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Author Topic: Democrats at least pretend to have a spine, it's a Christmas miracle!
Orincoro
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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 ]

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Destineer
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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.

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fugu13
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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.
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Orincoro
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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.
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The Rabbit
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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.
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Week-Dead Possum
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Who would buy them?
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The Rabbit
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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.

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Tresopax
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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.
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katharina
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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.
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Orincoro
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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.

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katharina
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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.

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Swampjedi
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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.

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DarkKnight
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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.

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TomDavidson
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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.
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Mucus
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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."
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Destineer
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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.

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katharina
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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.

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DarkKnight
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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.
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Destineer
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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.
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katharina
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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.

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Destineer
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Neither do I, but we're on an unsustainable course as a nation now anyway (cf the wars).
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Destineer
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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.
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katharina
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I'm interested in an actual, practical, sustainable solution.
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Destineer
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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.

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katharina
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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.

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kmbboots
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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

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katharina
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Great. Do more hand wringing. I guess I'll check back in when someone wants to talk pragmatics.
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kmbboots
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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.
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scholarette
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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.
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katharina
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"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.

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kmbboots
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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.
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Raymond Arnold
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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?

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The Rabbit
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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?

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Mucus
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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
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Orincoro
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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.

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kmbboots
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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.
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Tresopax
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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.

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The Rabbit
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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.
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scholarette
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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)?
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katharina
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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 ]

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katharina
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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 ]

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Raymond Arnold
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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.
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katharina
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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.
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Raymond Arnold
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And people have been talking about that for the past few pages.
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CT
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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.
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CT
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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.

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MattP
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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.

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Ryoko
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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"?

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BlackBlade
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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.
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kmbboots
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How long do insurance companies generally cover people in this condition?
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