 for a couple of packs of smokes and a magazine that I bought in the tuck shop.

[Ivan Seeking]

updated 4:43 a.m. PT, Wed., Feb. 2, 2005
BOSTON - Costly illnesses trigger about half of all personal bankruptcies, and most of those who go bankrupt because of medical problems have health insurance, according to findings from a Harvard University study to be released Wednesday...
http://www.msnbc.msn.com/id/6895896/

[mheslep]

The insurance companies do not engage in "mistakes and abuses". They intentionally deny and delay payment as long as possible to make money off the interest on their holdings, and the magnitude of the fraud is incredible. A couple of decades ago, banks were required to clear checks on a timely basis to stop them from capitalizing on the "float" - insurance companies are presently exempt and are raking in the dough.

If you think that a government-based program will perpetuate this kind of crap, please link to some legitimate sources to support your claim.You've made three claims above, without qualification, as in all of them, all the time. (The interest part is nonsense - every company in the world attempts to speed collectibles and stretch payments (30 days, 90, etc) as much as they possibly can). Also, look into the magnitude of medicare / medicaid fraud if you want to see some large numbers.

[Al68]

You only need one visit to the hospital to realize that the US health system is FUBAR.One cannot judge a program consisting of 7,569 different facilities employing 5.1 million people (and that's just the hospitals, not the rest of the US health system) by a single cursory glance at one facility.

I am at a loss of words to emphasize how poor such judgement that is.
Not to mention the obvious fact that it's not a system at all in the sense that all 7569 facilities don't have management or ownership in common. It amazes me that so many people continually refer to a number of unaffiliated, separate private ventures as a "system".

It's simply not reasonable to expect thousands of individual, private, voluntary organizations to function as if they were subdivisions of a single authority operating as an agent of the public (government). They are not agents of the government and they never knowingly joined any such "system". The U.S. has no such system, so it doesn't make sense to say the system is "good" or "bad". It doesn't exist. Private ventures try to make up for the fact that a "system" doesn't exist by providing health care services, then people claim that they are now the "system" and anything wrong with "the system" is their fault.

That's like a bum claiming it's my fault he only has $10, after I was the one that gave him the $10.

[lisab]

Your understanding of our system is severely misguided.
My first hernia was diagnosed by my family doctor, who had me in to see a specialist two days later. With another day, I was in surgery. I stayed awake and watched the operation with a mirror, chatting with the staff, and went home within 4 hours.
A year later, the other side blew out. Diagnosis and scheduling were the same, but they used a different procedure so I had a general and stayed in the hospital for 3 days.
Total cost out of my pocket for the first procedure was $0. The second cost me $21.50 for a couple of packs of smokes and a magazine that I bought in the tuck shop.

I work quite often with Canadians, and I've never heard anything but these kinds of stories about their health care.

The horror stories are always "friend of a friend" accounts, mostly from my conservative friends here in the States.

[Evo]

http://www.msnbc.msn.com/id/6895896/People that accrue medical debt are encouraged to file bankruptcy to dismiss that debt.

When I went into the hosptial I was handed a pamphlet that told me if I wasn't covered under private insurance that they would make arrangements to either get it covered through charitible funds or dismiss it outright. Yes, people with private insurance arre expected to bear the brundt, but I was impressed.

I am sure that unusual medical costs are another issue, but I am surprised that where I live, hospital costs are forgiven, I've posted about this before.

[Huckleberry]

http://www.msnbc.msn.com/id/6895896/

I know a woman that this has happened to. It happened within a period of 2 months. She was diagnosed with a brain tumor and her son attempted to overdose on drugs which left him in a coma for a few days and permanent liver damage. They had insurance and the bill for the removal of the tumor was $17'000. I don't know how much the drug overdose cost the family.

In 2007 there were nearly 46 million people without health care in the US, which is over 10x the population of the entire state of Kentucky. Cristo's link may have chosen some of the worst areas, but if a person doesn't have insurance then I don't see how it matters where they live or how educated they are.
http://www.nchc.org/facts/coverage.shtml (pro health-care organization)
http://briansullivan.blogs.foxbusiness.com/2009/06/16/are-46-million-really-without-health-insurance-in-america-yes-no/ (counterarguments to why the number of uninsured is so high)

Personally, I measure the success of a health care system by how it treats those least able to afford it. Affordable health care is a luxury in the US. It should be a right.

[dlgoff]

As has been suggested, some hospitals are in it just for profit. I once had a set of test run at one hospital that was $2500 and then had them redone an another hospital that charged $900.

[Evo]

Personally, I measure the success of a health care system by how it treats those least able to afford it. Affordable health care is a luxury in the US. It should be a right.That's easy for someone to say when they aren't being asked to pay for that "free' medical care. I would be the one paying through the nose to provide this care and I don't think it's fair.

I already pay medicare taxes to pay for health care for the poor, I can't afford to pay any more. Where is this money going to come from?

[maverick_starstrider]

That's easy for someone to say when they aren't being asked to pay for that "free' medical care. I would be the one paying through the nose to provide this care and I don't think it's fair.

Lol. Then you really must not like Canada. My perspective is that health care, education and transit should be free (if not heavily subsidized) and for everyone. Farming subsidies to non-competitive farms, corporate bail outs, bloated public projects, keeping unionized sectors afloat? No go. I'm willing to do my part to front peoples hospital and education bills (says the grad student, although my family is quite wealthy) but stay out of micromanaging the economy. Let's face it Mr. Government, you suck at it.

[mheslep]

I went into hospital emergency room recently with sever pain in my abdomen. I was seen by a doctor within an hour and had an x-ray and scan within thirty minutes of that, results about another half an hour later and then discharged (although they were lining me up for having my apendix removed that week if required). It depends on what is wrong with you and what the current waiting times are. If people can't afford the operation in america, they don't have it (non-emergency room of course), whereas in the UK, you are queued up. If in that time someone more urgent comes along, they get priority....I would hope that the NHS can offer some service, it is the largest public employer in the world after the Chinese Red Army and Indian Railways (http://www.timesonline.co.uk/tol/comment/columnists/camilla_cavendish/article5941273.ece) and, under PM Brown, is breaking Britain's treasury.

[Evo]

Let's face it Mr. Government, you suck at it.Exactly why the government should not be in charge of our health care.

And when I pay ~$10,000 a year in taxes to subsidize government medical care already, just where does it stop?

Medicare and medicaid are horribly managed government health programs, you think they should take over all public health care? Are you aware of the rampant fraud in these systems? Do you even pay taxes?

[Al68]

Affordable health care is a luxury in the US. It should be a right.A person should have the "right" to the servitude of others? Seriously?

Any logic behind this?

[mheslep]

Lol. Then you really must not like Canada. My perspective is that health care, education and transit should be free (if not heavily subsidized) and for everyone. Clearly nothing is 'free', certainly none of the items in your list are. In my opinion we'd raise the level of this discussion if that term were not used again in this thread. In this context, it appears you mean you want someone else to pay for those things for you.

[sylas]

It costs much less than you might think to spend money on basic health care for other people. Health problems are picked up sooner, and there is a real economic cost for a society when there are widespread health problems in society.

The strongly individualistic perspective, which trades off your own wealth against the basic health of people less fortunate than yourself is not a simple equation, even if self-interest is your only motivation.

There was a very interesting set of articles at the "denialism" blog (which looks at sloppy thinking on all kinds of science and health related topics: recommended) comparing health care in different countries. There are many different approaches used around the world. See: May 2009 archive (http://scienceblogs.com/denialism/2009/05/); there are a series of posts on this subject. The blog is part of the seed blog group "scienceblogs" and the authors are medical practitioners.

Cheers -- sylas

[russ_watters]

I also stated explicity that I don't know what health care is like in other countries. Please bother to read the post before responding. I also cited the WHO study that ranks the US as 37th in the world. Um, maybe you should reread my post, Ivan - heck, while you're at it, reread your own! You're not asking and answering the same questions in the OP or with that statement - pointing out that you don't know about other countries doesn't address the flaw. Twice, now, you've asked one question and answered a different questions. Throw in a direct contradiction ('I don't know how how healthcare is in other countries - but we're 37th with respect to them') and you've got a tangled mess of illogic there, Ivan. It is also made clear that the fallacy is in thinking that the system can't be vastly improved - that it's good enough. Right - that has nothing whatsoever to do with whether it is the best in the world. And the corollary applies too: the fact that we are 37th in whatever that was does not imply improvement is necessary. They simply aren't the same question and can't be answered as if they are.

What you are doing is throwing up strawmen to make it easier to put down republicans.
Let me tell you what I think after nearly thirty years of close association with medical care in this country: I would rather drop dead now than be a victim of our health care system. That is no exaggeration. I know what goes on in hospitals. Recall for example the man at MLK in LA that called 911 from the ER because his wife was getting no attention. She died in a pool of blood that she vomited while waiting in the ER for someone to help her. That is about as far removed from logical thought as you can get, Ivan - you've broken at least two rules of logical debate at once. First is citing one anecdote as being representative - obviously illogical, since I also gave a single anecdote that says the opposite, thus revealing the flaw in making judgements based on the anecdote. Second, um....if you drop dead, you don't need healthcare, you need a funeral.

While we're at it.... This claim is often made by those who oppose Obama's efforts to reform the medical system. Is it? Could you cite an example of who says that sort of thing? Do politicians say it or just someone on the street who can't put together a coherent thought? In what context? (the statement can have more than one meaning). My point is, that platitude has no value and thus has no place as a starting point for a discussion on our health care system. If your goal is to have a reasonable discussion about how to improve our health care system (or what/if it needs improvement), don't start it with a cheap shot attack.

[russ_watters]

Your understanding of our system is severely misguided.
My first hernia was diagnosed by my family doctor, who had me in to see a specialist two days later. With another day, I was in surgery. How bad was the hernia? It is my understanding that the severity of the problem has a big impact on the wait time for care. My doctor told me I didn't even need the surgery if I didn't want it.

Wait time *is* a problem in canada, acknowledged by the Canadian government in that they set up a program to deal with the problem: http://www.hc-sc.gc.ca/hcs-sss/qual/acces/wait-attente/index-eng.php

[maverick_starstrider]

Clearly nothing is 'free', certainly none of the items in you list. In my opinion we'd raise the level of this discussion if that term were not used again in this thread. In the this context, it appears you mean you want someone else to pay for those things for you.

To answer you an Evo's questions; I've never worked a full tax year but I have certainly made enough (through coop in CS or medical physics jobs) to be taxed in a given year and yes I was living off that money and also my dad makes around 7 figures so I'm well aware how much money goes out the window (he probably pays $400,000 a year in taxes), one could say, god forbid, that that's my inheritance. However, gov't is a social contract and I am willing to sign on the dotted line because I believe the positive externalities to society as a whole (and ultimately, selfishly, to the average pay in my pocket) make it a good investment. Now yes, as I have previously said, the gov't runs a bawdy ineffecient ship but no one's life should be derailed by a curable injury or have their potential bottlenecked not at their merit but at their circumstances. And the fact of the matter is that, especially in a mother of a country like canada, some people need the bank that is the federal gov't (not the national bank). For example, in canada, all internet in the whole country runs through bell's infrastructure (I don't know if Bell is the phone/internet provider of choice in america) and you have companies like Cogeco that offer internet service with different stipulations but ultimately all they do is LOAN bandwidth from bell. This is very clearly a monopoly however the fact of the matter is that Canada is huge. it's ginormous. No major corporation, much less a start-up company, could afford to run a second internet line from east canada to west canada to compete with bell. The only reason that project got accomplished is that the gov't helped out. Canada has the same problem with railways. Private railway companies want to stop offering fares from east canada to west canada. They simply make more money by dropping those routes and focussing on transit between major cities that are less that 300km apart. But they're gov't subsidised and the gov't say you run that route or we stop picking up the slack. and i think that's a necessary evil.

[maverick_starstrider]

How bad was the hernia? It is my understanding that the severity of the problem has a big impact on the wait time for care. My doctor told me I didn't even need the surgery if I didn't want it.

Wait time is a problem in canada, acknowledged by the Canadian government in that they set up a program to deal with the problem: http://www.hc-sc.gc.ca/hcs-sss/qual/acces/wait-attente/index-eng.php

OH YAH! Wait time is most definetly a problem in Canada. Although it's a somewhat recent problem not entirely unconnected with recent global economics

[TheStatutoryApe]

I'd say that these people would answer no!
http://www.harp.org/clinics.htm
List of free clinics in Southern CA. Pretty much where ever you live in CA you will be able to find a free clinic with decent care near by.
Recall for example the man at MLK in LA that called 911 from the ER because his wife was getting no attention. She died in a pool of blood that she vomited while waiting in the ER for someone to help her.

The wonders of modern medicine are truly amazing. The system is horrifying!
http://en.wikipedia.org/wiki/Martin_Luther_King_Jr.-Harbor_Hospital
MLK was a nightmare of incompetence and mismanagement and was shut down for it. It would seem that it was actually a good hospital at some point since it was a teaching hospital and was around since the sixties.


I do support the idea of national health care though. Healthcare is a necessity more basic than education. I remember being a kid and deciding not to tell my mother anymore if I thought I might need to go to the hospital because I was afraid we couldn't afford it.

[Huckleberry]

That's easy for someone to say when they aren't being asked to pay for that "free' medical care. I would be the one paying through the nose to provide this care and I don't think it's fair.

I already pay medicare taxes to pay for health care for the poor, I can't afford to pay any more. Where is this money going to come from?

I don't know where the money should come from. Hopefully some clever solutions can be found that are somewhat fair to everyone. It's a conundrum to me. I suspect corruption, but I really don't know.

That woman I know that had a brain tumor had to pay through the nose. I just feel it is important that many millions of people have the care they need when they are ill without being impoverished by it. I can't accept the fact that there are people who are sick and aren't getting help based on their income. The wealth of the well-to-do is less important than the well-being af anyone. The fears you have are a reality for millions.

[Al68]

However, gov't is a social contract and I am willing to sign on the dotted line...The real question isn't whether you are willing to sign the dotted line, but whether you are in favor of using force against those that choose not to sign it to force them to serve others against their will.

[maverick_starstrider]

Well to toss americanism back at (I assume) an american "There are only two certainties in life; death and taxes". This isn't like the drug debate that I think we were on the same side of. You pay the taxes, you protest the taxes, or you leave the country. Option 2 doesn't seem to be a problem in canada and option 3 is not related to this issues.

[TheStatutoryApe]

The real question isn't whether you are willing to sign the dotted line, but whether you are in favor of using force against those that choose not to sign it to force them to serve others against their will.

I really have no idea why anyone would desire to live in a community and receive the benefits of that community but not be willing to help out those people who make up that community.

[Evo]

To answer you an Evo's questions; I've never worked a full tax year but I have certainly made enough (through coop in CS or medical physics jobs) to be taxed in a given year and yes I was living off that money and also my dad makes around 7 figures so I'm well aware how much money goes out the window (he probably pays $400,000 a year in taxes),.There are tax caps, the amount you pay in social security, for example, is capped on income over $106,800 for 2009. Any income earned over that amount is tax free. Actually, I was thinking of my total of social security and medicare tax.

If you make 10 billion dollars a year, the most tax that can be withheld for social security is $6,621.60 a year. Medicare is 1.45% of wages. If your dad makes a 7 digit income and doesn't itemize to get rid of most of the tax, I don't know what to say. But very little of it goes to health and welfare. He basically pays no more than someone making $100,000 a year. Someone that makes 1 million dollars a year only pays $14,500 towards medicare, and is way better off than the average American in being able to afford it. It's the American making less that $100,000 a year that is bearing the brunt.

I would like the rich to have an equal share of the burden.

[Al68]

I really have no idea why anyone would desire to live in a community and receive the benefits of that community but not be willing to help out those people who make up that community.Me either. But I don't see how that's relevant to the post you quoted.

Being willing to help others isn't the same issue as being willing to force someone else to help others against their will.

[maverick_starstrider]

There are tax caps, the amount you pay in social security, for example, is capped on income over $106,800 for 2009. Any income earned over that amount is tax free. Actually, I was thinking of my total of social security and medicare tax.

If you make 10 billion dollars a year, the most tax that can be withheld for social security is $6,621.60 a year. Medicare is 1.45% of wages. If your dad makes a 7 digit income and doesn't itemize to get rid of most of the tax, I don't know what to say. But very little of it goes to health and welfare. He basically pays no more than someone making $100,000 a year. Someone that makes 1 million dollars a year only pays $14,500 towards medicare, and is way better off than the average American in being able to afford it. It's the American making less that $100,000 a year that is bearing the brunt.

I would like the rich to have an equal share of the burden.

<---- Canadian

Top tax bracket here is like 44% or some such.

[mheslep]

Here (http://www.foxnews.com/story/0,2933,529410,00.html)is the actual claim made Sunday by Senate Minority Leader Mitch Mcconnell, echoed by many others:
MCCONNELL: Well, listening to them, you wouldn't recognize that America has the finest health care system in the world. We have some problems with access and with cost, which can -- addressed without wrecking the best health care system in the world. He's right. He's right in the first instance as to the quality of medicine, i.e, medical results and there is plenty of evidence to back him up. He's right about the cost and access problems. He does not say that US health care "cannot be significantly [dramatically] improved", but then nobody does.

This so called reform process is off the rails. It seems to me that having our health care tied to our job in the 21st century is just crazy. My health care should be tied to me, not my job. As an employer I should no more be providing health services than food or housing or sexual services. Getting rid of that system appears to be widely acknowledged by all of the health system experts on both sides, as clear a way to improve the cost and access problems. Senator Max Baucus (D) chairman of finance committee championed it for awhile. McCain ran on it. But Obama and Reid have stifled the idea (http://www.bloomberg.com/apps/news?pid=20601103&sid=afAVl0OAFJAI), thanks I expect to demagoguery during the campaign. Bogus medical malpractice lawsuits are another huge problem driving up costs directly through suits and indirectly through defensive medicine. The draft health bill does nothing about it, except to make it worse (http://overlawyered.com/2009/07/medicare-qui-tam-a-health-care-bill-surprise/):

...The newly added language in the Thursday morning version of the health bill (for those following along, it’s Section 1620 on pp. 713-721) would greatly expand the scope of these suits against third parties, while doing something entirely new: allow freelance lawyers to file them on behalf of the government — without asking permission — and collect rich bounties if they manage thereby to extract money from the defendants...

[Al68]

Well to toss americanism back at (I assume) an american "There are only two certainties in life; death and taxes". This isn't like the drug debate that I think we were on the same side of. You pay the taxes, you protest the taxes, or you leave the country. Option 2 doesn't seem to be a problem in canada and option 3 is not related to this issues.The two options I was referring to were whether or not to force others to serve their neighbors, not whether or not we should do it ourselves. But I think you knew that.:frown:

[mheslep]

I do support the idea of national health care though. Healthcare is a necessity more basic than education. I remember being a kid and deciding not to tell my mother anymore if I thought I might need to go to the hospital because I was afraid we couldn't afford it.But we know how to do that for the unfortunate: give them money! Not: have the government run the health system (or the auto industry, or the banking industry ...)

[maverick_starstrider]

But we know how to do that for the unfortunate: give them money! Not: have the government run the health system (or the auto industry, or the banking industry ...)
Health care is an entirely different bease then your standard, other, private industry. Healthcare has positive externalities.

[Evo]

<---- Canadian

Top tax bracket here is like 44% or some such.
But this is about US healthcare and taxes.

Medicare is the most mismanaged and corrupt government agency there is. The amount of bribery, kickbacks and corruption are phenomenal. That anyone would be in favor of this agency taking over national health is insane. If we can't even handle medicare, how the hell are we supposed to take on something on the scope of national universal healthcare? It's frightening beyond belief.

Nice to imagine, not realistic in practise.

I want something there incase I lose my job, but it's not realistic. Better that I save up my money and use the charities and dismissal of debt policies currently in place.

[Al68]

If you make 10 billion dollars a year, the most tax that can be withheld for social security is $6,621.60 a year. Medicare is 1.45% of wages. If your dad makes a 7 digit income and doesn't itemize to get rid of most of the tax, I don't know what to say. But very little of it goes to health and welfare. He basically pays no more than someone making $100,000 a year. Someone that makes 1 million dollars a year only pays $14,500 towards medicare, and is way better off than the average American in being able to afford it. It's the American making less that $100,000 a year that is bearing the brunt.It should be pointed out that benefits paid out are similarly related to past income, and the income made over the cap cannot be claimed at retirement. The rich guy pays out a smaller percentage of his income, and receives a smaller percentage at retirement. This is insurance, after all, not welfare.

The cap is a limit on how much insurance can be "bought". It's also a limit on what is paid out at retirement.

[maverick_starstrider]

But this is about US healthcare and taxes.

Yes, and its bestatude (yes I know that's not a word). Which implies comparison's. So I don't see a discussion of, in many ways, a cultural neighbour and their system being off topic.

[Al68]

Yes, and its bestatude (yes I know that's not a word).I think it's spelled bestitude.:smile: Or bestness.

[mheslep]

Health care is an entirely different bease then your standard, other, private industry. Healthcare has positive externalities.Yes, so? That only has relevance to the question of mandated health coverage, not by who or how it is run.

[Evo]

It should be pointed out that benefits paid out are similarly related to past income, and the income made over the cap cannot be claimed at retirement. The rich guy pays out a smaller percentage of his income, and receives a smaller percentage at retirement. This is insurance, after all, not welfare.

The cap is a limit on how much insurance can be "bought". It's also a limit on what is paid out at retirement.How dependent on that small stipend is a billionaire?

If I made that much money, I would refuse my social security payment. It would barely pay for a pair of shoes for someone that rich.

People in my tax bracket get killed, someone making twice what I do (like my ex-husband) pay the same as I do, but have twice the income. Who do you think feels it?

I feel I should pay something to help my fellow man, but I also feel that someone that makes twice what I do, with twice the disposable income should pay more, the more they make the less they are going to feel it. It's the only way we can afford a universal health plan. Us little people can NOT foot the bill. The rich get richer...

[Al68]

How dependent on that small stipend is a billionaire?

If I made that much money, I would refuse my social security payment. It would barely pay for a pair of shoes for someone that rich.

People in my tax bracket get killed, someone making twice what I do (like my ex-husband) pay the same as I do, but have twice the income. Who do you think feels it?Many rich people don't bother applying for it. I agree with you there, I wouldn't apply for the benefits either if I were rich. And I think the SS tax burden on working people is preposterous. And forcing people to participate is just reminder of how bad of a deal it is.

I just thought the facts about what the cap is about should be pointed out. It's a limit on how much insurance coverage the rich can buy. The SS system is an insurance program, not a welfare program.

[TheStatutoryApe]

Me either. But I don't see how that's relevant to the post you quoted.

Being willing to help others isn't the same issue as being willing to force someone else to help others against their will.
My comment wonders at the necessity of needing to force people to help others.
Am I willing to force people to help others?
Why should I have to?

[maverick_starstrider]

How dependent on that small stipend is a billionaire?

If I made that much money, I would refuse my social security payment. It would barely pay for a pair of shoes for someone that rich.

People in my tax bracket get killed, someone making twice what I do (like my ex-husband) pay the same as I do, but have twice the income. Who do you think feels it?

I feel I should pay something to help my fellow man, but I also feel that someone that makes twice what I do, with twice the disposable income should pay more, the more they make the less they are going to feel it. It's the only way we can afford a universal health plan. Us little people can NOT foot the bill. The rich get richer...

I see. You think it's silly that you have to pay for the hobo but it's ok for the millionaire to pay for you... After all, they're rich, they can afford it.

[cristo]

To claim that this is representative of the US as a whole is ridiculous.

Note that I wasn't really making an argument, I was just presenting that clip since I found it pretty interesting. I'm not claiming that the situation in that clip is representative of the US as a whole, but still, the fact that there exist areas of the US that are in that much poverty is quite a surprise (at least to me).

At least in my opinion, a healthcare system that fails the very poorest of the population is not working, and is certainly not the "best in the world." Of course, as you say, to have a nationalised healthcare system would mean that the more well off people are subsidising even more for the less wealthy people. I think that's the way that healthcare should work, otherwise we get into a more and more elitist society where the rich get richer. However, I fully understand that you (and most other Americans) believe in healthcare, like other things in life, being earned by hard work. After all, this is pretty much the American dream.

[Huckleberry]

My comment wonders at the necessity of needing to force people to help others.
Am I willing to force people to help others?
Why should I have to?

When one benefits from their community but doesn't contribute to it fairly then it's just a matter of time before the community comes knocking at the door to collect, unless one controls the community through their basic needs. They aren't a part of the community, but its governors through force or deceit.

[maverick_starstrider]

Note that I wasn't really making an argument, I was just presenting that clip since I found it pretty interesting. I'm not claiming that the situation in that clip is representative of the US as a whole, but still, the fact that there exist areas of the US that are in that much poverty is quite a surprise (at least to me).

At least in my opinion, a healthcare system that fails the very poorest of the population is not working, and is certainly not the "best in the world." Of course, as you say, to have a nationalised healthcare system would mean that the more well off people are subsidising even more for the less wealthy people. I think that's the way that healthcare should work, otherwise we get into a more and more elitist society where the rich get richer. However, I fully understand that you (and most other Americans) believe in healthcare, like other things in life, being earned by hard work. After all, this is pretty much the American dream.

Really, you (in the collective sense) consider healthcare part of meritocracy? I've always viewed disease as a kind of russian roullette from an economic perspective. Person X catches a cold, person Y doesn't. That's meritous selection (for lack of a better term) in action? I hate freeloading hobos as much as the next callous guy but I don't wish them a slow death from a curable disease. Even if they did bring it upon themselves (like alcoholism).

[Al68]

Us little people can NOT foot the bill.All public bills are footed by us little people one way or another. Either we pay it directly, or pay the cost of inflation. Or pay in the form of reduced economic investment.

Any tax bill paid by the rich comes out of their investment in the economy, not out of their "spending money". So, basically, any and all government spending will always be paid for by us little people one way or another. And I agree it's not fair, and it should be reduced drastically. Like you said, we're getting killed here.

[maverick_starstrider]

All public bills are footed by us little people one way or another. Either we pay it directly, or pay the cost of inflation. Or pay in the form of reduced economic investment.

Any tax bill paid by the rich comes out of their investment in the economy, not out of their "spending money". So, basically, any and all government spending will always be paid for by us little people one way or another. And I agree it's not fair, and it should be reduced drastically. Like you said, we're getting killed here.

Yes but economies need rich investors. Economies need underpaying free loaders like I need a third nipple. I've never understood the entitlement that those in low income brackets feel to the money of those in high income brackets. If you think you just "deserve" it more then you are incredibly deluded.

[Al68]

My comment wonders at the necessity of needing to force people to help others.
Am I willing to force people to help others?
Why should I have to?Well, if a person doesn't do so voluntarily, you either will use force against him or not. Those are your choices. Whether he will do so voluntarily without being forced is not your choice or mine. It's his and his alone regardless of what we think.

As far as why should you have to use force, you don't. You could choose not to use force against others despite the fact that they are not serving your cause. Or you can try to force them to serve.

This is a politics forum, and politics isn't about people doing everything you want without the use of force. That's just not the way it works.

If politics was about whether or not helping others is a good thing, 99% of us would be on the same side.

[Evo]

Yes but economies need rich investors. Economies need underpaying free loaders like I need a third nipple. I've never understood the entitlement that those in low income brackets feel to the money of those in high income brackets. If you think you just "deserve" it more then you are incredibly deluded.No, it's just that amount taken out of my income takes much more of my disposabl income than it does from someone with twice the income. They're not hurting like I am, so instead of excusing them from paying taxes, they should continue paying, and perhaps even pay more.

If someone making $40,000 annually pays a 6.2% social security tax, shouldn't someone making $250,000 a year pay the same 6.2%? Yes, they should, but they pay NOTHING!

So, the people that make the least are paying all of the taxes, and the rich pay none.

[mheslep]

...Altogether, I had to live with the hernia for about a month from the time I realized what it was to when I got the surgery. I shudder to think about how long I would have had to wait if I was Canadian... 99 days in the UK (http://www.takebackmedicine.com/storage/factsheets/ukandcanada.pdf)

Your understanding of our system is severely misguided.
...Is it? Wait lists for particular operations can drop in government run systems if and when the government decides to pour funding into some area or another for whatever reason. But they can not do that across the board. Do you challenge these wait list statistics (http://www.takebackmedicine.com/storage/factsheets/ukandcanada.pdf) below(based on 2008 OECD data)? Edit: In general, the wait for non-emergency surgery is 1-3 months for 60% of patients, and greater than 3 months for 20% per Statistics Canada (http://www.statcan.gc.ca/pub/82-575-x/2006002/c-g/4151080-eng.htm).

[Al68]

Yes but economies need rich investors. Economies need underpaying free loaders like I need a third nipple. I've never understood the entitlement that those in low income brackets feel to the money of those in high income brackets. If you think you just "deserve" it more then you are incredibly deluded.Did you accidentally respond to the wrong post here? Or did you misread my post?

Did I accidentally make a typo and say the opposite of what I intended? I don't know what to make of this response.

[maverick_starstrider]

No, it's just that amount taken out of my income takes much more of my disposabl income than it does from someone with twice the income. They're not hurting like I am, so instead of excusing them from paying taxes, they should continue paying, and perhaps even pay more.

If someone making $40,000 annually pays a 6.2% social security tax, shouldn't someone making $250,000 a year pay the same 6.2%? Yes, they should, but they pay NOTHING!

So, the people that make the least are paying all of the taxes, and the rich pay none.

Well I don't know about the states but someone here in canada that makes over $100,000 pays about 30% tax federally and like 10% tax provincially. A person how makes $40,00 pays maybe 20% total. That's twice as much tax for twice as much income. Then any money they make past that $100,000 practically goes half to the gov't half to me, half to the gov't half to me....

[Al68]

No, it's just that amount taken out of my income takes much more of my disposabl income than it does from someone with twice the income. They're not hurting like I am, so instead of excusing them from paying taxes, they should continue paying, and perhaps even pay more.

If someone making $40,000 annually pays a 6.2% social security tax, shouldn't someone making $250,000 a year pay the same 6.2%? Yes, they should, but they pay NOTHING!
So based on that logic, if the person making $40K pays $4 for a happy meal, then someone making $250K should pay $25 for a happy meal. And my son should charge him $75 for a pizza instead of $12. etc, etc.

The actual cost to government of providing retirement insurance to someone isn't proportional to income, so why should the price be?

[maverick_starstrider]

Meritocracy, more like mediocrity. You do too well and the state claims almost an even cut on your prosperity. If you don't, well.. that's ok, we'll prop you up.

[Al68]

Well I don't know about the states but someone here in canada that makes over $100,000 pays about 30% tax federally and like 10% tax provincially. A person how makes $40,00 pays maybe 20% total. That's twice as much tax for twice as much income. Then any money they make past that $100,000 practically goes half to the gov't half to me, half to the gov't half to me....It's similar in the U.S., politicians are just more successful at lying and misleading people about it here.

[mheslep]

...Here is one study that ranks the US as 37th in the world, in health care.http://dll.umaine.edu/ble/U.S.%20HCweb.pdf..

... I also cited the WHO study that ranks the US as 37th in the world.
The WHO study has been discussed several times in other threads. Its rankings include weighted metrics for things like health spending, and measures of 'fairness' (as the authors choose to measure it). It also uses life expectancy and infant mortality which are related to many things having nothing to do with medical practice (e.g. homicides). That's fine for whatever purpose they may have had in mind, but it is highly misleading if one is looking for the best possible outcomes in the case you actually get hurt/sick. If one corrects for these irrelevant factors, for instance in the case of life expectancy, it has been shown (http://www.aei.org/docLib/20061017_OhsfeldtSchneiderPresentation.pdf) (table 1-5) that the US has the highest life expectancy in the world by a slight margin, whereas the raw WHO figures have the US 24th in life expectancy.

[TheStatutoryApe]

Well, if a person doesn't do so voluntarily, you either will use force against him or not. Those are your choices. Whether he will do so voluntarily without being forced is not your choice or mine. It's his and his alone regardless of what we think.

As far as why should you have to use force, you don't. You could choose not to use force against others despite the fact that they are not serving your cause. Or you can try to force them to serve.

This is a politics forum, and politics isn't about people doing everything you want without the use of force. That's just not the way it works.

If politics was about whether or not helping others is a good thing, 99% of us would be on the same side.

I'll make sure to keep this all in mind while I decide whether or not to force people to not steal, force people to not do violence upon one another, ect.
Obviously laws, taxes, government, and such have nothing to do with helping anyone.

[Danger]

How bad was the hernia? It is my understanding that the severity of the problem has a big impact on the wait time for care. My doctor told me I didn't even need the surgery if I didn't want it.

Neither was serious. They restricted my lifting capacity to a fair extent (I could carry only 1 24-pack of beer bottles rather than the 3 that I usually did; I was bartending at the time), I avoided gassy food, and they made sex a bit painful. I could easily have gone a year untreated.

[Danger]

Do you challenge these wait list statistics (http://www.takebackmedicine.com/storage/factsheets/ukandcanada.pdf) below(based on 2008 OECD data)? Edit: In general, the wait for non-emergency surgery is 1-3 months for 60% of patients, and greater than 3 months for 20% per Statistics Canada (http://www.statcan.gc.ca/pub/82-575-x/2006002/c-g/4151080-eng.htm).

All I can say is that I've never known those stats to apply to anyone that I know. ER wait times can be pretty lengthy at some hospitals due to staff or space shortages, but it's done on a worst-served-first basis.
By the bye, each province has its own system. I'm in Alberta, where they just eliminated the $130/3-months health care insurance premiums that we used to have to pay.

[Al68]

I'll make sure to keep this all in mind while I decide whether or not to force people to not steal, force people to not do violence upon one another, ect.
Obviously laws, taxes, government, and such have nothing to do with helping anyone.

Huh? Of course they do. Or at least they can.

My point was that the fact that we may disagree about whether or not to use force against someone doesn't mean we disagree about what we think they should do.

[TheStatutoryApe]

Huh? Of course they do. Or at least they can.

My point was that the fact that we may disagree about whether or not to use force against someone doesn't mean we disagree about what we think they should do.

Are you against taxes?

[Al68]

Are you against taxes?Not in general. I'm not opposed to all uses of force. I'm a libertarian, not an anarchist.

[TheStatutoryApe]

Not in general. I'm not opposed to all uses of force. I'm a libertarian, not an anarchist.

Well... People decided, or at least were convinced, that taxes needed to be paid and that force ought to be used to make sure they were paid if necessary. The force being used isn't about any single avenue of spending, its just about tax collection in general. So the force that would be wielded to make sure that the money is collected that would go to national health care is also the force that would be wielded to make sure that the money is collected that goes to make sure the white house lawn gets mowed, American flags for capital buildings are bought and properly cared for, the president gets his lunch, ect.

Do you agree with force being used against people to make sure that the white house lawn gets mowed?

[mheslep]

Universal Car Care:
http://www.youtube.com/watch?v=Kadjlv-LPbI

[Al68]

Well... People decided, or at least were convinced, that taxes needed to be paid and that force ought to be used to make sure they were paid if necessary. The force being used isn't about any single avenue of spending, its just about tax collection in general. So the force that would be wielded to make sure that the money is collected that would go to national health care is also the force that would be wielded to make sure that the money is collected that goes to make sure the white house lawn gets mowed, American flags for capital buildings are bought and properly cared for, the president gets his lunch, ect.

Do you agree with force being used against people to make sure that the white house lawn gets mowed?No, actually, but that's because any mowing service around would gladly do it for free, or even pay to do it. That would be a valuable advertisement for them. I'd bet John Deere would cut a big check just for using their mower.

As far as the force being the same, if I use force to collect $100 that someone has that belongs to me, and while I'm at it I collect an extra $200 just because he had it and my neighbor needed it, it's the same force used for both. But using force to collect the $200 because my neighbor needed it was theft, even if it's the same force used to collect a legitimate debt. So part of the "collection" was theft and part of it was not. It's simply untrue to say that either it's all theft or none of it is.

Would you say that it's OK to imprison 10 people if only one of them is a convicted criminal because the force used to imprison the innocent is the same force used to imprison the guilty? After all, the force used isn't just to imprison the innocent, it's for imprisonment in general.

[TheStatutoryApe]

No, actually, but that's because any mowing service around would gladly do it for free, or even pay to do it. That would be a valuable advertisement for them. I'd bet John Deere would cut a big check just for using their mower.

As far as the force being the same, if I use force to collect $100 that someone has that belongs to me, and while I'm at it I collect an extra $200 just because he had it and my neighbor needed it, it's the same force used for both. But using force to collect the $200 because my neighbor needed it was theft, even if it's the same force used to collect a legitimate debt. So part of the "collection" was theft and part of it was not. It's simply untrue to say that either it's all theft or none of it is.

Would you say that it's OK to imprison 10 people if only one of them is a convicted criminal because the force used to imprison the innocent is the same force used to imprison the guilty? After all, the force used isn't just to imprison the innocent, it's for imprisonment in general.
What? Are you saying now that if taxes were introduced to pay for national health care it would be illegal? Akin to the IRS just deciding one day that they were going to make you cough up some extra cash? or just throw someone in prison even though they paid their taxes?

Your metaphors are a bit wonky.

So far this is the impression that I am getting...



IRS: Excuse me. We're here to collect the taxes you owe. I am very sorry about this but if you refuse we will have to take it from you by force.

Al68: Oh, well I completely respect that. Here let me write you a check, and aswell you should throw me in jail if I refuse to pay you.

IRS: Good good. You see we really need the money to pay for this new National Health Care deal.

Al68: Uh oh, sorry fellas but I don't agree with my money being spent on National Health Care. I'm just going to have to tear up this check here and since I don't agree with the way you want to spend my money, well, I don't think I can allow you to take me to jail.

IRS: Oh no, well dash. It's too bad you don't agree with the way we want to spend your money since we'd really like to arrest you for not paying your taxes but if that's the way it is then I guess we'll just have to leave you alone. Carry on then.

Al68: Thanks for understanding guys. Maybe we'll have this sorted out by next year. See ya then!



Is that about right?

[D H]

Your metaphors are a bit wonky.
Really. You are the one who introduced the wonky lawn mowing metaphor. Al68's answer was spot in the sense of "ask a stupid question, get a smartass answer".

[TheStatutoryApe]

Really. You are the one who introduced the wonky lawn mowing metaphor.

That's not a metaphor. It is, in fact, one of the many rather small things our tax dollars go to pay for. So saying that you are being made to pay for health care by threat of force is the same as saying you are being made to pay for the President's lawn care (or any number of other inane little things) by threat of force.
"if ... then ..." not "... is like ..."

[D H]

That's not a metaphor. It is, in fact, one of the many rather small things our tax dollars go to pay for.It is 5:00 AM, for crying out loud. Give me a break. What you presented is, to be 5:00 AM blunt, a stupid argument. You are missing Al68's point, which is that all taxation is legalized theft. That is a fairly common viewpoint amongst libertarians. The taxes might well be necessary and constitutional used to fund necessary and constitutional projects, but they remain nonetheless legalized theft. When that legalized theft is used to fund something viewed to be unconstitutional it grates just a bit. Many libertarians and conservatives view nationalized health care as unconstitutional.


Now back to less silly arguments:
No, it's just that amount taken out of my income takes much more of my disposabl income than it does from someone with twice the income.
This exemplifies why I think the legalized theft, aka taxation, must be progressive to some extent. IMHO, discussions about fairness in taxation schemes are misguided. There can be no such thing as a fair tax for the simple reason that taxation is inherently unfair. However, some level of taxation is also very necessary. The best we can do is to spread the pain around evenly. A flat tax does not come close to achieving that end. It would induce incredible misery upon everyone but the very rich, and would make the very rich extremely happy. Even a proportional tax fails this "spread the pain" test. Take 25% of a poor person's income and that poor person will have to forego eating for several days a month. Take 25% of a rich person's income and they might forego a nibble of caviar.

[TheStatutoryApe]

It is 5:00 AM, for crying out loud. Give me a break. What you presented is, to be 5:00 AM blunt, a stupid argument. You are missing Al68's point, which is that all taxation is legalized theft. That is a fairly common viewpoint amongst libertarians. The taxes might well be necessary and constitutional used to fund necessary and constitutional projects, but they remain nonetheless legalized theft. When that legalized theft is used to fund something viewed to be unconstitutional it grates just a bit. Many libertarians and conservatives view nationalized health care as unconstitutional.

Stupid? He has taken an idea and made the rhetorical implication that it is somehow distasteful or even unethical. I'm pointing out the rediculousness in his implication by extending it to encompass all things paid for by taxes and not just those which he is currently arguing against. That is I would find it much less distasteful if money taken from me by force (or legalized theft) were spent on something as important as health care than to be made, by threat of force, to pay for someone's lawn care. Tell me, which application of the threat of force do you find the most distasteful?

[seycyrus]

The insurance companies do not engage in "mistakes and abuses". They intentionally deny and delay payment as long as possible to make money off the interest on their holdings, and the magnitude of the fraud is incredible.

Uhm, that IS an abuse. Why would you claim that it is not? Perhaps your eagerness to attack anyone who raises the merest suggestion of questioning an Obama policy caused momentary dyslexia?


If you think that a government-based program will perpetuate this kind of crap, please link to some legitimate sources to support your claim.

Oh, I see. this thread can be originated by anecdotal stories, but when I mention my real life experiences, *I* get called on it.

Same old hypocrisy.

Keep up the cheerleading!

[turbo-1]

It is certainly not "anecdotal" to cite the massive cost of overhead created by the private insurance companies. It is common knowledge and is well-covered in the press.

http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/

The insurance companies and their shills in Congress loudly proclaim that having public health insurance would be too expensive. The truth is that the stranglehold that the private insurers have would be broken. I have worked in the medical field as a network administrator, and I have written programs to help financial administrators keep track of the aging of their receivables, and prompt the coding specialists to review, recode, and re-file claims so that (hopefully) the insurance companies will pay.

One truly pathetic "feature" of our current system is that the insurance companies cherry-pick who they will or will not cover, and if you come down with a serious illness, they will drop your coverage rather than pay for your treatment. As for doctors, I have a friend who is a pediatric ophthalmologist, and a very large portion of his patients are Medicaid recipients (low-income). Despite Medicaid's caps on reimbursements, his practice is doing well because Medicaid's coding requirements are clear and they pay promptly, so he doesn't need to pay coding and billing specialists to re-submit claims again and again.

[seycyrus]

It is certainly not "anecdotal" to cite the massive cost of overhead ...

Such flagrant abuse of selective response should be a violation of PF rules. I specifically stated that this thread had its origin in the form of anecdotes.

.... As for doctors, I have a friend who is a pediatric ophthalmologist, ...

Oh, another anecdote!

Guess what? I work in the govt. system *now*. the more govt. gets its hands in something, the more it screws you up.

Keep on keeping on with the anecdotes. I'll match you two for one on how the govt. can screw up something simple and make it far far worse. I can come up with a new story on a daily basis!

[mheslep]

It is certainly not "anecdotal" to cite the massive cost of overhead created by the private insurance companies. It is common knowledge and is well-covered in the press.

http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/

The insurance companies and their shills in Congress loudly proclaim that having public health insurance would be too expensive. I don't know about the shills, but the CBO (http://cboblog.cbo.gov/?p=324) says so
According to that assessment, enacting those provisions by themselves would result in a net increase in federal budget deficits of $1,042 billion over the 2010–2019 period.

The truth is that the stranglehold that the private insurers have would be broken. There are several other alternatives to breaking up the insurance monopolies including allowing competition between states, breaking the employer-health care coupling (both were McCain proposals) - all of which by the way was set up that way in the first place by government laws and tax code.

[mheslep]

It is certainly not "anecdotal" to cite the massive cost of overhead created by the private insurance companies. It is common knowledge and is well-covered in the press.

http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/
There's good evidence to the contrary, that Medicare in reality does not have lower administrative costs, but let us assume for the moment that is true.

.... As for doctors, I have a friend who is a pediatric ophthalmologist, and a very large portion of his patients are Medicaid recipients (low-income). Despite Medicaid's caps on reimbursements, his practice is doing well because Medicaid's coding requirements are clear and they pay promptly, so he doesn't need to pay coding and billing specialists to re-submit claims again and again.Bingo. Yes Im sure they pay. They pay for any invoice on anything. That's why these programs incur such massive fraud. Just send them an invoice and it is paid, no questions asked. This also goes to why Medicare/Medicaid appear to have lower administrative costs: they don't employ anywhere near the staff required to properly vet claims, by a factor of twenty I've read. One is playing with fire in attempting to defraud a private insurance company. But with Medicare/Medicaid, its 'what took you so long to join the rip-off party?'

WSJ (http://online.wsj.com/article/SB124649425934283347.html)
The White House made a big show last week about "turning the heat up" on Medicare fraud, as Jane Friday -- er, HHS Secretary Kathleen Sebelius put it. The dragnet resulted in 53 indictments in Detroit for a $50 million scheme to submit bills for HIV drugs and physical therapy that were never provided, as well as busting up a Miami ring that used fake storefronts to steal some $100 million...

U.S. Charges 61 in Medicare Crackdown (http://online.wsj.com/article/SB124586523348648621.html)
The federal government announced indictments of 53 people allegedly involved in a Medicare-fraud scheme in Detroit, a day after charging eight others in Miami suspected of running a similar fraud.
...
In the Detroit case, the alleged fraud was estimated at $50 million. Those charged included doctors, health-care executives and beneficiaries. The scheme in Miami allegedly used fake store fronts in an attempt to cheat Medicare out of $100 million.

http://www.usdoj.gov/opa/pr/2009/May/09-ag-491.html
"Every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud. That is six tens of billions every year per the WSJ.

[Al68]

What? Are you saying now that if taxes were introduced to pay for national health care it would be illegal? Akin to the IRS just deciding one day that they were going to make you cough up some extra cash? or just throw someone in prison even though they paid their taxes?

Your metaphors are a bit wonky.

So far this is the impression that I am getting...



IRS: Excuse me. We're here to collect the taxes you owe. I am very sorry about this but if you refuse we will have to take it from you by force.

Al68: Oh, well I completely respect that. Here let me write you a check, and aswell you should throw me in jail if I refuse to pay you.

IRS: Good good. You see we really need the money to pay for this new National Health Care deal.

Al68: Uh oh, sorry fellas but I don't agree with my money being spent on National Health Care. I'm just going to have to tear up this check here and since I don't agree with the way you want to spend my money, well, I don't think I can allow you to take me to jail.

IRS: Oh no, well dash. It's too bad you don't agree with the way we want to spend your money since we'd really like to arrest you for not paying your taxes but if that's the way it is then I guess we'll just have to leave you alone. Carry on then.

Al68: Thanks for understanding guys. Maybe we'll have this sorted out by next year. See ya then!



Is that about right?

My analogy was intended to show that using the "same" force for two purposes doesn't make the purposes equal.

The conversation above seems backwards.

We were discussing whether or not to collect the money by force, not whether or not to be collected from. That being said, the above "conversation" sure sounds silly if you operate under the assumption that people's earnings don't rightfully belong to them.

[turbo-1]

Michele Bachmann and John Kline (both GOP, BTW) say that public health insurance would be 30-40% cheaper than private health insurance, and are using that as an argument AGAINST it. Small businesses are the real "job-engines" in our economy, and it is hardly good conservative practice to work against a program that can greatly reduce the expenses of these businesses who want to offer health insurance coverage to their employees.

http://minnesotaindependent.com/39874/bachmann-kline-oppose-public-option-because-its-cheaper

Now, for those who rail that government can't do anything right, please look here: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3272

Most retirees pay just $96.40/month for Medicare Part B (doctor's visits, prescription drug coverage, etc) and a married couple would have to be making almost $1/2M per year to pay the maximum premium of $308.30/month. Please bear in mind that the people being served by this program are primarily elderly retirees, with people on Social Security Disability thrown in. Those are demographics with more health problems than average and the cost of their health care should be higher than average. If the government can put together a similar public program WITH the addition of people from healthier demographic groups, costs and premiums should go down significantly.

The GOP is playing the politics of fear and uncertainty to try to derail universal health-care coverage.

[Al68]

Most retirees pay just $96.40/month for Medicare Part B (doctor's visits, prescription drug coverage, etc) and a married couple would have to be making almost $1/2M per year to pay the maximum premium of $308.30/month. Please bear in mind that the people being served by this program are primarily elderly retirees, with people on Social Security Disability thrown in. Those are demographics with more health problems than average and the cost of their health care should be higher than average. And is. Surely you're not suggesting that the above premiums represent the total cost of the coverage.The GOP is playing the politics of fear and uncertainty to try to derail universal health-care coverage.That's better than being the ones advocating such a thing to be feared.

[Al68]

Stupid? He has taken an idea and made the rhetorical implication that it is somehow distasteful or even unethical. I'm pointing out the rediculousness in his implication by extending it to encompass all things paid for by taxes and not just those which he is currently arguing against. That is I would find it much less distasteful if money taken from me by force (or legalized theft) were spent on something as important as health care than to be made, by threat of force, to pay for someone's lawn care. Tell me, which application of the threat of force do you find the most distasteful?Distasteful? You can't seriously think that's what this is about. Why would it be a valid point to extend an objection to theft to encompass things that are not theft?

And not all taxes are legalized theft. I use the word theft only to refer to the portion that's use is not related to services provided to the person paying the tax. The road (fuel) tax is an obvious example of a tax that is not theft.

Income taxes are doubly problematic. Not only are the taxes collected from a person by force unrelated to services provided to that person (theft), the right to privacy is violated by the governments demand to know someone's personal income.

Can you explain how an individual's personal income is even government's business?

[mheslep]

Its over, at least for this Summer.
http://twitter.com/GStephanopoulos
"Top Senate aides confirm Obama's August deadline for healthcare won't be met. Durbin tells "The Hill" not "possible" Takes bullet for POTUS"

Maybe when they come back in the Fall they'll work some plans that make sense.

[TheStatutoryApe]

Distasteful? You can't seriously think that's what this is about. Why would it be a valid point to extend an objection to theft to encompass things that are not theft?

And not all taxes are legalized theft. I use the word theft only to refer to the portion that's use is not related to services provided to the person paying the tax. The road (fuel) tax is an obvious example of a tax that is not theft.

Income taxes are doubly problematic. Not only are the taxes collected from a person by force unrelated to services provided to that person (theft), the right to privacy is violated by the governments demand to know someone's personal income.

Can you explain how an individual's personal income is even government's business?
Again, here we go with the rhetoric used to make your position seem self evident. "It's theft I say! Theft!"

There are any number of things that your taxes go to pay for that you do not benefit from directly. Do you necessarily benefit directly from paying for the police? I mean when was the last time they helped you specifically? And maybe they have helped you, who knows, but what about the guy who pays his taxes and never receives any help from the police at all? Does he deserve a refund? Or would you say that he is benefiting indirectly from the work done by the police?

Well you can benefit indirectly from national health care too. Imagine all of your co-workers and/or employees getting the medical attention they need. They'll probably call out from work less often. They will probably be less likely to suffer work related injuries. They will likely be healthier and in better spirits and so more productive and easier to work with.
The same goes for clients, vendors, contractors, customers, ect, ect. The healthier the populace, the better and more smoothly everything will run, and the better the economy will be. How is this any different than the indirect benefits that people receive from the vast majority of things that they pay taxes for?

Of course we still pay taxes for all sorts of things that we arguably receive no benefit from at all. Does a pretty well lit flag in from of the capital building benefit you really? Does a politician being driven around in a limo help you out much?
Of all the inane crap that your tax money goes to pay for there are much better things you could be refering to as "theft" than national health care.

[Al68]

Again, here we go with the rhetoric used to make your position seem self evident. "It's theft I say! Theft!"

There are any number of things that your taxes go to pay for that you do not benefit from directly. Do you necessarily benefit directly from paying for the police? I mean when was the last time they helped you specifically? And maybe they have helped you, who knows, but what about the guy who pays his taxes and never receives any help from the police at all? Does he deserve a refund? Or would you say that he is benefiting indirectly from the work done by the police?

Well you can benefit indirectly from national health care too. Imagine all of your co-workers and/or employees getting the medical attention they need. They'll probably call out from work less often. They will probably be less likely to suffer work related injuries. They will likely be healthier and in better spirits and so more productive and easier to work with.
The same goes for clients, vendors, contractors, customers, ect, ect. The healthier the populace, the better and more smoothly everything will run, and the better the economy will be. How is this any different than the indirect benefits that people receive from the vast majority of things that they pay taxes for?

Of course we still pay taxes for all sorts of things that we arguably receive no benefit from at all. Does a pretty well lit flag in from of the capital building benefit you really? Does a politician being driven around in a limo help you out much?
Of all the inane crap that your tax money goes to pay for there are much better things you could be refering to as "theft" than national health care.Sure there are plenty of other things I could refer to as theft, I agree, and you didn't even put a dent in them, but those other things are not the subject of this thread.

As far as using the word theft, what definition of theft would it not meet? Except of course a definition that was conditional on legality. Theft is "the act of stealing" and steal means "to take (the property of another or others) without permission or right, esp. secretly or by force".

Would the exact same actions be theft if committed by someone other than government? If so, then it's theft, unless your definition of theft conveniently has the "unless it's the government" clause.

[TheStatutoryApe]

Sure there are plenty of other things I could refer to as theft, I agree, and you didn't even put a dent in them, but those other things are not the subject of this thread.

As far as using the word theft, what definition of theft would it not meet? Except of course a definition that was conditional on legality. Theft is "the act of stealing" and steal means "to take (the property of another or others) without permission or right, esp. secretly or by force".

Would the exact same actions be theft if committed by someone other than government? If so, then it's theft, unless your definition of theft conveniently has the "unless it's the government" clause.
If you take a look at the conventional definition of theft it bares little resemblence to a system put in place and maintained by duely elected representatives of the people to collect money necessary for the betterment and maintenance of their society. Strip anything of context and amplify selected characteristics and you can make it look however you'd like.

So maybe you can drop this argument by rhetoric and actually make an argument? Would you like to actually respond to the main thrust of my post which you quoted? That is: What of things paid for with taxes which you benefit from indirectly such as perhaps the police? Is the benefit you receive indirectly from national health care really all that different?

[Huckleberry]

As far as using the word theft, what definition of theft would it not meet? Except of course a definition that was conditional on legality. Theft is "the act of stealing" and steal means "to take (the property of another or others) without permission or right, esp. secretly or by force".

Would the exact same actions be theft if committed by someone other than government? If so, then it's theft, unless your definition of theft conveniently has the "unless it's the government" clause.

The government has the right to tax the people it justly represents and provides services for. Not paying taxes is stealing from the government and the people. Without taxes there is no government. Without government there is no nation. That's what you're getting for your money. Whether that is of value to you or not doesn't exclude you from contributing to it, by force if necessary.

If the government becomes corrupt or no longer justly represents the people then I'll be right there with you in prison, not paying taxes.

[Al68]

If you take a look at the conventional definition of theft it bares little resemblence to a system put in place and maintained by duely elected representatives of the people to collect money necessary for the betterment and maintenance of their society.So you mean the conventional definition with the added "unless it's the government" clause. In that case it wouldn't meet that definition of theft. But that's just semantics.
So maybe you can drop this argument by rhetoric and actually make an argument? Would you like to actually respond to the main thrust of my post which you quoted? That is: What of things paid for with taxes which you benefit from indirectly such as perhaps the police? Is the benefit you receive indirectly from national health care really all that different?I'd say first that national health care would be a detriment, on average, not a benefit to the people paying for it. Even if we could say it was of some benefit, it wouldn't come close to a service provided to everyone with value roughly in line with the amount each person is taxed, like police, fire, national defense, roads, etc. That's a big difference from claiming that everyone would get some benefit, but not only is the price not in line with the value of the benefit, it's designed purposely not to be.

I would also note that being a libertarian means that I don't consider changing, altering, modifying, or "bettering" society to be a legitimate function of government, while protecting liberty is. The legitimate role of government is to protect the liberty of people to decide for themselves what to do, not take it away so government can decide what's best for society.

[Al68]

The government has the right to tax the people it justly represents and provides services for. Not paying taxes is stealing from the government and the people. Without taxes there is no government. Without government there is no nation. That's what you're getting for your money. Whether that is of value to you or not doesn't exclude you from contributing to it, by force if necessary.

If the government becomes corrupt or no longer justly represents the people then I'll be right there with you in prison, not paying taxes.Did you accidentally respond to the wrong post? I never advocated anyone not paying taxes.

I never objected to the government collecting taxes in general, or for services provided. My objection is to using the tax code for theft, not to paying taxes.

My objection is based on my role in helping to decide government policy, not in following it.

[Ivan Seeking]

Wrt the cost of health care:

SACRAMENTO, California (CNN) -- Debbie Brown used to process medical and dental forms for a living before a debilitating illness forced her into early disability retirement and left her in a simple, no-frills wheelchair -- a rented wheelchair that has cost taxpayers about $1,200.

Brown says the public should be outraged about her wheelchair.

Why? She says she could buy a comparable wheelchair on the Internet for $440 if she had the money. It sounded hard to believe that her rented, $1,200 taxpayer-funded wheelchair could be bought for $440, so CNN decided to check -- and instead found an even better deal.

CNN went to the same company that charges Medicare for Brown's chair, Apria Healthcare, and bought it for $349 -- about a fourth of what taxpayers' have paid for Brown's rented wheelchair...
http://www.cnn.com/2009/US/07/20/healthcare.wheelchair/index.html

[Al68]

Wrt the cost of health care:

SACRAMENTO, California (CNN) -- Debbie Brown used to process medical and dental forms for a living before a debilitating illness forced her into early disability retirement and left her in a simple, no-frills wheelchair -- a rented wheelchair that has cost taxpayers about $1,200.

Brown says the public should be outraged about her wheelchair.

Why? She says she could buy a comparable wheelchair on the Internet for $440 if she had the money. It sounded hard to believe that her rented, $1,200 taxpayer-funded wheelchair could be bought for $440, so CNN decided to check -- and instead found an even better deal.

CNN went to the same company that charges Medicare for Brown's chair, Apria Healthcare, and bought it for $349 -- about a fourth of what taxpayers' have paid for Brown's rented wheelchair...
http://www.cnn.com/2009/US/07/20/healthcare.wheelchair/index.htmlThe only surprise here is that Medicare paid only $1200 over 4 years at about $25/month. Being involved with government projects quite a bit, that's a much better deal than a lot of other things government buys.

Of course everybody (except government) knows if you rent something for 4 years it will cost much more than just buying it. You're better off buying than renting most things if you're going to have it over a year.

This is just what happens when the spender of the cash gets it for free, and the more they spend the better off they are, and the more they can claim to need in the future. If I allowed my child to tell me how much allowance he needed, and he continually claimed it wasn't enough no matter how much it was and how much he wasted, I would go broke in no time. Sound familiar?

[Huckleberry]

Did you accidentally respond to the wrong post? I never advocated anyone not paying taxes.

I never objected to the government collecting taxes in general, or for services provided. My objection is to using the tax code for theft, not to paying taxes.

My objection is based on my role in helping to decide government policy, not in following it.

It isn't theft. We benefit as individuals from living in a nation. We pay for those benefits with our taxes. The government uses those taxes to promote the general welfare, among other things as specified in the Constitution. We benefit from the nation and owe a fair contribution to it.

It's interesting you want to exclude a legal right for governments to collect taxes from any counterargument. A democratic government's legal right is given to it by the representatives of the people. If the government is acting in the interests of the people then it is justified in its right to collect taxes on their behalf. Accepting a legal right would mean that you would have no case for calling it tax theft. Dismissing a legal right would give some merit to your argument and lead counterarguments into semantics, but deny the legitimacy of democracy in America.

You have as much voice in deciding policy as any other average American, but just because you prefer a libertarian perspective of democracy doesn't mean that everyone should. There's plenty of times I feel that majority rules outcomes are unfair, but I have to live with whatever decision is made. Democracy isn't a government of the person by the person. That is no government at all.

[gravenewworld]

http://atlantis2.cbsnews.com/video/watch/?id=3641677n

Insurance Won't Pay; Girl Dies

December 22, 2007 1:01 AM

An insurance company denied a teenage girl a liver transplant. When they changed their minds, it was too late. The girl had died and now many are outraged. John Blackstone reports.



http://www.kmbc.com/health/13298245/detail.html


Cancer Patient Upset With Coventry Insurance
Company Refuses To Pay For Prescription Drug
KANSAS CITY, Mo. -- Her doctor said she needs a drug to survive, but her insurance company refused to pay for it.






http://cbs5.com/local/cancer.treatment.denied.2.1007394.html

Insurance Won't Pay NorCal Mom's Cancer Treatment

SAN FRANCISCO (CBS 5) ?


Will your insurance company pay for the treatment your doctors recommend? They may not. That's what a single mother from Chico said she found out.




http://cbs5.com/investigates/CyberKnife.blue.shield.2.716740.html


Blue Shield Denies New Cancer Treatment Claim














Boooooooooooooooo!!!!!!!!!! I don't want the stinkin' government bureaucrats making health care decisions for me! I'd much rather have a pencil pusher behind a desk at an insurance company doing it!

[Pupil]

I've read many of the posts here, but not all (just got here too late, I suppose!). Anyway, this scared me quite a bit. (http://skepticalob.blogspot.com/2009/06/yes-patient-might-die-but-im-not-going.html) It's things like this that need to change.

[JDStupi]

Though I have no personal experiences with our health system currently, I believe that it is undeniable to anybody that the United States health care system is in need of improvement, but I find that too often people look at as if it was only a binary situation; Either the current system stays and we take the bad with the good or we convert to the Obama-proposed government provided health care system. People fight back and forth endlessly over the pro's and con's of both systems, but there is always other options and various synthesises of the different options. I personally have no suggestions as of yet because I am not informed enough to say something with authority, but I do know that there is more than just these two options. The left charges the right with corporate corruption, the right charges the left with the possibility of bureaucratic idiocy, both are true and both won't go away unless we deal with them. I may be an idealist, but I think we should focus on ways to end the corporate corruption of highly capitalistic systems without throwing away the benefits of the capitalistic system, similarly we should acknoledge the government can do some good to a certain extent if we find a way to fix the bureaucratic system. I will admit I'm young and have yet to reach the age to vote, therefore my opinions may be discredited by many as being "too inexperienced" and that may be true to some extent, but I still hold that it is not an either/or situation. I hope some people more informed then I can possibly explicate upon what I said hopefully with more detail and possibly proposals.

[mheslep]

http://atlantis2.cbsnews.com/video/watch/?id=3641677n

Insurance Won't Pay; Girl Dies

December 22, 2007 1:01 AM

An insurance company denied a teenage girl a liver transplant. When they changed their minds, it was too late. The girl had died and now many are outraged. John Blackstone reports.



http://www.kmbc.com/health/13298245/detail.html

Boooooooooooooooo!!!!!!!!!! I don't want the stinkin' government bureaucrats making health care decisions for me! I'd much rather have a pencil pusher behind a desk at an insurance company doing it!On average, US transplant patients are better off in the US's flawed system than in other government run systems.

[Pupil]

On average, US transplant patients are better off in the US's flawed system than in other government run systems.

Do you have any studies or information that indicates this? I'm not trying to be an ***, but there are a lot of claims going around this thread and I don't know what's true or not.

[BobG]

http://atlantis2.cbsnews.com/video/watch/?id=3641677n

Insurance Won't Pay; Girl Dies

December 22, 2007 1:01 AM

An insurance company denied a teenage girl a liver transplant. When they changed their minds, it was too late. The girl had died and now many are outraged. John Blackstone reports.



http://www.kmbc.com/health/13298245/detail.html


Cancer Patient Upset With Coventry Insurance
Company Refuses To Pay For Prescription Drug
KANSAS CITY, Mo. -- Her doctor said she needs a drug to survive, but her insurance company refused to pay for it.






http://cbs5.com/local/cancer.treatment.denied.2.1007394.html

Insurance Won't Pay NorCal Mom's Cancer Treatment

SAN FRANCISCO (CBS 5) ?


Will your insurance company pay for the treatment your doctors recommend? They may not. That's what a single mother from Chico said she found out.




http://cbs5.com/investigates/CyberKnife.blue.shield.2.716740.html


Blue Shield Denies New Cancer Treatment Claim




Boooooooooooooooo!!!!!!!!!! I don't want the stinkin' government bureaucrats making health care decisions for me! I'd much rather have a pencil pusher behind a desk at an insurance company doing it!

Two problems may be being mixed together.

1) Some "low cost" health insurance policies can charge low premiums because their policy covers nothing. They make their profit by denying claims, thereby reducing what they have to pay out in benefits.

2) To a patient staring death in the face, any treatment and any cost seems reasonable. That doesn't mean the treatment has a good enough chance of succeeding to be worth the cost to the objective observer. The insurance company is denying treatments it will cover for good reason.

(Yes, telling the difference between the first and second can sometimes be hard).

Government health care would eliminate the first problem. People wouldn't waste their money (even if only a little) for "insurance" that wasn't worth the money it was printed on.

If government eliminates the second problem by granting any treatment that offers even a sliver of hope, then government health care will just bankrupt the government. Someone looking at the odds objectively has to decide if the treatment is worth paying for even if it's the government doing the paying.

[mheslep]

Do you have any studies or information that indicates this? I'm not trying to be an ***, but there are a lot of claims going around this thread and I don't know what's true or not.Yes.

First, the big choke point on transplants is organ availability, not the operation itself(102k waiting as of today, ~5k donors over 4 mos (http://optn.transplant.hrsa.gov/)), so obviously there has to be some unavoidably ruthless triage done. Second, transplant patients in the even the US's flawed system seem to fairly well in terms of availability and outcome:

http://online.wsj.com/article/SB120001235968882563.html?mod=opinion_main_comment aries
Availability:
...In 2002 -- a year comparative data is available -- U.S. doctors performed 18.5 liver transplants per one million Americans. This is significantly more than in the U.K. or in single-payer France, which performed 4.6 per million citizens, or in Canada, which performed 10 per million....

A study in the Journal of Heart and Lung Transplantation compared statistics on heart transplants over the mid 1990s. It found patients were more likely to receive hearts in the U.S., even when they were older and sicker. The rate was 8.8 transplants per one million people, compared to 5.4 in the U.K. Over the same period, about 15% of patients died while waiting for new hearts in the U.K. compared to 12% in the U.S. In 2006, there were 28,931 transplants of all organ types in the U.S., 96.8 transplants for every one million Americans. There were 2,999 total organ transplants in the U.K., 49.5 transplants for every one million British citizens.

Survivability
...recent study found that patients' five-year mortality after transplants for acute liver failure, the type from which Ms. Sarkisyan presumably suffered, was about 5% higher in the U.K. and Irleand than the U.S. The same study also found that in the period right after surgery, death rates were as much as 27% higher in the U.K. and Ireland than in the U.S., although differences in longer-term outcomes equilibrated once patients survived the first year of their transplant.

The same link shows transplant availability is not all about income either. Most of the liver transplants are due to Hep-C and alcoholism - diseases of the poor or fallen.

[mheslep]

Two problems may be being mixed together.

1) Some "low cost" health insurance policies can charge low premiums because their policy covers nothing. They make their profit by denying claims, thereby reducing what they have to pay out in benefits.

2) To a patient staring death in the face, any treatment and any cost seems reasonable. That doesn't mean the treatment has a good enough chance of succeeding to be worth the cost to the objective observer. The insurance company is denying treatments it will cover for good reason.

(Yes, telling the difference between the first and second can sometimes be hard).

Government health care would eliminate the first problem. People wouldn't waste their money (even if only a little) for "insurance" that wasn't worth the money it was printed on.Eliminate the problem? It would only eliminate the option to pay: all would be forced to pay through taxes, you might still get bad care.

If government eliminates the second problem by granting any treatment that offers even a sliver of hope, then government health care will just bankrupt the government. Someone looking at the odds objectively has to decide if the treatment is worth paying for even if it's the government doing the paying."...just bankrupt the nation..." and "...even if it's the people doing the paying." would be more accurate.

[Al68]

It isn't theft. We benefit as individuals from living in a nation. We pay for those benefits with our taxes. The government uses those taxes to promote the general welfare, among other things as specified in the Constitution. We benefit from the nation and owe a fair contribution to it.

It's interesting you want to exclude a legal right for governments to collect taxes from any counterargument. A democratic government's legal right is given to it by the representatives of the people. If the government is acting in the interests of the people then it is justified in its right to collect taxes on their behalf. Accepting a legal right would mean that you would have no case for calling it tax theft. Dismissing a legal right would give some merit to your argument and lead counterarguments into semantics, but deny the legitimacy of democracy in America.

You have as much voice in deciding policy as any other average American, but just because you prefer a libertarian perspective of democracy doesn't mean that everyone should. There's plenty of times I feel that majority rules outcomes are unfair, but I have to live with whatever decision is made. Democracy isn't a government of the person by the person. That is no government at all.You have again grossly misconstrued my position. I never even suggested that the government shouldn't collect taxes. Why do you continue to respond to my posts with statements I agree with and pretend that they contradict something I said?

That's called a "strawman argument" when you argue against a position that nobody has advocated. Just because politicians do it all the time on TV doesn't mean it's not fallacious logic.

I repeat, I do not oppose the legitimate power of government to levy taxes for the reasons you stated. The only thing in your post I don't agree (or disagree) with is the first sentence "It isn't theft", and that's just because I don't know what "it" you are referring to.

Edit: And I'm not quite sure what you mean by "deny the legitimacy of democracy in America." The U.S. is not a democracy in the absolute sense you imply. It's only a democracy by the broad definition that loosely includes a constitutional republic with limited, enumerated powers. The government is elected by the people (republic), but does not have unlimited power like a pure democracy.

[mgb_phys]

On average, US transplant patients are better off in the US's flawed system than in other government run systems.
Although the mortality rate is 35% higher than Canada according to http://www.ustransplant.org/

The donation rate in the US is good but not the highest - in spite of the great efforts made by US drivers.

[turbo-1]

I think I'd rather get my transplantation performed in Australia or NZ than in the US, unless it was a pancreas graft procedure.

http://www.geocities.com/organdonate/AAACh8SurvivalStats.html

In 1997, prior to the suppression of Australian transplant survival statistics (except for kidneys), the heart transplant patient survival rate as published by the government agency, ACCORD, was 90% for the first year and 77% for five years. The US statistics published by UNOS in 1999 show a lower patient survival at 85% for the first year and 69% for five years.

Similarly, US liver transplant survival rates are 79% for one year and 63% for five years while the Australian were 83% for one year and 73% for five years. The US pancreas patient survival rate is 96% for the first year and 82% for five years. In Australia it is 94% for one year and 87% for five years. The above is patient survival but the actual pancreas graft survival is another story. Graft survival is where the patient may survive but the transplanted organ fails or is rejected and must be cut out before it goes rotten. U.S. pancreas graft survival is 76% for one year and 35% for five years so you can understand why the Australians suppress graft survival figures. It doesn’t fit in with their "life-saving" transplant sales theme they throw at grieving relatives in the waiting room and at the public through mass advertising campaigns.

Pancreas graft failure means the patient is back on insulin and the whole thing was a waste of time with increased suffering, expense and risk of death from surgery and drugs. There doesn’t seem to be any proof that pancreas transplants increase life expectancy and, with the anti-rejection drugs and surgery, may actually reduce it.

The kidney statistics for 1999 from The Australia New Zealand Dialysis and Transplant Registry (ANZDATA), based in the Queen Elizabeth Hospital in Adelaide, indicate one-year kidney patient survival at 95% while the kidney or graft survival is 91%. Harvest promoters never fail to broadcast these encouragingly good figures. But these one-year figures are misleading in that they only include people receiving their first kidneys. Five year patient survival is 84% while 72% of kidneys kept functioning. 41a

Ultimately, though, comparing transplant survival figures is complicated by willingness (or lack of) to donate organs, condition of the host, sickness of the recipient, etc. In this regard, it is pretty tough to make a substantiated claim that the US has the best transplant survival rate. There are just too many factors, including whether a private insurer will pay for the procedure.

[Office_Shredder]

Those statistics are useless. It doesn't break it up into what kind of risk is involved... imagine country A, where only one out of ten people gets a transplant. That lucky 10% is going to be the people with the highest chance of survival. Country B gives everyone a new organ. Their survival rate is probably half of country A's. That doesn't make it a worse place to get a transplant though

[mheslep]

Although the mortality rate is 35% higher than Canada according to http://www.ustransplant.org/
That would seem to conflict with this for the US:
http://www.surgery.com/procedure/kidney-transplant/morbidity-mortality
Survival rates for patients undergoing kidney transplants are 95–96% one year post-transplant, and 91% three years after transplant....How is it possible to improve 35% absolutely over a 95 or 91% survival rate?

[mheslep]

Those statistics are useless. It doesn't break it up into what kind of risk is involved... imagine country A, where only one out of ten people gets a transplant. That lucky 10% is going to be the people with the highest chance of survival. Country B gives everyone a new organ. Their survival rate is probably half of country A's. That doesn't make it a worse place to get a transplant thoughTransplant triage is a factor to consider for mortality, but it doesn't impact the availability / number of operations statistics.

[mheslep]

I think I'd rather get my transplantation performed in Australia or NZ than in the US, unless it was a pancreas graft procedure.

http://www.geocities.com/organdonate/AAACh8SurvivalStats.htmlIt's also a bit tricky to run comparisons against a country (~4m) with half the population of a large US city (8M). One might find that, say, the Mayo Clinic area of Minnesota, has a much better transplant survival rate than NZ and save the trip.

[Huckleberry]

I repeat, I do not oppose the legitimate power of government to levy taxes for the reasons you stated. The only thing in your post I don't agree (or disagree) with is the first sentence "It isn't theft", and that's just because I don't know what "it" you are referring to.

Edit: And I'm not quite sure what you mean by "deny the legitimacy of democracy in America." The U.S. is not a democracy in the absolute sense you imply. It's only a democracy by the broad definition that loosely includes a constitutional republic with limited, enumerated powers. The government is elected by the people (republic), but does not have unlimited power like a pure democracy.

What you say here is true. Rephrasing the statement I would say - Dismissing a legal right would give some merit to your argument and lead counterarguments into semantics, but deny the legitimacy of the democratic republic in America. (I was lazy and imprecise) People govern themselves as they see fit. In the US, democracy takes the form of a republic. That doesn't make it illegitimate if it is the will of the people.

Though I wouldn't call myself libertarian, I share many libertarian viewpoints. It seems to me that you are saying some taxes are theft because they aren't based on libertarian principles. I think I understand the reasons that you believe it is theft, but the government does have a legal right to collect any and all taxes supported by the majority of people it justly represents. It won't always be fair to any individual, but that doesn't make collecting any particular tax theft.

If the government is corrupt, or doesn't represent the people, or uses force or deciet to manipulate the will of the people, then I'm on your side. Those taxes are theft. Any tax that does represent the will of the majority is not theft. It would be a theft not to pay them.

When it comes to issues of basic human necessity I drop the libertarian perspective in favor of a social one. It's impossible for me to watch someone suffer and say that has nothing to do with me, especially when it is through no fault of their own. I believe that in order to have a civilized society it is important that its individual members have an obligation to the well-being of other individuals, particularly ones in that society. The current health care system (or lack thereof) in the US has some serious problems. I don't have any solutions, but a solution that doesn't abandon and impoverish people seems preferable to me. Otherwise I favor as much elbow room as possible.

[Office_Shredder]

Transplant triage is a factor to consider for mortality, but it doesn't impact the availability / number of operations statistics.

I was responding specifically to turbo's survival rate post

[TheStatutoryApe]

So you mean the conventional definition with the added "unless it's the government" clause. In that case it wouldn't meet that definition of theft. But that's just semantics.
No. The difference is not that it is the government since obviously the government can take money from you that it is not entitled to take and that would be a form of theft.
Huck's last post pretty well sums up my position on this.
The "added clause" would be "unless the person[s] taking the money are endowed with the power to do so by the consent of the people". The level of direct benefit received by the tax payer is moot unless you can show me something that says the governments ability to tax is restricted in this fashion.
Better yet I will find something regarding the matter myself...
The Congress shall have power to lay and collect taxes on incomes, from whatever source derived, without apportionment among the several States, and without regard to any census or enumeration.
This is apparently the conditions for tax collection (or lack thereof) consented to by the people.
I'd say first that national health care would be a detriment, on average, not a benefit to the people paying for it. Even if we could say it was of some benefit, it wouldn't come close to a service provided to everyone with value roughly in line with the amount each person is taxed, like police, fire, national defense, roads, etc. That's a big difference from claiming that everyone would get some benefit, but not only is the price not in line with the value of the benefit, it's designed purposely not to be.

I would also note that being a libertarian means that I don't consider changing, altering, modifying, or "bettering" society to be a legitimate function of government, while protecting liberty is. The legitimate role of government is to protect the liberty of people to decide for themselves what to do, not take it away so government can decide what's best for society.
Having health care for everyone would be a detriment on average? I find that hard to believe. Perhaps you could actually explain how and and why it would be a detriment?

As for the direct benefit received in proportion to the amount of taxes paid nothing you have mentioned seems to me to have a proportionate level of benefit. From what I read and hear in the news there are plenty of people out there who have had their homes saved by firemen. I never have and I do not know anyone who has either. I actually know someone who lost their home and all of their possessions to a fire. Do we deserve refunds? Surely my acquaintance who lost his home and possessions ought to receive something back yes? Nor have the police intervened on my behalf in a crime in progress. My laptop was stolen and I filed a police report. It has not been returned to me yet. Are they going to reimburse me for their failure to retrieve my property? Does the person whose property is returned to them have to pay extra for that added benefit?

Besides all of that the people have apparently consented to allow taxes to be taken from them without regard to the apportionment as noted above in the article from the United States constitution.

[BobG]

Although the mortality rate is 35% higher than Canada according to http://www.ustransplant.org/

That would seem to conflict with this for the US:
http://www.surgery.com/procedure/kid...dity-mortality

Survival rates for patients undergoing kidney transplants are 95–96% one year post-transplant, and 91% three years after transplant....

How is it possible to improve 35% absolutely over a 95 or 91% survival rate? That would seem to conflict with this for the US:


If the survival rate is 91%, then there's a 9% mortality rate. If Canada's mortality rate is 6.7% (meaning they have a 93.3% survival rate), then the US mortality rate is 35% higher than Canada's.

Survival rate: Canada - 93% (the US rate was only given to 2 significant digits, so it's not fair to carry Canada's out to 3); US - 91%

Mortality rate: Canada - 6.7%; US - approximately 9% (once you get down to only 1 significant digit left, you start running into problems - actually, you can't be sure it's 9 to 6.7; it could be 8.8 to 6.5% or something like that)

Obviously, looking at the smaller side of the numbers looks more impressive if you want to emphasize how much better Canada's survival rate is.

[BobG]

Two problems may be being mixed together.

1) Some "low cost" health insurance policies can charge low premiums because their policy covers nothing. They make their profit by denying claims, thereby reducing what they have to pay out in benefits.

2) To a patient staring death in the face, any treatment and any cost seems reasonable. That doesn't mean the treatment has a good enough chance of succeeding to be worth the cost to the objective observer. The insurance company is denying treatments it will cover for good reason.

(Yes, telling the difference between the first and second can sometimes be hard).

Government health care would eliminate the first problem. People wouldn't waste their money (even if only a little) for "insurance" that wasn't worth the money it was printed on.
Eliminate the problem? It would only eliminate the option to pay: all would be forced to pay through taxes, you might still get bad care.

You might still get bad care no matter what. I think you're making some leap in logic that you've not stated and are trying to make some kind of point. As is, it sounds like you're saying a person might still die in a car crash even if they're wearing seat belts, so why wear them.

What it would eliminate is people throwing money away on worthless insurance policies. Since the government insures everyone and quite a few people would be savvy enough to complain if the policy were junk, even the people who don't really understand what they're paying for get a decent policy (you could probably accomplish the same goal by imposing more regulations on private insurance companies).


If government eliminates the second problem by granting any treatment that offers even a sliver of hope, then government health care will just bankrupt the government. Someone looking at the odds objectively has to decide if the treatment is worth paying for even if it's the government doing the paying.


"...just bankrupt the nation..." and "...even if it's the people doing the paying." would be more accurate.

The point I was making was that, if the company and/or the government have a fair insurance policy, it doesn't matter who's making the decision. Some care is going to be denied and some "customers" are going to feel that denial cost them their life.

Among the news articles linked, there wasn't enough info to discern which were stories about the "bargain" insurance companies that never pay out or which were stories about an insurance company denying unreasonable treatments. I kind of had a feeling that there were examples of each in the stories linked.

[mheslep]

If the survival rate is 91%, then there's a 9% mortality rate. If Canada's mortality rate is 6.7% (meaning they have a 93.3% survival rate), then the US mortality rate is 35% higher than Canada's....Arg, yes of course, should have seen that.

[Al68]

It seems to me that you are saying some taxes are theft because they aren't based on libertarian principles. No.I think I understand the reasons that you believe it is theft, but the government does have a legal right to collect any and all taxes supported by the majority of people it justly represents. So you're using a definition of theft with a "unless it's supported by a majority" clause. Again, that's a matter of semantics.It won't always be fair to any individual, but that doesn't make collecting any particular tax theft.It is a legitimate debate whether certain non-theft taxes are collected fairly, like for fire stations, police, etc. But no one disputes that the service is provided, the only dispute is exactly what the service is worth to each person. What I'm referring to is taking money with not so much as any attempt to pretend it's in return for a service provided to the person paying.

If the government is corrupt, or doesn't represent the people, or uses force or deciet to manipulate the will of the people, then I'm on your side. Those taxes are theft.Well your claim here represents even a larger portion of taxes in the U.S. is theft than I ever claimed. Any tax that does represent the will of the majority is not theft.Unless that will is manipulated? Or is this the "unless it's the will of the majority" clause in your definition of theft? It would be a theft not to pay them.Failure to give to the majority what the majority wants is theft? I must assume this is either a typo or a joke.

[Al68]

Having health care for everyone would be a detriment on average? I didn't say that, and you know it. Just like I didn't say it would be a detriment to society for no one to ever get sick. Why can't we just institute that policy? That's my new policy. Let's just pass a law that says nobody will ever get sick again. Seriously, I said "national health care" would be a detriment overall. I'm sure you didn't think I meant that the "good" aspect of it in isolation would be a detriment.
Besides all of that the people have apparently consented to allow taxes to be taken from them without regard to the apportionment as noted above in the article from the United States constitution.I'm well aware of the income tax amendment. It doesn't obligate me to agree with the majority. And it doesn't authorize government to collect and spend money for anything it wants, it just authorizes government to use income taxes to collect money to do those things authorized by the constitution.The "added clause" would be "unless the person[s] taking the money are endowed with the power to do so by the consent of the people".If we use a definition of theft with this clause, then you're correct, there would be no such thing as "majority approved" theft. Again, that's a matter of semantics. I think it's obvious that I was not using such a definition when I used the word theft in my posts.

[Huckleberry]

Failure to give to the majority what the majority wants is theft? I must assume this is either a typo or a joke.

If the government represents the will of the majority then my answer is yes. That's democracy. I'm not saying that all laws are morally right, just that they are legally right, hence your proposal that some taxes are theft is untrue on a legal basis. The government does have the right to collect taxes within its legal parameters and it cannot logically be considered theft to collect that tax. That's just the reality of the situation.

Your argument is logical, but was semantics from the moment you stated it, because it follows from moral premises. You're using your personal definition of 'right'. Not everyone agrees with you.

What I see so far is a semantic argument that denies semantics, a moral argument that claims to be founded in logic, denial of 'unless clauses' as an attempt to make your argument infallible and a disregard for the reality of the situation. Believe whatever pleases you, but the laws of a democracy are based on what the majority feels is right, not what you feel is right. Your only recourse is to convince the majority of your moral correctness.

[Al68]

I'm not saying that all laws are morally right, just that they are legally right, hence your proposal that some taxes are theft is untrue on a legal basis. I never suggested any taxes were "legally" wrong, so you misconstrue my proposal. The word theft has meaning beyond the concept of "legally wrong". Obviously the taxes I referred to are legal, so cannot be claimed to be theft according to any legal code. I was not using the word theft to mean "illegal theft". That would make the term "legalized theft" a self contradiction.The government does have the right to collect taxes within its legal parameters and it cannot logically be considered theft to collect that tax. That's just the reality of the situation.It cannot logically be considered illegal theft, but I thought it would be obvious that's not what I meant.Believe whatever pleases you, but the laws of a democracy are based on what the majority feels is right, not what you feel is right. Your only recourse is to convince the majority of your moral correctness.I agree, and have never said otherwise. Again, you say things that it should be obvious I agree with, as if you're saying them to disagree with me.

Where did you get the idea that I was claiming that any taxes were theft in the legal sense of the word? That wouldn't even make any logical sense.

And you're absolutely right that this is all about semantics. But you knew from the beginning, since it was too obvious not to, that I wasn't using the word theft to mean "illegal theft", but your responses have assumed I was nevertheless. Did you really think that I was claiming that "legalized theft" was "illegal theft"?

[TheStatutoryApe]

I never suggested any taxes were "legally" wrong, so you misconstrue my proposal. The word theft has meaning beyond the concept of "legally wrong". Obviously the taxes I referred to are legal, so cannot be claimed to be theft according to any legal code. I was not using the word theft to mean "illegal theft". That would make the term "legalized theft" a self contradiction.It cannot logically be considered illegal theft, but I thought it would be obvious that's not what I meant.I agree, and have never said otherwise. Again, you say things that it should be obvious I agree with, as if you're saying them to disagree with me.

Where did you get the idea that I was claiming that any taxes were theft in the legal sense of the word? That wouldn't even make any logical sense.

And you're absolutely right that this is all about semantics. But you knew from the beginning, since it was too obvious not to, that I wasn't using the word theft to mean "illegal theft", but your responses have assumed I was nevertheless. Did you really think that I was claiming that "legalized theft" was "illegal theft"?

Ah... so as Huck and I both have said now, you are just using the word "theft" to make your argument seem self evident. Gotcha.

[Al68]

Ah... so as Huck and I both have said now, you are just using the word "theft" to make your argument seem self evident. No, I used the word theft to make clear that that was why I opposed universal health care, not for the variety of other nonsensical reasons normally attributed to detractors. Have we become so government dependent that we can't even conceive of a word like theft to have any meaning independent of government policy?

The reason I, and many others, oppose "universal health care" is because we think it's wrong to steal. We think it's wrong to steal even if the majority approve and it's legal. That's the reason, plain and simple. Everyone knows what the words theft and steal mean in this context, despite the pretense to the contrary.

Is there another word I could use instead to convey the same meaning?

[Huckleberry]

Did you really think that I was claiming that "legalized theft" was "illegal theft"?No, I didn't think that. I was using it as a counterpoint to isolate the source of the argument as your personal opinion. Is there another word I could use instead to convey the same meaning? We aren't disagreeing on the meaning of theft. We are disagreeing on what is morally correct, and whether the word applies at all.Have we become so government dependent that we can't even conceive of a word like theft to have any meaning independent of government policy? The problem isn't conception of the use of a word, but agreement on if the word is applicable. Democratic government policy is the best we can do to agree. The policy becomes the reality that we live by.

Your logic is good. If one accepts your premise then you are right that these taxes are theft. I understand why you believe that. Someone starting from a different premise will arrive at a different conclusion that is just as valid to them as yours is to you. Not everyone considers universal health care as theft. Can you understand that? If you can then our argument is back to where it began, which seems like a good place to conclude it. There will be no resolution to a moral argument.

[j93]

What is the point of arguing if one side starts from the premise that taxes are inherently theft, before arguing if a certain program is a good use of tax revenue everyone should agree in that in the idea of taxes.

[D H]

Many people do not think that this particular program is a good use of tax revenue.

This whole theft thing is a side-issue that obscures the main questions, to wit

Is health care a problem? Ivan started this thread with a reference to a WHO study that others have pointed out was deeply flawed.


If it is a problem, is it one that government has any business solving? Our government was founded on the two potentially conflicting principles: inalienable rights and limited government interference. Is health care an inalienable right? If not, what is the rationale for this government takeover?


If a government takeover is appropriate, will doing that solve the problem? Are there approaches that are more in line with our basic principles that could solve the problem?

[drankin]

Many people do not think that this particular program is a good use of tax revenue.

This whole theft thing is a side-issue that obscures the main questions, to wit

Is health care a problem? Ivan started this thread with a reference to a WHO study that others have pointed out was deeply flawed.


If it is a problem, is it one that government has any business solving? Our government was founded on the two potentially conflicting principles: inalienable rights and limited government interference. Is health care an inalienable right? If not, what is the rationale for this government takeover?


If a government takeover is appropriate, will doing that solve the problem? Are there approaches that are more in line with our basic principles that could solve the problem?

Excellent summary. Ultimately, we will be taxing the working class to provide health care to those who do not work. Those of us who currently do work but do not have insurance pay for our health care directly. It has been this way long before health insurance was ever created. Health insurance is not a right.

In the end, the government will be the ones denying or delaying health care as well as creating an immense and expensive bureaucracy to disperse it.

[j93]

Excellent summary. Ultimately, we will be taxing the working class to provide health care to those who do not work.
If this is true this is a problem with the taxing structure not the program which means that argument is off-topic because it is based on a totally different problem.

Those of us who currently do work but do not have insurance pay for our health care directly.

This is obviously false unless you define working as having health insurance and employment.

[TheStatutoryApe]

Is health care an inalienable right?
I believe the idea that all people should benefit from the aid of medicine has been at the core of medical ethics for a couple thousand years now. Arguably any civilized society ought to take measures to insure this whether or not you title it an "inalienable right".

Excellent summary. Ultimately, we will be taxing the working class to provide health care to those who do not work. Those of us who currently do work but do not have insurance pay for our health care directly. It has been this way long before health insurance was ever created. Health insurance is not a right.

In the end, the government will be the ones denying or delaying health care as well as creating an immense and expensive bureaucracy to disperse it.
We already pay for people who do not work to get medical treatment. Often this comes in the form of expensive emergency room visits for people who should have gotten medical attention earlier (for cheaper) but could not afford it. The people who are getting screwed currently are the one who have jobs and make enough money to not be elegible for free medical treatment but do not make enough to afford health insurance. The idea that denying universal health care would protect the working class from having to pay for lazy non-working bums seems inaccurate.

[Al68]

No, I didn't think that. I was using it as a counterpoint to isolate the source of the argument as your personal opinion. We aren't disagreeing on the meaning of theft. We are disagreeing on what is morally correct, and whether the word applies at all. The problem isn't conception of the use of a word, but agreement on if the word is applicable. Democratic government policy is the best we can do to agree. The policy becomes the reality that we live by.

Your logic is good. If one accepts your premise then you are right that these taxes are theft. I understand why you believe that. Someone starting from a different premise will arrive at a different conclusion that is just as valid to them as yours is to you. Not everyone considers universal health care as theft. Can you understand that? If you can then our argument is back to where it began, which seems like a good place to conclude it. There will be no resolution to a moral argument.I agree with all of this. Maybe I misunderstood something you said along the way.

[Al68]

Our government was founded on the two potentially conflicting principles: inalienable rights and limited government interference. Is health care an inalienable right? I think the word "entitlement" might fit better for health care, since at the time our nation was founded, the words right and entitlement were not used interchangeably. The word right refers to liberties while the word entitlement refers to something provided by other people, and was not a founding principle. The potential conflict is between limited government interference and "entitlements", not inalienable rights.

[mheslep]

I believe the idea that all people should benefit from the aid of medicine has been at the core of medical ethics for a couple thousand years now. Arguably any civilized society ought to take measures to insure this whether or not you title it an "inalienable right"....I agree with the initial premise there - 'should', 'benefit', traditional practice - as this is the language responsibility. You lose me though in the indifference to labelling health care a right, since a right is a radically different thing from responsibility, most importantly in who owns which.

A 'right', at least in the sense the US Constitution uses it, is that which can not be taken from any citizen in good standing, not taken by anyone, and especially not taken by the government. In that sense, calling a health care a right wrecks the chances for rationale approach to the health care problem before it begins. That discussion begins, reasonably, with matters of efficiency, quality, distribution, cost, i.e. economics - all of which are completely antithetical to the idea rights. There is no resource scarcity applicability to free speech rights, or to the right to be free from illegal search and seizure. So we end up with a schizophrenic debate. Moreover, since I agree I have a responsibility to help my neighbour, having the recipient call that help a right - something I must provide to him without infringement - poisons the well.

[mheslep]

Thanks for grabbing the wheel and placing us back between the lines. My take below, perhaps redundant:
Many people do not think that this particular program is a good use of tax revenue.

This whole theft thing is a side-issue that obscures the main questions, to wit[list=1]

Is health care a problem? Ivan started this thread with a reference to a WHO study that others have pointed out was deeply flawed.

Quality of medicine for those who have access to it is not a problem. Cost (9-10% increase a year), and access (10-20million who really can't get it) are the US problems.

If it is a problem, is it one that government has any business solving? Very good question. Informed govt. plan advocates will concede that though we don't have free market heath care, they would say that free markets won't work (http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/) with health care because a) illness can't be planned, b) when catastrophic illness does occur almost nobody has the means to pay for it, and therefore c) the system requires insurers (third parties). To the extent the 3rd party is involved the buyer and the provider are separated there is no market, they would say, and bad things like adverse selection and moral hazard happen. There are some valid points in these arguments, though there are institutions (e.g. coops) that have evolved to counter these problems. But here's what those advocates miss: they don't provide a good argument that government solves these problems.
If a government takeover is appropriate, will doing that solve the problem?I believe the evidence is overwhelming that it will not. Edit: That is, it will not provide the same quality care for lower cost. Typically, single payer forces costs down and limits care (rationing: fewer specialists, less new equipment investment, wait lists, etc)
Are there approaches that are more in line with our basic principles that could solve the problem?I believe so. The McCain plan during the campaign was a good articulation, and now Wyden Bennett has some good ideas.

[TheStatutoryApe]

I agree with the initial premise there - 'should', 'benefit', traditional practice - as this is the language responsibility. You lose me though in the indifference to labelling health care a right, since a right is a radically different thing from responsibility, most importantly in who owns which.

I was not intimating that health care may, or ought to be, labelled a right but responding to the post referencing a responsibility, or limititation, on the part of the government only to protect rights.

[mheslep]

I was not intimating that health care may, or ought to be, labelled a right but responding to the post referencing a responsibility, or limitation, on the part of the government only to protect rights.Ok I suspect we're not far apart, though I wouldn't have used protect for the case of the federal government. In its charter, the language concerning rights is entirely about restricting how government may act. Its all about No. The Congress shall pass No law. As in, No, no, no, no, govt. shall not. The only original protection responsibility of the federal government was foreign defense. Since the 14th amendment that roll was extended to restriction of actions of state governments.

I indulged in a couple of sentences there to build the case that if government is used to provide healthcare, it should not do so on the grounds that it is protecting its citizens. That's is not its primary role (Federal).

[Count Iblis]

Medical charity helping US poor (http://news.bbc.co.uk/2/hi/americas/7420744.stm)

[Evo]

Medical charity helping US poor (http://news.bbc.co.uk/2/hi/americas/7420744.stm)No one is contesting the fact that the US has very remote, poor areas that have little in the way of medical facilities. But this is a miniscule drop in the bucket of people in the country. What, in all of these areas around the country we're talking about a few thousand people, out of a population of over 303 million?

[turbo-1]

Bill Moyers did a very interesting interview with Wendell Potter, who was once the top PR man at Cigna, regarding the tactics of the health insurance companies and the way that they will scuttle health-care reform. About 1/2 way through, Potter points out that of every dollar spent on Medicare, 3% goes to administrative costs and overhead, vs 20% on administrative costs and overhead for private insurers. He also explains how insurance companies deny claims, drop patients, and get rid of whole employer programs if someone in such a program gets a catastrophic illness, to keep the "medical loss ratio" at 80% or less. I have seen this stuff play out for years as a network administrator/programmer/IT guy in a large medical practice, but some folks here seem to pooh-pooh that experience. Here it is from a guy who was Cigna's top communications officer - please watch this. If you think that a public health insurance option is a horrible idea, then PLEASE watch this.

http://www.pbs.org/moyers/journal/07102009/watch2.html

To address the OP: The US has the capability of providing the best health care in the world, but only if you can get access to it, and there are about 50 million people who have no insurance, and many more that have plans that cover so little that their "coverage" is a joke. The two most profitable surgeons in our ophthalmic practice were the retinal surgeons because retinal procedures are tricky and $$$$. The two surgeons with the most expensive deferred or denied reimbursements were those same two surgeons. When someone had a retinal detachment, they operated (invasively, with lasers, a combination, etc) to try to save the person's vision. If the patient was uninsured or their insurance company dropped them or denied the claim, the practice had to eat those losses.

[j93]

Im slightly confused it seems like the thought seems to be that the level of medical care that those without insurance receive or in some cases do not receive is good enough yet at the same time people believe they would die if their was a government program ala medicare.

[mheslep]

Medical charity helping US poor (http://news.bbc.co.uk/2/hi/americas/7420744.stm)

Closing:
...He has heard his old country has a shortage of NHS dentists.

"I am sure we'll get just as large a crowd as we're getting here in the US," he says.

[mheslep]

The 3% overhead Medicare numbers are bogus, as has been shown in this thread. They are propaganda that the Medicare staff like to encourage.

Yes, private insurance has some lousy service and denials, therefore the public option must be good? C'mon. Lets first nationalize all the paper mills and see how that works out. Or all the lawyers. Heck, effective legal representation is something the constitution actually does give us a right to.

I still have hopes that the '50 million' figure will vanish from the discussion: For the illegals and Medicaid eligibles included in that number, no public plan on the table is going to cover them any better than they are now.

[turbo-1]

Did you watch the interview, mheslep? Potter is credible, detailed and an insurance insider.

BTW, nay-saying Medicare's 3% overhead does not equate to proving the number wrong. Michelle Bachman is railing against a public health-care plan because she claims that it would be 30-40% cheaper than private plans. She's probably right, but that is no reason to reject a public plan, unless you are a sadist.

[mheslep]

...

http://www.pbs.org/moyers/journal/07102009/watch2.html

For the Wise, WVa clip, how many people there all already eligible for the government Medicaid plan now? Why isn't that working now? Don't people understand that the government pays half of all health dollars, now?

[mheslep]

On Michael Moore's Sicko clip from Moyers: "I thought he hit the nail on the head". Good grief.

Here's another video on Canadian health care:
http://pajamasmedia.com/blog/pjtvs-hidden-camera-team-exposes-canadas-socialized-health-care/

[turbo-1]

Working people in low-paying jobs generally don't qualify for Medicaid, but they can't afford private insurance, either. Those are likely the people that drove from several states away to attend the Wise event. This is not a black-and-white issue. There are lots of people who can't get any coverage, and there are lots of people who are dropped like hot potatoes when they get sick. If my wife lost her job, I wouldn't qualify for any private health insurance due to some pre-existing conditions. As Potter said, it's easy to talk about number of policies and claims until you realize that they are people - men, women, and children who are being denied health care.

[Al68]

Michelle Bachman is railing against a public health-care plan because she claims that it would be 30-40% cheaper than private plans. She's probably right, but that is no reason to reject a public plan, unless you are a sadist.That's a gross misrepresentation of what she said. She never said the total cost would be less. She said that since 30-40% of the public plan insurance premiums would be subsidized by taxpayers, an individual would pay 30-40% less for coverage (after subsidization) by switching from their employer's plan to the public plan.

The reason they would save 30-40% is not because the public plan actually costs less than the private plan, but because they would be forced to help pay (by taxes) 30-40% of the public plan whether they switched or not.

[mheslep]

Did you watch the interview, mheslep?Yes, the entire thing.
Potter is credible,
On the insurance industry maybe, and in particular about health lobbying as PR was his job, but not on much else in my opinion.
detailed
On our public proposals, or on, say, Canada's plan, or on people in need in Wise, WVA, he provides absolutely none, not a word of detail. Instead he spews slogan's like "oh yeah, I think he hit the nail on the head".
and an insurance insider.Yes. Another a guilt ridden rich guy. Yes the private insurance system is a broken, rigged game. It was the government that set it up that way post WWII and in the 70s. The only thing worse would be a broken, rigged, government plan.

BTW, nay-saying Medicare's 3% overhead does not equate to proving the number wrong.I did not just simply nay say it, I provided references earlier, and I'm tired. The 3% numbers just reflect Medicare's internal, government employee costs. Medicare hires additional -guess who- private insurer help to administer those claims, and they do not include those costs in the 3%. Furthermore, Medicare is rife with fraud, up to $60B / year as reported by the US Attorney General, because in part they don't employ nearly enough staff to vet claims properly, and they don't want to do so. It is far better politically for the Medicare program to suffer losses blamed on random outside crooks than to risk having an adequate staff that properly vets claims, and then having rejected nose job complaints go back up the political ladder with a name on each end. Run a whole country that way and we'll break it.

[turbo-1]

On Michael Moore's Sicko clip from Moyers: "I thought he hit the nail on the head". Good grief.

Here's another video on Canadian health care:
http://pajamasmedia.com/blog/pjtvs-hidden-camera-team-exposes-canadas-socialized-health-care/I have friends in Canada, since except for our western border with NH, we are surrounded by Canada, and lots of my family originally came from there. My wife and I are very close to a couple with a large brood of kids in Nova Scotia who are operating a gas-station, convenience-store, auto repair business near Truro and they LOVE the Canadian health-care plan. Same with the family who used to be our closest neighbors, but whose applications for permanent residency were turned down by the US gov't during the Bush administration. She is a medical technician, and he is a well-respected graphic artist. They moved here to get to a more temperate climate (central Ontario is pretty frigid) and they loved Maine. We got to be great friends. Their biggest complaint with the US was the limited access to health-care and the cost of insurance. The guy and his daughter were in good health, but the wife is epileptic, and her medications were very expensive here. The reason they bought a house in our neighborhood is that we were a 5-minute walk from the hospital so she could walk to work, and it was a nice quiet neighborhood on a cul-de-sac where their young daughter could spend lots of time outdoors with her dog, Moon. I hated to see them get refused residency. Both were very nice, hard-working people and their daughter was a joy to have around.

[mheslep]

And I love my plan(s), and the doctors, and the hospitals. Has taken good care of my family over multiple trips to the hospital; never had a serious problem w/ a payment. Some 70-80% of Americans say the same thing. I have friends in the UK, they won't touch NHS anymore. Had an American friend living in Belgium for awhile, got seriously ill, got right into see a GP, was told to she'd have to wait many months to get specialist help and she flew home.

[wildman]

There was a breakdown of how much each country's government spent on health care on physicsforums a while ago (maybe someone can find that breakdown and point a link to it). That breakdown showed that the US was no where near the bottom of the pile as far as spending on socialized medicine went.

Why do we apparently get so little for our socialized medicine as compared to other countries? Why isn't everyone covered one way or another when we are apparently spending more than enough to cover everyone?

[mheslep]

Timelymedical, a Canadian company that arranges for, among other things, Canadians to receive surgery in the US has this list (Canadian public vs Canadian private):

http://www.timelymedical.ca/waitlist-public-versus-private.html
#Wait to see a specialist for initial consultation
* Public: 6 - 12 months
* Private: 10 days

# Wait for diagnostic imaging (excluding X-Rays) after seeing surgeon

* Public: 4 - 8 months
* Private: 24 hours

# Wait for a biopsy (if necessary)

* Public: 2 months
* Private: 4 days

# Wait for pathological analysis of tissue

* Public: 14 days
* Private: 1 - 3 days

# Wait for follow-up visit to surgeon to discuss results of diagnostics

* Public: 1 - 3 months
* Private: 7 days

# Wait for a surgical/hospital date to be set

* Public: 6 - 18 months
* Private: 1 day

# Wait for surgery after date is set

* Public: 6 - 10 months
* Private: 7 days

[Evo]

There was a breakdown of how much each country's government spent on health care on physicsforums a while ago (maybe someone can find that breakdown and point a link to it). That breakdown showed that the US was no where near the bottom of the pile as far as spending on socialized medicine went.

Why do we apparently get so little for our socialized medicine as compared to other countries? Why isn't everyone covered one way or another when we are apparently spending more than enough to cover everyone?Fraud. Incompetance in government run programs.

Supposedly the plan Obama is proposing will be a "no frills" alternative to private insurance. He said that Americans can still use their private insurance for the best care. Or they can buy the government controlled insurance options with lower quality care, maybe that's not fair, in his speech I believe that he used the words "not the most expensive care". He said the care won't be the best, but it will be adequate. I'm just wondering how much this adequate care will cost? Since it is an option and comes at a cost, I'm not quite getting where the poor get it free, but supposedly there is an option for them. I'm still waiting to see the details.

[lisab]

Timelymedical, a Canadian company that arranges for, among other things, Canadians to receive surgery in the US has this list (Canadian public vs Canadian private):

http://www.timelymedical.ca/waitlist-public-versus-private.html
#Wait to see a specialist for initial consultation
* Public: 6 - 12 months
* Private: 10 days

# Wait for diagnostic imaging (excluding X-Rays) after seeing surgeon

* Public: 4 - 8 months
* Private: 24 hours

# Wait for a biopsy (if necessary)

* Public: 2 months
* Private: 4 days

# Wait for pathological analysis of tissue

* Public: 14 days
* Private: 1 - 3 days

# Wait for follow-up visit to surgeon to discuss results of diagnostics

* Public: 1 - 3 months
* Private: 7 days

# Wait for a surgical/hospital date to be set

* Public: 6 - 18 months
* Private: 1 day

# Wait for surgery after date is set

* Public: 6 - 10 months
* Private: 7 days

Seems that if these wait times are correct, there should be a noticeable difference in life expectancy...but the data don't show (https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html) that the US system results in longer life.

Obviously it's because so many of my fellow citizens don't have health insurance. Maybe the title of the thread should be, Insured citizens of the US have the best health care in the world (screw the 47 million of you who don't (http://www.medscape.com/viewarticle/567737)).

I wonder if there are any data available that show life expectancy of insured vs. uninsured in the US, to compare to those who live with socialized medicine.

[mheslep]

There was a breakdown of how much each country's government spent on health care on physicsforums a while ago (maybe someone can find that breakdown and point a link to it). That breakdown showed that the US was no where near the bottom of the pile as far as spending on socialized medicine went.
http://apps.who.int/whosis/database/core/core_select_process.cfm?countries=all&indicators=nha
US govt heath spending per cap: $2862 (PPP dollars)
US total health spending per cap: $6350 (most expensive in the world by a large margin)

France govt health spending per cap: $2646
France total per cap: $3314
Why do we apparently get so little for our socialized medicine as compared to other countries? Why isn't everyone covered one way or another when we are apparently spending more than enough to cover everyone?Good question.

[Evo]

Seems that if these wait times are correct, there should be a noticeable difference in life expectancy...but the data don't show (https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html) that the US system results in longer life.

Obviously it's because so many of my fellow citizens don't have health insurance. Maybe the title of the thread should be, Insured citizens of the US have the best health care in the world (screw the 47 million of you who don't (http://www.medscape.com/viewarticle/567737)).

I wonder if there are any data available that show life expectancy of insured vs. uninsured in the US, to compare to those who live with socialized medicine.My mother uses Medicare (no private insurance) and the "public" Canadian figures seem to mirror her wait times. Of course in the US if you have no insurance and don't qualify for Medicare or Medicaid, you get same day care for all of those things in ER, and it is covered mostly by charities. The Evo Child's ex-bf had no insurance and had a chronic condition that required him to go to the ER every 3 months and then costs were always covered by the hospital's alternative coverage plans.

Socialized medicine in Italy. They killed my ex-fiancee's father. Misdiagnosed him. Then put him on a 6 month waiting list to use 1 of the 2 MRI's in the country and he had to fly from Sicily to Milan, to boot (and this was only after I made him raise hell to get a SCAN, the Italian doctors didn't want to do it). By the time they properly diagnosed him the cancer was too advanced. First they almost killed him by administering the wrong chemotherapy at 20 times the dose. He died 6 months later.

[GeorginaS]

Timelymedical, a Canadian company that arranges for, among other things, Canadians to receive surgery in the US has this list (Canadian public vs Canadian private):



You don't think that a company that sells health services to Canadians to go out of country would have any sort of bias in their reporting, now do you?

I could give you a step-by-step account (But anecdotal evidence doesn't count for much, right? Except for the fact that I live here and live with the system.) of the time-line of a good friend of mine being diagnosed with colorectal cancer at the end of May as a result of a colonoscopy to the various further diagnostic tests he had, and radiation treatments performed, and surgery to remove the growth in the second week of July. There's no way a system could have moved any faster or better. And my friends didn't have to mortgage their home to care for him.

But, that's anecdotal from my home last week and the above are stats from a "company".

[wildman]

Of course in the US if you have no insurance and don't qualify for Medicare or Medicaid, you get same day care for all of those things in ER, and it is covered mostly by charities.

I thought that the ER costs in the end are mainly picked up by the government and that was one of the reasons of our out of control government health care spending. Or am I mistaken? That is what my wife has told me. Could someone in the health field give us some expert input?

[mheslep]

Seems that if these wait times are correct, there should be a noticeable difference in life expectancy...but the data don't show (https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html) that the US system results in longer life.
Uncorrected numbers (CIA) include many things having nothing to do with health care. US has the highest health related life expectancy in the world by a slight margin.
http://www.aei.org/docLib/20061017_OhsfeldtSchneiderPresentation.pdf
Table 1-5

Obviously it's because so many of my fellow citizens don't have health insurance. Maybe the title of the thread should be, Insured citizens of the US have the best health care in the world (screw the 47 million of you who don't (http://www.medscape.com/viewarticle/567737)).

I wonder if there are any data available that show life expectancy of insured vs. uninsured in the US, to compare to those who live with socialized medicine.Of the 47 million (http://www.google.com/url?sa=t&source=web&ct=res&cd=3&url=http%3A%2F%2Fwww.aei.org%2FdocLib%2F20071120_3 522443OTIMankiw_g.pdf&ei=2n5uSt2JEJGCtgeRnKiKBQ&usg=AFQjCNH7WPvMC2We26sjZMYDbFzG7y_xNw&sig2=e6e0xs5JHU7PpPGpCQopSA), 10m are illegals and no policy on the table will cover them socialized or otherwise. Millions more are eligible for Medicaid but don't sign up. 18m of the uninsured earn more than $50k/year but decline coverage.

We can get health care to everybody, but it doesn't require socializing everything to do it.

[Evo]

I thought that the ER costs in the end are mainly picked up by the government and that was one of the reasons of our out of control government health care spending. Or am I mistaken? That is what my wife has told me. Could someone in the health field give us some expert input?It depends, in inner city trauma centers, it might be picked up by government, but out in the suburbs, it's customary that either the hospital write it off, and/or get the balance paid through local charities.

[mheslep]

You don't think that a company that sells health services to Canadians to go out of country would have any sort of bias in their reporting, now do you?

I could give you a step-by-step account (But anecdotal evidence doesn't count for much, right? Except for the fact that I live here and live with the system.) of the time-line of a good friend of mine being diagnosed with colorectal cancer at the end of May as a result of a colonoscopy to the various further diagnostic tests he had, and radiation treatments performed, and surgery to remove the growth in the second week of June. There's no way a system could have moved any faster or better. And my friends didn't have to mortgage their home to care for him.

But, that's anecdotal from my home last week and the above are stats from a "company".
As I understand it the wait lists work as follows: If you get hit by a bus and have immediate life threatening injuries, there's no wait to speak of at all, treatment is also essentially immediate. Same with Cancer. If you get hit by a bus and sustain severe injury but the injury is not immediately life threatening, i.e., your condition is stable, then regardless of how debilitating or painful the injury, the surgery is considered elective and you are placed on the queues, with numbers like the earlier post.

[TheStatutoryApe]

I was hit by a car and had knee problems. I did not have insurance but nor was I applying for assistence. Got an appointment to see a doctor in private practice, had to wait about a month to get in. All he did was take a look at my knee and order an MRI. Got an appointment for an MRI on a date about a month after that day. Got the MRI and waited for the doctor to call me and let me know when they received the MRI. I wound up calling them until they told me they had it about a month later. I was then able to set up another appointment to see the doctor slated for about a month later. I went into the office for my appointment and it turned out that the doctor decided to take the day off and I would have to reschedule for about a month later. When I got in to see the doc again I waited hours to see him for him to breeze in, show me the MRI, say "you need surgery" and breeze out five minutes later.

Going to see a doctor in private practice just to get a scan and a diagnosis took approximately half a year. After that it only got worse. It was a year and a half after the accident before I was able to get my surgery and that was with a lawyer getting me in to see doctors and setting up payment deals with them.

When anyone anywhere says they are able to get in to see a doctor and get taken care of in a matter of weeks it blows my mind.

[j93]

I was hit by a car and had knee problems. I did not have insurance but nor was I applying for assistence. Got an appointment to see a doctor in private practice, had to wait about a month to get in. All he did was take a look at my knee and order an MRI. Got an appointment for an MRI on a date about a month after that day. Got the MRI and waited for the doctor to call me and let me know when they received the MRI. I wound up calling them until they told me they had it about a month later. I was then able to set up another appointment to see the doctor slated for about a month later. I went into the office for my appointment and it turned out that the doctor decided to take the day off and I would have to reschedule for about a month later. When I got in to see the doc again I waited hours to see him for him to breeze in, show me the MRI, say "you need surgery" and breeze out five minutes later.

Going to see a doctor in private practice just to get a scan and a diagnosis took approximately half a year. After that it only got worse. It was a year and a half after the accident before I was able to get my surgery and that was with a lawyer getting me in to see doctors and setting up payment deals with them.


I think the long wait times are problem for most of the population either way for those with a long approval process it is stalled to a process and for those with decent HMO's it can be stalled by doctors trying to milk your insurance.
When anyone anywhere says they are able to get in to see a doctor and get taken care of in a matter of weeks it blows my mind.

I had a similar experience with a cyst in a finger in which I was passed on from specialist to specialist for a few months with appointments where I would go to appointments where a specialist would just look at my finger in one appointment, take an x-ray and pass me to another specialist. I felt like they were passing me around because I had an HMO so that they could all get a piece of the pie.

[drankin]

I was hit by a car and had knee problems. I did not have insurance but nor was I applying for assistence. Got an appointment to see a doctor in private practice, had to wait about a month to get in. All he did was take a look at my knee and order an MRI. Got an appointment for an MRI on a date about a month after that day. Got the MRI and waited for the doctor to call me and let me know when they received the MRI. I wound up calling them until they told me they had it about a month later. I was then able to set up another appointment to see the doctor slated for about a month later. I went into the office for my appointment and it turned out that the doctor decided to take the day off and I would have to reschedule for about a month later. When I got in to see the doc again I waited hours to see him for him to breeze in, show me the MRI, say "you need surgery" and breeze out five minutes later.

Going to see a doctor in private practice just to get a scan and a diagnosis took approximately half a year. After that it only got worse. It was a year and a half after the accident before I was able to get my surgery and that was with a lawyer getting me in to see doctors and setting up payment deals with them.

When anyone anywhere says they are able to get in to see a doctor and get taken care of in a matter of weeks it blows my mind.

In this country, you have to pay for a service rendered. If you get yourself runover, then you are responsible for your recovery. Which means that you either get yourself insured or have some money saved for the likelyhood that you might step in front of an icecream truck. Typically, a motorist is required to be insured in the event they runover someone, among other mishaps. That would be another avenue of compensation.

How can you complain about getting shoddy services from a business that you cannot compensate? Is a private business requried to give you a service based on YOUR terms of payment?? It sounds like they gave you some basic services to help you out figuring that they were not going to be compensated for their trouble.

Sounds a lot like my mother-in-law inviting herself over for a week and then complaining how poorly she was served, she may just quit frequenting our establishment (crossing fingers).

[TheStatutoryApe]

In this country, you have to pay for a service rendered. If you get yourself runover, then you are responsible for your recovery. Which means that you either get yourself insured or have some money saved for the likelyhood that you might step in front of an icecream truck. Typically, a motorist is required to be insured in the event they runover someone, among other mishaps. That would be another avenue of compensation.

How can you complain about getting shoddy services from a business that you cannot compensate? Is a private business requried to give you a service based on YOUR terms of payment?? It sounds like they gave you some basic services to help you out figuring that they were not going to be compensated for their trouble.

Sounds a lot like my mother-in-law inviting herself over for a week and then complaining how poorly she was served, she may just quit frequenting our establishment (crossing fingers).
I was hit while crossing the street in the cross walk by a guy in an oversized pickup who was probably busy talking on his cellphone. I refused the ambulance ride to the emergency room in hopes that I could just walk it off because I knew that I could not afford the medical bills.

I got money from the claim with the insurance company after they hassled me, tried to pressure me into a lowball figure, and even seemingly influenced a witness to call me a belligerent liar in her deposition. The bills were paid with that money.

I'll remember that next time though, that its really my fault for being a schmuck who can't afford medical insurance and deciding to get myself hit by a truck.

[Count Iblis]

No one is contesting the fact that the US has very remote, poor areas that have little in the way of medical facilities. But this is a miniscule drop in the bucket of people in the country. What, in all of these areas around the country we're talking about a few thousand people, out of a population of over 303 million?

Yes, but as long as the system is not fixed, this is the only help some people can get.

[Count Iblis]

I think fixing the health care system is a complicated issue, which requires a pragmatic debate. If you have a polarized debate on ideological grounds in Congress, where one side really does not want to do much at all and brings in bogus arguments to try to torpedo a health care bill, then you may end up with a bad compromize.

[turbo-1]

I think fixing the health care system is a complicated issue, which requires a pragmatic debate. If you have a polarized debate on ideological grounds in Congress, where one side really does not want to do much at all and brings in bogus arguments to try to torpedo a health care bill, then you may end up with a bad compromize.One of the factors that is most overlooked in the polarized debates is a critical one. Preventive care can catch problems earlier, while they are more treatable and/or offer the chance of a better outcome. People with no insurance often are not diagnosed until their condition(s) have become serious, more expensive to treat, and often with more radical interventions. In one way or another, we all end up paying more for health care because so many people lack access to regular check-ups and preventative care. Another significant waste arises when patients do not have a primary care physician, and when they need to be seen by a doctor, the doctor is unfamiliar with the patient's medical history, responses to certain classes of drugs, etc. Having a long-established relationship with a doctor you trust saves him/her and you time and effort on each visit, and the doctor knows you well enough to know if you'll understand what he has to say about how a certain drug acts, how to monitor your progress, etc.

Letting uninsured people resort to ER visits for medical care is wasteful in many, many ways - not just lost or reduced income on the part of the providers.

[drankin]

I was hit while crossing the street in the cross walk by a guy in an oversized pickup who was probably busy talking on his cellphone. I refused the ambulance ride to the emergency room in hopes that I could just walk it off because I knew that I could not afford the medical bills.

I got money from the claim with the insurance company after they hassled me, tried to pressure me into a lowball figure, and even seemingly influenced a witness to call me a belligerent liar in her deposition. The bills were paid with that money.

I'll remember that next time though, that its really my fault for being a schmuck who can't afford medical insurance and deciding to get myself hit by a truck.

I apologize for being insensitive about your injury but my point is that ultimately we are responsible for our own welfare. If a particular private doctor does not give you the service that you expect, FIRE him/her. I've done it myself. I'll walk out of the office if a doctor does not attend to me within 20min after an appointment time. If the gov't begins dictating who we go to then we can't FIRE them for poor service.

[madness]

I actually laughed when i saw this thread. Even Cuba has better healthcare than America. In fact one of the American officials involved in the assassination of Che Guevarra recently went to Cuba to get medical treatment on his eyes. I find it really sad that a country like America is unwilling to provide healthcare for its poorer citizens. I suppose it's a kind of cultural difference that in America privatisation and completely free markets are seen as a good thing, whereas where I live they mostly aren't.

[mgb_phys]

Insured citizens of the US have the best health care in the world
I suppose you could claim that the US has the best public transport in the world - because it has a space shuttle and everywhere else just has trains.

[Office_Shredder]

I suppose you could claim that the US has the best public transport in the world - because it has a space shuttle and everywhere else just has trains.

If there were space shuttles for 250 million Americans, then yeah, it probably would be the best public transport system in the world. Admit it, you'd move just to ride one.


I actually laughed when i saw this thread. Even Cuba has better healthcare than America. In fact one of the American officials involved in the assassination of Che Guevarra recently went to Cuba to get medical treatment on his eyes. I find it really sad that a country like America is unwilling to provide healthcare for its poorer citizens. I suppose it's a kind of cultural difference that in America privatisation and completely free markets are seen as a good thing, whereas where I live they mostly aren't.

And there are stories of Canadians going to America to get treatment. Therefore...?

If you have a healthcare system that can't treat the wealthiest members of society well, how can it possibly treat ANYBODY well? Besides, it's not the poorest members of society who don't have access to medical coverage, it's the people who are just above the government subsidisation line that get screwed

[madness]

Unless you live in a communist society, then you will most likely have the option of going private if you aren't satisfied with your national health care. I don't think wealthy people ever have a problem getting good healthcare. At least with the NHS everyone can get a decent level of healthcare no matter how much they earn (and the NHS really isn't that bad). I once had a conversation with an American where I asked him what he thought about not having government healthcare, and he told me he liked the fact that if a homeless guy broke his arm who had contributed nothing to society then he wouldn't be treated. I really thought that was a terrible way to look at things and I hope it's not a common point of view in America.

[mgb_phys]

If there were space shuttles for 250 million Americans, then yeah, it probably would be the best public transport system in the world. Admit it, you'd move just to ride one.
I'd move to somewhere with the Holywood health care system where a team of 5 doctors is devoted just to me if I have more than one symptom.

I would also like the police system where half a dozen detectives, an entire forensic lab (and for some reason a mossad agent) + lots of helicopters are involved the next time my bike gets stolen.

[turbo-1]

And there are stories of Canadians going to America to get treatment. Therefore...?Generally glossed over is the fact that much of Canada is VERY rural, and if there is more sophisticated diagnostic equipment, etc, available nearer in by crossing to the US instead of traveling the half-way across Canada, Canada's public health care system picks up the tab for the US medical care. The incidence of Canadians being treated in the US is NOT a clear case of rich Canadians choosing to come to the US. Very often (perhaps a majority - I don't know) are ordinary Canadians who live in very rural areas and the Canadian health care system willingly pays for care in the nearest US facility if there are no nearby Canadian facilities with equivalent resources.

This is not a reason to claim that the Canadian insurance system is inferior. It is actually more efficient and superior to a private carrier in that advanced diagnostics, etc, are not rationed by your location. We should realize that there are places in the US, as well, that can be many hours of travel from the nearest MRI facility, for example, and it doesn't make economic sense to set up MRI facilities in every little farming town of more than a couple of thousand people. Here in Somerset Country, in Maine, we have had to address that by contracting with a portable MRI service that brings a self-contained tractor trailer "lab" to the regional hospital on a scheduled basis. The hospital is located in the county seat - a "city" of less than 7000 and serves towns from at least 75 miles away, most of which have populations of several hundreds to a couple of thousand or so. There is no way that our regional hospital could finance and support a full-time MRI lab. I doubt that the population density in Canada's wheat-belt could support such advanced equipment either. US diagnostics can be the least-expensive and most effective option in that case.

[Count Iblis]

If you have a healthcare system that can't treat the wealthiest members of society well...

They can only get the same treatment everyone else can get, while they have the financial resources to pay for more. But I don't see this becoming a problem in the US.

[Count Iblis]

I'd move to somewhere with the Holywood health care system where a team of 5 doctors is devoted just to me if I have more than one symptom.


And then you'll die of cardiac arrest due to over-medication like Michael Jackson. :biggrin:

[madness]

I have friends studying political sciences who were told in lectures that America is in line with many third world countries in terms of health care. I imagine this refers to how much of the population can access good health care, since the rich in America do have access to good health care.

[drankin]

I have friends studying political sciences who were told in lectures that America is in line with many third world countries in terms of health care. I imagine this refers to how much of the population can access good health care, since the rich in America do have access to good health care.

I'm American, I'm not rich, and I get excellent health care. If I don't feel like I get good treatment at one facility I can go to another provider. The "rich" can pay for their health care and of course it's going to be as good as they are willing to pay for. If you are a bum on the street you will get basic health care but you won't much of a choice as to what you get. As it should be. Health care is free market service here, just like most everything else.

It's not typical in American towns but even the police where I live had to compete and win the contract to work in our town. If they didn't provide a good service we have the ability to hire different police when their contract is up.

[mgb_phys]

It's not typical in American towns but even the police where I live had to compete and win the contract to work in our town. If they didn't provide a good service we have the ability to hire different police when their contract is up.

So you collect money from everybody in the town, rich and poor, and force them to use the same single police force without any choice in which cop arrests them - sounds awfully socialist to me.

[madness]

Sounds anarcho-sydicalist to me haha

[mgb_phys]

Sounds anarcho-sydicalist to me haha
Only if you take it in turns to act as a sort of executive officer for the week.
But all the decision of that officer have to be ratified at a special bi-weekly meeting--
By a simple majority in the case of purely internal affairs,--
But by a two-thirds majority in the case of more major--

[drankin]

So you collect money from everybody in the town, rich and poor, and force them to use the same single police force without any choice in which cop arrests them - sounds awfully socialist to me.

It is, I don't need no stinkin poh-leese.

A free market system allows you to have the best services. When there is no competition the quality of a service suffers, of course.

[madness]

If a free market system allows the best services then why is Sweden at the top of the UN human development chart especially in terms of healthcare, when it has national healthcare and a socialist government?

[mheslep]

I was hit by a car and had knee problems...Where?

[Astronuc]

Interesting article that points to some of the problems with US healthcare.
Health Care in Crisis: Needless Costs, Needless Deaths
http://news.yahoo.com/s/bw/20090728/bs_bw/jul2009db20090727675410

. . . .
Heart Operations: Most "Are at Best Unnecessary"

It is operations such as these that have sent U.S. health-care costs soaring out of control, certainly when compared to those of other industrialized nations. Dr. Ralph Rashbaum, a renowned back specialist with the Texas Back Institute in Plano, frequently speaks on this issue. Rashbaum is a physician who believes surgery should always be the last resort to correct medical problems -- often counter to what the public wants to believe. People are convinced that somehow the miracle of modern surgery can cure all ills.

Rashbaum also knows the other key reason why U.S. health-care costs are so outrageously high. Some 80% of all spending on health care goes to only 20% of the public -- in the last two years of their lives. Representative Michael Burgess (R-Tex.), a physician, seemed to agree with Rashbaum's analysis of the problematical costs for health care: "I hope we could use this opportunity to educate patients and families of risks before and after illnesses."

As for the costs and risks involved in heart operations, Dr. Michael Ozner, author of The Great American Heart Hoax, lays out the problem: "More than 1.5 million Americans undergo angioplasties and coronary bypass surgeries annually in the U.S." While in many cases these operations save the lives of the patients, he estimates that "70% to 90% of these procedures are at best unnecessary."
. . . .

When there is no competition the quality of a service suffers, of course. And I've seen when the is competition the quality of service or product suffers - because people underbid, then cut costs, and provide less service, often at poorer quality. Competition also produces redundancy.

Quality is dependent on the integrity of the provider/produce/seller, and as we've seen in the meltdown of the economy, integrity is sorely lacking in many cases.

[Astronuc]

I was hit by a car and had knee problems...Where? The knee. :biggrin:

[mheslep]

... where one side really does not want to do much at all..One reason the debate is polarized is repetition of bogus talking points like that. See, e.g., Wyden(D)-Bennett(R). My money is on WB as the legislation that will really happen.

Senate:
A Health-Care Plan That Could Bridge the Divide (http://online.wsj.com/article/SB123931859150606821.html)
Thinking About Wyden(D)-Bennett(R) (http://theglitteringeye.com/?p=7409)

House-Senate
Republicans Offer Health-Care Plan (http://online.wsj.com/article/SB124286548605041517.html)
Called the Patients' Choice Act, it would eliminate the tax break that employers receive for providing health-insurance benefits to their workers. Instead, it would give an annual tax credit of $2,300 to each individual and $5,700 to each family that they could use to offset the cost of their health insurance. Low-income families would get extra money to buy into private insurance plans.

McCain Plan
http://www.ncpa.org/pub/ba629

[mheslep]

The knee. :biggrin:Jeez I always fall for those. :biggrin:

[Evo]

The things that I agree with in Obama's plan, and are critical, IMO, is the coverage of pre-existing illness and catastrophic illness. We obviously need to provide healthcare to cover illness before it becomes life threatening or debilitating. I think his idea to tax the wealthy at the same rate that the middle class and poor pay is essential. Obama claims that making the wealthy, (I think that is people making over $250k annually) pay the same percent of tax would pay for the entire health plan. And this was shot down. Why aren't we screaming and raising hell to get the politicians to approve this? Looks like a great solution to me.

[mheslep]

The things that I agree with in Obama's plan, and are critical, IMO, is the coverage of pre-existing illness and catastrophic illness. We obviously need to provide healthcare to cover illness before it becomes life threatening or debilitating. I think his idea to tax the wealthy at the same rate that the middle class and poor pay is essential. Obama claims that making the wealthy, (I think that is people making over $250k annually) pay the same percent of tax would pay for the entire health plan. And this was shot down. ..Could you explain? Obama's repeatedly stated he will place no additional taxes whatsoever on the middle class. The 'rich' will pay it all - 5% surtax or so. What do you mean by 'the same rate'?

Edit:
Should the rich finance healthcare reform?



Choosing to finance health care reform by taxing the rich is bad economic policy, bad health policy, bad budget policy and poor leadership.

It is bad economic policy because, coupled with the scheduled expiration of the Bush tax cuts, it would raise marginal tax rates by 10 percentage points for high-income households. While I object to the general hue and cry that occurs anytime anyone discusses any potential tax increase for the rich, it is nevertheless quite fair to say that a 10 percentage point increase in taxation on the return to labor and capital income is a lot and shouldn’t be the first choice. (But please spare me the small business arguments.) ...

[turbo-1]

Another thing that bothers me about all the "either-or" wrangling in DC is that the most conservative option is rejected by the "conservatives". If you own a car, and it's not running well, or is smoking, or the brakes are spongy, you don't wait until a castastrophic failure occurs, perhaps ruining your car, perhaps resulting in a loss of property or life. You get the vehicle maintained properly to protect your investment and to protect the safety of the public and your family and yourself.

The fact is, that if everybody had access to periodic check-ups, and preventive care, lots of very expensive interventions could be avoided, and the total cost of health-care could come down. If people are unable to get regular care because they can't get insurance (perhaps because of pre-existing conditions, perhaps due to a lack of money) and then present themselves at an ER after their problems have become too severe to ignore, treatments can be expensive, and outcomes can be sub-optimal, just like when you refuse to maintain your vehicle. Providing reliable regular exams and preventive care should be a goal of all conservatives if they truly want to reduce the cost of health-care in the US.

[Office_Shredder]

I'd move to somewhere with the Holywood health care system where a team of 5 doctors is devoted just to me if I have more than one symptom.

I would also like the police system where half a dozen detectives, an entire forensic lab (and for some reason a mossad agent) + lots of helicopters are involved the next time my bike gets stolen.

First, someone said that the US healthcare system apparently works great except for the 47 million uninsured Americans. That leaves some 250 million insured Americans. Then the 47 million uninsured Americans were compared to all the people who don't fly around in space shuttles. I pointed out the absurdity of this comparison, and I guess you missed it



Generally glossed over is the fact that much of Canada is VERY rural, and if there is more sophisticated diagnostic equipment, etc, available nearer in by crossing to the US instead of traveling the half-way across Canada, Canada's public health care system picks up the tab for the US medical care. The incidence of Canadians being treated in the US is NOT a clear case of rich Canadians choosing to come to the US. Very often (perhaps a majority - I don't know) are ordinary Canadians who live in very rural areas and the Canadian health care system willingly pays for care in the nearest US facility if there are no nearby Canadian facilities with equivalent resources.

This is not a reason to claim that the Canadian insurance system is inferior. It is actually more efficient and superior to a private carrier in that advanced diagnostics, etc, are not rationed by your location. We should realize that there are places in the US, as well, that can be many hours of travel from the nearest MRI facility, for example, and it doesn't make economic sense to set up MRI facilities in every little farming town of more than a couple of thousand people. Here in Somerset Country, in Maine, we have had to address that by contracting with a portable MRI service that brings a self-contained tractor trailer "lab" to the regional hospital on a scheduled basis. The hospital is located in the county seat - a "city" of less than 7000 and serves towns from at least 75 miles away, most of which have populations of several hundreds to a couple of thousand or so. There is no way that our regional hospital could finance and support a full-time MRI lab. I doubt that the population density in Canada's wheat-belt could support such advanced equipment either. US diagnostics can be the least-expensive and most effective option in that case.

So your argument is... people from Canada go to the US because there aren't any Canadian specialists near enough to their homes... and the Canadian system is superior because you don't have problems like having to travel far to get health service. I'll buy it, but only if it comes with a 30 day money back guarantee

[Evo]

Could you explain? Obama's repeatedly stated he will place no additional taxes whatsoever on the middle class. The 'rich' will pay it all - 5% surtax or so. What do you mean by 'the same rate'?Just stating what Obama said in his speech the other night. I disagree that it is bad policy to adopt. The wealthy will continue to get wealthy, they will continue to invest. It's just not right that so much of the wealth they accumulate should be sheltered from being taxed. They get to keep so much more of their money than the average wage earner, and no, I don't think it's right. At one time I was making over $250k a year. I didn't feel entitled to tax shelters. Probably why I never got rich.

[mheslep]

Just stating what Obama said in his speech the other night. I disagree that it is bad policy to adopt. The wealthy will continue to get wealthy, they will continue to invest. ....Well T* is out there somewhere, otherwise the government could just crank up the tax rate to 100% and collect all the revenue they need.
http://upload.wikimedia.org/wikipedia/commons/3/36/Laffer-Curve.svg

[j93]

And I've seen when the is competition the quality of service or product suffers - because people underbid, then cut costs, and provide less service, often at poorer quality. Competition also produces redundancy.

Quality is dependent on the integrity of the provider/produce/seller, and as we've seen in the meltdown of the economy, integrity is sorely lacking in many cases.
Thats a good point.

[mgb_phys]

And I've seen when the is competition the quality of service or product suffers - because people underbid, then cut costs, and provide less service, often at poorer quality. Competition also produces redundancy.
Thats become a problem outside health.
The rail services in the UK are franchised, the government own the track but companies bid to provide the services. The company that runs the main London to Edinburgh line decided it wasn't making a profit in the current climate and walked away. Leaving the government to either bailout, run the service themselves or have England and Scotland with no rail link.

[avant-garde]

The strongly individualistic perspective, which trades off your own wealth against the basic health of people less fortunate than yourself is not a simple equation, even if self-interest is your only motivation.
Self-interest is not the motivation here. It's about having the right to save what you have from bums taking it away. After health care, what's next?

[Al68]

It's just not right that so much of the wealth they accumulate should be sheltered from being taxed. They get to keep so much more of their money than the average wage earner, and no, I don't think it's right.Any evidence for this claim?

[Evo]

Any evidence for this claim?Yes, US tax laws.

The poorer you are, the less likey it is that you can take anything other than the standard deductions. The key is "adjusted gross income" this is the dollar amount that your taxes are paid on. The wealthy can, through tax shelters and exemptions, vastly reduce the amount of their income that can be taxed. So even looking at a tax % on the "taxable amount" of income left after deductions (adjusted gross income) isn't a true picture of the % of tax averaged over their total real income.

Tax Burden Shifts to the Middle

Since 2001, President Bush's tax cuts have shifted federal tax payments from the richest Americans to a wide swath of middle-class families, the Congressional Budget Office has found, a conclusion likely to roil the presidential election campaign.

The conclusions are stark. The effective federal tax rate of the top 1 percent of taxpayers has fallen from 33.4 percent to 26.7 percent, a 20 percent drop. In contrast, the middle 20 percent of taxpayers -- whose incomes averaged $51,500 in 2001 -- saw their tax rates drop 9.3 percent. The poorest taxpayers saw their taxes fall 16 percent.

http://www.washingtonpost.com/wp-dyn/articles/A61178-2004Aug12.html

[lisab]

Yes, US tax laws.

The poorer you are, the less likey it is that you can take anything other than the standard deductions. The key is "adjusted gross income" this is the dollar amount that your taxes are paid on. The wealthy can, through tax shelters and exemptions, vastly reduce the amount of their income that can be taxed. So even looking at a tax % on the "taxable amount" of income left after deductions (adjusted gross income) isn't a true picture of the % of tax averaged over their total real income.


True...I expect most people earing high incomes don't file using the 1040-EZ form.

[Vanadium 50]

So, I was intrigued by Evo's comment, and looked up the data. The IRS posts it here (http://www.irs.gov/pub/irs-soi/06in11si.xls), and the most recent year for which there is data is 2006.

It's fascinating - I won't even attempt to categorize all the interesting features. But some things that caught my eye are:

Just under 16,000 people made $10M or more per year. (That alone is amazing) This 0.0053% of the population makes 5.6% of the total income in the US, and pays 8.9% of the income tax.

Half of the total income tax is paid by 3% of the population.

The income tax rate on AGI behaves more or less as one expects - monotonically increasing until incomes of many millions (which is likely dominated by capital gains) when it dips slightly. If one instead uses total income, rather than taxable income, the picture is different: it pretty much grows monotonically until it hits 20% for people making $100-200K per year. Then it starts falling, rises again between $1M and $2M, and then starts falling again.

[Ivan Seeking]

More scare tactics from the Republicans.

Amid a debate about national health care, Rep. Virginia Foxx, R-5th, caused a stir yesterday with comments before the U.S. House.

Foxx said the Republican version of the health-care plan "is pro-life because it will not put seniors in a position of being put to death by their government."
http://www2.journalnow.com/content/2009/jul/29/foxx-causes-stir-comments-health-care/

[j93]

I am still confused why the health care program is being used as whipping post for tax code.

Tax code has become a joke but Im not sure what anyone could do about it because those with the most money also have the most resources to look for loopholes and means to lower taxes paid.

[drankin]

I am still confused why the health care program is being used as whipping post for tax code.

Tax code has become a joke but Im not sure what anyone could do about it because those with the most money also have the most resources to look for loopholes and means to lower taxes paid.

Can you give an example? I've heard this comment several times without a supported example at least. Of course the more money you have the more assets you have and with that you have the same write-offs that a middle-class individual would have owning a single such asset. The IRS doesn't just figure that if you make half a mil a year you don't have to pay taxes on your assets the same as a middle class individual that may have the same thing. People like yourself simply imply that there is an injustice in the tax code and lower income people do not get a fair shake. So far, I see this as an unsupported allegation with a bias against those who have become financially successful (small business owners, entrepreneurs, professionals in various fields that have put themselves in valuable positions).

[Evo]

Of course the more money you have the more assets you have and with that you have the same write-offs that a middle-class individual would have owning a single such asset..Right, a middle class American gets to claim deductions on their $2 million dollar yacht, claiming that they use it for business. Same goes for the helicopter that's used for "business". My yacht actually has a helio pad on it to land my clients directly onboard for important business "meetings".

[Ivan Seeking]

Right, a middle class American gets to claim deductions on their $2 million dollar yacht, claiming that they use it for business. Same goes for the helicopter that's used for "business". My yacht actually has a helio pad on it to land my clients directly onboard for important business "meetings".

That is exactly how it works. Even for a small businessman like me, the write-offs are fantastic. The key is to blend lifestyle options with business needs.

My mother actually got angry when she discovered that I could deduct my BBQ. :rofl: "That's just not right", she objected. Then I told her just how much I get to deduct for everything from coffee, to a new well system, to the guy that mows my pasture.

I ALWAYS go by the book, btw.

[drankin]

Right, a middle class American gets to claim deductions on their $2 million dollar yacht, claiming that they use it for business. Same goes for the helicopter that's used for "business". My yacht actually has a helio pad on it to land my clients directly onboard for important business "meetings".

Do you have an actual example? I suppose a yacht manufacturer would hold meetings on thier yachts. This is a made up scenario in which you do not know the IRS code related to it.

"Business is generally not considered to be the main purpose when business and entertainment are combined on hunting or fishing trips, or on yachts or other pleasure boats. Even if you show that business was the main purpose, you generally cannot deduct the expenses for the use of an entertainment facility. See Entertainment facilities under What Entertainment Expenses Are Not Deductible? later in this chapter. " http://www.irs.gov/publications/p463/ch02.html

[Ivan Seeking]

Do you have an actual example? I suppose a yacht manufacturer would hold meetings on thier yachts. This is a made up scenario in which you do not know the IRS code related to it.

"Business is generally not considered to be the main purpose when business and entertainment are combined on hunting or fishing trips, or on yachts or other pleasure boats. Even if you show that business was the main purpose, you generally cannot deduct the expenses for the use of an entertainment facility. See Entertainment facilities under What Entertainment Expenses Are Not Deductible? later in this chapter. " http://www.irs.gov/publications/p463/ch02.html

Then the key is to show that the yacht is not an entertainment facility. Perhaps all that is required is to have an office on the boat, or simply designate it an office, or use it for legitimate business travel.

[turbo-1]

All kinds of gifts and perks fly "under the radar" for people in positions of influence and expenses are charged off to "business meetings". On small scales, when I was selling and servicing expensive fabrics for paper machines, my employers often required me to set up get-away weekends at ski resorts at which all the food, accomodations, booze, lift tickets, and gifts (new parka and goggles, anyone?) were picked up by my expense account. I'd be asked (required) to set up out-of state junkets for golf, often at pretty pricey country-clubs. Generally, those junkets were stag and involved some chauffeured bar-hopping or private parties, though the ski weekends were usually all-family affairs and my employers expected me to get my wife to come along and help entertain the spouses and kids.

Higher brass like paper mill superintendents, production managers, mill managers, purchasing managers, etc, got nicer trips - maybe to Steamboat Springs for skiing, or to the keys for deep-sea fishing, or Alaska for salmon or big-game. The recipients don't claim all this on their taxes, and the people paying for the "entertainment" write it all off as "business expenses". Most ordinary folks have no idea how much of this stuff goes on nor how their tax burden is increased by having to make up for all the freebies sloshing around behind the scenes.

When Congressional members, their families, aides and staff, are invited to "informational" meetings in exotic locales, please keep in mind that money is "grease".

[drankin]

All kinds of gifts and perks fly "under the radar" for people in positions of influence and expenses are charged off to "business meetings". On small scales, when I was selling and servicing expensive fabrics for paper machines, my employers often required me to set up get-away weekends at ski resorts at which all the food, accomodations, booze, lift tickets, and gifts (new parka and goggles, anyone?) were picked up by my expense account. I'd be asked (required) to set up out-of state junkets for golf, often at pretty pricey country-clubs. Generally, those junkets were stag and involved some chauffeured bar-hopping or private parties, though the ski weekends were usually all-family affairs and my employers expected me to get my wife to come along and help entertain the spouses and kids.

Higher brass like paper mill superintendents, production managers, mill managers, purchasing managers, etc, got nicer trips - maybe to Steamboat Springs for skiing, or to the keys for deep-sea fishing, or Alaska for salmon or big-game. The recipients don't claim all this on their taxes, and the people paying for the "entertainment" write it all off as "business expenses". Most ordinary folks have no idea how much of this stuff goes on nor how their tax burden is increased by having to make up for all the freebies sloshing around behind the scenes.

When Congressional members, their families, aides and staff, are invited to "informational" meetings in exotic locales, please keep in mind that money is "grease".

Of course the system is abused by all income brackets but it is not a matter of the wealthy having special tax rights just because they are wealthy. The IRS doesn't discriminate tax law application concerning write-offs based on income. At least I've seen no evidence of this provided in this forum or IRS.gov.

[j93]

Of course the system is abused by all income brackets but it is not a matter of the wealthy having special tax rights just because they are wealthy. The IRS doesn't discriminate tax law application concerning write-offs based on income. At least I've seen no evidence of this provided in this forum or IRS.gov.
I think the implicit truth is that the wealthy have more opportunities to write off and abuse the system.
Example a middle class may abuse the system by writing off his Hummer

but someone in the top of the income distribution can write off a yacht , a helicopter, multiple cars, ...

given the greater amount of opportunities to abuse the system the only way you could say that the wealthy abuse the system at the same level as the middle and lower class is if they decide to decline these opportunities more often than middle/lower class individuals ie. the wealthy are much more likely to pay their taxes faithfully than middle/lower class individuals.

[turbo-1]

The wealthy, and business interests operate on a whole different level than folks earning in the low 6 figures. When I signed on as a technical consultant for a supplier to the pulp and paper industry, I expected to be paid well, and to be required to participate in professional conferences and other functions in order to improve my knowledge and my relations with industry contacts. I never expected to find myself with a "bottomless" expense account that rivaled or exceeded my salary and bonuses.

I found myself arranging get-aways for key customers and their families in 5-star American-plan resorts that were so expensive (with the extras) that my wife and I might have only contemplate booking a weekend there once every few years. Junkets to the White Mountains in NH are not cheap but they were close enough that we all could drive there and back and people in production positions would not be held up in distant airports due to weather problems. Spa-treatments and massages for the wives? Riding lessons for the kids? Golf for anyone who is so-inclined? Side trips to local attractions with all expenses paid? All covered. Every nickel of my expense-account was presented as a legitimate business expense, and due to the growth of sales in my territory for two consecutive employers, my managers encouraged me to spend even MORE money courting existing or potential clients who had purchasing power. I got out of that rat-race eventually, but it really opened up my eyes to the sub-current of undeclared compensation in this country. The middle-class and the poor (yes, even the poor pay unavoidable taxes such as sales taxes, property taxes, etc) are paying much more than they should because of the fraud that occurs in higher-income groups.

In my jobs in that industry, I wanted to sell you custom-engineered industrial textiles that would save your company money in reduced steam costs (the biggest fixed cost in the production of paper), reduced wear, and lower replacement rates. A big paper machine might have a couple of forming fabrics, 2-4 pressing fabrics, and maybe 10 dryer fabrics. They need regular replacement, and back then 20 years ago, replacing the two forming fabrics might have cost $200K plus downtime and lost production. Replacing all the press fabrics could easily have cost well over $150K, and the dryer fabrics were typically $35-50K each - much higher in demanding applications.

I know that I have blathered on and on about this, but please consider that this is accurate. Now, consider what goes on behind the scenes in the medical field when costs are astronomical, and the profit potential is commensurate? A reasonable person might expect that tax-avoidance techniques and tactics that work perfectly well in industry will work equally well in the medical field. In other words, the sellers will successfully write off the expenses incurred in the bribing of the people that ultimately buy their services.

Is there anybody here that has worked in health-care that does not have a life-time supply of pens and notepads emblazoned with the name of prescription drugs, and some tote-bags, drink cozies, insulated lunch bags, etc? These are not "free". They are produced and distributed at some cost by the vendors, and that cost is written off as "promotion" - a cost of doing business. I still have a golf umbrella with the name of a drug emblazoned on it that was given to me by one of the docs in the practice that didn't play golf. I would have preferred a Sage fly-rod, but you can't be picky. The example in this last paragraph are minuscule in value compared to the really huge abuses, but every cent contributes to the overhead of our health-care system.

[drankin]

I think the implicit truth is that the wealthy have more opportunities to write off and abuse the system.
Example a middle class may abuse the system by writing off his Hummer

but someone in the top of the income distribution can write off a yacht , a helicopter, multiple cars, ...

I agree with that. But as I've shown, writing off a yacht isn't so easy as it is considered an entertainment vehicle. A helicopter, maybe if it's part of a business. How many rich people commute via helicopter anyway? I live in Redmond, WA home of Microsoft and I don't see private helicopters flying around.

The IRS hassles businesses and higher income folks more than lower income folks simply because they are interested with the amount of money owed.

I just don't see a large injustice in the tax code worth the "tax sheltered rich" stereotype implied.

[Evo]

It's the fact that many middle to low income people cannot even itemize. They have to take the standard deductions. They don't even have the opportunity to exclude their income from taxes. Therefore, they pay the highest percentage of taxes when averaged across their real income than people that can write things off or find tax shelters. Pretending it doesn't happen is not just naive, it's disengenious.

[turbo-1]

It's the fact that many middle to low income people cannot even itemize. They have to take the standard deductions. They don't even have the opportunity to exclude their income from taxes. Therefore, they pay the highest percentage of taxes when averaged across their real income than people that can write things off or find tax shelters. Pretending it doesn't happen is not just naive, it's disengenious.I have not been able to itemize for many years, even when I was at my highest-gross earnings. I had no mortgage, no "strategic" debt, and no way to work the system. I was fresh meat for the system that was designed to let inflating cost and wages and a stagnant alternative minimum tax start stripping lots of extra money from hard-working folks.

[turbo-1]

I should mention that our tax system rewards indebtedness, and punishes actual conservatives who pay their own way. It may take a radical overhaul and simplification of the US tax code before wealthy people are required to pay their fair share of the upkeep of the government that helped make them wealthy, and protects their privileged status.

A $64m yacht owned by a Scottish billionaire docked in Bangor a couple of days ago, with 5 huge decks and a helicopter (with the main blades currently stowed). It certainly has been an attraction in an area in which countless thousands in the region have no employment and no prospect of any. As my mother used to tell me as a child, "Even a cat can look at the Queen." I wish the "Queen" would look back in this case and offer a response.

[j93]

At least in the state level sales tax also matters
http://www.itepnet.org/whopays.htm

[aquitaine]

Jumping in a bit late, I admit I haven't read in everything in the thread, one of my parents works in an insurance company and appearently part of the reason why healthcare costs so much is the hospitals deliberatly overcharge patients in order to bilk as much as possible from the insurance company, and often times the insurance will only pay for half of that leaving the patience to hold the bag, and that does of course assumes that you are _not_ one of the 40+ million people without health insurance, and no doubt many millions more also have the so called "Utah Insurance" (insurance that doesn't actually pay for anything). What amazes me about our healthcare system is not just the fraud, but also the waste, inefficiency, and corruption in the entire system. Healthcare will be one of the last bubbles to pop, and frankly I can't say I would miss it.


EDIT: And I'll also throw this in (http://www.huliq.com/3478/81839/60-u-s-bankruptcy-cases-are-caused-health-care-bills):

According to Reuters:

Medical bills are behind more than 60 percent of U.S. personal bankruptcies, U.S. researchers reported on Thursday in a report they said demonstrates that healthcare reform is on the wrong track.

More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts, the team at Harvard Law School, Harvard Medical School and Ohio University reported in the American Journal of Medicine.

Seriously, what is wrong with this picture?

EDIT2:

And I don't pay through the nose in taxes to pay for any of that. My employer pays for it, private medical insurance is a perk.

What happens when you lose your job and can't get another one with such good benefits? Ooops.....

[Evo]

What happens when you lose your job and can't get another one with such good benefits? Ooops.....Unfortunately I won't have to lose my job to lose my insurance, if Obama's health plan is passed, my employer will stop providing health insurance when they are no longer able to get a tax break to do so.

I had a talk with my doctor today, he said that the proposed healthplan is dreaded by doctors, they are absolutely against it. If you believe the media, doctors love Obama's proposal, he said it couldn't be farther from the truth. He said he sees the ability of doctors to make the best decisions for their patients a thing of the past. Right now they have to fight with insurance companies to get the best procedures approved, the new health care plan won't even let them fight that battle.

[j93]

A doctor also stands to make less money by passing healthcare reform.

[mheslep]

It's the fact that many middle to low income people cannot even itemize. They have to take the standard deductions ...True.

It is also a fact that many low income people pay no federal income tax at all. It's a fact that of the higher incomes (ranked by gross income - before deductions), the top 1% of earners pay 34% of all US federal income taxes, that the top 5% pay 54%, that the top 10% pay 66%, that the top 25% pay 84%.
http://www.irs.ustreas.gov/pub/irs-soi/03in05tr.xls

[Evo]

True.

It is also a fact that many low income people pay no federal income tax at all. It's a fact that of the higher incomes (ranked by gross income - before deductions), the top 1% of earners pay 34% of all US federal income taxes, that the top 5% pay 54%, that the top 10% pay 66%, that the top 25% pay 84%.
http://www.irs.ustreas.gov/pub/irs-soi/03in05tr.xlsNot sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.

[TheStatutoryApe]

I apologize for being insensitive about your injury but my point is that ultimately we are responsible for our own welfare. If a particular private doctor does not give you the service that you expect, FIRE him/her. I've done it myself. I'll walk out of the office if a doctor does not attend to me within 20min after an appointment time. If the gov't begins dictating who we go to then we can't FIRE them for poor service.
Some of us can afford that and some of us can not. Some of us can not even afford to look for another job if our employers are shafting us. That does not make these people any less deserving of medical attention. The whole point of the medical profession is to help others, including those that are unfortunate. I think we can all agree that every one should get proper medical treatment. The real question is whether or not we can give everyone proper medical treatment. My opinion simply is that our seeming inability to provide this for our citizens is not reason enough to abandon the idea of doing so. Changes need to be made towards such a goal and ideas for reaching that goal must be worked on.
As far as being able to or not being able to fire an incompetent doctor there is no reason why this could not be accomplished in a national health care system. This system does not yet exist, we can not say how it will or will not be. If we perceive certain problems in other countries implimentation of such programs then we can attempt to avoid them. If the problems crop up anyway they can be fixed. Merely decrying something as doomed to failure accomplishes nothing in preventing that failure. And many of the opponents of the idea will only be too happy to see it become a failure instead of trying to help fix it.

Where?
I lived in Orange County in Southern California at the time. Lots and lots of hospitals and MRI machines everywhere. This is why it stumped me that it took so long. Maybe it was really just because of where I went but I have not really had very different experiences even when I was growing up and covered by my parents insurance.

[CRGreathouse]

Not sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.

You seem to misunderstand. That's total tax burden -- the top 25% of earners provide 84% of the government's money, and the bottom 75% provide the other 16%. (That's gross, not net -- I imagine the top 25% provides more than 100% net.)

This is a drop from previous percentages. The wealthy have lost a larger percentage of their wealth than the non-wealthy in the last 10 years, so their aggregate tax share has dropped. But still, it makes you wonder. Being in that lower 75% myself, I'm very thankful that I *don't* have to pay a proportional share.

[TheStatutoryApe]

Not sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.

I believe the idea is that that is the percentage of the total revenue paid by these people.

[mheslep]

Not sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.
Sorry bad link. Here
http://www.irs.ustreas.gov/pub/irs-soi/03in05ty.xls
See line 186.

It is not an 84% tax rate, rather the top 1/4 of taxpayers pay 84% of all US federal income tax revenue. The top half of taxpayers pay essentially all of the income tax revenue (97%). And that is ranked by gross income.

No doubt the super wealthy get large tax breaks. Warren Buffet complained that he owed only 17.7%, probably because his 'income' is dividends and cap. gains. But the average top 1% earner ($1.28 million) in this country makes most of his/her money from working. The day of the leisure class capitalists is gone, replaced by the working rich. She, typically, is a successful neuro surgeon, with eight years of school and another eight in training. She has the big mortgage deduction and some smaller ones, but they're still paying 35% on a million or more, soon to increase. And lop off another 10% if you are in California.

[j93]

The wealth distribution would be relevant here
http://zfacts.com/p/728.html

Roughly it would seem like the bottom half should be paying about 2.5% considering the amount of wealth they hold, rightly this is a very rough calculation assuming a flat tax.

[drankin]

Some of us can afford that and some of us can not. Some of us can not even afford to look for another job if our employers are shafting us. That does not make these people any less deserving of medical attention. The whole point of the medical profession is to help others, including those that are unfortunate. I think we can all agree that every one should get proper medical treatment. The real question is whether or not we can give everyone proper medical treatment. My opinion simply is that our seeming inability to provide this for our citizens is not reason enough to abandon the idea of doing so. Changes need to be made towards such a goal and ideas for reaching that goal must be worked on.
As far as being able to or not being able to fire an incompetent doctor there is no reason why this could not be accomplished in a national health care system. This system does not yet exist, we can not say how it will or will not be. If we perceive certain problems in other countries implimentation of such programs then we can attempt to avoid them. If the problems crop up anyway they can be fixed. Merely decrying something as doomed to failure accomplishes nothing in preventing that failure. And many of the opponents of the idea will only be too happy to see it become a failure instead of trying to help fix it.


I lived in Orange County in Southern California at the time. Lots and lots of hospitals and MRI machines everywhere. This is why it stumped me that it took so long. Maybe it was really just because of where I went but I have not really had very different experiences even when I was growing up and covered by my parents insurance.

So, you believe that with a national health care system you will be able to fire your doctor and get another with an appointment in a reasonable time? I don't believe there is a national health care on the planet that you can do that with. You say that people shouldn't be "less deserving" of health care? It's not about "deserving". Why the hell do you deserve better health care that you aren't even paying for? You get what you pay for. If you can't pay for it then you don't get it. That goes for any private service. Doctors don't owe you health care. If you think insurance coverage is bad, wait till uncle sam is running the show.

That's why competition gives you the best your money can buy. Because they are competing for your patronage. Take that away and the doctors office turns into the damn DMV.

[j93]

I think we can all agree that every one should get proper medical treatment.

Apparently Not
You get what you pay for. If you can't pay for it then you don't get it.

[Huckleberry]

So, you believe that with a national health care system you will be able to fire your doctor and get another with an appointment in a reasonable time? I don't believe there is a national health care on the planet that you can do that with. You say that people shouldn't be "less deserving" of health care? It's not about "deserving". Why the hell do you deserve better health care that you aren't even paying for? You get what you pay for. If you can't pay for it then you don't get it. That goes for any private service. Doctors don't owe you health care. If you think insurance coverage is bad, wait till uncle sam is running the show.

That's why competition gives you the best your money can buy. Because they are competing for your patronage. Take that away and the doctors office turns into the damn DMV.

In emergencies hospitals are obligated by law to provide health care at no cost.
The Emergency Medical Treatment and Active Labor Act (42 U.S.C. § 1395dd, EMTALA) is a United States Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act. It requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions.http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

Also, many doctors swear by a hippocratic oath that obligates them to help the sick. I don't think this oath is mandatory any longer, but many still swear by it. Nothing in it is enforcable, except by existing law.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.http://www.pbs.org/wgbh/nova/doctors/oath_modern.html

So if someone hurt their knee and it isn't life threatening then they are out of luck legally. I'm sure there are many doctors that would like to help, but an individual doctor can't pay for treatment for every uninsured or underinsured person that asks them, even if they were sincere in their oath. As far as I can tell, legally, the hospital has the right to deny service in non-emergency situations. Without some kind of government provision they are in a similar situation as the doctors. I'm sure that most hospitals would like to treat as many people as they can, but they can't do it for free even if they wanted to.

What concerns me is the appearance that the money is the motivating factor and not the treatment for the benefit of the sick, as stated in the hippocratic oath. Medical treatment is more than a service to be provided or not based purely on profit. It is often a requirement for a healthy life as well. Finding a balance between these necessities is important, but neither can be ignored.

[Vanadium 50]

I am still confused why the health care program is being used as whipping post for tax code.

Because it's related. "Free health care for everyone" is a great idea. The question is, how do we pay for it. The same issue comes up with "free education for everyone", where we as a society answered that a) we would pay for it via state and property taxes, b) it would be free up until high school and subsidized afterwards, and c) if you didn't like this, you could pay for it yourself.

[Al68]

Any evidence for this claim?Yes, US tax laws.

The poorer you are, the less likey it is that you can take anything other than the standard deductions. The key is "adjusted gross income" this is the dollar amount that your taxes are paid on. The wealthy can, through tax shelters and exemptions, vastly reduce the amount of their income that can be taxed. So even looking at a tax % on the "taxable amount" of income left after deductions (adjusted gross income) isn't a true picture of the % of tax averaged over their total real income.
Tax Burden Shifts to the Middle

Since 2001, President Bush's tax cuts have shifted federal tax payments from the richest Americans to a wide swath of middle-class families, the Congressional Budget Office has found, a conclusion likely to roil the presidential election campaign.

The conclusions are stark. The effective federal tax rate of the top 1 percent of taxpayers has fallen from 33.4 percent to 26.7 percent, a 20 percent drop. In contrast, the middle 20 percent of taxpayers -- whose incomes averaged $51,500 in 2001 -- saw their tax rates drop 9.3 percent. The poorest taxpayers saw their taxes fall 16 percent.
http://www.washingtonpost.com/wp-dyn/articles/A61178-2004Aug12.htmlShould I take that as a no? Nothing in this substantiates your claim. Even the Wash. Post article says nothing resembling your claim, and it's misleading and biased by considering only the tax rates instead of the actual revenues received from each group as a percentage of income (which has a vastly different result). The fact is that the result of the Bush tax cut in terms of actual dollars collected from different income groups is that the burden was shifted from the poor and middle class to the rich. The Washington Post is simply misleading people by reporting the marginal rate changes instead of the actual revenue received. The relationship between tax rate and revenue isn't linear, and everyone knows it, including the liars of the so called left.

Did I misunderstand your claim? Weren't you claiming that the rich paid a smaller percentage of their income in taxes than the rest of us?

[Al68]

It's the fact that many middle to low income people cannot even itemize. They have to take the standard deductions. They don't even have the opportunity to exclude their income from taxes. Therefore, they pay the highest percentage of taxes when averaged across their real income than people that can write things off or find tax shelters. Pretending it doesn't happen is not just naive, it's disengenious.More false statements.

No one is disputing that what you claim happens anecdotally. The claim that "they" pay less compared to their income is simply false.

That's one of the biggest problems with the income tax code. It's so complicated that it's very easy to lie, commit fraud against the people, and mislead them about who is paying what.

[mheslep]

...Weren't you claiming that the rich paid a smaller percentage of their income in taxes than the rest of us?Lets back off from the absolutes for a moment. There are cases (Warren Buffet) where that is true.

[Al68]

Being in that lower 75% myself, I'm very thankful that I *don't* have to pay a proportional share.Me too. And there's good reason for that. If we had a flat income tax, we would all be in the same boat. Then the power hungry politicians couldn't turn us all against each other, mislead us about who is paying what, then claim it's the "other guy" that's getting soaked while they bend us over.

There will never come a day when the power hungry will think the government has enough money and power.

And a timely quote from the classical liberal Fredric Bastiat: "When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."

[turbo-1]

Lets back off from the absolutes for a moment. There are cases (Warren Buffet) where that is true.Good point, and let's take another step toward reality and acknowledge that the very wealthy often pay far less of their income percentage-wise than us mere mortals.

The compensation packages of corporate officers are usually structured such that much of their compensation is not counted as "income" by the IRS and is therefor not taxed as such. In addition, much of their compensation may be deferred. If the board votes to grant stock options to a CEO, (s)he gets to exercise them at will, and the profit realized from that is not taxable until that action is taken. If the CEO retires, and takes on some debt that can be written off (per IRS guidelines) as investments, then is a good time to exercise some of the stock options, and take the profit when their salary is nil and there is debt to offset the profit.

I don't think so many corporate officers would be flying around in corporate jets and riding in chauffeured limos if those perks were taxed at their true cost, either.

[Al68]

...Weren't you claiming that the rich paid a smaller percentage of their income in taxes than the rest of us?Lets back off from the absolutes for a moment. There are cases (Warren Buffet) where that is true.Sure, like I said: No one is disputing that what you claim happens anecdotally.Unless I misunderstood the claim, Evo was using the terms "the rich" and "they" to mean in general, not just a specific case.

[Al68]

At least in the state level sales tax also matters
http://www.itepnet.org/whopays.htmWell, if we were to use the same logical analysis for sales taxes as Democrats use to justify "corporate income taxes", sales taxes are paid by the business, not the consumer. I wonder how differently people would think about corporate income taxes and regulation if their actual cost were disclosed on the label of everything they bought. Or charged separately like a sales tax.

[turbo-1]

Another point missing from this debate/conversation is that if you are an ordinary wage-earner (even if you make a lot of money compared to average folks) you are only one serious illness away from bankruptcy and financial ruin. When your doctor starts submitting claims for visits, diagnostic tests, etc, that point to a very serious and expensive-to-treat illness, the very first thing that your insurance company will do is try to dump you on any possible grounds, so they never have to pay.

I am lucky that my wife's employer has a very large pool of employees, and we didn't get dumped, BUT there is a little wrinkle that was extremely costly. I was doing pretty well at work and at home, until I got my division's profits jacked up. Then, the owner of the company "gave" me his girlfriend as my administrative assistant so that she could rake in some of the incentive pay generated by those profits. She was a middle-aged woman aspiring to the Barbie ideal and came to work every day wearing more cosmetics than any Avon lady could sell, and I became chronically ill, and at a much worse level than ever before. My primary-care doc referred me to a respiratory doc, who referred me to the most prominent chemical-injury doc in New England (practices and teaches at Dartmouth-Hitchcock). The problem? CIGNA refused to pay for my consultations, treatment, etc, because they claimed my illness was work-related, and MEMIC (Maine's worker's comp insurer) refused to pay for my medical bills because they said that I could not prove that my illness was work-related. I am countless thousands of dollars out-of-pocket trying to get adequate medical care. If my wife loses her job or her company goes under, I will never again be able to get any private health-insurance coverage. I think we need a new system.

[mheslep]

... I think we need a new system.Most everyone agrees. I like Ryan's, McCain's, or Bennett's ideas, all of which would allow one to get out of the insured-through-work-only concept as it is now.

[Evo]

Did I misunderstand your claim? Weren't you claiming that the rich paid a smaller percentage of their income in taxes than the rest of us?Yes, have you read anything that was posted about Adjusted Gross Income? Do you understand Adjusted Gross income? Have you ever filed an itemized tax return and understand the reason behind it? Do you undersatand US tax laws? You don't seem to.

I've made over $250 a year and had tons of exemptions, and the percent of tax I paid, when averaged over my actual gross income, not the percentage I paid on the AGI that was taxable, was a much lower percentage than I pay now, and I make just under $100k a year now and have no deductions. I'll say it one more time. I'm not talking about the % of tax on AGI, I'm talking about the $ amount of taxes paid, and what percent of a person's total UNadjusted gross income that equates too. Do you understand now? Based on a person's TOTAL ACTUAL annual income, unless they do not itemize, the rich pay a lower percent of tax based on their TOTAL annual income.

[drankin]

Yes, have you read any of the about Adjusted Gross ncome? Do you understand Adjusted Gross income? Have you ever filed an itemized tax return and understand the reason behind it? Do you undersatand US tax laws? You don't seem to.

You seem to be implying an injustice that favors the wealthy. The purpose of write-offs is to offset costs associated with business in one form or another. A major deduction is a home, this is to encourage home purchases and helps the real estate industry. Then there are children, this helps the poor. At one time I recieved more money from the IRS than I would put in because of earned income credit and claiming my children. Earned income credit is specifically for low-income families. Our income tax requirements are such that the more you make the more they take percentage wise. I have a reasonable grasp of US tax laws. Where is the injustice?

BTW, I would be in favor of a simple flat tax even if it were modestly progressive.

[j93]

Our income tax requirements are such that the more you make the more they take percentage wise. I have a reasonable grasp of US tax laws. Where is the injustice?
If mheslep is right the bottom half is being taxed such that they account for 3% of tax revenue even though they only hold 2.5% of the wealth.

Sorry bad link. Here
http://www.irs.ustreas.gov/pub/irs-soi/03in05ty.xls
See line 186.

It is not an 84% tax rate, rather the top 1/4 of taxpayers pay 84% of all US federal income tax revenue. The top half of taxpayers pay essentially all of the income tax revenue (97%). And that is ranked by gross income.


The wealth distribution would be relevant here
http://zfacts.com/p/728.html

Roughly it would seem like the bottom half should be paying about 2.5% considering the amount of wealth they hold, rightly this is a very rough calculation assuming a flat tax.

[Evo]

You seem to be implying an injustice that favors the wealthy. The purpose of write-offs is to offset costs associated with business in one form or another. A major deduction is a home, this is to encourage home purchases and helps the real estate industry. Then there are children, this helps the poor. At one time I recieved more money from the IRS than I would put in because of earned income credit and claiming my children. Earned income credit is specifically for low-income families. Our income tax requirements are such that the more you make the more they take percentage wise. I have a reasonable grasp of US tax laws. Where is the injustice?Homeownership is not a right. People that rent or already own their home are being discriminated against. Deductions for children are standard, that's not even in discussion here. The issue here is that the rich have many ways of NOT paying taxes on income. For example, a person making $500k annually may only pay taxes on $300k of that income. The other $200k is tax free. They will pay $99,000 in tax, that's a little under 20% of their total income. A single person making $70K that cannot itemize, may have to pay taxes on $66.5K of that income. So what if the rich person pays 33% tax on $300k, that's still only comes out to less than 20% on their total income. The $70k earner will pay 25% on $66,500, that 's $16,625, that's almost 24% of their total income.

[drankin]

If mheslep is right the bottom half is being taxed such that they account for 3% of tax revenue even though they only hold 2.5% of the wealth.

That is significant. I will concede that those with a significantly higher revenue need to contribute at a moderately progressive rate. Flat tax baby! One of the big problems with this is a huge tax preparation industry is going to get axed. Along with the lawyers... sounds like a good thing.

[drankin]

Homeownership is not a right. People that rent or already own their home are being discriminated against. Deductions for children are standard, that's not even in discussion here. The issue here is that the rich have many ways of NOT paying taxes on income. For example, a person making $500k annually may only pay taxes on $300k of that income. The other $200k is tax free. They will pay $99,000 in tax, that's a little under 20% of their total income. A single person making $70K that cannot itemize, may have to pay taxes on $66.5K of that income. So what if the rich person pays 33% tax on $300k, that's still only comes out to less than 20% on their total income. The $70k earner will pay 25% on $66,500, that 's $16,625, that's almost 24% of their total income.

Point taken, Evo. Thanks for digging up the figures.

[mheslep]

... Flat tax baby! 2nd that. Seems to be working well in several countries.

[j93]

2nd that. Seems to be working well in several countries.
From wiki about flat taxes
"Perhaps the single biggest necessary deduction is for business expenses. If businesses were not allowed to deduct expenses then businesses with a profit margin below the flat tax rate could never earn any money since the tax on revenues would always exceed the earnings. For example, grocery stores typically earn pennies on every dollar of revenue; they could not pay a tax rate of 25% on revenues unless their markup exceeded 25%. Thus business must be able to deduct their expenses even if individual citizens cannot. A practical difficulty now arises as to identifying what is an expense for a business. For example, if a peanut butter maker purchases a jar manufacturer, is that an expense (since they have to purchase jars somehow) or a sheltering of their income through investment. How deductions are implemented will dramatically change the effective, and thus flatness, of the tax."

[mheslep]

From wiki about flat taxes

Good topic for another thread.

[aquitaine]

Unfortunately I won't have to lose my job to lose my insurance, if Obama's health plan is passed, my employer will stop providing health insurance when they are no longer able to get a tax break to do so.

I had a talk with my doctor today, he said that the proposed healthplan is dreaded by doctors, they are absolutely against it. If you believe the media, doctors love Obama's proposal, he said it couldn't be farther from the truth. He said he sees the ability of doctors to make the best decisions for their patients a thing of the past. Right now they have to fight with insurance companies to get the best procedures approved, the new health care plan won't even let them fight that battle.


A.) Like I said, hospitals intentionally inflate costs.

B.) Its blatantly obvious our system isn't working, tens of millions of people can't get care, millions more go bankrupt because of it, and outrageous out of control costs clearly indicate something is wrong. As a country we spend far more as a percentage of our GDP than any other country in the world, yet according to the WHO we are less healthy than many other developed countries. More for less.......doesn't look very efficient to me.

C.) Nice dodging the issues, especially what happens to your healthcare if you lose your job or if insurance doesn't cover your problem like what happened to turbo-1.

[mheslep]

B.) Its blatantly obvious our system isn't working, tens of millions of people can't get care, millions more go bankrupt because of it, and outrageous out of control costs clearly indicate something is wrong. As a country we spend far more as a percentage of our GDP than any other country in the world, yet according to the WHO we are less healthy than many other developed countries. More for less.......doesn't look very efficient to me.
Access to and the cost of the system don't work well. The medical outcomes portion works quite well (WHO is not relevant in that regard).

I'd like to go with something like this:
http://www.heritage.org/research/healthcare/bg2198.cfm
Equal tax treatment for health coverage. The Senator would replace the special tax breaks for employer-based health insurance with a universal system of health care tax credits for the purchase of health insurance.
...
Health insurance competition on a national scale. Currently, only federal workers and retirees in the Federal Employees Health Benefits Program (FEHBP) benefit from competition among private health insurance companies on a national scale. In sharp contrast with almost every other sector of the economy, competition across state lines in health insurance is virtually nonexistent. The McCain health plan would change this by allowing individuals and families to buy health plans domiciled and regulated in other states
...
Federal assistance to the states to cover vulnerable populations. The Senator envisions a large role for state innovation and experimentation in health care financing and delivery, but he would provide safety-net funding to ensure coverage of the most vulnerable populations: the hard-to-insure and the uninsurable. McCain's Guaranteed Access Plan would provide federal assistance to the states to secure access to health insurance coverage through state high-risk pools or similar arrangements.

[mheslep]

...I had a talk with my doctor today, he said that the proposed healthplan is dreaded by doctors, they are absolutely against it. If you believe the media, doctors love Obama's proposal, he said it couldn't be farther from the truth. He said he sees the ability of doctors to make the best decisions for their patients a thing of the past. ...Your doc, and all the others, must have loved the President's doctor slight the other day:

The doctor may look at the reimbursement system and say to himself, 'You know what? I make a lot more money if I take this kid's tonsils out,'
http://www.realclearpolitics.com/video/2009/07/22/obama_doctors_taking_tonsils_out_for_money_instead _of_diagnosing_it_as_allergies.html

Doctors are on the make and the cops are stupid, not his best week.

[Evo]

I'd like to go with something like this:
http://www.heritage.org/research/healthcare/bg2198.cfmThat isn't going to work as it's proposed. The piddly tax credit to buy insurance would be $2,400 a year for a single person, my employer pays over $6,000 a year for my plan and that's based on a discount for have ~ 100,000 employees. $2,400 a year wouldn't be a drop in the bucket towards the cost I would have to pay to maintain the same health insurance. I am totally opposed to this idea, back to the drawing board.

[Office_Shredder]

http://www.realclearpolitics.com/video/2009/07/22/obama_doctors_taking_tonsils_out_for_money_instead _of_diagnosing_it_as_allergies.html


You don't think doctors ever do this?



That isn't going to work as it's proposed. The piddly tax credit to buy insurance would be $2,400 a year for a single person, my employer pays over $6,000 a year for my plan and that's based on a discount for have ~ 100,000 employees. $2,400 a year wouldn't be a drop in the bucket towards the cost I would have to pay to maintain the same health insurance. I am totally opposed to this idea, back to the drawing board.

The idea is your employer can turn around and pay you 6,000 dollars a year more also

[Evo]

The idea is your employer can turn around and pay you 6,000 dollars a year more alsoThis won't happen, they won't be getting a tax break. If people being left to fend for themselves becomes the norm, then there go my my benefits.

[Office_Shredder]

This won't happen, they won't be getting a tax break. If people being left to fend for themselves becomes the norm, then there go my my benefits.


Yes they do. Paying you is the same business expense as paying for your health insurance. It's better for the insurance company to pay for your health insurance than for you to pay for it because you get taxed on your income spent on health insurance right now, and your employer doesn't. Unfortunately the health credit doesn't completely cover the difference, but it's a good start

If there weren't rules regarding use of company cars etc., it would also be financially better for your company to buy you your car, pay for your mortgage (actually, there are tax credits for that, so maybe not) buy your food, pay for your cable, buy you your new computer, pay your electrity bill, etc. Because it can all be written off by the business, and you can't do that

[Evo]

Yes they do. Paying you is the same business expense as paying for your health insurance. It's better for the insurance company to pay for your health insurance than for you to pay for it because you get taxed on your income spent on health insurance right now, and your employer doesn't. Unfortunately the health credit doesn't completely cover the difference, but it's a good startPart of the health care reform is that employers would no longer receive tax breaks to give insurance to their employees, and that employees would be taxed on any benefits they receive. That is not how it is right now. I'm hoping some common sense kicks in.

I have had use of a company car, but i opted to use my own and get paid mileage. My employer subsidizes mortgage loans and car loans. They pay for college tuition. They pay my personal legal costs. They offer pet insurance. They provide many things.

[mheslep]

That isn't going to work as it's proposed. The piddly tax credit to buy insurance would be $2,400 a year for a single person, my employer pays over $6,000 a year for my plan and that's based on a discount for have ~ 100,000 employees. $2,400 a year wouldn't be a drop in the bucket towards the cost I would have to pay to maintain the same health insurance. I am totally opposed to this idea, back to the drawing board.I've looked into this my partnership a bit, so couple things:
1. The $6,000 should not be compared to the $2,400. The former is income you've earned whether spent on Evo care or Evo cats; the latter is to compensate for the tax break, not the income. So your employer could keep right on maintaining a health plan, paying the same $6k (or not). You simply lose the tax break under your employer, and its given back again as an individual tax credit. Meanwhile this, and the elimination of the state only laws, begins to break up the insurance-hospital-doctor monopolies because that money is now in your hands, and you comparatively decide how to spend it - not the employer-insurance bundle.

2. There are already large organizations (e.g. IEEE) out there that provide big group coverage to negotiate in strength. Nobody thinks much about them because the current obstacles get in their way: the employer tax break and the state domicile only insurance laws make them a second choice. That McCain plan does away with both of those problems.

3. As already mentioned, as it is now if you should lose your job you effectively lose your coverage. And if you pick up another one, as you probably well know there's a fair chance their new plan will force a change in doctors. Again the chance of that all disappears with this plan. We could all keep the same coverage for life, over a dozen job changes across a dozen states.

4. Most all of the experts on both sides of this debate agree the employer related tax plan has got to go. They disagree on how to replace it, but it is the number one single factor driving the wild cost escalations in the system, and they all acknowledge a plan that doesn't change it will never get costs under control. So keep things the way they are, and in 10 years (in my opinion here) we will have all employers forced to drop health insurance or go the way of GM.

[mheslep]

You don't think doctors ever do this?...I think there are people on the make in every profession, every walk of life, and I think docs are probably more honest than most of them. For the President to stand up there and single out doctors when he especially requires their support, and to make the implication that somehow that government can step in and fix it all was, eh, unwise.

Yep, from the tonsillectomy docs:
We, too, are in favor of evidence-based medicine that supports quality patient care. President Obama’s statement highlights the complexity of medical decisions like this. However, the AAO-HNS is disappointed by the President's portrayal of the decision making processes by the physicians who perform these surgeries. In many cases, tonsillectomy may be a more effective treatment, and less costly, than prolonged or repeated treatments for an infected throat
http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20090723006009&newsLang=en

[mheslep]

This won't happen, they won't be getting a tax break.They don't get the tax break now, you do. No doubt all the pay stubs look the same: the medical benefit money is shown paid to you under tax exempt status, and then immediately deducted out to the insurer.

[mheslep]

Senate testimony from the Congressional Budget Office, 1994

Statement of
Rosemary D. Marcuss
Assistant Director for Tax Analysis
Congressional Budget Office


The Tax Treatment of
Employment-Based Health Insurance
http://www.cbo.gov/doc.cfm?index=4828&type=0
...
Long-Run Effects

Over the long run, some of those who benefit from the tax exclusion may also bear some of its cost. The tax exclusion raises health care costs for everyone, including those who directly benefit from the subsidy. As a result, it exacerbates the problems of the uninsured and raises insurance costs for the insured. The revenue losses that result from the exclusion contribute to higher deficits, higher taxes, or reduced government services, which ultimately affect everyone. In sum, even the apparent beneficiaries of the tax exclusion might be better off eventually if the subsidy were curtailed.
...

CONCLUSIONS

The present unlimited tax exclusion for employment-based health insurance has helped many people obtain health insurance, but it has also contributed to the high cost of health care by discouraging the purchase of cost-effective health insurance. The tax subsidy also provides uneven benefits, helping insured working people, but it provides no benefit to the uninsured and those who purchase their own insurance. It provides the largest subsidies to those who are most likely to obtain insurance even without a subsidy. And the subsidy is only valuable to those firms that can afford to sponsor health insurance for their employees, so it gives these firms an advantage in hiring employees compared with other firms.

A tax cap would heighten workers' consciousness of the cost of health insurance and is thus an important element of market-based approaches to control the cost of health care. Whether the cap is imposed on employers or on employees, employees will ultimately bear the cost of any cap and would have a similar incentive to reduce their spending on health insurance in either case. The revenues generated could also be used to advance other aims, such as reducing the number of people without insurance.


Testimony CBO Chair 2009
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/16/AR2009071602242.html
Elmendorf suggested changing the way Medicare reimburses providers to create incentives for reducing costs. He also suggested ending or limiting the tax-free treatment of employer-provided health benefits, calling it a federal "subsidy" that encourages spending on ever-more-expensive health packages.

[mheslep]

Sorry bad link. Here
http://www.irs.ustreas.gov/pub/irs-soi/03in05ty.xls
See line 186.

It is not an 84% tax rate, rather the top 1/4 of taxpayers pay 84% of all US federal income tax revenue. The top half of taxpayers pay essentially all of the income tax revenue (97%). And that is ranked by gross income.
...There's some new IRS data out. The top 1% of taxpayers by income now pay over 40% (http://www.taxfoundation.org/UserFiles/Image/Blog/blog20090729-chart2.jpg) of all income tax revenue. That is up from 34% in the 2003 data I linked earlier.

[Al68]

Yes, have you read anything that was posted about Adjusted Gross Income? Do you understand Adjusted Gross income? Have you ever filed an itemized tax return and understand the reason behind it? Do you undersatand US tax laws? You don't seem to.

I've made over $250 a year and had tons of exemptions, and the percent of tax I paid, when averaged over my actual gross income, not the percentage I paid on the AGI that was taxable, was a much lower percentage than I pay now, and I make just under $100k a year now and have no deductions. I'll say it one more time. I'm not talking about the % of tax on AGI, I'm talking about the $ amount of taxes paid, and what percent of a person's total UNadjusted gross income that equates too. Do you understand now? Based on a person's TOTAL ACTUAL annual income, unless they do not itemize, the rich pay a lower percent of tax based on their TOTAL annual income.You still haven't substantiated your claim. Anecdotal evidence of one person isn't substantiation if your claim is about rich/poor people in general.

And despite your insulting tone, the reason I challenged your absurd unsubstantiated claim is the fact that I do understand the tax code, and I'm familiar with the issue. You can't possibly believe I don't know the difference between a marginal tax rate and an effective tax rate. You point it out as if I were so mentally challenged I couldn't grasp such a simple concept.

You seem to think that anyone who disputes your claim must just not understand taxes the way you do. Anyone who disagrees must know less than you, not more than you. And that logic apparently means you have no need to substantiate your claim, despite the fact that the relevant data is widely available on the net.

It couldn't possibly be that you found the relevant data (contradicting your claim) after you made the claim, then decided you didn't need to substantiate your claim when you could just demean and belittle anyone who challenged it instead.:frown::frown::frown::frown:

[Al68]

If mheslep is right the bottom half is being taxed such that they account for 3% of tax revenue even though they only hold 2.5% of the wealth.Are you aware that annual income and net worth are two different things? The bottom half hold 2.5% of the wealth, they make much more than 2.5% of the income.

That's because poor people have a much lower net worth to income ratio than the rich, for obvious reasons.

It's a progressive income tax, not a net worth tax.

[Al68]

Flat tax baby! One of the big problems with this is a huge tax preparation industry is going to get axed.That reminds me of watching a congressional hearing on a flat tax in the mid 90's. The Democrats on the committee called the President of H&R Block as their main witness to talk about how terrible a flat tax would be. No, I'm not joking.

[Al68]

From wiki about flat taxes
"Perhaps the single biggest necessary deduction is for business expenses. If businesses were not allowed to deduct expenses then businesses with a profit margin below the flat tax rate could never earn any money since the tax on revenues would always exceed the earnings. For example, grocery stores typically earn pennies on every dollar of revenue; they could not pay a tax rate of 25% on revenues unless their markup exceeded 25%. Thus business must be able to deduct their expenses even if individual citizens cannot. A practical difficulty now arises as to identifying what is an expense for a business. For example, if a peanut butter maker purchases a jar manufacturer, is that an expense (since they have to purchase jars somehow) or a sheltering of their income through investment. How deductions are implemented will dramatically change the effective, and thus flatness, of the tax."That's only a problem if someone confuses business revenues with profit. Obviously any tax on business revenues is the equivalent of a sales tax.

The flat tax proposals I've seen consider the profits of the business, not the business' total revenue, to be personal income for the business owner.

This would be an issue for anyone who is not an official employee. Even a work at home Mom selling Mary Kay. A 25% tax on her revenue would be a sales tax, not a personal income tax. And let's face it, there are just too many women out there that we don't want to see without their makeup to start making it more expensive.:yuck:

[j93]

Are you aware that annual income and net worth are two different things? The bottom half hold 2.5% of the wealth, they make much more than 2.5% of the income.

That's because poor people have a much lower net worth to income ratio than the rich, for obvious reasons.

It's a progressive income tax, not a net worth tax.
Yes, but as a rough measure it means something and as I previously had posted it was only a rough measure. However it would be nice if you imposed on yourself the same standards on yourself that you are trying to impose on others. I simplified the examples by color coding.
You still haven't substantiated your claim. Anecdotal evidence of one person isn't substantiation if your claim is about rich/poor people in general.

And despite your insulting tone, the reason I challenged your absurd unsubstantiated claim is the fact that I do understand the tax code, and I'm familiar with the issue. You can't possibly believe I don't know the difference between a marginal tax rate and an effective tax rate. You point it out as if I were so mentally challenged I couldn't grasp such a simple concept.

You seem to think that anyone who disputes your claim must just not understand taxes the way you do. Anyone who disagrees must know less than you, not more than you. And that logic apparently means you have no need to substantiate your claim, despite the fact that the relevant data is widely available on the net.

[Al68]

Yes, but as a rough measure it means something and as I previously had posted it was only a rough measure. However it would be nice if you imposed on yourself the same standards on yourself that you are trying to impose on others.Point taken.

Here's some real data from CBO (2005):

Percentage of total Federal tax revenues (including SS taxes) paid by:

Top 20%..........68.7%
Second 20%.....16.9%
Middle 20%........9.3%
Fourth 20%........4.1%
Bottom 20%.......0.8%

And how about total Federal taxes paid as a percentage of their total income. These are Effective tax rates of total income, not marginal tax rates after deductions, and again includes SS taxes:

Top 20%..........25.5%
Second 20%.....17.4%
Middle 20%.......14.2%
Fourth 20%.........9.9%
Bottom 20%........4.3%

These numbers also include the employer paid portion of SS taxes as paid by the employee instead. The numbers are even more progressive for the income tax alone, even negative rates for the lowest two groups, reflecting refundable tax credits.

Source: http://www.cbo.gov/ftpdocs/88xx/doc8885/EffectiveTaxRates.shtml

[gravenewworld]

The US is around 10th in cancer mortality (2006) whereas "socialist" countries like Spain and Sweden and even Communist France have much better outcomes for cancer patients. Some of the other statistics here also show that the US system is not as great as, for example, Senator Grassley, would have you believe. Read the stats for yourself. From one of my most favorite sources the OECD:

http://www.oecd.org/document/16/0,2340,en_2649_34631_2085200_1_1_1_1,00.html

(the only way to see it is to download the excel and look at the stats).

[mheslep]

Mortality and treatment outcomes are two different metrics and sometimes confused. Simple mortality (from the OECD link) counts all deaths from some illness, period. That of course is impacted by many things besides the quality of medical treatment, e.g. genetics, obesity rates, Chernobyl radiation release.

Outcomes, not reported in this OECD sheet, tell us what our chances are should we get sick and enter the health system (survival rate X years after treatment,etc). In many such outcomes (certainly not all) the US ranks near or at the top. For the particular case of cancer outcomes, the US is particularly strong and leads the world. Averaged across all cancer malignancies, the US has a higher survival rate than the EU. (Dramatically better than some large EU countries for particular cases like prostate)
http://www.ncpa.org/images/1703.gif

[Al68]

The US is around 10th in cancer mortality (2006) whereas "socialist" countries like Spain and Sweden and even Communist France have much better outcomes for cancer patients.This is misleading, even fraudulent. The cancer mortality rates are the percentage of the population, not cancer patients, that die of cancer, and is not indicative of the quality of any cancer treatment, or "better outcomes for cancer patients". (edit:I see mheslep beat me to it)

The fraudulent use of statistics like this misleads people and turns them against anyone capable of thinking for themselves.

The cancer survival rates of cancer patients, however, is indicative of the quality of care.

And guess who's number one in the world for cancer survival rates, consistently. The U.S.

Source: http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-rate-lowest-in-Europe.html

[Ivan Seeking]

After a talk with a very conservative friend of mine, one thing that seems worth mentioning is this: This is a difficult issue. In the grand tradition of democracy, it [health care reform] should be a down-and-dirty dog fight. That is how democracy works; esp when it comes to issues as weighty as this one. So while I do object to people disrupting town halls and the like, I think a big nasty fight in the form of legitimate discourse is exactly what we NEED to see.

That is, provided that we actually do see change. We cannot afford to bury this one again.

[jimmysnyder]

This post concerns universal health care, not universal health insurance, so it is a bit off-topic.

My sister-in-law (my wife's sixth sister) has kidney troubles and was slated for an operation to remove one of them. However, she now has been diagnosed with cancer of the uterus and her situation is so grave that the operation for the kidney has been called off. Instead, she will receive chemo-therapy for the cancer and if there is a good outcome, they will then address the kidney. My wife never goes for a checkup in spite of repeated pleading on my part. However, this tragedy has softened her position a little bit. She said that she is afraid of needles so I compromised with her. She will take all the tests that the doctor prescribes except those that require a needle. I recommend testing for everyone. At my age I can't imagine missing my yearly checkup.

My wife informs me that fourth sister does not go to the free doctor supplied by the national health agency in Taiwan, but prefers to pay for her own checkups as they tend to find more things. I have no idea if sixth sister would have her kidney operation if she paid on her own but I doubt it as she is well off and could afford it to save her life. I suppose that in the US, people will not be satisfied with universal health care and those who can afford it will simply pay for treatment outside the system. As doctors realize that they have a choice of treating patients willing to pay, the 'free' system will suffer and the effect will spiral.

[mgb_phys]

The cancer survival rates of cancer patients, however, is indicative of the quality of care.
Cancer survival rates are indicative of how early you detect the cancer.

If you detect a cancer 6years before it kills the victim and do nothing, your "5year survival rate" - which is what the stats are based on - counts that as a win.
If you detect them four years before they die, then even if your treatment gave them an extra four years of life that is a lose.
If you don't detect them or treat them and don't do an autopsy - that's a win.

[drankin]

After a talk with a very conservative friend of mine, one thing that seems worth mentioning is this: This is a difficult issue. In the grand tradition of democracy, it [health care reform] should be a down-and-dirty dog fight. That is how democracy works; esp when it comes to issues as weighty as this one. So while I do object to people disrupting town halls and the like, I think a big nasty fight in the form of legitimate discourse is exactly what we NEED to see.

That is, provided that we actually do see change. We cannot afford to bury this one again.

I can only disagree with your last sentence. I think we CAN afford to bury this one.

I did hear an interesting suggestion from the talking heads on the radio. 400 billion dollars is spent a year for malpractice insurance, according to an interviewer. He suggested that malpractice insurance be abolished and that the government create an agency that disperses funds to those who have valid malpractice claims. And this same agency is responsible for taking bad doctors out of practice. The taxpayer would be paying for this agency but the monies wouldn't be going to lawyers and insurance companies. And it would save doctors an immense amount of money of which the cost is being passed on to patients.

I like this idea.

[mheslep]

I can only disagree with your last sentence. I think we CAN afford to bury this one. ...If by that you mean leave everything as it is and not do something other than the Democratic proposals, then I can't fathom your thinking. I take it you've been following the various medical threads, and therefore know that the unfunded and unfund-able liabilities of the existing medicaid program alone will break this country. Likewise private insurance premiums are increasing far faster than inflation and are also unsupportable. Then there's ~10 million or so uncovered people who can't afford anything. Now I oppose much of the content in the Democratic proposals, but something has got to be done, we can not just turn the lights out and go home on this one.

[mheslep]

Cancer survival rates are indicative of how early you detect the cancer.

If you detect a cancer 6years before it kills the victim and do nothing, your "5year survival rate" - which is what the stats are based on - counts that as a win.
If you detect them four years before they die, then even if your treatment gave them an extra four years of life that is a lose.
If you don't detect them or treat them and don't do an autopsy - that's a win.Well the cancer outcome stats are broken down by the stage of cancer (0,I,II,III, IV) at discovery. Breast cancer for instance has a 100% five year survival rate for stages 0, 1 in the US; its lower in, say, the UK.

Also, it seems to me the testing system is also indicative of the quality of the medical system. For instance, one can see in some of the numerous outcome links above that prostrate and mammogram screens are much more prevalent in the US than elsewhere.

[drankin]

If by that you mean leave everything as it is and not do something other than the Democratic proposals, then I can't fathom your thinking. I take it you've been following the various medical threads, and therefore know that the unfunded and unfund-able liabilities of the existing medicaid program alone will break this country. Likewise private insurance premiums are increasing far faster than inflation and are also unsupportable. Then there's ~10 million or so uncovered people who can't afford anything. Now I oppose much of the content in the Democratic proposals, but something has got to be done, we can not just turn the lights out and go home on this one.

I was being specific to what is being proposed right now.

I large chunk of the cost of health care is for malpractice insurance. If malpractice insurance was out of the costs associated with health care it would go along way towards lowering the overall cost of health care in this country. I think the absence of this expense is the advantage socialist health care has over a more free market health care system.

[mheslep]

...
I suppose that in the US, people will not be satisfied with universal health care and those who can afford it will simply pay for treatment outside the system. As doctors realize that they have a choice of treating patients willing to pay, the 'free' system will suffer and the effect will spiral.
That seems to be the case in the UK. Some 90% of the populace is on NHS, and the private insurance for the remaining 10% is very, very expensive.

[mheslep]

I was being specific to what is being proposed right now.Ok, agreed.

I large chunk of the cost of health care is for malpractice insurance. If malpractice insurance was out of the costs associated with health care it would go along way towards lowering the overall cost of health care in this country. I think the absence of this expense is the advantage socialist health care has over a more free market health care system.My expectation would also be that the costs are large, but when I've researched this issue I found it complex and hard to quantify. There are certainly numbers for the actual malpractice payments and court judgements. Those numbers are big, but not huge. What's hard to quantify is the cost of defensive medicine: when the doc is 99% sure all you need is an aspirin but orders up 3-4 tests costing $1k to cover himself. If you can find good numbers on defensive medicine costs I'd enjoy seeing them. Also, there's at least one good counter to these arguments from the other side: several states have indeed placed caps on malpractice settlements without much impact, or so I heard, haven't run this one down either.

[drankin]

Ok, agreed.

My expectation would also be that the costs are large, but when I've researched this issue I found it complex and hard to quantify. There are certainly numbers for the actual malpractice payments and court judgements. Those numbers are big, but not huge. What's hard to quantify is the cost of defensive medicine: when the doc is 99% sure all you need is an aspirin but orders up 3-4 tests costing $1k to cover himself. If you can find good numbers on defensive medicine costs I'd enjoy seeing them. Also, there's at least one good counter these arguments from the other side: several states have indeed placed caps on malpractice settlements without much impact, or so I heard, haven't run this one down either.

It was an idea I had heard. It is a solution that would have a seemingly large impact on overall costs and still allow us to maintain a free market system. It's a change both sides of the aisle could get on board with I think. It would still be a cost to the taxpayer but it would be easier to sell the idea of getting lawyers and insurance companies out of an industry.

[Count Iblis]

The US ranks very low in the life expectancy ranking. It is at 50th place ranking below all the Western countries that have government funded "socialist" health care systems.

[mheslep]

The US ranks very low in the life expectancy ranking. It is at 50th place ranking below all the Western countries that have government funded "socialist" health care systems.Consider that life expectancy is also dependent on many factors unrelated to health care or medicine. http://www.aei.org/docLib/20061017_OhsfeldtSchneiderPresentation.pdf Table 5-1

[Al68]

The cancer survival rates of cancer patients, however, is indicative of the quality of care.
Cancer survival rates are indicative of how early you detect the cancer.You're right, and early detection is directly related to quality of care.

[Al68]

After a talk with a very conservative friend of mine, one thing that seems worth mentioning is this: This is a difficult issue. In the grand tradition of democracy, it [health care reform] should be a down-and-dirty dog fight. That is how democracy works; esp when it comes to issues as weighty as this one. So while I do object to people disrupting town halls and the like, I think a big nasty fight in the form of legitimate discourse is exactly what we NEED to see.

That is, provided that we actually do see change. We cannot afford to bury this one again.I agree with all of this, but I don't know anyone that is generally opposed to change. Of course the change I want is in the opposite direction of the change you want. The current proposal (abomination) in congress desperately needs burying.

[Al68]

The US ranks very low in the life expectancy ranking. It is at 50th place ranking below all the Western countries that have government funded "socialist" health care systems.Yeah, and France has more topless beaches, too. Must be related.:rolleyes:

[jimmysnyder]

Free National Health Care =
Joe, Sarah, Bob, Emily, and Frank are sitting in the waiting room of the local NHS office as they do every day, discussing their grandchildren, their ailments, the long wait to see a doctor, and Amy who couldn't come today because she wasn't feeling well.

[Count Iblis]

Yeah, and France has more topless beaches, too. Must be related.:rolleyes:

First, I think it is a prori reasonable to assume that there is a link between the health care system and life expectancy (although there are other factors that influence life expectancy as wel).

Second, I'm not sure that the 49 countries that have a higher life expectancy than the US, all have more topless beaches than the US.

[Count Iblis]

Free National Health Care =
Joe, Sarah, Bob, Emily, and Frank are sitting in the waiting room of the local NHS office as they do every day, discussing their grandchildren, their ailments, the long wait to see a doctor, and Amy who couldn't come today because she wasn't feeling well.


More precisely, this belongs to the subset: "mismanaged free health care systems".

[mheslep]

First, I think it is a prori reasonable to assume that there is a link between the health care system and life expectancy (although there are other factors that influence life expectancy as wel)....Then why waste your time (and ours) with those conflicted measurements when instead one can go directly to purely health system related outcomes such as cancer survivor rates, transplant survivor rates and so on?

[Count Iblis]

Then why waste your time (and ours) with those conflicted measurements when instead one can go directly to purely health system related outcomes such as cancer survivor rates, transplant survivor rates and so on?


The performance of the health care system should be judged by the net result. If in the US a lot of older man are diagnosed with prostate cancer which typically doesn't kill if left untreated, while in other countries less of these cancers are detected in the first place (becuase they don't do screening for these cancers), then obviously the US is going to have a seemingly higher "cancer survival rate".

Also, in the US many more people get skin cancer than in Europe. This is usually detected in early stages and usually doesn't lead to death.

[sylas]

This is sort of relevant to the thread, though a bit of a laugh on the side. It is too good to pass up, and it is relevant both to physics and to health care systems...

From the "Investors Business Daily", editorial, July 31, 2009 (http://www.ibdeditorials.com/IBDArticles.aspx?id=333933006516877):

People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.

http://lh5.ggpht.com/_WtnYwFZtgHI/SoGFt1y84yI/AAAAAAAAAcE/h_pRYhQAt8w/s400/double-facepalm.jpg

[mgb_phys]

People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.
You have to wonder if any US university could hire him with an existing medical condition.

[jimmysnyder]

More precisely, this belongs to the subset: "mismanaged free health care systems".
No, I think it would apply to anything that was free, whether health care system, or candy.

[avec_holl]

Free National Health Care =
Joe, Sarah, Bob, Emily, and Frank are sitting in the waiting room of the local NHS office as they do every day, discussing their grandchildren, their ailments, the long wait to see a doctor, and Amy who couldn't come today because she wasn't feeling well.

How does this pertain to the current health care reform bill? The current bill would allow Joe, Sarah, Bob, Emily, Frank and Amy to keep private health care if they desired and does not cut funding from medicaid or medicare.

[mgb_phys]

This is sort of relevant to the thread, though a bit of a laugh on the side. It is too good to pass up, and it is relevant both to physics and to health care systems...

From the "Investors Business Daily", editorial, July 31, 2009 (http://www.ibdeditorials.com/IBDArticles.aspx?id=333933006516877):

The same article also suggests doctors must be opposed to a free health care system because:
....Hippocratic Oath doctors take to first do no harm, compelling them "as an imperative to do everything for the patient regardless of cost or effect on others," thereby avoiding the inevitable move toward "socially sustainable, cost-effective care."
So good news - under a commercial system no doctor at a hospital or a managed care provider would ever; refuse or delay regardless of cost or effect on others.

[CRGreathouse]

How does this pertain to the current health care reform bill? The current bill would allow Joe, Sarah, Bob, Emily, Frank and Amy to keep private health care if they desired and does not cut funding from medicaid or medicare.

Because Joe, Sarah, Bob, Emily, Frank and Amy will subsidize the system. Employer-funded healthcare (beyond a certain point) becomes taxable, unlike current law. And the smart money says money will come, directly or indirectly, from general funds as well.

The money doesn't come from nowhere.

[jimmysnyder]

My little story was not about health care. It was about the value that people place on things that are 'free'.

[mgb_phys]

My little story was not about health care. It was about the value that people place on things that are 'free'.
Funny but perhaps a little too subtle!

[Al68]

The performance of the health care system should be judged by the net result. If in the US a lot of older man are diagnosed with prostate cancer which typically doesn't kill if left untreated, while in other countries less of these cancers are detected in the first place (becuase they don't do screening for these cancers), then obviously the US is going to have a seemingly higher "cancer survival rate".

Also, in the US many more people get skin cancer than in Europe. This is usually detected in early stages and usually doesn't lead to death.So the cancer survival rate isn't indicative of the quality of care, but the overall life expectancy is? Life expectancy isn't a "net result" of health care quality. Cancer survival rates are, even if not a perfect indicator.

[mgb_phys]

So the cancer survival rate isn't indicative of the quality of care, but the overall life expectancy is?
Cancer cure rates might be, cancer survival rates just mean you were alive 5years after they declared 'cancer'.

Life expectancy isn't a "net result" of health care quality. Cancer survival rates are, even if not a perfect indicator.
Life expectancy is heavily dependant on childhood and neonatal health so it is also sensitive to nutrition and housing.
Cancer rates only measure those people that get cancer !

[Al68]

The current bill would allow Joe, Sarah, Bob, Emily, Frank and Amy to keep private health care if they desired and does not cut funding from medicaid or medicare.No, it won't, unless you call a private company participating in a government system "private health care". If someone gets a private insurance plan that does not qualify for the government system (because they are against subsidizing the types of things covered, or just because they only need insurance for the unexpected instead of a comprehensive health plan that covers everything under the sun), they will have to pay an income tax penalty (limited to the average cost of a qualifying plan, of course). Simply put, this bill assesses an income tax penalty against any American for failure to prove to government they have a "qualifying" plan. Whether or not the plan meets the standards of the person getting it is irrelevant. You call that "private health care"?

Allowed to keep their current plan, maybe. Allowed to ignore the new law and make their own choice without being penalized, no.

And being able to choose among the "government approved" choices doesn't count as freedom of choice despite the fraud and deception being perpetrated.

Of course the details aren't finalized, but I doubt if they will take out the part that says, "join this system or pay a stiff penalty".

[Al68]

Cancer cure rates might be, cancer survival rates just mean you were alive 5years after they declared 'cancer'.


Life expectancy is heavily dependant on childhood and neonatal health so it is also sensitive to nutrition and housing.
Cancer rates only measure those people that get cancer !You're right! Three times! (I assume you agree that 5 years after diagnosis, it's fairly important to the patient whether or not he/she's alive.)

[Al68]

First, I think it is a prori reasonable to assume that there is a link between the health care system and life expectancy (although there are other factors that influence life expectancy as wel).

Second, I'm not sure that the 49 countries that have a higher life expectancy than the US, all have more topless beaches than the US.Maybe not, but they all have a larger percentage of their cancer patients dead after five years.

It's much more reasonable to consider cancer survival rates a much better indicator of health care quality than life expectancy, because life expectancy depends on so many more things completely unrelated to health care quality, such as genetics, lifestyle, eating habits, smoking, drinking, job/family stress, etc.

Cancer survival rates at least mostly can be expected to depend on the quality of medical care received. And the other factors are much less likely to depend on what country you're in, so would be much less relevant.

[Count Iblis]

Maybe not, but they all have a larger percentage of their cancer patients dead after five years.

It's much more reasonable to consider cancer survival rates a much better indicator of health care quality than life expectancy, because life expectancy depends on so many more things completely unrelated to health care quality, such as genetics, lifestyle, eating habits, smoking, drinking, job/family stress, etc.

Cancer survival rates at least mostly can be expected to depend on the quality of medical care received. And the other factors are much less likely to depend on what country you're in, so would be much less relevant.

Cancer survival rates also depend on a number of factors that are not directly related to the medical treatment, genetic factors being an important factor.

Another factor is screening. In the US you e.g. screen for prostate cancer. But almost all men who have prostate cancer survive this without any form of treatment. In Europe we don't screen for it. The people who are detected to have it, have prostate cancer that is causing complaints and those cancers are a bit more likely to kill.

So, if you compare survival rates for prostate cancer in the US to survival rates for prostate cancer in Europe, you're not measuring a difference in the effectiveness of any treatment.

[Al68]

Cancer survival rates also depend on a number of factors that are not directly related to the medical treatment, genetic factors being an important factor.
I agree. But the number and extent of the other factors affecting life expectancy is much greater than for cancer survival rates. My point was that cancer survival rates were a much better indicator than life expectancy, not that it was a perfect indicator.
Another factor is screening. In the US you e.g. screen for prostate cancer. But almost all men who have prostate cancer survive this without any form of treatment. In Europe we don't screen for it. The people who are detected to have it, have prostate cancer that is causing complaints and those cancers are a bit more likely to kill.

So, if you compare survival rates for prostate cancer in the US to survival rates for prostate cancer in Europe, you're not measuring a difference in the effectiveness of any treatment.I agree that prostate cancer survival rates aren't very indicative of anything. But based on your post, the lack of early detection seems to be a relevant factor in Europe, since prostate cancer rarely kills within 5 years if detected early, before it causes complaints.

[mheslep]

Cancer survival rates also depend on a number of factors that are not directly related to the medical treatment, genetic factors being an important factor.
You are likely confusing cancer incident or mortality rates (very dependent on non medical system factors) with outcomes (which are not). They are two very different things.

[mheslep]

Another factor is screening. In the US you e.g. screen for prostate cancer. But almost all men who have prostate cancer survive this without any form of treatment. That's completely false. Prostrate is slow moving, but it will inevitably kill you without treatment and is the second leading cause of cancer death in the US.
In the US: (http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_prostat e_cancer_36.asp?rnav=cri)
5 year 100%
10 year 91%
15 year 76%

UK (00-'01): (http://info.cancerresearchuk.org/cancerstats/types/prostate/survival/)
5 year 90%
10 year 70%
15 year 55%
Also, from the same UK source:
The increase in prostate cancer survival rates is particularly pronounced in the 1990s when PSA testing became more prevalent.

but In Europe we don't screen for it.
If that's true in general for Europe then it is at the cost a greater death rate for prostrate cancer.

[mheslep]

Cancer cure rates might be, cancer survival rates just mean you were alive 5years after they declared 'cancer'....
What are you talking about? Physicians don't use the word 'cure' in connection with cancer.
Look, a woman is diagnosed with breast cancer. In the US her chance of dying inside five years is essentially zero. In the UK, 1 chance in 5 she's dead in five years.

...Life expectancy is heavily dependant on childhood and neonatal health...and also dependent on
-driving after 19 pints 'o Guiness,
-being capped in the head by a jealous husband,
-eating 14 donuts at every meal,
-whether or not a parent died of a heart attack at 39

... so it is also sensitive to nutrition and housing.
Cancer rates only measure those people that get cancer !That may be true, but the thread is not about nutrition and housing in any major way. My Medicare taxes and your NHS taxes don't go to food and housing. The thread is about _health care_, as in that which is provided by doctors, nurses, and hospitals, in hopes of informing decisions about the make up the _heath care_ system.

[cristo]

In the US her chances of dying in five years is essentially zero.


Of those that are known about, yes. But what happens to the person who is uninsured and can't afford to pay the fees to go to hospital. The bean counters will never know that her illness existed, it will never have been diagnosed, since she can't afford to get it diagnosed. In the UK, such a person will be diagnosed, and thus will be counted in the statistics. Thus, as with all statistics, they must be taken with a pinch of salt.

Incidentally, these are the people that a health care system should be supporting: those who cannot afford to support themselves. However, it appears to me, that in the US these are the people that are forgotten about. It brings me back to the same point that I make whenever such a topic is discussed, namely, what is the metric you choose to measure the "best in the world"? Is the best system the one that offers assistance to everyone, or is the best system the one that has the most effective treatment in the world for those who can afford it?

[mheslep]

...It brings me back to the same point that I make whenever such a topic is discussed, namely, what is the metric you choose to measure the "best in the world"? Is the best system the one that offers assistance to everyone, or is the best system the one that has the most effective treatment in the world for those who can afford it?All of the above, and answered I believe back in #55 (Sen. McConnell statement).
http://www.physicsforums.com/showpost.php?p=2280345&postcount=55
The US has lousy cost performance compared to other countries, insurance coverage problems, but the effectiveness of the medical practice itself can reasonably be called the 'best in the world.'

[cristo]

The US has lousy cost performance compared to other countries, insurance coverage problems, but the effectiveness of the medical practice itself can reasonably be called the 'best in the world.'

Fine, but then to go around and say your health care system is the best in the world (which is what people who are opposed to nationalised health care systems do) is incorrect. The metric to judge whether a health care system is the best in the world is a combination of the health care available and the ability for every resident of that country to access it. It's all well and good having fantastic health care, but when the use of that health care is restricted to the wealthy, you've got to be asking questions about the system.

[mheslep]

...Incidentally, these are the people that a health care system should be supporting: those who cannot afford to support themselves. However, it appears to me, that in the US these are the people that are forgotten about...Yes, you've so stated a few times. A reminder: US state and federal government Medicaid (single payer health care for the poor) spending was some $338 billion (http://www.hhs.gov/news/press/2008pres/10/20081017a.html) last year, US government Medicare spending (single payer for seniors) was $440 billion (http://www.kff.org/medicare/upload/7731.pdf).

Edit: and the U.S. EMPTALA law that mandates nobody can be turned away from an emergency room.
BTW, I don't really think any of the programs are a good idea, as they are.

[drankin]

Fine, but then to go around and say your health care system is the best in the world (which is what people who are opposed to nationalised health care systems do) is incorrect. The metric to judge whether a health care system is the best in the world is a combination of the health care available and the ability for every resident of that country to access it. It's all well and good having fantastic health care, but when the use of that health care is restricted to the wealthy, you've got to be asking questions about the system.

It's not restricted to the wealthy. I'm not wealthy. I have "fantastic" health care, that I pay for.

[mheslep]

Fine, but then to go around and say your health care system is the best in the world (which is what people who are opposed to nationalised health care systems do) is incorrect.A reasonable take on what people say is that which I quoted from the opposition leader - a statement addressing the strengths and weaknesses.

The metric to judge whether a health care system is the best in the world is a combination of the health care available and the ability for every resident of that country to access it. Interesting that you left out quality. My metric is quality, affordability, availability - all three.

It's all well and good having fantastic health care, but when the use of that health care is restricted to the wealthy,'Restricted' is not an apt description of the gaps in the system.
you've got to be asking questions about the system.Obviously we are.

[mheslep]

Speaking of the 'forgotten', I'm reminded of the splendid essay by Prof WG Sumner, The Forgotten Man, written in (I think) 1896. It's historically relevant because Franklin Roosevelt alluded to it and the "Forgotten Man" in his inaugural speech, though FDR changed the meaning a bit in his version. As I hope you'll agree, I think it worthy of insertion in this thread.

Briefly: Sumner broke down the construct of government based social programs algebraically: 'A' wants to help 'X'. 'B' wants to help 'X'. Then comes the problem when 'A' and 'B' conjure some legislation to force 'C' to help 'X'. 'C' then, per Sumner, is the man who pays, the man who prays, the man who is not thought of.

http://www.blupete.com/Literature/Essays/Best/SumnerForgotten.htm


"The Forgotten Man"
By William Graham Sumner.

The type and formula of most schemes of philanthropy or humanitarianism is this: A and B put their heads together to decide what C shall be made to do for D. The radical vice of all these schemes, from a sociological point of view, is that C is not allowed a voice in the matter, and his position, character, and interests, as well as the ultimate effects on society through C's interests, are entirely overlooked. I call C the Forgotten Man.
...
the characteristic of all social doctors is, that they fix their minds on some man or group of men whose case appeals to the sympathies and the imagination, and they plan remedies addressed to the particular trouble; ... They are always under the dominion of the superstition of government, and, forgetting that a government produces nothing at all, they leave out of sight the first fact to be remembered in all social discussion - that the State cannot get a cent for any man without taking it from some other man, and this latter must be a man who has produced and saved it. This latter is the Forgotten Man
...
go and search for the Forgotten Man. He will be found to be worthy, industrious, independent, and self-supporting. He is not, technically, "poor" or "weak"; he minds his own business, and makes no complaint. Consequently the philanthropists never think of him, and trample on him....
...
The fallacy of all prohibitory, sumptuary, and moral legislation is the same. A and B determine to be teetotalers, which is often a wise determination, and sometimes a necessary one. If A and B are moved by considerations which seem to them good, that is enough. But A and B put their heads together to get a law passed which shall force C to be a teetotaler for the sake of D, who is in danger of drinking too much. There is no pressure on A and B. They are having their own way, and they like it. There is rarely any pressure on D. He does not like it, and evades it. The pressure all comes on C. The question then arises, Who is C? He is the man who wants alcoholic liquors for any honest purpose whatsoever, who would use his liberty without abusing it, who would occasion no public question, and trouble nobody at all. He is the Forgotten Man again, and as soon as he is drawn from his obscurity we see that he is just what each one of us ought to be.

[cristo]

Speaking of the 'forgotten'

It's not a matter of people being 'forgotten'. Americans know that these people exist, but choose to ignore them. The two notions are entirely different.

[cristo]

Interesting that you left out quality.

I meant to say
a combination of the [quality of the] health care available and the ability for every resident of that country to access it.

[mheslep]

I meant to say

a combination of the [quality of the] health care available and the ability for every resident of that country to access it.
Well then there we generally have common ground on the goals.

[mheslep]

Americans know that these people exist, but choose to ignore them. And here we don't. As per the Sumner essay above, I don't agree that enacting an anonymous social program, funded by forced taxation, is particularly paying attention to my fellow man.

[drankin]

And here we don't. As per the Sumner essay above, I don't agree that enacting an anonymous social program, funded by forced taxation, is particularly paying attention to my fellow man.

Agreed (following your response to cristo), and the assumption that fellow men are "forgotten" is bologne. In this country, you have the right to become "forgotten" if you so chose (to an extent, of course). It's not that they are ignored but we respect their desire to be ignored.

cristo, please point out these folks that are intentionally ignored. Provide some references.

[cristo]

cristo, please point out these folks that are intentionally ignored. Provide some references.

For example...
2VyNbuWbirU

[Count Iblis]

That's completely false. Prostrate is slow moving, but it will inevitably kill you without treatment and is the second leading cause of cancer death in the US.
In the US: (http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_prostat e_cancer_36.asp?rnav=cri)
5 year 100%
10 year 91%
15 year 76%

UK (00-'01): (http://info.cancerresearchuk.org/cancerstats/types/prostate/survival/)
5 year 90%
10 year 70%
15 year 55%
Also, from the same UK source:



If that's true in general for Europe then it is at the cost a greater death rate for prostrate cancer.

Utter nonsense. It is well known that a large fraction of men have prostate cancer at the time of their death without it being a factor in their death. The reason why we don't screen in Europe is because of false positives in intial test, the cumbersome follow up tests and then, even if you detect prostate cancer, it is very unlikely to kill you.

Then, The major reason why prostate cancer survival rates appear to be much better in the US, is not because the early detection makes treatment better. It is simply the trivial statistical effect caused by the undetected prostate cancer survivors in Europe.

[Ivan Seeking]

I just wanted to post and say how thrilling it is to see the town hall meetings in the last couple of days. The crowds are still emotional, but things have calmed down a bit and we are now seeing some of the most engaged public discussion of a serious issue that I have ever seen in this country. Some of the critics are saying that the issue is spiralling out of control, but my view is the opposite. I think we are seeing the best of democracy in action. This is wonderful!

I for one want to see a bipartisan solution. I don't want the Dems to ram this through as long as the Republicans are being reasonable. However, if the Reps show that they only want to "hand Obama his Waterloo", not to arrive at an equitable solution in the best interest of the people, then the Dems will have no choice.

[turbo-1]

I for one want to see a bipartisan solution. I don't want the Dems to ram this through as long as the Republicans are being reasonable. However, if the Reps show that they only want to "hand Obama his Waterloo", not to arrive at an equitable solution in the best interest of the people, then the Dems will have no choice.Unfortunately, one of the biggest GOP players on the bi-partisan effort (Grassly) is ramping up the fear factor, saying that people should fear that the government would "pull the plug on Granny". That is just vile.

[Ivan Seeking]

Unfortunately, one of the biggest GOP players on the bi-partisan effort (Grassly) is ramping up the fear factor, saying that people should fear that the government would "pull the plug on Granny". That is just vile.

Hopefully that boils down to nothing more than the following question: Should a government plan include payment for assisted suicide where it is legal? I would have to say no. While the States have the right to allow assisted suicide, there should be no impetus on the taxpayers who object to assisted suicide, to pay for it; unless the SC rules that assisted suicide is a right protected by the Constitution, and not a matter for the States.

The nutty side of this is the claim that payment for "end of life counselling" is somehow related to euthanasia. The provision related to counselling describes coverage already provided by many private insurers. The true intent of providing terminal patients with options and information has been palinized to mean something completely different than it does.

[Ivan Seeking]

I also think there is legitimate concern [in principle] wrt language in the plan that would open the door to problems later. That is to say that while I don't think there are any dark motives, unintended consequences are always a potential problem. There will always be people who try to abuse the system for their own selfish purposes - up to and including pulling the plug on grandma.

[mheslep]

... It is well known that a large fraction of men have prostate cancer at the time of their death without it being a factor in their death. Yes, it is said that if a man lives long enough it is certain that eventually he will contract prostate cancer. People no doubt carry many fatal ailments to the grave that because because some ailments are slower than others to act. So what?
... even if you detect prostate cancer, it is very unlikely to kill you.
Not so unlikely: (http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_prostat e_cancer_36.asp?rnav=cri)
Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 35 will die of prostate cancer. Prostate cancer accounts for about 10% of cancer-related deaths in men. It appears you are mistaking the fact that prostate cancer is often very slow growing with the equally true facts that a) even when slow growing it eventually can and will kill, and b) prostate cancer can also spread quickly though not commonly.

Then, The major reason why prostate cancer survival rates appear to be much better in the US, is not because the early detection makes treatment better. It is simply the trivial statistical effect caused by the undetected prostate cancer survivors in Europe.I think you are referring to survivor time bias here, that is, the survivor statistics should be differentiated by the cancer stage at diagnosis as was discussed above in #255 (http://www.physicsforums.com/showpost.php?p=2304039&postcount=295). I agree that for especially for slow cancers like prostate time bias will skew the stats. I'll come back here w/ something by stage.

[Al68]

The metric to judge whether a health care system is the best in the world is a combination of the health care available and the ability for every resident of that country to access it.Based on such a definition, the U.S. does not have a good or a bad system. There simply is no such system. And there never has been.

Historically, in the U.S., most health care has been private, not part of a system.

It's just faulty logic to refer to a bunch of individual private voluntary agreements as a "system", when they're not in fact part of any real system, then blame them for shortcomings in a "system" that they were never intended to have anything to do with.

[Al68]

While the States have the right to allow assisted suicide, there should be no impetus on the taxpayers who object to assisted suicide, to pay for it...What about all the other things that a plan must cover to be a "qualifying" plan, that many Americans object to paying for, and will have to pay an income tax penalty if they don't participate?

I know the details aren't finalized, but some examples might be: abortion, sterilization, Ritalin, etc.

There is an exception for members of recognized religious "sects" (Amish?), but many non-sect belonging people would object to participating as well.

[mheslep]

For example...
...
Amusing advertisement from Gordon Brown state TV.

BTW, Brock, the orgnizer of that clinic also comments:
He is also seriously thinking of returning to Britain - with a team of RAM volunteers.

He has heard his old country has a shortage of NHS dentists.

"I am sure we'll get just as large a crowd as we're getting here in the US," he says.
http://news.bbc.co.uk/2/hi/americas/7420744.stm

[mheslep]

...Then, The major reason why prostate cancer survival rates appear to be much better in the US, is not because the early detection makes treatment better. It is simply the trivial statistical effect caused by the undetected prostate cancer survivors in Europe.


...I think you are referring to survivor time bias here, that is, the survivor statistics should be differentiated by the cancer stage at diagnosis as was discussed above in #255 (http://www.physicsforums.com/showpost.php?p=2304039&postcount=295). I agree that for especially for slow cancers like prostate time bias will skew the stats. I'll come back here w/ something by stage.
I can't quickly locate by stage stats on prostate, so here are the five year survival rates by stage for breast cancer, which is also faster acting than prostate:
US: (http://www.imaginis.com/breasthealth/statistics2.asp#5)
0 100%
I 100% (in situ)
IIA 92%, IIB 81%,
IIIA 67%, IIIB 54%
IV 20%

UK: (http://www.guardian.co.uk/lifeandstyle/besttreatments/breast-cancer-survival-rates-for-breast-cancer)
I 88%
II 69%
III 43%
IV 12%

Overall 5 year survival rate is 90% US, 79% UK. (http://repository.upenn.edu/cgi/viewcontent.cgi?article=1012&context=psc_working_papers) (the overall figure is as of 2001-2003 for the UK)

[cristo]

Amusing advertisement from Gordon Brown state TV.

I'm sorry, but are you claiming that was a staged scene, and that the people interviewed were actors? If so, I'd like to see your evidence. What I see is a documentary from one of the best documentary makers in the world. If you've actually ever watched anything from the BBC, you'll know that it is not a puppet channel.


BTW, Brock, the orgnizer of that clinic also comments:


I'm not going to argue that there aren't problems with the dental system, but then, what are the odds of dying of toothache against dying of cancer? The fact is that every single citizen of the UK can see a doctor at any time by walking into a clinic, or making an appointment with their GP, for no charge. The same thing cannot be said for the US, hence why people are fighting their way into a sports hall at 4am to be seen by a third world charity (as per the above film).

[Al68]

After rereading the bill, it's clear that it's a complete government takeover of health insurance in the U.S. Although there is a 5 year grace period for some employer based plans, and a grandfather clause for some policies, they are only relevant in the short term. After that all health insurance in the U.S. that are not part of the government "system" will be outlawed. Source: Section 102(c)(1) of http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:

Although private companies may offer insurance as part of the system, they cannot offer private insurance plans "outside" the new system.

Anyone who chooses not to subsidize the things they find objectionable, or simply have no interest in being in the new system, not only will have to pay an income tax penalty, but will not be able to obtain other health insurance at all in the long term.

Apparently, Democrats are just counting on the fact that most people won't read the bill, and the media won't report the facts, to get away with not telling the truth, and demonizing anyone who does.

The tree of liberty in the U.S. is getting thinner and thinner.

[WhoWee]

Full disclosure, I'm a licensed insurance broker. I operate a self quote website with multiple carriers. I am very unhappy with the current discussion in Congress. Health insurance underwriting is down by as much as 80%, as are renewals. People who have lost their jobs are opting for the COBRA extension are facing the reality of future disqualification (pre-existing conditions) due to a new event happening while between policies. I know of cases where people have actually dropped their coverage to (save money now) because "free" health care is on the way. Agents have told me the people opting out of coverage aren't worried about getting sick because the government will take care of them. This is very risky behavior.

As the President mused recently about UPS and FedEx getting it right and the Post Office always being in trouble, the same is true with private insurance companies and Medicare/Medicaid/Social Security.

The biggest challenges to profitability the private companies have are in dealing with government regulation and lawsuits. Otherwise, the insurance companies already have the very best IT in place. The insurance companies are efficient. Insurance companies are rated by how fast they can pay a claim. This information is public and must be disclosed to all applicants.

If you want to address health care reform, start with Tort reform. Then, clean up the fraud and waste in the government run programs.

One aspect of private insurance that works is high deductible catastrophic coverage ($10,000 to $25,000 deductibles) coupled with Health Savings Accounts. Under these plans, patients pay all of the doctor visits and routine tests out of pocket and can write off roughly $5,000 per year. They only use their insurance for large claims such as surgery or cancer treatments. The Health Reform Bills under consideration will outlaw this type of plans.

The next issue is eligibility. Why should US taxpayers pay for the health care of illegal immigrants? If you want to break the law and sneak into this country to work, then pay for your own health insurance - just saying.

Last, modern medicine has extended life-spans. The longer we live, the more medical care will cost. We can debate quality of life (well, until we die) but the prospect/fear of someone making that decision for us is terrifying to most people.

[mheslep]

I'm sorry, but are you claiming that was a staged scene, and that the people interviewed were actors? No I'm not claiming any staging. I claim a great deal of the commentary was bogus, and I suspect the scenes were cherry picked.

If so, I'd like to see your evidence. What I see is a documentary from one of the best documentary makers in the world. If you've actually ever watched anything from the BBC, you'll know that it is not a puppet channel.And I see a state run broadcasting station, with some good quality programming, but to my mind still biased out over the horizon.

...I'm not going to argue that there aren't problems with the dental system, but then, what are the odds of dying of toothache against dying of cancer?
The cancer treatment is better in the US, better odds of survival.
...The fact is that every single citizen of the UK can see a doctor at any time by walking into a clinic, or making an appointment with their GP, for no charge. Even if that's true, to what end? Seeing a free GP does not necessarily equal good medical care, as the survival statistics and the waiting lists show. And every single US citizen can walk into an emergency room in the US, and not be turned away based on ability to pay (though I'd change this).

The same thing cannot be said for the US, hence why people are fighting their way into a sports hall at 4am to be seen by a third world charity (as per the above film).I'd like to know how many of those folks qualified for US Medicaid (single payer for the poor), and avoided that government run system to attend the hall, perhaps because they thought so little of it.

[mheslep]

...

One aspect of private insurance that works is high deductible catastrophic coverage ($10,000 to $25,000 deductibles) coupled with Health Savings Accounts. Under these plans, patients pay all of the doctor visits and routine tests out of pocket and can write off roughly $5,000 per year. They only use their insurance for large claims such as surgery or cancer treatments. The Health Reform Bills under consideration will outlaw this type of plans....What section of the House bill would outlaw HSAs?

[cristo]

No I'm not claiming any staging. I claim a great deal of the commentary was bogus, and I suspect the scenes were cherry picked.

Cherry picked or not, the fact of the matter is that such scenes exist.


And I see a state run broadcasting station, with some good quality programming, but to my mind still biased out over the horizon.

What would be the gain to the viewers to be biased about this? It is providing documentary coverage of the situation in a completely different part of the world to the UK. The NHS is not under debate in the UK-- both major parties support it-- so there really is no point to the alleged bias.


The cancer treatment is better in the US, better odds of survival.
Sorry, are you reading different things to those that I'm writing? I don't recall questioning that in the quote...


Even if that's true, to what end? Seeing a free GP does not necessarily equal good medical care, as the survival statistics and the waiting lists show. And every single US citizen can walk into an emergency room in the US, and not be turned away based on ability to pay (though I'd change this).

But a GP and an emergency room are two completely different things, aimed at solving completely different issues. Are you telling me that I can go into an emergency room in the US and say "I think I've got cancer, can you test me and find out?" and walk out, having been tested, and given treatment to help cure me without having to pay a penny?


I'd like to know how many of those folks qualified for US Medicaid (single payer for the poor), and avoided that government run system to attend the hall, perhaps because they thought so little of it.

So they'd rather die than use the aid they could be provided with? Not very likely to me!

[Al68]

...One aspect of private insurance that works is high deductible catastrophic coverage ($10,000 to $25,000 deductibles) coupled with Health Savings Accounts. Under these plans, patients pay all of the doctor visits and routine tests out of pocket and can write off roughly $5,000 per year. They only use their insurance for large claims such as surgery or cancer treatments. The Health Reform Bills under consideration will outlaw this type of plans...What section of the House bill would outlaw HSAs?I think WhoWee was referring to the insurance plans being outlawed, not HSA's. It's in section 102(c)(1).

Personally, I like the medium deductible ($1,000 to $5000) catastrophic coverage plans. They're a fraction of the cost of comprehensive health plans, and a bargain for people that just need insurance in case they are seriously injured or get sick, but don't need a comprehensive plan that covers everything under the sun.

Democrats apparently have no problem outlawing private agreements between private parties, violating the right of private individuals to contract.

[mheslep]

...But a GP and an emergency room are two completely different things, aimed at solving completely different issues. Are you telling me that I can go into an emergency room in the US and say "I think I've got cancer, can you test me and find out?" and walk out, having been tested, and given treatment to help cure me without having to pay a penny?Yes the GP and emergency room serve different purposes. But then GP's also don't test for cancer, specialists do. Are you telling me you can walk into a specialist office? I just had a family member go to a specialist for a cancer test within two days of a GP visit. And I don't agree w/ the the not-paying-a-penny. You simply don't pay at the door. Also we've heard in this thread that if you ask for say, a PSA test for prostate, its sorry we don't do that, its unnecessary.

So they'd rather die than use the aid they could be provided with? Not very likely to me!Again there the suggestion that all aid is the same. Visibly it is not. Maybe the government aid was known to be rude and indifferent, and this at the town hall was not.

[mheslep]

...What would be the gain to the viewers to be biased about this? It is providing documentary coverage of the situation in a completely different part of the world to the UK. Why would a government run broadcasting network travel around making documentaries emphasizing how superior this of that government run program is to private alternatives? Not hard to imagine.

The NHS is not under debate in the UK-- both major parties support it-- so there really is no point to the alleged bias.
Perhaps that is a reflection of the BBC coverage. Perhaps the lack of debate reflects that the fact the NHS employs 1.2 million voters. I know of at least of one UK EMP (back bencher) that attacks it regularly.

[Hurkyl]

Cherry picked or not, the fact of the matter is that such scenes exist.
Is that relevant? Is mere existence the thing you (or the documentary) were trying to argue?

Or were you trying to argue something about the extent to which such scenes exist? In that case, cherry picking scenes and presenting them as if they are representative is a rather nasty bit of intellectual dishonesty.

[Al68]

The NHS is not under debate in the UK-- both major parties support it-- so there really is no point to the alleged bias.Are you serious? There's no point in the BBC being biased in favor of British policy over the U.S.? Come on, now.

[WhoWee]

I think WhoWee was referring to the insurance plans being outlawed, not HSA's. It's in section 102(c)(1).

Personally, I like the medium deductible ($1,000 to $5000) catastrophic coverage plans. They're a fraction of the cost of comprehensive health plans, and a bargain for people that just need insurance in case they are seriously injured or get sick, but don't need a comprehensive plan that covers everything under the sun.

Democrats apparently have no problem outlawing private agreements between private parties, violating the right of private individuals to contract.


I didn't mean to infer the (individual and family $3k to $5k approx) HSA's were on the chopping block. I'm referring to high deductible Catastrophic Plans. I'll double check the section.

[cristo]

Yes the GP and emergency room serve different purposes. But then GP's also don't test for cancer, specialists do. Are you telling me you can walk into a specialist office?

No, I'm saying you can walk into a GP's office and they will then arrange an appointment with a specialist.

You simply don't pay at the door.

No. If I had no job, and thus didn't pay taxes, I would be able to walk into a GP's office and then get an appointment with a specialist. In the US, I could not walk into an emergency room and then get an appointment with specialist. That is my point.


Why would a government run broadcasting network travel around making documentaries emphasizing how superior this of that government run program is to private alternatives? Not hard to imagine.

The BBC isn't run by the government, it is supported by a royal charter, and supported by license fee money. The monarch is not part of the government!! (That's a very basic lack of knowledge for someone who wants to debate this issue!)


Perhaps that is a reflection of the BBC coverage. Perhaps the lack of debate reflects that the fact the NHS employs 1.2 million voters.

Idle speculation.


Is that relevant? Is mere existence the thing you (or the documentary) were trying to argue?

Existence is exactly what I was trying to argue! The fact that 100 people are in a situation where they have no access to healthcare is good enough proof that the current healthcare service does not work in the best interest of every American!

[Al68]

The fact that 100 people are in a situation where they have no access to healthcare is good enough proof that the current healthcare service does not work in the best interest of every American!Why would you refer to individual private agreements between private parties as a "current healthcare service"?

[russ_watters]

Existence is exactly what I was trying to argue! The fact that 100 people are in a situation where they have no access to healthcare is good enough proof that the current healthcare service does not work in the best interest of every American! How is that useful? Are you saying that there is a way to provide healthcare that is within the best interest of everyone? I can assure you that no system will ever satisfy everyone at once.

It's been pointed out before, but maybe it is worth pointing out again: what makes the US different from the rest of the west is the level of freedom and with it the level of personal responsibility its citizens have. It is a double-edged sword, of course, but in the US we don't sacrifice the freedom of 80% of the population for the sake of picking up the 20% who have failed to live up to their personal responsibility.....at least not yet. :wink:

The idea that those 80% somehow owe something to those 20% just isn't how the US works, philosophically.

[cristo]

Why would you refer to individual private agreements between private parties as a "current healthcare service"?

If you don't see it as a healthcare system, then you are essentially admitting that it's an every man for himself situation. Then, it's clearly the poor (the most in need) that will be missing out. Are you happy living in a situation where you just ignore the health needs of poor people who cannot afford to be enter into such private agreements?

[cristo]

I can assure you that no system will ever satisfy everyone at once

No, but you can have a system whereby everyone is on an equal footing, and advantages are not given out by how wealthy a person is.


It's been pointed out before, but maybe it is worth pointing out again: what makes the US different from the rest of the west is the level of freedom and with it the level of personal responsibility its citizens have. It is a double-edged sword, of course, but in the US we don't sacrifice the freedom of 80% of the population for the sake of picking up the 20% who have failed to live up to their personal responsibility.....at least not yet. :wink:

This is always quoted, but I fail to see how this has anything to do with "freedom". Unless, of course, you take the view that it is the poor's fault that they are in the situation they are in. I live in a world where I will try to help my fellow countrymen, and not first judge whether they have "live[d] up to their personal responsibility" or not.

[Al68]

If you don't see it as a healthcare system, then you are essentially admitting that it's an every man for himself situation. Then, it's clearly the poor (the most in need) that will be missing out. Are you happy living in a situation where you just ignore the health needs of poor people who cannot afford to be enter into such private agreements?You missed the point. I never suggested we should ignore poor people. I said that the private agreements referred to aren't made for that purpose, and aren't intended or claimed to be for that purpose.

Just like my car insurance policy isn't intended to help poor people. Or my agreement with the plumber I had to call last week. Or my cell phone contract.

Is it the fault of my cell phone contract that some people can't afford a cell phone? Should I say that the "cell phone system" is defective as a result? Is the "plumber system" defective?

Is the car insurance "system" defective since it doesn't fix the cars of people without a policy or cover pre-existing conditions?

Is there any chance at all this debate can stop being so absurd and fraudulent?

[WhoWee]

If you don't see it as a healthcare system, then you are essentially admitting that it's an every man for himself situation. Then, it's clearly the poor (the most in need) that will be missing out. Are you happy living in a situation where you just ignore the health needs of poor people who cannot afford to be enter into such private agreements?

There is a big misconception in this area. The "poor" people already have free healthcare.

It's the working poor that lack coverage. People who earn from minimum wage to (as much as) $20 per hour based on family size are the ones struggling to pay for coverage.

Comprehensive 80/20, $1,000 deductible, individual/family health coverage can easily cost $200+ per person per month. One of the reasons the working poor don't have insurance is that small business owners can't afford the minimum wage, let alone benefit programs.

The other major problem is people who have adequate income, but only qualify for (some are very expensive) indemnity plans or discount (association/network) plans due to pre-existing conditions.

[Al68]

No, but you can have a system whereby everyone is on an equal footing, and advantages are not given out by how wealthy a person is.Given out? By who? Equality of outcomes is obviously incompatible with individual liberty.This is always quoted, but I fail to see how this has anything to do with "freedom". Unless, of course, you take the view that it is the poor's fault that they are in the situation they are in. I live in a world where I will try to help my fellow countrymen, and not first judge whether they have "live[d] up to their personal responsibility" or not.Huh? The issue isn't whether you should help your countrymen, it's whether you should force them to help each other against their will and outlaw private agreements. That's how "freedom" is relevant.

Being reluctant to advocate the oppression of others (ostensibly to help the poor) isn't equal to "the view that it is the poor's fault that they are in the situation they are in".

Personal responsibility is a necessary consequence of freedom for obvious reasons, not something imposed by others.

[cristo]

You missed the point. I never suggested we should ignore poor people. I said that the private agreements referred to aren't made for that purpose, and aren't intended or claimed to be for that purpose.

Ok fine, then let's put it another way. What should be provided for the people who cannot afford to enter into private agreements?

There is a big misconception in this area. The "poor" people already have free healthcare.

It's the working poor that lack coverage.

Well, I would still class the working poor as "poor"! Still, you're right. Whilst medicare will of course support the very worst off, there are still be people in poverty who will not be supported by medicare (whom you refer to as the working poor).

Given out? By who?

"Given out" by whoever decided the healthcare policies.



Being reluctant to advocate the oppression of others (ostensibly to help the poor) isn't equal to "the view that it is the poor's fault that they are in the situation they are in".

I don't see how it's oppressive for a government to help out the people who can't help themselves. I'll ask the above question again, then: what should be put in place to help such people?

[Al68]

Ok fine, then let's put it another way. What should be provided for the people who cannot afford to enter into private agreements?Provided by who? Charitable organizations? I'd say it would be a compromise between what is needed and the resources of the organization.

It should be obvious that the difference between positions on this issue isn't about what poor people "should have".

The difference is about the violations of liberty contained in the proposal. The fact that such violations are claimed to be for the purpose of helping the poor doesn't mean that being against the violations equals being against the poor, despite the propaganda.

This type of propaganda has been used to promote the hatred of libertarians for decades in the U.S., and has no basis in fact. According to the oppressors, anyone opposing them must "not care about poor people", "be for the rich", etc.

Most importantly, the people who are against violations of liberty have no obligation to justify the conditions claimed to be the reason the violations of liberty are "needed". It is those that advocate such violations that have the obligation to justify them (other than "the ends justify the means").

[cristo]

Provided by who? Charitable organizations?

No, by the government. Clearly you don't believe that the government should bear responsibility for people who cannot afford to look after themselves. That's fine, it's your opinion. In my opinion, it's certainly a good thing that you have a leader who is looking towards taking on some of the responsibility of the problem.

There's probably no point continuing this, since neither of us will change our opinion.

[Al68]

"Given out" by whoever decided the healthcare policies.They can give out whatever they can afford. The more the better. After all most of them are far richer than the rest of us.
Being reluctant to advocate the oppression of others (ostensibly to help the poor) isn't equal to "the view that it is the poor's fault that they are in the situation they are in".I don't see how it's oppressive for a government to help out the people who can't help themselves.I didn't say it was. The means used ostensibly for that goal are often oppressive, as is the case with the current proposal.

[Al68]

Provided by who? Charitable organizations?No, by the government.The U.S. government doesn't have it's own money, so is it safe to assume you mean that the government should take it by force from people for that purpose?There's probably no point continuing this, since neither of us will change our opinion.There's certainly no point in continuing as long as you insist on ignoring the point of disagreement between us, and concentrating on something that everyone agrees on (poor people need help) as if we disagreed on that. That's both fruitless and insulting.

[cosmo123]

How is that useful? Are you saying that there is a way to provide healthcare that is within the best interest of everyone? I can assure you that no system will ever satisfy everyone at once.

It's been pointed out before, but maybe it is worth pointing out again: what makes the US different from the rest of the west is the level of freedom and with it the level of personal responsibility its citizens have. It is a double-edged sword, of course, but in the US we don't sacrifice the freedom of 80% of the population for the sake of picking up the 20% who have failed to live up to their personal responsibility.....at least not yet. :wink:

The idea that those 80% somehow owe something to those 20% just isn't how the US works, philosophically.

It seems like the ultimate version of personal responsibility would be one where there are no taxes and you pay for what you use.

The top 90% can afford to use the roads.
The top 80% can afford healthcare.
The top 70% can go to school.
The top 60% can afford the police.
The top 50% can afford the fire service.
The top 20% can afford the lifeguard service.

Sounds like a rosey future we should all aspire to.

[WhoWee]

Yes, have you read anything that was posted about Adjusted Gross Income? Do you understand Adjusted Gross income? Have you ever filed an itemized tax return and understand the reason behind it? Do you undersatand US tax laws? You don't seem to.

I've made over $250 a year and had tons of exemptions, and the percent of tax I paid, when averaged over my actual gross income, not the percentage I paid on the AGI that was taxable, was a much lower percentage than I pay now, and I make just under $100k a year now and have no deductions. I'll say it one more time. I'm not talking about the % of tax on AGI, I'm talking about the $ amount of taxes paid, and what percent of a person's total UNadjusted gross income that equates too. Do you understand now? Based on a person's TOTAL ACTUAL annual income, unless they do not itemize, the rich pay a lower percent of tax based on their TOTAL annual income.


There is another aspect to this discussion that's not talked about much. Income taxes are only one form of taxation.

Taxes based on consumption/use are a much higher portion of income for people who earn less. Taxes are included on everything from (the most noticeable) retail sales, fuel, utilities (including phones and cable), syrup, alcohol, tobacco, and etc. An individual (rich or poor) can only consume so much per year.

For a modest person that only saves or invests 5% per year, it's possible the other 95% is subject to some form of tax. To compensate, luxury taxes, etc. have been imposed on the wealthy, but it doesn't bring equality.

In the context of this point, the next very dangerous threat to the middle class tax rates will be INFLATION (as we print Dollars and borrow from China due to increased deficit spending). As consumer prices inflate, the TAXES on those purchases INCREASE accordingly. (I know the savings of the wealthy are devalued - that's not the point).

[mheslep]

...No. If I had no job, and thus didn't pay taxes, I would be able to walk into a GP's office and then get an appointment with a specialist.
Obviously the vast majority of UK citizens pay substantially through the tax system. And in the US if one has no or very little income (<~20k/yr), then they are eligible for government based health care via the Medicaid program as I posted before, and before, and before. I make no claims about the quality of that, or any other government sponsored health care program.

In the US, I could not walk into an emergency room and then get an appointment with specialist. That is my point.... Right, you go see your US GP and get to the specialist in short order.

...Idle speculation. Speculation, but not idle. That's where you've taken us with claims like "...there really is no point to the alleged bias." about the BBC.

[Ivan Seeking]

Right, you go see your US GP and get to the specialist in short order.

:rofl::rofl::rofl::rofl::rofl::rofl: In short order!!! :rofl::rofl::rofl:

Wait six weeks to see the GP, and then eight to ten weeks to see a specialist. If the situation is hypercritical then they MIGHT get you in quickly.

I recently made an appointment with my dermatologist - I have psoriasis and had a bad outbreak this summer. It was making life miserable.

I called in early July and got an appointment for September 1st.

My wife struggles with a thyroid condition that ranges from being a minor nuisance, to being virtually incapacitating. When she starts having problems, first we have to wait six or eight weeks for her to see the specialist. Then we have to wait another two or three weeks for the tests to be scheduled, and another week or two for the results. Then, after another week or two, they will decide on new dosages for her meds. After a month they begin to take effect. So from the day we know she is having problems, by which time things are getting serious, there is no hope for help for at least the next two months, and normally it takes more like three months.

People who think this system is so wonderful obviously have little experience with the health care systems; that or they were just one of the lucky ones.

My father just had a heart attack and is not doing well. Unliked my mother who fell victim to private care, my dad is a vet. The VA hospital [you know, that socialist organization] has been WONDERFUL!!! Thank God for government run health care!

[Al68]

:rofl::rofl::rofl::rofl::rofl::rofl: In short order!!! :rofl::rofl::rofl:

Wait six weeks to see the GP, and then eight to ten weeks to see a specialist. If the situation is hypercritical then they MIGHT get you in quickly.

I recently made an appointment with my dermatologist - I have psoriasis and had a bad outbreak this summer. It was making life miserable.

I called in early July and got an appointment for September 1st.

My wife struggles with a thyroid condition that ranges from being a minor nuisance, to being virtually incapacitating. When she starts having problems, first we have to wait six or eight weeks for her to see the specialist. Then we have to wait another two or three weeks for the tests to be scheduled, and another week or two for the results. Then, after another week or two, they will decide on new dosages for her meds. After a month they begin to take effect. So from the day we know she is having problems, by which time things are getting serious, there is no hope for help for at least the next two months, and normally it takes more like three months.

People who think this system is so wonderful obviously have little experience with the health care systems; that or they were just one of the lucky ones. Your post indicates you believe there is only one dermatologist and one thyroid specialist around, or that you are part of some insurance system that I am not, and never would be. Or a receptionist told you you "had" to wait and you took it literally. You certainly never explained why you waited, so it doesn't even provide any anecdotal evidence.

Regardless of how long you waited, the fact remains that I would not have waited that long. Period. If a specialist doesn't have time to see me, he/she loses my business and another one gains it. It's that simple. I'm in charge, not some imaginary "system" some people seem to think they're a part of.

While I have been told a specific doctor couldn't see me any time soon, I have never been forced to wait for care. No one in this country currently has the power to tell me I must wait, and I'd like it to stay that way.

And no, I'm not rich, far from it, but I do choose my insurance policies wisely. And I don't let my employer choose it for me, despite the tax code's attempt to coerce me to do so.

[mheslep]

...Wait six weeks to see the GP, and then eight to ten weeks to see a specialist. If the situation is hypercritical then they MIGHT get you in quickly.
I recently made an appointment with my dermatologist - I have psoriasis and had a bad outbreak this summer. It was making life miserable. I called in early July and got an appointment for September 1st.So 6 to 8 weeks in your case.

You might consider a new GP or insurance network. Average time to see a family practice GP in Portland (2009) is 9 days. (http://www.merritthawkins.com/pdf/mha2009waittimesurvey.pdf) Average time to see a Dermatologist is 25 days. In Boston, where they've instituted a near universally run government program, the wait for a GP is 63 days, the worst in the country by far. Dermatologist wait in Boston is 54 days. Interestingly, the worst case wait in Boston for a Dermatologist jumped to one year in 2009, tripling the old worst case of time of 120 days in 2004 before the universal plan kicked in.

These longer US times I would call unacceptable, but they're still short compared to, say, Canada. Orthopedic surgery wait in Portland is 9 days, in Canada its 26.5 weeks. (http://www.fraserinstitute.org/researchandpublications/publications/2548.aspx)

Lego fun version (http://www.youtube.com/watch?v=AqD-nMpsYAY&eurl=http%3A%2F%2Fpoliticalmath.wordpress.com%2F20 09%2F07%2F04%2Fobama-health-care-reform-and-wait-times-visualization-in-lego%2F&feature=player_embedded#t=130)

Of course though it won't get you into a specialist, for $25 to ~$75 anyone from illegals to the President can walk into a clinic (http://nurse-practitioners.advanceweb.com/editorial/content/editorial.aspx?cc=116098), Walmart houses many of them.

A personal aside, my wife recently got into see her GP after ~4days. She got into see a specialist on a semi-urgent matter 48 hours latter. I seriously wish yours the same fortune.

Also, Medicare is coming your way soon (now?). Do you expect quality to greatly improve under Medicare? Do you expect Medicare will have some drug that doesn't take a month to have impact after taking it? The Mayo clinic for instance has stopped participating in Medicare (http://www.mayoclinic.org/billing-rst/faqs2.html), they got fed up with Medicare's payments.

My father just had a heart attack and is not doing well. Unliked my mother who fell victim to private care, my dad is a vet. The VA hospital has been WONDERFUL!!! Thank God for government run health care!I'm happy your father's care went well after his illness , but the VA has had many well publicized disasters.

Soldiers Face Neglect, Frustration At Army's Top Medical Facility (http://www.washingtonpost.com/wp-dyn/content/article/2007/02/17/AR2007021701172.html)

[mheslep]

I didn't mean to infer the (individual and family $3k to $5k approx) HSA's were on the chopping block. I'm referring to high deductible Catastrophic Plans. I'll double check the section.Turn's out HSA's are on the chopping block in HR 3200. Rep. Cantor put it an amendment to keep them (http://blog.heritage.org/wp-content/uploads/2009/08/cantor-26.pdf) and it was voted down.

No Freedom to Choose Health Savings Accounts. Once again, the president has said repeatedly that if Americans like the coverage they have today, they would be able to keep it. But under the House bill, the benefits and the terms and conditions of the health benefits that are included in Americans’ health insurance would be determined by federal officials. The House bill would set conditions for what is or is not “acceptable” health insurance coverage.

Many Americans have personally chosen to enroll in high-deductible plans combined with a Health Savings Account (HSA). They have chosen this option because they want to have more direct control over their health-care dollars and how their health-care dollars are spent. To protect consumers who currently hold these plans, Rep. Eric Cantor (R., Va.) proposed an amendment that would include high-deductible plans with HSAs in the House bill’s definition of a “qualified health benefits plan.” The amendment would have prohibited the Secretary of Health and Human Services (HHS) from restricting enrollment in private health plans with HSAs. The Cantor amendment was defeated. In other words, contrary to the president’s promise, under the terms of HR 3200 Americans with HSAs could be forced to switch out of their current plans.

Likewise, Rep. Dave Reichert (R., Wash.) introduced an amendment that would repeal the House bill’s statutory prohibition on new enrollees into individual private health-insurance plans. As currently drafted, HR 3200 prevents individual plans from enrolling new members after 2013 unless the plan is specifically “grandfathered” under the law or is transformed into a “qualified health benefits plan,” as determined by federal officials, and available through the national Health Insurance Exchange. The Reichert amendment was also defeated. This means that Americans would be prohibited by law from enrolling in a private individual health-insurance plan and would be forced by the federal government to buy a different health plan in the national Health Insurance Exchange.
http://healthcare.nationalreview.com/post/?q=MzdiZGU2YjA0ZGQ1ZTQxODRmNjY3NjI5ZGQ3Yzg5NGQ=

[mheslep]

Dr and politcal columnist Charles Krauthammer is to my mind the most thoughtful conservative columnist writing today. His health ideas here. Short and to the point as usual. Only two parts: 1. Tort Reform, 2. Kill the employer tax rule and give people the money back directly.

Health-Care Reform: A Better Plan (http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080602933.html?hpid=opinionsbox1)

[WhoWee]

Turn's out HSA's are on the chopping block in HR 3200. Rep. Cantor put it an amendment to keep them (http://blog.heritage.org/wp-content/uploads/2009/08/cantor-26.pdf) and it was voted down.


http://healthcare.nationalreview.com/post/?q=MzdiZGU2YjA0ZGQ1ZTQxODRmNjY3NjI5ZGQ3Yzg5NGQ=

I'll be shocked if HSA's are eliminated. They are the most popular (relatively speaking) new products out there. The Health Savings Account plans allow individuals to purchase higher deductible plans (typically $3/$5K) at a lower premium and save money in a special bank account (most have debit cards assigned) to use strictly for medical expenses. The funds are allowed to accumulate and roll over to the next year. Plus there are tax incentives.

The other high deductible plans I mentioned are the $10,000 to $25,000 deductible plans. The premiums are very low, but the risk is obvious. These plans have also been growing in popularity with self employed people, often coupled with accident plans and/or association benefits.

A quick explanation of the $25,000 deductible plan... even though the deductibles are high, the "in-network discounts" are still in effect and the services rendered may actually reach $50,000 total ($25 "in-network" discounts and $25 out of pocket) before the insurance company actually pays anything. Insurance companies love these plans, medical providers aren't as happy about them.

[cristo]

Obviously the vast majority of UK citizens pay substantially through the tax system.

Substantially means nothing, unless you are using a comparison. The UK spends a lot less on healthcare per capita than the US, for example (and has a higher life expectancy...)


And in the US if one has no or very little income (<~20k/yr), then they are eligible for government based health care via the Medicaid program as I posted before, and before, and before.

Not true:

Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups.



Speculation, but not idle. That's where you've taken us with claims like "...there really is no point to the alleged bias." about the BBC.

You know nothing about the things you're trying to debate. Please try and stop being so ignorant. It's fine for you to admit that you don't understand how the BBC is funded, but to claim that it is run by government is incorrect.

[mheslep]

Substantially means nothing, unless you are using a comparison. The UK spends a lot less on healthcare per capita than the US, for example (and has a higher life expectancy...)The comparison in this context was to your statement about not having to pay a penny, (http://www.physicsforums.com/showpost.php?p=2308009&postcount=356) as you well know.

[mheslep]

Not true:
Yes, generally, regarding Medicaid it is true. Clearly the eligibility criterion are more complex than my one sentence statement, it includes other things including the size of ones assets, such as a fat bank account or a flashy boat in the backyard. I might have said simply 'poor', but that has such a wide definition that its not useful. Generally speaking:
Medicaid is health insurance that helps many people who can't afford medical care pay for some or all of their medical bills.
And in fact Medicaid covers "approximately 58 million low-income Americans. (http://www.cdc.gov/pcd/issues/2009/Jul/08_0153.htm)"

In general, you should apply for Medicaid if your income is limited and you match one of the descriptions of the Eligibility Groups. (Even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)
Low-income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds
An able bodied adult male with no dependants will have a hard time qualifying.

Clearly neither Medicaid nor Medicare cover everyone that lack insurance, though given that the US is closing in on spending a trillion dollars annually on the two programs collectively one might think they would. So given the 58 million people on the Medicaid roles alone along with funding, it is simply nonsense to claim only the 'wealthy' have access to medical help in the US.

There remains roughly 3-4% of US citizens that don't qualify for help as destitute but still can't manage to afford access. I'd like to see action taken to get it to them, though not via what's on the table now.

[turbo-1]

There remains roughly 3-4% of US citizens that don't qualify for help as destitute but still can't manage to afford access. I'd like to see action taken to get it to them, though not via what's on the table now.How do you know what's on the table? Have you read any of the mark-ups coming out of the various committees? Do you have a crystal ball to see what could emerge as a reconciled bill merging the House's language with the Senate's? Nobody has a clear view of where all this will end up yet, which is why the neo-cons are stirring people up to shout "We don't want it." when they haven't a clue what has come out of committees. One thing for sure - if we don't contain costs and rein in the cost of health-care, the US is headed for economic catastrophe.

Reps Bachman and Kline have both come out saying that public insurance would be cheaper. So as true neo-cons, they are against cutting waste and inefficiency, and want to let insurance companies decide who lives or dies.

http://minnesotaindependent.com/39874/bachmann-kline-oppose-public-option-because-its-cheaper

[mheslep]

How do you know what's on the table? Have you read any of the mark-ups coming out of the various committees? Do you have a crystal ball to see what could emerge as a reconciled bill merging the House's language with the Senate's? Nobody has a clear view of where all this will end up yet, which is why the neo-cons are stirring people up to shout "We don't want it." when they haven't a clue what has come out of committees. One thing for sure - if we don't contain costs and rein in the cost of health-care, the US is headed for economic catastrophe....I'm only ~familiar w/ HR3200, as much as I can understand it without running down all the redirections, and with various statements from this or that Senator. There's some good in there, but mainly I think its a mistake. There are other plans I do like, mostly, and have posted about them here.

[WhoWee]

How do you know what's on the table? Have you read any of the mark-ups coming out of the various committees? Do you have a crystal ball to see what could emerge as a reconciled bill merging the House's language with the Senate's? Nobody has a clear view of where all this will end up yet, which is why the neo-cons are stirring people up to shout "We don't want it." when they haven't a clue what has come out of committees. One thing for sure - if we don't contain costs and rein in the cost of health-care, the US is headed for economic catastrophe.

Reps Bachman and Kline have both come out saying that public insurance would be cheaper. So as true neo-cons, they are against cutting waste and inefficiency, and want to let insurance companies decide who lives or dies.

http://minnesotaindependent.com/39874/bachmann-kline-oppose-public-option-because-its-cheaper

I agree that we need to allow Congress to do their job. However, their first priority should be to address the problems with the existing Government run systems. Instead, the President has pushed for his $600 billion+ "down payment" to restructure health care. Bigger doesn't always mean better - adding to the problem will undoubtedly make it worse.

One place to start in the Government programs might be to encourage doctors to volunteer at free clinics (reward them with tax credits - not cash). This would certainly cut down on treatment at emergency rooms for colds, flu and other non-emergency treatments. This will require new free clinics - which some of the stimulus money could build-out.

Next, one of the biggest problems with private health insurance is denial of coverage for pre-existing conditions. I'm sure the insurance industry could teach the Government how to design and manage one super-sized risk pool to address this issue. The Government is the only entity that could establish such a pool.

Last, if someone sneaks into this country to work - that is take a job away from a citizen - they should use their earnings to pay for their own health insurance. If they snuck into this country to live off welfare and enjoy free health care - they should be deported. We can't be expected to provide health care for people who are here illegally.

The bottom line is this - health care should not be a political matter. This is not a Democrat vs Republican issue and we shouldn't allow it to be a left vs right issue.

Everything the Government touches cost too much and is mired in red tape. The less involved the Government is in the details, the better. If they want to fund a risk pool to cover un-insurable people, clean up their own programs, reward doctors for helping under-insured people, and tell illegal immigrants to go home (instead of trying to get their votes), the industry can fix itself - they now understand they don't have a choice.

[3thanol]

I have never been to a medical centre in the US, or know enough about the US healthcare system to make a fair comment. Like many Americans making comments about the NHS or other social healthcare you don't know our/there system either to give an un-biased opinion. Each have there problems and many people can pick faults in both.

However I rest assured that at any time any place, me or any member of my family can make an appointment, or if an emergency, make a simple call and we will be given an appointment or rescued and taken care of to a very good standard.

I or my family don't have to worry about forms, insurances, level of cover, money.

I don't mind putting money into the pot for everyone to get healthcare if they need it, it should be a given right like the air we breath. I have paid into the system all my life and do not begrudge someone who may not have paid as much as me into the system. As are the current world circumstance, if I ever lost my job and could not get another for awhile, and could not pay insurance for healthcare it would not worry me, I rest assured the NHS is there for me and my family regardless.

If the issue is paying for people who do not pay there share towards healthcare or the system. Then why is this issue not raised when billions are given in aid to foreign nations for grain and vaccinations etc in Africa, Asia etc these people don't pay into your system, yet you pay for all of it through your taxes. then you question helping a fellow citizen when they need it. your government spends hundreds of Billions on defence to safeguard it's population etc yet 1000's die or have ill health because the lack of health insurance. Because of what seems a capitalist healthcare system. If half the healthcare system was non profit yet the doctors are getting paid well and the drug company's are still making profit everyone is getting treated, I struggle to see the issue

There are certain things that should not have been or be privatised or for profit.
Health, Water, Power (to the home) all are necessities and should be available to all at a cost which covers running costs and a percentage for future required investments, not excess amounts to pay shareholders.

Sorry if it turned into a small rant, no one likes there country being picked on or highlighted to having flaws. ours is far from perfect like yours but we will defend it when highlighted for the wrong reasons :).

[turbo-1]

I agree that we need to allow Congress to do their job. However, their first priority should be to address the problems with the existing Government run systems. Instead, the President has pushed for his $600 billion+ "down payment" to restructure health care. Bigger doesn't always mean better - adding to the problem will undoubtedly make it worse.

Next, one of the biggest problems with private health insurance is denial of coverage for pre-existing conditions. I'm sure the insurance industry could teach the Government how to design and manage one super-sized risk pool to address this issue. The Government is the only entity that could establish such a poolDenial of coverage and refusal to pay for covered services are the insurance companies' biggest money-makers. A not-for-profit government-run system would be much better at bringing down costs. Neo-cons know this and have made it an arguing point.

[mheslep]

Why after opening with a reasonable comment like this
I have never been to a medical centre in the US, or know enough about the US healthcare system to make a fair comment. Like many Americans making comments about the NHS or other social healthcare you don't know our/there system either to give an un-biased opinion. Each have there problems and many people can pick faults in both....
do you then follow up with this comment?
...yet 100,000's die because of what seems a capitalist healthcare system.

[WhoWee]

Denial of coverage and refusal to pay for covered services are the insurance companies' biggest money-makers. A not-for-profit government-run system would be much better at bringing down costs. Neo-cons know this and have made it an arguing point.

Turbo,

I honestly don't believe the Government can run anything at a lower cost - it's just not their specialty. If they can fix medicare, medicaid, and social security (without blending it into a bigger program), I'll eat my words.

The reason insurance companies deny pre-existing conditions is because the pre-existing conditions (diabetes, high blood pressure, high cholesterol, cancer) all lead to other very expensive conditions.

Insurance companies don't insure people who build in flood plains or in wild fire or earthquake areas unless they build the risk into their pricing. Dangerous drivers pay more for car insurance. Insurance companies don't place bad bets. AIG is an example of what happens when they do something risky.

A Government led risk-pool to assist with the associated costs of assuming the risk of pre-existing conditions could solve the problem. By sharing the risk, insurance companies won't risk their ability to pay other claims (and earn profits).

When a region is declared a disaster area due to a natural disaster, the Government steps in to help, it's the same basic model. The insurance companies pay their claims and the Government helps the under-insured and un-insured.

[drankin]

Turbo,

I honestly don't believe the Government can run anything at a lower cost - it's just not their specialty. If they can fix medicare, medicaid, and social security (without blending it into a bigger program), I'll eat my words.

The reason insurance companies deny pre-existing conditions is because the pre-existing conditions (diabetes, high blood pressure, high cholesterol, cancer) all lead to other very expensive conditions.

Insurance companies don't insure people who build in flood plains or in wild fire or earthquake areas unless they build the risk into their pricing. Dangerous drivers pay more for car insurance. Insurance companies don't place bad bets. AIG is an example of what happens when they do something risky.

A Government led risk-pool to assist with the associated costs of assuming the risk of pre-existing conditions could solve the problem. By sharing the risk, insurance companies won't risk their ability to pay other claims (and earn profits).

When a region is declared a disaster area due to a natural disaster, the Government steps in to help, it's the same basic model. The insurance companies pay their claims and the Government helps the under-insured and un-insured.

That makes too much sense to be something the Government would do. I like it, though.

[cristo]

Yes, generally, regarding Medicaid it is true.

Again are you reading different things to me? You say:

And in the US if one has no or very little income (<~20k/yr), then they are eligible for government based health care via the Medicaid program as I posted before, and before, and before.

Yet, I quoted from the source:

Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups.

The poverty line in the US is something like a wage of $10,000. Now, pray tell, if the medicaid guidelines state that being in poverty is not sufficient to receive aid, how is every person with a wage of $20,000 eligible to receive such aid?

Your figures just don't add up, yet you try say that I'm wrong. Prove it, or stop making such claims. That's now (at least) two cases of misinformation you've made in this thread, and this discussion is getting pretty tiresome.

[Al68]

How do you know what's on the table? Have you read any of the mark-ups coming out of the various committees? Do you have a crystal ball to see what could emerge as a reconciled bill merging the House's language with the Senate's? Nobody has a clear view of where all this will end up yet, which is why the neo-cons are stirring people up to shout "We don't want it." when they haven't a clue what has come out of committees. Nothing passed by any committee as of yet changes the bulk of the objectionable parts of the proposal. Any attempt by Republicans to amend it so that it doesn't outlaw all insurance plans that aren't part of the new system will fail according to my crystal ball. One thing for sure - if we don't contain costs and rein in the cost of health-care, the US is headed for economic catastrophe.Unsubstantiated bunk. Reps Bachman and Kline have both come out saying that public insurance would be cheaper. As has been pointed out to you before, what they actually are saying is that public insurance will be "cheaper" to a consumer because they will pay for 30-40% of the public insurance by taxation whether they choose it or not, then pay the other 60-70% directly for the (subsidized) public insurance. If they choose private insurance, they will pay the premium (100%) plus the 30-40% on top, making the public plan the cheaper choice artificially.So as true neo-cons, they are against cutting waste and inefficiency, and want to let insurance companies decide who lives or dies.This is an outright hateful lie, and you know it. Forum rules can be found here: http://www.physicsforums.com/showthread.php?t=113181

[turbo-1]

It's not an outright hateful lie. I only wish it were not true. Right now, if you own a small business and offer health insurance to your employees and one of your employees comes down with a catastrophic illness the insurance company will either jack up your rates or refuse to renew your policy. If you have been paying for private coverage for years and you come down with a catastrophic illness, it's likely that your insurance company will drop you on some pretext to avoid paying for your care. This is the status quo, and this is the system that the GOP wants to perpetuate. We can speculate about their motivations, but the end result is the same.

In regard to "death panels" cited by Palin, Gingrich, and Grassley, guess who voted to fund end-of-life counseling in 2003? The blatant lying and fear-mongering on the right are disheartening. They seem determined to undermine reform by whatever means available.

http://swampland.blogs.time.com/2009/08/13/oh-those-death-panels/

[gravenewworld]

http://jama.ama-assn.org/cgi/content/full/298/6/638?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=1900&resourcetype=HWFIG


Despite the ability of vaccines to prevent illness and death, our current system of vaccine financing has resulted in a gap for underinsured children. Current trends in health insurance products, including enrollment in high-deductible health plans that may or may not provide immunizations or other preventive benefits before a high deductible has been met, are likely to increase the magnitude of this gap and must be carefully monitored. Furthermore, the impact of the gap in vaccine financing for underinsured children on vaccination rates deserves further study once data on coverage rates for new vaccines become available. Evidence from past studies supports the premise that the availability of financing affects immunization rates.11, 21 Meanwhile, strategies are needed to address the current needs of underinsured children and should include efforts to enhance immunization benefits through requirements or incentives for insurers and employers. Until such enhancements in private insurance coverage for immunization are implemented, however, support of the public sector safety net is critical to ensure the protection of this vulnerable group of children in the United States.



Sounds like the best system of health care in the world to me.

[WhoWee]

It's not an outright hateful lie. I only wish it were not true. Right now, if you own a small business and offer health insurance to your employees and one of your employees comes down with a catastrophic illness the insurance company will either jack up your rates or refuse to renew your policy. If you have been paying for private coverage for years and you come down with a catastrophic illness, it's likely that your insurance company will drop you on some pretext to avoid paying for your care. This is the status quo, and this is the system that the GOP wants to perpetuate. We can speculate about their motivations, but the end result is the same.

http://swampland.blogs.time.com/2009/08/13/oh-those-death-panels/

This is a result of small group risk pools. One sick person can raise the rates of everyone in the pool.

Without restating my earlier posts, this is a major problem in covering high risk individuals. To look at the problem another way, when the Government looked at the mortgage industry they identified certain "toxic assets". Plans were developed to isolate these assets and deal with them as a group. The same type of approach could be used for health insurance. Basically, move people out of low risk pools into Government subsidized pools as they develop more serious conditions. Government doesn't need to run health care, just guarantee the catastrophic and ensure availability of Prevention/Wellness.

If you think of health care as tiered - similar to the way prescriptions are categorized you would have the following (based on the way health insurance policies are organized):

Tier 1 - Preventative Care/Wellness This includes all of the annual physicals and routine exams, diet and exercise evaluation and routine testing.

Tier 2 - Emergency/Outpatient Care/Rehab

Tier 3 - Hospital/In-patient Care/Surgery

Tier 4 - Long Term Care/Disease Management

Tier 5 - Critical Illness/Intensive Care

The cost/risk increases through each Tier. Currently (as Turbo pointed out) if only 1 person in a small group becomes seriously ill, everyone's rates in that group can be affected.

At the same time, the current Government plans do not address the prioritization of illness. As an example, if a person on welfare catches a cold (and can't afford to pay for an $85 doctor's visit) they often go to the (Tier 2) emergency room for diagnosis and medicine - it's their best option- but far more costly to the system than seeking Tier 1 Wellness care.

This is part of the "waste" component in the Government program - it's like going to the car dealer to buy tires or a battery for your used car - it will cost more than if you went to a tire or battery store - the dealer has more overhead and a higher hourly rate.

Many of the problems with our current system can be fixed by applying common sense.

[turbo-1]

Another factor that is often glossed over in the discussions about health-care reform is that the costs associated with treating the uninsured are passed on to those with insurance. For-profit hospitals and medical practices do not simply "eat" those costs - they pass them on in the form of higher charges. When I worked for a large ophthalmic practice, we had two retinal surgeons, one of whom had to be on call at all times. If they got a call about someone who had suffered a retinal detachment in an accident, they wouldn't ask if the victim had insurance. They would get to the operating theaters STAT and do their best to re-attach the retina(s) in an effort to preserve the victim's sight. If the victim was uninsured and unable to pay for that $$$$$ surgery, the medical practice and the hospital passed those costs on to insured people in the form of higher charges for services.

If we had a public health insurance option, this situation could be resolved, resulting in more reasonable charges for procedures. Also, as WhoWee pointed out, giving the currently uninsured/underinsured access to preventative health care should help resolve potential health problems before they become more serious and require more expensive interventions. There are some potentially huge improvements in efficiency and cost-containment that could be brought about by a well-crafted reform bill. It's a shame that most of the GOP in Congress can't bring themselves to participate, because simple nay-saying and obstruction will not result in the best possible bill.

[Hurkyl]

For-profit hospitals and medical practices do not simply "eat" those costs - they pass them on in the form of higher charges. ... If we had a public health insurance option, this situation could be resolved, resulting in more reasonable charges for procedures.
Those costs do not magically go away -- they are just going to be passed on in the form of "taxes" rather than in the form of "higher charges".

[WhoWee]

If we had a public health insurance option, this situation could be resolved, resulting in more reasonable charges for procedures. Also, as WhoWee pointed out, giving the currently uninsured/underinsured access to preventative health care should help resolve potential health problems before they become more serious and require more expensive interventions. There are some potentially huge improvements in efficiency and cost-containment that could be brought about by a well-crafted reform bill. It's a shame that most of the GOP in Congress can't bring themselves to participate, because simple nay-saying and obstruction will not result in the best possible bill.

Control of health care should not be a political prize. The system we have needs refinement and support.

We need to diagnose the problems with medicare, medicaid and social security - and fix those problems - not roll them into a much bigger program where they will never be cured.

The President made a comparison of UPS and FedEx to the US Postal service. If UPS and FedEx lost $7,000,000,000 per year (as the Post Office is projecting) would they continue to exist?

Insurance companies and health care networks operate at a profit. Their operations are efficient. A great deal of the waste in health care is already under Government control, a result of Government regulation, or can be addressed by Tort Reform.

Does anyone realize how much HIPPA regulations have cost the industry - and consumers?

When politicians talk about IT improvements, are they unaware of HIPPA requirements? Are they unaware of the millions of dollars already (mandated and) invested by the industry?

Our President and many others in Government are lawyers. Lawyers are taught how to analyze problems in a methodical manner. First gather all of the information, study and prioritize that information, (using all of the information available) make strategic plans and measure their possible outcomes, re-examine and tweak, take action on the best strategy.

This basic problem solving model needs to be used in dealing with health care reform. This is not something that can be done in haste or rammed through with political grandstanding. This is life and death and a large part of our economy.

Our elected officials need to start acting like adults and do their jobs. I expect our elected politicians to read the Bills and understand what they are voting on - if they can't - we need to find better qualified people to make the decisions.

[f95toli]

Insurance companies and health care networks operate at a profit. Their operations are efficient.

Operating at a profit does not mean that they are efficient for society as a whole.
A lot of of republicans have attacked the NHS here in the UK over the past few days claiming it is inefficient etc.
Now, if the NHS is that inefficient, why is it that the total cost of health care in the UK is HALF of what it is in the US (in terms of GDP)?

[gravenewworld]

Emotions say tort reform would save a lot of money, but the facts (or lack thereof) so far say otherwise:

http://www.cbo.gov/ftpdocs/49xx/doc4968/01-08-MedicalMalpractice.pdf


Evidence from the states indicates that premiums for malpractice
insurance are lower when tort liability is restricted
than they would be otherwise. But even large savings
in premiums can have only a small direct impact on
health care spending—private or governmental—because
malpractice costs account for less than 2 percent of that
spending.3 Advocates or opponents cite other possible effects
of limiting tort liability, such as reducing the extent
to which physicians practice “defensive medicine” by conducting
excessive procedures; preventing widespread
problems of access to health care; or conversely, increasing
medical injuries. However, evidence for those other
effects is weak or inconclusive.

[turbo-1]

Those costs do not magically go away -- they are just going to be passed on in the form of "taxes" rather than in the form of "higher charges".My point is that we already pay these costs in the current system, in the form of higher fees for service. Hospitals and medical practices pad their fees because they know that they are going to have to treat the uninsured and need to keep their profits up. With the recent job-losses, many more people are losing insurance coverage, and that will place additional pressure on ERs, etc.

My wife had to change doctors after her employer switched carriers and ended up with a plan that he couldn't afford to participate with. With a single doctor and a single staffer, the coding requirements, paperwork, etc would have sunk his practice. He is an Osteopathic country-doctor in a rural area, and he only charges $60 for an office visit. That still can be a lot of money for an out-of work uninsured person to come up with, but it's far cheaper than letting the uninsured get sicker until they show up at the ER. Give people access to preventive care and the their medical needs will be addressed before they need to resort to an ER.

There really needs to be a public option that will cover all people. I have a disability (pre-existing condition) that would prevent me from ever getting private insurance if my wife should lose her job. How many people in this country are at risk this way? Getting denied insurance coverage puts you just one serious illness away from bankruptcy, and that's unconscionable.

[WhoWee]

Emotions say tort reform would save a lot of money, but the facts (or lack thereof) so far say otherwise:

http://www.cbo.gov/ftpdocs/49xx/doc4968/01-08-MedicalMalpractice.pdf

The cost isn't just from lawsuits.

The hidden costs often include ordering extra tests to cover the doctor and hospital. Medicine has come a long way from ancient times. Doctors have a difficult job and are often forced to make fast decisions. Their priority should be in saving the patients, not shielding themselves from litigation.

I believe that doctors should be held accountable, but there needs to be reasonable limits and expectations.

[gravenewworld]

The cost isn't just from lawsuits.

The hidden costs often include ordering extra tests to cover the doctor and hospital. Medicine has come a long way from ancient times. Doctors have a difficult job and are often forced to make fast decisions. Their priority should be in saving the patients, not shielding themselves from litigation.

I believe that doctors should be held accountable, but there needs to be reasonable limits and expectations.

Maybe I need to REPOST with bolded words. Try reading the PDF this time before posting please.

http://www.cbo.gov/ftpdocs/49xx/doc4968/01-08-MedicalMalpractice.pdf

Evidence from the states indicates that premiums for malpractice
insurance are lower when tort liability is restricted
than they would be otherwise. But even large savings
in premiums can have only a small direct impact on
health care spending—private or governmental—because
malpractice costs account for less than 2 percent of that
spending.3 Advocates or opponents cite other possible effects
of limiting tort liability, such as reducing the extent
to which physicians practice “defensive medicine” by conducting
excessive procedures; preventing widespread
problems of access to health care; or conversely, increasing
medical injuries. However, evidence for those other
effects is weak or inconclusive.


States that have enacted forms tort reform still haven't seen their health costs go down significantly. Why?

[WhoWee]

Maybe I need to REPOST with bolded words. Try reading the PDF this time before posting please.

http://www.cbo.gov/ftpdocs/49xx/doc4968/01-08-MedicalMalpractice.pdf




States that have enacted forms tort reform still haven't seen their health costs go down significantly. Why?

I read your post and I deal with this issue daily.

Maybe you need to post the specifics of their reforms in bold. Perhaps their reforms were not adequate or focused?

Perhaps the trial lawyers helped draft the reforms?

[gravenewworld]

I read your post and I deal with this issue daily.

Maybe you need to post the specifics of their reforms in bold. Perhaps their reforms were not adequate or focused?

Perhaps the trial lawyers helped draft the reforms?

Effects on Defensive Medicine

Proponents of limiting malpractice liability have argued
that much greater savings in health care costs would be
possible through reductions in the practice of defensive
medicine. However, some so-called defensive medicine
may be motivated less by liability concerns than by the
income it generates for physicians or by the positive (albeit
small) benefits to patients. On the basis of existingstudies and its own research, CBO believes that savingsfrom reducing defensive medicine would be very small.
A comprehensive study using 1984 data from the state of
New York did not find a strong relationship between the
threat of litigation and medical costs, even though physicians
reported that their practices had been affected by
the threat of lawsuits.14 More recently, some researchers
observed reductions in health care spending correlated
with changes in tort law, but their studies were based on a
narrow part of the population and considered spending
for only a few ailments. One study analyzed the impact of
tort limits on Medicare hospital spending for patients
who had been hospitalized for acute myocardial infarction
or ischemic heart disease; it observed a significant
decline in spending in states that had enacted certain tort
restrictions.15 Other research examined the effect of tort
limits on the proportion of births by cesarean section. It
also found savings in states with tort limits, though of a
much smaller magnitude.16
However, when CBO applied the methods used in the
study of Medicare patients hospitalized for two types of
heart disease to a broader set of ailments, it found no evidence
that restrictions on tort liability reduce medical
spending. Moreover, using a different set of data, CBO
found no statistically significant difference in per capita
health care spending between states with and without
limits on malpractice torts. Still, the question of whether
such limits reduce spending remains open, and CBO
continues to explore it using other research methods.



This CBO report here probably will answer a lot of questions you have, it's kind of long but worth the read:

http://www.cbo.gov/ftpdocs/55xx/doc5549/Report.pdf



The evidence that tort reform would have a significant impact on defensive medicine has been weak so far. Who says doctors aren't ordering more tests simply to line their own pockets?

[WhoWee]

Here's something else to consider, how many of the service providers in the study operate in states outside of the one's with reforms? How many of those hospital networks have system-wide policies in place to protect the organization as a whole?

Insurance companies and health service providers deal must conform to the rules of each individual state - this also adds cost.

[WhoWee]

This CBO report here probably will answer a lot of questions you have, it's kind of long but worth the read:

http://www.cbo.gov/ftpdocs/55xx/doc5549/Report.pdf



The evidence that tort reform would have a significant impact on defensive medicine has been weak so far. Who says doctors aren't ordering more tests simply to line their own pockets?

Don't forget, doctors can order tests until their pens break, the insurance companies (or patients) have to pay for those tests.

The tests have to be a good business decision or the insurance companies will not go along.

Isolated incidents where patients ultimately pay for unnecessary tests based upon emotions is unfortunate and unacceptable.

[turbo-1]

The evidence that tort reform would have a significant impact on defensive medicine has been weak so far. Who says doctors aren't ordering more tests simply to line their own pockets?Doctors who own diagnostic equipment or who own a share of a local hospital can certainly drive up costs in the quest for profit. You might be surprised to learn, though, that some of the "unnecessary" diagnostic testing is done to satisfy the insurance companies. If a doctor performs a procedure on a patient without jumping through all the insurance companies' hoops, the claim will be denied. Each insurance company has its own requirements, and if the doctor has not provided the specific diagnostic evidence they require, they will not pay for the treatment. Insurance companies drive up the administrative costs in medical practices and hospitals and actually foster more spending on diagnostic testing than one might expect.

[WhoWee]

Doctors who own diagnostic equipment or who own a share of a local hospital can certainly drive up costs in the quest for profit. You might be surprised to learn, though, that some of the "unnecessary" diagnostic testing is done to satisfy the insurance companies. If a doctor performs a procedure on a patient without jumping through all the insurance companies' hoops, the claim will be denied. Each insurance company has its own requirements, and if the doctor has not provided the specific diagnostic evidence they require, they will not pay for the treatment. Insurance companies drive up the administrative costs in medical practices and hospitals and actually foster more spending on diagnostic testing than one might expect.

Turbo brought up another very interesting point - who owns the MRI's and other equipment? Is it wrong for doctor's to invest in equipment they understand - and can guarantee clients will use?

Going back to my earlier post, it might be wise for the Government to not only invest in clinics - staffed by doctors who receive tax credits for services rendered - but to invest in the diagnostic and research labs - and leave the management and operations to the professionals.

I'm 100% in favor of Government investment in hard assets and underwriting high risk insurance pools - just not anything that involves administration or control.

[turbo-1]

I should add that not only do the diagnostic tests have to match the insurance companies' requirements, but that the tests, diagnoses, and treatments have to be coded to match the insurance companies' coding requirements before they will reimburse the doctor/clinic/hospital.

I suggest that anyone interested in reducing the administrative cost burdens on health-care providers Google on "medical coding specialists" to see what those people do. Coding specialists can make or break your facility, and the plethora of coding standards imposed by the various private insurers is quite daunting. My cousin is a coding specialist for a small pediatric ophthalmic practice that takes lots of Medicaid applicants. The saving grace in that client-base is that the coding requirements are rather stable and monolithic, so she can do the job all by herself, even though she has to spend most of her time wading through the ever-changing coding requirements of the private insurers.

[WhoWee]

This is an example of hidden costs

"For affected organizations, HIPAA compliance can be a costly, Herculean task. In fact, many
of these efforts have been compared with Y2K preparations in terms of their impact and costs.
Surveys project upgrade costs to vary from $10,000 for a small private practice to $14 million
for a larger organization (Nunn, McGuire, 2005). The average cost of $3.1 million from
surveyed firms is considerably more expensive than the projected average estimate of
$450,000 that was done prior to implementation."

http://lorrie.cranor.org/courses/fa05/mpimenterichaa.pdf

There is a big gap between an estimate of $450,000 and an actual cost of $3,100,000.

We are all paying for these Government mandated regulations.

[WhoWee]

Now consider the irony of the IRS enforcing health insurance mandates.

[Count Iblis]

The brutal truth about America’s healthcare (http://www.independent.co.uk/news/world/americas/the-brutal-truth-about-americarsquos-healthcare-1772580.html)

[sylas]

The brutal truth about America’s healthcare (http://www.independent.co.uk/news/world/americas/the-brutal-truth-about-americarsquos-healthcare-1772580.html)

Mostly I've been watching this thread with fascination mingled with horror.

What I find most interesting in this link here is not the article itself, nor the story it tells in support, but some of the comments following after the story, from americans... which tends to echo some of what I am reading here in this thread.

See, for example, one rather extreme example: this comment from "independentusa" (http://news.independentminds.livejournal.com/3753821.html?thread=22834525#t22834525). This comment represents what is sometimes taken as a convenient caricature of the USAmerican by some of us in other countries.

The commenter does not actually say anything much about health care or the story in the the article, but merely asserts that "A majority of Americans DO NOT want universal health care as you have in England."

And why not? Because its "socialized". It would be a "handout" to the "poor and illegal migrants". It is "government is trying to force Progressive and Liberal ideas down our throats". In this person's comment, "liberal" and "progressive" are negative terms. (Which is wierd in itself.) All the things that are "liberal" and "progressive", such as diversity, inclusiveness, social justice and a lot more (there's a list given) are, for this commenter, just ways of saying "redistribution of wealth".

The whole comment is just surreal.

But here's the thing. The commenter is wrong. The government has recently changed in the USA towards these more liberal ideas because it was voted that way by a very clear majority of citizens. Far from representing a majority of Americans, this comment seems to be the shill cry of an extreme point on a side of conservative political thought that is a minority. Most USAmericans don't deserve this kind of comment as their caricature.

Cheers -- sylas

[cristo]

See, for example, one rather extreme example: this comment from "independentusa" (http://news.independentminds.livejournal.com/3753821.html?thread=22834525#t22834525). This comment represents what is sometimes taken as a convenient caricature of the USAmerican by some of us in other countries.

That guy's clearly an idiot, though. Someone who says something like

We Americans have empathy with our friends in England, and think that it is wrong of your government to CENSURE englander's FREE SPEECH. SPEECH CODES ARE SIMPLY WRONG. WE MUST ALLOW ALL TYPES OF SPEECH, EVEN WHEN THEY ARE LABELED AS "HATE SPEECH", in order to hear ALL ideas period.

and

The main source of TRUTH in our media right now is FOX NEWS CHANNEL period.

doesn't deserve to be taken seriously! The former comment is presumably pointed towards the BNP party, who recently won a few seats in the European parliament. Well, whilst I would agree that they are permitted to stand for elections, and to campaign, such campaigns which are based upon racism and bigotry should not be permitted. Perhaps this guy thinks racist rallies should be allowed, but in which case he cannot empathise with me, as a British citizen. The latter comment is clearly nonsense, as anyone with two brain cells will be able to see.

[sylas]

That guy's clearly an idiot, though.

Of course. He or she represents an extreme that is sometimes used as a stereotype of the ugly american. I'm noting that the extreme is there, but that it is an extreme, and not fair as a generalization of Americans. But imagine, if you can bear it, how it comes across to readers in the UK.... where the article appears.

Cheers -- sylas

[Al68]

It's not an outright hateful lie. I only wish it were not true. Right now, if you own a small business and offer health insurance to your employees and one of your employees comes down with a catastrophic illness the insurance company will either jack up your rates or refuse to renew your policy. If you have been paying for private coverage for years and you come down with a catastrophic illness, it's likely that your insurance company will drop you on some pretext to avoid paying for your care. This is the status quo, and this is the system that the GOP wants to perpetuate. We can speculate about their motivations, but the end result is the same.Being against the current proposal, as I am, does not constitute being in favor of "wanting insurance companies to decide who lives and dies", and again, you know it.

It's obvious you have contempt for the idea that an insurance policy is a voluntary agreement on both sides, which means it can be withdrawn by either side for any reason. This is what freedom of contract means.

My contract with my insurance company isn't a "system", it's a voluntary agreement on both sides that government is not a party to. Why is the concept of a private agreement so difficult to understand?

Bottom line is that those who advocate the government's use of force are the ones that have an obligation to defend their position. Those of us that think people who want to be left alone should be left alone have no such obligation, despite the hateful lies accusing us of wanting to perpetuate some imaginary system.

[lisab]

Of course. He or she represents an extreme that is sometimes used as a stereotype of the ugly american. I'm noting that the extreme is there, but that it is an extreme, and not fair as a generalization of Americans. But imagine, if you can bear it, how it comes across to readers in the UK.... where the article appears.

Cheers -- sylas

Given that there are over 300,000,000 of us, I don't think there is a "fair generaliztion of Americans." In fact when I read any statement that begins with "Americans are...", my eyes automatically roll. I would call it a knee-jerk reaction but my knees aren't affected :tongue2:.

And as far as how we come across to the Brits...well, they're our closest ally (despite that little spat some 230 years ago). I feel confident that idiots like that commenter aren't going to affect the bond between our countries. I do wish that their experience with their medical system was better known and understood by my fellow citizens, though.

[Al68]

See, for example, one rather extreme example: this comment from "independentusa" (http://news.independentminds.livejournal.com/3753821.html?thread=22834525#t22834525). This comment represents what is sometimes taken as a convenient caricature of the USAmerican by some of us in other countries.

The commenter does not actually say anything much about health care or the story in the the article, but merely asserts that "A majority of Americans DO NOT want universal health care as you have in England."

And why not? Because its "socialized". It would be a "handout" to the "poor and illegal migrants". It is "government is trying to force Progressive and Liberal ideas down our throats". In this person's comment, "liberal" and "progressive" are negative terms. (Which is wierd in itself.) All the things that are "liberal" and "progressive", such as diversity, inclusiveness, social justice and a lot more (there's a list given) are, for this commenter, just ways of saying "redistribution of wealth".I just read that link, and while I don't agree with everything he said, you misinterpreted it completely. He was referring to the fact that the words "liberal", "progressive", "diversity", "social justice", etc. are commonly mis-used to refer to oppression. He was saying that "social justice" was used as a a code word for policies he disagreed with, not that he actually disagreed with social justice.

The word "liberal" is rarely used according to its dictionary definition in the U.S. It is mostly incorrectly used as a synonym for "socialist". Actual liberals in the U.S. are referred to most commonly as "right wing wacko extremists".

[noblegas]

Insurance is meant to be used in case of emergencies, i.e. when you are diagnosed with cancer or when you cut off your hand and subsequently lose a ton of blood; Insurance is not meant to be used when you have a minor ailment like a cold or body aches; If americans would allocate their earnings that would be used for typical doctor visits and used there health insurance exclusively for emergencies, health care insurance would not be as expensive; Look at it this way; Most people wouldn't used their car insurance to add extra car accesories like Monster wheels , rims , those neon lights on the bottom of some cars ,or a better quality engine, they used their insurance when their car is severely damaged, because the owner knows the cost of insurance will increase; People should used their insurance when its absolutely necessary

[sylas]

I just read that link, and while I don't agree with everything he said, you misinterpreted it completely. He was referring to the fact that the words "liberal", "progressive", "diversity", "social justice", etc. are commonly mis-used to refer to oppression. He was saying that "social justice" was used as a a code word for policies he disagreed with, not that he actually disagreed with social justice.


I don't agree; I think I understand him just fine, and that he -- and you -- use words in ways that don't fit with normal usage in the rest of the world. That's the point. We can add "oppression" to this list of words, in my opinion.

Cheers -- sylas

[lisab]

Insurance is meant to be used in case of emergencies, i.e. when you are diagnosed with cancer or when you cut off your hand and subsequently lose a ton of blood; Insurance is not meant to be used when you have a minor ailment like a cold or body aches; If americans would allocate their earnings that would be used for typical doctor visits and used there health insurance exclusively for emergencies, health care insurance would not be as expensive; Look at it this way; Most people wouldn't used their car insurance to add extra car accesories like Monster wheels , rims , those neon lights on the bottom of some cars ,or a better quality engine, they used their insurance when their car is severely damaged, because the owner knows the cost of insurance will increase; People should used their insurance when its absolutely necessary

Not sure where you're posting from, noblegas. Are you aware of what health care costs in the US? It's very expensive. Something simple, like a broken arm or a root canal, can cost thousands of dollars...an expense many people can't afford.

[f95toli]

Just out of curiosity:
How many of those opposing the suggested health care reform are "extreme" laissez-faire liberals? I.e. they oppose the very idea of the state being involved in health care at all (i.e. not even in case of emergencies: if you can't pay you don't get the necessary treatment even if it means you die).
I've seen a quite a few comments that could be interpreted that way; but only one or two where someone has openly expressed that opinion.

I must say I find it hard to understand how someone could think that it is right to e.g. let a child die if the parents can't afford to pay for treatment (which was the essence of one of the comments I saw, from a town hall meeting).

[noblegas]

I must say I find it hard to understand how someone could think that it is right to e.g. let a child die if the parents can't afford to pay for treatment (which was the essence of one of the comments I saw, from a town hall meeting).

There is no outrage over starvation in this country about starving children and there is no big push in washington for food insurance because starvation is minimal to non-existent in the US or no push in washington for "universal food coverage". Why is universal health coverage seen as a good and benevolent force for our society? We basically have universal education for all of our children, yet our kids our performing badly compared to other industrialized countries plus acquiring poor reading skills and critical thinking skills after they graduate; Yet when someone suggest to privatize such institutions like education or healthcare to improve efficiency and quality , they are labeled as "greedy" and "cold-hearted" "robberbarons" out for only profit; I also wanted to add that children are covered for those who can't afford it; http://en.wikipedia.org/wiki/Medicaid ; http://en.wikipedia.org/wiki/State_Children%27s_Health_Insurance_Program

[mheslep]

Yes, generally, regarding Medicaid it is true.
Again are you reading different things to me? You say: And in the US if one has no or very little income (<~20k/yr), then they are eligible for government based health care via the Medicaid program as I posted before, and before, and before.


...Yet, I quoted from the source:So did I, more extensively than you did.

The poverty line in the US is something like a wage of $10,000. Now, pray tell, if the medicaid guidelines state that being in poverty is not sufficient to receive aid, how is every person with a wage of $20,000 eligible to receive such aid?I never said 'every', I added 'generally' in the second post, and sourced some of the caveats (e.g. large assets). 'Generally' in this case meaning (again) that Medicaid covers
approximately 58 million low-income Americans. (http://www.cdc.gov/pcd/issues/2009/Jul/08_0153.htm) which is pretty damn general.

Likewise the poverty guidelines are much more complicated than 'something like a wage of $10,000'. It turns out that the poverty level for a family of four in 2005 was $19,350. Some states extend eligibility up to 250% of the poverty level (http://books.google.com/books?id=bs4XwhXsVsIC&pg=PA157&lpg=PA157&dq=medicaid+percentage+of+poverty+level+income&source=bl&ots=PZ2eoimgr-&sig=LbnmQSGp5ETLl-NWNunyeMQqD44&hl=en&ei=kGKHSuyWHYP8tgfkwtXnDA&sa=X&oi=book_result&ct=result&resnum=2#v=onepage&q=&f=false), covering the family of four up to $48,375
http://www.cms.hhs.gov/MedicaidEligibility/Downloads/MedicaidataGlance05.pdf, pg 6.

Your figures just don't add up, yet you try say that I'm wrong. Prove it, or stop making such claims. That's now (at least) two cases of misinformation you've made in this thread, and this discussion is getting pretty tiresome.These unexamined responses are growing tiresome.

[noblegas]

Not sure where you're posting from, noblegas. Are you aware of what health care costs in the US? It's very expensive. Something simple, like a broken arm or a root canal, can cost thousands of dollars...an expense many people can't afford.

Well , as a healthcare insurance provides insurance to a growing pool of people, insurance will inevitably go up for everyone ; So therefore , I expect healthcare expenses also to rise; What has also been contributing to the costly expenses are the health care insurance companies paying for a large bulk of administrative expenses . As much as 30 percent of the costs derive from administrative expenses. (http://www.pnhp.org/publications/nejmadmin.pdf); I think cost would be reduced if competition were encouraged on a global scale , i.e. being able to choose health insurances plans outside the state and nation you live in, being able to buy medical drugs legally outside the country; I think the customers would be happy with the quality of the healthcare they received if the healthcare services provided to them were between just the patient and the doctor;

[mheslep]

Given that there are over 300,000,000 of us, I don't think there is a "fair generaliztion of Americans." In fact when I read any statement that begins with "Americans are...", my eyes automatically roll. ...Amen. It's a huge country.

[Al68]

I just read that link, and while I don't agree with everything he said, you misinterpreted it completely. He was referring to the fact that the words "liberal", "progressive", "diversity", "social justice", etc. are commonly mis-used to refer to oppression. He was saying that "social justice" was used as a a code word for policies he disagreed with, not that he actually disagreed with social justice. I don't agree; I think I understand him just fine, and that he -- and you -- use words in ways that don't fit with normal usage in the rest of the world. That's the point. We can add "oppression" to this list of words, in my opinion.Well, I suppose you believe he is against what he himself considers to be "social justice", then.

As far as using words differently from others, I pointed out that it was very common for the word "liberal" to be used as a synonym for socialist, and you're right, I don't and won't use it that way because the dictionary defines the word "liberal" to mean just the opposite.

The fact that a word is commonly misused for the purpose of misleading people doesn't obligate me to use it the same way, just because others do as "normal usage".

And I used the word oppression to mean economic oppression, ie the restricting of economic liberty, the same way any libertarian or classical liberal would. And of course it's not "normal usage" today because libertarianism/classical liberalism is not the norm.

Edit: What word should I use, instead of "oppression", to refer to the use of force by government to restrict individual liberty?

Here's an example of the word liberal used according to the dictionary definition:
Just out of curiosity:
How many of those opposing the suggested health care reform are "extreme" laissez-faire liberals? I.e. they oppose the very idea of the state being involved in health care at all...Although I certainly disagree with the suggestion in that post that anyone thinks it's "right" to let children die, at least the word liberal is used correctly, ie not the way it "normally" is.

[Al68]

Just out of curiosity:
How many of those opposing the suggested health care reform are "extreme" laissez-faire liberals?Virtually all of the opposition I've seen to the current proposal has been (at least partially) on that basis, even though some of the objections are from people who are not completely "laissez-faire liberals". None of this opposition has been even acknowledged by those politicians advocating the plan.

They seem to be under the delusion that anyone who opposes their plan must be against their goals and motives, not the substance of their plan. Or more likely they would just rather debate a strawman than the actual objections to their plan.

Edit: Your use of the word "extreme" reminds me of a Barry Goldwater quote: "Extremism in defense of liberty is no vice."

[cristo]

'Generally' in this case meaning (again) that Medicaid covers
... which is pretty damn general.

That's not what it means to append the word generally to your previous comment. If you're saying that, in general, the following statement is true:

And in the US if one has no or very little income (<~20k/yr), then they are eligible for government based health care via the Medicaid program as I posted before, and before, and before.

Then it means that most people with an income less than $20,000 a year are eligible for Medicaid support. However, I have shown that the poverty line is around $10,000, and that medicaid doesn't even support all people in poverty, thus most people earning less than $20,000 are not supported.



Likewise the poverty guidelines are much more complicated than 'something like a wage of $10,000'. It turns out that the poverty level for a family of four in 2005 was $19,350.

So now we're talking about families of four. Your previous statement was talking about "one". You should really tell your opposition if you decide to move the goalposts mid match.



These unexamined responses are growing tiresome.

Stop making snarky little responses like this. Since you have refused to retract your previous statements of misinformation, I can only assume that everything you state in future will be liberally sprinkled with false information. Note that this is strictly against PF rules.

[cristo]

Of course. He or she represents an extreme that is sometimes used as a stereotype of the ugly american. I'm noting that the extreme is there, but that it is an extreme, and not fair as a generalization of Americans. But imagine, if you can bear it, how it comes across to readers in the UK.... where the article appears.

Cheers -- sylas

I am in the UK! I think it does come across as the stereotypical American point of view. Then again, if you read lots of comments to news articles, you will get similar types of comments. I think as a rule, such commenters are a different breed. It is somewhat insulting, as I mentioned above, for someone to "empathise" with me with something they know nothing about (presuming that the BNP situation is what that guy was alluding to).

[Al68]

Then it means that most people with an income less than $20,000 a year are eligible for Medicaid support. However, I have shown that the poverty line is around $10,000, and that medicaid doesn't even support all people in poverty, thus most people earning less than $20,000 are not supported. This is faulty logic, independent of whether the conclusion is true or false.

Clearly not everyone who made < $10,000/yr would not be eligible, since there are other factors. One example is someone who has a lot of cash in the bank while taking time off from working.

That fact doesn't imply anything about the percentage of people who make under $20,000/yr that are eligible, except that it's not 100%.

[cristo]

This is faulty logic, independent of whether the conclusion is true or false.

Now you're just picking an argument for the sake of it.

Note that I was not the one making the claim that almost all people earning less than $20,000 a year is eligible for support. I simply refuted this claim.

Of course, such a statement does not have impeccable logic since there are far too many unknowns. However, one needs to make reasonable assumptions. It is a reasonable assumption to say that there are probably around the same number of people earning $10,000 to £20,000 as there are earning under $10,000 (in fact there are probably more). It is also a reasonable assumption to say that most of these people probably do not have extenuating circumstances. Thus, since not all the people earning less than $10,000 are eligible, it is reasonable to draw the conclusion that a lot less than all people earning less than $20,000 are eligible. So, a statement like "And in the US if one has no or very little income (<~20k/yr), then they are eligible for government based health care via the Medicaid program as I posted before, and before, and before." is false.

Of course, had the member above adhered to PF rules and refrained from making unsubstantiated claims, then we would not be having this discussion. Since he did not, and so he has not presented any information to support his claims, there's little more I can do than argue following reasonable assumptions.

[drankin]

Insurance is meant to be used in case of emergencies, i.e. when you are diagnosed with cancer or when you cut off your hand and subsequently lose a ton of blood; Insurance is not meant to be used when you have a minor ailment like a cold or body aches; If americans would allocate their earnings that would be used for typical doctor visits and used there health insurance exclusively for emergencies, health care insurance would not be as expensive; Look at it this way; Most people wouldn't used their car insurance to add extra car accesories like Monster wheels , rims , those neon lights on the bottom of some cars ,or a better quality engine, they used their insurance when their car is severely damaged, because the owner knows the cost of insurance will increase; People should used their insurance when its absolutely necessary

Here's what's going on. The bulk of the US citizens cannot manage their money far enough to cover themselves in the case of an emergency. There is no savings. So, what does a voter do when they don't have a savings? They vote in a handout.

The purpose for insurance is to cover you in the case of an emergency. An insurance company is a for profit institution. If you don't like it, don't start a policy. And SAVE yourself enough money to cover your azz if you have a catastrophic emergency. It's incredible to me to see so many people think that they are entitled to health care. I just don't get the mentality.

It's fundamental. The more responsibility you do not take for yourself, the less liberty you will have.

[WhoWee]

Insurance is meant to be used in case of emergencies, i.e. when you are diagnosed with cancer or when you cut off your hand and subsequently lose a ton of blood; Insurance is not meant to be used when you have a minor ailment like a cold or body aches; If americans would allocate their earnings that would be used for typical doctor visits and used there health insurance exclusively for emergencies, health care insurance would not be as expensive; Look at it this way; Most people wouldn't used their car insurance to add extra car accesories like Monster wheels , rims , those neon lights on the bottom of some cars ,or a better quality engine, they used their insurance when their car is severely damaged, because the owner knows the cost of insurance will increase; People should used their insurance when its absolutely necessary

You've outlined the basic premise of high deductible, catastrophic policies, and Health Savings Accounts (HSA's). A few earlier posts discuss their application and the potential consequences/changes to them under consideration.

[mheslep]

Then it means that most people with an income less than $20,000 a year are eligible for Medicaid support. However, I have shown that the poverty line is around $10,000, and that medicaid doesn't even support all people in poverty, thus most people earning less than $20,000 are not supported. You did not show, you asserted, twice now. The poverty guidelines are as I have posted from the source above.

So now we're talking about families of four. Your previous statement was talking about "one". You should really tell your opposition if you decide to move the goalposts mid match.yes and I also said (http://www.physicsforums.com/showpost.php?p=2309163&postcount=387)
Yes, generally, regarding Medicaid it is true. Clearly the eligibility criterion are more complex than my one sentence statement, it includes other things including the size of ones assets, such as a fat bank account or a flashy boat in the backyard.
I did not immediately address dependents. I followed up with the full poverty guidelines posting above. For that matter, 'one' can still be one wage earner, with any number of dependents, and in some states Medicaid eligibility extends up to 250% of poverty, or almost $24k (http://www.physicsforums.com/attachment.php?attachmentid=20125&d=1250387948) for one person with no dependents.

You seem to be hanging on the assertion you made above:...Now, pray tell, if the medicaid guidelines state that being in poverty is not sufficient to receive aid...which is incomplete. The Medicaid guidelines state, that low income by itself is not sufficient to receive aid. There are other criterion, especially asset size. Never the less, low income groups are the primary target of the program. Again, from the HHS Overview of Medicaid:
In general, you should apply for Medicaid if your income is low and you match one of the descriptions of the Eligibility Groups.
http://www.cms.hhs.gov/MedicaidGenInfo/

[cristo]

In general, you should apply for Medicaid if your income is low and you match one of the descriptions of the Eligibility Groups.

What about those who don't fit into the eligibility groups? You're just cherrypicking statistics, and rearranging your argument so it sounds like you know what you're talking about. Dear god, this is like smacking my head against a brick wall.

[mheslep]

What about those who don't fit into the eligibility groupsAlready addressed, repeatedly. Not every low income person qualifies, yet 53 million are covered by Medicaid
You're just cherrypicking statistics, and rearranging your argument so it sounds like you know what you're talking about. Nonsense. They figures and sources are there for all to see.
Dear god, this is like smacking my head against a brick wall.
Stop making snarky little responses like this...

[cristo]

Not every low income person qualifies, yet 53 million are covered by Medicaid


You use the phrase "in general" but you don't know what the phrase means. It means "in all cases but a few exceptions" but you think it means "oh, this is a really big number.. wow, it's pretty general". You're just wrong: face it, and move on. Seriously. This is really boring.

[WhoWee]

The debate over health care is often side-tracked as evidenced in the last several posts. Until the debate re-focuses on the specific problems inherent to both the Government and private insurance programs (plus the cause and effect of current mandates), and addresses specific and well thought out solutions, nothing productive will ever be accomplished.

If the politicians choose to use this to grab power and ram-rod "reform" through Congress the way the stimulus package was handled - no time to read the Bill - just throw money at it - the results could be catastrophic to both health care and the economy.

It's time for a serious adult conversation - no politics - health care (and reform) is too important to fail - and we need to take as much time as necessary to get it right.

[turbo-1]

It's time for a serious adult conversation - no politics - health care (and reform) is too important to fail - and we need to take as much time as necessary to get it right.Thank you!!! I don't favor delay for the sake of obstuctionism, but hope that some adults (if there are any) in Congress will try to put something together that works for the common good. Too many people are marginalized or bankrupted by the current system, and that's no way to treat people.