Democrats & Liberals Archives

Evaluating Healthcare Recommendations

Now that the presidential sweepstakes have started, each of the 20 or so Democratic and Republican candidates will present his or her own package of healthcare recommendations. John Edwards has already presented his ideas. We need a set of guidelines to evaluate all the recommendations that will be thrown at us.

Here are my healthcare system guidelines:

  1. A NATIONAL SYSTEM - All the pieces, individuals and institutions should fit together in a coordinated system. Provision should be made for analysis of errors and faults throughout the system with the idea of constantly improving quality of healthcare

  2. EVERYBODY IS INCLUDED - Nobody is uninsured. Nobody is refused medical care

  3. NOT EMPLOYER DEPENDENT - Company may offer a healthcare system different from the broad national system. However, employees must be given an easy and fast way to join the national system when they leave the company or for whatever reason they choose

  4. GUARANTED HELP WITH CATACLYSMIC EVENTS - Everybody is guaranteed healthcare in horrible situations, such as a father or grandmother sent to a nursing home or a hospice, or a child born with a defect that would scar him for life, or anyone experiencing an accident that leaves him physically unable to function

  5. INSURERS MUST USE COMMUNITY RATING - Nobody is refused because of previous conditions or for any other such reason. All people are eligible. No cherry picking. Insurance pools are as broad as possible

  6. INSURERS MAY NOT INTERFERE WITH DOCTOR DECISIONS - Doctors are not bossed around by insurance companies - or other organizations - that tell them they may use this procedure but not that procedure, this medicine but not that medicine

  7. HOSPITALS MUST SUBMIT TO QUALITY CONTROL - They must supply information, especially about outcomes of various procedures, to the quality control section of the system. They must also implement recommendations emanating from quality evaluations

  8. DOCTORS HAVE THE LAST WORD - In order for this to happen, we want to make sure doctors are competent. This means that they must offer information about their operations and results that patients may access to know which doctor to choose.

  9. PATIENTS MAY CHOOSE ANY DOCTOR - Any doctor in the system, of course. A second opinion is always available. Patients may choose a doctor out of the system at their own expense
I left out taxes. It seems to me that taxes will be needed for the implementation of any decent system. There will be arguments about how to tax. However, I consider this a separate issue. These guidelines are for evaluating the usefulness of a recommended system.

What do you think?

Posted by Paul Siegel at February 6, 2007 5:42 PM
Comments
Comment #206853

Paul,

Excellent post. About “leaving out taxes,” remember this: we are already spending that money. The money is what we (employees and employers) currently pay for insurance. Remember that private insurance is 20% administrative costs (v. Medicare admin at 3%). We may even get a “tax cut” in the end because we more to an economically more efficient system.

Posted by: Steve K at February 6, 2007 8:02 PM
Comment #206860

Paul
Pretty good list except #5 and #7. For a really good system we need to get insurers out of the picture entirely. Do not fall into the trap of thinking health coverage and health care are the same thing. They are not. Insurance provides absolutly NO healthcare. They use the accunting term”medical loses” for what they have to pay for medical care.They take up an enormous amount of our healthcare dollars in profit and administration. The only reason to keep them involved is for political reasons. Keeping them involved is like asking a burglur over to ask them about home security.Let them go insure capital or homes or anythig else instead of sucking the blood out of people and then denying them when they get sick.
We will here shrieks from the right about “socialized medicine” but I believe a single payer system is the best way for us to go. It is not socializeds medicine. The facilities would stay in private hands for the most part and most providers would work for companies or themselves as is now the case. The difference is that all the bills would be paid by the government after fair prices were negotiated for set services.This is not like the Canadian system but seems to me more viable for this country. Private hospitals etc. that want more money would have to compete with better customer service to get more business for example.

Posted by: BillS at February 6, 2007 9:19 PM
Comment #206861

Paul,

I like the ideas. There are a few concerns I have though.

Coordinated National System

How would one accomplish this and still have competitive business.

If we were to limit the way we do business to a certain criteria we take a huge risk in creating a monopoly in the health care system and that is very scary.

For instance say XHealthCo becomes the contracted government company. Then say YHealthCo becomes the leader in the private business sector. If X has government contract it has a lock down on business and if it is allowed to compete with private sector its market will be far more competitive leaving Y very little chance of survival.

Community Rating

This sounds very good, but wouldn’t this result in every body’s insurance going up if the insurance has to dish out more money?

If you stop them from increasing costs with the increase of expenditures then they will go out of business and it is very likely no company will pick up a lost cause.

Dr in System VS Dr Out

If you have such a limitation to the system, then who decides who is in the system and what are the requirements.

If it is going to be a government agency you could be talking about expenses in the tens of billions to administrate a system that is supplying medical to 350 million people.

Insurers May Not Interfere With Doctor’s Decisions

I don’t see how we would be able to stop this.

The same companies that own insurance own prescriptions, supplies, and doctors. We would have to either completely remove the ‘corporate veil’, which is unconstitutional, or outlaw incorporation, which could result in a depression much worse than before.

I think overall you have a very good thing started here. We should work out the details and see if we can’t make this a reality.

I for one would like to avoid persecuting any rights of either the individuals or the companies.

These companies are after all owned by individuals and employ millions of individuals just like us.

Posted by: Bryan AJ Kennedy at February 6, 2007 9:32 PM
Comment #206862

Paul,

When I was reading your last article, “Budgets Demonstrate Party Differences”, and some of the responses particularly regarding healthcare, I was also somewhat watching TV news (CNN I think) and overheard part of L. Paul Bremer’s testimony in front of the House Oversight committee regarding the accountability for the pallets of cash sent to Iraq. I did that funny thing where the coffee I just swallowed tried to exit my nose when I heard this:

“The deep crisis had been brought about not by war, nor by sanctions, but by decades-long corruption and incompetence of Saddam’s regime. Among many other shocking facts:

During the 1990’s Saddam cut health care spending by 90%. No new hospitals had been built in 20 years. More than half of the country’s public health clinics were closed.”

Bremer’s entire statement is here:
http://oversight.house.gov/Documents/20070206131720-22115.pdf

Does anyone else see the irony in that statement and the Republican goal of “starving the beast”?

Posted by: KansasDem at February 6, 2007 9:46 PM
Comment #206863

The problem with a fantasy wishlist like Paul’s is that it might sound good, but it fails to account for how addressing one percieved problem can create ten more.

Take number 6 and 8 for example. Insurers cannot interfere with doctor decisions? Is it really better, then, to have the government interfering with doctor decisions? Do you really believe that a federally controlled system is not going to set limitations on treatment, that doctors are just going to be given unlimited resources to do whatever they wish? That free means free?

Fat chance. Two major problems arise. Examples:

1). Take your car to the mechanic, tell him that your rich uncle is paying for it all and that money is no object. See where that leads. There would HAVE to be government-imposed limits or the entire system would collapse overnight.

or 2). Take you car to a mechanic who offers free and unlimited services to absolutely everybody. You’ll find that cars are lined up into the next zip code and his main goal is to get you through his shop as quickly as possible. This is exactly what happens in single-payer health systems around the world.

Also, I notice that in Paul’s long list, he doesn’t address at all one of the most serious drains on the system: the issue of medical malpractice lawsuits. Trial lawyers will absolutely love a single-payer with pockets as deep as Uncle Sam’s.

Posted by: Loyal Opposition at February 6, 2007 9:54 PM
Comment #206866

L.O.

I think we could solve the suites by passing a ‘responsible for consumer decision’ act.

The law should state that you are responsible for the medical attention you request and attention should only provide what is requested.

The doctor should say ” we can do this, this, or this, none are gaurunteed to work, use at your own risk”.

Heck, if people were to take responsibility for their own health care they would realize that the cheapest health care is the private unsibsidized outside of the business or government provided options.

Alas, this will never happen among the spoiled fully grown children who raise ungrown children in this country that used to be powerful AND proud.

So, I think the best we can do at this point is force healthcare upon them and make them pay the government cost for it which is never cheap (i.e. military, courts, police, eductaion, roads, ss, and everything else uncle sam has done or changed over the last half century).

At least then we won’t catch their diseases.

If you want an extreme option that will work… privatize, but it won’t happen any sooner than they will let me fix the economy, which I already proved I could do twice on this blog site.

Posted by: Bryan AJ Kennedy at February 6, 2007 10:19 PM
Comment #206875

LO & B.Kennedy

Some of your concerns would be met by a single payer system. Most provider would remain private but would be payed a set fee for services. Other than that to stay in business they would have to provide good care or their clientele will just go somewhere else.
As for malpractice suits that is a red herring. They just do not amount to that much and most cases are far from frivalous.The main cause of them is malpractice.If you cut the leg off the wrong patient you should have the hell sued out of you.Better charting etc would go a long way in preventing medical errors. This could be assisted with a single payer system as well as licenseing enforcement.Another factor would be more competition in the mal-practice insurance field. All those companies no longer insuring paitients would be insureing doctors.
As LO pointed out there could be long lines etc. Guess what,for many there already is,especially at E-rooms where there should be the shortest wait.This is where the uninsured often get their care. The preventive care aspects and the opportunity for regular appointments should help greatly.
Concerns about huge amounts of government paper work are always in order but well managed government programs do generate less of it that private sector. SS for example runs a less than 10% overhead. Much less than a private annuity for example. Some estimates show that the cost of the paperwork generated by the medical insurance industry is enough to provide healthcare to the uninsured. That is private industry.Another paperwork reducer is the fact that with universal care there are economies of scale to take advantage of.

Posted by: BillS at February 6, 2007 11:44 PM
Comment #206876


Bryan: Could you post a list of books you have writen on economics so that we might understand your economic philosophy in more detail?

Paul: One thing that you didn’t mention which I think should be stressed above all else is management. I am very tired of mismanaged government programs.

Giving doctors a totally free hand is not wise at all. Doctors, not all, are a major problem with medicare and medicaid. I have a friend on medicaid who has had 4 doctors in 6 years. He has also had every test known to modern medicine including 4 cat scans in 6 years. As soon as my friend gets comfortable with a doctor, he is told that the doctor has to many patients or twice, the doctor is leaving town and he is told to find another doctor. You can see how some are working the system.

Posted by: jlw at February 6, 2007 11:49 PM
Comment #206878

BillS, I seriously doubt there would be less paperwork and red tape in a system which would automatically become the largest, most complex and most expensive government program ever attempted anywhere by mankind.

There is hardly ever any motivation for streamlining such systems without the pressure of a profit motive, something the private sector tends to understand better than government. The reason for so much paperwork and red tape now is regulation and government involvement—something we’re talking here about increasing by ten-fold.

Posted by: Loyal Opposition at February 7, 2007 12:02 AM
Comment #206880
For a really good system we need to get insurers out of the picture entirely.

That’s a really good point. The only reason we have health insurance is because otherwise, only the wealthy could afford medical treatment.

Any national system is going to require efforts to make health care cheaper.

One method everyone agrees on is modernizing the providers’ administration systems. The current paper-based systems cost us as much as $25 per transaction — none of which goes to the actual care — as opposed to banks which can do the same kind of billing and communication for less than a penny.

Make healthcare affordable to the average American and everything else becomes possible.

John Kerry had a pretty good plan for that. I’m sure we’ll see parts of it again.

Posted by: American Pundit at February 7, 2007 12:15 AM
Comment #206888

LO
There are several examples of large government run healthcare providers that work pretty good with less paperwork than we have now in our private delivery system. One that we have in this country that by most accounts works well is the VA. What I am suggesting involves less direct government involvement than that.
You are right to be concerned about redtape. Good management is the key,of course.The paperwork for payment should only be as complicated as necessary to make sure payment goes to the right people for services performed. The patients(US) should seldom even see it.Medical record keeping would remain private but should meet standard guidlines.I am not real thrilled with a vast government bank of medical records myself.Another plus for single payer vs pure socialist system.

Posted by: BillS at February 7, 2007 2:26 AM
Comment #206889

LO
PS. The largest ,most complex,and expensive government program in history was the Cold War.Lots of paperwork too.

Posted by: BillS at February 7, 2007 2:30 AM
Comment #206904

I seriously doubt there would be less paperwork and red tape in a system which would automatically become the largest, most complex and most expensive government program ever attempted anywhere by mankind.

LO,

Medicare’s administrative costs: 3%
Private insurance administrative costs: 20%

Which do you think has more paperwork and red tape?

Posted by: Steve K at February 7, 2007 8:31 AM
Comment #206917

By not talking about how to pay for socialist healthcare, you have done nothing but create a wishlist to help buy votes.
Vote for the Democrat candidate and you won’t have to use your own money or plan for yourself, we will force everybody else to pay for your healthcare.

Most Americans probably wouldn’t have a problem with most of your suggestions Paul. Its the individual rights that would be trampled in order to pay for it that would piss them off.

Posted by: kctim at February 7, 2007 9:50 AM
Comment #206925

kctim,

I’ve shown that 1. we are paying for it now, and 2. government has already demonstrated that it provides health care more efficiently.

Posted by: Steve K at February 7, 2007 10:17 AM
Comment #206931

Thats all fine and dandy Steve, but that has nothing to do with how our current system or an even more socialist system such as Paul outlines, would trample our rights.
We pay for it now because we are forced to. One persons beliefs are forced onto others. That is wrong.
Govt provides health care more efficiently? So what. If its not voluntary, its not Constitutional.

Posted by: kctim at February 7, 2007 10:37 AM
Comment #206935

Why are insurance companies needed?
If government collects taxes for healthcare coverage, why include any unnecessary middlemen?
OHHhhhh … right … government is FOR-SALE.
Some bought-and-paid-for incumbent politicians are in the pocket of big-money-donor insurance companies, eh?
This will be interesting (and probably another dismal failure).

The best solution is to get rid of the middlemen.

Since the healthcare industry is unwilling to deal with their customers directly (which begs the question, WHY?), we should at least eliminate all unnecessary middlemen, since that is largely part of the reason for high costs (not to mention insurance companies trying to make medical decisions)?

If the government healthcare system involves insurance companies, it will be a farce, and costs will contiue to climb while healthcare becomes increasingly unreliable and dangerous.

Politicians love bribing voters with their own tax dollars and perpetuating the myth that we can all live at the expense of everyone. The mismanaged condition of Social Security, Medicare, and PBGC does not bode well for a National Healthcare system. Perhaps it will be the straw that finally breaks the camel’s back?

Posted by: d.a.n at February 7, 2007 11:09 AM
Comment #206936
BillS wrote: Paul Pretty good list except #5 and #7. For a really good system we need to get insurers out of the picture entirely. Do not fall into the trap of thinking health coverage and health care are the same thing. They are not. Insurance provides absolutly NO healthcare. They use the accunting term “medical loses” for what they have to pay for medical care.

BillS,
You are absolutely correct.
There is no need to involve insurance companies.
Not only are they a completely unnecessary middleman, but try to make medical decisions too.

Posted by: d.a.n at February 7, 2007 11:12 AM
Comment #206938

Why can’t there just be an insurance program for those who are self insured or unisured to buy into based on income?
An insurance as good as say - what GM employees or GE employees receive?
Those who are ‘the poorest of the poorest’ are already taken care of.
Our government has no problem figuring out a percentage to pay into FICA, local, state,and federal taxes.

Posted by: dawn at February 7, 2007 11:52 AM
Comment #206942

kctim,

Your argument suggests you want to abolish Social Security as well. Do you?

Posted by: Steve K at February 7, 2007 12:01 PM
Comment #206947

jlw,

I appreciate that. =) I have not written a book, but I am a homeowner, own a respectable car, have investment plans, nest egg, a half million in retirement already accumulated. Not bad for a 24 year old college student who made a little less than $9k last year. Before college I was still only making a little over $20k. I think that is proof enough that I know money and economy.

I am willing to bet any amount of money that no politician in office today could do that.

You know, now that you mention it, I should write a book. It would be a nice little bonus income after I get done with college. I could even use my thesis paper as the introduction. You don’t want points off the net sells for it being your idea, do you? ;)


American Pundit,

“The current paper-based systems cost us as much as $25 per transaction — none of which goes to the actual care — as opposed to banks which can do the same kind of billing and communication for less than a penny.”

That is a very good point, this is because of the amount of filing that the medical field has to do with the government vs. the amount the banks have to do.

I agree, if we reduce the over head of medical every one could afford it. Could the medical industry be more productive and produce better results if it wasn’t excessively governed?

I think it would be.


BillS,

You are absolutely right, the VA system works great and affordable. If we could do that minus the military involvement it would be much cheaper. That is a system I would very much like to see.


Dawn,

I think that is pretty much the gist of what BillS and myself are trying to say. We already do that with so many different programs as is, they have been effective, there is no reason it wouldn’t work here as well.


Everyone,

I think this is the most respectful and productive blog to date. We should all get pats on the backs. If only congress could be this supportive of their fellows. =)

Posted by: Bryan AJ Kennedy at February 7, 2007 12:14 PM
Comment #206955

d.a.n.
Yeah,pretty much. In CA. a single payer plan passed the legislature and was vetoed by Swartzenneger. The insurance industry gave his campaign millions. He said he wanted a free market solution. Of course the free market as it is has already failed. He has proposed a plan that is convuluted to include insurance and they are still not happy because they will not be able to dump sick people.
You are wrong about SS being mis-managed. The SS Trust itself has very low overhead,issues millions of checks efficiently and has wisely put aside money to pay for the boom. The mis-management is not the program but the other part of the federal government that sold the bonds. The US has never de-faulted on its notes before and should not be allowed to in the future.If they must de-fault let them de-fault on China not us.

Posted by: BillS at February 7, 2007 12:49 PM
Comment #206960

Steve K.
“Your argument suggests you want to abolish Social Security as well. Do you?”

Yes. Or at least make it voluntary.

Posted by: kctim at February 7, 2007 1:18 PM
Comment #206962

kctim,

My dad-inlaw tried not to collect SS. He told them to give it to the people who really need it.

The government told him he is qualified and must be sent a check.

Yes. He gives alot to churches & charities.

Posted by: dawn at February 7, 2007 1:32 PM
Comment #206979

I appreciate all your comments.

It seems that the main issue of contention is the role of insurers. Some, like BillS and d.a.n, want to get rid of them entirely. My instincts are to go along with them. However, I’m convinced that such a system will never be enacted, even if the presidency and both houses of Congress are under Democratic control.

This means we must have a system that does not include most of the bad effects due to the presence of insurers. This is why I want a national system that guarantees that people with catastrophic ailments and disabilities are taken care of. This is why I insist on community rating and that insurers not interfere with doctor decisions.

Doctors have the final word. However, they must contribute to a quality control system that evaluates them so that patients can choose doctors wisely.

Posted by: Paul Siegel at February 7, 2007 3:12 PM
Comment #206989

There are many very good ideas in these posts. We need to keep up this dialog and maybe we can all, left and right, arrive at a system out legislators could work with.
The mentions of the VA and SSA are absolutely correct. They are both run very efficiently and they both provide needed services.
My son recently spent 15 months in various hospitals and rehab facilities. The bill for his medical treatment will run into the millions. Fortunately, he had insurance that covered most of the bills, but he will never be able to pay for the remainder.
I firmly believe in universal health care and I’m very glad Paul started the ball rolling.
Let’s keep it moving!
jack p

Posted by: jack p at February 7, 2007 3:53 PM
Comment #206990

I agree that ss should be voluntary.

No free person should have to do anything that is not a criminal act to refuse.

Posted by: Bryan AJ Kennedy at February 7, 2007 3:53 PM
Comment #206998

Jack P
How would you pay for this universal healthcare that you firmly believe in?

Posted by: kctim at February 7, 2007 4:26 PM
Comment #207005

Paul
Getting insurance companies out of the picture is not politically impossible. What is impossible is solving a problem with the cause of the problem left intact.
A single -payer plan made it through the legislature in CA. It was vetoed by our Rep governor but he will not be governor for ever.

LO does bring up high mal-practice insurance rates. Sure it is a red herring but the rates are indeed high. Rather than the usual blamming of the victums we get from the right how about regulation of the industry. Let them justify their rates like we do with car insurance rates in CA. Since we started doing so the rates have fallen consistently and competition has increased.

Mr. Kennedy
Quite a sweeping statement.So you are opposed to driver license and insurance requirements. How about military drafts, compulsary education,travel visas,child vaccinations,dog licenses etc.

Posted by: BillS at February 7, 2007 4:46 PM
Comment #207007

Other than the army BillS, why exactly should people give up their personal rights and freedoms to the federal govt for the other things you mention?

Posted by: kctim at February 7, 2007 4:55 PM
Comment #207014

kctm
“If it is not voluntary it is not Constitutional” That is a legally inaccurate statement.

Beyond that If one looks at the system we have now you will see that the uninsred do get healthcare,often at E-rooms,as a last resort. Their care would be better and cheaper if they had earlier access. Those of us with insurance wind up paying for it. that is the biggest reason why our rates are so high.Why we pay 12$ for a cotton ball or 30$ for a plastic bedpan. It is a decending spiral. the more uninsured the higher our rates. The higher our rates the more uninsured. What we have is the worst aspects of a socialized system,where we all have to pay for others like it or not,without the price and quality oversite that a well managed government system would bring. If the government system works poorly at least you have a chance to vote for new leadership,too petition for change etc.

Posted by: BillS at February 7, 2007 5:07 PM
Comment #207018

kctm
Most of what I mentioned is not the province of the federal government. Visa,passports etc.? You tell me. Perhaps because other countries insist.

Posted by: BillS at February 7, 2007 5:17 PM
Comment #207024

BillS
Legally inaccurate? Please cite one place in the Constitution where it says stealing from one and giving to another is ok. Or where it says forcing one persons beliefs onto another is ok.

And the reason our rates are so high is because people no longer care nor do they feel as if it is their own responsibility.
That is the root of the problem and I for one do not give a crap if somebody suffers because they are too lazy or dumb to plan.
Many of you “say” you do care though and that is very nice of you. Too bad you expect everybody else to pay for it. Actually doing something would help alot of people and wouldn’t trample others rights.

I don’t want to force my beliefs onto you, why do you think its ok to force yours onto me?

Posted by: kctim at February 7, 2007 5:31 PM
Comment #207027

You are right Bill. The federal govt is responsible for complying with international travel requirements. My bad for reading over those two.

Posted by: kctim at February 7, 2007 5:35 PM
Comment #207032

BillS,

Not as sweeping as you percieve it to be.

Nearly all those things you listed are criminal to be non-compliant with.

Driver’s liscenses, vehicle insurance, travel visas, child vaccinations, and pet liscenses are not mandatory as you are not required to drive, travel, breed, or own animals.

There is no way around ss and there is no law saying it is criminal not to participate. With the exception of a few vague references from our tax evasion prohibitations.

If we already have our own retirement funds that are producing greater results than ss than we should not be required to lessen our investment by participating in some half assed retirement plan that won’t even pay the rent of the average recipient.

So I say it again:

No free person should have to do anything that is not a criminal act to refuse.

Still pro-draft, still pro-education, still pro-liscenses, still pro-insurance, still pro-parental responsibility, and my point still stands unscathed.

Posted by: Bryan AJ Kennedy at February 7, 2007 5:50 PM
Comment #207034

kctm
Rather than get into an already deeply plowed furrow here lets please look to common sense. You may not like the idea of paying for someone elses treatment but that is exactly what you are doing when you pay high health premiums or care cost. It is also in your personal interest for someone with typhoid or t.b. etc. to recieve treatment as opposed to running around infecting others.What this thread has mostly been about is how to best control the already high cost and improve care and efficiency.

Posted by: BillS at February 7, 2007 5:52 PM
Comment #207039

Mr. Kennedy
You can avoid SS easily. Just do not work. See,problem solved. You are not required to work and many do not,the idle rich for example.

Posted by: BillS at February 7, 2007 5:57 PM
Comment #207045

BillS,

Not so.

The idle rich still mandatorily recieve ss benefits upon retirement.

That is the afore-mentioned problem with KcTim’s father getting ss he denied wanting, it should of went to some disabled veteran or handicapable person instead of he, who clearly had plenty.

If you don’t work, you still get the check, so problem not solved.

In fact the not working by anyone who is not paying into ss is exactly what makes it so lousy.

The majority of you investment is going to support the unemployed, wether they are filthy rich or just absolutely lazy.

Granted there are those who can’t possible work at all and I have no problem helping them, but you can’t not prove in any way that even a fair amount of ss or welfare for that matter goes to people who deserve it.

I grew up in a welfare nieghborhood and they were all drug addicts and gang-bangers.

I can’t recall more than three of the hundreds of person getting ss/welfare benefits who were actually incapable of work.

Not to mention the few who did deserve it, didn’t really need it because they were already getting help through sponsorship programs.

Wasted investment, wasted on lazy people who don’t deserve it.

Posted by: Bryan AJ Kennedy at February 7, 2007 6:09 PM
Comment #207046

BillS
I don’t get into a “deeply plowed furrow” on here, I have to much fun.

I understand how I am paying for the bums who do not want to pay for themselves to. That goes along with the personal responsibility thing I mentioned as being the root of the high costs. If they cared enough to plan, I wouldn’t be forced to pay for them.
But they do not have any reason to care nowadays. The govt does everything for them and gives it to them for free.

And this thread has mostly been about a wishlist and people intentionally left out how to pay for it because that is where the problem lies.
Telling people you want to force them to degrade their personal lifestyle so as to better anothers, isn’t a good way to scare up votes.

Posted by: kctim at February 7, 2007 6:09 PM
Comment #207051

Bryan,

‘Wasted investment, wasted on lazy people who don’t deserve it.’

I have seen exactly what you are describing.

How does one ‘prove’ another is capable of work without stomping on their civil rights?

kctim,

I suggested how to pay for ‘it’.

Charging premiums for those who are self-insured or under-insured - based on income- and give the same healthcare coverage as the medicare program provides.

‘Big business’ receives discount rates, insurance companies deal wih providers to receive lower costs.
If one is not part of either of those, they pay the maximum rates - both for insurance, and for healthcare.

Why can’t the government buy health insurance for people at the same rates given to big business?
A person/family could sign up.
Then like the fight that began over prescription plans for senior began , the fight over insuring those through the government plan can begin.


Posted by: dawn at February 7, 2007 6:24 PM
Comment #207057

kctm
Inability to pay the high premiums is a more prevalent cause than poor planning. That is why the numbers are increasing.As for leaving out how to pay for it,WE ARE ALREADY PAYING FOR IT. We are just not getting a good deal for our money. Americans pay more for healthcare and we do not get things like universal care or even the best care.

Mr. Kennedy
Amuzing thought, to retire after a long career of being idly rich. At any rate besides disability you are wrong. If you do not pay into it through wages or self employment taxes you and your dependants are not eligable.SS is not welfare. That is one reason many oppose means testing. It is also our national widows and orphans fund. I suppose you and kctm are right. I have a two year old daughter. If I die she will recieve benefits based on my claim. She has never even once showed any interest in getting a job. Must be because she expects the government to take care of her.

Posted by: BillS at February 7, 2007 6:46 PM
Comment #207083

Dawn,

They have already established these means, they are just not always used or repeated.

People heal, eight children will eventually grow up and move out or be picked up by CPS. I saw a lot of the later growing up.

Many people get them for being the child of some one who used drugs while pregnant. Granted this does cause birth-defects. There are many born as such who have no defect. Very many.


BillS,

Now your just averting the point.

I have not stated anywhere that I want to abolish ss. I like the idea. I just think it should be optional.

I for one, would still pay some into it, just not the ridiculous amount I am paying now.

Ridiculous, when one considers the pathetic return on the dollar.

If you invested that percentage of your income into rothchilds and government bonds you could retire more than well off after about fourty years of working for minimum wage (18-58).

As I stated before and will again, those who truely can not work should be covered and there is no reason some one should oppose such an idea.

I am talking about the multitudes of people who are soaking it up unjustified. They despite never working still get ss upon retiree age, I know this first hand.

Not to mention, it is these masses of worthless people who are robbing your daughter of the additional money she would require to survive until she reached the working age.

If we weren’t dishing out unneccessary funds to people who are perfectly capable of working there would be plenty of money for your daughter in the case of your untimely demise.

As is, she wouldn’t get enough to cover rent.

Besides as a parent it should be your responsibility to have a life insurance policy as well as medical and dental that has continuance for your child in the case of untimely demise.

One could also consider that a national healthcare plan could easily paid for with the money we are wasting on social-welfare on those capable of work.

Also, as pointed out by kctim, just because some one pays into it doesn’t mean they actually need it, hence the original statement:

“No free person should have to do anything that is not a criminal act to refuse.”

Posted by: Bryan AJ Kennedy at February 7, 2007 8:02 PM
Comment #207101
BillS wrote: d.a.n , You are wrong about Social Security being mis-managed. The Social Security Trust itself has very low overhead, issues millions of checks efficiently and has wisely put aside money to pay for the boom… . The US has never de-faulted on its notes before and should not be allowed to in the future. If they must de-fault let them de-fault on China not us.
Social Security isn’t mismanaged? $12.8 trillion in the hole ? The Trust Funds you speak of are worthless government bonds. Do the math. Extrapolate GDP, population, tax revenues, debt, and entitlements. And you don’t see the train-wreck coming? Posted by: d.a.n at February 7, 2007 9:27 PM
Comment #207105

Mr. Kennedy
There is a provision that allows widows or widowers to collect a portion of their departed spouses benefits upon reaching retirement age if they were married for 10 or more years. Is that what you are talking about.My mother recieves that and it is a Godsend. That and disability ,dependant child are the only way one one can collect without making contributions. If that is not what you mean then what you know first hand ain’t so.

We are paying a lot.You are correct. The reason we are paying more than the actual cost is to build up a reserve large enough to meet the needs of the baby boomers. The conservative trutees of the SS fund predict solvemcy until 2042 and seventy percent afterwards. The doom and gloom you hear is comming from those who are idealogically opposed to the system and/or want a piece of it.
If you invested the money yourself you might do better, true, or you might not.Just ask the Enron investors. If you were to shop around for an annuity that would pay you a lifetime benefit starting at age 62-65 with no end plus pay you if you becaome disabled at any age,plus pay a lifetime benefit to your spouse or dependant child I doubt you’d be able to get it any where nere the price you are paying for SS.
Why most,but not all workers pay into it is because some do not plan or act responsibly. We are not a nation that lets orphans go hungry. The rest of us would chip in. With SS some of a workers pay is assured to help out with their own. Not so bad.

Posted by: BillS at February 7, 2007 9:43 PM
Comment #207109

d.a.n.

I have been in agreement with you surprisingly often lately.Not on this one though. For starters you numbers are wrong. The figure is closer to 3.5 trillion. Yes that is a huge amount and I know how many zeros.
Secondly we are talking apples and oranges here. I am talking about the separate,distinct legal entity called the SS Administration. Taxation was increased years ago to provide for the baby boom bubble. They do not hold cash. This created the surplus. They do not hold cash but by law must lend the money to the general fund. in exchange for this the fund hold t-bills that bear interest. Thesee bills are negotiable and have always been honored. OK back to my contention. The managers of the fund do a good job at their responsibilities. The overhead is kept low,lower than private annuities by far, and they efficiently administer a huge fund. The mis-management problem is with the general fund. For years little heed was paid to the eventual need to make good on the notes it sold to the SS fund. As the time draws closer to when the SS fund will start needing to cash in those bonds panic is setting in. It is like they did not expect us to live this long. Tough tit. Pay up. Still the management problem is not in the SS administration but with consecutive congresses and administrations as you so often point out.
Regards Bill

Posted by: BillS at February 7, 2007 10:02 PM
Comment #207145

B AJ Kennedy,If you see all this fraud and waste yet remain quiet instead of doing your duty and reporting the fraud then are you part of the problem or part of the solution?

Posted by: j2t2 at February 8, 2007 1:00 AM
Comment #207166
BillS wrote: d.a.n , … For starters you numbers are wrong [re: Social Security debt] . The figure is closer to 3.5 trillion. Yes that is a huge amount and I know how many zeros.

BillS,
CATO Institute states the Social Security debt is $12.8 trillion. That is the total current (not future) Social Security debt. Source: CATO institute (read the first paragraph) states:

The short answer is that Social Security is already $12.8 trillion in debt.

As you say (below), the Social Security Trust Funds are just paper.
There is no money in the lock-box.
There is no lock-box.
There should be, and that’s the way it was originally, but Congress was irked by the inability to spend those funds and changed the law shortly after Social Security began, so that they could plunder the cash in Social Security. Hence, Social Security is purely Pay-as-You-Go.

BillS wrote: Secondly we are talking apples and oranges here. I am talking about the separate,distinct legal entity called the SS Administration. Taxation was increased years ago to provide for the baby boom bubble. They do not hold cash. This created the surplus.
Right. It’s just paper.
BillS wrote: The managers of the fund do a good job at their responsibilities.
Depends on how you look at it.

If they had actually managed Social Security correctly, they wouldn’t have let the surpluses be spent on other things. But Congress is to blame for it. They changed the laws so that they could spend the cash from Social Security and replace that cash with worthless bonds.

BillS wrote: The mis-management problem is with the general fund. For years little heed was paid to the eventual need to make good on the notes it sold to the SS fund. As the time draws closer to when the SS fund will start needing to cash in those bonds panic is setting in.
Yes, panic and anger could result of 77 million baby boomers don’t get their expected benefits.
BillS wrote: It is like they did not expect us to live this long. Tough tit. Pay up. Still the management problem is not in the SS administration but with consecutive congresses and administrations as you so often point out. Regards Bill
Does it matter whether the mismanagement is by the Social Security administration or the general fund?

Congress is behind all of it. The mismanagement of one area (i.e. the general fund) hurts all other areas (Social Security, Medicare, FEMA, Medicaid, etc.).

Deficit spending will continue as it always has since year 1960 (the last year when there was a real annual surplus and the national debt was slightly reduced).

Inflation will increase. The Federal Reserve and government will print more money, because defaulting on the $8.7 trillion National Debt or failing to pay Social Security benefits, Medicare benefits, or PBGC pension benefits, etc. (totaling over $22 trillion) would trigger an economic melt-down.

So, the excessive printing of money could cause inflation to climb in to the double-digit range (like it did in the late 1970s and early 1980s).

Regardless, Social Security, Medicare, and the PBGC are threatened, because of massive debt, borrowing, uncontrolled spending, and excessive money-printing.

Here’s what the Social Security and Medicare Trustees say in the 2006 Annual Report:

  • Projected OASDI tax income will begin to fall short of outlays in 2017, and will be sufficient to finance only 74 percent of scheduled annual benefits in 2040, when the combined OASDI trust fund is projected to be exhausted.

  • Social Security could be brought into actuarial balance over the next 75 years in various ways, including an immediate increase of 16 percent in payroll tax revenues or an immediate reduction in benefits of 13 percent (or some combination of the two).

  • Medicare: As we reported last year, Medicare’s financial difficulties come sooner-and are much more severe-than those confronting Social Security. While both programs face demographic challenges, the impact is more severe for Medicare because health care costs increase at older ages… . now projected to surpass Social Security expenditures in a little more than 20 years …

As bad as that sounds, it’s still too rosy, since the so-called surpluses in Social Security are merely paper, Medicare is already in trouble, the National Debt is over $8.7 trillion, and the PBGC is $450 billion in the hole. Now add the cost of wars in Iraq, Afghanistan, and the cost of Katrina, and the cost of a National Healthcare system to the mix?

Younger workers/voters are not likely to tolerate a 16% increase on their taxes (just to keep Social Security afloat, much less tax increases needed to fund Medicare too, the PBGC, interest on the $8.7 trillion national debt, wars, Katrina, etc.).

There is ample reason for concern, and even the Trustees of the Social Security and Medicare systems are calling for action now. Yet, Do-Nothing Congress keeps ignoring it, along with many of the nation’s most pressing problems.

Posted by: d.a.n at February 8, 2007 10:09 AM
Comment #207212

d.a.n.
Wikipedia shows an even lower figure than 3.5. The CATO institute is yet one more right wing propaganda mill. Check some other sources for a more accurate look. Even so 3.5 is an enormous amount and your point remains solid.

Posted by: BillS at February 8, 2007 4:08 PM
Comment #207216

I have two comments on national health care.

1) We shouldn’t look at it until after we get our fiscal house in order. A balanced budget plan past both houses and the president. Also fix the other huge budget breaking programs, medicare and social security. We have no business starting a huge, new, entitlement program until we fix whats’ broken

2) I’m for national health care. I’m against the broken system other nations have. I think we ought to take the best of what they do and mix it with the best of what we do and make something that really works. Forget a radical socialist plan because left wing nuts want to make the US a socialist nation. Hillarys plan for instance, it was so bad even demcorats announced it DEAD ON ARRIVAL. It socialised 1/7th of the US economy, was huge, unwieldy, 1,000 page plan that was rediculous. So bad even democratic party leadership declared it was useless.

Posted by: Stephen at February 8, 2007 4:59 PM
Comment #207217

stephen:
FYI Nixon proposed a plan almost exactly like Hillary’s plan. Was he a left wing nut?

At any rate one of the reason I favor a single-payer plan is that it is not “socialist”. Facilities and healthcare workers would remain in the private sector.Set prices and quaility controls would be set by the government after negotiations.

Posted by: BillS at February 8, 2007 5:33 PM
Comment #207237

Stephen,
You’re recommendation is sound.
We need to get a handle on other pressing problems first.

Posted by: d.a.n at February 8, 2007 8:25 PM
Comment #207238
BillS, d.a.n. Wikipedia shows an even lower figure than $3.5 [trillion]. The CATO institute is yet one more right wing propaganda mill. Check some other sources for a more accurate look. Even so 3.5 is an enormous amount and your point remains solid.
BillS, I believe you are talking about the Social Security Surplus, and I’m talking about the Social Security debt (two different things).

Still, as you say, a $3.5 trillion surplus in the form of bonds ain’t worth much. It’s just paper, and the other $22 trillion of federal debt doesn’t bode well for the repayment of any Social Security bonds.

Posted by: d.a.n at February 8, 2007 8:31 PM
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