[nonhuman]

If you support putting US healthcare in the hands of the government, are you for or against legal abortions? Because it seems to me that, given the political climate in our country, and given the specific hot button issues for various groups, that putting the government in charge of all healthcare would be a very effective way of essentially putting an end to legal abortions.

Anyone who supports the right (of anyone) to choose (anything) should be opposed to any scheme in which the government is granted monopoly power over any area of our lives.

[ghporter]

Originally Posted by nonhuman 

Anyone who supports the right (of anyone) to choose (anything) should be opposed to any scheme in which the government is granted monopoly power over any area of our lives.

This is an extremely good point. I do not support "government provided" health care, but rather some mechanism through which being poor doesn't guarantee that you get care that is poor, limited, or in any other way lesser than what people who aren't poor can get. I support a system that makes health care available to everyone in one way or another, and that ensures both access and quality meet at least some minimum level that is established by health care professionals, not bureaucrats.

I've worked in health care in poor communities, and I've worked where most patients have substantially better than average coverage. In situations at both ends of the spectrum, prevention is severely underemphasized - and could save millions of dollars in treatment costs if it were pushed as much as treatments and therapeutic interventions are pushed ("come use our newest MRI machine!!!").

And this is really on topic: the same people that don't want anyone to have abortions also don't want anyone to teach anyone about contraception, nor to provide coverage for contraceptive therapy (the pill, longer term medical interventions, etc.). So in this case they're arguing that their "moral sense" forbids abortion, but also that they are too sensitive and delicate to support providing prescription medicines to prevent pregnancy in the first place. I hope I'm not the only one that thinks such people are effectively saying "we want you to pay a price for getting sex" (and implying that they aren't getting any and are jealous of people who are).

While I'll bet this isn't exactly the sort of reply you expected, I'll also bet that it puts the issue into some sort of context that will produce some pretty interesting discussion.

[besson3c]

ghporter: do you support Medicare?

[screener]

Originally Posted by ghporter 

I support a system that makes health care available to everyone in one way or another, and that ensures both access and quality meet at least some minimum level that is established by health care professionals, not bureaucrats.

Right, the bean counters at your favorite HMO have your best interests at heart.

[ghporter]

I certainly didn't say I wanted it run by current insurance companies. And I don't know what your HMO is like, but few if any actually have physicians making individual medical decisions about coverage. Instead, they have script-followers who effectively make medical decisions (without a license, of course) who are instructed to deny claims as often as possible.

What I'm talking about is a system that provides the care the physician calls for first, then decides if the physician gets good results-and if he/she is relatively efficient in getting those results. A lot of testing is done to avoid successful litigation, not to nail down a diagnosis, and those extra tests cost a lot of money. If physicians did not have to worry about being second guessed, they might also be more efficient in getting to a diagnosis that gets treatment results quickly. And this system should reward patients and physicians who stress prevention to avoid the need for treatment. NO current HMO does this.

One more thing: the system needs to completely divorce itself from the use of Medicare rules, which every single HMO attends to because it is simpler than making up their own rules. Medicare rules are in need of a complete revision in any case, and for some reason HMOs apply those rules to every coverage area, even though it never makes sense to apply rules that were written to manage geriatric care to caring for babies and little kids... Rules that are built around a short term expectation of "tolerable" quality of life for a short term life expectancy do not make sense when making decisions about a child with his or her whole life ahead of him or her, but insurance companies still limit coverage for kids with major yet treatable issues as if the kid only had a five-year future.

[screener]

Originally Posted by ghporter 

And I don't know what your HMO is like,

I don't have one, I'm Canadian.

[el chupacabra]

Originally Posted by ghporter 

I do not support "government provided" health care, but rather some mechanism through which being poor doesn't guarantee that you get care that is poor, limited, or in any other way lesser than what people who aren't poor can get. I support a system that makes health care available to everyone in one way or another, and that ensures both access and quality meet at least some minimum level that is established by health care professionals, not bureaucrats.

I like the idea. But isn't this somewhat contradictory to every other industry from a capitalistic point of view? We live in a world where everything is rationed. Not everyone can have a BMW, Lamborghini, private jet, the fanciest computer, a big house, the highest quality food etc.... Most people have to settle for the "lesser" quality car, house, computer, food or whatever; based on what they can afford or what priorities they save their money for. The problem with health care is some of the resources/technologies really don't exist in enough quantity to service/treat everyone. One conundrum is that there is no limit to how sick you can be. Diseases that nobody would've bothered treating in the past because they were considered fatal; are now treatable... with a price. The line of where a person is considered untreatable or terminally ill is always changing as technology evolves. And the problem is EVERYBODY seems to think once a technology exists to treat an illness, that EVERYBODY should have access to it. Even if it's brand new and the resources don't exist... Even if there is no cure for something people want infinite treatment to prolong their life a day here and there until they die. Everybody wants not just good...not just the best, but the best-est treatment when it come to healthcare. And that seems to me, to be impossible to provide.

I've posted before what my health care plan would entail. Such as allowing 4 year degree'ers to do all the simple routine treatments such as strep, flu, asthma etc. Leaving the docs for the more important stuff.... And forcing insurance companies to put a ~$3000 annual deductible before they pay for anything; in order to bring back price shopping to the med field. And force individuals to have ROLLOVER health savings accounts.

I'm curious what would be ghporter's health care plan? I see you've listed some of it in the post below but how would you overhaul the whole thing if you were the government? How do you address the rationing problem I stated above?

In situations at both ends of the spectrum, prevention is severely underemphasized - and could save millions of dollars in treatment costs if it were pushed as much as treatments and therapeutic interventions are pushed ("come use our newest MRI machine!!!").

I agree, but it seems when people go in for preventable care, more often than not they're treated like hypochondriacs. I only go to the doc a few times a year; but when I feel the onset of something strange I go right in and the doc acts like I'm wasting his time and jumps to the "it's just an infection" diagnosis.

And this is really on topic: the same people that don't want anyone to have abortions also don't want anyone to teach anyone about contraception, nor to provide coverage for contraceptive therapy (the pill, longer term medical interventions, etc.). So in this case they're arguing that their "moral sense" forbids abortion, but also that they are too sensitive and delicate to support providing prescription medicines to prevent pregnancy in the first place. I hope I'm not the only one that thinks such people are effectively saying "we want you to pay a price for getting sex" (and implying that they aren't getting any and are jealous of people who are).

I think the only reason people pretend to care about abortion is because it's what their club/party/religion tells them to believe. If they really cared they wouldn't be the ones obsessed with having 3-5 kids and instead would adopt. My thing is if you want to be pro life fine. But then do something the help the would-be-aborted kids.

[Big Mac]

Originally Posted by besson3c 

ghporter: do you support Medicare?

I don't. Repeal LBJ's Socialist abomination now!

[besson3c]

Originally Posted by Big Mac 

I don't. Repeal LBJ's Socialist abomination now!

I am utterly shocked! Shocked I tell ya!!

[Big Mac]

I'm full of surprises. Haha.

Do you support Medicare, besson?

[besson3c]

Originally Posted by Big Mac 

I'm full of surprises. Haha.

Do you support Medicare, besson?

The concept of it, yes, but not necessarily its current implementation/mutation.

Right now I cannot see how it makes any economic sense to not have some sort of safety net for those that can't afford their own care. I think it's too expensive to have a society without something like this, and I don't think that just accepting these people to the ER is efficient either.

[Big Mac]

I essentially agree with you.

[besson3c]

Originally Posted by Big Mac 

I essentially agree with you.

If you do, how does the "socialist abomination" rhetoric line up with this?

[Big Mac]

Because I said essentially. Not completely. Medicare is a Socialized/Socialist abomination that was pushed through by LBJ with the sinister expectation that soon enough Socialized medicine for seniors would lead to universal Socialized medicine. It's an abomination because despite the repeated assurances that it would be cost effective and save younger Americans from having to bear the burdens of their elderly relatives, the costs of the program rapidly far exceeded the government's original projections, and now it's the biggest single threat to our national financial future. It's even worse than what FDR saddled us with, Social Security, because Medicare isn't just funded by payroll contributions like Social Security is - it also has a warrant on general funds, which means that it increasingly consumes far more tax money than the dedicated, confiscated wealth that is set aside for it; it will continue to worsen our deficit/debt crisis unless it's reformed, and it's due to get many times costlier in the next decade as all the Baby Boomers retire and implode the system.

I essentially agree with what you wrote. I believe it's important to have safety nets of various kinds for those who fall on financial hard times, but universal federal government Entitlements get forced on everyone, not just the needy, and they should never have been imposed on this country that was founded and predicated on liberty. I believe that universal Entitlements corrupt our country by conditioning citizens to expect and demand that the federal government and ultimately tax payers take care of their medical needs. I also don't believe that citizens/residents are entitled to demand health care from medical professionals and to force medical professionals to practice under the threat of government force instead of freely, based on free market supply and demand. Government coercion of medical professionals is a given in countries with Socialized medicine.

Safety nets should be for the truly economic needy, and they should be mostly state based and market oriented. Medicare isn't just a safety net for the needy - everyone is forced to pay into it, and eventually all those who attain retirement age are required to be in it (being victimized by the system in youth and then victimizing the youth decades later). If the Federal government wants to provide portability of benefits for citizens who move from one state to another and want to preserve their accrued state entitlement benefits (assuming individual states choose to provide such entitlements), perhaps that could be done in some fashion. That, I think, if structured properly, would be a permissible application of Interstate Commerce Clause power held by Congress. But federally-based general Entitlements like Medicare (that everyone is forced into) have proved destructive to our rights liberties and property (the dollars we save to see debased by inflation) and may ultimately destroy the United States. And if we let that happen it will have been our own faults for allowing our leaders to willfully violate the Constitution, which provides no authorization for such Entitlements, and we will truly have no one to blame for the death of our country other than the American citizenry, past, present and future.

[besson3c]

I fail to see how the distinction of fiscal holes puts Medicare squarely in the domain of where such extreme language is appropriate. Sorry, maybe I'm just sensitive to hyperbole.

[Big Mac]

It's not hyperbole. And we're not talking about small financial holes - we're talking about national bankruptcy or the destruction of the dollar through hyperinflation. I hate - honestly detest - Medicare, even though I essentially agree with the spirit, if not the details, of what you wrote. Medicare's passage was an act of reprehensible fraud against the citizens of the country, and if the country is to survive that fraud we're going to have to seriously reform, if not abolish, this Socialist abomination.

My brother said if I ever want to run for office and speak out like this I'll likely get assassinated by an AARP assassin. And there's probably a lot of truth in what he says. I understand how popular Medicare and Social Security are among the ignorant masses. I understand that a great portion of the populace has been conditioned to love these programs. But I also know that there have been other popular government initiatives in history that have been evil and destructive despite the fact that they too were supported by the masses. So I speak out for the honest truth even though very few will recognize it as such.

[besson3c]

There is still a massive disconnect.

Saying that something is socialist alone implies a philosophy you disagree with. If Medicare weren't bankrupting the country it sounds like you would be fine with it, therefore the problem is not one of philosophy.

[Big Mac]

Then you're not understanding my complete argument. As you can see I hate Medicare for more reasons than just because it's one of the major forces bankrupting the country. That's the biggest reason certainly, but I also hate it because it's unconstitutional, it's forced on the whole citizenry instead of being targeted to the needy, it distorts market pricing of health care goods and services, it puts government coercion into the practice of medicine, it conditions the general public to demand that the government take care of their medical needs and wants (creating self-perpetuating government dependency), it promotes over consumption of medical goods and services because the cost of those services are hidden from the one receiving the benefits (which is also true to a lesser extent with all insurance programs, but it's much more problematic when government is picking up the tab because government just foists the cost burden on to the tax payer), etc.

If it weren't bankrupting the country I wouldn't call it an abomination. I would still call it Socialist and oppose it for many of the same reasons. But it is a Socialist abomination as it stands right now. That's how I characterize it, and I don't believe that to be an unfair or hyperbolic description at all.

[besson3c]

How would you propose creating a safety net that provided medical care to poor people and paying for it then, if not "forcing it on the whole citizenry"?

If you agree with what I wrote, how would providing a safety net not be socialist?

[Big Mac]

A safety net is defined as a safeguard against possible adversity. What we have in Medicare is not a safety net that protects against possible adversity, it's a broad Entitlement that everyone is forced to support through confiscation of a portion of their income, and which everyone who attains retirement age is forced to receive. If it were only for the needy it would be a much less costly and therefore less destructive program, but it's not targeted to the needy.

Medicaid is a medical safety net. It's often a very poor safety net with its own big problems (although that varies from state to state because states get some power to direct how the program is administered), but at least it's targeted to those of limited economic means.

It's rather obscene that a billionaire like Warren Buffet gets Medicare and Social Security, don't you think?

When Social Security was passed, the average life expectancy was a year lower than the retirement age to receive benefits. And originally it was targeted to the needy who were poor in old age. When Medicare was passed it was sold as a cost effective way to provide medical coverage to the elderly so that they could afford medical care. Of course life expectancy was much lower than in 1965 than it is today, but the retirement age has remained fixed. The Democrats seem to hate the rich during their productive working years, but then when the rich retire the Democrats become their best friends, resisting all past attempts by Republicans to introduce means testing for benefits. It has been shown that as of this current generation of retirees, as a class they have a substantially greater share of national wealth than their children and grandchildren. Certainly a great many seniors don't have substantial wealth, but taken as a class they are wealthy. Yet most of them have no problem continuing to allow the younger generation to pay for lavish retirement benefits that the country can't afford. And this was by design. The cretins who originally created this pyramid scheme may not have realized the hell they were going to unleash based on unbalanced demographics and increasing life spans, but they did know that once a broad government Entitlement is created it's nearly impossible to take it away. They did not care about the Constitution nor the long term financial implications of what they were instituting. They simply wanted to greatly expand the power of the federal government, and the bastards certainly succeeded.

[besson3c]

Originally Posted by Big Mac 

A safety net is defined as a safeguard against possible adversity. What we have in Medicare is not a safety net that protects against possible adversity, it's a broad Entitlement that everyone is forced to support and which everyone who attains retirement age is forced to receive. If it were only for the needy it would be a much less costly and therefore less destructive program, but it's not targeted to the needy.

Medicaid is a medical safety net. It's often a very poor safety net with its own big problems (although that varies from state to state because states get some power to direct how the program is administered), but at least it's targeted to those of limited economic means.

It's a safety net for the (increasing) costs of health care particularly when you are old, and is a safety net which ensures that old people are able to afford their care. It does not pay for everything, it's sort of like having a little trust fund or something. I'm of course focusing on old age since that seems to be the part of this you disagree with the most.

How is this safety net fundamentally different than one that wouldn't be subject to the wrath of Big Mac?

[lpkmckenna]

Originally Posted by nonhuman 

If you support putting US healthcare in the hands of the government, are you for or against legal abortions? Because it seems to me that, given the political climate in our country, and given the specific hot button issues for various groups, that putting the government in charge of all healthcare would be a very effective way of essentially putting an end to legal abortions.

Yet somehow, Canada has universal healthcare and legal abortion. Amazing!

[Big Mac]

Originally Posted by besson3c 

How is this safety net fundamentally different than one that wouldn't be subject to the wrath of Big Mac?

Like I said, a program that's targeted to the truly needy, one that's financially sound, market-oriented, directed by the states as much as possible instead of the federal overlords - that's the type of safety net I could wholeheartedly support.

I'm not a cruel, unfeeling person; I'm not an ogre. I know what it's like to experience tough economic times. But I'm an absolutist when it comes to fealty to the Constitution and government policy that protects and enhances liberty (including economic liberty), instead of one that progressively robs us of it and threatens to destroy the country. The preservation of the Constitution is more important to me than the economic hardship of any disadvantaged American - even if that sounds very cold to you, maintaining limited, Constitutionally constrained government and therefore individual liberty is far more important to me than helping even needy citizens get health care. And I believe that aside from perhaps the truly needy, the common man's needs to have access to quality health care can be provided by free market solutions like a national market for health insurance plans, health savings accounts coupled with high deductible hospitalization plans for those who want to use that strategy of cost management, and the force of competition-driven supply and demand. We do not need, nor can we afford any further, the 1965 Socialized status quo that has been failing for some time and is imperiling the country (and consequently the world) financially.

[besson3c]

Originally Posted by Big Mac 

Like I said, a program that's targeted to the truly needy, financially sound, market-oriented, directed by the states as much as possible instead of the federal overlords, that's the type of safety net I can support.

- Truly needy: so, you disagree with the coverage threshold. For both the elderly and poor, or just one or the other?
- Financially sound: we agree
- Market oriented: private businesses should provide a safety net? What does this mean?
- State driven: why? What advantages would exist this way?

A disagreement on threshold, a non-philosophical problem, and two undefined problems result in such a harsh philosophical label? I still don't get it.

[Big Mac]

Originally Posted by besson3c 

- Truly needy: so, you disagree with the coverage threshold. For both the elderly and poor, or just one or the other?

Truly needy, as in below a certain income or asset threshold, regardless of age. I would also have it apply to the small, unfortunate percentage of Americans/American families who may have decent finances but also have very serious, chronic medical problems that require a level of care that would be unaffordable for them on their own.

- Financially sound: we agree

Good, although when it comes to well intentioned programs financial soundness is easier said than done.

- Market oriented: private businesses should provide a safety net? What does this mean?

I mean, provide subsidies and individual coverage guarantees to make private insurance affordable and accessible. Don't make government the insurer of last resort. Even ObamaCare, to its credit, has this component.

- State driven: why? What advantages would exist this away?

If you look at Medicaid, it's not the same type of top down, fully federally-controlled system like Medicare. With Medicaid the states receive grants to fund their individual programs. And when you look at the outcomes, there are some states that manage their Medicaid systems better than other states. If you don't like the way your state is managing itself in this or any other area, you can move to 49 others. But if you don't like the way the federal government is managing itself, you have no other American options to switch to; you have to try to find a new country to live in. Therefore, the Constitution purposely created a very limited federal government, with the individual states retaining most powers. The New Deal heavily undermined that arrangement, to the country's great detriment.

[besson3c]

Originally Posted by Big Mac 

Truly needy, as in below a certain income or asset threshold, regardless of age. I would also have it apply to the small, unfortunate percentage of Americans/American families who may have decent finances but also have very serious, chronic medical problems that require a level of care that would be unaffordable to them on their own.

Do you realize that there would be many middle class old people that would be unable to pay for their care? It is bad enough as it is that costs just keep on going up and up, it is pretty much impossible for middle class people to tuck aside enough money to pay for their old age care on their own.

I mean, provide subsidies and individual coverage guarantees to make private insurance affordable and accessible. Don't make government the insurer of last resort. Even ObamaCare, to its credit, has this component.

Fair enough, but that's not a fair criticism of Medicare, because this is outside of its scope.

If you look at Medicaid, it's not the same type of top down, fully federally-controlled system like Medicare. With Medicaid the states receive grants to fund their individual programs. And when you look at the outcomes, there are some states that manage their Medicaid systems better than other states. If you don't like the way your state is managing itself in this or any other area, you can move to 49 others. But if you don't like the way the federal government is managing itself, you have no other American options to switch to; you have to try to find a new country to live in. Therefore, the Constitution purposely created a very limited federal government, with the individual states retaining most powers.

I really don't think that the vast, vast majority of old people are going to move to a new state because of disagreements with how this program is being managed in their state. A federally managed program also has the advantage of being able to coordinate administration between states so that it isn't, for instance, a freaking nightmare to deal with relocation from state to state. Hence, I don't really see a great deal of upside in making it a state managed program.

[Big Mac]

Originally Posted by besson3c 

Do you realize that there would be many middle class old people that would be unable to pay for their care? It is bad enough as it is that costs just keep on going up and up, it is pretty much impossible for middle class people to tuck aside enough money to pay for their old age care on their own.

If that's true then we need to get to the root of why costs keep increasing. I believe that government intrusions into the medical sphere are responsible for much of the cost escalation. There's a huge fraud rate in Medicare and Medicaid. There are doubtlessly other areas of waste and greed that could be cut out. A lot of it is likely due to insufficient competition and the distortion of third party payments. Then there's the aspect of inflation of the dollar that makes medical prices seem much higher than they would be but for the debased dollar. In all respects, however, if the prices of medical services get too high for people to afford individually, they will also be too high for the tax payers to afford collectively. More government won't do anything to solve the problem of high prices in medicine because government has precious little incentive to deliver services cost effectively (as long as there is the moronic attitude that government can continually deficit spend in perpetuity).

Modern medicine is very advanced, and that advanced medicine is good but costly. Modern medical technology is very expensive. And the cost of becoming a doctor is terrifically expensive. And lest I forget, lawsuits and the threat thereof add tremendous costs to medicine in the US. There are ways to bring many of these costs back down, primarily through competition as well as through some targeted reform efforts. But simply saying that things are expensive and therefore we should maintain something resembling the broken and bankrupting status quo is no solution in my opinion.

Fair enough, but that's not a fair criticism of Medicare, because this is outside of its scope.

You asked me how I would reform Medicare, and I gave you an answer. What I wrote is very much within the scope of this discussion.

I really don't think that the vast, vast majority of old people are going to move to a new state because of disagreements with how this program is being managed in their state.

You may be surprised. A lot of older people choose to move out of the states they've lived in all their lives because there are better living opportunities elsewhere. Tons of older people move to Florida in retirement, for example. My aunt will be moving out of California to Oregon when she retires. Retired people aren't necessarily helpless mush eaters. As I said this current generation of retirees is wealthy, and many of them have a good number of years ahead of them. Even older people will act in their own self-interests, and if a state is going down the drain (like my state), at least some portion of people will move to greener pastures.

We have the luxury of being able to move from state to state according to our desire. But there is only one federal government that has no national competition, and if it goes south the entire country is screwed. So again, that's why the country was originally designed with a very limited federal government and much more powerful states. When that relationship was reversed primarily with the New Deal, we started the journey on the increasingly perilous road we've been on and that is about to run out and dead end. Now our enormous, Socialistic, unconstitutional federal government is going bankrupt. It's time to either sit back and watch the system collapse (which will cause far more devastation to the elderly and the poor than anything I'm advocating) or to seriously reform that which is broken. Medicare is broken. Social Security is broken to a lesser extent. The wars we've been fighting have run the course of their usefulness. Let's reform all these areas and save the country. Doesn't that sound better than the alternative of national bankruptcy or Weimar-style hyperinflation?

A federally managed program also has the advantage of being able to coordinate administration between states so that it isn't, for instance, a freaking nightmare to deal with relocation from state to state. Hence, I don't really see a great deal of upside in making it a state managed program.

As I said, I can a role for the federal government in setting some minimum standards and in helping to migrate accrued safety net benefits from one state to another for people who move to new states. I believe that if structured properly, that would be a perfectly fine use of federal authority under the Interstate Commerce Clause. But the federal government should never have been turned into the direct administrator of the retirement Entitlements.

[besson3c]

Originally Posted by Big Mac 

If that's true then we need to get to the root of why costs keep increasing.

I definitely agree with that. As I've said before, I think politicians should be obsessing over this issue every day, it is upsetting that we don't seem to be discussing and debating this issue nationally. Regardless of what you think we ought to do with Medicare/Medicaid, simply understanding what the hell is driving up the costs would be excellent information to debate, many of which may be apparent regardless of what policy exists.

I believe that government intrusions into the medical sphere are responsible for much of the cost escalation. There's a huge fraud rate in Medicare and Medicaid.

Care to develop this argument?

There are doubtlessly other areas of waste and greed that could be cut out. A lot of it is likely due to insufficient competition and the distortion of third party payments. Then there's the aspect of inflation of the dollar that makes medical prices seem much higher than they would be but for the debased dollar.

Inflation, plus a lack of middle class earnings increase over many administrations could definitely be a part of it.

In all respects, however, if the prices of medical services get too high for people to afford individually, they will also be too high for the tax payers to afford collectively. More government won't do anything to solve the problem of high prices in medicine because government has precious little incentive to deliver services cost effectively (as long as there is the moronic attitude that government can continually deficit spend in perpetuity).

Makes sense...

Modern medicine is very advanced, and that advanced medicine is good but costly. Modern medical technology is very expensive. And the cost of becoming a doctor is terrifically expensive. And lest I forget, lawsuits and the threat thereof add tremendous costs to medicine in the US. There are ways to bring many of these costs back down, primarily through competition as well as through some targeted reform efforts. But simply saying that things are expensive and therefore we should maintain something resembling the broken and bankrupting status quo is no solution in my opinion.

The cost of administration is very expensive too. This is one advantage that a system like Canada's has, administrative overhead is very small compared to others from private doctors on up to big hospitals. Us patients have to help pay their salaries.

You may be surprised. A lot of older people choose to move out of the states they've lived in all their lives because there are better living opportunities elsewhere. Tons of older people move to Florida in retirement, for example. My aunt will be moving out of California to Oregon when she retires. Retired people aren't necessarily helpless mush eaters. As I said this current generation of retirees is wealthy, and many of them have a good number of years ahead of them. Even older people will act in their own self-interests, and if a state is going down the drain (like my state), at least some portion of people will move to greener pastures.

There are many other factors to take into consideration with old people moving to a place like Florida though, right?

- cost of living outside of health care
- housing costs/options
- cultural/entertainment options
- proximity to grandkids
- climate
- cheap oatmeal and ointment

We have the luxury of being able to move from state to state according to our desire. But there is only one federal government that has no national competition, and if it goes south the entire country is screwed. So again, that's why the country was originally designed with a very limited federal government and much more powerful states. When that relationship was reversed primarily with the New Deal, we started the journey on the increasingly perilous road we've been on and that is about to run out and dead end. Now our enormous, Socialistic, unconstitutional federal government is going bankrupt. It's time to either sit back and watch the system collapse (which will cause far more devastation to the elderly and the poor than anything I'm advocating) or to seriously reform that which is broken. Medicare is broken. Social Security is broken to a lesser extent. The wars we've been fighting have run the course of their usefulness. Let's reform all these areas and save the country. Doesn't that sound better than the alternative of national bankruptcy or Weimar-style hyperinflation?

It really sounds like to me that the root of your problem with Medicare/Medicaid is its lack of sustainability, as well as some particulars of its implementation when it comes to deciding who is covered and stuff. That's fine, but I'm still having a hard time seeing how a policy you don't like has become a "socialist abomination". What words would you use to describe legalization of slavery?

[olePigeon]

Any sort of government provided health care, even medicare or medicaid, should work in principle. It's a savings plan for health insurance. The main issue is that the Congress keeps dipping their greedy little hands into these services, not allowing them to mature and do what they're supposed to do; which is provide subsidized or full health care to people who need it.

I have no problem with government health care, but I do have a problem with our government. They're like little kids. I wouldn't trust them with health care. As much as I want them to be responsible and provide a service that would potentially help millions of people at no extra cost, they're just too inept and too greedy.

[besson3c]

Originally Posted by olePigeon 

Any sort of government provided health care, even medicare or medicaid, should work in principle. It's a savings plan for health insurance. The main issue is that the Congress keeps dipping their greedy little hands into these services, not allowing them to mature and do what they're supposed to do; which is provide subsidized or full health care to people who need it.

I have no problem with government health care, but I do have a problem with our government. They're like little kids. I wouldn't trust them with health care. As much as I want them to be responsible and provide a service that would potentially help millions of people at no extra cost, they're just too inept and too greedy.

I feel this way constantly.

What I haven't decided is whether the approach that the right seems to embrace of "see, the government sucks, elect me so that I help ensure it stays that way" is just making the problem worse or embracing the reality that no matter what, government will always be as you describe.

See, if we all felt better about our government and felt that they were doing their jobs well, and their approval ratings were all generally higher in all branches of government, I think we'd be far more comfortable with the government being more involved with health care. If we thought higher of our government, chances are they would be doing a better job and we'd all be much better off.

Why is it that although government is no panacea in Canada for instance where they are universally adored, Canadians are far more comfortable with leaving health care to their government? I mean, the approval rate of Canadian Medicare is over 90%. What do 90% of Americans agree on?

[ghporter]

Are we talking about "the government" being federal lawmakers, who as a class most agree are not trustworthy, or are we including the career civil service people who make less money than people in similar private sector jobs but who make sure food inspections get done, etc? "The government" in the latter case includes so many working stiffs who just want to put in their time and do a good job in the process that I would have to completely disagree with their inclusion.

In short, I think we're really all in agreement that lawmakers can't be trusted to wear matching socks, and that they are the least likely to set up something that will serve everyone fairly. Painting "the government" with the same brush as legislators is disingenuous (or naive).

[nonhuman]

Originally Posted by lpkmckenna 

Yet somehow, Canada has universal healthcare and legal abortion. Amazing!

Canada is not the US. That, at least, seems like it should be pretty clear.

[Paco500]

Let me start by saying I think the Medicare system as it exists is broken and a real problem, but I think the rallying cry of turning it over to the states and putting it in hands of private industry is illl-conceived.

1) Inefficencies and waste. The federal government is not efficient. The states are likely more efficient. The states are not 50 times more efficient than the federal govemment. Turning it over to the states means 50 bureaucracies instead of one. It may appeal to the constructionists in some of you but to pretend it will be more efficient defies logic.

2) Fraud. The fraud in Medicare is not, in the whole, being committed by individuals and bureaucrats. Shure, there is some low level fraud committed by these groups, but the really big, high dollars fraud is being committed by the private health-care industry- health-care C.E.O.'s go to prison at an alarming rate. So the argument seems to be- the private industry is robbing the government blind, so let's put them in charge to clean it up. How does this make sense?

3) Rising costs. There a lot of factors here. Too many lawsuits with too high payouts. Something could and should be done about this. New medical advances mean people have more treatment options and are living longer to use them. Unless we start rationing health-care or just let people die, not much we can do about this. I don't see how changing Medicare to a state run or private system will have any effect. Drug costs are too high. Allowing Medicare to negotiate with drug companies for better pricing would help, something the drug lobby has prevented thus far. If this were allowed, a monolithic system should be able to get better prices than 50 (or more if privatized) systems.

Thoughts?

[Wiskedjak]

Originally Posted by nonhuman 

If you support putting US healthcare in the hands of the government, are you for or against legal abortions?

In this new era of identifying Gotcha Questions, would this qualify as a gotcha question?

[Shaddim]

Originally Posted by olePigeon 

Any sort of government provided health care, even medicare or medicaid, should work in principle. It's a savings plan for health insurance. The main issue is that the Congress keeps dipping their greedy little hands into these services, not allowing them to mature and do what they're supposed to do; which is provide subsidized or full health care to people who need it.

I have no problem with government health care, but I do have a problem with our government. They're like little kids. I wouldn't trust them with health care. As much as I want them to be responsible and provide a service that would potentially help millions of people at no extra cost, they're just too inept and too greedy.

Great googly-moogly, I agree with olePigeon. Someone check the temperature in Hades.

They're a bunch of retards I wouldn't trust with a potato gun.

[Athens]

You can't have both a Private system and a public system operating side by side offering the same services. It will never work and this was Obama's problem with his reforms. If you do a dual system like that what happens is the private insurance companies cherry pick the healthy and get really rich while leaving the less then healthy or the poor into the public system causing it to go broke. For either system, public or private you need the wealthy and healthy to pay for the sick and poor. A dual system just splits that income up and one system gets really rich and the other system gets really poor.

Canada's model is a public INSURANCE system that pays for most services and basic care with PRIVATE DELIVERY which is what Americans get wrong all the time. And we also have a healthy private insurance business that picks up what the public insurance does not cover. The private insurance though can not offer services for what is covered under the public insurance and the public insurance is mandatory for every one. Those that can't pay don't. You have less administrative costs through out the system, universal coverage and good care. Private business plays a very big part in the system.

The UK on the other hand has a totally socialized system with the government providing the insurance and the delivery. Doctors are government employees in the UK. I don't know enough about the system to argue advantages or disadvantages and costs.

The Swiss used to have the exact same system as the US and made radical changes a few years ago. Its still all private insurance and delivery but with rules that govern it. IE can't make profit off medical insurance its a at cost service BUT its still profitable with secondary insurance like home insurance and auto insurance that private companies still compete to offer medical coverage.

Would the UK model, Canadian model or Swiss model be better for the US? Who knows but what I do know is that if the US tries to run multiple systems side by side it will waste a lot of money and not get the results it hopes to. The US already runs multiple systems as it is now and it appears to be a failure.

[lpkmckenna]

Originally Posted by Athens 

You can't have both a Private system and a public system operating side by side offering the same services. It will never work and this was Obama's problem with his reforms...The UK on the other hand has a totally socialized system with the government providing the insurance and the delivery. Doctors are government employees in the UK. I don't know enough about the system to argue advantages or disadvantages and costs.

Britain does have both private and public systems.

[finboy]

Originally Posted by Athens 

If you do a dual system like that what happens is the private insurance companies cherry pick the healthy and get really rich while leaving the less then healthy or the poor into the public system causing it to go broke. For either system, public or private you need the wealthy and healthy to pay for the sick and poor. A dual system just splits that income up and one system gets really rich and the other system gets really poor.

Example: Medicare. Another point that you left out, though: Medicare coverage drives up prices, and lowers access to services (in several way, but most recently by undercompensating doctors and driving them out of the system).

The "dual system" effect is already happening under ObamaCare. Insurance Companies are limiting their policy terms and underwriting, and companies are dropping employees from their health coverage and letting them go out and find their own, in anticipation of public programs or "pools" when the time comes.

[Athens]

Originally Posted by lpkmckenna 

Britain does have both private and public systems.

Isn't usage of private delivery still paid for by NHS?

[Athens]

Originally Posted by finboy 

Example: Medicare. Another point that you left out, though: Medicare coverage drives up prices, and lowers access to services (in several way, but most recently by undercompensating doctors and driving them out of the system).

The "dual system" effect is already happening under ObamaCare. Insurance Companies are limiting their policy terms and underwriting, and companies are dropping employees from their health coverage and letting them go out and find their own, in anticipation of public programs or "pools" when the time comes.

Prob more then dual system. Medicare, Medicaid, VA Health Care... look how badly it works. The current Medicare system is broke, uses up a lot of money and undercompensate's for services and thats mostly because the people it insures are not "contributors". Its already a example of how dual systems fail and it only covers 35 million people.

Im not saying the US should do a Canadian style system. I'm saying the US can't afford a Canadian style system along side a private system it has now.

[lpkmckenna]

Originally Posted by Athens 

Isn't usage of private delivery still paid for by NHS?

No. Go to a private hospital or private doctor, you pay yourself or with private insurance. (Though there is some limited contracting out to private hospitals by the NHS, but that's very rare.)

[Athens]

Real Canadians talk about their Healthcare - YouTube

This is about as accurate as it gets for most of Canada.

[olePigeon]

I don't know about Government provided, but how about better enforced laws to protect people? I don't want people to be dropped from their insurance plan after being diagnosed with an illness or acquiring a disability. Insurance companies need to better prepare their finances to cover those sorts of incidents without raising premiums on everyone to ridiculous levels.

As for abortions, it's up to the State. At the Federal level, however, religious hospitals and clinics that serve people outside their denomination are therefor participating in the free market, and can not discriminate against clients requesting services approved by (or remove services banned by) the State regardless of religion. I think the Supreme Court is heading this direction as well. That means if a doctor in a Catholic hospital must perform an abortion to save the life of the mother, the operation can not be denied based on the religious feelings of the hospital's owners.

[OldManMac]

Originally Posted by Athens 

Real Canadians talk about their Healthcare - YouTube

This is about as accurate as it gets for most of Canada.

There's a huge difference in the way people look at each other in the U. S., and Canada. Canadians are smart enough to realize that society as a whole functions better when everybody prospers, and are willing to pay higher taxes to cover those less fortunate. The prevailing opinion here is that it's a dog-eat-dog world, and if one has "succeeded" it's because of one's own initiative, and those who haven't are just slothful, and waiting for someone to take care of them. As a whole, nothing could be further from the truth, but the truth isn't what's important.

[Athens]

I dont even think its that. Honestly I dont think its about caring for each other. We are smart enough to know that a collective insurance system that isn't profit driven keeps our own personal costs down. I think its more selfish in that under our system we are taken care of with no worry or risk of being bankrupted, losing our homes, and owing hundreds of thousands of dollars. Its a feel good thing to say because I care about the other people who otherwise couldn't afford medical but the reality is I don't want to gamble at losing everything and paying out the ass. In the end every person needs expensive medical treatment except those that are killed in accidents. Every single person will need expensive care at some point. Its foolish to think you would never ever need it.

[Athens]

BTW Canadians pay less for medical (mostly through taxes) then Americans do (through taxes and personally). Our slightly higher taxes we pay covers a hell of a lot more then just medical. Keeps University and College cheaper by more then half of whats paid out in the US. Our roads are better. Things like employment insurance, old age security, and other entitlement programs all contribute to our overall slightly higher taxes. End result is a overall lower cost of living or a safety net that protects us from temporarily job loss we generally don't lose it all.

Per person in medical costs, through taxes, user fees, co-pays, personal insurance or public insurance in Canada its just under $4000 per person and in the US its just under $8000 per person.

The largest problem affecting our system isn't money but skill shortages and rural living. Could double how much money goes into the system now and still face most of the problems we have now.


I just looked at what my Tax and Fee contribution would be until retirement, at today's costs assuming it would be the same my entire life. Its not because of inflation and wage increases but it still gives a overall general look at my life time contributions


Medical premiums $648.00
Income Tax on current Income $6000
Sales Tax on spending $1800

45 years = $380,160


A single major medical problem could easily cost that. Just one. And at 65 i would be taking back out of the system money. And over those 45 years times between jobs I would be taking out of the system. If 3 times in those 45 years I lived off of Ei alone for say 6 months each time that's almost 40 000 right there back to me. I have already cost the medical system at least 15 000 in my life. And If I lived 20 years on CPP with say the last 5 years of my life in a home, my costs to the system would exceed every penny I ever paid into it. Im trying to figure out how doing everything on your own is beneficial and cheaper. What would the costs be for a family if everything was a user pay, no taxes at all.

[ghporter]

One problem with US healthcare costs that doesn't seem to get enough notice is the cost of covering the uninsured. Part of the $8,000 each my wife and I pay goes to pay for the health care costs generated by people who are either not employed enough to get some sort of basic covage or who receive too much in assistance to qualify for free (Medicare) coverage. While that might just sound like a redistribution of the costs (employed people paying more to cover unemployed people), it isn't. Instead, the way most uninsured people get treatment is by visiting an emergency room, where they must be seen regardless of ability to pay.

ER for basic health support is a bad choice for many reasons. One is that it encourages people to put off seeking aid until at the problem is very serious, which of course jacks up the cost significantly. Another is that ERs are built to stabilize emergency cases, not treat bronchitis that has progressed to pneumonia because the patient (or the patient's parents) delayed treatment, so people often get immediate treatment with instructions to follow up in a week...but with no "regular doctor" to follow up with, they usually don't, and they get sicker and sicker. Compounding this is the underemployed/underinsured person who cannot afford to take time off (whether or not they earn sick days) to see a doctor or to take their kids to see a doctor.

So out per capita cost is actually inflated as much by delayed treatment for a whole lot of people as by administrative rules about how government or insurers (who model their requirements on government rules) pay for treatment in the first place. It should also be noted that "customary charges" are typically inflated by a significant amount because all payors discount charges by even more. You can't go by a "price list" for a particular event or illness because every person's impact and course of treatment is different, but just try telling an insurer that. So the "customary charge" for each item, treatment, and procedure is set to capture what tends to work out as an average cost for that component of care.

Finally, with all this number tomfoolery, a whole lot of money goes to bean counters and number crunchers who have to follow stacks of stupid, arcane and impractical rules to get treatment paid for. For example, Medicare and Medicaid rules for coverage limits, intended to manage costs for chronically I'll elderly people, are applied across the board. Which means that kids with developmental or congenital problems have their therapies limited by rules that are meant to keep 90 year olds from soaking up an inappropriate amount of treatment. Sure, you can get these limits waived, but that has to be done regularly-there's no blanket waiver, let alone rules that are set just for kids. When I worked as a pediatric therapist, I spent a lot of rather expensive time just writing clinical justifications for continuing treatment of kids with congenital problems. That jacks up the costs of treatment by a lot all by itself, and for some stupid reason, just about every insurer applies Medicare/Medicaid rules to their own coverage... The system is built stupid by people who do not have any real knowledge of what health care services really entail, and so it is inherently inefficient and thus inhrently overly expensive.

[ebuddy]

Originally Posted by besson3c 

How would you propose creating a safety net that provided medical care to poor people and paying for it then, if not "forcing it on the whole citizenry"?

Establish and partially subsidize means-tested health savings accounts that can be rolled over the next plan-year, encouraging one to be a steward over their own allotments and expenditures.

[ebuddy]

Originally Posted by ghporter 

One problem with US healthcare costs that doesn't seem to get enough notice is the cost of covering the uninsured. Part of the $8,000 each my wife and I pay goes to pay for the health care costs generated by people who are either not employed enough to get some sort of basic covage or who receive too much in assistance to qualify for free (Medicare) coverage. While that might just sound like a redistribution of the costs (employed people paying more to cover unemployed people), it isn't. Instead, the way most uninsured people get treatment is by visiting an emergency room, where they must be seen regardless of ability to pay.

You mean illegal immigrants? My wife, child, and I started off on Medicare and not once did we visit an emergency room for anything other than emergency situations. If you don't have health insurance in this country, it is because you either don't want it or you're not trying to get it. If we placed half as much into an HSA as we do on eating out and entertainment on an annual basis, we wouldn't be having these discussions. Everyone knows welfare is for the middle class.

[Athens]

Hospital visits are a problem here too, mostly because of shortages in clinics that operate after hours or on weekends. Even I have had to go to the ER a few times in my life due to issues that couldn't wait.

Simple solution to this is to operate 24/7 clinics at hospitals that ERs can refer non emergency patients to. Dunno why its not done.