News Republicans' Plan to Repeal Healthcare?

[adrenaline]

adrenaline, is retirement an option in your situation?

No, I love what I do. Even though I have paid my student loans, I practice internal medicine in an area where there are so few of us left ( we have nine doctors who take call at the hospital for 45 docs who won't come to the hospital anymore ) that there would be a critical shortage of care if I retired. We see all the unsassigned , indigent patients and other docs patients along with ours that it is getting to be a nightmare but the situation is not getting better as more students owing half a million are going into lucrative interventional radiology, dermatology etc.

 

[turbo]

Your right, I tell people medicare pays me less but i probably spend 3 dollars for every 100 dollars i collect on clerical work and probably spend 33 dollars for every 100 i collect from private insurance. Most of us polled want single payer ( NEJM, JAMA) poll after poll shows most docs will take less payment just to deal with a more streamlined , consistent, single payer than the beurocratic garbage we have to deal with now.

That's something that the GOP and the blue-dogs don't want to happen for some reason. Health care costs could drop like a rock with a single payer system because medical practice overhead would plummet. Also, if you had a single coding guide-book and coding standard to deal with, not only would your administrative staff be much smaller, you wouldn't have to pay to re-educate them over and over as insurance companies come up with new ways to deny payment. Getting regular payments on claims (even at reduced reimbursement rates) would be a boon to private practices. As you might imagine, advances in ocular surgeries often come with some very $$$$ equipment. If you'd like to add new surgical laser to a new field office (we did!) your line of credit with the bank had better be healthy. That can be tough when you have receivables that are aged 2-3 months or more because the insurance companies deny and delay, and make you recode and re-submit. Meanwhile those insurance companies are investing that "float" and making money at the expense of medical practitioners.

This bill should have radically reformed health-care insurance. It did not. The health-care system in this country is struggling under the weight of massive bureaucracy imposed by the insurance companies, who often have regional monopolies. Progressives and true fiscal conservatives should join with willing members of Congress and keep fighting for a single-payer option. If the private insurers can't or won't compete, then they should get out of the business. The bill as passed is a boon to the insurance companies who get millions of new customers, many of them healthy, without reducing rates.

 

[adrenaline]

the PHNP says we will save 400 billion a year if we go single payer.
I opt for single payer with privatized secondary insurance.

 

[turbo]

the PHNP says we will save 400 billion a year if we go single payer.
I opt for single payer with privatized secondary insurance.

That would be ideal. Let every citizen buy into Medicare, and the younger, healthier people would reduce the experience rate of the older members. That would immediately reduce the payout per patient, and save Medicare some really big money, while keeping it solvent. If you want private insurance instead of or in addition to the public coverage, you buy it.

Somehow, the fiscally-attractive options to the status-quo are not seriously considered on the Hill. If we follow lobbyists' money, I'm pretty sure we'll know why. Congress' constituency only includes us when they want our votes, and after the election, they do the bidding of the men with the money.

 

[mheslep]

I know I linked to this in another thread, but it fit here too. http://www.frumforum.com/waterloo".

That part of Frum's essay I think is a silly strawman. What would be proposed is a replacement bill, not a go-back-to-the-way-it-was repeal.

 

[adrenaline]

Somehow, the fiscally-attractive options to the status-quo are not seriously considered on the Hill. If we follow lobbyists' money, I'm pretty sure we'll know why.

I believe the insurance lobby is the second most powerful, both dems and repubs have their pockets lined by them. That's why no public option and instead federally funded 30 million new clients for the insurance industry in the exchange. Oh Obama, you were pro single payer as a senator, now you kow tow to the industry, you let me down...

 

[mheslep]

Can the law be overturned some other way? There are two - one is that the law needs to survive a court challenge. I think it will, after Wickard v. Fillburn, but one can never tell.

W v F was a stretch it was, and this health mandate is different in that the health consumer is just that - a consumer not producing any saleable product unlike that wheat farmer. There are constitution limits on what the government can mandate. To make this law fly, the Dem's would have had to offer up some kind of rule that strikes a balance, that is maintains a balance, between the government's commerce regulation authority and the citizen's right to otherwise be left alone. Instead, their argument is that we need the mandate to make health care pay off, health care is a good thing, therefore the mandate is legal, which amounts to little more than the 'we want it that way' legal argument. If their logic holds, some examples of where the government can go next on the same basis:

• As it is in the national interest to have a large domestic auto manufacturing capability, IF you buy a car, it shall be a GM made car, unless you reside in Nebraska, Florida, Louisiana, or Montana.
• As it is in the national interest to have a well informed citizenry, you shall purchase a daily newspaper. Qualifying newspapers will be listed on a national exchange.
• As it is in the national interest to promote science and engineering education, all graduates of science or engineering academic programs or those with long work experience in these fields shall purchase a two year subscription to Physics Forums.

Edit: Here's the summary position of the Florida AG's suit:

Florida’s lawsuit will make three claims: that Congress lacks the authority to require individuals to buy health insurance; that the penalty for those who do not buy health insurance violates the U.S. Constitution’s tax-apportionment clause; and that the legislation violates the 10th Amendment by granting the federal government new powers.

http://blogs.wsj.com/law/2010/03/23/back-to-tallahassee-health-bill-suit-starts-taking-shape/

 

[mheslep]

Do you have a reference for an estimate of the risk? The CBO has released estimates projecting decreases in the deficit over the next 10 years.

See cost estimates: http://www.cbo.gov/publications/collections/health.cfmhttp://www.cbo.gov/publications/collections/health.cfm

Here's the right link, I think, for what you intended:
http://www.cbo.gov/publications/collections/health.cfm

The question is for what did CBO release a projection? The current reconciliation bill http://www.cbo.gov/doc.cfm?index=11376&type=1" Yes, that's the number, but is that 'health care'? Well for the first four years it is all taxes and no/little benefits, so I'd say no in that respect it is not 'health care'. Then there are other kitchen sink items thrown into 4872 such as the student loan program to make the bill's $numbers look better, but student loans are not health care either.

In any case, the actual health care part seems to have an total price tag of about $1 trillion over ten years. The bill pays for that with about $500B in new taxes, and by $500B in cuts to Medicare, both also over 10 years, without a corresponding change to Medicare's obligations. The problem of course as shown in the CBO main link that http://www.cbo.gov/publications/collections/graphics/health3.gif" . I see no way out of the US defaulting on Medicare obligations with current policy.

 

[mheslep]

This bill does nothing to prevent my carrier from raising premiums 178% like it has over the ten years I have been partner.

Not so. The bill has many provisions that theoretically allow the government to reject any insurer rates it doesn't like, though that doesn't mean the government will do so. I expect the decision will be completely political, just as are current utility rates.

Information about Insurance Plan Expenditures, and a Rebate to Assure Value
o Each year, insurers will report the percentage of Americans’ premiums they spend on items other than health care costs, such as bureaucracy, marketing, or executive compensation.
o Americans will receive a rebate if their health insurer’s non-medical costs exceed 15 percent of premium costs in the group market or 20 percent in the small group and individual market. Using cost data from this year, rebates will begin in 2011 and the policy applies to all insurance plans.
[...]
Protection from Exorbitant Out-of-Pocket Costs
o Insurance companies will abide by yearly caps on what they may charge beneficiaries for out-of-pocket expenses, like co-payments or co-insurance charges. This will ensure that Americans are not forced to file bankruptcy due to high health care costs.
 Notification and Justification of Premium Increases
o Insurers will be required to publicly disclose the amount of any premium increase prior to the increase taking effect, and to provide a justification for the increase. This will limit the industry’s current practice of hiking up insurance rates in order to push less healthy individuals and small businesses off their rolls.

http://dpc.senate.gov/healthreformbill/healthbill54.pdf

 

[mheslep]

Also, I have always felt it was unfair that I have to pay more in premiums just becau se my employees are predominantly female.

That's also gone. The only justifications now allowed for rate differential are age, family composition, geography, and tobacco. Period.

 

[adrenaline]

That's also gone. The only justifications now allowed for rate differential are age, family composition, geography, and tobacco. Period.

But not right away.
I read that the insurance exchange would prohibit the sale of policies that discriminate on the basis of gender, this ban would not apply to companies with more than 100 employees until 2017.
It almost sounds as if it is only for insurance offered on the insurance exchange? Or am I misreading it?

 

[mheslep]

But not right away.
I read that the insurance exchange would prohibit the sale of policies that discriminate on the basis of gender, this ban would not apply to companies with more than 100 employees until 2017.
It almost sounds as if it is only for insurance offered on the insurance exchange? Or am I misreading it?

hmm, dunno, I missed that caveat. It may be exchange insurance only.

 

[adrenaline]

Not so. The bill has many provisions that theoretically allow the government to reject any insurer rates it doesn't like, though that doesn't mean the government will do so. I expect the decision will be completely political, just as are current utility rates.http://dpc.senate.gov/healthreformbill/healthbill54.pdf

That is the problem, I don't trust the government to look out for me as a small business. What might be low insurance rate hike for a interventional radiologist with less overhead and less clerical personell is exponentially higher for primary care operating on razor thin profit margins.

 

[mheslep]

That is the problem, I don't trust the government to look out for me as a small business. What might be low insurance rate hike for a interventional radiologist is exponentially higher for primary care operating on razor thin profit margins.

Neither do I. But then why on Earth would you favor single payer which entirely cedes all financial health care authority to the government?

 

[turbo]

Neither do I. But then why on Earth would you favor single payer which entirely cedes all financial health care authority to the government?

Go back to post #50 and read an exchange of information from people who have been intimately involved in the business-aspects of private medical practices.

If you get your information from politicians, lobbyists, and talking-heads, you will be sadly misinformed. I have spent years in the business, as has adrenaline, and we know what economic forces have the most leverage on medical practices. Sadly, health-care reform was turned into a political football, with no rational discourse regarding the economic advantages of single-payer systems.

 

[adrenaline]

Neither do I. But then why on Earth would you favor single payer which entirely cedes all financial health care authority to the government?

probably because i have had less problems with medicare than most , but not all, private insurances.

And, I want to be back in the business of being a doctor, right now, running a business with a majority of employees in the non medical field, thinking up ways to keep our business solvent, yet needing so many personell to check insurances to figure out where I can run the labs ( quest vs labcorp vs inhouse labs), where to send for MRI, will their insurance pay for open MRI down the street, hiring extra MAs just to do precerts, prior auths etc. it takes the joy out of medicine. I am most at home just changing vent settings in the ICU or putting a chest tube in a collapsed lung, not listining to my office manager tell me how I have to code better, how to keep track of drug formulaies, listining to phone calls telling me I have to change a drug prescription because it used to be on the formulay but now it's not etc. At least with Medicare, I deal with one single set of rules and regulations. And honestly, I've never had to deal with a gum popping knucklehead begging them for an MRI in a person with a fever of 102 and loss of anal wink ( since I suspect spinal abscess) and telling me it will be another four hours before they can give me the approval.

It is all the above that a majority of us favor single payer.

Don't get me wrong, there are private insurances that are a joy to deal with but it is far and few between.

 

[turbo]

Don't get me wrong, there are private insurances that are a joy to deal with but it is far and few between.

Whatever insurance company covers Maine teachers was pretty darned good. One of my oldest, dearest friends was deeply in love with a teacher, and when he noticed her dropping parts of her daily routines (like laying out clothes for the next school day), he talked to her sister, and they got her checked out. Glioblastoma. Generally a death-sentence with a 6 month term or less. The insurance company paid for tests, re-tests, surgery, radiation, etc... Linda lasted over a year, and though she had her ups and downs, we got to visit with her at home, take her soups and stews, home-made breads, etc. Her insurance company didn't drop her, restrict treatment, etc.

 

[jbunniii]

I know I linked to this in another thread, but it fit here too. http://www.frumforum.com/waterloo".

That's a pretty amazing essay. It illustrates the mindset of a political strategist, who might be the only species on Earth who could write both of these things regarding the same bill:

"Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.

It’s hard to exaggerate the magnitude of the disaster."

and

"But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994."

So the plan is more or less what their own party wanted in 1993-1994, but its passage is now a disaster? Why is it a disaster? Because their party chose to oppose it so militantly and it passed anyway? Well, whose fault is that?

And WHY did they choose to oppose it so militantly if they actually agreed with most of its tenets? Why didn't they negotiate and compromise like grown-ups do, particularly grown-ups who are in the minority party? They could have steered the bill to align it even more closely with their interests, and then they could declare a victory not only for their conservative principles but also their bipartisan ethos.

Instead they held their breath until they turned blue like big ol' babies. No wonder so many people consider our political system to be completely broken.

 

[Nebula815]

I suggest you look up the CBO report on the legislation that was passed, and they will put out another report on the amendments once they make their way through the Senate.

Like I said, the CBO is wrong; there is just no way they can accurately calculate something like this.

Do you have any links to support your claim that the CBO is wrong?

You don't need any official links for that one. It is basic common sense. They double-count Medicare, and furthermore, there is no example of any government healthcare program paying for itself that this nation has created. Even in Europe, many of the programs are heavily in debt, like France, they are having to ration within the UK, etc...

Just because the CBO says something will work doesn't mean it will, you might as well have meteorologists trying to predict the weather years from now.

The CBO has to rely on a lot of assumptions, regarding economic growth, that there won't be any big recessions further in the future, etc...

Like I've said before, it is the policy equivalent of engineering a brand-new jumbo jet, and then rather than build a few prototypes and test them, you just have a group of the best engineers analyze all the parts, the whole design, and "calculate" whether the plane will fly or not.

Well they can compute and calculate till the cows come home, you don't put the aircraft into production until you actually build a few versions and start flying them to see how all the parts function together.

But we are doing the policy equivalent of just this, engineer the jumbo jet then throw it into production. Sure, theoretically it will fly, reality is a whole different ballgame!

And thus far, the previous jets we have put into production have all crashed, or are headed towards crash.

 

[Nebula815]

And WHY did they choose to oppose it so militantly if they actually agreed with most of its tenets? Why didn't they negotiate and compromise like grown-ups do, particularly grown-ups who are in the minority party? They could have steered the bill to align it even more closely with their interests, and then they could declare a victory not only for their conservative principles but also their bipartisan ethos.

Instead they held their breath until they turned blue like big ol' babies. No wonder so many people consider our political system to be completely broken.

Because like I said before, that would be like asking Democrats to compromise on having abortion banned. Some things you cannot compromise on. Conservatives could not compromise on having the government take control over the health insurance industry.

The aspects they wanted the Democrats would never do. The Republicans wanted tort reform. No way. They wanted to remove the ban on purchasing health insurance across state lines. Again, no dice (and no debating it either!). And so forth.

 

[Char. Limit]

Because like I said before, that would be like asking Democrats to compromise on having abortion banned. Some things you cannot compromise on. Conservatives could not compromise on having the government take control over the health insurance industry.

The aspects they wanted the Democrats would never do. The Republicans wanted tort reform. No way. They wanted to remove the ban on purchasing health insurance across state lines. Again, no dice (and no debating it either!). And so forth.

You can't compromise on banning abortion... a ban is absolute, or it's no ban. So, indeed, it would be very hard to ask Democrats to compromise on something that if compromised on, no longer exists.

I do believe that tort reform and the public option should have been in, along with purchasing health insurance across state lines. I'm pro-responsibility, so I would not have favored my tax dollars (and I do pay tax dollars; just because I'm 17 doesn't mean I don't have a job) heading to abortion, no matter my views on abortion itself. Whether abortion is right or wrong, it shouldn't be tax-supported. After all, as I said earlier in this paragraph, I'm pro-responsibility. If you don't want the baby, don't have sex. I give exceptions in the case of rape or to save the life of the mother. Of course, the problem with this is that the already-high false rape accusation rate would skyrocket as women would find out that they were pregnant and then claim rape so they could get rid of the pregnancy. To sum up this overly blathering paragraph, tort reform, cross-state health insurance, and the public option should have been in, and tax-supported abortions should have been out.

 

[mheslep]

probably because i have had less problems with medicare than most , but not all, private insurances.
...

It is all the above that a majority of us favor single payer.

As we https://www.physicsforums.com/showpost.php?p=2316756&postcount=507", I doubt that a majority of US physicians favor single payer. As far as I can tell, universal single payer is fairly rare approach to universal health care throughout the world. There's Canada, who else?

 

[mheslep]

Like I said, the CBO is wrong; there is just no way they can accurately calculate something like this.

If the latter is true, then it would be more correct to say the CBO estimates are not credible in this case, not that they are wrong.

 

[adrenaline]

As we https://www.physicsforums.com/showpost.php?p=2316756&postcount=507", I doubt that a majority of US physicians favor single payer. As far as I can tell, universal single payer is fairly rare approach to universal health care throughout the world. There's Canada, who else?

Taiwan, where i came from it works fabulously, they were just like us until enacting national health insurance. My relatives in high paying professions like derm, urology there are doing just as well, they had to go electronic medical records, but are finding themselves hiring less staff,dealing with less beurocracy, etc.

 

[adrenaline]

as I am in academia and have to deal with real life free market overhead costs

Majority (57%) of Academic Medicine Physicians Favor Single-Payer
PRINT PAGE
EN ESPAÑOL

March, 1999

Study in New England Journal of Medicine Finds Medical School Deans, Faculty, Residents and Students Favor Single-Payer 3 to 1 Over Managed Care

Managed care is bad for your health, according to the first comprehensive survey of physicians involved in research and teaching published in this week's New England Journal of Medicine. But the nation's best and brightest physicians don't want to return to the old fee-for-service system, either.

So what does this prestigious group think would make a good health system? According to the study, "all groups [Deans, department chairs, residency training directors, physician faculty at medical schools, resident physicians, and medical students] expressed a preference for a single-payer health care system over both managed-care and fee-for-service systems. Overall, 57.1 percent thought that a single-payer system with universal coverage was the best health care system... A total of 21.7 percent favored managed care, and 18.7 percent preferred a fee-for-service system."

"I'm not surprised at all by these findings," said Dr. Douglas Robins, Chair of the D.C. chapter of Physicians for a National Health Program. "A survey of all physicians members of the D.C. medical society found that 69 percent support single payer. The academic medicine physicians are just the tip of the iceberg."

In an accompanying editorial in the Journal, Dr. Robert Michels strongly disagreed with the view that the purpose of medical education should be to "prepare students to fit into the new world of health care, to work in it effectively and presumably happily." Dr. Michels noted that "the unhappiness of academic physicians...reflects the recognition that managed care threatens medicine's core values," and that "medical education is working well...by underlining the urgent need to change managed care [emphasis added]." He also noted that physicians support single payer national health insurance even though physicians know that "a single-payer system would be unlikely to increase the financial rewards of medical practice."

"We know physicians support single-payer national health insurance because of the increasing numbers of medical associations and prominent physicians that are endorsing it," said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard.

They include: The D.C. branch of the American Medical Association (AMA), the American Medical Women's Association (AMWA), the National Medical Association (NMA), the Gay and Lesbian Medical Association (GLMA), the American Medical Student Association (AMSA), the American Public Health Association (APHA), the Islamic Medical Association (IMA), the American Association of Community Psychiatrists (AACP), the American Family Therapy Association, and others. The Maryland and Massachusetts branches of the AMA are studying single payer, and the American College of Surgeons' Dr. David Murray testified before Congress in 1994 that single payer would "probably provide the best assurance that patients would be able to seek care from any doctor of their choice."

Yes, overpaid specialists like interventional radiology, dermatology, nurse anesthestists that make more than me and don't have to continue stabilizing patients in the ICU when they crash, favor the status quo.

 

[adrenaline]

another poll showing a majority of us favor single payer

http://www.reuters.com/article/idUSN31432035


and another
http://www.workdayminnesota.org/index.php?article_1_115

and another( many studies in one chart)

http://www.wpasinglepayer.org/PollResults.html

and another

http://www.news.harvard.edu/gazette/2004/02.12/09-singlepayer.html


it goes on and on

 

[turbo]

I haven't polled the ophthalmologists that I worked for as their IT manager, but I am dead-certain that they would prefer single-payer insurance, as well. The practice had over 30 docs spread over 3 large permanent, and 4 smaller part-time locations. We were constantly sending our coders for training to keep up with the vague and ever-changing demands of the insurance companies. Keeping qualified, experienced people in administrative positions was critical to keeping the practice solvent. The practice was growing, and associate doctors that were working out well were offered partnerships. As you might imagine, the fiscal health of the practice, including the aging of receivables, solidity of lines of credit, etc were high in the minds of doctors considering buying into partnerships, so the senior partners needed access to accurate timely information regarding those.

If you have every worked in ophthalmology, you'd know that a great many of the people referred to your practice have serious complications arising from diabetes, and other conditions that usually only crop up late in life. Because of that, we had a lot of poor people on Medicaid, and a lot of elderly people on Medicare. Payments from those programs were on-time and were rarely held back due to trivial details, unlike the private insurers. The practice would never consider refusing a new patient because they had government-managed insurance. Those docs are highly-paid specialists. Some did refractive surgeries, some did retinal surgeries and repairs, some did plastic surgery (reconstructive, following accidents usually) you get the drill. Still, they were very hands-on when we had meetings about the business side of the practice, and I never heard a single one of them suggest that there was a down-side to accepting and keeping patients who were on public plans. They understood the tremendous imbalance in overhead that resulted from dealing with public vs private plans. There were sometimes discussions about the possibility of dropping participation with some of the nastiest private plans, but never Medicare or Medicaid.

 

[mheslep]

as I am in academia and have to deal with real life free market overhead costs

I thought we all agreed there is very little 'free market' health care in the US.

...Yes, overpaid specialists like interventional radiology, dermatology, nurse anesthestists that make more than me and don't have to continue stabilizing patients in the ICU when they crash, favor the status quo.

I think discussion might go better if we look at the source and not summaries from the PNHP web site. http://www.pnhp.org/news/1999/march/majority_57_of_ac.php
That 1999 summary didn't post a NEJM title, I'm looking ...

 

[adrenaline]

I thought we all agreed there is very little 'free market' health care in the US.

i meant that my overhead goes up every year, my staff expects increases in salaries, and bonuses etc as if we can adjust our prices based on free market principles. Most employees just don't realize that I can't bill higher for a cold just because i need to find the 20 % in rent incurred this year etc.

 

[Char. Limit]

There's no free market, there's just a "free" market, when it comes to insurance...

After all, if insurance were a free market, companies would have incentive to stay competitive. But they don't compete...

 

[noblegas]

another poll showing a majority of us favor single payer

http://www.reuters.com/article/idUSN31432035


and another
http://www.workdayminnesota.org/index.php?article_1_115

and another( many studies in one chart)

http://www.wpasinglepayer.org/PollResults.html

and another

http://www.news.harvard.edu/gazette/2004/02.12/09-singlepayer.html


it goes on and on

Even if polls show that most americans want a healthcare system that resembles a single payer system , so what? That doesn't mean that the federal government should nationalize healthcare in order to grant the wishes of the majority of americans nor does it mean that americans are automatically entitled to healthcare because most want universal healthcare. Universal healtcare is immoral because you will be stealing the earnings of every US citizen without their consent to pay for a service that some don't want to use. 50 years ago ,Most americans did not support racial integration, does that mean since most americans did not support racial segregation that blacks should be stripped away of all of their rights that whites were fully allow to legally carry out? Polls use to show that most americans did not want to legalize gay marriage, but because most americans are uncomfortable seeing to gays in Holy Matrimony ,does that mean gays should not be allowed to get married? It is wrong to force americans to pay for a service that they are not naturally entitled to just like we are not automatically entitled to cars and free food, we should not be entitled to a "free" healthcare services.

 

[mheslep]

another poll showing a majority of us favor single payer

http://www.reuters.com/article/idUSN31432035

The authors are the same Carrol and Ackerman as in the 2004 study which https://www.physicsforums.com/showpost.php?p=2316756&postcount=507" , again Carrol is the PNHP leader/advocate.

and another
http://www.workdayminnesota.org/index.php?article_1_115

I see the author Dr Hart is a leader of the http://www.pnhp.org/states/minnesota" . Membership does not pertain, but I discount polls run by advocacy organization leaders.

and another( many studies in one chart)

http://www.wpasinglepayer.org/PollResults.html

Yes, cites the Hart and Carrol studies mentioned above, and public at large (not physicians) news organization polls along the lines of "Do you favor national health care or the existing system which sucks" strawmen. The links provided for further information are mainly back to PNHP website summaries. Sorry if I missed something more apropos but this is getting tiresome.

 

[mheslep]

i meant that my overhead goes up every year, my staff expects increases in salaries, and bonuses etc as if we can adjust our prices based on free market principles. Most employees just don't realize that I can't bill higher for a cold just because i need to find the 20 % in rent incurred this year etc.

Ah. Well all the best with your practice Dr A.

 

[adrenaline]

That 1999 summary didn't post a NEJM title, I'm looking ...

Volume 340:928-936, March 25th, 1999 #12
I have not renewed my subscription to nejm, so i could not get the full text sorry
but you may have access to it

And this was not in any way related to people in phnp

 

[adrenaline]

Membership does not pertain, but I discount polls run by advocacy organization leaders.

fair enough

Yes, cites the Hart and Carrol studies mentioned above, and public at large (not physicians) news organization polls along the lines of "Do you favor national health care or the existing system which sucks" strawmen. The links provided for further information are mainly back to PNHP website summaries. Sorry if I missed something more apropos but this is getting tiresome.

i'm sorry i meant to post that was a public opinion sorry, my lack of sleep is making me sloppy again

what about the study in the archives of internal medicine, granted it was limited to one state, but it seemed a reasonable poll of representative physicians?

 

[TMFKAN64]

Universal healthcare is immoral because you will be stealing the earnings of every US citizen without their consent to pay for a service that some don't want to use.

So you think that K-12 education, the interstate highway system, the space program and the U.S. military are similarly immoral?

 

[adrenaline]

So you think that K-12 education, the interstate highway system, the space program and the U.S. military are similarly immoral?

Yes let's not forget that most americans pay for the uninsured anyway with higher charges by the hospital ( ten dollar asprins to recover the costs of the uninsured on non payers) and that all health insurance premiums are higher just for the purpose of covering the uninsured. I believe I read some estimate an extra 1000 dollars for families and less than that for individuals. Can't remember the exact numbers.
Thus, American families are already picking up the tab for universal health coverage. Remember, providers often pass along the cost of treating the uninsured to their insured patients.

Consider it a hidden tax for taking care of the uninsured.

 

[BobG]

Universal healthcare is immoral because you will be stealing the earnings of every US citizen without their consent to pay for a service that some don't want to use.

So you think that K-12 education, the interstate highway system, the space program and the U.S. military are similarly immoral?

There's certainly some that would say using taxpayer dollars for K-12 education is immoral because they'd prefer a school voucher system.

 

[Nebula815]

Yes let's not forget that most americans pay for the uninsured anyway with higher charges by the hospital ( ten dollar asprins to recover the costs of the uninsured on non payers) and that all health insurance premiums are higher just for the purpose of covering the uninsured. I believe I read some estimate an extra 1000 dollars for families and less than that for individuals. Can't remember the exact numbers.
Thus, American families are already picking up the tab for universal health coverage. Remember, providers often pass along the cost of treating the uninsured to their insured patients.

Consider it a hidden tax for taking care of the uninsured.

One can make the above argument to argue that it would be better if everyone purchase health insurance, but that doesn't justify forcing people to buy health insurance IMO.

 

[adrenaline]

One can make the above argument to argue that it would be better if everyone purchase health insurance, but that doesn't justify forcing people to buy health insurance IMO.

I did not agree with the individual mandate, ( originally designed by Mitt Romney it looked like ) trust me, I opposed this health care reform bill but it is the only way to prevent the insurance industry who are now forced to cover preexisting from going bankrupt. human behavior is such they will wait till they are sick or diagnosed with a bad disease before purchasing health insurance on the exchange, kind of like allowing a person to obtain car insurance right after an accident. Thus, by forcing all comers healthy and sick to purchase the insurance you prevent this financial ruin for the health insurance companies. Don't you think the insurance lobby thought this through and helped pushed this through?

someone just sent this quote to me, I'm sure it is on another discussion panel.

"
Some of my libertarian friends balk at what looks like an individual mandate,'' Romney wrote in The Wall Street Journal in 2006. ``But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian.'' -Mitt Romney
"

 

[turbo]

One can make the above argument to argue that it would be better if everyone purchase health insurance, but that doesn't justify forcing people to buy health insurance IMO.

What? The Government is forcing me to buy education for children that I don't have. My wife and I have no kids, but over half of our property taxes go directly to paying for public education for children of others. If you want a system with no mandates, no social contracts between government and citizens, you'll be hard-pressed to find one.

 

[adrenaline]

Yeah, since I ride my mountain bike to work, ( heck I almost ride on the grass the whole time since rednecks run me off the road) I should not have to pay taxes for road construction when I buy gas to fill my lawnmower...

 

[Ivan Seeking]

Based on a news report, I estimated one year that we paid almost exactly enough Federal tax to pay for the warhead, IIRC, on one cruise missile; this for a war that I didn't support and that was shown to be folly.

 

[Nebula815]

What? The Government is forcing me to buy education for children that I don't have. My wife and I have no kids, but over half of our property taxes go directly to paying for public education for children of others. If you want a system with no mandates, no social contracts between government and citizens, you'll be hard-pressed to find one.

Well for one, I do not really agree with taxing people to pay for other people children's education, nor do I agree with property taxes either. Government is not supposed to be able to tax property.

Just because the government has gotten away with infringing on our freedoms in a few ways doesn't justify further infringements.

And this isn't really a tax in the classic sense. It's a mandate that you have to purchase a product, or be fined.

 

[Nebula815]

I did not agree with the individual mandate, ( originally designed by Mitt Romney it looked like ) trust me, I opposed this health care reform bill but it is the only way to prevent the insurance industry who are now forced to cover preexisting from going bankrupt.

Yes, but they to prevent the health insurance industry from going bankrupt, they might have just put the country on a path towards bankruptcy. There were other alternatives we could have worked on for fixing healthcare, things to fix that drive up cost; Medicare and Medicaid themselves are partially responsible for driving up health insurance costs too.

 

[Astronuc]

Well for one, I do not really agree with taxing people to pay for other people children's education, . . .

I'm sure one's education was paid by taxpayers.

. . . nor do I agree with property taxes either. Government is not supposed to be able to tax property.

Governments have taxed property since there were governments.

Government can tax whatever the government decides to tax.

 

[noblegas]

So you think that K-12 education, the interstate highway system, the space program and the U.S. military are similarly immoral?

Most certainly. there lots of parents who homescooled their children, who send their kids to private schools, or don't have any kids at all but still they are forced to subsidize the costs of public education. It would be just as immoral to force a person to pay for someone else education as it would be to force a person to buy any product on the market that they did not want to spend money on.

 

[Nebula815]

I'm sure one's education was paid by taxpayers.

Yes, I'm saying I'm not sure I agree with having such a system. I mean the system is now established, no un-doing it, but if we were having a national debate over whether to institute a taxpayer-funded K-12 system, not sure I'd agree. Maybe with a proper voucher program to promote competition.

Governments have taxed property since there were governments.

Governments have also enslaved people since there were governments. That's why our Founding Fathers spent so much time thinking about how to design our government, because there never have really been any good ones.

Protection of private property rights is one of the most important aspects of a free society. When government can tax your property, this means technically you no longer own your property, because even if you pay it off, if you stop paying the taxes, you find out who really owns it.

Just because government can do something doesn't mean it should.

Government can tax whatever the government decides to tax.

Not our government. Our government can tax whatever the people allow it to tax since it is a representative government, but that requires a vigiliant citizenry.

 

[noblegas]

I'm sure one's education was paid by taxpayers.

I certainly received a better quality education outside my public school than I did while I was in public school. Most Kids I know forgot what they learn within a month, despite the thousands of dollars being invested in their education

 

[Astronuc]

Governments have also enslaved people since there were governments. That's why our Founding Fathers spent so much time thinking about how to design our government, because there never have really been any good ones.

Protection of private property rights is one of the most important aspects of a free society. When government can tax your property, this means technically you no longer own your property, because even if you pay it off, if you stop paying the taxes, you find out who really owns it.

Just because government can do something doesn't mean it should.

The US government owned all the land that was not owned by private citizens. Those citizens had purchased the land or had received grants from the King.

The government determines land rights - and always has.


The government (like Caesar) giveth and taketh away.

Public education was necessary to maximize literacy in the population. Left to private/personal means, we'd have ~90% illiteracy, as was the case in England and the US in colonial times. Women were essentially excluded from education.

For the most part, from my observations, governments are run like corporations. Corporations (governments) serve mainly the management (politicians) rather than the investors/employees (people).