Assuming Affordable Care Act Is Shot Down, Should There Be a Healthcare Hospital Tax?

[WhoWee]

I did so. It's not my fault that you have an idealogical resistance to the support.

You quoted from a website labeled (PNHP) "Physicians for a National Health Program" and I "have an idealogical resistance"?

Please support their "facts" - I don't see their source anywhere - do you?

 

[russ_watters]

Here's a rebuttal of turbo-1's myth (these are easy to find): http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf

The cost of collecting the insurance "premiums" (taxes) isn't included in that 3%. The real overhead fraction is much higher, but very difficult to calculate because government accounting isn't transparent, whereas private insurance company accounting is (ironic).

It also, of course, doesn't speak to the effect of competition on the cost of the care itself. Overhead fraction is misleading if the cost of care isn't identical.

 

[WhoWee]

Here's a rebuttal of turbo-1's myth (these are easy to find): http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf

The cost of collecting the insurance "premiums" (taxes) isn't included in that 3%. The real overhead fraction is much higher, but very difficult to calculate because government accounting isn't transparent, whereas private insurance company accounting is (ironic).

Great find Russ! Again, the same failed arguments seem to be made every time one of these healthcare threads begins - nothing new.

 

[russ_watters]

There are some things that governments can do more efficiently than smaller entities. Providing for common defense, public education, roads, rails, etc. Economies of scale factor in. [emphasis added]

As a conservative and a believer in freedom and it's mirror personal responsibility, I believe that the government should provide only those services that the public can't provide for themselves.

 

[turbo]

Great find Russ! Again, the same failed arguments seem to be made every time one of these healthcare threads begins - nothing new.

Think that Russ' source is honest and unbiased?

http://www.sourcewatch.org/index.php?title=Council_for_Affordable_Health_Insurance

 

[Antiphon]

Russ, good point but let's sharpen the definition so the leftists can't pull a fast one.

It should provide only those services that the public can't, even in principle, provide for themselves.

No individual can, even in principle, build the interstate highway system.

The leftists will try to twist your words into the following pretzel: "Well, there are lots of poor who can't afford health insurance. They can't provide it for themselves, so everyone else should be forced to do it for them."

 

[WhoWee]

Think that Russ' source is honest and unbiased?

http://www.sourcewatch.org/index.php?title=Council_for_Affordable_Health_Insurance

Have you found support for YOUR post yet?

 

[Gokul43201]

Russ, good point but let's sharpen the definition so the leftists can't pull a fast one.

It should provide only those services that the public can't, even in principle, provide for themselves.

No individual can, even in principle, build the interstate highway system.

But individuals can certainly travel without it (and did).

Try this: no individual can, even in principle, create a government healthcare system.

 

[ParticleGrl]

As a conservative and a believer in freedom and it's mirror personal responsibility, I believe that the government should provide only those services that the public can't provide for themselves.

You need to define can't in this context. Certainly anything that the government provides, a private sector COULD provide.

The question is more desirability. Is it desirable to have large, private armies on American soil? Probably not so much. Hence, a public army.

Could private companies provide police and jail services? Yes, but its the potential for abuse is pretty high (not that the current system is perfect). Hence, public police,courts, jails.

So how do you draw the line on what's desirable? If it could be shown that the government could provide the same (or better) health care at a lower price, should we go with a government health care problem? Or should our ideology direct us to spend more money?

 

[Vanadium 50]

It also, of course, doesn't speak to the effect of competition on the cost of the care itself. Overhead fraction is misleading if the cost of care isn't identical.

That is, in fact, the larger effect. Administrative dollars per patient are slightly larger in dollars per person (an average of around 20%, but with large year-to-year fluctuations - nevertheless, private insurance is uniformly cheaper) for Medicare than for private insurance. But costs for direct patient care are ~3x larger for Medicare, so as a fraction of total expenditures, this number is smaller.

My personal view is that neither the Right nor the Left is using the proper number - and they both just happen to pick a number that makes their case look best. You have two kinds of costs - costs that (on average) scale per patient, and costs that (again, on average) scale per procedure. You need to model that before making any comparisons between programs with such widely different patient cohorts.

There is also the additional complication of the overhead that is involved in monitoring fraud. In 1995 (the latest number I have found) private companies investigated 42,950 cases. This year, the equivalent number for Medicare is 867. Reducing fraud reduces the amount paid out, and increases the overhead (because you have to pay someone to find it), and thus makes the outfit attempting to reduce fraud appear less efficient in the ratio.

 

[WhoWee]

That is, in fact, the larger effect. Administrative dollars per patient are slightly larger in dollars per person (an average of around 20%, but with large year-to-year fluctuations - nevertheless, private insurance is uniformly cheaper) for Medicare than for private insurance. But costs for direct patient care are ~3x larger for Medicare, so as a fraction of total expenditures, this number is smaller.

My personal view is that neither the Right nor the Left is using the proper number - and they both just happen to pick a number that makes their case look best. You have two kinds of costs - costs that (on average) scale per patient, and costs that (again, on average) scale per procedure. You need to model that before making any comparisons between programs with such widely different patient cohorts.

There is also the additional complication of the overhead that is involved in monitoring fraud. In 1995 (the latest number I have found) private companies investigated 42,950 cases. This year, the equivalent number for Medicare is 867. Reducing fraud reduces the amount paid out, and increases the overhead (because you have to pay someone to find it), and thus makes the outfit attempting to reduce fraud appear less efficient in the ratio.

Part of the problem is the administrative, regulative, and compliance burden placed onto (and in some cases transferred to) the insurance industry by CMS.

 

[russ_watters]

Think that Russ' source is honest and unbiased?

http://www.sourcewatch.org/index.php?title=Council_for_Affordable_Health_Insurance

Oh dear lord, turbo! Even your link criticising the bias of my link has an adjenda:

The Center for Media and Democracy (CMD) publishes SourceWatch, this collaborative, specialized encyclopedia of the people, organizations, and issues shaping the public agenda. SourceWatch profiles the activities of front groups, PR spinners, industry-friendly experts, industry-funded organizations, and think tanks trying to manipulate public opinion on behalf of corporations or government.

They don't even list your special interest group.

So please, cut the crap and attempted burden-of-proof shifting. Both your link and my link include facts that are easy to understand and judge. There is no need to read the opinions of either much less attack either. The facts are the facts and the context behind them is clear.

 

[russ_watters]

But individuals can certainly travel without it (and did).

Yes, and...?

Try this: no individual can, even in principle, create a government healthcare system.

That's a pointless tautology.

 

[russ_watters]

You need to define can't in this context. Certainly anything that the government provides, a private sector COULD provide.

That's not really true. Roads and a military are a good example of things that simply can't be done privately. Recently, we've seen examples of failure of communities offering private fire departments. We're getting down to real basics here: this is essentially the whole point of government! We've recently lost touch with that with the emergence of the idea of the welfare state.

Some of the reasons:
1. Funding. If you make things like a fire department private, people won't fund it. We saw this recently with the case where a fire department sat by and watched a guys's house burn down because he wasn't paying the monthly fee.
2. Roads provide a host of problems: standardization/consistency, eminent domain. There is just no way that large-scale private roads could be made and actually be functional.
3. Control and effectiveness. Who runs all the private militaries and how could they possibly provide protection for a single state?

The question is more desirability. Is it desirable to have large, private armies on American soil? Probably not so much. Hence, a public army.

No. That's just plain not accurate. Private armies on a national scale would not be able to function. They must be under the control of the federal government or the federal government ceases to be the federal government!

Could private companies provide police and jail services? Yes, but its the potential for abuse is pretty high (not that the current system is perfect). Hence, public police,courts, jails.

...um...so in other words, they would be pretty much non-functional?

So how do you draw the line on what's desirable? If it could be shown that the government could provide the same (or better) health care at a lower price, should we go with a government health care problem? Or should our ideology direct us to spend more money?

Since there is an ocean of difference between 'could government provide the same or better' and the other examples which would be vastly worse to the point of being non-functional, it isn't a fair comparison. Again, with the inception of the welfare state in the 20th century, many people have become comfortable with the idea that government provivde everything for them, even if it could be done privately (or worse, provided by themselves!).

Believing that if the government can, it should, is forgetting history.

 

[Gokul43201]

Yes, and...?
That's a pointless tautology.

As is the one I was responding to. And ... that was the point of my response.

 

[russ_watters]

As is the one I was responding to. And ... that was the point of my response.

Well I'm glad we're in agreement about what you said, but what I (and Antiphoton) said was most certainly neither a tautology, nor pointless.

You're trying to obfuscate a concept that is both real and clear.

Heck, Gokul, you (and particlegirl) are basically arguing that anarchy would work fine, therefore we should have government provide us with everything. It's not just wrong, it's nonsensical.

 

[russ_watters]

Russ, good point but let's sharpen the definition so the leftists can't pull a fast one.

It should provide only those services that the public can't, even in principle, provide for themselves.

No individual can, even in principle, build the interstate highway system.

The leftists will try to twist your words into the following pretzel: "Well, there are lots of poor who can't afford health insurance. They can't provide it for themselves, so everyone else should be forced to do it for them."

I didn't at first see the difference between what you said and what I said, but I do now...

Yes, you are correct that the "even in principle" part is critical. This should be obvious given the two-sided coin I mentioned before of personal freedom and personal responsibility (which is why I overlooked it), but people just aren't thinking that way anymore. We've gone so far beyond "even in principle" though, with now 47% of tax filers paying no federal income tax and thus not contributing to the cost of the associated federally provided services. People don't even have to fail or choose not to provide for themselves - we're not even asking them to anymore.

 

[Gokul43201]

It is as much a tautology that a public individual can not build The Interstate System as it is a tautology that a public individual can not exert governmental control over healthcare.

My argument is farther to the right than yours - I'm saying that private roadways are not, in principle, impossible.

 

[russ_watters]

It is as much a tautology that a public individual can not build The Interstate System as it is a tautology that a public individual can not exert governmental control over healthcare.

It most certainly is not. Yours was a tautology because you included the word "government" in it. You made yours logically impossible - you made it self-contradictory by its very wording. A privately-run state road/interstate system is functionally impossible. Meaning that people could try it, but it wouldn't work.

This isn't a word-game, Gokul.

My argument is farther to the right than yours - I'm saying that private roadways are not, in principle, impossible.

You haven't made any arguments yet! This is the first I've seen of a point from you! So: why do you believe that private roadways are possible? And please, don't make this about small-scale communities. I live in such a community and my 1/4 mile road is privately-owned and works fine. This isn't about that.

Governments need to build and maintain roads because private companies wouldn't build roads where/how they are needed, they'd build them where/how they could make the most money. So people in rural areas would suffer, maintenance and quality would suffer, etc. The need for government control of roads is exactly the same as the need for government control of the power grid. Even as private companies own the wires, they are essentially just government contractors at that. People in rural areas would still not have electricity today if the government didn't require it.

 

[Gokul43201]

It most certainly is not. Yours was a tautology because you included the word "government" in it. You made yours logically impossible - you made it self-contradictory by its very wording.

Antiphon made his logically impossible by his choice of words: The Interstate System. The existing interstate system could not, even in principle, be operated privately (it goes through government owned and protected lands, etc).

A privately-run state road/interstate system is functionally impossible. Meaning that people could try it, but it wouldn't work.

That's your contention, and might very well be true. But it's also a slightly different choice of words than antiphon used.

This isn't a word-game, Gokul.

It's not a word game - maybe a nitpick, if you wish.

You haven't made any arguments yet!

I didn't wish to. Pointing out an error in an existing argument is not against forum rules.

This is the first I've seen of a point from you! So: why do you believe that private roadways are possible?

I didn't think the clarification was necessary to understand what I was saying. And at that point I had no intention of going further - didn't have the time for it either, but I've burned that bridge now.

To answer your question: In many parts of Asia (probably in the US too), plenty of roadways are born privately, and operated privately until they recoup construction costs and then the government takes over ownership. Italy has thousands of miles of private highways. There are probably many more such countries that I'm unaware of. I suspect you will find better arguments in the wiki page on "free market roads" than you will from anything I write here.

And please, don't make this about small-scale communities. I live in such a community and my 1/4 mile road is privately-owned and works fine. This isn't about that.

It's not.

Governments need to build and maintain roads because private companies wouldn't build roads where/how they are needed, they'd build them where/how they could make the most money. So people in rural areas would suffer, maintenance and quality would suffer, etc. The need for government control of roads is exactly the same as the need for government control of the power grid. Even as private companies own the wires, they are essentially just government contractors at that. People in rural areas would still not have electricity today if the government didn't require it.

I don't object to the government providing a road system in areas where private industry will not (were that to become necessary). But the present interstate system clearly does a lot more than just that. I'm also not in opposition to a government system to provide for heath assistance in situations where private industry will not. Clearly, I think, a system of Universal Healthcare does a lot more than just that.

This is about all the time I have today. I hope I've made my arguments abundantly clear. You may disagree with them, but that would be an improvement.

 

[ParticleGrl]

We've gone so far beyond "even in principle" though, with now 47% of tax filers paying no federal income tax and thus not contributing to the cost of the associated federally provided services.

This is bad reasoning- there are more forms of federal taxation than income tax (payroll tax, for one, which is somewhat regressive).

That's not really true. Roads and a military are a good example of things that simply can't be done privately.

Thats not true- private military contractors (mercenaries) exist, and it is certainly possible for the federal government to hire a private sector military contracting company. This is being done to supplement forces in Iraq/Afghanistan, and we COULD if we wanted, disband our military and hire it out to private sector contractors. It is NOT true that it can't be done privately. Its not a good idea, but its not impossible.

Governments need to build and maintain roads because private companies wouldn't build roads where/how they are needed, they'd build them where/how they could make the most money. So people in rural areas would suffer, maintenance and quality would suffer, etc.

Here your argument is NOT that its impossible for the private sector to build roads. Your argument is that the government is BETTER at providing roads.

If the government were better at providing health insurance (I'm not saying they are, just postulating the IF), than why not have the government provide health insurance?

The same argument you are making for roads could be made for risk pools/insurance. Private companies would only take the least risky people, leaving people with genetic illness (or bad family histories of such illness) to suffer, the elderly would suffer, etc. There is no profit in insuring risky people, just like there isn't much profit in rural roads or electricity.

 

[Astronuc]

It most certainly is not. Yours was a tautology because you included the word "government" in it. You made yours logically impossible - you made it self-contradictory by its very wording. A privately-run state road/interstate system is functionally impossible. Meaning that people could try it, but it wouldn't work.

This isn't a word-game, Gokul. You haven't made any arguments yet! This is the first I've seen of a point from you! So: why do you believe that private roadways are possible? And please, don't make this about small-scale communities. I live in such a community and my 1/4 mile road is privately-owned and works fine. This isn't about that.

Governments need to build and maintain roads because private companies wouldn't build roads where/how they are needed, they'd build them where/how they could make the most money. So people in rural areas would suffer, maintenance and quality would suffer, etc. The need for government control of roads is exactly the same as the need for government control of the power grid. Even as private companies own the wires, they are essentially just government contractors at that. People in rural areas would still not have electricity today if the government didn't require it.

Private roads/highways would be difficult now at the scale that is required.

However, historically, private tolls roads did exist.
http://en.wikipedia.org/wiki/Philadelphia_and_Lancaster_Turnpike

It was the first turnpike of importance, and because the Commonwealth of Pennsylvania could not afford to pay for its construction, it was privately built by the Philadelphia and Lancaster Turnpike Road Company.

http://explorepahistory.com/hmarker.php?markerId=1-A-F3

http://en.wikipedia.org/wiki/First_Great_Western_Turnpike#Origins

http://eh.net/encyclopedia/article/klein.majewski.turnpikes

Private turnpikes were business corporations that built and maintained a road for the right to collect fees from travelers. Accounts of the nineteenth-century transportation revolution often treat turnpikes as merely a prelude to more important improvements such as canals and railroads. Turnpikes, however, left important social and political imprints on the communities that debated and supported them. Although turnpikes rarely paid dividends or other forms of direct profit, they nevertheless attracted enough capital to expand both the coverage and quality of the U. S. road system. Turnpikes demonstrated how nineteenth-century Americans integrated elements of the modern corporation – with its emphasis on profit-taking residual claimants – with non-pecuniary motivations such as use and esteem.

Private road building came and went in waves throughout the nineteenth century and across the country, with between 2,500 and 3,200 companies successfully financing, building, and operating their toll road. There were three especially important episodes of toll road construction: the turnpike era of the eastern states 1792 to 1845; the plank road boom 1847 to 1853; and the toll road of the far West 1850 to 1902.
. . . .

There were also privately chartered canal companies and railroads, and some toll roads could not compete with railroads and canals.

As for private armies - a more recent event.
http://www.nytimes.com/2011/05/15/world/middleeast/15prince.html

. . . . In fact, they were soldiers for a secret American-led mercenary army being built by Erik Prince, the billionaire founder of Blackwater Worldwide, with $529 million from the oil-soaked sheikdom.
. . .

Ostensibly, if one has the monetary resources, then a private military is feasible.

When the Santa Fe Railroad and the Denver and Rio Grande Western were competing over the Royal Gorge, both railroads hired private armies to battle it out. Federal intervention was required to end the fighting.

Labor conflicts in Pennsylvania’s coal mines and steel mills during the nineteenth and early-twentieth centuries were usually violent. In order to insure that they had the upper hand and to avoid relying on local police (who were sometimes sympathetic to strikers), mine and mill operators set up their own “Coal and Iron Police” as early as the 1870s. Public reaction against these private armies led the Pennsylvania legislature to create a Department of State Police as an ostensibly more neutral and highly-trained law enforcement body. But the cure turned out to be worse than the disease. In the 1910 strike at Bethlehem Steel, the state police proved to be as pro-management as the Coal and Iron Police and even more brutal. The following testimony from workers and labor leaders appearing before the U.S. Commission on Industrial Relations in 1915 underscored the anger and discontent of common laborers with the military mindset of the newly formed Pennsylvania State Police.

http://historymatters.gmu.edu/d/5661/

 

[Vanadium 50]

This is bad reasoning- there are more forms of federal taxation than income tax (payroll tax, for one, which is somewhat regressive).

Yes, but of majority of people who pay no income tax (according to the IRS, for 2009, it is now 51% of filers), a majority of them (60%) receive a refundable credit. For many of them, this will balance FICA.

 

[ParticleGrl]

Yes, but of majority of people who pay no income tax (according to the IRS, for 2009, it is now 51% of filers), a majority of them (60%) receive a refundable credit. For many of them, this will balance FICA.

I can't find a specific breakdown of credits vs. FICA (the best I can find includes state taxes and sales tax). If we include payroll and credits, roughly how many people pay no federal tax?

 

[Vanadium 50]

I don't think that information exists, as they are two separate taxes that go through two completely separate chains - i.e. you don't calculate FICA on your 1040. Someone in the IRS would have to get this by matching 1040's and W-2's. Not a small job.

What we do know is that 30% of tax filers have a refundable credit.

So here's the approximate breakdown:

• 30% pays negative income taxes.
• The next 20% pays no income tax.
• the next 40% pays half the income tax.
• The last 10% pays the other half.

 

[mege]

... Unfortunately, the big insurance companies are pricing regular people out of the market.

... but there may be some morons in our government who actually believe that keeping health-insurance companies fat is good for our economy.

Why are the insurance companies, pharm companies and other for profit medical industries for the ACA?

BCBS and a few other smaller NFP insurers have come out and said they don't think it's sustainable without major infrastructure changes.

What I don't ultimately get in the ACA is: if our current health insurance system is so bad and broken, why are we forcing the rest of the country to join in on it with little fundamental change? (except now the government is acting as the broker for everything - in a loose sense)

 

[WhoWee]

Why are the insurance companies, pharm companies and other for profit medical industries for the ACA?

BCBS and a few other smaller NFP insurers have come out and said they don't think it's sustainable without major infrastructure changes.

What I don't ultimately get in the ACA is: if our current health insurance system is so bad and broken, why are we forcing the rest of the country to join in on it with little fundamental change? (except now the government is acting as the broker for everything - in a loose sense)

Control/power?

 

[WhoWee]

Fox News just reported 20% of April Health Care Waivers went to Nancy Pelosi's Congressional District.
http://nation.foxnews.com/nancy-pelosi/2011/05/17/pelosi-caught-hand-obamacare-waiver-cookie-jar
"Pelosi Caught With Hand in Obamacare Waiver Cookie Jar "

 

[WhoWee]

Fox News just reported 20% of April Health Care Waivers went to Nancy Pelosi's Congressional District.
http://nation.foxnews.com/nancy-pelosi/2011/05/17/pelosi-caught-hand-obamacare-waiver-cookie-jar
"Pelosi Caught With Hand in Obamacare Waiver Cookie Jar "

I guess people in her District finally read the legislation - now they know what's in it?

 

[Ryumast3r]

Why are the insurance companies, pharm companies and other for profit medical industries for the ACA?

BCBS and a few other smaller NFP insurers have come out and said they don't think it's sustainable without major infrastructure changes.

What I don't ultimately get in the ACA is: if our current health insurance system is so bad and broken, why are we forcing the rest of the country to join in on it with little fundamental change? (except now the government is acting as the broker for everything - in a loose sense)

They tried to get those fundamental changes in, but didn't have the support (no I'm not talking about JUST the government option, which, honestly, I don't see as all that bad since France has only government options and they rate pretty high in healthcare, but that's a different debate), so they went with the "let's get everyone on to insurance and see what we're able to come up with down the road" plan.