I searched Meetup for Northfield-area groups who support the various presidential candidates but couldn’t find any.
Are there any organized gatherings yet?
If you know of any, attach a comment with the info.
1/31 update: I’ve removed Edwards and Giuliani from the blog post title since they dropped out this week.
2/9 update: I’ve removed Romney from the blog post title since he dropped out this week.
4/17: I’ve removed Huckabee and Paul from the blog post title
6/3: I’ve removed Clinton from the blog post title
Paul- As far as efficiency goes, the most efficient application of resources is one man seeing a need and taking care of it. This, of course, is an idealistic impossibility in a country of our size. As our government has been given more and more responsibilities by the electorate, there has been a greater need for redundancy and accountablility on all levels. This, unfortunately, arises out of the common trait of greed in men. There has to be watch dogs of the watch dogs. It is just the nature of the beast, and this is what I’m refering to in my quip. It is the proverbial catch 22. I don’t believe that government employees are, as you say,”…by default wrong, wasteful, harmful, incompetent.” I think they, for the most part, get a lot done with the resources they actually receive.
My greatest concern for growth in government is the loss of taxable production of goods and services as they are taken over by non-taxable government. If everyone ends up an employee of the government, and more businesses are turned into government entities, then where does the government get its money? This is one of my greatest concerns in the socialization of the health care industry, for one example. Another industry that concerns me is the oil industry. As there is a greater and greater outcry against the rising cost of energy and transportation, will this be the next industry to get federalized? Even farming, where the farm program has for years been a pay-out to farmers to not produce crops because of the vast oversupply of grain, is now coming under scrutiny because of the percieved shortage of grain for food. Where does it stop?
Bright…One of the reasons our government was established was to guarantee individual rights. Not majority rights, not minority rights, but individual rights. Sorting out those rights in relation to a civil society has been one of the central issues that has faced the republic.
The primary reasons for nations are: (1) provide for the common defense, (2) coining of money, (3) provide for enforcement of contracts. Our Constitution adds several other novel ideas (free speech, an armed citizen, protection from the legal system’s agents (search, seizure)). And these protections are reinforced by a system that used to protect the minority by requiring supermajorities for some sorts of changes. I’m not so sure that is working out though, watching abberations like earmarks eat away at the shared society, turning from “what can we do for our country” into a bunch of “what can my country do for me?” types.
Paul Z and others, I said “first and foremost”, not “only. ” You can’t have the other things so nicely delineated by Bruce WM as easily if you are busy trying to knock off people who are trying to harm you and blow up your house.
Bright,
In #204 you wrote:
Paul Z and others, I said “first and foremost”, not “only. ”
But in #198 you wrote:
Government is here to protect us from foreign invaders.
That’s the first and only reason people who came here within the last few hundred years ever established a government.
Hence our confusion.
John, in #201 you wrote:
As far as efficiency goes, the most efficient application of resources is one man seeing a need and taking care of it. This, of course, is an idealistic impossibility in a country of our size.
The idea that individual action is inherently more efficient than group action is just wrong. Have you built your own highway recently? Or mined your own ore? The problem, I think, is not a failure of idealism or an excess of “man’s greed”, but the fact that large, complex tasks sometimes require large, complex responses. Governmental and other large-scale action obviously poses its own problems, but what’s the alternative?
Then you wrote:
My greatest concern for growth in government is the loss of taxable production of goods and services as they are taken over by non-taxable government. If everyone ends up an employee of the government, and more businesses are turned into government entities, then where does the government get its money?
Of course it’s a problem is “everybody” works for the government, but I see no immediate prospect of this. Do you? Do you know how the US compares with other rich countries as regards the fraction of the economy controlled by government?
This is one of my greatest concerns in the socialization of the health care industry, for one example.
The present structure of health care is not exactly a poster boy for the wonders of no government. It doesn’t necessarily follow, of course, that government should do everything about health care, but there’s a lot of room between here and there.
Another industry that concerns me is the oil industry. As there is a greater and greater outcry against the rising cost of energy and transportation, will this be the next industry to get federalized?
At last we agree — indeed, “federalizing” the oil industry is a bad idea. But neither of us should lose sleep worrying about such a prospect. I’d put its chances somewhere below those of vanquishing evil and achieving world peace.
I apologize…senior moment? You are right, Paul Z. Well, I meant foremost. lol.
Paul Z.- Your comment, “… Have you built your own highway recently? Or mined your own ore? The problem, I think, is not a failure of idealism or an excess of “man’s greed”, but the fact that large, complex tasks sometimes require large, complex responses. Governmental and other large-scale action obviously poses its own problems, but what’s the alternative?” is a better way of stating what I was thinking about. I probably shouldn’t try working on these things late at night, but sometimes that is the only time I have. You had one other comment, “…The idea that individual action is inherently more efficient than group action is just wrong.” I would have to argue that this statement is true depending on the scale of the project. Your examples of major projects are good. I’m not sure that having a whole department concentrating on being sure that our neighbor’s child gets fed when you have food in your own home to give him is a proper use of resources. Does this make sense?
As far as the health care system in its present state, I feel there is so much government involvement at this time as to make it a veritible quagmire for the average person to try to wade through. My concern is the push to a single payer (government) system as the only solution for this.
As for the oil industry, I’m not losing any sleep over this, but things are changing much more quickly, now. When Roe v Wade came around, we were assured that abortion would not be used as a method of birth control. This is exactly the major use of it today. That is why I don’t completely trust the opinions of the social engineers.
As far as everyone working for the government, of course personal income taxes will always be a source of revenue. Perhaps this is why some of the Scandanavian countries have 35% plus tax rates for everyone. They are some of the largest socialized societies in the free world. The last I looked, I think the government accounts for about 42% of the GNP. What happens when it becomes 50% or more?
An issue that isn’t talked about enough is the fact that the US spends more money on defense than the rest of the world, friends and enemies combined. A Republican president, Eisenhower, warned us of the military-industrial complex, but only just before he left office.
Now with the deregulation of major media, we have companies like GE that do defense contracts, and which also owns NBC, which decides what is news, what we should hear about, and how we should hear it-- so we have the military-industrial-media complex.
After 9-11, we have a huge spike in spending on private security firms like Blackwater, so some talk of the military-industrial-security complex.
There has been a push toward privatization of prisons in recent decades, and some of the same corporations involved in the military-industrial complex have gone into the business of privatized prison management. They can also then lobby for tougher prison sentences, which then gives them more money from the government trough. Some call this the prison-industrial complex.
The above described sectors are where a huge portion of our tax dollars go. It is war and prison profiteering, with the mainstream media as cheerleaders when we go to war.
Sadly, when people complain about their taxes, they complain about property taxes, and welfare, while private companies are making huge profits of what they claim is for the common good.
Republican Smedley Butler, a much decorated Marine general at the end of World War I, suggested that if we draft young men to serve in war at low pay, then we should draft industry at low pay to make weapons and boots and uniforms (and other services) instead of tolerating the profiteering. He was not a socialist, but his suggestion was that taking the profit out of war would make us much less likely to get into wars of agression for the sake of profit.
Along these lines, treating oil and coal as a public utility, with profit caps, and with regulation requiring investment in a conversion to a renewable energy economy, would actually do a lot of good (John G, I disagree with you on that point). This is not the same as socialism in which the state runs things; a public utility is still a profit-earning business, but because it’s too much like a monopoly, it’s highly regulated, and because it supplies a public need, it’s profits are limited.
In the same way, health care should not be run by insurance companies whose goal is to make profits. Health care should be a nonprofit enterprise for the common good, and this would actually save costs when you add health care to taxes, not increase the total.
Paul F.- Interesting thoughts on oil & coal being public utilities. What I’m not clear on is why there has been no investment in new refineries. I checked the EIA sight for some stats, and it appears that the 149 refineries we have had since 2002 are only running at about 85-88% capacity. There is quite a bit of discussion about alternative energy sources on one of the other threads.
Back to Obama and McCain, whomever gets elected is going to have his hands full trying to sort out what is going on. I’m not sure years of experience or lofty ideals in and of themselves are the complete answer. I think Bruce M.’s comments, “…turning from ‘what can we do for our country’ into a bunch of ‘what can my country do for me?’ types,” touches on part of the problem with attitudes in our society right now. I believe we need to move away from this concept of entitlement.
Paul F,
What do you mean by coal and oil being “public utilities”? Would this be something like the regulated monopoly system in place for electricity? Or something like the US postal service? Would coal miners, roustabouts, and roughnecks become civil servants? And would profit ceilings be complemented by profit floors? Who would set prices? Would there be production quotas? Who takes the hit in a bad year? Seems to me there are lots of devils in such details.
As for health care, you wrote:
In the same way, health care should not be run by insurance companies whose goal is to make profits. Health care should be a nonprofit enterprise for the common good …
I agree … passionately … that acceptable health care is a right, properly guaranteed and assured by government. But I don’t see it as axiomatic that profits and “the common good” are as fundamentally opposed as you seem to imply (unless I’m mistaken). Profit (and loss) are powerful motives, and they can (sometimes) be harnessed to good purpose.
This conversation has drifted a bit, it now sounds more like a Politics and a Pint conversation than a candidates’ merits debate.
And there are some really long, involved and deep into the system arguments going on here. Could some of you remember that most voters are of the “bumper-sticker” and t-shirt slogan generation? Condense those long, referenced and cross-referenced discussions down to bumper stickers for the rest of us. I’ll start with:
Arm the whales!
Forgive me for adding to the drift, but I have been awed and amazed by the personal, individual responses to the weather-related tragedies of recent weeks. From the tornado in Hugo to the one at the scout camp last night to the seemingly endless demand for help sandbagging against flood swollen rivers, people have shown up in such numbers and so quickly that in some cases they have had to be turned away. As the waters recede there will be more need for aid and volunteers, and I’m sure they will come.
What struck me was that these weren’t FEMA efforts, or Red Cross efforts of church mission teams. These were people who saw the news and got in their cars and came to help. Nobody asked whether the person in need or the person working next to them was gay or straight or had an abortion in their past or was overweight or behind in their mortgage or here illegally. They just pitched in and worked for the common good.
This is the most inspiring demonstration of the good in America and power of individual good will that I’ve seen in my lifetime. I think the purpose of government is providing the tools to help people continue this kind of nonjudgmental community achievement.
I think Obama may be tapping into something that’s already there, a feeling that it’s not going to be government that solves the problems but people who come together to solve them.
I prefer the right to arm bears.
Patrick- I thinks bears are mean enough as it is without giving them guns. Oops! There I go, shooting off my mouth again!
Pardon the thread drift, but I guess I believe we need citizens to discuss and learn about issues, and to get away from bumper-sticker mentality.
Paul Z.: To take the issues (public utility and health care) backwards:
Healthcare: Too many citizens don’t know the difference between single-payer and universal health care. When we talk about single-payer, most mean that it should be modeled after the medicare model, which is many times more efficient than private for-profit health insurance. Universal could mean any number of things, including perhaps a government handout to private insurance companies who might provide insurance for those who can’t afford it for themselves.
Single-payer health care could still have some degree of competition and profit. Clinics and doctors who have a higher success rate in treating certain conditions might deserve some kind of bonus, or more business than those that experience more failure, except in cases where literacy and poverty might become greater obstacles to completing care.
Regarding coal and oil as public utilities, or deregulated private corporations, or state-run, or windfall profit-taxed, either applying windfall taxes or treating them as public utilities would be preferable to the current situation. I’m not in favor of a fully state-run coal and oil, and don’t see how it would work for the US (as long as we depend on foreign oil) to send US ships to other countries to get their oil (guarded by US military?). Some have talked about using windfall profit taxes to speed up development of renewable energy infrastructure, but I think it should be more than just windfall profits designated for this.
And to connect back to the thread topic: No matter who we elect, there is strong need for reform in health care and in the burning of fossil fuels. McCain and Obama both speak more in terms of universal than in terms of single-payer health care. They both favor some kind of reforms related to greenhouse gasses and global warming. To predict how they might differ on these issues when elected, one might consult not only their stated positions on the topics, but also examine their voting records on related legislation in the past.
Regarding the health care issue, I haven’t given it a great deal of thought, but I know from my experience of living around US Steel and later, Bethlehem Steel, and the people who worked therein, that there is much to be learned from that whole scenario.
These people were hard working people, they were amongst the highest paid skilled and not so skilled laborers. They had families. The kids had eye glasses, and glasses, and glasses. Why? Because they knew they could get as many glasses as they needed. So, the needed to break them about once a month, and they needed to toss them over the side of the boat about once a summer, and they need to do all sorts of things, and they got more glasses everytime. After a while, because of the way they thought about the glasses being replaced, and the hearing aids and the colds that needed emergency care, and all sorts of things like that, the companies went out of business. OH, yeah, you can tell me about cheaper foreign steel workers and all that. Well, yeah. It’s just how the workers felt so put upon, and that they deserved every thing they could get, well, maybe they did, but that doesn’t keep the butter bubbling in the pan, you know. Eventually, we run out of glasses and hearing aids and butter and the time by professionals who see the patients. Maybe there is an endless supply, but I don’t think so.
Bright: the waste you describe (if real and not urban legend) is never justified, but the waste via contractors in Iraq is much worse. There are eyewitness accounts of fully-loaded SUV’s used to transport civilian contractors being burned, destroyed, merely because they needed an oil change. Contractors have cost-plus contracts, so if they found an excuse to replace an SUV, they would, and made a profit on it every time. Health care and welfare waste pales in comparison. Yet it’s more popular among working class folks to go after health care and welfare fraud and waste instead of the larger forms of waste and corruption. Until and unless we take on the military-industrial complex, we won’t get spending and taxes under control. It’s the elephant in the living room.
Paul F.- No matter what industry or government system where there is fraud and graft, the basic motivation that seems to drive this is greed. This is not a characteristic of the industry or the department involved. It is most often a characteristic of the people who fill the divisions of these areas. I know from my wife’s own discriptions from her involvement with the system of entitlements, if your department does not use the money given it for a year, you will be cut back the following year. So, instead of looking for cost savings, the whole idea is to spend more than was budgeted so that more can be requested the next time around. I think this same attitude permeates both the private and public sectors. That is why I believe it is a people problem and not necessarily an organizational problem. Obama is correct in his assesment that we need change in this country. I’m not sure we would see eye to eye as to WHAT needs to be changed and how to go about doing it.
Good Morning, Paul F and John G. Myth, no, this is from the mouths of the parents of the kids who were left to be that irresponsible. And many other accounts like that…I only gave the easy outstanding one as an example.
John, I have always said that the government is people, albeit people over a period of time, as the society is people and the companies are people. When people blame the govt, society or the company, they are somehow trying to cover up for the people themselves, as the one blaming is often one of the “people”, one of the perpetrators of corruption and greed.
Then, others learn it as a customary way of speaking, inaccurate as it really is. So, John I think we find agreement once again.
As for Obama and the ‘Change’ chant, things change all the time. Everything is constantly changing in relationship to other things whether or not the original thing actually changed or not. haha. It’s kind of amusing, isn’t it?
JohnG: It’s true that greed and waste are often people problems more than systems problems. But just as some people are greedier and more wasteful than others, some systems (government and industry) are more wasteful than others.
It’s wrong to generalize from anecdotal evidence via your wife or anyone in government (“entitlement”) work, and to claim that it’s just a people problem, and therefore all systems are equally wasteful and corrupted by greed. It’ just ain’t so.
The medicare system is far less wasteful, far more efficient, than the current health insurance industry. A single-payer, medicare-like system would be a much more efficient way of spending our health-care and tax dollars than the systems we have now.
Paul F.- You are correct, that all the waste cannot be lumped onto greed of men, nor can it be all lumped into the ineffeciency of various systems. I think we are maybe trying to define a very complex problem with too simplistic terms, none of which really does the job. As far as anecdotal evidence, who is actually going to document these practices?
As far as health care goes, I do not know all the ins and outs of a single payer system. I do have some figures from my mother’s estate that we are in the midst of settling. Over the last couple years of her life, (it is said that over 80% of a person’s lifetime health care costs are in the last 10 years of their life) she amassed over $200,000 of health care costs. There were two heart related episodes, one at Abbott and one at Mercy in Iowa City, plus some home health care. I don’t have the exact figures in front of me, but Medicare picked up about $80,000 of this and the State of Iowa picked up about $11,000. That is less that half the actual value. Are we dealing with inflated values here, or is the medical industry just out the remainder? There is a lot of $$ that were written off, according to the billings. I think it is this type of disparency that needs to be resolved before we can have successful medical care for everyone. Someone has to pay the bottom line.
John…The benefit of a single payer is that risk and administrative costs are spread amongst a large group…the entire population of the country. The medicare system, as Paul F. points out, is quite efficient in controlling costs…gaining economy of scale, leveraging market dominance (other than the drug benefit), and reducing duplication of overhead costs, not the least of which are the advertising and marketing expenses required in a competitive environment.
The disadvantage of a single payer is that there is a single payer. There is no competition for health insurance dollars which can reduce innovation in both coverage and service. There is a risk that the single payer will reduce and ration health services.
But in general people in countries with single payer systems are quite satisfied with their health care. More satisfied it seems than are Americans with their system. The alternative to a single payer system is mandatory insurance (the Swiss have a system like this) that must be purchased by individuals or, if they lack funds, is provided by a government payment or a government pool. It is important that the insurance policies all have the same coverages…I say use the policy options that federal government employees have as a standard.
I don’t know which system is best. In either case I think it is safe to say that the cost of health insurance would be reduced for most people. Some would probably pay more since additional payroll and/or income taxes would pay for the system, but that would only be the top earners. Somehow the dollars spent by employers for health insurance would have to be distributed to employees to offset their higher taxes or insurance costs. I think employers would do that…if not there could be some kind of mandate that would make it happen.
Single payer or mandatory health insurance…I don’t care which. There has been enough talk on this issue. It’s time for this country to join the rest of the developed world and provide universal health care.
John George (221), I received the Northfield Hospital’s Annual Report yesterday. I’m assuming the report was mailed to every Northfield address.
The report has a table titled “Northfield Hospital Community Benefit Summary”. The total value of community contributions is $13.5 million. $5.5 million of this is “costs in excess of Medicare payments”. So it appears that some of the “efficiency” of the Medicare system stems from its ability to pay providers less for services than the services cost the providers.
John George’s experience with medical bills being written off is an indicator of the mess we find ourselves in. Just as Canadian drugs are cheaper because US patients pay more than their fair share, so is our billed care cost much higher than necessary because hospitals are expected to not refuse patients who present at the ER, to not kick people out when their insurance has run out and are expected to accept what the government will pay. All of which means that an honest patient paying their own way will end up “taxed” to cover those uncollectable bills. Is that bad? Only if you think that people should be honest with each other. If you think that “Free coffee with every meal” means you don’t pay for that coffee (indirectly), then maybe the smoke and mirrors of the current system or the single-payer systems will appeal to you. (And as Curt points out, Medicare is one system taking advantage of that smoke and mirrors system. It’s too bad that so many voters think that bullying translates to efficiency. )
William S, you say you’d like a single payer system that offers what federal government employees get. Unfortunately the fed employees are a powerful group and have bullied their way into incredibly good coverage. We simply cannot afford to give that coverage to everyone. Ask GM how well it works to give high quality coverage to a large unproductive group (in GM’s case, retirees).
As for rationing health care, that has to happen in any system. Look at this discussion in the Australasian Legal Information Institute (http://bar.austlii.edu.au/au/journals/ElderLRev/2002/9.html) and ask how you want us to handle this delicate question. Consider the fine, well-meaning people who brought FEMA to New Orleans, and who are now figuring out how to continue that stupidity by allowing rebuilding behind levees so we will certainly get to see another multi-year crying jag. Do you want them deciding your access to health care? The primary criticism of HMO’s is that they are so powerful that they almost become governments. Hmmmm.
As for “only the top earners” getting to pay more, I think it is important to remember that most of our “top earners” do not produce wealth directly, so any taxes they pay are actually paid by the producers who work for them. We may have an income disparity problem, but trying to solve it through government means (taxes, etc.) is exchanging one bad system for another.
Sorry if this if off-topic, but this whole thread is off-title at least.
Based on one couple I know only, she works for the Fed and he works for an applicance company. She has diabetes and heart problems, is obese, so also has multiple other health problems related to that, such as bad knees, and he has had a bypass. They use his company insurance exclusively because it pays better.
We here in the US have a lot of really unnecessary emergency room bills due to the violence in the cities. Get shot, go to ER, get repaired, be back again next year. No, not a myth. Spend a few days at Cook County Hospital ER in Chicago sometime. I think it has improved somewhat in the last decade, but what it used to be was beyond the beyond. We hear about the murders, but not so much the day to day injuries. A dead person doesn’t cost nearly as much as an injured live one.
Bruce and others,
Seems to me that discussion of health care models is at least near the supposed topic, since health care is (or should be) an important issue and, I hope, point of difference, in the presidential campaign. To bring the discussion directly to the advertised topic, perhaps someone could briefly summarize or offer pointers to Obama’s and McCain’s proposals for doing something about this.
I’m with William in favoring universal coverage, but not being deeply committed, either way, to a single-payer or private-insurance-based system as the means to the universal coverage end. I can imagine either approach working well or poorly, depending on how costs and incentives are managed.
There are European models of both systems that appear to work at least decently well. Sure, there are anecdotes (my grandmother’s best friend’s cousin’s daughter’s fiance in Ireland had to wait two hours for a prescription, and then the chemist was rude), but (a) no system is perfect; and (b) the big picture should rule. Sometimes the perfect is the enemy of the good.
Paul Zorn
PS to Bruce, on another live election issue, taxes:
We may have an income disparity problem, but trying to solve it through government means (taxes, etc.) is exchanging one bad system for another.
Do we indeed have an income disparity problem? If so, how else but through “government means” would you propose addressing it? A la Robin Hood?
Paul Z. Well, we have seen the horror’s that governments bring when they think they have the “Truth”. I think that is why we are a republic with a written Constitution to temper the will of the majority. So while I put a marginal comment in about income disparity and suggest that it is a problem, I do not think that we can simply legislate away the symptom and think we have solved the problem … I have discovered a truly wonderful proof of this, but the margin is too narrow to hold it. Perhaps a continuation of some previous Politics and a Pint discussions would be in order.
Bruce,
Indeed, this sounds like the sort of discussion that calls for at least a pint of grain-derived ethanol … the prairie-grass version tastes awful.
Still, taxes are a key issue in the campaign, and I hope we’ll get some chance to discuss them here. IMO, the principal object of taxation is not to reduce inequality, even though that may be an inevitable side effect. Taxation exists mainly to raise the money needed to pay for public goods of all kinds. Everyone loves to argue over what qualifies as a public good, but these arguments tend to be over what we should buy, not how much we should spend.
Accepting (as we must, IMO) that government needs a lot of money, it follows that the money needs to be raised from somewhere. Since the poor are … uh … poor they can’t possibly pay their numerically “fair” share, so *some* element of redistribution (known in some quarters as “class warfare”) is *mathematically* required — no need for a marginal proof here, Monsieur Fermat.
The live argument, like it or not, is over the parameters.
Regarding the cause of high costs of health care, and also the incentive or lack thereof for competition and quality:
Bruce is correct in noting that emergency rooms won’t refuse care to patients without insurance. But this does not mean that health insurance companies pick up all of this cost. Sometimes the hospitals themselves do, so some of these costs are not passed on to insurance companies.
High costs are due in part to expensive technologies, but hospitals and clinics are finding ways to share CAT scan and other equipment on moveable truck trailers, as does the Allina clinic in town.
There are some illnesses that can be treated with vitamins and home remedies (studies show that lemon juice and honey is good for sore throats; changing diet can help with cholesterol etc.), but many doctors prefer to prescribe drugs. This drives up the cost of health care, and it lines the pockets of drug companies nicely.
Higher administrative costs are the prime culprit for higher costs via private health insurance as compared to medicare, period. This is due in part to high CEO and other executive pay.
Regarding competition or lack thereof in a single-payer system:
It would not be hard to build-in requirements for competition. Doctors and clinics that had a higher success and/or customer satisfaction rating could receive bonuses or more referrals. You simply find ways to build it in. There’s nothing intrinsic to a single payer system that rules out competition in some aspects of the system.
Paul Z, you said the true argument is over the parameters (and therefore the functional form). Spoken like a true mathematician. We’ve talked taxes at Politics and a Pint, where we evaluated lots of possible methods. Perhaps we should reprise that discussion and extend it.
This is off the off topic even, but it’s the way I roll, so hopefully I don’t have to apologize for it everytime.
If people would be allowed the opportunity to work for a few hours per week,
if that’s all they can do, to pay for insurance or meds or whatever, we could see some headway through the endless sea of papers, rules, negotiations and other red tape issues that do nothing to help the patient heal up faster. You know, the stress of getting well while dealing with insurance companies, etc., can kill somebody sometimes.
Also, just a thought on my part, maybe you don’t need one system to cover everyone. Maybe you need two or three. One for emergencies, one for chronic health care and one for the operate, patch em up and get them out of here types…and a seamless way to pass some through from one to the other.
Bruce…I misspoke with regard to rationing. You’re right, there is rationing going on now (socio-economic) and it will go on in the future regardless of the kind of health care system we have. How care will be ‘rationed’ to the elderly in the future is a situation that faces every country. The problem has not caused other developed nations to abandon universal health coverage. There will probably have to be some kind of limits of coverage imposed…it is indeed a ‘delicate question’…but one we are not alone in facing.
You mention that ‘we’ can not afford to provide to all Americans, the type of coverages that are offered to government workers. I disagree…these employees have a wide variety of plan choices. No one forces insurers to bid for their business by proposing a choice…I don’t consider this bullying…unless you think the free market is bullying. It seems to me that adding millions of Americans to these policy pools will just make that business that much more attractive to those bidding for it now.
Regarding GM’s problems with retiree health care costs. GM’s concern was the competitive disadvantage of their US plants in relation to companies based in countries with universal health care. And while the big 3 automakers can’t quite stomach the idea of endorsing universal health care here, (prefering bailouts for their high health care costs) they have had no problem endorsing it in Canada, where they have been enthusiastic supporters of that country’s popular single payer system.
I keep coming back to a simple question. If all these other countries can afford it why can’t we?
William Seimers (#222), how do you know about the satisfaction levels of people in single payer systems in other countries? I’m not taking issue with you, I’m just wondering. (I got on the google and didn’t the right info.)
Paul Z I always appreciate your mathematical mind in analyzing issues. One thing that seems to get lost in the discussion of individual health care and its related costs is the simple question “How much should an individual be expected to pay for their personal health care?” I’m sure all of us have differing opinions on what dollar amount, or percent of income, that an individual should dedicate to their own health care.
One of the ideas that I have always liked is one that answers that question….and was put forth by Tom Neuville a couple of years ago. Work out a figure that seems reasonable and realistic….say 10 percent of ones income. Once an individual has reached that threshold, government health assistance could kick in. Using a straight percentage of income is a pretty fair way to calculate health care costs. I imagine many of the people reading this thread would never cross the 10 percent threshold, and would therefore be on their own for their health care. But once the threshold is crossed the government would step in and take over payments. It seems a plan like this would allow the best of both worlds…individuals make their choices for care as we have done for years, but there is a government safety net for the big costs.
I agree with others in this thread that a pure government plan is not something I would want to see in America. We have a free market system that has produced what many feel is the best health care system in the world. I say our system is the best in the world because it operates in the free market. Everyone should pay for their own health care—we just need to figure out to what degree.
Ray,
I like the basic thrust of Tom Neuville’s 10% solution, and I appreciate Tom’s courage in floating an idea that, I think, many Republicans would diss as socialist (which it is, after all, in a sense, and that’s fine with me).
But I’d change some of the parameters. For instance, it’s a lot easier for you or me to pay 10% toward health care than it is for somebody living hand to mouth. So (were I czar) I might exempt something like the first $15K of income per person in a family, and then make something like 12% or 15% of the rest vulnerable — whatever it takes. As with any general idea, there would be some details to work out (how to treat single parents, for instance, or wards of the state), but I think there’s the germ of a good idea here.
I think we’d agree that, for better or worse, a workable and enact-able American health system will have to involve some elements of user choice and, probably, some free-market ingredients, like insurance companies or doctors competing with each other. Where we might differ is in your view that the American system is right now the best in the world. True, many Americans might feel this way, but I see no evidence to support such a sweeping conclusion. And if it *were* true, why should we support any change?
Ray,
You say “We have a free market system that has produced what many feel is the best health care system in the world. I say our system is the best in the world because it operates in the free market.” I don’t see why, just because we have a (supposedly) free market system, that means it’s the best in the world.
Would the best health care system in the world spend more per capita (by a wide margin) on health care than any of its peer nations in the OECD, yet leave 14.8% (43.6 million) of its citizens uninsured, (while all the other countries cover everyone), and yield a US life expectancy significantly lower than most (or all) of its peer nations? It doesn’t seem to compute.
I don’t care how we get it done, but we need to:
If single-payer is the best way to get there, so be it. If there is a better mechanism, let’s do that. I’m no health care expert, but surely the (arguably) most affluent and innovative society the world has ever seen can provide decent, affordable health care for everyone.
Curt B.
Here are some links that will aid you in comparing systems and citizen satisfaction levels in industrialized nations….As I said…In general people with single payer systems are quite satisfied. I think these surveys of 15 systems bears that out. I’ll add that only one country’s citizens (Italy) were less satisfied with their system than citizens of the US
http://dll.umaine.edu/ble/U.S.%20HCweb.pdf
http://content.healthaffairs.org/cgi/content/full/20/3/10
http://content.healthaffairs.org/cgi/content/full/21/3/182/
Bruce (#236): I just have a footnote to your link to the CDC site. You’d think their numbers would be accurate, but in this case I’d check before giving them out. They don’t say so, but I think they’re including foreign nationals living in the United States, as well as people who make enough to buy insurance but just don’t feel like it. I’m not sure why they’d to this other than to inflate their numbers.
On a more personal note, I never thought of throwing money away on health insurance until I got married (at which point my wife, responsibly, signed me up for it). So I was uninsured between the ages of 18 and 27, which is about 10% or better of average life expectancy.
Bruce, I say we have the best medical system in the world because we do. You don’t see people heading to any other countries for top notch care. Right here in Minnesota we have people coming here daily from all over the world to access this great care.
We have developed more medical devices to help humanity than any other country. Many of these devices, and care protocol, are exported all over the world. America’s care reaches far and wide.
It sounds like your measurement for ‘best health care’ is based on how little is spent per capita. To do all the things we do costs money. If we don’t do them who will? When you need a less invasive procedure to fix your heart, you will get it here because we are developing those systems. You might get it eventually in one of the socialized medicine countries, but then again you might not.
And Scott notes one of our increasing problems with a private system…those who opt out of paying for the system—but do in fact share in the benefits of the system when they show up in the emergency room of a hospital. I totally agree that there are many people who can afford health insurance but elect not to purchase it. That should be a very simple fix. Something tied to our tax return such as providing concurrent evidence of health care for the year. We all submit our W-2 forms to prove income….one more could prove health insurance. Can’t do it? Then the government can add a surcharge to your income taxes.
I again ask, espeically Bruce, what is wrong with a system that relies on our private system of delivery, and incorporates new administrative efficiencies, but provides government coverage for all health care costs an individual incurrs over 10 percent of their income? People with little or no income meet the test virtually right away. Many wealthy people would most likely never receive any government support for their health care….they would pay for it themselves, as they should. Personal responsibility would drive such a plan very nicely.
Paul Z, I assume as you do that we would incorporate such ideas in a “10%” health care plan. Remember, we already do much of that using our earned income tax credits. Millions of people today receive a tax rebate from the government that is far greater than the total of the taxes they pay in in a given year. I think that is a pretty good way to get the tax burden off the low income folks. We can do the same thing with the “10%” health plan that Tom and others have promoted. This plan really does address health care in a proper, caring manner without creating massive government programs…something any good conservative should want!
Health care costs are astronomical and cause hardship for every part of our life. Our schools, hospitals and every business that is trying to provide health insurance for their people must constantly increase their spending just to stay even (if that is possible.)
We are self-employed. Health insurance costs about $15000 per year for my family. It has DOUBLED in 6 years. DOUBLED.
We have a right to a free and appropriate education through the 12th grade, but we do not have the right to preventative health care.
Ray, the measurement of the quality of the system is not what we produce that the rich can afford, but on the ability of our system to provide health care for its citizens. If they can’t afford to get the care, they are not benefiting from all the medical devices we produce.
Among states in the USA, Minnesota is probably one of the best off, with a high ratio of medical professionals to population and several world-wide reputation health care facilities, so do not judge the level of health care in the United States by how well we do in Minnesota.
And it is difficult to judge people who decide to take a chance and not carry health insurance so they can pay their mortgage, put gas in their car and food on the table. Unfortunately, if they get sick, we all get to pay when they go to the emergency room for care.
Our system is WAY broken. Health group executives receive excessive salaries (see United Health Group) while denying coverage for “experimental” but life saving cancer treatment. It is an area where greed has made for a bad market.
Tax credits maybe would work, but there are many, many more people who need health care than file and pay taxes (or get EIC refunds.) Certainly, an expansion of the EIC would be reasonable, but it really seems unfair to give tax credits for paying health insurance to companies that are gouging the public in order to provide excessive salaries to their executives.
Many insurance companies are running over 20% for management expenses, while Medicaid is at about 2%. This is one where we have to take the private greed out of the equasion for the good of everyone.
Imagine….an insurance policy that does not depend on your employer--if corporations thought about how much they would save in administering and paying for health insurance, they could easily pony up a special tax for universal insurance.
There are just some things that don’t work well in the capitalistic system, and should be public. Parks. Roads and bridges. Schools. And the right to good health.
Jane- In your post #241, you said,”We have a right to a free and appropriate education through the 12th grade…” Surely you do not mean that. The last I looked, we do not have a free education system through the 12th. grade. If that is the case, then where are my property taxes going? You went on to say,”… but we do not have the right to preventative health care.” Health care for anyone costs money, but I believe there is a difference between preventative health care and medical treatment for chronic deseases. The latter are the expensive things. I know, just from what I have to spend in co-pays to stay on top of my diabetes and atrial fibrilation. I can’t imaging what a person with a more serious debilitating desease, such as fibral myalgia, would have to pay. The task Ray is trying to address here is how to do that equitably. There is a question as to whether private interprise or government administration is the best method to do this. For many of us, the prospect of government administration of this care does not produce hope on the horizon. A case in point is the quality of care being administered in our own VA facility in Minneapolis.
Jane: Thanks for your fine statement on the problems in the current system and the need for serious reform.
John, I mean no offense, but you nit-pick when you comment on Jane’s statements about “free” education. You know what she means. She knows it costs money to provide health care, education and freeways. Everyone reading this knows. It doesn’t help the discussion.
John, you write, “The task Ray is trying to address here is how to do that equitably.” In fact, all proposals Ray has put forward, including Neuville’s 10% proposal and health savings accounts, have been designed not for equity, but for preserving the profits of corporations that have their fingers in the health care pie.
If we’re going to talk about equity, you can’t ignore elephants in the living room like obscene CEO pay and high administrative costs, and just go after small fish (relatively).
Recent (2007) Nobel Prize-winning economists (on Mechanism Design Theory) noted that the “invisible hand” of the market may be good at regulating some things, but it’s not good at regulating health care, clean air or clean water — things that are in the public sphere and matters of public good:
http://nobelprize.org/nobel_prizes/economics/laureates/2007/ecoadv07.pdf
But if you’re stuck in an ideology that says private market economics MUST be better in all situations, regardless of evidence or facts, then you will only hear and see what you want to hear and see.
Some of us still believe that government has a job to do, and can do it.
Others believe (or want us to believe) that government will always mess things up, or even if they don’t, it would be better to have things privatized so someone can make a killing. To this end, lacking any faith in the possibility of good government, they always seek to shrink government and taxes.
This has no basis in fact, as private enterprise shows every indication that it has just as much capacity for waste and corruption as does government. But such people, for some self-defeating reason, sometimes run for public office, and sometimes win.
It’s best to vote such folks out of their jobs as soon as possible. Anyone who is that negative about the prospects for government to do a job and do it well has no place in government.
Too much of the health care debate is not about health care or reality at all, but simply about political ideology.
Norm Coleman got up at the Republican convention in Rochester and complained that the Democrats want single-payer, which he said means that the Democrats
want to put the same people in charge of your health care as were in charge of Katrina relief.
Pretty devoid of fact or substance. This is pure spin. Why in the world would Democrats put Bush political appointees Michael Brown and Michael Chertoff in charge of a single-payer health care system?
You’d think that the Republicans in Rochester would have choked on this remark, given the fact that Bush appointees Brown and Chertoff messed up so badly on Katrina. It seemed like a Freudian slip: In trying to disparage Democrats and single-payer, Coleman ended up evoking one of the worst episodes and signs of greatest incompetence in this Republican presidency.
There’s something really sad about listening to Coleman on this, like watching someone spit or pee into the wind, or watching a nervous breakdown, or a seriously dysfunctional family.
I think de-linking health insurance from employment makes sense and should appeal have way more support in the Republican Party than it does.
Health insurance costs are passed along in our manufactured products, making them less competitively priced.
People with entrepreneurial ideas are reluctant to take the risky move into self employment because they can’t afford the insurance, and can’t take the risk of being uninsured.
Many of the self employed people I know have their family insurance needs met by an employed spouse. Those that don’t have this option are out of luck.
Paul & Jane- I don’t mean to nit-pick on this, but I have heard all my life, it seems, that if you get something from the government, it is free. It isn’t, and I appologize for projectiing my past experiences into this discussion. In fact, I think Curt B. expressed this very well in his post. There is, I believe, a need for community approach to taking care of major infrastructure. My question is whether health care should be included in the infrastructure. It is an ideology difference, and I respect your freedom to disagree with that. I just disagree that this is the only approach. Social care used to be a ministry of the churches, but we have dropped the ball so badly on this that the government has no choice but to step in in most cases.
John and Curt, you both make excellent points on the health care issue. It absolutely should be decoupled from employment. It ended up there as a result of wage and price controls the government imposed after WWII, not from following any well thought out plan. Businesses could ‘give’ the perk to employees as a benefit and stay under the government price controls. In the same manner, Duluth is now facing a $300 million per year defecit due to the fact that city leaders ‘gave’ health care to just about anybody during the 1960′s and 1970′s without making provisions to pay for it. I know none of them ever thought they would see health care premiums where they are today.
We need to ask ourselves “how much should each individual pay for their health care”. Until that question is identified, we will continue to struggle. This is no different than the question “how much does it take to educate a student for a year”. We have to address that fundemental issue. There can be quite a range in the answer.
Some, who want complete government take over of health care, feel the answer should be ‘zero’ out of your pocket, but 100% out of taxes. I don’t share that plan at all, but do think we can and should move to a system, such as the 10% payment plan, that keeps individuals with ‘skin in the game’ but creates a government managed and paid for portion for those that have significant needs.
Regarding the 10% of income plan-
As I understand it, this is essentially a high deductible single payer plan. A family of 4 with a household income of $100,000 would have a deductible of $10,000. Then government insurance would kick in for any additional medical costs over the deductible. On the face of it this looks like a good step toward universal coverage.
What is the cost of such a system and how will it be funded? High deductible plans typically cost 25% below the cost of traditional health care plans. The average cost for a traditional individual policy was about $4500 in 2007. A high deductible plan (typically a $3000 initial deductible) costs about $3400 per year on average. The single payer system should reduce private insurance overhead by a minimum of 10%, so I’ll figure the government cost at $3000 per individual. Using a similar analysis, family coverage would cost the government cost of about $10,000 per year. So the total cost of such a system is the cost to the government for providing a high deductible policy, plus the deductible amounts, up to 10% of income, paid by citizens who have income.
Most high income individuals and families will never reach the 10% of income threshold. Low income citizens will certainly reach it, or be eligible immediately because of some variation of an earned income credit. Middle income folks have a very good chance of satisfying the deductible and becoming eligible for the single payer system. Median individual income is $32,000. Median household income is $47,000. Since per capita health care spending (less Medicare) is about $6000 per year, it seems safe to say that most people will use their 10% of income and come into the single payer system.
My point is that if most people will end up in a single payer system…Why not start them in the single payer system? At any given time ten percent of the population uses 70% of health care resources. People getting preventative and primary care treatment through office visits, therapy, medications, etc. are not straining the system. Children getting a broken arms set are not straining the system. Normal pregnancies are not straining the system. But paying for this kind of care does strain the budget of anyone with a high deductible plan, except for the most well off. If, as the 10% plan suggests, the government can afford to pay for insurance for the most expensive parts of healthcare…surgeries, extended hospital stays, transplants, cancer care, chronic conditions debilitating conditions, etc…. why not pay for the least expensive portions of health care?
The 10% payment seems equitable but is really not fair. A healthy family will have similar health care costs regardless of their income. The proponents of this system know that 9 times out of 10 the wealthy will pay the same as the middle class…that’s why they like it. And, for the one time out of ten, they know the wealthy will have purchased bridge insurance to cover the unexpected catastrophic shortfall. A more equitable method is to tax everyone on all income and/or wealth, depending on the circumstances, and provide health care for all from day one of every year.
Ray, re #246, I think Duluth’s $300 million unfunded retiree health insurance liability might be $300 million total--not per year. If it is per year, it would cost each Duluth resident $3500/year. Correct me if I’m wrong.
And to open another potential can of worms, how does Northfield (city and school district) fare regarding unfunded retiree health benefits? Do we have a potential problem?
You are correct Curt…fingers flying too fast; not annual, but an annual budget item. Duluth now has about a $340M unfunded health care liability. Due to GASB 45 rule they, and all cities, have to show the liability in their budget. They also have to propose how they plan to pay for the noted liability if they want to secure public bonds. I have no idea how they plan to resolve this issue. They’ve talked about raising revenue from new taxes on electricity. They recently changed the number of years that an employee must work for the city to qualify for ‘free’ lifetime health care from 3 to 20. But it seems the clock keeps ticking on this time bomb for Duluth.
I think this is actually a very good accounting rule as public bodies really should line item identified costs for obligations like this, unused sick days, etc. I remember well when I was on the school board here and went through my first budget session. I couldn’t find where we accrued sick days. I ask about it and was told ‘schools don’t have to show that obligation.’ That is terrible accounting, especially when so many teachers bank the days and are paid a good many when they retire.
William, regarding comment 247, there are many ways a 10% plan could work. You have laid out one method. I think the approach most are taking is that you would be able to purchase insurance from whatever provider you wanted and would pay the premiums and the high deductible, but that the government would step in a provide a tax credit for amounts that exceed 10% of income.
Tax policy is complex. When you provide a tax credit for private purchase choices, you subsidize those that chose to spend more. One of the criticisms of tuition deduction is that it leads to colleges charging higher tuition rather than a general lowering of the costs. The same would be true for a “10% plan”, as the insurance companies would encourage expensive plans since they would lead to a tax credit for the insured, i.e., “buy this more expensive plan and it will only cost you a little bit more since it puts you in the bracket that gets a credit.”
I don’t care for these types of plan or, in general for a tax-based plan as they tend to be regressive--still costing the poor substantially more as a percentage of income. In addition, it requires taxpayers to pay for a year out of pocket before they file their return and get a tax-credit refund. When deciding between a future refund or food on the table, insurance loses out and they go without coverage.
Congress could easily lighten the health-cost by not limiting the deductibility of medical expenses by a percentage of AGI. Again, this is regressive and also discourages economies in the industry.
Some of the proposed plans retain insurance companies as administrators but require all citizens to have insurance, with those unable to afford insurance eligible for public subsidy. Others provide basic insurance through the federal government for everyone while allowing individuals to purchase additional coverage if they so wish.
My concern is that the system we have is now broken. My husband and I are both self-employed. Our insurance is $975 per month (family of 5) with about $4500 deductible. It is good insurance, but it is not $3500 per year.
Anyway, I agree with you William that the “10% plan” is flawed. Just trying to administer this type of tax credit would be expensive. Then you would have plenty of fraud as people falsely claim excessive medical expenses in order to be eligible for the credit. On top of that, you would be subsidizing the insurance companies instead of incenting them to reduce administrative costs.
Ray’s comment asking how much should we have to pay for decent health care is the real question. Is it really an area where corporations should be looking to provide profits to shareholders? Or is that going to incent them to deny coverage and continually raise premiums?