December 23, 2007
National Health Care Solution?
My response to the first half of David Remer’s excellent article titled Past is not Prologue grew to article length so I decided to post it as an article.
David:
Excellent article. I have only made it half way through and have to comment. You wrote:
But, Medicare now faces, not 4 trillion dollars in shortfalls, but, forty trillion dollars in revenue shortfalls to sustain the program.
and:
When Republicans are in power, one set of uncompromising solutions are promoted which negate and reverse solutions implemented by Democrats. And when Democrats are in power, they in turn reverse and negate the solutions implemented by Republicans.
Your premise here is that either set of solutions would work if followed through on. I disagree. Follow through is important. Following through on a fatally flawed approach will only guarantee failure.
The "Proposal of the Physicians' Working Group for Single-Payer National Health Insurance" say it best:
For seven decades, opponents have blocked proposals for national health insurance, touting private sector solutions. Their reforms over the past quarter century have emphasized market mechanisms, endorsed the central role of private insurers, and nourished investor-ownership of care. But vows of greater efficiency, cost control, and consumer responsiveness are unfulfilled; meanwhile the ranks of the uninsured have swelled. HMOs, launched as health care’s bright hope, have raised Medicare costs by billions, and fallen to the basement of public esteem. Investor-owned hospital chains, born of the promise of efficiency, have been wracked by scandal; their costs high, their quality low. And drug firms, which have secured the highest profits and lowest taxes of any industry, price drugs out of reach of those who need them most.Many in today’s political climate propose pushing on with the marketization of health care. They would shift more public money to private insurers; funnel Medicare through private managed care; and further fray the threadbare safety net of Medicaid, public hospitals and community clinics. These steps would fortify investors’ control of care, squander additional billions on useless paperwork, and raise barriers to care still higher.
Read the rest of their plan which is closer to Democratic perspective.
Listen, lets do a mind experiment a little like Einstein and Schroedinger used to do:
Lets do away with Medicare - the Repubs will love that. if private industry provides that service: Do you seriously think that the cost of the care that Medicare is committed to providing will be any less than $40 trillion? More than $40 trillion? Or the same? I would argue that it would cost at least $40 tril, probably more.
The Repubs are correct that doing away with Medicare would save money. It would save money by not providing needed services to millions of people who would suffer as David Remer eloquently states in his article.
If you are going to provide those services to people, it is going to cost some money. The Physicians for a National Health Program have a plan that could save some of that money - but it is going to cost some money. If you were going to provide these services to everyone in America, even with their savings, it would cost at least $40 tril.
The questions are:
Are we going to provide those services?
If so:
What is the best, fairest, most efficient way to provide them?
How are we going to pay for them?
The Repubs will remind us that providing National Health Care will result in waiting lists for care of non life threatening conditions. They are right. In Canada, people do have to wait a few months for knee replacements.
Do you think that no one is waiting for health care now? People without insurance, who cannot work because they need a knee replacement, wait their whole life - in pain - until they finally mercifully die prematurely of a heart attack because they were in too much pain to exercise. We save a lot of money though. What about the money we lose to their lack of productivity?
The Republican plan for health care works for the elite. It will only work for the elite. That is the only people that is intended to work for.
If you want to provide health care to the broader mass of American people. You are going to have to spend some money - at least 40 tril - and the only plan that will ever really work is the Democratic plan modeled on Medicare.
This is not a choice between which solution is best. This is a choice between a solution and no solution.
Do not comment on this article without reading: "Proposal of the Physicians' Working Group for Single-Payer National Health Insurance"
Posted by Ray Guest at December 23, 2007 11:42 PM
The sure sign of a bad solution is a proponent of it telling you that there are only 2, or even worse, 1.
Humans are a smart species and if we were to actually remove biases and partisanship from the discussion I imagine we could find several good, quality, solutions.
But that wouldn’t advance anyone’s individual party, would it?
Posted by: Rhinehold at December 24, 2007 12:56 AMRhinehold,
True. I am sure there are many real solutions. But there are two basic approaches offered. Of those two - only one is valid.
Posted by: Ray Guest at December 24, 2007 01:02 AMOne way to allow free market economics to really work would be to allow anyone to practice medicine.
I will do your knee surgery if you will do mine. I have a chain saw. That solution might work - but it is not on the table.
You got a better idea?
Posted by: Ray Guest at December 24, 2007 01:07 AMI imainge there are more, but they are just not debated because the RNC or DNC are not putting them out in their talking points…
It’s too bad we have to choose between liberty and health.
Personally, I support the motto of New Hampshire…
Posted by: Rhinehold at December 24, 2007 01:09 AMRay, I have a question though, since you seem be around.
What is the difference between a single payer system that is tax collected and paid for by the government and a single payer system that is fees paid (a small percentage of each doctor visit) and run by a private organization that is chartered by the government and then left alone with only bi-annual oversight hearings?
Posted by: Rhinehold at December 24, 2007 01:13 AMWell, other than the fact that Americans still retain their liberty and we keep politics out of our healthcare system (which we have failed to do so far for the past 60 years…)
Posted by: Rhinehold at December 24, 2007 01:14 AMExcellent post Ray,
I was unaware of this group, thanks for the info.
Rhinehold,
No one is taking away your precious liberty, you can still protest by dying in the street and refusing medical care.
Posted by: googlumpus at December 24, 2007 03:36 AMgooglumpus,
Does that mean you don’t want to answer my question or can’t?
And yes, the various plans do. You don’t want to accept it but that doesn’t mean the facts don’t support it.
Finally, your distaste when you wrote ‘your precious liberty’ is telling and sadly indicative of how far we have strayed from what our founding fathers risked their lives to provide for us.
Posted by: Rhinehold at December 24, 2007 04:08 AMAgain, the question I have is why does the government have to run the program? What specifically does bringing the government into running the program instead of setting up a non for profit organization, led by doctors, to implement a program that would manage the new crop of Healthcare Savings Accounts, that are not tied to employment, roll over each year and earn interest? It could be paid for by a surcharge on doctor and hospital visits, say 1 or 2 dollars.
Why is this not a valid solution and why does it only work if the government is involved? (Hint: I know the answer already)
Posted by: Rhinehold at December 24, 2007 04:13 AMRhinehold,
I have no problem with a non-profit single payor system - in theory. It needs to be a single payor. That is what rings the bureaucratic waste out of the system - perhaps as much as 30%.
One of the better charities here is United Way. Several decades ago - when I was making about 30,000 per year, their director was making 90,000. It is a good charity - but… Non-profits can be profits in disguise.
The Physicians for a National Health program call for hospitals and testing facilities to become non-profit. I think pharmaceutical companies should be non-profit as well.
The physicians plan would allow people to chose their own doctors and keep politics out of health care decisions. You are concerned about government political interference in health care decisions. Currently we have corporate political interference in health care decisions. That is also political, less transparent, less democratic, driven by predatory intent.
Thanks all for your thoughtful comments.
Rhinehold,
I’m not sure which question you want me to answer.
As to my use of the word precious , I am referring to your nebulous overuse of the word liberty. I asked in another thread what liberties exactly you fear losing from a NHI program. You did not respond.
I recently listened to Ron Paul describe it as socialized medicine. Yeah? So What? The fear mongering through the pejorative use of the words liberty and socialism, that are intended to strike fear in the heart of red-blooded Americans, is what I find distasteful and diminish the values of real liberty.
Posted by: googlumpus at December 24, 2007 12:03 PMRhinehold asked: “What is the difference between a single payer system that is tax collected and paid for by the government and a single payer system that is fees paid (a small percentage of each doctor visit) and run by a private organization that is chartered by the government and then left alone with only bi-annual oversight hearings?”
There are several differences. But, the biggest is that a government single payer plan does not involve a middleman taking profits and raising health care costs to cover those profits, which a middle man private single payer would. Difference: one to several trillion dollars in health care costs between 2010 and 2075, depending on the greed and monopoly power of the private intermediary. Big enough difference for you?
Posted by: David R. Remer at December 24, 2007 03:35 PMRay, one correction: Medicare as currently operated, depending upon private profit industry care delivers, is estimated at 40 trillion in unfunded mandates.
A single payer government sponsored plan which provided Basic preventive care coverage AND which gave preferential treatment to non-profit health care deliverers, could potentially drive that unfunded mandate down from 40 trillion to 30 trillion.
But, the fact remains, our economy in the current geo-political-economic future, cannot sustain the current 9 trillion plus 30 trillion national debt. Economic collapse will certainly occur long before we hit that 39 trillion national debt level.
A single payer government sponsored universal coverage plan has the capacity to reduce overall health care costs, but, for the government and economy to survive, only Basic preventive and emergency life saving care can be afforded universally. To go beyond that level incurs the kind of unfunded mandate that is unsustainable.
And that is what is wrong with the Democrat’s plan. It offers more coverage than it can hope to pay for in tax revenues, resulting in bankrupting national debt. This can be part of a solution to prevent such lofty national debt, but, only a part. Other pieces to the solution must be devised that will dramatically lower the cost of health care delivery and a great deal of medical care will have to be electively available to those who can afford it. These are economic realities that many Democrats on the Hill have yet to come to grips with.
Republicans answer is those who can afford private insurance or self insurance should receive care and those who can’t, shouldn’t as just reward for sloth and lack of initiative. Not very Christian, and not very politically astute but, that is their plan.
Of the two, BOTH sink the nation, Democrats sink it with debt, and Republicans sink it through revolution and civil conflict that would result from media coverage of 10’s of millions of Americans and seniors dying and suffering in deplorable 3rd world type poverty and destitution, or an about face in 15 years to universal single payer or similar alternative which comes to late to save the economy form massive and bankrupting national debt.
In the end, it is hard to know which is better. In the beginning however, the Democrat’s approach has benefits which can be merged with other cost reduction actions with the potential of actually not sinking the nation if they can be found and implemented.
Posted by: David R. Remer at December 24, 2007 03:52 PMRay,
I’m glad you wrote this article and I hope to see some thoughtful debate come out of it. I believe that very few would deny that our nation is facing a health care crisis. Sadly some will, just as some choose to ignore David R. Remer’s and d.a.n.’s warnings regarding both personal and national debt, these are the times we live in ((((((((((sigh)))))))))))!
The first question that needs to be answered is whether a majority of American voters believes that “Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to assure this right.” That quote comes directly from the PNHP link you provided, and I certainly believe that to be an indisputable fact.
Those who disagree might as well speak to the wall as try to argue with me because it’s a purely ideological belief, yet there are certain other considerations. If the answer to that one key question is NO then we must end Medicare, Medicaid, SCHIP’s, and I would certainly hope we’d stop providing taxpayer provided insurance for ALL elected officials at every level of government.
Beyond the social impact, what effect would that have on the economy? How many Americans would suddenly find themselves burdened with their elderly or disabled parents (and/or other loved ones) health expenses? (BTW: the same is true of Social Security and the most pressing issue there is the governments ability to cough up the “trust fund” that will sustain the system for another 30 to 40 years ………. but that’s another “debt” issue that some choose to deny even exists!)
To me it all boils down to one thing beyond that; how do we provide the most bang for the buck? Recent changes to Medicare (re: Medicare Advantage Plans) during the Bush regime have proven that “privatization” costs the taxpayer anywhere from 11% to 13% more than traditional Medicare!
When it comes to illness the “best way should be the easy way” (although I was recently told that was ignorant), just go to the doctor and the pharmacy and don’t sweat it. I somehow doubt that people will intentionally get sick to try it out :^/
Posted by: KansasDem at December 24, 2007 04:51 PMDavid R. Remer,
You always make very good points. I’d add this as someone who worked from the age of 14 up until 51: I could easily absorb a 20% reduction in my Social Security Disability payments. I could absorb as much as a 30% reduction, but it would be uncomfortable. So, undoubtedly I KNOW that some adjustments CAN be made to salvage the future of Social Security.
The point I hope to make is that some sacrifice may be needed to salvage the USA from the dire straits we find ourselves in but WE can do it if we have the will. Right now the sacrifice is disproportionately the burden of the middle class!!!!!!!! And every indication is that will continue to get worse!!!!!!!!!!!
I believe that the current “credit crunch” may well precipitate a true change. Sadly that “change” could either create a “caste” society or the majority of this Democracy will recognize their follies and find solutions that keep us afloat.
I must admit that I have a dismal outlook. Debt and death sound a hell of a lot alike.
Posted by: KansasDem at December 24, 2007 05:26 PMDavid,
Thanks for the correction - that 40 tril is only the unfunded portion of the mandate.
You wrote:
A single payer government sponsored universal coverage plan has the capacity to reduce overall health care costs, but, for the government and economy to survive, only Basic preventive and emergency life saving care can be afforded universally. To go beyond that level incurs the kind of unfunded mandate that is unsustainable.
I strongly disagree. All medically necessary care must covered - no exclusions. We don’t have to cover boob jobs - but everything else.
Personally, I hate to see women mutilate their bodies like that anyway. Small boobs are perky and besides when they do a boob job, they cut the nipples off and sew them back on in a new location resulting in a total loss of sensitivity. Even, old saggy boobs are far better than that. They have served well and continue to serve well. To borrow a phrase from KansasDem: ((((((sigh)))))).
Back to the point, Physicians for National Health Care point out: As long as some medically necessary care is not covered, the private insurance industry will have something to sell and they will relentlessly use their campaign contributions and lobbying influence to undermine and sabotage the program. They will constantly lobby to get this or that procedure not covered so that people have to buy their insurance, so that they can continue their stranglehold on us.
The private health insurance beast must be killed once and for all. A wooden stake must driven through its heart. If they want to sell insurance for completely elective procedures - so be it - not a good business model.
The one thing that is missing from your analysis that total health care will bankrupt the nation is that a lot of money is already spent on health care.
A lot of that money is wasted on bureaucracy, on corporate profits for hospitals, insurance companies, pharmaceutical companies, MRI centers and the like. That money is already a huge tax on our economy, paid to private industry ultimately by us.
That money could be transfered into a new revenue stream to support the new program. A new revenue stream to fully fund new mandates without any new economic disruption. If General Motors doesn’t have to pay for my health care, they can afford to pay higher taxes, ect., ect.
We must pay as we go - but we can pay as we go. Other countries do it successfully. We can too.
A big piece of the puzzle is what to do with big Pharma. An article in itself.
KansasDem,
No time to respond to your comment now. I will respond later. Thanks.
KansasDem,
You wrote:
I must admit that I have a dismal outlook. Debt and death sound a hell of a lot alike.
I like the alliteration.
Social Security is fully funded with all of the money that we owe it. The Republican Reagan lie that Democrats swept under the rug comes home to roost.
Ray Guest:
Nice article. I sure don’t like the part that says that I have no choice but to join in. I understand the need to take care of the poor’s health care needs, but I am for a way that leaves me alone to figure out my own medical coverage.
There are some very simple things that would be important to me first.
Here is #1. Why do we subsidize multi millionaire’s medicare? Why do we subsidize anyone making say $80,000 in retirement income’s medicare?
I make a good inoome, and will in retirement. Before you take away my choices stop subsidizing my retirement!! I wont need it. Take that money and help the poor. I don’t want or need a government subsidy for my health care.
“I understand the need to take care of the poor’s health care needs”
Craig,
The thing is that the “poor” are pretty well (not altogether) covered under the current Medicaid, Medicare, S-CHIP, etc. programs. The people that are falling through the holes in our safety net are those who are paying for the safety net but not quite able to rise above it.
You asked, “Why do we subsidize multi millionaire’s medicare? “
Great question! While I’m far from a millionaire I question why I receive as much Social Security Disability as I do. Of course it’s because I paid a lot into the program but, as I said before, to me it makes sense to reduce payments at high end, but ………… and this is a long but!!!!!!!!!!!!!!
It’s time for everybody to take a big bite out of this debt sandwich!!!!!!!!!!! That includes the wars!!!!!!!!!!!!
We CANNOT continue down this path of indebtedness. Several times I was inclined to comment on David R. Remers’ last thread about the national debt but I’d read the denials and I simply knew that I could not stay within the “Rules of Participation”. Quite simply, we’re in deep shit and in order to get out WE must all sacrifice a bit.
ALL is the key word!!!!!!!!!!!!!!!!!!
Posted by: KansasDem at December 24, 2007 09:04 PMCraig
Thanks for your comment. KansasDem posed the question:
The first question that needs to be answered is whether a majority of American voters believes that “Access to comprehensive health care is a human right.
I believe that it is. If it is, one way to avoid subsidizing the wealthy is to make them pay their fair share through taxes. The problem is: What is their fair share? The answer is: I don’t know. Proably more than they pay now. But figuring that out requires the wisdom of Solomon. Good luck with that. People who work hard and get ahead should be ahead. On the other hand many of these people are using our commons to get ahead; air, water, roads, and as David Remer points out in his article; political stability.
Human being evolve socially as well as genetically. It is why our species is so successful and adaptable. Long ago, we human beings through social evolution made the social contract of committing ourselves to civilization through political units larger than hunting and gathering bands.
This has involved concentrating many our resources under the control of a central authority and allowing that authority to assume responsibility for many of our needs, i.e. taxation and social saftey nets.
Posted by: Ray Guest at December 24, 2007 09:23 PMThis NHI proposal sounds like a shuffling of the cards. It’s not a new solution, it’s a reconfiguration of the existing problems.
What if every doctor had a fully stocked ambulance instead of an office? This would reduce the emergency room use tremendously.
What if government paid for R&D for new drugs and then incorporated the production of the new drug. Charter a corporation to produce the new drug at 5 cents to produce and 6 cent sale price?
Why couldn’t community leaders purchase an MRI and ask a corporation to use a fee-for-use to payroll the attendant? Prevention would be much more effective if an MRI was performed on a newborn and comparative MRI’s were performed each year. If everybody had an MRI every year the cost would go down and the benefits would go up! (I’m using Algore’s terminology)
The article I was told to read before I responded is a knee-jerk reaction to the problem. It takes the existing delemma and shuffles it around and then says the government should pay for all of it.
I’m willing to listen to new approaches. Are you?
Posted by: Weary Willie at December 24, 2007 11:37 PMBy the way, Merry Christmas to you all. I know he was just a man but he was a good man.
There are several differences. But, the biggest is that a government single payer plan does not involve a middleman taking profits and raising health care costs to cover those profits, which a middle man private single payer would.
You didn’t read my question very well then, because I asked what the difference was between a non for profit organization set up to perform this function and a governmental agency set up to perform this function.
So, try again? You say there are ‘many differences’, what are they?
Posted by: Rhinehold at December 25, 2007 01:17 AMThe first question that needs to be answered is whether a majority of American voters believes that “Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to assure this right.”
And this is where we different on what is a right and what isn’t. Personally, I don’t believe that a right can exist if in order for it to exist other rights must be violated. Progressives differ on this important point.
Which, of course, is the case with medical care. If medical care is a right then everyone, no matter what, must be able to see a doctor at a moment’s notice without fail. If there are not enough doctors and not enough individuals are willing to become doctors then we will have to force people, against their will, to become doctors. The same with nurses, we are already seeing a nursing crunch, if we think we need to provide this care but there are not enough people to do the job then they must be pressed into service.
Nevermind that a ‘single payer’ system, like the one detailed in this article, demands that going outside of the program would be illegal. THAT is the difference between this system and a non for profit that exists to fulfill this role, the non for profit cannot use force on citizens while the government can.
It also violates a right to privacy that individuals should be able to enjoy. The debate, just in the comments of this article, already start talking about what should be covered and what shouldn’t be, getting inbetween the doctor and patient, and we haven’t even gotten the politics into the system yet. In order to determine if a medical procedure is ‘covered’ the nature of the procedure would have to be presented to the government. I’m sorry, but I do not want, nor should I be required, to tell the government, the only group that has the power to force me to do things, to know what is going on inside my body. A private matter that should exist only between my doctor and I.
I have been asked what ‘liberties’ would I lose with this plan? Well, three big ones right there, don’t you think?
Oh wait, that’s right, those little things (freedom of choice, freedom of doing what you want with your life and right to privacy) are just not important when it is a progressive agenda. We’ll rail about them when it is convenient against Bush, but if it is something we think is important they can just be pushed aside. Which is why most progressives who claim to be upset about a loss of rights under this administration just ring HOLLOW.
Posted by: Rhinehold at December 25, 2007 01:30 AMI certainly can’t comment on much of whats presented here as I am not as well read on the ins and outs of the health care system. I do have my opinions; however, I will not overburden other posters with those.
I will say this. I have a dog that takes the human medicine gabapentin (generic form of neurontin). I go to Costco and purchase it for anywhere from $12.00 to $18.00 for 100 pills never more than that. I asked about it at Walmart cause I have to travel about 30 miles to get to the Costco. At Walmart 90 pills cost over $100.00. I was floored I kept saying that must be wrong, I confirmed the spelling, repeated the name more than once. She spelled it back to me. Next time I was at Costco I asked how they could sell it so much cheaper. Their response “Costco does not mark up anything in the store more than 30% some pharmacies mark up prescriptions as much as 300%”. Anybody else see the problem here?
Posted by: Carolina at December 25, 2007 08:22 AMRhinehold, how can one debate with you when you don’t even recall what YOU said, let alone what others said. I responded to your question. Then you turn around and reply that the question I responded to was not what you asked. But, it was: AND I QUOTE:
“What is the difference between a single payer system that is tax collected and paid for by the government and a single payer system that is fees paid (a small percentage of each doctor visit) and run by a private organization that is chartered by the government and then left alone with only bi-annual oversight hearings?”
Your question refers to the difference between a government sponsored (non-profit) single payer system, and a private organization hired by the government which collects a percentage of the cost of each Dr. Visit from the patient presumably to fund nation’s health care system.
First, you did not stipulate that the private organization be a non-profit. What is the private company’s incentive above and beyond that of a government single payer agency if not profitability?
Are you seriously suggesting a flat percentage be paid by the flu shot recipient and the lung or heart transplant patient, equally? And what if the heart transplant patient doesn’t have $25,000 in cash lying around to cover their 10% of the procedural cost? Just die, and make room for someone else?
Posted by: David R. Remer at December 25, 2007 09:35 AMRay, your last reply to me indicates you either have no appreciation for the consequences of a national debt rising to 20-30 or even 40 trillion dollars, or, you are in a state of denial regarding health care inflation underway and the incredible cost of trying to cover everything a doctor would say is needed.
What of the 50 year old writer who upon raising their right arm over their shoulder complains of serious pain due to a bone spur in the shoulder ball socket? Can they not live without having that procedure taken care of by a universal health care system, by limiting how high they raise their right arm. What if the same condition exists for a 24 year old firefighter? Is it now a medically required procedure?
Using just these two hypothetical patients, covering both doubles the cost to the government, taxpayers, and deficits. Calling the firefighter’s procedure necessary but the writer’s procedure not, cuts the cost to the government, taxpayers, and deficits by half.
IT does no good in the long run to provide universal health care while destroying the economy and government solvency which underwrites it. Those championing a universal health care system MUST get their noses into the dirt and devise a plan that is affordable and protects this nation from the unfunded 40 trillion mandate now facing Medicare. Some realistic sustainable decisions have to be made which prevent Medicare’s 40 trillion unfunded mandate from becoming a reality. That requires limiting what is covered and what is not, along actual number crunching lines.
Otherwise, it won’t pass, and even if it did, it would be a short lived policy as national debt hits and reaches past 20 trillion dollars in 12 to 15 years. Covering everyone for everything except elective cosmetic procedures is not a realistic or sustainable option.
Posted by: David R. Remer at December 25, 2007 09:46 AMDavid,
I will read your replies later and respond… but I have a great concern about national debt. I said:
We must pay as we go - but we can pay as we go. Other countries do it successfully. We can too.
I think that our national debt is already too high. The world used to owe us money and should owe us money.
Posted by: Ray Guest at December 25, 2007 10:41 AMRhinehold:
Please explain why I should pay taxes for schools, fire departments and police? I don’t need them, I have no kids, I have never called the police for myself, and never set fires or allow my house to deteriorate into a fire hazard. The point that I should contribute to the health of my country is no more absurd than these. As to being forced to participate, your argument is childish.
Going outside the system would be illegal. Says who?
Sure you’d have to contribute taxes to live in a country providing such a system, like Canada, but you most certainly could choose to be treated outside the system. That’s just another red herring, If you are wealthy, you have choices.
As to telling the government your health condition for payment, what do you think happens with any health insurance? There could be and likely would be, safeguards for this info. Don’t want to participate? Pay a private provider. Another childish red herring.
Again, I ask, What Liberties would you lose? Other than paying taxes for the right to live in a society that chooses not to ignore it’s poorer folks, none. You can always immigrate if you find this too repulsive. Freedom isn’t about being a hermit or ignoring your fellow man. If that’s what freedom is to you, then your really need to read our founding fathers more closely.
Posted by: googlumpus at December 25, 2007 11:54 AMI responded to your question. Then you turn around and reply that the question I responded to was not what you asked. But, it was: AND I QUOTE:“What is the difference between a single payer system that is tax collected and paid for by the government and a single payer system that is fees paid (a small percentage of each doctor visit) and run by a private organization that is chartered by the government and then left alone with only bi-annual oversight hearings?”
Your question refers to the difference between a government sponsored (non-profit) single payer system, and a private organization hired by the government which collects a percentage of the cost of each Dr. Visit from the patient presumably to fund nation’s health care system.
First, you did not stipulate that the private organization be a non-profit. What is the private company’s incentive above and beyond that of a government single payer agency if not profitability?
I did in my second attempt at getting the question answered, which I am sure you read, but even if you didn’t you made an assumption. That’s ok, but don’t take a false assumption out on me.
However, what is the motivation behind the United Way? The Nature Conservancy? There are thousands, if not more, organization that are chartered, set up, and run as non-profit organizations because the people who set them up want them to be.
And your response was that they would be a third party, when that is precisely what the government would be as well. The only way to eliminate a third party would be to create HSAs (as we have done) and let the buyer of services and provider of services agree on prices. Any other method, government run as well, introduces a third party into the equation.
Are you seriously suggesting a flat percentage be paid by the flu shot recipient and the lung or heart transplant patient, equally? And what if the heart transplant patient doesn’t have $25,000 in cash lying around to cover their 10% of the procedural cost? Just die, and make room for someone else?
Oh dear lord, why is that so many people feel the need to resort to demagoguery when debating this issue?
{demagoguery} Yes, that’s what I’m saying David, we should just let people die. I’m a cruel heartless bastard. This of course won’t happen in a government run program, people will be treated with the best of breed medical care and never have an issue, just like our VA Hospitals. Why, I know that is where *I* go whenever I need medical attention…{/demagoguery}
These are things we can work out in the details. In case you missed it, this was my later attempt at starting this discussion.
Again, the question I have is why does the government have to run the program? What specifically does bringing the government into running the program instead of setting up a non for profit organization, led by doctors, to implement a program that would manage the new crop of Healthcare Savings Accounts, that are not tied to employment, roll over each year and earn interest? It could be paid for by a surcharge on doctor and hospital visits, say 1 or 2 dollars.
I am not tied to a percentage, obviously. In fact, let’s completely emulate the progam proffered by Ray, without all of the force and privacy issues it raises. Why would that not work?
But the problem is I seriously want to discuss the actual differences between what I am suggesting (lets hash out the points without emotion and asinine attacks) and the single-payer system that itself says has to be the only way a patient can approach a doctor once implemented. Why is the ONLY answer, as Ray says, government intervention?
Posted by: Rhinehold at December 25, 2007 11:56 AMRinehold are you for real??
I hear others compliment you on your debating skills, but these past few threads do not reveal that skill
The above is a good example —
“I did in my second attempt at getting the question answered”
But during that “second attempt” you critized him for not reading, nor responding properly to your FIRST attempt, which you yourself, now imply was flawed. — He was supposed to read your mind that you meant “non-profit”?? Oh, but then only the second attempt counts, but thats too late because he had already responded to your first attempt —
Your arguements have the same flaw that I find in others that have not thought out their proposals.
The normal rationale is “It isn’t MEANT to work that way” — sorry, but in my experience it doesn’t matter what somebody THOUGHT it MEANT, I have found that it ONLY counts what is WRITTEN. If the law says only such and such get paid, and one can present the likely (but initially unintended) extreme consequence — bet that it will happen — I have seen too much of “Sorry, but that is the rule, can’t do anything about it”.
I have also seen you advocate getting rid of “restrive government” — but never really explaining the intricacies of that — as when people tell you what that would result in, your response is “oh, but of course I didn’t mean THAT”
What do you mean Rhinehold? Do you know, or do you just keep your thinking in abstract, vague notions that could never be implemented (and therefore cannot be challanged because you constantly change the bar)?
Ray said: “The world used to owe us money and should owe us money.”
I don’t see how they should owe us money when we are doing the borrowing to live beyond our present means. And fashioning trade deals that for 30 years in a row have resulted in trade deficits for our nation (a net export of American wealth).
Posted by: David R. Remer at December 25, 2007 12:29 PMRhinehold, attempting to debate you is like trying to carry on a conversation with someone on LSD. Your points keeps shifting, your past statements keep morphing, and your comments blame others for not responding to your their rambling and shifting nature.
I thank you though for the opportunity to continue to point out the indefensability of your Libertarian arguments. One does have to be a real mental and principle gymnast to live in the real world and still support many Libertarian positions which are not based in reality at all, but a perspective hinged to a return to 18th century paradigms and Colonial context.
Oh, and btw, if the Patient is the first party, the Dr. is the second party, that would make the government in a universal single payer plan a third party, and by your own words, a private company chartered by the government as a collection agency for premiums would be 4TH Party.
Just thought you needed a little help with the Arithmetic there, since you attempted to equate the government and the private company as both being 3rd parties, when by your own descriptive phrasing, the private company is a 4th party contracted with by the government (the third party).
Happy holiday!
Posted by: David R. Remer at December 25, 2007 12:39 PMHe was supposed to read your mind that you meant “non-profit”?? Oh, but then only the second attempt counts, but thats too late because he had already responded to your first attempt —
1) both questions were posed before he responded to either
2) Why did he assume for profit, the question did not read that as it stated it was an organization set up by the government. When does government set up for profit organizations?
Either way, think of me what you will, I care the tiniest amout…
Posted by: Rhinehold at December 25, 2007 01:10 PMa private company chartered by the government as a collection agency for premiums would be 4TH Party.
No, once set up the government would not be involved at all. I never said it would be contracted by the government, it would be set up by the government…
So, since we are not communicating well on this, let’s try a different tact.
My question posed to you:
“What is the benefit of having this run by the government, why can’t a private organization, like the United Way or Habitat for Humanity, be set up to perform this function instead?”
Now, since you ignore the freedom of choice and privacy issues that I’ve already raised, I’ll take that as acquiescense that we will have to deal with those in this ‘final solution’ offered by Ray. Wouldn’t we avoid those issues by taking the running of this plan out of the hands of government?
Posted by: Rhinehold at December 25, 2007 01:17 PMI have also seen you advocate getting rid of “restrive government” — but never really explaining the intricacies of that — as when people tell you what that would result in, your response is “oh, but of course I didn’t mean THAT”
You can start here if you really are interested. Or ask me specific questions, as I stated already I was not going to get into large non-specifics with someone who made it clear on the outset he wasn’t interested.
But yeah, I have made it clear and I’ll do so again, I’m not an anarchist. I’ve also stated that the philosophy is a simple one, “be free to live your life as you wish without interferrence as long as you do not violate another’s right to the same”.
And I’ll be consistent with this despite attempts to label me as otherwise by someone who would rather set up windmills to attack and straw men to fight.
Posted by: Rhinehold at December 25, 2007 01:21 PMLibertarian positions which are not based in reality at all, but a perspective hinged to a return to 18th century paradigms and Colonial context.
If thinking that liberty and freedom are dead and only exist as an 18th century belief, then so be it.
But “be free to live your life as you wish without interferrence as long as you do not violate another’s right to the same” is not a belief that died in 1932 as you seem to think it did.
Posted by: Rhinehold at December 25, 2007 01:29 PMRay
One area the PWG does not go into,for understandable reasons, is the very high recompense doctors command.They should be paid well,maybe as much as $10,000 a month,not the $10,000 a day some of them get.
One reason for this is the high cost of a medical education. Not only does this saddle many of them with large debt but it also requires a huge investment. Huge investments generally insist on huge returns. This causes some wierd market place occurances that seldom happen with other services. Seems the more doctors there are in a given area the higher the average healthcare cost become.There is a built in incentive to over treat.There are some small programs to fund medical education already,requireing those recieving the government paid education to serve in underserved areas in exchange.There is mixed results. Many doctors simply do not fulfill their obligation,prefering instead to simply pay off their education once they are practiceing. These programs should be expanded to cover ALL medical trainning for doctors.That is the only way to effectively put in place price controls on the cost of that education.Its a matter of balance and fairness. If the government esentially controls the income of phyiscians we should also reduce the cost of their trainning.Selection for trainning should be strictly by aptitude. No AA and no legacy. If its our dime we want the best.
Rhinehold
Your mis-trust of government is respectable.There are some ares where government works well though. One example is SS. You may disagree with the fundemental concept but must admit,after looking at the results,the agency itself does a pretty good(not perfect) job.They send out millions of legitamet payments,on time ,every month at about a %2 overhead as compared with private annuity disbursements that cost %20 or more.Even SS fiduciary responsibilities are handeled well. The administrators have done a good job collecting increased funding for the baby bubble etc. The SS problem does not lay with the SS Administration but with the larger federal government. I do not want to side track here.
Another example is the Postal Service. Sure you may LOL at that but on the whole they do a spectacular job reliably moving a tremendous amout of mail at a fairly reasonable cost.Those who have spent much time abroad will confirm they are one of the best in the world even with much of the most lucrative aspects cherry picked off by private carriers.
The key to both these agencies success lies with their largely autonomious status.They are insulated somewhat from political winds in their actual operation.. When we set up a heathcare single payer administration caution must be taken to do the same. We would not want some politician to attempt to gain votes by authorizing breast augmentation for example,although he could get my vote that way LOL.
The proposal Ray cited does a good job of explainning why single payer needs to be universal to work.The wealthy cannot be allowed to cherry pick their healthcare or we would wind up with a two tiered system with constant political pressure to reduce funding to the second tier where most Americans would recieve care.Its not a happy situation to bring that much government power into play but in this case is justified by the de facto failure of the market to address healthcare.
I should also point out that a single payer system is not socialized medicine. It is a compromise,a hybrid if you like. The VA is a socialized system,for example. Single payer leaves most facilities and healthcare employees in privatly held organizations and patients could choose where they wish to be treated.
Merry Xmas
BillS
Ray guest:
I believe that it is. If it is, one way to avoid subsidizing the wealthy is to make them pay their fair share through taxes. The problem is: What is their fair share? The answer is: I don’t know. Proably more than they pay now. But figuring that out requires the wisdom of Solomon. Good luck with that. People who work hard and get ahead should be ahead. On the other hand many of these people are using our commons to get ahead; air, water, roads, and as David Remer points out in his article; political stability.
I don’t like when we say “Make the wealthy pay their fair share”. The wealthy pay the vast majority of taxes as it is.
I would prefer to end the subisdy of people a certain percentage over the poverty level. That would include myself. Stop subsidizing me first before you start taxing me!
I am not ultimatley opposed to universal health care. Or I should say univeral access. I am oppposed to limiting my access to health care by going to a Canadian system.
I also understand that my taxes may need to be raised at somepoint to do that. I can’t support increasing taxes on medical expentures until subsidies are stopped on the affluent. I’m for means testing.
I would like to have medicare at an option AT FULL PRICE. Medicare does many things right, inspite of the fraud contained within.
In today’s world there is no reason other than what is between our ears “expectations” for people to not work in some form until age 70.
This entire issue is a mental game. The world is simply changing in some wonderful ways. Specifically people are living longer and are healthier than their parents.
There is absolutley nothing wrong with raising retirement age other than what society expects. In fact the vast majority of people approaching retirement expect and want to continue working well into their late 60s. And you should see the numbers on the budget side flip if we enable people to do what they want to do. (work longer).
I think we need to look very seriously at revamping our work expectations. I plan to work until 70. I have several charities I want to donate to and am fortunate that my work skills should be in great demand for a long time.
Working longer is a huge posibility. I think we need to get out of the way of this desire of older workers to stay working by enabling it through tax credits and incentives.
There are many other great ideas. But until we stop subsidizing the affluent, and create a system to encourage workers to work past 65 I’m not in favor if increasing taxes on the wealthy.
Merry Christmas!!
Ray Guest:
I think on belief that we all share is the need to rethink health care in general and medicare/ss/medicaid etc in specific.
One issue that I do not hear much about is that boomers differ drastically than the greatest generation.
Much research is comming to bear on what boomers want to do in retirement. The big cahoonah (Not sure how to spell cahoonah) is that boomers plan to continue to work. Labor participation of workers over 65 are already starting to rise.
I guess my question to you is that should boomers continue on with this belief, how does that change your thoughts on health care?
Just to juice the pot a bit on your answer, please remember that the retired take up a huge percentage of health care expenses.
One noted writer who is Hillary Clinton’s polster says in his book micro trends is on the opposite side as David. He says that we likey wont have a fiscal problem as enough people should continue to work to pay the bills.
I’m somewhere in between David and Mark Penn
Posted by: Craig Holmes at December 25, 2007 05:00 PMCraige Holmes and others
Raising the retirement age is just ducky if those with physically undemanding jobs.That is not everybody or even most of us.Going to shuffling papers , counting nickles,or sending emails back and forth is one thing.A year or two longer is no big deal. How about farm labor,the building trades,firefighting,truck driving and a thousand other occupations that wear on peoples bodies?Do you want a bunch of 70 yo firemen trying to rescue your family from a burning building? How about building your homes or bridges?True the choices one makes in carreer paths have results and these are a personal responsibilty but if the results of becomeing a construction worker for example include sinking into poverty just who is going to make that choice and who is going to build our structures?True also is the possibility of riseing to a management position. Not only is that not desired or suitable for most but just how many managers do we need? A thousand Architects can not get one bridge built, no matter how many emails they send to each other.
Bills:
Thank you for your response.
Forcing people to work longer is probably not the correct solution.
Understand this fact. Over 70% of Babyboomers WANT to continue to work at least part time during retirment. It would seem to me that it is in all of our interest to encourage them to do so. I think people are usually wise enough to make their own decisions.
Let me put it this way to you. Would you rather have 1. your retirement benefits cut, 2, your taxes raised, or 3. find a way to encourage those who want to to continue to work and thus reduce the cost of medicare etc?
There are probably touch choices ahead. This one seems like low hanging fruit. There is a match between babyboomers retirement plans and the nations self interest. If we can create a way to facilitate boomer desires to work longer, it helps us all. It is not the whole answer but is a slice!!
Posted by: Craig Holmes at December 25, 2007 06:02 PMWould you rather have 1. your retirement benefits cut, 2, your taxes raised, or 3. find a way to encourage those who want to to continue to work and thus reduce the cost of medicare etc?
Employers either drop coverage or force employees who are 65 to sign up for Medicare in order to continue any company insurance (which would act as a Medicare supplement)…so, working longer doesn’t have any effect on the number of people signing up for Medicare or its cost…besides, if you don’t sign up for Medicare at 65 when you become eligible, there are monetary penalties to you…
Craig…for future reference:
Kahuna
The big cahoonah (Not sure how to spell cahoonah)Posted by: Rachel at December 25, 2007 07:57 PM
Rachel:
Employers either drop coverage or force employees who are 65 to sign up for Medicare in order to continue any company insurance (which would act as a Medicare supplement)…so, working longer doesn’t have any effect on the number of people signing up for Medicare or its cost…besides, if you don’t sign up for Medicare at 65 when you become eligible, there are monetary penalties to you…
But even in the current system, retirees pay more income and SS taxes if they continue to work.
With 70% plus baby boomers saying they want to continue to work after retirement and labor shortages predicted, it seems a no brainer to facilitate it with tax incentives.
thank you for the kahuna spelling.
Posted by: Craig Holmes at December 25, 2007 08:47 PMThanks all for your comments. I am going to have a hard time catching up with all of it. But I appreciate the substantive debate.
Weary Willie,
It must be hard to be so tired. You wrote:
I’m willing to listen to new approaches. Are you?
Yes I am.
Rhinehold,
Thanks for the in depth comment. You wrote:
I don’t believe that a right can exist if in order for it to exist other rights must be violated. Progressives differ on this important point.I agree that rights need to be balanced. For example: You should have a right to smoke, but not to expose me to it.
To say that someone has a basic human right to health care does not mean that right trumps my right of choice not to be a doctor - nor does it mean that there will be no rationing.
Rationing could be carried out by putting people on a 3 month waiting list for a knee replacement. In a crisis, rationing could be and is carried out by triaging the most critically ill patients and focusing resources where they will do the most good. That is about balancing rights. Everyone has a basic right to care, but the limited resource must be shared. The question is will it be shared in an equitable way or will the haves continue to disenfranchise the have nots. Rationing can, does, and will occur.
Rights are balanced against each other all the time. The “right to life” does exist. So does the “freedom to choose” what to do with ones own body.
Now to the rest of your comment:
Where to start though gosh… I suggested above that perhaps anyone should be allowed to practice. It was half factitious - but it is a serious question. I agree that you should be able to do anything that you want with your body - including abortion.
Of course, letting anyone actually practice medicine would be a disaster. There are currently standards care that doctors - for better or worse - often for worse. Yet, the alternative to professionally set standards of care would be worse - any quack could waddle like a duck. Professional standards of care is part of our social evolution. It part of our social contract.
Those standards of care, developed by doctors and health care professionals, based on the best available scientific evidence is the what the Physicians plan would use to determine what procedures to cover. They do include cost benefit analysis.
That would be the case whether it was the government or a private non-profit corporation. Those standards are not politicized in the traditional sense of the word. Those standards of care already exist.
A patient currently makes his choices in consultation with his doctor based on the available options which are based on the standards of care. The Physician’s plan would not change that. The government would not be in between the doctor and patient any more than it already is.
David,
I think that I have given you the impression that I do take your concerns about political gridlock and national financial solvency seriously. I think that both of those issues are serious. I agree that, in many areas, a Democratic, Republican, Independent, or bi-partisan solution that was followed through on would work equally well.
My point was that there are some situations where one solution will work and the other will never work. I wrote this article with the opinion that health care was one of those areas. I made the statement that the choice was between solution and no solution. I am no longer sure about that.
This debate has convinced me that “solution” has to be defined. Solution = caring for tens / hundreds of millions of suffering Americans??? + National financial solvency??? - National financial solvency??? Only National financial solvency??? Solution = providing health care only for the rich and powerful elite??? So the whole question hinges how we define solution. There are as many “solutions” as there are ways of defining the word.
Defining the word in the way that I do, I think that there is only one basic solution, although your suggestion of providing only preventitive and emergency life saving care would be a big step forward - but not IMO a complete solution. I do agree that national financial solvency is more important than a complete solution. I just believe that we can have a complete solution + national financial solvency… if it is done right. The devil is in the details and the devil makes sure we never do anything right - but maybe we could get it close to right.
Left is the new right.
That said, you wrote about a 50 year old writer and fire fighter with a bone spur in their shoulder. Then you wrote:
IT does no good in the long run to provide universal health care while destroying the economy and government solvency which underwrites it.I agree. People will die if we bankrupt our country. If we cannot take care of the fifty year old writer without deficit spending then we should define that care as not medically necessary. That would of course open a whole can of worms about private insurance, but national financial solvency is important. My argument with you is that I believe that we can take care of both the writer and the fireman without bankrupting the country.
In fact, I would argue that is less expensive to take care of both. The private insurance can of worms would drive up the cost of all care because the doctors would still have to be able code for and bill to hundreds of insurance companies and thousands of insurance plans if we don’t cover both the fireman and the writer.
There is an economy of scale as well.
Finally, covering both, gives the government more power as the only payor, (the only game in town), more power to negotiate lower procedure fees with the AMA which would function essentially as a union for doctors under the Physician’s plan. The doctors can afford to accept lower fees per procedure, because they would have lower “billing” overhead and would get paid for every procedure they perform.
Free market economics would rule. If the government set the fees too low doctors would refuse to perform procedures. Doctors would no longer need to “gouge” the rest of us to cover the cost of all of the free gratis care that they already provide to the poor. People would not need to use emergency rooms as primary care providers. Cancers would be diagnosed and treated early and more economically. We can do this. If we do it right.
Posted by: Ray Guest at December 25, 2007 11:07 PM
Rhinehold
Windmills and strawmen are all they have my friend.
How can you expect to “be free to live your life as you wish without interferrence as long as you do not violate another’s right to the same,” when they believe they know whats best for you, better than you yourself knows?
Besides, if they couldn’t use govt to force others to believe as they do, they would have to actually practice what they preach, and we both know that isn’t going to happen.
As with most issues, they “say” they “care,” just not enough to change their own lifestyle to support their beliefs. If govt forces everybody to support their beliefs, they have to sacrifice less.
Please explain why I should pay taxes for schools, fire departments and police? I don’t need them, I have no kids, I have never called the police for myself, and never set fires or allow my house to deteriorate into a fire hazard. The point that I should contribute to the health of my country is no more absurd than these. As to being forced to participate, your argument is childish.
Childish? In what way exactly? That I have a political philosphy of liberty that I want to be consistent with and do not wish to force what I think is the right way to live onto other people and expect them to do the same?
Government should exist to protect our rights. That is where the police come in, they are there to protect our individual rights from being violated. As for fire and education, they should not be ‘taxed’ as much as communiites should have homeowner fees (property taxes) to pay for these things. The taxes for these are not based upon income but on property that you own, if you do not wish to pay those taxes or have those provided for you, you are free to move to another community that does not charge as much or provide them at all. That is a choice you can make.
Going outside the system would be illegal. Says who?
The proposed plan. It says that in order for this program to work people who not be allowed to go outside of the system. That is why they need government involved, so that they can use the government’s power of force to ensure that the plan is not bypassed.
Sure you’d have to contribute taxes to live in a country providing such a system, like Canada, but you most certainly could choose to be treated outside the system. That’s just another red herring, If you are wealthy, you have choices.
Read the plan again, they do not want the wealthy being able to bypass the system or it would fall in upon itself.
As to telling the government your health condition for payment, what do you think happens with any health insurance?
No health insurance company can force me to do anything, they are just a private organization and have no power over me. The government is a different story, they do have that power. I only answer the one question on my census that I am required by law to answer, the rest are left blank because I do not want this information known for possible use in the future against me by an entity that can use force on me.
There could be and likely would be, safeguards for this info. Don’t want to participate? Pay a private provider. Another childish red herring.
You really might want to read what you are defending before calling other people childish…
From the proposed plan:
Private insurance that duplicates the NHI coverage would undermine the public system in several ways. (1) The market for private coverage would disappear if the public coverage were fully adequate. Hence, private insurers would continually lobby for underfunding of the public system. (2) If the wealthy could turn to private coverage, their support for adequate funding of NHI would also wane. Why pay taxes for coverage they don’t use? (3) Private coverage would encourage doctors and hospitals to provide two classes of care. (4) A fractured payment system, preserving the chaos of multiple claims data bases, would subvert quality improvement efforts, e.g. the monitoring of surgical death rates and other patterns of care. (5) Eliminating multiple payers is essential to cost containment. Only a true single payer system would realize large administrative savings. Perpetuating multiple payers - even two - would force hospitals to maintain expensive cost accounting systems to attribute costs and charges to individual patients and payers.
If you had read the article instead of trying to defend the concept of ‘taking care of our poor by force’ you might have read this part that is pretty near the first thing stated…
Again, I ask, What Liberties would you lose? Other than paying taxes for the right to live in a society that chooses not to ignore it’s poorer folks, none. You can always immigrate if you find this too repulsive. Freedom isn’t about being a hermit or ignoring your fellow man. If that’s what freedom is to you, then your really need to read our founding fathers more closely.
I don’t think it is me that is missing what our founding fathers intended. :/
As for liberties I would lose, I’ve already named three big ones.
And I am in no way suggesting that we ‘live as hermits’ or ‘ignore our fellow man’, which are childish accusations indeed. “Oh you must be a selfish bastard if you don’t want to help these people”, how boorish, rude and ignorant of what is being discussed. I work hard in my community to make it better and help other people in actually helpful ways, not just handing out money. People need real help, not handouts. But because I oppose limiting liberty (remember, liberty is absence of government interference in our lives) you assume I don’t care about people? Maybe you should stick to learning about what you are defending and leave the interpreting motives to others because you completely miss the mark here…
The best way to reduce cost in the medical field is as I have already stated, and is being implemented, the new HSAs. Of course, that requires that people become viligent and prudent of their own spending, something that we need to return to instead of leaving it all to someone else. That is what has gotten us to where we are now, not greed but removing personal responsibility from the equation. Catastrophic insurance coupled with an HSA is the best way to ensure that no matter who is running our government we still have good adequate healthcare available to us.
BTW, I love how these topics usually start out as ‘access to healthcare is a right’ which is a statement I agree with. Then we devolve into saying that PROVIDING healthcare is a right, which it is not. Because to provide healthcare to everyone requires the loss of liberty that I’ve already pointed out. It is just that my concerns are apparently ‘childish’ and ‘against our founding father’s wishes’ according to you.
Posted by: Rhinehold at December 26, 2007 10:14 AMOh, and btw…
Monopolies are bad, mmmkay?
Posted by: Rhinehold at December 26, 2007 10:36 AMRhinehold:
What this system is meant to prevent, is a parallel system that feeds off public health care, by offering falsely low rates due to cherry picking less expensive procedures and healthier patients. I don’t have a problem with outlawing predatory insurance, why do you? Let’s not confuse insurance with health care.
It would not preclude someone wealthy from flying to Mexico, India, Indonesia, as many do today, for elective procedures. I doubt it would prevent private practice, entirely. Some procedures will be disallowed and practices that cover those, I’m sure, would be permitted. The only liberty taken would be the avoidance of participation financially.
Other than not being a tax evader, no other liberty would be robbed from you. The privacy issue is BS and not an issue. There are agencies in government that do not share data. If your worried about privacy, look into law enforcement
(that agency you say protects our individual rights) or Homeland Security, there you might find some real issues rather than this scare tactic you falsely raise.
Government should exist to protect our rights. That is where the police come in, they are there to protect our individual rights from being violated. As for fire and education, they should not be ‘taxed’ as much as communiites should have homeowner fees (property taxes) to pay for these things. The taxes for these are not based upon income but on property that you own, if you do not wish to pay those taxes or have those provided for you, you are free to move to another community that does not charge as much or provide them at all. That is a choice you can make.Posted by: googlumpus at December 26, 2007 10:46 AMAnd again, I ask, why are these different than a government that protects the poor and middle class from predatory insurance?
I agree health care isn’t a right. However in a wealthy industrial nation, it is blatantly unfair to allow the predatory health insurance industry to prey on Americans. Every other industrialized nation understands this. Your preference apparently, though you wrap yourself in founder’s flags, is that they should just die off if they didn’t earn enough.
Portly Gentleman: At this festive time of year, Mr. Scrooge, it is more than usually desirable that we should make some slight provision for the poor and destitute, who suffer greatly at the present time.
Ebenezer: Why? Are there no prisons? Are there no workhouses?
Portly Gentleman: Many can’t go there; and many would rather die.
Ebenezer: If they would rather die, they had better do it, and decrease the surplus population.Perhaps your arguments aren’t childish, just miserly.
Craig:
But, you didn’t answer the fact that when turning 65, everyone pretty much has to sign up for Medicare, working or not…
What is the true impact of those people still contributing to Medicare out of their earnings??? Has anyone actually researched this?? There are a good number of people retiring early and being caught without insurance…and those who can afford the insurance are sailing around the world or doing charitable work, not spending work $$ on Medicare…
What are the real numbers??
Posted by: Rachel at December 26, 2007 11:34 AMRay, we seem to agree on far more than we disagree. The difference I see in our comments is your optimism that this can be largely accomplished without first seeing the numbers crunched, and my skepticism without first seeing the numbers crunched. Whittling a 40 trillion dollar unfunded obligation down to say 2 to 4 trillion while preserving today’s level of health care and better over the next 65 years is akin to the goal of having human colonies up and thriving on Mars in the next 65 years. Impossible? Perhaps not. But, the enormity and complexity of the task make the potential highly improbable.
One thing is certain however. If we don’t try, a calamity in human suffering will result. Therefore, the attempt must be made. That is the selling argument.
Posted by: David R. Remer at December 26, 2007 11:40 AMRhinehold said:
“No, once set up the government would not be involved at all. “
Let’s see, the government would mandate the collections, oversee the private company, adjust the rates collected as conditions warrant, obtain and award competitive bids by other private companies wanting to perform the service, and yet you contend the government would not be involved at all?
“I never said it would be contracted by the government, it would be set up by the government…”
How does that work exactly, set up a service to be performed by legal mandate of the government by a private corporation without a contract?
“So, since we are not communicating well on this,”
Obviously.
“My question posed to you:
“What is the benefit of having this run by the government, why can’t a private organization, like the United Way or Habitat for Humanity, be set up to perform this function instead?””
The Government never contracted with or for, nor “set up” the Red Cross, United Way, or Habitat for Humanity. Those are private run not for profit organizations whose only relationship with government is tax exemption in exchange for public oversight of accounting and funding. There is no public obligation to save these organizations should they fail to generate operating funds.
“Now, since you ignore the freedom of choice and privacy issues that I’ve already raised,”
The issue of human suffering on a massive scale transcends an individual’s right to prevent the society from alleviating that suffering. Not, ignored, just dismissed as an invalid argument. Those who want true independence and liberty from society’s decisions need to leave that society. To choose to live in that society is a choice to bow to the will of that society, however that will is manifested, or seek to change the public will according to one’s individual drothers, rare, but, not impossible in a democratically elected society’s government.
“Wouldn’t we avoid those issues by taking the running of this plan out of the hands of government?”
The government runs very little in this plan. It mandates by law universal coverage and mandates tax collection to underwrite the cost of the universal insurance coverage, then oversees the needed adjustments to the limits of that coverage and amount of taxation toward the end of keeping the both the government and the economy solvent while providing that universal insurance coverage. Actual medicare care is managed and delivered by the private sector.
The implication that the government will manage and administer health care is completely false. Not saying you intended to imply that, but, many on the Right do.
Posted by: David R. Remer at December 26, 2007 12:03 PM“The issue of human suffering on a massive scale transcends an individual’s right to prevent the society from alleviating that suffering. Not, ignored, just dismissed as an invalid argument”
Respecting individual rights does NOT prevent society from doing anything, David.
And, dismissing ones desire to actually help others themselves, rather than wait for govt to do it for them, as an invalid argument, is ridiculous at best.
You, and others who believe as you, have the right and every chance you need, to help those you wish to help.
Those of us who believe in individual rights, deserve to have those same rights and chances.
The fact that you all refuse to do it yourselves, should not enable you all to strip that right away from others either.
Its not about “not helping others.” Its about respecting the rights of EVERYBODY and letting them act as according to their own beliefs. NOT YOUR BELIEFS!
You want us to leave because we do not accept your beliefs, but yet, we and our beliefs were here first and are what this country was founded on.
A-freakin-mazing!
You want others to use govt to force you to believe like them? YOU leave.
Posted by: kctim at December 26, 2007 01:16 PMAll
Lets not leave out of the debate the fact that we are already paying much more for healthcare than any other industialized country. We are paying for it. We are just not getting it.
Rachel:
But, you didn’t answer the fact that when turning 65, everyone pretty much has to sign up for Medicare, working or not…What is the true impact of those people still contributing to Medicare out of their earnings??? Has anyone actually researched this?? There are a good number of people retiring early and being caught without insurance…and those who can afford the insurance are sailing around the world or doing charitable work, not spending work $$ on Medicare…
What are the real numbers??
Here is a quote from Microtrends. Again this is Mark Penn’s work. (A Democrat!!)
According to Eugene Steuerle, and economist with the Urban Institute, if everyone worked just one year beyond expected retirement, we’d completely offset the anticipated shortfall between benefits and taxes in the old age insurance portion of Social Security. If everyone worked five more years, the overall additional taxes to the governmenet alone would be greater than the shortfall.
There are numerous studies on this subject. If you want more info just tell me to turn on the flow.
What I think is critical to this discussion is that when we look at medicare and SS, we are using expectations of the greatest gernation which are radically different from the baby boomer generation. It’s really important that we not assume that those 20 years from now will think at all like those on medicare now.
Study after study is coming out showing that a new revolution is about to take place. Boomers are about to create a new life stage between their career jobs and complet retirement. Some are calling this new career/lifestage “Encore”.
Studies are showing that 70% of boomers want to continue to work in their retirement. (Admitedly part time).
What is actually interesting about this coming revolution is that it is actually good for boomers. Appropriate work is healthy and prolongs life. So it is healthy, good for our country fiscally and what boomers want to do.
A basic conclusion is that we probably need to start from scratch, and feel free to create a retirement medical system that is inline with the needs and goals of this new generation of retirees. By the way, the first members of this generation are eligible for SS in 6 days. First Boomers his 62 January 1, 2008.
Posted by: Craig Holmes at December 26, 2007 01:48 PMWe are “just not getting it,” BillS?
I can see a doctor anytime I want and get medications when needed, how does that mean I am not getting healthcare?
Rhinehold said: “Respecting individual rights does NOT prevent society from doing anything, David.”
Rhinehold, your comment reflects a total absence of ability to carry a logical proposition to its conclusion.
If just ONE individual’s ‘right’ is respected to exempt themselves from a national health insurance tax, preferring instead to self-insure, then that same ‘right’ must be respected for all others wishing to be exempt. That of course results in keeping the current BROKEN health care system in place, i.e., those who can afford it get it, and those who can’t, don’t, and the 40 trillion dollar unfunded Medicare mandate bankrupts the nation.
ERGO, the individual’s claimed co-called ‘right’ to be exempt from national or universal health insurance taxation/premuiums, would prevent society from implementing that universal health insurance capable of making sure no person suffers unnecessarily for lack of medical care.
So, Yes, respecting one person’s claim to a so called ‘right’ can indeed prevent the society from solving this problem facing its future.
Craig, expanding the age of mandatory retirement, and providing incentives to seniors to remain in the work force, are no doubt going to be part of the solution.
There are a number of impediments however to this partial solution being as fully realized as one might think. Location being but one of the largest factors. Large numbers of seniors will choose to live where they family is. The jobs available to their age and condition will not be located where the senior chooses to live in a great many cases.
Transportation is another issue. Many seniors may not elect to fight the traffic and its risks, or be capable of retaining a driver’s license due to medical condition or medications.
And last, but certainly not least, is the jobs skills matching to the job market. Millions of seniors will have outdated skill sets to remain in the work force.
Posted by: David R. Remer at December 26, 2007 02:12 PMThat was me, not Rhinehold, David.
“your comment reflects a total absence of ability to carry a logical thought to is conclusion”
No, your refusal to give it logical thought, is what prevents you from seeing the most important conclusion which respects EVERYBODY’s right to believe and live, as they wish.
You are correct in saying if you respect ONE persons right to be exempt, then you must respect EVERYBODYs right to do the same. But you are wrong in saying we would be stuck with the same broken system that can’t be fixed.
Those members of society, who believe in this universal healthcare scam, are quite capable to fix it now. They just don’t want to sacrafice enough for what they “say” they believe is the right thing to do.
Society is not prevented from helping others one bit when individual rights are respected, it benefits.
Posted by: kctim at December 26, 2007 02:24 PMDavid:
Thank you for your thoughtful reply. I agree that there are issues/obstacles with the working retired.
If viewed from the side of encouragement instead of mandating I think many issues can be evaporated. If the low hanging fruit is identified and taken advantage of, we can put a huge dent in fiscal problems in the future.
What is really great about this if done correctly is that it actually prolongs life. Meaningful work is healthy later in life. It just has to be suitable for the retire.
In terms of capabilities, I am not worried about finding jobs that people in their 60’s can do. Actually there is no reason healthy people cannot work until age 70.
Counselors who help seniors transition encourage them to “retire” at about 64ish. (It’s important to know assume one size fits all here). And then find new employement. The reason for this is that we all want to avoid and ugly departure because we have a different view of our capabilities than our employers do. When rehired, we then know that our skills are appreciated.
AARP is a leader in research on this subject. Even though there is much work to do in our country we are actually a world leader on this subject because of our lack of mandatory retirement laws.
David:
If we take Penn’s source above at his word, which is if we could keep people working 5 more years, then there is no problem with fiscal issues in terms of medicare.
And then if we assume very little works in the ideal. (Basically idealism goes to crap over time). Then we could set a national goal of increasing the retirement age by one year and thus solve 20% of the problem.
Since working in retirement can in fact healthy, and boomers want to continue to work currently, it would seem like a great goal. All our country would need to do would be to search out and eliminate obsticals that keep boomers from doing what they want to do!!
Secondly, I would really like to know how much of the problem could be solved from eliminating subsidies from the affluent. From a moral basis, I would like to know why we are subsidizing affluent retirees when many of the working poor do not have health coverage.
Posted by: Craig Holmes at December 26, 2007 03:15 PMRhinehold,
You wrote:
The proposed plan. It says that in order for this program to work people who not be allowed to go outside of the system. That is why they need government involved, so that they can use the government’s power of force to ensure that the plan is not bypassed.
Correct.
The Physicians wrote:
Perpetuating multiple payers - even two - would force hospitals to maintain expensive cost accounting systems to attribute costs and charges to individual patients and payers.
In other words, your freedom to choose to be private pay or have your own insurance would infringe our freedom to have affordable national health care because it would force hospitals to track bandaids for billing purposes which would drive up the cost of my care / taxes. It is about balancing freedoms and rights to achieve the greatest freedom and the greatest good for the greatest number.
The Physicians also answer your concerns about government interference in between doctors and patients. They write:
Bureaucratic interference in clinical decision making would sharply diminish. Costs would be contained by controlling overall spending and limiting entrepreneurial incentives, obviating the need for the kind of detailed administrative oversight characteristic of current practice.
and:
Incremental changes cannot solve these problems; further reliance on market-based strategies will exacerbate them. What needs to be changed is the system itself.
You write:
No health insurance company can force me to do anything, they are just a private organization and have no power over me.
But you do share that info with your health insurance company or you don’t get treated. Further, doctors are under reporting rules and routinely report info to the police and CDC. Your concerns about privacy are well founded, but that ship has sailed, that battle is long lost. You have no privacy.
The government knowing that you had a splinter removed is not what you need to concern yourself about. The government monitoring your radical comments here - as they do - is of much deeper concern.
The government spying on Chief Justice John Roberts and President Hillary possibly finding out that he likes bathroom sex is worse. If we were to catch John Roberts liking bathroom sex with undercover police officers - no problem - it would just make some more fun for us libs. But if President Hillary found that out through these spying programs that Bush has inaugerated, she could, probably would use it to blackmail him. That is a problem. That is where your privacy concerns need to be focused. We need to protect his privacy, not yours or mine. Frankly, we are not important enough to matter. His privacy is the privacy that matters.
Posted by: Ray Guest at December 26, 2007 03:35 PMStudies are showing that 70% of boomers want to continue to work in their retirement. (Admitedly part time).
So, this means they will be earning at most half of what they earned before so they won’t be contributing nearly as much as when they worked fulltime…plus many are taking jobs that don’t pay an hourly rate anywhere near what they got for a fulltime job…perhaps you’re overestimating what retired “workers” will be contributing to Medicare???
Posted by: Rachel at December 26, 2007 04:29 PMRachel:
So, this means they will be earning at most half of what they earned before so they won’t be contributing nearly as much as when they worked fulltime…plus many are taking jobs that don’t pay an hourly rate anywhere near what they got for a fulltime job…perhaps you’re overestimating what retired “workers” will be contributing to Medicare???
That is already figured in. Typically retirees don’t need as much income to keep their current standard of living. Again one can’t paint with one brush. Usually college expenses for kids are gone. In addition mortgage payments are a lower portion of their income because they have been paying on them for a while. They may have a small defined benefit program etc.
Delaying taking money out of retirement programs is huge. For instance just assume someone has $200,000 in retirement savings tax deferred. Lets say they earn 8% by investing in a balance of equity funds and bond funds. By delaying one year that ups their investments by $16,000 which is taxed at some future point! Delaying five years increases the balance by nearly 50% which means 50% more taxable income from this investments alone over this persons life span.
Add to that the additonal taxes from part time work and it works out to very large tax numbers.
Posted by: Craig Holmes at December 26, 2007 04:39 PMKCTM
The “we” I was refering to is the inclusive we. “We” as in all Americans.I understand this is a difficult concept for some to grasp but a consistant and callous disregard for the travails of our fellow Americans is a personality defect,not a relevant method of evaluating public policy proposals.
Rhinehold
The notion that single payer or any other contemplated method of achieveing universal healthcare access is a threat to freedom or liberty is simply not supported by the evidence. We are not the first industrial democracy to proceed down that path. Actually we are the last to do so. Canada is not a totalarian state. Nor is England,France, Belgium, Norway, Sweden,Germany,the Netherlands,Iceland,Poland …….. etc. Universal healthcare has been shown to co-exist with democracy and freedom worldwide.
Freedom can and is lost to other institutions besides government. An example of this fact occurs all the time. What is the difference to the heirs if an estate is forfieted to a healthcare corporation instead of to a confiscatory inheritance tax? None I would say.
Rhinehold,
remember, liberty is absence of government interference in our lives
Hum, that your definition, inline with individualists and liberals conception of liberty, dubbed “negative liberty”. It’s not an universal view, as the opposite “positive liberty” attest and the concept of Liberty as a whole is very debatable.
You can’t assert *your* is the ultimate one.
May I suggest you explore the *others* concepts:
http://en.wikipedia.org/wiki/Liberty
I see BillS. So, since you have no idea of how I personally feel about or choose to help others myself, you must be suggesting that I have a personality defect because I do not believe as you do. Interesting concept there.
Tell me, what would be a good “method of evaluating public policy proposals?” Stripping rights of everybody in order to appease the few? Doing what some think is right and forcing others to go along with it?
Or how about this: make healthcare available to everybody (which it is) respect everybodys beliefs (which you do not) and give everybody the same opportunity to help as much as they wish or not (which we do now, but some people just don’t really believe in it THAT much)
Here’s a newsflash for you: WE, as in ALL Americans, DO have access to healthcare. Some just do not choose to take advantage of it and others choose not to help them themselves, but would rather have govt do it for them.
Posted by: kctim at December 26, 2007 09:12 PMYou guys are getting pretty brainy here. Of course anything we do as a nation pretty much interferes with someone’s liberty. Every road built “adjusts” someones property rights.
I feel pretty silly screaming about my rights in the comfort of my nice home while some do not have access to basic health care.
I think if we want to bet into how many angels God can put on the head of a pin, I would just use my favorite philosopher, larry the cable guy.
“It’s time to get ‘er done.”
Posted by: Craig Holmes at December 26, 2007 10:18 PMHere’s a newsflash for you: WE, as in ALL Americans, DO have access to healthcare. Some just do not choose to take advantage of it and others choose not to help them themselves, but would rather have govt do it for them.
Emergency room care is NOT the same as access to regular medical check-ups and preventative medical care…it’s too late for many patients if all they have is the ER as their only access point…
Goodness…do you really believe everyone has access to medical care???
Posted by: Rachel at December 26, 2007 10:24 PMDelaying taking money out of retirement programs is huge. For instance just assume someone has $200,000 in retirement savings tax deferred. …Add to that the additonal taxes from part time work and it works out to very large tax numbers.
And exactly how much goes to Medicare???? And, people 65, working or not, have to sign up for Medicare and insurance companies demand that Medicare is the primary insurance and any other insurance is supplementary…so where is the savings???
Posted by: Rachel at December 26, 2007 10:26 PMRachel:
And exactly how much goes to Medicare????
With medicare projected to be in deficit spending any income tax helps reduce the deficit and indirectly helps medicare.
And, people 65, working or not, have to sign up for Medicare and insurance companies demand that Medicare is the primary insurance and any other insurance is supplementary…so where is the savings???
I don’t think that would need to change. The big advantage is that working seniors produce more tax revenue and thus indirectly help offset costs for their retirement.
Every dollar of income taxes/ss tax revenue from seniors who continue to work goes against that $40 trillion dollar deficit David continues to bring up. Every dollar.
Posted by: Craig Holmes at December 26, 2007 10:45 PMRay,
Since Social Security has been brought up I thought you might appreciate this article I stumbled across today:
http://www.bestcyrano.org/THOMASPAINE/?p=511
One of the best I’ve read in some time.
Posted by: KansasDem at December 26, 2007 11:05 PMRhinehold said: “remember, liberty is absence of government interference in our lives”
There is that anarchist voice again. The absence of government is anarchy. Liberty in modern times is protected and defended by government, particularly democratically elected Constitutional or Parliamentarian governments.
Government by definition, intrudes into people’s lives, by establishing rules, laws, and consequences for failing to abide them.
Do you ever ponder why the word anarchist is thrown your way so frequently, Rhinhehold? Perhaps there is a sound reason for that to be found in your comments similar to this one above.
Posted by: David R. Remer at December 26, 2007 11:46 PMDavid:
Is the difference between a libertarian and and anarchist perception?
Posted by: Craig Holmes at December 26, 2007 11:48 PM“Goodness…do you really believe everyone has access to medical care???”
Rachel,
According to our wonderful president ALL American’s DO have access. Who are we to argue ;^/
I’ve been giving the site Ray provided a thorough reading and this blows holes in many of the myths:
http://tinyurl.com/yqrqb6 (in pdf)
Sadly there is not enough support for single payer health care. To my knowledge Kucinich is the only Presidential candidate even proposing such a plan.
Posted by: KansasDem at December 26, 2007 11:53 PMkctim said like a true anarchist: “Society is not prevented from helping others one bit when individual rights are respected, it benefits.”
Every individual’s rights? Even those whose rights are defined differently than other people define them? Who defines those rights, if not the majority and the representatives of the people? And if they decided, as our founding fathers did with the ratification of the Bill of Rights, is not the precedent set for the majority and their representatives to define what rights are and what social obligations are.
As those on the Right are so fond of saying, with freedom comes responsibility. Right’s lie at the heart of freedom. Since those rights are to be protected by society at large, is not every individual obligated to the protect and defend the society which protects and defends their individual rights? As for example in the paying of taxes, obeyance of laws and rules, even when the individual feels them to be an infringement upon their freedom and individual right to have things just the way they want them for themselves and be left alone by society at large?
This issue of individual rights and society’s needs to protect its future is not an unfamiliar one to our courts. In fact, a great deal of precedence has been laid down over the centuries which establishes the good of the society outweighs the wishes of the individual. The very concept of government presumes this to be true, for every government, including our own, establishes laws that prevent any individual from usurping the government’s continuation or authority.
We may all inherit an unalienable right to life from the creator, but, it is the government that will protect life, spend it, or take it, on this corporeal earth as it deems necessary for the benefit of the nation and government overseeing it. War, the death penalty, and police powers are all testament to this true and fundamental fact that rights are defined government, regardless of whether that government is republican, authoritarian, communist, or parliamentarian.
If it were not so, our Constitution would have had no need of the Bill of Rights. It was no accident that our Constitution set forth the POWER of government first and foremost, and individual rights as amendments. Individual rights are defined differently by different people.
Like you kctim believe you should have the right to remain in America, enjoy the host of benefits and securities that attend your residency without the obligation of paying taxes the majority of voters assent to paying and keeping intact. You rail on this subject frequently here as if you think you have a right to be free of taxation, or at least those taxations which you individually find burdensome.
I hope you see the dilemma your position poses for defending itself. If indeed you pay your taxes whether you agree with them or not, you are in fact, assenting to them, in the most meaningful way one can. Which makes your objections just apparitions of desire and wishful thinking. An individual who truly believes certain taxes are an infringement on personal liberty would, as our founders did, refuse to pay them and accept the consequences for that action.
Is that principle to be found in your position kctim? Or, are you just another taxpaying assenting citizen who supports the very system they so fondly participate in idly criticizing as the great American past time.
Posted by: David R. Remer at December 27, 2007 12:20 AMDavid:
Ok here is my question for you on anarchy. Isn’t an Anarchist simply a fundamentalist libertarian?
Posted by: Craig Holmes at December 27, 2007 12:30 AMRhinehold said: “remember, liberty is absence of government interference in our lives”There is that anarchist voice again. The absence of government is anarchy
Sorry David, but your inability to read is the problem here, not my views.
I *NEVER* said an absence of government, I said an absence of government INTEFERENCE.
There is a difference, one you seem to be unable to comprehend, even though I explained ad naseum about a hundred times. Either you are just unwilling or unable to see that the basic libertarian philosophy, of being free to live your life without the government telling you how as long as you are not preventing another from the same, is not the same thing as having no government at all. And quite frankly, it is getting old and boring having to stop in the middle of any debate and reiterate the same point over and over again.
And no, Craig, an Anarchist is not a fundamentalist libertarian, you fail to understand as well. Government is necessary to defend the rights of individuals from others who violate those libertarian beliefs, you know the ones about letting you live your life as you wish? I had a long argument with Ian of Free Talk Live about a year ago (another anarchist passing himself off as a libertarian) on this subject and he refuses to accept that even if you don’t CALL it a government, when two or more individuals get together to stop another from violating those rights, it is a government, albeit small and possibly temporary.
The sad part about this whole debate is we are now told we either have to have a governmentally controlled healthcare system or a broken semi-government controlled, semi-corporate controlled one like we have now. No one wants to even entertain OTHER possiblities because that would not be ‘fair’ or ‘partisan’ enough.
I hear that we need this because right now poor people only avail themselves of the ER for medical care. While this is true, it is not because they have no other options, there are free clinics and other charitable organizations out there trying, but most people are not seeking medical care until the need it. If they have forethought and planning, most of them wouldn’t be in the situation they are in. And no, this is not a ‘mean’ view of poor people, I work with them every day, it is just a sad fact of life. They are either going through a depression/other mental disorder, were never tought how to take care of themsevles and just need someone to talk to, are convinced that nothing they do will matter (the man is keeping them down), don’t want to better themselves at all ever, or, a small minority, are just down on their luck and are trying their best to get back in the game.
The only people we can help with our current programs are the last group, the minority of the poor, because we are just throwing money at the situation, no one is addressing the real issues that these people have and getting them better.
So the sad result is that, again, we are going to implement a program that will do f*** all to actually help the problem while we pat ourselves on the backs for how great and giving we are by voting to take money from everyone to give it to others. People who want to use preventative medical care will do so as they are doing now and no one else will because they don’t WANT to. It is not that hard or expensive to get minor medical coverate in this country. And with the new HSAs, it makes good sense. But the fact that so many people choose not to will not change with a national healthcare system.
So what are we trying to fix? The cost? If you want the cost to go down, get the person who is purchasing the services to pay for it. Give them an incentive to shop around. Bring competition back into the system (it is gone completely these days). This proposal that Ray offers will be just like any other governmental budget, it will always increase greater than the cost of living. I’ve worked in those budget process