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

[WhoWee]

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

 

[adrenaline]

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

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

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

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

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

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

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

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

 

[Al68]

They are coerced, if you cite lack of choice.

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

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

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

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

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

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

 

[adrenaline]

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

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

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

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

My 62 year old ATT worker who found out his family lifetime limit decreased from 5 million to one million can't just up and change jobs ( His wife has had a prior history of lymphoma and there is a chance it will come back). Who hires a 62 year old? Second, The man with burkits had no idea the plan he had since he was 17 practiced such abusive practices,( afterall, they did not give him grief over his yearly physicals and occassional shoulder bursal injections.) do you know if your does? ( I'll give you a hint, his is a top three insurance carrier) The woman with t cell lymphoma had no idea she was going to use up her lifetime limit when she was diagnosed with the cancer. When she did, she tried to get the health insurance carrier to extend the lifetime limit, even if it meant paying an extra thousand dollars a month, ( she was willing)

Your statements make no sense with both examples I used.

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

 

[mheslep]

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

My point was that there is healthy biomedical research going on in these other counteries. Not denying our own accomplishments...

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

 

[adrenaline]

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

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

 

[adrenaline]

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

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

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

 

[Al68]

So your suggest they change jobs, for the sake of health insurance benefits?

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

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

Your statements make no sense with both examples I used.

That's because you gave no examples of coercion.

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

 

[adrenaline]

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

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

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

 

[adrenaline]

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

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

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

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

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

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

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

 

[WhoWee]

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

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

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

 

[Al68]

Perhaps I shouldn't have called it coercion, more like "no options"...

Then I might have agreed, at least "no practical options". And again, government intervention (preferential tax treatment for employer based insurance) is the biggest cause of the problems you mention. People who choose their own insurance policy will naturally know a lot more about it.

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

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

 

[wildman]

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

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

 

[Al68]

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

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

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

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

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

 

[wildman]

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

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

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

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

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

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

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

 

[WheelsRCool]

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

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

 

[adrenaline]

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

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

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

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

Embryonic stem cell research and its immediate application is still in such an infantile stage, it's probably not a beneficial line of resource allocation in R and D for most private companies, at such a basic scientific reasearch level, I think government funding provides the "fuel" that allows it to grow exponentially in its knowledge base and therefore future application.I believe, Israel, a powerhouse in this line of research is almost 100% funded by the government, especially the science and technology ministry and the Ministry of industry, trade and labor.

 

[noblegas]

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

 

[WhoWee]

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

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

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

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

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

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

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

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

Now a few new things

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

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

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

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

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

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

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

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

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

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

 

[mheslep]

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

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

 

[mheslep]

...

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

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

Now a few new things

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

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

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

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

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

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

 

[Ivan Seeking]

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

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

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

 

[WhoWee]

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

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

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

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

 

[WhoWee]

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

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

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

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

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

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

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

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

 

[GeorginaS]

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

[snip]

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

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

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

 

[WhoWee]

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

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

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

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

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

Shall I calculate the per household deficit spending as well?

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

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

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

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

 

[GeorginaS]

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

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

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

Shall I calculate the per household deficit spending as well?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

[WhoWee]

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

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

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

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

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

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

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

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

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

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

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

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

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

Who is going to pay for all of this spending?

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

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

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

 

[Hurkyl]

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

 

[WhoWee]

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

Are we not all in this together?

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

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

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

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

 

[LBloom]

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

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

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

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

 

[WhoWee]

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

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

WOW! THE PLAN IS SOCIALISM.

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

 

[LBloom]

WOW! THE PLAN IS SOCIALISM.

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

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

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

 

[WhoWee]

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

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

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

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

 

[WhoWee]

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

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

 

[Hurkyl]

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

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

 

[LBloom]

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

Anyway, now I am done

 

[WhoWee]

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

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

 

[WhoWee]

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

Anyway, now I am done

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

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

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

 

[Evo]

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

Anyway, now I am done

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

 

[Hurkyl]

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

Then you don't know what's relevant. How could that figure possibly be a relevant statistic? I know you earlier claimed

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

but that calculation has pretty much nothing to do with what HR3200 will cost "a lot of people".

 

[Wax]

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

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

 

[WhoWee]

Then you don't know what's relevant. How could that figure possibly be a relevant statistic? I know you earlier claimed

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

but that calculation has pretty much nothing to do with what HR3200 will cost "a lot of people".

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

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

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

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

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

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

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

 

[Wax]

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

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


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

 

[Hurkyl]

What don't I understand? What isn't relevant? Please explain it to me - I clearly do not understand why you disagree.

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

 

[WhoWee]

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

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

 

[WhoWee]

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

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

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

BOSTON - Costly illnesses trigger about half of all personal bankruptcies, and most of those who go bankrupt because of medical problems have health insurance, according to findings from a Harvard University study to be released Wednesday.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

[Hurkyl]

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

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

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

1: Actually, you made this claim explicit[/size]

 

[WhoWee]

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

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

1: Actually, you made this claim explicit[/size]

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

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

 

[Hurkyl]

How do we calculate the cost to any "average Joe" taxpayer?

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

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