Republicans & Conservatives: Archives

Lee -
Thanks for the summary. The discussion sounds really productive, and there’s no way I was going to read 145 comments to find that out.

Good idea… and keep up the intelligent positing!

Posted by: Chops at March 28, 2008 01:34 PM

Thanks, though it really has not been my doing.

It is difficult to transplant a discussion from one place to another, especially one that was born in the bowels of another issue. In this case, because, as Remer points out in the center column, ignorance is used against us by politicians, appeals to our “rights” to medical care have been one party’s wedge to gain power and another’s wedge to condemn the power-grabs of the first. For us to have a really constructive approach to medical care we must tune out the rhetoric and look for things that work.

This is an issue where the people must lead and force the politicians to shut up and follow.

Posted by: Lee Jamison at March 28, 2008 02:28 PM

I think we DO have to address how we are going to allocate resources and ration healthcare. We ARE doing it now, but poorly. I think the French and even British or Canadian systems are good plans.

As to flight for excess taxation, nice scare tactic, but the Cayman’s are going to get awful crowded.

Posted by: googlumpus at March 28, 2008 02:55 PM

Any discussion about health care immediately spills over into issues of rights, the role of government and other ideologically divided and divisive frameworks.

I can’t work up a lot of enthusiasm for the ultra individualistic and ultra libertarian positions.
When they talk about the ‘tyranny’ of needing to contribute to the welfare of our society at large and then follow it up with threats to move elsewhere should things not work out their way, I’m reminded of spoiled children threatening to run away from home the minute they are required to practice responsibility to others in the family.

That said the tension between the individual and his society is natural and eternal. We need to discuss how to calibrate it without going to either exteme.

Pragmatically speaking. the failure of health care provisions affects everyone, even how the rugged individualists conduct their own lives. Money spent for emergency room care in place of a GP visit is not available for infrastucture, etc.

No modern society can survive UTube videos of people dying in the streets, so at some point, taxpayers do have to fund dealing with the consequences. The only question, and this is not an easy one, is whether we should deal with this proactively or depend on mop-up operations.
Which is more cost-effective over the long run?

There is often a cycle of neglecting significant sectors of society (whether they have a ‘right’ to attention or not) leading to ill considered bakclash measures. The antipathy to trade agreements is an example of such a backlash, something that should have been foreseen but was not addressed.

I see no alternative, then, to admitting the need to personally contribute to the health care available to all Americans. Improving the health of our work force brings more people into the ranks of contributors and reduces the ranks of those who deplete funds without contibuting.

What are called government programs need not be executed by government employyes.
A true public/private partnership, however, does imply more than just contracting services out. Opportunites for the private sector to profit need to be balanced with assuming its share of responsibility for the consequences.

Posted by: sisuntas at March 28, 2008 02:56 PM

Mr. Jamison et al

We say that we are talking about health care but we always end up talking about sick care. Here is something form AARP on better health:
http://www.aarpmagazine.org/health/9_Secrets_Better_Health.html

and one definition of right, a word that has over 60 meanings, form dictionary com:

a moral, ethical, or legal principle considered as an underlying cause of truth, justice, morality, or ethics.
akin to L réctus ruled, Gk orektós upright

For most of the population, it is more important to get the medication that they are prescribing for themselves for conditions that they are well aware of. The FDA should make more medications available without prescription, and more presriptions should be made refillable without another doctor visit. To throw something new into the mix this time around, marijuana should be legalized and made available in small quantities by prescription.

Posted by: ohrealy at March 28, 2008 03:11 PM

sisuntas,
OK, so take a look at the French system. Could that be a starting place?

ohrealy,
I’d like to see something that quantifies what diseases and other health problems cost us the most in medical resources.

If we start talking about marijuana we’ll lose the thread. That’s for another day.

Posted by: Lee Jamison at March 28, 2008 03:24 PM

Lee, all these statistics start from this page:
http://www.cdc.gov/nccdphp/programs/index.htm Cancer Control
According to the National Institutes of Health (NIH), in 2007, cancers will cost the United States an estimated $219 billion, including $130 billion for lost productivity and $89 billion in direct medical costs.
///
Diabetes
According to the American Diabetes Association, the cost of diabetes in the United States in 2007 was as follows:
Total costs (direct and indirect): $174 billion.
Direct medical costs: $116 billion.
Indirect costs (related to disability, work loss, premature death): $58 billion.
Cost of caring for someone with diagnosed diabetes: $1 out of every $5 in total health care costs.
///
Heart Disease and Stroke
There is a whole series of graphs on heart disease and stroke here:
http://www.cdc.gov/nccdphp/publications/AAG/dhdsp.htm
The figures include direct and indirect costs. The cost of heart disease and stroke in the United States is projected to be more than $448 billion in 2008, including health care expenditures and lost productivity from death and disability. As the population ages, the economic impact of cardiovascular diseases on our nation’s health care system will become even greater.

///
On Obesity:
In the past 30 years, the prevalence of overweight and obesity has increased sharply for both adults and children. Between 1976–1980 and 2003–2004, the prevalence of obesity among adults aged 20–74 years increased from 15.0% to 32.9%. Among young people, the prevalence of overweight increased from 5.0% to 13.9% for those aged 2–5 years, 6.5% to 18.8% for those aged 6–11 years, and 5.0% to 17.4% for those aged 12–19 years.

People who are obese are at increased risk for heart disease, high blood pressure, diabetes, arthritis-related disabilities, and some cancers. The estimated total cost of obesity in the United States in 2000 was about $117 billion.

Promoting regular physical activity and healthy eating and creating an environment that supports these behaviors are essential to addressing the problem.
…
Despite the proven benefits of physical activity, more than 50% of U.S. adults do not get enough physical activity to provide health benefits; 24% are not active at all in their leisure time. Activity decreases with age, and sufficient activity is less common among women than men and among those with lower incomes and less education. Insufficient physical activity is not limited to adults. About two-thirds of young people in grades 9–12 are not engaged in recommended levels of physical activity. Daily participation in high school physical education classes dropped from 42% in 1991 to 33% in 2005.

Heart disease: 287 billion
(includes indirect costs)
Diabetes: 166 billion
Cancer: 89 billion
(direct medical costs only for these two)

Posted by: ohrealy at March 28, 2008 04:07 PM

Lee-

The last two paragraphs of the Boston Globe story are especially true. We must move away from our employer based health system and how we move away from it should be the debate.

Most of the anecdotal “horror stories” you hear about health care have to do with our employer based system. My personal experiences are no exception. As soon as my father in law was diagnosed with liver disease his employer of 18 years “eliminated his position.” Another in-law has cancer. There is no way she will ever be able to leave her employer until she reaches Medicare age.

You don’t need the government to take over health care in order to address the employer based system. Just making insurance premiums tax deductible would bring market forces back to the insurance industry and foster the development of better individual products.

Posted by: George in SC at March 28, 2008 04:37 PM

Lutheran General Hospital in Park Ridge had a little thrift store in DesPlaines, IL for many years. They had one full time and one part time employee, and all the others were volunteers. As their full time employee aged, she began to have numerous health problems, including a hip replacement. When Lutheran General became part of Advocate, they closed this store, eliminating their health care costs for this person. If you add up enough anecdotes, they become our real national health care policy.

Posted by: ohrealy at March 28, 2008 04:54 PM

Jamison,

I think the French system is a very good place to start discussions. I would not support importing it wholesale, however. For one thing, anyone (tourists included) can arrive in a French hospital and, claiming vague symptoms, demand an array of specific, sophisticated and expensive tests.

The French, I think, are begininning to discuss limitations on health care largesse, and we would do well to follow those and learn from them.
An unquatifiable by-product of their sysem is that people don’t need to fear illness as a financial catastrophy. They read about he American experience as a lesson in what not to do.

I find it odd that on both sies of the Atlantic one topic is taboo: the consequences of technologies that extend life in both directions.
Premature babies at earlier and earller stages of gestation can now be saved and very ill people can live longer and longer.
Where are we going with this and what does this mean in terms of sustaining as well as preserving life?

Posted by: sisuntas at March 28, 2008 05:00 PM

George from SC brought up two important points.

One of them I agree with.
We should move away from employer provided insurance to portable insurence. That would free individuals from the need to choose between keeping coverage by staying in an unwanted job and risking financial ruin. It would also free business from the burden in order to compete internationally with rivals who have no such encumbrances.

Jumping to a pure reliance on the market is going too far, IMO. The market does not work the same way in all areas.
Health insurance is not like buying a new car. People can affect mrket forces by refusing to buy any car at all, if they are all too expensive.
They can’t opt out of needing health care in the same way.

Additionally, market forces involve investors as well as prodiders and consumers. That breaks the traditional link betwee the provider and customer satisfation. Now it’s often investor satisfaction that determines provided services.

Posted by: sisuntas at March 28, 2008 05:33 PM

H. R. 3344

To amend the Internal Revenue Code of 1986 to allow medical care providers a credit against income tax for uncompensated emergency medical care and to allow hospitals a deduction for such care.

H. R. 1898

To amend the Internal Revenue Code of 1986 to allow individuals a credit against income tax for medical expenses for dependents.

Food for thought.

Posted by: Weary Willie at March 28, 2008 05:36 PM

The “rights” discussion on the blog that lead to this post contained numerous references to the “unfair” practice by insurance companies of assessing the applicant for insurance according to his/her medical history with some being denied coverage.

There are some on this site that apparently confuse insurance with something completely different. Any kind of insurance you can think of, including life, health, long-term care, auto, home, boat, etc. is based upon an assessment of risk to the insurer. When you or I complete an application for insurance we are making the insurance company an offer. The insurance company can accept the offer and issue the policy at the agreed upon premium, make a counter-offer with a higher premium or decline our offer.

With little risk the insured receives favorable premium treatment. As risk increases, premiums increase until a point is reached when the insurance company considers the risk unacceptable and refuses to accept the applicant under any circumstances.

Few would argue that this concept of insurability is unfair as it describes the very nature and essence of the business. It is not insurance if the insurer is not at risk for loss, and in consideration of the exposure to loss, the insurer is required to access the degree of loss to which it is exposed and charge premium accordingly.

A simple comparison would be the interest charged on a loan or credit card. Those with the best demonstrated credit receive the most favorable rates. Those with demonstrated poor credit receive higher rates or are denied credit. Were this not the case, banks would be hard-pressed to protect their depositors and rates charged to persons with proven good credit would pay much more in interest to subsidize the poor credit and higher risk applicant.

We should all stop referring to any form of universal health care as insurance…it’s not. If everyone understood this simple concept it would make for a much better discussion and we could eliminate the need for some to refer to insurance companies as greedy, uncaring, overbearing, etc. Instead, we would all understand that insurance is a legal contract with rights and duties afforded both the insured and insurer.

And, we would all understand why an insurance company has the legal and sensible right to charge premium according to risk or deny applications.

Posted by: Jim M at March 28, 2008 06:13 PM

Regardless of whether which type of health care system we devise, that system would probably be much more efficient and affordable by eliminating the unnecessary middlemen, implementing some government and civil oversight, and stopping other abuses that are undermining and destroying many of our systems.

However, if a new government-run health care system is run like the current Medicare and Social Security systems, it may be the final straw, since the following are at record levels or have never been worse before:

• the federal government already has a $9.4 Trillion National Debt, and $12.8 Trillion was borrowed and spent from Social Security (leaving it pay-as-you-go, with a 77 million baby-boomer bubble approaching); the total federal debt of $22.2 Trillion has never been larger in size or as a percentage of the $13.86 Trillion GDP;


• nation-wide debt is $53 Trillion (excluding the $12.8 Trillion borrowed from Social Security; $65.8 Trillion including it); $53 Trillion is 3.81 times the nation’s $13.86 Trillion GDP and has never been larger in size and as a percentage of the nation’s $13.86 Trillion GDP;


• 80% of Americans own only 17% of all wealth in the U.S. (the largest wealth disparity gap since year 1930);


• real median incomes have fallen since year 1999, and they have also fallen since year 1978 when also factoring in more workers per household (real median household income in 2004 dollars was $40K in year 1978, and it only rose $3K to $43K in by year 2006);


• home equities have fallen below 50%, the lowest level in 62 years (since year 1945)


• inflation is eroding incomes and savings, and the U.S. Dollar has fallen signifcantly against all major international currencies since year 1999;


• foreclosures (220,000 per month in Jan-2008) are at the highest levels in over 50 years (www.washingtonpost.com/wp-dyn/content/article/2007/06/14/AR2007061400513_pf.html);


• as of 06-Mar-2008, the mortgage delinquency rate of 5.82% was the highest rate in 23 years (since year 1985).


• as of Dec-2007, home ownership (money.cnn.com/2008/01/29/news/economy/home_ownership_vacancies/index.htm?postversion=2008012913) has taken a record plunge, and the 4th quarter of 2007 saw the biggest one-year drop in new home owners (1.1%) since tracking began in year 1965;


• health care costs are not just high, but ridiculous; and health care is increasingly dangerous too, with an average of 195,000 people in the U.S. dying due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002. Since 1999, that is over 1.5 million people killed by preventable medical mistakes. That is more than all the U.S. troops killed in the American Revolution (4,435), the War of 1812 (2,260), the Indian Wars (1,000), the Mexican War (1,733), the Civil War (462,000), the Spanish American War (385), WWI (53,402), WWII (291,557), Vietnam War (58,209), Korean War (36,574), the Iraq Gulf War (529), the war in Afghanistan, and the current Iraq war Mar-2003-present (4,005), combined!


• energy, electricity, and fuel costs are higher than ever before (even worse than the spike in year 1981, when adjusting for inflation);


• the net losses due to illegal immigration has never been worse (costing Americans net losses of an estimated $70 Billion to $339 Billion per year);


• average savings rates have been negative since year 2005, and have reached the worst levels since year 1933;

Perhaps we should fix some of this other stuff before asking the already severely bloated, wasteful, pork-happy, irresponsible and corrupt federal government to manage the heatlh care system?

Posted by: d.a.n at March 28, 2008 06:15 PM

I apologize, up front, for not including links in my posting; I don’t know how to incorporate links into what I write. I apologize because I am going to make a couple of assertions that would be more defensible if readers could link to the data on which I based the assertions. Alas, readers will simply have to google the subject to find the data that I found.
The United States spends more (per capita or as a percentage of GDP or by any other measure)than any country in the world. We spend roughly 40% more than Switzerland, which is in second place, and more than double the average spent by developed nations. Many, if not most, of these other nations provide insured health care to a much higher percentage of their populations than we do, so it is reasonable to conclude that if we covered as many people as other countries cover, our total costs would be even higher than they now are. In short, health care in our country is dramatically more expensive than it is anywhere else in the world.
We might find this high cost acceptable if it were accompanied by equivalently better outcomes. Sadly, it is not. Our health outcomes (measured by life expectancy, infant mortality, prevelence of various diseases, and other measures)are not as good as most of the highly developed nations. We are paying more and getting less.
One would think that inquiring minds would wonder why we have such high costs and such mediocre outcomes. And, there have been studies…a few hundred studies, at least. Most of the studies I have found reached very limited conclusions. For example, a Johns Hopkins study in 2005 concluded that the cost differences between us and other nations were not driven by malpractice litigation or by waiting lists in those other nations. Another study concluded that the difference in outcomes was not the result of our “bad habits,” such as smoking or drinking to excess or driving too fast. Apparantly the citizens of other developed nations are careless about their health, just as we are.
But, there seems to be an abysmal lack of national curiosity about why we pay so much and get so little out of our health care system. Instead, we and our elected and aspiring leaders talk about more government health care or more private health care or mandates or incentives, etc. I would like to hear at least one of our candidates for president say something like this:
“Frankly, I don’t know why we spend so much on health care, get middling outcomes, and leave a big chuck of people uninsured. But, if you elect me president, I will pull out all the stops to learn why. Then, based on what we learn, I will propose changes to our current system.”

Posted by: Steve at March 28, 2008 06:39 PM

The blosated, corrupt and wasteful government argument sounds hollow to me, even though it is, to a large extent, tue. It’s counteracted by the greedy and irresponsible corporations argument on the other side, which is equally hollow.

People are greedy and susceptible to corruption whether their pay check is signed by Uncle Sam or Bussinees, Inc.

That, in fact, is why I suuport a marriage between business and government - so they can counterbalance each other’s worst instincts. With a little luck, a co-operative effort could even give birth to adopting best practices by both.

In the meantime, it would help to remember that this is still an impwefect world, managed by lawed people. No plan will satisfy all people or solve all problems.

Taking up exteme positions will only guarantee extended debates instead of decisive action.

Posted by: sisuntas at March 28, 2008 07:01 PM

Lee another concept we should take a serious look at is one proposed in an early article by Ray Guest, the singlepayer system as proposed by the Doctors themselves. Here is a link to their site.

http://www.pnhp.org/facts/singlepayer_faq.php#socialized

I favored the french system as a start because it seemed to “violate less rights” and although French less “socialized” than some other plans. If we could get ideology out of the way and see what actually works the PNHP plan sounds good and as you know we should always listen to the doctor.

Posted by: j2t2 at March 28, 2008 08:00 PM

Doctors want single payer to help them get paid. It will not directly affect the care that their patients get, just accounting expenses.

Posted by: ohrealy at March 28, 2008 08:18 PM

Whenever you have a third person paying for a service there is inflated cost. This was appearant in a discussion I was having with a tow-truck operator.
He was angry because nepetism in the local police force was dominating the calls for tow service in our county. He felt he should be allowed his turn along with the relatives of the police officers on duty because “..it’s insurance, and you can charge more!”

Third party payer relieves the receiver of service the obligation to control the cost. If each person had to pay, the outrage would reduce the cost immediately.

I’ve seen a 3 dollar charge for a 1 inch piece of rubber tubing used to drain an abcess. That is ridiculous and outrageous. But it’s being charged and the insurance is paying and the receipient is outside the loop with no motivation to stand up and complain.

Posted by: Weary Willie at March 28, 2008 08:41 PM

We debate this occasionally so commenting on the French system is easy.

Disadvantages,

Taxes spread out over numerous areas, employers, employees and co pays (out of pocket 30%). Also included in auto licensing fees.
High unemployment nationally due to the great expense to employers.
Tension between doctors unions and the government for pay rate increases and caps are undesirable
It is fairly new in the present form and costs are rising, including co pays.
Started in 2000; before then a plan existed that didn’t cover everyone. It really hasn’t been proven.

Advantages.

Hindrances from lawyers and lawsuits are eliminated and therefore waivers and high liability are nonexistent .
http://www.huffingtonpost.com/martin-varsavsky/us-vs-french-medical-care_b_44164.html
Doctors and patient relationship is protected. Patients can go to whoever they want.
Patients can go directly to specialists without referral.
Billing is streamlined.
Supplemental private policies are allowed ; 85% have them.
The bottom ten percent in income have their co-pays waived.

I agree that the states should be encouraged to start their own. I just left a mismanaged state. That is the advantage of having united states. We can examine each other’s disadvantages and advantages and make changes accordingly.
A federal system will require too many people to manage it and a large portion goes to administrative costs for such a dinosaur. Also lobbying is limited with a smaller program. (As was stated previously) France has a 64 million population vs. US 300 million. California alone has 37 million.
We should eliminate all federal taxes from income. It is too invasive and is closer to unlawful search and seizure than most of the privacy complaints I hear today. Employers should be able to focus on business instead of entitlement. Employees won’t feel trapped by benefits.
If we start a new entitlement, or rather replace the ones we have now, it should be a broad sales tax. If gas tax pays for roads, maybe a food tax would pay for human maintenance.
The entity to disperse should be private with a board of experts to provide oversight for minimum requirements. Everything stays the same except the risk factor “insurance” principal would be eliminated in the minimum policy.
We can start by applying the changes in the first four advantages to our present system.

Posted by: Kruser at March 28, 2008 08:59 PM

“Patients can go directly to specialists without referral.”
Sounds like the best idea in the French system, but I don’t think we will ever get over our desire to sue incompetent doctors. Maybe we have more people chasing ambulances here than they have, or we just like revenge more.

Posted by: ohrealy at March 28, 2008 09:26 PM

A bifurcated system:

Universal coverage for:
Basic (annual exams and preventive) care, Emergency care (accident, high fever, etc.), and long term catastrophic care (50% coverage).

Private insurance and private practice care for all other Medical conditions and situations.

Lastly, any medical patents generated on the back of taxpayer paid research and development requires the patent holder to remit 1/2 of 1% of all revenues derived from that patent back to the federal government in annual payments, as a precondition to participation or purchase rights of patents developed with tax payer funding.

Posted by: David R. Remer at March 28, 2008 10:36 PM

I am repeating myself here but I have to say again, we already have a universal, single-payer system in this country. It presently covers most of the sick, almost all of the elderly, and most of the disabled. It’s called “Medicare”.
It is in terrible financial shape because it does not have the healthy people in this country paying into it … that money is going to the health insurance industry.
I realize that I’m over simplifiying the solution but I would at least think that it would be looked at before considering the “french system”. (I hate those guys!).
I think most health care providers (those people that actually provide health care!) would accept a universal Medicare system. Maybe reimbursment would not be as good but it is a single billing system, with a single set of rules and dependable payment returns. They may lose a little on reimbursement but save a ton on A/R recovery costs.
Can Medicare be improved? Yes. I have really no idea how but I know with the cost savings of single payer they could improve payment to providers, dedicate money to research (credits to those companies doing research), and fund training to address the chronic shortage endured in many disiplines (nursing, pharmacists, rural medical care to name a few); and, at the end of it all, there would still be tremendous savings.
Government single payer would certainly influence the health care system but it does not have to run it. It need not force consumers toward any service or provider.
I know that familiarity breeds contempt and Medicare is a system with which most Americans have had direct or indirect experience with but, jeez, the French??? Liberal or not, I have to say, I HATE the French!

Posted by: charles Ross at March 28, 2008 10:38 PM

Steve said “Frankly, I don’t know why we spend so much on health care, get middling outcomes, and leave a big chuck of people uninsured. But, if you elect me president, I will pull out all the stops to learn why. Then, based on what we learn, I will propose changes to our current system.”

Perhaps its because the focus is on profits and competition instead of healthcare. As an example, with dueling hospital chains competing for a greater share of the market they each have to purchase expensive equipment that if distriubted correctly (shared) could serve the community at less cost. How many MRI’s does one city need?

“High unemployment nationally due to the great expense to employers.”

Kruser do you think the expenses to employers in France for healthcare are greater than the expenses to employers that offer insurance to employees in this Country?

“Tension between doctors unions and the government for pay rate increases and caps are undesirable”

I would think we need more tension here. Seems that a reason for cutting costs/improving efficiency would help here. Perhaps a method for paying for the education of the doctors so they arent buried in debt before they start practicing medicine would help.

“It is fairly new in the present form and costs are rising, including co pays.
Started in 2000; before then a plan existed that didn’t cover everyone. It really hasn’t been proven.”

The French have been working on their system since 1947. Just because they tweak it now and then doesnt mean it hasnt been proven. If we wait till a system is proven we could be waitng quite a while. Even in this country costs are rising and coverages are declining. That problem is universal.

“I agree that the states should be encouraged to start their own.”

I would think that may help to streamline costs and avoid unnecessary layers of nonmedical personnel. The smaller population states could partner with a neighbor for cost effective care.

“I know that familiarity breeds contempt and Medicare is a system with which most Americans have had direct or indirect experience with but, jeez, the French??? Liberal or not, I have to say, I HATE the French!”

Well its not like we are asking them to administer it we are just using what gthey have learned to improve our system.

Posted by: j2t2 at March 29, 2008 12:42 AM

Given that our present Medicare system alone will one day demand every single dollar the government has, maybe we better deal with that before we expand health care to others.

Of course, that would require something of democrats and republicans we haven’t seen for a long time in either party. Responsible government, and ultimately CUTS because we have promised too much to too many and can’t possibly tax enough to deliver it all without destroying our economy.

Posted by: Stephen at March 29, 2008 04:32 AM

ohrealy wrote March 28, 2008 08:18 PM Comment #249452: Doctors want single payer to help them get paid. It will not directly affect the care that their patients get, just accounting expenses.

Good point.

There was a time when health care providers dealt directly with their customers (patients).
What happened?
What caused health care costs to not only skyrocket, but EXPLODE ! ? !

Weary Willie wrote March 28, 2008 08:41 PM Comment #249452: Whenever you have a third person paying for a service there is inflated cost… . Third party payer relieves the receiver of service the obligation to control the cost. If each person had to pay, the outrage would reduce the cost immediately.

True. We have to reduce or eliminate the unnecessary middlemen.

Then, we have to reduce or eliminate the motives for greed (i.e. profit).

Currently, the Medicare HI (Hospital Insurance) trust fund, financed by federal payroll taxes (2.9% of gross; 1.45% from employee, 1.45% from employer), is currently running a deficit and is projected to be exhausted by 2018/2019.
The rapid growth in Medicare expenditures is fiscally unsustainable.
That also does not account for any decreases in federal payroll taxes in the event of economic downturns(s).
Especially with the affect of the current mortgage bubble that will easily continue in 2010 (or longer).
The 2008 Medicare Trustees Report states that expenditures in 2007 were $432 billion (32% of the $13.86 Trillion GDP), and in the next 75 years, the expenditures are scheduled to rise rapidly to 110% of GDP due in part to the 77 million baby-boomer bubble (13,175 new recipients per day). The trustees also estimate that Medicare’s long-term unfunded obligations will be $36 trillion (260% of GDP).

110% of GDP, much less 260% of GDP for Medicare is not possible.
Medicare’s current costs (and borrowing) can not be sustained.
The federal debt can not grow much larger.
The federal government is already taking about one fifth of GDP in federal taxes.
Even if the tax system is fixed to remove regressive taxation, it still would not be enough to support unfunded liabilities.

Then there’s Social Security.
$12.8 Trillion was already borrowed and spent from Social Security, leaving it pay-as-you-go, with a 77 million baby boomer bubble approaching.

sisuntas wrote March 28, 2008 07:01 PM Comment #249443: Taking up exteme positions will only guarantee extended debates instead of decisive action.

True.

But is it extreme to question whether government should take on another vast health care system, in view of the current massive federal debt, 77 million baby boomer bubble, unfunded liabilities, and $53 Trillion nation-wide debt (3.81 times the $13.86 Trillion GDP), and current government bloat and dysfunction?

Despite the Federal Reserves ability to create money out of thin air, that can not last forever.
Eventually, that pyramid scheme will collapse when the nation can not carry any more debt.
The $53 Trillion nation-wide debt is already 3.81 times the $13.86 Trillion GDP.
The $9.4 Trillion National Debt is 3.5 times the federal government’s 2.7 Trillion in tax revenues.
And that does not even include the $12.8 Trillion borrowed and spent from Social Security, leaving it pay-as-you-go, with a 77 million baby boomer bubble approaching.

Seriously. Where is the money going to come from?
What ever system is decided on, it should save money for most (if not all) people, except for the CEOs and shareholders making millions and billions by capitalizing on others’, and capitalizing on these abuses.

After all, no one can say where the money come will come from to pay the interest alone on the $53 Trillion of nation-wide debt, much less the money to reduce the principal $53 Trillion of nation-wide debt, when that money does not yet exist, and 80% of the U.S. population owns only 17% of all wealth?

Posted by: d.a.n at March 29, 2008 11:08 AM

Kruser Seems the state insurance idea is not favored by the insurance industry. Under Bushes just revealed plan to regulate fiscal concerns the insurance industry has managed to get in on the act with a national regulator instead of state regulation.
According to yahoo news-
“The plan would create a national regulator for the insurance industry, which is now largely governed by the states, and would create a Mortgage Origination Commission to try to address the abuses exposed in the current tidal wave of mortgage defaults.”

Posted by: j2t2 at March 29, 2008 11:50 AM

Steve,

I would be interested in your links. Look just above this posting box and you will see “HTML formatting tips”. The second from the bottom is the one you use.
What you do is copy your link address by highlighting it and using the copy command (left click in the address bar and then use the ‘ctrl + c’ command), then follow the form you see in the tips. Paste the address you copied with the ‘ctrl + v’ command. You can see how we do it directly by clicking on the “view” button at the top of your browser window and then clicking on “source”. That will show you the actual text characters we typed in to produce an article and its links.

d.a.n.,
It is irrelevant whether we will “take on” another health care system. We, whether through taxes or through expenses tranferred from public payers and charity work to insured payers, are already paying for it. All we are really talking about is whether we will or will not organize the provision of those services efficiently.

What I see in the French system I like is that the medical system is not burdened with the support of people like clerks, insurance administrators, and lawyers who provide no medical care. Compare the two medical systems to flying creatures and the French system is a seagull, while the American system is a griffin that is being required to fly while pulling a plow.

In the previous discussion I referred to economics happening in “real time”. Here is a good example. American medicine is a burden on the economy not because it can’t fill our medical needs, but because we have appended so many unneeded people to the process of delivering medical care. They not only don’t improve care, their pointless participation in medical practice prevents them from doing genuinely useful, productive work. They are a drain on the whole American economy because they consume, but do not create.

The other “real time” issue going on from here will be that politicians have made a promise that people would have services provided for them that are simply impossible to provide in real time. Had the 12+ trillion dollars from Social Security been placed in investments in improving the capital foundations of our economy we might have been able to produce far more goods with far fewer people as boomers retired. Instead, we used that money primarily to provide consumer goods and services that didn’t increase our productivity. That means we can’t have people leave the workforce while continuing to consume goods and services. The money, which as I have said many times is an imaginary metric (just look at the value of it over the last decade) no longer exists. If the economy wants to eat, and have medical care, it will have to work.

Period.

charles ross,
In the intro above I meant to mention your contributions to the prior discussion as well. Hope you didn’t feel slighted.

Posted by: Lee Jamison at March 29, 2008 12:42 PM

“Few would argue that this concept of insurability is unfair as it describes the very nature and essence of the business. It is not insurance if the insurer is not at risk for loss, and in consideration of the exposure to loss, the insurer is required to access the degree of loss to which it is exposed and charge premium accordingly.”

Jim M , Yes you are correct on this matter. However this is akin to ” I was just doing my job”. Its just that insurance is not what is needed to solve the problem, because it is the problem. The purpose of health insurance companies is to make money on the backs of the sick and at the expense of doctors and hospitals. It seems the insurance companies drain money from the health care system. They actually work against those in need. How does this help contain costs?
I dont know of a way the private for-profit sector can solve the problem. What is needed is a pool of money that people contribute to and then draw from when needed to cover health related costs. On the other end cost effective processes and treatment are needed. The current approach no longer serves us well IMHO. What are your ideas on this?

Posted by: j2t2 at March 29, 2008 01:18 PM

j2t2,
The for-profit part of insurance is just a means of incentivizing the availability of capital with which to distribute risk. Unlike the ‘pool of money’ notion you have, in which the government would presumably sit on a pool of money so that it could be doled out as the need arose (look at the governments relative success at resisting the temptation to spend that pool…) the profit motive demands that the insurance industry keep that money doing useful things even as it is pooled for the proverbial rainy day. Government maintains a “lockbox” full of IOUs to the Social Security Trust Fund pricipally so they don’t have to admit the principal is gone.

Otherwise the ‘pool of money’ idea sounds wonderful.

Posted by: Lee Jamison at March 29, 2008 01:37 PM

charles ross,
Get over how you feel about the French for a moment and just look at the system. Systems are non-personal, don’t smell odd, and don’t get mad at you if you complain about Paris or expect them to speak English.

Oh, my word. I just thought of several ways the French act like Texans.

Posted by: Lee Jamison at March 29, 2008 03:05 PM

Lee I would not want to argue in favor of the government on this issue. But there is coming a day when we will be forced to address the SS and Medicare issue. Those funds should go to a lock box and out of the reach of politicians. In fact that should be an election year issue instead of this foolishness we are seeing now. But to continue to rely upon the same methods that got us to where we are doesnt seem all that smart to me.

Posted by: j2t2 at March 29, 2008 03:10 PM

j2t2,
That is another “real time” issue. The economy will not expand by 500% overnight (and, actually, those are time-distributed obligations) but will be made of as many people as there are. A certain percentage of them will work and all of them consume at least something. What we will work out is how the WORK will be distributed.

For the time being the money, debt, etc. is a distraction from the really important things like the capacity of the medical industry to serve a given population to some level we think we can sustain. That is a function of how we distribute PEOPLE in the economy and how useful we make their labor.

Posted by: Lee Jamison at March 29, 2008 03:35 PM

” I dont know of a way the private for-profit sector can solve the problem. What is needed is a pool of money that people contribute to and then draw from when needed to cover health related costs. On the other end cost effective processes and treatment are needed. The current approach no longer serves us well IMHO. What are your ideas on this?”
Posted by: j2t2 at March 29, 2008 01:18 PM

j2t2, I disagree with your assessment of insurance companies in your paragraph just above the one I quoted. Replace insurance company with any other type of company and they are also making money on the “backs” of someone, right?

The problem with your pool of money outlined above is twofold. Who pays into this pool, and how much does each person pay? Without assessing risk, as is done by an insurance company, how can anyone calculate how large the pool of money must be to afford everyone the ability to withdraw benefits from the pool to pay costs?

Are we back to the “soak the rich” attitude so prevalent in liberal thinking? If so, any plan based upon the “rich” paying for the program will fail. And, how does government decide which doctor visits and hospital procedures are necessary and which are not? There is massive fraud already in Medicare and even worse fraud in Medicaid that isn’t being corrected contributing to massive red ink in those programs.

I am on Medicare and my physician regularly wants me to have expensive tests performed which I believe are unnecessary and I don’t have them done. The same is true with my urologist. Even thought my prostate is small and smooth as evidenced by an inexpensive DRE, he wants to be safe and has already done two prostate biopsies costing Medicare thousands of dollars in what I believe is CYA medicine. I refuse to have any more biopsies done unless there is a change in the size and contour of my prostate and will save Medicare many more thousands of dollars.

The problem j2t2, is that there are many folks, given the opportunity, who would elect to have every procedure their physician recommends done if it didn’t directly come from their own pocket. With private insurance the insurance company acts to restrain unnecessary spending. While there may be abuses, restraint is still necessary for any system of health care to remain solvent. And as witnessed by the failures in Medicare and Medicaid to exercise oversight and restraint, I can’t see how any new health care program would be any different.

I read the article in the website someone recommended on the “French System” and find that it too is deeply in red ink already with much more to follow unless premiums are increased.

Frankly, I don’t believe it is possible to provide all the health care people want at government expense. Social Security doesn’t provide all the retirement income everyone would like to have and consequently those who can, save money from their own incomes to provide income in excess of SS in their retirement years. Government encourages this type of planning by offering tax incentives such as IRA’s, Pension Plans, etc. Who would argue that those who have saved for their retirement should share that savings with those who didn’t?

Those who can’t afford to save for their own retirement are left with SS. Now, even that minimal safeguard is being threatened because of mismanagement by politicians. Who will bail out SS? Who will bail out Medicare and Medicaid? Who will bail out national health care if such a system is ever installed?

Government has attempted to help people with health savings accounts. Without going into detail I believe HSA’s are a great idea and are being used by millions of people. It encourages people to become directly involved in their care and the cost of that care. It involves people in some responsibility for their care and rewards those who shop carefully and use their common sense.

Perhaps some very smart people can figure out a way to provide HSA’s to every American combined with some form of minimal preventive medicine but there must be a cost to everyone, including the poor. Humans value that which costs them something, and as a rule, do not value that which is free.

Posted by: Jim M at March 29, 2008 04:13 PM

Reading over the comments has been dishearteninng in one sense: The word ‘universal’ seems to evoke such emotional reactions when it appears in the context of health insurance. Considering that the problem is universal, that seems distinctly odd. After all the problem is universal, just like crime is universal. You may not have been personally robbed, but the existence of crime necessitates financing a police force, building jails and prisons, and etc.

Everyone is affected when a society has so many without access to basic health care because affordable health insurance is not available.
We all pay the hospital bills of those without insurance who can’t pay their bills. The business owner is affected if his employees aren’t healthy enough to show up for work because of ill health. Like it or not, we’re all in it together, and thinking that an individual can escape the universal effects of our current situation is an illusion.

The underlying argument for universal coverage is not to be found in a business model that is suitable for credit cards or selling merchandise. It relies on the notion of pooling risks and resources. The more people are participants, the more the risks are diffused and the more resources are made available via premiums.

The argument about overhead costs is also seriously misrepresented. Actually, overhead for governemtn programs is lover than in the private ssector. The relative savings by contracted services comes from the temporaty nature of the cnatract (no pensions, etc), not the cost of prividing a service perse. That applies to Blackwater but not to health insurance, where the contract is not duration specific.

What is missing in programs like Medicare is an effective means of detecting waste and fraud. In the age of such sopisticated software programs tracking every move you make on the Internet, it just seems stupid (for lack of a better word) that there is no implanted mechanism for doing so.
That’s a political problem, and it requires citizen vigilance to demand accountability - in both government and participating businesses.

Posted by: sisuntas at March 29, 2008 04:30 PM

CORRECTION:

The 2008 Medicare Trustees Report states that expenditures in 2007 were $432 billion ( 32% 3.2% of the $13.86 Trillion GDP), and in the next 75 years, the expenditures are scheduled to rise rapidly to 110% 11.0% of GDP due in part to the 77 million baby-boomer bubble (13,175 new recipients per day). The trustees also estimate that Medicare’s long-term unfunded obligations will be $36 trillion (260% of GDP). 110% 11% of GDP for Medicare alone, much less 260% of GDP for Medicare over 75 years is not possible.

Lee Jamison wrote at March 29, 2008 12:42 PM Comment #249487: d.a.n., It is irrelevant whether we will “take on” another health care system. We, whether through taxes or through expenses tranferred from public payers and charity work to insured payers, are already paying for it. All we are really talking about is whether we will or will not organize the provision of those services efficiently.

If it saves most Americans money, that’s great. If it doesn’t, it may be the last straw, with $22 Trillion of total Federal debt and $53 Trillion total nation-wide debt.

Lee Jamison wrote: What I see in the French system I like is that the medical system is not burdened with the support of people like clerks, insurance administrators, and lawyers who provide no medical care. Compare the two medical systems to flying creatures and the French system is a seagull, while the American system is a griffin that is being required to fly while pulling a plow.

Maybe.

BTW, many of the French also have supplemental insurance too.
What works in France may not work so well in the U.S.

I still think we should address the obvious abuses either (a) first OR (b) simultanteously (e.g. regressive taxation, illegal immigration, killing 195,000 people per year due to potentially preventable medical mistakes; 101,000 of those being from adverse drug reactions). Otherwise, I think a new government-run health care system will be a complete flop. Especially with so much nation-wide ($53 Trillion)and federal government debt.

Posted by: d.a.n at March 29, 2008 08:55 PM

The whole issue of preventable medical mistakes is an extremely important one, but it’s just not that obvious why who is paying for medical care—whether the government, individuals, or insurance companies—is key to resolving this.

That is a front-line medical issue. People also debate education as a national issue, but I don’t think that anybody believes that vouchers, increased public funding, or any other measures will suddenly make the profession of teaching infallible and that we’ll suddenly have zero illiteracy and across-the-board perfection no matter what we do. Human error and the inability to be perfect always will be there no matter what. In medicine like anything else.

Posted by: Loyal Opposition at March 29, 2008 11:29 PM

Something that hasn’t been discussed much is the high cost of educating a doctor as a factor in health care cost. Tuition rates increase much faster than inflation. I have a son and daughter in law who just finished pharmacy school. Ask them or new doctors to cap rates for service and you will have a student loan crisis on your hands.
We have those who want universal care and criticize doctor pay, yet colleges are untouchable for the abusive charges to our students.
The same goes for lawyer lobbies and liability rates.
These abuses will continue with a new or revised plan. Just pass it on to the taxpayer.

Limit tuition and lawsuits and then discuss limiting charges with doctors.

To be honest I see a shortage of doctors (even with the high pay) on the horizon.
My son is one who easily has the capability to become a doctor yet he doesn’t want to accumulate huge expenses until he is thirty and pay off loans into his forties. The requirements for education to get his degree and the charges are simply too high and are increasing.
What do we pay per doctor for education as compared to the French? This information should be included in any comparisons but in all the articles I have read it isn’t. They just say it is free. What do they pay the professors, administrators and colleges to educate per student compared to us?

Posted by: Kruser at March 30, 2008 12:53 AM

When you talk about fraud in the medicare/medicaid system does the costs include the fraud perpetrated on the American public by all parties involved in the “no negoiating on the cost of drugs” bill from the 108th Congress? Maybe one of the answers to medicare fraud is an incentive to the patient for keeping costs low. It just seems that if the French can do it why cant we. Not just the French the whole of the industrialized world except us can do it. With 300 million people you would think certain effeicienies would be available that would allow us to lower our high cost of health care while providing coverage to most people.

“Replace insurance company with any other type of company and they are also making money on the “backs” of someone, right?”

Not if it is a not for profit entity.

“Government has attempted to help people with health savings accounts. Without going into detail I believe HSA’s are a great idea and are being used by millions of people. It encourages people to become directly involved in their care and the cost of that care. It involves people in some responsibility for their care and rewards those who shop carefully and use their common sense.”

HSA’s would be ok as part of the answer such as deductables, copays and in lieu of or to pay for supplemental insurance. But for most people without anvanced degrees in this country its tougher to save anything significent on $10 /hr wages in this day and age.

“Are we back to the “soak the rich” attitude so prevalent in liberal thinking? If so, any plan based upon the “rich” paying for the program will fail.”

Oh heaven forbid the rich should have to pay their fair share Jim M.. Thats what the middle class is for,afterall someone has to pay taxes.
After the way they have stacked the deck in the past 30 years why should they have to pay anything for anybody but themselves. Isnt that exactly what our forefathers wanted an aristocracy above the law in this country. I know that not the kind of respect you would expect but after watching the $30 bil note from the taxpayers to bailout bear stearns while the Ceo walked away with $60 mil Im not real respectful of what the rich want right now.

” And, how does government decide which doctor visits and hospital procedures are necessary and which are not?”

The doctors decide not the insurance companies nor the government. The patient and the doctor decide.

“With private insurance the insurance company acts to restrain unnecessary spending. While there may be abuses, restraint is still necessary for any system of health care to remain solvent.”

How do you know its in the best interest of the patient Jim M.? Why would you think the insurance company is looking out for anyone but themselves? If the insurance company suspects the doctor ordering the “extra care” is not exercising good sound medical judgement then take the doctor off the list of those your insured can use. One persons restraint is another’s careless. Now if as a patient you choose to exercise restraint then dont blame your doctor down the road, but more power to you.

“And as witnessed by the failures in Medicare and Medicaid to exercise oversight and restraint, I can’t see how any new health care program would be any different.There is massive fraud already in Medicare and even worse fraud in Medicaid that isn’t being corrected contributing to massive red ink in those programs.”

Without a doubt, when we have such a hell bent desire to maximize profit at any cost their will be fraud. Enough swindling of the system for your own personal gain and you can become rich so you are protected from having to pay your fair share. Its the prevelant attitude of the day, cut taxes lax or no enforcement, no serious time if your caught, whats to lose. Maybe if a few of those caught lose their corporate charter things might change. Of course the Ceo’s should be exempted afterall they are just trying to get rich so they dont have to pay their fair share. :)

The problem is attitude and ideology. We are to divided as a country to take on anything of any importance. Maybe the time has come to call in Chinese and Indian help to solve the problem. Surely Doctors from those countries will work cheaper here in return for citizenship. Then we can deregulate the industry by getting rid of the AMA and bring in prescription drugs from Mexico. With deregualtion anybody would be able to make the drugs cheaper than the drug companies especially without any FDA interference. Hell we could get rid of insurance regulations and licenses for agents and other professionals and let others try their hand at it. We could off shore hospitals and/or bring in nurses from 3rd world countries, degrees wont be required after deregulation. While smuggling people and illegal drugs into the country the Columbians could transport sick Americans to off shored hospitals on the return trips. Maybe then we could bring costs down. Quality might be an issue but hey what are ya gonna do, its worked for all the other industries in this Country. Afterall Jim M wasnt this deregulation thing the idea of those rich guys you seem to want to protect so much and who gained so much from it at the expense of all of us? :)

Posted by: j2t2 at March 30, 2008 01:12 AM

Loyal Opp said: “The whole issue of preventable medical mistakes is an extremely important one, but it’s just not that obvious why who is paying for medical care—whether the government, individuals, or insurance companies—is key to resolving this.”

To some extent it is obvious. When a for profit corporate medical care delivery institution’s investors and managment’s profits are dependent upon processing the maximum number of patient’s per hour through their facilities, efficiency will inevitably compete with quality, and people will die from malpractice caused by speed of action and decision making which facilitate profitability.

That is why I believe that the government sponsored Medicare system should contract first and foremost with NON-Profit health care delivery institutions which have no shareholder profit concerns bearing down on the Board of Directors, and whose Board of Directors and management is not bearing down on medical practitioners to make speed compete with quality. Non-profits can reverse the managerial accounting priorities, quality first, efficiency goals secondary to quality treatment and decision making.

I worked for Ford where cranks were molded, cleaned, heat treated, inspected, and shipped. There was a 6% rejection quota we inspectors were expected to not exceed. Meaning we would not hear from the Foreman for 3% or less rejects being sent back to the melting pot for remanufacture. That 3% figure was derived at by the managerial accounting
department which determined that this rate of rejection would maximize quality and customer satisfaction, (not guarantee it) while minimizing the overhead costs of recycling rejects. Which is fine for automobile cranks.

Not for human beings. A 3% malpractice rate, failure to deliver responsible medical care and treatment to 3 out of 100 people, would be intolerable. Our malpractice rate is substantially less than 3%, but, when it comes to human life and suffering, there is no acceptable rate of malpractice at the hands of medical care deliverers. Not if you are the patient suffering the malpractice or family member of the deceased due to malpractice.

Posted by: David R. Remer at March 30, 2008 06:27 AM

Kruser said: “Limit tuition and lawsuits and then discuss limiting charges with doctors.”

If you do that, you will vastly increase doctors engaging in medical malpractice and malfeasance. Law suits encourage quality medical care.

I agree with you entirely that our nation has a nursing shortage of major proportions and is facing a severe doctor shortage with boomer retirements, but the answer is not to simply lower the bar and increase graduates who have nothing to fear by hurrying and making mistakes to maximize annual earnings.

We do need to lower the costs of medical education but at the same time such lowering of costs must be commensurate with lowering of Doctor compensation to keep the cost of medical care from rising.

I think we desperately need vastly superior peer review and medical review courts, who can and WILL bar repeat malpracticers from practicing medicine. That alone would dramatically reduce litigation for malpractice, and hence, insurance rates or costs to the taxpayer for Medicare underwriting.

Another practice I think needs to be implemented is a patient review system, in which patients may provide feedback on doctors and nurses and such a database could be reviewed statistically for anomalies to spark investigatory reviews of health care deliverers. This too would increase customer satisfaction and promote an enhanced trust relationship between patients and health care deliverers overall, which in turn would drive down frivolous malpractice litigation.

Lastly, I think we should invest in lowering the cost of attorney educations and like the medical system, install review and oversight systems that could detect and remove abusers of the system, clients, and insurance underwriters. The peer review system now in place is an utter joke.

Finally, I believe Congress could/should pass a stronger set of ethical and legal standards for the legal profession, in addition to facilitating a vast increase in lower courts, in order to regain the right to a speedy trial, a right abrogated and denied to citizens for decades now.

Posted by: David R. Remer at March 30, 2008 06:44 AM

“The problem is attitude and ideology.”

Posted by: j2t2 at March 30, 2008 01:12 AM

The truest statement I’ve seen so far.

One attitude is that the government owns all resourses including your labor. The other attitude is that of private property.

Who owns the fruits of our labor? A person buries his nose in books from the time he starts school untill he’s almost 30 years old, amassing hundreds of thousands of dollars of debt. I believe they, as anyone else, deserve to charge what the market will bear for their service or product.

Posted by: BOHICA at March 30, 2008 09:03 AM

I agree with you Dave on ways to limit lawsuits and malpractice you showed.
Peer review and courts sounds like a private system and would be an improvement.
The requirements and charges, however, have little governing force and are contributing to runaway costs.
My son will have excess of 100k and six plus years to simply dispense medicine (can’t perscribe) with a computerized system. It seems there are a large amount of usless required classes that charge too much. They need better regulation also.
Malpractice (neglect) in America is not an educational issue but a moral one. Education cannot make people care. I have experience in taking care of the elderly and this is definatly a big problem.
Does anyone know the Licensing requirments for the French and the cost of their degrees to the government?

Posted by: Kruser at March 30, 2008 10:01 AM

Governing officials in a non profit system will also need high wages to keep them there, otherwise we will have incompetent low wage people managing things. That would be a form of neglect toward the recipients.
This is an advantage of a private for profit system. You won’t remove high managerial costs by socializing it.

Posted by: Kruser at March 30, 2008 10:24 AM

“One attitude is that the government owns all resourses including your labor. The other attitude is that of private property.”

Actually thats not attitude Bohica, that just another misrepresentation of the facts based upon your own personel ideology.

Posted by: j2t2 at March 30, 2008 12:35 PM

Kruser seems education costs for french students are high to.

http://chronicle.com/news/article/3780/french-students-increasingly-become-prostitutes-to-pay-tuition-2-books-suggest

Posted by: j2t2 at March 30, 2008 12:42 PM

French health care from the British point of view. Also some continueing education for French doctors information.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1079565

Posted by: j2t2 at March 30, 2008 12:53 PM

j2t2, I have decided not to respond to your rebuttal as you apparently read, but didn’t comprehend what I wrote.

The link to the French health care system article someone provided said that nearly 85% of the French population purchase private supplemental insurance to pay deductibles and co-pays. This is similar to the number of Americans on Medicare who purchase private Medicare supplement insurance. My question, if the French health care program is cost efficient compared to private health insurance why did they not go all the way and provide 100% of coverage and eliminate the need for private supplemental insurance? Was this need left uncovered to throw a bone to the private insurance companies? The article said that the private insurance companies providing these supplement policies were making a nice profit and the competition was fierce for the business. Couldn’t the profit on these private supplemental policies have been used to provide 100% coverage with no copays or deductibles? If 80% socialized health care is better, why would 100% not be great? What am I missing here?

The U.S. government in its unfailing wisdom has determined a national level of poverty. Those living below the arbitrarily established poverty threshold are entitled to certain government benefits to bring them up to this floor.

Question; why hasn’t government established a similar floor for health care? What is the minimum accepted level of health care in the U.S. We have been told what it is for poverty, why not for health care?

Next, was the official poverty level established as a percentage of the income of the wealthiest people in America. Or, was it established by measuring the cost of the most basic needs of food, clothing and shelter? If the answer is the latter, couldn’t the government in its great compassionate wisdom establish a poverty level for health care based upon the most basic needs?

Why, in establishing a base level for poverty are we willing to recognize and accept a disparity in living standards and in health care we are not willing to accept any disparity at all. Many demand that everyone receive health care equal to what government employees have by virtue of their employment, but these same people don’t demand the same equality in living standard.

The reality is that people capable of, and willing to work, are earning the money to enable them to have choices. Those incapable of or unwilling to work will have their choices diminished. And we, those paying the bills, get to choose the level of poverty benefits we are willing to pay for.

Posted by: Jim M at March 30, 2008 01:55 PM

(1) We need more doctors and health care providers, but there are some that want to limit the number of new students, pharmacists, etc.
We need to create more schools and create incentives to increase the numbers seeking a career in the medical profession.
Currently, the U.S. medical schools graduate only about 16,000 doctors each year.
That number has been almost constant for over two decades.
There are 20,000 first year residencies available each year.
Where do the additional 4,000 doctors come from?
They are coming from overseas (e.g. Pakistan, India, the Middle East, etc.).
Also, the number of students in American medical schools preparing to become primary care physicians is going down (not up).
The basic laws of supply and demand help explain another of many reasons for exploding health care costs.

(2) Another huge cost that many Americans choose to ignore is illegal immigration.
Hundreds of hospitals are closing their doors. Between years 1993 and 2003, 60 hospitals in California closed, and 24 others were near closure.

In year 2005, in only one city in Texas (Laredo), there are 2,000 anchor babies born annually to illegal aliens in the Laredo Medical Center maternity ward, only one of hundreds of U.S. maternity wards, paving the way for blue PassPorts for the parents. Despite the estimated $70 Billion to $338 Billion in annual net losses due to illegal immigration, hundreds of hospitals closing in border states, and the untold cost of crime, job displacement, 20,000 public-school teacher lay-offs in California (www.fairus.org/site/PageServer?pagename=research_research2fdc), many Americans still choose to ignore it. And part of the looking-the-other-way seems to be due to partisan loyalties; i.e. over-looking it, since their candidate and party don’t have a good voting record or any real plan to deal with it. As a result, many of our services will simply continue to decline in quality or disappear completely (such as the 60-to-84 hospitals and 20,000 teachers jobs in California). Also, border states are not alone. Pennsylvania and New Jersey hospitals gave almost $2 billion in free emergency and short-term care to uninsured patients, of which a large percentage are illegal aliens. Chicago’s Alivio Medical Center provides $1 million a year in uncompensated care and estimates that more than half of its 20,000 annual patients are illegal aliens (more … www.wvwnews.net/story.php?id=3978). And securing the borders alone will not resolve the problem. And another amnesty could quadruple the problem, as did the amnesty of 1986. Compassion is great, but now when it leaves you, your family without, and fellow American citizens without.

(3) Any plan is also likely to fail if the U.S. continues to do nothing about the abuses that are hurting many of its social service systems (e.g. education, health care, lawlessness, regressive taxation, wars, inflation, nassive nation-wide debt, election problems, and government bloat, corruption, and waste).

Also, many of those abuses that ail the health care system are quite likely the same things ailing the public education system, tax system, law enforcement, economy, mortgage meltdown, massive nation-wide debt, government bloat, corruption, and waste. Some will simply try to rationalize it away, and claim mediocrity is normal, but it isn’t normal, and it isn’t getting better. The $53 Trillion of nation-wide debt alone has the real potential for causing an economic downturn that could last for years. If the major abuses were addressed first, we may find out a lot of solutions will naturally follow. If not, few (if any) new government-run systems are likely to succeed.

(4) Lastly, repeatedly rewarding Congress with 93%-to-99% re-election rates is not likely to lead to anything different, except more abuses and painful consequences (one-simple-idea.com/Factors1.htm).

At any rate, the voters will have the government that the voters elect.

Posted by: d.a.n at March 30, 2008 02:11 PM

Kruser said: “Governing officials in a non profit system will also need high wages to keep them there, otherwise we will have incompetent low wage people managing things”

True. But, their high wages would be competitively priced, and not supported by the profit margin on number of patients processed per minute. Non-profit providers can and will insure quality care supersedes efficiency. Efficiency in processing (maximizing patients per minute) is for-profit’s primary incentive, likely resulting in significantly higher malpractice events.

Posted by: David R. Remer at March 30, 2008 05:21 PM

True. But, their high wages would be competitively priced, and not supported by the profit margin on number of patients processed per minute. Non-profit providers can and will insure quality care supersedes efficiency.

It could work.

However, it isn’t likely if they do not eliminate the middlemen (insurance companies), and if too many voters continue to reward irresponsible incumbent politicians with 93%-to-99% re-election rates.

A government health care system must SAVE money.
It can’t be another huge, bloated, mismanaged mess like Medicare and Social Security.
It can’t be another huge Ponzi scheme like Social Security, where $12.8 Trillion has been borrowed and spent from it, leaving it pay-as-you-go, with a 77 million baby boomer bubble approaching.
It can’t be another huge debt generator like Medicare, with tens of trillions of unfunded liabilites.

Otherwise, it will most certainly fail.
The odds of it faling are VERY high.
We have not yet got our ducks in a row.
The economy is already in a very precarious state, and the politicians appear to be pandering to grow the debt ever larger by bailing out banks and mortgages holders.
The politicians are promising this and that, but none of them can tell us where the money to pay the interest alone on the the $53 Trillion of nation-wide debt will come from, much less the money to reduce the principal so that it stops growing larger.
It’s lunacy.
Instead of focusing on fixing a number of serious problems, we appear to be adding to the list.

The candidates for president and Congress don’t seem to get it. The spending and borrowing has to stop soon, or the problem will solve itself the hard and painful way. The debt has been growing worse and worse every year for decades, and is now at a record $53 Trillion, which is not only the largest debt ever in size, but also the largest debt as a percentage of $13.86 Trillion GDP.

I don’t think a government-run health care system has much of a chance at the moment, until the many abuses that are already destroying the health care system are addressed.

(1) Education: train more doctors and healthcare providers.
(2) Stop tens of millions of illegal aliens from overruning the healt care system and numerous other systems.
(3) Stop the other abuses destroying the health care system, and burdening many other systems.

In case no one has noticed, the list of economic factors have been growing worse for many years.

While it isn’t impossible, and while the current system is pretty bad (i.e. 195,000 deaths due per year to potentially preventable medical mistakes), who really thinks the government is going to create a government-run health care system that is better?

At any rate, the voters will have the government that the voters elect.

Posted by: d.a.n at March 30, 2008 07:47 PM

“Oh heaven forbid the rich should have to pay their fair share Jim M..”

The premise that you can “soak the rich” has proven to be false. The richest 1% simply move their money into investments which are low tax or tax exempt. Thus, most policies which intend to make the rich pay “their fair share” simply don’t do so. Instead, the results are often counter to the stated intent because these policies increase the tax burden paid by the middle class. So isn’t it logical to assume based on past results that an attempt to defray the costs of the poor (health care or otherwise) onto the rich is very likely to fail just as Jim M stated?

That’s why IMO, class warfare, “soak the rich” arguments only take away from a legitimate debate on what policies enable the pursuit of economic prosperity for the other ~99% of Americans.

Posted by: Mr. Haney at March 30, 2008 10:43 PM

d.a.n., If you simply expand medicare to the population as a whole you would not be creating a government run health care system. Medicare, right now, pays most of the medical bills in this country because it accepts the elderly and the disabled into its system. Why does it have to do this? Because no one else wants them!! Everyone is so concerned about government running our health care system (a system that many conservatives proclaim is the best in the world), and yet do not seem to acknowledge that medicare is already, now, deeply involved in a single payer system for all the sick, injured and disabled. All that’s being suggested is that healthy people be brought into that same system.
Medicare is going bankrupt because most of its members are in need of healthcare. (a guess, but a reasonable one.) A single payer system is far more efficient than what we have now. Filing and refiling claims, trying to figure out what Blue Cross, Pacific Care, Aetna, Kaiser, Life Care and all the thousand others require in claim verification in order to process it and generate a check to the health provider is costly, time consuming and wasteful. It is not unusual for an office to dedicate 25 to 30 percent of their resources to A/R the Get The Money department.
Where would tax money come from? I don’t know. Probably we should end the present employer based health care system, and raise taxes across the board. (a move espoused by the big 3 automakers for obvious reasons) You don’t need to go back the the 70 percent corporate taxes of the 60’s; maybe 39%, where it was in the 90’s (remember those years when we actually came close to a balanced budget). establish a higher tax rate on dividends and cap gains ( presently a tax benefit just about useless to the middle class in this country), establish a fair tax on estates that is indexed, take good care of the illegals who come to the emergency room AND THEN SEND THEM HOME!!, and establish a modest fee-for-each-service that will support the system and yet not keep people away from seeking medical help.
Finally, we need to be heavily taxing those things in our society that are bad for our health. Do I need to list them? ok. i will: ciggies, gas guzzling autos (don’t laugh, people who live along our freeway system here in Portland have extremely high levels of benzene in their blood) Cars that are less efficient are, I would think, more polluting. Food that is determined to be unhealthy. Why in the world would the government subsidize the production of corn syrup and give nothing to, say, the carrot growers? At least John Mccain is the honest one here with what he said to the Iowa caucus goers. Anyhow, my thoughts

Posted by: charles ross at March 30, 2008 11:13 PM

Mr. Haney, I would like to point out that the rich pay most of the taxes in this country, not the middle class. They pay most of the taxes because THEY HAVE MOST OF THE MONEY!!!!!!
I’m not sure what “soaking the rich” means. After the’re soaked would they still be rich? Then I say soak ‘em!

Posted by: Charles ross at March 30, 2008 11:18 PM

Charles,

Yes, exactly. The top 1% pay over 35% of the taxes. And so on… The point I am making is that a 5% increase in the top marginal tax rates creates no net increase on the average tax rate paid for the top 1%(see Note). Since most middle class Americans can’t access the tax shelters, they can’t avoid paying when the top marginal rates are increased.

I don’t know what soaking the rich means either. Though, I have to agree that soakin ‘em does sound like a good time.

Finally, I just saw the Congressional Budget Office report on the Geographic Variation in Health Care Spending, and I thought it might be of interest to those participating in this discussion.

Note: The tax rates in the IRS tables linked above are calculated using adjusted gross income. The graph in the article I linked before uses unadjusted gross or “comprehensive household” income for its calculation. The difference in calculation methods should account for the difference in the “average tax rate” trends.

Posted by: Mr. Haney at March 31, 2008 01:25 AM

David,
“Efficiency in processing (maximizing patients per minute) is for-profit’s primary incentive, likely resulting in significantly higher malpractice events.”

That is not exactly true. For-profits’ incentive is maximizing profit. That means maximizing the amount of money paid by each customer and minimizing the loss per customer. The issue in malpractice events is that this often includes a scenario such as you describe in which there is a minimization of the number of practitioner-minutes per patient. When the HMO craze first hit in the ’80s I experienced this with the family practice clinic we went to as their patient burden suddenly grew exponentially. Doctors were so harried that they simply could not deal with the patient loads and they made mistakes. Such a strategy breaks down as a business model, though, because, as with our clinic, doctors refuse to continue the program. The HMO they had contracted with failed.

The strategy of the day is to cherry-pick only patients who will not use services and kick the rest down to the government. This is the industry blatantly throwing in the towel and making hay while the sun shines. This market place is going away and they know it. In ten years we will have some sort of centralized payment structure that provides the funds to deal with private medical contractors of some sort, and there will be a huge restructuring of the industry along the way.

As some mentioned before this discussion became principally about medicine I think the model that will eventually prevail in the reorganization will be like that of public infrastructure. By that model highways, for example, are designed and organized by government entities which contract with private firms to carry out their (our) desires. It is not the most efficient conceivable system, but it is the most practical one.

As for “soak-the-rich” tax systems, they are all variations on cutting the golden goose open. The rich are rich because they are productive and create jobs, goods, and opportunities. They are productive because they maximize the productivity of capital. Taxation reduces the amount of capital they have to maximize and, therefore, their ability to be productive and create jobs, goods, and opportunities. You may be able to maximize the tax output of the goose by keeping a laparoscope in it, scraping off bits of golden eggs, but you might also miscalculate and damage your source of gold.

What else happens when you “soak-the-rich”? Exxon-Mobil makes 12 billion dollars in a reporting period and people scream! Well, surprise, surprise! That is a pre-tax report. Those 12 billion are currently taxed at 42% in aggregate taxes which reduces MY RETIREMENT because the mutual funds in which I am invested own stock in Exxon-Mobil. Politicians want to REDUCE MY RETIREMENT EVEN MORE by slapping ME with “windfall profits taxes”.

That strikes me as typical scumball sleight-of-hand. As someone who has never grossed $80,000 in a year, and only got close to that once, I can say with confidence “soaking the rich” is a bad deal.

Posted by: Lee Jamison at March 31, 2008 09:41 AM

I want to address tort theory for a moment because it is an important part of this discussion. In an entrepreneurial society torts are a means of keeping common sense in the process of dealing legally with a rapidly changing environment.

It is not hard, for example, to establish a fine stucture for traffic violations that helps us to provide order to automotive traffic. That’s because the parameters of street traffic have remained essentially the same for years.

Things are different in, say, the online computer environment. There the ways in which harm may be done can change almost by the day and one can’t anticipate how to create administrative controls for specific potential threats. Torts provide for us a means of asking, and answering, the question of whether harm has been done and whether the practitioners at a given state of an industry’s art could have anticipated that harm.

Unfortunately, because it is possible to make a lot of money in tort law, there is a disincentive to make the logical transition from the entrepreneurial phase of regulation to the administrative phase a more mature market demands.

Most of what passes for medical malpractice is utterly predictable. Procedures become well established as do the sorts of errors people can make in them. The logical approach is to establish administrative remedies in fines, reimbursements, and procedural oversights as formerly novel procedures work their way to maturity.

Torts are necessary. Preserved too long, however, they become an impediment to proper integration of technical advances in common practice.

Posted by: Lee Jamison at March 31, 2008 10:39 AM

“No plan will satisfy all people or solve all problems”

Which is why our founders were smart enough to limit govt and leave such things up to the individual.

And respecting the rights of others and expecting your own rights to be respected as well, is now nothing more than “ideology?” If your going to take our “rights” out of the equation, then you might as well do it right and set everybodys pay as the same, make everybody drive the same vehicle, wear the same clothes, pay the same 80% in taxes, live in the same size house, make every business govt owned and let govt run every aspect of our lives.

As with most issues, rights are the main roadblock here, and the fact that you all are so eager to ignore that roadblock just because something else “may be easier” in your eyes, just shows how far our country has fallen.

The only thing special about the USA, is what we once had and what we foolishly gave up.

Posted by: kctim at March 31, 2008 10:48 AM

“Those 12 billion are currently taxed at 42% in aggregate taxes which reduces MY RETIREMENT because the mutual funds in which I am invested own stock in Exxon-Mobil. Politicians want to REDUCE MY RETIREMENT EVEN MORE by slapping ME with “windfall profits taxes”.”

Lee the day Exxon pays 42% in taxes is the day I’ll kiss …. well lets just say that if you want me to believe that please show some proof. My bet is their actual tax rate is lower than mine.

Posted by: j2t2 at March 31, 2008 10:58 AM

j2t2,
From Investor’s Business Daily I find these statements-

“This year, according to Mark Perry, the economist who made this striking observation on the Seeking Alpha Web site, Exxon will pay $30 billion in taxes, at a 42% rate, leaving $40.6 billion in profit.”

and

“And it’s not just Exxon Mobil that’s paying the freight. From 1977 to 2004, according to Tax Foundation data, U.S. oil companies cleared $630 billion after taxes while paying $518 billion in federal and state corporate taxes at an average rate of 45%.”

There has been online criticism of the editorial in question but the numbers are not all coming from a single source.

Posted by: Lee Jamison at March 31, 2008 11:14 AM

charles ross wrote: Mr. Haney, I would like to point out that the rich pay most of the taxes in this country, not the middle class.

The tax system is regressive, as evidenced by Warren Buffet, who paid 17.7% in federal taxes on $46 Million in year 2006, while his secretary paid 30% in federal taxes on $60K. People point to the progressive income tax rates, but often omit a few key factors. Not all income is taxed the same. Capital gains are taxed at 15%, and are not subject to Social Security and Medicare taxes. Also, the Social Security cap of 94,200 (in year 2006; $97,500 in year 2007) is clearly regressive.

charles ross wrote: d.a.n., If you simply expand medicare to the population as a whole you would not be creating a government run health care system.

Where will the money come from?

Medicare is not even really pay-as-you-go, because the federal government is borrowing and creating money out of thin air to fund it.
The nation-wide debt is already $53 Trillion (3.81 times the naiton’s $13.86 Trillion GDP).
Interest on the $9.4 Trillion National Debt is costing $1.3 Billion per day in interest alone and the debt grows larger every day.
Americans need to look closer at the math, and they might seriously reconsider these vast programs to grow government ever larger.
Part of the problem is the myth perpetrated by pandering politicians that we can all live at the expense of someone else.

The nation is already swimming in massive debt, and suffering from multiple abuses, and reforms and abuses need to be addressed FIRST, before creating more vast and costly overnment-run systems that will most likely be mismanaged as badly (or worse) than the current Medicare, Social Security, and other various systems.
That may seem too ambitious, but it is in fact a necessity.

charles ross wrote: Medicare, right now, pays most of the medical bills in this country because it accepts the elderly and the disabled into its system.

Not really. That money is being borrowed and created out of thin air.

Also, many doctors already do not accept Medicare patients, and other limit their number of Medicare patients. Why is that?

Everyone is so concerned about government running our health care system (a system that many conservatives proclaim is the best in the world), and yet do not seem to acknowledge that medicare is already, now, deeply involved in a single payer system for all the sick, injured and disabled. All that’s being suggested is that healthy people be brought into that same system.

And based on the federal government’s track record, why should we believe an expanded health care system will be better (e.g. massive Medicare fraud; $12.8 Trillion borrowed from Social Security, leaving it pay-as-you-go, with a 77 million baby boomer bubble approaching; illegal immigration continues to cost Americans $70 Billion to $338 Billion in annual net losses; etc.)?

Regarding Medicare fraud, consider how many people could be treated with the $30 Billion in annual Medicare fraud (7% of the 432 Billion in Medicare expenditures in year 2007). Consider Bill Frist’s HCA hospitals, which bilked Medicare out of $1 billion (resulting in a final fine of $631 Million, which ended the investigation (www.sourcewatch.org/index.php?title=Bill_Frist#HCA-Medicare_investigation).

Corruption within government is a large part of the problem, since it is the duty of government to enforce laws, and prosecute violators. Instead, Bill Frist’s HCA paid a massive $631 Million fine, and the investigation was discontinued. The point is, the corruption is not only within for-profit corporations, but government too. And that is why the abuses should be addressed FIRST, before creating more vast and costly overnment-run systems that will most likely be mismanaged as badly (or worse) than the current Medicare, Social Security, and other various systems.

charles ross wrote: Medicare is going bankrupt because most of its members are in need of healthcare (a guess, but a reasonable one).

Medicare is already bankrupt, and the unfunded liabilities are growing, and the money is being borrowed and created out of thin air.

The math simply does not work.
The rapid growth in Medicare expenditures is fiscally unsustainable
The 2008 Medicare Trustees Report states that expenditures in 2007 were $432 billion, which is 16% of the federal government’s total $3.7 Trillion in tax revenues.
Medicare’s current costs (and borrowing) can not be sustained.
The federal debt can not grow much larger.
The federal government is already consuming about one fifth of the $13.98 Trillion GDP in federal taxes.
Even if the tax system is fixed to remove regressive taxation, it still would not be enough to support the unfunded liabilities.

Something has to give somewhere. Major changes in spending, taxation, illegal immigration, end the war in Iraq, and law enforcement would have to occur first, and that ain’t likely when too many voters continue to reward incumbent politicians with 93%-to-99% re-election rates.

Since those major reforms are very unlikely to come about voluntarily, they will more likely come about the more painful way, and the first casualty will be wide-spread economic consequences? Especially since the current candidates and Congress are so eager to pander to voters that want something from the government, instead of focusing on the abuses that are destroying our numerous social services.

charles ross wrote: A single payer system is far more efficient than what we have now. Filing and refiling claims, trying to figure out what Blue Cross, Pacific Care, Aetna, Kaiser, Life Care and all the thousand others require in claim verification in order to process it and generate a check to the health provider is costly, time consuming and wasteful. It is not unusual for an office to dedicate 25 to 30 percent of their resources to A/R the Get The Money department.

True. It’s ridiculous. However, even a single payer system (which I also advocate; non-profit too), that eliminates the middle-men (for-profit insurance companies) is part of the solution.

But that will fail also if the abuses are not addressed FIRST ( one-simple-idea.com/DisparityTrend.htm ).

charles ross wrote: Where would tax money come from? I don’t know. Probably we should end the present employer based health care system, and raise taxes across the board. (a move espoused by the big 3 automakers for obvious reasons) You don’t need to go back the the 70 percent corporate taxes of the 60’s; maybe 39%, where it was in the 90’s (remember those years when we actually came close to a balanced budget).

Corporate taxes should be eliminated, and corporations simply pass through health care and insurance costs ( one-simple-idea.com/TaxSystemReform.htm ). Corporate taxes are essentially regressive hidden sales taxes passed onto consumers. All sales taxes are regressive.

The first step to reforming the tax system is to simplify it to make it fairer (instead of the current system, which is regressive).
Addressing the many abuses to the tax system and health care system would save tax payers hundreds of billions per year:

• (1) reduce fraud; enforce existing laws; reduce lawlessness;


• (2) reduce the $70 Billion to $338 Billion in net losses due to illegal immigration (not to mention the untold cost of hundreds of hospitals closing, job displacement, and crime: VictimsOfIllegalAliens.com ). If Americans want all these numerous government-run services, Americans need to learn that they can not afford to provide them to tens of millions of illegal aliens too.


• (3) fix the regressive tax system; the complexity alone costs billions per year;


• (4) start bringing home the U.S. troops from Iraq (monetary costs ranging from $517 Billion to $2 Trillion; zfacts.com/p/447.html , www.nytimes.com/2008/03/19/washington/19cost.html)


• (5) fix the inflationary, dishonest, usurious monetary system that creates bubble after bubble, breeds corruption, fuels ponzi schemes (e.g. the sub-prine mortgage melt-down), and destabilizes the economy; also, rework the regulations to increase transparency and accountability to reduce these bubbles which are driven by greed and rampant with fraud;


• (6) reduce the 101,000 people killed per year due to adverse drug reactions; reduce the 195,000 people killed per year by preventable medical mistakes;


• (7) deal with the massive $53 Trillion nation-wide debt

charles ross wrote: … establish a higher tax rate on dividends and cap gains ( presently a tax benefit just about useless to the middle class in this country), establish a fair tax on estates that is indexed, take good care of the illegals who come to the emergency room AND THEN SEND THEM HOME!!, and establish a modest fee-for-each-service that will support the system and yet not keep people away from seeking medical help.

Unfortunately, many Americans choose to ignore the cost of illegal immigration. Their compassion is misplaced when they, their children, and their fellow Americans that go without? And that is what is happening, as hundreds of overrun hospitals are closing (60-to-84 in California alone).

charles ross wrote: Finally, we need to be heavily taxing those things in our society that are bad for our health. Do I need to list them? ok. i will: ciggies, gas guzzling autos (don’t laugh, people who live along our freeway system here in Portland have extremely high levels of benzene in their blood).

You are right. It isn’t a laughing matter. Urban sprawl kills. The lack of urban planning is actually deadly (indirectly). A one hour commute (1 way) is 65 eight-hour days per year sitting in traffic. The fuel cost is only part of it. That isn’t healthy either. Air pollution in many cities are unhealthy. Dallas (where I live) don’t only have RED OZONE alert days, but PURPLE OZONE alert days.

charles ross wrote: Cars that are less efficient are, I would think, more polluting. Food that is determined to be unhealthy. Why in the world would the government subsidize the production of corn syrup and give nothing to, say, the carrot growers?

There are some common-sense things that cities and employers could do to greatly reduce traffic and congestion.

For one thing, all going to work at the same time (e.g. 8 AM) is not too smart.
If employers adjusted their shifts (e.g. 8 to 5, 9 to 6, 10 to 7, etc.), everyone would spend much less time in traffic (saving fuel and time).
Also, more mass transit would save fuel, money, and reduce air pollution.
Also, cities could increase the number of HOV lanes, and reduce the number of single occupancy vehicles.
And many people could take advantage of telecommuting (e.g. one or more days per week).

The problem is not so much that we lack good ideas and solutions.
The problem is that Congress and government is where good ideas and solutions go to die, and too many voters help cause it by repeatedly rewarding irresponsible incumbent politicians with 93%-to-99% re-election rates ( one-simple-idea.com/CongressMakeUp_1855_2008.htm ).

kctim wrote: Which is why our founders were smart enough to limit govt and leave such things up to the individual.

Which is why I still prefer a voluntary, non-profit health care system with only civil and government over-sight ( one-simple-idea.com/HealthCareSolutions.htm ).

I can accept paying taxes for national defense and welfare for the truly needy.
But it bugs me when government starts trying to take care of people from cradle to grave, and does such a pathetic job of it (as evidenced by massive Medicare fraud (7% of annual expenditures); the $12.8 Trillion borrowed and spent from Social Security, leaving it pay-as-you-go, with a 77 million baby-boomer bubble approaching, regressive taxation, massive $9.4 Trillion national debt, massive unfunded liabilities, etc.).

Also, I think it may not only be a total flop, but could possibly contriubute to worsening economic conditions so severely as to bring about a severe economic down-turn, unless the many abuses hammering the economy are not a