News The US has the best health care in the world?

[Evo]

I'd like to go with something like this:
http://www.heritage.org/research/healthcare/bg2198.cfm

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.

 

[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 also

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.

 

[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 start

Part 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/...d=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 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.

 

[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.

 

[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.