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Posted by Lyrhawn (Member # 7039) on :
 
The big story on CNN and anywhere politics is mentioned is that House Democrats are rejecting Obama's deal with Republicans regarding taxes.

Thus far, they have refused to schedule a vote on the bill, and have voted as a caucus not to support it. Obama remains steadfast that the bill is no longer negotiable, Republicans say they will not negotiate, and Democrats are saying it is currently unacceptable. So who gives way? Normally I'd say the Democrats, easily. They've proven time and again that they'll always lay down without so much as lip service whenever Republicans seriously challenge them on an issue.

And even here, I'd normally say that Democrats are ripe for surrender, but, this is highly uncharacteristic of them to begin with. Now that Pelosi has been given a new lease on life, is she really going to take the ball and run with it? Is this a prelude to Democrats playing minority sniper like the GOP has done so well for the last few years? Will Senate Democrats back them up? Is this all just smoke and mirrors?

I'm actually a little excited. Don't let me down Democrats! At least pretend to care!
 
Posted by JanitorBlade (Member # 12343) on :
 
I'm sympathetic to the criticisms of the estate tax, but the exemption for all estates worth over 10 million dollars is ridiculous. If anything, I think the exemption should be for those worth less than 10 million.
 
Posted by Raymond Arnold (Member # 11712) on :
 
quote:
the exemption for all estates worth over 10 million dollars...
BWUH!!???
 
Posted by Lyrhawn (Member # 7039) on :
 
I'm pretty sure the new exemption is for $5 million. I'm actually perfectly fine with that.

The reason few people in Congress argue about that is largely because of small farms, which can easily be valued at $5 million when equipment, buildings, property and produce are taken into account. Congress frowns upon the Estate Tax destroying family farms.
 
Posted by BlackBlade (Member # 8376) on :
 
quote:
Originally posted by Raymond Arnold:
quote:
the exemption for all estates worth over 10 million dollars...
BWUH!!???
I got that aspect wrong. It's less than 5 million.

Link.

"Republicans generally appear supportive of the package, which the White House advisers noted gave them their two main priorities -- an extension of the lower tax rates from the Bush era to everyone, including the wealthiest Americans, and setting a 35 percent estate tax only on inheritances of more than $5 million.

The estate tax is scheduled to be reinstated at a higher rate of 55 percent next year, with the exemption up to $1 million. A bill that passed in the House a year ago set the threshold for the exemption at $3.5 million and the tax rate at 45 percent, while the provision in the tax deal exempts estates up to $5 million and sets a lower rate."

I could have *sworn* I read an article just a few minutes ago that said exemptions for estates over 10 million. But I'm not finding it.

-----

Found it, from the Washington Post,

"Democrats are still angry about what they view as Obama's capitulation to GOP demands to preserve tax cuts for the wealthiest Americans, particularly a deal to exempt estates worth as much as $10 million from a revived inheritance tax."

So it was up to $10 million, not everything over $10 million.
 
Posted by MrSquicky (Member # 1802) on :
 
I'd be fine if the Democrats said they would hold the cote up until the Republicans comes forward with actual evidence that letting the over $250k (or especially the $1 million+) cuts expire would hurt the national economy.

As far as I can tell, that's the only thing that would make this a reasonable position, but there's no evidence that I can tell that this would likely be the case.

It should be so bizarre that the GOP have problems with extending the more generous unemployment benefits (which does have evidence that discontinuing it would hurt the recovery) because it's fiscally irresponsible to rack up deficits and then, in the same conversation, refuse to countenance the expiration of these tax cuts because...I don't know, they want bankers to be able to afford that third vacation house. Sadly, this is pretty commonplace.
 
Posted by MrSquicky (Member # 1802) on :
 
quote:
Originally posted by Lyrhawn:
I'm pretty sure the new exemption is for $5 million. I'm actually perfectly fine with that.

The reason few people in Congress argue about that is largely because of small farms, which can easily be valued at $5 million when equipment, buildings, property and produce are taken into account. Congress frowns upon the Estate Tax destroying family farms.

But it's pretty easy to exempt family farms. Most estate tax revision proposals have this exemption written into them.
 
Posted by Lyrhawn (Member # 7039) on :
 
quote:
Originally posted by MrSquicky:
quote:
Originally posted by Lyrhawn:
I'm pretty sure the new exemption is for $5 million. I'm actually perfectly fine with that.

The reason few people in Congress argue about that is largely because of small farms, which can easily be valued at $5 million when equipment, buildings, property and produce are taken into account. Congress frowns upon the Estate Tax destroying family farms.

But it's pretty easy to exempt family farms. Most estate tax revision proposals have this exemption written into them.
I suspect opponents would argue that the definition of what constitutes either a "small" farm or a "family" farm is where the problem lies.

I'm not really going to argue either side, but as I understand it, those are the arguments used. I recognize that it might largely be a smokescreen to have the cap at the level it's at, but, that's where the lip service goes.
 
Posted by Juxtapose (Member # 8837) on :
 
Lyrhawn, I'd be interested to hear what you think about this article.

It argues that liberals are selling short how much Obama was able to negotiate for in this deal.
 
Posted by Stephan (Member # 7549) on :
 
Estate tax is theft, no matter what the value is.
 
Posted by rivka (Member # 4859) on :
 
Do you consider income tax theft as well?
 
Posted by Blayne Bradley (Member # 8565) on :
 
quote:
Originally posted by Stephan:
Estate tax is theft, no matter what the value is.

There is no reason why irresponsible young people should be able to get instantly rich from the hard work of their parents.
 
Posted by BlackBlade (Member # 8376) on :
 
quote:
Originally posted by Blayne Bradley:
quote:
Originally posted by Stephan:
Estate tax is theft, no matter what the value is.

There is no reason why irresponsible young people should be able to get instantly rich from the hard work of their parents.
Well the counter argument is that income that has already been taxed in the earning shouldn't be taxed again in the dying.

edit: Not to mention my property is mine to give to whom I wish.
 
Posted by Geraine (Member # 9913) on :
 
quote:
Originally posted by BlackBlade:
quote:
Originally posted by Blayne Bradley:
quote:
Originally posted by Stephan:
Estate tax is theft, no matter what the value is.

There is no reason why irresponsible young people should be able to get instantly rich from the hard work of their parents.
Well the counter argument is that income that has already been taxed in the earning shouldn't be taxed again in the dying.

edit: Not to mention my property is mine to give to whom I wish.

I share your view. We are taxed on money when we earned it, and taxed again when we buy something. Why should I be taxed for dying?

The government can start taxing me for choosing to die as soon as someone invents affordable immortality for everyone.

Edit: I have horrible spelling

[ December 10, 2010, 11:07 AM: Message edited by: Geraine ]
 
Posted by fugu13 (Member # 2859) on :
 
You aren't taxed for dying, the people who get the property are taxed for receiving (that is, a certain sort of income). Just as they would be for any other significantly-sized transfer from you. If anything, the inequity is in favor of the dying against the living, because there's a much bigger exemption.

Where's your outrage against the gift tax?
 
Posted by Juxtapose (Member # 8837) on :
 
It's not like taxes are levied against specific dollar bills, and once that bill has been taxed it's exempt from all further taxes forever and ever amen. "Double taxation" is a bizarre way of looking at the situation that has been invented, as near as I can tell, specifically to generate outrage against the estate tax.
 
Posted by Raymond Arnold (Member # 11712) on :
 
What baffles me is the notion that the Estate Tax can be removed, without the money then having to come from somewhere else.

If you remove the tax on dying, then instead the money would come from taxing the living. And I, for one, would FAR rather have my money taxed at the end of my life when I've had plenty of time to prepare and won't personally be needing it any more.
 
Posted by Stephan (Member # 7549) on :
 
quote:
Originally posted by rivka:
Do you consider income tax theft as well?

No, and I would be fine with one or the other. In fact I would be perfectly happy if the government took 100% of my estate when I died if it meant not paying a dime while I lived.

Both is wrong.

If I manage to create $10 million dollars through my hard work, it has already been taxed. Income tax, property tax, interest tax, and capital gain tax.

Taking half when I die after already having taken all of the above is immoral.

My heirs would continue to pay interest tax, capital gain tax, and property tax on the estate anyways.

Comparing it to the gift tax? I don't know. Without the gift tax it would be much easier to cheat on your taxes. So I can understand that.
 
Posted by rivka (Member # 4859) on :
 
quote:
Originally posted by Stephan:
If I manage to create $10 million dollars

You have done no such thing. You have caused that money to be transferred to you, almost certainly by methods involving things the government provides (roads and other physical infrastructures, safety provided by the police, etc.) You have not "created" money. The banks you keep that money in are insured by the FDIC (guess what the "F" is for?).

You are taxed when you transfer money. How is it any different if you transfer it at your death instead of before? (Except that, as fugu pointed out, you are taxed LESS if it's at your death?)

Raymond's point is also an excellent one.
 
Posted by Mucus (Member # 9735) on :
 
I think fugu's point about the gift tax is worth emphasizing. The US discourages people avoiding the estate tax by imposing a gift tax, the two are pragmatically linked (whereas Canada simply lacks the two and uses other mechanisms to make up the difference).
 
Posted by JanitorBlade (Member # 12343) on :
 
Geraine: In the interest of full disclosure I was responding to Blayne. I myself am not opposed to an estate tax in principle.
 
Posted by Lyrhawn (Member # 7039) on :
 
quote:
Originally posted by Juxtapose:
Lyrhawn, I'd be interested to hear what you think about this article.

It argues that liberals are selling short how much Obama was able to negotiate for in this deal.

I have a lot of competing thoughts on this.

1. Do I like the content of the deal? For the most part sure. Lots of great stuff in there. Lots of meaningful and helpful stuff that even with the stupid tax break for the wealthy, I'd probably be okay with as an intellectual exercise devoid of circumstance.

2. I do have a problem with the content, however. Most of the arguments that went into this bill revolved around the economy. This thing is going to cost almost as much as Obama's stimulus plan cost, but is anyone seriously arguing that it's going to have a greater or even equal impact? That leads me to...

3. I'm not mad at Democrats for the deal, I'm mad because of the packaging, because of the message. Republicans hammered away at a single point relating to lower taxes for the wealthy: it helps the economy. But no one has furnished proof that this is true. Meanwhile they were willing to let jobless benefits, which DO help the economy, expire as a way to leverage tax breaks for the wealthy. It's about forcing the debate on its merits. Democrats had so much going for them! Republicans are ready to sign off on a massive eight or nine hundred BILLION dollars tax deal after railing against out of control spending? Democrats spent the last couple months saying compromise, and Republicans so we will not negotiate!

There was a far more fundamental battle at play here that was never fought because instead of compromising by spending less and/or taxing more, we simply let everyone have what they wanted and dramatically increased spending! That's not a solution! That's punting in the worst possible way!

And Democrats never really even got off the ground! They never presented their side of the story. They never called Republicans on it, not in the way you have to to get your message across. Obama hasn't barnstormed the nation to talk about why HIS ideas are the RIGHT ideas. I appreciate his aloof tendency to really think about things, but at some point you have to fire up the troops and force the issue. Force the issue! This was a winnable issue and they gave it away. It's not about this fight, it's about the NEXT fight. It's about not being too chicken shit to actually present your ideas to the American people, STICK TO THEM, and then see what the public actually thinks. They haven't done that in YEARS. They continually hem and haw, and retreat from their beliefs because they're afraid of how they will be portrayed instead of PORTRAYING THEMSELVES without letting someone else define them.

I'm sick of the Democratic identity crisis. I'm sick of it because I want someone to challenge Republicans. I'm sick of it because liberal ideas aren't just being demonized, a lot of them are, I think, necessary to fixing the nation but they never seriously get considered because their champions are weak-kneed losers afraid of their own shadow.

So, do I think it's a good deal? Sure. Whatever. A six year old could have negotiated that if he had carte blanche with the federal budget. It's irresponsible, and signals that Open Season on Democrats will continue. And that Open Season started when Democrats were in power!

/rant
 
Posted by Lyrhawn (Member # 7039) on :
 
quote:
Originally posted by rivka:
quote:
Originally posted by Stephan:
If I manage to create $10 million dollars

You have done no such thing. You have caused that money to be transferred to you, almost certainly by methods involving things the government provides (roads and other physical infrastructures, safety provided by the police, etc.) You have not "created" money. The banks you keep that money in are insured by the FDIC (guess what the "F" is for?).

You are taxed when you transfer money. How is it any different if you transfer it at your death instead of before? (Except that, as fugu pointed out, you are taxed LESS if it's at your death?)

Raymond's point is also an excellent one.

Yeah but, aren't most of those things paid for in other ways? I mean, we have a gas tax that is ostensibly there to pay for road infrastructure. We have income taxes to pay for other government services. I don't really see why there needs to be a gift tax or an estate tax. And if we're going to have one, I really don't think they should be even as stringent as they are.

If I work my whole life, and instead of frittering my money away, I manage to build up some serious nest egg for my family, why can't they have all of it? Isn't a serious founding principle of the nation the idea of generational advancement? That you might have grown up poor, but your kids will graduate high school and get a good job, and their kids will go to college, and slowly a family builds wealth over time? The Estate Tax seems to run counter to that. And the Gift Tax strikes me as silly as well. It's my money, why can't I give it to whom I please without penalty?

I guess at the end of the day, I'd probably still support the Estate Tax, but, my rule probably would have something like a 5-10 million exemption, and anything over that might fall into a 10% tax, but nothing so harsh as a third.
 
Posted by fugu13 (Member # 2859) on :
 
quote:
I don't really see why there needs to be a gift tax or an estate tax.
A few reasons. One, to prevent people from avoiding taxes too easily. Another, to make the income and other taxes lower. By taxing people at a point where the fewest people are relying on the income (when it is being gifted, or when the person who had been relying on it is dead), that's less money that needs to be raised through other, typically much less conveniently targeted, taxes.

The estate tax is also an extremely successful method for encouraging support for non-profit efforts.

quote:
It's my money, why can't I give it to whom I please without penalty?
I understand the sentiment, but it is a silly one for anyone who accepts the existence of any taxes. Every tax someone pays (including indirectly) takes away some of 'your money', preventing you from doing something you please with it.
 
Posted by SoaPiNuReYe (Member # 9144) on :
 
quote:
Originally posted by Stephan:
quote:
Originally posted by rivka:
Do you consider income tax theft as well?

No, and I would be fine with one or the other. In fact I would be perfectly happy if the government took 100% of my estate when I died if it meant not paying a dime while I lived.

Both is wrong.

If I manage to create $10 million dollars through my hard work, it has already been taxed. Income tax, property tax, interest tax, and capital gain tax.

Taking half when I die after already having taken all of the above is immoral.

My heirs would continue to pay interest tax, capital gain tax, and property tax on the estate anyways.

Comparing it to the gift tax? I don't know. Without the gift tax it would be much easier to cheat on your taxes. So I can understand that.

You do realize that this tax affects on the top 3/10ths of 1 percent of the US population right?
 
Posted by Mucus (Member # 9735) on :
 
quote:
Originally posted by Lyrhawn:
... Isn't a serious founding principle of the nation the idea of generational advancement?

From the outside, it seems to me that you could argue the reverse (in the sense that the estate tax is consistent with that principle). A few years back**, one could say that Canada, maybe being based on the British system, not having an estate tax allows for the class differences to intensify over time as wealth builds up and concentrates in the aristocracy. Where as in the US, you can work hard to provide* for your children and the egalitarian nature of the system allows your children to have a shot at moving up.

*In the sense of providing education and values that lead to success, not the money that comes from success.

** Arguably less relevant now
 
Posted by Lyrhawn (Member # 7039) on :
 
quote:
I understand the sentiment, but it is a silly one for anyone who accepts the existence of any taxes. Every tax someone pays (including indirectly) takes away some of 'your money', preventing you from doing something you please with it.
Still strikes me as a little silly. Most taxes at least have a veneer of purpose behind them. As I mentioned earlier, gas taxes for driving infrastructure. Makes perfect sense to me. I'm down with that. Payroll tax, makes perfect sense, might as well take it out there, and then use it for government services, okay. But a tax on me giving my money to someone else? I don't see the purpose behind it. Or, if we're going to have it, and specifically if we're going to have it as a way to stop people from trying to skip out on other taxes (which actually, I AM perfectly okay with), then I think the exemption should be a lot higher than what it is. My brother and I both graduate undergrad this year. What if my parents wanted to give us each a car for graduation? They have to pay tax on their income, sales tax on the cars, and then a gift tax to give them over to us?

I'm sorry but I don't see the point. Just raise taxes in general.
 
Posted by rivka (Member # 4859) on :
 
Your parents (two people) could give you and your brother each a car with fair market value of up to $26,000 without paying gift tax on a penny.

And if your parents have $52,000 extra to throw around, excuse me for thinking some of that should go to taxes, instead of increasing the tax burden on some poor schmoe who barely makes that much a year.
 
Posted by Mucus (Member # 9735) on :
 
If you're looking for a veneer of purpose, isn't that to handicap the generational transfer of wealth? Granted, I don't think there's necessarily a reason to provide a "veneer of purpose"* for this tax or this tax as long as it works out pragmatically.

* In the sense of this pot of taxation is intended to fund this purpose

But if you require a veneer, that seems good enough.
 
Posted by Lyrhawn (Member # 7039) on :
 
quote:
Originally posted by rivka:
Your parents (two people) could give you and your brother each a car with fair market value of up to $26,000 without paying gift tax on a penny.

And if your parents have $52,000 extra to throw around, excuse me for thinking some of that should go to taxes, instead of increasing the tax burden on some poor schmoe who barely makes that much a year.

God I wish. It was a hypothetical. And last I checked, the gift tax exemption maxed out at $13K, or I suppose $26K for a married couple (which my parents are not). And the tax is upon the giver, not the receiver, so it's not like it could be split between my brother and I. So, if they did give us both a $26K car, they'd be double the limit.

Keeping with the hypothetical though, why? I mean, if my parents really did have that kind of money, wouldn't they have already been paying much higher taxes than the poor schmoe? If that's what this is about, then raise the income tax on the rich guy to start with. I'm not against the wealthy paying higher taxes, I'm actually all for it. This particular form of taxation though, with such a low exemption rate, really annoys me though. Why not charge an Idle Tax for letting your money sit too long in the bank? It's silly.

You know I jokingly suggested to my mom a couple weeks ago that when I graduate, she should buy out the lease on her Ford Focus and give it to me. I haven't seen her laugh that hard in awhile. Then I suggested that maybe she could just buy me a little of it, like, from the trunk back. Then she as less amused because she thought I was serious. Oh well, I bought the first car, no reason why I can't buy the second one.
 
Posted by rivka (Member # 4859) on :
 
Your parents are two people. If they jointly give you a car, the max would be $26,000.

And actually, because of how the tax laws work, the very rich (who income is likely to come front interest, disbursements from corporations, and other things that are not taxed the same way a salary is) are often not paying all that high an actual tax rate.
 
Posted by Lyrhawn (Member # 7039) on :
 
Yeah, but if they gave us EACH a $26,000 car, that'd be $52,000, and thus over the limit.

My bigger problem is with the exemption than the law itself. I don't think it's a particularly good tax, but whatever, I'm fine with it I guess. I just think $13,000 is too low a cutoff.

quote:
And actually, because of how the tax laws work, the very rich (who income is likely to come front interest, disbursements from corporations, and other things that are not taxed the same way a salary is) are often not paying all that high an actual tax rate.
Yeah this is a pet peeve of mine as well. I don't see why they can't just refine the tax code to cut out the loopholes that have them paying such a lower rate and then lower their taxes to at the very least make it revenue neutral but perfectly understandable. I remember Warren Buffet one time saying that because of loopholes, his secretary paid a higher tax rate than he did.
 
Posted by rivka (Member # 4859) on :
 
quote:
Originally posted by Lyrhawn:
Yeah, but if they gave us EACH a $26,000 car, that'd be $52,000, and thus over the limit.

Nope. Each of your parents can give as many people as they like a $13,000 gift each year. IRS link

And it's not a question of "refining the tax code" -- the loopholes exist as they do for (for the most part) fairly good reasons. Removing them would have OTHER consequences that I suspect you actually might not like.
 
Posted by Dan_Frank (Member # 8488) on :
 
quote:
Originally posted by rivka:
quote:
Originally posted by Stephan:
If I manage to create $10 million dollars

You have done no such thing. You have caused that money to be transferred to you, almost certainly by methods involving things the government provides (roads and other physical infrastructures, safety provided by the police, etc.) You have not "created" money. The banks you keep that money in are insured by the FDIC (guess what the "F" is for?).

Assuming Stephan doesn't work for the Fed, you're technically correct that he did not "create" dollars in a literal sense.

But he certainly created 10 million dollars of wealth.

PS: Stephan, can I borrow a couple hundred grand? I promise I'll pay you back soon, man. You won't even notice it's gone.
 
Posted by Lyrhawn (Member # 7039) on :
 
rivka -

Huh, I was under the impression that the limit was upon the donater, rather than the person donated to. I guess that's a little better.

And from what I've read, though I've never gone line by line through the tax code, much of what allows them to pay less consists of provisions written into the tax code specifically to dodge income tax, rather than a nice bonus that came as a result of useful provisions. I've also been given to understand that simplifying the tax code would eliminate many of these provisions and would likely reduce their tax rate, but not the tax burden.
 
Posted by rivka (Member # 4859) on :
 
quote:
Originally posted by Lyrhawn:
Huh, I was under the impression that the limit was upon the donater, rather than the person donated to.

The limit is on neither the donor nor the donee. It's on specific donor-donee transfers. You can also get as many $13,000 gifts per year as you like, as long as each is from a different person.

And I'm all for a true simplification of the tax code. But that means a complete overhaul, NOT removing individual elements.

I nominate fugu to come up with a good, workable tax code. [Wink]
 
Posted by AvidReader (Member # 6007) on :
 
quote:
Originally posted by Lyrhawn:
I remember Warren Buffet one time saying that because of loopholes, his secretary paid a higher tax rate than he did.

But isn't, say 5% on $1,000,000 still way more than 10% on $50,000? At some point, I think we have to ask how much of the very rich's money we feel entitled to give back to others. Cause I've seen the way my friends spend on stupid things. Warren would just get it back anyway.

Now, the evil bankers who took massive bonuses with tax payer funds and slashed their workforces and lending while illegally foreclosing on people's homes? Forget taxes. Just confiscate their stuff and start over.
 
Posted by fugu13 (Member # 2859) on :
 
quote:
I nominate fugu to come up with a good, workable tax code.
So long as it can be politically dead on arrival, been there, done that, got the t-shirt (well, the exact levels of tax would need to be fine-tuned, but that's mostly a statistical exercise). Sadly, political viability seems to be some sort of strange requirement . . . [Wink]
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by BlackBlade:
quote:
Originally posted by Blayne Bradley:
quote:
Originally posted by Stephan:
Estate tax is theft, no matter what the value is.

There is no reason why irresponsible young people should be able to get instantly rich from the hard work of their parents.
Well the counter argument is that income that has already been taxed in the earning shouldn't be taxed again in the dying.

edit: Not to mention my property is mine to give to whom I wish.

A very large portion of inheritance includes moneys that have never been taxed like appreciated stocks, appreciated real estate and so on.

I think the family farm issue is a deliberate deception. Last time I checked, a family farm is only taxable if it is sold. Placing the family farm or business in a trust can usually make it exempt from an estate tax.
 
Posted by Rakeesh (Member # 2001) on :
 
quote:
If I manage to create $10 million dollars through my hard work, it has already been taxed. Income tax, property tax, interest tax, and capital gain tax.
Pretty much what rivka said. You didn't create that $10mil in a vacuum, first of all. So let's just dispense with this notion that it's wrong for someone besides yourself to get a piece of that right from the bat. Politically speaking, I think that's one of the most harmful, incorrect ideas that actually gets brought to the table in mainstream political discussion regularly: the idea that any taxation is by definition immoral. It's fine to not like it, I mean come on we're talking about money here, but let's be reasonable.

---------

quote:
But he certainly created 10 million dollars of wealth.
And, again, no he didn't. Or at least, not alone. That's what rivka's point was. Others are entitled to some of it-that's simply a moral fact, Dan. The only reasonable point of discussion is, "How much?"

---------

As for estate taxes, there are some very real sociological motivations for doing something to mitigate the ease of transference of enormous sums of wealth down family lines, unless we want to make plutocracy more attainable. Then there's the consideration that even with the estate tax as-is, it's not exactly difficult for those affected by it to pass on their wealth to their children.
 
Posted by Wussy Actor (Member # 5937) on :
 
(Lurker comes out of hiding.)

My problem is that the Democrats have decided to find their spine when it plays right into the Republicans hands. They should have done this two months ago when the Republicans came out and admitted that they were blocking all other bills until the tax cut was passed. That was the time to band together and make the case that it was all about protecting the very rich and nothing else. Doing it now is counterproductive. Now the Repubs can say, “We tried to compromise, even Obama is on our side, but those whiny Congressional Democrats have to have things their own way.” They have put themselves in a position where the Repubs can very easily paint them as stubborn petulant children when in fact it’s the other way around. Where is the leadership and political savvy? I never thought I would miss Bill Clinton this much.
 
Posted by Darth_Mauve (Member # 4709) on :
 
I read this challenge more along this line:

Republicans blackmail Democrats--We will do nothing until tax break deal.

President Obama sits down and within a couple of days a deal is struck.

Now the Republicans start talking about "Oh, well, we'll do the deal but there isn't time for anything else so you still get nothing." or "Now we'll do nothing until our next mandatory legislation is dealt with."

The Democrats, seeing themselves being forced into a losing corner, push back saying "Well then, it looks like since you are backing out of the deal to work on other legislation, we'll just back out of this deal."

Which they could do only because of the cover the Left was giving them about the bad part of the deal.
 
Posted by Wussy Actor (Member # 5937) on :
 
Its the timing that drives me crazy. There really isn't time for anything else. And I fault Obama for that. If he was going to cave, he should have caved when there was time to take some advantage of the tiny bit of political capital gained. Now the Repubs get to take credit for making the tax cuts happen and give up nothing they didn't want to give up anyway. If this is the start of the Democrats hardline of opposition that is going to be carried into the new Congress, that's one thing. But it really doesn't come across as that organized or focused. It feels more like taking advantage of one last chance to flip the Republicans the bird.
 
Posted by Raymond Arnold (Member # 11712) on :
 
First of all, again, the government has lots of programs it needs or wants to pay for. It needs to pay for them somehow. On top of that the national debt is 13 trillion dollars. Why does an Estate Tax need a "purpose" distinct from the Income Tax? Their purpose is to pay for government programs. If you want to lower one tax, you have to raise the other tax.

If you want to cut spending, fine. You still have a total budget, even if it's $100 billion instead of $500 billion (or whatever the current number is, I'm scared to look it up). You still have a choice of where to tax the money. I would STILL prefer to have as much as practical taxed after I die then why I am living. But I also am a little wary of a government dependent on people dying to get taxes, so yes, I would prefer both.

And on top of ALL of that, I think that stopping generational accumulation of massive wealth is a valuable goal, all by itself. One of the few good buzzwords I've seen the democrats come up with is countering the "Death Tax" moniker with "The Paris Hilton Tax," because that's basically what this.

Starting your life off with millions of dollars that you didn't earn is not beneficial, either to your personal happiness or to the world in general. It lets the wealthy get wealthier and stay wealthier, accumulating increasingly disproportionate power over society. People like to IMAGINE themselves being part of the wealthy side, and they associate the extreme wealth end of the spectrum as the epitome of the American dream, but that comes at the expense of hundreds of other people not achieving theirs.
 
Posted by Stephan (Member # 7549) on :
 
Property tax doesn't tax the transfer of anything.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by rivka:
Your parents (two people) could give you and your brother each a car with fair market value of up to $26,000 without paying gift tax on a penny.

And if your parents have $52,000 extra to throw around, excuse me for thinking some of that should go to taxes, instead of increasing the tax burden on some poor schmoe who barely makes that much a year.

Your sentiment is right, but taxes in order to be right, need to make sense. Taxing somebody *just because* they can afford to pay the tax is wrong. You need to have a rationale behind the tax that you actually believe is going to be of benefit to the economy or society in some way. This is why, for instance, I don't buy the idea that tax cuts on the rich will stimulate the economy by increasing spending, simply because we know more or less for a fact that it doesn't do that in the way republicans would like it to. But, on the other hand, the argument that gift taxes may stifle spending is more reasonable- $52,000 plus as a gift might not be given at all if it is taxed at too high a rate, whereas tax free gifts have either no adverse impact on spending (neither person would have spend it) or a positive effect on spending (the giver doesn't need it, and the recipient does). And there is no rationale for the tax- what should that tax be paying for? What affect do you actually want to have on the economy by imposing it? Or are you just taking advantage of an opportunity to tax people because they have money?

Income tax is quite different- it pays for the upkeep of a national and state government which regulates business and overseas trade, and many other things like defense- facilitating the ability of private and publicly shared businesses to operate safely and to treat their employees fairly. It could be seen as a sort of service charge- the government tries to maintain the conditions in which business can happen, and they take a piece off the back end of all business dealings- what people get paid to be in business. But after you've already paid that, after you've made your contribution for earning that money, and you are not availing yourself of that system yet again (as you would do with, say, sales or capital gains tax), what rationale is there for taxing your money again? And at such a high rate?

I don't think I'm totally nuts on this either, because for some reason I can accept one form of taxes, even high rates, but the other I find abhorrent. I imagine my father working his whole life to amass a fortune of, say, 5 million dollars which he uses to secure his lifestyle and to secure the lives of his children and grandkids as they start their own lives. That's a great blessing for a family in my opinion, and it was one his own step-father and grandfather bestowed upon him when they died. Now, the idea that the government would take that money, all of which was won by playing by the rules, paying his taxes, his capital gains, his parcel tax, etc, and take a huge chunk out of it... I too simply cannot see the logic in that. I don't see how the government does anything to deserve that money. I will gladly pay my income tax to be assured that the government protects my interests in a million ways, or tries to. But this is beyond the pale- to take such a chunk out of the product of a life's work, seems callous to me.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by Raymond Arnold:
First of all, again, the government has lots of programs it needs or wants to pay for. It needs to pay for them somehow. On top of that the national debt is 13 trillion dollars. Why does an Estate Tax need a "purpose" distinct from the Income Tax? Their purpose is to pay for government programs. If you want to lower one tax, you have to raise the other tax.

Or you could just be reasonable and raise the taxes that have a clearly defined rationale for their existence. Like income taxes!
 
Posted by Raymond Arnold (Member # 11712) on :
 
How is one tax "clearly defined" and the other tax not? They both exist because the government has programs it needs to pay for and it needs money to pay for them. The rationale is exactly the same.

If you want lower taxes, tell the government which programs to cut.
 
Posted by rivka (Member # 4859) on :
 
quote:
Originally posted by Raymond Arnold:
How is one tax "clearly defined" and the other tax not? They both exist because the government has programs it needs to pay for and it needs money to pay for them. The rationale is exactly the same.

Bingo.

Mucus gave a good reason as well.
 
Posted by Rawrain (Member # 12414) on :
 
We need to stop giving rich peopel tax breaks, all it does is make them have more money for themselves, sure it's a good thing for buissiness owners, but not all of them are rich either>>> Movie stars, Sports players, lots of people in the government, and much more... and none of them employ ANYONE, besides maybe a butler or maid -.-
-------
Tax cuts should only go toward buisinesses and not people with lots of money.

:D hard to understand me? I'm confused about what I just said.

But from what I know tax cuts for the rich were put there so 'they' (the rich people) would then spend their money on things like buisinesses as employers or consumers what have you... but I honestly think poor people actually contribute more money towards the developement of America than the rich do, expecually those that higher someone to get them EVEN more taxbreaks than fesibly possible....
 
Posted by Hobbes (Member # 433) on :
 
quote:
Originally posted by Raymond Arnold:
How is one tax "clearly defined" and the other tax not? They both exist because the government has programs it needs to pay for and it needs money to pay for them. The rationale is exactly the same.

If you want lower taxes, tell the government which programs to cut.

I think the point is that there's better and worse ways to implement taxes. If we agree that, say 2 trillion is going to the government this and we need to collect that in taxes (because we finally got our head out of our ... ummm ... butts and decided to balance the budget) that doesn't mean that anyway we get that 2 trillion is the same as any other. Collecting taxes does more than just funnel money into government programs. It strikes me there are three main reasons people have addressed here for determining tax law. The one you're most concerned with is making sure there's enough money for the government to function. Obviously an essential component. However, there's also the consideration of "fairness" or proportionality that Orincoro was talking about. That we implement taxes to try to accurately represent the use of the taxes. In this case that income is the result of living in a free and protected society (etc... etc...) and thus it gets taxed. Gas goes along with driving on the roads so there's a tax there and so on. The third consideration being most efficient means of extracting money in terms of the impact on the economy.

We all agree the government needs to money to run, but the fact that a tax is fulfilling that purpose doesn't make it a good tax by definition. What if we just picked a percentage of the population and decided that we'd use all their money to pay for programs and leave everyone else untouched? It fulfills the first requirement of paying for the government programs yet we all agree it's ludicrous. And of course that's because it doesn't meet the second requirement of fair (or the third for that matter). I can see how you can think the estate tax is fair, but arguing that "we need to get the money somehow and this way gets money" isn't really a complete argument for the estate tax.

Hobbes [Smile]
 
Posted by Raymond Arnold (Member # 11712) on :
 
Except part of my point was that A) I consider an Estate tax to be MORE fair than an income tax, B) I think preventing generational accumulation of wealth is a necessary goal by itself.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by Raymond Arnold:
How is one tax "clearly defined" and the other tax not? They both exist because the government has programs it needs to pay for and it needs money to pay for them. The rationale is exactly the same.

It is not "exactly" the same. They are different types of taxes. They are taxes on different kinds of money. If they have "exactly the same" kind of rationale behind them, then there is indeed something wrong. Taxes are not a cookie jar or a biggie bank- different taxes have different uses and different purposes. Those purposes and uses should be clear.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by Raymond Arnold:
Except part of my point was that A) I consider an Estate tax to be MORE fair than an income tax, B) I think preventing generational accumulation of wealth is a necessary goal by itself.

Why?
 
Posted by Hobbes (Member # 433) on :
 
[ETA post I was referring to]
quote:
Except part of my point was that A) I consider an Estate tax to be MORE fair than an income tax, B) I think preventing generational accumulation of wealth is a necessary goal by itself.
I guess I just didn't get that from your posts, my apologies. I read it as: we need a tax, I guess I could come up with some rational if you wanted but mostly this is a tax and the government needs money so this tax is justified by that alone. Misunderstanding then. [Cool]

I have to admit I side with those who find the estate tax to be "unfair" (whatever that means), but I'm not that interested in it as compared to other economic needs. I was close friends with a family which it ended up destroying so that doesn't really make me partial in its favor but I recognize that's anecdotal and not proof of anything.

Hobbes [Smile]
 
Posted by Orincoro (Member # 8854) on :
 
Yeah, but it's relevant. The facts are that a climbing marginal tax rate is not an adverse penalty on wealth. You make more, you pay a higher percentage of it in your taxes on a rising scale- as fair as such a thing can possibly be to both the poor and the rich. But penalizing the accumulation of wealth through inheritance has consequences outside of this, and those are not fair consequences- especially when considering that we are not just talking about cash, but other things such as possessions, property, etc. Suppose my parents had bought and maintained a number of paintings which increased in value exponentially until they died? What am I supposed to do if that collection, which is a possession of my family, is subject to an inheritance tax? I'm supposed to give them away, to sell them because I need to pay the government? They're mine. They don't belong to anyone else. It gets worse if it's a single property, like a family home. That kind of tax can be destructive.
 
Posted by Raymond Arnold (Member # 11712) on :
 
quote:
I was close friends with a family which it ended up destroying so that doesn't really make me partial in its favor but I recognize that's anecdotal and not proof of anything.
Can you elaborate on that at all? Right now my position is based on a theoretically model revolving around "I'd rather have money taken from me after I die than while I'm still alive."
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by Raymond Arnold:
[QUOTE] Right now my position is based on a theoretically model revolving around "I'd rather have money taken from me after I die than while I'm still alive."

That is not a helpful model because it doesn't fit the current reality, nor is it the one anyone else is working from here. Perhaps this is why we are in disagreement. There are also logistical concerns which complicate that view much more than you have allowed in your argument.
 
Posted by Geraine (Member # 9913) on :
 
quote:
Originally posted by Raymond Arnold:

Starting your life off with millions of dollars that you didn't earn is not beneficial, either to your personal happiness or to the world in general. It lets the wealthy get wealthier and stay wealthier, accumulating increasingly disproportionate power over society. People like to IMAGINE themselves being part of the wealthy side, and they associate the extreme wealth end of the spectrum as the epitome of the American dream, but that comes at the expense of hundreds of other people not achieving theirs.

And who are you (or the government) to decide who is worthy of money or not? If the people are irresponsible with the money, then they will waste it, which will benefit the economy. If they are responsible and they grow their wealth, well then they may be able to hire people, which benefits the economy as well.

I don't understand the mentality of demonizing the rich. I'm sure some of them are shady and got their money in less than honest ways, but most of them worked hard for it.
 
Posted by Rawrain (Member # 12414) on :
 
"Democrats at least pretend to have a spine, it's a Christmas miracle! "

I think they are just trying to prevent themselves from being taxed on their million dollar estates and such.
 
Posted by Hobbes (Member # 433) on :
 
quote:
Originally posted by Raymond Arnold:
quote:
I was close friends with a family which it ended up destroying so that doesn't really make me partial in its favor but I recognize that's anecdotal and not proof of anything.
Can you elaborate on that at all? Right now my position is based on a theoretically model revolving around "I'd rather have money taken from me after I die than while I'm still alive."
I knew a couple, they were in their late 60s I think, maybe early 70s (but still very active) where the wife's father died. She had grown up on, and her father still owned, a very large ranch in NM. The plan had been to pass it down to her brother who was the only sibling that stayed on the ranch (which was fine with everyone else apparently). However he killed himself shortly before his Father's death so whatever they had had in place did not work out and the ranch transfered to the widow. The ET took every penny of the savings they had collected over the decades they had worked the ranch but they managed not to have to sell it. However the widow wasn't in great health and they knew that she'd go soon too and there was no more cash to payoff the ET when that happened. So they attempted to put it in a trust but the bickering and fighting that caused (working out the details) destroyed most of the relationships between the siblings and did not end up in a trust. Then the daughter that I knew moved down there to help out on the project which ended up putting enough stress on the marriage of 50 years that they divorced. I don't know what ended up happening with the ranch, I think they were beginning to go down the road of defeat and decide to just sell the land when it passed again, but the whole thing left a pretty bad taste in my mouth as an observer.

Hobbes [Smile]
 
Posted by shadowland (Member # 12366) on :
 
quote:
Originally posted by Geraine:
I don't understand the mentality of demonizing the rich.... most of them worked hard for it.

I'm not sure that anyone here is demonizing the rich. In any case, this argument would work better for me if wealth were more strongly correlated with working hard.
 
Posted by Rawrain (Member # 12414) on :
 
quote:
Originally posted by shadowland:
quote:
Originally posted by Geraine:
I don't understand the mentality of demonizing the rich.... most of them worked hard for it.

I'm not sure that anyone here is demonizing the rich. In any case, this argument would work better for me if wealth were more strongly correlated with working hard.
Not all rich people work hard for it, in fact some rich people don't have to work at all, consider Rockefellers (quite possibly the worst rich people I could even think of) none of them have to work at all because all of them are just sitting on John Rockefellers original fortune... Basically all of them work their whole lives solely to do what they want.
 
Posted by Mucus (Member # 9735) on :
 
quote:
Originally posted by Hobbes:
... In this case that income is the result of living in a free and protected society (etc... etc...) and thus it gets taxed.

*shrug* Of course it can be pointed out that if you say that income is a result of living in a free and protected society, that is just as true, if not more for wealth.

There are two contrasting ideas here:
quote:
Originally posted by Geraine:
... I'm sure some of them are shady and got their money in less than honest ways, but most of them worked hard for it.

quote:
Originally posted by Orincoro:
... Suppose my parents had bought and maintained a number of paintings which increased in value exponentially until they died?

The view that seems more correct is that the majority of wealth accumulation when it comes to the very rich isn't through working hard for earned income but from unearned income such as in the latter scenario (capital gains on investments in general).

Knowing this actually actually has consequences because in a system where there is no inheritance tax (such as in Canada), we just treat it as a transfer of wealth which counts as realizing capital gains, which can result in having to pay capital gains tax anyway.

So I'm not particularly excited about this one way or another.

[ December 10, 2010, 01:59 PM: Message edited by: Mucus ]
 
Posted by Darth_Mauve (Member # 4709) on :
 
Here is a great lesson in how political groups have taken control of the debate by taking control of the terms. Welcome to the Info-Wars.

What is the "Estate Tax"?

Its a tax on generational transfer of funds.

Who is taxed? Not the person who generated the money. That person is dead. It is the person who receives the money who is taxed.

But powers who don't want this tax have fought hard to phrase the argument into one about the rights of the wealth creator to use that wealth as they wish. It became a Tax of the Dead Person. If I make $10,000,000 I should have the right to give it all to whoever I please, not have to give any of it the government.

In reality, I don't think there is a religion or philosophy in existence that says a dead person should or could be thinking about their earthly wealth after they die.

The tax is on the recipient of the wealth. If someone were to leave me $10,000,000 I'd be happy. The question is, what did I do to deserve that $10,000,000? Since the majority of such inheritances are from parents to children--all I had to do was be born.

I did not work hard for that money.

I did not earn it.

Now, some folks do work hard for their inheritance. Some folk work hard with their inherited money.

Some folks don't.

So what is the problem with inherited money? Money can be used to attract money. It is a tool that can be used to make even more money. If I am left $10,000,000 and hire people who can invest it well for me, then when I die I may have Hundreds of Millions, or perhaps billions. And by the third generation, Billions and maybe Trillions. And by the fourth generation--well-- a majority of the wealth in the country end up in the hands of fewer and fewer people.

Sure, some will waste it. Some will toss it away. But it would be hard to toss away $100,000,000.

And mean while, others working hard and helping society have less and less wealth that they can earn, and see less and less reason to work hard. Why should I work hard for company X when the daughter of the company X never did anything more strenuous than call her maid. Last month she inherited more money than me and all the rest of us on my shift will ever earn working 60 hours a week for the next 40 years?

Are there problems with ET? Sure. There are questions about small businesses and farms that may over pass the base limits and folks will "lose the farm." But these problems can be fixed without throwing the whole ET out.

But its these small businesses and farms that those against the ET parade out.

Its a brilliant move, not as obvious as labeling it a "Death Tax", but more powerful. Poor rich guys getting their hard earned wealth taxed after they are dead and can't defend themselves. Makes me almost want to cry for them.

Instead of poor working class who see wealthy folks earning their wealth the old fashioned way. They inherit it free and clear.
 
Posted by Juxtapose (Member # 8837) on :
 
quote:
Originally posted by Orincoro:
quote:
Originally posted by Raymond Arnold:
How is one tax "clearly defined" and the other tax not? They both exist because the government has programs it needs to pay for and it needs money to pay for them. The rationale is exactly the same.

It is not "exactly" the same. They are different types of taxes. They are taxes on different kinds of money. If they have "exactly the same" kind of rationale behind them, then there is indeed something wrong. Taxes are not a cookie jar or a biggie bank- different taxes have different uses and different purposes. Those purposes and uses should be clear.
Maybe you've addressed this, and if so I apologize, but what is the purpose of income tax? Or sales tax? Or property tax?

It seems to me that requiring that each and every type of tax be paired with some corresponding benefit related to that tax (as with gas taxes/road maintenance) would be unworkably complicated.
 
Posted by Rakeesh (Member # 2001) on :
 
quote:
And who are you (or the government) to decide who is worthy of money or not? If the people are irresponsible with the money, then they will waste it, which will benefit the economy. If they are responsible and they grow their wealth, well then they may be able to hire people, which benefits the economy as well.
Well, obviously no one or at least many fewer people would get rich if civilization didn't exist in order to provide the infrastructure to make it possible. That's just a given, for all that some folks on the fringe like to argue otherwise. Therefore government, both as a practical and as a moral matter have some basis for determining who is 'worthy' of money, Geraine. Again, the problem becomes deciding just when they get to make that determination and how much they determine. There's tons of room for discussion on those points, but in my opinion there's none at all on the notion of whether or not government has a stake in that one at all.

Anyway, next point: if people are irresponsible with their money, they'll waste it, which will benefit the economy. Well, no. It will benefit someone is the only certainty. If some trust fund baby turns up their trust and goes crazy spending it and throws money out like tic tacs, well, sure, the economy at large will likely benefit, but that's not always what happens. Sometimes what happens is that they're irresponsible and only very few people benefit, and those few people spend elsewhere, for example. I'm not saying that's always what happens, but again you're using a conservative talking point as a given when it really isn't.

Next point, if they're responsible they may grow their wealth and hire more people. Again, if they're responsible, they may grow their wealth, and that wealth will (if they're responsible) ultimately be invested somewhere and be used to hire someone, but where? It's certainly by no means a given that it will be done here. So whose economy is benefited? Your rhetoric is geared towards the point that if you largely leave the wealthy alone to accrue more wealth, that will benefit the domestic economy, but the fact is it just isn't true. What is true is that if you largely leave the wealthy alone to accrue more wealth, what'll mostly happen is that they'll be able to accrue more wealth...and sometimes, incidentally, our economy will be benefited.

quote:
I don't understand the mentality of demonizing the rich. I'm sure some of them are shady and got their money in less than honest ways, but most of them worked hard for it.
What's that got to do with the estate tax? In fact, this statement would seem to support the estate tax.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by Geraine:
And who are you (or the government) to decide who is worthy of money or not?

All governments in the entire world can and will do this to a pretty reliable extent. There's already plenty of arguments that are fairly persuasive to all but those of a hyperlibertarian/anarcho-capitalist bent.
 
Posted by MattP (Member # 10495) on :
 
Lie stream of an honest-to-goodness, stand there and keep talking filibuster.

http://tpmdc.talkingpointsmemo.com/2010/12/sanders-launches-actual-filibuster-of-tax-relief.php

Bernie Sanders has been going for six hours so far.
 
Posted by The Rabbit (Member # 671) on :
 
I pointed this out before but since it seems everyone missed it I'm going to say it again. The majority of wealth that gets hit with an estate tax has never been taxed and never will be if the estate tax is removed. This is not evident to most people because for ordinary folks most of what we own is stuff we worked hard for an paid for with out of an income that was taxed as we earned it.

But look at someone like Bill Gates. Bill Gates didn't get his multibillion dollar fortune one pay check at a time. The overwhelming majority of that fortune is in Microsoft Stock, whose value has increase thousands of times since he started the company. Since appreciation on stocks isn't taxed until the stocks are sold, Bill Gates hasn't paid any taxes on those billions of dollars. If the estate tax were completely eliminated, he could leave all of those billions to his son having never paid a dime of taxes on the money.

The estate tax is an essential companion to the laws that exempt us from paying taxes on appreciating assets until they are sold. Would you prefer to pay income tax each year on the appreciation of your home and mutual funds or wait until you sell them? If you die before you sell them, why should you pay less in tax than the person who sold them before they died?
 
Posted by MattP (Member # 10495) on :
 
Perhaps I'm missing something, but aren't those assets taxed when they are sold by your heirs or your estate?
 
Posted by The Rabbit (Member # 671) on :
 
MattP, No, at least not as I understand it. If you sell a property or stocks you inherited, you will only pay capital gains taxes on the sale value minus its fair market value at the time you inherited the property.

[ December 10, 2010, 05:59 PM: Message edited by: The Rabbit ]
 
Posted by Glenn Arnold (Member # 3192) on :
 
I don't know how the estate tax was structured historically, but it seems to me that you could have separate taxes that apply to different inherited assets differently.

As it is, there is an exemption in the capital gains tax for a home that you sell which has gained value. You could just as easily make an exemption for family items, such as collectibles like the paintings previously mentioned, or a classic car that has gained value, or the family home or family farm below a certain value, but still tax financial assets for their full value. Or you could just call inherited financial assets "income."

From what I can tell, at this point, Rabbit's point about Bill Gates is true. If he were to die right now (with the Estate Tax suspended) his heirs could receive all his financial assets absolutely tax free. I think Gates has other arrangements, however, so maybe he's not the best example. But I don't think George Steinbrenner left any of his estate to pay down the national debt.
 
Posted by Samprimary (Member # 8561) on :
 
it'll sure be nice when the republicans succeed against the estate tax and I get to be mr. moneybags for doing absolutely dick-all but just be born into the right family.

anyway, i'm watching sanders filibuster all day. it's depressing hearing him talk about the chinese infrastructural plan versus our own because he's right. I can't wait till we're sitting on top of crusty has-been economic framework and wondering why we're still leaking power to a country smart enough to lay down high speed rail everywhere.
 
Posted by Mucus (Member # 9735) on :
 
quote:
Originally posted by The Rabbit:
MattP, No, at least not as I understand it. If you sell a property or stocks you inherited, you will only pay capital gains taxes on the sale value minus its fair market value at the time you inherited the property.

As I said, I don't think this is true. An estate tax resets the cost base when you pay estate tax to avoid *real* double taxation. Repeal the estate tax and the cost base will simply be inherited and you pay the full capital gains tax at sale.

American example:
quote:
A sole heir who sells inherited assets valued at more than $1.3 million must account for their original cost. So if Grandpa bequeaths 100 shares of Google Inc. he bought in 2004’s initial public offering at $85 a share to a granddaughter and those shares were worth $600 each in January when he died, the granddaughter would pay a 15 percent capital-gains tax on $51,500 if she sells the stock, or $7,725.

Last year, the granddaughter might have paid nothing because the old estate-tax law effectively reset the securities’ worth to fair market value on the day they were inherited.

http://www.bloomberg.com/news/2010-05-07/death-tax-lives-after-federal-estate-repeal-for-heirs-who-must-sell-assets.html
 
Posted by AvidReader (Member # 6007) on :
 
quote:
Originally posted by The Rabbit:
Since appreciation on stocks isn't taxed until the stocks are sold, Bill Gates hasn't paid any taxes on those billions of dollars.

We would be having this discussion a few months before I get my tax statements. [Wink]

I'm pretty sure my mutual fund end of year tax form comes with a capital gains box that I plug into Turbo Tax. So that's only the money that I owe from rebalancing my portfolio? The rest of the appreciation isn't in there?

So why do I need a 401k? The whole point is that my money grows tax free. Why do I need a special account if I can just not rebalance my regular investment?
 
Posted by MrSquicky (Member # 1802) on :
 
AR,
Mutual funds are not individual stocks. They are a changing group of stocks, bonds, and other investments. Capital gains come in when an investment is sold. If you get capital gains on your mutual fund, that means that it sold some of what it was holding during the past year and made a net gain from all it's selling transactions.

If you buy a stock, you pay no capital gains on it until you sell it. So, yes, Bill Gates doesn't pay any taxes on his Microsoft stock. But, if he wants to use that wealth for anything other than what you can do with stock, he'd have to sell it and thus would pay a 15% tax on the gains on it.

401k's are ways to package investment vehicles like mutual funds for a specific purpose (i.e. providing for retirement) that has been judged important to support and encourage, so you don't pay for the capital gains incurred by the things grouped into the 401k.
 
Posted by ScottF (Member # 9356) on :
 
quote:
Originally posted by The Rabbit:
If the estate tax were completely eliminated, he could leave all of those billions to his son having never paid a dime of taxes on the money.

Your analogy doesn't work for a number of reasons, the biggest being that estate tax is *not a proxy for gains tax in the event of death. Estate tax is based on the entire value of the estate, not just the gains.

As for the earlier debate on having a more clearly defined "reason" for the estate tax, it's really a non starter. The reason, clearly, is to redistribute wealth back into the citizenry via government programs. The programs can be debated but the motive/reason behind estate tax is indisputable.
 
Posted by Rakeesh (Member # 2001) on :
 
quote:

As for the earlier debate on having a more clearly defined "reason" for the estate tax, it's really a non starter. The reason, clearly, is to redistribute wealth back into the citizenry via government programs. The programs can be debated but the motive/reason behind estate tax is indisputable.

Well, no, it's not so clear as that. It's not like taxes go straight from the wealthy to the rest of the population via the estate tax and that's it. They also go to programs that benefit everyone, such as infrastructure, military, emergency services, etc.
 
Posted by MrSquicky (Member # 1802) on :
 
I don't know that I'd call it redistributing wealth - the person who had the wealth before is dead, but I completely agree that one of the major reasons for the estate tax is to prevent the massive generational accumulation of wealth that would likely result otherwise.

This accumulation would be a direct threat to the middle class that is the backbone of modern liberal democracy. I think the estate tax is also justified as a special case of taxes on wealth transfer, but that's a secondary justification.
 
Posted by MrSquicky (Member # 1802) on :
 
About high speed rail, I read this recently: Why the US will not get China's high speed rail.

I think we need to focus on infrastructure, both physical and intellectual, but I think high speed rail just isn't going to happen.
 
Posted by ScottF (Member # 9356) on :
 
quote:
Originally posted by Rakeesh:
Well, no, it's not so clear as that. It's not like taxes go straight from the wealthy to the rest of the population via the estate tax and that's it. They also go to programs that benefit everyone, such as infrastructure, military, emergency services, etc. [/QB]

Its exactly that clear. I didn't mention anything about which programs or who benefits, merely that the money is redistributed via government programs, which you echo above.
 
Posted by ScottF (Member # 9356) on :
 
quote:
Originally posted by MrSquicky:
I don't know that I'd call it redistributing wealth - the person who had the wealth before is dead, but I completely agree that one of the major reasons for the estate tax is to prevent the massive generational accumulation of wealth that would likely result otherwise.

This accumulation would be a direct threat to the middle class that is the backbone of modern liberal democracy. I think the estate tax is also justified as a special case of taxes on wealth transfer, but that's a secondary justification.

There's not a lot of semantic parsing needed; the government takes the wealth accumulated by one individual (in this case,deceased) and redistributes it to others. As I said, you can argue about the how and why, but not the fact itself.
 
Posted by MrSquicky (Member # 1802) on :
 
By that definition, anything that happens to someone's estate - other then it being destroyed or otherwise made not usable by anyone else - would be wealth redistribution. That's fine if you're clear that's what you are talking about, but I don't believe that this is the common usage of the term.

Rakeesh's point is also important here. In general, wealth redistribution involves money going from one person to other people. When the government takes money and uses it for things like infrastructure or supporting things that the whole society benefits from, this doesn't fit into the general usage of wealth redistribution. It's fine if you are clear, but without specifying this, I think you run the risk of people thinking you're talking about something other than you are.
 
Posted by fugu13 (Member # 2859) on :
 
Wealth redistribution definitely does include things like spending money on services (such as infrastructure) to help the general populace, and taking it disproportionately from the wealthiest.

The sorts of things you seem to be talking about, MrSquicky, are wealth transfers.

And yeah, high speed rail is almost entirely a boondoggle here (and a lot of the high speed rail lines in China might be boondoggles, too). Though, since our 'high speed rail' isn't going to be terribly high speed, it might just turn out to be a back door way into getting some basic train routes set up (though I'd prefer seeing more local trains in major cities).

quote:
As for the earlier debate on having a more clearly defined "reason" for the estate tax, it's really a non starter. The reason, clearly, is to redistribute wealth back into the citizenry via government programs. The programs can be debated but the motive/reason behind estate tax is indisputable.
It is quite disputable. Most of the wealth that would be taxed by the estate tax is not taxed, and a large chunk of that is because of the existence of the estate tax: the holders of the wealth donate it to charitable purposes, instead (and far more than would if there were no estate tax). That's the biggest part of the estate tax's purpose.
 
Posted by Dan_Frank (Member # 8488) on :
 
quote:
Originally posted by Darth_Mauve:

So what is the problem with inherited money? Money can be used to attract money. It is a tool that can be used to make even more money. If I am left $10,000,000 and hire people who can invest it well for me, then when I die I may have Hundreds of Millions, or perhaps billions. And by the third generation, Billions and maybe Trillions. And by the fourth generation--well-- a majority of the wealth in the country end up in the hands of fewer and fewer people.

The problem with this idea is you ignore the fact that by investing that money you are making things better, and making other people wealthier, as a result. The concept of wealth as a finite commodity that gets passed around form person to person, and could theoretically all end up getting transfered to one guy, is flawed. Wealth is infinite.
 
Posted by ScottF (Member # 9356) on :
 
You're arguing it's justification, which is disputable. I was referring to it's ultimate purpose, (maybe poorly worded on my part) which is not.
 
Posted by Ron Lambert (Member # 2872) on :
 
Estate taxes would really hurt small businesses under ten million dollars (which is most of the job producers in this country), including family farms. All their equipment, facilities, and land are taxed in estate taxes. If the taxes go as high as 50%, or even just 35%, most businesses would have to sell off their equipment, lay off their workers, and close when the original owner dies. Family farms would have to sell some of their land, and maybe their animals, tractors, combines, hay balers, etc., to pay their tax bill. As usual the class-warfare demagogues of the fanatical left have failed to think things through, and failed to appreciate the wide-reaching and immense harm their policies would do to the country.
 
Posted by Blayne Bradley (Member # 8565) on :
 
Bullshit.
 
Posted by DDDaysh (Member # 9499) on :
 
Hmmm, I find this interesting.

First, I'm not sure how the estate tax is levied if we're talking about only one person dying in a marriage. If something is a marital asset, how can it be taxed? That's confusing to me, partially because I KNOW that no "estate tax" was paid when my grandmother died. Maybe we just evaded taxes???

Anyway, my grandfather died just a little over a year after that. He owned a family farm (actually two separate plots of land), a rental home, and 1/5 of a small business. He also had a few hundred thousand in investments, annuities, etc. The estate tax didn't cause my family any particularly undo hardship, but maybe that is because everyone prepared for it ahead of time.

It seems like the same could be done for most small businesses/family farms that are valued above the limit. For instance, couldn't you take out a mortgage on the property and use that to pay the tax? If the property itself is really worth so much to the family, then that seems like a reasonable way of paying the tax without destroying the property.

I honestly don't see why having assets tied up in real property should exempt those assets from the tax. I don't really understand how generational transfer of extreme wealth does the country much good. I'm not against putting a minimum value on estates that are taxed (even as high as $10mil and possibly with increases tied to the CPI), but getting rid of it altogether seems foolhardy.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
ONE OF THE chief arguments of those seeking permanent repeal of the estate tax is that it cruelly penalizes farmers and owners of small businesses whose heirs are forced to sell off their holdings to pay the tax. "In order to make sure our farms stay within our farming families, we need to get rid of the death tax once and for all," President Bush proclaimed in a speech last month to the Future Farmers of America.

This assertion, though, is more convenient myth than fact -- something that senators might consider when they're called on, perhaps as soon as this week, to vote on abolishing the tax. A new study by the Congressional Budget Office examined estate tax returns filed by farmers and owners of small businesses in 1999 and 2000. The numbers that owed estate tax, the CBO found, were paltry, and the number without enough cash on hand to pay the bill even punier: In 2000, for example, just 1,659 farm estates had taxes due, of which 138 didn't report enough liquid assets to cover their tax liability.

But at that time the amount of money that could be passed on to heirs free of taxes was just half what it is now. With the current exemption level of $1.5 million, the CBO analysis found, only 300 farm estates in 2000 would have owed any tax at all -- and of those, just 27 would have a tax bill in excess of their liquid assets. At the even more generous exemption scheduled to take effect in 2009, $3.5 million, the ranks of those potentially hit hard by the tax would have dwindled even further; 65 farm estates would owe taxes and 13 would not have enough cash to cover the bill.

http://www.washingtonpost.com/wp-dyn/content/article/2005/07/23/AR2005072300741.html
 
Posted by rivka (Member # 4859) on :
 
DDDaysh, there is a marital transfer exception.
 
Posted by Ron Lambert (Member # 2872) on :
 
Most small businesses and family farms have been able to deal with estate taxes upon the death of the founder/original owner, because the rates have been lower and exemptions have been allowed, and those who could have spread the ownership to other family members. But raise the estate tax rate to 50%, as some democrats are advocating, and do away with the exemptions, as those who hate the "wealthy" would prefer to do, and the result would not just be a massive theft from the wealthy of the assets they have accummulated through a lifetime of work, it would swell the ranks of the unemployed. Anyone who would deny this is just being deliberately obtuse. The rest of the nation cannot afford to see them learn their lesson the hard way yet again. (And in the past, their leftist dogma has blinded them from learning the lessons they should have learned, no matter how many people they hurt.)

Lest the ignorant leftist mental dwarves in the typical mainstream media seem intelligent to anyone, it should be noted that almost all businesses leverage their cash flow continually using just about all the credit they can manage. Mortgaging the company, the factory, the equipment, to pay estate taxes would probably exceed their already stretched capacity to raise money. This is especially true of family farms, which typically borrow heavily each year to finance the next year--and if there is a crop failure, or a significant downturn in their market (especially more than one year running), such family farms run a serious risk of bankruptcy and loss of everything. They can't raise any more money. Their farms are already mortgaged!

[ December 12, 2010, 11:52 AM: Message edited by: Ron Lambert ]
 
Posted by Samprimary (Member # 8561) on :
 
Do you even know what percentage of family owned farms are mortgaged, or are you just essentially making all of this up in order to rail on those rascally leftists in your head?
 
Posted by Blayne Bradley (Member # 8565) on :
 
You know if I can't say Tea Bagger than you shouldn't be allowed to use the word "leftist" the same way McCarthy says "Communist".
 
Posted by Dan_Frank (Member # 8488) on :
 
Really Blayne? Really?
 
Posted by Blayne Bradley (Member # 8565) on :
 
Yes.

You can't have your cake and eat it.
 
Posted by BlackBlade (Member # 8376) on :
 
quote:
Originally posted by Blayne Bradley:
Yes.

You can't have your cake and eat it.

Blayne are you saying this because this point really means a great deal to you, or just to stick it to your opposition?
 
Posted by Blayne Bradley (Member # 8565) on :
 
Everytime he goes into a thread he shouts the same rhetoric, never backs up his claims, never listens to refutations always shifts the goalposts around always claims evolution is a myth taught by satan, will always without fail state, claim, or imply that 'leftists' are all godless eldritch abominations out to destroy america and that we're all damned to hell and he's been doing this for years and yeeeeeeeeaaaars and goes into every thread even if only remotely tangentially related to "The Left", or "Science" to spout his irrelevant discredited irredeemable pseudoscience crap and will never at any point budge from that positions except on the few exceptions where he phrases it in such a way as to infuriatingly imply that he had that belief all along and pretends that he just guided you to that conclusion nodding along in his sublime ignorance.

Seriously:
quote:

Lest the ignorant leftist mental dwarves

What does this even mean?
 
Posted by jebus202 (Member # 2524) on :
 
I'm not gonna lie, you aroused me there Blayne.
 
Posted by Dan_Frank (Member # 8488) on :
 
Blayne, where I live most people use the term "right winger" like an epithet. And yeah, Ron pretty much uses "leftist" the same way. But the terms, inherently, are not insulting. If one identifies themselves as politically left or right then the terms aren't even factually misleading. Intent definitely counts for something, but comparing a term like that to a blatantly insulting sexual slur seems like a pretty big leap to me.

Heck, take the line you just quoted! Which part is more insulting? That he called someone a leftist, or that he called them a mental dwarf?
 
Posted by Orincoro (Member # 8854) on :
 
Dan, there is a legitimate point there. The use of jargon and specific kinds of terminology in specific ways is part of an attempt to other the opposition and characterize them, and people like them (ie: the left and people who are "leftist"), as a single unified force or a well defined set of motivations. Jargon like that is meant to generate a simplified idea of the opposition, or the person being addressed, in order to appeal to negative associations with that word or category of people. So, "right-winger" and "leftist" are not epithets, as you say, but they are shaded language which can be used to deride and disparage opposition by associating it with an already described oppositional force. Essentially, "leftist" and "right-winger" are mostly propagandistic and useless as actually denominators of political alignment. So Blayne is right in that people ought to avoid using them if their intention is not to engage in or service propaganda. This doesn't mean their use *constitutes* propaganda- it simply appeals to it.
 
Posted by Dan_Frank (Member # 8488) on :
 
That's an interesting point, Orincoro. I can see what you mean. But Blayne was specifically saying that if Ron was going to call people leftists then he ought to be allowed to call people tea baggers. (I didn't quote anything, so I just want to make sure you're aware of the whole context of our conversation.)

It seems to me those two terms are wildly different and ultimately designed to serve different goals. As you said, "leftist" or "right winger" or similar are perhaps propagandist terms designed to simplify the opposition. And therefore I can see the argument that all such terms are unhelpful in reasonable, civil discourse.

But terms like "teabagger" or, say, "mental dwarf," are designed to ridicule and insult. Totally unproductive, not just designed to simplify the opposition but to shut down any dialogue with them whatsoever. Not in the same category at all, in my opinion.
 
Posted by Orincoro (Member # 8854) on :
 
Sure, I think he was posing a more or less rhetorical point- "if you do this, I should get to do that." Tea-bagger is more openly derisive than leftist, but I think the important point here is that these terms are not very helpful, regardless of how offensive they may be. Blayne was reacting to a term he found derisive- his argument about another derisive term is incidental to that.


quote:
But terms like "teabagger" or, say, "mental dwarf," are designed to ridicule and insult. Totally unproductive, not just designed to simplify the opposition but to shut down any dialogue with them whatsoever. Not in the same category at all, in my opinion
As a matter of degree, yes. In fact I think the more explosive term I read on this very website was the word, "leftaliban," which was just about the most casually offensive thing OSC has ever written. Certainly though, I think we're talking about mandarin and oranges, rather than apples and oranges. If your intent is to malign the opposition through propagandistic language, then it's all a matter of degree. I try, I think more out of a sense of needing to feel at least moderately original, not to employ such terms. I think that's probably a good policy.
 
Posted by Dan_Frank (Member # 8488) on :
 
Clearly, you speak Blayne better than I do. [Smile]
 
Posted by Orincoro (Member # 8854) on :
 
I don't doubt that.
 
Posted by Samprimary (Member # 8561) on :
 
it's actually kind of useful when ron lambert begins speaking of leftists, because you can be sure that he has begun to speak of a nebulous group which as defined thankfully does not exist

it is also kind of like how if he says anything resembling 'disagreement with me on this matter is proof of lack of critical thought'
 
Posted by Samprimary (Member # 8561) on :
 
meanwhile: individual mandate for enrollment in health care ruled against, goes to higher court
 
Posted by The Rabbit (Member # 671) on :
 
How unfortunate for Americans.
 
Posted by MrSquicky (Member # 1802) on :
 
I haven't seen anything that makes me believe that the individual mandate is anything but blatantly unconstitutional, but I still doubt that the current Supreme Court is going to check the government's assumption of power.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by The Rabbit:
How unfortunate for Americans.

perhaps if we just, say, provide proactive healthcare via taxes, then we don't have to worry about the constitutionality of forcing americans to participate in interstate commerce.

oh but no, that is like Übersocialism, we can't have that, not in my americas
 
Posted by BlackBlade (Member # 8376) on :
 
Perhaps I am missing the legal nuances, but how is requiring citizens to purchase health insurance any different than states requiring people who have car insurance?

Is it because cars are not something people must have?
 
Posted by MrSquicky (Member # 1802) on :
 
Car insurance is not required, except as a condition for driving on public roads. It's also a state, not a federal requirement.

The individual mandate forces everyone to give money to private companies or face a fine imposed by the federal government. There is no provision for anything like this in the U.S. Constitution.

If this is ruled constitutional, then it opens the door for the federal government to require you to buy pretty much anything they want you to.
 
Posted by Rakeesh (Member # 2001) on :
 
I look at it (like many people, I suspect) as one of those things we really ought to have gotten around to putting into the Constitution ages ago, in some form or another: everyone is going to get sick at some point or another in their lives. It's a given. And it's going to be, again at some point in their lives, beyond their ability to pay for on their own, also a given. When that happens, well, as a society we're not going to just let them get sicker and die, we're going to care for them-causing a drain on the economy as a whole.

Therefore, mandate some sort of requirement that everyone must have health care or mandate that when they do get sick if they don't have health care, we really will let them get sicker and sicker with no help from anyone else in government. But...I'm not aware of anything in the Constitution right now that spells anything like that out, either. I think it should be there, but that's a far cry from saying it's there now. Then again, it's extremely possible I don't know about it.
 
Posted by TheHumanTarget (Member # 7129) on :
 
quote:
The individual mandate forces everyone to give money to private companies or face a fine imposed by the federal government. There is no provision for anything like this in the U.S. Constitution.
This is precisely why a public option should exist! Then it wouldn't be an issue of Constitutionality, but of common sense. The current system isn't sustainable or effective, so propping it up by forcing people to buy it is counter-productive.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by Rakeesh:
I look at it (like many people, I suspect) as one of those things we really ought to have gotten around to putting into the Constitution ages ago, in some form or another

Not really. The whole thing is a massively inferior option to public, universal healthcare. In a grimly utilitarian way it would be maybe better to let the free-marketeers sabotage the bill enough so that we putter around with private non-universal coverage long enough for the entire system to implode, because then reform would be swift via necessity.

taxes!
 
Posted by TheHumanTarget (Member # 7129) on :
 
quote:
Not really. The whole thing is a massively inferior option to public, universal healthcare. In a grimly utilitarian way it would be maybe better to let the free-marketeers sabotage the bill enough so that we putter around with private non-universal coverage long enough for the entire system to implode, because then reform would be swift via necessity.
I'm really baffled at the intense, visceral reaction that I get from some people when I mention a public option.

Would taxes be raised to pay for it?
Probably.

Would it be in addition to what most of us are already paying for health insurance?

Probably not.
 
Posted by MrSquicky (Member # 1802) on :
 
quote:
Originally posted by TheHumanTarget:
quote:
The individual mandate forces everyone to give money to private companies or face a fine imposed by the federal government. There is no provision for anything like this in the U.S. Constitution.
This is precisely why a public option should exist! Then it wouldn't be an issue of Constitutionality, but of common sense. The current system isn't sustainable or effective, so propping it up by forcing people to buy it is counter-productive.
I'm definitely not against a more "socialist" form of health care reform.

In this case, I think they set up a situation where their system hinges on forcing people to buy private insurance and didn't care that they didn't have the right to do this and that the states (and honestly, individuals) have perfect right to challenge and refuse to do it. And I don't view "But we need to do this!" as adequate justification for blatantly violating the Constitution, even if I agree with the thing they are ultimately trying to do.

But the Supreme Court is very pro-government power right now, even moreso with the addition of Elena Kagan, so I expect that they will rule in favor of the government on this one.
 
Posted by TheHumanTarget (Member # 7129) on :
 
quote:
I expect that they will rule in favor of the government on this one.
I'd be surprised if they don't strike down provisions of this law and open the door for a public option (which is what the Democrats were angling for originally).

The conspiracy theorist in me believes this is what they intended all along...
 
Posted by BlackBlade (Member # 8376) on :
 
They don't have the congress to pass a public option yet. Obamacare has not yet become unassailable as it hasn't been in place long enough to change minds.
 
Posted by MattP (Member # 10495) on :
 
I always considered the "mandate" to just be a tax break given to people who purchase health insurance.
It's effectively the same as saying "There is a $2000 (or whatever) healthcare tax for everyone. If you purchase your own insurance, you don't have to pay that tax."
 
Posted by fugu13 (Member # 2859) on :
 
It isn't quite that. In a mandate, not having insurance is a type of offense, which it isn't with the tax break.
 
Posted by MattP (Member # 10495) on :
 
Taking a tax break that you aren't qualified for is also an offense, so I think it still think it's effectively the same.

Scenario 1:
There is a mandate with a $2000 fine. I don't buy health insurance, I owe the fine. I don't pay the fine - I get in trouble.

Scenario 2:
There is a $2000 health insurance tax and a $2000 credit if I purchase insurance. I don't purchase insurance. I take the credit - I get in trouble.
 
Posted by Geraine (Member # 9913) on :
 
Hey, as soon as the US Government can show me one program that they haven't completely screwed up, I'll be on board for a public option.

One program. That's all I'm asking for.
 
Posted by 0Megabyte (Member # 8624) on :
 
The interstate highway system?
 
Posted by Orincoro (Member # 8854) on :
 
The Marshal Plan? The GI bill?
 
Posted by Glenn Arnold (Member # 3192) on :
 
Apollo? WPA?
 
Posted by Blayne Bradley (Member # 8565) on :
 
The US Army?

National Parks?

Civil Rights Act?
 
Posted by Blayne Bradley (Member # 8565) on :
 
And what about other gov'ts, like say Canada, where our healthcare service works pretty well?

Now answer me this, find me one gov't program that hasn't worked but NOT because of republicans interfearance/meddling*?

*Including times when it was done by Democrats but in efforts to appeal to or compromise with republicans.

Social Security doesn't count.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by Blayne Bradley:
And what about other gov'ts, like say Canada, where our healthcare service works pretty well?

Your healthcare service is awful, really. And that's an even better argument in favor of socialized medicine, because as bad as your system is, it *still* beats the US system hands down and blindfolded.
 
Posted by Geraine (Member # 9913) on :
 
I concede, though none of those have the magnitude of something such as Social Security or the Health Care Bill.


I'll never see any Social Security payments when I hit 67. The post office is losing billions of dollars a year.

I think the best way to reduce health care costs isn't to force everyone to take it, nor put everyone on a single payer system. Health insurance companies are forced to cover you for things you have no chance of getting. In Nevada, my health care provider is forced to cover me in the event I get cervical cancer...Problem is I'm male.

If health care providers were able to create customized plans and levels of coverage based on what you actually need covered, you would see costs go down and more people being able to sign up for it. I don't need coverage for cervical cancer or for some childhood diseases. That may change when I have children, and would be more than likely to sign up for that extra coverage when I do have children. Until then I don't feel I should pay for a service I will never use.

[ December 14, 2010, 11:14 AM: Message edited by: Geraine ]
 
Posted by fugu13 (Member # 2859) on :
 
quote:
I'll never see any Social Security payments when I hit 67.
The retirement age might be pushed back a few years, but that's a natural consequence of the higher functioning older people have at the same ages than they did in the past, not a failure of government. Much as I think social security's accounting needs fixing, the actual program is fairly successful.

quote:
I'll never see any Social Security payments when I hit 67. The post office is losing billions of dollars a year. A study was released about a year ago that said women with no insurance had higher survival rates from
I'm not absolutely sure what you're referring to, since your post cuts off, but all the studies like that I'm aware of have serious problems controlling for other variables and dealing with other confounding effects.

quote:
If health care providers were able to create customized plans and levels of coverage based on what you actually need covered, you would see costs go down and more people being able to sign up for it. I don't need coverage for cervical cancer or for some childhood diseases. That may change when I have children, and would be more than likely to sign up for that extra coverage when I do have children. Until then I don't feel I should pay for a service I will never use.
If it is just a public option, you don't have to. Just don't buy the public option, and buy some private plan (edit: that is, the fact that coverage for cervical cancer is required seems entirely orthogonal to the question of a public option). If we're talking about single payer, as the conversation had veered onto, this complaint is just silly. The whole point of single payer is that payment by individuals is unrelated to need. What's more, you'll find few, if any, private insurance plans break up things in the way you seem to want, for the simple reason that it is an accounting nightmare. The added costs of trying to have such nuanced plans completely outweighs any 'savings' individuals would have from such tailored plans. This is true of most public goods, such as publicly funded fire departments ("I just want to pay for coverage of my home. I don't own a barn, so I don't want to pay for barn coverage" -- see how little sense that makes?).

quote:
Taking a tax break that you aren't qualified for is also an offense, so I think it still think it's effectively the same.

I wasn't saying not paying the fine was an offense, I was saying the fine itself was to satisfy an offence. Someone who doesn't get insurance and pays the fine has legally transgressed against society in a way that someone who doesn't get insurance and doesn't take a tax break for insured people hasn't.

[ December 13, 2010, 08:38 PM: Message edited by: fugu13 ]
 
Posted by Samprimary (Member # 8561) on :
 
quote:
If health care providers were able to create customized plans and levels of coverage based on what you actually need covered, you would see costs go down and more people being able to sign up for it.
under this plan:

young healthy people: Yo this still looks like a crimpable expense *continue leaving coverage*

older and more risk-prone people with known medical issues: hey that just leaves us!!

insurance companies: sorry mates we can't make money covering just you, time to jack your rates up!

young people: hey some of us got serious medical events ANYWAY, whoops, guess the people still insured are picking up that tab

insurance companies: whoops, rates go up again!

*more young people leave as a result*

*cycle continues*
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by Samprimary:
quote:
If health care providers were able to create customized plans and levels of coverage based on what you actually need covered, you would see costs go down and more people being able to sign up for it.
under this plan:

young healthy people: Yo this still looks like a crimpable expense *continue leaving coverage*

older and more risk-prone people with known medical issues: hey that just leaves us!!

insurance companies: sorry mates we can't make money covering just you, time to jack your rates up!

young people: hey some of us got serious medical events ANYWAY, whoops, guess the people still insured are picking up that tab

insurance companies: whoops, rates go up again!

*more young people leave as a result*

*cycle continues*

Heh. Pretty much Geraine, everything you understand and believe about free market capitalism does not apply to health care in any way because health care is not a commodity with a fixed value. The value of health coverage varies widely across the market, because individuals require radically different levels of coverage- this destabilizes prices and costs and drives the market higher despite the effect of shrinking the consumer base. It is a commodity that cannot function under a capital market structure.
 
Posted by AvidReader (Member # 6007) on :
 
quote:
Originally posted by Orincoro:
It is a commodity that cannot function under a capital market structure.

I'm not sure I understand how a competing public option helps, then.

To use Florida's public option home insurance as an example, we've got near constant claims by the for-profit insurance that the state is artificially keeping rates down in an attempt to drive them out. (While the citizens beg the state to allow the rate hike so they can keep State Farm!) Meanwhile, there are near constant claims that the government insurance is actuarily unsound and would require tax hikes to replenish its funds after another big storm.

See, there's the difference between the two. A private company has to operate at a profit pretty much all the time. The government can pretty much do what it wants knowing it can always jack up taxes later.

So while I wouldn't mind a tax to provide care for the catastrophically ill in our country, I'd rather just go there directly. The guy making the rules for the product shouldn't be selling it. Period.
 
Posted by Week-Dead Possum (Member # 11917) on :
 
quote:
Originally posted by AvidReader:
quote:
Originally posted by Orincoro:
It is a commodity that cannot function under a capital market structure.

I'm not sure I understand how a competing public option helps, then.

Well, a few things. The public option would be a less than ideal compromise which needs a number of other pieces in place to fulfill its function.

The public option would be tax-payer backed, but the object of having it in place is as a part of a regulated, transparent marketplace. So, for instance, the public option would come with guarantees of not being dropped from coverage, but it would also require that all other insurance programs have similar guarantees. Likewise, the public option would meet a minimum standard of coverage which legislation would need to require all people to have. The effect here is to provide a program which allows all people, without exception, to fulfill a government requirement to be covered, by providing a government guaranteed mechanism for obtaining that coverage. The effect is to lower costs across the board, because the government is in a position to legislate in favor of other market place regulations which make the program more feasable. For instance, the government could, through legislation, institute certain price controls which would effect the entire health industry. At present, private payers and small insurance companies are charged exhorbitant medical costs which are negotiated down by large insurance companies and by employers, so that there is a HUGE economic penalty for not having insurance through an employer backed program. Insurance companies have the capital to negotiate lower rates, while they demand that prices remain high as stated, in order to keep people from changing or disrupting their insurance coverage. This kind of behavior is, simply, abuse.

For all the whinging and fear-mongering about a big government backed system costing us a lot of money, some recent history and a look at other countries tells us, with a great deal of assuredness, that the overall effect of this kind of legislation would be to drop the overall health care costs in the US by roughly half. A great deal of what would be eliminated would be corporate profits, on both the care and insurance sides. While there is a considerably economic effect in eliminating that pool of money, you need to remember that a great deal of that is being sucked out of the otherwise wealth producing middle class, which is hardest struck by medical cost inflation. So while the health care industry is profitable overall, it still represents a powerful economic drain on the most productive portions of our economy by limiting access to health care, destroying family savings, and locking workers into jobs tied to health care plans.
 
Posted by Samprimary (Member # 8561) on :
 
the judge who found the health care law to be unconstitutional is part-owner of a campaign consulting firm that helps Republican candidates who think it is unconstitutional so I guess that might muddle the issue judicially before it goes on

however if the 'activist judges alglarblargl' crowd goes notably silent on this issue, it'll at least be worth a laugh!
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by AvidReader:

So while I wouldn't mind a tax to provide care for the catastrophically ill in our country, I'd rather just go there directly.

I should have also addressed this. We have this. It is grossly, grossly inefficient. It involves uninsured people receiving the minimm of care in emergency rooms. Would you like to expand that kind of program so that it would depress the number of people, especially young people, who carry insurance because uncle sam will foot the bill anyway if they get really, really sick? Why are you in favor of that fairly awful type of social insurance, and not in favor of more effective measures?


quote:
The guy making the rules for the product shouldn't be selling it. Period.
Then don't think of it as a product. You don't have a problem with the government making the rules for cops, firemen, public works, air traffic control, the military, or any other of the many branches of government service, I assume. You know that ultimately the tax-payers who foot the bill will be responsible for what laws and regulations remain in place. And in case you haven't noticed this before now, though I have no idea how that could be possible if you are well read on this issue, the insurance industry *already* makes the rules for the products they sell. There has been very little check on what they have been allowed to do. Obama's plan would have takken control of the industry out of the hands of the insurance companies, who have been making the rules by buying (and I don't find that too strong a term in this debate) the votes of congressmen and senators for many years. Somebody is going to make the rules- and that somebody is going to have a financial interest in what those rules are. Personally, I think that somebody ought to be us, the voters. Who it should not be is an insurance industry that robs us blind and pays out of our pockets to lobby congress for more liberty to rob us.
 
Posted by MrSquicky (Member # 1802) on :
 
So, Geraine, given that people have given you a multitude of things that fulfilled your request, are you now on board with the public option, like you said you would be?
 
Posted by katharina (Member # 827) on :
 
quote:
Would it be in addition to what most of us are already paying for health insurance?

Probably not.

Taxes would most certainly go up, and on top of what people pay for private insurance right now.

Currently, many people are not getting health care. Any solution that means more health care where there currently isn't means the money for it has to come from somewhere.

It isn't just a matter of shifting things around. When more of an activity happens, it requires more resources. Health care that covers everyone will certainly cost more than health care that doesn't cover everyone. Since the people currently with health care correlate strongly with the people with money, getting health care that covers everyone will overwhelmingly likely mean that the people who currently have health care will pay more.

There's no getting around it.
 
Posted by Geraine (Member # 9913) on :
 
quote:
Originally posted by Orincoro:
quote:
Originally posted by AvidReader:
[qb]


[QUOTE] The guy making the rules for the product shouldn't be selling it. Period.

Then don't think of it as a product. You don't have a problem with the government making the rules for cops, firemen, public works, air traffic control, the military, or any other of the many branches of government service, I assume. You know that ultimately the tax-payers who foot the bill will be responsible for what laws and regulations remain in place. And in case you haven't noticed this before now, though I have no idea how that could be possible if you are well read on this issue, the insurance industry *already* makes the rules for the products they sell. There has been very little check on what they have been allowed to do. Obama's plan would have takken control of the industry out of the hands of the insurance companies, who have been making the rules by buying (and I don't find that too strong a term in this debate) the votes of congressmen and senators for many years. Somebody is going to make the rules- and that somebody is going to have a financial interest in what those rules are. Personally, I think that somebody ought to be us, the voters. Who it should not be is an insurance industry that robs us blind and pays out of our pockets to lobby congress for more liberty to rob us.
Whether it is a tangible product or a service does not even matter. Right now if I don't like the insurance my company provides, I can find my own health care plan. I lose that ability with a single payer program.

I'm curious to know if there is an industry you think the government shouldn't take control of?

You seem to think insurance companies are just out to screw everyone. Perhaps you should look at the insane amount of regulation already on the insurance companies imposed on the state and federal levels. Then ask yourself if any of these regulations would cause health insurance payments to rise. I know that once the healthcare law passed my rates for next year went up while also losing benefits. You can blame the insurance companies all you like, but regulation is what really caused it.

Let's look at Social Security. We pay 6.2% of our income into this program, and our employer matches that amount every payroll. I'm forced to pay this because the government thinks it knows how to invest my money better than I do. I also have a 401(k) that I contribute to. What kind of returns am I getting on both?

On my latest social security statement, it says I'll get about $1200 a month (after inflation) when I retire at 67 (more than likely the retirement age will be increased before then) That will be in 2048. As it currently stands, estimates say Social Security is set to be gone by 2042 unless something drastic is done. That is if all of the money that the two Bush presidencies and Clinton plundered from the fund is repaid. I'm not very hopeful right now.

My 401(k) however has grown over 13% a year for the past 4 years I've been contributing at my current job. If I keep contributing for the next 37 years and continue to get the same rate of return I should have a few million tucked away.

For me, it all comes down to how much I want the government choosing how I spend or invest my own money. It is about personal responsibility. I was raised being taught that if I wanted something, to work for it. I shouldn't rely on the government or anyone else to feed me, clothe me, or provide me with anything.

I'm not someone that believes that the situation you were born in prohibits you from any opportunity. There are immigrants that come here all the time with only the clothes on their back and work hard to accumulate wealth. The problem is that too many people are willing to just hold their hand out, because they know it will be filled.

I'm not trying to be a cold hearted bastard. I'm all for helping those less fortunate than I. Show you are trying to improve your situation, and I have no problem helping you.

The difference is that I'd like to choose to help rather than be forced to.
 
Posted by scholarette (Member # 11540) on :
 
kat- the thing is, the govt is not going to increase taxes by 10-25%. Heck, even the 4% increase back to Clinton levels for the richest group of Americans was massively opposed. So, odds are, I stop paying 10-25% of my paycheck to health insurance, taxes increase, and I will still end up with more money in my paycheck. The 10-25% is the percent of my paycheck I paid towards health care when I had it.

Also, many people not getting health care actually end up increasing the cost when they do need health care. Biggest example- a diabetic patient can be effectively treated for very cheap. Untreated, they can cost many, many thousand dollars. So, we treat them for a few hundred dollars a year or we leave them untreated and pay thousands when they have an emergency, which can leave them disabled and unable to work, putting them on welfare. In many ways health care is kinda like that oil spill. For a few bucks, the safety measures could have been increased which would have prevented the whole disaster or you can "save" those few books and spend millions to fix it when everything explodes.
 
Posted by katharina (Member # 827) on :
 
What makes you think you are going to be covered by the new insurance? You have insurance now - you're covered. No one wants to add you to the public dole when you can already pay for yourself. And if everyone drops what they have now and 300 million people's health care gets paid for by the government, when health care is already over 15% of GDP, taxes will not incrase 4%. It will increase by much, much more than that.

While it would be nice if the savings for not having things develop into a crisis would cover regular health care for everyone, it isn't true. Crisis health care is more expensive than the same event on someone whose diabetes has been managed, but one or two crises is considerably cheaper than a lifetime of continuous care.
 
Posted by Tresopax (Member # 1063) on :
 
quote:
Whether it is a tangible product or a service does not even matter. Right now if I don't like the insurance my company provides, I can find my own health care plan. I lose that ability with a single payer program.
This is not true. Public education doesn't prevent the existence of private schools, public mail delivery doesn't prevent the existence of UPS, public police doesn't prevent the existence of the private security industry, and if enough people wanted additional health care coverage then public health care wouldn't prevent the existence of private plans.
 
Posted by katharina (Member # 827) on :
 
This isn't to say that I'm opposed to socialized medicine.

But if it happened, it would be enormously expensive, it would be paid for by the people who have and are generally happy with their health care, and it would require massive tax increases. If we are going to debate the proposition, I'd rather do it with a true idea of the costs. It would cost.
 
Posted by scholarette (Member # 11540) on :
 
I don't have time to find the numbers, but I am pretty sure that for diabetes the numbers have been worked and the savings in preventing those crisis are huge- way way over the cost of lifetime care for diabetes (mostly because the crisis for diabetes usually leaves someone with severe disability so now need lifetime care).

But I was shocked when I looked at the numbers. Every first world country out there is able to do managed health care hugely cheaper than we do and with overall better results. I think the only area we did best on was cancer treatment. Even things like surgery that people claim the US is best in had significantly worse results than in most other countries. So why can't the US do this? What is so special about us that we spend twice as much as everyone else and get worse results?
 
Posted by MattP (Member # 10495) on :
 
quote:
Right now if I don't like the insurance my company provides, I can find my own health care plan.
This is extraordinarily expensive to do, to the extent that it's not a practical option for most people. And that's in the best case scenario where you don't actually have any ongoing or recent medical conditions that you will need continuing treatment for. If you do have such a condition (likely in a scenario where you've had a recent reason to be dissatisfied with your present insurance) then preexisting conditions clauses make it altogether impossible.

The ability to switch providers at will is largely a theoretical benefit which most people can't or won't exercise.
 
Posted by Blayne Bradley (Member # 8565) on :
 
quote:
Originally posted by katharina:
This isn't to say that I'm opposed to socialized medicine.

But if it happened, it would be enormously expensive, it would be paid for by the people who have and are generally happy with their health care, and it would require massive tax increases. If we are going to debate the proposition, I'd rather do it with a true idea of the costs. It would cost.

The digitalization of the healthcare system records/etc would save upwards of 200 billions that could go towards any potential short term increase.

But the idea that you need massive tax hikes, or that costs would truly go up, are a myth propogated by the Republican Right.
 
Posted by katharina (Member # 827) on :
 
BB - No. You don't get something for nothing, and if 40 million who didn't have health care suddenly get health care, that costs money. If 315 million get health care paid for by the government, that costs a LOT of money.

People use whatever is available - be it energy, health care, food, everything. If unlimited health care is available for everyone, then it will cost an enormous amount of money and people use what they need and more. There's no getting around that.

-----

scholarette - I've seen those numbers, too, and maybe it would eventually get to where it isn't as expensive. But the infrastructure of health care in America won't change overnight, and switching to a one payer system giving everyone equal access to our bells and whistles hospitals won't suddenly turn those bells and whistles hospitals into a strictly utilitarian ones.

Like I said, I'm not saying it shouldn't be done. But we should be honest about the costs, and the costs, while possibly (but not definitey) lower in the long term, would be enormous in the short and mid term.

My major objections about the health care bill that just passed was all the lies told in order to pass it. If you have to lie to people to get support, then it doesn't deserve support.

------

The worst part of the recent health care was the lie that it would be paid by cutting Medicare payments to doctors. That was abandoned within months, and Obama did some rhetoric about no way old people should have to get less. But without those promises of Medicare cuts, it wouldn't have passed. This is a serious problem.

My favorite part of the bill are the exchanges. State-wide exchanges, with easily understood ways to sort the offerings, would go a long way towards bringing a breath of fresh market-driven air to health care.

Also, I think doctors should have to publish their price lists. The reason health care costs keeps going up is because the costs are hidden and paid by a third party. If the individual services were actually subject to market pressure, that would stop the crazy inflation in its tracks.
 
Posted by Raymond Arnold (Member # 11712) on :
 
The point is that while the initial cost may be high, it will create longterm savings. Any change from status quo always costs more initially, but the long term savings are such that putting "cost" as a principle objection isn't a productive way to frame the discussion.

The savings are not only from everyone getting care and avoiding "emergencies," its from the massive drop in bureaucratic work needed to figure out who has insurance and what is covered.

(This is talking more specifically about universal health care. I'm not sure precisely what subject we're on right now, but my frame of mind is that any change in that direction helps us build momentum towards it)
 
Posted by scholarette (Member # 11540) on :
 
On list prices- from the doctor's I have talked to, the 3rd party that pays is the one setting my price. For example, one doctor says when she agreed to take Cigna, Cigna came back and told her you will bill us $200 for this service. We will then negotiate down to $98 and the patient will then pay $15. Not a single price point was set by her (even the initial bill that they then negotiated). She could either take it or leave it. So if you have cigna, that is what she charges. Blue Cross might tell her you charge $209 and then negotiate to $99 and the pateinet pays $20. Her secretary keeps track of the insurance and their billing rate and that is just how it goes. Only when you have no insurance involved at all does she get to set the price.
 
Posted by MattP (Member # 10495) on :
 
quote:
Also, I think doctors should have to publish their price lists.
No physician actually charges a single price as the price varies (substantially!) between the negotiated rates of the several insurance networks that any given doctor is a member of. I had a recent surgery and have been privileged to view the statements for a wide variety of different services related to that. The insurance company price has varied 10-80% from the price billed by the physician, depending on the service.

Posting price lists might help some uninsured people shop around, assuming they know which procedures they need, but will have little effect on insurance companies or the insured, which is who the doctors really care about.

[ December 14, 2010, 01:25 PM: Message edited by: MattP ]
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Also, many people not getting health care actually end up increasing the cost when they do need health care. Biggest example- a diabetic patient can be effectively treated for very cheap.
While it seems logical that covering everyone will be more expensive than covering only some people, it isn't that simple. The current US medical care system is so incredibly inefficient from a cost perspective, that it would not be difficulty to cover everyone and reduce the overall cost of health care. In fact, every other developed country in the world is able to cover all their citizens for a per capita cost that is a fraction of what we pay in the US.
 
Posted by CT (Member # 8342) on :
 
Yes to [all three] posts above.

[Regarding the top 2 posts on the page:] And there are additional restrictions that are harder to see: e.g., if you accept payment for seeing patients on Medicaid and/or Medicare, there are put into place other restrictions on what you can and cannot charge at least some non-Medicaid, non-Medicare patients.
 
Posted by katharina (Member # 827) on :
 
It would take time - a great deal of time - to get rid of the inefficiencies. In the meantime, 315 million people would be on the inefficient system. That is an enormous amount of money.

------

I'm aware of the way the cost system currently works. It stinks. That's why costs go up. Moving to a published price list would get rid of that tiered system where health care costs wildly different amounts depending on who you are and how much money you have. Getting rid of that system is EXACTLY why I want published cost lists.

Chase away the inefficiences with a little illumation! Transperency is desperately, desperately needed here.

----

Redoing health care means changing EVERYTHING. If you aren't prepared for the amazing immediate costs and you aren't prepared to change everythign about the system, then advocating for change is irresponsible. Changing completely will cost a lot, but changing only the payer and not everything else is a disaster and deserves to be opposed.
 
Posted by dabbler (Member # 6443) on :
 
I haven't found useful statistics yet about the cost of a given illness with versus without health insurance (such as diabetes), but I did come across the Agency for Healthcare Research and Quality page for Healthcare cost research. Good place to start browsing if you want to see what epidemiologists, statisticians, and other researchers suggest are the problems and solutions.
 
Posted by MattP (Member # 10495) on :
 
quote:
Moving to a published price list would get rid of that tiered system where health care costs wildly different amounts depending on who you are and how much money you have. Getting rid of that system is EXACTLY why I want published cost lists.
So what you are really asking for is that care providers be required to charge one price for a given service. I still don't see how this would help, other than perhaps saving the uninsured some money by getting them access to insurance company rates. As for overall costs though, the insurance companies already know what all the prices are so there would be no improved transparency to them, while the "true cost" of healthcare to us end-users is still hidden in our employer-provided, tax-deductible, benefits package.
 
Posted by CT (Member # 8342) on :
 
It is useful sometimes to look at what has and hasn't worked elsewhere. I am not saying there is an equivalency, nor that any given system's experience will tell us what would happen if the same changes were applied in the US.

However, the experience in Canada was that a switchover to universal coverage was feared in many quarters, fraught with problems, and required serious intervention to succeed. The physicians in Saskatchewan, the first province to institute full coverage, went on strike in 1962. The physicians went on strike, and the Prime Minister had to fly in physicians from other provinces to continue healthcare services.

Now all provinces have full coverage programs, and the majority of physicians in Canada (by far) support this. However, Canada was not always on a universal system, nor was it a straightforward process to switch over. Quite the contrary.

I think the necessary discussions have begun in the US. I think there is a lot of conflict ahead. I don't think we will (or could, even if we tried) repeat the Saskatchewan experience, but I'd rather learn from it what we can, even if that is just that there may be more resistance to certain proposed changes than may have been expected. Knowing that may mean different outcomes should be prepared for, and it may guide such things as dissemination of information.
 
Posted by katharina (Member # 827) on :
 
MattP:

Not necessarily only one price. But people deserve to know that their insurance is higher this year because doctors charge more to treat them than their neighbor.

If tiered pricing is okay, shine a light on it.

I bet it won't be as okay with people once they know. Not only do they have to pay into Medicare for health care for other people, but their own health care costs them even more than it would if they were on Medicare. So the people who are actually working are subsidizing Medicare not only with direct taxes, but by paying higher prices at the doctors' offices.

If the system can't tolerate illumination, that's an even bigger reason to provide the illumination.
 
Posted by dabbler (Member # 6443) on :
 
As a psychiatrist, I don't have a problem with it. I believe it's currently against the health insurance contract that a physician signs with the health insurance to publish their rates. A patient knows how much their health insurance reimburses the physician, the physician's public rate, and their copay. But a physician currently isn't allowed to tell the patient that Insurance B, which they also take, reimburses them X instead.

Transparency is good. I think the biggest bang for the buck though, is going to be the transparency in service cost. A patient in the hospital yesterday received a comprehensive drug screen because of a possible overdose. A medical student asked if we should repeat it today. It's not medically indicated, so we aren't doing it. What the student, most physicians, and the patient don't know is that the test costs about $1000. Medication A costs $50, medication B costs $300. A physician should have the information easily accessible to talk about the pros and cons of these medical decisions with the patient. I think it's something missing from the informed consent process.
 
Posted by katharina (Member # 827) on :
 
Yes, to everything in your last paragragh. Stick a dollar figure on all of it. No wonder costs outstrip inflation every year - the costs that figure into inflation are transparent, and medical costs are hidden. Of course things get more expensive if the costs are not subject to market forces.

And consumers should be able to know what their costs is compared to what it would be if they got insurance from a competitor.
 
Posted by scholarette (Member # 11540) on :
 
Except I do know what my cost would be if I got insurance from a competitor- at least on a vast majority of things. My copay is going to be X at Cigna and y at blue cross. Whether my dr gets $50 or $100 doesn't actually affect that. My copay is still x. I suppose if your insurance does things as 90% versus copay, it would matter but most give copays. Even a hospital stay on my new one is a flat fee. Though I believe that is because it is an HMO while a PPO is different
 
Posted by CT (Member # 8342) on :
 
There is some interesting reasearch on what factors seem to consistently make a difference in healthcare consumers' choices. As I recall, some of the findings were counter-intuitive.

A lot of this work was done by large provider organizations (such as Kaiser Permanente, IIRC) to try to figure out how to distinguish between what they thought would help and what actually helped people be more informed.

At a certain point, for example, more information was counter-productive. Information overload. People started making decisions effectively randomly, and when interviewed qualitatively, said things like "it was toomuch information, so I didn't look at any of it. I just did what my colleague did."

Doesn't mean that transparency isn't the best principle, but be aware of possible unintended consequences.
 
Posted by fugu13 (Member # 2859) on :
 
I realize the conversation has moved on, but there's something that needs correcting.

quote:
As it currently stands, estimates say Social Security is set to be gone by 2042 unless something drastic is done.
This is completely false. The 'trust fund', which is just a long period of small surpluses saved up due to there being a large paying population (the baby boomers), will be gone in 2042-ish, ceteris paribus. That's not anything like the same as social security being gone. Social security is not a savings program. Money is taxed from a broad, employed population base, and immediately distributed to the smaller retired/disabled/etc population in higher concentration. When there's a surplus, that can be used to handle deficits in later years (what will soon be happening). However, if there's no remaining surplus and a deficit comes along, all that means is the benefit formula (eligibility, means testing, et cetera) needs to be adjusted. It would only take a few minor, though politically hazardous adjustments to bring social security again into balance around the time of 2042 (though the adjustments should be pursued gradually, postponing that date).

In other words, you're right on track to having social security benefits in 2048 or a few years after (depending on eligibility adjustments). Social security will not have been gone in 2042, and that is a lie perpetuated by people who find it politically useful, which is the sort of thing you would be well advised to research before repeating.
 
Posted by katharina (Member # 827) on :
 
quote:
My copay is going to be X at Cigna and y at blue cross. Whether my dr gets $50 or $100 doesn't actually affect that.
When your insurance pays your doctor, they aren't taking the money from thin air. It all comes from you eventually. Your copay is your immediate cost, but you pay for the total cost through your premiums.

Insurance companies don't manufacture money. There is no magic health care tree that pays for what you don't see. All those costs do eventually get paid for, and it is either the end customer or else the taxpayer.

-----

Social Security is a Ponzi scheme - there's the lie that it is forced savings, but it isn't. There will be something at that time, but the benefits we are paying for today will NOT be available to us later.
 
Posted by MattP (Member # 10495) on :
 
quote:
When your insurance pays your doctor, they aren't taking the money from thin air. It all comes from you eventually. Your copay is your immediate cost, but you pay for the total cost through your premiums.
Well sure, but no one is going to look at the price list and say "Hey! A check-up cost $200 this year and it cost $100 last year, I'm going to leave my free employer-provided healthcare and pay $1500/month to get my own plan."

Alternately you can complain to your HR department, who is going to go with the best package they can get for the money irrespective of how much providers are payed, or the insurance company, who you aren't really a customer of in any meaningful way, or your doctor, who will probably tell you that the price was set by the insurance company in the first place.
 
Posted by Destineer (Member # 821) on :
 
Another suspect line from that Geraine post:

quote:
My 401(k) however has grown over 13% a year for the past 4 years I've been contributing at my current job.
This account made over 13% returns in 2008? The year the S&P had an annual return of -37%?
 
Posted by scholarette (Member # 11540) on :
 
MattP responded better than I could. [Smile]
 
Posted by katharina (Member # 827) on :
 
I honestly don't understand why people are DEFENDING hidden pricing. You prefer a system where the true costs are kept under wraps? Why??

--------

A good start, better than expand-the-welfare-state-without-changing-the-fundamentals we got this year:

1. Exchanges where the types of policies are put in categories and there is an easy comparison between policies.

I participate in one of these - companies who want to offer health insurance to federal employees have to put their offerings into the exchange. There are dozens of options, they are easy to compare, and you can switch every year.

It works fantastically. That should absolutely be available to everyone. As soon as possible.

2. Clinics publish their pricing. They can keep it tiered if they want, but why needs to be clear. So people who want just catastrophic insurance (which they can pick off the exchange) because it's cheaper for them to pay for a few doctor's visits per year can actually run the numbers.
 
Posted by Raymond Arnold (Member # 11712) on :
 
I certainly think transparency is better. But I think the point they're making is that when the system is as complex as the one we have now, transparency simply isn't going to help much.
 
Posted by katharina (Member # 827) on :
 
Keeping costs hidden certainly makes things worse. Why on earth someone who doesn't have a financial stake (and there are many who do, which is why costs are hidden) prefers a system where their money is spent without oversight to costs , I do not understand.
 
Posted by dabbler (Member # 6443) on :
 
And honestly, the payment given to a physician for a check up is such a miniscule part of the health care system. Sure, do it. But its not going to make a big difference numbers-wise. Procedures, yes, you'll find a much bigger impact. Knowing that the opthalmologist will get paid $5000 for that cataract surgery (I made up the number) from Insurance A, versus $3800 from Insurance B could make a big difference if people switched from Insurance A to B. But also there's a LOT more going into the quality of Insurance A versus B besides their reimbursement to doctors. What % is taken in profit? How much overhead for staffing to deny or process claims? How many hoops does your PCP have to go through to get something approved? What number and quality of doctors take your health insurance? Does your hospital? If Insurance B really does reimburse that poorly, that awesome surgeon may just opt out of taking that insurance all together. You get to see a different one, but it may not be the one with the fewest complication rates.
 
Posted by Raymond Arnold (Member # 11712) on :
 
I don't think anyone's arguing it's BETTER to keep things hidden. They're just arguing that when the cost/difficulty of switching insurers outweighs the extent to which they screw you over on individual things, knowing exactly how you're getting gouged doesn't help. Because you can't do anything about it.

I'm still on parent's insurance and I don't know enough to really comment on whether that's accurate. But that's what the actual argument is, not "transparency is worse."
 
Posted by MattP (Member # 10495) on :
 
I'm not defending hidden pricing. Just pointing out that there's not an obvious substantial benefit to posting price lists. I think it's fine to do it, but like the booklets of nutritional facts available from major fast food chains, most people aren't going to care.

At least with the nutritional data for fast food you can make an immediate choice based on the data. If you are in an employer-provided healthcare plan and your doctor's fee for service X *seems* too high, then what? Do you really care if you've got a $10 copay regardless of the fee. Even a 10% copay would require pretty substantial price differences for me to leave my family doctor for a better deal.

A public price list is only useful when individuals are actually shopping around for treatment based on cost. This means uninsured individuals and, to a lesser extent, people on high deductible HSA plans. (I'm on one of these plans, but it's associated with a major insurance network so the price is the same across providers anyway.)

ETA: I don't know, but suspect, that pricing for basic services like checkups and x-rays are pretty consistent across the board because there is already competition between insurance companies and they are aware of what other companies are paying. Where there is likely to be disparity is in special services related to emergent conditions.

Given that assumption, I don't think there will be a lot of surprises or market effects as a result of posting prices for basic services and it would be impractical to read a complete list of the hundreds of unique services billed by a given doctor or the thousands provided by a hospital. How in the world would a healthy person make a useful distinction between insurance carriers by knowing what they would pay for chemotherapy or angioplasty?

Such a price list, again, only make sense in a world without insurance, or with a dramatically different type of insurance than we have now.

As long as our insurance plans just pay for whatever we need, we won't generally care about the billed cost of a service any more than we worry about wrecking into a Lexus instead of a Ford even though that Lexus wreck is more likely to contribute to higher premiums in the future than the Ford wreck.

[ December 14, 2010, 04:23 PM: Message edited by: MattP ]
 
Posted by scholarette (Member # 11540) on :
 
The other problem is health isn't really something you shop around for. If I need surgery, how much I can negotiate is pretty limited by the fact that I need it. this is my life. Price comparison is pretty limited.
 
Posted by CT (Member # 8342) on :
 
I'm happy to have transparency, but it wouldn't be a price list. If it were precise enough to be accurate, it would be a snarl of a flow diagram. With special Venn diagram foldout!

Which is okay, but likely not as useful as one might hope. And, as I noted about, too much information can be counterproductive. Just know that you may end up making things worse, depending on how the informaiton is presented.
 
Posted by katharina (Member # 827) on :
 
Neither of those things make sense to me:

1. I certainly do care that a Ford costs less to wreck than a Lexus. How much a car is going to cost in insurance is absolutely a factor in the decision-making car-buying process.

2. I may not be able to negotiate that I need a heart bypass, but if the prices were posted, I could weigh the cost of having it done at which of the three hospitals in town, or the cost of a trip to Houston with its larger number of medical centers versus staying in town. There is a great deal of room to negotiate.

For most people, buying a car isn't particularly negotiable, but that doesn't mean we'd be better off if no one listed car prices.
 
Posted by MattP (Member # 10495) on :
 
quote:
Originally posted by scholarette:
The other problem is health isn't really something you shop around for. If I need surgery, how much I can negotiate is pretty limited by the fact that I need it. this is my life. Price comparison is pretty limited.

That and at the moment it's determined that you need surgery your insurance company mobility is zero. The only way to switch to a different company would be to switch from one employer with a group plan to another employer with a group plan with a different carrier. That's impracticable to the point of ridiculousness.

If you're uninsured then price lists may help, but in my experience you can call different providers and get their prices already. We've been doing that just today so we can weigh when and where to get a dental surgery done for one my children which isn't covered (much) by our insurance.
 
Posted by katharina (Member # 827) on :
 
[quote]in my experience you can call different providers and get their prices already.[quote]

Not even remotely in my experience. I called ten different doctors last month trying to get a quote on a simple procedure, and all ten just tried to get my insurance information and get me to come in for an office visit before quoting a price.

Dentistry is different - because lots of people don't have dental insurance. But for medical doctors? They got downright offended when I asked for the price of an office visit off the street, not even to mention the cost of simple procedure. Very irritating. I'm even more advocating for public pricing than I was before.

You have found benefit in being able to comparison shop for dental surgery. Why should gallbladder surgery be different?

And yes - it would change the system. THAT'S THE POINT. What is untenable is changing nothing of the system and trying to convince the government to get someone else to pay for it all. Not going to happen, and it shouldn't. The system absolutely should be changed, and public pricing should be part of it. It would be both a consequence and a driver of change, and that's the point.
 
Posted by katharina (Member # 827) on :
 
quote:
only way to switch to a different company would be to switch from one employer with a group plan to another employer with a group plan with a different carrier.
Did you even read my post above? Set up exchanges where people can switch health care companies without changing employers - it can happen. It happens now. That's what my employer does, and it works great. And then have doctors and hospitals publish pricing.

Those two things alone would go very far to reign in the monstrous inflation connected to health care costs.
 
Posted by MattP (Member # 10495) on :
 
kat,

quote:
1. I certainly do care that a Ford costs less to wreck than a Lexus. How much a car is going to cost in insurance is absolutely a factor in the decision-making car-buying process.
The analogy here is to which car you're going to crash *into*, not which car you are driving. The bigger ticket healthcare items are the emergent situations. Not the check-ups and bloodwork.

quote:
2. I may not be able to negotiate that I need a heart bypass, but if the prices were posted, I could weigh the cost of having it done at which of the three hospitals in town, or the cost of a trip to Houston with its larger number of medical centers versus staying in town. There is a great deal of room to negotiate.
This is only the case if you don't have insurance. For everyone else the cost is a non-issue because the most individually cost-effective option is to get the surgery done at one of the in-network providers, all of which will charge the same amount.

I agree that posting price lists could be beneficial to people that don't have insurance. I just don't think those people are market drivers.

ETA: Another complication to the "post a price list" - most physicians that I know will give need-based discounts, which render even their "standard" prices as just rough guidelines.
 
Posted by katharina (Member # 827) on :
 
I disagree with all of that - you keep defending hidden pricing by saying that under the current system, open pricing wouldn't matter. I'm telling you that's because the current system is broken and a single payer is not the only option to fix it. That open pricing doesn't fit with the current system is the exact point.

We ought to at least give the free and open market a shot. It's done a wonderful job of lowering costs for just about everything else.

quote:
most physicians that I know will give need-based discounts, which render even their "standard" prices as just rough guidelines.
Open pricing won't stop doctors from giving need-based discounts. That's not an argument against.
 
Posted by scholarette (Member # 11540) on :
 
For price listing to matter, you first need to change the system. Listing prices would not be the way to change the system.
 
Posted by CT (Member # 8342) on :
 
quote:
Originally posted by katharina:
... Set up exchanges where people can switch health care companies without changing employers - it can happen. It happens now. That's what my employer does, and it works great. And then have doctors and hospitals publish pricing.

Those two things alone would go very far to reign in the monstrous inflation connected to health care costs.

Where this has been studied and tracked specifically in the actual healthcare market, rather than in theory, the latter has had no significant effect on pricing. To claim it would go very far to rein in matter is, I think, a clear overstatement.

For example, see the California experience. The Assembly Bill 1627.54 from 2003 required most hospitals to make pricing accessible onsite, with average costs of 25 specific Diagnosis Related Groups available online by 2006. There has been no significant price change correlating with that data since then.

In other, smaller tests, sometimes it makes a difference: sometimes lower costs, sometimes not. But most of the data out there is based on extrapolations from outside the healthcare environment. It doesn't necessarily translate, and the best data we have says that it does not.
 
Posted by MattP (Member # 10495) on :
 
quote:
you keep defending hidden pricing
Again, I'm not defending anything. Show me one single sentence where I've indicated that hidden pricing is good or stop saying that. All I'm saying is that price lists do not a free market make nor are they likely to have a substantial effect on prices until insurance mobility is ubiquitous - not just available for some people in some places.
 
Posted by CT (Member # 8342) on :
 
quote:
Originally posted by MattP:
quote:
you keep defending hidden pricing
Again, I'm not defending anything. Show me one single sentence where I've indicated that hidden pricing is good or stop saying that. All I'm saying is that price lists do not a free market make nor are they likely to have a substantial effect on prices until insurance mobility is ubiquitous - not just available for some people in some places.
Ditto for me. And I worry about unintended consequences as noted above. That isn't a reason to hide pricing, but it is good reason to publish it in a layered way, so that someone who wants more details can find them, and someone who does not want details can still pick out the forest from the trees.
 
Posted by kmbboots (Member # 8576) on :
 
Maybe I am just not understanding and a scenario would help.

Let's say that John has insurance through the Smith Insurance company. John works for a company large enough to have some options so he could change to Jones Insurance Company in February.

In July John gets appendicitis. Smith Insurance has an agreement with Hospital A that charges $10,000 for a surgeon to perform an appendectomy, $5,000 for the anesthesiologist, $4500 for the use of the operating room, $4000 each for the operating room nurses, $1600 per day for staying in the hospital, $400 for the various drugs John needs. (Obviously these prices are entirely made up and there are lots of costs I am omitting.)

Hospital B is a little further away and doesn't have an agreement with Smith Insurance. They charge $25,000 for the surgeon, $$9,000 for the room and so forth. The anesthesiologist has a deal with Smith so they only charge $1,000.

Hospital C is even further has agreements with both Smith and Jones and charges $8,000 for the surgeon, $3,000 for the anesthesiologist, $2,000 for the room and so forth.

The cost to John (deductibles and co-pays and so forth) are the same at Hospital A and Hospital C. John can't afford Hospital B at all.

How does knowing the prices help John?

If this scenario isn't what you have in mind, I would be glad to consider a different one.

[ December 14, 2010, 05:23 PM: Message edited by: kmbboots ]
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by katharina:
This isn't to say that I'm opposed to socialized medicine.

But if it happened, it would be enormously expensive, it would be paid for by the people who have and are generally happy with their health care, and it would require massive tax increases. If we are going to debate the proposition, I'd rather do it with a true idea of the costs. It would cost.

I've been asleep for most of the debate, but I want to come back to this point to make my own. Yes it would cost. I don't want to give the impression that I don't think it would.

*However.* Health care now accounts for some 15%-17% of GDP, and the current system also bears an economic cost in inefficiency (for instance, due to debt and lack of liquidity among the uninsured, as well as lost work due to lack of preventative care) which pushes the total cost above even that figure. In most industrialized countries, the cost is well below 10%. So while I've seen you make this point many, many times, I don't see why you don't pay more attention to that factor. The point really is to lower the overall costs, and shifting the costs from an ineffective private system, one in which freelance working people like me are unable to obtain satisfactory coverage, to a tax based system could achieve that. If your taxes go up 4%, but your health care costs go down just as much, or if the productivity of the overall economy is increased to compensate for that cost, what's the issue? Do you just believe that can't be done? Are the examples of it being done in other countries not good enough?

In all this, you constantly return to the fact that you and others are happy with their current health care situation. Bully for you. But this is a systemic problem- and the fact that you personally are happy already comes at the cost of many people who are not, and who have much reason to worry about their future in this regard.

quote:
People use whatever is available - be it energy, health care, food, everything. If unlimited health care is available for everyone, then it will cost an enormous amount of money and people use what they need and more. There's no getting around that.
It's free to call the cops. Do you call them all the time? If not, why not?

In this country, as an example, extremely nominal fees for service have had an enormous effect on this type of abuse. We have a public-backed option model, where seeing a specialist costs the insured approximately $1.50. In a country where people will go to the doctor at the drop of a hat, the percentage of GDP spending is in line with the industrialized world standard at about 9%. A real life example of your theory not working out. Sometimes I just suspect you think very little of the morality of poor people.

quote:
We ought to at least give the free and open market a shot. It's done a wonderful job of lowering costs for just about everything else.
Health care is unlike any other commodity. Simple explication: the value of an antibiotic course today, for me, is zero dollars. I don't have any infections. The value of an antibiotic course a year from now, when I life threatening pneumonia, is my entire life savings. Is there another commodity that functions that way, that you can think of? That's why we have insurance markets, and insurance markets *require* regulation. That is, if your goal is to make health care available to everyone. Describe to me another commodity that functions in that way, and I'll listen. I can't think of one.

[ December 14, 2010, 05:47 PM: Message edited by: Orincoro ]
 
Posted by MattP (Member # 10495) on :
 
Even for those of us who are happy with our current situation, it's not a sustainable situation. As long as health care costs are rising at their current rate even our cushy employer-provided plans aren't going to survive for long. Its notable that wages have been stagnant for quite some time, largely because of rising healthcare costs. So while we may be "happy" with our insurance, we really should be pissed off at what's happened to our take-home pay.

And that's just my selfish view of things. When I start considering the non-salary worker, small business person, self-employed, unemployed, etc. it's much more bleak.
 
Posted by dabbler (Member # 6443) on :
 
kmmboots, the problem is that there's also the layer of what the cost will be to the patient.

Insurance 1:
You pay $300 a month, your work pays $300.
Hospital A gets paid $25,500
You get charged $1000 deductible

Hosp B would get paid ~40,000
You would get charged $2000 because it's out of network

Hosp C would get paid $25,500
You get charged $500 deductible because it's preferred network.

Insurance 2:
You pay $250 a month and your work pays $250.
Hosp A gets paid $27,000
You get charged $1200

Hosp B gets paid $45,000
You get charged $2500

Hosp C gets paid $24,000
You get charged $1200

Insurance C:
You pay $350, your work pays $300

Hosp A gets paid $26,000
You pay $500

Hosp B gets paid $32,000
You pay $750

Hosp C gets paid $20,000
You pay $750

If you're deciding based on what the hospital would get paid, you might go for the last option. If you're deciding based on how much you pay, you might pick a different option. Who the hell knows.

Again, I think it's fine to have that information available but I want to stress that it's currently the health insurance companies that are restricting that information, not your physician.
 
Posted by kmbboots (Member # 8576) on :
 
Dabbler, right. I was oversimplifying and even then it was too complicated. And even in your scenario, "Hospital A" is generally not one lump sum entity but many charges to different people/groups some of which may be on your insurance and some of which may not.
 
Posted by katharina (Member # 827) on :
 
quote:
Originally posted by Orincoro:
quote:
Originally posted by katharina:
This isn't to say that I'm opposed to socialized medicine.

But if it happened, it would be enormously expensive, it would be paid for by the people who have and are generally happy with their health care, and it would require massive tax increases. If we are going to debate the proposition, I'd rather do it with a true idea of the costs. It would cost.

I've been asleep for most of the debate, but I want to come back to this point to make my own. Yes it would cost. I don't want to give the impression that I don't think it would.

*However.* Health care now accounts for some 15%-17% of GDP, and the current system also bears an economic cost in inefficiency (for instance, due to debt and lack of liquidity among the uninsured, as well as lost work due to lack of preventative care) which pushes the total cost above even that figure. In most industrialized countries, the cost is well below 10%. So while I've seen you make this point many, many times, I don't see why you don't pay more attention to that factor. The point really is to lower the overall costs, and shifting the costs from an ineffective private system, one in which freelance working people like me are unable to obtain satisfactory coverage, to a tax based system could achieve that. If your taxes go up 4%, but your health care costs go down just as much, or if the productivity of the overall economy is increased to compensate for that cost, what's the issue? Do you just believe that can't be done? Are the examples of it being done in other countries not good enough?

In all this, you constantly return to the fact that you and others are happy with their current health care situation. Bully for you. But this is a systemic problem- and the fact that you personally are happy already comes at the cost of many people who are not, and who have much reason to worry about their future in this regard.

quote:
People use whatever is available - be it energy, health care, food, everything. If unlimited health care is available for everyone, then it will cost an enormous amount of money and people use what they need and more. There's no getting around that.
It's free to call the cops. Do you call them all the time? If not, why not?

In this country, as an example, extremely nominal fees for service have had an enormous effect on this type of abuse. We have a public-backed option model, where seeing a specialist costs the insured approximately $1.50. In a country where people will go to the doctor at the drop of a hat, the percentage of GDP spending is in line with the industrialized world standard at about 9%. A real life example of your theory not working out. Sometimes I just suspect you think very little of the morality of poor people.

quote:
We ought to at least give the free and open market a shot. It's done a wonderful job of lowering costs for just about everything else.
Health care is unlike any other commodity. Simple explication: the value of an antibiotic course today, for me, is zero dollars. I don't have any infections. The value of an antibiotic course a year from now, when I life threatening pneumonia, is my entire life savings. Is there another commodity that functions that way, that you can think of? That's why we have insurance markets, and insurance markets *require* regulation. That is, if your goal is to make health care available to everyone. Describe to me another commodity that functions in that way, and I'll listen. I can't think of one.

People who have more coverage use more health care services. The same people on basic Medicare versus Medicare Advantage - the people on Medicare Advantage have more tests, go to the doctor more often, stay longer in hospitals. Health care is more than a course of antibiotics. It's a decision of whether to see a doctor if you pull a muscle running. It's that second opinion. It's another MRI. It's rerunning the tests to make sure. It's going to the doctor on the fourth day of a cough. There are many, many places where, if health care is perecieved to be costless to the consumer, the consumer uses more health care.
 
Posted by katharina (Member # 827) on :
 
What about the people with no insurance? But there are other situations where people might choose to have catastrophic insurance and pay for the regular care out of pocket. True insurance - it's there in case of a disaster, but it isn't meant to be a maintenance thing. Like car insurance, which pays for a fender bender but not for an oil change.

Or if someone has an enormous deductible - if the first $5000 comes out of pocket, I would certainly hope people would care how efficiently that $5000 is spent, so in most years, they don't even have to reach that number.

Open pricing would be such a great thing. When coupled with true exchanges where the insurance company isn't chosen by HR but the consumers get to pick from a selection, it would go far to reign in costs. It would be part of a great solution - why wait to do it last? If you are fixing something, why not do the good, easiest-in-comparison stuff first?

I think it would actually change the system - if people could actually get a good idea of what thigns were costing, then there'd be more honest conversations about the cost of it and it would be miles easier to make comparisons and cost/benefit analyses. Those are nothing but good when you are choosing where to allocate resources.
 
Posted by CT (Member # 8342) on :
 
quote:
Originally posted by katharina:
There are many, many places where, if health care is perecieved to be costless to the consumer, the consumer uses more health care.

There is research on this as well. The amount of cost at which people seem to curb their unwarranted usage is quite small, as Orincoro noted. Above that, there is little effect on usage.

dabbler and kmboots, to your rapidly-expanding model, add the factor of outcomes measures. Just knowing the cost (in matters of healthcare) is not enough, and it can be misleading. This isn't like buying a car, where the car you buy from Place A is pretty much like the same make and model you buy from Place B.
 
Posted by CT (Member # 8342) on :
 
quote:
Originally posted by katharina:
Open pricing would be such a great thing. When coupled with true exchanges where the insurance company isn't chosen by HR but the consumers get to pick from a selection, it would go far to reign in costs.
...
I think it would actually change the system ...

I know you think it would actually change the system. When it has been tried and evaluated, that doesn't seem to be the case. I think better assessments are made based on what actually seems to happen with a given change, rather than what we believe will or ought to happen, contrary to the facts -- at least, when that information is available.

Again, I'm not arguing that costs should be hidden. I am trying to figure out why you still believe so strongly that something would happen when, in fact, it didn't.
 
Posted by kmbboots (Member # 8576) on :
 
If John has no insurance, it would make sense for him (in my scenario) to choose Hospital C if the ambulance will take him there. Unless it is cheaper because it is not as good. Or there isn't enough time to get to the furthest away hospital.

Unless he only thinks he has appendicitis. Hospital A charges $450 test and Hospital C charges $600 for that test. If it is a gall bladder, the surgeon at Hospital B is cheapest but he drinks.
 
Posted by CT (Member # 8342) on :
 
katharina, I think I'm pressing too hard and too directly. As you can probably tell, this is an issue that weighs on my mind a lot, and I get chompy at the bit about it. But I do not mean to be uncivil, and I'll drop it for just a bit.

[ December 14, 2010, 07:40 PM: Message edited by: CT ]
 
Posted by dabbler (Member # 6443) on :
 
(Ack: to CT's post a couple posts up, not the most recent one) Definitely, CT. It's a very very complicated scenario.
 
Posted by CT (Member # 8342) on :
 
quote:
Originally posted by dabbler:
(Ack: to CT's post a couple posts up, not the most recent one) Definitely, CT. It's a very very complicated scenario.

(Billions and billions! [Wink] Which isn't to say that there isn't much to be done, of course.)
 
Posted by Geraine (Member # 9913) on :
 
quote:
Originally posted by Destineer:
Another suspect line from that Geraine post:

quote:
My 401(k) however has grown over 13% a year for the past 4 years I've been contributing at my current job.
This account made over 13% returns in 2008? The year the S&P had an annual return of -37%?
Yes, 13% return. Do you know a lot about the stock market? A negative return as a whole =/= everyone lost money. There are people that made millions in profits in 2008. Over 50% of my 401(k) contributions are invested in foreign stocks, which helped my return rate.

The way things are going right now, I'm almost tempted to buy stock exclusively in Chinese owned entities. Maybe I'll buy some US Bonds [Razz]

Fugu, perhaps you should read up on the so called "Social Security Trust Fund" you defend before you post about it. I think you are confused about how it works.

It works like this:

You pay your OASDI tax from your check. Your employer pays his share. The Treasury receives the money and holds onto it until it is paid out as a benefit or otherwise spent by the government.There is no actual account the money is deposited into. The trust fund is in fact nothing but an accounting mechanism. The treasury credits the SS trust fund with the money, and then they deduct the amount paid out. The rest of the money is converted into Treasury Bonds, which are nothing but IOU's. The government then takes that money and spends it on whatever they want. Boats, aircraft, botox for Nancy Pelosi, etc.

For example, in 2003 the Treasury received about $544 billion in taxes and paid out $406 billion in benefits. The rest of that money that was collected isn't sitting in a trust fund somewhere. It was spent by the government , with an IOU in it's place.

The trust fund shows how much the government has BORROWED from Social Security, not how much is available for future benefits. The Office of Management and Budget under Clinton even said that they are not real assets, and that the only way to finance these IOU's will be to raise taxes or cut benefits.
 
Posted by Orincoro (Member # 8854) on :
 
Geraine, everyone ought to be aware of that fact already. The intent of social security is for it to work as a safety net. It should not be exposed to risk in the marketplace, and so it has to remain a government backed obligation. And yes, that means raising taxes. The horror!

The fact that privatization people will never get around is that the social security program is intended to prevent old age poverty by guaranteeing a nominal income to these people in the future. If you attach risk to that scenario in the form of a gamble on the open market, you eliminate the guarantee of security. What then? You introduce some other program called "Social Security Security," so that those who lose their social security are still secure? The whole point is having the program in place, with the guarantee, no matter what. That money exists solely as an obligation, and so it needs to be met by taxation. That's *why* it exists, to force us to pay for it later, not to save the money now, and certainly not to create a risk-heavy investment piggy-bank for the federal government. Saving the cash would be stupid- what we will have to do, no question, is raise taxes. The money doesn't come from nowhere.

People like you forget, constantly, that the reason this program exists is to safeguard against even larger expenses, such as an impoverished elderly population draining the resources of family, local communities, and ultimately governments as well. What might might work out for you personally, in the short term no less, is not at issue, and *never* was. What is at issue is the possibility of millions of baby boomers being hit so hard by an economic disaster that they become unable to feed themselves. That's why this obligation exists, and as much as that may get you riled up- the measure is there to protect your interests as a taxpayer and a member of society. You are a member of society, no?

[ December 14, 2010, 08:36 PM: Message edited by: Orincoro ]
 
Posted by Destineer (Member # 821) on :
 
quote:
Yes, 13% return. Do you know a lot about the stock market? A negative return as a whole =/= everyone lost money. There are people that made millions in profits in 2008. Over 50% of my 401(k) contributions are invested in foreign stocks, which helped my return rate.
Well, congrats, then. The fact remains that most Americans suffered great losses during that year (as I did), and if Social Security had been "privatized" it would've suffered a similar fate.

I don't think being a smart and/or lucky investor should be a precondition for having a safe and happy retirement.
 
Posted by fugu13 (Member # 2859) on :
 
quote:
For example, in 2003 the Treasury received about $544 billion in taxes and paid out $406 billion in benefits. The rest of that money that was collected isn't sitting in a trust fund somewhere. It was spent by the government , with an IOU in it's place.

The trust fund received treasury bonds and other securities in exchange. It isn't like it could be held in cash, and it is required to minimize risk. The lowest risk investment around is US government bonds and other securities. Obviously when they purchase the bonds from the government, the government receives the money for their purchase. This is not at all relevant to fact that the money is accounted for future benefits.

By your argument, no one in the US who owns government bonds is saving, because the government just spends the money they pay for the bonds with!

quote:
The Office of Management and Budget under Clinton even said that they are not real assets, and that the only way to finance these IOU's will be to raise taxes or cut benefits.
Yes, that sounds just about like what I said. What's the disagreement, here? Nothing about the "trust fund" running out in 2042 (which means, nothing about it having cashed out it's bonds and other securities) makes social security go away in 2042. You're the one who asserted social security would go away in 2042, a blatantly wrong statement.
 
Posted by Orincoro (Member # 8854) on :
 
Fugu, I think Geraine seriously entertained the notion that the government was supposed to actually keep those assets as cash. Pretty much the whole "privatize social security" bit is about a misunderstanding of how the government manages the program's assets.
 
Posted by The Rabbit (Member # 671) on :
 
The government would not necessarily have to raise taxes to pay off the bonds held by social security. There is the option of selling the bonds to someone else.
 
Posted by Week-Dead Possum (Member # 11917) on :
 
Who would buy them?
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by Week-Dead Possum:
Who would buy them?

If the interest rate is competitive, all kinds of people would buy them. The US has never had difficult selling bonds. If the demand goes down, the government raises the interest rates to make them more attractive to investors. Despite all the distress over the US public debt right now, the government isn't having any trouble finding buyers even at quite low interest rates.

US government bonds are considered to be one of the safest investments. Any future in which the US government would be likely to default on its debts, would be a future so bleak that this would be the least of our problems.
 
Posted by Tresopax (Member # 1063) on :
 
Given the extremely high cost of health care in our current system and the fact that socialized health care in other industrialized countries has been shown to cost less, I don't think there's a very reasonable argument to be made against the single-payer system on the grounds of overall cost. If there's a reason not to make the change, it's going to have to be for a different reason than that.
 
Posted by katharina (Member # 827) on :
 
It would depend on how it is done. If people expect the same level of service on socialized medicine, they are going to be dissapointed. And the costs of transition matter - the lower cost wouldn't come right away.
 
Posted by Orincoro (Member # 8854) on :
 
Kat, you're involved in a conversation with at least one person who *cannot afford* insurance. So there is no possible way I would be dissapointed with the level of service. And I'm sure my father who is 62, has dementia, and high blood pressure, is totally dependent on insulin, and is going blind from cataracts would love to not be paying the ungodly sum he does to stay covered. Not to mention never having to worry that his insurance is suddenly going to decide he isn't worth their trouble anymore. This while he carries a tax burden which puts him in a reasonably high bracket anyway.

And the best part of it is- if you can afford it, nothing in socialized medicine says you can't get private insurance. People do it all over the world. I realize you have some compassionate bones in your body, but they way you talk about this stuff, one might wonder.
 
Posted by katharina (Member # 827) on :
 
If you "cannot afford" insurance, then you would not be in the group of people paying for universal medical care, most of whom already have health care coverage. Those people's experiences matter, too, and possibly more.

Sure, people can buy private on top of insurance, like paying for private school on top of paying taxes for the public schools. But considering those people now only pay once, and you want them to pay twice, attention must be paid to what they want.

UPDATE: Actually, most people already pay twice - once for their own coverage, and again for Medicare. What you want is for them to pay three times - for themselves, for old people, and for you.
 
Posted by Swampjedi (Member # 7374) on :
 
Is it even possible to talk about cutting overall costs without rethinking our philosophy on health care? The traditional American idea seems to be that death is an enemy that should be resisted whatever the cost.

That needs to change. Personally, I have a living will that (hopefully) will ensure that my family won't bankrupt themselves trying to keep me alive.

What percentage of our expenditures are spent rearranging deck chairs on the Titanic, so to speak? If I remember my medical sociology class correctly, the number is shockingly high.
 
Posted by DarkKnight (Member # 7536) on :
 
quote:
Given the extremely high cost of health care in our current system
This is a much much bigger discussion than a simple statement. Americans spend more on health care for many many reasons which is different than saying we have extremely high costs for health care.
If we want to reduce the amount spent on health care, then we need to reduce the amount of health care we receive. This means less testing, less screening, less treatments and so on.
 
Posted by TomDavidson (Member # 124) on :
 
quote:
If we want to reduce the amount spent on health care, then we need to reduce the amount of health care we receive.
This is not necessarily true. It may also require that we receive more less expensive healthcare, in lieu of more expensive healthcare later.
 
Posted by Mucus (Member # 9735) on :
 
quote:
Originally posted by Orincoro:
... And yes, that means raising taxes. The horror!

2030: PatriotFoxNews: Republicans refuse to raise taxes to pay for social security unless Democrats reduce the marginal tax rate on the highest tax bracket to -2%. House majority leader Bristol Palin comments, "the poor have had a free ride for too long. It is only fair that the rich have a turn."
 
Posted by Destineer (Member # 821) on :
 
quote:
If you "cannot afford" insurance, then you would not be in the group of people paying for universal medical care, most of whom already have health care coverage. Those people's experiences matter, too, and possibly more.

Why would they matter more? Maybe for reasons of political expedience, but surely not for moral reasons.

You seem a little flippant about the issue of the uninsured. These people are dying (and becoming disabled) at alarming rates. I'd happily pay twice to save those lives.

And who am I to force others to do the same? Well, I say the purpose of the law is at least partly to force people to meet their moral obligations.
 
Posted by katharina (Member # 827) on :
 
I am flippant about nothing.

However, if you want to fund something with actual money, then you should pay attention to where the money comes from.

------

If you want to establish universal health care as a moral obligation, then you are welcome to make that argument. But that hasn't been established, and it isn't universally agreed upon, so you can't ignore all the money aspects by pretending that it is already an existing obligation.

-------

I am not even remotely interested in discussing the moral obligations. There's been enough talk about it, and I'm not interested in that aspect.

I am interested in practical details. All the philosophy in the world won't make it happen unless the practical details get worked out, and embarking on a program without paying attention to the practical details is irresponsible.
 
Posted by DarkKnight (Member # 7536) on :
 
quote:
This is not necessarily true. It may also require that we receive more less expensive healthcare, in lieu of more expensive healthcare later.
It isn't necessarily true in some anecdotal cases but is true for our overall costs in healthcare.
 
Posted by Destineer (Member # 821) on :
 
Maybe. I'd sooner pay for universal coverage with debt, the way we pay for wars these days, than let the inhumane status quo continue.
 
Posted by katharina (Member # 827) on :
 
Greece agrees with you. The less you know about economics, the easier it is use the credit card.

I don't consider "pay for it with debt" to be a sustainable solution.
 
Posted by Destineer (Member # 821) on :
 
Neither do I, but we're on an unsustainable course as a nation now anyway (cf the wars).
 
Posted by Destineer (Member # 821) on :
 
I'm not really suggesting that we pay for our health care with debt, but I do think that these economic points have to be prefaced by the well-known fact that we're not talking about throwing a monkey wrench into a well-oiled economic machine. We're talking about a difference in degree from the extremely irresponsible spending that no one in Washington seriously intends to stop.
 
Posted by katharina (Member # 827) on :
 
I'm interested in an actual, practical, sustainable solution.
 
Posted by Destineer (Member # 821) on :
 
Yes, but a solution to what? What's the problem we're supposed to be solving? Without answering that "philosophical" question, we can't very well debate solutions.

I say the problem we need to solve is the fact that anyone in this country, anyone at all, is uninsured. Since the present (pre-Obamacare) system doesn't solve that problem, maintaining it is a non-option.
 
Posted by katharina (Member # 827) on :
 
Okay, you can turn it back to a philisophical debate. But I don't care about that, and I think there has been enough hand-wringing over the uninsured who don't have access to start with that as a goal - no uninsured without access. That's enough of the philosophy - now to try for a solution. A real one, that will work good enough for the vast majority of interested parties, and is sustainable.

------

"Anything is better than this" is not actually true. There are many, many ways to make it worse. It would be to nice to actually plan the solution instead of dumping the present system - which the majority of Americans are happy with - without a plan of what to do instead.

Do you have any practical ideas? "Not this" and "pay with debt" don't seem to fit the bill.
 
Posted by kmbboots (Member # 8576) on :
 
I don't think that there has been nearly enough "hand wringing" over the uninsured.

It may be surprising to learn that, as a whole, we are not all that much happier with our health care compared to other countries.

http://www.gallup.com/poll/117205/americans-not-feeling-health-benefits-high-spending.aspx

http://www.gallup.com/poll/8056/healthcare-system-ratings-us-great-britain-canada.aspx
 
Posted by katharina (Member # 827) on :
 
Great. Do more hand wringing. I guess I'll check back in when someone wants to talk pragmatics.
 
Posted by kmbboots (Member # 8576) on :
 
Practical solutions have been offered here. Canada, for example, has a pretty practical solution. What we have now is not practical, not sustainable, not humane, and we really aren't all that crazy about it anyway.
 
Posted by scholarette (Member # 11540) on :
 
I am not happy with my health care and I think I am on the cadillac plan. As far as services, lots of the services we get don't do any good. Doctors prescribe lots of tests that do nothing. They have compared the most costly places in America to less costly ones. More costly have higher number of tests, worse outcomes, less costly less tests, better outcomes. Arguably the doctors in less costly places are just better, but they did control for the patients. Also, the most costly place in America is in Texas which has limited ability to sue doctors, so malpractice fears should not be valid.
 
Posted by katharina (Member # 827) on :
 
"Canada" does not count as a practical solution. I mean ACTUAL solutions, actionable accounts, risk assessments, accounting for factors and infrastructure, price controls, sources of revenue - you know, the things you need to pay attention to if you want to accomplish something well. "Canada" doesn't count.


-----

I am personally thrilled with my health care. Free to me yearly checkups, low copay for regular medicines, multiple locations, robust customer service, and low premiums. Maybe there's a downside, but I haven't found it yet.

If someone wants to take it away and replace it with something else, there had better be an actual plan. I want to see the proposal for the destination system, an accounting for the various interests, and a transition plan, all with realistic dollar figures attached and sources of revenue identified.

Anything else is just talk.
 
Posted by kmbboots (Member # 8576) on :
 
One downside is that my taxes are paying for it. I would be happier if my taxes were going toward accessible health care for more people.
 
Posted by Raymond Arnold (Member # 11712) on :
 
What exactly are we hoping this conversation will accomplish? We're not sitting around on hatrack intending to come up with a fully fleshed solution to deliver to Congress.

If we know that another country tried something, it had some growing pains, but that it works now and the people there are happy with it, that seems like a perfectly good starting point to me. For purposes of an internet discussion (which ultimately is for my personal enrichment. No matter what, eventually is going to boil down to "just talk" unless someone here is seriously mounting a lobby campaign for health reform), I would like to know WHY we can't just do what Canada did. I keep hearing people say "Canada was a different place, just copying them wouldn't work" but I haven't heard any concrete examples of what the differences were and what we'd expect to happen if it were tried here.

(I'm not saying we SHOULD just do "what Canada did." I'm just trying to learn right now)

If you really do want to get into the gritty details of how to implement an ideal solution for America, feel free to start by proposing how you would do it. So far all you've said is "it'll cost money." Okay, I believe you (seriously, I do). I also think the money investment is worth it. So, having said "it'll cost money, and is still worth doing," what are we supposed to talk about next?
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by kmbboots:
Practical solutions have been offered here. Canada, for example, has a pretty practical solution. What we have now is not practical, not sustainable, not humane, and we really aren't all that crazy about it anyway.

I'm really frustrated the the nay sayers in health care reform never offer any solid data. Claims like "covering everyone will cost more", and "the free market will bring down prices" may sound reasonable, but the studies don't support these conclusions. The US health care isn't a "free market", but it is the freest in the world. If the system that is the least government regulated in the developed world and costs the most, why should we then conclude that freeing up the market even more won't lead to even higher prices?

Studies have shown again and again that competition does not lead to high quality affordable medical care.

There are at least a dozen countries out there with some form of what conservatives call "socialized medicine". All of them out perform the US system in terms of health outcomes, citizen satisfaction and affordability.

Why should we gamble on something unproven and counter indicated by existing data (like all the free market initiatives) when we have numerous proven alternatives?
 
Posted by Mucus (Member # 9735) on :
 
Canada doesn't require a uniquely American approach [Wink]

Actually, from my perspective, one of the more horrifying spectacles was that of rescission, which effectively meant that many people who thought that they had medical coverage and were paying for it for years would find out that they really didn't when they actually needed it.

I can't imagine being having that kind of pseudo-coverage hanging over my head.

It was nice when that seemed to be on its way out, but maybe no more? ...
quote:
Virginia Attorney General Ken Cuccinelli, who brought the suit, predicts that without the individual mandate, the health care reform law's provisions prohibiting insurance companies from denying coverage to those with pre-existing conditions will be voided. Presumably, that would also allow insurance companies to resume the practice of "rescission," that is, dropping coverage retroactively by claiming that a patient failed to disclose a pre-existing condition, even if it has no bearing on the current illness.
http://articles.baltimoresun.com/2010-12-14/news/bs-ed-health-care-reform-20101214_1_individual-mandate-health-care-reform-health-insurance
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by katharina:
If you "cannot afford" insurance, then you would not be in the group of people paying for universal medical care, most of whom already have health care coverage. Those people's experiences matter, too, and possibly more.

...

I don't know what to say to that. "Flippant" doesn't begin to cover your attitude. This is rather demonstrative of your thinking on this matter. That is to say: you have always demonstrated a deep sort of selfishness which must be common, though few are so shameless about it. Perhaps you don't notice how you sound. Clearly you don't care.
 
Posted by kmbboots (Member # 8576) on :
 
I am sure that katherina is not as selfish in person as it may seem from her posts. In any case, personal attacks aren't going to be helpful.
 
Posted by Tresopax (Member # 1063) on :
 
quote:
Okay, you can turn it back to a philisophical debate. But I don't care about that, and I think there has been enough hand-wringing over the uninsured who don't have access to start with that as a goal - no uninsured without access. That's enough of the philosophy - now to try for a solution.
Since you say you aren't interested in philosophical debate, would you be willing to simply grant without debate that our goal here is to fulfill a moral obligation to ensure everyone gets health care, and do so at as low a cost as is possible while still fulfilling that goal?

If you are willing to accept that without debate, then we can move on to the more practical questions:

Firstly, the downside of your current health care plan is that, even if it satisfies you personally, it doesn't fulfill the above goal because many people don't have halth care.

Secondly, if you'd like a practical solution that would fix that, here it is: Single-payer system based on similar systems abroad. This would fulfill our goal of getting everyone health care.

Thirdly, to pay for it we simply tax people for it. Since they are now being given health care, that tax is offset by the health care payments most no longer have to make.

If you're willing to grant the philosophical goal without any debate, then it seems that fleshing out the practical details of a solution would be fairly straightforward. The only reason there isn't agreement on a solution these days is because most people disagree on the philosophical goals of health care policy.
 
Posted by The Rabbit (Member # 671) on :
 
There are a lot of people who have gone to the trouble of doing fully fleshed out plans including detailed cost estimates.

quote:
http://www.utahpatientspac.com/execSummary
This group is promoting state administered single payer health care. They say their plan can insure everyone at the current health care costs. According to their data, Americans spend $400 billion each year on excess administrative overhead in the health care system. Going to a single payer system can eliminate most or all of that excess administrative cost associated with claims processing, underwriting, pre-authorization and duplication.
 
Posted by scholarette (Member # 11540) on :
 
Even if you are happy now, would you be happy if you needed it? Like truly needed? If tomorrow you find out you have leukemia or a super costly disease, how confident are you that you won't be dropped? that your insurance won't jack up the company's cost to insure so high they find any excuse to fire you? And since that cost is now part of hiring you, how confident are you in your ability to find an employer who doesn't mind the extra million dollars to cover you? Or more mundane, what if next year, your employer switches insurance to a more costly, worse version (my husband work just doubled the cost of insurance plus the plan changed so we pay double what we used to on copays, deductibles, etc- with no raises again, salary basically shrunk)?
 
Posted by katharina (Member # 827) on :
 
No. I don't think there is a moral obligation.

I do, however, think that generally people seem to want to do it, and that's a good enough reason. I don't think there is any obligation to make sure it happens, but I think there is a strong enough general interest that a search for a sustainable solution is more than justified.

Most of your practical issues are predicated on their being a moral obligaton. I don't think there is. So, that something doesn't fulfill the moral obligation isn't a downside for me because I don't think there is one.

quote:
then it seems that fleshing out the practical details of a solution would be fairly straightforward.
This is the problem - no, it isn't. A great many things would have to fundamentally change, from the way the taxes are collected, to continuity of service, to how private practice doctors are compensated versus salaried, to what the incentives are. You have to watch the incentives, because if you do things badly, you'll incentivize the wrong behaviors.

And the tax plan - flat, progressive, regressive? Individuals or corporate? Do you distinguish between type of industry if corporate? General pot or dedicated fund? And what about the transition - abrupt change or gradual transition? What changes gradually?

And for those people who are perfectly happy where they are now - why can't they opt out? Half and half?

We have a single payer system supplemented by private insurance now - it's called Medicare. Do we just enroll the entire nation on Medicare? Are private insurance companies involved at all in basic care? Or is there a combo of Medicaid and Medicare (as a side note, this sucks. Medicaid is definitely inferior, and its the least among us who get stuck on it). Medicare just for old people is close to bankrupting us now - if we switch the 17% of the GDP that is health to all being paid for byt ht government, how much do we have to raise taxes? What would be the effects of that?

And if all the above might happen, what about the majority of Americans who are happy with the health care now? Will they be less happy? If they are...since I don't agree that there is a moral obligation, then it is only after the plan is made that a decision should be made whether or not to go forward. If it makes the majority unhappy, then I don't think it should.

[ December 15, 2010, 01:09 PM: Message edited by: katharina ]
 
Posted by katharina (Member # 827) on :
 
quote:
Originally posted by scholarette:
Even if you are happy now, would you be happy if you needed it? Like truly needed? If tomorrow you find out you have leukemia or a super costly disease, how confident are you that you won't be dropped? that your insurance won't jack up the company's cost to insure so high they find any excuse to fire you? And since that cost is now part of hiring you, how confident are you in your ability to find an employer who doesn't mind the extra million dollars to cover you? Or more mundane, what if next year, your employer switches insurance to a more costly, worse version (my husband work just doubled the cost of insurance plus the plan changed so we pay double what we used to on copays, deductibles, etc- with no raises again, salary basically shrunk)?

Very sure, very sure, and I am part of an exchange - my employer doesn't decide my carrier. My carrier has to compete with dozens of other companies, and there are minimum standards. It works splendidly and I love it. If I had to give that up for something crappier, I am not in favor of it.

-----

The personal attacks are beyond stupid. If you don't have answers, then don't pretend that someone asking for a little bit of actual practical planning is the devil. It just means you can't be part of the solution because "WAAAAAAAAAHHH!!! SOBB!!" is not a useful contribution.

Unless the point is a lot of self righteous posturing, which it very well may be, then moving on to details is EXACTLY the right conversation tack to take.

[ December 15, 2010, 01:13 PM: Message edited by: katharina ]
 
Posted by Raymond Arnold (Member # 11712) on :
 
quote:
Most of your practical issues are predicated on their being a moral obligaton
Not sure which of us you're talking to at here, but I (and most of the people who have been arguing here) are basing most of their argument on the fact that our current system is grossly inefficient and costs more than other countries that DO cover everyone. Whenever the evidence suggests, strongly, that you can SAVE money by helping MORE people, yes, you have an obligation to do so, not because the universe inherently cares if people are generous, but because spending more money for less is just silly.
 
Posted by katharina (Member # 827) on :
 
That was to Destineer, who brought up the moral obligation.

quote:
our current system is grossly inefficient and costs more than other countries that DO cover everyone.
Now THAT is a good reason to develop a working solution.
 
Posted by Raymond Arnold (Member # 11712) on :
 
And people have been talking about that for the past few pages.
 
Posted by CT (Member # 8342) on :
 
quote:
Originally posted by katharina:
And if all the above might happen, what about the majority of Americans who are happy with the health care now?

But the majority of Americans are not happy with the health care now.

Again, when you look at the data, the situation is different than you might want or expect it to be. I think it's important to be aware of that and concerned enough about that to correct one's misperceptions, especially when the context is an important one. I am sure you do, too.

The Commonwealth Fund (along with the Harvard School of Public Health) conducts regular surveys of public satisfaction in health care across 5 nations, including the US (link is to Fox News report from 2004 -- and since then, consumer satisfaction with healthcare has decreased).

quote:
One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16 percent of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed.

---
Edited to add:

quote:
Originally posted by katharina:
Unless the point is a lot of self righteous posturing, which it very well may be, then moving on to details is EXACTLY the right conversation tack to take.

I would agree in general. Specifically, I would like the details we are already discussing to be accurate before we move on with the conversation.
 
Posted by CT (Member # 8342) on :
 
This is a link to one of the most recent Commonwealth Fund reports. Highlights include:

quote:
Key Findings

■ One-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs, compared with as few as 5 percent of adults in the United Kingdom and 6 percent in the Netherlands.

■ One-fifth (20%) of U.S. adults had major problems paying medical bills, compared with 9 percent or less in all other countries.

■ Thirty-one percent of U.S. adults reported spending a lot of time dealing with insurance paperwork, disputes, having a claim denied by their insurer, or receiving less payment than expected. Only 13 percent of adults in Switzerland, 20 percent in the Netherlands, and 23 percent in Germany—all countries with competitive insurance markets that allow consumers a choice of health plan—reported these concerns.

■ The study found persistent and wide disparities by income within the U.S.—even for those with insurance coverage. Nearly half (46%) of working-age U.S. adults with below-average incomes who were insured all year went without needed care, double the rate reported by above-average-income U.S. adults with insurance.

■ The U.S. lags behind many countries in access to primary care when sick. Only 57 percent of adults in the U.S. saw their doctor the same or next day when they were sick, compared with 70 percent of U.K. adults, 72 percent of Dutch adults, 78 percent of New Zealand adults, and 93 percent of Swiss adults.

■ U.S. , German, and Swiss adults reported the most rapid access to specialists. Eighty percent of U.S. adults, 83 percent of German adults, and 82 percent of Swiss adults waited less than four weeks for a specialist appointment. U.K. (72%) and Dutch (70%) adults also reported prompt specialist access.

---
Edited to add:

And again of note, the US has in general worse morbidity and mortality for most major indicators than the other countries surveyed. The system we have is inefficient and gives inadequate quality of care, compared to what other people receive in the developed world.
 
Posted by MattP (Member # 10495) on :
 
Like kat, I am thrilled with my current healthcare. I have a huge network of providers, excellent facilities, and my out of pocket costs are almost nothing. From a superficially selfish perspective, I'm happy as a clam.

However:
1) Medical costs are rising rapidly. My out of pocket costs go up incrementally every year while my salary is depressed to offset the increasing insurance costs paid by my employer.

2) My coverage is contingent on my employment. The distance from "Cadillac plan" to "uninsured" or even "uninsurable" is not far. My employment is stable, but then that's what I thought when I got laid off from my last job a few months ago after 10+ years in that position. Thank God I got another job with good health benefits before the preexisting conditions coverage window closed. I might not be so lucky next time and the job market isn't looking to be getting a lot better soon.

Even from a purely selfish standpoint, if I think much beyond my current situation the status quo is far from ideal.
 
Posted by Ryoko (Member # 4947) on :
 
Frontline's "Facing Death"

quote:
The new population of chronically critically ill?

There's a population of patients that in America are growing, that for the most part don't exist anywhere else on earth. There are very few other countries that either have the cultural belief system or the health care system or the finances to create these patients, but here in America we're doing a great job. And these are people that come to the intensive care unit, that as part of their illness, they require mechanical ventilation, and despite doing everything possible to improve them quickly, they do not improve; they don't die but they stay suspended in limbo. And after the next seven, 10, 14 days, they're still on a ventilator, and they need a tracheotomy done in order to continue to ventilate them. Those patients, we have labeled chronically critically ill. And that population of patients is growing.

It is the worst outcome, as far as I'm concerned, of critical illness. The best thing clearly is to improve quickly and to leave. Although terrible, the second best thing is to die but to die quickly. But the worst thing is to remain in this state of suspended animation, because that can go on for months to years. And what's so sad about it is that the better we get at practicing critical care, the more of these patients we are creating.

And it's growing as a direct result, paradoxically, of our ability to do a better job in the intensive care unit. Because 25 years ago or 30 years ago, all these patients would have died. But since we've gotten very good at all the other stuff we do they're not dying. But they're also not getting better. And they remain in this state of suspended animation for days and for weeks and for months and sometimes for years. And again, it's an American thing -- the result of the American health care system, the cultural belief system in America, and quite honestly, the ability of American health care to pay for it.

I'm curious what your thoughts are regarding this issue in the context of Universal Healthcare.

The Frontline program indicates that this is a problem that will continue to increase in the future, and therefore will become more and more of a financial burden.

Should there be a limit (as far as universal healthcare is concerned) to how long patients should be allowed to stay "suspended in limbo"?
 
Posted by BlackBlade (Member # 8376) on :
 
That is an extraordinarily complicated question. I for one am thankful that we are permitted to even consider it now, whereas once the question moot. I've thought about it before, but I've never come up with anything I was satisfied with, let alone willing to try to share with others.
 
Posted by kmbboots (Member # 8576) on :
 
How long do insurance companies generally cover people in this condition?
 
Posted by Swampjedi (Member # 7374) on :
 
That's basically what I was getting at, above.

I say yes.

Resources are scarce. If we want the government to be involved in health care, then it has to make choices of how to allocate resources. Some of these allocations will directly result in death. Call them death panels if you want, but the finite nature of resources makes them necessary.

Edit: Stupid TOPP.

People want a painless solution where hard choices don't have to be made (e.g., the federal budget).
 
Posted by Destineer (Member # 821) on :
 
Be careful here. They won't be death panels, exactly. They'll be "how long are we going to pay to keep you alive?" panels.

After the govt stops paying, it should always be your option to pay out of pocket, or with private health insurance if they'll cover you.
 
Posted by kmbboots (Member # 8576) on :
 
Right. But are there limits now as to what insurance will cover? Even the spiffiest Blue Cross policy I could find had a lifetime limit. Surely people can and do pay for care beyond that out of pocket. Any reason they couldn't do so under a different plan?

Edit: Or what Destineer wrote.
 
Posted by Ryoko (Member # 4947) on :
 
As I understand it, one of the biggest problems with this issue is that in many cases patients do not have advanced directives that adequately indicate their wishes.

Perhaps a first step (in a universal healthcare system) might be to require everyone to make some sort of choice (sort of like we do with organ donation) about whether to sustain life below a certain threshold or not.

This is a scary choice to make, obviously.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Resources are scarce. If we want the government to be involved in health care, then it has to make choices of how to allocate resources. Some of these allocations will directly result in death. Call them death panels if you want, but the finite nature of resources makes them necessary.
Can you please provide some data to back up this assertion.

It is contradicted by all the data with which I am familiar. Under the current system, 45,000 Americans die annually because of lack of health insurance. link to press release Link to Harvard Study Link to another study with similar findings

The "free market" death panel is killing 45,000 deaths a year. Before I get worked up about how many people will be denied life saving medical care under "socialized medicine", I want to see some evidence that it will be worse than the current system.
 
Posted by Raymond Arnold (Member # 11712) on :
 
I thought Swampjedi was making the same point you were, Rabbit.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by kmbboots:
Right. But are there limits now as to what insurance will cover? Even the spiffiest Blue Cross policy I could find had a lifetime limit. Surely people can and do pay for care beyond that out of pocket. Any reason they couldn't do so under a different plan?

Edit: Or what Destineer wrote.

What people seem to be missing is that we (everyone who pays taxes, has medical insurance and/or pays any medical bill out of pocket) are subsidizing these people right now. People who exceed the lifetime limit are generally people who are critically ill and in intensive care for extended periods of time. If you are in intensive care, the hospital doesn't throw you out when you exceed your lifetime limit. They don't check to see if you can pay out of pocket and dump you out on the street if you can't. And if your lifetime medical costs are already in the millions, chances that you and your estate will be able to pay any significant fraction of the additional costs are next to nothing. So how do hospitals recoup the those costs, they pass them on to everyone else.

Under the current system, we are already paying for these people.
 
Posted by kmbboots (Member # 8576) on :
 
Right. I am just trying to find out why people think that people will be kicked out under a new system any more than they already are.
 
Posted by The Rabbit (Member # 671) on :
 
I think one of the biggest misconceptions in this debate is that under the current system, people who are uninsured don't cost the rest of us anything.

Not having health insurance and not getting any medical care are not the same thing. People who have strokes and heart attacks, are injured in accidents or have any medical emergency nearly always get medical treatment whether they have insurance or not. If you look at the current US medical spending, it includes all of that.

What people who don't have insurance are generally skipping is routing health care. They aren't having their blood pressure checked, aren't being screened for heart disease, diabetes and cancer, aren't getting medication for chronic conditions. aren't getting proper follow ups when they've been seriously ill and so on. In other words, under the current system uninsured people are not getting the most cost effective types of medical care and thus incur much more expensive care when they become critically ill. When those people can't pay the huge bills (which they generally can't), they declare bankruptcy and the rest of us pick up the tab.
 
Posted by kmbboots (Member # 8576) on :
 
Yep. They get very stuck and we get stuck with them. Even people with insurance but higher copays or deductibles end up having to skimp. I have good insurance, am reasonably healthy and I still have almost a grand in medical bills.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by Raymond Arnold:
I thought Swampjedi was making the same point you were, Rabbit.

Perhaps he was, I thought he was arguing that having the government allocating limited health care resources would lead to more deaths than the current system. All the evidence points in the opposite direction.
 
Posted by Ryoko (Member # 4947) on :
 
Rabbit,

What do you think about the idea of requiring people to make some sort of advanced directive (under a universal healthcare plan)?
 
Posted by Geraine (Member # 9913) on :
 
As horrible as some people think healthcare in this country is, I think it is pretty good. My rates may have gone up, but I don't feel like it is going to waste. I don't have to wait for anything. I can call up a doctor today and get in the same day.

I believe healthcare should be available to everyone, but should not be provided to everyone.

As much as people complain about our current system, there are issues with single payer systems as well. This page has a ton of articles from the British press regarding their own system:

http://aolanswers.com/questions/american_media_fail_tell_8627579461110

I don't think there is a good solution to the health care issue yet. Our current system may be broken (though not as badly as some claim) but putting your life in the hands of the government and just trusting that they know what is best for you is ridiculous.

Pretty soon they will be telling you when you can retire, what drugs you can take, what food you can eat, and what cars you can drive......Oh wait... [Razz]

For me this is about freedom. Do I want to hand more power over the government? For those of you that want a single payer system, I would like to know why you personally believe that the government is the best entity suited to running health care. What has the government done in the past that makes you want to entrust your entire well being to their whim?
 
Posted by kmbboots (Member # 8576) on :
 
Geraine, single payer health care won't tell people what kind of health care they can have; it will tell people what kind of health care it will pay for. Just like insurance companies do now.

Like right now, you can retire whenever you want to. If you don't want to wait for Social Security to kick in, nobody is making you.

What have insurance companies done that make you want to entrust your entire well-being to their whim? More to the point, to their bottom line?
 
Posted by The Rabbit (Member # 671) on :
 
quote:
As horrible as some people think healthcare in this country is, I think it is pretty good. My rates may have gone up, but I don't feel like it is going to waste. I don't have to wait for anything. I can call up a doctor today and get in the same day.
What kinds of medical care have you and your family needed recently? There generally isn't much of a wait anywhere to see GP, but waits for specialists are a different story. Have you had to help oversee medical care for anyone who was critically ill?

quote:
I believe healthcare should be available to everyone, but should not be provided to everyone.
How would you propose we decide who should be provided with healthcare and who should not? Ability to pay is not always easy to determine before a patient is treated. Would you have emergency rooms check for ability to pay before they treat a trauma patient? If a member of your family were suffering from a stroke or bleeding to death, would you want the hospital to delay treatment until they could verify your insurance? Would you have hospitals kick people out when they reach their maximum lifetime limit?

Furthermore, the extent of medical bills often isn't known (by anyone) when treatment is started. People often fully intend to pay their medical bills, but as they begin to mount find that they can not. Medical bills are one of the leading reasons people declare bankruptcy? How would you suggest we deal with that?

Let me give you a real life example. Some friends of mine who are married are both employed in jobs that offer no medical insurance. Because of her medical history, they cannot obtain medical insurance for less than a king's ransom. They could likely afford the average premium payment, but that option isn't available to them because of her history so they have no insurance. Last year she broke her ankle. She had a metal plate and some screws which became infected leading to three separate hospitalizations, three surgeries and some time spent in intensive care with septicemia. As a result of one broken ankle, they now have medical bills that are several times their annual income and have no choice but to declare bankruptcy (which of course means that you and I will end up paying their medical bills). How would you suggest we should handle this kind of situation?
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by Ryoko:
Rabbit,

What do you think about the idea of requiring people to make some sort of advanced directive (under a universal healthcare plan)?

I think its a good idea for people to have a living will, with or without universal healthcare. I don't particularly like the idea of mandating it and don't really see what advantage there would be to doing it.

I think an official policy that refused insurance coverage for very expensive treatments which were unlikely to provide significant life extension, would make a lot more sense than the current system of maximum lifetime limits (regardless of the prognosis) and seemingly arbitrary decisions about what treatments will and will not be covered.
 
Posted by MattP (Member # 10495) on :
 
quote:
I think an official policy that refused insurance coverage for very expensive treatments which were unlikely to provide significant life extension, would make a lot more sense than the current system of maximum lifetime limits (regardless of the prognosis) and seemingly arbitrary decisions about what treatments will and will not be covered.
I think those policies are already present in addition to the maximums.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by MattP:
quote:
I think an official policy that refused insurance coverage for very expensive treatments which were unlikely to provide significant life extension, would make a lot more sense than the current system of maximum lifetime limits (regardless of the prognosis) and seemingly arbitrary decisions about what treatments will and will not be covered.
I think those policies are already present in addition to the maximums.
If they are, I have yet to see them clearly articulated in any policy, public or private.
 
Posted by kmbboots (Member # 8576) on :
 
Generally, you have to have approval for treatments. All insurance companies need to do is to deny approval for treatments that, in their opinion, aren't worth the expense.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by kmbboots:
Generally, you have to have approval for treatments. All insurance companies need to do is to deny approval for treatments that, in their opinion, aren't worth the expense.

Which is what I meant by "seemingly arbitrary decisions about what will and will not be covered".
 
Posted by kmbboots (Member # 8576) on :
 
I am not contradicting you, just expanding on what MattP wrote.
 
Posted by Darth_Mauve (Member # 4709) on :
 
There was an interesting comment made about why Health Care and being forced to to buy insurance was different than being forced to buy any other service or product.

"If I don't buy a Big Screen TV, and my team makes it to the Superbowl, I can't run out to the store and demand that they give me a big screen TV to watch the game. However, if I don't own insurance, and I discover I have cancer, I can go to the hospital and demand they cure me for free."

Many conservatives are arguing that having the government not allowed to force us to buy insurance means the end to liberal dreams of fixing the health care system.

But if the present system is not working--medical expenses are taking up larger and larger percentages of our income--with more and more people finding them larger than they can afford--and it will continue--and insurance reform isn't going to be allowed to work, what can we do? The answer is treat it like a fire department.

They used to sell fire insurance--so that if your house catches on fire the fire department will come out and put the fire out. Then they discovered that if your neighbor didn't buy fire insurance, and their house caught on fire, then that fire became a danger to your house. So most governments decided to forget the outsourced, pay-as-you-go fire departments--and just had everyone pay in the form of Property Taxes.

So if we can't get health insurance reform approved, the only option left is to take over the whole thing, kick out insurance companies and privately employed medicals, and do it all through the government.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by kmbboots:
I am not contradicting you, just expanding on what MattP wrote.

And I was just expanding on what I'd written and why I thought the existing system is undesirable.

I would much rather have decisions about rationing medical care made by a group of people who were responsible to the public than by the invisible hand of the market or an insurance company whose primary responsibility is to make a profit for their share holders.

Markets are great for maximizing profit and economic activity. If you consider profit and economic growth to be the primary objective of a health care system, then the US system is in fact the best in the world as it generates the most profit and the highest GDP.

If on the other hand, you think the objective of a health care system should be to improve the peoples health and well being, . . . .
 
Posted by katharina (Member # 827) on :
 
quote:
Markets are great for maximizing profit and economic activity
They also maximize productivity, efficiency, innovation, and lower costs. All good things, for everyone. And the lack of a free market strangles those things.

Any accounting of the cost needs to account for the lost incentives and cost-lowering power of market pressure. True market pressure, which doesn't currently exist.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by Geraine:
[QB] As horrible as some people think healthcare in this country is, I think it is pretty good.QB]

That's just so FANTASTIC!.

Good thing you HAVE insurance!

If only I had thought of THAT!
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by katharina:
quote:
Markets are great for maximizing profit and economic activity
They also maximize productivity, efficiency, innovation, and lower costs. All good things, for everyone. And the lack of a free market strangles those things.

Any accounting of the cost needs to account for the lost incentives and cost-lowering power of market pressure. True market pressure, which doesn't currently exist.

That is the dogma of the free market fundamentalists**. While it is true that freeing up markets can under certain circumstances stimulate innovation and efficiency there is no evidence that it always does this or that it is the only thing that does this. In fact, there is strong evidence that market competition actually degrades the quality of medical care.

Since we are dealing with an issue that influences the lives and well being of real people, its really important not to gamble on unproven theories. We need to look at what the data says and all the data points toward the same thing -- universal coverage under a single payer system.

**Free market fundamentalist is a term I learned from the nobel prize winning economist Joseph Steglitz. It implies an unshakable faith in free markets even in the presence of strong evidence to the contrary. I believe it is appropriate in this context as all of the data is strongly against the benefits of free market for health care. If you disagree, please provide links to the data and studies that would support this contention rather than simply repeating it as a self evident truth.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by katharina:
quote:
Markets are great for maximizing profit and economic activity
They also maximize productivity, efficiency, innovation, and lower costs. All good things, for everyone. And the lack of a free market strangles those things.

Are you aware of the concept of a "public good?"

Let me give you the example Planet Money used a few weeks back. Lighthouses. Lighthouses, I think you will agree, are good for productivity and economic activity. Without lighthouses, shipping would be more difficult and dangerous, and therefore costly.

However, there were some economic barriers to building lighthouses before the advent of a federal government. The free market, for instance, would love to *have* light houses in certain places where it is expensive to build and maintain them, such as on rocky shoals and cliffs. However, the free market did not, before the government stepped in, build such lighthouses. The reason was that there was no mechanism for limiting the use of a lighthouse, and so there was no incentive for trading partners who benefited unequally from their existence to cooperate in building them. One might abstain from contributing, and reap more benefit from doing so, while other companies might desperately need lighthouses to do their shipping. So, no lighthouses where it wasn't absolutely necessary and sure to be profitable for those who could afford to build them- because the industry as a whole could not cooperate in this.

The public good model fits with health care just as well or better than it does with certain other already government controlled industries, such as the mail. The mail, as a counter-example *is* limitable. You don't put on a stamp, you don't get your letter sent. The USPS exists because the government has an interest in a guaranteed means of communication and delivery separate from market forces, in order to maintain communication and trade. Likewise, health care is a public good. It is a good that cannot (read *will never*) be provided to all who need it by a private industry, leastwise a poorly regulated one. Yet this commodity is not limitable. Hospitals cannot turn away patients, and doctors are sworn to do no harm- so we end up with shitty care for a lot of people who could have gotten even ok care earlier, but couldn't. Why? Because the industry will make the same sorts of decisions that the lighthouse builders used to make. "What is good for my company, right now?" That is the kind of question we expect private industry to ask. And sometimes what is good for the market is not good for society. And that is a situation I find unacceptable. You need to look about as far as overall health care spending to see what I'm talking about here. The health care industry takes in more money per capita than in any other system in the world. So that's a successful industry right? By most economic metrics, we're not only doing ok, we're doing *GREAT.* Except millions of people still don't have adequate access to care. Strange that. I wonder how that happens.

And as to a much earlier and very cynical question Geraine asked of me, as to what industries I think should *not* be socialized: the answer is most of them. But there are features of good government they don't talk about on fox news. Government, at its very base, is intended to fulfill exactly this sort of function- to operate where private industry is incapable of stabilizing the dispersal of goods in a way that is beneficial to mutual security, peace, and well-being. It's not a wonder to me that the republicans don't seem to believe in government anymore. Perhaps they don't believe in these things either.
 
Posted by The Rabbit (Member # 671) on :
 
Health care markets simply do not function the way people intuitively believe markets should function. Competition between hospitals can result in higher costs and poorer outcomes. For example, studies have found that there is an inverse correlation between the number of neo-natal ICUs there are in a community (pre capita) and survival rates for premature babies and a direct correlation with cost.

Free market fundamentalists will argue that more competition will lead to lower costs and better quality, but that is exactly the opposite of what happens. Here's why. There is a limited demand for NICUs. That demand isn't going to increase no matter how many NICUs there are or how cheap they might be. But hospitals aren't just competing for NICU patients, they are competing for delivering babies. Since child birth is something you know is going to happen months in advance, parents can shop around for a hospital. They are more likely to choose a hospital that has a NICU just in case. The result is that every hospital wants a NICU. But NICUs are expensive to own and operate. They require a lot of expensive specialized equipment and specialized nursing care. Since only a small fraction of babies require a NICU, a community is better served by concentrating equipment and expertise in a small number of facilities. Competition actually drives it in the opposite direction, more lower quality NICUs at a higher price.
 
Posted by CT (Member # 8342) on :
 
quote:
Originally posted by The Rabbit:
Health care markets simply do not function the way people intuitively believe markets should function.

Again and again, this is what assessments show.

Good example, The Rabbit.
 
Posted by Glenn Arnold (Member # 3192) on :
 
I'd just like to comment on the "you have to wait for health care in Canada" meme, from my personal experience. (Wow, this is really long)

I hurt my back in 1996. I went to the doctor (Dr. Compain). He told me I had a back strain, gave me pills and told me to take a couple of days off. When I went back to work, the safety manager and I filled out an accident report form, and it asked if I had any x-rays or MRIs taken. I hadn't, and the manager told me to ask the doctor why, on my follow up visit. I did, and he answered angrily that the safety manager could order his own MRI when he got a medical degree. I switched doctors.

The new doctor said that without an MRI, he really didn't know what was going on in my back, but he didn't order one. It seemed like he was taking a "wait and see" approach, but time went on, and he kept refusing to order the MRI. I went to a chiropractor, who told me to get a lawyer. The doctors were getting paid, and I was still working, so I didn't see the point in getting a lawyer.

I have a seasonal cough (probably related to allergies) which caused my back to get worse during cough season. Each year it got worse. I went to the doctor, and each time he mentioned an MRI, but didn't order one. I asked him why, and he said that he couldn't get one without authorization from worker's comp, but didn't go into details.

I switched chiropractors, and the new one also told me to get a lawyer, and also sent me to a neurologist. The neurologist listened to my story, and said that based on my initial symptoms, that it was clear that I had pretty serious disc involvement, but that I needed to get a lawyer so I could get approval for an MRI from worker's comp. I finally got a lawyer, and he told me to have the neurologist request authorization. He also told me that worker's comp has 30 days before they are required to respond, and that I should call them after 31 days, because they wouldn't authorize the MRI. 31 days later I called. They told me that they hadn't got a request from the doctor.

I told the doctor this, he rolled his eyes and said he'd send in another request. 31 days later, I called again. They hadn't got a request from the doctor. I argued that he had sent it in twice, but they insisted that he hadn't. After some argument they said they hadn't had any requests from Dr. Compain since I had initially seen him over 2 years earlier. I told them that I had seen several doctors since then, and that the request came from my neurologist, Dr. Benjamin. They said they had absolutely no record that I had seen Dr. Benjamin.

I went to see Dr. Benjamin, told him the story, and he said to his receptionist: "Show him the checks." His office scans every check and keeps a copy with the patient's file. They had been paid by the company that had "absolutely no record" that I'd seen him.

I called the insurance adjuster again, told her this, and told her that I needed the MRI because I was in pain and needed help. She told me that I wasn't in any pain. Just like that. "You're not in any pain."

At this point my lawyer explained that unless we could get a document from the insurance company that denied approval of the MRI, we couldn't take it to the comp board. He sent a letter to the insurance company, but still nothing happened.

A friend at work told me to stop coming to work. My co-workers could see from the way I was walking, wincing, generally going through ridiculous gyrations to escape the pain that I needed help, but I didn't see how taking a couple of days off would actually let my back get better, so I kept going.

Eventually I caught a cold that caused me to sneeze and cough more severely than normal, and one night I found that I couldn't walk. I kind of fell on the bed and my wife called the ambulance. They hauled me the emergency room, bawling like a baby (it was really embarrassing!). There they said that if the MRI was open, they would take one, but it wasn't. So they gave me a shot of morphine.

I stopped going to work. I was still coughing, and I tried to make an appointment to see my Primary Care doctor, but I had to see a physicians assistant. I told her the cough HAD to stop, because it was tearing my back apart. She gave me codiene, and told me to see my doctor, and ask him to submit the request for an MRI to my regular medical insurance, and tell them it was a worker's comp case, but that they wouldn't approve the MRI, and let them work it out between the two companies.

I week later I saw the doctor, told him what the P.A. had said, and he crossed out the encounter form, told me that the receptionist would give me back my co-pay, and that he was going to pretend this visit hadn't happened, because I was asking him to commit fraud.

At this point I felt absolutely hopeless. After a week or so, I decided to call the insurance company myself, and they told me that yes, that was exactly what the doctor should do, and said the doctor had no business claiming that I was asking him to commit fraud.

I went back to the doctor, and told him what they'd said. He answered tersely that he would do this, but made it clear that he didn't think it was kosher. The next day I got a letter from his office telling me that I had "threatened him and his staff" and that I "should find another doctor." I'm not sure how a cripple who could barely walk could threaten them. Anyway he ordered the MRI.

I got the MRI, and took copies to the neurologist, and the chiropractor. I had bulges on both sides of my l-4,l-5 disc, about the thickness of my thumb on both sides. The neurologist sent me to a neurosurgeon, who scheduled surgery for July 25, 2001.

In the meantime, my lawyer finally got a denial from the insurance company, and scheduled the first of many court appointments.

I got the surgery, and was declared "permanently partially disabled" and told that I would be covered for medical treatments for the rest of my life. That was in 2002. Since then, I've had about 6 court appointments, because every time I need treatment greater than a doctor visit, I have to get approval from worker's comp. They have 30 days to respond. 31 days later they claim they didn't get a request. My lawyer serves them a request. They deny it, and a court date is set for sometime within the next six months. Then the court approves the treatment, but usually by that time the acute pain is gone. I get the treatment anyway because I know that if I don't, it will look bad that I got approval but didn't get the treatment.

This is the way worker's comp insurance works in the U.S.
 
Posted by Samprimary (Member # 8561) on :
 
lol @ 'you're not in any pain'

*jedi mind trick hand wave*
 
Posted by Samprimary (Member # 8561) on :
 
Also to note:

quote:
Originally posted by katharina:
Health care that covers everyone will certainly cost more than health care that doesn't cover everyone.

Remember always how many times we have to go back to reiterating how this is demonstrably false. Our coverage system ends up costing more precisely because of a lack of coverage for millions, among other things.
 
Posted by Juxtapose (Member # 8837) on :
 
Glenn, thanks for sharing all that.

I can't imagine how frustrating that would be, but it's fascinating in an awful way.
 
Posted by AvidReader (Member # 6007) on :
 
quote:
Originally posted by CT:
Key Findings

■ Thirty-one percent of U.S. adults reported spending a lot of time dealing with insurance paperwork, disputes, having a claim denied by their insurer, or receiving less payment than expected. Only 13 percent of adults in Switzerland, 20 percent in the Netherlands, and 23 percent in Germany—all countries with competitive insurance markets that allow consumers a choice of health plan—reported these concerns.

■ The U.S. lags behind many countries in access to primary care when sick. Only 57 percent of adults in the U.S. saw their doctor the same or next day when they were sick, compared with 70 percent of U.K. adults, 72 percent of Dutch adults, 78 percent of New Zealand adults, and 93 percent of Swiss adults.

■ U.S. , German, and Swiss adults reported the most rapid access to specialists. Eighty percent of U.S. adults, 83 percent of German adults, and 82 percent of Swiss adults waited less than four weeks for a specialist appointment. U.K. (72%) and Dutch (70%) adults also reported prompt specialist access.

Hmm. Sounds like I need to do some research on what the Swiss are doing.

Thanks for the link, CT!

ETA: I can't spell thanks, but I mean it. [Smile]
 
Posted by Swampjedi (Member # 7374) on :
 
quote:
Originally posted by The Rabbit:
quote:
Originally posted by Raymond Arnold:
I thought Swampjedi was making the same point you were, Rabbit.

Perhaps he was, I thought he was arguing that having the government allocating limited health care resources would lead to more deaths than the current system. All the evidence points in the opposite direction.
Perhaps the use of the phrase "death panels" flipped on a filter. [Cool]

Rabbit, I do, in fact, agree with you on this. The free market decides who lives and dies, too.

Destineer, correct. There will always be the option to go it alone, as there is now. However, the result of (government|corporate) decisions on when supported care ends is likely quick demise. If I've been fighting cancer for decades, chances are I'm broke from being nickel-and-dimed ( X some large factor) by OOP expenses.

How do we deal with the "bathtub" curve of expenses (High at either end, relatively low in the middle), especially with an aging (and politically powerful) population?
 
Posted by katharina (Member # 827) on :
 
quote:
Originally posted by The Rabbit:
quote:
Originally posted by katharina:
quote:
Markets are great for maximizing profit and economic activity
They also maximize productivity, efficiency, innovation, and lower costs. All good things, for everyone. And the lack of a free market strangles those things.

Any accounting of the cost needs to account for the lost incentives and cost-lowering power of market pressure. True market pressure, which doesn't currently exist.

That is the dogma of the free market fundamentalists**. While it is true that freeing up markets can under certain circumstances stimulate innovation and efficiency there is no evidence that it always does this or that it is the only thing that does this. In fact, there is strong evidence that market competition actually degrades the quality of medical care.

Since we are dealing with an issue that influences the lives and well being of real people, its really important not to gamble on unproven theories. We need to look at what the data says and all the data points toward the same thing -- universal coverage under a single payer system.

**Free market fundamentalist is a term I learned from the nobel prize winning economist Joseph Steglitz. It implies an unshakable faith in free markets even in the presence of strong evidence to the contrary. I believe it is appropriate in this context as all of the data is strongly against the benefits of free market for health care. If you disagree, please provide links to the data and studies that would support this contention rather than simply repeating it as a self evident truth.

Namecalling. [Roll Eyes]

This discussion is too deliberately stupid to be worth the bother.
 
Posted by The Rabbit (Member # 671) on :
 
I have not called anyone involved in this thread any names. I used a name for a certain belief system which has been defined and used by very notable individuals. As I said before, I believe the term applies because all the data with which I am familiar demonstrates that the free market leads to higher prices and poorer quality health care. If you are familiar with studies that support your point of view, please provide the links rather than simply continuing to assert that the free market will solve all problems.
 
Posted by Darth_Mauve (Member # 4709) on :
 
There are three reasons that Health Care does not fit standard capitalist models.

1) When purchasing a widget there is a rational hierarchy of requirements. Cost, Quality, and Speed of Delivery vary on specific cases, but in each case the buyer can decide is X cost worth Y quality delivered in Z amount of time or is X-10 worth Y-10% delivered in Z+3 Days?

However, in health care the distance between the value of Y--Quality--is almost infinitely more important than X--Dollars. How much would you need to save before going to a 2nd rate physician for heart surgery, or using a 2nd rate procedure with only 50% chance to save your life instead of 90%?

2) Z is often the most deciding factor. Z = time. If you are having a heart attack, or you are feeling ill, you want to be healthy now, not after shopping around doctors and determining that a 10% savings is offered by Doc Oct on the other end of town.

Rational decisions which are required for a rational market to exist, are rarely made when the health of you or your loved one is at stake.

3) Even if you could act rationally about your own health, the basic market formula does not work.

Mr. W sells Widgets. If I want to buy them I shop around, so Mr. W has an incentive to keep his prices low to induce me to buy his widgets.

Dr. D sells his services. He sells them to the insurance companies, though I am the recipient of his services. He has an incentive to keep his prices to the insurance company low or else my insurance company won't accept him as a doctor.

However, the insurance company is selling the option on his services to my employer. My employer is looking for an insurance company that offers the most doctors at the cheapest price. The insurance company is looking to keep doctors on their lists more than lowering prices so they can sell more programs.

My employer is looking for the least expensive--to them--insurance program that will result in the fewest complaints. The service the doctor gives the patient is irrelevant. The service the insurance company gives to the patients is what is important. If only 1 in 100 patients is ill to the point of having issues with the insurance company, the number of complaints is small. If 25 in 100 complain that their doctor is not on the approved list, the number of complaints is large, and the employer will go to another insurance company. Hence the insurance company has only a limited motivation to keep standard costs down.

It gets much more complicated than that, but basically the simple supply/demand mechanics of the market are splintered and motivations are lost when there are 4 active players--Patient, Doctor, Insurance, Employer. Add Hospital, Billing Agency, and more to the list and it becomes gridlock.

So the question becomes, who would you rather have on a death panel--an expert who's job is controlled by a corporation looking only for profit, or an expert who's job is controlled by an elected official looking only for reelection.
 
Posted by DarkKnight (Member # 7536) on :
 
quote:
Remember always how many times we have to go back to reiterating how this is demonstrably false. Our coverage system ends up costing more precisely because of a lack of coverage for millions, among other things.
As a wealthy country, we choose to spend more on healthcare which is vastly different than costing more. Lack of coverage is a factor, not THE factor
 
Posted by kmbboots (Member # 8576) on :
 
But why do we choose to spend more when we could get better for less? And help those the some of us feel we have a moral obligation to help?
 
Posted by DarkKnight (Member # 7536) on :
 
The choice of spending more includes more testing, more procedures, and consuming more health care not necessarily paying more.
 
Posted by CT (Member # 8342) on :
 
quote:
Originally posted by DarkKnight:
The choice of spending more includes more testing, more procedures, and consuming more health care not necessarily paying more.

I can't quite parse that.
 
Posted by Orincoro (Member # 8854) on :
 
Don't sweat it Rabbit. You win, so Katharina changes the rules or quits. She does this often. I know you know it- I am just saying to be clear to anybody who might be reading this and thinking... what awful people abuse this poor person so??
 
Posted by DarkKnight (Member # 7536) on :
 
CT, To clarify, Americans get more testing done which costs more overall. If a Canadian goes to the doctor they may have one test done whereas Americans may have 5 tests done. Not all of those tests may be necessary but in America we get them done to be 'thorough'.
 
Posted by MrSquicky (Member # 1802) on :
 
Rabbit,
I've appreciated the restraint and patience you (and others) have shown in this thread.
 
Posted by kmbboots (Member # 8576) on :
 
I am more and more convinced that all the data in the world won't be enough to convince those that, in their hearts, really don't feel that other people are worth helping.
 
Posted by Blayne Bradley (Member # 8565) on :
 
quote:
Originally posted by DarkKnight:
CT, To clarify, Americans get more testing done which costs more overall. If a Canadian goes to the doctor they may have one test done whereas Americans may have 5 tests done. Not all of those tests may be necessary but in America we get them done to be 'thorough'.

No you get them done to avoid getting sued.

Remove the ability to get sued and the costs of testing goes away.
 
Posted by CT (Member # 8342) on :
 
quote:
Originally posted by DarkKnight:
CT, To clarify, Americans get more testing done which costs more overall. If a Canadian goes to the doctor they may have one test done whereas Americans may have 5 tests done. Not all of those tests may be necessary but in America we get them done to be 'thorough'.

Oh, that I get. I have intimate knowledge of that concept.

I have trouble parsing your sentence, particularly how the latter portion connects to the former. But no matter -- whether or not I understand you is of little matter, and likely not worth your time. [Smile]
 
Posted by MrSquicky (Member # 1802) on :
 
quote:
Originally posted by Blayne Bradley:
quote:
Originally posted by DarkKnight:
CT, To clarify, Americans get more testing done which costs more overall. If a Canadian goes to the doctor they may have one test done whereas Americans may have 5 tests done. Not all of those tests may be necessary but in America we get them done to be 'thorough'.

No you get them done to avoid getting sued.

Remove the ability to get sued and the costs of testing goes away.

There's a lot of reason why we run more tests. One the big ones is that, in our current insurance model, they're a good revenue stream for the doctors who order them.
 
Posted by Destineer (Member # 821) on :
 
quote:
Originally posted by Geraine:
For those of you that want a single payer system, I would like to know why you personally believe that the government is the best entity suited to running health care. What has the government done in the past that makes you want to entrust your entire well being to their whim?

Didn't you ask this exact same question a couple pages back, and receive a perfectly satisfactory asnwer in terms of a list of govt programs that work very well?
 
Posted by CT (Member # 8342) on :
 
It's high time for the "Links You've Probably Already Seen" Thread.
 
Posted by MrSquicky (Member # 1802) on :
 
<snip>Actually, I should make this a new thread. It really doesn't fit here.</snip>
 
Posted by kmbboots (Member # 8576) on :
 
quote:
Originally posted by CT:
It's high time for the "Links You've Probably Already Seen" Thread.

Like this one?

http://www.npr.org/series/113581659/how-health-care-became-so-expensive

quote:
For a variety of reasons, it's really hard for doctors to say no to patient requests, even when those requests are unreasonable, wrongheaded and potentially harmful.

For example, Zebley says that several times a week a patient comes in asking for a test that he is 99.99 percent sure would be a complete waste of time. But Zebley will almost always give the patient the test they request, even though he knows it will cost money and time. The main reason: malpractice.

There are three segments. I recommend listening to all three.
 
Posted by Geraine (Member # 9913) on :
 
quote:
Originally posted by Destineer:
quote:
Originally posted by Geraine:
For those of you that want a single payer system, I would like to know why you personally believe that the government is the best entity suited to running health care. What has the government done in the past that makes you want to entrust your entire well being to their whim?

Didn't you ask this exact same question a couple pages back, and receive a perfectly satisfactory asnwer in terms of a list of govt programs that work very well?
Actually no. You have a choice to go to a National Park, to use interstate roads, or join the military. This is about removing the freedom of choosing your own healthcare and placing it squarely on the government. In some countries where single payer systems are active, it is often illegal to obtain private insurance in addition to the government provided healthcare.

quote:
Originally posted by kmbboots:
I am more and more convinced that all the data in the world won't be enough to convince those that, in their hearts, really don't feel that other people are worth helping.

I'm willing to help people that are willing to help themselves. I'm not for a nanny state that provides cradle to grave benefits for everyone.

There are changes that need to be made. I don't think there is one person that believes that a terminally ill person should be dropped from their insurance plan. But just because some people can't afford it or have high health costs doesn't mean we should just scrap what we have and just trust that the government is going to take care of us.

Please stop acting like those that don't want a single payer system aren't compassionate and that you have the moral highground.

Give a man a fish and he'll eat for a day. Teach a man to fish and he'll eat for a lifetime. I'd like to give the man a fish once or twice until he is able to catch his own. You'd have everyone else fish and give him some of our catch until we as society decides he isn't worth feeding anymore.
 
Posted by CT (Member # 8342) on :
 
quote:
Originally posted by kmbboots:
quote:
Originally posted by CT:
It's high time for the "Links You've Probably Already Seen" Thread.

Like this one?
That's pretty good.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
In some countries where single payer systems are active, it is often illegal to obtain private insurance in addition to the government provided healthcare.
I'm not sure how this is relevant since no on that I'm aware of is proposing to make it illegal in the US to have private insurance or pay medical expenses out of pocket.

You haven't addressed my question about how you envision a system would work where people were not provided with health care unless they are able to pay for it. Under our current system, people get health care they can't afford to pay for all the time. It isn't practical to pay for urgently needed or emergency medical care in advance or check credit record before admitting a person to the hospital. It really isn't a simple problem and I would like you to address it.

Most of the people who declare bankruptcy because of huge medical bills aren't trying to defraud the system. They fully intended to pay their bills but due to a string of bad luck they can't. Is it any wonder that a person who's gone septic or had a heart attack will seek treatment before they go through all the calculations to figure out how they are going to pay for it? Would you want it any other way?
 
Posted by rivka (Member # 4859) on :
 
quote:
Originally posted by Geraine:
In some countries where single payer systems are active, it is often illegal to obtain private insurance in addition to the government provided healthcare.

Really? Such as?

I have relatives in several countries with single-payer systems, and I am unfamiliar with such laws. Of course, I don't claim to know all the countries with single-payer, so I'm curious which countries have this restriction. It's certainly not a part-and-parcel thing, in any case. So like Rabbit, I wonder why this is relevant. But I'm also curious what countries you are referring to.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by kmbboots:
I am more and more convinced that all the data in the world won't be enough to convince those that, in their hearts, really don't feel that other people are worth helping.

BINGO!

Eta: I honestly feel this is why conservatives think that socialized medicine or anything even remotely like it is all part of some liberal gambit to "control" people*. The idea that you would want people to have the chance to live better lives when you don't even know them, never mind that this would also help you in your own life, is right out as a possibility.

*But somehow fail to map that instinct onto their own political preferences to see if it holds up to the same sort of logic.
 
Posted by MrSquicky (Member # 1802) on :
 
quote:
Eta: I honestly feel this is why conservatives think that socialized medicine or anything even remotely like it is all part of some liberal gambit to "control" people*. The idea that you would want people to have the chance to live better lives when you don't even know them, never mind that this would also help you in your own life, is right out as a possibility.
I think that is extremely unfair to a large number of conservatives.
 
Posted by Geraine (Member # 9913) on :
 
quote:
Originally posted by The Rabbit:
quote:
In some countries where single payer systems are active, it is often illegal to obtain private insurance in addition to the government provided healthcare.
I'm not sure how this is relevant since no on that I'm aware of is proposing to make it illegal in the US to have private insurance or pay medical expenses out of pocket.

You haven't addressed my question about how you envision a system would work where people were not provided with health care unless they are able to pay for it. Under our current system, people get health care they can't afford to pay for all the time. It isn't practical to pay for urgently needed or emergency medical care in advance or check credit record before admitting a person to the hospital. It really isn't a simple problem and I would like you to address it.

Most of the people who declare bankruptcy because of huge medical bills aren't trying to defraud the system. They fully intended to pay their bills but due to a string of bad luck they can't. Is it any wonder that a person who's gone septic or had a heart attack will seek treatment before they go through all the calculations to figure out how they are going to pay for it? Would you want it any other way?

In 6 out of 10 provinces in Canada it is illegal to obtain private health insurance.

http://www.cmaj.ca/cgi/content/full/164/6/825?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=illegality+of+private+health+care&searchid=1141074978157_4633&FIRSTINDEX=0&volume=16 4&issue=6&journalcode=cmaj

I understand that people have issues paying health insurance due to sickness Rabbit. The question is why? WHY are costs for health insurance so high? I know you want to blame the insurance companies. I'm sure they deserve some of the blame. When you look however at the amount of regulation that the insurance, pharmaseutical companies, and even doctors have to go through, is it any wonder it costs so much? You blame inurance companies for dropping coverage and thousands of people die. Well lets look at the FDA. Due to the 1962 Kefauver-Harris Amendments, between 1963 and 1999, 4.7 million people died prematurely while the medicines that would have saved their lives were going through manded FCC testing. We saved a few thousand lives with the regulation while letting 4.7 million people die because the treatments that would have saved them were being regulated into oblivion.

And private insurance companies are the bad ones? In 2006 the FTC released a statement as follows:

quote:


For drugs entering human clinical trials for the first time between 1989 and 2002, the paper estimated the cost per new drug to be 868 million dollars. However, our estimates vary from around 500 million dollars to more than 2,000 million dollars [$2 billion], depending on the therapy or the developing firm.


http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=16522582

So between half a billion to 2 billion dollars for one drug to go through the approval process. And you wonder why drugs cost so much?

The reason single payer systems operate at a lower cost is because it is a single entity that regulates itself. They make their own rules. If a private company did that you would be in an uproar. If the government does it you are all for it. I find it hard to comprehend. Part of the reason that we spend the most in healthcare is because of the regulation we currently have. The other reason we have highest spending on healthcare? Medical research.

I don't have a catch all solution for covering those that do not have healthcare. I think parts of the health care bill were positive in that it did away with lifetime maximums and covers pre-existing conditions. I don't agree with many other parts of it, but those two were a step in the right direction.

As I said before though. The discussion shouldn't be how to provide healthcare for everyone, but how to make it affordably available to everyone. There are ways to do that without a government take over of healthcare.
 
Posted by Blayne Bradley (Member # 8565) on :
 
Without those regulations what if the medicens that end up approved prematurely to make money end up killing 3.6 million people?
 
Posted by scholarette (Member # 11540) on :
 
How much did we save by not letting thalidomide into the country?
 
Posted by The Rabbit (Member # 671) on :
 
Geraine, Drug companies are just as regulated in the EU and Canada as they are in the US (possibly more so) and yet they manage to sell drugs at a fraction of the US cost in those countries. It has some times been claimed that the US pays for development, but that simply isn't factually accurate. More drugs have been developed in Europe during the past few years than the US.
 
Posted by MrSquicky (Member # 1802) on :
 
Geraine,
How much would you say that drug companies spend on marketing in relation to how much they spend on research? This is something that people always seem to mention in terms of drug company spending and you seem to be representing yourself as someone knowledgeable in this area.
 
Posted by ScottF (Member # 9356) on :
 
Insurance has also risen because of how much longer everyone is living. Yes you pay premiums longer, but the payout of the insurance is massively back-end loaded and goes on for much longer because of that pesky life expectancy rate.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Part of the reason that we spend the most in healthcare is because of the regulation we currently have. The other reason we have highest spending on healthcare? Medical research.
As I noted above, these factors do not explain the difference in medical cost between the US and other developed countries. The EU does an enormous amount of medical research. All those countries heavily regulate doctors and pharmaceutical companies. Despite the heavy regulation, pharmaceutical companies in the US are making enormous profits. It hardly appears that they are over burdened by government regulation.
 
Posted by Mucus (Member # 9735) on :
 
quote:
Originally posted by Geraine:
In some countries where single payer systems are active, it is often illegal to obtain private insurance in addition to the government provided healthcare.

quote:
Originally posted by Geraine:
In 6 out of 10 provinces in Canada it is illegal to obtain private health insurance.

*looks at employee benefits booklet, sees coverage for extended healthcare benefits*

Yeah, I think you're jumping the gun a bit over there.
 
Posted by Blayne Bradley (Member # 8565) on :
 
"For twelve years, you have been asking: Who is John Galt? This is John Galt speaking. I am the man who loves his life. I am the man who—[63 pages of pure speech]—I will never live for the sake of another man, nor ask another man to live for mine."
—John Galt, Atlas Shrugged

This at its core is the GOP principle, never ever under any circumstances help people, but then forget that they are not to be helped in turn and end up using legislation to enrich themselves.
 
Posted by ScottF (Member # 9356) on :
 
quote:
Originally posted by Blayne Bradley:
"For twelve years, you have been asking: Who is John Galt? This is John Galt speaking. I am the man who loves his life. I am the man who—[63 pages of pure speech]—I will never live for the sake of another man, nor ask another man to live for mine."
—John Galt, Atlas Shrugged

This at its core is the GOP principle, never ever under any circumstances help people, but then forget that they are not to be helped in turn and end up using legislation to enrich themselves.

Yes, every single Republican I know subscribes to this and never, ever helps other people. Thank goodness you are shining a light on this.

Although to be fair, I once did see a conservative douse a burning homeless man so he could get near enough to light his cigar off of the embers. An exception, to be sure.
 
Posted by kmbboots (Member # 8576) on :
 
Yes. Blayne exaggerates. On the other hand, we have an example right here who feels no moral obligation to help those less fortunate and another who believed he is capable of deciding who is worthy of help. At least on this topic, it is difficult for me to understand why conservatives are so afraid to believe the data in front of them.
 
Posted by Blayne Bradley (Member # 8565) on :
 
Because they think the evidence is liberally biased and that the solution is to completely remove all gov't regulation from the healthcare sector.
 
Posted by kmbboots (Member # 8576) on :
 
Blayne, I suspect that is an oversimplification.
 
Posted by Blayne Bradley (Member # 8565) on :
 
Unfortunately it is not based on my experience on These boards that I was banned from for being "an arrogant liberal".

Reality has a left wing bias indeed, would explain why they are so out of touch with it.

I am 100% serious and that it is a widely accepted "FACT" to them that the answer is to remove all or remove the teeth from all regulation.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by Geraine:
Give a man a fish and he'll eat for a day. Teach a man to fish and he'll eat for a lifetime. I'd like to give the man a fish once or twice until he is able to catch his own. You'd have everyone else fish and give him some of our catch until we as society decides he isn't worth feeding anymore.

Yeah, when applied to the social healthcare debate, this becomes kind of ridiculous. It's like "cure a man's leukemia once and he doesn't have leukemia for .. a day? and .. teach a man to cure his own leukemia, and .. well, uh, they can .. um, .."
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by Blayne Bradley:
Unfortunately it is not based on my experience on These boards that I was banned from for being "an arrogant liberal".

So you joined a site full of virulent right-wing islamophobes and armchair generalissimos and are using that experience to, essentially, summarize a much larger group?

Ask how many of the conservatives here, for instance, would even waste more than a glance on that site?
 
Posted by Blayne Bradley (Member # 8565) on :
 
Tbf I didn't know that much at first, I went in as I was invited by Stuart Slade (author of The Salvation War) and figured would be a great new experience to get to know conversatives who to all appearances were experts in their related fields, analysts, doctors, professional service members etc.

The ban came about rather rudely and suddenly (by Stuart Slade no less) when I complained that my honorable opponents arguments were fallacious.

Of course I must ask the question what do you mean or imply when you say I speak about a "much larger group" where precisely am I accusing conservatism as a whole as being virulent right wing islamophones?

I don't recall making that accusation myself though your observation of that site is hilariously accurate.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by MrSquicky:
quote:
Eta: I honestly feel this is why conservatives think that socialized medicine or anything even remotely like it is all part of some liberal gambit to "control" people*. The idea that you would want people to have the chance to live better lives when you don't even know them, never mind that this would also help you in your own life, is right out as a possibility.
I think that is extremely unfair to a large number of conservatives.
Probably. However I would bet that those it does injustice to are the types who support essentially every tenet of socialized medicine when it is explained to them, and when it is not called "socialized medicine." Those people are just stupid, rather than heartless.
 
Posted by FoolishTook (Member # 5358) on :
 
Wow...

There's a vast difference between sanctimoniously crying for everyone else to "do something" and stepping in to do (or pay for) something yourself.
 
Posted by Dan_Frank (Member # 8488) on :
 
quote:
Originally posted by ScottF:
quote:
Originally posted by Blayne Bradley:
"For twelve years, you have been asking: Who is John Galt? This is John Galt speaking. I am the man who loves his life. I am the man who—[63 pages of pure speech]—I will never live for the sake of another man, nor ask another man to live for mine."
—John Galt, Atlas Shrugged

This at its core is the GOP principle, never ever under any circumstances help people, but then forget that they are not to be helped in turn and end up using legislation to enrich themselves.

Yes, every single Republican I know subscribes to this and never, ever helps other people. Thank goodness you are shining a light on this.

Although to be fair, I once did see a conservative douse a burning homeless man so he could get near enough to light his cigar off of the embers. An exception, to be sure.

Yeah, when I see homeless people on fire I usually pee on them.

But only if I'm having a hard time finding a public restroom.
 
Posted by fugu13 (Member # 2859) on :
 
quote:
Despite the heavy regulation, pharmaceutical companies in the US are making enormous profits. It hardly appears that they are over burdened by government regulation.
Receiving excessively high profits is a common symptom of regulation, not a sign of lack of regulation (typical profits in unregulated fields without natural barriers to entry tend to be at most two to four percent, long run). Many regulations take the form of rent-seeking, imposing barriers to entry in a market that current market participants are able to meet, but new market participants would find hard to meet. This creates an artificial oligopoly that raises prices (and profits) above what would normally be seen. There are numerous extant examples.
 
Posted by Samprimary (Member # 8561) on :
 
Just when I thought John McCain couldn't be any more stubborn, he turns around and holds up the Military Suicide Prevention Bill - a bill meant to provide more resources for suicide prevention to Reserve members). According to McCain, having counselors check up on Reservists is "way overreaching."
 
Posted by Darth_Mauve (Member # 4709) on :
 
Fugu--Could there also be a faith component in these profits? I don't mean religious faith, but faith in the product.

Right now if a doctor prescribes a medicine I know that it is safe and beneficial. If we did not have the mandated research and testing that people are complaining of, I would not know the medicines would be effective, or even safe. As such I would not rely on them unless desperate.

Look at the state of pharmaceuticals from 100 years ago. Bringing a medicine to market was simple and cheap. You whipped up a batch of whatever in your bath-tub and sold it with any promise you can make. Then you walk away with the profits before the patient died or could sue.

Read "Road to Wellsville" as a good example.
 
Posted by The Rabbit (Member # 671) on :
 
I think the biggest component contributing to excessive pharmaceutical profits is a body of regulation known as "patent law". Developing new drugs and testing them for adequate safety is going to be very expensive regardless of government involvement.
 
Posted by Samprimary (Member # 8561) on :
 
there is also the issue of safety testing in general; regulations that mandate testing of drugs make them a very expensive affair in general, and more risky when dangerous drugs get pushed regardless and have to be taken off market.
 
Posted by The Rabbit (Member # 671) on :
 
Yes, but given the alternative between a drug that had been tested for safety and efficacy and one that hadn't, which would you choose? How much would the price matter? This isn't simply an artificial barrier introduced by government regulations.

In fact, we currently have an entire class of "medicines" (i.e. nutricuticals) that are not required to pass the same FDA tests for efficacy and safety. The existence of this unregulated market does not seem pose any serious competition to the regulated pharmaceutical industry.
 
Posted by fugu13 (Member # 2859) on :
 
quote:
Fugu--Could there also be a faith component in these profits? I don't mean religious faith, but faith in the product.
Sure, that can be a source of partial monopoly power. In simpler terms, it is product differentiation.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by The Rabbit:
Yes, but given the alternative between a drug that had been tested for safety and efficacy and one that hadn't, which would you choose?

I would take the tested route, knowing full well that government acting as an overarching regulator over pharmacological companies has been shown to be vastly superior as an option over getting rid of that and just largely expecting them to regulate themselves.
 
Posted by fugu13 (Member # 2859) on :
 
quote:
I would take the tested route, knowing full well that government acting as an overarching regulator over pharmacological companies has been shown to be vastly superior as an option over getting rid of that and just largely expecting them to regulate themselves.
While there are plenty of good arguments for your position, it has hardly been shown.
 
Posted by Samprimary (Member # 8561) on :
 
the argument is generally that the businesses, operating on the rational self-interest of not wanting to sell a harmful product, would regulate themselves in order to maintain profitability. In the past few years alone, we've seen numerous examples of how that's nothing that can be used to guarantee even remotely that the major pharmas will not regularly knowingly push hazardous drugs to market and even try to conceal research showing their dangerousness, since there is so much already invested in the drug's research and development. The more passive the FDA is in circumstances like these, as they were for most of the Vioxx and Avandia debacles, the more damage is ultimately done.
 
Posted by fugu13 (Member # 2859) on :
 
As I said. You've only argued that there would be more harmful drugs released without the FDA. I think that's definitely true. That's not conclusive at all. Some questions are, in a culture where there was no government authority telling people that drugs were regulated for safety, would people be more careful to watch for other consumers' experience with drugs and the certification of consumer-run watchdogs? Would the lives saved and improved of effective drugs' earlier release on the market be greater than the harm caused by the increase in less-checked drugs?

As I said, not shown at all, not even close.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
in a culture where there was no government authority telling people that drugs were regulated for safety, would people be more careful to watch for other consumers' experience with drugs and the certification of consumer-run watchdogs?
given the experiences of the culture of unregulated 'supplements' and complete hogwash like Zicam and the popularity of homeopathy and alternate medicines that are provided to us, the answer doesn't look good.

quote:
Would the lives saved and improved of effective drugs' earlier release on the market be greater than the harm caused by the increase in less-checked drugs?
No, because we would be awash in the claims of snake-oil salesmen and the malleability of our medical institutions. More people would come to harm merely out of the fact that the number of people who were bypassing effective treatments for well-marketed but useless alternatives, who now don't even have to mention on their labeling that their claims aren't certified by the FDA.

If people weren't so depressingly gullible when it comes to the promise of medication — and if we didn't have a profound history of that, continuing to this day in countries like China and Germany — I wouldn't personally find it so obvious.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Given the experiences of the culture of unregulated 'supplements' and complete hogwash like Zicam and the popularity of homeopathy and alternate medicines that are provided to us, the answer doesn't look good.
Yup. This is why I mentioned nutriceuticals earlier. There is plenty of evidence that market forces are ineffective at reducing the number of ineffective and even dangers treatments on the market. Even minor changes to the FDA which made it more closely linked to the pharmeceutical companies have resulted in more dangerous medicines being released.

Furthermore, most of time it takes to get a drug approved is time spent actually doing clinical trials and other needed testing so it is highly unlikely that a company could get a properly tested drug to market significantly faster in the absence of any regulation. Without those tests, a company can not know whether they are marketing a beneficial medicine or harmful snake oil. Even if we could rely on companies to police themselves (which is laughable given the past 5 years), there is no reason to believe it would significantly reduce the cost needed to bring a proven safe reliable drug to market.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by fugu13:
As I said. You've only argued that there would be more harmful drugs released without the FDA. I think that's definitely true. That's not conclusive at all. Some questions are, in a culture where there was no government authority telling people that drugs were regulated for safety, would people be more careful to watch for other consumers' experience with drugs and the certification of consumer-run watchdogs? Would the lives saved and improved of effective drugs' earlier release on the market be greater than the harm caused by the increase in less-checked drugs?

As I said, not shown at all, not even close.

The wonderful think about being a free market advocate is that since no truly free market has every existed, you can claim they have any magical property you desire and no evidence will ever be able to prove you wrong.

When freeing up markets has the effect you predict, you can claim that as proof of principle. When it does not, you can always argue the market just wasn't free enough. It's like a free license to cherry pick the data.
 
Posted by Raymond Arnold (Member # 11712) on :
 
Wasn't the industrial revolution pretty free, and didn't it suck?
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by The Rabbit:
When freeing up markets has the effect you predict, you can claim that as proof of principle. When it does not, you can always argue the market just wasn't free enough. It's like a free license to cherry pick the data.

Hm. Ironically, the industrialization eras / gilded age being a perfect example of this. It just wasn't free enough, the argument goes, robber barons were a product of government, and no harmful natural monopoly exists etc etc etc
 
Posted by fugu13 (Member # 2859) on :
 
quote:
given the experiences of the culture of unregulated 'supplements' and complete hogwash like Zicam and the popularity of homeopathy and alternate medicines that are provided to us, the answer doesn't look good.

Eh, while they're big business, and some harm is done, the harm is ultimately small potatoes compared to many other harms in the world. For instance, we can fairly easily measure the number of lives that would have been saved or vastly improved had certain ground-breaking medicines been available sooner, and the numbers get up into the tens, maybe hundreds, of millions. How many are being killed by your examples?

Also, keep in mind that the nonexistence of pre-approval doesn't mean there wouldn't be strong anti-fraud laws. Claiming unfounded effects would still be illegal (or maybe even more illegal), for instance.

quote:
The wonderful think about being a free market advocate is that since no truly free market has every existed, you can claim they have any magical property you desire and no evidence will ever be able to prove you wrong.

When freeing up markets has the effect you predict, you can claim that as proof of principle. When it does not, you can always argue the market just wasn't free enough. It's like a free license to cherry pick the data.

Since I'm 1) a strong advocate of many kinds of regulation, such as the aforementioned anti-fraud regulation, as a way to help the existence of a free market (which I have repeatedly made clear I do not view as a lack of government regulation; I've come out in favor of carbon restrictions, universal health care, guaranteed minimum income, and more that you'd be hard-put to shoehorn into a radical free market position, so maybe you should listen a bit instead of doing that), 2) not particularly arguing anything other than that the situation is not nearly so clear-cut as has been asserted, 3) giving some simple questions that have been at best poorly answered, here and in research on the question, I think it makes sense to stop and think instead of engaging in kneejerk positions that are founded on disliking things rather than analyzing them.

quote:
Hm. Ironically, the industrialization eras / gilded age being a perfect example of this. It just wasn't free enough, the argument goes, robber barons were a product of government, and no harmful natural monopoly exists etc etc etc
You'll never see me arguing that, and anyone who's read my posts and has the least bit of intellectual honesty will recognize that my positions are nothing like that. (And I'm not even sure if my position is for or against regimes like our current one; but I'm able to see the downsides of the current system, and be unsure as to whether the upsides are superior, instead of claiming based on very weak argumentation that the case is closed).

quote:
Wasn't the industrial revolution pretty free, and didn't it suck?
Yes and no, and yes and no. Even as we look at many of the side effects of the industrial revolution negatively, such as the atrocious factory conditions, the net effect on quality of life of those factory conditions was pretty definitely positive -- life expectancy shot up dramatically during that period. Many of the things that were tied up in the industrial revolution involved things no free market advocate would countenance, especially fairly extreme coercion. Other things were just things that happened, such as handling carcinogens to paint watch dials. Now we look at the factories and see death traps with insane hours. Most people at the time of the industrial revolution saw jobs with reduced hours, better pay, opportunity for advancement, and demanded more and more. The tricky bit that most people have a problem with is, you don't have to reject one perspective to accept the other.

quote:
When freeing up markets has the effect you predict, you can claim that as proof of principle. When it does not, you can always argue the market just wasn't free enough. It's like a free license to cherry pick the data.
Except for, you know, all the times I talk about how there are market failures that need to be handled by the government changing the regulatory structure (establishing limits on carbon output, putting huge populations into single health insurance groups and eliminating pre-existing condition clauses, handing large sums of money to poor people that have been taxed from richer people to reduce human misery and suffering, you get the idea).
 
Posted by The Rabbit (Member # 671) on :
 
fugu, I'm sorry that post should not have been directed at you. You are not a free market fundamentalist, that is someone who has a unflagging faith in that the free market would solve all problem even in the face of clear evidence to the contrary.

The problem is that I've heard so much total nonsense from libertarian, tea-party style free market fundamentalism over the past few months, I've developed an reflex response to any mention of the virtues of the free market.

Once again, I'm sorry you were the one I hit with it. Although I disagree with your economic philosophy, you are not a free market fundamentalist and did not deserve to be called one.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Claiming unfounded effects would still be illegal (or maybe even more illegal), for instance.
Walk into a Pharmaca someday and read the labels and the claims on average naturopathic, herbal, and homeopathic medicines. Look at various 'alternate remedy.' Find a scanned picture of Zicam's packaging. Read the label information for HeadOn, which is a stick of wax that gullible people rub on their foreheads to alleviate headache pain. In the millions. Take a look at how many unfounded effects you can claim right now. None of it is illegal!

besides, why make unfounded claims? Just do what Merck had happen with rofecoxib, and what glaxo has done with multiple new drugs: block publication of critical findings during the testing phase and augment those that appear to show no danger. In fact, just run internal tests and cherrypick if there's no real requirement towards regulation and more open testing.
 
Posted by fugu13 (Member # 2859) on :
 
quote:
The problem is that I've heard so much total nonsense from libertarian, tea-party style free market fundamentalism over the past few months, I've developed an reflex response to any mention of the virtues of the free market.

Fair enough [Smile] . While we approach things from different angles, I suspect we'd be able to agree on a lot of solutions.

quote:
Walk into a Pharmaca someday and read the labels and the claims on average naturopathic, herbal, and homeopathic medicines. Look at various 'alternate remedy.' Find a scanned picture of Zicam's packaging. Read the label information for HeadOn, which is a stick of wax that gullible people rub on their foreheads to alleviate headache pain. In the millions. Take a look at how many unfounded effects you can claim right now. None of it is illegal!

besides, why make unfounded claims? Just do what Merck had happen with rofecoxib, and what glaxo has done with multiple new drugs: block publication of critical findings during the testing phase and augment those that appear to show no danger. In fact, just run internal tests and cherrypick if there's no real requirement towards regulation and more open testing.

Yes, yes, all this occurs now, and would probably occur more if there was no pre-approval of drugs. However, that is a far cry from showing that the negative effects (which you still haven't provided a measure of currently) would outweigh the positive effects (which would be demonstrably huge, from even just a few of the most helpful drugs reaching market sooner).
 
Posted by Samprimary (Member # 8561) on :
 
So we've got the whole thing that there would be more harmful drugs released without the fda; the note that there would be more manipulation of research data by drug manufacturers and anyone they could bribe (thus resulting to a lack of ability for independent consumer advocates to have availability to a culture of independent research that accurately indicates harm of a drug), and we've both noted that okay, yes, there's a huge amount of gullibility and (essentially) fraudulent claims in the existing market for people taking drugs. I mean, removing government regulation of drugs would create a vastly greater degree of susceptibility to false claims and a diminishment of public faith in pharmaceuticals versus snake oil. Personally, do you think that we would be better off without an FDA for drugs? Why or why not?
 
Posted by fugu13 (Member # 2859) on :
 
I don't know, as I've said. I can point to tens of millions (at least) of lives saved, and hundreds of millions of lives greatly improved by the elimination of the FDA at some point in the past, no problem; it doesn't take many wonder drugs to do that, and while they only come along now and then, that's all it takes. Of course, the pace of drug discovery has slowed down, so the rate at which such blockbuster medicines will continue to come out has slowed down.

Conversely, I doubt that more than hundreds of thousands of people have been severely harmed (and fewer killed) by the current acts of unregulated parts of the 'medicinal' industry. So the question becomes how much that increases, and the other side decreases. I think you're being rather alarmist, projecting a very different time into today. Alternative medicines and treatments today, even completely unregulated ones, largely aren't harmful (just ineffectual). There are numerous well-trained physicians to serve as gatekeepers and mediators of the use of many medicines; they aren't impossible to fool or sway, but neither are they dupes. I don't doubt (as I've said before) the problem would increase; the question remains, how much?

I suspect that, on the whole, an eliminated or greatly reduced FDA (perhaps voluntary certifications of some kind, in addition to a testing and policing role) in combination with a vast expansion of medical fraud legislation, would improve welfare. That's nothing more than a vague suspicion, though; it would require substantially more study before I would even begin to call it a position.
 
Posted by Destineer (Member # 821) on :
 
quote:
I don't know, as I've said. I can point to tens of millions (at least) of lives saved, and hundreds of millions of lives greatly improved by the elimination of the FDA at some point in the past, no problem;
Is that really right? As Samp points out, if the FDA weren't there it would be harder to get good information about which drugs were effective. So perhaps news of the wonder drugs' effectiveness would not have reached the consumers much faster than it actually did.

It seems to me that under the system you're suggesting, doctors would likely become extremely cautious about recommending or prescribing new medicines. Especially after a couple of (near-inevitable) bad experiences with untried drugs harming their patients.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by fugu13:
I don't know, as I've said. I can point to tens of millions (at least) of lives saved, and hundreds of millions of lives greatly improved by the elimination of the FDA at some point in the past, no problem

Tens of millions, no problem? From what?
 
Posted by Ron Lambert (Member # 2872) on :
 
There was a proven anti-cold medication produced by Viropharma, Pleconaril (also called Picovir) which passed all three phases of its trials successfully and was shown to shorten the duration of viral colds, and also had effectiveness against a wide variety of other viruses, which was denied approval by the FDA in 2001, because in some cases it might neutralize the effectiveness of some birth control pills.

Pleconaril worked by binding to the sites on the outer protein capsule of viruses which they use to anchor themselves to cells (like keys in a keyhole) in order to infect the cells. Many people, including most scientists and medical professionals, were enthusiastic that a cure for the common cold had finally been found. But the FDA did not want to chance having anyone's contraceptives be deactivated (never mind that warnings could be printed on the label, and other methods of contraception exist). The FDA judges (mostly Clinton appointees, natch) apparently didn't want to spoil anyone's fun, least of all their own.

That same year that the true cure for the common cold was rejected, the utterly worthless product, Zicam, was approved. As a HOMEOPATHIC medicine, which means it was not really medicine at all, just a folk remedy. Zicam wasn't even that. Its lab trials were inconclusive, and the results were given a favorable spin by a researcher in the pay of the manufacturer. It grates on me every time I see a Zicam commercial. We got this worthless snakeoil instead of a genuine medicine that worked on a sound, scientific basis, and was proven in human trials to shorten the duration of colds by one to several days, and often prevented them when taken early enough.

[ December 24, 2010, 01:41 PM: Message edited by: Ron Lambert ]
 
Posted by TomDavidson (Member # 124) on :
 
Zicam has not actually been approved by the FDA as any sort of medicine at all, Ron. The FDA does not approve or reject things claiming to be "homopathic medicine," but only steps in to explicitly ban such "medicines" that they believe have been proven harmful -- like, actually, three Zicam intranasal remedies that they had pulled off the market last year.
 
Posted by rivka (Member # 4859) on :
 
And Pleconaril has been denied approval based on safety concerns (notably, heart issues), NOT (solely) your conspiracy-theory reasons. (Puh-leeeez. Quite a few antibiotics neutralize BC pills. Get a grip.)

And "cure for the common cold" is a HUGE overstatement. It helped people's colds go away faster. That's hardly the same thing.
 
Posted by Ron Lambert (Member # 2872) on :
 
Zicam had to have FDA approval in order to be marketed. Not as a medicine in the usual sense. But even as homeopathic quakery, it had to be approved for general sale to the public. Zicam's trail results did have to be submitted for consideration. The bar, of course, is set very low for things that claim to be homeopathic remedies.

What was cited by the FDA judges as the reason for their action to refuse to allow Pleconaril on the market was the possibility of lawsuits for "wrongful pregnancies." Plenty of medicines can have complications for heart patients, and are still on the market today, with due notification. The main proviso is that they are available on a prescription basis only. But Pleconaril was going to be available on a prescription basis.

And yes, Rivka, it was truly the cure for the common cold. That is not an overstatement at all. Pleconaril was the first ever medicine that actually attacked the mechanism by which picornaviruses infect cells. It also (This is Very Important) substantially reduced the time during which a person with a cold was infectious, since any viruses still being shed were deactivated--which had huge potential benefits for preventing the spread of colds in the workplace and in schools. The clinical trial with humans also showed that if Pleconaril were taken soon after exposure to cold viruses, before symptoms began to manifest, the cold might be prevented entirely. It was in many test subjects. While the minimum shortening of the duration of a cold was only one day among all the test subjects, many had the duration of the cold shortened by three or even more days. And like I said, once test subjects began taking Pleconaril, they almost immediately ceased being contagious. Think of the lost productivity that could have been saved nationwide! Not to mention the benefits to kids in school (schools these days should be listed as official disease vectors).

The debacle concerning Pleconaril is the worst failure of the FDA in that institution's history, and shows clearly the serious harm that misguided PC-type thinking does to us all. The strange refusal of some people to face up to the seriousness of this failure certainly does not help matters any, since if the lessons that should be learned are not learned, then such errors will continue to be made.
 
Posted by Darth_Mauve (Member # 4709) on :
 
Ron, the bar is so low for food additives, which is what homeopathic quackery is considered, as to make it useless. For it Not to be approved someone must PROVE that it does harm. That someone is not the FDA or the manufacturer, but what ever victims and their families survive to make the case.

And even then the company can argue about it.

I do not know the story of Pleconaril. However I usually try to get my information from one source, so until I research it I will have to say the FDA is doing a better job than not having an FDA around.

Drug companies are companies.

Companies are sociopathic. For the most part they do not try to do good, or to do harm. They only try to make money.

Doctors on their own do not have the time, the energy, the resources or the calling to double check every new drug that some advertiser shoves in their face. Right now Billions of dollars, about 10 times the research budget, are being spent to sell doctors on new medicines.

Saying the removing the FDA because they like to make sure the science is good before allowing possible poisons on the market is a going to somehow enable my family doctor to know not only which medicine I should take, but which of the promised miracle cures the rep is paying him to use is the best based solely on the research of the manufacturer is hard to swallow. Sorry for the big sentence.

If I have a million, I can make a drug called Darthia. It costs me $50,000 to manufacture. I spend $50,000 to buy some scientist to tell me it works. I then spend $500,000 on advertising--drug reps to bribe, coerce, sleep with, or convince doctors int he region that Darthia is great for relieving migraine headaches. $400,000 is on retainer to pay for any issues that come up--law suits, etc. At $5 a pill, I get ten thousand people to get 100 pills and I've made $4 Million in profit.

Right now, this same thing is happening, but instead of the $50,000 to buy someone to say your drug is good, you actually have to make a good drug.
 
Posted by rivka (Member # 4859) on :
 
Might =! CURE [Roll Eyes]

But hey, don't let me interfere with your conspiracy theory of the week.
 
Posted by Jon Boy (Member # 4284) on :
 
I've found that it's pretty much impossible to interfere with someone's conspiracy theory of the week.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by Ron Lambert:
And yes, Rivka, it was truly the cure for the common cold. That is not an overstatement at all.

What? No. It's absolutely an overstatement. It's not a cure; you'll still go through a cold's full stages even if you start taking it at the absolute onset of symptoms.

But, .. you've taken the position that it is, so there's an excruciatingly minimal chance you can be corrected, I guess?
 
Posted by rivka (Member # 4859) on :
 
quote:
Originally posted by Jon Boy:
I've found that it's pretty much impossible to interfere with someone's conspiracy theory of the week.

But . . . but . . . !
 
Posted by dabbler (Member # 6443) on :
 
If anyone would like to see the full background information used by the FDA to decide on that med, it is here
 
Posted by Ron Lambert (Member # 2872) on :
 
I was an investor in Viropharma at the time when Pleconaril was rejected by the FDA, and the stock price tanked, so I am very well acquainted with the situation.

Darth, I do not advocate eliminating the FDA. For the most part, it does a decent job. I am just saying in this one case involving Pleconaril, PC-type thinking denied all of us something that could have been of great benefit to society.

That is a good observation, where you said that most companies are sociopathic.

One of the really good things the FDA did was refuse to allow Thalidomide to be approved for general use in the USA, even though it was commonly being used already in Europe. A few women obtained the drug anyway, and regretted it, when they joined with many European mothers in having seriously deformed babies. I think it was mainly one woman who was responsible for blocking approval of Thalidomide. She said she did it mainly on a hunch, and took a lot of criticism for it at first. In her case, she went against PC thinking, at least in terms of the example set by Europeans.
 
Posted by Rakeesh (Member # 2001) on :
 
quote:
I was an investor in Viropharma at the time when Pleconaril was rejected by the FDA, and the stock price tanked, so I am very well acquainted with the situation.
So you probably lost a bit of money, therefore clouding your objectivity on the matter. But let's not discuss that when examining such statements as 'truly a cure for the common cold', oh, heavens no.
 
Posted by rivka (Member # 4859) on :
 
quote:
Originally posted by dabbler:
If anyone would like to see the full background information used by the FDA to decide on that med, it is here

Thanks. That was interesting.
 
Posted by dabbler (Member # 6443) on :
 
Ron, while you state that you were well acquainted, I wonder if your information came from the company press releases and journalists' enthusiastic but not scientific articles about the topic. If you have read the backgrounder, great. But if not, I suggest you do in order to actually embrace more knowledge than say you're above it.
 
Posted by Ron Lambert (Member # 2872) on :
 
Since Pleconaril was the only medicine actually to affect the mechanism by which picornaviruses attach to cells and infect them, it was truly a cure for the common cold. Not a mere treatment for symptoms, not a mere snakeoil homeopathic remedy that does nothing like Zicam, but an actual treatment that worked. In clinical trials it did reduce the average length of colds for everyone, by at least a day, in many cases more. And it stopped an infected person from being contagious almost immediately, since all the virus shed after taking Pleconaril were deactivated. Pleconaril was formulated using various substances already established as being harmless for humans. It passed its first and second clinical trials with flying colors. All the controversy involves the third clinical trial, with humans. There is no question that the drug did what it was claimed to do. The only questions that arose were side effects for some people. The real reason it was rejected was the possibility that it could neutralize some birth control medications. Everything else was just window-dressing added to make it look like the real reason wasn't the real reason.

I followed the stock and the drug through its clinical trials for over two years. When I saw that Viropharma was going to make a presentation about Pleconaril at a large conference of medical professionals, I purchased more of the stock, and made a profit a couple of days later when the stock went up at about 12 percent, due to the reaction of the people at the conference.

I was certainly disappointed by the FDA's final refusal to approve Pleconaril, and did not appreciate losing money. But I was also motivated far more than most people to keep abreast of all the discussions among investors about it, and read through the official reports (including reading between the lines which you have to do with government-speak and business-speak).

At least I can say that I cut my losses by selling my shares immediately. Some people indulged in a bit of denial, and held onto the stock for a few more days, and suffered even worse when the stock price was halved again.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by Rakeesh:
quote:
I was an investor in Viropharma at the time when Pleconaril was rejected by the FDA, and the stock price tanked, so I am very well acquainted with the situation.
So you probably lost a bit of money, therefore clouding your objectivity on the matter. But let's not discuss that when examining such statements as 'truly a cure for the common cold', oh, heavens no.
I like how Ron assumes that his investment in the company adds to his credibility when making claims about how good a product it had. Sometimes he sounds exactly like I imagine Michael Scott might sound.
 
Posted by rivka (Member # 4859) on :
 
quote:
Originally posted by dabbler:
Ron, while you state that you were well acquainted, I wonder if your information came from the company press releases and journalists' enthusiastic but not scientific articles about the topic.

Bingo.
 
Posted by Samprimary (Member # 8561) on :
 
Well, at least I know why Ron considers the delay of approval of picovir the "worst failure of the FDA in that institution's history" — it has to be, as he personally lost money on it.

There is no possible way that there is emotional and exposure bias at play, of course.
 
Posted by Orincoro (Member # 8854) on :
 
Well let me tell you samp, I followed the 2008 Presidential elections much more closely than I had ever done before, I read lots about them, did lots of studying, read many analyses and books after the fact, and have been thinking a lot about it, and I can tell you it was the single most important presidential election in our nation's history. [Roll Eyes]

Funny how that works, neh? Ron probably thinks exposure bias means that he is biased because he was exposed to a financial loss.
 
Posted by Blayne Bradley (Member # 8565) on :
 
quote:
Originally posted by Ron Lambert:
Since Pleconaril was the only medicine actually to affect the mechanism by which picornaviruses attach to cells and infect them, it was truly a cure for the common cold. Not a mere treatment for symptoms, not a mere snakeoil homeopathic remedy that does nothing like Zicam, but an actual treatment that worked. In clinical trials it did reduce the average length of colds for everyone, by at least a day, in many cases more. And it stopped an infected person from being contagious almost immediately, since all the virus shed after taking Pleconaril were deactivated. Pleconaril was formulated using various substances already established as being harmless for humans. It passed its first and second clinical trials with flying colors. All the controversy involves the third clinical trial, with humans. There is no question that the drug did what it was claimed to do. The only questions that arose were side effects for some people. The real reason it was rejected was the possibility that it could neutralize some birth control medications. Everything else was just window-dressing added to make it look like the real reason wasn't the real reason.

I followed the stock and the drug through its clinical trials for over two years. When I saw that Viropharma was going to make a presentation about Pleconaril at a large conference of medical professionals, I purchased more of the stock, and made a profit a couple of days later when the stock went up at about 12 percent, due to the reaction of the people at the conference.

I was certainly disappointed by the FDA's final refusal to approve Pleconaril, and did not appreciate losing money. But I was also motivated far more than most people to keep abreast of all the discussions among investors about it, and read through the official reports (including reading between the lines which you have to do with government-speak and business-speak).

At least I can say that I cut my losses by selling my shares immediately. Some people indulged in a bit of denial, and held onto the stock for a few more days, and suffered even worse when the stock price was halved again.

... So you think Evolution is a myth... But seem to fully support or accept the fact of medicines developed using knowledge derived from evolutionary theory?
 
Posted by 0Megabyte (Member # 8624) on :
 
Maybe this isn't the time or place for that, Blayne. Dog piling Ron even on unrelated subjects smacks me as just mean-spirited.

Besides, it distracts from the issue. And it's not a very convincing argument, to boot.
 
Posted by rivka (Member # 4859) on :
 
quote:
Originally posted by 0Megabyte:
Maybe this isn't the time or place for that, Blayne. Dog piling Ron even on unrelated subjects smacks me as just mean-spirited.

Agreed. Let's try to stick to one argument at a time, shall we?
 
Posted by Ron Lambert (Member # 2872) on :
 
Ah, a hint of fairness! What a breath of fresh air! Thanks, OMegabyte and rivka. And a Happy New Year to you both. No visit from Santa's Dark Elf for you!
 
Posted by rivka (Member # 4859) on :
 
But no comment on the on-topic posts?
 
Posted by Ron Lambert (Member # 2872) on :
 
I've already commented at length, rivka, and I've already answered--directly or implicitly--all the criticisms. At this point I would merely be repeating myself to people who did not read closely or weigh properly what I said already.
 
Posted by Orincoro (Member # 8854) on :
 
Oh that's good. I like that. If you don't agree with me, it's because you didn't properly appreciate my point of view. And it's your fault.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by Ron Lambert:
I've already commented at length, rivka, and I've already answered--directly or implicitly--all the criticisms. At this point I would merely be repeating myself to people who did not read closely or weigh properly what I said already.

Whenever a person reads your position closely and weighs it properly and then disagrees with you anyway, you default to insisting that it is a result of not reading closely or weighing properly.

It gets old.
 
Posted by Ron Lambert (Member # 2872) on :
 
Sam, it is clear that what is irreducible is disagreement of opinion. As far as I am concerned, you and Blayne and Orincoro and Rakeesh can take your ill-informed arrogance and proclaim yourselves masters of the apes. Who cares?
 
Posted by TomDavidson (Member # 124) on :
 
What makes you suspect that they are ill-informed, Ron?
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by Ron Lambert:
Sam, it is clear that what is irreducible is disagreement of opinion. As far as I am concerned, you and Blayne and Orincoro and Rakeesh can take your ill-informed arrogance and proclaim yourselves masters of the apes. Who cares?

I actually don't have an opinion on this particular point, I just object to your logic, which is flawed. I also don't like you.
 
Posted by Samprimary (Member # 8561) on :
 
To bring this back sorta to the issue of healthcare, this was a headliner on reddit:

quote:
Congratulations USA! You now have 50,000,000 citizens without health insurance! And 27% of the uninsured used all of their assets and savings to pay medical bills! 1/4 required medical care and didn't get it due to cost!
and it's just ...

sigh.
 
Posted by Rakeesh (Member # 2001) on :
 
quote:
Sam, it is clear that what is irreducible is disagreement of opinion. As far as I am concerned, you and Blayne and Orincoro and Rakeesh can take your ill-informed arrogance and proclaim yourselves masters of the apes. Who cares?
Well, clearly you do, Ron. Anyway, you're either self-aware to acknowledge that you might have some bias in a case where you lost some money or not.

Really, most folks expecting to be taken seriously would've simply acknowledged the point and taken pains to explain, "No, I thought of this, took it into account, here's why," as one should when there's a glaring reason the listener perhaps ought to disregard their statements. And in your case we had >two, the other being 'truly was a cure for the common cold'.

I don't claim to be well-informed at all about this particular subject, but I'm sufficiently well-informed about people in general to know that when an individual has gotten burned on an investment, it is prudent to take their statements on that investment with a grain of salt-particularly when their politics start getting involved. Especially when they start making grandiose unlikely statements about common colds.

Now, where's some monkeys for me to be master of?
 
Posted by BlackBlade (Member # 8376) on :
 
quote:
Now, where's some monkeys for me to be master of?
Apes Rakeesh, apes.
 
Posted by Rakeesh (Member # 2001) on :
 
Well, yes, but that ruins the alliterative affect I was going for.
 
Posted by Samprimary (Member # 8561) on :
 
you could be an authoritarian ape autocrat, ably aggrandizing absolute authority; an able arch-administrator amongst anthropocene ancestors.
 
Posted by Orincoro (Member # 8854) on :
 
Ass.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
I can point to tens of millions (at least) of lives saved, and hundreds of millions of lives greatly improved by the elimination of the FDA at some point in the past, no problem; it doesn't take many wonder drugs to do that.
Fugu, I keep hearing these kinds of numbers being thrown around but I can't find a credible source for them. Do you have one?

Frankly, tens of millions of lives saved by eliminating the FDA seems highly improbable. At its worst, average time for drug approval by the FDA was around 3 years. Between 1980 and 1999, the average was 2 years.

The major killers in the US over the past 50 years have been cardiovascular disease, cancer and diabetes. Roughly 500,000 Americans die each year from Cancer. The American Cancer Society estimates that between 1990 and 2005, ~ 750,000 cancer deaths were prevented by medical advances (including early diagnosis, drugs, surgery, radiation, etc). I'll be generous and assume that 50% more could have been saved with out the 2 year FDA delay, and extrapolate that backwards for 50 years and we get 1.25 million lives that could have been saved. Which is a lot, but no where near tens of millions and that's using an extremely generous assumption

Around 800,000 people in the US die annually from cardiovascular disease. Between 1990 and 2000, the death rate from Cardiovascular disease declined ~2% per year. If you could push that curve back 2 years by eliminating the FDA, and extrapolate of the last 50 years, you get around 1.5 million deaths prevented. Large, but no where close to the numbers you are claiming.

2.4 million people die annually in the US. Over a 50 year period, that's roughly 120 million deaths. (Death rates have declined substantially but the population has grown so that's probably a fair estimate). For your statistic to be valid, at least 10% of all the deaths in the US in the past half century could have been prevented by a drug that was under review by the FDA. I just don't think that's remotely reasonable.
 
Posted by scholarette (Member # 11540) on :
 
I have trouble believing the FDA would not approve a drug because it decreases the efficiency of birth control. As someone on birth control, I have in the past been informed, use backup method while taking this drug. I have a friend who was young and stupid and when the dr said make sure to use protection while on this pill thought that meant to just not forget her pills and 9 months later had a beautiful baby boy. So, if this drug was so great, why would it be refused when lots of other drugs have the same failing and aren't refused?

I actually would like to see three classifications of drugs-safe, effective and safe and effective. I know a doctor who uses herbal methods. Generally by the time people make it to him, they are going to die (severe burn and infections). He says many methods he believes are not very effective, but for that one person who it works for, it is the difference between life and death. I am aware of, but confidential, some other research where there wan great effects for some people that were pretty clearly an effect of treatment but others had no effect at all. To make it worse, the mechanism was uncertain. So, it was absolutely safe, but the efficacy was overall low. For some patients though, it was a lifesaver. For drugs like that, perhaps labeling them as safe, but not proven effective would be of use.

I also am aware of some treatments that may lead to ten years of improved life, but life threatening side effects. I think a patient with debilitating disease should be able to choose if they want a shortened life for a few years of pain free living. So, effective but not safe. Clearly label, require clear consent but let the patient decide.
 
Posted by Xavier (Member # 405) on :
 
Without the FDA, I'm not sure those "miracle drugs" would ever have existed in the first place, much less make it to the market sooner.

Why spend billions on devising a new drug when you can just spend millions to advertise your snake oil instead?

If you do invent a miracle drug, why should a doctor prescribe yours over the other dozens of drugs that claim to cure the same illness?

I'm just not buying that line of thought.
 
Posted by The Rabbit (Member # 671) on :
 
I would really like to see the source for the "tens of millions of lives saved". I want to see what methods they used and what assumptions they made. On the face of it, the number is simply ridiculously high.
 
Posted by Ron Lambert (Member # 2872) on :
 
My positiion simply stated is that the FDA is worthwhile, and performs a needed service, but sometimes it can err seriously because of the fallible judgment of humans and their pet biases.

I have also heard it said that under modern guidelines, asprin would never receive FDA approval (it is prone to produce or aggravate bleeding ulcers), so it is a good thing it has been "grandfathered in" as a derrivative of the herbal remedy, willow leaves. Maybe we would still be better off using willow leaves. But the 81-grain asprin dosage has been shown to reduce the likelihood of heart attacks or strokes, while not being likely to aggravate anyone's ulcer. Then again, vitamin E and folic acid probably are just as efficacious for those things.

Rabbit, I would remind you again of Thalidomide, which could have produced a large crop of deformed and even stillborn babies, had it been approved in this country like it was in Europe.

Go back over a hundred years or so, and you will find a medical science that routinely prescribed mercury chloride (calumel) for treatment of many illnesses, and that even taught it was a valid principle to use small amounts of known poisons to combat disease. Even after many medical professionals had finally learned better, it took an agency like the FDA to put a stop to the systematic poisoning of patients.

quote:
"Mercury became a popular remedy for a variety of physical and mental ailments during the age of 'heroic medicine.' It was used by doctors in America throughout the 18th century, and during the revolution, to make patients regurgitate and release their body from 'impurities'. Benjamin Rush, a famed physician in colonial Philadelphia and signatory to the Declaration of Independence, was one particular well-known advocate of mercury in medicine and famously used calomel to treat sufferers of yellow fever during its outbreak in the city in 1793. Calomel was given to patients as a purgative until they began to salivate. However, it was often administered to patients in such great quantities that their hair and teeth fell out. Shortly after yellow fever struck Philadelphia, the disease broke out in Jamaica. A war of words broke out in the newspapers concerning the best treatment for yellow fever; bleeding or calomel. Anecdotal evidence indicates calomel was more effective than bleeding."
Link: http://en.wikipedia.org/wiki/Calomel

It is also worth noting that medical historians believe that Sir Isaac Newton's five-year-long period of insanity was caused by his imbibing mercury--his lab notes described the taste of mercury in various experiments. The expression "mad as a hatter" came from the fact that hat makers routinely used mercury in the manufacture of felt, and in the persuit of their craft, often inhaled mercury fumes. Many of them went insane, at least for a time.

[ January 01, 2011, 05:07 PM: Message edited by: Ron Lambert ]
 
Posted by Samprimary (Member # 8561) on :
 
quote:
I have also heard it said that under modern guidelines, asprin would never receive FDA approval (it is prone to produce or aggravate bleeding ulcers), so it is a good thing it has been "grandfathered in" as a derrivative of the herbal remedy, willow leaves.
I have heard many things said. I have heard it said that the world is flat and we didn't land on the moon. Where's this inescapable procedure of FDA approval that would invariably prevent approval of aspirin? I don't think it exists.
 
Posted by Ron Lambert (Member # 2872) on :
 
Prove it doesn't exist. [Smile]
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Originally posted by Ron Lambert:
Prove it doesn't exist. [Smile]

The FDA approved aspirin for stroke prevention in 2007. So yes the idea the aspirin could not be approved under modern FDA guidelines is a complete myth.

The FDA has approved naproxin and ibuprofen for over the counter use. Both of these medications have similar adverse side effects to aspirin.
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by Ron Lambert:
Prove it doesn't exist. [Smile]

Ok here.

quote:

Contained within that quote is all the relevant regulatory guidelines of the FDA which would have part-and parcel disallowed the approval of aspirin without grandfathering.

Notice how the quote is empty.

Ok, that was pretty easy! Let me know if you find anything which can be put into that quote.

[ January 02, 2011, 08:12 PM: Message edited by: Samprimary ]
 
Posted by The Rabbit (Member # 671) on :
 
quote:
Rabbit, I would remind you again of Thalidomide, which could have produced a large crop of deformed and even stillborn babies, had it been approved in this country like it was in Europe.
Why are you reminding me of this, I have never disputed it. I have been asking specifically about Fugu13's claim that tens of millions lives could have been saved by eliminating the FDA. I would still like to see some sources for this number because it seems outrageously high.

[ January 03, 2011, 08:40 AM: Message edited by: The Rabbit ]
 
Posted by Ron Lambert (Member # 2872) on :
 
And I have been contending for largely the same thing, Rabbit, that the FDA has done far more good than harm. I would say that tens of millions of lives have been saved that would have been lost without the FDA. I only stipulate that sometimes the FDA can and has made mistakes, because they are all human.

I talked to a person one time who was lamenting about the terrible experience she had on jury duty, even though the evidence (including multiple direct eye-witnesses) was conclusive that the accused followed someone into a fast-food drive-in, brandished a gun and yelled at the driver for some perceived provocation on the road (a road-rage case). One jurer held on for days because the defendent was a medical doctor, and she said she just couldn't believe a doctor would behave that way.

Doctors can behave wrongly, because they are no less human than anyone else. Likewise scientists can behave wrongly. Likewise government officials can behave wrongly.
 
Posted by Parkour (Member # 12078) on :
 
So, have nothing to say aboout the approval of aspirin thing?
 
Posted by The Rabbit (Member # 671) on :
 
Ron, I still have no idea why you chose to address me with the question, implying my arguments indicated I'd forgotten the obvious. Perhaps you were confusing me with someone else?

My question to fugu13 still remains. Can you give me a source for your numbers? I have searched and the highest estimates I've been able to find for lives lost due to FDA delaying miracle drugs are ~100,000, which is a factor of 100 less than the minimum number you cite. I would not expect you to make up that kind of number so I am very curious where it comes from.
 
Posted by fugu13 (Member # 2859) on :
 
Sorry, I've mostly been avoiding this thread because of the, ah, lowering of quality by certain posters.

The estimates you're seeing are around 100k statistical lives per year. That is, entire average human lifespans made to exist that wouldn't have before, each and every year. By lives saved all I meant was that people who would have otherwise died from something would not die from that thing, or at least not for a very substantial period of time. If the average extension of lifespan is around twenty years, that's already about 500k lives saved in my terminology, easily hitting tens of millions over a few decades. Also, that's a relatively recent estimate; I said " by the elimination of the FDA at some point in the past". The rate of lives saved by new drugs has decreased dramatically from the mid-20th century, roughly when I was imagining the elimination. Even nowadays the calculus of lives saved would be huge (100k statistical lives a year is a breathtaking number on a population the scale of the US).

To deal with a few other tropes that have popped up in this thread now and again:

quote:
Without the FDA, I'm not sure those "miracle drugs" would ever have existed in the first place, much less make it to the market sooner.

Why not? We have extraordinarily successful research programs in numerous areas.

quote:
If you do invent a miracle drug, why should a doctor prescribe yours over the other dozens of drugs that claim to cure the same illness?

This doesn't make any sense at all. There are numerous professionals in numerous fields who somehow manage to deal with evolving techniques, procedures, and technologies without the government pre-approving, yet they aren't taken in by "snake oil" at any noticeable rate. What is it about doctors that will somehow lead them to be deluded en masse into failing to do research and learn which sources can be trusted and which cannot? Again, this will happen in some cases and for some doctors, but where's the evidence that it will happen to a huge degree leading to outweighing the huge numbers of lives saved each year by having drugs available more rapidly?

Also, I note that many defenders of the FDA as absolutely, indubitably necessary seem to also think that drug companies regularly put one over on the FDA right now. There seems to be at least a little cognitive dissonance going on.
 
Posted by The Rabbit (Member # 671) on :
 
quote:
The estimates you're seeing are around 100k statistical lives per year.
No the estimates I've found are 100 K lives, total since the 1960s. These were not statistical lives, they were defined in the same way you are defining it.

You still haven't given me a reference. Please, I want to know where these numbers are coming from.
 
Posted by fugu13 (Member # 2859) on :
 
Then I'm not sure where you're finding such estimates. Could you cite your study particularly the lack of using statistical lives as a measure of comparison?

You can find numerous estimates, both higher and lower than what I've described, in papers linked from this page: http://www.fdareview.org/harm.shtml You'll see mentioned even in the overview examples of drugs that would have saved tens of thousands of lives a year if deployed a few years earlier (and were in Europe, which had pre-approval, but with a shorter delay). It is hard to see how tens of thousands of lives a year (in those few cases where we have an effective lag for assessing the effect) can only become a a hundred thousand lives over several decades.

Oh, a reason for believing drug discovery might be better off in some ways without the FDA. Right now a drug will only be pursued with large amounts of resources for development if it stands a substantial chance of being a blockbuster drug profitable enough to make a huge profit in the years it is patented minus the years it awaits FDA approval. Take a few years off the timeline for drug approval, and suddenly the profitability margin drops by a substantial amount, encouraging new drug development.
 
Posted by Ron Lambert (Member # 2872) on :
 
Parkour, the people whom I have heard question whether asprin would be approved by modern standards were medical people. It was merely their opinion, though I give it some weight because of their backgrounds.

The Rabbit: Never mind.

fugu13, in the interest of crystal clarity, are you advocating that it would be better if the USFDA were abolished? That seems to be what you are saying. If so, then feel free to move to Mexico, or some other country in Latin America, where their standards for food and drugs are more lax. Somehow I do not see those countries as evincing greater health. Mexican doctors can treat you with laetrile, but I do not believe their cure rate for cancer is any greater than that of our doctors.

Having said that, I do still take exception to the practice of USFDA agents barging into health food stores and confiscating apricot seeds (from which laetril is derived), as they did frequently back in the 1970's. A friend of mine who operated a health food store actually had to defend himself in court for selling apricot seeds.

[ January 04, 2011, 04:37 PM: Message edited by: Ron Lambert ]
 
Posted by The Rabbit (Member # 671) on :
 
Thanks for the link fugu, I will check out the details and let you know what I think.
 


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