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Post by nomad943 on Oct 4, 2007 6:16:47 GMT -6
I couldnt find any comments on Bush's veto of the childrens health care thingie .... I was wondering if I was the only one out here who was applauding this veto ... I mean, why would I be interested in paying for healthcare for famlies making 82K$? Anyone else feel this way, like what a treat we are in for next year once the spending ball begins?
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Post by graybeard on Oct 4, 2007 7:37:07 GMT -6
Uh, "spending ball"? Dems are labeled "Tax and Spend." Repubs Borrow and Spend LOTS MORE. Darth and the other idiots say deficits don't matter. Try that with your personal budget. The last balanced federal budget was under Clinton, sorry to say. Our national debt will hit $1 Trillion before Bu$h is impeached.
$82K in family wages does not assure against bankruptcy from medical bills. My wife's 11 days in hosp. this year, with no surgery, was well over $50K. Sure glad to have health insurance. Yes, the whole industry needs an overhaul, and this childcare thing is better than what we have now. Note: I do not have children or grandchildren who would be eligible for this. Just like education, good healthcare is good for America.
See the other comments on healthcare.
GB
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Post by nomad943 on Oct 4, 2007 8:55:25 GMT -6
I guess it was the source of funding that set me off. I live in a blue state and I also smoke. As such I have become accustomed to being the punching bag for every leftist need. I routinly shell out 5 bucks for a pack of butts that is actualy worth about 80 cents. Okay, so once again others get to choose what I want. Whoo-hoo. I am alergic to any program that selectivly provides benifit to some group while also ALSO selectivly finding another group to bear the burdon. If health care is good, than all should have it and all should shoulder the burdon. This, "lets find a minority and stick it to them" stuff gets real flipping tired. Why not tax fat people? I would be happy to submit my body fat index every year with my w2 and pay the appropriate surtax ... what do you think? Nah ... that would be mean spirited, lets focus on smokers, cell phone users, inner city drivers ... name your group as long as its not me ... see I can think like a liberal too.
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Post by nomad943 on Oct 4, 2007 9:15:54 GMT -6
I also have to call you on your statement that the last balanced budget was Clintons ... sorry to inform you dude, but that one was debunked. It really got me angry when I found out how he got away with the LIE ... Havent you been clued in to the story yet? I actualy got it from a democratic debate, not some neocon talking point, Mike Gravel spilled the beans ... Clinton had them move the social security liabilities off the books so they wouldnt count against the proceeds they kept on registering ....Check it out yourslef, pretty freaking classless to then go on bragging about the "accomplishment". I know what the meaning of IS IS and I also know the smell of BS and I am so pissed that I spent years repeating his lie on the balanced budget thing .... GRRRR <seething>
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Post by liberalcapitalist on Oct 4, 2007 15:15:50 GMT -6
I couldnt find any comments on Bush's veto of the childrens health care thingie .... I was wondering if I was the only one out here who was applauding this veto ... I mean, why would I be interested in paying for healthcare for famlies making 82K$? Anyone else feel this way, like what a treat we are in for next year once the spending ball begins? Only Kool-aid drinking right wing whackos are applauding this veto. welcome to the site.
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Post by nomad943 on Oct 4, 2007 16:07:58 GMT -6
"Only Kool-aid drinking right wing whackos are applauding this veto."
Thanks for the welcome but ... There ya go with the name calling ... Hate to be the one to tell you but; you be wrong. The left whines over this and the right may applaud but its everyone in the middle that the DNC neglected to look at with this and other recent ploys (5000 bucks for native born babies was nice and while your at it lets get them borders opened up wide so we can get us a new crop of breeders). Last I checked smokers still represent 30-35% of the population and if you haven't noticed the Dem's just declared war upon them personally ... all in the name of saving little Jenny (from having her comfortably paid parents having to foot the bill for her system clogging checkup for that nagging semi weekly sneeze) just like in the Christian Children's Fund ad campaign that bores to tears ... Maybe there is some hope for continued gridlock after all ... the past 2 years has been preferable to a 4 year super Dem majority being rammed down our throats visa the war they also voted for, and damn it waswas starting to look like a lock until the recent run of showing their cards all so early. ).
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Post by proletariat on Oct 4, 2007 17:30:00 GMT -6
I am glad it was vetoed. Cigarette taxes are regressive, so I find it difficult to support such a measure. There are much more progressive ways to fund such a program.
The veto is a big win for the Dems if they use it wisely. I do not have much confidence they will.
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Post by graybeard on Oct 4, 2007 21:06:07 GMT -6
Tobacco taxes are Great; same would go for big taxes on booze, sugar and animal fats. Those are important, avoidable causes of health problems and their cost to other taxpayers.
Laws for bicycle and motorcycle helmets are not to protect people from themselves, but to protect us taxpayers from the horrible costs of tramautic brain injuries, probably most of which are paid by Medicaid. Just last year, the adult son of a friend of mine was thrown off a hopped up ATV at about 80mph after a few beers, and laid in coma for 3 months before they pulled the plug. Per a 1942 law, insurance is not allowed to cover the costs when booze is involved, so the hospital - and taxpayers got stuck for $1.4 Million.
Wanna' smoke? Keep the smoke to yourself, and with luck you won't live long enough to be on Medicare or Medicaid, and a drain on the public trough.
GB
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Post by nomad943 on Oct 5, 2007 6:53:33 GMT -6
Graybeard; Well, you certainly have been candid. Allow me to be the same. My thoughts on healthcare costs in general, where we go wrong. I think what we miss in general is ... people die. It happens, it will happen and no amount of money will alter that fact. How many perfectly healthy people live impecible lives only to grow old and in their final months proceed to sucumb to the system that spends millions in some futile effort to prevent the inevirable? Everyone I know. Thats who, everyone (unless your lucky enough to get hit by a bus) .Smoke drink or live like a monk ... very few people are lucky enough to just exit. Everyone will check into a hospital one day and run up a huge bill. Everyone. Thats what we need to think about. Its how we live that matters. Not wether we can avoid dying.
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Post by blueneck on Oct 6, 2007 14:04:51 GMT -6
There is a difference, however subtle, between a sin tax like that on tobacco and liquor ( and some say should be on pot too) and regressive taxation. we have to be careful to differentiate the two.
Smoking and drinking cause all sort of ills in our society, from health problems to spousal abuse and other societal problems of addiction. As such a smoker puts more of a drain on the health system and adds to its costs than a non smoker typically would - I have no problem taxing smokers and drinkers as an offset to the damage they cause to their own health and societies health. Perhaps if the economic incentive gets high enough smokers will finally stop with their "little white slavers".
Again - a sin tax is taxing something done by the choice of the user - they can opt out of it by not buying the product (or seeking it on the black market) a true regressive tax is one that can not be avoided by lower wage earners either thru payroll deduction or other costs of necessities.
Back on topic - I think its criminal that children go without health care in what is supposedly the wealthiest nation in the world and the one with the highest health care costs in the world too. Last time I checked a family of 4 earning $80k a year isn't exactly living "high on the hog" and if you are in a high living cost region that $80k sure doesn't go far at all.
But someone enlighten me on where this 80k the wingnuts keep throwing around is coming from? from what I understand this wage cap or whatever you want to call it isn't even mentioned in the legislation? The funny thing is that Schip is modeled on a system that Bush himself endorsed when he was governor of TX, and one that is currently supported by a majority of republican governors.
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Post by blueneck on Oct 6, 2007 15:12:38 GMT -6
Being a former smoker, we are always the worst anti smoking Nazis there are.
What convinced me to stop was sitting down and looking at what this nasty habit was costing me - 100 bucks a month 1200 a year!
pretty strong incentive to stop
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Post by nomad943 on Oct 6, 2007 15:30:26 GMT -6
BlueNeck; A former smoker huh? Howdy. I've been there, done that and I am familiar with other "zeolots" as you described yourself. Never been that myself, never felt particularly pious based on whether or not I had a pack of 'bros in my sleeve. I've smoked off and on for 30-40 years ... quit sometimes for years and then start up again at some point when I want to, and thats it ... when I want to. I have never felt any particular effect from smoking except the cash drain you mention, I stay physicaly active so maybe thats the offset, but if I enjoy something I choose the when and how. Thats freedom and thats the problem here, someone else is choosing for me, snooping, nannying. All this crap about cost to society, hell us smokers are doing the company a favor. We check out a few years earlier on average, big freaking deal. I cant count the people I have known that have passed on due to the big C, good people paid their whole life into the system and didnt have to stick around to watch the side show life has become ... all these supposed "pro choicers" choosing for others this and that. Then spend a few extra golden years hooked up to bedpans and walkers in the semi weekly stays at the clinic assuming they get a furlough from time to time ... lets roll out a new series of tests, why not, heres the card to cover them .... Know what, I wont wear my seat belt either .. nya nya/ Live free or die man. We only get one go around on this earth and I wont spend my time on my knees. GO RON PAUL
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Post by blueneck on Oct 6, 2007 17:08:37 GMT -6
I prefer not to wear my seat belts either, or more correctly I prefer the government not telling me I have to - I wear it because its the right thing to do - That is a personal choice matter, just like smoking.
You admit that you smoke by choice - so again you pay the sin tax by choice - you also have th echoice to not smoke as well.
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Post by proletariat on Oct 6, 2007 19:02:22 GMT -6
Blueneck,
No, we don't have to be careful. All we have to look at which class is paying the blunt of the tax. First, we know that smoking tends to be concentrated on the lower economic classes. Second, even if it wasn't, the lower economic classes pay a greater proportion of their income on a carton of cigarettes. Its a regressive tax, sin or otherwise.
For the record I am an ex-smoker, and militant one to boot. This is not about smoking, taxing sins, but the Democrats relying on a regressive tax structure. Democrats say they want to turn back Bush's tax cuts but they never do. Every time I turn around they are using regressive taxing measure that disproportionately fall on the working class
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Post by blueneck on Oct 6, 2007 19:24:58 GMT -6
I hear ya, but I am not buying it. Smoking is a choice , I quit when it became a financial reality what it was costing me and the toll it was taking on my health. You have a choice to not pay the sin tax by stopping smoking, just like I did.
But I do agree, any talk of rolling back the Bush tax cuts by democrats has been just that, talk and no action. So yes there is some hypocrisy on the part of democrats who refuse to act on the tax cuts for the wealthy - they depend on the same special interest money that the other side does.
Taxes are the democrats abortion - they talk the talk to rally the troops but have no intentions of doing anything about it, just like the republicans on abortion
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Post by nomad943 on Oct 6, 2007 19:46:02 GMT -6
BlueNeck; Listen to yourself. I cant believe what I am reading. You say smoking is a personal choice. I'm with you on that. Then you go on and say that you quit because of the inhibitive cost (which is a direct result of the tax which government applies to it); A "sin" tax and thats okay because you can always avoid the tax by quiting smoking. There you go. You have just given up your right to choose by allowing the government the privilege of deciding for you what activities are sinful and merit penalty. Where did they get that right if smoking was a personal choice to begin with. Is what you do with your personal time your business or theirs. Who are they to comment? You didn't decide to quit, they decided for you. See the disconnect. You are not a free man, none of us are.
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Post by unlawflcombatnt on Oct 6, 2007 22:55:55 GMT -6
All we have to look at which class is paying the blunt of the tax. First, we know that smoking tends to be concentrated on the lower economic classes. Second, even if it wasn't, the lower economic classes pay a greater proportion of their income on a carton of cigarettes. Its a regressive tax, sin or otherwise. For the record I am an ex-smoker, and militant one to boot. This is not about smoking, taxing sins, but the Democrats relying on a regressive tax structure. Democrats say they want to turn back Bush's tax cuts but they never do. Every time I turn around they are using regressive taxing measure that disproportionately fall on the working class Proletariat, I have to agree with you here. I've never smoked and don't like being around it. Smoking does increase health problems. That being said, I strongly oppose any quasi-mandate by the government against smoking, or any other activities it considers unhealthy. Though smoking is unhealthy, the risk from other allegedly "unhealthy" habits is exaggerated in many cases. In many others, the increased risk is completely non-existent. I don't want the government substituting it's typically poor judgment for my own judgment--at least not when it comes to my own personal health matters. (They've certainly done a bang-up job protecting us from dangerous imports.) I don't want government taking away a person's freedom to make their own health choices. As an M.D., I probably know a little more about health than the average attorney-turned-politician. I believe I should be allowed to make my own choices regarding my own body. And I believe others should have that same freedom. From an economic standpoint, I fully agree that a cigarette tax is regressive. It takes a proportionately bigger bite out of the less affluent. I'm disappointed that the Democrats have done nothing but talk about rolling back Bush's tax cuts on the top 2%. Meanwhile, they're eager to impose a new tax that falls more heavily on the less affluent. This just exemplifies whose interests they're really serving--those of their rich campaign contributors. Instead of a "sin" tax, how about a a "luxury" tax? How about a tax that falls more heavily on those who can better afford it? Or maybe Democrats could just roll back Bush's reverse Robin Hood tax cuts-- like the said they would-- instead of just talking about it. Maybe Democrats could stop worrying about winning over pro-tax-cut Republicans and big Corporations, and worry about their rank-and-file instead. Maybe Dems could stop concerning themselves only with the interests of their big campaign contributors, and start worrying about the Democratic voters who elected them. I like the idea of expanding SCHIP. It would compete with private insurance--reducing demand for private insurance, and driving down prices as a result. There definitely needs to be a specific funding source before any expansion. But the taxes to fund it should come from those who can best afford it, not those who can least afford it. Though I've never smoked, I'm well aware of how difficult it is to quit. In medicine, smoking is acknowledged as one of the most addictive habits, if not the most addictive. Some consider smoking harder to quit than to heroin. I agree that we should discourage people from smoking. But I don't think we should crucify smokers. And I don't believe we should be trying to force them to quit. And I certainly don't think we should put another financial burden on those least able to afford it. Pay for SCHIP by rolling back Bush's tax cuts on the top 2%. Or, even better, eliminate the foreign income tax exclusion on income taxes. Better still, put high tariffs on foreign imports, especially on those from China. (My own favorite)
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Post by proletariat on Oct 7, 2007 5:52:44 GMT -6
And it doesn't even follow the logic of a sin tax. Funding the health care program is dependent of smokers smoking more, and others joining them.
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Post by blueneck on Oct 7, 2007 6:38:23 GMT -6
Well it looks like we will all have to agree to disagree on this one.
I have run over my response many times. My logic is sound, nomad. You however make a jump to a conclusion that is a non-sequitor.
I see no problems with sin taxes - gambling, alcohol, tobacco alls should be taxed. these are all done by choice - you choose to participate or not.
Maybe this is just the ticket to get folks to stop wasting their money on tobacco and the subsequent health care costs that tobacco use will cause
I hear that some people have dificulty quitting. I guess I was lucky as when I made the decision - I just stopped and that was that. It was rough for the first several days but I got over it. My health and my wallet have thanked me for it ever since. A little will power and substitute activities and avoidence of social situations that encourage smoking all helped.
I think we can all agree that democrats are all talk when it comes to rolling back tax cuts for the wealthy.
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Post by nomad943 on Oct 7, 2007 6:58:58 GMT -6
BlueNeck; The entire sin tax topic makes me livid. Thats what set me off so badly with this piece of legislation, the mix of a needed health care reform with the same tired rhetoric and whipping boys. When it comes to addictive behaviors the government has grown into the biggest addict of all. It is addicted to cashing in on the actions of others ... and it doesn't add up, none of it ever does, so they wash it over with feel good rhetoric and somehow we are supposed to bite. Do the math ... The federal govt rakes in about 7 billion a year with its current 39 cent excise tax on smokes. They want to raise that 60 cents to buck ... at best if all else remains equal that would pull in 10 billion. With that 10 billion they will fund a 30 billion expansion? Ummmm ... whats the rest of the story that they dont tell us? Here's another tidbit that doesn't make the news. State governments are also balanced on the sin tax idea. The superfund settlement that the big tobacco companies are paying out ... remember that one, well, last year the court lowered the mandated payments because big tobacco had lost so much market share it could no longer pay ... less revenue for the states. So how do they react ... CASINOS on every corner ... great idea? If you think gambling doesn't damage society maybe, but who is the biggest PUSHER already ... thats right, the government. The only competitor to the casinos is the lottery... get it. they take from one hand to give to the other but the total just gets smaller. When we need innovative thinking we get Shillary and the same old song. It doesn't add up/
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Post by blueneck on Oct 7, 2007 7:39:50 GMT -6
I see no pint in further beating this horse- I've made it pretty clear where I stand on this matter and my mind will not be changing.
Lets get back to the original topic though. The hypocrisy arrow is pointing more towards the right than the left on this matter
Isn't funny how Bush rubber stamped every spending bill for his republican colleagues like bridges to nowhere and all kinds of cockamamy pet projects.
Now he is vetoing a health care plan for children?? And one that was based on a program he championed while governor of TX? One that the majority of republican governors endorse? Indiana for example is held up as having one of the most successful SCHIP programs in the country - championed by Republican governor and former Bush crony Mitch Daniels and financed partially by cigarette taxes to boot.
The way I see it is Bushes attempts at cutting the budget now are a day late and a dollar short, and certainly with all kinds of f-ed up priorities, cutting health care for low income kids is down right despicable.
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Post by nomad943 on Oct 7, 2007 8:27:34 GMT -6
Apples ... Oranges .... I wont discuss the man (dubyah) as a subject with any personal redeeming qualities either. Even a broken clock is right twice a day and IMO this is the first time I can recall agreeing with him on any action although I have no idea why this time is different. Coincidence maybe. But lets look at even this last statement of yours and see how its wrapped up in the standard misinformation
Health care for low income kids .... low income kids ... low income ... What to you is low income and who are kids?... is this bill extending coverage to folks in the 80K range or isn't it? ... are there actually adults enrolled in it or not. Noone argues with the extension of the existing program. If it is allowed to expire it will be solely because the Dem led congress did not submit the legislation to extend it. Instead they chose, at the risk of the aforementioned kids, to again make a calculated political gamble for political gain. We know where Hillary is trying to push us, is this the test balloon or isn't it and if it is than why not just state the actual case instead of repeating the "for the poor children" rhetoric which is what it is, nothing more and nothing less.
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Post by nomad943 on Oct 7, 2007 9:26:26 GMT -6
This is an open challenge to the left ... Here is the best analysis I have found so far of the proposed "stalemate". www.nationalcenter.org/NPA560.htmlI am aware of the nature of this articles source and I am open to considering other viewpoints. If anyone is aware of a detailed democratic analysis could they please link it. Does anyone still have access to democratic blogs (not yet banned for thinking for themselves) ? That might be the place to seek such analisis. Unfortunatly all I can find are tear jerker videos and my ability to question has been long since been silenced in those spheres.
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Post by Bluestocking on Oct 7, 2007 17:09:53 GMT -6
My understanding is that originally Congress wanted to remove the overpayments to Medicare Advantage (private) plans along with some other cost saving measures to Medicare to help fund the expansion of SCHIP. www.cbpp.org/5-10-07health.htmWhen private plans were added to Medicare it was to reduce cost and be more efficient. MedPAC and CBO have found that Medicare Advantage (private) plans are paid on average 12% (I've also seen up to 19%) more than covering the same beneficiary through traditional Medicare. These overpayments amount to about $1,000 per enrollee and total about $54 billion over 5 years and $149 billion over 10 years. So do we give that money to insurance industry or children? The Republican ideology is that private markets hold down costs and if that is so, why do they need overpayments? I've also seen reports of abuse (surprise) by private plans through Medicare. www.truthout.org/docs_2006/100707G.shtml. Shows the true nature of private plans. Insurance is about profits not about health. Anyway, when this plan to remove overpayments was before congress the Republicans filibustered, so it failed. Shows you who they want to protect. They came up with this bipartisan bill for $35 billion funded by cigarette tax which I agree affects more low income. Also, SChip is a ten year program where the states set up the criteria and mostly PRIVATE PLANS provide the service. So government is payor not provider. It is not government doctors but private doctors who provide care. This website, www.cbpp.org/pubs/recent.html, I have been following since researching Medicare part D for my mother, another private industry giveaway. These overpayments and part D draw down the trust fund faster making it seem that Medicare is the problem when it is these other high cost. If you scroll through you will find other interesting articles. I think it is a good site so I would be interested in what you think.
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Post by nomad943 on Oct 7, 2007 18:50:06 GMT -6
BlueStocking; Thanks for the linkage. Lots of info on there that I am just starting to plow through but it is making for some good reading so far.
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Post by unlawflcombatnt on Oct 7, 2007 19:06:09 GMT -6
Nomad,
Thanks for posting the article link. I'm going to address it by reviewing some of the points from the conclusion.
"CONCLUSION On its face, it is difficult to understand why the political left would support this expansion of SCHIP. First, the expansion does not focus on low-income children, but rather extends benefits to those clearly in the middle class and a few in the upper class.
Second, the expansion is funded by imposing taxes on the lower class. In short, SCHIP expansion results in the lower class paying for benefits of the middle and upper class—something that the political left should adamantly oppose...."
This is a valid point. I completely agree.
"The primary concern has been achieving a universal, government-run system...."
The "government-run" assertion is not entirely true.
A comparison with "government-run" Medicare is in order here. Yes, Medicare is funded and administered by the government. Yes, reimbursements for specific "units" of care are are controlled by the government. In fact, physician reimbursement for participating providers is 100% controlled by the government. (This means Medicare does impose price controls. More specifically, for a given geographical area, participating providers are paid exactly the same amount by Medicare for the same service. Medicare pays 80% of the allowed amount, patients are billed for the remaining 20%. Providers can balance bill patients only for that fixed amount--the 20% of the allowable amount not paid by Medicare. And they cannot bill for more. In fact, it is AGAINST THE LAW for a participating provider to balance bill patients more than the allowed 20%. Balance billing patients for more can result in disbarment from Medicare. It can further result in criminal prosecution. Conviction can result in a fine, or even a prison sentence.)
Utilization, however, is not under the exclusive control of the government. Medicare utilization is controlled more by doctors and patients, than it is with private insurance. Thus, with "government-run" Medicare, patients and physicians have more control. Though Medicare utilization has limits, it's still controlled more by physicians--and less by non-medical administrators. And utilization limits are consistent across the board, and not subject to the arbitrary denials of private insurers.
In addition, Medicare enrollment is not controlled by Corporate management, administrators, or investors. Medicare enrollment is not affected by profit motive. It's determined by anticipated medical need, not by anticipated profitability. It's determined by age, which is a rough predictor of future need. Enrollment is also extended to the disabled, because such disability prevents them from getting private insurance. (Employment and/or income are needed to obtain private insurance.) In general, Medicare enrollment is determined by anticipated medical need, not by anticipated cost or profitability. Medicare does not deny enrollment for pre-existing conditions, nor does it deny treatment for pre-existing conditions.
Medicare's driving force is to provide medical care, not to provide profits for management and investors.
In contrast, the driving force behind private insurance is profits. Exclusively. Since insurance companies' gross revenue comes from fixed premiums (and fixed gross revenue per enrollee), the ONLY way to increase profits is to reduce pay-outs. Since providing more medical care increases pay-outs, insurer motivation is ALWAYS to provide less care. Increasing premiums increases gross revenue. Increasing enrollment increases gross revenue. Reducing payouts for medical care increases net revenue and profits. Therefore, reducing the amount of medical care provided also improves the bottom line.
Private medical care results in an incentive that is counter-productive to providing medical care. It rewards those who deny the most medical care, and it penalizes those who authorize the most. Providing medical care reduces profits. Denying medical care increases profits.
Though universal government-funded care is much demonized, it has the advantage of not rewarding stockholders or Corporate management for providing less care. It removes the incentive to deny medical care, replacing it with the incentive to provide it. Though no one likes to admit this, it also removes the incentive to let the sickest patients to die. (Since they're the most expensive.) Universal government-funded care also removes the incentive to dis-enroll the sickest patients.
A potential drawback is that the system might be overutilized by patients and doctors. This "problem", however, is greatly exaggerated. Medicare utilization guidelines greatly reduce this problem. Medicare denies payment for care when it's considered unnecessary. In addition, Medicare enthusiastically prosecutes health care professionals, if the care provided was considered excessive or unnecessary. Such prosecutions are very-well publicized. Even the formal ACCUSATION (or indictment) is well-publicized. A deputy DA, filing a Medicare-related indictment, will report it to all local newspapers. In fact, the prosecuting DA will voice their own opinion about the charges, liberally using words such as "egregious". State medical boards will also list a still-unsubstantiated indictment on their web site. Just the unproven accusation from the indictment bans a health care professional from Medicaid/Med-Cal programs. (I know this from personal experience.)
Such action serves as a warning-shot fired over the heads of Medicare providers. It sends a clear message to Medicare providers. Over-utilize and you WILL be prosecuted--and to the fullest extent of the law. You may even go to prison. (This is not an idle threat. A number of health care providers have gone to prison for fraud convictions.) If we even suspect you're over-utilizing, we'll indict you. And we'll report the indictment to every local news outlet, the state medical board, and anyone else who'll listen. And you'll have to pay an attorney anywhere from $30,000 - $60,000 to defend yourself. As such, "over-utilization" of a government-funded system is a relatively small.
The free market does NOT work when a private 3rd-party payor is involved. When incoming gross revenue is fixed, profitability increases only from less pay-outs, and decreases with more. The monetary incentive to enroll patients, as well as to provide care, is backwards. The incentive encourages providing less care to members, and excluding new members who need the most medical care. The most "profitable" customers are those needing the least medical care, since they cost the least. In an insurance company's perfect world, they'd enroll only people who'd never use their health insurance, while excluding those who would.
Our health care system is broken when the only incentive is to provide less care. It is broken when utilization is controlled mainly by Corporate management, instead of by physicians and patients.
The "free market" does work best in most areas--but not in all. In some, the "free market" works poorly. In some, it doesn't work at all. In some cases it provides inferior goods and services, and at higher prices. Even the most libertarian-minded people acknowledge this.
There are some noteworthy examples where free markets work poorly, or not at all. The military is one such example. The military cannot be under private control, and cannot be subject to the "free market." Police and fire departments cannot be under private control, and would function worse on the free market. K12 education cannot be left exclusively to the free market.
When the free market profit-incentive of an industry provides worse results than government control of the industry, government control is justified. In selected cases, government control of even part of the market is beneficial. In some cases, the government can provide a better service for that part of the market--the part not well-served by the private "free market." As with education, better medical care would result from government control of even part of the market. The government-controlled portion would compete with the private portion for market share. A lower-priced competitor puts downward price pressure on the private market. It encourages private market competitors to lower prices, provide more service, provide better service, or any combination of the 3.
Private-insurance healthcare has only 1 incentive--to spend less on medical care. This means providing less medical care. Per-enrollee profits are determined by how much medical care is not provided, and how much is not paid for. The incentive is to enroll those needing medical the least, and to provide the least possible medical care to enrollees. The incentive is to discourage enrollees needing medical care the most, and disenroll them when possible.
"Providing near universal coverage for children, and funding it via cigarette taxes, is a big step toward achieving that goal.... Anyone who opposes providing coverage for children can be attacked as heartless and cruel. Cigarette taxes are one of the few types of taxes that the public will not oppose. Indeed, anyone who opposes cigarette taxes can be attacked as being “pro tobacco.”..."
I agree that a cigarette tax is not the best wasy to fund this.
"The thinking of the political left seems to be that if government covers enough children of enough people high up the income ladder, then eventually enough of the public will be supportive of extending such government insurance to everyone."
Yes, and that's exactly what we need. We need a "government-run" plan to compete with private insurance. And if a private insurer can't provide better or less expensive care for enrollees, it will go under. To which I can only say: Good riddance.
"Given how poorly universal, government-run health care systems work in many other nations, such a system is not the route the United States should travel."
Wrong comparison.
A better comparison is with our own government-run Medicare. Medicare stands up quite well to private insurance, and costs enrollees much less. According to CMS, Medicare Part B costs an average of $4,300 per year per enrollee. And these are much older and sicker patients than private insurance covers. How many private insurers cost less? How many cost less to cover the sickest and oldest patients that Medicare covers? How much less would Medicare cost to cover younger and less sick patients, like the cherry-picked enrollees of private insurance plans?
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Post by Bluestocking on Oct 7, 2007 20:19:36 GMT -6
Another reason I think private insurance doesn't work as well as Medicare is because private insurance fragments the risk pool raising costs. To keep costs down you need to have a large risk pool spreading the cost for sicker recipients over a larger pool of people.
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Post by graybeard on Oct 7, 2007 20:36:33 GMT -6
Excellent, UC; thanks. It has improved my understanding of the whole situation. One more question: how does Medicaid fit in?
If Al Gore, our real President had been in charge these last 7 years, we would probably have universal care now, a la Medicare, instead of that ripoff part D, drug insurance. Everyone in the large minority who voted for BU$H should be ashamed.
BTW, I lost a friend last year to stomach cancer. Kaiser would not see him to start treatments until it was too late. He drank lots of diet pepsi, FWIW.
GB
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Post by unlawflcombatnt on Oct 8, 2007 4:35:48 GMT -6
Excellent, UC; thanks. It has improved my understanding of the whole situation. One more question: how does Medicaid fit in? I know less about Medicaid (Medi-Cal in California) than I do about Medicare. I do know, however, that Medi-Cal pays very little for office visits-- somewhere on the order of $8/visit. Medical is only profitable for hospital procedures and surgery, and for HMOs that are paid a monthly rate for each Medical patient that have. In the middle 90's, the HMO I worked for was paid $70/month per Medical patient. If the patient never received medical care, the HMO was still paid $70/month. The HMO made money by enrolling Medical patients, and lost money when they had to pay for medical care. Most physicians, like myself, were on salary. Thus, most payouts to physicians were fixed. The only increase in physician payouts came when patients were referred to outside specialists. The HMO controls which specialists it allows. Needless to say, the HMO contracted with the least expensive specialists. The least expensive specialists were those who performed the least procedures. The least expensive surgeons were those who did the least surgery. The ideal HMO surgeon was one who never recommended surgery, never performed surgery, and never had to paid for doing surgery. The above may sound sarcastic, but it really isn't. For example, patients with back pain from herniated lumbar disks were referred only to Neurosurgeons, and never to Orthopedic surgeons. There is a specific reason for this. Neurosurgeons rarely perform surgery for centralized, non-radiating back pain--because no nerve injury is involved. They usually restrict their surgery to herniated disks that cause sciatica and radiating pain, as this indicates nerve injury. In contrast, Orthopedic surgeons frequently operate on herniated disks causing only back pain, without sciatica or radiculopathy. They will operate for intractable back pain from disk herniation, even without suggestion of nerve injury. Obviously this results in more back surgery being performed by an Orthopedic surgeon than by a Neurosurgeon. So an HMO, by contracting only with Neurosurgeons for treatment of back pain, reduce the number of back surgeries is performed. And the pay-outs for back surgeries are reduced as well. I have more than just an academic interest here. I had a back injury while working for the HMO. I ruptured a lumbar disk during my time of employment. It caused intractable back pain, but little apparent nerve injury. I was referred to the HMO's back pain consultants--all Neurosurgeons--who categorically refused to do surgery. No nerve injury = no surgery. Fortunately, I had signed up for AMA health insurance in addition to my worthless HMO insurance. When my waiting period was over, I went to see an orthopedic surgeon. (A surgeon, by the way, that had previously been on the HMO's provider list, but had recently been dropped). His recommendation was spinal fusion surgery. I had the surgery and the back pain was resolved. The HMO would never have authorized the surgery. My experience with a Medi-Cal HMO was an eye-opener. Profit motive always trumped medical care. Good medical care does not increase profits. Cheap medical care does. More medical care reduces profits. Less medical care increases them. Every denial of care reduces costs, as well as increasing profits. Any system involving patient payment of a fixed premium, or government payment of a capitated rate, results in an incentive to provide less care. And if the government pays a private insurance company to provide medical care, how does that differ from a "government-run" system? If differs only in that the profits are "privatized", while the costs are "socialized". Which is the worst combination of both. Private insurance doesn't reduce costs. It reduces only the insurer's costs. The cost paid by patients and taxpayers is not reduced. Insurance companies only reduce costs when it increases profits, and never when it reduces them. As a result, they provide no savings for enrollees or government payors. Because reducing those costs reduces profits.
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Post by nomad943 on Oct 8, 2007 9:15:10 GMT -6
Whoa ... now we are getting someplace, some really good food for thought here. It always amazes me that when I choose to look into any single topic, just how much related to that topic that I know absolutely zippo about. And I am of a naturally curious nature so what would that say about Joe publics grasp on the overall situation? Hmmm .. Sound bites and propaganda we get plenty of, actual info is rationed or absent entirely. One would hope that if we as a nation are embarking on the exercise of entirely rewriting health care coverage on a societal scale, people will demand to know the facts about what is being proposed and not be led along by the nose in one or the other directions. I look forward to viewing the debate but I am skeptical as to whether or not I will see one. Back to the Schip issue, the nugget being toyed with at present ... wow, I didn't realize that they actually had their hands on a rational solution with the overpayment approach. It sounds like the homework was done and the solution presented itself but it was then abandoned to pursue this confrontation touting this BAD bill. Its a lot like the immigration debate ... politicos will advance a bill that no one likes and convince us it is better than doing nothing. Why don't they fight for the real thing instead? And isn't doing nothing better than making things worse? Thats where I get lost. UC; I have to really think on the concept of how a TRULY free market would function with regards to health coverage. My understanding of the philosophy is that it is theoretical only, but if applied in measured doses it is sometimes quite an effective tool in fighting what ails us. Also, I see touted quite regularly on leftist blogs a concept called "single payer" health care systems as in contrast to what we have now or what is being proposed. You seem to be knowledgeable on this subject, so excuse my french but ..... what the hell is that all about?
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