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Healthcare


By Barbara Gordon - Posted on 06 February 2008

How to counter accusations that Obama's plan is socialized medicine? The phrase "socialized medicine" is vague at best, which makes it harder to work with. Obama's plan is volutary, whereas Hillary's is not, but that's the best I can come up with. I was thinking Obama's plan is not much different from what Romney accomplished in Massachusetts, but I don't know for sure.

 

Thoughts?

All the "improvements" and "changes" sound great... In the long-run, we simply can't afford them.

Barbara, have you strongly considered this and its impact to the future generations?

http://youtube.com/watch?v=OS2fI2p9iVs 

Ric, my family has great insurance through my husbands job. HOWEVER, my dear friend, who is a 27 yr old woman who went back to school for her CPA and is working a job with no benefits that will work around her school schedule. SHE has some health issues, but is afraid to have things checked out for 2 reasons. First, she can't afford it. Second, if it is something, she will have a preexisting health condition that could affect her ability to get health insurance if things remain the status quo. YOU TELL ME RIC, what is she supposed to do? Seriously, I'd love an answer.  Maybe get pregnant so she can go on medicade? Then she can find out if she is seriously ill? I have always been conservative, but if that means leaving out people who get caught in the middle......that seems so sad!

Sandi,

Ric is coming from a different angle, one that renders individual stories and such irrelevant.

Ric's approach isn't about being fair or worrying about who is and isn't covered. That was never the point. The point is rather what the government is and is not authorized to provide, and what the government can and cannot afford. So stories like your friend's don't really provide an effective counterargument.

The central questions are

1. Can provisions related to health be justified as "promoting the general welfare"? If not, how else?

2. Even if they can be justified, can our government realistically cover the bill? 

-

Ric, I didn't see your post earlier. Yes, I'm aware of the problem. Let me pull my thoughts together and get back to you. I don't imagine I'll get very far, but you've raised a legitimate point and you deserve something of an answer.

 

 

That's a tough situation - serveral things come to mind:

1) Health coverage isn't something people have a right to get - just like a car and a house. I went without coverage for a while, and fortunately, I didn't have any health problems. It sounds like she should have opened an HSA or MSA in order to plan ahead.

2) We have to get to the root cause of why coverage is so expensive, not direct the gov't to give folks more money so they can afford it (as that will drive prices further up). We need to allow experienced nurses to take care of many of the common problems that doctors are required to deal with. That would speed up lines, drive prices down, and encourage people to get more checkups.

3) There are colleges that offer video outreach programs (they will mail her dvd/vcr lectures) so that she wouldn't have had to give up a better job in order to get a better education.

1) Health coverage isn't something people have a right to get - just like a car and a house.        That was the most profound thing you could have written. I could "chose" to have a car. I can even "chose" to have a house. But nobody "choses" to be ill. The older I get the more I cannot believe I have believed that somehow the ones who could afford to go to the doctor somehow deserved better care than those who could not. It really is tragic. My stomach is turning realizing that little children, because their parents have no money, don't get the care that my children get because we do. And thank GOD there are programs for the truly poor, but what about the parents who make OK money and then their child gets hit with Cancer. I realize RIC, you are protecting what you have built by your working hard, but what if something happened to you and you lost your job and all your planning ahead didn't matter, and then your child got cancer. Your community would do a BENEFIT to help you....isn't that what we are talking about? Just on a larger scale? You won't be convinced by what I am writing, but you know what....I just convinced myself. There is no way the level of care to another human being should be directly relative to the money they have and the insurance they carry. I think I just officially became a liberal.

Oh, and you do make a great point with number 2 and 3, so I will give you much credit for that.

You are right - you are a liberal.

Actually the poor are Covered, so are the rich

Its the working middle class that are completely screwed.If you work in or even own a small business chances you will not be able to afford coverage,certainly not good coverage. How much blame goes to Govt.meddling ,Insurance Companies. Trial lawyers.Greedy Hospitals/.doctors, Im not sure

 

This is correct. It's the lower middle class, the ones whose employers don't provide health insurance, that are left out of our current system.

Becoming ill can be a tragedy, just like getting in a car accident or home accident - just like being disabled. When should the gov't step in? I think they should if someone needs a hand up or if someone is disabled. I think medical care is separate all together - I think it's gotten out of hand.

You're right that you choose none of them, and as far as deserving better coverage for more money goes, that's true of our current system, but, expand your thinking a bit - what if medical care was fairly cheap (as now it can be very expensive)? Canadian perscription pills are much cheaper than those in the US. Gotta ask yourself, "why is that??" We should be making changes so that medical care is cheap so that we don't have children going without and so that we don't have higher taxes on the middle class (making it further affordable)! We also need to change birthright citizenship to be closer to Great Britain's system (at least one parent must be in the country legally) so that the 10-20 million illegal aliens don't get the currently expensive health care for free at the expense of everyone else. If we continue with our current system (with or without Obama), it's going to hurt the middle class the most, in my opinion. The reason I feel that way is because the gov't WILL get the money required in one way or another. Drug companies and HMO's know this and can easily lobby and justify raising prices, and the reason it'll hurt the middle class the most is due to our tax system; the current IRS system is a racket. The very wealthy have flexibility to exploit numerous loop-holes (such as owning large amounts of property which gets classified as unfarmed farmland thus obtaining thousands of dollars of tax credits for them, or they hide income in foreign banks or investments, or donate old, unwanted, yet expensive, items to shelters and write it off, etc.). 

I think you really get the best of both worlds (liberal and conservative) if you lean more towards conservative-libertarian - get our military out of Iraq, Japan, Korea, and other countries in Europe; we should be like Switzerland, armed to the teeth and always neutral unless we declare a defensive war. Let our troops work here, be with family here, and spend their money here in the US. We'd save billions on the military (you know we, the US, spend over $600 billion a year on the military? The next highest military spender spends $60 billion). Have a look at this chart too: http://www.warresisters.org/piechart.htm

We should abolish the IRS, reform/remove Dept of Education (as only 20-50 cents per dollar that passes through there actually makes it to the schools), reform/remove the Dept of Homeland Security (yes, the name sounds good, but know what they really do? Take a look and browse around their R&D):

http://www.engadget.com/2007/08/07/homeland-securitys-latest-non-lethal-weapon-the-pukelight/

http://www.engadget.com/search/?q=homeland+security 

IMO, we should also do something to limit medical lawsuits, so that every Tom, Dick and Harry cannot sue.  Stop lawyers from ADVERTISING for class action lawsuits due the side effects of a drug.  Sadly, things do go wrong in the practice of medicine, but most of the time, there is no true negligence.  That would be a starting place to lower health care costs.

It seems to me there should be a way to elimate all government medical aid, such as medicaid, and create a large pool using the insurance companies.  Those who are not insured at work, etc, are put into this pool, and the insurance companies have to take them, much like a group policy.  No added costs for pre-existing conditions, age, etc.  All companies would end up with a balance of healty young people, and the higher risk ones, just like group policies in the workplace.  The government could then help subsidize the premiums on an ability to pay basis.  I haven't thought this out completely, but it seems like a viable option, using resourses we already have.  The savings on the ill-run "charity" systems would go a long way towards paying for this, and the insurance business would not be hurt.   Just a thought......

I agree with Sandi that no one should do without health care, or get sub-standard care because they lack money.  In the early days of our nation, doctors were concerned with healing, more so than with money.  The often worked for a jar of honey or a chicken.  Our hospitals were run, often by religious organizations, for the care of the communities.  We have somehow worked ourselves to a point where medical care is just another business, with the all important  bottom line.  We need to find a way to take care of the people of our nation, so that none have to suffer and/or die due to a small bank account.

+

In comparing the 3 Healthcare plans (Clinton, McCain, and Obama), it appears that Senator Obama’s plan is the only one that does not use “tax credits” to fund the proposal. Even $4000 would not be enough to allow a self-employed individual and his family to purchase a plan.   Furthermore, it would encourage Insurance companies to further increase premiums and limit benefits. I am a physician in South Georgia, and I see the faces of the uninsured working class families, and the underinsured, whose premiums, deductibles, copays, and limitations siphon their savings.   More than 20% of my patients have no health insurance (most of them employed) I have little faith in the free market economy and the Insurance industry to help the majority of Americans, just as I have little faith in the one-payer Government model (Medicare and Medicaid are just as infuriating as private insurers). The Obama plan seems to be a happy medium.  If smaller employers and individuals have the means to provide coverage, either by purchasing insurance or by payroll tax, more capital will be available to the health care system (as less unreimbursed care is absorbed, and the costs passed on to cash or insurance paying customers will diminish). Also, the Federal government is the only power I believe that could bring some sense of sanity to the Insurance industry.   Deciphering a healthcare policy is harder that breaking the German Enigma codes of the Second World War. In reading the healthcare plans of the 3 candidates, I believe Senator Obama’s is the most concise and well written of the lot. If only the plan had addressed tort reform, and just who gets to pay for the introduction of electronic medical records…

 

You know, MKS, I was thinking the same thing about the electronic records. That's a great idea in theory, but who's going to subsidize the conversion? How is it going to be enforced? And what about the problems we've had in the past with electronic medical records being filed un-securely on overseas servers?

It's nice to have a doc's thoughts on the proposals. A lot of times we forget how these initiatives will impact the physicians themselves. I know docs who have abandoned their practices because it wasn't worth the insurance hassle and the liability risks anymore. I'm not holding my breath, but I do hope we improve the system soon.

Dear MKS of South Georgia-  Thank you for your insight, which as a doctor, brings an invaluable and credible perspective.  I was wondering what you think of this idea that has been floating around in my head:  Obviously hospitals are profitable entities these days.  Therefore, if the Federal govt owned hospitals and could turn a profit, why couldn't they use that profit to provide healthcare to the uninsured?  For example, it is my understanding that city or county hospitals already do that.  You thoughts will be appreciated.

EBC

Therefore, if the Federal govt owned hospitals and could turn a profit, why couldn't they use that profit to provide healthcare to the"

You an be sure the Govt will be guranteed to take anything making a profit and Screw it up completely!!! Look at the Post Office,Amtrak or anything they do.

 

 

Dr Mks

Could you please list all the reasons why the  Healthcare System is so out of control. I pay close to $1000  p m for individual coverage.Im a small business owner!

Whatever people choose to label social medicine, the undeniable fact of the matter is that healthcare is a birthrite. No matter where you are born, healthcare should be a communal thing, the cost absorbed by the community you are in (whether it be a city, state or country). Come on people, what would Jesus do, or in my belief the Buddha? It is a moral obligation to help your fellow mankind when they are in need. I know we all work hard to have nice things, but there are people who are needy beyond there control and we should band together to care for them. Jesus absolutely would give his last treasure to or his life to save one. Many people sacrificed money and wordly goods to help the poor for eons. They set an example to give to others. Do it for your faith, beliefs, or whatever motivates you.

We should stop squabbling about how to pay for it and just agree it is a birthrite as a world citizen. Once we agree that it is a fundamental right, then we will be able to come up with a way to pay for it. I am not going to BS anyone, I am not good with the math part, but I think drawing down our troops from Iraq to a minimal level, like Afghanistan would be a big start. I think we should not have gone in, but now that we are there we have a moral obligation to help them after we messed it up. Just draw down a large portion. How about we continue to require employers who are paying employees insurance to pay into a fund to pay for medical care for all? We subsidize the rest of the cost somehow. Or something. Let's just start helping helping the sick without destroying anymore families. It takes a community to raise a child the saying goes, so why not, it takes a community to help the sick?

Kepp up the good work.

cant Speak for Jesus,but hope he would smite ths Lawyers and HMOs

Wow... It's not a birthright!

Advocating that is advocating stealing something from someone (in this case a service) and giving it to others. Doing that is a violation of civil liberties.

"Once we agree that it is a fundamental right, then we will be able to come up with a way to pay for it."

Just insane; I still can't get over this statement - do you also think we ought to be like China and force people to become doctors if there aren't enough???

Ken
RepublicansForObama.org

I think Ric's concern is valid. It is critical that any healthcare system have mechanism in place to protect against fraud and punish those that abuse the system. Fiscal responsibility is a trademark of Republicans and any healthcare system must be "self sustaining". We cannot afford to send our nation further into debt and we must protect against a collapse caused by employers dropping health insurance coverage. I believe this is achievable, but it will take our best minds to figure it out, something Washington is very short of.

However, liberalfruitcake, is also correct in that healthcare for everyone should not be a privilege of the wealthy. When we factor in the costs of providing healthcare, we need to consider the social cost of not providing it. Such as the retiree that has scraped their entire life to retire and maintain their standard of living, only to see it evaporate due to a family illness. Or children that miss days of school or infect dozens of other children because their parents cannot afford to take them to a doctor for routine care. Or the millions of people that die in this country every year from treatable illness because they can't afford to go to the doctor or take prescriptions unless it's an emergency.

I'm not a fan of Michael Moore. I don't think he knows what the words "unbiased" or "documentary" truly mean. However, his latest movie Sicko does ask the right questions and provides valuable insight into how the rest of the world handles healthcare. We seriously have to question, if our healthcare system is so great, why is our health so poor compared to other western countries? Clearly we have the most "advanced" healthcare in the world, but what does that matter if we have the highest mortality rate due to untreated diabetes, or an infant mortality rate that rivals El Salvador? I think this question of "socialized medicine" will be critical in this election. Beware of those that use it to scare us into thinking universal healthcare is unachievable.

Lastly, it's 'birthright', not 'birthrite'. A rite is a ritual. While I don't agree with 'liberalfruitcake' on all points, open and respectful debate is what this site (not sight) and Barack Obama are all about.

What I've supported in previous posts is making health care truely affordable for everyone, not simply giving them enough money or insurance to afford it... gov't subsidizing helps in the short run, but typically increases consumer prices in the long run.

Medication here in the US, for example, is a lot more expensive than in Canada - increased gov't spending and more federal regulations will not fix that problem. It will, in the long run, only make US drugs, and therefore medical care overall, more expensive.

The fact is, that health is a basic human tenet, and it is written right into our laws. I haven't the right to do physical harm to you. Have you stopped and thought about why that is? As anyone who has ever been truly sick knows, that old saying "at least you have your health" is not just a trite observation. A sufficiently severe injury or illness is perhaps the single biggest obstacle to a pursuit of happiness that a human being can be presented with and, odds are, it's going to happen to all of us some point between when we're born and when we die. Hence, if health is a basic human tenet, we rely on our government to provide us with sufficient protection, just like any other inalienable human right. Also, you cannot tell me that you, yourself, do not benefit from those around you being healthy.

Now, to the issue about whether a free (that is, publically funded), single-payer, universal system can work in America. First, let's explore why our privatized, multi-payer system does NOT work by any reasonable standard of effectiveness or efficiency. Honestly, it was our boneheaded decision to privitize the system in the first place. In a health care system, the primary metric of value as far as the user is concerned is, of course, one's health. In a privatized system, the primary metric of value for those administering the health care is money. That's an instant dichotomy that is absolutely not going to work out in the users' favor. Whenever a company is put in a position to choose between money and . . . some other thing, money usually wins. As a matter of fact, that other thing usually only wins if someone shrewdly determines it will bring more money in later.

You see there's a myth out there that if you actually manage to get your hands on health care and if you can manage to pay for it . . . you're homefree. Absolutely, completely, and demonstrably untrue. According to the National Coalition on Health Care, a full 50% of individuals filing for bankruptcy did so stating medical costs as a major contributing factor. That probably doesn't surprise a lot of you. The figure that will surprise you is that 70% of those people had health insurance. Have you ever read your health insurance contract? Do you realize how thin the protection really is? When comparing the cost of services to the amount of protection offered to the amount of reasons they can get away with taking it away from you, expecting health insurance to protect you from a major medical emergency is like holding up a peice of gauze to defend against a Mack truck.

The reason for this is that, while technology, technique, and cost all skyrocketed in the past couple of decades, the system we have in place to pay for it all stayed the same. The administration costs are hefty and overly bloated. There is fraud. There is price gouging. There are many things at work to drive up health insurance rates at twice the cost of inflation and make overall health care costs for Americans the highest in the world, per capita (16% of GDP). One would think that if we are paying the most, we are getting the most. Yet we are currently ranked number 37 in the World Health Organization's list (just ahead of Slovenia and just behind Costa Rica).

So our system doesn't work. It's horribly broken. The fact is, there is not a single solitary industrialized, first-world country on the planet that doesn't have some form of universal health care - except us. Even Iraqis and Afghanis get universal health care on our dime. And yes, it can work in America. Why? Because these systems are built to be scalable, based on population and the amount of services required. It's an efficient algorithm that, while not perfect, works fairly well and grants a much higher quality of life and a more accessible pursuit of happiness. A good system will also invest heavily in free preventative medicine that will make for a much healthier populace, and the healthier the populace, the less money needs to be spent on keeping it healthy.

Really, socialized effort for the sick is something that we already do. If someone in the neighborhood gets sick and can't afford to take care of themselves, we all get together and help out. We cook meals, we donate time, we have fundraisers, we write letters, we drive them to the hospital, etc., etc. We need to take that game to the national level.

I do agree that it can't happen right away. There is too much organizational change that must happen and too much resistance to that. In particular, many people who work for health insurance companies would be out of a job and doctors would need to be convinced that they can live a perfectly healthy and luxurious lifestyle on a slightly more modest salary. This takes time and incremental steps to get there, and Obama definitely understands that.

I hope this clears up some of the myths regarding universal healthcare for some people.

References:

National Coalition on Health Care, World Health Organization Rankings, Wikipedia

"Really, socialized effort for the sick is something that we already do. If someone in the neighborhood gets sick and can't afford to take care of themselves, we all get together and help out. We cook meals, we donate time, we have fundraisers, we write letters, we drive them to the hospital, etc., etc. We need to take that game to the national level."

You're arguing my case. When we do things at a national level, though, only a small fraction of each dollar you and I send gets efficiently used, and you and I lose a little more freedom (either monitary freedom through giving up our money or freedom of choice)... The best algorithm here (you're speaking with a software engineer btw lol) is charity/nonprofit for those who can't afford it. You and I, then, have more money to help those in need, and we know that for every dollar we give to their cause, 100% will directly benefit them.  Take that into the long-run, and you see that more and more gov't and more and more redistributing money through taxes (which btw people PASSIONATELY try to pay less or avoid or are dishonest about; and some simply can't afford their taxes) and you see how more things need to be handled locally by us (because, "yes we can!") rather than giving that power to the gov't.

How a society views is sick, its weakest, and its less fortunate is a metric by which to judge that society.    I cannot argue that the provision of healthcare is an inalienable right, but I believe it to be the duty of society to make such a provision.

Perhaps if we look at an entirely economic view of healthcare, we can justify some hybrid of the private-socialized medicine concept.  (And I believe the insurance companies make many monetary donations to both sides of the aisle, so the dissolution of the private system is very unlikely).  I can think of 3 win-win situations that Senator Obama's plan may create.

In covering more people, through taxes and guaranteed coverage (but not mandatory), the overall risk is spread and costs will decrease (as physicians like myself and hospitals do not have to shift the cost of unreimbursed care to private insurances and cash-payeing consumers).   Hence, an individual, family, or business should have a decrease in costs with an increase in services.   Partner this with private medical savings accounts, perhaps we have a win-win situation.

I also believe our society (whose leaders reside inside the Beltway and in 50 state capitals) would like American business and workers to be competitive with China, the Far East, Central-South America, and the rest of the world.  If corporations and employers could reduce financial burdens and compete more effectively in the world economy, we have another win-win scenario.

Of course, more expansive (but not necessarily more expense) health care should result in healthier and happier (thus more productive workers) and would ease financial, emotional, a physical strains on the American people. 

As a professional cynic, I will admit that there is only one group I trust less than the government to help with my health care, and that is the Insurance Companies. 

As a side note, caring for the uninsured is a challenge.   With the epidemic of diabetes and hypertension, even the $4 drug lists of Walmart, Target, and Krogers is not enough (it certainly helps).  And the underinsured - those with supposedly good policies often have enormous co-pays, limited formularies, and high deductibles, along with staggering montly premiums.  

As for some Medicaid plans, many private physicians (I am employed in a Rural Health Clinic by a medium sized hospital system) dare not accept those patients because the paucity of reimbursement, mixed with the generally higher level of patient complexity, often does not cover the costs of the services provided.   I have reviewed acquisition costs of vacccines in the past for a previous practice, and Medicaid, Medicare, and Private Insurers reimursed our office less than the cost of the vaccine, not to mention the costs of administering the vaccine.

 The above was my long-winded way of saying that improved government supervision of privately managed insurance (with mandated clarity of policies, mandatory coverages, and consumer protections) would also create a win-win scenario.

Fortunately, I have 8 months to decide between Donkey and Elephant this year. 

In covering more people, through taxes and guaranteed coverage (but not mandatory),Will this be FULL Coverage? pre existing conditions,et all?

the overall risk is spread and costs will decrease (as physicians like myself and hospitals do not have to shift the cosT How ?will the same amount of money be spread over a greater Number? Will tort reform ,fraud reform and less bureaurocracy engender savings that can be funnelled directly to teh  doctor/patient.Will "Mandatory " insurance mandate the price of premiums?Deductables?Full Coverage? or just add 40 Million new customers to The Insurance Companies?  Can this be even acheived without more red tape and Govt Bungling,with more fraud and more waste and lowering standards??  Have youre dealings with Medicaid and Medicare given you any confidence this is doable???

 

I am a former republican, born and raised in Texas.  When I was in my 20's and early 30's I felt invincible.  I was not concerned in the least about health care.  Then I went for an assignment in Canada for 8 years.  I could go to the doctor any time I wanted AND my wife had a pre-existing condition from an earlier surgical mishap that occured a couple of years earlier in the good old U.S.A. 

That problem she had was just before I was going to become a small business owner in Tennessee.   Cobra had ran out and nobody would insure my wife for a price that we could afford.  Since she was in her early 30's, I didn't want to see her die because we could afford the best doctors, AND I didn't want to end up bankrupt because we couldn't afford our-of-pocket medical care. 

My wife had a surger done by a liver transplant surgeon in Canada that saved her life.  I was on work visa and was still eligeable for their health care.  It saved  her life.  It cost me parking meter fees to visit her in Toronto General hospital.

My dear fellow Americans and friends, health care should be a right, not a privelage.  It should be for every man, woman and child who is here in the U.S.A. legally.  To not have socialized medicine is crimes against humanity. 

For all of you pig-headed conservatives that disagree, well, I used to be just like you until my family was thrust into a situation where we could have faced financial ruin with one surgery, or worse, my wife could die because the best medical care was not available.  Yoú don't think about it until it happens to you.  The chances of it happening to you are greater than you think.

Obama, I pray to dear God that you can be successful in bringing socialized medicine to our country and get rid of these thieves called lobbyists, insurance companies and scores of people that make up the beurocracy that sucks the money out of the medical system.  AND put CAPS on mal-practice so that doctors can afford to be doctors on Government incomes.  That will put the malpractice lawyers out of business.  That's GREAT! 

Also, why are American drugs 1/5th the price everywhere in the world?  Take the corruption out of pharmacuticals.  Regulate it!!!!  They whine about needing money for research.  Don't worry, they have it without overcharging the hell out of us.

God Bless Obama!!!

 

 

Scott

Glad youre wife is well ,but my experieence with the B C System hasnt been all that rosy. My siter(a NUrse in Vancouver)herself had to wait for 8 Months to get a test to  see if she had ovarian cancer. She went to Seattle. Now she has to wait anther 8 mths to a year to get Surgery> there are only two surgeons in Vancouver doing that kind of procedure. Shes going to India!!

Really enjoying this thread (minus your wife's trouble with American doctors, Scott... but I'm glad Canada saved the day!)... Just a quick question for all of those arguing that healthcare is a "birthright" or a "duty" etc. If we're willing to concede that (which I may very well be), then don't we have to flip it around and also say that a person who eats well, exercises, and goes to regular check-ups has a "right", in a certain sense, to pay less into the pot than someone who eats fast food, smokes, and rarely exercises? I'm willing to admit that a certain baseline health care ought to be provided for all, but any system needs to in turn reward people who demonstrably take better care of themselves. Right? (I think this is essentially Ric's view about violating civil liberties... something along the lines of Nozick's argument for entitlement)... For example, gym memberships should become tax deductible... or better yet, simply impose a "saturated fat" tax which would increase the price of anything containing saturated fat or high-fructose corn syrup beyond a certain threshold to help defer the costs of the new system. It would discourage unhealthy eating in some and penalize in a targeted way those who choose to be a drain on the system. I agree that pre-existing conditions ought not be a barrier to health care, but we do, after all, as Obama himself has said, want a Health Care system, not a Disease Care system. So shouldn't there be mechanisms built in to encourage healthy behavior in the first place??

http://news.bbc.co.uk/2/hi/uk_news/england/4355981.stm

I agree with 90% of what's being said here...

The 10% I don't agree with is the mechanisms by which it's accomplished.

Socialism, here, is frowned upon... why?

If the gov't can do a great job of taking care of our sick and poor, why should it not take care of the well and well-off too? What makes a birthright a birthright?

Should we not allocate all our earnings and trust through taxes to the gov't (leaving individuals with no earnings) and thereby place everyone on gov't welfare? If we vote to take that step, is that an expression of freedom of choice or tyranny of the majority? If we did vote to give 100% of individual earnings to the gov't, the gov't would have a huge increase in funds. Food and shelter could then be a right, transportation and electricity too - along with anything (or nothing) else the gov't grants. Maybe, though, our individual earnings and property are a right, and maybe the gov't is encroaching upon this by taking from us through taxes.

My stance is that we do have a responsibility to the sick and poor, I'm just not sure why people want to force "morality" on everyone (implying we are not a great nation/society and need forcing), turn their backs and wash their hands of the sick and the poor and throw them under the gov't bus.

"Also, why are American drugs 1/5th the price everywhere in the world?  Take the corruption out of pharmacuticals.  Regulate it!!!!  They whine about needing money for research.  Don't worry, they have it without overcharging the hell out of us"

Lack of competition is your answer. Regulation will not simulate competition. Competition drives consumer prices down and in many cases drives quality up. Regulation/tariffs/taxes typically increase production costs which inhibit fair  or true competition and could then lead to necessary gov't subsidies to save the same companies - it's just better for everyone in the long-run when gov't stays out. 

Ric, personally, I think we should be ashamed that America is the only industrialized nation to fail to provide healthcare to all its citizens.

You once said we can't afford healthcare for all. That's baloney. We're America, arguably the wealthiest nation on earth. We can afford whatever the hell we want. We just have to pay for it.

Currently there's an invisible tax of over $1000 per household to cover the cost of writing off healthcare for the uninsured. That goes a long way toward covering the costs of universal healthcare. In addition, there are enormous costs to society due to the failure to provide care for the lower working class: lack of work productivity, reduced education, etc.

Americans spend significantly more on healthcare than any other country in the world, yet we rank near the bottom in every quantifiable measure of health and well being. That's unacceptible if we're to remain competitive in the real world.

I don't think we should socialize medicine (a system in which the hospitals and doctors are all owned by the government), but we do have to find a means to provide care for all. It's just that simple.

Sorry for constantly following your comments on various fora, Barbara; your comments are always thought provoking and I can rarely help sharing my thoughts.

What do you think of my suggestion to tax unhealthy behavior (see posts above and below)?  If we're agreed about the end (healthcare for the poor and needy) but simply at a loss as to the potential means (but generally averse to outright socialism), isn't a sin-tax on blatantly unhealthy behavior an equitable, market-based way to raise the money necessary to provide health care for all?  Help straighten me out on this one...

Yes yes yes. I meant to post on the McDonald's tax earlier. Great idea. See, one problem we have is that it's become more expensive to eat healthy foods than unhealthy. I have no idea how you'd tax unhealthy food alone, but it would be a great start.

I have an ultraconservative (and very wealthy) friend who has an aversion to subsidized health care. He says he would prefer to subsidized healthy lifestyle choices instead. Encouragement in that direction is certainly something many Americans need, though of course it's not a substitute for adequate health care. As you point out you could use the tax revenue to help toward the cost. Sorting out the costs of universal health coverage is a very complicated business, though. No one really knows how much it will cost us nor how much it will save us.

Ric

I agree with you  about Govt interference screwing everything up,but there has to be some solution. My premiums went up to $1000 (with higher deductibles and lower coveraga)and monthly cost of Drugs almost $ 800 after developing heart problems.I paid insurance premiums for 20 years without claiming anything.I own a home and am not eligble for any kind of assistance.

I think the drug companies  do not really compete but collude with each other to keep prices sky high.Their profit margin is almost double of the Oil Companies.

Socialized medicine is crappy ( and it is bad)but ill take  some coverage over nothing at all!!

Great comments as usual, Ric... just wanted to clarify, though... You're being sarcastic when you say this, right?

"If the gov't can do a great job of taking care of our sick and poor, why should it not take care of the well and well-off too?"

The answer, of course, is that the well and well-off are capable of taking care of themselves without gov't intervention. My post above tries to get at the crux of the argument: should poor people who have never been able to afford health care or those with preexisting conditions be held responsible for their current health situation? I'd say no. But, should those who have had access to health care their whole lives and still chosen to lead an unhealthy lifestyle, thereby becoming a drain on the system, bear some culbability for the enormous costs on our system? I'd like to think that an affirmative answer at least shouldn't be dismissed out of hand, right? And so, a system which would penalize those who choose to be unhealthy in order to support those who have little or no choice in the matter seems to be the optimal solution.

But these mechanisms would hardly be considered "socialist", would they? What I'm talking about is letting the market influence the outcome, at least to some extent...

And, for the record, although I'm gung-ho on Obama, what I'm describing hardly characterizes his plan. I mean, the guy can't be perfect...

And so, a system which would penalize those who choose to be unhealthy in order to support those who have little or no choice in the matter seems to be the optimal solution.

Very difficult to make that distinction,

Dont you know people who exercise diet and still struggle with their weight? Others who drink smoke,eat like pigs and have the devils luck?? Many alcoholics,adictive personalities  have genetically predispositions to their pathological behaviours!!

What about Cops,soldiers ,Firemen,Loggers those in risky professions?

I agree that it would be difficult, if not impossible to make distinctions.  My guess is that it would be like any other pool, such as group policies at work.  All accepted, and the costs to the insurer will average out between those that are at risk, and those that are very healthyand seldom use the coverage. Most people will fall somewhere in between.

Great point Charles... And I really dig your name, by the way. Just wanted to quickly respond; I just landed after 30 hours of flying and have to be on another flight in 8 hours, so I apologize if this is a bit incoherent.

I do indeed know that people who diet and exercise still struggle with their weight. The point is, under a system along the lines of the one I've suggested here, it wouldn't be the results that would be the rewarding / penalizing criterion, but rather the motivation. In other words, making gym memberships tax deductible for everyone, not simply the people who happen to respond well to the exercise. Similarly, taxing the heck out of obviously unhealthy foods (think Twinkies, Oreos, some fast food, soda, etc.), thereby rewarding those who make other choices (even if they might not see positive results); so, those whom, as you say, "eat like pigs and have the devil's luck" would still pay a proper pig's share...

So on all that I hope we're in perfect agreement, right?

As for the genetic disposition to eat foods with saturated fats or to not work out, you'll have to sell me a little harder before I buy it. I tend to think that most of our diets are socially and culturally determined, for the most part. In the same way that we've eliminated certain foods which have been found to be obviously harmful (i.e. anything from additive mercury to reduced levels of benzoic acid in preseveratives) through legislation, it seems that we might be able to at least temper the devastation that saturated fat and high fructose corn syrup visit on our health care system with the right balance of penalties and rewards...

 

http://news.bbc.co.uk/1/hi/health/958023.stm

Two Reasons

1)It wont work!!!Vendors will spread the Costs ie a Restaurant will Up the cost of a salad to cover the cheeseburger Tax.

2) A whole new layer of Beaurocrats(food police) Again Cost passed on to ALL Consumers.

3)Taxes collected will be swallowed by the Govt  and will not be used to do any good .The tobacco Settlements have been swallowed up by Trial Lawyersm and being used by State Govts for other purposes

4)Trial Lawyers will  go on a rampage!!!!Chefs will be sued for using 5 gms of butter ,rather than 3 like is said in the menu etc etc etc .Food outlets Insurance Liability will skyrocket.Many will close down,and guess who pays...Consumers!!

5) People will eat what tastes good!! Bottom line!! 

6) My Libertarian instincts revolt at the thought of surrendering one more freedom to the Govt. there will be no end!! the Vegetarians will insist ALL meat be taxed,the Vegan crowd will insist that Dairy be taxed,and the Raw food Nuts will say all cooked food is unheakthy and should be taxed!!! Aye Carramba!!!

 

This is probably the most thoughtful discussion of the healthcare problem I've been witness to in a very long time, and being a physician, I've been witness to many.  Very refreshing.  Many good points have been made here.  The problem is so complex that it's often difficult to know what to do or where to start, but, in my opinion, the most fundamental problem right now is the health insurance companies.  Remember, there's a difference between the cost of health care and the cost of health insurance.  Insurance companies increase premiums while they find every excuse to deny claims.  This is how they make all their money; they're in the middle keeping all of it.  There's no way that you will have this change as long as the health insurance companies remain beholden to their shareholders.  Their main goal is to maximize profits and there are only so many ways to do this - raise prices, minimize what they pay out and invest.  I think one of the answers is to make health insurance companies non-profit, but I won't pretend to know how you go about doing this.  Short of that, regulating them is necessary.  Heck, I'm regulated up the you-know-what as a physician, what's wrong with regulating a health insurance industry that's gone out of control?  Malpractice is another problem, but that seems to have mellowed out over the last couple of years.  Also important are preventive care, insuring all of the uninsured, promoting good health habits, the list goes on and on.  It's very complicated, but, although not perfect, I like Obama's plan because it's the only one that at least addresses all of these problems.  And, I really thinking making the purchase of insurance mandatory is a mistake because what will the penalty be for those who can't or won't buy it.

Dr Adl

I grew up in an Asian Country where there was no Insurance at all .

if you were sick you went to the Doctor ,paid out of pocket and even lower middle class people could comfortably afford this service.The quality of treatment was nowhere as good as here ,and Doctors/Nurses were not Rich,but it seemed to work.No one was bankrupted by falling sick!

 

ADL, Thank you for your insight.

With a profoundly handicapped son, I'm a consumer of more healthcare than I'd probably like. It wasn't until I had reason to navigate every tributary of the system that I began to realize just how badly change is needed. It's so difficult for us to procure the care needed, and we're among the fortunate ones that have private insurance. I can't imagine what it's like for the ones left out - those who have no insurance but don't qualify for government programs.

And the doctors are caught in the middle, having to try to care for private pay patients as best as possible; having to hire armies of administrative professionals to handle the insurance companies, medicare, and medicaid. And then the doctors don't even get to determine what to charge for their own services! And that's not to mention liability insurance and tort excesses, which are driving some of our most experienced doctors into retirement.

I have no idea what the solution is, but something needs to be done. Right now an uninsured woman with breast cancer is twice as likely to succumb to the disease as her insured counterpart. That's just not right. I can't help but think that as Americans we should be pretty embarrassed. How can we  spend $275 million per DAY on a war halfway around the world, but we can't take care of our own??

 

 

Oh, and to answer the initial question, socialized medicine, in my opinion is where the doctors and other health care practitioners are employed by the government and healthcare is provided free of charge to all citizens.  I don't believe any of the candidate's plans qualify as socialized medicine.

"I don't believe any of the candidate's plans qualify as socialized medicine."

Nader

 

Short on time; I'll respond more later today.

I disagree with many of the assumptions in the thread

    * Procedure-driven billing practices inflates the cost of health care at least two fold over socialized programs.  Doctors excessively claim procedures and max their bills to usual and customary levels to cover other work that is otherwise uncompensated.
    * For every minute a doctor spends with a patient he or she spends at least 4-minutes filling out paperwork and doing phone-work.
    * A nurse fresh out of school makes 90+K a year in the cities.  A doctor will make less than minimum wage, given their hours, fresh out of medical school.  Our country's current free market heavily relies on importing nurses from south-east asia and central American just to meet demand.  The regulatory practices of our health care system do NOT allow a free market.  Enormous barriers currently exists.  If you don't eliminate the stifling regulatory practices of insurance companies with a nationalized competitor, someone needs to explain an alternative to get us into a free market.
    * Limiting preventative care yet complaining about free rides is hypocrisy. Investing $1 on keeping the homeless of the streets saves ~$100 medical costs.  The cost of a hospital bed for one night is between $2.5-10K.  A homeless man can be sheltered for life for the same cost.  There is no political will to stop mandating health care for the homeless and start mandating programs to get them off the street.
    * The US government already implements a superlative nationalized health care program: the VA.  Nationalized medicine has many ways to go wrong--our health care for veterans before the late nineties was the definition of bureaucracy.   Yet the VA is now the model of efficiency and superlative care; only for very specialized care are the top hospitals in the country any better.  Whoever seeks to critique a socialized health care program should understand where the VA system went wrong and why it is currently right.

Anyway way you dice it, we are are paying way too much for health in the name of an illusory "highest quality." The truth is that a well-planed, informed nationalized insurance program is, for most non-specialized treatments, an effective method to dramatically reduce costs with zero compromise in quality.  And for specialized treatments, private health should always still be readily available.  The real boon is that the regulatory practices of insurance companies will have to compete with minimum red-tape universal health insurance.

The flip side is if this plan is not done right is has the potential to be a catastrophic disaster.  Does Obama has the advisors to pull it off?  I don't know, but something needs to be done about our current lack of free market and no one has been able to figure out an alternative for the past 25 years.

We pay more to support our healthcare system than any other country (by a lot), yet we're only serving 85% of the population. Our piecemeal system is increasing costs for everyone.

Barb

Do you think we could acheive Single Payer with the current level of expenditure a(maybe slightly more) with the similar level of quality/Waiting Period? (s;ight;y ;ess?) if so ,Im with you

  Does Obama has the advisors to pull it off?  I don't know, but something needs to be done about our current lack of free market and no one has been able to figure out an alternative for the past 25 ye

MAYBE BOBBY JINDAL COULD!!! 

MAYBE BOBBY JINDAL COULD!!!

I don't understand this comment.  Could you explain please?

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