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

[TheStatutoryApe]

I apologize for being insensitive about your injury but my point is that ultimately we are responsible for our own welfare. If a particular private doctor does not give you the service that you expect, FIRE him/her. I've done it myself. I'll walk out of the office if a doctor does not attend to me within 20min after an appointment time. If the gov't begins dictating who we go to then we can't FIRE them for poor service.

Some of us can afford that and some of us can not. Some of us can not even afford to look for another job if our employers are shafting us. That does not make these people any less deserving of medical attention. The whole point of the medical profession is to help others, including those that are unfortunate. I think we can all agree that every one should get proper medical treatment. The real question is whether or not we can give everyone proper medical treatment. My opinion simply is that our seeming inability to provide this for our citizens is not reason enough to abandon the idea of doing so. Changes need to be made towards such a goal and ideas for reaching that goal must be worked on.
As far as being able to or not being able to fire an incompetent doctor there is no reason why this could not be accomplished in a national health care system. This system does not yet exist, we can not say how it will or will not be. If we perceive certain problems in other countries implimentation of such programs then we can attempt to avoid them. If the problems crop up anyway they can be fixed. Merely decrying something as doomed to failure accomplishes nothing in preventing that failure. And many of the opponents of the idea will only be too happy to see it become a failure instead of trying to help fix it.

Where?

I lived in Orange County in Southern California at the time. Lots and lots of hospitals and MRI machines everywhere. This is why it stumped me that it took so long. Maybe it was really just because of where I went but I have not really had very different experiences even when I was growing up and covered by my parents insurance.

 

[CRGreathouse]

Not sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.

You seem to misunderstand. That's total tax burden -- the top 25% of earners provide 84% of the government's money, and the bottom 75% provide the other 16%. (That's gross, not net -- I imagine the top 25% provides more than 100% net.)

This is a drop from previous percentages. The wealthy have lost a larger percentage of their wealth than the non-wealthy in the last 10 years, so their aggregate tax share has dropped. But still, it makes you wonder. Being in that lower 75% myself, I'm very thankful that I *don't* have to pay a proportional share.

 

[TheStatutoryApe]

Not sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.

I believe the idea is that that is the percentage of the total revenue paid by these people.

 

[mheslep]

Not sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.

Sorry bad link. Here
http://www.irs.ustreas.gov/pub/irs-soi/03in05ty.xls
See line 186.

It is not an 84% tax rate, rather the top 1/4 of taxpayers pay 84% of all US federal income tax revenue. The top half of taxpayers pay essentially all of the income tax revenue (97%). And that is ranked by gross income.

No doubt the super wealthy get large tax breaks. Warren Buffet complained that he owed only 17.7%, probably because his 'income' is dividends and cap. gains. But the average top 1% earner ($1.28 million) in this country makes most of his/her money from working. The day of the leisure class capitalists is gone, replaced by the working rich. She, typically, is a successful neuro surgeon, with eight years of school and another eight in training. She has the big mortgage deduction and some smaller ones, but they're still paying 35% on a million or more, soon to increase. And lop off another 10% if you are in California.

 

[j93]

The wealth distribution would be relevant here
http://zfacts.com/p/728.html

Roughly it would seem like the bottom half should be paying about 2.5% considering the amount of wealth they hold, rightly this is a very rough calculation assuming a flat tax.

 

[drankin]

Some of us can afford that and some of us can not. Some of us can not even afford to look for another job if our employers are shafting us. That does not make these people any less deserving of medical attention. The whole point of the medical profession is to help others, including those that are unfortunate. I think we can all agree that every one should get proper medical treatment. The real question is whether or not we can give everyone proper medical treatment. My opinion simply is that our seeming inability to provide this for our citizens is not reason enough to abandon the idea of doing so. Changes need to be made towards such a goal and ideas for reaching that goal must be worked on.
As far as being able to or not being able to fire an incompetent doctor there is no reason why this could not be accomplished in a national health care system. This system does not yet exist, we can not say how it will or will not be. If we perceive certain problems in other countries implimentation of such programs then we can attempt to avoid them. If the problems crop up anyway they can be fixed. Merely decrying something as doomed to failure accomplishes nothing in preventing that failure. And many of the opponents of the idea will only be too happy to see it become a failure instead of trying to help fix it.


I lived in Orange County in Southern California at the time. Lots and lots of hospitals and MRI machines everywhere. This is why it stumped me that it took so long. Maybe it was really just because of where I went but I have not really had very different experiences even when I was growing up and covered by my parents insurance.

So, you believe that with a national health care system you will be able to fire your doctor and get another with an appointment in a reasonable time? I don't believe there is a national health care on the planet that you can do that with. You say that people shouldn't be "less deserving" of health care? It's not about "deserving". Why the hell do you deserve better health care that you aren't even paying for? You get what you pay for. If you can't pay for it then you don't get it. That goes for any private service. Doctors don't owe you health care. If you think insurance coverage is bad, wait till uncle sam is running the show.

That's why competition gives you the best your money can buy. Because they are competing for your patronage. Take that away and the doctors office turns into the damn DMV.

 

[j93]

I think we can all agree that every one should get proper medical treatment.

Apparently Not

You get what you pay for. If you can't pay for it then you don't get it.

 

[Huckleberry]

So, you believe that with a national health care system you will be able to fire your doctor and get another with an appointment in a reasonable time? I don't believe there is a national health care on the planet that you can do that with. You say that people shouldn't be "less deserving" of health care? It's not about "deserving". Why the hell do you deserve better health care that you aren't even paying for? You get what you pay for. If you can't pay for it then you don't get it. That goes for any private service. Doctors don't owe you health care. If you think insurance coverage is bad, wait till uncle sam is running the show.

That's why competition gives you the best your money can buy. Because they are competing for your patronage. Take that away and the doctors office turns into the damn DMV.

In emergencies hospitals are obligated by law to provide health care at no cost.

The Emergency Medical Treatment and Active Labor Act (42 U.S.C. § 1395dd, EMTALA) is a United States Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act. It requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions.

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

Also, many doctors swear by a hippocratic oath that obligates them to help the sick. I don't think this oath is mandatory any longer, but many still swear by it. Nothing in it is enforcable, except by existing law.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

http://www.pbs.org/wgbh/nova/doctors/oath_modern.html

So if someone hurt their knee and it isn't life threatening then they are out of luck legally. I'm sure there are many doctors that would like to help, but an individual doctor can't pay for treatment for every uninsured or underinsured person that asks them, even if they were sincere in their oath. As far as I can tell, legally, the hospital has the right to deny service in non-emergency situations. Without some kind of government provision they are in a similar situation as the doctors. I'm sure that most hospitals would like to treat as many people as they can, but they can't do it for free even if they wanted to.

What concerns me is the appearance that the money is the motivating factor and not the treatment for the benefit of the sick, as stated in the hippocratic oath. Medical treatment is more than a service to be provided or not based purely on profit. It is often a requirement for a healthy life as well. Finding a balance between these necessities is important, but neither can be ignored.

 

[Vanadium 50]

I am still confused why the health care program is being used as whipping post for tax code.

Because it's related. "Free health care for everyone" is a great idea. The question is, how do we pay for it. The same issue comes up with "free education for everyone", where we as a society answered that a) we would pay for it via state and property taxes, b) it would be free up until high school and subsidized afterwards, and c) if you didn't like this, you could pay for it yourself.

 

[Al68]

Any evidence for this claim?

Yes, US tax laws.

The poorer you are, the less likey it is that you can take anything other than the standard deductions. The key is "adjusted gross income" this is the dollar amount that your taxes are paid on. The wealthy can, through tax shelters and exemptions, vastly reduce the amount of their income that can be taxed. So even looking at a tax % on the "taxable amount" of income left after deductions (adjusted gross income) isn't a true picture of the % of tax averaged over their total real income.

Tax Burden Shifts to the Middle

Since 2001, President Bush's tax cuts have shifted federal tax payments from the richest Americans to a wide swath of middle-class families, the Congressional Budget Office has found, a conclusion likely to roil the presidential election campaign.

The conclusions are stark. The effective federal tax rate of the top 1 percent of taxpayers has fallen from 33.4 percent to 26.7 percent, a 20 percent drop. In contrast, the middle 20 percent of taxpayers -- whose incomes averaged $51,500 in 2001 -- saw their tax rates drop 9.3 percent. The poorest taxpayers saw their taxes fall 16 percent.

http://www.washingtonpost.com/wp-dyn/articles/A61178-2004Aug12.html

Should I take that as a no? Nothing in this substantiates your claim. Even the Wash. Post article says nothing resembling your claim, and it's misleading and biased by considering only the tax rates instead of the actual revenues received from each group as a percentage of income (which has a vastly different result). The fact is that the result of the Bush tax cut in terms of actual dollars collected from different income groups is that the burden was shifted from the poor and middle class to the rich. The Washington Post is simply misleading people by reporting the marginal rate changes instead of the actual revenue received. The relationship between tax rate and revenue isn't linear, and everyone knows it, including the liars of the so called left.

Did I misunderstand your claim? Weren't you claiming that the rich paid a smaller percentage of their income in taxes than the rest of us?

 

[Al68]

It's the fact that many middle to low income people cannot even itemize. They have to take the standard deductions. They don't even have the opportunity to exclude their income from taxes. Therefore, they pay the highest percentage of taxes when averaged across their real income than people that can write things off or find tax shelters. Pretending it doesn't happen is not just naive, it's disengenious.

More false statements.

No one is disputing that what you claim happens anecdotally. The claim that "they" pay less compared to their income is simply false.

That's one of the biggest problems with the income tax code. It's so complicated that it's very easy to lie, commit fraud against the people, and mislead them about who is paying what.

 

[mheslep]

...Weren't you claiming that the rich paid a smaller percentage of their income in taxes than the rest of us?

Lets back off from the absolutes for a moment. There are cases (Warren Buffet) where that is true.

 

[Al68]

Being in that lower 75% myself, I'm very thankful that I *don't* have to pay a proportional share.

Me too. And there's good reason for that. If we had a flat income tax, we would all be in the same boat. Then the power hungry politicians couldn't turn us all against each other, mislead us about who is paying what, then claim it's the "other guy" that's getting soaked while they bend us over.

There will never come a day when the power hungry will think the government has enough money and power.

And a timely quote from the classical liberal Fredric Bastiat: "When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."

 

[turbo]

Lets back off from the absolutes for a moment. There are cases (Warren Buffet) where that is true.

Good point, and let's take another step toward reality and acknowledge that the very wealthy often pay far less of their income percentage-wise than us mere mortals.

The compensation packages of corporate officers are usually structured such that much of their compensation is not counted as "income" by the IRS and is therefor not taxed as such. In addition, much of their compensation may be deferred. If the board votes to grant stock options to a CEO, (s)he gets to exercise them at will, and the profit realized from that is not taxable until that action is taken. If the CEO retires, and takes on some debt that can be written off (per IRS guidelines) as investments, then is a good time to exercise some of the stock options, and take the profit when their salary is nil and there is debt to offset the profit.

I don't think so many corporate officers would be flying around in corporate jets and riding in chauffeured limos if those perks were taxed at their true cost, either.

 

[Al68]

...Weren't you claiming that the rich paid a smaller percentage of their income in taxes than the rest of us?

Lets back off from the absolutes for a moment. There are cases (Warren Buffet) where that is true.

Sure, like I said:

No one is disputing that what you claim happens anecdotally.

Unless I misunderstood the claim, Evo was using the terms "the rich" and "they" to mean in general, not just a specific case.

 

[Al68]

At least in the state level sales tax also matters
http://www.itepnet.org/whopays.htm

Well, if we were to use the same logical analysis for sales taxes as Democrats use to justify "corporate income taxes", sales taxes are paid by the business, not the consumer. I wonder how differently people would think about corporate income taxes and regulation if their actual cost were disclosed on the label of everything they bought. Or charged separately like a sales tax.

 

[turbo]

Another point missing from this debate/conversation is that if you are an ordinary wage-earner (even if you make a lot of money compared to average folks) you are only one serious illness away from bankruptcy and financial ruin. When your doctor starts submitting claims for visits, diagnostic tests, etc, that point to a very serious and expensive-to-treat illness, the very first thing that your insurance company will do is try to dump you on any possible grounds, so they never have to pay.

I am lucky that my wife's employer has a very large pool of employees, and we didn't get dumped, BUT there is a little wrinkle that was extremely costly. I was doing pretty well at work and at home, until I got my division's profits jacked up. Then, the owner of the company "gave" me his girlfriend as my administrative assistant so that she could rake in some of the incentive pay generated by those profits. She was a middle-aged woman aspiring to the Barbie ideal and came to work every day wearing more cosmetics than any Avon lady could sell, and I became chronically ill, and at a much worse level than ever before. My primary-care doc referred me to a respiratory doc, who referred me to the most prominent chemical-injury doc in New England (practices and teaches at Dartmouth-Hitchcock). The problem? CIGNA refused to pay for my consultations, treatment, etc, because they claimed my illness was work-related, and MEMIC (Maine's worker's comp insurer) refused to pay for my medical bills because they said that I could not prove that my illness was work-related. I am countless thousands of dollars out-of-pocket trying to get adequate medical care. If my wife loses her job or her company goes under, I will never again be able to get any private health-insurance coverage. I think we need a new system.

 

[mheslep]

... I think we need a new system.

Most everyone agrees. I like Ryan's, McCain's, or Bennett's ideas, all of which would allow one to get out of the insured-through-work-only concept as it is now.

 

[Evo]

Did I misunderstand your claim? Weren't you claiming that the rich paid a smaller percentage of their income in taxes than the rest of us?

Yes, have you read anything that was posted about Adjusted Gross Income? Do you understand Adjusted Gross income? Have you ever filed an itemized tax return and understand the reason behind it? Do you undersatand US tax laws? You don't seem to.

I've made over $250 a year and had tons of exemptions, and the percent of tax I paid, when averaged over my actual gross income, not the percentage I paid on the AGI that was taxable, was a much lower percentage than I pay now, and I make just under $100k a year now and have no deductions. I'll say it one more time. I'm not talking about the % of tax on AGI, I'm talking about the $ amount of taxes paid, and what percent of a person's total UNadjusted gross income that equates too. Do you understand now? Based on a person's TOTAL ACTUAL annual income, unless they do not itemize, the rich pay a lower percent of tax based on their TOTAL annual income.

 

[drankin]

Yes, have you read any of the about Adjusted Gross ncome? Do you understand Adjusted Gross income? Have you ever filed an itemized tax return and understand the reason behind it? Do you undersatand US tax laws? You don't seem to.

You seem to be implying an injustice that favors the wealthy. The purpose of write-offs is to offset costs associated with business in one form or another. A major deduction is a home, this is to encourage home purchases and helps the real estate industry. Then there are children, this helps the poor. At one time I received more money from the IRS than I would put in because of earned income credit and claiming my children. Earned income credit is specifically for low-income families. Our income tax requirements are such that the more you make the more they take percentage wise. I have a reasonable grasp of US tax laws. Where is the injustice?

BTW, I would be in favor of a simple flat tax even if it were modestly progressive.

 

[j93]

Our income tax requirements are such that the more you make the more they take percentage wise. I have a reasonable grasp of US tax laws. Where is the injustice?

If mheslep is right the bottom half is being taxed such that they account for 3% of tax revenue even though they only hold 2.5% of the wealth.

Sorry bad link. Here
http://www.irs.ustreas.gov/pub/irs-soi/03in05ty.xls
See line 186.

It is not an 84% tax rate, rather the top 1/4 of taxpayers pay 84% of all US federal income tax revenue. The top half of taxpayers pay essentially all of the income tax revenue (97%). And that is ranked by gross income.

The wealth distribution would be relevant here
http://zfacts.com/p/728.html

Roughly it would seem like the bottom half should be paying about 2.5% considering the amount of wealth they hold, rightly this is a very rough calculation assuming a flat tax.

 

[Evo]

You seem to be implying an injustice that favors the wealthy. The purpose of write-offs is to offset costs associated with business in one form or another. A major deduction is a home, this is to encourage home purchases and helps the real estate industry. Then there are children, this helps the poor. At one time I received more money from the IRS than I would put in because of earned income credit and claiming my children. Earned income credit is specifically for low-income families. Our income tax requirements are such that the more you make the more they take percentage wise. I have a reasonable grasp of US tax laws. Where is the injustice?

Homeownership is not a right. People that rent or already own their home are being discriminated against. Deductions for children are standard, that's not even in discussion here. The issue here is that the rich have many ways of NOT paying taxes on income. For example, a person making $500k annually may only pay taxes on $300k of that income. The other $200k is tax free. They will pay $99,000 in tax, that's a little under 20% of their total income. A single person making $70K that cannot itemize, may have to pay taxes on $66.5K of that income. So what if the rich person pays 33% tax on $300k, that's still only comes out to less than 20% on their total income. The $70k earner will pay 25% on $66,500, that 's $16,625, that's almost 24% of their total income.

 

[drankin]

If mheslep is right the bottom half is being taxed such that they account for 3% of tax revenue even though they only hold 2.5% of the wealth.

That is significant. I will concede that those with a significantly higher revenue need to contribute at a moderately progressive rate. Flat tax baby! One of the big problems with this is a huge tax preparation industry is going to get axed. Along with the lawyers... sounds like a good thing.

 

[drankin]

Homeownership is not a right. People that rent or already own their home are being discriminated against. Deductions for children are standard, that's not even in discussion here. The issue here is that the rich have many ways of NOT paying taxes on income. For example, a person making $500k annually may only pay taxes on $300k of that income. The other $200k is tax free. They will pay $99,000 in tax, that's a little under 20% of their total income. A single person making $70K that cannot itemize, may have to pay taxes on $66.5K of that income. So what if the rich person pays 33% tax on $300k, that's still only comes out to less than 20% on their total income. The $70k earner will pay 25% on $66,500, that 's $16,625, that's almost 24% of their total income.

Point taken, Evo. Thanks for digging up the figures.

 

[mheslep]

... Flat tax baby!

2nd that. Seems to be working well in several countries.

 

[j93]

2nd that. Seems to be working well in several countries.

From wiki about flat taxes
"Perhaps the single biggest necessary deduction is for business expenses. If businesses were not allowed to deduct expenses then businesses with a profit margin below the flat tax rate could never earn any money since the tax on revenues would always exceed the earnings. For example, grocery stores typically earn pennies on every dollar of revenue; they could not pay a tax rate of 25% on revenues unless their markup exceeded 25%. Thus business must be able to deduct their expenses even if individual citizens cannot. A practical difficulty now arises as to identifying what is an expense for a business. For example, if a peanut butter maker purchases a jar manufacturer, is that an expense (since they have to purchase jars somehow) or a sheltering of their income through investment. How deductions are implemented will dramatically change the effective, and thus flatness, of the tax."

 

[mheslep]

From wiki about flat taxes

Good topic for another thread.

 

[aquitaine]

Unfortunately I won't have to lose my job to lose my insurance, if Obama's health plan is passed, my employer will stop providing health insurance when they are no longer able to get a tax break to do so.

I had a talk with my doctor today, he said that the proposed healthplan is dreaded by doctors, they are absolutely against it. If you believe the media, doctors love Obama's proposal, he said it couldn't be farther from the truth. He said he sees the ability of doctors to make the best decisions for their patients a thing of the past. Right now they have to fight with insurance companies to get the best procedures approved, the new health care plan won't even let them fight that battle.

A.) Like I said, hospitals intentionally inflate costs.

B.) Its blatantly obvious our system isn't working, tens of millions of people can't get care, millions more go bankrupt because of it, and outrageous out of control costs clearly indicate something is wrong. As a country we spend far more as a percentage of our GDP than any other country in the world, yet according to the WHO we are less healthy than many other developed countries. More for less...doesn't look very efficient to me.

C.) Nice dodging the issues, especially what happens to your healthcare if you lose your job or if insurance doesn't cover your problem like what happened to turbo-1.

 

[mheslep]

B.) Its blatantly obvious our system isn't working, tens of millions of people can't get care, millions more go bankrupt because of it, and outrageous out of control costs clearly indicate something is wrong. As a country we spend far more as a percentage of our GDP than any other country in the world, yet according to the WHO we are less healthy than many other developed countries. More for less...doesn't look very efficient to me.

Access to and the cost of the system don't work well. The medical outcomes portion works quite well (WHO is not relevant in that regard).

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

Equal tax treatment for health coverage. The Senator would replace the special tax breaks for employer-based health insurance with a universal system of health care tax credits for the purchase of health insurance.
...
Health insurance competition on a national scale. Currently, only federal workers and retirees in the Federal Employees Health Benefits Program (FEHBP) benefit from competition among private health insurance companies on a national scale. In sharp contrast with almost every other sector of the economy, competition across state lines in health insurance is virtually nonexistent. The McCain health plan would change this by allowing individuals and families to buy health plans domiciled and regulated in other states
...
Federal assistance to the states to cover vulnerable populations. The Senator envisions a large role for state innovation and experimentation in health care financing and delivery, but he would provide safety-net funding to ensure coverage of the most vulnerable populations: the hard-to-insure and the uninsurable. McCain's Guaranteed Access Plan would provide federal assistance to the states to secure access to health insurance coverage through state high-risk pools or similar arrangements.

 

[mheslep]

...I had a talk with my doctor today, he said that the proposed healthplan is dreaded by doctors, they are absolutely against it. If you believe the media, doctors love Obama's proposal, he said it couldn't be farther from the truth. He said he sees the ability of doctors to make the best decisions for their patients a thing of the past. ...

Your doc, and all the others, must have loved the President's doctor slight the other day:

The doctor may look at the reimbursement system and say to himself, 'You know what? I make a lot more money if I take this kid's tonsils out,'

http://www.realclearpolitics.com/video/2009/07/22/obama_doctors_taking_tonsils_out_for_money_instead_of_diagnosing_it_as_allergies.html

Doctors are on the make and the cops are stupid, not his best week.