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]

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]

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.

[JaredJames]

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!

[JaredJames]

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.

[JaredJames]

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.

[JaredJames]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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.

[Jimmy Snyder]

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:

[Jimmy Snyder]

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.

[Jimmy Snyder]

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.

[Jimmy Snyder]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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.

[Ivan Seeking]

I thought Tom Daschle put the issue of health care into perspective nicely with this statement on Meet The Press, this morning:

We have islands of excellence in a sea of mediocrity

[WhoWee]

I thought Tom Daschle put the issue of health care into perspective nicely with this statement on Meet The Press, this morning:

I'm not sure of the context of the statement, but have to agree if he meant that we do have the best components to start with and can build a system second to none.

[Ivan Seeking]

I'm not sure of the context of the statement, but have to agree if he meant that we do have the best components to start with and can build a system second to none.

That is more or less my understanding of his statement as well as my perspective. For example, there is no doubt that advanced FMRI, Spiral CT, PET, and diagnostic imaging technologies generally are second to none. Heck, it is impossible to even keep up at times. But the problem that I saw personally with these technolgies was the cost. Back in the bad old days of CT, I can remember circuit boards covered with perhaps 20 or 30 chips - all TTL and early CMOS - costing $100,000 each. Then, the additional cost of the support contracts was absurd. Like so much of technology, the development costs, and more importantly I think, the cost of continued advances is put on the user [patient].

While a non-invasive scan beats exploratory surgery every time, the continual cost burden of purchasing and maintaining state-of-the-art technologies plays a large role in driving the cost of health care. In the meantime, the essentials of medicine take a back seat and it becomes a money game. That is why in part we see things as ridiculous as a pianist playing a grand piano in the lobby of a major hospital; or a woman vomiting blood until she dies in the ER waiting room, unassisted.

Another minor absurdity that comes to mind is the tendency for hospitals to remodel and install carpeting in areas where hospital workers have to push gurneys. Not only does this present problems when body fluids hit the floor, but it also puts a burden on the workers who have to push the gurney. The reason for the carpeting is that it looks nice for investors, as does a fine grand piano. But perhaps my favorite example was the ER entry [internal access] that was too narrow for a gurney! Talk about missing the mark!!!

Some hospitals now require medical workers to wear nice clothes instead of scrubs. Why? Is it better or more practical? Heck no, but it looks nice.

The point: Decisions driving the industry are improperly motivated.

[wildman]

I finally found a answer on who pays for those emergency room calls by people without insurance. What apparently happens is that the hospital raises its rates on everyone. In other words it is a business cost which is expensed over its insured customers. The charity that Evo was talking about is all of us.

[wildman]

I finally found a answer on who pays for those emergency room calls by people without insurance. What apparently happens is that the hospital raises its rates on everyone. In other words it is a business cost which is expensed over its insured customers. The charity that Evo was talking about is all of us.

In other words, we already have a form of socialized medicine in the US whether we like it or not. The people with insurance and the government are paying for the poor and the uninsured. It is however a very strange and completely out of control form of socialized medicine and also VERY expensive.

In view of this, the debate about socialized medicine people are having in the US takes on a Twilight Zone kind of air. It is almost like people were debating whether automobiles should be allowed in American cities and almost half the people thought that there were no automobiles in our cities at the present time.....

[Al68]

I finally found a answer on who pays for those emergency room calls by people without insurance. What apparently happens is that the hospital raises its rates on everyone. In other words it is a business cost which is expensed over its insured customers. The charity that Evo was talking about is all of us.

In other words, we already have a form of socialized medicine in the US whether we like it or not. The people with insurance and the government are paying for the poor and the uninsured. It is however a very strange and completely out of control form of socialized medicine and also VERY expensive.

In view of this, the debate about socialized medicine people are having in the US takes on a Twilight Zone kind of air. It is almost like people were debating whether automobiles should be allowed in American cities and almost half the people thought that there were no automobiles in our cities at the present time.....Good point, kind of. But the issue is whether to greatly expand socialist policy, not whether socialist policy currently exists at all.

More like debating about whether or not to drastically increase the number of cars in our cities, to use your analogy.

[Al68]

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.The fact that these are necessities is more reason, not less, that there should be competition from multiple providers, instead of provided by government.

When private companies compete for consumers, the total price, including profits to shareholders, is much less than the total price if controlled by government, or any monopoly, even with zero profit. This is just basic economics, which some politicians count on people not understanding.

Treating private profit as if the same service would be cheaper without it is just faulty. The opposite is true. This is why the same politicians who want to take control of a private industry have no interest in competing with it instead.

[WhoWee]

That is more or less my understanding of his statement as well as my perspective. For example, there is no doubt that advanced FMRI, Spiral CT, PET, and diagnostic imaging technologies generally are second to none. Heck, it is impossible to even keep up at times. But the problem that I saw personally with these technolgies was the cost. Back in the bad old days of CT, I can remember circuit boards covered with perhaps 20 or 30 chips - all TTL and early CMOS - costing $100,000 each. Then, the additional cost of the support contracts was absurd. Like so much of technology, the development costs, and more importantly I think, the cost of continued advances is put on the user [patient].

While a non-invasive scan beats exploratory surgery every time, the continual cost burden of purchasing and maintaining state-of-the-art technologies plays a large role in driving the cost of health care. In the meantime, the essentials of medicine take a back seat and it becomes a money game. That is why in part we see things as ridiculous as a pianist playing a grand piano in the lobby of a major hospital; or a woman vomiting blood until she dies in the ER waiting room, unassisted.

Another minor absurdity that comes to mind is the tendency for hospitals to remodel and install carpeting in areas where hospital workers have to push gurneys. Not only does this present problems when body fluids hit the floor, but it also puts a burden on the workers who have to push the gurney. The reason for the carpeting is that it looks nice for investors, as does a fine grand piano. But perhaps my favorite example was the ER entry [internal access] that was too narrow for a gurney! Talk about missing the mark!!!

Some hospitals now require medical workers to wear nice clothes instead of scrubs. Why? Is it better or more practical? Heck no, but it looks nice.

The point: Decisions driving the industry are improperly motivated.

Ivan has hit upon something important. Hospitals compete for business - and capital, and talent. The beautiful new buildings and hi-def TV's and open balcony dining areas are all part of the marketing. However, the cost of amenities compared to the cost of the latest hi-tech machine is insignificant.

This is where one of my previous posts was headed. The Government has the wherewithal to fund capital equipment and real estate on a grand scale. The hospital networks can operate the facilities and equipment, and the insurance companies are well equipped to do their part. Government involvement doesn't have to be an expense to taxpayers. Healthcare is a profitable business model.

First, if Government were to make an investment in the buildings and equipment necessary to provide adequate care to everyone in the country, the health care system could lease the packages at a significant ROI to taxpayers. Each new hospital facility could include a preventative care/wellness clinic. By reducing the need to obtain capital, the health care networks would be more competitive - that is smaller players would have an equal opportunity to compete.

Second, if doctors were provided tax credits in exchange for services rendered in the new preventative care/wellness clinics the doors would open for everyone with minor health care issues - and remove the cost and burden from the emergency rooms.

Last, if the Government would guarantee high risk insurance pools, the doors would swing open and include everyone with pre-existing conditions. Managed properly, and with shared costs, this could reduce long term costs currently absorbed by Government plans.

This is of course over-simplified, but would address specific problems. In areas with well developed hospital networks, perhaps the Government could engage in sale/leaseback transactions to free capital for re-investment into research and add stand-alone preventative care/wellness clinics - even incorporate them into new school properties?

If everyone has the same building and equipment package, the networks will need to compete on the basis of quality and service - then we win as both consumers and investors.

[Al68]

Last, if the Government would guarantee high risk insurance pools, the doors would swing open and include everyone with pre-existing conditions.Assuming you mean that government would cover the cost of the pre-existing conditions, why would anyone ever buy medical insurance until after they're sick or injured? Then they can buy "insurance" at the discounted (subsidized) rate after they're sick/injured.

Of course, using the term "insurance" to refer to something that covers something pre-existing is a logical contradiction, so it might be more accurate to use the phrase "health care plan".

Obviously the cost of "insurance" for someone that's not already sick/injured is a fraction of the cost of a "health care plan" for someone already sick/injured. Are you suggesting that government cover the difference? If so, health "insurance" would no longer exist, because nobody would buy it.

If government covered the cost of car "insurance" paying for "pre-existing" damage, there would be no reason to buy car insurance until after the damage. (Actually this is exactly what some people have done, anyway).

[Count Iblis]

...why would anyone ever buy medical insurance until after they're sick or injured? Then they can buy "insurance" at the discounted (subsidized) rate after they're sick/injured.


And that's why in most Western countries health insurance is compulsory. If foreign tourists from third world countries visit a Western Euopean country, they won't even be let in unless they have proof that they have adequate health insurance.

[WhoWee]

Assuming you mean that government would cover the cost of the pre-existing conditions, why would anyone ever buy medical insurance until after they're sick or injured? Then they can buy "insurance" at the discounted (subsidized) rate after they're sick/injured.

Of course, using the term "insurance" to refer to something that covers something pre-existing is a logical contradiction, so it might be more accurate to use the phrase "health care plan".

Obviously the cost of "insurance" for someone that's not already sick/injured is a fraction of the cost of a "health care plan" for someone already sick/injured. Are you suggesting that government cover the difference? If so, health "insurance" would no longer exist, because nobody would buy it.

If government covered the cost of car "insurance" paying for "pre-existing" damage, there would be no reason to buy car insurance until after the damage. (Actually this is exactly what some people have done, anyway).

I posted earlier in greater detail.

However, what I'm addressing is the need to create high risk insurance pools co-funded/guaranteed by the Government - similar in concept to what is done after an emergency is declared after a national disaster. Insurance companies pay their claims and the Government helps the under-insured and uninsured.

[Al68]

And that's why in most Western countries health insurance is compulsory.Yeah, I know. And that's why the proposed bill in the U.S. makes it compulsory (or charges a stiff tax penalty). And it makes it compulsory to buy a (much more expensive) health care plan that covers all pre-existing conditions, even if they have none. And it forces people to buy insurance to cover the kinds of things a lot of people would never voluntarily buy insurance for. Most Americans don't realize what this bill contains, or its true purpose. Obviously, if the purpose were to just help poor people get insurance, they would just propose expanding Medicare.

And if the goal were just to make insurance cheaper, they would just propose establishing a public insurance company to compete with the private ones.

They aren't even considering those two options, yet they claim those are their purposes.

[Al68]

I posted earlier in greater detail.

However, what I'm addressing is the need to create high risk insurance pools co-funded/guaranteed by the Government - similar in concept to what is done after an emergency is declared after a national disaster. Insurance companies pay their claims and the Government helps the under-insured and uninsured.Well, if all you meant was the equivalent of expanding Medicaid eligibility, it would have been simpler just to say so.:smile:

I must have misinterpreted your post, my bad.

[WhoWee]

Well, if all you meant was the equivalent of expanding Medicaid eligibility, it would have been simpler just to say so.:smile:

I must have misinterpreted your post, my bad.

That's not exactly what I'm saying. The Government doesn't have to carry the bulk of the burden.

[drankin]

I found this article today. According to Dr Ann Doig, "the incoming president of the Canadian Medical Association", the current system is "unsustainable".
http://www.foxnews.com/story/0,2933,539943,00.html

Of course it's from fox news. So we can discount what the Dr says outright.

[WhoWee]

I watched a panel style discussion with Kent Conrad over the weekend.

I think he's going to be a key player in shaping the final healthcare legislation. Here's a link to his website.

http://conrad.senate.gov/issues/healthcare.cfm

[Count Iblis]

I found this article today. According to Dr Ann Doig, "the incoming president of the Canadian Medical Association", the current system is "unsustainable".
http://www.foxnews.com/story/0,2933,539943,00.html

Of course it's from fox news. So we can discount what the Dr says outright.

The question is if this is a systematic problem in all of the Government regulated health care systems that exist in the Western World.

[drankin]

The question is if this is a systematic problem in all of the Government regulated health care systems that exist in the Western World.

I agree. But, if Dr Ann Doig is correct, the current Canadian model will not work for us.

[BoomBoom]

I finally found a answer on who pays for those emergency room calls by people without insurance. What apparently happens is that the hospital raises its rates on everyone. In other words it is a business cost which is expensed over its insured customers. The charity that Evo was talking about is all of us.

Correct, in addition, I believe we all are also paying for everyone's insurance that is provided by employers to employees in just about every product you buy and the (reduced) wages you earn. If anyone thinks these high healthcare costs aren't already passed on to all of us, then I suggest they are naive.

[turbo]

Correct, in addition, I believe we all are also paying for everyone's insurance that is provided by employers to employees in just about every product you buy and the (reduced) wages you earn. If anyone thinks these high healthcare costs aren't already passed on to all of us, then I suggest they are naive.Ding! Ding! Ding! Where do I sent the Cuban Cigar?


Health insurance is not a zero-sum game. It is a system through which many US citizens are denied health care, yet are forced to pay for other peoples' coverage. Probably the worst offenses are against people who have to buy private coverage, and whose hospital bills and charges for doctor's visits are jacked up by the business-model that pushes the costs of the uninsured onto the insured.

[wildman]

Good point, kind of. But the issue is whether to greatly expand socialist policy, not whether socialist policy currently exists at all.

More like debating about whether or not to drastically increase the number of cars in our cities, to use your analogy.

I don't see any expansion of socialist medicine??? Could you explain? Under the proposed plan, the people who have private insurance will keep it so no expansion there (or am I mistaken?) and the other people are simply moved from a very expensive model (emergency room visits) to a (hopefully) less expensive model (early visits to the doctor's office) of socialized medicine. So socialism would not increase at all. Or am I missing something?

[Al68]

I don't see any expansion of socialist medicine??? Could you explain? Under the proposed plan, the people who have private insurance will keep it so no expansion there (or am I mistaken?) and the other people are simply moved from a very expensive model (emergency room visits) to a (hopefully) less expensive model (early visits to the doctor's office) of socialized medicine. So socialism would not increase at all. Or am I missing something?Yes, you're missing a lot. The current proposal outlaws private insurance that is not part of the new "system" and meets its requirements (most normal private insurance. There is a grandfather clause, and employer based plans are legal for 5 years, but that's just relevant in the short term. The claim that an individual can just keep what he has is misleading, to say the least.

And anyone who doesn't buy the "new and improved" type of overly comprehensive health coverage will be charged a stiff income tax penalty.

The advocates have talked a lot about the goals of the proposal, but very little about the substance of it.

[mheslep]

I don't see any expansion of socialist medicine??? Could you explain? Under the proposed plan, the people who have private insurance will keep it so no expansion there (or am I mistaken?) and the other people are simply moved from a very expensive model (emergency room visits) to a (hopefully) less expensive model (early visits to the doctor's office) of socialized medicine. So socialism would not increase at all. Or am I missing something?

Under the draft House plan there will certainly be several million people leaving private insurance and joining the government public option. There is, however, substantial wonkish disagreement about how many millions. On the low side, the CBO [1] says some 6 million people would leave private, with 12 million total on the public option. On the high side the Lewin group [2] says 88 million will leave private, with ~100 million in total on the public option. The CBO report actually addresses the Lewin report. The President is technically right when he says the current proposal doesn't legally force people off private, but it appears it will set up a situation where its unaffordable for many of them or their employer to maintain private coverage.

If we assumed that workers at larger firms would be allowed to purchase coverage
through the exchanges, our estimate of the number of enrollees involved would
undoubtedly be greater than 6 million, but we have not estimated the magnitude. Analysts
at the Lewin Group recently estimated that if all employers were given access to the
insurance exchanges, more than 100 million people would end up enrolling in the public
plan.4 For several reasons, we anticipate that our estimate of the number of enrollees in
the public plan would be substantially smaller than the Lewin Group’s, even if we
assumed that all employers would have that option.

[1] http://www.cbo.gov/ftpdocs/104xx/doc10400/07-26-InfoOnTriCommProposal.pdf
[2] http://www.heritage.org/Research/HealthCare/upload/HouseBillHeritageRevised.pdf

[Al68]

The President is technically right when he says the current proposal doesn't legally force people off private, but it appears it will set up a situation where its unaffordable for many of them or their employer to maintain private coverage.Except for some grandfathered private policies, which will only stay grandfathered under certain conditions, and a 5 year grace period on employer based policies, which are both irrelevant in the long term, the proposal will outlaw all private policies that aren't in the "system", meeting the comprehensive requirements.

Sure he's telling the truth (barely and misleadingly) that a lot of people can keep their current policies temporarily, but long term, the only way they can keep them is if they are changed to meet the requirements for the new "system", which effectively means it's a different policy.

Whether we use the words "government takeover" or not is a matter of semantics, but despite claims to the contrary, the people that Democrats claim are being "mislead" into thinking it's a takeover still grossly underestimate the increase in government power over health insurance that is actually in the bill.

What would Dems do if everyone read the bill? Never mind, they know that won't happen.

[WheelsRCool]

I agree that the current health system definitely needs reform, but I think the Obama administration is going about completely wrong, for reasons stated in previous posts.

[WhoWee]

Except for some grandfathered private policies, which will only stay grandfathered under certain conditions, and a 5 year grace period on employer based policies, which are both irrelevant in the long term, the proposal will outlaw all private policies that aren't in the "system", meeting the comprehensive requirements.

Sure he's telling the truth (barely and misleadingly) that a lot of people can keep their current policies temporarily, but long term, the only way they can keep them is if they are changed to meet the requirements for the new "system", which effectively means it's a different policy.

Whether we use the words "government takeover" or not is a matter of semantics, but despite claims to the contrary, the people that Democrats claim are being "mislead" into thinking it's a takeover still grossly underestimate the increase in government power over health insurance that is actually in the bill.

What would Dems do if everyone read the bill? Never mind, they know that won't happen.

Don't act surprised, every time we elect a lawyer - we get lawyer-speak.

Step back and look at the process and it will begin to make sense.

Think of the election campaign (say anything to get elected - like no more lobbists, save or creat x jobs, and televised healthcare discussions), the run up to the stimulus (no time to read it - shovel ready projects), now healthcare (keep your insurance/doctor) as the "opening statements" - a rosey (one-sided) picture is painted and a general strategy is outlined - the lawyer preps his audience but doesn't present any evidence.

Once the trial begins or the legislation is passed (in this discussion) the lawyer works through the details and counter-arguments. In a courtroom, this is where the lawyer (or his team - Pelosi, Frank, Reid and assoc.) begins to face opposition - after he's had an opportunity to present his case. Ultimately, the lawyer makes a deal - a plea bargain.

Obama is trained to think like a lawyer. He selects his words carefully, keeps his eye on the prize, and looks for possible areas of compromise to make a deal.

There is no reason for him to become mired in the details of healthcare. His associates in the House and Senate are presenting arguments and at the close of the "trial", he'll step in and make a deal.

[Count Iblis]

I agree that the current health system definitely needs reform, but I think the Obama administration is going about completely wrong, for reasons stated in previous posts.


Hmmmm, any reform will have to include the government stepping in in one way or another. The problem is that some people a priori assume that any government intervention is a pretext to implement "bad socialist policies". So, these people can always raise the same type of objections against any proposed health care system that would work.

[WhoWee]

Hmmmm, any reform will have to include the government stepping in in one way or another. The problem is that some people a priori assume that any government intervention is a pretext to implement "bad socialist policies". So, these people can always raise the same type of objections against any proposed health care system that would work.

You can't even call this a debate until someone presents a list of specific problems, objectives, and solutions.

Starting with 1,000 pages of legislation that nobody understands tells me the "reform" is not real.

[Astronuc]

The Truth About Record-Setting U.S. Life Expectancy
http://news.yahoo.com/s/livescience/20090819/sc_livescience/thetruthaboutrecordsettinguslifeexpectancy

Life expectancy in the United States rose to an all-time high, the U.S. Centers for Disease Control and Prevention said today. But that's only half the story.

The country is behind about 30 others on this measure.

Though the United States has by far the highest level of health care spending per capita in the world, we have one of the lowest life expectancies among developed nations - lower than Italy, Spain and Cuba and just a smidgeon ahead of Chile, Costa Rica and Slovenia, according to the United Nations. China does almost as well as we do. Japan tops the list at 83 years.
Interesting.

[BoomBoom]

You can't even call this a debate until someone presents a list of specific problems, objectives, and solutions.

Starting with 1,000 pages of legislation that nobody understands tells me the "reform" is not real.

Maybe they should put it in the form of a pop-up book?

[Ivan Seeking]

You can't even call this a debate until someone presents a list of specific problems, objectives, and solutions.

Starting with 1,000 pages of legislation that nobody understands tells me the "reform" is not real.

The sausage making has been going on in Congress for many weeks, but unless you happen to make a living debating and negotiating in congressional committees, you would really have no way to know what is being argued. As of right now there is no single plan. There are about five plans. Apparently you haven't been paying attention.

Specific problems:

1). Lifetime limits on coverage that are exhausted in the event of a serious illness
2). Dropped coverage when illness strikes
3). Denial of coverage due to preexisting conditions
4). 50 million people who can't afford health insurance
5). Increasing costs that will certainly overwhelm the country as the baby boomers retire and the cost of medicine skyrockets
6). We pay far more per capita for medical care than do than other nations, for less in terms of results.

[turbo]

Ivan's #1 is a nasty one. The rates that hospitals and large practices keep rising - when is the last time your insurance company informed you that they had raised your life-time cap to keep current with these increased costs? Get out your policy and find the lifetime cap (it's buried in there somewhere) and then consider how soon you might hit it if a serious infection caused your kidneys to fail. How many years would the insurance company pay for dialysis to keep you alive while you wait for a donor? Would they pay the screenings or for the surgeries for you and the donor if you were already near your cap? There are the REAL "death panels".

[mheslep]

The Truth About Record-Setting U.S. Life Expectancy
http://news.yahoo.com/s/livescience/20090819/sc_livescience/thetruthaboutrecordsettinguslifeexpectancy


Interesting.
Many of those life expectancy factors have little to do with medical practice or insurance.
http://repository.upenn.edu/cgi/viewcontent.cgi?article=1012&context=psc_working_papers
...a country could still have poor measured health if personal health care practices were unusually deleterious. This is not a remote possibility in the United States, which had the highest level of cigarette consumption per capita in the developed world over a 50-year period ending in the mid-80’s (Forey et al. 2002). Smoking in early life has left an imprint on mortality patterns that remains visible as cohorts age (Preston and Wang 2006; Haldorsen and Grimsrud 1999). One recent study estimated that, if deaths attributable to smoking were eliminated, the ranking of US men in life expectancy at age 50 among 20 OECD countries would improve from 14th to 9th, while US women would move from 18th to 7th (Preston, Glei, and Wilmoth 2009). Recent trends in obesity are also more adverse in the United States than in other developed countries (OECD 2008; Cutler, Glaeser, and Shapiro 2003).If the deaths from homicides and accidents and the like are also corrected for the US moves to or near the highest in life expectancy.

[WhoWee]

Maybe they should put it in the form of a pop-up book?

Are you suggesting they have approached the problem in a methodical way? Or perhaps you mean Barney and co will have an easier time with a pop-up illustration?

[mheslep]

...
4). 50 million people who can't afford health insurance
More like 10 million

[Ivan Seeking]

Specific problems:

1). Lifetime limits on coverage that are exhausted in the event of a serious illness
2). Dropped coverage when illness strikes
3). Denial of coverage due to preexisting conditions
4). 50 million people who can't afford health insurance
5). Increasing costs that will certainly overwhelm the country as the baby boomers retire and the cost of medicine skyrockets
6). We pay far more per capita for medical care than do than other nations, for less in terms of results.

Objectives:
1). Eliminate lifetime caps
2). Eliminate dropped coverage when illness strikes
3). Eliminate the denial of coverage due to preexisting conditions
4). Provide a means to affordably insure 50 million more people
5). Reduce the cost of medical care
6). Increase the efficiency of the medical care systems

Some options considered in no specific order:
1). Government regulation of the terms of insurance
2). Create competition for the private insurance industry with a government option for those without insurance - the universal health care option
3). Create a single-payer system with the government acting as the central agent for insurance.
*Note that This is not government run health care. It is government run health care insurance. Calling this government run health care is like saying that Farmers Insurance runs the local hospital now.
4). Form co-ops to create competition for private insurance
5). Through part of the existing government stimulus programs, invest in state-of-the-art information technology to streamline everything from the tracking of drug interactions, to the ordering of studies, to payment, for the entire healthcare system. Consider for example, it is claimed that as much as 50%-80% of the cost associated with running a doctor's office can be attributed to paperwork and insurance regulations. Also, many of the errors made in hospitals that result in death or injury are preventable though information technology.
6). Here is one of the latetest suggestions being considered: Implement a program like that instituted by Gov Romney, in Massachusetts.

[WhoWee]

The sausage making has been going on in Congress for many weeks, but unless you happen to make a living debating and negotiating in congressional committees, you would really have no way to know what is being argued. As of right now there is no single plan. There are about five plans. Apparently you haven't been paying attention.

Specific problems:

1). Lifetime limits on coverage that are exhausted in the event of a serious illness
2). Dropped coverage when illness strikes
3). Denial of coverage due to preexisting conditions
4). 50 million people who can't afford health insurance
5). Increasing costs that will certainly overwhelm the country as the baby boomers retire and the cost of medicine skyrockets
6). We pay far more per capita for medical care than do than other nations, for less in terms of results.

What is your "specific" source - an Obama town hall meeting?

Problems, objectives, and solutions - I see a few general talking points on your list - no specifics.

1.) Some private policies have $1.0 million limits and some have $7 million.
2.) Can you please explain this - under what specific circumstances does this happen?
3.) Denial of coverage is what happens when the person (under your #2 example) loses coverage and re-applies. This is a major problem but a general category of pre-existing doesn't begin to describe the overall situation.
4.) Are any of these 50 million people illegal immigrants, people who choose to self-insure, people already on public assistance, people already accounted for in #2 and #3, are any of these people on the extended COBRA plan and just developed a problem that will now be considered pre-existing - or are these people not in any of these categories that can't afford coverage? Again, a statement of "50 million uninsured" does not fully describe the actual problem - it is a talking point.
5.) Obama says reform will save money, even though the CBO doesn't agree - again, another talking point with no factual support.
6.) As Astronuc pointed out above. Could the reason be that our lifestyles have something to do with the data - WE ARE A FAT NATION - diabetes, high blood pressure, etc. Junk food and lack of exercise need to be factored in and then re-evaluate the data.

I have been paying attention - and nobody thus far has presented a comprehensive plan that itemizes all of the problems, objectives, and solutions. Writing a fast 1,000 page Bill and ramming it through won't solve anything - do you trust your life to Barney, Nancy, and Harry? This Bill needs to be understood. Obama promised a "line by line" review of anything that he signs - did HE read the stimulus Bill? Will he read and understand this Bill?

[WhoWee]

Objectives:
1). Eliminate lifetime caps
2). Eliminate dropped coverage when illness strikes
3). Eliminate the denial of coverage due to preexisting conditions
4). Provide a means to affordably insure 50 million more people
5). Reduce the cost of medical care
6). Increase the efficiency of the medical care systems

Some options considered in no specific order:
1). Government regulation of the terms of insurance
2). Create competition for the private insurance industry with a government option for those without insurance - the universal health care option
3). Create a single-payer system with the government acting as the central agent for insurance.
*Note that This is not government run health care. It is government run health care insurance. Calling this government run health care is like saying that Farmers Insurance runs the local hospital now.
4). Form co-ops to create competition for private insurance
5). Through part of the existing government stimulus programs, invest in state-of-the-art information technology to streamline everything from the tracking of drug interactions, to the ordering of studies, to payment, for the entire healthcare system. Consider for example, it is claimed that as much as 50%-80% of the cost associated with running a doctor's office can be attributed to paperwork and insurance regulations. Also, many of the errors made in hospitals that result in death or injury are preventable though information technology.
6). Here is one of the latetest suggestions being considered: Implement a program like that instituted by Gov Romney, in Massachusetts.

Again, what is your source? What politician has listed these things?

[Ivan Seeking]

Again, what is your source? What politician has listed these things?

For one, Obama has talked about some of it; esp wrt universal care vs single-payer system. HE did just a few days ago in his press conference, and he did again this morning on Conservative radio.

Where do you get your news? What do you think people have been talking about for the last several months? There are I believe five active committees in Congress. What do you think they are debating?

[Ivan Seeking]

During his campaign for the White House, President-elect Barack Obama proposed lowering health care costs and helping the 45 million uninsured Americans. Now he faces the tough task of implementing those reforms during a likely recession...
http://www.pbs.org/newshour/indepth_coverage/health/uninsured/index.html
http://www.pbs.org/newshour/indepth_coverage/health/uninsured/map_flash.html

Also to be considered, the underinsured.

[Ivan Seeking]

Here is one version discussed in the House. A vote was not taken before the summer recess, so the issue is being discussed in town halls all around the country, every day. Perhaps the problem is that nuts like Sarah Palin have tried their best to misdirect the discussion with crackpot claims.

http://energycommerce.house.gov/Press_111/20090714/aahca.pdf

[Ivan Seeking]

The Palin effect:

nYlZiWK2Iy8

[drankin]

The Truth About Record-Setting U.S. Life Expectancy
http://news.yahoo.com/s/livescience/20090819/sc_livescience/thetruthaboutrecordsettinguslifeexpectancy


Interesting.

I don't think we are looking at all the factors in life expectancy. How does the American diet compare to those of other developed countries? The Japanese, for example, have a very healthy diet (variety of fish and rice products) in comparison to Americans (hamburgers/french fries/bacon). In my experience with people in the UK, American meal serving sizes are much larger. A lifetime of that has to have an impact on life expectancy.

[cristo]

The Palin effect

Comparing Obama to Hitler.. genius :rolleyes: Methinks a little history and/or politics needs to be taught to people asking such questions. It's all well and good defending first amendment rights (which I agree with, by the way) but noone takes such claims seriously, do they? I liked that representative's response.

[WhoWee]

http://www.pbs.org/newshour/indepth_coverage/health/uninsured/index.html
http://www.pbs.org/newshour/indepth_coverage/health/uninsured/map_flash.html

Also to be considered, the underinsured.

Obama says a lot of things...is it 45 million or is it 50 million? It makes a difference when we're talking about people.

I'm afraid the collective result of your posts is that you made my point for me.

Also, while I appreciate your posting of the 1017 pages of HR3200, I have to admit I can't comprehend what specific problems it addresses, the clear objectives of the Bill, or the intended solutions - or consequences of implementation.

When I hire an attorney to work on a complicated problem, I expect him to understand the problem and resolve it. I also expect him to explain all of the possible outcomes, remedies, and consequences of our actions/agreements.

I also expect our elected officials to do the same. Our elected officials need to understand the specifics of the problems they address, have a clear understanding of their objectives in dealing with the problem, and consider all possible solutions.

I expect every politician who votes on a Bill to read the Bill and understand what they are voting on - if they can't, maybe they aren't qualified to represent us.

This is too important. This is 20% of our economy. This is life and death. This should not be a political matter. Why is health care political?

Again, we need our elected officials to act like adults and address the problem in a professional manner - regardless of how long it takes.

[Count Iblis]

Many of those life expectancy factors have little to do with medical practice or insurance.
http://repository.upenn.edu/cgi/viewcontent.cgi?article=1012&context=psc_working_papers
If the deaths from homicides and accidents and the like are also corrected for the US moves to or near the highest in life expectancy.

Those other factors are related to the same "small government" ideology that makes health care reform so very controversial. There are many more extremely obese people in the US than in Europe, because a lot of the government policies we have in Europe to fight obesity would be regarded as unacceptable government interference in the US.

The reason why it took so long for the US to curb back on smoking is basicaly similar. In the end, you had to have a Senate hearing to prove that nicotine is addictive and only then could action be taken.

You also believe that people have the right to bear arms.

[mheslep]

...There are many more extremely obese people in the US than in Europe, because a lot of the government policies we have in Europe to fight obesity would be regarded as unacceptable government interference in the US...To what government policies are you referring? What policies does Europe have to fight obesity, aside from research efforts which the US has as well?

[mheslep]

The Palin effect:AKA the Rep Rangel (http://books.google.com/books?id=epuO2UNGCtsC&lpg=PA247&ots=AlIGgABZJH&dq=Rep%20rangel%20nazis&pg=PA247#v=onepage&q=&f=false) effect, or the Rep Dingel effect, or the Al Gore effect (http://www.sunjournal.com/node/77682), or the Sen Reid effect (http://briefingroom.thehill.com/2009/08/13/reid-protesters-are-evil-mongers/), or the Rep Baird effect (http://briefingroom.thehill.com/2009/08/13/baird-apologizes-for-brown-shirt-comments/).

[Al68]

Hmmmm, any reform will have to include the government stepping in in one way or another. Huh??? How about stepping out instead?

I would consider actual "reform" to be a reduction of government involvement from what we have now, not an increase. Free market reform.

Adding corruption and regulation while using force to restrict individual liberty isn't "reform" just because the advocates use the word reform in the name.

[Al68]

Objectives:
1). Eliminate lifetime caps
2). Eliminate dropped coverage when illness strikes
3). Eliminate the denial of coverage due to preexisting conditions
4). Provide a means to affordably insure 50 million more people
5). Reduce the cost of medical care
6). Increase the efficiency of the medical care systems
So those of who currently choose to buy a policy with a lifetime cap (because it's cheaper), doesn't cover pre-existing conditions (because I have none and it's cheaper) or anything else I have chosen, should be denied our right to contract? My insurance policy is a private agreement between me and a private company offering the policy. The government is not a party to that contract.

Calling millions of individual private contracts a "system" doesn't change the facts. Government is too involved in our private lives and we should now accept the claim that it's not involved enough?

Why is it so difficult to understand that my health care is my private business?

[WhoWee]

Huh??? How about stepping out instead?

I would consider actual "reform" to be a reduction of government involvement from what we have now, not an increase. Free market reform.

Adding corruption and regulation while using force to restrict individual liberty isn't "reform" just because the advocates use the word reform in the name.

Are you absolutely sure you don't want the IRS to enforce health insurance??? If they are just half as effective as the (car insurance lobby) states enforcing car insurance mandates by suspending drivers licenses - everyone will either be insured or (in jail???), or homeless?

Can anyone find a section in HR3200 that addresses eligibility of persons made homeless by the IRS for not purchasing health insurance - will they still be eligible for medicare/medicaid?

[Evo]

Off topic posts deleted.

[DavidSnider]

The Palin effect:

nYlZiWK2Iy8

Palin effect? The woman in that video is a Lyndon LaRouche follower.

[adrenaline]

http://www.pnhp.org/facts/single_payer_resources.php

I have become a member of PHNP ( physicians for national health plan) after over a decade dealing with all the games the private insurances play. ( And, no national health insurance is not socialized medicine anymore than medicare ( national health insurance for the elderly) socialized our health system.

I personally deal with less beaurocracy from medicare and medicaid.

For anyone who thinks the private sector automatically means less cost and greater efficiency and better care, they don't know about the failure of medicare advantage plans ( privatized medicare ) and privitization of medicaid into HMOs. https://www.cbo.gov/doc.cfm?index=8265&type=0 As a physician, I would have had to hire at least a dozen more administrative personell just to deal with the administrative paperwork from these plans. Thousands of patients in my community who opted into those private plans suddenly were without a single doctor who would take them. ( By the way, none of the medicare advantage plans pays for your first three days in the hospital or past 3 days in rehabilitation...as for the latter, if you are an elderly with a stroke, you only get three days of rehab...)

Remember this, private plans ration to protect their corporate interests and profits. And believe me they do.
The government may ration but ethically, I can stomach rationing based on resources available vs. frank greed.

[turbo]

http://www.pnhp.org/facts/single_payer_resources.php

I have become a member of PHNP ( physicians for national health plan) after over a decade dealing with all the games the private insurances play. ( And, no national health insurance is not socialized medicine anymore than medicare ( national health insurance for the elderly) socialized our health system.

I personally deal with less beaurocracy from medicare and medicaid.

For anyone who thinks the private sector automatically means less cost and greater efficiency and better care, they don't know about the failure of medicare advantage plans ( privatized medicare ) and privitization of medicaid into HMOs. Google 'failure of medicare advantage plans". As a physician, I would have had to hire at least a dozen more administrative personell just to deal with the administrative paperwork from these plans. Thousands of patients in my community who opted into those private plans suddenly were without a single doctor who would take them.

Remember this, private plans ration to protect their corporate interests and profits. And believe me they do.
The government may ration but ethically, I can stomach rationing based on resources available vs. frank greed.Thank you for weighing in with a doctor's viewpoint. My wife and I had a wide selection of doctors on her old insurance plan, but then her employer switched to BCBS. There are practices here that operate with a single doctor and one or two staff, and they can't afford all the administrative overhead that some HMOs place on them (denials, re-coding, resubmission, delays in payment...) My wife had to find a new doctor, after having had a wonderful country-doctor for years. I was able to keep mine because his multi-doc practice is affiliated with the local hospital.

I was the network administrator for a very large multi-location ophthalmic practice, and I was shocked to see the aging of the practice's receivables. Much of it would get paid eventually, but in the meantime, it limited the practice's line of credit from the commercial banks. When a patient's vision is at risk, they would get prompt treatment, then the insurance companies would play games with coding requirements, bouncing claims, etc. I wrote accounting programs for other businesses before taking that job, and I can assure you that manufacturers, large trucking companies, etc would have had their lines of credit pulled if their receivables were in such a sorry state.

My cousin was that practice's top coding specialist, and she currently works for a pediatric ophthalmologist who takes a lot of Medicaid referrals. She loves her job now - the coding standards for Medicaid are more transparent and the rules don't change without notice. That leaves more time for her to fight the private insurers for payment.

[DavidSnider]

I was the network administrator for a very large multi-location ophthalmic practice, and I was shocked to see the aging of the practice's receivables. Much of it would get paid eventually, but in the meantime, it limited the practice's line of credit from the commercial banks. When a patient's vision is at risk, they would get prompt treatment, then the insurance companies would play games with coding requirements, bouncing claims, etc. I wrote accounting programs for other businesses before taking that job, and I can assure you that manufacturers, large trucking companies, etc would have had their lines of credit pulled if their receivables were in such a sorry state.


I've just started writing software geared towards automating some of the administrative work in the health care industry. I am convinced that the overhead is largely due to administrative waste and not "value added services" as the insurance companies claim.

[adrenaline]

at least half of the physicians or more favor a single payor national health insurance
http://www.homepages.indiana.edu/011604/text/docs.shtml

Jama has a survey that shows a majority of physicians favor it, and here is one where a clear majority favored it http://www.pnhp.org/news/2004/february/most_physicians_endo.phpand

all in part due to the waste we see on the admininstrative end

[Evo]

at least half of the physicians or more favor a single payor national health insurance
http://www.homepages.indiana.edu/011604/text/docs.shtml

Jama has a survey that shows a majority of physicians favor it, and all in part due to the waste we see on the admininstrative endMy doctor is against it, he also said the majority of doctors (at least those he's affiliated with) are against it. I wonder if it depends on the doctor's practice.

[Ivan Seeking]

but noone takes such claims seriously, do they?

Yes. Sarah Palin and Rush Limbaugh have orchestrated this fiasco in an effort derail legitimate reform. I don't know if they are delusional or crooks, but they have a large enough audience to distract the media from legitimate discussions. News Fauxs like Fox eat this stuff up! I would wager that 20-30% of the country believes this idiocy.

The irony is that while these people persuade their audiences that they are fighting for America, fighting for freedom, fighting for this that and the other thing, they are in fact trying to steer the public herd right over a cliff. We desperately need health care reform in this country, but these people will do everything in their power to prevent it in order to "hand Obama his Waterloo", as one Republican put it. What they are really doing, whether they know it or not, is working to hand the American people their Waterloo.

This is the paradox of American politics today: It is in the best interest of the Republican party to block health care reform, whether it best serves the public interest of not, because, if successful, Obama will almost certainly be reelected in 2012. The Democrats will have taken-on and handled one of the biggest problems that we face - something the Republicans have never even tried to do.

[adrenaline]

My doctor is against it, he also said the majority of doctors (at least those he's affiliated with) are against it. I wonder if it depends on the doctor's practice.


Probably, the specialties most against it are radiologists ( who never have to get precerts or priorauthorizations since the primary care docs do all the work) and anesthesiologists ( once again, the elective surgery has been begged for by the surgeon or primary care doc.) They don't have to hire extra personell to deal with precerts and denials, extra coders and billers etc. In addition, many doctors are republicans and they tend to listin to the misinformation propagated by hannity, rush, etc.

There is just as much misinformation among doctors about national health insurance being "socialized medicine". My retort is ...as a provider for medicare patients, are you in any way a salaried government employee or restricted in ordering necessary tests and treatments ? ( Medicare has far less restrictions than many of the HMOs). Granted, they pay me less but for every 100 dollars I collect from medicare I use probably 3 dollars for administrative work vs almost a third of the 100 dollars I collect from private insurers.

These doctors may not have much sense of the business end of their practice, as senior partner who does not believe all the business end should be handeled by accountants, I am acutely aware where every cent goes to.

[mheslep]

at least half of the physicians or more favor a single payor national health insurance
http://www.homepages.indiana.edu/011604/text/docs.shtml...The study is in a respected peer reviewed journal. I also read that, the lead author of this study purported to determine the opinion of physicians regarding single payer insurance Dr. Aaron E. Carroll, is on the the board the physicians group advocating single payer insurance - PNHP. It also appears he is a fairly single minded advocate for single-payer from his statements on the web.
http://pnhp.org/about/board_of_directors.php

The PNHP review (http://www.pnhp.org/news/2008/april/physician_opinion_ti.php) of the study also states:
The findings came from a random sample of 5,000 physicians from the AMA Masterfile. ....

About 500 questionnaires were undeliverable, 197 were returned by physicians no longer in practice, and 2,193 were completed (51% response rate) and returned to Drs. Carroll and Ackermann.Thus they reported results come not from a random population, but from those that responded.

It also seems odd that PNHP would have only 14,000 (http://www.pnhpwesternwashington.org/about.htm) members in a country with 800,000 physicians, the majority of which per Carroll's study support single payer.

[turbo]

(Medicare has far less restrictions than many of the HMOs). Granted, they pay me less but for every 100 dollars I collect from medicare I use probably 3 dollars for administrative work vs almost a third of the 100 dollars I collect from private insurers.
The efficiencies gained from adding under-insured and uninsured people to a public option might make opting out of CIGNA, BCBS, and other plans look like a good deal for smaller practices. Slash administrative costs and reduce the aging of receivables to something attractive to your lenders, if you should need new equipment, etc. Maybe the big HMOs would have to curb some of their greed in order to keep docs participating in their plans. That certainly would not be a bad thing for the doctors. Private practices have been fattening insurance companies (involuntarily) with floating lines of credit in the form of denials and delays, and that's robbery. The banks were forced some time ago to clear our checks promptly instead of holding them for a week or two and investing the "float" - it's time that insurance companies were held to similar standards.

[Ivan Seeking]

Granted, they pay me less but for every 100 dollars I collect from medicare I use probably 3 dollars for administrative work vs almost a third of the 100 dollars I collect from private insurers.

As mentioned earlier, I have heard that 50-80% of the cost of running a doctors office can be attributed to paperwork and insurance regulations. Do you think these are somewhat inflated and that the real number is more like 30%, or could the numbers legitimately vary between 30-80%, when everything is considered and depending on the office?

Also, do you have any thoughts as to how the cost of medical care, from an operational point of view, can be reduced [beyond illness prevention]?

[mheslep]

...

There is just as much misinformation among doctors about national health insurance being "socialized medicine". My retort is ...as a provider for medicare patients, are you in any way a salaried government employee or restricted in ordering necessary tests and treatments ? ( Medicare has far less restrictions than many of the HMOs). Granted, they pay me less but for every 100 dollars I collect from medicare I use probably 3 dollars for administrative work vs almost a third of the 100 dollars I collect from private insurers....How do we address losses attributed to Medicare fraud? That is, one can make the argument that Medicare saves administrative costs by not hiring the staff to properly administrate, and this is reflected in the $60B (http://www.usdoj.gov/opa/pr/2009/May/09-ag-491.html) in fraud losses every year. Extend such a system as is to the entire country and either the fraud breaks the treasury or the new system must also vastly ramp up administration costs.

[WhoWee]

http://www.pnhp.org/facts/single_payer_resources.php

I have become a member of PHNP ( physicians for national health plan) after over a decade dealing with all the games the private insurances play. ( And, no national health insurance is not socialized medicine anymore than medicare ( national health insurance for the elderly) socialized our health system.

I personally deal with less beaurocracy from medicare and medicaid.

For anyone who thinks the private sector automatically means less cost and greater efficiency and better care, they don't know about the failure of medicare advantage plans ( privatized medicare ) and privitization of medicaid into HMOs. https://www.cbo.gov/doc.cfm?index=8265&type=0 As a physician, I would have had to hire at least a dozen more administrative personell just to deal with the administrative paperwork from these plans. Thousands of patients in my community who opted into those private plans suddenly were without a single doctor who would take them. ( By the way, none of the medicare advantage plans pays for your first three days in the hospital or past 3 days in rehabilitation...as for the latter, if you are an elderly with a stroke, you only get three days of rehab...)

Remember this, private plans ration to protect their corporate interests and profits. And believe me they do.
The government may ration but ethically, I can stomach rationing based on resources available vs. frank greed.

I'm curious as to how much HIPPA has cost your practice and network - any estimate?

[adrenaline]

How do we address losses attributed to Medicare fraud? That is, one can make the argument that Medicare saves administrative costs by not hiring the staff to properly administrate, and this is reflected in the $60B (http://www.usdoj.gov/opa/pr/2009/May/09-ag-491.html) in fraud losses every year. Extend such a system as is to the entire country and either the fraud breaks the treasury or the new system must also vastly ramp up administration costs.

There is fraud with private insurance as well, seperate issue but does not negate the benefit of single payer insurance.

Now let me also define what is medicare fraud... if I see a single mother who is uninsured and I treat her sinus infection for free, and I charge a medicare recipient 35 dollars to treat the same problem, that is fraud. In other words, medicare won't let me play robin hood doctor.

If I admit a patient for what I presumed is systolic congestive heart failure and she ends up with diastolic heart failure ( the latter pays less), that is fraud. In the meantime, I have admitted the patient while on call for another doctor at 2 am and coded it as systolic chf, the attending doctor gets an echo that shows it is diastolic heart failure ( two days later) so he codes it diastolic heart failure. Did I commit fraud? No, I coded it according to my clinical assessment for the night. In other words, medicare definition of fraud is very, very broad.

[WhoWee]

There is fraud with private insurance as well, seperate issue but does not negate the benefit of single payer insurance.

Now let me also define what is medicare fraud... if I see a single mother who is uninsured and I treat her sinus infection for free, and I charge a medicare recipient 35 dollars to treat the same problem, that is fraud. In other words, medicare won't let me play robin hood doctor.

If I admit a patient for what I presumed is systolic congestive heart failure and she ends up with diastolic heart failure ( the latter pays less), that is fraud. In the meantime, I have admitted the patient while on call for another doctor at 2 am and coded it as systolic chf, the attending doctor gets an echo that shows it is diastolic heart failure ( two days later) so he codes it diastolic heart failure. Did I commit fraud? No, I coded it according to my clinical assessment for the night. In other words, medicare definition of fraud is very, very broad.

You're saying that Government regulations (regarding medicare) are the actual problem (in the context of 35% estimate of fraud in the system)?

[adrenaline]

Also, do you have any thoughts as to how the cost of medical care, from an operational point of view, can be reduced [beyond illness prevention]?


it is estimated we would save 700 billion a year if we did not have to practice defensive medicine.
http://www.sltrib.com/opinion/ci_12973517

we all do it. This is our line of thinking

1. What is the clinical diagnosis based on the symptoms and signs I have?
2. what tests do I reasonably order to rule in or out the disease?
3. And what tests do I need to order in case my a$$ gets sued?

Tort reform can mean something as simple as exonerating a physician if he or she practices evidence based medicine. That is not the case currently, a recent ruling where a 54 year old engineer agreed not to have his PSA done ( since it is one of the few cancer tests that has not really been shown to affect mortality) after being counseled extensively by a resident at a medical school and was aware of the risk involved in not testing. ( By the way the american cancer society and the united task force prevention service do not recommend routine psa screening). He ended dieing of prostate cancer and the family sued the medical school and won based on the fact that evidence based medicine was trumped by "standard of care". ( the latter by the way is not always the "best" care based on recent clinical evidence).

granted, there are doctors who over order tests for financial gain although the Stark laws have eliminated most of that, but the majority of us are just scared to death of being sued.

there is an adage in medicine " you don't get sued for the test you ordered, you get sued for the test you didn't order...."

[adrenaline]

You're saying that Government regulations (regarding medicare) are the actual problem (in the context of 35% estimate of fraud in the system)?

all I am saying is their definition of "fraud" is overencompassing and thus the numbers may be inflated. How much, I honestly don't know...

[adrenaline]

I'm curious as to how much HIPPA has cost your practice and network - any estimate?


I had to send my office manager to numerous classes that were not cheap, hired a consultant and software engineer to make our electronic medical records Hippa compliant, had to renovate our office ( put glass panels between nurses stations and patient rooms) and make our office hippa compliant, etc. probably 50-75 thous?

[turbo]

You're saying that Government regulations (regarding medicare) are the actual problem (in the context of 35% estimate of fraud in the system)?That is an outrageously inflated number and I'd love to see where it came from. According to the Coalition Against Insurance Fraud:
he U.S. spends more than $2 trillion on healthcare annually. At least 3 percent of that spending — or $68 billion — is lost to fraud each year. (National Health Care Anti-Fraud Association, 2008)

Medicare and Medicaid made an estimated $23.7 billion in improper payments in 2007. These included $10.8 billion for Medicare and $12.9 billion for Medicaid. Medicare’s fee-for-service reduced its error rate from 4.4 percent to 3.9 percent. (U.S. Office of Management and Budget, 2008)

http://www.insurancefraud.org/stats.htm

I didn't see any 35% fraud numbers in there. If you want to stop Medicare fraud, stop the companies that lease or sell really expensive wheelchairs, scooters, etc to people who either don't need them and/or never receive them anyway. Doctors are not responsible for initiating that kind of fraud, for the most part.

[adrenaline]

The study is in a respected peer reviewed journal. I also read that, the lead author of this study purported to determine the opinion of physicians regarding single payer insurance Dr. Aaron E. Carroll, is on the the board the physicians group advocating single payer insurance - PNHP. It also appears he is a fairly single minded advocate for single-payer from his statements on the web.
http://pnhp.org/about/board_of_directors.php

The PNHP review (http://www.pnhp.org/news/2008/april/physician_opinion_ti.php) of the study also states:
Thus they reported results come not from a random population, but from those that responded.

It also seems odd that PNHP would have only 14,000 (http://www.pnhpwesternwashington.org/about.htm) members in a country with 800,000 physicians, the majority of which per Carroll's study support single payer.


good points as to membership I can tell you I don't pay my membership dues. Only 25% of doctors in the country are technically members of the AMA but tthe AMA claim to represent us.....Most doctors in general don't agree with all the tenets of the AMA or PHNP so we choose not to belong to anything in particular. As a whole, doctors are lousy at organizing our group into a collective voice....

[Al68]

There is just as much misinformation among doctors about national health insurance being "socialized medicine".The current proposal outlaws private contracts, imposes income tax penalties on those that don't join the "system", and uses force to confiscate wealth from some Americans to give to others. Calling it socialist is misinformation?

What other word could be used to describe government controlling the economic activity of citizens?

[adrenaline]

I didn't see any 35% fraud numbers in there. If you want to stop Medicare fraud, stop the companies that lease or sell really expensive wheelchairs, scooters, etc to people who either don't need them and/or never receive them anyway. Doctors are not responsible for initiating that kind of fraud, for the most part.

I think people assume if there were improper payments that fraud was involved when many times it is a matter of coding ( as I showed in my example.).

It's interesting that when I went to electronic medical records I found that I had undercoded by over 100 thousand a year. Naturally, this caught the attention of medicare since my charges were so much higher, they could not find any overpayment (thank you electronic medical records) and still found underpayments. It's amazing, they will collect from us if we over charge but they donn't reimburse us when they found we undercharge.....I'll bet that is not in any of these studies.

[adrenaline]

The current proposal outlaws private contracts, imposes income tax penalties on those that don't join the "system", and uses force to confiscate wealth from some Americans to give to others. Calling it socialist is misinformation?

What other word could be used to describe government controlling the economic activity of citizens?


outlaws private contracts? here is a fact check, for the record, britain ( the standard of socialized medicine) has a very health private insurance market ( half the population uses the private sector.)


http://factcheck.org/2009/08/private-insurance-not-outlawed/

In fact, the bill envisions a wide variety of private policies being offered to the public through a new national health insurance exchange resembling the Federal Employee Health Benefits plan, which makes 269 different private plans in total available to federal workers, including members of Congress.

What page 16 actually says is that those who like their current policies are "grandfathered" and can keep them, even if the policies don’t meet new standards.

The false idea that H.R. 3200 would prohibit insurance companies from accepting new policyholders stems from the conservative Investors’ Business Daily, which made the claim in a July editorial:

Investor’s Business Daily, July 15: It didn’t take long to run into an "uh-oh" moment when reading the House’s "health care for all Americans" bill. Right there on Page 16 is a provision making individual private medical insurance illegal. … The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.

So we can all keep our coverage, just as promised – with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

Here, however, is the paragraph immediately preceding IBD’s quote:

H.R. 3200: Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term “grandfathered health insurance coverage” means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met.

In other words, the quote IBD references is part of the definition of “grandfathered” health insurance coverage. That quote doesn’t say that insurers can’t take on new enrollees; it says that if they do, that won’t be considered grandfathered coverage. In other words, any new individual policies would have to meet minimum standards and be offered through the new health insurance exchange.

The proposed health care model would indeed encourage individuals not already covered by employer-provided health policies to buy coverage through the nationwide insurance exchange.[b] The choices would include a range of private plans meeting the new standards, as well as a new federal plan, as the House bill is currently written. People with individually purchased insurance who wish (or need) to change their grandfathered plans will have to purchase insurance through the exchange. If an individual would rather keep his plan, he can do so for as long as the insurance company keeps offering it. At any rate, nobody will be forced into the federal health insurance option – they’ll have their pick of private ones.

In fact, some say the biggest change will be that individual insurance gets better. "In a lot of ways it would improve options for people buying coverage on the individual market right now," said Sara Collins, vice president of the Commonwealth Fund, a nonpartisan organization that supports “a high performing health care system." The exchange plans would not be underwritten, and would be required to provide a minimum level of service to everybody. There would also be subsidies available for individuals and small employers to offset the cost of purchasing insurance through...



I opposed the obama health plan because it was not a single payer insurance, even the physicians for national health plan opposed it.http://www.pnhp.org/news/2009/july/why_obamas_public_o.php

Why Obama's Public Option Is Defective, and Why We Need Single-Payer
the phnp support a flat tax to fund this on everyone. so they are not socialist.

As for a miniscule tax on someone who is irresponsible enough to do without health insurance ( even when the government gives it to you) , it's called responsibility, since the uninsured drive up the cost for everyone else around them, including the insured.http://www.usatoday.com/money/industries/health/2005-06-08-uninsured-costs_x.htm?csp=24&RM_Exclude=Juno

as for the surtax on those of us who make more than $350,000.... cry me a river....I'm not going to hurt one bit by the small surtax but then I didn't buy into the huge Mcmansions and luxury car "necessities"' that afflicts most of my collegues. ( In fact my house will be paid off in five years and all my cars are paid for ( old jeep, civic hybrid and silverado truck.)

[DavidSnider]

The current proposal outlaws private contracts, imposes income tax penalties on those that don't join the "system", and uses force to confiscate wealth from some Americans to give to others. Calling it socialist is misinformation?

What other word could be used to describe government controlling the economic activity of citizens?

God forbid they confiscate the wealth we are borrowing from the Chinese.

[Al68]

The current proposal outlaws private contracts, imposes income tax penalties on those that don't join the "system", and uses force to confiscate wealth from some Americans to give to others. Calling it socialist is misinformation?

What other word could be used to describe government controlling the economic activity of citizens?
outlaws private contracts? here is a fact check, for the record, britain ( the standard of socialized medicine) has a very health private insurance market ( half the population uses the private sector.)

http://factcheck.org/2009/08/seven-falsehoods-about-health-care/
http://factcheck.org/2009/08/private-insurance-not-outlawed/
Your link verifies that private contracts would be outlawed. I never said all private insurance would be outlawed. But mine will be, along with any type of policy I would ever be interested in buying. I, and many others, will have to buy the kind of insurance that we don't need or want, or are morally opposed to, or pay the tax penalty and live without medical insurance.

I notice you didn't answer my question: What other word could be used to describe government controlling the economic activity of citizens?

[adrenaline]

By the way, if it wasn't for government funded health care medicare, the private plans would not have been so economically prosperous. Medicare "socialized " the eldery and disabled, ( thus diminishing the subset of the population that over utilizes health care) and privatized the young, working class. Once again, I support a single payer system, not obama's patchwork of competing public options. And don't forget, the cry of socialization also was also cried in vain when l. johnson signed medicare into law, people screamed american medicine would become socialized. It didn't happen with medicare.

I still don't see where the link confirms private contracts will be outlawed.


Look, I'm not going to get into debating socialism. If you want unfettered libertarian free market go to calcutta india or look at what lack of government oversite does for china's level of industrial pollution and food contamination , child labor usage etc. And it was precisley the laissez free economics that destroyed the banking industry and put us in the mess we are in. We need to find that balance and we are looking for it now.

The bigger question, why are we the only industrialized, free nation that does not offer basic health care to our all of our population ? Investment in our infrastructure, our health , is as important as any other infrastructure investment..no?

Let's not forget, the best avante garde basic medical research is done by NIH, government funded, ( socialized) without profit motive. Health insurance companies don't do medical research, drug companies are resorting to "me too" drugs or slight modifications of existing drugs ( ie: nexium from prilosec, lexapro from celexa) for the quick profit turn around.

[Al68]

As for a miniscule tax on someone who is irresponsible enough to do without health insurance ( even when the government gives it to you) , it's called responsibility, since the uninsured drive up the cost for everyone else around them, including the insured.http://www.usatoday.com/money/industries/health/2005-06-08-uninsured-costs_x.htm?csp=24&RM_Exclude=Juno

as for the surtax on those of us who make more than $350,000.... cry me a river....I'm not going to hurt one bit by the small surtax but then I didn't buy into the huge Mcmansions and luxury car "necessities"' that afflicts most of my collegues. ( In fact my house will be paid off in five years and all my cars are paid for ( old jeep, civic hybrid and silverado truck.)Who's crying for them? Strawman argument?

And I'm irresponsible because the new bill will outlaw my insurance? And yes, I know that temporarily there is a grandfather clause, and it doesn't apply to any new policies. The proposal outlaws all new policies that aren't part of the system.

[WhoWee]

By the way, if it wasn't for government funded health care medicare, the private plans would not have been so economically prosperous. Medicare "socialized " the eldery and disabled, ( thus diminishing the subset of the population that over utilizes health care) and privatized the young, working class. Once again, I support a single payer system, not obama's patchwork of competing public options. And don't forget, the cry of socialization also was also cried in vain when l. johnson signed medicare into law, people screamed american medicine would become socialized. It didn't happen with medicare.

Please explain the danger of "patchwork" as you described the plan.

I often hear it referred to as over-layed, and other descriptions - basically layers of regulations imposed instead of fixing the initial problem. As is often the case with Government efforts, they often transform one problem into a different problem (or worse).

[bleedblue1234]

People have this entire situation convoluted... here's a post I made on another forum...

The problem is that we have the definition of 'insurance' in this country and every country in the world completely convoluted...

Let's examine...
"Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss."

Well in medicine insurance is a complete misnomer... people pay for everything that involves health care with insurance, and this is the exact problem. We need to realise insurance is only for catastrophic care (death, brain cancer, cancer, heart attacks, stroke) .... insurance is meant so people hedge against risk and thus avert financial catastrophe if the slim chance that something disastrous happens in fact does occur. For example, one has fire insurance for the slight chance that their house or part of their house or belongings is damaged due to fire... now I am sure the risk of that is inherently slim and as such insurance is not nearly as costly, but premiums cover the cost over the long term..... and such a happening as a fire is financially very expensive, but the risk is also very small, thus low premiums and coverage so you are not financially destroyed.

Healthcare on the other hand is not anywhere close to this model. People file millions of sheets of paper to the insurance company for things such as checkups, ankle sprains, infections, etc... and as such people don't care WHAT the cost is nor due to doctors.

A good example is cosmetics. Cosmetic surgery is not usually covered by insurance companies and as such is payed for out of pocket. Costs in cosmetic surgery have increased at less than 1/3 the rate of other comparable surgeries, and the quality of the doctors (due to if I botch a surgery, my reputation is on the line) and the fact that people are paying through savings rather than through some system where they never see a first hand cost-benefit to shopping for a cheaper procedure.

The doctors are also payed much more because there is a lot less insurance overhead and it is much easier to process patients. If we cut the middle man (insurance) markup on health care costs, and we eliminate the tax incentives for employers to provide health insurance, and instead decrease income taxes and encourage people to save for health expenses, while still having catastrophic care insurance, we could save an extremely large amount of money.

Granted, there will be people in this country that would be uninsured, but it is up to the society/voters to determine whether it is more beneficial to cover the uninsured at a large premium and provide health care through redistribution of income, or have healthcare be an individual choice that is saved for and is not payed for through a third party that extracts trillions in overhead costs....

There is no risk management with the current system, as almost everyone uses it from anything like sprains and check ups, to heart attacks and emergency room visits....

[cristo]

outlaws private contracts? here is a fact check, for the record, britain ( the standard of socialized medicine) has a very health private insurance market ( half the population uses the private sector.)


Have you got any facts to back that up, because I don't believe it!

http://news.bbc.co.uk/1/hi/health/8201711.stm

About 11% have private health insurance. Private GP services very small.

http://www.euro.who.int/document/Obs/Private_Medical_Insurance_UK.pdf

Private health coverage as % of UK population: 2003, 11.2%

[Al68]

I still don't see where the link confirms private contracts will be outlawed.Well, I saw it right away. And of course it's in the text of the bill. Why would your link point out that some private policies wouldn't be outlawed if none were outlawed? Why am I wasting my effort explaining the obvious?And it was precisley the laissez free economics that destroyed the banking industry and put us in the mess we are in.That's just false. Government intervention created the problems. Government created the artificial demand for bad mortgages. There was never any private demand for them.

The biggest problem with "mixed" economies is that socialists claim credit for the benefits of the capitalism, while blaming capitalism for the negative effects of socialist policy. And they succeed with large numbers of people simply by repeating lies continuously and convincingly.

And the simple fact is that I don't need to justify my liberty to make private agreements between private parties. Yet those that would use force to infringe on my liberty act like they're not the bad guys, and demonize anyone who opposes their oppression.

[adrenaline]

Please explain the danger of "patchwork" as you described the plan.

I often hear it referred to as over-layed, and other descriptions - basically layers of regulations imposed instead of fixing the initial problem. As is often the case with Government efforts, they often transform one problem into a different problem (or worse).

here is a good synopsis about the public option facts and myths
http://www.pnhp.org/change/Public_Option_Myths_and_Facts.pdf


see page 2


Obama's public option won't save me on my adminstrative and beaurocratic costs.


I have one medicare/medicaid coder and biller, I have a army to deal with the 200 private insurance plans, I have six check in and check out people to confirm insurances, wether they pay for physicals, what labs I must send blood work to etc., I have over 8 -telephone people at all times not just fielding questions but also helping with prior authorizations and precerts, etc. If the public option now offers me another say 100 plans, all with different formularies, contsraints on procedures, which labs I have to send my blood ( lab corp,quest etc.) I will have to hire another slew of office workers just to deal with them.

Medicare's rules are simple, their formulary does not change every three months, I know where I stand with them. WHen they privatized into competeing HMOs, most of us just could not handle the "patchwork" of differing regulations and rules etc, hence, most of us don't take privatized medicare. ( in my county)

[turbo]

That's just false. Government intervention created the problems. Government created the artificial demand for bad mortgages. There was never any private demand for them.That's the Kool-Aid talking, Al. The government did not create the demand for bad mortgages, and there is no way that you can back that up. The government (GOP administration) refused to rein in highly leveraged investments made on bundled mortgages of dubious value. Government was NOT the problem, but should have been the solution, and it was not. The GOP has made a name for itself claiming that government causes all problems and cannot work, and then when they get elected, they obstruct everything possible to make that come true. I quit the GOP when then became the party of jingoism and nihilism. There are precious few conservatives left on the "right".

[adrenaline]

The way the bill is written, it completely bans private policies in one section - but in the next, it allows them again, through a new mechanism. It merely changes the way they are sold, instead of banning them. But the law has to be written all legal-like. This is typical legal crap.

If you go read the bill, you see the language in Title I referred to in this article, and you see that it contains an exception. That exception is Title II, which allows PRIVATE insurers to offer PRIVATE plans through a new mechanism called a Health Insurance Exchange. I don't know the details yet, but it looks like it's basically one-stop shopping for health insurance, to make it easier for people to compare plans. They could choose a private plan, the government's plan, or Medicare, etc. if they qualify. I think it also makes it possible to choose a plan from any state, nationalizing the health insurance market and making more competition possible. It has some kind of tax benefits too. I found this article praising the idea, from a CONSERVATIVE think tank:

http://www.heritage.org/research/healthcare/wm1230.cfm



Short of congressional action to reform the tax code, the burden to improve health coverage rests with state officials. The best way to enable individuals and families to buy, own, and keep health insurance from job to job—without losing the tax advantages of the employment-based coverage—is to transform the balkanized and dysfunctional state health insurance market into a single health insurance market. This new market would function well for all sorts of individuals and small businesses, not just workers employed by large companies....



The best option is a health insurance market exchange. A properly designed health insurance exchange would function as a single market for all kinds of health insurance plans, including traditional insurance plans, health maintenance organizations, health savings accounts, and other new coverage options that might emerge in response to consumer demand. In principle, it would function like a stock exchange, which is a single market for all varieties of stocks and reduces the costs of buying, selling, and trading stocks. For the same reasons, other types of market transactions are also centralized, such as farmers’ markets, single locations where shoppers can purchase a variety of fresh fruits and vegetables, and Carmax, where consumers can choose from among all kinds of makes and models of automobiles.



In the case of a statewide health insurance exchange, employers would designate the health insurance exchange itself as their “plan” for the purpose of the federal and state tax codes. Thus all defined contributions would be tax free, just as they would be for conventional employer-based health insurance. The major benefits of this arrangement for employers, particularly small employers, are a reduction in administrative costs and paperwork and the ability to make defined contributions to their employees’ preferred plans.



As a vehicle for a defined-contribution approach to health care financing, an exchange would expand coverage and choice. Rather than have to decide whether to pay for full coverage or not, employers could make defined contributions of any size to the exchange. Moreover, employers could also enable employees, including those working part-time and on contract, to buy health insurance with pre-tax dollars. Under a Section 125 plan, any premium payments made by workers, even part-time workers or contract employees, would be 100 percent tax-free. This is especially important for workers in firms that require them to pay part of the health insurance premium. Employees, not employers, would buy the health care coverage with pre-tax dollars, would own their own health plans, and would take them from job to job without the loss of the generous tax benefits of conventional employer-based coverage. This is a revolutionary change in the health insurance market.



Unlike other state-based initiatives, the creation of a statewide health insurance exchange would not violate the Employee Retirement Income Security Act of 1974 (ERISA). This approach complies with ERISA because employer participation in an exchange is voluntary—though, given the benefits of an exchange, few small businesses would turn down the option. An exchange can be designed within the existing framework of other federal insurance laws, including the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Health Insurance Portability and Accountability Act (HIPAA).

Personally, as a small business owner who spends an exorbitant amount of my overhead on health insurance premiums this "stock exchange" set up for when I shop around for health insurance can be very appealing.

As a doctor, it sucks, because that means many more players to deal with and it does not streamline my adminstrative work and overhead.

[Al68]

The way the bill is written, it completely bans private policies in one section - but in the next, it allows them again, through a new mechanism.No, it doesn't allow the same policies it bans. It outlaws private policies, then in the other section, it allows only private policies that meet the criteria and are part of the "exchange", or temporarily grandfathered.

The "exchange" only allows comprehensive health plans that meet the requirements. All other (new) private policies are outlawed.

Anyone who can read and takes the effort knows this, so there is no reason to deny it in this forum.

[Evo]

I have to sy, that as an employee of a large company that has incredible health insurance, this plan scares the crap out of me. For me, it means higher health costs to maintain the same level of healthcare, if I can even get the same level of healthcare, my doctor is afraid that if this passes he will no longer be free to fight the battles to get the best care for his patients. He feels he will be forced to accept whatever is deemed "acceptable".

Adrenaline, I know you are one of those saints that helps the poor in your area. So, you care more about universal care. But what are your thoughts on the future of cutting edge medicine in the US if the health industry is limited to government fixed costs?

[Al68]

That's the Kool-Aid talking, Al. The government did not create the demand for bad mortgages...Yeah, banks were just making loans they knew would lose money for themselves. It had nothing to do with Fannie Mae and Freddie Mac wanting them. And of course F&F didn't want bad mortgages bundled with the good ones. :uhh:

Seriously, I asked in another thread if anyone could show a single example of those bad mortgages being issued for any other reason than to sell to Fannie and Freddie (government created demand). Can you?

[adrenaline]

I have to sy, that as an employee of a large company that has incredible health insurance, this plan scares the crap out of me. For me, it means higher health costs to maintain the same level of healthcare, if I can even get the same level of healthcare, my doctor is afraid that if this passes he will no longer be free to fight the battles to get the best care for his patients. He feels he will be forced to accept whatever is deemed "acceptable".

Adrenaline, I know you are one of those saints that helps the poor in your area. So, you care more about universal care. But what are your thoughts on the future of cutting edge medicine in the US if the health industry is limited to government fixed costs?

large companies are the only ones with any advantage in purchasing group health insurance, small to medium size business owners like myself, it is breaking our backs and the the growing percentage of our overhead is exploding. The statistics show that the percentage of businesses offering health insurance as a benefit has been dropping steadily, this is before any
"public option" was proposed. http://www.usatoday.com/money/smallbusiness/columnist/abrams/2009-07-31-health-care-reform-and-small-business_N.htm

This trend will continue if we do nothing. the cuurrent toxic environment punishes small businesses, it is unsustainable, the backbone of the american workforce is being royally screwed in terms of an ever burdensome share of providing health insurance. If we do nothing, only our children who work for big conglomerates will have health insurance. the single payer option will help them. remember, i don't like obama's plan, but support a single payer option.


Let's not forget that close to 40% of all medical research funded in this country is through the NIH ( tax govt sponsored) and gets the most return. For three decades between 1965 -1995 7/21 life changing drugs were govt sponsored research , that's just drugs, not other biomedical advances. Everyone assumes that a " socialized" medicine" will stop any new advancements, heck the singular AIDs drug that altered the course if childhood aids was 3tc invented by canadian researchers and there are numerous numerous advances coming from that country published in my medical literature.

if you want to see what counteries with "government constraints"capable of. let's look at canada,




http://www.lhsc.on.ca/About_Us/LHSC/...akthroughs.htm





Canadian first for totally endoscopic closed-chest robotic bypass surgery...


Media ReleaseCanadian first for totally endoscopic closed-chest robotic bypass surgery


On May 4, 2007, CSTAR (Canadian Surgical Technologies & Advanced Robotics) announced that a cardiac surgery team led by Dr. Bob Kiaii, cardiac surgeon and director of Minimally Invasive and Robotic Cardiac Surgery, performed a totally endoscopic closed-chest robotic coronary artery bypass surgery on a patient’s beating heart at University Hospital.

Canadian first for robotic assisted gallstone surgery..


LHSC physicians achieve a Canadian first in using new technology to treat atrial fibrillation......

A world first at CSTAR: surgical robot helps to reduce stroke in common cardiac disorder



Canadian first for robotic assisted gallstone surgery.... etc.


i know that new magnetic contrasts agents for biomedical imaging research and applying nanotechnology to it is being conducted in Université Laval, Québec....etc.

Many of the high quality medical research I am seeing in my medical journals are coming from countries where "government" control of health care plays a major role ( most of europe, canada etc.)

to say cutting biomedical research will tank is absolutely not true. As for our drug companies, I have not seen any real revolutionary products come down the pipeline , only the "me too" drugs and slight modifications over existing drugs that are pushed once the others go generic.

[WheelsRCool]

That's the Kool-Aid talking, Al. The government did not create the demand for bad mortgages, and there is no way that you can back that up.

Fannie Mae and Freddie Mac were established to create demand for the bad mortgages. George W. Bush tried multiple times to bring them under heavier regulation and oversight, but Fannie/Freddie gave large contributions to politicians in Congress from both parties, so Congress killed all attempts to bring them under greater oversight. Barack Obama himself was the second-largest recipient in campaign contributions from Fannie Mae, and Fannie/Freddie had been large sources of campaign contributions for politicians for years.

Quasi-government, quasi-private institutions like Fannie/Freddie need to be watched closely.

The government (GOP administration) refused to rein in highly leveraged investments made on bundled mortgages of dubious value.

For one, I doubt most of the people in government had any idea of how risky much of the investments were, this being because the financial institutions themselves didn't. Big companies hate risk. They do everything they can to minimize it. They thought they had. They had no idea they were playing Russian Roulette with billions of dollars.

Right prior to the crash, it had actually become believed by many that we had reached a point where financial instruments were so accurate that they could allocate capital precisely to those who needed it (and maybe they could, but they tied everything ultimately into the housing market, which crashed nationally).

Government was NOT the problem, but should have been the solution, and it was not. The GOP has made a name for itself claiming that government causes all problems and cannot work, and then when they get elected, they obstruct everything possible to make that come true.

For the most part, government does cause most problems and it doesn't work. You want to see how the Left run things, with government trying to fix things, take a look at California, New York City in the mid-1970s, New York State right now, Michigan, Illinois, or any of the other Leftist-run states or cities.

And the GOP is not the party of small government. They never have been. Ronald Reagan was. The GOP has always been a party for bigger government, just a different kind of bigger government than the Democrats. The only time the GOP revert to being for limited government is when the Democrats are in charge.

When Ronald Reagan sought to deregulate the financial industry, it was the Republican establishment on Wall Street at the time that fought very hard against it, because they knew it would end their monopoly on the industry by creating competition. The great irony to this is that because of Reagan, Wall Street now is no longer any Republican stronghold, it has a lot more Democrats on it.

The truth is that this crises is more complex than a claim of too little government or too much. In some areas of the financial industry, it is possibly too under-regulated. Or it just may need re-regulation.

But ask yourself, if the big corporations couldn't see the enormous risks they were taking on, what makes anyone think a regulator would have been able to spot them?

Fannie/Freddie were clearly under-regulated.

I quit the GOP when then became the party of jingoism and nihilism. There are precious few conservatives left on the "right".

You sure about that, b/c right now, the GOP is being accused of being too "right-wing."

As for this universal healthcare, I notice that the President is now trying the religion card. Now if it was a Republican president and they were trying this, there'd be hell to pay in the mainstream media I have a feeling.

[Evo]

Before I delete more off topic threads...this is about HEALTH CARE.

[WheelsRCool]

Before I delete more off topic threads...this is about HEALTH CARE.

OKAY!! Sorry.

[adrenaline]

http://www.care2.com/causes/health-policy/blog/insurers-to-continue-practice-of-canceling-insurance-for-the-sick/

Probably my biggest reason for some sort of health care reform from the goverenment is the continued practrice of "rescinding" health care policies that is happening at a more alarming rate with my privately insured patients. I am right now struggeling with a 42 year old I diagnosed with burkitts lymphoma. I have been his doc for 11 years and his insurance carrier told him his diagnosis was a preexisting condition based on some fatigue complaints he expressed to a nurse practioner 4 years ago. ( at the time he was working second shift and was diagnosed with shift work disorder and improved when he was able to get first shift duty). His physicals year after year did not relieve any lymphadenoapthy until his last one. They dropped him. He can't obtain private insurance, I have had him put all his assets in his exwifes name and soon he will qualify for medicaid which will pick up all his treatment 100% this was a man who worked full time since he was 17 for this paint production factory.

Though not an example of rescinding I had a 41 year old diagnosed with cutaneous t cell lymphoma, two years into her treatment ( full body radiations, sepsis from repeated pseudomonas infections etc.) she reached her one million dollar lifetime maximum and was essentially going to have to pay 100% of any future medical costs and treatments. her employer did not offer her any other type of plan. I put her on disabilty and now medicare and medicaid secondary has stepped up to the plate and has been paying for her treatments for the last 9 years. ( she is now 50).

If you think the government rations care, think again...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.

[mheslep]

The free market has not been given much of chance to work in US health care. Some states have only one insurance company left, and they're protected from the competing firm in other states. Patients for the most part have no idea of the cost incurred; they pay their copay or deductible and walk. In some other related businesses with no insurance model, like Lasik eye surgery, or Veterinary medicine* the costs have remained flat or even dropped while the state of the art has advanced.

*per pet. $120 each pet in 2001, $127 in 2007
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf
http://www.avma.org/reference/marketstats/ownership.asp

Edit: In case of the high technology medicine is driving costs up argument:
State-of-the art MRI technology for pets (http://www.petsdx.com/)

[WheelsRCool]

If you think the government rations care, think again...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.

Those against things like socialized medicine and universal health insurance (I know government-run healthcare and government health insurance are not necessarily the same thing), are not saying the healthcare system does not need reform. But to switch from the current system to a government model seems like trading one set of problems for another.

Right now, U.S. healthcare is not really free-market. It is about 50% government (Medicare and Medicaid) and the private insurance sector I believe is very highly regulated by the states, some so heavily that it is nearly impossible for them to function in the states they're in. It isn't really a free-market in the normal sense. Healthcare seems like a double-edged sword. With the private health insurance sector, you have corporate bureaucrats making decisions. With government, you have government bureaucrats.

For-profit health insurance companies will try to do everything as efficiently and cheaply as possible, which can mean denying care, while government-run health insurance companies waste money and are very inefficient.

For example, Medicare and Medicaid I believe are government-run health insurance companies, and they are monuments to waste, fraud, corruption, etc...

Since hospitals and so forth (I believe) have a ceiling on what price they can charge to people with Medicare or Medicaid, the healthcare businesses would pass those costs onto those with private insurance.

I would imagine that since Medicare and Medicaid's costs have ballooned way beyond what they were ever intended to, that this contributes to the rising costs of the private sector healthcare. Lawsuits I also think are a contributing factor.

Then there's regulations, for example, in my state of New York here, I remember during the Congressional elections, there was a radio commercial in which some candidate criticized his opponent for refusing to sign a bill that would prevent health insurance companies from raising the price on X service for customers.

If health insurance companies cannot charge higher prices for Medicare and Medicaid people, and cannot raise prices for certain services in the private sector either, what do people think will happen? The only option left is to flat-out deny said service (i.e. ration).

I think it is all these things combined (various price controls, lawsuits, Medicare and Medicaid costs), throughout the states (I believe health insurance companies are regulated by the states), that contribute to rising healthcare costs.

In theory, that would mean one way to begin to control healthcare costs in the private sector is to get Medicare and Medicaid under control.

But that also leads to the other parts I don't get: Medicare and Medicaid are both government-run. And both have ballooned way out of control cost-wise. So wouldn't the logical thing be to figure out how to get them both under control first, before creating a whole new government health program?

We also have the example of the Massachusettes universal care experiment, which was supposed to not balloon out of control cost-wise, yet that is what has happened. And the fears that creation of a public option would be a Trojan horse to destroy the private insurance industry to eventually push the country onto a single-payer system.

[Al68]

...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.It's less evil because no one is using force against their fellow man to coerce them. Or are you just pretending to not understand what is meant by the term "socialist" when used by those opposed to this proposal?

And the tax penalty isn't for not wanting to buy medical insurance, it's for not participating in the government system. But I assume you knew that already.

And as far as the "grandfather" clause, while it would temporarily allow some existing private policies, it will immediately eliminate the ability of consumers to shop around for a private policy that isn't in the "exchange".

[Al68]

Right now, U.S. healthcare is not really free-market. It is about 50% government (Medicare and Medicaid) and the private insurance sector I believe is very highly regulated by the states, some so heavily that it is nearly impossible for them to function in the states they're in. It isn't really a free-market in the normal sense.This is a good point. We have seen decades of government regulation repeatedly being used to correct problems caused by previous regulation. Then each time regulation causes more problems, they are blamed on capitalism, and the solution is more regulation. And now after decades of ever increasing regulation causing increasing problems, we're told that the solution is, guess what: government regulation.

[wildman]

http://www.care2.com/causes/health-policy/blog/insurers-to-continue-practice-of-canceling-insurance-for-the-sick/

Probably my biggest reason for some sort of health care reform from the goverenment is the continued practrice of "rescinding" health care policies that is happening at a more alarming rate with my privately insured patients. I am right now struggeling with a 42 year old I diagnosed with burkitts lymphoma. I have been his doc for 11 years and his insurance carrier told him his diagnosis was a preexisting condition based on some fatigue complaints he expressed to a nurse practioner 4 years ago. ( at the time he was working second shift and was diagnosed with shift work disorder and improved when he was able to get first shift duty). His physicals year after year did not relieve any lymphadenoapthy until his last one. They dropped him. He can't obtain private insurance, I have had him put all his assets in his exwifes name and soon he will qualify for medicaid which will pick up all his treatment 100% this was a man who worked full time since he was 17 for this paint production factory.

Though not an example of rescinding I had a 41 year old diagnosed with cutaneous t cell lymphoma, two years into her treatment ( full body radiations, sepsis from repeated pseudomonas infections etc.) she reached her one million dollar lifetime maximum and was essentially going to have to pay 100% of any future medical costs and treatments. her employer did not offer her any other type of plan. I put her on disabilty and now medicare and medicaid secondary has stepped up to the plate and has been paying for her treatments for the last 9 years. ( she is now 50).

If you think the government rations care, think again...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.

This is what I mean when I say we already have socialism. The problem is that it is an uncontrolled crazy form of socialism. It is far more expensive (if you figure in emergency room costs that are spread over all the insured, medicare and medicaid) than the more rational forms of socialism in other countries. It is literally driving us bankrupt. I am not sure what we should replace it with, but if you don't think we are paying already then I got a bridge to sell you (cheap!).

[mheslep]

...Let's not forget, the best avante garde basic medical research is done by NIH, government funded, ( socialized) without profit motive. ...

drug companies are resorting to "me too" drugs or slight modifications of existing drugs ( ie: nexium from prilosec, lexapro from celexa) for the quick profit turn around.

No doubt NIH research has produced countless nobel prizes. It's a national resource for basic research, especially from what little I know about the reported cancer, heart disease, and of course genome research there. But it's hardly the beginning and end of day to day medical advances in this country as I read the history. In that line, a couple years ago Health Affairs published a survey of internists on the top 10 most useful high tech medical innovations world wide, and I can't find NIH footprints on any of them.

* MRI/CT
* ACE inhibitors
* Balloon angiography
* Statins
* Mammography
* Coronary Artery Bypass Graft surgery
* H2-receptor antagonists
* Selective serotonin reuptake inhibitors (SSRIs)
* Cataract extraction and lens implants
* Hip and knee replacements
http://healthaff.highwire.org/cgi/reprint/20/5/30

NIH certainly had no fundamental role in the development of the MRI. Some of the rest:


Statins come from the work of Japanese biochemist Akira Endo while working at Sankyo, with later work by Merck to isolate a statin from Endo's fungus.
Captopril, the first available ACE Inhibitor, was developed by Bristol Meyers Squib scientists, based on the fundamental work of English scientists K. K. F. Ng & J. R. Vane.
Angiography was invented by radiologist Charles Dotter out of the University of Oregon and the first devices made by entrepreneur Bill Cook.
The first CABG was done at the Albert Einstein college of medicine by US Drs. Goetz, Rohman, Haller, Dee. The first five SSRIs (antidepressants) came out of five different drug companies: Lundbeck, Solvay, Eli Lilly, SmithKline-Beecham, and Pfizer.
Modern cataract surgery was enabled by the invention of phacoemulsification by US Opthamologist Charles Kelman.
The MRI was developed by P. Lauterbur of the University of Illinois at Urbana-Champaign and P. Mansfield of the University of Nottingham, Nobel prize winners for their work.


Sorry if this is pedantic, but the above comment is not the first on the 'who needs industry, government/academia does it all anyway' line. There's some notable academic pushing that concept recently, against what seems to me a mountain of evidence to the contrary.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=101126
http://www.preskorn.com/books/ssri_s2.html
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/article/articleDetail.jsp?id=98075

[Al68]

This is what I mean when I say we already have socialism. The problem is that it is an uncontrolled crazy form of socialism. It is far more expensive (if you figure in emergency room costs that are spread over all the insured, medicare and medicaid) than the more rational forms of socialism in other countries. It is literally driving us bankrupt. I am not sure what we should replace it with...That seems like asking someone with a tumor what he would replace it with. The answer is just to get rid of it, not replace it. That's what I'd say about socialist policies in the U.S. They don't need to be replaced, just eliminated. And certainly not expanded even more.

[WhoWee]

The way the bill is written, it completely bans private policies in one section - but in the next, it allows them again, through a new mechanism. It merely changes the way they are sold, instead of banning them. But the law has to be written all legal-like. This is typical legal crap.

If you go read the bill, you see the language in Title I referred to in this article, and you see that it contains an exception. That exception is Title II, which allows PRIVATE insurers to offer PRIVATE plans through a new mechanism called a Health Insurance Exchange. I don't know the details yet, but it looks like it's basically one-stop shopping for health insurance, to make it easier for people to compare plans. They could choose a private plan, the government's plan, or Medicare, etc. if they qualify. I think it also makes it possible to choose a plan from any state, nationalizing the health insurance market and making more competition possible. It has some kind of tax benefits too. I found this article praising the idea, from a CONSERVATIVE think tank:

http://www.heritage.org/research/healthcare/wm1230.cfm





Personally, as a small business owner who spends an exorbitant amount of my overhead on health insurance premiums this "stock exchange" set up for when I shop around for health insurance can be very appealing.

As a doctor, it sucks, because that means many more players to deal with and it does not streamline my adminstrative work and overhead.

I'd like to elaborate on the heritage.org piece:
"As a vehicle for a defined-contribution approach to health care financing, an exchange would expand coverage and choice. Rather than have to decide whether to pay for full coverage or not, employers could make defined contributions of any size to the exchange. Moreover, employers could also enable employees, including those working part-time and on contract, to buy health insurance with pre-tax dollars. Under a Section 125 plan, any premium payments made by workers, even part-time workers or contract employees, would be 100 percent tax-free. This is especially important for workers in firms that require them to pay part of the health insurance premium. Employees, not employers, would buy the health care coverage with pre-tax dollars, would own their own health plans, and would take them from job to job without the loss of the generous tax benefits of conventional employer-based coverage. This is a revolutionary change in the health insurance market."

An example of a "Cafeteria" section 125 qualified plan is an Aflac accident policy. Another example is a "flex-spending account". Basically, pre-tax dollars are used to pay premiums.

To qualify, a business needs to register and implement a qualified plan. Assume the business is a light manufacturing company with 100 workers - and the workers earn from $10 to $30 per hour. The Aflac policies will typically cost less than $50 per month and will be paid by the employees that decide to participate.

The direct benefits to the employer are as follows.
1.) The $50 cost is deducted from the employees gross wages - if $15/hour @ 40 hours = $600 per week - $50 Aflac = $550 gross. The employer now pays matching taxes on the lower amount.
2.) With an accident policy in place, a worker is less likely to use a workers compensation plan if injured during non-working hours - this means lower workers comp costs in the long term.
3.) A lower gross also means lower FICA contributions for the employee.

For anyone interested in learning more, this is worth a look
http://www.mathematica-mpr.com/publications/PDFs/section125brief.pdf

[adrenaline]

Healthcare seems like a double-edged sword. With the private health insurance sector, you have corporate bureaucrats making decisions. With government, you have government bureaucrats.

we both agree. At the same time, no other nation would tolerate a system that consumes one-third of insurance premiums on insurance functions.


For example, Medicare and Medicaid I believe are government-run health insurance companies, and they are monuments to waste, fraud, corruption, etc...

The private sector did no better and had more waste ( and most likely fraud as well) in the failed experiment called medicare advantage plans. ( They deny paying the first three days of hosptialization, deny rehab care over three days and still cost more!)


Lawsuits I also think are a contributing factor.

in the form of defensive medicine we both agree. that is one glaring defect of the obama plan, no real call for tort reform.



In theory, that would mean one way to begin to control healthcare costs in the private sector is to get Medicare and Medicaid under control.

All other industrialized nations have universal programs whether through government ownership, single payer insurance programs etc. and have been more successful at slowing the rate of health care inflation, spending much less than we do, while providing care for everyone. We need to engage in an active dialogue and learn from them rather than the general consensus of ignoring them.


I believe the government would not make allowances for the 80 percent of research that is designed simply to restart the patent clock.

As for fixing medicare, lets start with overuse of high-tech, specialized services that provide no health care benefit which have characterized much of our system. For example, drug eluting stents cost two to 5 times more than bare metal stents, though they have lower early restenosis rates, they have much higher late restenosis rates ( one year out) so these patients have to take plavix, 300 dolllar a month drug, much longer due to fear of this. A single payer system would have much better information resources to help realign incentives to promote more optimal use of the technologically-advanced products and services. I believe obama's plan calls for such an ovesite board to evaluate effectiveness of different therapeutic options.

Private plans have not been innovators in cost management but have merely followed the government’s lead through measures such as private, managed care price fixining. When I was chief of medicine, many of our quality initiatives in the hospital ( prevention of readmission rates etc.) and efficiency was driven soley by medicare mandates, not private health plans. For instance, medicare does not pay the hospital if the patient is readmitted within 24-48 hours after discharge for the same diagnosis. Otherwise, what was to prevent us doctors from booting out a patient too early and getting paid to readmit them ( admission payments are high) the next day? Thus, there was great incentive to provide for post hospital followup ( home health), predischarge planning ( education about disease) , and keeping them in the hosptial long enough to ensure that the chief medical problem has been resolved adequetly? ( we still need work on that by the way)





We also have the example of the Massachusettes universal care experiment, which was supposed to not balloon out of control cost-wise, yet that is what has happened. And the fears that creation of a public option would be a Trojan horse to destroy the private insurance industry to eventually push the country onto a single-payer system.

let's not forget our media conveniently ignore's taiwan's single payor success story. Right now, the current environment rewards practioners in highly lucriative fields, interventional radiology etc, and has created a shortage of primary care practioners. ( afterall, a family practioner owes as much as a future radiologist when they come out of medical school.) ( Another reason why the massachessets plan failed but that is another long discussion. ) A strong primary care infrastructure provides higher quality care at lower costs. Our primary care system is rapidly deteriorating. A single payer could realign incentives to strengthen our primary care base. Our costs would be lower, and everyone would have access to the quality provided by a medical home of their choice. Right now, primary care docs, paid at the bottom of private and medicare reimbursements must hire the most administrative personell to deal with all the insurance rules and regulations.

[adrenaline]

It's less evil because no one is using force against their fellow man to coerce them. .

They are coerced, if you cite lack of choice.

Most of my patients have no options regarding the plan their employer provides.

The woman with t cell lymphoma did not have an option from her employer for a higher lifetime limit plan.( past the million dollars.) Instead, the private plans dumps her after they have spent too much money on her and our tax dollars now have to take care of her ( despite 15 years having wages suppressed and garnished paying the premiums). The man with burkits lymphoma did not have a choice in a company plan that practices rescinding more than others.

I myself can only offer my employees humana ppo or hmo, nothing else. WHen two of my nurses developed breast cancer I could not afford to change insurance carriers.

[WhoWee]

adrenaline,
It might help if you explain how the Government indirectly sets the payment standards for insurance companies through Medicare fee schedules.
http://www.cms.hhs.gov/FeeScheduleGenInfo/

[adrenaline]

No doubt NIH research has produced countless nobel prizes. It's a national resource for basic research, especially from what little I know about the reported cancer, heart disease, and of course genome research there. But it's hardly the beginning and end of day to day medical advances in this country as I read the history. In that line, a couple years ago Health Affairs published a survey of internists on the top 10 most useful high tech medical innovations world wide, and I can't find NIH footprints on any of them.

* MRI/CT
* ACE inhibitors
* Balloon angiography
* Statins
* Mammography
* Coronary Artery Bypass Graft surgery
* H2-receptor antagonists
* Selective serotonin reuptake inhibitors (SSRIs)
* Cataract extraction and lens implants
* Hip and knee replacements
http://healthaff.highwire.org/cgi/reprint/20/5/30

NIH certainly had no fundamental role in the development of the MRI. Some of the rest:


Statins come from the work of Japanese biochemist Akira Endo while working at Sankyo, with later work by Merck to isolate a statin from Endo's fungus.
Captopril, the first available ACE Inhibitor, was developed by Bristol Meyers Squib scientists, based on the fundamental work of English scientists K. K. F. Ng & J. R. Vane.
Angiography was invented by radiologist Charles Dotter out of the University of Oregon and the first devices made by entrepreneur Bill Cook.
The first CABG was done at the Albert Einstein college of medicine by US Drs. Goetz, Rohman, Haller, Dee. The first five SSRIs (antidepressants) came out of five different drug companies: Lundbeck, Solvay, Eli Lilly, SmithKline-Beecham, and Pfizer.
Modern cataract surgery was enabled by the invention of phacoemulsification by US Opthamologist Charles Kelman.
The MRI was developed by P. Lauterbur of the University of Illinois at Urbana-Champaign and P. Mansfield of the University of Nottingham, Nobel prize winners for their work.


Sorry if this is pedantic, but the above comment is not the first on the 'who needs industry, government/academia does it all anyway' line. There's some notable academic pushing that concept recently, against what seems to me a mountain of evidence to the contrary.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=101126
http://www.preskorn.com/books/ssri_s2.html
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/article/articleDetail.jsp?id=98075


all true in the past, but the current environment of quick profit turnovers now force the "innovative "drug companies to spend 80 percent of their research dollars "extending" patents on on say left handed isomers on old racemic drugs, new "drug delivery" encapsulation for the same drug etc....

My point was that there is healthy biomedical research going on in these other counteries. Not denying our own accomplishments. Of course, it would be unfair to use embryonic stem cell research advances in these countries since the religious whackos tied our county's hands for many years under Bush.

[Al68]

They are coerced, if you cite lack of choice.

Most of my patients have no options regarding the plan their employer provides.

The woman with t cell lymphoma did not have an option from her employer for a higher lifetime limit plan.( past the million dollars.) Instead, the private plans dumps her after they have spent too much money on her and our tax dollars now have to take care of her ( despite 15 years having wages suppressed and garnished paying the premiums). The man with burkits lymphoma did not have a choice in a company plan that practices rescinding more than others.

I myself can only offer my employees humana ppo or hmo, nothing else. WHen two of my nurses developed breast cancer I could not afford to change insurance carriers.No, they are not being coerced by force. They have the insurance they chose. Just claiming someone has no choice doesn't make it true. Claiming someone has no choice because their employer only offers one plan is absurd. That's like claiming I have no choice about what kind of food to eat because a hot dog cart only offers hot dogs.

That kind of logic only works for people incapable of thinking for themselves.

Gee, most people have no options regarding what kind of food the local hot dog cart offers. So they're "coerced" into eating a hot dog. Silly, huh?

[adrenaline]

No, they are not being coerced by force. They have the insurance they chose. Just claiming someone has no choice doesn't make it true. Claiming someone has no choice because their employer only offers one plan is absurd. That's like claiming I have no choice about what kind of food to eat because the hot dog cart only offers hot dogs.

That kind of logic only works for people incapable of thinking for themselves.

Gee, most people have no options regarding what kind of food the local hot dog cart offers. So they're "coerced" into eating a hot dog. Silly, huh?



So your suggest they change jobs, for the sake of health insurance benefits? That is equally absured especially in this economic climate.

My 62 year old ATT worker who found out his family lifetime limit decreased from 5 million to one million can't just up and change jobs ( His wife has had a prior history of lymphoma and there is a chance it will come back). Who hires a 62 year old?


Second, The man with burkits had no idea the plan he had since he was 17 practiced such abusive practices,( afterall, they did not give him grief over his yearly physicals and occassional shoulder bursal injections.) do you know if your does? ( I'll give you a hint, his is a top three insurance carrier)


The woman with t cell lymphoma had no idea she was going to use up her lifetime limit when she was diagnosed with the cancer. When she did, she tried to get the health insurance carrier to extend the lifetime limit, even if it meant paying an extra thousand dollars a month, ( she was willing)

Your statements make no sense with both examples I used.

And let's not forget that both examples I used, the government did not ration care, it saved them. The private insurance carriers did the most ultimate and cruel form of rationing, cut them off when they were needed the most.

[mheslep]

all true in the past, but the current environment of quick profit turnovers now force the "innovative "drug companies to spend 80 percent of their research dollars "extending" patents on on say left handed isomers on old racemic drugs, new "drug delivery" encapsulation for the same drug etc....

My point was that there is healthy biomedical research going on in these other counteries. Not denying our own accomplishments...I'm unable to speak to the more recent innovations, except to say that if the US has had all these accomplishments in the past (majority of the 10 were US based), then what's changed now? I don't buy that its all or even mostly on industry - that today's industry is all about quick profits but somehow that twenty, thirty years ago they were not. I'd be more inclined to open up the hood on the today's FDA imposed costs of developing truly new medicines/procedures measured against the government imposed costs of that era, or perhaps the coupling behind today's big pharma and today's FDA that prevents new smaller players from entering.

[adrenaline]

adrenaline,
It might help if you explain how the Government indirectly sets the payment standards for insurance companies through Medicare fee schedules.
http://www.cms.hhs.gov/FeeScheduleGenInfo/

all i know is private insurances follow medicare fee schedules. some pay less ( I fire those plans when I review their contract and see they are paying us less than medicare set fees)

[adrenaline]

I'm unable to speak to the more recent innovations, except to say that if the US has had all these accomplishments in the past (majority of the 10 were US based), then what's changed now? I don't buy that its all or even mostly on industry - that today's industry is all about quick profits but somehow that twenty, thirty years ago they were not. I'd be more inclined to open up the hood on the today's FDA's imposed costs of developing truly new medicines/procedures measured against the government imposed costs of that era, or perhaps the coupling behind today's big pharma and today's FDA that prevents new smaller players from entering.


I blame the growing wave of any advanced scientific research, not just biomedical, being done in most other countries to the hemmohraging pool of foreign basic scientists and engineers returning to their country of origin. That in itself is multfactorial ( china and India's living standards are better so more advanced degreed chinese and indian scientists and engineers voluntarily return to their countries rather than stay with a company here.) When I look at journals and look at many of the medical directors of the academic medical facilities,they are now mostly foreigners ( at least by name). I am assuming since they are the ones pursuing the advanced research degrees. I'm sure that is another whole discussion.

My short lived career as a chemist, I remember being one of few Americans in my classes as well as the workplace.

[Al68]

So your suggest they change jobs, for the sake of health insurance benefits?No, I'm suggesting that they can choose their own medical insurance like I do.

A hot dog cart choosing to only offer hot dogs isn't "coercion" simply because I "needed" to buy one today for practical reasons. Having limited practical choices is not the definition of coercion.
Your statements make no sense with both examples I used.That's because you gave no examples of coercion.

I will say I very much dislike employer based health insurance, partly for the reasons you state, and that is a problem caused by government intervention (preferential tax treatment). People (like me) who shop around for private insurance tend to know a lot more about the policy they buy.

[adrenaline]

This is what I mean when I say we already have socialism. The problem is that it is an uncontrolled crazy form of socialism. It is far more expensive (if you figure in emergency room costs that are spread over all the insured, medicare and medicaid) than the more rational forms of socialism in other countries. It is literally driving us bankrupt. I am not sure what we should replace it with, but if you don't think we are paying already then I got a bridge to sell you (cheap!).

True, part of the reasons hospitals charge medicare and insured patients more is to try to recover the cost of treating the uninsured. Our private insurance premiums have been shown to be higher because of the uninsured. And this is also something to keep in mind, the uninsured are more likely to sue a hospital or doctor in an attempt to recover and recopu costs, that drives up everyone's cost....

And let's also remember 60% of all medical bankruptcies are due to medical costs, anywhere from a half to 3/4 were insured before bankruptcy ( many of them lost insurance after losing their jobs due to illness, went past their 18 month cobra, or reached their lifetime limit). Having health insurance does not protect you from medical bankruptcy!http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/index.html?eref=rss_health

[adrenaline]

No, I'm suggesting that they can choose their own medical insurance like I do.

A hot dog cart choosing to only offer hot dogs isn't "coercion" simply because I "needed" to buy one today for practical reasons. Having limited practical choices is not the definition of coercion.


The 62 year old whose wife had a prior history of lymphoma would have had to pay close to 3,000 a month to insure his family ( he also had multiple basal cell cancers.) on a private plan. He had no choice.Now, I have 3,000 a month extra to boot the bill but I bet 99 % of the posters here cannot suddenly afford 3,000 dollars a month to insure their family because they don't like their insurance. Before his wife was diagnosed, it made no sense to insure his family on his own since only 32 dollars a months was being garnished from his wages to insure him, his wife and three kids. do you know how expensive it is to insure all those together?

The man with burkits lymphoma had no choice because he had no idea his plan was going to rescind him, at that point he was no longer "insurable" due to his preexisting.

Do you know what your lifetime limit is on your insurance plan? Remember, if you get a leukemia and need a bone marrow transplant you will eat up a million within the first 12 months.

Perhaps I shouldn't have called it coercion, more like "no options" when a perfect storm of events outside their control came together so that they had no other opition... the only option was a public one for two of them, privided by medicare/ medicaid but only if one quit her job to qualify for disability despite wanting to work and another had to give up all his assets to a exwife.

got to go, the hosptal just called me in for tonight.

[WhoWee]

I think we should all thank adrenaline for sharing so much with us. These are the type of details our elected representatives should be considering.

For every legislative action - there (might be?) equal (or compounded?) consequences?

The point is we shouldn't jump to conclusions - health care reform is very complicated.

[Al68]

Perhaps I shouldn't have called it coercion, more like "no options"...Then I might have agreed, at least "no practical options". And again, government intervention (preferential tax treatment for employer based insurance) is the biggest cause of the problems you mention. People who choose their own insurance policy will naturally know a lot more about it.

And yes, I know the lifetime maximum for my policy because I chose the policy. I know the deductibles, what it does and doesn't cover, and lots of other things that everyone should know instead of blaming some imaginary "system" for their lack of knowledge.

The range of choices in private policies might surprise most people, and are limited only by government intervention.

[wildman]

That seems like asking someone with a tumor what he would replace it with. The answer is just to get rid of it, not replace it. That's what I'd say about socialist policies in the U.S. They don't need to be replaced, just eliminated. And certainly not expanded even more.

What do you propose? Do you wish to just let the people without insurance just die or do you have another workable idea? Actually, politically, just letting people die probably isn't politically possible since if you did that, most people in the country would be on the death list and you know this is a democracy.....

[Al68]

What do you propose? Do you wish to just let the people without insurance just die or do you have another workable idea? Actually, politically, just letting people die probably isn't politically possible since if you did that, most people in the country would be on the death list and you know this is a democracy.....Do you seriously believe "most people" would be completely helpless without a nanny government? That most people "need" socialist policy?

This reminds me of a famous quote by Ben Franklin: "Necessity is the cry of tyrants and the creed of slaves."

And the U.S. is not a "democracy" in the absolute sense you imply (tyranny of the majority). It's only a democracy within the broader definition that includes any republican form of government.

As far as "wishing to just let the people without insurance to just die", that's not exactly conducive to honest debate, it's just blatant socialist hate mongering. And overuse of the word "just".

[wildman]

Do you seriously believe "most people" would be completely helpless without a nanny government? That most people "need" socialist policy?

This reminds me of a famous quote by Ben Franklin: "Necessity is the cry of tyrants and the creed of slaves."

And the U.S. is not a "democracy" in the absolute sense you imply (tyranny of the majority). It's only a democracy within the broader definition that includes any republican form of government.

As far as "wishing to just let the people without insurance to just die", that's not exactly conducive to honest debate, it's just blatant socialist hate mongering.

I have lived in a Third World country and yes without the nanny government people just die and infectious disease runs wild. It is not fear mongering. It is my experience. Health care is very expensive and someone has to pay for it. A lot of people don't have money to pay for it and yes they are helpless. Charity can only go so far. What do you propose to do? You didn't answer my question.

As far as democracy goes.... What I am saying is if you disenfranchise enough people you run into political problems. You can't just wave your hands and just make that go away. I'm not pushing socialized medicine or anything else, I just want to know what you propose to do.

Basically, the present system is running out of control as far as cost goes. It is socialized medicine without cost control. But if we take the people who are now on government care off of it, you run into political problems. It is a catch-22 without many solutions. So what do you propose to do?

[WheelsRCool]

Of course, it would be unfair to use embryonic stem cell research advances in these countries since the religious whackos tied our county's hands for many years under Bush.

Well being cautious of embryonic stem cell research isn't because of religion (per se, there are religious whackos in it), it is because many view it as tied in with the old eugenics movement. Also there are no restrictions on performing embryonic stem cell research in the United States, the use of Federal money for it is what was restricted.

[adrenaline]

Well being cautious of embryonic stem cell research isn't because of religion (per se, there are religious whackos in it), it is because many view it as tied in with the old eugenics movement. Also there are no restrictions on performing embryonic stem cell research in the United States, the use of Federal money for it is what was restricted.


true, but once again, I trust research from the NIH (goevernment )more than I trust research from private corporations.

In my field , of course, I have to discern pharmaceutical company sponsered drug trials ( which are prevalent) and bear in mind that there has been a history where negative or neutrals results do not seem to get published , ( example paxil in teenagers http://healthfully.org/index/id9.html). I am more inclined to believe the NIH sponsored trial that showed benefit of zocor statin in preventing heart disease in normal lipid diabetics than one sponsored by zocor . As a whole, physicians trust NIH sponsored data more.

The same can be argued about any benefits of embryonic stem cell research and its application to medicine.

Embryonic stem cell research and its immediate application is still in such an infantile stage, it's probably not a beneficial line of resource allocation in R and D for most private companies, at such a basic scientific reasearch level, I think government funding provides the "fuel" that allows it to grow exponentially in its knowledge base and therefore future application.


I believe, Israel, a powerhouse in this line of research is almost 100% funded by the government, especially the science and technology ministry and the Ministry of industry, trade and labor.

[noblegas]

IMO if the american middle class family is able to pay for two cars that probably costs together, $8000-16000 , depending on what section of the middle class income strata you fall under, why can't you pay a measily $4000-5000 dollars in comparison for healthcare insurance? Shouldn't sacrifices be made on your end rather than the insurance companies to make healthcare insurance affordable for you? Does a family really need to buy two cars, nay three if you have children who want cars, not to mentioned a host of other expenses not essential for living like a two story house, college education, $2000 white picket fence ; Americans should really look at the expenses on their list of things that they bought over the years before they can say they cannot afford health insurance;

[WhoWee]

I think we can all agree on these few items. The one thing Government is very good at doing is spending money. Politicians love large projects. They are very bad in the areas of management (the US Post Office is PLANNING to lose $7,000,000,000 per year) and downright anal about details (think about $600 toilet seats, the DMV, building permits - all of those people need to justify all of those jobs). (Has anyone been through a SOX audit?) Hence, everything they oversee has waste and in-efficiency built-in.

As a manager, coach, and father, I've learned to look at the task at hand, look at the individual capabilities of my team and our resources, then devise a strategy that matches CAPABILITY to TASK and identifies weak areas to resolve.

The Government already spends enormous sums of money on health care. The programs are already in big trouble - it's a political "hot potato". The Government plans need to be reformed first.

This should save money and improve care. However, this will take too long and there is NO SIZZLE for the politicians to sell at home. It's hard to hang your name on this type of reform.

If the problems in the existing Government programs are not addressed, they will most likely get worse. By doing another "Patchwork" repair, they will only disguise the current problems and possibly create additional ones.

Politicians want to spend money, the Government is good at spending money, and the health care industry runs on money. Government and health care should be a good match.

(This is the 3rd time I've posted these ideas - sorry if it's the 3rd time you've read it.)

1.) Government investment into facilities, equipment and research would be terrific.
2.) Government investment into high risk insurance pools (to allow access to private insurance to people with pre-existing conditions) would be terrific.
3.) Government built wellness clinics (part of #1), staffed (part time) by experienced doctors (paid with tax (REDUCTION) credits) would provide basic care to everyone and reduce the strain on emergency rooms. The doctors would use the Reduction credits to keep more of their earnings. A reduction is a dollar for dollar tax credit - not a deduction from income.

Now a few new things

4.) Standardization of health insurance. Much of the waste in the insurance industry is dealing with the 52+ Masters - Federal and state governments plus D.C., etc.

Each insurance company, each insurance policy, and each insurance agent must be approved and licensed with each individual state. The costs to consumers is enormous - but hidden.

5.) As others have pointed out, insurance is designed for protection against catastrophic loss.

If you have homeowners insurance, you don't file a claim to have it power washed, painted, re-shingled, or to cut the grass. Instead, you save for those situations and pay out of pocket. If a tree falls on your roof, you call the insurance company.

High deductible ($10,000 to $25,000 deductible) policies and HMO's have grown in popularity the past few years. The owner of the policy saves money in their own personal bank account to use for routine doctor visits and tests (up to the deductible) and only uses the insurance for large events - like hospital stays and surgery. The premiums on these high deductible plans are MUCH lower and often provide greater lifetime maximums and 100% coverage once the deductible is met.

The large employer paid or "Cadillac" plans allow for unlimited doctor visits, tests, medicine, teeth cleanings, eye exams, glasses, etc., etc., etc. Some of these plans were negotiated by unions, some corporations used their massive buying power to negotiate, others are used by business to attract and retain top talent (like the one Evo described).

Most individuals do not have access to and cannot afford these "Cadillac" plans. Small employers often purchase their own private personal insurance, then form a Section 125 Cafeteria plan, with supplemental and accident plans paid by the employees, but nothing else. Mandated coverage of minimum wage and part time workers will certainly guarantee loss of jobs and closing of many struggling businesses. These workers (the working poor) don't have many choices. They make too much to be included in welfare programs and too little for private insurance.

I like the idea of reforming Government waste. Re-allocating the "stimulus" money to fund new hospitals, clinics, and research. Re-allocation of "TARP" funds into a high risk insurance pool to allow access for pre-existing conditions, providing tax incentives to doctors for volunteer work (they are one of the few professions that can actually utilize tax credits) and keeping Government out of the management of health care.

The Government has a role (investment) - it's not the day to day management of health care. Let doctors and the medical professionals run health care. Let insurance companies offer standardized plans and insure against catastrophic events.

We need to step back, use common sense, and remove politics from the debate.

[mheslep]

...Do you know what your lifetime limit is on your insurance plan? Remember, if you get a leukemia and need a bone marrow transplant you will eat up a million within the first 12 months.Aside: I have a good friend with exactly those conditions just now - leukemia + transplant required; he's located donors and yes one million is indeed the cost he tells me. My question: does it really need to cost that much? There seems to be an assumption in health care discussions that the cost of these procedures has a fixed value, now and forever, like a 1000 ounces of gold. The computing and telecommunications power in my cellphone used to require a million dollar device not that many years ago. The economics of the free market were required to make that capability affordable to me, not simply basic research.

[mheslep]

...

(This is the 3rd time I've posted these ideas - sorry if it's the 3rd time you've read it.)

1.) Government investment into facilities, equipment and research would be terrific.
2.) Government investment into high risk insurance pools (to allow access to private insurance to people with pre-existing conditions) would be terrific.
3.) Government built wellness clinics (part of #1), staffed (part time) by experienced doctors (paid with tax (REDUCTION) credits) would provide basic care to everyone and reduce the strain on emergency rooms. The doctors would use the Reduction credits to keep more of their earnings. A reduction is a dollar for dollar tax credit - not a deduction from income.

Now a few new things

4.) Standardization of health insurance. Much of the waste in the insurance industry is dealing with the 52+ Masters - Federal and state governments plus D.C., etc.

Each insurance company, each insurance policy, and each insurance agent must be approved and licensed with each individual state. The costs to consumers is enormous - but hidden.

5.) As others have pointed out, insurance is designed for protection against catastrophic loss.

If you have homeowners insurance, you don't file a claim to have it power washed, painted, re-shingled, or to cut the grass. Instead, you save for those situations and pay out of pocket. If a tree falls on your roof, you call the insurance company.

High deductible ($10,000 to $25,000 deductible) policies and HMO's have grown in popularity the past few years. The owner of the policy saves money in their own personal bank account to use for routine doctor visits and tests (up to the deductible) and only uses the insurance for large events - like hospital stays and surgery. The premiums on these high deductible plans are MUCH lower and often provide greater lifetime maximums and 100% coverage once the deductible is met.
...

You didn't mention Tort Reform and medical malpractice. Intentionally?

[Ivan Seeking]

I can only quote from CNN for the moment but will dig up some references. A qualified panel discussion including David Gergen, and Sanjay Gupta, was just on AC 360. Christine Romans, CNN financial analyst, stated the following:

The number one cause of personal bankruptcy is the cost asssociated with catastrophic illness or injury. Half of those people have health insurance.

Apparently this relates directly to medical bills, and not just lost income.

[WhoWee]

You didn't mention Tort Reform and medical malpractice. Intentionally?

No, my post was already too long. I posted about Tort reform earlier.

I want to stop talking about what we can't do and start thinking about what is possible.

The strength of the Government is massive spending capability. The weakness of the Government is also the ability to throw money at problems - then mismanage.

[WhoWee]

I can only quote from CNN for the moment but will dig up some references. A qualified panel discussion including David Gergen, and Sanjay Gupta, was just on AC 360. Christine Romans, CNN financial analyst, stated the following:

The number one cause of personal bankruptcy is the cost asssociated with catastrophic illness or injury. Half of those people have health insurance.

Apparently this relates directly to medical bills, and not just lost income.

To be accurate, aren't they actually saying the NUMBER 1 REASON to file bankruptcy is to avoid paying medical bills?

This is a discussion that needs to be explored. I've looked at this before and will gather data this week from the credit and collection industry to post.

The last time I looked, the reports showed the majority of people filing due to medical bills did so to protect assets. I'll try to find information on the total amount of medical bills compared to total liabilities and total assets as well.

Another point is the "injury" point of her statement. In many instances car insurance and accident insurance is insufficient.

I think you'll be surprised to find out how many people file bankruptcy over medical bills of less than $50,000.

[GeorginaS]

To be accurate, aren't they actually saying the NUMBER 1 REASON to file bankruptcy is to avoid paying medical bills?

[snip]

I think you'll be surprised to find out how many people file bankruptcy over medical bills of less than $50,000.

They may well file bankruptcy to avoid paying medical bills. Somehow, I can't quite fathom that.

Your other sentence is interesting, though. You do realise that $50,000.00 is a lot of money, right? And you do realise that that's well beyond an awful lot of people's means, yes?

[WhoWee]

They may well file bankruptcy to avoid paying medical bills. Somehow, I can't quite fathom that.

Your other sentence is interesting, though. You do realise that $50,000.00 is a lot of money, right? And you do realise that that's well beyond an awful lot of people's means, yes?

A quick estimate of US households is 112,000,000 - (rounded up from Wiki)
http://wiki.answers.com/Q/How_many_households_are_in_the_US

The stimulus package is $787,000,000,000

$787 billion / 112 million households = $ 7,026 per family - do you "realise that that's well beyond an awful lot of people's means, yes?"

Shall I calculate the per household deficit spending as well?

How about this instead, it keeps us focused on health care -
"Obama Proposes $634 Billion Fund For Health Care
Aides Call Money a 'Down Payment' Toward Universal-Coverage Efforts"

$634,000,000,000 / 112,000,000 = $5,660 per household.

The stimulus plus the Obama "down payment" = $7,026 + $5,660 = $12,686 pe US household.

I'm worried about all of these costs. I think all of these expenses are completely out of control.

[GeorginaS]

A quick estimate of US households is 112,000,000 - (rounded up from Wiki)
http://wiki.answers.com/Q/How_many_households_are_in_the_US

The stimulus package is $787,000,000,000

$787 billion / 112 million households = $ 7,026 per family - do you "realise that that's well beyond an awful lot of people's means, yes?"

Shall I calculate the per household deficit spending as well?

How about this instead, it keeps us focused on health care -
"Obama Proposes $634 Billion Fund For Health Care
Aides Call Money a 'Down Payment' Toward Universal-Coverage Efforts"

$634,000,000,000 / 112,000,000 = $5,660 per household.

The stimulus plus the Obama "down payment" = $7,026 + $5,660 = $12,686 pe US household.

I'm worried about all of these costs. I think all of these expenses are completely out of control.

I feel as if I've missed something, here. You wrote in a previous post you wrote:

I think you'll be surprised to find out how many people file bankruptcy over medical bills of less than $50,000.

which suggested, by your use of language, and the fact that you were saying people were dodging medical bills with bankruptcy, that, in your estimation, $50,000.00 was a paltry amount of money to file for bankruptcy for. If I'm wrong in that understanding, please correct me.

That's why I pointed out that $50,000.00 is, in fact, quite a bit of money.

Then you launched into this whole "what the cost per household" would be under the proposed expenditures. Please define that conversational leap for me, would you?

How about this? The US's combined current wars (I won't even comment what I think about them) are costing between 9 and 12 billion dollars per month.

http://usgovinfo.about.com/library/weekly/aairaqwarcost.htm

http://usgovinfo.about.com/library/weekly/aairaqwarcost.htm

What term are your health care cost numbers being amortised over?

At any rate, it wasn't my intention to engage in some sort of number-crunching/parsing conversation. I was simply pointing out that I didn't think the slant being placed on the bankruptcy issue was exactly fair.

[WhoWee]

I feel as if I've missed something, here. You wrote in a previous post you wrote:

I think you'll be surprised to find out how many people file bankruptcy over medical bills of less than $50,000.

which suggested, by your use of language, and the fact that you were saying people were dodging medical bills with bankruptcy, that, in your estimation, $50,000.00 was a paltry amount of money to file for bankruptcy for. If I'm wrong in that understanding, please correct me.

That's why I pointed out that $50,000.00 is, in fact, quite a bit of money.

Then you launched into this whole "what the cost per household" would be under the proposed expenditures. Please define that conversational leap for me, would you?

How about this? The US's combined current wars (I won't even comment what I think about them) are costing between 9 and 12 billion dollars per month.

http://usgovinfo.about.com/library/weekly/aairaqwarcost.htm

http://usgovinfo.about.com/library/weekly/aairaqwarcost.htm

What term are your health care cost numbers being amortised over?

At any rate, it wasn't my intention to engage in some sort of number-crunching/parsing conversation. I was simply pointing out that I didn't think the slant being placed on the bankruptcy issue was exactly fair.

I don't recall ever calling $50,000 a "paltry amount" or saying that people were "dodging" medical expenses. I think it is a lot of money and I think some people are in very bad situations.

I also think a discussion about health care that will add $1,042,000,000,000 or more to deficits as per the CBO is a great deal of money. http://www.cbo.gov/ftpdocs/104xx/doc10464/hr3200.pdf
This is an additional $9,303 per household - if the Government stays within budget.

US citizens are going bankrupt right now for amounts less than $50,000 to protect their homes from medical expenses.

Who is going to pay for all of this spending?

Our current system is designed to provide free care to welfare recipients with no assets and leave people with assets out in the cold if their insurance reaches maximum limits or they have pre-existing conditions.

My previous posts are clear - I'm in favor of reform. But I think reform must start with Government programs and limiting future Government involvement to making investments that will provide a ROI and enable people with pre-existing conditions to become eligible for coverage.

I'm not being snooty - I'm scared.

[Hurkyl]

I would like to remind people that taking government expenditures and averaging them evenly across all households is not a useful statistic (unless you are being intentionally deceptive), since the "average joe" is going to pay far less than that.

[WhoWee]

I would like to remind people that taking government expenditures and averaging them evenly across all households is not a useful statistic (unless you are being intentionally deceptive), since the "average joe" is going to pay far less than that.

Are we not all in this together?

How much is the "average Joe" expected to pay?

Are tax burdens and health care costs only for the top 5% income bracket?

Why don't we consider only the top 5% of the 112,000,000 households - 5,600,000 would be our "tax paying base"

At a cost of $1,042,000,000,000 in (CBO est) deficit spending for HR3200 the cost would be $186,000 per household - is that more fair/accurate/realistic?

[LBloom]

Are tax burdens and health care costs only for the top 5% income bracket?

Why don't we consider only the top 5% of the 112,000,000 households - 5,600,000 would be our "tax paying base"

1) A lot of this health care bill will be funded by reducing waste in Medicare (and theres plenty of it), so its deceptive to divide the total cost by households because American households are not expected to pay for most of the costs

2) Yes, it is completely appropriate for the top 1-5% to pay for most of the bill. In today's America, the top 1% take home 50% of the nation's income. We live in a world of obscene wealth and inequality that has never been seen before. Inequality is higher now than in the 1920s, a period of decadence if there ever was one. Not only that, but during the Bush Boom, the top 1% took home 75% of all economic growth.
Believe me, they are not hurting, and they should pay much more in taxes so the average Joe, who has had almost stagnant income growth since the Reagan Revolution, does not need to choose between food and healthcare.

[WhoWee]

1) A lot of this health care bill will be funded by reducing waste in Medicare (and theres plenty of it), so its deceptive to divide the total cost by households because American households are not expected to pay for most of the costs

2) Yes, it is completely appropriate for the top 1-5% to pay for most of the bill. In today's America, the top 1% take home 50% of the nation's income. We live in a world of obscene wealth and inequality that has never been seen before. Inequality is higher now than in the 1920s, a period of decadence if there ever was one. Not only that, but during the Bush Boom, the top 1% took home 75% of all economic growth.
Believe me, they are not hurting, and they should pay much more in taxes so the average Joe, who has had almost stagnant income growth since the Reagan Revolution, does not need to choose between food and healthcare.

WOW! THE PLAN IS SOCIALISM.

This is why I've posted across several threads that only taxpayers should be allowed to vote.

[LBloom]

WOW! THE PLAN IS SOCIALISM.

This is why I've posted across several threads that only taxpayers should be allowed to vote.

umm, you quoted my whole piece without actually responding. I mean i didnt even mention the plan itself, so you couldn't have inferred from it that the plan is socialistic. That deserves a wow. I think it should be noted that we have a progressive tax code and that the rich have always paid more than the average household.
By the way, a progressive taxcode does not equal socialism. Adam Smith of all people was in favor of progressive taxation (he wanted to tax luxury carriages along w/ income more).
What this plan will do is tax the rich more so reform allows everybody access to good healthcare. May I mention other areas of society where the rich contribute more so everybody has access to certain necessary goods: Libraries, police force, schools, fire departments, the army, food stamps, social security.
Everybody has access to protection, food, and education. It's long past time we catch up with the rest of the world and add healthcare to that list. And no, that is not socialism.

btw: i can see an ideologue from a mile away, so i'm not gonna waste any more time on this thread.

[WhoWee]

1)
Believe me, they are not hurting, and they should pay much more in taxes so the average Joe, who has had almost stagnant income growth since the Reagan Revolution, does not need to choose between food and healthcare.

"Believe you"? What is your source? Who is the "average Joe"? Are we talking about auto workers? They own GM.

Let's make it easy, what is the growth rate of the minimum wage since the Reagan Revolution" - 300%?

Better yet, let's look at the top 5% - what is the net loss of capital for this group as a result of the recent stock market and real estate collapses?

[WhoWee]

btw: i can see an ideologue from a mile away, so i'm not gonna waste any more time on this thread.


I'm the ideologue? You want the top 1% - 5% to pay for everyone else - what do you call that position - are you a "re-distributor"?

[Hurkyl]

Are tax burdens and health care costs only for the top 5% income bracket?
If you're complaining about how taxes work, then go do it in another thread -- don't pretend you're saying anything relevant about health care.

[LBloom]

I never said everything and i never said how much. I just said more than they are currently contributing. Everybody pays taxes and everybody should pay their fair share. An increase of 3% or so considering their skyrocketing incomes is hardly uncalled for. They pay 35% now. Is 38-39% socialism? Where is the line? 37.5? The increase needed is not going to change anyone's lives or change the structure of our system. Its simply a matter of helping the those who cannot help themselves.
Sorry about the charge of being an ideologue, but when "SOCIALISM" is your immediate response to a well-reasoned critique of our current tax system, its hard not to think otherwise.

Anyway, now I am done

[WhoWee]

If you're complaining about how taxes work, then go do it in another thread -- don't pretend you're saying anything relevant about health care.

I'm talking about the average cost per household of HR3200 - if that isn't relevant I don't know what is relevant.

[WhoWee]

I never said everything and i never said how much. I just said more than they are currently contributing. Everybody pays taxes and everybody should pay their fair share. An increase of 3% or so considering their skyrocketing incomes is hardly uncalled for. They pay 35% now. Is 38-39% socialism? Where is the line? 37.5? The increase needed is not going to change anyone's lives or change the structure of our system. Its simply a matter of helping the those who cannot help themselves.
Sorry about the charge of being an ideologue, but when "SOCIALISM" is your immediate response to a well-reasoned critique of our current tax system, its hard not to think otherwise.

Anyway, now I am done

I apologize for the tone of the way I typed that response - it was excessive and a complete de-railment of the conversation.

This all started with a discussion of medical related bankruptcies of less than $50,000 and the comparison of the per household cost of HR3200. My point was that people are going bankrupt over amounts consistent with the average household cost of this Bill.

I'm not sure if you've been engaged in this thread over the past few pages, but I sincerely wish you would continue to contribute to this discussion.

[Evo]

I never said everything and i never said how much. I just said more than they are currently contributing. Everybody pays taxes and everybody should pay their fair share. An increase of 3% or so considering their skyrocketing incomes is hardly uncalled for. They pay 35% now. Is 38-39% socialism? Where is the line? 37.5? The increase needed is not going to change anyone's lives or change the structure of our system. Its simply a matter of helping the those who cannot help themselves.
Sorry about the charge of being an ideologue, but when "SOCIALISM" is your immediate response to a well-reasoned critique of our current tax system, its hard not to think otherwise.

Anyway, now I am doneThe tax rate is rather bogus, the rich don't pay 35% tax, unless they're crazy, they have deductions and tax shelters, so their adjusted tax is actually less than a much poorer person that can't claim deductions. It's Adjusted Gross Income (AGI). Even though they have a higher tax rate, they pay that tax rate on less of their income. This was discussed in another thread. Not only that, but there is no social security tax on income above something like $102,000. So where I pay social security tax on 100% of my income, a rich person pays nothing on income above the cap.

[Hurkyl]

I'm talking about the average cost per household of HR3200 - if that isn't relevant I don't know what is relevant.
Then you don't know what's relevant. How could that figure possibly be a relevant statistic? I know you earlier claimed
$787 billion / 112 million households = $ 7,026 per family - do you "realise that that's well beyond an awful lot of people's means, yes?"
but that calculation has pretty much nothing to do with what HR3200 will cost "a lot of people".

[Wax]

I'm not sure if this has been mentioned before but one of the reasons that Health Care is going to be reformed this year is due to the baby boomers. About seventy million baby boomers are retiring in the next ten years. I think Obama's main goal is to offer a public option at a reduced payment in order to help fund medicaid and medicare. The only other options are to raise everyone's taxes or cut back on the programs.

http://www.prb.org/Articles/2002/JustHowManyBabyBoomersAreThere.aspx

[WhoWee]

Then you don't know what's relevant. How could that figure possibly be a relevant statistic? I know you earlier claimed
$787 billion / 112 million households = $ 7,026 per family - do you "realise that that's well beyond an awful lot of people's means, yes?"
but that calculation has pretty much nothing to do with what HR3200 will cost "a lot of people".

From Webster - this is the definition of relevant that I'm working from
Main Entry: rel·e·vant
Pronunciation: \ˈre-lə-vənt\
Function: adjective
Etymology: Medieval Latin relevant-, relevans, from Latin, present participle of relevare to raise up — more at relieve
Date: 1560
1 a : having significant and demonstrable bearing on the matter at hand b : affording evidence tending to prove or disprove the matter at issue or under discussion <relevant testimony> c : having social relevance

The matter at hand is the significant cost of health care. The discussion includes the incresed number of bankruptcies due to medical expenses. US citizens have filed bankruptcy due to medical bills of less than $50,000, to save their homes.

By comparison, recent stimulus spending of $787 billion and the "downpayment" on healthcare of $634 billion and now the CBO estimate of $1,042 billion deficit spending for HR3200 will total $2,463,000,000,000. All of this spending is being driven by President Obama and Congressional leaders in the first 8 months of 2009. Given the 112,000,000 households in the US, this equates to $21,989 per household.

I made an assumption that people who own homes (and have insurance that was inadequate to cover the medical expenses) were employed - and pay taxes. All government spending is paid from taxes, printing money or borrowing. Thus these same people will incur these additional tax burdens.

If you don't like this measurement, how would you like to distribute/allocate the cost? There are 300,000,000 people, thats $8,210 per person. Perhaps you want to consider only 1% of the population - 3,000,000 people would equate to $821,000 per "wealthy" person.

Someone has to pay for these programs - according to the CBO, the spending is not "deficit neutral" as Obama insists.

What don't I understand? What isn't relevant? Please explain it to me - I clearly do not understand why you disagree. Who do you think will pay the $1,042,000,000,000 for HR3200 - and what will it cost "them"?

[Wax]

What don't I understand? What isn't relevant? Please explain it to me - I clearly do not understand why you disagree. Who do you think will pay the $1,042,000,000,000 for HR3200 - and what will it cost "them"?

That's an extremely large number. Where did it come from? :bugeye:


Edit: Ahhh.. Okay I see now. I've never seen a trillion written down on paper before. :rofl:

[Hurkyl]

What don't I understand? What isn't relevant? Please explain it to me - I clearly do not understand why you disagree.
How can the number be relevant? Numbers on their own are meaningless. What do you intend to compare it to? The disposable income an American household might have to spend on health care? If so, then you're comparing apples to oranges -- those two numbers have little to do with each other.

[WhoWee]

How can the number be relevant? Numbers on their own are meaningless. What do you intend to compare it to? The disposable income an American household might have to spend on health care? If so, then you're comparing apples to oranges -- those two numbers have little to do with each other.

How can projected deficit spending of $1.024 trillion for HR3200 not be relevant to every US household?

[WhoWee]

This point is not insignificant. Per capita and per household deficit spending for health care reform is very relevant.

This story posted on MSNBC is a little dated but makes the point. The average amount of medical bills of bankruptcy filers in this study was $13,460 (more than their insurance covered) - not the $50,000 average we've been discussing. The $1.024 trillion projected deficit spending for "health care reform" will approximate $9,142 per household - if the plan stays on-budget.

http://www.msnbc.msn.com/id/6895896/
"Medical bills make up half of bankruptcies
Study finds most bankruptcy filers had health insurance

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.

Researchers from Harvard’s law and medical schools said the findings underscore the inadequacy of many private insurance plans that offer worst-case catastrophic coverage, but little financial security for less severe illnesses.

“Unless you’re Bill Gates, you’re just one serious illness away from bankruptcy,” said Dr. David Himmelstein, the study’s lead author and an associate professor of medicine. “Most of the medically bankrupt were average Americans who happened to get sick.”
Story continues below ↓advertisement | your ad here

The study, to be published online Wednesday by the journal Health Affairs, distributed questionnaires to 1,771 bankruptcy filers in 2001 in California, Illinois, Pennsylvania, Tennessee and Texas. That year, there were 1.46 million personal bankruptcies in the United States.

More than 900 of those questioned underwent more detailed interviews about their financial and medical circumstances for what the authors say is the first in-depth study of medical causes of personal bankruptcies, which have risen rapidly in recent years.

Illness and medical bills were cited as the cause, at least in part, for 46.2 percent of the personal bankruptcies in the study. Himmelstein said the figure rose to 54.5 percent when three other factors were counted as medical-related triggers for bankruptcies: births, deaths and pathological gambling addiction.

The study estimates medical-caused bankruptcies affect about 2 million Americans each year, counting debtors and their dependents, including 700,000 children.

Most were insured
Most of those seeking court protection from creditors had health insurance, with more than three-quarters reporting they had coverage at the start of the illness that triggered bankruptcy. The study said 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy, with illness frequently leading to the loss of both a job and insurance.

Out-of-pocket medical expenses covering co-payments, deductibles and uncovered health services averaged $13,460 for bankruptcy filers who had private insurance at the onset of illness, compared with $10,893 for those without coverage. Those who initially had private coverage but lost it during their illness faced the highest cost, an average of $18,005.

“We need to rethink health reform,” said Dr. Steffie Woolhandler, a study co-author and associate professor of medicine at Cambridge-based Harvard. “Covering the uninsured isn’t enough. We also must upgrade and guarantee continuous coverage for those who have insurance.”

Susan Pisano, a spokeswoman for America’s Health Insurance Plans, representing nearly 1,300 health insurance providers, said the study did not adequately explore the role that disability income protection plans and personal savings can play in helping someone with a medical problem avoid bankruptcy.

“It’s very important to ask questions about what the financial stressors are for American families, but we don’t think this study digs deeply enough,” Pisano said.

Middle-class hit hard
The findings indicate medical-related bankruptcies hit middle-class families hard — 56 percent of the filers owned a home, and the same number had attended college.

“Families with coverage faced unaffordable co-payments, deductibles and bills for uncovered items like physical therapy, psychiatric care and prescription drugs,” Himmelstein said.

The study, funded by the Robert Wood Johnson Foundation, did not examine how many bankruptcy filers were from dual-income families where both partners had insurance, Himmelstein said.

Jeff Morris, resident scholar at the American Bankruptcy Institute, founded by Congress in 1982 to analyze bankruptcy trends, said the Harvard findings roughly mirror those of a 1996 ABI study in which 57 percent of bankruptcy filers cited medical problems as a primary bankruptcy cause. Respondents in that study were more likely to cite three other factors as primary causes, including easy access to credit, job loss and financial mismanagement.

Morris said he was aware of no data indicating that the Harvard study, which was based on 2001 bankruptcy filings, does not accurately reflect current trends in medical-related bankruptcies.

“Medical coverage is becoming more for catastrophic loss than for intermediate expenses,” Morris said.
© 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed."

How does additional deficit spending of $9,142 per household "fix" the problem when US citizens are filing bankruptcy over $13,460 in bills? Reform must start with cost control - not wild spending.

Again, the place to start reform is in current Government programs (already dependent upon deficit spending), standardization of insurance across all 50 states (to reduce insurance company administrative and legal expenses), Tort reform, and incentives for doctors to participate in wellness programs (to reduce costs of emergency rooms).

[Hurkyl]

How can projected deficit spending of $1.024 trillion for HR3200 not be relevant to every US household?
Again, numbers on their own aren't meaningful. But that number can be compared meaningfully to other numbers we might have available.

Trying to boil it down to a cost per household or a cost per capita is nothing more than a silly exercise in arithmetic -- it doesn't tell us anything meaningful about anything. It's only use in a discussion like this is (AFAIK) flat-out deception; the implied claim1 that this number somehow represents the cost to a taxpayer is a (vast?) exaggeration of reality.

1: Actually, you made this claim explicit

[WhoWee]

Again, numbers on their own aren't meaningful. But that number can be compared meaningfully to other numbers we might be interested in.

Trying to boil it down to a cost per household or a cost per capita is nothing more than a silly exercise in arithmetic -- it doesn't tell us anything meaningful about anything. It's only use in a discussion like this is (AFAIK) flat-out deception; the implied claim1 that this number somehow represents the cost to a taxpayer is a (vast?) exaggeration of reality.

1: Actually, you made this claim explicit

Again, who will pay this "number"? How do we calculate the cost to any "average Joe" taxpayer? What am I being deceitful about?

Instead of telling me I'm wrong, tell me how to make the calculation - to make the comparison "meaningful".

[Hurkyl]

How do we calculate the cost to any "average Joe" taxpayer?
The right answer is quite probably "we don't". Evo already pointed out one of the ways that the distribution of taxes is complicated, and that was only the tip of the iceberg of the difficulties in making this kind of estimation.

There are surely people in this world who could do the calculation -- but you and I are not those people.

[WhoWee]

The right answer is quite probably "we don't". Evo already pointed out one of the ways that the distribution of taxes is complicated, and that was only the tip of the iceberg of the difficulties in making this kind of estimation.

There are surely people in this world who could do the calculation -- but you and I are not those people.

I agree taxes are complicated. I don't know how to make the specific calculation. But this discussion is about health care reform. Accordingly, I made the only comparison that is relevant to me. I'm an "average Joe taxpayer". I want to know how much my family will ultimately need to pay in future taxes as a result of HR3200. I don't consider this someone else's problem.

Let's put this into it's proper context - starting with the overall current deficit.

http://www.foxnews.com/politics/2009/08/21/official-obama-increase-year-deficit-trillion/

Obama Administration to Increase 10-Year Deficit Estimate to $9 Trillion
The 2010-2019 cumulative deficit projection replaces the administration's previous estimate of $7.108 trillion

This estimate doesn't yet include the cost of "health care reform" - which the CBO estimates at $1.042 trillion additional.

As far as I know, every US taxpayer ultimately owns a share of this debt - am I wrong? Aren't we all subject to taxes? Like it or not, this is our problem.

The responsible solution is to deal with the specific problems of health care costs now (starting with social security, medicare, and medicaid "reform") - not make the program larger, throw more money at it, and pass the problem on to future generations.

[bleedblue1234]

:rofl::rofl::rofl:

"Who Will Pay for It?"

Everyone asks.. no one has an answers.

"Tax the 'Rich'", Some Say....
"It Doesn't Matter", Some Say....
"Pay For It? We Have to Pay for Stuff?" Some Say....

One thing I can guarantee is that with fiscal deficits hitting $10+ Trillion MORE projected into the next decade, someone will pay for it. (and it will be US, the average American who will be paying drastically higher prices for everything we buy)

[WhoWee]

The right answer is quite probably "we don't". Evo already pointed out one of the ways that the distribution of taxes is complicated, and that was only the tip of the iceberg of the difficulties in making this kind of estimation.

There are surely people in this world who could do the calculation -- but you and I are not those people.

Can we agree on this - given the CBO estimate of $1.042 trillion in deficit spending for health care reform and approximately 112 million households in the US, the minimum cost of HR3200 for each household (that actually pays taxes) over time will be $1.042 trillion/112 million = $9,303 - then after subtracting the allocation from each household that doesn't pay taxes, the cost will be re-distributed accordingly to the households that do pay taxes?

Is this a correct assumption?

[Ivan Seeking]

:rofl::rofl::rofl:

"Who Will Pay for It?"

Everyone asks.. no one has an answers.

"Tax the 'Rich'", Some Say....
"It Doesn't Matter", Some Say....
"Pay For It? We Have to Pay for Stuff?" Some Say....

One thing I can guarantee is that with fiscal deficits hitting $10+ Trillion MORE projected into the next decade, someone will pay for it. (and it will be US, the average American who will be paying drastically higher prices for everything we buy)

We will certainly pay for it if we don't do something. The fallacy is the notion that we have a choice.

[Ivan Seeking]

As far as I know, every US taxpayer ultimately owns a share of this debt - am I wrong? Aren't we all subject to taxes? Like it or not, this is our problem.

You can't look at this in isolation. If we can return to a healty GDP, we can better afford the debt. If we don't return to a healthy GDP, we are hosed anyway. This is why issues like health care are directly connected to issues like a dwindling US manufacturing base.

Also consider that, for example, by eliminating oil imports, we easily could pay for universal health care; and even more so because oil imports deplete wealth by taking the money out of the domestic economy. Health care circulates wealth within the domestic economy. So while the costs associated with health care are real, so are the benefits of the big picture. We need to redirect the course of the nation. Health care reform is just a part of the equation.

[turbo]

It is certainly true that we don't have a choice if we want to revive our economy. Health-care costs are rising too fast, and that money is enriching middlemen that obstruct the system instead of contributing to it. It is very easy for someone young and healthy to say "I've got my health insurance, and everybody else should have to get their own." This attitude ignores the fact that too many people can't afford health insurance and many more couldn't get coverage at any cost due to pre-existing conditions. It also blithely ignores the sad fact that if the currently-healthy young person develops a serious condition (kidney failure, one of the many hard-to-treat cancers, etc), and the insurance company doesn't drop them outright, the soaring cost of treatment will cause them to hit their lifetime cap very quickly, and continued treatment will eat up their savings and other assets, including perhaps their home. I certainly don't want to leave my wife facing her retirement penniless just because I couldn't get adequate insurance coverage. There is no reason that citizens of the US should have to turn over all their assets to the health-care providers just because they get sick. They should be able to provide for their loved ones without driving them into poverty. The current system is heartless and terribly regressive.

[Ivan Seeking]

National Health Care Spending

National health spending is expected to reach $2.5 trillion in 2009, accounting for 17.6 percent of the gross domestic product (GDP). By 2018, national health care expenditures are expected to reach $4.4 trillion—more than double 2007 spending.1

National health expenditures are expected to increase faster than the growth in GDP: between 2008 and 2018, the average increase in national health expenditures is expected to be 6.2 percent per year, while the GDP is expected to increase only 4.1 percent per year. 1

In just three years, the Medicare and Medicaid programs will account for 50 percent of all national health spending. 1

Medicare's Hospital Insurance (HI) Trust Fund is expected to pay out more in hospital benefits and other expenditures this year than it receives in taxes and other dedicated revenues. In addition, the Medicare Supplementary Medical Insurance (SMI) Trust Fund that pays for physician services and the prescription drug benefit will continue to require general revenue financing and charges on beneficiaries that will grow substantially faster than the economy and beneficiary incomes over time. 2

According to one study, of the $2.1 trillion the U.S. spent on health care in 2006, nearly $650 billion was above what we would expect to spend based on the level of U.S. wealth versus other nations. These additional costs are attributable to $436 billion outpatient care and another $186 billion of spending related to high administrative costs. 3...
http://www.nchc.org/facts/cost.shtml

[jreelawg]

Certainly something should be done about health care in the US. I don't understand why iut must cost us over a trillion.

One thing that seams like a no brainer is providing medicine at realistic prices. In cuba an inhaler cost about 5 US cents, and in the states up to 120 US dollars. That 2400% more. I can find no other explanation why this should be the case except that someone knows they can make a 2400% profit. Solving this issue won't happen because their is too much pressure from drug dealers who are making a killing.

Another thing that doesn't make sense is this issue of pre-existing conditions and the system in which turning you down for care is the first attempted action when you need care. It wouldn't be hard for congress to regulate this, yet it goes on and on.

Why can't we fix these things one at a time and spend next to nothing?

Lastly, I want to clear something up that confuses me about Obama's health care plan.

They say it is a government option to compete. Do you have to pay into it to get the option, or is it a "free" option with the cost reflected only in the deficit?

[Wax]

Obama said you have to buy into the government option.

[BoomBoom]

Hmmm, I wonder if you had insurance through your employer and decided you wanted the gov't plan instead, if your employer would be required to increase your salary by a % of the amount they were contributing to your health insurance costs? :approve:

[Wax]

Hmmm, I wonder if you had insurance through your employer and decided you wanted the gov't plan instead, if your employer would be required to increase your salary by a % of the amount they were contributing to your health insurance costs? :approve:

lol

You probably would get a raise. That was one of Obama's main points. He was saying the reason you haven't noticed an increase in salary is because your health care cost is eating it up. You'd receive a down grade in your health care service if you opted for the public option though.

[BoomBoom]

You probably would get a raise. That was one of Obama's main points. He was saying the reason you haven't noticed an increase in salary is because your health care cost is eating it up. You'd receive a down grade in your health care service if you opted for the public option though.

The plan I have through my employer is really splendid and I pay no premiums at all, but I hardly ever use it. The amount of $$ they put up for my healthcare is probably nearly as much as my salary. If there were a public plan available, I'd rather all that $$ go to support the general healthcare costs of all, than have it go to lining the pockets of rich insurance bigwigs.

....so even if the plan wasn't as good (which it wouldn't be), it would still be better IMO. :smile:

[WhoWee]

You can't look at this in isolation. If we can return to a healty GDP, we can better afford the debt. If we don't return to a healthy GDP, we are hosed anyway. This is why issues like health care are directly connected to issues like a dwindling US manufacturing base.

Also consider that, for example, by eliminating oil imports, we easily could pay for universal health care; and even more so because oil imports deplete wealth by taking the money out of the domestic economy. Health care circulates wealth within the domestic economy. So while the costs associated with health care are real, so are the benefits of the big picture. We need to redirect the course of the nation. Health care reform is just a part of the equation.

I don't have as much confidence in a fast recovery as you Ivan.

As for oil imports. Domestic drilling is unpopular/discouraged. We're being told to reduce dependence on foreign oil, to build wind mills and invest in solar.

Then we hear reports President Obama may be assisting a prominent campaign supporter/investor in Petrobras, a Brazillian company, to drill offshore? I don't know if this is accurate or not - I haven't read the original WSJ article that all of the stories reference - most reports say $2 billion - this says up to $10 billion.

http://iplextra.indiatimes.com/article/0emQh1ye2nbuQ?q=Barack+Obama
Obama Helps Soros Drill Oil In Brazil

"The U.S. government is prepared to provide up to $10 billion in loans to finance the development of massive hydrocarbon reserves off Brazil’s coast, a Brazilian official said Wednesday. "

http://sweetness-light.com/archive/obama-helps-soros-drill-oil-in-brazil
I don't see a clear policy from the White House regarding oil.

No, I think we do need to isolate health care spending, put it under the microscope and fix it before it gets any worse.

[WhoWee]

Oil link follow up - this is from the WSJ site.
http://online.wsj.com/article/SB10001424052970203863204574346610120524166.html

[Ivan Seeking]

I don't have as much confidence in a fast recovery as you Ivan.

We have no choice. We have to pay in regards to health care whether we do something or not. And we have to turn this ALL around. If we don't, it won't matter what we do about health care.

As for oil imports. Domestic drilling is unpopular/discouraged. We're being told to reduce dependence on foreign oil, to build wind mills and invest in solar.

Biodiesel from algae is the ticket. And now Exxon, Shell, and DARPA agree. DARPA even thinks it can make diesel fuel for $3 a gallon in war zones and eliminate the need to ship in the fuel! [that even wows me, and I've been pushing this for three years now!] Obama is already focused on alternative fuels to help get us out of this mess.

http://www.nytimes.com/2009/07/14/business/energy-environment/14fuel.html
http://green.autoblog.com/2007/12/12/shell-oil-to-grow-biofuels-from-marine-algae/
http://www.independent.co.uk/news/business/analysis-and-features/solarpowered-soldiers-in-the-pipeline-1766017.html
http://www.physicsforums.com/showthread.php?t=211274

As for the oil, the potential for large reserves in the coastal waters of Brazil probably motivates exploration for the sake of national security. But while the Fox Newspaper [WSJ is owned by Murdoch, much to the dismay of those who built the paper] takes cheap shots, in the grand tradition of infotainment, it makes no attempt to explain the decision or provide any context.

The only reason we haven't exploited US coastal reserves, along with many many acres already open to drilling here in the US, is that the price of the oil from those reserves is too high. As soon as the price of oil justified offshore drilling, we saw movement in that direction. Heck, we even saw people in Texas putting oil rigs in their back yards! As soon as the price fell, you heard nothing. With the prices rising, it becomes an issue again. If the oil companies could be competitive at the current price of crude, the demand for offshore drilling would be relentless. As for arctic reserves, it would barely amount to a trickle compared to the entire supply. The only thing tempting about the arctic oil reserves are the billions of profit to be made; that is unless you get excited about a minor bump on a curve.

[Ivan Seeking]

Sorry, that was a pretty severe diversion, but the point is that we can't solve any of these problems in isolation. We have to look at the entire picture; beginning with the cost of health care if we do nothing. It is a pretty dismal picture. Obama says he wants a plan that is revenue-neutral. Others say that isn't possible. Maybe it isn't possible, but its not like we don't have other ways of paying for it. With some good planning and a clear national vision, we can come out of this stronger than ever. That is why many people like me voted for Obama: He is looking at the big picture.

[WhoWee]

Sorry, that was a pretty severe diversion, but the point is that we can't solve any of these problems in isolation. We have to look at the entire picture; beginning with the cost of health care if we do nothing. It is a pretty dismal picture. Obama says he wants a plan that is revenue-neutral. Others say that isn't possible. Maybe it isn't possible, but its not like we don't have other ways of paying for it. With some good planning and a clear national vision, we can come out of this stronger than ever. That is why many people like me voted for Obama: He is looking at the big picture.

I too agree that we need to look at the big picture. My concern is that as a tax payer, I fully comprehend that my household share of the national debt exceeds my total personal debt. I'm not "netting" or subtracting assets from my liabilities - this is a debt to debt comparison.

[WhoWee]

But while the Fox Newspaper [WSJ is owned by Murdoch, much to the dismay of those who built the paper] takes cheap shots, in the grand tradition of infotainment, it makes no attempt to explain the decision or provide any context.


By the way, Bloomberg also reported. They just didn't point out Mr. Soros investment.
http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aogq9sBiBhYo

[WhoWee]

Bloomberg has several interesting stories on health care today.
http://www.bloomberg.com/apps/news?pid=specialreport

Special Report

The Health Care Debate

Obama, Democrats Consider Bypassing Republicans on Health Care Legislation President Barack Obama and Democratic congressional leaders, unable to reach a deal with Republicans in health care, are considering alternatives to a bipartisan bill, Senator Charles Schumer said.

Biden Announces U.S. Grants to Increase Use of Electronic Medical Records Vice President Joe Biden announced almost $1.2 billion in grants to help health-care providers convert to electronic medical records, during a stop in Chicago.

Town Hall Turmoil Leads to Trauma for Obama's Health-Care Overhaul Effort There was Ed Hairston, again. In the front row of the convention hall and angry, he tried to tell Representative Vic Snyder what was wrong with President Barack Obama’s health-care plan.

McClellan Says Health Debate Should Focus on Care System, Not Insurance The Obama administration’s decision to focus on the insurance industry in its bid to revamp the U.S. health-care system misses the point, said Mark McClellan, former head of the Centers for Medicare and Medicaid Services.

Obama Campaign Ad Firms Now Reaping Cash to Pitch Health-Care Overhaul Two firms that received $343.3 million to handle advertising for Barack Obama’s White House run last year have profited from his top priority as president by taking on his push for health-care overhaul.

Town Hall Crowd Shoots Health Reform Message and Messenger: Caroline Baum Members of Congress have gone home for the August recess, and a relaxing vacation it isn’t.

Democrats Can't Repeat Health-Care Failure: Commentary by Albert R. Hunt Bill Kristol, a powerhouse policy guru for Republicans, often has a tin ear for politics. A week before last year’s presidential election he predicted John McCain would “win huge.” In May, he said President Barack Obama had decided to nominate Michigan Governor Jennifer Granholm to the Supreme Court, and he’s been a cheerleader for Sarah Palin.

Armey Leaves Law Firm Over Role in Rallying Health-Care Overhaul Opponents Former House Majority Leader Richard Armey is leaving his job as a consultant for the DLA Piper law firm amid questions about his role in rallying opposition to President Barack Obama’s drive to remake the U.S. health-care system.

House Committees Approve Health-Care Overhaul With Tax on the Wealthiest Two House committees approved a plan for the biggest overhaul of the U.S. health-care system in four decades today, including a surtax of as much as 5.4 percent on the nation’s wealthiest households to pay for it.

Mr. Market Chokes on Obama-Style Health Care: Commentary by Caroline Baum Health care is different. It’s ill- suited to market mechanisms because it deals with matters of life and death.

[Hurkyl]

There are surely people in this world who could do the calculation -- but you and I are not those people.
I take it back -- the calculation is impossible even in principle.

There are essentially two cases (that aren't exclusive)
(1) Funding for health care comes from juggling the budget. This means there is no added monetary cost to the taxpayers, but some other government services get reduced funding

(2) Funding comes from raising taxes. Who pays extra (and how much) is completely arbitrary -- taxes can be raised in whatever fashion the government wants.

[WhoWee]

I take it back -- the calculation is impossible even in principle.

There are essentially two cases (that aren't exclusive)
(1) Funding for health care comes from juggling the budget. This means there is no added monetary cost to the taxpayers, but some other government services get reduced funding

(2) Funding comes from raising taxes. Who pays extra (and how much) is completely arbitrary -- taxes can be raised in whatever fashion the government wants.

That is my point - the Government will have to raise taxes to pay for HR3200 - nobody really knows how much. Middle class Americans are going bankrupt over $13,000 in medical expenses - how much will they be able to pay in extra taxes?

If the plan is to make the wealthy pay the entire amount - there's a childrens tale about eating a "golden goose" that might be applicable.

[Al68]

The tax rate is rather bogus, the rich don't pay 35% tax, unless they're crazy, they have deductions and tax shelters, so their adjusted tax is actually less than a much poorer person that can't claim deductions.You know this statement is false. This is not the first time you've made this absurd and provably false claim. Here's real data from the CBO (2005):

Total Federal taxes paid as a percentage of total income. These are Effective tax rates of total income, not marginal tax rates after deductions, and 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.

CBO has a lot more data, with more details at:

Source: http://www.cbo.gov/ftpdocs/88xx/doc8...TaxRates.shtml

[Al68]

I have lived in a Third World country and yes without the nanny government people just die and infectious disease runs wild. It is not fear mongering. It is my experience.So you experienced people "wishing for the uninsured to just die", then. OK. I guess it's not hatespeech if that's your experience. :uhh:

As far as third world countries, it's not the lack of a nanny state that keeps them down, just the opposite. Oppressive government is keeping them down, just because they're so against free enterprise they restrict it at the expense of the people.

[Al68]

I would like to remind people that taking government expenditures and averaging them evenly across all households is not a useful statistic (unless you are being intentionally deceptive), since the "average joe" is going to pay far less than that.Only on the surface. In reality "average joes" and poor people pay the actual price of government spending in the form of inflation, reduced GDP growth, reduction in decent jobs, etc.

Sure the rich pay a lot, but who cares? The resulting price paid by the rest of us is far more costly.

[mheslep]

...
There are essentially two cases (that aren't exclusive)
(1) Funding for health care comes from juggling the budget. This means there is no added monetary cost to the taxpayers, but some other government services get reduced funding

(2) Funding comes from raising taxes. Who pays extra (and how much) is completely arbitrary -- taxes can be raised in whatever fashion the government wants.
or, for the short term, (3) Borrow or print the money

[turbo]

or, for the short term, (3) Borrow or print the moneyNot a good idea to do too much of that. Much of the US debt is being held by foreigners, and if they see their holdings being diluted, they will pull back. That would bring calls on a lot of debt in a short time, making things even worse. I was disappointed in Bernanke's re-appointment today because he has followed Greenspan's policy of keeping money cheap for the financial gamblers on Wall Street, to the detriment of hard-working Americans who have saved all their lives and can get no interest on their savings. As a life-long fiscal conservative, I am disgusted by the Fed's pandering to gamblers while dumping people who have saved.

Health care must be reformed, but it is such a huge prize that every creep is trying to swing it their way so that they can make fortunes off whatever leverage they might be able to apply. We cannot afford to let the people who allowed this situation to develop be allowed to direct the "recovery" because their vested interests are demonstrably NOT for the public good.

[gravenewworld]

People are in a hissy fit over the projected deficits the US is going to run into over the next ten years, but let's not forget where a large chunk of it is coming from (the 2001-2003 tax cuts). Just how much are the tax cuts costing the US government?

http://www.brookings.edu/articles/2004/0919useconomics_gale.aspx

· Making the tax cuts permanent would generate large, backloaded revenue losses over the next 10 years. Combined with a minimal but necessary fix to the government's Alternative Minimum Tax, making the tax cuts permanent would reduce federal revenues by almost $1.8 trillion over 10 years — and that's in addition to the $1.7 trillion of revenue losses already locked into law. By 2014, the annual revenue loss would amount to $400 billion, or 2 percent of gross domestic product — almost the size of this year's federal budget deficit.

http://graphics8.nytimes.com/images/2008/02/06/opinion/07chart.533.gif

http://articles.latimes.com/2006/may/14/nation/na-outlook14

http://www.washingtonpost.com/wp-dyn/content/article/2006/02/17/AR2006021701848.html


You can take the sources with a grain of salt, but one thing is clear. The tax cuts are costing a hell of a lot of money. Maybe they should just let them expire.

[WhoWee]

Not a good idea to do too much of that. Much of the US debt is being held by foreigners, and if they see their holdings being diluted, they will pull back. That would bring calls on a lot of debt in a short time, making things even worse.

Last year the interest on our debt was $452 billion - that's $8,692,307,692.30 per week?

This is a Chinese perspective.

http://www.chinapost.com.tw/business/americas/2009/07/15/216272/U.S.-budget.htm

"... The Treasury Department said Monday that the deficit in June totaled US$94.3 billion, pushing the total since the budget year started in October to US$1.09 trillion. The administration forecasts that the deficit for the entire year will hit US$1.84 trillion in October.

Government spending is on the rise to address the worst financial crisis since the Great Depression and an unemployment rate that has climbed to 9.5 percent.

Congress already approved a US$700 billion financial bailout for banks, automakers and other sectors, and a US$787 billion economic stimulus package to try to jump-start a recovery. Outlays through the first nine months of this budget year total US$2.67 trillion, up 20.5 percent from the same period a year ago.

There is growing talk among some Obama administration officials that a second round of stimulus may eventually be necessary.

That has many Republicans and deficit hawks worried that the U.S. could be setting itself up for more financial pain down the road if interest rates and inflation surge. They also are raising alarms about additional spending the administration is proposing, including its plan to reform health care.

President Barack Obama and Treasury Secretary Timothy Geithner have said the U.S. is committed to bringing down the deficits once the economy and financial sector recover. The Obama administration has set a goal of cutting the deficit in half by the end of his first term in office.

In the meantime, the U.S. debt now stands at US$11.5 trillion. Interest payments on the debt cost US$452 billion last year — the largest federal spending category after Medicare-Medicaid, Social Security and defense.

The overall debt is now slightly more than 80 percent of the annual output of the entire U.S. economy, as measured by the gross domestic product. During World War II, it briefly rose to 120 percent of GDP.

The debt is largely financed by the sale of Treasury bonds and bills."

The cost of HR3200 is expected to add about 10% to this total.

[WhoWee]

People are in a hissy fit over the projected deficits the US is going to run into over the next ten years, but let's not forget where a large chunk of it is coming from (the 2001-2003 tax cuts). Just how much are the tax cuts costing the US government?

http://www.brookings.edu/articles/2004/0919useconomics_gale.aspx



http://graphics8.nytimes.com/images/2008/02/06/opinion/07chart.533.gif

http://articles.latimes.com/2006/may/14/nation/na-outlook14

http://www.washingtonpost.com/wp-dyn/content/article/2006/02/17/AR2006021701848.html


You can take the sources with a grain of salt, but one thing is clear. The tax cuts are costing a hell of a lot of money. Maybe they should just let them expire.

Has anyone adjusted for the loss of revenue/earnings as a result of the recession?

Many of the tax incentives will go unused (if profits are reduced). An example is wage credits - $9 billion went unclaimed last year.

[WhoWee]

People are in a hissy fit over the projected deficits the US is going to run into over the next ten years, but let's not forget where a large chunk of it is coming from (the 2001-2003 tax cuts). Just how much are the tax cuts costing the US government?

http://www.brookings.edu/articles/2004/0919useconomics_gale.aspx



http://graphics8.nytimes.com/images/2008/02/06/opinion/07chart.533.gif

http://articles.latimes.com/2006/may/14/nation/na-outlook14

http://www.washingtonpost.com/wp-dyn/content/article/2006/02/17/AR2006021701848.html


You can take the sources with a grain of salt, but one thing is clear. The tax cuts are costing a hell of a lot of money. Maybe they should just let them expire.

By the way, it appears you articles all pre-date the recent Congressional/Obama spending spree. What do these graphs look like with all of Obama's additional $Trillions?.

[Al68]

You can take the sources with a grain of salt, but one thing is clear. The tax cuts are costing a hell of a lot of money. Maybe they should just let them expire.CBO predictions purposefully use "static" modeling for their projections instead of "dynamic" modeling. Static modeling underestimates tax revenues at lower tax rates by ignoring the effect of different tax rates on the tax base. This is way off topic, but actual revenues after tax cuts historically greatly exceed CBO projections, even greatly exceeding the revenues actually collected by the previous higher tax rates.

Of course those advocating higher taxes will insist on preferring CBO projections to actual historical data, even after the actual data shows the projections to be way off. Some even still try to convince people that the deficits of the 1980's were caused by tax cuts, despite the fact that actual tax revenues doubled during the 1980's.

[mheslep]

People are in a hissy fit over the projected deficits the US is going to run into over the next ten years, but let's not forget where a large chunk of it is coming from (the 2001-2003 tax cuts). Just how much are the tax cuts costing the US government?


You can take the sources with a grain of salt, but one thing is clear. The tax cuts are costing a hell of a lot of money. Maybe they should just let them expire.They are expiring on the top brackets, in fact effective rates will be increased above the existing levels prior to the '01-'03 tax cuts per the latest budget law. The 10 year $9 trillion deficit (http://www.nytimes.com/2009/08/26/business/economy/26deficit.html?hp) people are in a hissy fit about includes the higher taxes. The predicted red section of the chart above - due to Bush tax cuts - will never happen under current law.
...That approach includes the assumption that various changes in tax law enacted since 2001 expire as scheduled, by the end of December 2010, causing a rise in revenues thereafter...
http://www.cbo.gov/ftpdocs/97xx/doc9706/09-08-Update.pdf

[WhoWee]

I've been reading through the "pilot programs" of HR3200. Has anyone found an estimate of how many jobs will be created to oversee this program or Government administrative costs in conjunction with this Bill?

[WhoWee]

I think some people should be fired at Social Security.

http://finance.yahoo.com/news/Stimulus-checks-not-boosting-apf-2542694170.html?x=0&.v=2

"3,900 stimulus checks went to prison inmates
Government sent 3,900 economic stimulus checks to prison inmates -- 2,200 got to keep them

* By Stephen Ohlemacher, Associated Press Writer
* On Wednesday August 26, 2009, 9:28 pm EDT

WASHINGTON (AP) -- The federal government sent about 3,900 economic stimulus payments of $250 each this spring to people who were in no position to use the money to help stimulate the economy: prison inmates.

...About $425,000 was incorrectly sent to inmates."

This is just one more example of Government waste. A private insurance company would never put up with this level of incompetence.

[Hurkyl]

That works out to what... 0.003% error rate? For the most part, I would be rather content with that level of government incompetence.

[WhoWee]

That works out to what... 0.003% error rate? For the most part, I would be rather content with that level of government incompetence.

Look at it another way, assume there are 4 employees who earn $100,000 each that are responsible for "oversight" of this program. The mistake is greater than their cumulative annual salaries.

What other occupation would permit this level of performance? Can you imagine a manager at WalMarts explaining they "misplaced" a $100,000 bank deposit?

I have to wonder if any of the people involved this time had oversight the last time when dead people received checks?

There's nothing funny about this - Government is too big and spending is too free.

I heard an interview earlier that provided some interesting details about PORK in the health care Bill. I'm looking in HR3200 for the $1 billion allocated for walking trails, jungle gyms, etc. I'll post when I find it.

[Ivan Seeking]

Health Reform Fact and Fiction
As Congress considers multiple versions of health reform, misunderstanding and falsehoods have crept into the national debate. Ray Suarez separates fact from fiction
http://newshour-tc.pbs.org/newshour/rss/media/2009/08/27/20090827_healthcare.mp3

Again it is stated that there are currently five plans working their way through Congress. Sunday, on Meet the Press, I believe, it was stated that there are six Republican plans alone, all things considered. I would assume that there are popular plans making the rounds, and other plans that don't have much of a following.

[WhoWee]

I was thinking about the length of the HR3200 document today - 1,000+ pages.

By comparison, the brokers field guide for United Health Care/Golden Rule including underwriting guidelines with 2 blank pages for notes is only 40 pages total.

The typical brochure outlining all of the details of a comprehensive health insurance plan along with state mandates is typically 20 to 30 pages total.

The State of Ohio revised code pertaining to health insurance is 86 pages long - other states are similar. By the way, Ohio is working on a plan to insure 100,000 additional people with stimulus funds.

The first step in reform should be to standardize coverage mandates across all 50 states. This would eliminate the need for 49 compliance departments at every insurance provider. It would also reduce staffing requirements at all 50 state departments of insurance.

More importantly, it would simplify reform.

[mheslep]

Regarding the PBS "Fact and Fiction" piece on the subject of abortion in the health bills:

...You’ve heard that this is all going to mean government funding of abortion. Not true...

Abortion: Which Side Is Fabricating?
Despite what Obama said, the House bill would allow abortions to be covered by a federal plan and by federally subsidized private plans. ...
http://factcheck.org/2009/08/abortion-which-side-is-fabricating/

[turbo]

The lies and dirty tricks keep coming. On the heels of the "death panels", a GOP push-poll suggests that a Democratic-designed health care system could examine voter-registration records and selectively deny health care to Republicans. Sick!

http://news.yahoo.com/s/ap/20090828/ap_on_go_co/us_health_care_scare;_ylt=AsVgr0Lyk6sNKzsss7krNF2s 0NUE;_ylu=X3oDMTFla3FrMzZrBHBvcwM4NwRzZWMDYWNjb3Jk aW9uX3BvbGl0aWNzBHNsawNnb3BoaW50c2RlbXM-

[WhoWee]

The lies and dirty tricks keep coming. On the heels of the "death panels", a GOP push-poll suggests that a Democratic-designed health care system could examine voter-registration records and selectively deny health care to Republicans. Sick!

http://news.yahoo.com/s/ap/20090828/ap_on_go_co/us_health_care_scare;_ylt=AsVgr0Lyk6sNKzsss7krNF2s 0NUE;_ylu=X3oDMTFla3FrMzZrBHBvcwM4NwRzZWMDYWNjb3Jk aW9uX3BvbGl0aWNzBHNsawNnb3BoaW50c2RlbXM-

I think "selective care" a complete over-reach, but the prospect of long term enforcement by the IRS doesn't exactly inspire me either.

As I've posted before, we need to remove politics from this process. We also need fix the problems we have (current Government programs and standardization of insurance mandates in all 50 states is a good place to begin) before creating new problems.

[Al68]

The first step in reform should be to standardize coverage mandates across all 50 states. This would eliminate the need for 49 compliance departments at every insurance provider.Just eliminate the state level regulations on insurance that serve to protect the big insurance companies from competition. This is where the federal government could actually use the interstate commerce clause for its intended purpose, instead of as a corrupt excuse for unrelated agendas.

Claiming that more regulation is needed to fix the problems caused by current regulation is preposterous. It's no coincidence that the most regulated consumer product in the country is the one everyone has a problem with.

The problems cited against private insurance companies are problems that would be impossible in a competitive free market. Insurance companies would have to satisfy consumers or be put out of business by their competitors.

True reform would start by eliminating the regulatory barriers to entry into the insurance market by competitors.

[mheslep]

Just eliminate the state level regulations on insurance that serve to protect the big insurance companies from competition. This is where the federal government could actually use the interstate commerce clause for its intended purpose, instead of as a corrupt excuse for unrelated agendas.Great comment.

[WhoWee]

Just eliminate the state level regulations on insurance that serve to protect the big insurance companies from competition. This is where the federal government could actually use the interstate commerce clause for its intended purpose, instead of as a corrupt excuse for unrelated agendas.

Claiming that more regulation is needed to fix the problems caused by current regulation is preposterous. It's no coincidence that the most regulated consumer product in the country is the one everyone has a problem with.

The problems cited against private insurance companies are problems that would be impossible in a competitive free market. Insurance companies would have to satisfy consumers or be put out of business by their competitors.

True reform would start by eliminating the regulatory barriers to entry into the insurance market by competitors.

I'm not sure what you were responding to, I said "As I've posted before, we need to remove politics from this process. We also need fix the problems we have (current Government programs and standardization of insurance mandates in all 50 states is a good place to begin) before creating new problems."

I want to standardize coverage requirements across all 50 states. This means level the playing field for all insurance companies to meet a single set of requirements, versus 50 different sets of requirements. The problem now is over-regulation.

[Al68]

I'm not sure what you were responding to, I said "As I've posted before, we need to remove politics from this process. We also need fix the problems we have (current Government programs and standardization of insurance mandates in all 50 states is a good place to begin) before creating new problems."

I want to standardize coverage requirements across all 50 states. This means level the playing field for all insurance companies to meet a single set of requirements, versus 50 different sets of requirements. The problem now is over-regulation.I was referring to the 50 different sets of regulations. And I have no problem with any government defining different standards, as long as private insurance companies are free to offer "standard" plans, non-standard plans, or both as needed to meet consumer demand.

We know what happens to crappy companies that offer crappy products/services in a competitive free market. They don't get to stay in business and convince people to blame the "system" and make new laws further protecting them from competition.

[WhoWee]

I was referring to the 50 different sets of regulations. And I have no problem with any government defining different standards, as long as private insurance companies are free to offer "standard" plans, non-standard plans, or both as needed to meet consumer demand.

We know what happens to crappy companies that offer crappy products/services in a competitive free market. They don't get to stay in business and convince people to blame the "system" and make new laws further protecting them from competition.

I think we're in agreement. Currently, each state sets it's own standards. Most of the mandates are reasonable and expected - some are not.

This link will provide insight into the complexity of the situation. Take your time and read through the charts.

http://www.cahi.org/cahi_contents/resources/pdf/HealthInsuranceMandates2009.pdf

"Why Is the Number of Mandates Growing? Elected representatives find it difficult to oppose any legislation that promises
enhanced care to potentially motivated voters. The sponsors of mandates know this fact of political life. As a result, government
interference in and control of the health care system is steadily increasing. So too is the cost of health insurance.
By the late 1960s, state legislatures had passed only a handful of mandated benefits; today, the Council for Affordable Health
Insurance (CAHI) has identified 2,133 mandated benefits and providers. And more are on their way.
How do state legislators justify their actions? One way is to deny a mandate is a mandate. For example, legislators may claim
that requiring health insurance to cover a type of provider — such as a chiropractor, podiatrist, midwife or naturopath — is
not a mandate because they aren’t requiring insurance to pay for a particular therapy. But that’s a distinction without a difference;
if insurance is required to cover the provider, it must pay for the service provided.

[Al68]

I think we're in agreement. Currently, each state sets it's own standards. Most of the mandates are reasonable and expected - some are not.
I wouldn't call any mandate reasonable that restricts the freedom of people to decide for themselves what type of coverage to buy.

I have no problem with insurance that covers midwives, wart removal, pedicures, or anything else. It's outlawing the policies that don't meet the "mandates" that I oppose.

And I agree that over-regulation is the main problem. Just imagine what insurance companies would be like if they had to satisfy consumers to stay in business, like they would have to if over-regulation wasn't keeping competition away.

It amazes me that politicians would actually suggest that the solution to a partial monopoly caused by government regulation is more regulation to create a more complete monopoly.

[WhoWee]

This is an informative piece for anyone serious about the topic of health care reform.

http://www.cms.hhs.gov/MedicareProgramRatesStats/Downloads/MedicareMedicaidSummaries2008.pdf

Costs have been increasing.

"Health spending in the United States has grown rapidly over the past few decades. From $27.5 billion in 1960, it grew to $912.6 billion in 1993, increasing at an average rate of 11.2 percent annually. This strong growth boosted health care’s role in the overall economy, with health expenditures rising from 5.2 percent to 13.7 percent of the Gross Domestic Product (GDP) between 1960 and 1993."

"National health expenditures are projected to reach $4.3 trillion in 2017, up from $2.1 trillion in 2006. After increasing 6.7 percent in 2006, NHE growth is projected to remain steady at 6.7 percent in 2007 and 6.6 percent in 2008. From 2006 through 2017, health care spending is projected to grow at an average annual rate of 6.7 percent, roughly 1.9 percentage points faster than the expected rate of GDP growth. As a percentage of GDP, national health spending is expected to reach 19.5 percent by 2017, up from 16.0 percent in 2006."

When the term "rationing of care" is used - this is ONE of the meanings -> $0 benefit for skilled nursing facility after 100 days.

"For hospital care covered under Part A, a fee-for-service beneficiary’s payment share includes a one-time deductible amount at the beginning of each benefit period ($1,068 in 2009). This deductible covers the beneficiary’s part of the first 60 days of each spell of inpatient hospital care. If continued inpatient care is needed beyond the 60 days, additional coinsurance payments ($267 per day in 2009) are required through the 90th day of a benefit period. Each Part A beneficiary also has a “lifetime reserve” of 60 additional hospital days that may be used when the covered days within a benefit period have been exhausted. Lifetime reserve days may be used only once, and coinsurance payments ($534 per day in 2009) are required.

For skilled nursing care covered under Part A, Medicare fully covers the first 20 days in a benefit period. But for days 21-100, a copayment ($133.50 per day in 2009) is required from the beneficiary. After 100 days per benefit period, Medicare pays nothing for SNF care. Home health care has no deductible or coinsurance payment by the beneficiary. In any Part A service, the beneficiary is responsible for fees to cover the first 3 pints or units of non-replaced blood per calendar year. The beneficiary has the option of paying the fee or of having the blood replaced."

We often hear that people who most need coverage are not covered. However, there were 56 million people covered under Medicaid in 2007 and 51% (28.7 million) were children.

"As with all health insurance programs, most Medicaid beneficiaries incur relatively small average expenditures per person each year, and a relatively small proportion incurs very large costs. Moreover, the average cost varies substantially by type of beneficiary. National data for 2005, for example, indicate that Medicaid payments for services for 28.7 million children, who constituted 51 percent of all Medicaid beneficiaries, averaged about $1,667 per child. Similarly, for 13.7 million adults, who comprised 24 percent of beneficiaries, payments averaged about $2,475 per person. However, other groups had much larger per-person expenditures. Medicaid payments for services for 4.9 million aged, who constituted 9 percent of all Medicaid beneficiaries, averaged about $13,675 per person; for 9.1 million disabled, who comprised 16 percent of beneficiaries, payments averaged about $13,846 per person. When expenditures for these high- and lower-cost beneficiaries are combined, the 2005 payments to health care vendors for 56.3 million Medicaid beneficiaries averaged $4,859 per person.
Long-term care is an important provision of Medicaid that will be increasingly utilized as our nation’s population ages. The Medicaid program paid for over 41 percent of the total cost of care for persons using nursing facility or home health services in 2005. National data for 2005 show that Medicaid payments for nursing facility services (excluding ICFs/MR) totaled $44.7 billion for more than 1.7 million beneficiaries of these services—an average expenditure of $26,234 per nursing home beneficiary. The national data also show that Medicaid payments for home health services totaled $5.4 billion for 24
1.2 million beneficiaries—an average expenditure of $4,510 per home health care beneficiary. With the percentage of our population who are elderly or disabled increasing faster than that of the younger groups, the need for long-term care is expected to increase.
Another significant development in Medicaid is the growth in managed care as an alternative service delivery concept different from the traditional fee-for-service system. Under managed care systems, HMOs, prepaid health plans (PHPs), or comparable entities agree to provide a specific set of services to Medicaid enrollees, usually in return for a predetermined periodic payment per enrollee. Managed care programs seek to enhance access to quality care in a cost-effective manner. Waivers may provide the States with greater flexibility in the design and implementation of their Medicaid managed care programs. Waiver authority under sections 1915(b) and 1115 of the Social Security Act is an important part of the Medicaid program. Section 1915(b) waivers allow States to develop innovative health care delivery or reimbursement systems. Section 1115 waivers allow statewide health care reform experimental demonstrations to cover uninsured populations and to test new delivery systems without increasing costs. Finally, the BBA provided States a new option to use managed care without a waiver. The number of Medicaid beneficiaries enrolled in some form of managed care program is growing rapidly, from 48 percent of enrollees in 1997 to 64 percent in 2007.
More than 56 million persons received health care services through the Medicaid program in FY 2005 (the last year for which beneficiary data are available). In FY 2007, total expenditures for the Medicaid program (Federal and State) were $335.8 billion, including direct payment to providers of $232.6 billion, payments for various premiums (for HMOs, Medicare, etc.) of $67.0 billion, payments to disproportionate share hospitals of $16.1 billion, administrative costs of $17.3 billion, and $2.7 billion for the Vaccines for Children Program. Expenditures under the SCHIP program in FY 2007 were $8.8 billion. With no changes to the program, spending under Medicaid is projected to reach $523 billion by FY 2013. (SCHIP is currently authorized and funded only through March 2009.)"

Again, this is an informative piece and should be reviewed in it's entirety.

[Ivan Seeking]

This is the sort of thing that drives me nuts. I was just talking with a contractor doing some work at our house. We ended up discussing health care a bit, and though I know better than to get into it too much with people around here [many die-hard Obama haters] I probe a bit without committing to any particular position wrt solutions.

We were comparing notes on health care as his wife has also been in the business for thirty years. He agrees that the system doesn't work [that health care fails miserably on many levels]. He agrees that the costs are too high. He also agrees that insurance regulations are a nightmare. He hears all of the same complaints from his wife that I hear from mine. So I asked what he thinks we should do.

He said, "I think they [meaning insurance carriers] should all be independent". "But they are now", I replied. He shrugged his shoulders and said something like "well then, I don't know". This just another example of how the "opposition" has people so confused that they have no idea what we have or what they want. He was quick to blame everything on Obama at every turn while having no idea what he was talking about.

At this point I think the Democrats need to abandon concerns about bipartisanship and ram something through. There is no hope for many of these folks [man on the street]. They have been brainwashed by people like Palin, Limbaugh, and Grassley.

[WhoWee]

At this point I think the Democrats need to abandon concerns about bipartisanship and ram something through. There is no hope for many of these folks [man on the street]. They have been brainwashed by people like Palin, Limbaugh, and Grassley.

I think the reason the Bill is SO complicated is that it causes frustration and the result is your posting - just do something already.

Nobody understands HR3200 and it's not the answer to our health care problems.

[jreelawg]

I don't think the length of the bill is necessarily a problem. The problem is that people don't read it, don't know what it says, and still hold serious opinions on it. How much it costs is one thing, and I am skeptical about whether or not we should be getting ourselves into this kind of debt. But, if the best that the opposition can do to refute it, is to make up bogus lies about what's in it, and resort to deception, then maybe it isn't all that bad.

As for the cost, if it is what it is supposed to be, then we should expect an eventual return. Just because the price is high now, doesn't mean we won't be better off in 4-8-or ten years. Why would Obama push this plan in his first term if he thought it would fail. If it does fail, he will have a hard time being re-elected. I am not an economist, but I know the difference between just spending and investing.

Lastly, if we can afford to go to war we should be able to afford the health care plan. If only we hadn't wasted so much money in Iraq, it would be no sweat. I think we should pull out of Afghanistan.

[turbo]

Right now, the GOP and no small portion of the Democratic party are doing the bidding of the insurance companies that bankroll their campaigns. Health-care costs are projected to double by 2020, so when some politician says "we have to slow down" I have to think how we will pay for the delay. We pay the costs associated with treating the uninsured and underinsured, in the form of higher charges for hospital visits, treatments, etc. If everybody was insured, hospitals and medical practices wouldn't have to jack up their fees to try to cover the costs of treating the uninsured and the cost of claims for the insured would fall. This is a complex argument to make in sound-bites, so the GOP is winning the debate among the poorly-informed and poorly-educated with their "death panels", "pull the plug on granny", "outlaw private coverage" lies.

[WhoWee]

I don't think the length of the bill is necessarily a problem. The problem is that people don't read it, don't know what it says, and still hold serious opinions on it. How much it costs is one thing, and I am skeptical about whether or not we should be getting ourselves into this kind of debt. But, if the best that the opposition can do to refute it, is to make up bogus lies about what's in it, and resort to deception, then maybe it isn't all that bad.

As for the cost, if it is what it is supposed to be, then we should expect an eventual return. Just because the price is high now, doesn't mean we won't be better off in 4-8-or ten years. Why would Obama push this plan in his first term if he thought it would fail. If it does fail, he will have a hard time being re-elected. I am not an economist, but I know the difference between just spending and investing.

Lastly, if we can afford to go to war we should be able to afford the health care plan. If only we hadn't wasted so much money in Iraq, it would be no sweat. I think we should pull out of Afghanistan.

Have you read the Bill? If not, what is the basis of your position? What are the "bogus lies" - who told you someone is telling a lie?

Why did Obama push the Stimulus Bill through - remember there wasn't time to read the Bill? Now, months later, less than 20% of the funds have been released. He needs to ram all of his spending through before we wake up.

Last, do you really believe the cost of Iraq is comparable to the cost of HR3200???

The interest payments on HR3200 will be more than the total cost of Iraq.

[Al68]

He agrees that the system doesn't work [that health care fails miserably on many levels]. He agrees that the costs are too high. He also agrees that insurance regulations are a nightmare. He hears all of the same complaints from his wife that I hear from mine. So I asked what he thinks we should do.

He said, "I think they [meaning insurance carriers] should all be independent". "But they are now", I replied.This is why I hate the word "system" being used. Insurance companies are independent of each other in every way, except that they have government regulation in common.

All the propaganda on the issue suggests that we are not talking about independent companies at all, but some system that insurance companies "joined". This is simply not the case.

[WhoWee]

This is why I hate the word "system" being used. Insurance companies are independent of each other in every way, except that they have government regulation in common.

All the propaganda on the issue suggests that we are not talking about independent companies at all, but some system that insurance companies "joined". This is simply not the case.

I'll post this again - we need standardization of insurance policies in all 50 states.

If an insurance company has 6 basic policies, they should be able to sell the same 6 policies in all 50 states - not 50 (states) x 6 (basic policies) = 300 different policies. The legal and administrative costs are enormous.

[jreelawg]

Have you read the Bill? If not, what is the basis of your position? What are the "bogus lies" - who told you someone is telling a lie?

Why did Obama push the Stimulus Bill through - remember there wasn't time to read the Bill? Now, months later, less than 20% of the funds have been released. He needs to ram all of his spending through before we wake up.

Last, do you really believe the cost of Iraq is comparable to the cost of HR3200???

The interest payments on HR3200 will be more than the total cost of Iraq.

The part about death panels actually just suggests that in the even that a person is under life sustaining care, the family of the person should discuss the options with their doctor. This simply means that they should have a discussion wether or not to pull the plug or not. Believe it or not, not everyone wants to be a tomato, and many people leave it up to family to make the decision when the time comes that they are unable.

Even expensive private insurance plans require this, and many insurance companies won't pay for life sustaining care.


I imagine that if the bill didn't promote having a discussion with the doctor in such a case, the same people would probably be arguing that a government Czar is going to keep you on a machine against your will.

[jreelawg]

"WASHINGTON (CNN) -- The total economic impact of the wars in Iraq and Afghanistan is estimated at $1.6 trillion by 2009, a congressional committee said in a report released Tuesday.

That is nearly double the $804 billion in direct war costs the White House requested so far from Congress, the Democratic-led Joint Economic Committee said.

The committee estimated $1.3 trillion in war costs by the end of 2008 for Iraq, and the remainder for Afghanistan.

The total war costs could grow to $3.5 trillion by 2017, the committee estimated.

The higher total economic impact comes from, among other things, the cost of borrowing money to pay for the war, lost productivity, higher oil prices and the cost of health care for veterans, the committee said."

http://www.cnn.com/2007/POLITICS/11/13/hidden.war.costs/

Where as the cost of the War goes up and up, the cost of the Health Care bill goes down and down as we get our money back in savings. The further you go in history, the more money we will have saved, and eventually the amount may be astronomical. This of coarse is assuming the plan works.

[WhoWee]

The part about death panels actually just suggests that in the even that a person is under life sustaining care, the family of the person should discuss the options with their doctor. This simply means that they should have a discussion wether or not to pull the plug or not. Believe it or not, not everyone wants to be a tomato, and many people leave it up to family to make the decision when the time comes that they are unable.

Even expensive private insurance plans require this, and many insurance companies won't pay for life sustaining care.


I imagine that if the bill didn't promote having a discussion with the doctor in such a case, the same people would probably be arguing that a government Czar is going to keep you on a machine against your will.

You said, "The problem is that people don't read it, don't know what it says, and still hold serious opinions on it. How much it costs is one thing, and I am skeptical about whether or not we should be getting ourselves into this kind of debt. But, if the best that the opposition can do to refute it, is to make up bogus lies about what's in it, and resort to deception, then maybe it isn't all that bad."

Accordingly, I asked "Have you read the Bill? If not, what is the basis of your position? What are the "bogus lies" - who told you someone is telling a lie?"

Should I assume your response is evidence that you haven't read the Bill and still have serious opinion on it?

[jreelawg]

You said, "The problem is that people don't read it, don't know what it says, and still hold serious opinions on it. How much it costs is one thing, and I am skeptical about whether or not we should be getting ourselves into this kind of debt. But, if the best that the opposition can do to refute it, is to make up bogus lies about what's in it, and resort to deception, then maybe it isn't all that bad."

Accordingly, I asked "Have you read the Bill? If not, what is the basis of your position? What are the "bogus lies" - who told you someone is telling a lie?"

Should I assume your response is evidence that you haven't read the Bill and still have serious opinion on it?

I don't have a serious opinion on it. I am not ready to vilify it, and I'm not ready to say it is going to work. But I do know that the death panel propaganda was a lie. This was exposed on the Daily Show, when a leading Death Panel propagandist was interviewed, brought the bill in with her to get some shock value at how long it is, claimed the part about death panels was right there on page X. When confronted, she tried to pretend she couldn't find it, then finally resorted to read the section I talked about which clearly proved her wrong.

[WhoWee]

"WASHINGTON (CNN) -- The total economic impact of the wars in Iraq and Afghanistan is estimated at $1.6 trillion by 2009, a congressional committee said in a report released Tuesday.

That is nearly double the $804 billion in direct war costs the White House requested so far from Congress, the Democratic-led Joint Economic Committee said.

The committee estimated $1.3 trillion in war costs by the end of 2008 for Iraq, and the remainder for Afghanistan.

The total war costs could grow to $3.5 trillion by 2017, the committee estimated.

The higher total economic impact comes from, among other things, the cost of borrowing money to pay for the war, lost productivity, higher oil prices and the cost of health care for veterans, the committee said."

http://www.cnn.com/2007/POLITICS/11/13/hidden.war.costs/

Where as the cost of the War goes up and up, the cost of the Health Care bill goes down and down as we get our money back in savings. The further you go in history, the more money we will have saved, and eventually the amount may be astronomical. This of coarse is assuming the plan works.

Again, you said "Lastly, if we can afford to go to war we should be able to afford the health care plan. If only we hadn't wasted so much money in Iraq, it would be no sweat. I think we should pull out of Afghanistan."

Now you're talking about lost productivity and projected costs through 2017?

The other number you're avoiding is the "fixed cost" of the military budget - regardless of whether those soldiers and resources are deployed or sitting in Kansas.

It's easy to manipulate stats - please find hard data on the actual (additional - in excess of fixed) cost of the wars and re-post.

[WhoWee]

I don't have a serious opinion on it. I am not ready to vilify it, and I'm not ready to say it is going to work. But I do know that the death panel propaganda was a lie. This was exposed on the Daily Show, when a leading Death Panel propagandist was interviewed, brought the bill in with her to get some shock value at how long it is, claimed the part about death panels was right there on page X. When confronted, she tried to pretend she couldn't find it, then finally resorted to read the section I talked about which clearly proved her wrong.

The "Daily Show"? You do realize that isn't a news show - right?

[jreelawg]

You could also argue that the human cost in lives lost of the war vs. the lives saved by healthcare make a difference. And I also stand by pointing out the difference in money thrown away vs, money invested.

[WhoWee]

"WASHINGTON (CNN) -- The total economic impact of the wars in Iraq and Afghanistan is estimated at $1.6 trillion by 2009, a congressional committee said in a report released Tuesday.

That is nearly double the $804 billion in direct war costs the White House requested so far from Congress, the Democratic-led Joint Economic Committee said.

The committee estimated $1.3 trillion in war costs by the end of 2008 for Iraq, and the remainder for Afghanistan.

The total war costs could grow to $3.5 trillion by 2017, the committee estimated.

The higher total economic impact comes from, among other things, the cost of borrowing money to pay for the war, lost productivity, higher oil prices and the cost of health care for veterans, the committee said."

http://www.cnn.com/2007/POLITICS/11/13/hidden.war.costs/

Where as the cost of the War goes up and up, the cost of the Health Care bill goes down and down as we get our money back in savings. The further you go in history, the more money we will have saved, and eventually the amount may be astronomical. This of coarse is assuming the plan works.

From the CBO report to Congress

http://www.cbo.gov/ftpdocs/104xx/doc10400/07-26-InfoOnTriCommProposal.pdf

Preliminary Analysis of the Insurance Coverage Specifications Provided by the House Tri-Committee Group
EFFECTS ON THE FEDERAL DEFICIT / a,b,c 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2010-2019
(Billions of dollars, by fiscal year)
Medicaid/CHIP Outlays /d,e 3 4 1 29 42 58 66 72 78 84 438
Exchange Subsidies 0 0 0 33 72 105 123 134 146 160 773
Payments by Employers to Exchanges /f,g 0 0 0 0 -3 -6 -8 -8 -9 -11 -45
Associated Effects on Tax Revenues /f * * * 10 10 3 -1 -1 -2 -4 15
Subtotal 3 4 1 72 122 160 180 196 213 230 1,182
Small Employer Credits /h 0 0 0 4 7 8 8 8 10 10 53
Payments by Uninsured Individuals 0 0 0 0 -6 -5 -4 -5 -5 -5 -29
"Play-or-Pay" Payments by Employers /f,h 0 0 0 -7 -16 -21 -26 -29 -31 -33 -163
NET IMPACT OF COVERAGE SPECIFICATIONS 3 4 1 69 107 141 158 171 187 202 1,042

[jreelawg]

The "Daily Show"? You do realize that isn't a news show - right?

When he interviews someone important, and they read the page out of the bill we are discussing, then it's news to me. If you disagree with my take on the death panel argument, then why don't you post some text from the bill. It would seem that it being such a hot topic, that FOX or someone would have it in a report.

[Al68]

This is a complex argument to make in sound-bites, so the GOP is winning the debate among the poorly-informed and poorly-educated with their "death panels", "pull the plug on granny", "outlaw private coverage" lies.While these first two are speculative to say the least, the last thing you call a lie is in HR3200 in clear black and white.

Although there is a grandfather clause so that insurance companies don't have to immediately drop their customers in some cases, it will be illegal (outlawed) for them to sell the same type of policy to anyone else, ever.

HR3200 does indeed immediately outlaw every private health insurance policy that isn't either a comprehensive health plan that meets the new requirements, or is a grandfathered existing policy. In other words, it outlaws any new policy that is similar to most existing policies today.

In this case, it is the "poorly-informed" that don't know this. Why would you call it a "lie"?

[Al68]

He said, "I think they [meaning insurance carriers] should all be independent". "But they are now", I replied. He shrugged his shoulders and said something like "well then, I don't know".After rereading this, it seems that maybe he really didn't realize that private insurance companies are not actually agents of government, like Democrats always seem to presume in their propaganda.

After all, most of their complaints against insurance companies amount to claims that their performance as agents of government is unsatisfactory. Considering insurance companies as private and independent instead of as part of some fictional system would unravel all their propaganda, rendering it completely nonsensical.

[turbo]

In this case, it is the "poorly-informed" that don't know this. Why would you call it a "lie"?Because it is. If you like your private coverage you can keep it. Opponents of health-care reform are trying to scare people into believing that they will lose their right to buy private coverage and be forced into a universal public plan. That is simply not true.

Re-regulating an out-of-control insurance industry is NOT the same as outlawing private coverage. Banking and finance needs to be re-regulated, as well - that is not the same as outlawing banks. If HR3200 requires insurance companies to offer policies that cannot be canceled at soon as you get sick and cannot be capped if you come down with a catastrophic illness, so be it. That is not the same as outlawing private insurance coverage.

[Al68]

Because it is. If you like your private coverage you can keep it. Only temporarily. And only an existing policy. So, yes, I can keep the policy I have for now, but I can't buy a new one like it for the rest of my life. And since only policies that refuse new enrollees are grandfathered, they won't last long. This is what Democrats mean when they say "gee, you can keep your private policy". Opponents of health-care reform are trying to scare people into believing that they will lose their right to buy private coverage and be forced into a universal public plan. That is simply not true.The reason that it "scares people" is because the truth in this case is scary. They will lose the ability to buy the kind of private insurance they choose. Their choices will be limited to those in the exchange. And, yes, there is a penalty (force) for not choosing and buying a policy in the exchange. And it's a stretch to even refer to such policies as semi-private.

And the "exchange" will not include any "just insurance" policies. It won't allow any kind of policy that doesn't include much, much more than just medical "insurance". No major medical policies. No basic insurance policies. There's a reason people buy basic policies that don't cover pre-existing conditions: The same reason they wouldn't pay the price for a car insurance policy that covers pre-existing damage.

Re-regulating an out-of-control insurance industry is NOT the same as outlawing private coverage. I didn't say it was. I said that HR3200 outlaws private insurance policies. ("policies" means more than one policy, not all policies).

No one is being mislead the way you claim. Everyone knows what is meant by the claim that HR3200 outlaws private policies. The claim means exactly what HR3200 says.

Claiming that private policies aren't outlawed because there will be different (and much larger) semi-private policies allowed under the plan is just disingenuous, and not conducive to honest debate.

[mheslep]

I think you guys are talking past each other a bit.

The private insurance angle depends on how its phrased. The house bill will not by law directly force people to drop their current private insurance or doctor. The bill's effect however, will none the less will be to take away the ability of a great deal of people to continue with the same insurer and thus possibly their doctor.

The CBO has forecast, that upon realization of this health plan many employers are immediately going to dump their private plans and throw their employees on the public plan. (Not everybody, but it is in the millions per CBO). As this happens, the costs for the remaining private insurers will go up on the smaller pool and the process snowballs. In that group of people so effected, some of them may or may not welcome the public plan; regardless, those working stiffs will have no choice. They are going to lose their chosen private insurance through their employer.

The President knows this full well, as when asked about employers dropping people he recently said:
"When I say if you have your plan and you like it, or you have a doctor and you like your doctor, that you don’t have to change plans, what I’m saying is the government is not going to make you change plans under health reform."
http://www.factcheck.org/2009/08/keep-your-insurance-not-everyone/

[Al68]

I think you guys are talking past each other a bit.

The private insurance angle depends on how its phrased. The house bill will not by law directly force people to drop their current private insurance or doctor. In effect however, it most certainly will take away the ability of a great deal of people to continue with the same insurer and thus possibly their doctor. Also, the "outlawing" of private plans is absolute for new policies that aren't in the exchange. This is the big issue.

Even if a person's current policy continues to exist, they lose the option to shop around, effectively making their existing policy the "only game in town" outside of the government "exchange". That's not exactly good for consumers.

And many don't realize that the exchange will only allow Cadillac comprehensive health care plans that are much larger than virtually anything on the market today. It won't allow any regular medical insurance policies at all. It won't even allow what are now considered very good policies by most.

[turbo]

In that group of people so effected, some of them may or may not welcome the public plan; regardless, those working stiffs will have no choice. They are going to lose their chosen private insurance through their employer.Remember that there is a vast pool of people who are working in low-wage jobs with no benefits, who will at last get an opportunity to buy health insurance if health-care reform is passed. There are lots of people who work for small employers that do not offer any health insurance, or who only offer to insure their full-time workers. The US has slid into a service-based economy in which the costs of caring for low-wage employees falls squarely on the rest of us. Your local hospital is not going to eat the cost of paying for an ER visit for the kid of a Wal-Mart cashier because the kid is sick and she can't pay for an office call. It is passed on to all of us through higher fees that the hospital charges to recover its costs.

Blocking health-care reform is a huge gift to the Wal-Marts, supermarket chains, and fast-food franchises. There are powerful special interests that benefit greatly from the status-quo, and they aren't the mom-and-pop business that power our local economies.

There may be some small businesses that wish to forgo tax incentives that they could have received for providing health insurance to their employees, and certainly if those employees cannot get reasonably-priced private insurance, they may end up transitioning to a publicly-administered plan. Is that the end of the world? Not for most of us. An influx of relatively healthy productive individuals into a public plan would represent a sharp decrease in the experience rate of the plan, compared to Medicare, whose recipients are generally either retired or disabled. I have friends who are doctors, and who are quite happy with the coding requirements and payment schedules of Medicare and Medicaid because the administrative overhead is low enough to more than compensate for the lower payment schedules.

[mheslep]

Yes, yes I agree that the the current system is badly rigged.

That doesn't change my opinion that this statement:
...If you like your private coverage you can keep it. Opponents of health-care reform are trying to scare people into believing that they will lose their right to buy private coverage and be forced into a universal public plan. That is simply not true...
has to do a lot of backing up to get to this one:

...There may be some small businesses that wish to forgo tax incentives that they could have received for providing health insurance to their employees, and certainly if those employees cannot get reasonably-priced private insurance, they may end up transitioning to a publicly-administered plan. Is that the end of the world? ...

[turbo]

In any reform, there will be re-alignment. That does not mean that employees will have to move to a public option if the employers are happy with the rates that the private insurers charge. Perhaps health-insurance underwriters will have to get competitive.

What a horrid thing! [/sarcasm]

Health-care costs have more than doubled in Maine since 2000, and we certainly cannot afford to allow that to continue, especially since we have such a large percentage of seasonal/part-time workers who get NO insurance and cannot afford it. When health-care takes up 1/6th of our economy, it's about time we got a handle on the industry and stop the bleeding. The US spends twice as much as any other industrialized nation on health care and gets sub-standard results. The "free market" is not going to fix this situation - capitalism is not thriving when the masses are held hostage by the few, despite what the neo-cons will tell you.

[Al68]

Perhaps health-insurance underwriters will have to get competitive.To compete with who? Already the regulatory barrier is big enough to protect big insurance companies from competition. HR3200 will outlaw all competing types of insurance outright. (ie major medical, etc)The "free market" is not going to fix this situationWell, we'll never know, but most of the complaints about insurance companies would be impossible with free market competition.capitalism is not thriving when the masses are held hostage by the few, despite what the neo-cons will tell you.Which "neo-con", whatever that means, said that?

It's the so-called left that wants to hold people hostage in this issue. They're the ones that are advocating the further restriction of individual liberty. They are the ones who want to force me to pay a middleman (insurance company) to pay my normal expected medical bills for no reason other than their profit. And they are the ones misleading the public by denying what is plainly written in the bill they advocate.

They are the ones that refuse to live and let live. They are the ones that just won't leave people alone that want nothing more from government than to be left alone. They are the ones advocating the use of force against people to get their way in this issue. They are the ones who fraudulently claim that anyone who dares to defend liberty from Democrats must just not care about people or otherwise have bad motives. They are the ones who call themselves "liberal" when they oppose liberty. [end of rant]

[Ivan Seeking]

Funny! David Brooks, a conservative journalist, just specified a new sect of the Republican Party -The Death Panel Conservatives.

Actually, he probably meant that to include Independents as well. It would interesting to know how this death panel claim breaks down by party and other demographics.

[WhoWee]

Funny! David Brooks, a conservative journalist, just specified a new sect of the Republican Party -The Death Panel Conservatives.

Actually, he probably meant that to include Independents as well. It would interesting to know how this death panel claim breaks down by party and other demographics.

Even funnier is how the debate has turned from "health care reform" to "health insurance reform".

Politics need to be removed from the equation and problem solving techniques applied. Personally, I don't think our political leaders are smart enough, detail oriented enough, or patient enough to deal with health care reform.

[turbo]

We should remain cognizant that the US has a (potentially) incredible health-care system that is being sucked dry by health "insurance". Such "insurance" defies the traditional definition of insurance as distributed risk - typical plans can bleed you dry before the "insurance" plan kicks in and can drop you like a hot potato if you get sick. It is high time that average workers are allowed to buy some coverage that won't evaporate the first time you need it.

[WhoWee]

We should remain cognizant that the US has a (potentially) incredible health-care system that is being sucked dry by health "insurance". Such "insurance" defies the traditional definition of insurance as distributed risk - typical plans can bleed you dry before the "insurance" plan kicks in and can drop you like a hot potato if you get sick. It is high time that average workers are allowed to buy some coverage that won't evaporate the first time you need it.

I think we also need to look at how we got to this point. I'll throw a little gas on the fire here to move the conversation forward.

How many people have health insurance that is comparable to the GM/Union health care policies? These "Cadillac" policies cover everything and are very expensive. An individual can not purchase such a policy, and if they could the price would be double their normal choices.

Health insurance (like car insurance, fire insurance, flood insurance, homeowners insurance, etc.) should be used for catastrophic events, not routine doctor visits, teeth cleanings, and eye glasses. But, large employer paid groups (including unions and government) have required such "coverage". This group is typically not willing to pay more for the same coverage.

A different aspect is the effect of a "network discount". Insurance companies don't pay "list price", they negotiate discounts. Accordingly, people that self pay for high deductible plans ($5,000 to $25,000 deductible - perhaps an HSA) pay less in monthly premiums but need to pay amounts up to the deductible. However, unlike the person with no insurance coverage at all, the people with high deductible coverages are entitled to a "network discount". A typical doctors visit costing $85 might actually cost the insured person $45. Whereas the uninsured person would pay the full $85 fee. The same is true for tests, etc. This is a major problem for uninsured people with pre-existing conditions - they are subject to the maximum price. Many find their best alternative is to purchase a catastrophic indemnity plan (pays fixed amount per a schedule) that provides network discounts. These plans can be expensive but do offer limited coverage.

Another important topic is prescription coverage. The government could be helpful to level the playing field for prescriptions. There are too many variables to address in this post.

Still another consideration is the capital requirements of an insurance company. They are rated by A.M. Best and others as to their ability to pay claims. A good company might be able to pay within 14 days, a below average company 45 days? Either way, the minimum capital requirement of a major health insurance company is typically $500 million to $1 billion in assets. Small companies are precluded - they are limited by their ability to pay claims.

These companies also need a very large administrative capability. As I posted earlier, they need to register the company with each state, register each policy they sell with each state, meet the mandates for each state for each policy, and register their agents with each state. Additionally, the companies must monitor the content of ads for each agent, provide training and support to the agent network, and insure HIPPA compliance at all times. Next, the companies must negotiate with (HMO/PPO) networks and work with these organization to pay claims and manage care.

My point is there are many variables to consider. The trend in Congress lately (stimulus Bill) has been to not even read the legislation before voting on a Bill. Health care reform (at nearly 20% of our economy) is too big and too important to approach as a political issue. Throwing money and more regulations at it won't fix the existing problems - just alter them.

[Al68]

We should remain cognizant that the US has a (potentially) incredible health-care system that is being sucked dry by health "insurance". Such "insurance" defies the traditional definition of insurance as distributed risk - typical plans can bleed you dry before the "insurance" plan kicks in and can drop you like a hot potato if you get sick. It is high time that average workers are allowed to buy some coverage that won't evaporate the first time you need it.Huh? Any evidence that workers are not allowed to buy such insurance in the U.S.? If so, I must be in big trouble, because I did.

[Al68]

How many people have health insurance that is comparable to the GM/Union health care policies? These "Cadillac" policies cover everything and are very expensive. An individual can not purchase such a policy, and if they could the price would be double their normal choices.Or much more than double. This is a major point that is being neglected.

If HR3200 passes, all (new) policies must be those "Cadillac" policies that, as you say, most individuals cannot purchase, would never purchase, and could never afford, and don't need. Yet HR3200 imposes penalties for not doing so.

The "exchange" in HR3200 simply will not allow any (new) policies even remotely similar to any normal policies that individuals buy now.

If everyone knew what HR3200 actually said, no politician that voted for it could ever be re-elected, so it's no surprise that they try to redirect debate from the substance of the bill to what they claim are their goals and "good intentions", and what they claim are the bad motives of anyone who opposes them because they actually read the bill.

Advocates of the bill know that discussing its contents won't get it passed, but ad hominem attacks and hate speech usually do the trick, especially among their constituency.

Even in this thread, advocates of HR3200 simply don't discuss the controversial contents of the bill.

[WhoWee]

At the end of the day, HR3200 is a political solution that will avoid fixing what is broken today. Specifically, medicare, medicaid, and social security are unsustainable in their current form. Additionally, health insurance is over-regulated in a manner that increases costs and prevents competition. Last, Doctors (not lawyers and politicians) should lead the way in a health care reform debate. Everyone should go back and read ALL of the earlier posts by adrenaline. She provides some very specific examples of challenges that need to be addressed.

To make a different type of comparison, if you were running a chemistry experiment, would you start with a contaminated test tube or would you start with a clean test tube? Better yet, if you didn't know what was in the contaminated vessel, would you run an analysis to determine the contents, or just guess and over-compensate in some erratic way and tell your associates to "just trust you"?

The problem needs to be studied in great detail and every proposal must be considered in it's entirety. This level of focus is not possible in the midst of an emotional, ideological, and political debate.

[Al68]

To make a different type of comparison, if you were running a chemistry experiment, would you start with a contaminated test tube or would you start with a clean test tube?Good analogy. In this case, most of the problems are caused by dirt in the test tube, and HR3200 proposes to add more dirt.

[WhoWee]

A new Obama strategy?
http://news.yahoo.com/s/ap/20090906/ap_on_go_pr_wh/us_health_care_overhaul

" By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer – 31 mins ago

WASHINGTON – The Obama administration's bottom line on a government health insurance option blurred Sunday as White House officials stressed support but stopped of short of calling it a must-have part of an overhaul.

As President Barack Obama prepares for a Wednesday night speech to Congress in a risky bid to salvage his top domestic priority, no other issue is so highly charged. Obama's liberal supporters consider the proposal for a public plan to compete with private insurers do-or-die. Republicans say it's unacceptable. It's doubtful the public plan can pass the Senate.

White House political adviser David Axelrod said Obama is "not walking away" from a public plan. But asked if the president would veto a bill that came to him without the option, Axelrod declined to answer.

The president "believes it should be in the plan, and he expects to be in the plan, and that's our position," Axelrod told The Associated Press.

Asked if that means a public plan has to be in the bill for Obama to sign it, Axelrod responded: "I'm not going to deal in hypotheticals. ... He believes it's important."

The biggest challenge Obama faces in his prime-time address is to take ownership of health care legislation that until now has been shaped by political conflicts in Congress. Lawmakers return this week from a summer break that saw eroding public support for an overhaul and contentious town hall meetings in their districts.

The idea of a public plan has become a symbol for the reach of government in a revamped health care system. Supporters say it would give workers and their families similarly secure benefits as older people now get through Medicare, while leaving medical decisions up to doctors and patients. The plan would be offered alongside private coverage through a new kind of purchasing pool called an insurance exchange. At least initially, the exchange would be open to small employers and people buying coverage on their own.

Insurers say they could never compete against the price-setting power of government. Employer groups warn it would undermine the system of job-based coverage.

While there's strong support for a public plan among House Democrats, the votes appear to be lacking in the Senate.

Democratic Sen. Ben Nelson of Nebraska, a swing vote on health care legislation, said the only way a public plan should be included is as a last resort. The government option would only be rolled out if after a few years, private insurers have failed to increase competition and restrain costs.

"If somehow the private market doesn't respond the way it's supposed to, then it would trigger a public option, or a government-run option," Nelson said on "State of the Union" on CNN. "But only as a fail-safe backstop."

White House spokesman Robert Gibbs, who joined Axelrod in a one-two administration punch on the Sunday talk shows, said the president believes a government plan would be "a valuable tool." But Gibbs danced around the question of whether it has to be in the final legislation.

Asked if Obama would sign legislation that lacked a government plan, Gibbs responded: "We're not going to prejudge what the process will be when we sign a bill, which the president expects to do this year."

Asked if Obama would say in his speech that he'd veto a bill without a government plan, Gibbs responded: "Well, I doubt that we're going to get into heavy veto threats on Wednesday."

The uncertainty over the administration's position isn't new. Health and Human Services Secretary Kathleen Sebelius said last month that a government alternative to private insurance is "not the essential element" in revamping the system to guarantee coverage for all and try to curb unsustainable costs.

Liberals — many of whom want to do away with the private health insurance industry and replace it with Medicare for all — were furious. At the time, White House officials said Sebelius' remarks were being misinterpreted. Left unclear was Obama's bottom line.

On a call with prominent liberal House members Friday, Obama refused to be pinned down on the issue, a participant told The Associated Press. "It was unclear as to whether the public option is on or off the table," said the official, who spoke on condition of anonymity because of the sensitivity of the issue.

Independents who helped propel Obama to the presidency are increasingly skeptical about his direction on health care. Unsubstantiated allegations that the legislation would promote euthanasia grabbed headlines last month. But beneath such controversies, voters appear most concerned about the scope and costs of the bill — around $1 trillion over 10 years. Obama has said he won't sign a bill unless it is fully paid for and doesn't add to the deficit.

Gibbs said Obama will refocus the debate on the benefits of overhauling the system: more security and lower costs for the majority of people who have health insurance, and new ways to help self-employed people and small businesses get coverage.

"People will leave that speech knowing where he stands," said Gibbs. He said Obama is considering offering his own health care legislation, instead of letting Congress sort out all the details.

Gibbs appeared on ABC's "This Week" and Axelrod was on NBC's "Meet the Press.""

[Ivan Seeking]

Another anecdote, but interesting. My father nearly died a few weeks ago. He had been under private care but recently moved to an area where he has easy access to a VA Hospital. What nearly killed him was the incompetence of his private care physicians. The VA ran a series of tests and then told him to quit taking just about everything he was taking. His blood had gotten so thick that his heart was failing to pump enough blood. This lead to a kidney infection. At the point that we became aware that he was having problems, he was into full-blown heart and renal failure.

He had triple-bypass done about twelve years ago and was under constant supervision by his doctors. How he got that bad with no one noticing is impossible to say, but it never should have happened. The only reason he went to the VA instead of his other physician was that he was rushed to the emergency room by my family. The VA put him an an entirely new regimine of drugs and he is now doing very well. So much for the fallacy that private care is implicitly better than government-run health care. The contrast between the VA and private care has been like day and night!

Government run health care is not even on the table, but now I'm almost wishing it was.

[Hurkyl]

Another anecdote, but interesting. ... So much for the fallacy that private care is implicitly better than government-run health care. The contrast between the VA and private care has been like day and night!
Proof by anecdote! I'll take your word for it that this isn't just a hasty generalization argument. (On second thought, I won't)

[Hans de Vries]

From the other thread:

A US health care system at the level of that of Sweden or Norway would have prevented
1,000,000 US citizens from dying unnecessary in their first year of life.

The infant mortality rate (IMR) is the number of deaths of infants under one year old in a given year per 1,000 live births in the same year. This rate is often used as an indicator of the level of health in a country"



Infant mortality per country worldwide
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate


Map of Infant mortality under non-Hispanic whites in the US per state:
http://www.statehealthfacts.org/comparemaptable.jsp?ind=48&cat=2&sub=13&yr=79&typ=3&o=a&sortc=1


Don't confuse the latter with the 2008 election map....


Regards, Hans

[WhoWee]

From the other thread:

A US health care system at the level of that of Sweden or Norway would have prevented
1,000,000 US citizens from dying unnecessary in their first year of life.





Infant mortality per country worldwide
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate


Map of Infant mortality under non-Hispanic whites in the US per state:
http://www.statehealthfacts.org/comparemaptable.jsp?ind=48&cat=2&sub=13&yr=79&typ=3&o=a&sortc=1


Don't confuse the latter with the 2008 election map....


Regards, Hans

Interesting stats. By the way, look closely, the US info doesn't track across the two charts.

As for the US by state chart. I don't think this is the point you wanted to make. But, I have to wonder how many of the Non-Hispanic Blacks are on a Government health plan?

The death rate for Blacks is more than double White and Hispanic. It seems to me there are a disproportionate number of Blacks (of child bearing age) on welfare/medicaid - could this be the cause??? Could Blacks on medicaid be experiencing a higher infant mortality rate?

[WhoWee]

The best example just happens to be D.C. here's a comparison US to D.C.
Non-Hisp White Non-Hisp Black Hispanic Total
US .................... 5.7% 13.6% 5.6% 6.9%
District of Columbia 3.4% 17.2% 7.2% 11.4%

Blacks account for 55% of the D.C. and only 13% of the US population.

[Al68]

A US health care system at the level of that of Sweden or Norway would have prevented 1,000,000 US citizens from dying unnecessary in their first year of life.That's a wild, unsubstantiated claim. Any evidence? Anecdotal evidence that obviously represents exceptions to a general trend don't count.The infant mortality rate (IMR) is the number of deaths of infants under one year old in a given year per 1,000 live births in the same year. This rate is often used as an indicator of the level of health in a country""Often used as an indicator of the level of health" doesn't equal valid indicator of good "government health care policy".

Also note that according to your source, the U.S. infant mortality rate is 6.3. Sure it's not number one, but the worldwide average is 49.4.

But the most obvious point is that if the rate were generally lower in socialist countries, and generally higher in economically freer countries, the rate in the U.S. would be much higher than average instead of much lower.

Cherry picking statistics and using exceptions to try to prove a rule is just faulty logic.

Notice the stark difference if, instead of picking Sweden and Norway, you picked socialist countries at random, or averaged them. Then you might see the trend instead of exceptions to it.

[Hans de Vries]

That's a wild, unsubstantiated claim. Any evidence? Anecdotal evidence that obviously represents exceptions to a general trend don't count."Often used as an indicator of the level of health" doesn't equal valid indicator of good "government health care policy".

I did provide the facts and figures from trusted and regarded sources.

Also note that according to your source, the U.S. infant mortality rate is 6.3. Sure it's not number one, but the worldwide average is 49.4.

But the most obvious point is that if the rate were generally lower in socialist countries, and generally higher in economically freer countries, the rate in the U.S. would be much higher than average instead of much lower.

Cherry picking statistics and using exceptions to try to prove a rule is just faulty logic.

Notice the stark difference if, instead of picking Sweden and Norway, you picked socialist countries at random, or averaged them. Then you might see the trend instead of exceptions to it.


The infant mortality under non Hispanic Whites in the conservative states
of the USA is much higher as in any Western European country.

Even though the European numbers DO include the very large immigrant
populations from North Africa and the Middle east.

If you don't like it... then Support a decent Health care system.


Regards, Hans

Map of Infant mortality under non-Hispanic whites in the US per state:
http://www.statehealthfacts.org/comparemaptable.jsp?ind=48&cat=2&sub=13&yr=79&typ=3&o=a&sortc=1
Infant mortality per country worldwide:
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

[Al68]

I did provide the facts and figures from trusted and regarded sources. But they simply did not back up your claim. In fact your source showed the opposite general trend of your claim. The infant mortality rate is, on average, much higher in countries with universal health care than in the U.S.

That's how statistics work. If you pick and choose data points, you can make any conclusion you want, even if it is the exception to the rule. If you want to relate universal health care to the infant mortality rate, then you must consider all countries with universal health care, not just choose the ones that happen to deviate from the general trend. If you don like it... then Support a decent Health care system.I have a better idea. If you don't like it, then support freedom.

[Hans de Vries]

But they simply did not back up your claim.

Your problem seems to be a lack of knowledge of which countries are
in Europe and which of them have welfare systems that you would call
"Socialist welfare systems"

The latter have lower infant mortality rates as the rest of Europe and
much lower as the USA.



Regards, Hans

[Al68]

Your problem seems to be a lack of knowledge of which countries are
in Europe and which of them have welfare systems that you would call
"Socialist welfare systems"Nope. It seems that you don't realize that your claim was that the reason that those European countries (that had lower infant mortality rates than the U.S.) did so because of universal health care, then you cited a source that showed that the countries you picked were exceptions to the general trend that most countries with universal health care have much higher infant mortality rates than the U.S.

If you're going to claim universal health care is the reason for low infant mortality rates, then you must compare all countries with universal health care, not just the ones you chose that you don't think I know are in Europe.

What if I were to claim that many, many millions of Indian children would be saved if only they eliminated universal health care? After all, their infant mortality rate is 55 compared to 6.3 in the U.S. The only difference between my ridiculous claim and yours is that my example (India) is close to the overall average of the data.

[Hans de Vries]

If you're going to claim universal health care is the reason for low infant mortality rates, then you must compare all countries with universal health care, not just the ones you chose that you don't think I know are in Europe.

What if I were to claim that many, many millions of Indian children would be saved if only they eliminated universal health care? After all, their infant mortality rate is 55 compared to 6.3 in the U.S. The only difference between my ridiculous claim and yours is that my example (India) is close to the overall average of the data.


There's no use at all in comparing the US with countries which do not have
similar standards of living and comparable GDP per capita.

India has 2% of the US GDP per capita, wide spread poverty and abysmal
water supply and sanitation. Furthermore, 60% of healthcare in India is
private-sector anyway... http://en.wikipedia.org/wiki/Healthcare_in_India


Regards, Hans

[Al68]

There's no use at all in comparing the US with countries which do not have
similar standards of living and comparable GDP per capita.That's like picking healthy smokers (instead of smokers at random) to claim that smoking is good for your health, claiming there is no use comparing non-smokers to people with lung cancer or emphysema.

Infant mortality rate is partially dependent on standard of living and GDP. And standard of living and GDP per capita is dependent on economic freedom. Notice that both Sweden and Norway rate rate higher than average (about 70) in the index of economic freedom overall, despite universal health care. If you want to isolate universal health care as a "cause" of something, you can't cherry pick the countries that have high standards of living/GDP to do it, when they are far from representative of most countries with universal health care.India has 2% of the US GDP per capita, wide spread poverty and abysmal
water supply and sanitation.Because of socialist policies. Furthermore, 60% of healthcare in India is
private-sector anyway...Not in the relevant sense here. They have universal health care.

[Hans de Vries]

That's like picking healthy smokers (instead of smokers at random) to claim that smoking is good for your health, claiming there is no use comparing non-smokers to people with lung cancer.

Infant mortality rate is partially dependent on standard of living and GDP. And standard of living and GDP per capita is dependent on economic freedom. Notice that both Sweden and Norway rate rate higher than average (about 70) in the index of economic freedom overall, despite universal health care. If you want to isolate universal health care as a "cause" of something, you can't cherry pick the countries that have high standards of living/GDP to do it, when they are far from representative of most countries with universal health care.Because of socialist policy.Not in the relevant sense here. They have universal health care.



Obama is looking at Western European countries which have demonstrated
better benchmarks in healthcare at reduced bureaucratic overhead and less
excessive costs.

These countries are what one would call Social Democracies with experienced
Welfare systems. They try to combine entrepreneurial freedom with
governmental responsibility.

Simplistic comparisons like "Obama=Socialism" totally ignore what is really
going on in these countries.


Regards Hans.

[Al68]

Obama is looking at Western European countries which have demonstrated
better benchmarks in healthcare at reduced bureaucratic overhead and less
excessive costs.

These countries are what one would call Social Democracies with experienced
Welfare systems. They try to combine entrepreneurial freedom with
governmental responsibility.

Simplistic comparisons like "Obama=Socialism" totally ignore what is really
going on in these countries. Well, if you're just claiming that the economic policies of Sweden and Norway are much better than those of most socialist countries, then I agree with you 100%.

They do have more economic freedom than most, despite not being libertarian paradises, and as a result they fit the general trend that economic freedom improves standards of living.

But universal health care isn't the cause of low infant mortality rates, like you earlier suggested. You just can't statistically isolate universal health care as a cause by picking the successes and ignoring the failures. Especially when failure is the norm, and the successes are obviously due to relative economic freedom (along with other factors of course).

In other words, Sweden and Norway are "right-wing" relative to most socialist countries, despite having universal health care in common. That's why they have a higher standard of living which leads to a lower infant mortality rate.

And another important point is country size. The U.S. must be compared to comparable size countries for any meaningful economic policy analysis. And as has been pointed out, among large countries, the U.S. consistently has a much higher standard of living, GDP per capita, it dominates all the charts when it comes to health, from infant mortality rates to cancer survival rates, and everything in between. Obviously that says something about which economic policies work best for large countries.

[WhoWee]

The health care debate is about cost. The current Government programs account for roughly 50% of the total cost already. These programs are mismanaged and (in the case of Social Security) surpluses are looted to pay for other projects.

http://www.nchc.org/facts/cost.shtml
"Facts on the Cost of Health Insurance and Health Care

Health care spending continues to rise at a rapid rate forcing businesses to cut back on health insurance coverage and forcing many families to cut back on basic necessities such as food and electricity and, in some cases, shelters and homes.

Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management and inappropriate care, waste and fraud. These problems increase the cost of medical care associated with government health programs like Medicare and Medicaid, and health insurance for employers and workers and affect the security of families.



National Health Care Spending

* National health spending is expected to reach $2.5 trillion in 2009, accounting for 17.6 percent of the gross domestic product (GDP). By 2018, national health care expenditures are expected to reach $4.4 trillion—more than double 2007 spending.1
* National health expenditures are expected to increase faster than the growth in GDP: between 2008 and 2018, the average increase in national health expenditures is expected to be 6.2 percent per year, while the GDP is expected to increase only 4.1 percent per year. 1
* In just three years, the Medicare and Medicaid programs will account for 50 percent of all national health spending. 1
* Medicare's Hospital Insurance (HI) Trust Fund is expected to pay out more in hospital benefits and other expenditures this year than it receives in taxes and other dedicated revenues. In addition, the Medicare Supplementary Medical Insurance (SMI) Trust Fund that pays for physician services and the prescription drug benefit will continue to require general revenue financing and charges on beneficiaries that will grow substantially faster than the economy and beneficiary incomes over time. 2
* According to one study, of the $2.1 trillion the U.S. spent on health care in 2006, nearly $650 billion was above what we would expect to spend based on the level of U.S. wealth versus other nations. These additional costs are attributable to $436 billion outpatient care and another $186 billion of spending related to high administrative costs. 3"


Also http://www.usatoday.com/money/industries/insurance/2009-05-28-hiddentax_N.htm


"By Seung Min Kim, USA TODAY
WASHINGTON — The average U.S. family and their employers paid an extra $1,017 in health care premiums last year to compensate for the uninsured, according to a study to be released Thursday by an advocacy group for health care consumers.

Families USA, which supports expanded health care coverage, found that about 37% of health care costs for people without insurance — or a total of $42.7 billion — went unpaid last year. That cost eventually was shifted to the insured through higher premiums, according to the group.

"I don't think anybody has any idea about how much they are paying because of the need to cover the health care costs of the uninsured," said Ron Pollack, the group's executive director. "This is a hidden tax on all insurance premiums, whether it is paid by business for their work or by families when they purchase their own coverage.""

We are already paying for the unpaid balances of the uninsured.

Universal health care or single payer will eventually funnel all of the health insurance premiums through Washington. This is not the answer. Our elected officials can not be trusted with "Trust Funds" - they've proven this point with their handling of Social Security funds.

[mheslep]

There's no use at all in comparing the US with countries which do not have
similar standards of living and comparable GDP per capita....
Hans, there's no use in making an infant mortality comparison unless you know the standards used in making the count. You do not, or have not demonstrated it here.
...First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.
http://health.usnews.com/usnews/health/articles/060924/2healy.htm
There are other factors, such as the abortion rate, that neatly remove what might high risk pregnancies from the statistics. The abortion rate (http://www.guttmacher.org/pubs/journals/25s3099.html)in Europe is nearly twice as high as in North America.

[mheslep]

Obama is looking at Western European countries which have demonstrated better benchmarks in healthcareNo, they have not demonstrated better medical care related outcomes. The US tops most of those.
at reduced bureaucratic overhead and less
excessive costs...Yes European health care costs less, nearly half the US, hence the the concentration on cost savings in this debate. I don't think the bureaucratic overhead claim holds everywhere.

[Hans de Vries]

Hans, there's no use in making an infant mortality comparison unless you know the standards used in making the count. You do not, or have not demonstrated it here.

These are the official lists used internationally to compare this particular statistic.
You have to give a quantitative indication of what percentage of births belongs
to these exceptional cases.


http://health.usnews.com/usnews/health/articles/060924/2healy.htm
There are other factors, such as the abortion rate, that neatly remove what might high risk pregnancies from the statistics. The abortion rate (http://www.guttmacher.org/pubs/journals/25s3099.html)in Europe is nearly twice as high as in North America.

Actually, It's the other way around for the countries we are talking
about. According to your source:

Abortion rates per 100 known pregnancies:

Western Europe...... 17
Northern Europe..... 23
Northern America... 26
Southern Europe.... 34
Eastern Europe.......65

The total number for Europe is skewed by the higher abortion rates in
the former Sovjet-Block states.

Regards, Hans

[mheslep]

These are the official lists used internationally to compare this particular statistic.
You have to give a quantitative indication of what percentage of births belongs
to these exceptional cases....'Official' list? Exceptional cases? There is no 'official' list, that's an argument from authority fallacy. The CIA list is a still just a list. There's a source, and we judge its accuracy and value depending on the documented process behind it. What does 'infant mortality' mean? How are premature or low birth weight pregnancies counted? What are the average ages of women having babies in those countries? I've provided a reference showing how these infant mortality comparisons between countries are fundamentally flawed due to serious differences in data collection, not some exceptional cases. The best one can do from these lists, without correcting for differences in the measurement, is to say a given nation is in the top 20% or so.

[Hans de Vries]

'Official' list? Exceptional cases? There is no 'official' list, that's a a argument from authority fallacy. The CIA list is a still just a list. There's a source, and we judge its accuracy and value depending on the documented process behind it. We can only assume that the CIA is using the OECD data like everyone else. I've provided a reference showing how these infant mortality comparisons between countries are fundamentally flawed due to serious differences in data collection, not some exceptional cases. The best one can do from these lists, without correcting for differences in the measurement, is to say a given nation is in the top 20% or so.

You fail to give any proof for your claims. You can't just simply bend the facts
until you like them. Do you really believe yourself what you are saying?

This is a SCIENTIFIC website. Try to argue in a SCIENTIFIC way. Give me FACTS
and not your BELIEFS.

[mheslep]

You fail to give any proof for your claims. You can't just simply bend the facts
until you like them. Do you really believe yourself what you are saying?

This is a SCIENTIFIC website. Try to argue in a SCIENTIFIC way. Give me FACTS
and not your BELIEFS.Han's YOU have made made the claims here, and followed them up with hyperbole and assertion. Where are your facts? You've quoted a Wiki page, with no backup or further definition. The conclusions you draw in #686 are simple nonsense, you should delete it.

[Hans de Vries]

Han's YOU have made made the claims here, and followed them up with hyperbole and assertion. Where are your facts? You've quoted a Wiki page, with no backup or further definition. The conclusions you draw in #686 are simple nonsense, you should delete it.



Some US states DO have "Western European" levels of infant mortality,
at least for whites:

New Jersey .......... 3.7
Massachusetts ..... 4.0
California ............. 4.6
New York ............. 4.6

Do these states "cheat" 3% to 4% away from their statistics as well?

The US average is dragged down by the states run by conservatives.
The numbers for non-Hispanic whites:

West Virginia ........ 7.5
Oklahoma ............. 7.5
Arkansas ............. 7.2
Louisiana ............. 7.1
Indiana ................ 7.0
Tennessee ........... 7.0
Mississippi ............ 7.0

It's the neocon fanatics who put the US to shame, again. Organizing a witch hunt
against Health care reform while failing to take care of their own newborns.



Map of Infant mortality under non-Hispanic whites in the US per state:
http://www.statehealthfacts.org/comparemaptable.jsp?ind=48&cat=2&sub=13&yr=79&typ=3&o=a&sortc=1
Infant mortality per country worldwide:
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

[mheslep]

As I alluded to above, one of the difficulties in counting is deciding what's a still birth and what's a live birth.
Dutch pediatric association:
http://news.bbc.co.uk/2/hi/programmes/panorama/3677278.stm
.. At 23/24 weeks' gestation, the chances of a positive prognosis for the premature baby are so slender that, in principle, no intensive [post natal] care is offered...Thus any birth at less that 25 weeks is counted as a still birth in the Netherlands. And the infant mortality statistics are heavily impacted (34% of all infant deaths) by premature births in the US:

CONCLUSIONS. On the basis of this evaluation, preterm birth is the most frequent cause of infant death in the United States, accounting for at least one third of infant deaths in 2002. The extreme prematurity of most of the infants and their short survival indicate that reducing infant mortality rates requires a comprehensive agenda to identify, to test, and to implement effective strategies for the prevention of preterm birth
http://pediatrics.aappublications.org/cgi/content/abstract/118/4/1566

[mheslep]

Some US states DO have "Western European" levels of infant mortality,
at least for whites:

New Jersey .......... 3.7
Massachusetts ..... 4.0
California ............. 4.6
New York ............. 4.6

Do these states "cheat" 3% to 4% away from their statistics as well?We can compare state to state in the US and have that discussion if you like, because live birth and still births are counted the same way across the US. They are NOT measured the same way across other countries as has been shown now in a couple of posts.
The US average is dragged down by the states run by conservatives.
Please. You were saying this is a scientific website?

[WhoWee]

It's the neocon fanatics who put the US to shame, again. Organizing a witch hunt
against Health care reform while failing to take care of their own newborns.

Hans,

Do you realize you've provided more data in this discussion
than the politicians leading the debate? There is of course a reason.

The Government run programs are in trouble. The Social Security funds have been stolen, and medicare and medicaid are both in trouble. Nobody wants to solve the inherent problems.

At the same time, the insurance industry is over-regulated (which leads to ineffciency and higher administrative costs) and competition is cost prohibitive. Additionally, the cost of uninsured (unpaid balances) are passed on to the insured and people with pre-existing conditions are forced to accept indemnity coverage or left on their own.

The politicians want a single payer system for one reason. They will control all of the money. Let me repeat, the politicians want to control ALL of the money. It's the best way for them to fix the Ponzi scheme (as described earlier) that social Security has become.

This debate is not focused on specific improvements to infant mortality or any other issues. We are hearing about H1N1 a lot in the past few days though - as Rahm Emanuel said ...take advantage of every crisis.

Until politics is removed from the debate and problem solving techniques are applied, nothing will be resolved.

[turbo]

At the same time, the insurance industry is over-regulated (which leads to ineffciency and higher administrative costs) and competition is cost prohibitive. Additionally, the cost of uninsured (unpaid balances) are passed on to the insured and people with pre-existing conditions are forced to accept indemnity coverage or left on their own.I have spent years in the bowels of a large private medical practice, I assure you (as Adreneline will attest) that this is NOT the case. Insurance companies are not over-regulated. They are under-regulated, and they make the rules under which our health-care providers have to operate, to the detriment of all of us.

There are those on the sidelines (mostly right-wingers with no experience in the provision of medical services) that claim that over-regulation of the insurance companies caused health insurance costs to double in less than a decade, when a reasonable review of the facts proves otherwise. It is the lack of oversight and regulation that allow health insurance companies to Balkanize US health care and create state-wide monopolies that are practically impossible to break.

We need to get the GOP/Dem dichotomy out of this, and break up a monopoly that threatens to destroy the US economy. If we don't get meaningful and effective (cost-savings) health care reform soon, the US will be a third-rate country with nothing but a bloated military and massive debt to distinguish us. That, and the fact that anyone who comes down with a catastrophic illness forfeits all his or her savings and assets to the wealthy in a possibly futile attempt to stay alive.

[WhoWee]

I have spent years in the bowels of a large private medical practice, I assure you (as Adreneline will attest) that this is NOT the case. Insurance companies are not over-regulated. They are under-regulated, and they make the rules under which our health-care providers have to operate, to the detriment of all of us.

There are those on the sidelines (mostly right-wingers with no experience in the provision of medical services) that claim that over-regulation of the insurance companies caused health insurance costs to double in less than a decade, when a reasonable review of the facts proves otherwise. It is the lack of oversight and regulation that allow health insurance companies to Balkanize US health care and create state-wide monopolies that are practically impossible to break.

We need to get the GOP/Dem dichotomy out of this, and break up a monopoly that threatens to destroy the US economy. If we don't get meaningful and effective (cost-savings) health care reform soon, the US will be a third-rate country with nothing but a bloated military and massive debt to distinguish us. That, and the fact that anyone who comes down with a catastrophic illness forfeits all his or her savings and assets to the wealthy in a possibly futile attempt to stay alive.

The over-regulation I'm referring to is primarily with regards to individual state mandates, HIPPA requirements, and tax considerations.

[WhoWee]

all i know is private insurances follow medicare fee schedules. some pay less ( I fire those plans when I review their contract and see they are paying us less than medicare set fees)

This directly effects health care quality.

[WhoWee]

here is a good synopsis about the public option facts and myths
http://www.pnhp.org/change/Public_Option_Myths_and_Facts.pdf


see page 2


Obama's public option won't save me on my adminstrative and beaurocratic costs.


I have one medicare/medicaid coder and biller, I have a army to deal with the 200 private insurance plans, I have six check in and check out people to confirm insurances, wether they pay for physicals, what labs I must send blood work to etc., I have over 8 -telephone people at all times not just fielding questions but also helping with prior authorizations and precerts, etc. If the public option now offers me another say 100 plans, all with different formularies, contsraints on procedures, which labs I have to send my blood ( lab corp,quest etc.) I will have to hire another slew of office workers just to deal with them.

Medicare's rules are simple, their formulary does not change every three months, I know where I stand with them. WHen they privatized into competeing HMOs, most of us just could not handle the "patchwork" of differing regulations and rules etc, hence, most of us don't take privatized medicare. ( in my county)

She outlined some of the problems regarding regulations.

[WhoWee]

I had to send my office manager to numerous classes that were not cheap, hired a consultant and software engineer to make our electronic medical records Hippa compliant, had to renovate our office ( put glass panels between nurses stations and patient rooms) and make our office hippa compliant, etc. probably 50-75 thous?

This was her response when I asked about the specific cost of HIPPA to her practice. It cost her over $50,000 and possibly as much as $75,000 - for one office.

[turbo]

I have one medicare/medicaid coder and biller, I have a army to deal with the 200 private insurance plans, I have six check in and check out people to confirm insurances, wether they pay for physicals, what labs I must send blood work to etc., I have over 8 -telephone people at all times not just fielding questions but also helping with prior authorizations and precerts, etc. If the public option now offers me another say 100 plans, all with different formularies, contsraints on procedures, which labs I have to send my blood ( lab corp,quest etc.) I will have to hire another slew of office workers just to deal with them.

Medicare's rules are simple, their formulary does not change every three months, I know where I stand with them. WHen they privatized into competeing HMOs, most of us just could not handle the "patchwork" of differing regulations and rules etc, hence, most of us don't take privatized medicare. ( in my county)You have badly mischaracterized Adreleline's statements. Re-read her quote and realize that her administrative costs are huge with private insurers, and are modest and predictable with Medicare/Medicaid. I have tried to make this point over and over again in this thread only to be put down for offering "apocryphal" stories. I lived this situation for years and years, trying to improve the practice's receivable aging. We did a lot, only to butt up against the brick wall of initial denials (which are worse in some companies than others, but are industry-standard). In a fair system, an insurance company should have to pay reasonable claims up-front, and then contest claims after the fact, if necessary. This is not the US system. The US system forces doctors to keep coders and billing specialists busy full-time coding, submitting, and re-coding and resubmitting in order to get any payment for services rendered. Health insurance is a protection racket. It is not "insurance" in any reasonable interpretation of the word, since your carrier will drop you as soon as you get any expensive illness.

[WhoWee]

You have badly mischaracterized Adreleline's statements. Re-read her quote and realize that her administrative costs are huge with private insurers, and are modest and predictable with Medicare/Medicaid. I have tried to make this point over and over again in this thread only to be put down for offering "apocryphal" stories. I lived this situation for years and years, trying to improve the practice's receivable aging. We did a lot, only to butt up against the brick wall of initial denials (which are worse in some companies than others, but are industry-standard). In a fair system, an insurance company should have to pay reasonable claims up-front, and then contest claims after the fact, if necessary. This is not the US system. The US system forces doctors to keep coders and billing specialists busy full-time coding, submitting, and re-coding and resubmitting in order to get any payment for services rendered. Health insurance is a protection racket. It is not "insurance" in any reasonable interpretation of the word, since your carrier will drop you as soon as you get any expensive illness.

I'm not trying to mischarachterize her statements - that's why I posted her entire statement. Instead, I wanted to draw attention to the administrative nightmare faced by insurance companies and providers.

When she says
"I have one medicare/medicaid coder and biller, I have a army to deal with the 200 private insurance plans, I have six check in and check out people to confirm insurances, wether they pay for physicals, what labs I must send blood work to etc., I have over 8 -telephone people at all times not just fielding questions but also helping with prior authorizations and precerts, etc. If the public option now offers me another say 100 plans, all with different formularies, contsraints on procedures, which labs I have to send my blood ( lab corp,quest etc.) I will have to hire another slew of office workers just to deal with them."

Her reference to 200 private insurance plans provides a real analysis of the difficulties providers face administratively. If those 200 plans are (most likely) spread across 25 to 30 (6 to 8 plans each) insurance companies total. Now expand those 25 to 30 companies and 200 policies to 50 states and we realize the same 25 to 30 companies have 10,000 (state specific) policies to manage.

Her concern is that HR3200 will greatly increase the problem by adding as many as 100 MORE plans to administer.

One of the biggest wastes in the insurance industry is differing standards mandated across the states. There is no reason whatsoever we can't have 10 or 12 basic health plans that everyone offers. This standardization would simplify coding, create competition, eliminate 49 compliance departments at each of the 25 to 30 insurance companies, eliminate duplication in all 50 state departments of insurance, speed payment, expand coverage (due to cost savings), and enable coverage for pre-existing conditions.

[WhoWee]

Again, we need to remove politics from the debate and focus on solving specific problems.

[Al68]

Some US states DO have "Western European" levels of infant mortality,
at least for whites:

New Jersey .......... 3.7
Massachusetts ..... 4.0
California ............. 4.6
New York ............. 4.6

Do these states "cheat" 3% to 4% away from their statistics as well?

The US average is dragged down by the states run by conservatives.
The numbers for non-Hispanic whites:

West Virginia ........ 7.5
Oklahoma ............. 7.5
Arkansas ............. 7.2
Louisiana ............. 7.1
Indiana ................ 7.0
Tennessee ........... 7.0
Mississippi ............ 7.0
Gee, the rich states have lower infant mortality rates. Big surprise.
It's the neocon fanatics who put the US to shame, again. Organizing a witch hunt
against Health care reform while failing to take care of their own newborns.
Why the hate? No one is against reform. The current proposal being debated in the U.S. is not reform, it just the opposite.

[Al68]

Again, we need to remove politics from the debate and focus on solving specific problems.That's hard to do when the debate is about whether to use political power to solve problems.

[Hans de Vries]

I've provided a reference showing how these infant mortality comparisons between countries are fundamentally flawed due to serious differences in data collection, not some exceptional cases. The best one can do from these lists, without correcting for differences in the measurement, is to say a given nation is in the top 20% or so.


You provided multiple wrong references:

All the countries you mention, but also the states of the USA, adopted the WHO
definition of infant mortality in the late 80's or the early 90's. Infant morality is
defined as dead before the first birthday after live birth, and


A live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or any definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat


Definitions used in the by the WHO, the European union, individual US states and
various other countries: http://www.gfmer.ch/Medical_education_En/Live_birth_definition.htm


Regards, Hans

[Hans de Vries]

World Health statistics 2009:

http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf
http://www.who.int/whosis/whostat/2009/en/index.html


Regards, Hans

[mheslep]

When you have a moment could you provide the source for this statement:..All the countries you mention, but also the states of the USA, adopted the WHO definition of infant mortality in the late 80's or the early 90's. Infant morality is defined as dead before the first birthday after live birth, and
Because this statement above and this one below
Definitions used in the by the WHO, the European union, individual US states and various other countries: http://www.gfmer.ch/Medical_education_En/Live_birth_definition.htm
appear to be at odds with one another.

[Hans de Vries]

When you have a moment could you provide the source for this statement:
Because this statement above and this one below
appear to be at odds with one another.


See reference [7] at the end of the third paragraph which specifically defuses the false claims in the reference you gave.

http://en.wikipedia.org/wiki/Infant_mortality#Comparing_infant_mortality_ratese


Regards

[mheslep]

See reference [7] at the end of the third paragraph which specifically defuses the false claims in the reference you gave.

http://en.wikipedia.org/wiki/Infant_mortality#Comparing_infant_mortality_rates
A wiki reference? You made that earlier post
..All the countries you mention, but also the states of the USA, adopted the WHO definition of infant mortality in the late 80's or the early 90's. Infantbased on a wiki reference, with no attribution to wiki? C'mon, I think you know better.

[Hans de Vries]

A wiki reference? You made that earlier post
based on a wiki reference, with no attribution to wiki? C'mon, I think you know better.

It's clear now that both the US and the European Union adopted the definition
of infant mortality and live birth as defined by the World Health Organization.

http://www.gfmer.ch/Medical_education_En/Live_birth_definition.htm
http://ec.europa.eu/health/ph_projects/2001/monitoring/fp_monitoring_2001_a1_frep_01_en.pdf

So that the tables entries can be compared one to one:

http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
http://www.statehealthfacts.org/comparemaptable.jsp?ind=48&cat=2&sub=13&yr=79&typ=3&o=a&sortc=1
http://epp.eurostat.ec.europa.eu/tgm/table.do?tab=table&language=en&pcode=tps00027&plugin=0&tableSelection=1&footnotes=yes&labeling=labels

Regards, Hans

[WhoWee]

Details begin to emerge - just like car insurance (?) with fines up to $3,800.
http://news.yahoo.com/s/ap/20090908/ap_on_go_pr_wh/us_health_care_overhaul

"
Fines proposed for going without health insurance AP

By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer – 10 mins ago

WASHINGTON – Americans would be fined up to $3,800 for failing to buy health insurance under a plan that circulated in Congress on Tuesday as divisions among Democrats undercut President Barack Obama's effort to regain traction on his health care overhaul.

As Obama talked strategy with Democratic leaders at the White House, the one idea that most appeals to his party's liberal base lost ground in Congress. Prospects for a government-run plan to compete with private insurers sank as a leading moderate Democrat said he could no longer support the idea.

The fast-moving developments put Obama in a box. As a candidate, he opposed fines to force individuals to buy health insurance, and he supported setting up a public insurance plan. On Tuesday, fellow Democrats publicly begged to differ on both ideas.

Democratic congressional leaders put on a bold front as they left the White House after their meeting with the president.

"We're re-energized; we're ready to do health care reform," said Senate Majority Leader Harry Reid of Nevada.

House Speaker Nancy Pelosi, D-Calif., insisted the public plan is still politically viable. "I believe that a public option will be essential to our passing a bill in the House of Representatives," she said.

After a month of contentious forums, Americans were seeking specifics from the president in his speech to a joint session of Congress on Wednesday night. So were his fellow Democrats, divided on how best to solve the problem of the nation's nearly 50 million uninsured.

The latest proposal: a ten-year, $900-billion bipartisan compromise that Sen. Max Baucus, D-Mont., a moderate who heads the influential Finance Committee, was trying to broker. It would guarantee coverage for nearly all Americans, regardless of medical problems.

But the Baucus plan also includes the fines that Obama has rejected. In what appeared to be a sign of tension, White House spokesman Robert Gibbs pointedly noted that the administration had not received a copy of the plan before it leaked to lobbyists and news media Tuesday.

The Baucus plan would require insurers to take all applicants, regardless of age or health. But smokers could be charged higher premiums. And 60-year-olds could be charged five times as much for a policy as 20-year-olds.

Baucus said Tuesday he's trying to get agreement from a small group of bipartisan negotiators in advance of Obama's speech. "Time is running out very quickly," he said. "I made that very clear to the group."

Some experts consider the $900-billion price tag a relative bargain because the country now spends about $2.5 trillion a year on health care. But it would require hefty fees on insurers, drug companies and others in the health care industry to help pay for it.

Just as auto coverage is now mandatory in nearly all states, Baucus would require that all Americans get health insurance once the system is overhauled. Penalties for failing to do so would start at $750 a year for individuals and $1,500 for families. Households making more than three times the federal poverty level — about $66,000 for a family of four — would face the maximum fines. For families, it would be $3,800, and for individuals, $950.

Baucus would offer tax credits to help pay premiums for households making up to three times the poverty level, and for small employers paying about average middle-class wages. People working for companies that offer coverage could avoid the fines by signing up.

The fines pose a dilemma for Obama. As a candidate, the president campaigned hard against making health insurance a requirement, and fining people for not getting it.

"Punishing families who can't afford health care to begin with just doesn't make sense," he said during his party's primaries. At the time, he proposed mandatory insurance only for children.

White House officials have since backed away somewhat from Obama's opposition to mandated coverage for all, but there's no indication that Obama would support fines.

One idea that Obama championed during and since the campaign — a government insurance option — appeared to be sinking fast.

House Majority Leader Steny Hoyer, D-Md., told reporters a Medicare-like plan for middle-class Americans and their families isn't an essential part of legislation for him. Hoyer's comments came shortly after a key Democratic moderate said he could no longer back a bill that includes a new government plan.

The fast-moving developments left liberals in a quandary. They've drawn a line, saying they won't vote for legislation if it doesn't include a public plan to compete with private insurance companies and force them to lower costs.

Rep. Mike Ross, D-Ark., who once supported a public option, said Tuesday that after hearing from constituents during the August recess, he's changed his mind.

"If House leadership presents a final bill that contains a government-run public option, I will oppose it," Ross said.

House Democrats are considering a fallback: using the public plan as a last resort if after a few years the insurance industry has failed to curb costs.

Obama's commitment to a public plan has been in question and lawmakers hoped his speech to Congress would make his position on that clear.

Baucus is calling for nonprofit co-ops to compete in the marketplace instead of a public plan.

An 18-page summary of the Baucus proposal was obtained by The Associated Press. The complex plan would make dozens of changes in the health care system, many of them contentious. For example, it includes new fees on insurers, drug companies, medical device manufacturers and clinical labs.

People working for major employers would probably not see big changes. The plan is geared to helping those who now have the hardest time getting and keeping coverage: the self-employed and small business owners. "

[Al68]

Details begin to emerge - just like car insurance (?) with fines up to $3,800.
http://news.yahoo.com/s/ap/20090908/ap_on_go_pr_wh/us_health_care_overhaul

"
Fines proposed for going without health insurance APThis isn't exactly breaking news, although the exact details are still being discussed. And the fine is not just for not having health insurance at all, it's for not buying one that meets HR3200 requirements, ie, a Cadillac superpolicy.

[adrenaline]

Although I may not agree with the fines it makes sense. We need everyone in the risk pool if we're going to effectively share risk and minimize premiums. If you support UHC then you have to support mandatory coverage.

This addresses the problem with those people who stay out of the insurance untill they think that they are running out of health. At that point they will suddenly opt in and gain coverage without all of the years of paying in. The young don't avoid health insurance because they are healthy, they avoid health insurance because they are cheap.

[WhoWee]

Although I may not agree with the fines it makes sense. We need everyone in the risk pool if we're going to effectively share risk and minimize premiums. If you support UHC then you have to support mandatory coverage.

This addresses the problem with those people who stay out of the insurance untill they think that they are running out of health. At that point they will suddenly opt in and gain coverage without all of the years of paying in. The young don't avoid health insurance because they are healthy, they avoid health insurance because they are cheap.

I understand why they've developed this strategy. However, unless they also hand out waivers to people who want insurance now (but really can't afford it), they're going to penalize the group that most needs coverage.

[WhoWee]

This isn't exactly breaking news, although the exact details are still being discussed. And the fine is not just for not having health insurance at all, it's for not buying one that meets HR3200 requirements, ie, a Cadillac superpolicy.

As I've disclosed previously, I'm a licensed insurance agent. If we can find the proposed coverage mandates, I'll pull a price quote for an average family of 4 - from a large company.

[jreelawg]

I understand why they've developed this strategy. However, unless they also hand out waivers to people who want insurance now (but really can't afford it), they're going to penalize the group that most needs coverage.

It is beginning to look like Hillary is going to get her way. Her campaign argued a mandatory insurance plan. During that time, my take was that it was a give away to insurance companies, by forcing people who can't afford it to buy it anyways. This would make it even easier to rip us off because they wouldn't need to make it affordable for the lower class, the lower class would just have to give up eating, or home heating, or electricity. Obama campaigned against this.

Now it seams that Obama's campaign promise is being snuffed out, and Hillary and the Insurance companies are getting what they want. I hope this isn't the case.

[Wax]

Make or break night on health care! I hope he makes it.

[mheslep]

Baucus, who apparently leads a group of bipartisan Senator's, has released an outline of his health plan.
http://www.politico.com/static/PPM116_framework.html

Key points:
-Mandated coverage
-Interstate insurance
-Co-ops
-Guaranteed issue, no pre-existing blocks.

I don't like the mandates, but we won't get guaranteed issue/no pre-existing condition without it. Co-ops from what I read are very tricky to get right; it appears Baucus has put some real work into the them.

Insurance Reform in the Non-Group Market. Beginning January 1, 2013, health insurance plans in the individual market would be required to offer coverage on a guaranteed issue basis and would be prohibited from excluding coverage for pre-existing health conditions.
...
Interstate Sale of Insurance. Starting in 2015, states may form “health care choice compacts” to allow for the purchase of non-group health insurance across state lines. Such compacts may exist between two or more states. Once compacts have been formed, insurers would be allowed to sell policies in any state participating in the compact. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued.
...
Individual Responsibility. Beginning in 2013, all US citizens and legal residents would be required to purchase health insurance or have health coverage from an employer, through a public program (i.e., Medicare, Medicaid, or CHIP), or through some other source that meets the minimum creditable coverage standard.


Edit: I expect this is closest to what will happen, perhaps by parts.

[WhoWee]

I heard a few things in Obama's speech that I liked. First, he pushed back on illegal immigrant coverage and down played the public option, the insurance exchange might mean standardization across the states (not sure) but will probably eliminate sales agents. Plus, he at least mentioned Tort reform - but also set it up to fail as a Bush initiative.

On the flip side, $0 deficit spending is laughable and no/low deductible, mandated testing, no limit to coverage, pre-existing inclusion, and elimination of the approval process is unrealistic as per cost. All of these things will increase premiums.

Accordingly (again, I'm a licensed insurance agent), I just pulled a quote for a family of 4 from one of the nations top 5 health insurance carriers - they have middle of the road pricing and a huge network.

As per the Presidents mandates, I rated-up one adult for a pre-existing (only 25% - same as high blood pressure - my guess is a real pre-existing will be a 100% + rate-up in practice), a family deductible of $1,000 total (including prescriptions and the mamography, Pap smear, and PSA testing), a $25 doctors visit co-pay, a $500 accident benefit, a $5.0 million lifetime benefit (they don't have a higher option amount - unlimited WILL cost more) and the premium would be $1,852 per month (with a 2 year agreement).

The total cost for this family of 4 would be $22,224 per year, plus the $1,000 deductible and the $25 co-pay per each doctor visit. For the record, this cost is in line with the so called "Cadillac Plans" the large unions typically enjoy.

The problem I see is that premiums will increase and make it impossible for a large number of average families - who will be fined for not purchasing the coverages.

On a final note, as long as the Government doesn't pay for these coverages, just mandates higher premiums, it could help offset the mandated costs to insurance companies and (this part of the plan) shouldn't add much to deficit spending.

[Al68]

Although I may not agree with the fines it makes sense. We need everyone in the risk pool if we're going to effectively share risk and minimize premiums.
Ahhh, necessity: the cry of tyrants and the creed of slaves. (Benjamin Franklin)

So, we are to be forced to "share" medical risks? Gee, nothing socialist about the government forcing people to share.:uhh:

[f95toli]

Gee, nothing socialist about the government forcing people to share.:uhh:

No offense, but I am getting REALLY tired of people throwing the word "socialist" around like that. Universal healthcare is definitely not just a "socialist" idea. you can find supporters for some form of government funded healtcare system is just about every major political ideology; socialism (obviously), conservatism (definitely modern paternal conservatism, but most branches would support it to some degree) and most branches of liberalism. That modern social-liberalism supports it goes without saying but even some forms of classical liberalism would potentially support a scheme like this.

The only political ideologies that could not (because of underlying principles) support UH are classical liberalism (a'la Spencer and other forms of "extreme" laissez-faire liberalism), probably libertarians and obviously anarcho-minimalists.
Anarchists would not support it simply because they don't believe in any form of government so they are not really relevant here.

[WhoWee]

No offense, but I am getting REALLY tired of people throwing the word "socialist" around like that. Universal healthcare is definitely not just a "socialist" idea. you can find supporters for some form of government funded healtcare system is just about every major political ideology; socialism (obviously), conservatism (definitely modern paternal conservatism, but most branches would support it to some degree) and most branches of liberalism. That modern social-liberalism supports it goes without saying but even some forms of classical liberalism would potentially support a scheme like this.

The only political ideologies that could not (because of underlying principles) support UH are classical liberalism (a'la Spencer and other forms of "extreme" laissez-faire liberalism), probably libertarians and obviously anarcho-minimalists.
Anarchists would not support it simply because they don't believe in any form of government so they are not really relevant here.

I'm not sure which ideologies are relevant to this discussion, but "The total cost for this family of 4 would be $22,224 per year, plus the $1,000 deductible and the $25 co-pay per each doctor visit. For the record, this cost is in line with the so called "Cadillac Plans" the large unions typically enjoy." the specific costs of these health care initiatives are relevant to everyone. The $22,224 equates to $5,556 per person per year - or face a fine to be enforced by the IRS.

I don't feel very "free" this morning.

[Wax]

On the flip side, $0 deficit spending is laughable and no/low deductible, mandated testing, no limit to coverage, pre-existing inclusion, and elimination of the approval process is unrealistic as per cost. All of these things will increase premiums.



No, zero deficit spending is the truth. The problem is he doesn't explain this part which is a big gap into why the American people don't trust him. He either doesn't know himself or he doesn't want the conservatives on the right to use it against him as a scare tactic that he might be cutting benefits for seniors. When people are talking about zero deficit spending, they are referring the future deficit.

Medicaid will run the American Financial system into the red because of one extremely large liability; the liability of taking care of 70 million baby boomers that are turning 65 in the next ten years. Ages 65 and over is the most expensive age group to insure. It is estimated to cost 4.9 trillion dollars in the next ten years to cover this age group with no health care reform. Obama doesn't have many options. He could cut medicaid all together, do nothing, or he can reform the system so that seniors will still be covered.


CUMULATIVE SPENDING ON MEDICAID BENEFITS PROJECTED TO REACH $4.9 TRILLION OVER 10 YEARS
http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3311

[WhoWee]

No, zero deficit spending is the truth. The problem is he doesn't explain this part which is a big gap into why the American people don't trust him. He either doesn't know himself or he doesn't want the conservatives on the right to use it against him as a scare tactic that he might be cutting benefits for seniors. When people are talking about zero deficit spending, they are referring the future deficit.

Medicaid will run the American Financial system into the red because of one extremely large liability; the liability of taking care of 70 million baby boomers that are turning 65 in the next ten years. Ages 65 and over is the most expensive age group to insure. It is estimated to cost 4.9 trillion dollars in the next ten years to cover this age group with no health care reform. Obama doesn't have many options. He could cut medicaid all together, do nothing, or he can reform the system so that seniors will still be covered.


CUMULATIVE SPENDING ON MEDICAID BENEFITS PROJECTED TO REACH $4.9 TRILLION OVER 10 YEARS
http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3311

Let me get this straight. He told the truth - there will be $0 deficit spending. But he can't explain how that's possible because he either doesn't understand or it will be used against him? Can you explain - at the risk of it being used against him?

[Wax]

Let me get this straight. He told the truth - there will be $0 deficit spending. But he can't explain how that's possible because he either doesn't understand or it will be used against him? Can you explain - at the risk of it being used against him?

He's restructuring the benefits for senior citizens which can easily be viewed as cutting benefits for senior citizens.

[WhoWee]

He's restructuring the benefits for senior citizens which can easily be viewed as cutting benefits for senior citizens.

And this will cover a $900,000,000,000 package?

[Wax]

And this will cover a $900,000,000,000 package?

I already showed you the data. He's talking about future liabilities. You know what a liability is right? If you really want him to spend ZERO then he'd have to cut the program all together.

[WhoWee]

I already showed you the data. He's talking about future liabilities. You know what a liability is right? If you really want him to spend ZERO then he'd have to cut the program all together.

Please highlight the specific data that you are referring to - I don't see ANY evidence that Obama can cover a $900,000,000,000 spending plan.

As for my personal knowledge of business, my first corporate position was in 1982 as Vice President of Operations for a public company with 800 retail locations and more than 20,000 employees in the US and Canada. I know what a liability is - present and future. What is your business experience?

As for what I want him to do - I want him to eliminate the fraud that he's apparently aware of right now. I want him to fire the officials in the Government that are responsible for monitoring these agencies and allowing these hundreds of billions of dollars of fraud to continue and further direct the Attorney General to look into the case immediately. I want him to fix the broken parts of our system before haphazardly applying his ideological agenda to satisfy his special interest groups.

Above all, I want him to be honest. If he has to cut the program because he lied or didn't understand (as you suggested) or mis-spoke - then he needs to cut the program, move out of the way and allow people with business experience solve the problem.

[humanino]

Why are people arguing ? There are other countries which do better than the US while spending less money to protect their citizen's health. Obviously what's happening is simple : if the US system is changed, a few people will make less money out of the health of all other people. Why is that bad ? Other countries do it better than you for less money than you : why would you refuse change ?

[Wax]

Please highlight the specific data that you are referring to - I don't see ANY evidence that Obama can cover a $900,000,000,000 spending plan.



I also don't see any evidence that the country can sustain a 4,900,000,000,000 liability. :rolleyes:

[Wax]

Above all, I want him to be honest. If he has to cut the program because he lied or didn't understand (as you suggested) or mis-spoke - then he needs to cut the program, move out of the way and allow people with business experience solve the problem.

Medicare/Medicaid is an existing government program. What did he lie about? So you actually think insurance companies want to cover age groups 65 and over? Now, you're just being naive...

[WhoWee]

Medicare/Medicaid is an existing government program. What did he lie about? So you actually think insurance companies want to cover age groups 65 and over? Now, you're just being naive...

I really don't understand your position. The system is broken and needs fixed. Obama's plan is naive and ideological - it won't work. Obama is inexperienced and it shows.

We need a better strategy. I challenge you to apply the Scientific Method to this problem and come to the conclusion Obama has reached.

Start with mandating more expensive coverage than people are currently choosing to purchase will make health care more affordable to everyone. Next, factor in unlimited lifetime caps on coverage - insurance companies will have open ended agreements and will no longer have a voice in the approval process - no chance for corruption in that scenario. Now, include everyone with pre-existing conditions into the mix (regardless of the cost) and mandate they purchase only approved coverage.

I posted the results of an actual insurance quote for a family of 4 last evening - $22,224 per year. If one of them had a pre-existing condition (heart attack or stroke for instance) the cost could easily be more than $3,000 per month. Best of all, if they elect to purchase a lesser plan of coverage, they would be fined over $3,000 and the fine would be enforced by the IRS.

Obama is either naive or doesn't care what will happen to struggling families under his burden.

[jreelawg]

Somehow I think that Obama's plan would be a huge success. You have to realize that his opposition wants to win an Election. Perhaps have an idiot like Sarah Palin elected president next term. The easiest way to make this happen would be to let Obama pull off his health care reform, watch it fail, and rake in votes for Sarah palin.

I think that his opposition knows the plan will work, and that is part of why they need it defeated. They have stated they are determined to make the president fail. If they truly thought Obama's plan will fail, they would let it happen.

[WhoWee]

Somehow I think that Obama's plan would be a huge success. You have to realize that his opposition wants to win an Election. Perhaps have an idiot like Sarah Palin elected president next term. The easiest way to make this happen would be to let Obama pull off his health care reform, watch it fail, and rake in votes for Sarah palin.

I think that his opposition knows the plan will work, and that is part of why they need it defeated. They have stated they are determined to make the president fail. If they truly thought Obama's plan will fail, they would let it happen.

Somehow?

Are you aware that Obama doesn't need a single Republican vote? He can pass his entire agenda with only Democrat votes.

This is his problem - he doesn't have the full support of his own party.

As for Sarah Palin - SOMEHOW I don't think she's going to be elected President beacuse Obama can't sell his plan.

[jreelawg]

Somehow?

Are you aware that Obama doesn't need a single Republican vote? He can pass his entire agenda with only Democrat votes.

This is his problem - he doesn't have the full support of his own party.

As for Sarah Palin - SOMEHOW I don't think she's going to be elected President beacuse Obama can't sell his plan.

Corruption is a bipartisan phenomena.

The price you came up with is the cost of insurance pre health care reform. You haven't considered the whole picture. In order to be convinced, I would need to know how much profit insurance companies would make off of the plan, because after reform, profits will be forced down as competition sets in.

Secondly, reform goes deeper than just these regulations. For example, a lot of the spending goes into making health care more efficient. For example, electronic records, which will save a lot of money. When you add up and account for all the factors which will save money, adjust the profit margin to a realistic level, and throw in the money earned by those who currently don;t have insurance who will be forced to, there would be a difference.

If the plan works, insurance companies will pay less because care will be cheaper, and they will lower their rates accordingly. The competition of a public option will enforce this.

[Vanadium 50]

Best of all, if they elect to purchase a lesser plan of coverage, they would be fined over $3,000 and the fine would be enforced by the IRS.

It looks like the rational thing to do is to buy cheap insurance, pay the $3000 fine, and then if you get really sick, then opt-in.

[Wax]

At the moment, electronic records doesn't save any money. It's more expensive to have someone monitor the system then to pull a document.

[WhoWee]

Corruption is a bipartisan phenomena.

The price you came up with is the cost of insurance pre health care reform. You haven't considered the whole picture. In order to be convinced, I would need to know how much profit insurance companies would make off of the plan, because after reform, profits will be forced down as competition sets in.

Secondly, reform goes deeper than just these regulations. For example, a lot of the spending goes into making health care more efficient. For example, electronic records, which will save a lot of money. When you add up and account for all the factors which will save money, adjust the profit margin to a realistic level, and throw in the money earned by those who currently don;t have insurance who will be forced to, there would be a difference.

If the plan works, insurance companies will pay less because care will be cheaper, and they will lower their rates accordingly. The competition of a public option will enforce this.

The cost of health insurance will increase due to Obama's mandates.

Obama has specified that policies will no longer have maximum lifetime limits. Currently, insurance purchasers can typically choose from $1 million, $3 million, $5 million, or $7 million per person on individual policies. The insurance companies consider their potential exposure and price accordingly. Now, assume you are the CEO of XYZ insurance, if the President mandates that you may not set a limit and tells you that you're no longer allowed to pre-approve procedures (which means doctors and patients are free to do whatever they want) and you realize your exposure could be $20 million, $50 million (who knows) - would you raise your rates?

Next, Obama has specified that people with pre-existing conditions will have to be accepted and can not be dropped. This means a person with a (bad heart, strokes, cancer, diabetes) has to be covered. You know their care will cost more. Would you charge them more than a health person?

[WhoWee]

It looks like the rational thing to do is to buy cheap insurance, pay the $3000 fine, and then if you get really sick, then opt-in.

That is one of the reasons why the President's estimate that only 5% of the people will be on the Government program is nonsense.

[Wax]

The cost of health insurance will increase due to Obama's mandates.

Obama has specified that policies will no longer have maximum lifetime limits. Currently, insurance purchasers can typically choose from $1 million, $3 million, $5 million, or $7 million per person on individual policies. The insurance companies consider their potential exposure and price accordingly. Now, assume you are the CEO of XYZ insurance, if the President mandates that you may not set a limit and tells you that you're no longer allowed to pre-approve procedures (which means doctors and patients are free to do whatever they want) and you realize your exposure could be $20 million, $50 million (who knows) - would you raise your rates?

Next, Obama has specified that people with pre-existing conditions will have to be accepted and can not be dropped. This means a person with a (bad heart, strokes, cancer, diabetes) has to be covered. You know their care will cost more. Would you charge them more than a health person?



That works fine for me. The doc can give me the best treatment possible without having to worry about what my insurance pays for. :biggrin:

There is no such thing as a pre-existing condition in any other industrialized country. Why must we have it? Every single developed country in the world has some type of nationalized health care system; everyone is covered which means there is no such thing as a pre-existing condition.

Costs will not rise with a public option. Insurance companies can't raise prices if they want to compete.

[WhoWee]

That works fine for me. The doc can give me the best treatment possible without having to worry about what my insurance pays for. :biggrin:

There is no such thing as a pre-existing condition in any other industrialized country. Why must we have it? Every single developed country in the world has some type of nationalized health care system; everyone is covered which means there is no such thing as a pre-existing condition.

Costs will not rise with a public option. Insurance companies can't raise prices if they want to compete.

If insurance premiums don't increase to cover the costs - then TAXES will increase or DEFICITS will increase.

[Wax]

If insurance premiums don't increase to cover the costs - then TAXES will increase or DEFICITS will increase.

Not of you restructure the payment plan. One of the main points of the bill is to reduce costs by restructuring the billing option. The concept of paying individually for an MRI, X-Ray, and checkups are being thrown out the door. The bill is being restructured so that you will be paying for your illness and not for the individual procedures. There will be no incentive to do extra procedures but there will be incentives to get it right the first time around.

[WhoWee]

Not of you restructure the payment plan. One of the main points of the bill is to reduce costs by restructuring the billing option. The concept of paying individually for an MRI, X-Ray, and checkups are being thrown out the door. The bill is being restructured so that you will be paying for your illness and not for the individual procedures. There will be no incentive to do extra procedures but there will be incentives to get it right the first time around.

Can you please reference the specific section of the Bill you are describing?

[Wax]

Can you please reference the specific section of the Bill you are describing?

Section 224
http://waysandmeans.house.gov/media/pdf/111/AAHCA09001xml.pdf

[mheslep]

In the Wed night speech I'm happy to see the US President vanquished the '47 million' uninsured figure he and other Democrats have used again and again, and again. Instead he now says (http://www.washingtontimes.com/news/2009/sep/09/text-barack-obamas-speech-joint-session//print/):
There are now more than thirty million American citizens who cannot get coverage.That's still overstated by ~twenty million, but at least he's now taking pains to subtract illegals from the former hyperbole.

[WhoWee]

Not of you restructure the payment plan. One of the main points of the bill is to reduce costs by restructuring the billing option. The concept of paying individually for an MRI, X-Ray, and checkups are being thrown out the door. The bill is being restructured so that you will be paying for your illness and not for the individual procedures. There will be no incentive to do extra procedures but there will be incentives to get it right the first time around.

This is the section you referenced.

"3 SEC. 224. MODERNIZED PAYMENT INITIATIVES AND DELIV4
ERY SYSTEM REFORM.
5 (a) IN GENERAL.—For plan years beginning with Y1,
6 the Secretary may utilize innovative payment mechanisms
7 and policies to determine payments for items and services
8 under the public health insurance option. The payment
9 mechanisms and policies under this section may include
10 patient-centered medical home and other care manage11
ment payments, accountable care organizations, value12
based purchasing, bundling of services, differential pay13
ment rates, performance or utilization based payments,
14 partial capitation, and direct contracting with providers.
15 (b) REQUIREMENTS FOR INNOVATIVE PAYMENTS.—
16 The Secretary shall design and implement the payment
17 mechanisms and policies under this section in a manner
18 that—
19 (1) seeks to—
20 (A) improve health outcomes;
21 (B) reduce health disparities (including ra22
cial, ethnic, and other disparities);
23 (C) provide efficent and affordable care;
24 (D) address geographic variation in the
25 provision of health services; or
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
July 14, 2009 (12:51 p.m.)
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
f:\VHLC\071409\071409.140.xml (444390|2)
126
1 (E) prevent or manage chronic illness; and
2 (2) promotes care that is integrated, patient3
centered, quality, and efficient.
4 (c) ENCOURAGING THE USE OF HIGH VALUE SERV5
ICES.—To the extent allowed by the benefit standards ap6
plied to all Exchange-participating health benefits plans,
7 the public health insurance option may modify cost shar8
ing and payment rates to encourage the use of services
9 that promote health and value.
10 (d) NON-UNIFORMITY PERMITTED.—Nothing in this
11 subtitle shall prevent the Secretary from varying payments
12 based on different payment structure models (such as ac13
countable care organizations and medical homes) under
14 the public health insurance option for different geographic
15 areas."

I don't see the level of specifics you've outlined - very vague - and seems to be focused on the public option.

Even if your interpretation is correct, the cost of individual tests must be paid somewhere - not just thrown out the door as you stated.

[Al68]

No offense, but I am getting REALLY tired of people throwing the word "socialist" around like that.I realize many people are offended by the word, but I'm using it generically, not as an insult or reference to infamous past socialists, or any official party.

Could you suggest an alternative to the word "socialist" that could be used, that would mean a belief in government control of economic matters?

I simply don't know an alternative that isn't either confusing because of multiple definitions (like "left", "liberal", "statist", etc.) or impractical because it takes too many words to explain.

[Vanadium 50]

The price you came up with is the cost of insurance pre health care reform. You haven't considered the whole picture. In order to be convinced, I would need to know how much profit insurance companies would make off of the plan, because after reform, profits will be forced down as competition sets in.

One can get an idea by looking at what the insurance companies are making now. According to their 10-K's, United Health Care has earnings that are 3.6% of revenues and Wellpoint has earnings that are 4.7%.

So, even in a world where health care profit is illegal, we'd expect the cost to be of order 4% cheaper overall.

[WhoWee]

I realize many people are offended by the word, but I'm using it generically, not as an insult or reference to infamous past socialists, or any official party.

Could you suggest an alternative to the word "socialist" that could be used, that would mean a belief in government control of economic matters?

I simply don't know an alternative that isn't either confusing because of multiple definitions (like "left", "liberal", "statist", etc.) or impractical because it takes too many words to explain.

Don't complicate things, just say "Tax and Spend Democrats" - nothing new here. Giving them control is like letting your kids do the shopping - lot's of junk, nothing you need, and very expensive.

[humanino]

One can get an idea by looking at what the insurance companies are making now. According to their 10-K's, United Health Care has earnings that are 3.6% of revenues and Wellpoint has earnings that are 4.7%.

So, even in a world where health care profit is illegal, we'd expect the cost to be of order 4% cheaper overall.I'm not sure it's that simple at all. Yesterday I heard that the non-profit "rocky mountain health plans" is 30% cheaper than the average in the US. The documentary was in french and I did not find numbers in an english reference. One explanation was that with much better coverage, illnesses are detected at earlier stages making the costs eventually less.

Anyway, the US spends 16% of GDP and the US average citizen has worse coverage than Germany of France spending 10% for instance, I guess everybody agrees on those numbers., whichever theory explains the difference, the US can do better for sure. The comparison is even similar with Canada.
http://upload.wikimedia.org/wikipedia/commons/a/a1/International_Comparison_-_Healthcare_spending_as_%25_GDP.png

[WhoWee]

One can get an idea by looking at what the insurance companies are making now. According to their 10-K's, United Health Care has earnings that are 3.6% of revenues and Wellpoint has earnings that are 4.7%.

So, even in a world where health care profit is illegal, we'd expect the cost to be of order 4% cheaper overall.

Now you want to make profits illegal?

What kind of industry (other than state-controlled) is funded and operated with no potential profits?

Are hospitals going to be allowed to earn profits? How about pharmaceutical companies and testing labs? While we're eliminating profits, don't forget about those manufacturers that build all of the custom fixtures and equipment.

Also, to be "fair", maybe the utility companies should supply power at their cost, food should be sold in the cafeteria at cost, all Government workers involved in healthcare paid minimum wage and everyone must sign a waiver before obtaining services (to protect from lawsuits- new age tort reform).

Last, the doctors and nurses should be taxed at 90% - to redistribute their wealth.

Insurance companies have investors that took a risk (like the bond holders in GM) in expectation of a return on investment - that's how business works. If profits are forbidden, the insurance companies will refocus on to other lines - leaving only a Government run insurance program.

The bottom line is this, how much do YOU want to pay in taxes - 50%, 60%, 70%, 80%, or 90%? The Government has mismanaged the Social Security funds, admits to $900,000,000,000 waste and fraud in medicare and medicaid, is scheduled to lose $7,000,000,000 at the post office this year and next, and let's not forget about Amtrak. Do YOU honestly believe they will be able to lower costs (and not spend that money somewhere else and still tax you more)?

[Al68]

I realize many people are offended by the word, but I'm using it generically, not as an insult or reference to infamous past socialists, or any official party.

Could you suggest an alternative to the word "socialist" that could be used, that would mean a belief in government control of economic matters?

I simply don't know an alternative that isn't either confusing because of multiple definitions (like "left", "liberal", "statist", etc.) or impractical because it takes too many words to explain.Don't complicate things, just say "Tax and Spend Democrats" - nothing new here. Giving them control is like letting your kids do the shopping - lot's of junk, nothing you need, and very expensive."Tax and Spend Democrats" doesn't convey the meaning I want to convey. I do notice that whenever I use the word "socialist", there is no confusion about what I mean. Some object to the word, yet know exactly what is meant by it with no confusion. Why object to the use of a word when its use accurately conveys the intended meaning? It's just a word.

[Al68]

One can get an idea by looking at what the insurance companies are making now. According to their 10-K's, United Health Care has earnings that are 3.6% of revenues and Wellpoint has earnings that are 4.7%.

So, even in a world where health care profit is illegal, we'd expect the cost to be of order 4% cheaper overall.Are you assuming that the existence of profit actually makes things cost more in general? What do you think things would cost if they weren't profitable?

This is why basic economics should be taught better in school. A little knowledge would keep people from being so easily mislead.

[WhoWee]

I'm not sure it's that simple at all. Yesterday I heard that the non-profit "rocky mountain health plans" is 30% cheaper than the average in the US. The documentary was in french and I did not find numbers in an english reference. One explanation was that with much better coverage, illnesses are detected at earlier stages making the costs eventually less.

Anyway, the US spends 16% of GDP and the US average citizen has worse coverage than Germany of France spending 10% for instance, I guess everybody agrees on those numbers., whichever theory explains the difference, the US can do better for sure. The comparison is even similar with Canada.
http://upload.wikimedia.org/wikipedia/commons/a/a1/International_Comparison_-_Healthcare_spending_as_%25_GDP.png

Have you adjusted for elective procedures such as cosmetic surgery and doctor supervised diet programs? How about ALL of the "happy pills" that are prescribed? Plus, let's not forget our sports medicine programs. Also, let's not overlook the cost associated with regulations such as HIPPA and the cumulative legal and administrative. Last, consider the amount of money spent on marketing per year.

A system with no competition, no choices, no innovation, no re-investment incentives, and no profit/capped wages should cost less in the short term. But, have you ever chosen to stay in an old and run down hospital if you could have chosen to stay in a nice new and modern one? Do you choose your doctor based on the lowest price?

[turbo]

In the Wed night speech I'm happy to see the US President vanquished the '47 million' uninsured figure he and other Democrats have used again and again, and again. Instead he now says (http://www.washingtontimes.com/news/2009/sep/09/text-barack-obamas-speech-joint-session//print/):
That's still overstated by ~twenty million, but at least he's now taking pains to subtract illegals from the former hyperbole.The Congressional Budget Office has a different take on the number of uninsured.

Analysts warned that increases in the overall numbers of the uninsured were likely to be just the beginning. Based on current job losses, some researchers estimate the present-day number of uninsured is closer to 50 million. That's the number now cited by the Congressional Budget Office and it could continue to grow without meaningful reform.

http://news.yahoo.com/s/ap/20090911/ap_on_go_ot/us_census_uninsured;_ylt=AshwU8hhGyvHi5JZEcGhL11p2 4cA;_ylu=X3oDMTJxZGdhZW5lBGFzc2V0A2FwLzIwMDkwOTExL 3VzX2NlbnN1c191bmluc3VyZWQEcG9zAzEwBHNlYwN5bl9wYWd pbmF0ZV9zdW1tYXJ5X2xpc3QEc2xrA2dyb3d0aG9mZ292dA--

[Vanadium 50]

Now you want to make profits illegal?

I'm not advocating anything. The argument was advanced that there would be cost savings with lower profits, and I am pointing out how much of an effect this is.

[mheslep]

The Congressional Budget Office has a different take on the number of uninsured.

http://news.yahoo.com/s/ap/20090911/ap_on_go_ot/us_census_uninsured;_ylt=AshwU8hhGyvHi5JZEcGhL11p2 4cA;_ylu=X3oDMTJxZGdhZW5lBGFzc2V0A2FwLzIwMDkwOTExL 3VzX2NlbnN1c191bmluc3VyZWQEcG9zAzEwBHNlYwN5bl9wYWd pbmF0ZV9zdW1tYXJ5X2xpc3QEc2xrA2dyb3d0aG9mZ292dA--Note your quote said simply said 50 million uninsured, it does not say citizens as did the President, because we know millions of them are not. When the 45-50 million figure is thrown around it is often done so to encourage the belief that passing a bill like HR3200 will simply cover all of them, and it certainly will not.

[mheslep]

I'm not advocating anything. The argument was advanced that there would be cost savings with lower profits, and I am pointing out how much of an effect this is.Yes, but the logic of your argument is that anywhere we eliminate profits, that we somehow we lower the delivered cost by roughly the amount of the former profits, while obtaining the same product/value. That does not follow.

[turbo]

Note your quote said simply said 50 million uninsured, it does not say citizens as did the President, because we know millions of them are not. When the 45-50 million figure is thrown around it is often done so to encourage the belief that passing a bill like HR3200 will simply cover all of them, and it certainly will not.
From the same article (emphasis mine):

Overall, the number of Americans without health insurance rose modestly to 46.3 million last year, up from 45.7 million in 2007. The poverty rate hit 13.2 percent, an 11-year high.

[Alfi]

I will go back and have a read of the last few pages of posts, but before I do I first want to thank your President for a very good speech.
It was so much easier on my ears than the last president's speeches.

I think he addressed the lies and misinformation very well.

[mheslep]

From the same article (emphasis mine):Then the AP is sloppy and wrong, and not for the first time. There are not 47-50 million uninsured Americans, implying citizens or at least legal residents, as has been documented numerous times in these health threads.

[Al68]

Then the AP is sloppy and wrong, and not for the first time.Surely you jest. It's not like they have consistently portrayed what Democrats tell them as objective unbiased fact for years. :uhh:

According to Wikipedia (http://en.wikipedia.org/wiki/Uninsured_in_the_United_States), which cites the U.S. Census Bureau (I'm too lazy right now to check their source):

The 46.3 million figure isn't the total number of uninsured at a given time, it's the number of people in the U.S., including non-U.S. citizens, that are without insurance at any time during the year. Obviously that inflates the figure.

10.2 million of those are not U.S. citizens.

18.1 million have more than $50,000 household income.

About one quarter are eligible for public coverage now, but decline.

There are many more stats available, but the bottom line is, as always, the AP uses whatever politically motivated numbers the Democrats use.

[Al68]

In the Wed night speech I'm happy to see the US President vanquished the '47 million' uninsured figure he and other Democrats have used again and again, and again. Instead he now says (http://www.washingtontimes.com/news/2009/sep/09/text-barack-obamas-speech-joint-session//print/):There are now more than thirty million American citizens who cannot get coverage.Notice that he dishonestly says over 30 million "cannot get coverage", knowing that a quarter of those are currently eligible for public coverage, and over 18 million of the uninsured have over $50,000 a year household income.

Why would he purposely choose to say "cannot get coverage" instead of "don't have coverage", knowing that there's a huge difference? It's like he went out of his way to make sure he lied, when telling the truth would have been easy, and almost as good for his purpose.

Is it possible it was an honest mistake?

And then he says: "These are the facts. Nobody disputes them." Huh??? Nobody? That's either an obvious blatant lie, or he is referring to many of us as "nobody".

[mheslep]

... and over 18 million of the uninsured have over $50,000 a year household income.'Household' income is an ambiguous creature. If there are 4.5 people in that house then all the individuals are under the poverty level.

[humanino]

Do you choose your doctor based on the lowest price?Interesting attempt at an argumentation. As a matter of fact, I have been in both systems, European and US. I dare say, the US health system is the single most important reason why I would consider not living in the US. Your argument essentially is "if it's cheap, it can not be good quality". I do not consider it deserves an answer.

Again, there is no argument, I do not care to argue, and I do not care to convince anybody. Your system is terribly bad. If you do not want to change it, that's your decision. I am just stating that it is silly and impossible to understand from an broader perspective.

[Al68]

'Household' income is an ambiguous creature.Good point. But the source I used listed it that way, so I had to.If there are 4.5 people in that house then all the individuals are under the poverty level.Well, not according to the U.S. Census Bureau (http://www.census.gov/hhes/www/poverty/threshld/thresh08.html), they would not be unless there were over ten people in the house. The relationship between required income and household size isn't linear.

My kids never lacked for anything (they needed) when I made much less with 4 of us.

[turbo]

Again, there is no argument, I do not care to argue, and I do not care to convince anybody. Your system is terribly bad. If you do not want to change it, that's your decision. I am just stating that it is silly and impossible to understand from an broader perspective.I have Canadian friends who feel exactly the same way, including a nice lady that works as a medical lab technician.

The GOP pretends that they are "conservatives" and the sheeples follow along. Allowing the cost of health care to more than double every decade is not a conservative position - it is a radical neo-con position. The system needs to be fixed or it will drive the US into 3rd-world status. Currently, most of us are one catastrophic illness away from bankruptcy and financial ruin. Suffer one such illness and survive, and you'll never get health insurance ever again. My wife and I have savings adequate for our retirement and a house on a small piece of property. If either of us comes down with a catastrophic illness, her health insurance company (BC/BS) will drop us, and we will lose everything that we have saved through a life-time of fiscal conservatism. That's OK with the GOP, though.

[mheslep]

My kids never lacked for anything (they needed) when I made much less with 4 of us.$50k is a livable wage for a family. But lets look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

[turbo]

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.That's not a bad thing, but if health insurance coverage is mandatory with no public option, people will have to buy their coverage from the private insurers, who will then have no incentive to reduce costs.

I suggest that people should be allowed to opt in to Medicare and pay for that coverage. That would bolster the pool of Medicare recipients (often elderly and disabled with high medical-service usages) with an influx of relatively healthier people, reducing the "experience rate" for the group as a whole. That would be a very simple fix, and one that I haven't seen suggested by any of our for-hire Congressional representatives.

[byronm]

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.

You're claim is even more ludicrous. Our government has been working for two centuries. Our democracy is strong. Affordable Health care only makes it stronger.

The only delusion there is, is the self prophesying delusion that government is a failure which is only true if your goal is to make it fail.

[WhoWee]

$50k is a livable wage for a family. But lets look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

The insurance quote I pulled yesterday for a family of 4 - with the coverage Obama specified in his speech - would cost $22,224 per year.

If they chose to purchase lesser insurance coverage, they would be penalized $3,800.

[byronm]

$50k is a livable wage for a family. But lets look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

At 50,000 dollar wages that tax incentive is meaningless and much less than what the monthly premium for insurance is.

What money would be used to "pool for the chronically ill" and who gets to decide who is covered by that pool and who isn't?

The best thing about the public option is that it doesn't chain me to my employer. I could go independent and still have benefits as i would working for someone else. Thats the ultimate democratization of health care if you ask me!

[WhoWee]

You're claim is even more ludicrous. Our government has been working for two centuries. Our democracy is strong. Affordable Health care only makes it stronger.

The only delusion there is, is the self prophesying delusion that government is a failure which is only true if your goal is to make it fail.

The Post Office is scheduled to lose $7,000,000,000 this year and next - that is a failure.

The President claims he can find $900,000,000,000 in fraud and waste in the Social Security, Medicare, and Medicaid programs - those are failures.

The Government is terrible at cost management.

[WhoWee]

The best thing about the public option is that it doesn't chain me to my employer. I could go independent and still have benefits as i would working for someone else. Thats the ultimate democratization of health care if you ask me!

Nobody is "chained to their employer" based plans now (unless you have a pre-existing condition). Employer based plans cost less for the individual, but you're free to spend more and buy your own.

[mheslep]

At 50,000 dollar wages that tax incentive is meaningless and much less than what the monthly premium for insurance is.The tax incentive would be the same as one gets from the employer, so the self employed is exactly on the same footing as one covered by an employer. That is anything but meaningless. It frees one from getting coverage via an employer, as you advocate below.

What money would be used to "pool for the chronically ill" and who gets to decide who is covered by that pool and who isn't?
Guranteed Access Plans - defined by the state and federal governments, funded by federal money given to the states. The idea is make insurance for the truly unexpected, and let the GAPs cover the chronic ongoing illnesses, thus cutting insurance costs.
Direct Help for the Hard Cases

I wouldimprove the non-employer, individual insurance market by building on existing Health Insurance Portability and Accountability Act (HIPAA) protections for people with pre-existing conditions and by expanding support for guar*anteed access plan (GAP) coverage in the states that would insure them if they are denied private coverage or only offered coverage at very high premium costs.[40]

Under McCain's Guaranteed Access Plan (GAP), the federal government would work with governors and provide federal assistance to develop models for states to ensure that individuals who experience dif*ficulty obtaining coverage would have access to health insurance. One model envisioned under this approach would be a type of high-risk pool, in which a state or states would provide insurance with reasonable premiums to uninsurable individu*als. In the recent analysis by the Lewin Group, the GAP provisions would cost an estimated $235.4 bil*lion over 10 years.[41]
http://www.heritage.org/research/healthcare/bg2198.cfm

The best thing about the public option is that it doesn't chain me to my employer. I could go independent and still have benefits as i would working for someone else. Thats the ultimate democratization of health care if you ask me!<shrug> I agree health care has to be cut loose from employers. But if we use a public option to do it then you're chained to a government program and the taxes to pay for it.

[mheslep]

Nobody is "chained to their employer" based plans now (unless you have a pre-existing condition). Employer based plans cost less for the individual, but you're free to spend more and buy your own.That's misleading. There is an economic chain. Outside of an employer, one takes a tax hit buying coverage. HSAs help that some, but they're still not the tax equivalent of employer coverage. Also, without the size advantage of a large pool there's a negotiation disadvantage.

[WhoWee]

That's misleading. There is an economic chain. Outside of an employer, one takes a tax hit buying coverage. HSAs help that some, but they're still not the tax equivalent of employer coverage. Also, without the size advantage of a large pool there's a negotiation disadvantage.

I opted for an HSA with a high deductible. It lowered my premium and allows me to save the funds in an account - to be used for medical purposes or roll over until next year. Once I meet my deductible, the plan pays 100%.

I think the tax benefits are fair.

[mheslep]

I opted for an HSA with a high deductible. It lowered my premium and allows me to save the funds in an account - to be used for medical purposes or roll over until next year. Once I meet my deductible, the plan pays 100%.

I think the tax benefits are fair.Yes I've looked into them too, a good way to if one is on their own. So? Employer based plans still have a tax and size advantage. I would prefer they didn't under current laws, but they do.

[Wax]

I don't see the level of specifics you've outlined - very vague - and seems to be focused on the public option.

Even if your interpretation is correct, the cost of individual tests must be paid somewhere - not just thrown out the door as you stated.

Nope, it doesn't. This isn't a case like an illegal alien going to an ER without health insurance. The government option is a choice, hospitals and clinics choose to accept the insurance. They are not in any way forced to take the payment plan. Government insurance exist today and it's called Medicaid and Medicare. They both pay 80% of what a private insurance company pays and the costs does not translate into higher private insurance because the hospitals and clinics chooses to accept those terms and conditions.

In summary, there is nothing for hospitals to write off because they accepted the payment plan. It's not a case in which an individual owes 20,000 dollars for a surgery and can not pay for it.

[mheslep]

...The government option is a choice, hospitals and clinics choose to accept the insurance. They are not in any way forced to take the payment plan. Government insurance exist today and it's called Medicaid and Medicare.
What choice? They accept the government insured patients or they go out of business, except for the high end operations like Mayo.

They both pay 80% of what a private insurance company pays and the costs does not translate into higher private insurance because the hospitals and clinics chooses to accept those terms and conditions.That's exactly wrong. It's well known that Medicaid/Medicare costs are shifted onto private insurance.

[Wax]

What choice? They accept the government insured patients or they go out of business, except for the high end operations like Mayo.

That's exactly wrong. It's well known that Medicaid/Medicare costs are shifted onto private insurance.

No, it's a choice. There are clinics inside of the U.S. today that only accept private insurance.

I haven't seen any article that says Medicaid and Medicare shifts costs onto private insurances.

[turbo]

No, it's a choice. There are clinics inside of the U.S. today that only accept private insurance.

I haven't seen any article that says Medicaid and Medicare shifts costs onto private insurances.The public plans don't shift costs onto private payers. The private payers shift costs onto others by refusing to cover people who actually get sick and need insurance to pay for treatment.

Regardless of what we hear from the right-wing, we ALL pay for uninsured and underinsured patients through higher charges by service providers. Health-care reform is absolutely necessary to protect our economy from further degradation, and to improve medical outcomes with early detection and preventative care. The "party of NO" wants to scare people into opposing health-care reform, and it seems to be working in large part. Fold in the "blue-dogs" and it might be impossible to get meaningful reform passed unless voters take up the issue with the elected representatives who answer to them.

[mheslep]

No, it's a choice. There are clinics inside of the U.S. today that only accept private insurance. Yes, I am aware of that and cited one. But not every clinic/hospital can be a world class Mayo. Many of them can not turn away all the government plan patients and survive. Likewise in single payer systems, a provider does what they are told by the government or they go out of business.

[Al68]

$50k is a livable wage for a family. But lets look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.I agree with you here. Obviously a family of 4 making $50K would never get a Cadillac policy, like the one HR3200 requires, unless it's part of their employment package. As someone pointed out before, their only practical option would be to simply keep the normal medical insurance they have temporarily.

Of course that would only be a temporary solution, since to continue being "grandfathered", their policy will have to refuse all new enrollments among other things, so they simply won't continue it for long. And HR3200 makes it illegal to buy any new policy that's not in the exchange. Then the family's only practical option is reduced to just paying the penalty and going uninsured.

[mheslep]

...I haven't seen any article that says Medicaid and Medicare shifts costs onto private insurances.

1. Obama at Aug. 14 2009 Montana Town Hall:
Whitehouse transcript (http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-in-town-hall-on-health-care-Belgrade-Montana/)
Q [...] I've learned that Medicare pays about 94 percent of hospital cost. And I've learned that Medicaid pays about 84 percent of hospital cost. And I've learned this from a reputable source, my brother who is a chief administrative officer at a large hospital group. He also explains to me, when I communicate with him, that private insurers -- his hospital collects about 135 percent of cost from private insurers, and that makes up the difference. So if public option is out there, will it pay for its way, or will be under-funded like Medicare and Medicaid? Thank you.

THE PRESIDENT: [...] But here's the short answer. I believe that Medicare should -- Medicare and Medicaid should not be obtaining savings just by squeezing providers.

Now, in some cases, we should change the delivery system, so that providers have a better incentive to provide smarter care. Right? So that they're treating the illness instead of just how many tests are done, or how many MRIs are done, or what have you -- let's pay for are you curing the patient. But that's different from simply saying, you know what, we need to save some money, so let's cut payments to doctors by 10 percent and see how that works out. Because that's where you do end up having the effect that you're talking about. If they're only collecting 80 cents on the dollar, they've got to make that up somewhere, and they end up getting it from people who have private insurance.

2. Medpac.gov
Services chapter, 2009 (http://medpac.gov/chapters/Mar09_Ch02A.pdf)
Table 2A-4, pg 56: 2007. Medicare payment margin: -5.9% (verifies the claim of the questioner in Montana re Medicare)

3. Millman study (at the request of the insurance industry)
Hospital and Physician Cost Shift: Payment Level Comparison of Medicare, Medicaid, and Commercial Payers (http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf)
[...]We estimate the total annual cost shift in the United States from Medicare to Medicaid to commercial payers is approximatey $88.8 billion. [...] Note that this only addresses hospitals and physicians. Many nursing homes receive most of their income from government plans, especially Medicaid (http://findarticles.com/p/articles/mi_m0795/is_n1_v13/ai_11676874/), and are very sensitive to underpayments. Nursing homes also consequently have no choice but to accept government plans, especially Medicaid, or go out of business. Yes there are exceptions for homes that specialize in the like of Bill Gates parents.

[mheslep]

If if it is not clear who calls the shots in a single payer system:

Interview by an NPR/WaPo reporter with Naoki Ikegami, Japan's top health economist:
[Q] If I'm a doctor, why don't I say, "I'm not going to do them; it's not enough money"?

[A] You forgot that we have only one payment system. So if you want to do your MRIs, unless you can get private-pay patients, which is almost impossible in Japan, you go out of business. ...
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html

[WhoWee]

Nope, it doesn't. This isn't a case like an illegal alien going to an ER without health insurance. The government option is a choice, hospitals and clinics choose to accept the insurance. They are not in any way forced to take the payment plan. Government insurance exist today and it's called Medicaid and Medicare. They both pay 80% of what a private insurance company pays and the costs does not translate into higher private insurance because the hospitals and clinics chooses to accept those terms and conditions.


I think you need to double check all of your information.

[Phrak]

"If either of us comes down with a catastrophic illness,..."

Are you expecting to live forever? I don't thing there is a health care plan that will fulfill this expectation. Not in the US. Maybe you can live forever in Sweden.

[turbo]

Got an update from a friend in Canada today. His daughter ended up with a sports injury resulting from years of running and Scottish Highland dancing, and had to have surgery on a hip. Once the surgeon got in there and took a look around, he decided that he could do a more extensive procedure and repair part of the "envelope" that he had planned on cutting away. The surgery took 3 hours instead of the anticipated 2 hours, and will result in a much shorter recovery time. The surgeon is the same guy who operated on Mario Lemieux's hip for a similar injury. Total cost to my friend - $0.00.

[turbo]

"If either of us comes down with a catastrophic illness,..."

Are you expecting to live forever? I don't thing there is a health care plan that will fulfill this expectation. Not in the US. Maybe you can live forever in Sweden.I'm not expecting to live forever, of course. I'd rather drop dead of a heart attack, though, than to come down with a tough-to-treat cancer, kidney failure, etc. Then you're at the mercy of the insurance company's "death panel" which decides whether or not to drop you for the sake of their bottom line.

[mheslep]

... Total cost to my friend - $0.00.Only at the hospital door. Otherwise no it was not free.

[WhoWee]

My son injured his ankle in a high school football game. It happened at 9:00. I took him to the ER by 10:00 - at the areas newest medical center. There was construction and I had to walk about 300 yards for a wheel chair and push him the same distance. There were about 11 people ahead of us. Two people were coughing, one had an injured finger, one was drunk (no other apparent issues), and the rest looked fine - walking around and talking.

I signed in at a podium, waited 30 minutes to be called for registration, at which time I requested an ice bag and a pain killer. The seating was very nice, the flat screen TV's were great and the AC set to ice-cold. We waited another 30 minutes and I went looking for an ice pack - took about 15 to 20 minutes longer. Then, at 12:00, a nurse came to take us to X-ray - another 60 minutes and I again requested pain meds. This waiting area was also very nice, had a small locker room, large flat screen TV's, etc. - ice cold AC also. Then we went to "Fast Trac" - the ER equivalent of a drive thru lane - another 60 minutes. Again, nice waiting area.

The nurse took his blood pressure and temperature. The doctor walked in, asked how it happened, and grabbed ahold to determine where it hurt (son jumped out of wheel chair) - I requested pain meds - still none. The doctor said it could be broken on the growth plate to sit tight - another 30 minutes - I reminded him of need for pain meds. Finally, a nurse showed up with crutches, an ace bandage, and a cushioned splint - no pain meds. She said it wasn't broken, just a bad sprain and possibly a tear. She hurt him some more (putting on the splint) and showed him how to use the crutches - I again asked for pain meds.

The last 30 minutes went slow, a hospital rep came in to discuss HIPPA and request the $100 co-pay, to which I responded "bill me" but make sure I'm not charged for any pain meds (then explained my comment). Eventually, the nurse came back, handed us a prescription for ibuprofin and some instructions and said they needed the room and to take care. My son was hungry and did the 400 yards back to the car at a rapid pace on his crutches (we added an additional 100 yards in the bowels of the complex). We got home around 3:30 and put him to bed. I can't wait to see the total bill.

I double checked our policy, (I had considered a $150/$1,500 policy a while back) it's $100 co-pay and $1,000 per accident (outpatient) after the network discount. (I have a high deductible HSA with an accident rider)

While we were at the hospital for 5 hours, we only received 20 minutes of attention by medical personnel, had an X-ray, and the doctor read the X-ray and wrote an order. As for material, they used some tape, 3 sets of disposable gloves, an ace bandage, a splint, and crutches - no pain meds were ever provided.

This was a legitimate emergency as my son was in a lot of pain and was injured. I'm responsible for $100 minimum, the insurance company will apply a discount to the total and pay the next $1,000 - anything over $1,100 (after the discount) is my responsibility. Hopefully the total will be about $900 and I'm done paying - except for the prescription.

In this experience, I'm quite happy with my insurance and very unhappy with the hospital.

[turbo]

Only at the hospital door. Otherwise no it was not free.I think you get my point. In Canada everybody pays a fair share and everybody gets coverage. That young girl got prompt and extensive treatment by a highly skilled orthopedic surgeon and is expected to be back running in about 6 weeks or so with minimal re-hab. If my friend was a US citizen, he would probably still be fighting to get authorization for the "elective" surgery that the neo-cons claim Canadians have to wait forever to get, and he would be out-of-pocket for any costs that the insurance company refused to cover.

I have friends and relatives in Ontario, PQ, New Brunswick, and Nova Scotia, and though some would like more local access to some specialties (the same problem we have here in rural central Maine), none of them would want to be plunked into a US-type system in which the insurance companies call the shots. And those stories about Canadians coming to the US for treatment? If you live in very rural part of Canada, and your travel options make it easier for you to get treatment in a US facility, the Canadian health-care system pays for you to get care in the US. This is most prevalent in the Canadian grain-belt provinces, which are very thinly-populated. So much for the "horrors" of socialized medicine in the Great White North.

[cristo]

In this experience, I'm quite happy with my insurance and very unhappy with the hospital.

I injured my ankle once, a few months ago. I rang up my GP and made an appointment for within the hour, he took a look at it and sent me round the corner to the hospital to get it xrayed, which took around half an hour. A 10 minute wait later, I was told it was just badly sprained and that I could have crutches if I wanted, but they weren't necessary. Total amount paid, £0; total amount of time taken, ~2 hours.

See, we can all tell anecdotal stories.

I still find it a little bemusing that Americans are all up in arms about their healthcare being "socialised". After all, you voted in a president who had a view to have a massive upheaval of the healthcare system. That it is now happening should not come as much of a surprise!

[Ivan Seeking]

I still find it a little bemusing that Americans are all up in arms about their healthcare being "socialised". After all, you voted in a president who had a view to have a massive upheaval of the healthcare system. That it is now happening should not come as much of a surprise!

What's more, health care isn't being socialized! That one isn't even on the table. The most extreme proposal is that we have a government run insurance option.

There are credible concerns about the best way to address the problems, but many right wing extemists have tried to make out "reform" to mean much more than it does. Apparently this is done to terrorize people into supporting a particular political position. The references made by shock jocks [Obama is a socialist, or a communist, or whatever it is this week] go all the way back to the Red Scare. The fact is that we accepted the need for some government programs long ago.

[Al68]

I still find it a little bemusing that Americans are all up in arms about their healthcare being "socialised". After all, you voted in a president who had a view to have a massive upheaval of the healthcare system. That it is now happening should not come as much of a surprise!You're right, no one should be surprised. And no one should be surprised that Democrats in congress tend to support it while Republicans are against it.

In the end, pass or fail, my anger will be at any Republican that betrays those that voted for them by supporting it, not Democrats that are only doing what they said they would do all along.

[cristo]

In the end, pass or fail, my anger will be at any Republican that betrays those that voted for them by supporting it, not Democrats that are only doing what they said they would do all along.

But just because a congressman is a Republican doesn't mean he will not support such healthcare reform, and vice versa. So your anger should be towards those Republican congressmen who stated, in their campaign manifestos, that they are against any form of publicisation of healthcare and then support such a bill in congress.

[Al68]

What's more, health care isn't being socialized!Well, if you think that a government run system isn't "socialized" because it allows the participation of private companies, then you would be right.

But I would consider that whether it is "socialized" depends on who controls it, not whether private companies can participate. By that standard, it's socialized big time.

The proposed system will be under the control of government, with a prohibition on medical insurance "outside" of the system. Does the word "socialized" mean something else?

[Al68]

But just because a congressman is a Republican doesn't mean he will not support such healthcare reform, and vice versa. So your anger should be towards those Republican congressmen who stated, in their campaign manifestos, that they are against any form of publicisation of healthcare and then support such a bill in congress.You're right, I was too general and should have been more specific. But I think that the number of Republicans that haven't spoken against at least some aspects of the current proposal during their campaign is very small. For the most part, the claimed positions and voting records of politicians are fairly well known.

[WhoWee]

What's more, health care isn't being socialized! That one isn't even on the table. The most extreme proposal is that we have a government run insurance option.

1.) Social Security, Medicare, and Medicaid are "socialized" now.

2.) The Government run insurance option will be an extension of those programs.

3.) Everyone who can't afford the coverages Obama is mandating will be required to purchase the Government run insurance option.

4.) The Government run insurance option will cover at minimum 30,000,000 currently uninsured persons - as per Obama estimates - yet he says only 5% of the population will participate???

Can you please explain how health care isn't going to be socialized?

[turbo]

What's more, health care isn't being socialized! That one isn't even on the table. The most extreme proposal is that we have a government run insurance option.

There are credible concerns about the best way to address the problems, but many right wing extemists have tried to make out "reform" to mean much more than it does.True. Adding an optional publicly-managed insurance option to our current system is not socialism. The right-wing would have us believe that having an option to ruinously expensive and capricious private insurance coverage would destroy the "American Way", and other such crap. This is bull. We need to provide a safety net for all Americans, so that nobody loses their savings, retirement funds, homes, etc, just because they get sick. Insurance was initially a way to spread the the risk out over large pools of people so that everybody would pay a reasonable premium, and nobody would be financially ruined because they needed expensive treatment. Unfortunately, the insurance companies have dominated the system to the point that they can raise anybody's premiums with no oversight, drop their coverage with no legal recourse, and abandon sick people, who will never again be able to buy coverage because they have a "pre-existing" condition. Our system is sick and cruel.

To those who are young and (currently) healthy and think you are bullet-proof and argue against a public option, consider my friend Linda. She was a vibrant, funny (former Chicago Improv member) woman who was diagnosed with glioblastoma (essentially a death-sentence brain cancer) in her 40's. She was living with an old friend of mine, who loved her dearly. She was given 6 months to live, and managed to tack on an extra year fighting for her life. The only thing that got her extended coverage was that she was a teacher, and the policy that the Maine State Teachers Association carried did not allow rescissions, so her treatments were paid for and she wasn't dropped.

I'm a bit passionate about this issue, because in Maine we have a huge seasonal/vacation economy that relies on seasonal part-time employment, and many of our citizens have never had affordable access to preventive care, much less actual health insurance. My dad's neighbor is a lobsterman, and he and his wife are the salt of the earth. They are only one serious illness away from losing everything, because they have to buy expensive policies with high co-pays and high deductibles. Lobstering is a very dangerous occupation with very slim profit margins. If they are lucky and stay healthy, they will get by. If not...well, there is always public assistance, though they are too proud to ask for any help unless they are at death's door.

[WhoWee]

Until politics are removed from the debate - health care problems will not be resolved.

The politicians want to control the insurance funds - it's the only light at the end of the tunnel for them given their mismangement of Social Security.

[Al68]

Adding an optional publicly-managed insurance option to our current system is not socialism.Uhhh, who said it was? Socialism is about government economic control. It's the expansion of control by government that is being called socialist.

No one is talking about just adding an optional publicly-managed insurance option. No one is calling such a proposal socialist.

It's the restricting of economic liberty by government that is being called socialist, and there is no good reason for anyone to pretend not to know that.

[jreelawg]

It's the restricting of economic liberty by government that is being called socialist, and there is no good reason for anyone to pretend not to know that.

Can you elaborate with specifics. What specific economic liberties are being restricted?

Would you call the fire department, police department, military, education, etc, brands of socialism, and would you favor these departments becoming privatized?

I guess you could argue that the Military is gradually becoming more and more of a private system rather than socialist. I guess we are just liberating mercenaries from economic oppression.

Why don't you tell us how, where, and what is happening specifically that is restricting economic freedom, put it in context, and tell us why you think it is a bad thing.

[turbo]

Uhhh, who said it was? Socialism is about government economic control. It's the expansion of control by government that is being called socialist.

No one is talking about just adding an optional publicly-managed insurance option. No one is calling such a proposal socialist.

It's the restricting of economic liberty by government that is being called socialist, and there is no good reason for anyone to pretend not to know that.Addressing the bold, the neo-cons and their minions have been relentless in their characterization of publicly-managed health insurance as socialism. I shouldn't have to waste any time pointing to the specific posts, since you are the bandwagon.

Let's not beat around the bush. The European "socialist" health-insurance programs cover far more people at lower cost with better outcomes than the US system. Can you come up with a single reason that we should allow the insurance companies to dominate our heath-care system, apart from the lies spouted by Glenn Beck, Rush Limbaugh, and David Brooks? I'll tear them apart, if you'd like. If all you have is jingoism and slogans, I'm done. Our health-care system is highly disfunctional and leaves more and more individuals uninsured every year as "insurance" companies decline to provide actual insurance and profit from people who can still pay premiums and who have not yet gotten sick enough to be kicked out for the sake of the bottom line.

[WhoWee]

Uhhh, who said it was? Socialism is about government economic control. It's the expansion of control by government that is being called socialist.

No one is talking about just adding an optional publicly-managed insurance option. No one is calling such a proposal socialist.

It's the restricting of economic liberty by government that is being called socialist, and there is no good reason for anyone to pretend not to know that.

The Government run insurance option is a means to an end. Re-direct private health insurance dollars into the Government and use the premiums to fund the Government - it's a political power play. They've been looting Social Security for a long time and don't know how to fix it.

[Al68]

Why don't you tell us how, where, and what is happening specifically that is restricting economic freedom, put it in context, and tell us why you think it is a bad thing.The context was HR3200. It restricts the liberty of individuals by outlawing any new insurance policy that is not in the "exchange". It imposes penalties on individuals for not participating in the new system, and makes it illegal to buy any new policy otherwise.

All of this has been discussed earlier in this thread.

[Al68]

Addressing the bold, the neo-cons and their minions have been relentless in their characterization of publicly-managed health insurance as socialism. I shouldn't have to waste any time pointing to the specific posts, since you are the bandwagon.Nice bait and switch. You won't find a single post where I called anything socialist just because it was publicly-managed. "Publicly-managed" may or may not be socialist, depending on whether force is used to restrict economic freedom. While I have called some "publicly-managed" programs socialist, it wasn't because they were "publicly-managed". You made the false claim that a publicly-managed alternative to private insurance policies was itself being called socialist, assuming it was completely optional. Did I misunderstand?

I have suggested myself that if government has a problem with private insurance companies, then compete with them instead of controlling them. Competing with them isn't socialist while controlling them (and us) with force is. Do you still pretend not to understand what is being called socialist?Can you come up with a single reason that we should allow the insurance companies to dominate our heath-care system.I don't need one, since I'm not advocating any such thing, and you know that.

Edit: Can you define "neocon" so everyone knows what you're talking about?
Dictionary.com defines neoconservatism as: "moderate political conservatism espoused or advocated by former liberals or socialists".

[WhoWee]

I injured my ankle once, a few months ago. I rang up my GP and made an appointment for within the hour, he took a look at it and sent me round the corner to the hospital to get it xrayed, which took around half an hour. A 10 minute wait later, I was told it was just badly sprained and that I could have crutches if I wanted, but they weren't necessary. Total amount paid, £0; total amount of time taken, ~2 hours.

See, we can all tell anecdotal stories.

I still find it a little bemusing that Americans are all up in arms about their healthcare being "socialised". After all, you voted in a president who had a view to have a massive upheaval of the healthcare system. That it is now happening should not come as much of a surprise!

Just out of curiosity, how much do you pay for a liter of petrol - and what percentage of it goes to the Government?

Also, don't you have a 40% income tax rate this year with a scheduled rise to 50% next year?

There's no such thing as "free health care". It has to be paid by someone - somewhere. I don't trust the politicians to take care of me - again Social Security, Medicare, Medicaid and the Post Office are examples of their management skills.

[mheslep]

... The European "socialist" health-insurance programs cover far more people at lower costYes
with better outcomes than the US system.That's simply wrong (http://www.ncpa.org/images/1703.gif). Saying it again and again doesn't make it true.

[mheslep]

I think you get my point. In Canada everybody pays a fair share and everybody gets coverage...But not everyone gets prompt health care. 'Coverage' is plan written on a piece of paper.

[cristo]

Just out of curiosity, how much do you pay for a liter of petrol - and what percentage of it goes to the Government?

How is this relevant? I thought we were talking about healthcare?


Also, don't you have a 40% income tax rate this year with a scheduled rise to 50% next year?

That's a highly misinformed statement: the 40% tax bracket is not being replaced by a 50% tax bracket.

In future, if you wish to make comments, then perhaps you should do a little research into whether the 'facts' that you state are correct.


There's no such thing as "free health care".

Well, there is: if you can't afford healthcare in the UK, then you don't have to pay for it. But anyway, I thought we were telling our own anecdotal stories...

[WhoWee]

How is this relevant? I thought we were talking about healthcare?



That's a highly misinformed statement: the 40% tax bracket is not being replaced by a 50% tax bracket.

In future, if you wish to make comments, then perhaps you should do a little research into whether the 'facts' that you state are correct.



Well, there is: if you can't afford healthcare in the UK, then you don't have to pay for it. But anyway, I thought we were telling our own anecdotal stories...

The point is that you are taxed at a much higher rate than us - you are paying for it.

As for the 40% to 50% increase - I wasn't certain and asked a question. I read somewhere this rate increase was about to be phased-in. Here are 2 links that indicate the rate is rising.
http://moneynews.newsmax.com/streettalk/uk_top_earner_tax_rate/2009/04/23/206408.html
http://www.breitbart.com/article.php?id=CNG.91afc63abb93d5e6768f1eb67b4c502 2.a91&show_article=1
""In order to help pay for additional support for people now, I have decided that the new rate will be 50 percent and will come in from next April -- a year earlier." "

As for petrol prices
http://www.petrolprices.com/price-of-petrol.html
Duty over 50%, Product 25%, VAT 15%, and Retailer/delivery less than 10%

a fuel tax overview
http://www.petrolprices.com/fuel-tax.html

[turbo]

Yes
That's simply wrong (http://www.ncpa.org/images/1703.gif). Saying it again and again doesn't make it true.It is not wrong, nor even remotely so. Even though Europeans have a relatively high rate of cigarette-smoking, their cancer-survival rates are better than those in the US. Most European nations spend much less per capita on health care than the US, cover virtually everybody under a public plan, and get better health outcomes. If you can prove otherwise, trot out your pony, because denying the basic facts repeatedly does not falsify them.

http://mjperry.blogspot.com/2009/08/us-vs-europe-life-expectancy-and-cancer.html

[cristo]

The point is that you are taxed at a much higher rate than us - you are paying for it.

Just because more money is paid in fuel duty does not mean that this is then ploughed into the NHS. In order to make such an argument, you would need to present the statistics on the governments spending of fuel duty, which you have not.


As for the 40% to 50% increase - I wasn't certain and asked a question. I read somewhere this rate increase was about to be phased-in. Here are 2 links that indicate the rate is rising.
http://moneynews.newsmax.com/streettalk/uk_top_earner_tax_rate/2009/04/23/206408.html
http://www.breitbart.com/article.php?id=CNG.91afc63abb93d5e6768f1eb67b4c502 2.a91&show_article=1
""In order to help pay for additional support for people now, I have decided that the new rate will be 50 percent and will come in from next April -- a year earlier." "

Those sources are incorrect. The top tax rate is currently 40% for salaries over about £35k. A new rate was proposed in the pre-budget report of 45% to be introduced in the 2011 tax year, but this was increased in the budget to 50% to be introduced in the 2010 tax year. This additional rate will affect people earning over £150k.


As for petrol prices
http://www.petrolprices.com/price-of-petrol.html
Duty over 50%, Product 25%, VAT 15%, and Retailer/delivery less than 10%

a fuel tax overview
http://www.petrolprices.com/fuel-tax.html

Again, pretty irrelevant on its own.

[Hans de Vries]

It is not wrong, nor even remotely so. Even though Europeans have a relatively high rate of cigarette-smoking, their cancer-survival rates are better than those in the US. Most European nations spend much less per capita on health care than the US, cover virtually everybody under a public plan, and get better health outcomes. If you can prove otherwise, trot out your pony, because denying the basic facts repeatedly does not falsify them.

http://mjperry.blogspot.com/2009/08/us-vs-europe-life-expectancy-and-cancer.html


This is an authoritative study on cancer survival rates and the US does very well actually:

http://v1.theglobeandmail.com/v5/content/pdf/CONCORD.pdf

On the other hand, the US has a higher percentage of it's population diagnosed with
cancer, twice that of France and four times that of Japan. My feeling is that the US
does more in preventive scanning resulting in earlier diagnosis, increasing the survival
rates, but that would need to be substantiated.


Regards, Hans.

[WhoWee]

Just because more money is paid in fuel duty does not mean that this is then ploughed into the NHS. In order to make such an argument, you would need to present the statistics on the governments spending of fuel duty, which you have not.



Those sources are incorrect. The top tax rate is currently 40% for salaries over about £35k. A new rate was proposed in the pre-budget report of 45% to be introduced in the 2011 tax year, but this was increased in the budget to 50% to be introduced in the 2010 tax year. This additional rate will affect people earning over £150k.



Again, pretty irrelevant on its own.

Assuming my analysis is incorrect, how is the NHS funded - who pays for your "free" health care?

[cristo]

Assuming my analysis is incorrect, how is the NHS funded - who pays for your "free" health care?

That's quite an assumption to make, given that you've just displayed your misconceptions about the British tax system. Still, the NHS is funded in part by employee and employer national insurance contributions and in part by a contribution from income tax. I am not aware of any funds from fuel duty which are put into the NHS though, of course, if you have any statistics you would like to present, please do so.

Anyway, it's pretty obvious who pays for my healthcare, after all it is a national health service. What I took objection to were your claims about fuel duty paying for the NHS, and your (incorrect) comments on taxation in the UK. At least bother to do some research for some acceptable sources before making claims.

I still stand by the claim that my healthcare was free-- it was funded by the people who can afford to pay for it, namely those who are employed!

[jreelawg]

The context was HR3200. It restricts the liberty of individuals by outlawing any new insurance policy that is not in the "exchange". It imposes penalties on individuals for not participating in the new system, and makes it illegal to buy any new policy otherwise.

All of this has been discussed earlier in this thread.

This is matter of protection. It will be illegal to buy a plan that may well end up being the factor that leads to your demise, both economically and physically. Too many people go bankrupt when they get sick. Too many people can't get coverage. Too many people have insurance when they get sick, only to find that the insurance company found a loop hole to drop them. All the incentives are towards less care and more profit, dishonesty, and deceptive marketing. This legal, economically free system feeds off of the public like parasites, and it ought to be held accountable.

[Al68]

This is matter of protection. It will be illegal to buy a plan that may well end up being the factor that leads to your demise, both economically and physically. Too many people go bankrupt when they get sick. Too many people can't get coverage. Too many people have insurance when they get sick, only to find that the insurance company found a loop hole to drop them. All the incentives are towards less care and more profit, dishonesty, and deceptive marketing. This legal, economically free system feeds off of the public like parasites, and it ought to be held accountable.Economic freedom means the freedom to make unwise and detrimental choices as well as good ones. That's no justification for restricting liberty.

Unless one insists on considering adults as children, and the government as parent to protect them by limiting their freedom.

My insurance policy can't "lead to my demise". At the very worst, it will fail to save me. I won't be worse off then if I didn't have it.

I expect my insurance policy to cover what the policy claims to cover, not anything and everything I might need. I never paid them to take me to raise, so why would I expect them to? I never paid them to cover pre-existing conditions, so why would I expect them to?

If I go bankrupt with medical bills, should I blame you? After all it would be true that you failed to pay my bills.

[Vanadium 50]

Economic freedom means the freedom to make unwise and detrimental choices as well as good ones. That's no justification for restricting liberty.

Not everyone holds to this position. Some feel that the government should protect people from making unwise choices.

[Ivan Seeking]

The context was HR3200. It restricts the liberty of individuals by outlawing any new insurance policy that is not in the "exchange".

How is this any different than any other approved activity? For example, why can't someone hang out a shingle saying "Dentist", and start practicing dentistry? Doesn't the requirement for licensed dentists take away my right to use the local pig farmer as a dentist? I'm sure he would be cheaper.

It imposes penalties on individuals for not participating in the new system

How is this any different than a tax for fire and police protection? It is effectively a tax based on the cost to society of the uninusured. Or is it your contention that hospitals should be able to refuse ER patients who don't have insurance?

and makes it illegal to buy any new policy otherwise.

I don't understand the meaning here. It is specifically illegal to buy an illegal policy?

[WhoWee]

How is this any different than any other approved activity? For example, why can't someone hang out a shingle saying "Dentist", and start practicing dentistry? Doesn't the requirement for licensed dentists take away my right to use the local pig farmer as a dentist? I'm sure he would be cheaper.

How is this any different than a tax for fire and police protection? It is effectively a tax based on the cost to society of the uninusured. Or is it your contention that hospitals should be able to refuse ER patients who don't have insurance?

I don't understand the meaning here. It is specifically illegal to buy an illegal policy?

You can't be serious. You're going to equate a regulation imposed on us by HR3200 to a pig farmer's credentials as a dentist?

Also, a Government mandate to buy a specific health plan equates more to extortion than a common share of police and fire protection.

Last, the only reason a policy (such as a high deductible with a low premium and self pay for doctor visits) would be illegal is because this Bill makes it illegal.

All this Bill will do is create an even largerer administrative mess and drive up premiums - people that don't currently have insurance because of cost will still not have any money to buy (the more expensive) insurance and then face fines of up to $3,800 - enforced by the IRS.

The "exchange" will be designed to eliminate independent insurance agents and their commissions - this will cost tens of thousands of more good jobs. There were 436,000 licensed agents in 2006.
http://www.bls.gov/oco/ocos118.htm

The first phase of the restructuring will be to put 50 to 100 agents per location in a telephone boiler room writing health plans the way car insurance is now transacted - no more face to face. The second phase will be a reduction of licensing requirements and "outsourcing" - and we all know what that means.

Under the current system, senior agents maintain portfolios of hundreds of clients developed over long careers, capable of fitting plans to meet needs and cost/investment/tax considerations. An average (producer) agent can expect to earn $60,000 to $80,000 per year, a senior agent with a large book of residuals over $250,000 per year. The basis of these businesses are agent accountability and built on word of mouth referrals and reputation. By the way, this one on one relationship helps keep YOUR medical information private.

The move to telemarketing style rooms will cut the pay rate to $10 per hour with $0 residuals - no more agent/client relationship. If you need something - call the info recording.

This isn't speculation, the staffing conversion is currently underway.

There's no "save or create" in this Bill. Instead, someone should do a study on the number of good jobs that HR3200 will "eliminate or reduce" to entry-level.

On a last note, HR3200 will ultimately force insurance rates to increase across the board for life, auto, home, business, etc. Nothing is free and open-end mandates are very expensive.

[humanino]

Also, a Government mandate to buy a specific health plan equates more to extortion than a common share of police and fire protection.Obama mentionned car insurance, did you listen ? Do you have car insurance ? How do you rank your car and your health ?

[WhoWee]

Obama mentionned car insurance, did you listen ? Do you have car insurance ? How do you rank your car and your health ?

I don't understand your question.

Obama cited mandatory car insurance as a good thing - most responsible drivers would disagree. Responsible drivers didn't need a mandate. The insurance companies use the DMV as their personal bill collectors. If you're late on your payment in Ohio, you can lose your driving privileges for a year - the first time.

Car insurance is very simple - type of asset along with risk of operator.

Health insurance is much more complicated - and important.

[mheslep]

It is not wrong, nor even remotely so. Even though Europeans have a relatively high rate of cigarette-smoking, their cancer-survival rates are better than those in the US. Most European nations spend much less per capita on health care than the US, cover virtually everybody under a public plan, and get better health outcomes. If you can prove otherwise, trot out your pony, because denying the basic facts repeatedly does not falsify them.

http://mjperry.blogspot.com/2009/08/us-vs-europe-life-expectancy-and-cancer.html
Did you happen to look at the figures in the link you provided? It shows the US does quite well compared to Europe on cancer survivor rates and general medical related life expectancy. And cigarette smoking is related mainly to mortality (how many cancers), not survival (chances of surviving once one has the cancer, i.e. quality of the treatment)

Edit: at the moment we are discussing only cancer outcomes in Europe and the US per your claim in #819

[WhoWee]

By the way, I was "rear-ended" by a driver that lost his license because of no insurance and was driving anyway. My vehicle sustained heavy damage and I was injured. The force of the collision flung me into the steering wheel, then backwards against the seat. The power seat fame was bent so badly it had to be replaced.

To make things worse, (because he didn't have a license or insurance) he tried to flee the scene and was cut off by other drivers until the police arrived (less than a minute).

I injured my neck and shoulder and required treatment including follow up therapy visits that cost me about $1,000 out of pocket. My insurance paid for my car - I paid the $250 deductible out of pocket. I couldn't work for the first week (too many meds) and couldn't sit in a car for another week. The third week I worked but needed someone to drive my car - I couldn't turn my head to view traffic conditions or park.

[mheslep]

...I still stand by the claim that my healthcare was free-- it was funded by the people who can afford to pay for it, namely those who are employed!The employed UK policeman or fireman with 2-3 children might well object to the affordability of those taxes, or not, I wouldn't know. Regardless, assuming one will be employed at sometime in the future, government health services are still not free since the government borrows money from the future.

[jreelawg]

I expect my insurance policy to cover what the policy claims to cover, not anything and everything I might need. I never paid them to take me to raise, so why would I expect them to? I never paid them to cover pre-existing conditions, so why would I expect them to?

If I go bankrupt with medical bills, should I blame you? After all it would be true that you failed to pay my bills.

There is a problem with your argument. People very often don't know that they won't be covered. They pay for insurance, they don't know they had some kind of pre-existing condition. Often their insurance plan is supposed to cover them. The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people. People have rightful claims, and have to play games with the insurance companies. Often insurance companies will keep this up hoping the patient gives up.

A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. Why should anybody feel sorry for the loss of this kind of job. They not only should be fired, they should be in prison. Not to mention the fact that their salaries are paid with money that people spend toward their health care.

The government surely has a right to protect consumer rights. This is not a matter of what an individual is able to buy, but what a company is able to sell. I disagree with the mandate, but it's one spoke in the wheel, and the wheel wouldn't spin as true without it.

As for a nanny state. I would be strongly in favor of making tobacco illegal. Or at least some of the 599 approved additives. Or at least so long as it has polonium in it.

[Al68]

There is a problem with your argument. People very often don't know that they won't be covered. They pay for insurance, they don't know they had some kind of pre-existing condition. Often their insurance plan is supposed to cover them. The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people. People have rightful claims, and have to play games with the insurance companies. Often insurance companies will keep this up hoping the patient gives up.Hold on there! If you're referring to an insurance company fraudulaently denying a claim it's obligated to pay, I agree that that should be illegal. No one is suggesting fraud should be legal.

That's not the issue in dispute here.

[WhoWee]

There is a problem with your argument. People very often don't know that they won't be covered. They pay for insurance, they don't know they had some kind of pre-existing condition. Often their insurance plan is supposed to cover them. The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people. People have rightful claims, and have to play games with the insurance companies. Often insurance companies will keep this up hoping the patient gives up.

A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. Why should anybody feel sorry for the loss of this kind of job. They not only should be fired, they should be in prison. Not to mention the fact that their salaries are paid with money that people spend toward their health care.

You need to either support or retract these statements - absolute nonsense.

[Al68]

How is this any different than any other approved activity? For example, why can't someone hang out a shingle saying "Dentist", and start practicing dentistry? Doesn't the requirement for licensed dentists take away my right to use the local pig farmer as a dentist? I'm sure he would be cheaper.

How is this any different than a tax for fire and police protection? It is effectively a tax based on the cost to society of the uninusured. Or is it your contention that hospitals should be able to refuse ER patients who don't have insurance?

I don't understand the meaning here. It is specifically illegal to buy an illegal policy?I'll address the last question, since Who Wee addressed the others.

That's an odd question. HR3200 doesn't outlaw what was already illegal. Yes, it makes it illegal to buy the policies that it makes illegal.

[Al68]

Economic freedom means the freedom to make unwise and detrimental choices as well as good ones. That's no justification for restricting liberty.Not everyone holds to this position. Some feel that the government should protect people from making unwise choices.Sure, but I'm not one of them. The post I responded to was asking how liberty was being restricted by HR3200, so I answered.

[turbo]

Hold on there! If you're referring to an insurance company fraudulaently denying a claim it's obligated to pay, I agree that that should be illegal. No one is suggesting fraud should be legal.

That's not the issue in dispute here.That is standard operating procedure for health insurance companies. I have told you that (as the former IT guy for a large medical practice) as has Adrenaline (doctor in private practice). If you choose not to believe us, fine, but don't argue that it doesn't happen because it does, constantly.

It was a very sore point for my doctors' practice in particular because they were ophthalmologists. If a person presented with a condition that required treatment lest they lose their vision, the person was treated, and then the games with the insurance companies would start. Often the insurance companies would deny the claim outright, (even dropping the patient's coverage on some pretext) or delay and delay the claim for months, making the practice re-code, re-submit, re-code and re-submit over and over again to have any chance of getting paid. Health insurance in the US is a very expensive protection racket, and you'll pay all that the market will bear until you really need the insurance, only to be dropped.

Such practices are fraud, and they should be illegal, but they are not. You won't hear much of this on TV. Actually, you won't hear any of this if you watch FOX, but even the major networks won't cover this story, which is really sad. Health-care costs in the US would drop like a rock once the fraud and gamesmanship by the insurance companies is outlawed and the laws are enforced. Private medical practices lose probably at least 30% of their income to the overhead required to fight this fraud and actually get paid.

[jreelawg]

You need to either support or retract these statements - absolute nonsense.

Isn't that what denying coverage is about. Are there not a whole lot of people who sit in an office thinking up creative ways to deny people coverage. Finding loopholes. Initial and subsequent denial of rightful claims, legal, intimidation.

How do they maximize profit except by denying people coverage? They come up with outlandish reasons to deny coverage, and if the customer wants to do anything about it, they must face a team of high dollar lawyers. Meanwhile they can't afford to save their own lives let alone hire lawyers and go through a lengthy legal process. So they give up, and the mastermind behind their loss is an employee.

You could say their only role is to maximize profit in the department of claims. But profit for a private entity is less relevant to health care as a role, than is the death and financial ruin of the patient. Which of coarse is the result, and ultimate indirect goal of the employee.

[WhoWee]

Isn't that what denying coverage is about. Are there not a whole lot of people who sit in an office thinking up creative ways to deny people coverage. Finding loopholes. Initial and subsequent denial of rightful claims, legal, intimidation.

How do they maximize profit except by denying people coverage? They come up with outlandish reasons to deny coverage, and if the customer wants to do anything about it, they must face a team of high dollar lawyers. Meanwhile they can't afford to save their own lives let alone hire lawyers and go through a lengthy legal process. So they give up, and the mastermind behind their loss is an employee.

You could say their only role is to maximize profit in the department of claims. But profit for a private entity is less relevant to health care as a role, than is the death and financial ruin of the patient. Which of coarse is the result, and ultimate indirect goal of the employee.

You stated, "The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. "

These are outrageous assertions.

[jreelawg]

You stated, "The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. "

These are outrageous assertions.

Other than the fact that insurance company employees have testified confirming this, it is an obvious logical result of the incentive structure which our health care system is built on.

All the incentives for the Insurance companies are towards less care and more cost to the consumer. Less care means more death and financial ruin. There are most certainly people who are working towards the companies incentives, and there are most certainly people who's job is specific to this cause.

[WhoWee]

Other than the fact that insurance company employees have testified confirming this, it is an obvious logical result of the incentive structure which our health care system is built on.

All the incentives for the Insurance companies are towards less care and more cost to the consumer. Less care means more death and financial ruin. There are most certainly people who are working towards the companies incentives, and there are most certainly people who's job is specific to this cause.

You claim that it's a FACT that insurance company employees testified that ""The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. ""

You need to support these outrageous comments.

[mheslep]

All the incentives for the Insurance companies are towards less care and more cost to the consumer. Less care means more death and financial ruin. There are most certainly people who are working towards the companies incentives, and there are most certainly people who's job is specific to this cause.Think about what you are saying and apply it to home insurance, car insurance, life insurance. There's a reason these businesses all don't simply up and up the cost and never pay off. Why do you think that is?

[jreelawg]

"Potter also faulted insurance companies for being misleading both in advertising their policies to new customers and in communicating with existing policyholders.

More and more people, he said, are falling victim to "deceptive marketing practices" that encourage them to buy "what essentially is fake insurance," policies with high costs but surprisingly limited benefits.

Insurance companies continue to mislead consumers through "explanation of benefits" documents that note what payments the insurance company made and what's left for consumers to pay out of pocket, Potter said.

The documents, he said, are "notoriously incomprehensible."

"Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away. And that's exactly the point," he said. "If they were more understandable, more consumers might realize that they are being ripped off."

.."They were no match for insurance companies who know exactly how to design and market plans whose gaping holes don't become apparent until it's much, much too late," she said.

http://abcnews.go.com/print?id=7911195

I guess this is where you come in Whowee

[WhoWee]

"Potter also faulted insurance companies for being misleading both in advertising their policies to new customers and in communicating with existing policyholders.

More and more people, he said, are falling victim to "deceptive marketing practices" that encourage them to buy "what essentially is fake insurance," policies with high costs but surprisingly limited benefits.

Insurance companies continue to mislead consumers through "explanation of benefits" documents that note what payments the insurance company made and what's left for consumers to pay out of pocket, Potter said.

The documents, he said, are "notoriously incomprehensible."

"Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away. And that's exactly the point," he said. "If they were more understandable, more consumers might realize that they are being ripped off."

.."They were no match for insurance companies who know exactly how to design and market plans whose gaping holes don't become apparent until it's much, much too late," she said.

http://abcnews.go.com/print?id=7911195

I guess this is where you come in Whowee

How exactly does this post support your statements of ""The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. ""

Also, I don't understand your comment "I guess this is where you come in Whowee" what exactly are you attempting to say?

[jreelawg]

How exactly does this post support your statements of ""The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. ""

"Workers received high marks on performance reviews after policies were rescinded, documents show. The health insurer denies the practice is a factor in evaluations."

The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

"Blue Cross of California encouraged employees through performance evaluations to cancel the health insurance policies of individuals with expensive illnesses, Rep. Bart Stupak (D-Mich.) charged at the start of a congressional hearing today on the controversial practice known as rescission."

"In November 2007, The Times reported that insurer Health Net Inc. paid bonuses to employees based in part on their involvement in rescinding policyholders. "
Also, I don't understand your comment "I guess this is where you come in Whowee" what exactly are you attempting to say?

http://articles.latimes.com/2009/jun/17/business/fi-rescind17

[WhoWee]

http://articles.latimes.com/2009/jun/17/business/fi-rescind17

I read the article and I'll ask again

"How exactly does this post support your statements of ""The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. """ also, "Also, I don't understand your comment "I guess this is where you come in Whowee" what exactly are you attempting to say?"

You haven't cited anything that supports your outrageous accusations of some insurance person being responsible for millions of deaths - please retract your nonsense and explain the "WhoWee" comment - again, please.

[jreelawg]

I read the article and I'll ask again

"How exactly does this post support your statements of ""The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. """ also, "Also, I don't understand your comment "I guess this is where you come in Whowee" what exactly are you attempting to say?"

You haven't cited anything that supports your outrageous accusations of some insurance person being responsible for millions of deaths - please retract your nonsense and explain the "WhoWee" comment - again, please.

I really meant people, obviously one person doesn't accomplish that much. Not one person. Everyone has their role, from the CEO, to the people who reviews claims, to the salesman. One sets em up another knocks em down. People ought to know what they are getting themselves into.

[WhoWee]

I really meant people, obviously one person doesn't accomplish that much. Not one person. Everyone has their role, from the CEO, to the people who reviews claims, to the salesman. One sets em up another knocks em down. People ought to know what they are getting themselves into.

Again, support your claims. You said ""The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. ""

Are you saying there's a giant conspiracy to commit murder? Or are you going to retract the nonsense?

Also, please explain this comment ""I guess this is where you come in Whowee"".

[turbo]

Where do the doctors stand on health-care reform?

A RWJF survey summarized in the September 14, 2009 edition of the New England Journal of Medicine shows that 62.9 percent of physicians nationwide support proposals to expand health care coverage that include both public and private insurance options—where people under the age of 65 would have the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans. The survey shows that just 27.3 percent of physicians support a new program that does not include a public option and instead provides subsidies for low-income people to purchase private insurance. Only 9.6 percent of doctors nationwide support a system where a Medicare-like public program is created in lieu of any private insurance. A majority of physicians (58%) also support expanding Medicare eligibility to those between the ages of 55 and 64.

In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists. Among those who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options.

The survey was conducted between June 25 and September 3, 2009 by Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H., of the Mount Sinai School of Medicine in New York City. While the survey was conducted in several “waves” over a tumultuous summer for the health reform debate, no statistically significant differences were identified in physician responses throughout the summer.

http://www.rwjf.org/healthreform/quality/product.jsp?id=48408

It's clear that doctors want reform. Doctors want a public option, and they want people to be able to opt into Medicare. Doctors are care-givers, but most are also business people. It would be a good idea for people on the sidelines (who are often fed their "facts" by outsiders) to heed doctors who are on the front-lines of health-care. I have quite a number of friends who are in the medical profession, and I can't think of a single one who doesn't want significant health-insurance reform. They are being squeezed by the insurance companies and they are being forced to fight for payment of legitimate claims. Worst of all, they are often being told that they cannot order what they believe is the best treatments for their patients because the insurance companies refuse to pay for them.

Edit: Notice that if you add the almost 10% of doctors who want a public-only program to the 62+% that want a public plan to supplement private plans, you have over 70% of doctors supporting the creation of a broader public plan in one form or another. In my personal experience, I find that number to be a bit low, but that's probably because I live in a rural area where many of my friend's practices are small and administrative costs are brutal. Doctors who specialize in high-dollar elective procedures like cosmetic surgery, breast enhancements, etc are probably not highly motivated to support a public option because it would have little impact on their practices. Not a lot of them around here, though, so the study is probably accurate across a broad range of practices from GP to specialties.

[jreelawg]

Again, support your claims. You said ""The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. ""

Are you saying there's a giant conspiracy to commit murder? Or are you going to retract the nonsense?

Also, please explain this comment ""I guess this is where you come in Whowee"".

"...and this particular act secured my reputation as a good medical director, and it insured my continued advancement in the ah, health care field. I went from making a few hundred dollars a week as a medical reviewer, to an escalating six figure income as a physician executive......I know how managed care maims and kills patients..... and I am haunted by the thousands of pieces of paper in which I have written that deadly word, denied."

Dr. Linda Peeno MD testifies in front of congress

http://www.youtube.com/watch?v=DoqpPwvUoP0&feature=related

[WhoWee]

I've disclosed previously that I'm a licensed insurance broker/agent. I am appointed with MULTIPLE insurance companies. Accordingly, I know hundreds of licensed agents around the country.

PLEASE NOTE - THIS POST IS NOT INTENDED TO DEFEND INSURANCE COMPANIES.

I can honestly make the following statement. Every insurance agent I know, is trained to fight for their clients when there is a problem with coverage. It is in the best interest of the agent to get claims paid - and in a timely manner. Individual health insurance sales are driven by referrals.

Most agents work on a commission only basis. Therefore it's also in the agent's best interest to sell the best coverage possible. Unfortunately, everyone can not afford the best coverage and everyone is not fully insurable.

Agents that take the money and run, and put people into the wrong coverage, don't last in the industry.

At the same time, people don't always tell the absolute truth on their applications. Every prescription you've ever had filled is on a national database.
http://www.mib.com/
If someone lies to obtain coverage, they are taking a very big risk. Instead, applicants need to tell the truth and select from the coverages that are available and in their price range.

I agree that we need reform in the health care industry. There are thousands of items to address and can not be over-simplified.

However, the first place I would start is with standardization of insurance coverage across all 50 states. Then (I've posted this before) the best Government option would be to fund a high risk pool that would guarantee acceptance of all pre-existing conditions.

These 2 steps alone would remove obstacles, reduce premiums (due to administrative and legal savings) and expand coverage to millions of currently uninsured or under-insured people.

Again, we need to remove politics from the debate and approach reform with a problem solving mind set.

[WhoWee]

"...and this particular act secured my reputation as a good medical director, and it insured my continued advancement in the ah, health care field. I went from making a few hundred dollars a week as a medical reviewer, to an escalating six figure income as a physician executive......I know how managed care maims and kills patients..... and I am haunted by the thousands of pieces of paper in which I have written that deadly word, denied."

Dr. Linda Peeno MD testifies in front of congress

http://www.youtube.com/watch?v=DoqpPwvUoP0&feature=related

You still haven't supported your claims that

""The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. ""

Please retract the nonsense.

[jreelawg]

You still haven't supported your claims that

""The person who reviews the claims makes more money denying people. Ultimately being responsible for killing millions of people." as well as "A whole lot of health insurance employees, really have no role in the health care system except to maximize death and bankruptcy of the sick. ""

Please retract the nonsense.

If they want to be rated well, and have the opportunity to move up, and get paid more, then they deny as many people as they can (translated save the company as much money as possible) This is how the incentives go. My initial interpretation may be coming on a little strong, and I know that there are probably differences between different insurance companies in policy. In some cases my interpretation is correct, and in some, not so much.

It seams clear that a persons evaluated performance would have a lot to do with wether a person advances, gets a raise, or gets fired. Whether or not in all cases the financial incentive to the employee is directly and officially based on rescinded coverage, rescinding care is commonly practiced, and saves the company money. Whether the reward for an employee's performance is spelled out, or whether the employee simply knows based on common sense that their performance is a factor in the success of their career and pay, the direction is towards dropping as many people as possible to save money. Obviously this results in the deaths, and financial ruin of their customers.

[mheslep]

This is an authoritative study on cancer survival rates and the US does very well actually:

http://v1.theglobeandmail.com/v5/content/pdf/CONCORD.pdf

On the other hand, the US has a higher percentage of it's population diagnosed with
cancer, twice that of France and four times that of Japan. My feeling is that the US
does more in preventive scanning resulting in earlier diagnosis, increasing the survival
rates, but that would need to be substantiated.


Regards, Hans.
Yes, ...five continents... reported in Lancet Oncology too:
http://www.thelancet.com/journals/lanonc/article/PIIS1470204508701797/abstract?iseop=true

[humanino]

Yes, ...five continents... reported in Lancet Oncology too:
http://www.thelancet.com/journals/lanonc/article/PIIS1470204508701797/abstract?iseop=trueIt is indeed fairly well known that the US does slightly better than western Europe on cancer. The link does not explains why, and it has already been pointed out that Europeans tend to smoke more for instance. But above all, the article points slight differences between US, Australia, Japan, and Europe for instance, while large differences with Bresil, the UK, Algeria, or Danemark for instance with prostate.

If we want to go into the slight differences we would have to look at variances by population and location for instance.

So we conclude that the US health care is good enough ? It seems to me, it remains to explain why the US does a couple percent better while spending 50% more.

[Vanadium 50]

So we conclude that the US health care is good enough ? It seems to me, it remains to explain why the US does a couple percent better while spending 50% more.

I think it would be more enlightening to compare treatment-by-treatment costs than total costs. Having lived in both Europe and the US, and having recently the unpleasant experience of watching relatives linger and die, I can tell you that one difference is that in the US there are heroic efforts to extend the life of dying patients a month or two. This can't come cheap.

Comparing like-with-like seems to me to be more valuable than comparing aggregates.

[Vanadium 50]

If they want to be rated well, and have the opportunity to move up, and get paid more, then they deny as many people as they can (translated save the company as much money as possible) This is how the incentives go. My initial interpretation may be coming on a little strong, and I know that there are probably differences between different insurance companies in policy. In some cases my interpretation is correct, and in some, not so much.

It seams clear that a persons evaluated performance would have a lot to do with wether a person advances, gets a raise, or gets fired. Whether or not in all cases the financial incentive to the employee is directly and officially based on rescinded coverage, rescinding care is commonly practiced, and saves the company money. Whether the reward for an employee's performance is spelled out, or whether the employee simply knows based on common sense that their performance is a factor in the success of their career and pay, the direction is towards dropping as many people as possible to save money. Obviously this results in the deaths, and financial ruin of their customers.

This sounds to me like a lot of guessin' and supposin' but not a lot of evidence. I think I agree with WhoWee that it would be good for you to provide some facts in support of your opinion.

I did provide one fact a zillion messages ago. The two biggest health insurance companies have profits of about 4%. So if people are being denied coverage that they deserve and have paid for so that the insurance companies can make a profit, we know that this can be at most 4% of the total. More than that, the problem isn't that insurance companies are making too much profit, it's that health insurance is underpriced.

[humanino]

I did provide one fact a zillion messages ago. The two biggest health insurance companies have profits of about 4%. So if people are being denied coverage that they deserve and have paid for so that the insurance companies can make a profit, we know that this can be at most 4% of the total. More than that, the problem isn't that insurance companies are making too much profit, it's that health insurance is underpriced.As an answer to this fact, I quoted mutual organization in the US providing health care insurance roughly 30% cheaper. Interestingly, this is in line with the US system being 50% more expensive than the European one. It is possible that, even with similar profits, services cost less with better organization, and above all, health costs are reduced if routine checkups are covered or possibly imposed. Those are just two examples where indeed, we do not compare "like-with-like" but we really change the philosophy of the system.

[Al68]

That is standard operating procedure for health insurance companies. I have told you that (as the former IT guy for a large medical practice) as has Adrenaline (doctor in private practice). If you choose not to believe us, fine, but don't argue that it doesn't happen because it does, constantly.I have never claimed that fraud didn't happen. I said the issue wasn't in dispute here. It takes two to constitute a disagreement, so the fact that you have mentioned fraud doesn't make it an issue in dispute.

In fact I have pointed out that claiming that insurance companies are all alike (as you have done) helps the bad companies get by with it.

And do any of the current proposals address the issue of fraudulently denied claims, anyway? Why should they, it's already illegal in every state.

[Al68]

The two biggest health insurance companies have profits of about 4%.One thing that many people seem to just not understand about economics is that in any (relatively) unregulated industry, higher profits result in products being both cheaper and higher quality for consumers, and vice versa.

"Excess" profits result from inadequate competition, and lure competition into the market, again benefiting consumers.

This just doesn't happen so much when there are regulatory barriers to entry into the market, like with health insurance. The result of the regulation is higher prices and an inferior product.

[mheslep]

...
and it has already been pointed out that Europeans tend to smoke more for instance.That's about how many people contract cancer - out of the of the reach of most medical reforms; the Concord/Lancet study above is about effectiveness of the medical treatment on people that have cancer - two very different things.
...So we conclude that the US health care is good enough ? We have hundreds of posts in this thread with almost universal agreement that US health care is _not_ good enough and has major flaws. The point is that it also has major strengths, such as the quality of oncological care demonstrated above, and we would like not to wreck that in the process of reforming the system.

[Count Iblis]

It's not just that by preventative screening leading to earlier treatment you have better survival chance. There is also the issue of prostate cancer in older men. Some percentage of men who die, have prostate cancer at the time of death, without the cancer being a factor in their death. Such cases go undetected in Europe while in the US, due to screening, they contribute to the cancer surviving rate statistics. I think that the incidence of non lethal prostate cancer is 10% or more in old men.

In the US, you also have a far larger incidence of easily treatable skin cancer compared to Europe.

[WhoWee]

Rangel is disappointed - where's the tax on the rich?:tongue:
http://www.ny1.com/content/top_stories/105791/rangel-raises-concerns-over-health-care-funding/Default.aspx
...and not enough for the poor?:rolleyes:

[WhoWee]

On a serious note, details of the Max Baucus Bill are drawing criticism.
http://online.wsj.com/article/SB125303845553412855.html

""This is not like shaving off things, this is reducing coverage for poor and working people," House Ways and Means Chairman Charles Rangel (D., N.Y.) said Monday. Mr. Rangel is an architect of the $1 trillion House health-care bill, which provides more generous subsidies.

Some Senate Democrats are voicing similar concerns. Sen. Jay Rockefeller (D., W.Va.) on Monday said there was "no way I can vote for the package" without changes. Sen. Debbie Stabenow (D., Mich.) vowed to seek additional subsidies, or possibly a new tax break, aimed at helping working families, when the bill comes before committee. "Fundamentally, we're doing this for American families, and we need to make sure this is affordable," she said.

The Baucus bill would provide federal subsidies to individuals and families with incomes as high as 300% of the federal poverty line. For people whose incomes fall between 300% and 400% of the poverty line, the bill would cap premiums at 13% of income.

Critics complain the 13% cap is too high and would impose unreasonable costs on middle-income family budgets. But Finance Committee aides argue that tens of millions of Americans would still benefit from the cap.
Opinion

The Senate Is Ready to Act on Health Care

Mr. Baucus said that because his bill would expand insurance coverage for Americans, "middle-class families are going to be much better off than they currently are." In an op-ed published Wednesday in The Wall Street Journal, Mr. Baucus said the "current system is simply unsustainable," and noted his bill would help small businesses and families stressed by the rapid growth in health costs. "The status quo is no longer an option," he said.

Republicans, meanwhile, have been seeking other changes to the bill. In private negotiations led by Mr. Baucus, Sen. Charles Grassley (R., Iowa) made a push this week to drop the proposed mandate requiring individuals to buy insurance. Instead, he has proposed creating a new "reinsurance pool" to help spread the risks associated with high-cost patients.

In a statement released late Tuesday, Mr. Grassley complained the Senate Democratic leadership is imposing an "artificial deadline" on the bipartisan talks led by Mr. Baucus, but vowed to "continue to work with" the chairman.

Health Care for America Now, a liberal advocacy group, estimates that a family of four earning $77,175 a year could pay as much as $10,033 a year for health insurance under Sen. Baucus's proposal. That is about $2,000 a year more than they would pay under a health bill passed through the Senate's Health, Education, Labor and Pensions Committee, as well as under two of the three bills passed through House committees.

Mr. Baucus's bill would also place higher caps than other versions on the amount consumers would pay for out-of-pocket health-care expenses. It would allow insurance companies to charge older customers premiums that are as much as five times as high as those for younger customers, a provision sought by insurance companies. The other bills would restrict them from charging older customers more than twice as much."

It sounds like the debate has just begun. The cap will have to increase with Obama's mandate of no lifetime maximum payout and no pre-existing conditions.

This is especially true when you consider the average cost of an employer paid policy is $13,000 per year.
http://www.google.com/hostednews/ap/article/ALeqM5hMAlWaPqqHfYA1aKXHRs7xjmXQMgD9ANTRAG0

"Health insurance premiums rose modestly in 2009

By TOM MURPHY (AP) – 8 hours ago

The cost of employer-sponsored health insurance rose modestly again this year, but researchers predict a return to bigger increases that may eventually produce crippling premiums if left unchecked.

Meanwhile, more workers with single coverage are facing high-deductible plans that make them pay $1,000 or more out of pocket before coverage starts, according to a report released Tuesday by the Kaiser Family Foundation and the Health Research and Educational Trust, a nonprofit research organization affiliated with the American Hospital Association.

The average annual premium — the amount charged for a fully insured policy — rose 5 percent for the third straight year to surpass $13,000 for employer-sponsored family health coverage.

Employers picked up about 74 percent of that cost, while workers paid the rest. Single coverage remained relatively flat at an average of $4,824, with employers paying 84 percent.

The 2009 increases represent much smaller growth than just a few years ago. Premiums increased anywhere from 10 percent to 13 percent from 2000 to 2004."

How can a 13% cap possibly work - when the median household income is less than $60,000?
[url]http://quickfacts.census.gov/qfd/states/00000.html

13% of $60,000 is only $7,800 - who is going to pay the difference $13,000 - $7,800 = $6,200 a 47% difference??? Is Obama going to be able to cut out 47% of the cost? The numbers don't compute.

[Count Iblis]

45,000 Americans die each year due to lack of insurance:

http://www.bizjournals.com/baltimore/stories/2009/09/14/daily65.html

[WhoWee]

45,000 Americans die each year due to lack of insurance:

http://www.bizjournals.com/baltimore/stories/2009/09/14/daily65.html

How many die that have insurance?

The article says 46 million people are uninsured - that means only 1 out of 1,000 people without insurance are likely to die.

[mheslep]

45,000 Americans die each year due to lack of insurance:

http://www.bizjournals.com/baltimore/stories/2009/09/14/daily65.html
You misstated the bizjournal headline. Also:
..The study was released by Physicians for a National Health Program, an organization that favors a single-payer system.

However, the study’s authors concede that ... they did not validate their subjects’ insurance status. :zzz:

Edit: link to the pre printed paper:
http://pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf

First line from this scientific paper:
The United States stands alone among industrialized nations in not providing health coverage to all of its citizens...

[mheslep]

Here's an example of why a consideration of the alternatives are important when slinging "people die!" claims around

People that die due to government healthcare (Medicaid):

summary from here (http://www.heritage.org/research/healthcare/bg2264.cfm#_ftnref31):
a study published in the Journal of the American College of Cardiology examined outcomes from coronary artery bypass surgery and found that Medicaid status was independently associated with a worse 12-year mortality than for patients with other types of insurance. In fact, Medicaid enrollees had a 54 percent greater 12-year risk-adjusted mortality than patients enrolled in other types of insurance plans.

Original paper:
Operative and Late Coronary Artery Bypass Grafting Outcomes in Matched African-American Versus Caucasian Patients: Evidence of a Late Survival-Medicaid Association
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T18-4H6XKYC-4&_user=3938616&_coverDate=10%2F18%2F2005&_alid=1017029657&_rdoc=1&_fmt=high&_orig=search&_cdi=4884&_docanchor=&view=c&_ct=22&_acct=C000061828&_version=1&_urlVersion=0&_userid=3938616&md5=0d406bdb032a533728bb3618197a4139

[...]
Medicaid status and late CABG [coronary artery bypass surgery] outcomes. Race did not predict CABG outcomes, but Medicaid status, which is more than four-fold more frequent among African Americans, did with a 54% greater 12-year mortality (HR 1.54;p 0.0047)....

[WhoWee]

Watching the debate this week, I think health care reform is moving in the direction of Medicare Advantage programs. That is, Government regulated, mandated, and guaranteed - but privately insured.

This is the CMS rule book.
http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf

[rutherdbrown]

Each and every service has a price.... and in US you can get best service if you are able to pay upto that extent.. Moreover, the one basic benefit for US to provide such facilities is that it has proper economy to buy latest and most advanced technology...

[mheslep]

Yesterday the US President spoke on the latest health care bill from the house, during which he again said (http://www.forbes.com/2009/10/29/health-care-remarks-business-washington-obama.html):
The first thing I want to make clear is that if you're happy with the insurance plan you have right now; if the costs you're paying and the benefits you're getting are what you want them to be--then you can keep offering that same plan. Nobody will make you change it.

But as I read the bill (http://docs.house.gov/rules/health/111_ahcaa.pdf), it appears to have a fairly narrow view of 'keep', if it is possible at all. Under this bill there will only be two approaches allowed: insurance offered under the guidelines of the federally controlled insurance exchange, and existing insurance that is 'grandfathered in', the latter must be that to which the President referred.

To be grandfathered in, the insurance provider is very limited in its ability to change the plan in terms of benefits, conditions , or premiums. Now I know my plan (which I like) changes its benefits more or less every year (adds mental health, adds fertility, etc), bumps its premiums every other year or so. Under these restrictions, I can only imagine the provider would throw up its hands and move on to the exchange, especially given millions will be making moves in the heath market forcing major upheavals in health economics for some time until things stabilize. Likewise, if I have to change jobs then no more existing plan, and I'm on to the exchange.

A more accurate statement about this bill is that it may not immediately throw everyone onto the federal exchange, for a moment it may leave a few alone, but it clearly intends to force everyone on to the federal health exchange as quickly as possible.

Pg 91
1 SEC. 202. PROTECTING THE CHOICE TO KEEP CURRENT
2 COVERAGE.
3 (a) GRANDFATHERED HEALTH INSURANCE COV4
ERAGE DEFINED.—Subject to the succeeding provisions of
5 this section, for purposes of establishing acceptable cov
6 erage under this division, the term ‘‘grandfathered health
7 insurance coverage’’ means individual health insurance
8 coverage that is offered and in force and effect before the
9 first day of Y1 if the following conditions are met:
10 (1) LIMITATION ON NEW ENROLLMENT.—
11 (A) IN GENERAL.—Except as provided in
12 this paragraph, the individual health insurance
13 issuer offering such coverage does not enroll
14 any individual in such coverage if the first ef
15 fective date of coverage is on or after the first
16 day of Y1.
...
21 (2) LIMITATION ON CHANGES IN TERMS OR
22 CONDITIONS.—Subject to paragraph (3) and except
23 as required by law, the issuer does not change any
24 of its terms or conditions, including benefits and
25 cost-sharing, from those in effect as of the day be
26 fore the first day of Y1.

1 (3) RESTRICTIONS ON PREMIUM INCREASES.—
2 The issuer cannot vary the percentage increase in
3 the premium for a risk group of enrollees in specific
4 grandfathered health insurance coverage without
5 changing the premium for all enrollees in the same
6 risk group at the same rate, as specified by the
7 Commissioner.

... [pg 94]

1 (c) LIMITATION ON INDIVIDUAL HEALTH INSURANCE
2 COVERAGE.—
3 (1) IN GENERAL.—Individual health insurance
4 coverage that is not grandfathered health insurance
5 coverage under subsection (a) may only be offered
6 on or after the first day of Y1

[turbo]

Under these restrictions, I can only imagine the provider would throw up its hands and move on to the exchange, especially given millions will be making moves in the heath market forcing major upheavals in health economics for some time until things stabilize.Do you think that the insurance companies will abandon the lucrative insurance industry? Is it possible that they might work to become (gasp!) competitive and stop doubling their premiums every 6 years or so? The breathless predictions of collapse of our health-care system if reform is initiated are getting really tedious. I guess if my father owned Cigna, I could jump on board to protect my villas in southern France and my yachts....

[mheslep]

Do you think that the insurance companies will abandon the lucrative insurance industry? Who said anything about abandoning in the industry? I said they will all be forced on the exchange. Do you have any comment on the validity of the President's statement yesterday?

[WhoWee]

This is one response from the insurance industry. This letter has been forwarded by thousands of agents to members of Congress this week. Please read the entire letter before posting.

"I am a health insurance agent and also a citizen of your district. I am writing to express my objections to a government run insurance program ("public plan") under consideration as part of health reform legislation. I am also very concerned for my customers and the buying public that the proposed legislation does not adequately address the issue of affordability. The bills I have read do very little to nothing to bend the cost curve for either public or private health plans.

The foundation of any effort to improve the health care system must include measures to control the costs of medical care. The current House and Senate legislation has as its primary focus the financing of medical services only (i.e., insurance). Even the public/government plan will make coverage more expensive as providers who are underpaid by the government shift that loss to the private sector insureds. The legislation simply fails to achieve the bipartisan goal of controlling health care costs.

I urge you to oppose the government-run plan and focus instead on reducing costs by instituting medical malpractice reform, eliminating unnecessary medical procedures, simplifying and standardizing administrative processes, focusing on wellness/prevention, and on a variety of other options -- all of which have been discussed at some point in the debate but were never included in the bills.

Although I have heard the rhetoric from many sources, at the "street level", I can tell you there is no way that any insurance company can "compete" with the government payor. Most private insurers do not have the ability to dictate pricing to providers. Maybe the largest 3 or 4 insurers do, and of course the government does. This is a significant advantage for the few, and will cause significant harm to all others. Instead of creating more competition, you are causing less.

Why does the government believe it can run a large health insurance program, and be successful at it? The current federal insurance plan -- Medicare -- has a $38 trillion deficit. And the deficit is at this exorbitant level even with the government paying much less for medical services than private insurers do. If the federal government was regulated the same as a private insurer, it would be placed into liquidation. This current health reform is supposed to be self-sustaining -- Medicare also was supposed to be.

Our government cannot afford to start yet another entitlement program with impossible spending levels. There are simply too many red flags in government run health insurance.

I am asking you to pause and step back for a moment, and remember that there is an enormous amount of necessary and non-controversial reform that could be implemented quickly and without a public plan. Let's begin with that. The economy is in terrible shape. Please work on passing realistic legislation without a government plan. Taxpayers don't need and can't afford that expense. We elect our Congressmen to represent our interests in Washington, not to act irresponsibly and make us fearful about our continuing ability to buy affordable health coverage.

Please do what is right for your constituents, stop spending billions of dollars on measures that have little impact, and take all the time needed to make sure that health care reform is done in the right way."

[Alfi]

Under health insurance reform, we will put an end to the days when an insurance company could use a worker's illness to justify jacking up premiums. We'll crack down on excessive overhead charges by setting strong standards on how much of your premiums can go toward administrative costs and requiring insurers to give you a refund if they violate those standards. It will be against the law for insurance companies to deny you coverage because of a pre-existing condition. And it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most.

They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. If you get your insurance through your employer, we'll change the cutoff on how old your kids can be to remain on your plan--we'll raise it to 26 years old. We'll place a limit on how much you can be charged for out-of-pocket expenses. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies-

In a nutshell, those seem to be the restrictions that will be placed on insurance providers.

There seem to be two issues. The first, addressed above, is Insurance reform. The second, less mentioned, is Health or Care reform. I think these two are being interchanged and confused.

[mheslep]

This is one response from the insurance industry. This letter has been forwarded by thousands of agents to members of Congress this week. Please read the entire letter before posting.Generally speaking: it might facilitate the discussion if you pull out the 2-3 concise points you consider salient; either that, or provide an extraordinary reason for us to read the entire text.

[WhoWee]

Generally speaking: it might facilitate the discussion if you pull out the 2-3 concise points you consider salient; either that, or provide an extraordinary reason for us to read the entire text.

Actually, I think you've just highlighted the main problem with the debate. Everyone wants 2 - 3 talking points and an avoidance of the details.

[mheslep]

No, OR provide the reason to read all the detail you provided. WhoWee millions of people write letters to Congress. We can't all read everything. Some context and and background is required to pick and choose what to read. Why is your page important? Why is it believable?

[Al68]

Actually, I think you've just highlighted the main problem with the debate. Everyone wants 2 - 3 talking points and an avoidance of the details.As someone who has read the details of the current proposal, I have to agree with mheslep. A good way to keep people from reading a post is to make it long.

It's the long posts that are avoided, not important details, and in the absence of a particular reason to believe a longer post is important, most of us just assume that it's an inefficient use of time to read it.

That being said, the letter you posted was worth reading, so it was an exception to the rule.

[Al68]

In a nutshell, those seem to be the restrictions that will be placed on insurance providers.And consumers. Those "restrictions" are placed on all of us. We will be "restricted" to either buying an expensive comprehensive health care plan that meets the new standards, or nothing at all.

It's not like those "Cadillac" policies aren't already available, we just aren't forced to buy them yet.

[Alfi]

From the Insurance agent's letter
Although I have heard the rhetoric from many sources, at the "street level", I can tell you there is no way that any insurance company can "compete" with the government payor. Do they compete without the restrictions that are proposed?
Would the restrictions alone work without a 'government payor'?
Street level knowledge might be questionable.

[WhoWee]

No, OR provide the reason to read all the detail you provided. WhoWee millions of people right letters to Congress. We can't all read everything. Some context and and background is required to pick and choose what to read. Why is your page important? Why is it believable?

This letter was written by the CEO of a large insurance company and made available to the agent network to send to their respective political representatives. My intent was to make a factual post, rather than pick and choose from the content.

If you really want to know my personal thoughts, please read the next few lines. Health care reform is needed. Any solution based upon the Medicare model is a mistake. An exhaustive review of the system - using a problem solving technique (scientific method) is needed before any additional legislation is enacted.

[mihna]

I find it fascinating that the proponents of maintaining the status quo choose to ignore the WHO's ranking of our medical system in favor of theoretical arguments against socialism, gov't bureaucracy and anecdotal reports of long que times in Canada.

I think that in itself is quite telling.

[WhoWee]

I find it fascinating that the proponents of maintaining the status quo choose to ignore the WHO's ranking of our medical system in favor of theoretical arguments against socialism, gov't bureaucracy and anecdotal reports of long que times in Canada.

I think that in itself is quite telling.

Welcome to PF.

Can you please elaborate?

[Al68]

I find it fascinating that the proponents of maintaining the status quo choose to ignore the WHO's ranking of our medical system in favor of theoretical arguments against socialism, gov't bureaucracy and anecdotal reports of long que times in Canada.

I think that in itself is quite telling.I think it's quite telling that you think opponents of the current proposals are "proponents of maintaining the status quo".

Do you have something to contribute other than snide comments?