ray

It doesn't matter that the private sector cost is increasing by less than 1% more per year. That's not relevant to the question of whether the US is bankrupting itself. I don't care if health care costs are increasing by 100% elsewhere; that's not relevant to the question of whether the US is bankrupting itself.

Sure does matter. You said medicare is bankrupting the country. I said horsehockey. Its medical costs not Medicare. And I said Medicare actually delivered its services cheaper and has controlled medical inflation better.
And that you don't care that there are examples elsewhere where costs and inflation are less, you pretty much put yourself into the head in hole group. Which again goes back to the top of the discussion. the original quote for this board was from Fareed Zakkaria. Sorry about that.

rickyp wrote:ray

It doesn't matter that the private sector cost is increasing by less than 1% more per year. That's not relevant to the question of whether the US is bankrupting itself. I don't care if health care costs are increasing by 100% elsewhere; that's not relevant to the question of whether the US is bankrupting itself.

Sure does matter. You said medicare is bankrupting the country. I said horsehockey. Its medical costs not Medicare.

Really? I only question that because I know that for a Canadian "horsehockey" is the highest form of telling someone they're wrong.

Now, let's do a radical thought experiment. What if Medicare did not exist? Would medical costs bankrupt the country?

I say "No." It might, given all the restrictions on insurance companies, put a lot of them in bankruptcy. Some old folks might wind up eating dog food. But, would the US go bankrupt?

Hmm, I think you'll have to prove that one, Richard, because I'm calling "horsefootball."

And I said Medicare actually delivered its services cheaper and has controlled medical inflation better.

There's more to this than meets the eye. It "cuts" doctor reimbursements, then the government corrects that with the "doctor fix" every year. Also, what Medicare refuses to pay gets pushed off on other patients and providers. In other words, the government gets over and private companies bear the burden.

the original quote for this board was from Fareed Zakkaria. Sorry about that.

Um, wait. Are you saying you confused George Will with Fareed Zakaria? That's like mixing up Michele Bachmann and Michelle Obama. Okay, actually, it's worse--because at least the women share a similar first name.

it's medical costs, not medicare? Medicare is for the payment of medical costs. The US government pays for medicare. The US government is bankrupting itself. You can use funky words now, but any independent observer of this conversation would view you as losing the debate, and wonder why I am wasting my time with you.

Ray Jay wrote:it's medical costs, not medicare? Medicare is for the payment of medical costs. The US government pays for medicare. The US government is bankrupting itself. You can use funky words now, but any independent observer of this conversation would view you as losing the debate, and wonder why I am wasting my time with you.

And, again, I challenge Richard with the ultimate American form of "you're wrong, mate," which is "horsefootball."

Let's see if he can just admit it--it was a case of over-reaching.

Archduke Russell John wrote:

danivon wrote:I note with interest that you are more happy to accept subsidy (which to me is closer to socialism) than a mandate (which is not socialist, per se).

For me the way I see it is the former is a choice the latter is not. Government can establish a choice and take actions to make it more attractive. What it can not do is require me to make a specific choice (with certain exceptions).

But... who pays the subsidies for making the choice more attractive? It's taxpayers who are compelled to pay their due tax. So even with just subsidies, there's an element of compulsions

Besides I don't actually expect most people to purchase Medicaid even if subsidized because it sucks.

Maybe. I think VA seems to be the real example of how the US can provide a fairly good level of cover on a public basis without major problems. However, it's subsidised by the taxpayer again, and it used to be poor 20 years or so ago.

danivon wrote: That's just a part of the 'principles' v 'practicality' argument.

You are correct it is. However, there are times when principles should be more important then practicality. For me this is one of those times . [/quote]I suppose. But medical efficacy affects lives and the quality of life. At some point there has to be a line crossed where principles don't outweigh human suffering. Sure, mandatory payment for the healthcare of others may seem egregious, and affect quality of life too, but realistically, there is always a balance to be met. I guess my line is in a different place to yours.

danivon wrote: When the Constitution doesn't serve the nation well, you can amend it. Somehow I doubt that you would be willing to support an Amendment to allow a mandate. So the principle seems to outweigh the consideration of whether it 'works'.

You are correct in that I probably would not support such an amendment. If for no other reasons the potential abuses of that kind of an amendment would be unimaginable.

Is there some way that limits could be placed on such an amendment that might quell your fears?

Besides, I think it would seriously surpass the limits a government should be operating under.

basically,if the Constitution did allow it, you'd be arguing against it anyway (and perhaps for an Amendment to stop it happening)? So the Constitution is a red herring in the debate then?

Ray Jay wrote:Oh, I totally get that. Another way to put it is that in the US we cure 7 out of every 4 fatal prostate cancers. There are men who are unnecessarily suffering from incontinence, sexual dysfunction, or worse who mistakenly believe that they've been cured of prostate cancer. Let's say a prayer for our brothers, liberals and conservatives alike.

Well, saying you cure 7 out of 4 fatal ones suggests that all fatal ones are cured as well as non-fatal. Unfortunately, that isn't the case and that's no detriment to the system, it's just that we can't.

And the cure for prostate cancer is not itself particularly nice, if it involves chemo- or radiotherapy.

I was responding to Ricky's diatribe that liberals use all the data and conservatives are idiots, or something like that.

As I said before, I tend to skip his posts nowadays. If an argument ensues, I may well read back and see what he was saying and perhaps join in, but to be honest, it's often too much work.

Fair point. (Shocked?)

well, I tend to see you as a pretty rational guy, compared to many on here.

Sequentially in my life I read the food stamp article and then I read Russell's post on government working. It wasn't one of those posts that I spent 3 hours thinking about. The contrast was too funny to ignore. When was the last time a large US government program demonstrated excellence? My most recent best example is 1991, and no doubt that would have some controversy.

Ah,

By the way, to prove your point, it's not good enough to show that the Dutch can arrange a national health care plan that works. Different countries have different sizes, histories, demographics, and political cultures. We can definitely learn from the Dutch, but we can't necessarily extrapolate to the US.

Perhaps not. Switzerland has a not dissimilar Federal structure to the US, but is much smaller. When it comes to culture, they compel men to bear arms, which is even stronger than the US's culture, so perhaps they are more prepared to accept compulsion in other areas. The Swiss have a strong defensive mentality, after being for several hundred years a republic surrounded by hostile and avaricious monarchies.

Holland is also small, more social-democrat in outlook, but fiercely independent (as a Protestant island which fought for about 100 years to be free from Hapsburg control.

When it comes to demographics, it's suprising how much European nations have changed from 50 years ago. When your dads and grand-dads were over helping to rid us of Hitler, we had very few Asian, African or other ethnic groups with any presence. Since the post-war colonial settlements (allowing former subjects to come over to work and stay, just when we needed a lot of able-bodied workers), things have changed a lot. It won't be the same as the USA, but it's a lot less different than is often assumed. Besides, it's not the genetic side as much as the cultural side (diet in particular) that has a major health impact.

Of course, the USA is big, but it's also made up of 50 states of varying size. How big does a country need to be to be capable of providing a model that can at least be looked at, if not copied wholesale? Germany has 80 million people. Japan close on 100 million. I can see that Singapore's system (very good, very efficient, heavily private, but with state co-ownership and a good basic minimum) is not easy to scale up because Singapore is a city-state and not really a country, so issues of distance and low-density population don't arise.

danivon wrote:But... who pays the subsidies for making the choice more attractive? It's taxpayers who are compelled to pay their due tax. So even with just subsidies, there's an element of compulsions

Yes but the burden is different. It also goes to the roll of government.

danivon wrote: I think VA seems to be the real example of how the US can provide a fairly good level of cover on a public basis without major problems. However, it's subsidised by the taxpayer again, and it used to be poor 20 years or so ago.

This made me laugh my ass off. It's better then it was 20 years ago but it still sucks. Examples abound like the 300 patients that were given unneeded raditation treatment that ended up causing cancer or the typical 6 month wait to see a specialist.

danivon wrote: I suppose. But medical efficacy affects lives and the quality of life. At some point there has to be a line crossed where principles don't outweigh human suffering. Sure, mandatory payment for the healthcare of others may seem egregious, and affect quality of life too, but realistically, there is always a balance to be met. I guess my line is in a different place to yours.

Which is exactly my point. Basic nutrition affects lives and the quality of life. As ricky loves to point out poor people in this country tend to buy crappy food that makes them fat. Part of the reason is the cost of crappy food when compared to healthy food. Government could provide them with healthy nutritious meal so why doesn't it? Because basically everybody agrees that is a step to far.

You and I just have a different location for the step to far.

danivon wrote: Is there some way that limits could be placed on such an amendment that might quell your fears?

I haven't really put any thought into a hypothetical Constitutional amendment that I have never seen.

Danivon wrote:basically,if the Constitution did allow it, you'd be arguing against it anyway (and perhaps for an Amendment to stop it happening)? So the Constitution is a red herring in the debate then?

No. You are arguing for something from the efficency/cost point of view. You use comparisons to other countries medical costs as evidence to support that argument. I am arguing that one of the primary components that makes those systems work is impossible in this country due to the limitations placed on government. I am arguing from the legal point of view. The Constitution currently supports my legal argument therefore it is completely valid position to take.

Medicare works in this country for one reason and one reason alone. It is supplimented by private insurance. Many retirees continue to be covered by their private insurance they received through their job. Those that do not get to purchase low cost supplimental policies from private insurance companies (Medicare Part C) that cover things not covered by Medicare Parts A & B.

Medicaid does not have these options. Which is why it sucks so bad.

Archduke Russell John wrote:

danivon wrote:But... who pays the subsidies for making the choice more attractive? It's taxpayers who are compelled to pay their due tax. So even with just subsidies, there's an element of compulsions

Yes but the burden is different. It also goes to the roll of government.

Is it really that different? And if the subsidies became high, would it not increase the burden?

As for the role of government, I'd say that if we look back at the history of government, it has had a lot of different roles.

danivon wrote: I think VA seems to be the real example of how the US can provide a fairly good level of cover on a public basis without major problems. However, it's subsidised by the taxpayer again, and it used to be poor 20 years or so ago.

This made me laugh my ass off. It's better then it was 20 years ago but it still sucks. Examples abound like the 300 patients that were given unneeded raditation treatment that ended up causing cancer or the typical 6 month wait to see a specialist.

Do you have a link to that? I'm sure that there is overzealous application of treatments at times (was this radiation treatment for cancers that turned out not to exist? Were there others who received the treatments who were correctly diagnosed and so saved? Misdiagnosis is not solely a feature of the VA or any system - it's a feature of medicine. Whatever the system is, it should be set up to try and reduce misdiagnosis, but it can never eliminate it.

Which is exactly my point. Basic nutrition affects lives and the quality of life. As ricky loves to point out poor people in this country tend to buy crappy food that makes them fat. Part of the reason is the cost of crappy food when compared to healthy food. Government could provide them with healthy nutritious meal so why doesn't it? Because basically everybody agrees that is a step to far.

You and I just have a different location for the step to far.

As agreed. Personally I don't like the idea of government telling me what food to eat. I have a liking for beer, for burgers, for fatty stuff, chocolate and so on. It's interesting that your government provides food stamps (ours does not, except for people claiming asylum), so it seems that for citizens, the US is further down the road of agreeing that it should pay for food than ours does.

danivon wrote: Is there some way that limits could be placed on such an amendment that might quell your fears?

I haven't really put any thought into a hypothetical Constitutional amendment that I have never seen. [/quote]True enough. I guess we know where each other stands then. I would like (for the sake of Americans, not for myself) for your country to be able to address the spiraling public and private costs of medicine. Even if the government doesn't keep pace, the people seem to be paying more and more for insurance. If that takes a specific Constitutional Amendment, one that grants limited powers, then it may help at least open up the options.

No. You are arguing for something from the efficency/cost point of view. You use comparisons to other countries medical costs as evidence to support that argument. I am arguing that one of the primary components that makes those systems work is impossible in this country due to the limitations placed on government. I am arguing from the legal point of view. The Constitution currently supports my legal argument therefore it is completely valid position to take.

What I mean is that you use the Constitution as a reason not to change, but you would not agree to a change in the Constitution to enable it. Which suggests to me that if the Constitution did clearly allow a more 'socialist' health system, you would still oppose it. I want to get past the legalistic arguments to the basis of them, and I'm satisfied that you have explained your position - that you don't see government should have the role.

I'm not just arguing on efficiency and cost. I'm also arguing on outcomes. For the richest Americans, health outcomes are among the best in the world. But most Americans are not in that 'richest' category. When even the middle classes are not able to get the same kind of outcomes as can be obtained elsewhere, you will perhaps start to see the other side. The way that insurance rates and policies are changing, that will happen soon. As it is, the NHS (which is by no means the best system in the world, and suffered from under-investment until the last decade) is keeping parity in terms of outcomes with standard occupational schemes in the USA. But at a cheaper rate (and for whole-of-life).

Medicare works in this country for one reason and one reason alone. It is supplimented by private insurance. Many retirees continue to be covered by their private insurance they received through their job. Those that do not get to purchase low cost supplimental policies from private insurance companies (Medicare Part C) that cover things not covered by Medicare Parts A & B.

Medicaid does not have these options. Which is why it sucks so bad.

I thought Medicaid was very limited anyway.

steve

Now, let's do a radical thought experiment. What if Medicare did not exist? Would medical costs bankrupt the country?
I say "No." It might, given all the restrictions on insurance companies, put a lot of them in bankruptcy. Some old folks might wind up eating dog food. But, would the US go bankrupt

?

You might want to reread the debates on this a year ago or more. Archduke proved pretty conclusively, at least to me, that insurance companies are Not really part of the problem OR solution for medical inflation. If you eliminated the profit margins and more expensive administration that private insurers have you've only have a one timesaving over a one-payer system.. A significant one timesaving, but then medical inflation would move ahead lock step if the one payer system simply passed along the inflationary demands of the service providers. Which is what private insurance does now,
Private insurance has no real stake in keeping costs low, only in maintaining the margin between receipts and expenditures. The easiest way to do that is to increase rates as inflation increases . (Alternative strategies include denial of claims and negotiating with suppliers. But the easiest is simply raising premiums.)
SO if Medicare did not exist would medical costs bankrupt the country? The answer lies in the Kaiser study which shows that medical inflation for private insurers is running slightly ahead of Medicare.
(And by the way, the part of the Kaiser report that isn't noted by ray is that three is a cost per service advantage by Medicare.)

rickyp wrote:SO if Medicare did not exist would medical costs bankrupt the country? The answer lies in the Kaiser study which shows that medical inflation for private insurers is running slightly ahead of Medicare.
(And by the way, the part of the Kaiser report that isn't noted by ray is that three is a cost per service advantage by Medicare.)

Seriously?

That's your response?

Newsflash: if Medicare didn't exist, the government would be off the hook for $100T in future bills, so it would NOT be insolvent.

Let's put it another way: if you had your bills cut by 30-40%%, would you be in better shape? That's how much Medicare will eventually cost. So, by eliminating it entirely, the government would be saved.

You say it's not Medicare that's the problem, but it clearly is. You can argue it's efficient, but it is still a GOVERNMENT OBLIGATION, which would be eliminated if the program didn't exist.

Do you understand?

Think about this, how many people would have life insurance if they had to buy a plan that had a minimum of 5 million in coverage? Not many middle class people would buy life insurance if it involved super high premiums, but when they can buy plans in the 100k-500k plan range, many people get it to protect their loved ones. Both federal and state plans keep upping the minimum standards of health insurance.

Check this out for giggles https://www.gopetplan.com/

Why can't a human being buy an insurance policy with limits and benefits that are precisely what they want and what some company is willing to offer. If there were plans with 8k and 20k limits that you could purchase for $15-$30/mo, there's no way job or no job I would ever be without coverage or have to need government provided/subsidized coverage.

danivon wrote:Do you have a link to that? I'm sure that there is overzealous application of treatments at times

Here is the original article that started it about a doctor who misimplanted radiation seeds in 92 of 116 operations in Philadelphia. I remember seeing more articles after this one but can't find it right now.

danivon wrote: It's interesting that your government provides food stamps (ours does not, except for people claiming asylum), so it seems that for citizens, the US is further down the road of agreeing that it should pay for food than ours does.

The public welfare system in this country is two tiered. The truly desperate focusing on single parents with multiple children can get flat out cash assistances. However for those termed the "working poor" we have seperate Housing (section 8) vouchers and food stamps. My understanding is the decision to issue "food stamps" instead of straight cash was to keep people from using it to buy something other then food.

danivon wrote: What I mean is that you use the Constitution as a reason not to change,

Untrue. I have specifically mentioned change I would support. I have saying your specific proposal is Unconstitutional.

danivon wrote:but you would not agree to a change in the Constitution to enable it. Which suggests to me that if the Constitution did clearly allow a more 'socialist' health system, you would still oppose it.

Further I would go so far as to say there are options available to make changes that would be Constitutional. However, the Republicans won't do it because they are contrary to their belief in governments roll and the Democrats won't do it because they lack the political will to take the hit if if proves unpopular.

danivon wrote:For the richest Americans, health outcomes are among the best in the world. But most Americans are not in that 'richest' category. When even the middle classes are not able to get the same kind of outcomes as can be obtained elsewhere, you will perhaps start to see the other side. The way that insurance rates and policies are changing, that will happen soon. As it is, the NHS (which is by no means the best system in the world, and suffered from under-investment until the last decade) is keeping parity in terms of outcomes with standard occupational schemes in the USA. But at a cheaper rate (and for whole-of-life).

Really. And the rich do not have better health outcome then the poor in your country? I read an article recently about a woman in England who has cancer. She wanted to get a specific type of cancer drug that is not on the NHS approved list because it is too expensive. She decided to raise the money to pay for the drug herself while still using the NHI for the rest of her cancer treatments. The NHS told her that if she followed through with her plan to pay for the unapproved drug, she would have to pay for all of her treatments. That seems to me that if a person is rich they would be able to buy better health care then those stuck with just the NHS.

danivon wrote:I thought Medicaid was very limited anyway.

I am not sure if you mean availability or what it covers. What I am saying is that Medicaid and Medicare Parts A & B offer pretty much the same coverage. Major medical/hospitalization and a limited list of "medically necessary" basic care. What makes Medicare better is Part C which allows for the purchase of private insurance for additional coverage at subsidized premiums.

Also Medicare pays more to the providers then Medicaid so more providers will accept it.

steve

Newsflash: if Medicare didn't exist, the government would be off the hook for $100T in future bills, so it would NOT be insolvent

Your nation spends 16 to 17% of its GDP on health care. 33% more than any other western nation. Only about 45% is spent by the government. The rest is personall household expendtitures...
Personal bankruptcies due to medical debts is unheard of in western nations outside of the US...
Now ray said, "bankrupting the country" , I asume he took the holistic view. That medicare was causing not just the govenrment deficit but the inability of Americans to maitain their standard of living and guarantee their heal;th care standard.
Bankrupting the nation...

And really Steve, your overall deficits and debt are the result of inadequate taxation, overall spending priorities and the inability to recognize that spending has to be controlled in all areas. If you eliminated half your defence spending the security of your nation would still be guaranteed and you could come close to balancing budgets.End agricultual subsdies started years ago and etc. etc.


Seeking to blame Medicare for all the budget woes is needlessly myopic.
Its also myopic to blame medicare for runaway health care costs. Which is the base problem NOT medicare itself. Medicare is only a part of the way health care costs are paid .(All government expenditures are 45%) Nothing you have in place in the US has proven to effectively combat inflation in this area. (And I know you beleive that "true competition" hasn't been achieved in the insurance business but even then you'll have to prove how insurance companies would bother to combat inflation since they care only for the maintenance of their margins and not for the overall costs...)

I demonstrated earlier that other "Socialist nations" have controlled meical costs. Regulation. (In actual fact a collaboration between the medical service providers and the regulator to ensrure that the industry remains rewarding to service providers and yet ensures that it remains affordable) . Other than the ideological revulsion there hasn't been a response that claims that this method has proven ineffective or inefficient when compared to the US system.

I don't think the US can possibly move to a single payer system until more household budgets become strained by the cost of insurance or medical bills.... At that point the need for aceptance of reality will lead to a pragmatic approach that ends the stigma.

neal

If there were plans with 8k and 20k limits that you could purchase for $15-$30/mo, there's no way job or no job I would ever be without coverage or have to need government provided/subsidized coverage

.

And can you demonstrate that with this kind of plan the private insurers could maintain the required profit margins ? There's the rub.
If this kind of plan doesn't exist, its probably that the actuaries can't make it work profitably.

I had been paying $320 a month for my family of 4 for health insurance for catastrophic care, which is the insurance that I needed. The rest I can cover privately without insurance. However, with Massachusetts new health care law which mandates coverage, that plan was ruled insufficient, subjecting me to a non-deductible penalty tax of over $2,000 per year with that insurance plan. I now pay $1,180.19 a month (I use exact numbers because I live in the real world) for a plan that is a little better. The State has mandated that I pay this private company this amount. It only makes sense economically for me to do so because I would rather pay a tax deductible $1,180.19 per month than a non-tax deductible penalty of over $2,000. The private insurance company has ensured their status via the legislation.

My insurance bill is increasing rapidly because many people decline insurance until they actually need it. However, if they contact something like cancer, they can then buy insurance no questions asked. The insurance company then has a huge loss which they manage by increasing everyone's premiums.

Mass is the model for the federal program, so I know what is coming.. Part of the reason for my insurance bill's going up is that the federal health car law mandates that certain things be covered that I don't need, but we all have to pay for. For example, kids who are under 27 must be included in the family coverage.

Neal's point is right on target in the real world that I live in.