A decent health care system would mean that consumers would have more of their money freed up to spend on consumption (or to save, perish the thought!), and it would help a lot of businesses save money.

The 1% or so with catastrophic medical situations would have more money.  Everybody else would have less, unless we’re going to deficit spend to pay for a “trip to the doctor at the first sign of the sniffles” with deficit spending in perpetuity.

Just an anecdote about women in male-dominated jobs…

I work in the office of a construction firm that does primarily interior work. One of the supers was on a big job and walked around, watching all the different teams work with (I think) a screw-gun of some kind.

The team made up of four female apprentices was going at a good pace: Shzzzzp! shzzzzp! shzzzzp! shzzzp!

The team made up of four male full carpenters just around the corner? Shzzzzzp! (pause) shzzzzzzp! (pause) Shzzzzzp! (pause) etc.

The super had words with the male team, letting them know that the work that the apprentice team was doing was what he expected of them. Heee!

Again, just a little anecdote, and I agree that the sort of programs that you are talking about would provide more jobs all around—just what we need!

Are you shitting me, Al?  People have their health care paid for and now they’re all hypochondriacs clogging up the waiting rooms?  My health care is paid for NOW, by my employer, and I still barely ever go.  I have this thing called “time”, and I don’t have much of it to spare.  I power through colds and injuries with Nyquil and WebMD.

In addition, national health care is never “free”, it’s paid for by taxes.  And while people don’t like paying taxes, they mind a lot less if they actually get something for their money.  I don’t really feel like I see a dime of my tax money spent on stuff that makes my life better, but if I knew that my taxes were stopping me from financial collapse if I got a serious illness or injury?  I’d be okay with that.

Just fyi, I think the concern that the stimilus package was more targetted at men’s careers was expressed by katha pollitt at the nation.

Also, the heath insurance premiums that most of us pay are already, in essence, going to the “1% or so with catastrophic medical situations,” as well as towards generating profits, which are a sign of inefficiency if you know your micro-econ, for the insurance company. A government program could just redirect that money so that more people can afford severe and preventitive medical treatment without the money withheld from your paycheck even changing.

Al:

The 1% or so with catastrophic medical situations would have more money. Everybody else would have less, unless we’re going to deficit spend to pay for a “trip to the doctor at the first sign of the sniffles” with deficit spending in perpetuity.

Hm. I’m guessing that you’re one of those people who honestly believes that most if not all of your premium payments go directly to actual health care, rather than blowing 65% or more of it on administration, bureaucratic waste, malpractice insurance, and straight-up profit.

While I appreciate the need for construction jobs, infrastructure improvement and all that other manly stuff, I too wonder what this “Stimulus” will mean.  Just more money thrown away, this time to developers and owners of construction companies?

Sure, bridges that don’t fall down would nice, hell, they would be great.  And it certainly helps me as, I suppose, I might be crossing a bridge or two before I shuffle off this poorly maintained coil.

But I want to point out that the FDR programs covered the entire spectrum.  Arts weren’t left out.  There are a lot of sectors of the country that could use a boost and would also make life a little better everyone.

It’s not as simple as some, perhaps not in thread, suggest, “build roads”.

For instance, I think we should nationalize GM and retool the factories to make nothing but electric cars and light rail/streetcars.  Sell them to local municipalities at a break even (or possibly subsidized price).  That means sustainable transportation that later republican administrations can “privatize”.

Well, that idea sounded good until the last part.

This is promising.  Yglesias had a post a little while ago about how a prolonged economic downturn could set back feminism if for some reason women were being disproportionately fired.  I don’t know the history at all here, but here’s what he says:

People don’t think about this much, but there was a kind of false dawn of feminist progress in the 1920s. The teens were an important time of women’s suffrage activism and the 19th amendment came into law in 1920. In the twenties you had a lot of women participating the workforce, and various shifts in sexual mores. Then came the Depression, which threw huge numbers of people out of work and led to a big drop in the divorce rate as people were too economically insecure to split up. The New Dealers had a lot of maternalist ideas, and the policies they put in place in the 1930s were specifically designed to reconstruct the economy on around an ideal of stay-at-home moms. And that’s what you saw emerge when the country emerged form the Depression during and after the war.

So yeah, if we end up creating a bunch of jobs for nurses, maybe it becomes more socially acceptable for the man to be a househusband and do the chores while the woman works outside the home, just because that’s how things sometimes shake out economically.

Amanda, et al.—What a great deal!  I get to keep my employer health coverage, and then pay for other people to have it to.  As it is, my marginal tax rate is about 50% (Federal + NY State + NY City).  I can’t wait to find out what it’s like to only keep thirty cents of every dollar I earn.

And for the, “It saves money!” crowd—if it saves money, then why did Hawaii just have to scrap their universal healthcare for kids program for budgetary reasons?  Why is Medicare on track to consume every federal tax dollar in 2030’s? Wake up.

Al, if your tax rate is 50% you must be making a pretty good living.  Whey do you people making so much money do nothing but whine and whimper?  I suppose Hawaii is under the same pressure as a lot of states with it’s budget because of the horrible mess the trickle downers have made out of the economy in the last eight years.  You tell us though.  You brought it up. 

Or do you know the reason and aren’t saying because it doesn’t fit your argument? 

Why is Medicare on track to consume every federal tax dolar in 2030’S?  Get real Al.  Nobody’s going for your bullshit.

“But I want to point out that the FDR programs covered the entire spectrum.  Arts weren’t left out.  There are a lot of sectors of the country that could use a boost and would also make life a little better everyone.”

Word.  The artists, musicians, teachers, librarians, and so forth could use some help too.  FDR had them painting murals, teaching literacy classes, and recording oral histories (which we now consider highly culturally valuable).  I want to see stuff like that, not just buildings and roads.

Al, no one is saying that it would save the government money, it won’t. But if you have health insurance, you are currently paying other people’s medical costs. And currently Americans spend about 15% of our enormous GDP on healthcare cost (through taxes, private insurance, copays, etc.) I know that this is by far the highest percentage in the industrial world—i think the next highest is Switzerland at like 10% and Canadians pay like 8% or something. The government is not going to save money, you are.

You are going to pay for healthcare regardless, the only choice is whether you want to pay into a private company whose goal is to collect the most money while providing the least service thus maximizing inefficiency, or pay into a public insurance pool with an underlying mission to provide the most service with the least cost.

Wake up.

The 1% or so with catastrophic medical situations would have more money.  Everybody else would have less, unless we’re going to deficit spend to pay for a “trip to the doctor at the first sign of the sniffles” with deficit spending in perpetuity.

Are you shitting me, Al?  People have their health care paid for and now they’re all hypochondriacs clogging up the waiting rooms?  My health care is paid for NOW, by my employer, and I still barely ever go.  I have this thing called “time”, and I don’t have much of it to spare.  I power through colds and injuries with Nyquil and WebMD.

Al is an idiot, but the point he brings up is a point which is going to have to be addressed, and constantly addressed, by everyone who either 1) belongs by nature on the leftish side of the political aisle or who 2) has affiliations therewith or leanings thereunto.  Not because Al’s point has anything to do with anything that’s pertinent or real, but because Al’s being good enough to favor us with a generous prerecital of the mantra the righties are already preparing to recite the moment whatever plan Obama’s got in mind begins to take effect. 

That Obama is inclined to count “women’s work” as “work” may be a good thing for women, but it may not be such a good thing (though I shudder to admit this) for any plan that Obama intends to institute, especiallly if charges such as Al’s remain unaddressed.  Al’s stated notion is basically that affordable/available health care amounts to frivolous health care, the equivalent of a trip to the day-spa or to the beautician.  “Frivolous” is an adjective long used to describe any occupation thought to be unsuitable to men, and during the last 20 years or so the righties have gotten into the habit of attaching it to situations in which (they feel) an unbecoming concern with the well-being of the physical body is demonstrated (for example, lawsuits which have to health and safety issues tend to be labeled by righties as “frivolous”.) 

Women plus health care plus job creation equals a rightie bad dream, a perfect-storm explosion of Girl Cooties.  Right-wingers are bound to object, vociferously, with everything that’s in them.  At this point (IMO) they have no reason or ability to do otherwise.  We’d better be ready, that’s all; we’d better be prepared to counter the backlash with everything that’s in us.

Thought I’d posted on this, but it’s either in moderation or I screwed it up somehow.  So, here’s some international information on health care costs:

Among 25 countries that have comparable accounting systems in the Organization for Economic Co-operation and Development in 2006, per-capita spending on health care remained highest in the United States at US$6,714.

That’s followed by Norway (US$4,520), Switzerland (US$4,311) and Luxembourg (US$4,303). Canada was in the top fifth of countries in per-capita spending on health, spending US$3,678 per person, in the same range as France, Germany, the Netherlands and Austria.

So, Al, we’re paying more per capita than all those socialists while leaving tens of millions of people uncovered.  Maybe we could learn something from them.  The UK, by the way, pays less than half what we do. 

The reason why Hawaii is taking apart its universal coverage system is because of the same reason so many states are not funding things as the economy goes bad.  They have balanced budget amendments, and they have to cut back on everything when the economy collapses, even if it’s saving the people money versus a private solution.  What you need is a national system, funded by the federal government, which ought to be doing countercyclical stimulus in a recession. 

One of the great things about federal stimulus in recessions is that treasury bonds usually get very low interest rates when you’re in a recession, because they’re a safe asset.  So running a deficit then for health care or public works can be done cheaper than at other times, while saving the economy.

I would to point out some things:

1)  Works projects are a poor idea the vast majority of the times.  The main reason this is so is because we have only so many people capable of doing the work.  So anything beyond a very shallow set of projects are quite liable to be ineffective in spreading dollars or serving our needs because pretty soon we’ll be giving money to people who can’t do the jobs, just because we want to be seen doing something.  And people who can’t do their jobs usually have enough time on their hands to get *really* good at getting handouts.  Lastly, most worthwhile public works projects takes a long time to happen and requires long term commitments that may not be politically feasible—like regional railway upgrading, nuke power plants, most worthwhile renewable energy plants etc, etc.

2)  Some things that need to happen, like a rationalization of health care is going to be net job-loss for awhile until a real health-care buildup happens.  Think of all the redundant private beaurocracy that would be let go when single-payer happens.  That’s waaaaaaaaay more jobs than we could ever properly grow until we build more hospitals, create more doctors and nurses, etc—which takes time to happen.  The job losses needs to happen, as with the auto industry, but we really do have to have a plan for welfare or productive retraining or probably both.

3)  The main problem in the country is pretty simple.  Class.  Ginni Coefficient, that sort of thing.  Too much money is getting sucked into an upper middle class that’s far too big for the country to support, and not enough money is leaving the upper classes.  In the most recent period leading to the breakdown of the economy, the system has been setup such that the upper classes who had access to the shadow banking system, and the money it generated first, used it to buy things before anyone else had access to that money.  Everyone else had to deal with the inflation it caused in things like housing, food, health care, education, and anything else that all classes had to consume.  The collaspe has happened because there is too little velocity of cash within the general economy.  It’s not going to be fixed by anyone at the top pouring cash into the economy.  That’s “pushing on a string” economics. 

The only way the problem can be fixed at this end is by punishing “savers” in favor of investors.  Not in the way it has been done in the past, against lower class people though regressive taxation (SS, sales, and property), but by taxing income that derives from big savings and rent-seeking.  That is, *much* higher max income tax brackets, and more importantly, increased capital gains taxes with a focus on bond income (and alt corp benefits like golden parachutes and stock options/bonuses).  We need to get people OUT of treasuries/gov’t backed securities/safe corp debt and force people to fucking FIND good business opportunities to invest in.  There are many of them around, but they aren’t easy or big on profits.  Obama has a start on it, since he has always been pretty anti-regressive taxation, but the targeted tax increases needs to go further.  This is the hardest part of any recovery agenda.  Bush was placed in office to make this world possible (and this crash inevitable), and there will be many politically entrenched people who will fight to the death to preserve their gains.  Money velocity in the general society is everything in staving off a depression, and Obama will not be able to accomodate or compromise with this people, not if he expects to make things better.  The credit market has been shut off for the majority of people—so the only way to keep things going is to get all that cash out of money markets and bonds and their likes and forced into the general economy, no matter what their “owners” think or say.

4)  So what kind of fiscal stimulus should we do?  I think this should be a mixture of fiscal stimulus and fiscal anti-stimulus.  The fiscal anti-stimulus is simple.  Way, way, way too many people are perched high on islands of debt to productively interact with each other.  That means a program of debt jubilees are necessary in order create productive capital that is in line with people’s capacity to earn.  This means cancelling debts on housing—modify loans such that the principle is lowered by a third, at least.  In turn, modify the homebuilder’s loans to match the financial benefits granted to the homeowners.  In turn, modify the banks to match that same loss of principle.  Cram down the holders of the mezzanine and higher risk loan derivatives—we don’t want that market to exist anyways.  Do the same with educational debt—modify the doctor and lawyer debt, then the colleges, and so on…  Do it carefully, and it should work out.  Housing gets cheaper, education gets cheaper, medicine and lawyering gets cheaper, and money churn can happen again.

On the stimulus side, have the government switch from using loans as an agent of policy to grants.  Restart up the GI Bill, which I think is one of the critical programs of the 20th century, and have the majority of student pay for their schooling with grants, and pay that income back in taxes, as they do in Australia.  This is generally the way a fiscal stimulus should work.  Swith over from loans to grants, and *always* use preexisting beaurocracy structures to funnel money through.  Hire more people to staff the pour through—and stop when the pipeline is saturated.  Focus on services that has a huge service industry on the other end.  That is, dramatically increase food stamp offerings, unemployment checks, Medicaid—these are all things that the private industry has huge capability to absorb demand.  Do the similar things like free dental cleanings for all citizens—we have tons of private dental practices in this countries, unlike GP doctors.

A new GI Bill is one example of a pretty long-term program.  We should have other long-term program, much in the vein of Manhattan or Apollo Projects.  A general science and engineering program that does not have to produce profitable inventions right away.  A big one can help absorb scientific talent and preserve it for the day that private capital can get going again.  We can do it for renewable energy, but I suspect a better idea is a renewed emphasis on either space or genetics (say a cure for cancer program).

I think this is long enough for now…let me know what y’all think.

Al, I’m sick of this constant stupid misinformation regarding how tragic it would be if everyone had health care. You could be in that 1% tomorrow. And unless you die in a car wreck or sudden heart attack, you ABSOLUTELY, POSITIVELY WILL BE in a situation of high or catastrophic health care needs sometime in your lifetime. There is no being perfectly healthy until you die, unless the above exceptions happen to you.

My fiancée is from Canada and I’m working my way there. I just read in a book called, “How to Move to Canada” by Kreuzer and Bennett, that Canada pays $9 for every $12.95 spent by the government in the U.S. And no, he doesn’t wait for months on end on waiting lists for care.

Also, one reason health care will be cheaper is because the ER will not be used for things that can either be easily prevented (flu shots) or can be taken care of in the office. In addition, there are thousands upon thousands of disabled people who linger on disability in poverty for the sole reason that they have to keep their medicaid because they cannot get health care any other way. Think of the savings if these folks could get off the rolls and out working and stimulating the economy.

I’m just sick of this stupid, ignorant shit about “socialized medicine.” Go out and educate yourself beyond Fox News. People’s entire lives are at stake.

unless we’re going to deficit spend to pay for a “trip to the doctor at the first sign of the sniffles”

Which would happen, of course, because people loooooove going to the doctor, waiting for an hour, taking off their clothes and sitting on a piece of butcher paper, etc etc etc.

The comment about women being left behind with big public works projects was from a letter in the New York Times.  I think it was discussed at Shakesville.

And for the, “It saves money!” crowd—if it saves money, then why did Hawaii just have to scrap their universal healthcare for kids program for budgetary reasons?

Yeah!  So did Canada, England, France, Japan, Spain, Germany. . . oh, right.

The problem that Al has, like so many of his fellow right-wing drones, is that he’s pathologically incapable of holding more than one idea in his pretty little head at a time. He actually doesn’t understand that governments are complex systems that must respond to multitudes of contributing social and economic factors. In his world, everything that has ever happened has had one and precisely one cause.

Hawaii had to dismantle its kids health-care program? Of course, it must be because publicly-funded health care doesn’t work. Surely, it can’t possibly be due to any one or more of dozens of other factors that affect all government programs.

bekabot, the problem with the “frivolous” dogwhistle is that lefties think that means “getting an antibiotic for your sniffles so it doesn’t turn into an emergency situation that costs 100 times as much”.  It’s obvious that regular check-ups and other “frivolous” care saves everyone money, for the obvious reason that $30 in antibiotics is cheaper than $15,000 in hospital bills.

Ah, well.  Pin a social conservative up against the wall and eventually he or she will admit that his (or her) conservatism doesn’t rest upon any financial consideration whatsoever, but instead upon the proposition that sinners ought to be punished.  Which is why comebacks and questions posed by social conservatives always run along such predictable lines: “I see you’re a nicotine abstainer.  So, do you want a lifelong smoker to be able to get heart surgery on your dime?”  Or:  “I notice you’re of normal weight.  Do you want a fatty fatty fattypants to be able to get heart surgery on your dime?”  Or: “I notice that you’re not a steady drinker; well, do you want an alcoholic to be able to get his stomach ulcers treated on your dime?  Why would you want that?  The problems such people run into result from their actions; who are you to interfere with another person’s freedom of action?  Besides, these are problems which are never going to affect you.”

Financial conservatives, when pinned up against the wall, will (OTOH) eventually admit that they don’t think the Omnificent Free Market ought to be meddled with under any circumstances; meaning: under any circumstances at all, even when, as a result of the free market’s unfettered operations, people die and wealth untold is disspated into nothingness.  Where financial conservatives are concerned, the Market, not God, is the idol.  A willingness to pour resources down the drain in the market’s honor is the mark of a principled person.  When God demanded that Abraham sacrifice his son, Abraham didn’t mope around asking whether or not the demand was justified, did he?  Nope, he fought a battle against his natural affections, and ultimately conquered them.  For social as well as for financial conservatives, that’s the goal.  That’s how you get to be a way-cool Monad instead of a dreary old Henid.  That’s how you start the Jacob’s Ladder journey which will hump you along toward Transcendant Being status.  That’s how you end up, if you’re very lucky, very observant, and if you do everything absolutely correctly, as a Master Of The Universe.  What both strains of conservatism are united in is the view that nobody ever got to be a Master Of The Universe by buying nappies or tissues or flu shots for other people’s dissolute snotfaced kids.

But to conservatives that it’s aimed at, “frivolous” means “people I don’t believe deserve health or even life getting care”.  Non-white people, gays, etc.—-they’re useful if they’re working, but if they get sick, then they’re suddenly “frivolous”.

Which is why social conservatives will cite fat people, smokers, alcoholics, and AIDS sufferers as potential medical freeloaders but will never approach, say, a vegetarian and ask that vegetarian whether he (or she) wants a meat-lover to be able to get colon cancer surgery…on the vegetarian’s dime.  Because, obviously, meat-lovers aren’t on the Enemies List.

.. and Hawaii’s problems certainly wouldn’t be with the fact that it doesn’t actually get to bank the savings that result from universal health care for kids, at least not for 10-20 years when they start growing up and going to work without as many chronic illnesses, or with fewer disabilities, or with fewer educational problems.

One of the things that’s going to happen in parallel with the expansion of hands-on health care is the contraction of indirect health-care expenditures (paper pushers and administrators). This will be interesting because the administrative side of healthcare, at least at the lower levels that employ hundreds of thousands of people, has traditionally been heavily female and heavily disempowered-pink-collar.  So we’ll probably see not just an expansion but a shift in kinds of employment.

Al, Here’s the thing:

My brother the libertarian makes the same argument to me. I point out to him that I have ms. I worked for 11 years with ms before it disabled me. I am a lawyer and gladly, yes, gladly payed my taxes when I was able. But at no time was I ever able to afford private insurance. I checked and since I was living in Mass. at the time, Mass. law required coverage of pre-existing conditions. But my premiums alone- never mind for my family- were always quoted at a minimum of several thousand dollars a month. Thank god, my wife worked and had coverage. But even with her coverage my deductible for one of my meds a month was over $300.00; so I did without. We moved to Tenn. for health reasons and Tenn. does not have mandatory coverage; so I am uninsurable. But, again, I was saved by my wife’s plan and medicare. But The co-pay on my one med is still over $300.00 a month. So, I still do without.

When I tried to point out to the insurance company that paying for my meds would be cheaper than paying my hospital bills, they said, and,  I quote: “That is a risk we are willing to take.” In other words, they hope I die before either I get to go to a hospital or my hospital stay is short and then I die.

Now, to you and my brother, that is just the way the dice fell; well, gee thanks. And this doesn’t even address the moral issue of health care. I would bet that, like this so-called Christian nation we are supposed to be, that you espouse some sort of belief in the same. So, what happened to the maxim of taking care of the sick and the poor?

I have always believed and said that it is a crime against humanity that even one person goes to bed hungry in America or that one person’s health needs are not taken care of by the rest of us. Little did I know that I would be in that boat.

This country can do better.

Here is another example of our current wonderful system, Al.

My mother had a high paying job and worked her whole adult life. She was healthy her whole life as well and all that time she paid for employer provided health insurance. A good 30 years worth of premiums for coverage of care that she used minimally for standard, basic health care needs.

At 54, she lost her job because the company she worked for went under. My father was just 2 and a half years from qualifying for Railroad Retirement (including health insurance for spouses) benefits. My mother bought a low cost policy to get her through the next 2 1/2 years or until she found a job. It had a $250,000 cap. Literally weeks after losing her job, she was diagnosed with grade IV glioblastoma, a severe brain tumor. She used up the $250,000 in 4 months. She died 5 months after that, leaving my father with slightly over $100,000 in medical bills.

If she would have lived longer, I don’t know what would have happened. All those premiums she paid for health care she barely used didn’t matter a bit, because of this screwed up system that bases healthcare on something as unpredictable as where and if you work. Think you or someone you know won’t be screwed by our current system? You just haven’t been alive long enough then. It will happen. Everyone changes their tune when they are sick and tired and ill with cancer and they are spending hours on the phone trying to get their insurance company to pay for their chemo or anti nausea meds. All you are, Al, is naive. It will catch up with you.

Universal health care programs, on a state level, don’t work all that well for many reasons, which Ezra over at the Prospect discusses frequently; you really have to do it nationally to do it right. I’d look up links, but I’m not going to make an effort for a troll, and anyone else can find it pretty easily.

I think we all suffer too much from trying to make Obama’s programs fit the WPA model. It isn’t the 30s, women are a much larger part of the workforce, and even your average construction project isn’t as much about brute strength anymore.

To whit, one of my female friends is a computer technician, and worked for many years teaching clients about using her company’s software—so that they could put up metal-frame buildings. Lots of women do similar jobs in the “trades” even if they’re not handling actual shovels, they are handling payrolls, plans, training, customer service, and recordkeeping positions, not to mention working in management. If more of those jobs open up, absent blatant sexism on the company’s part, they will move into them too.

In healthcare, next to nursing, there is a very large field of women workers who are primed to become part of a national system; midwives. They have struggled with the prejudice of doctors and the AMA for years, and still can’t practice legally, even when licensed, in several states. But there is quite a bit of study that shows them to be safe and cheaper to use for normal births than OBs are, with higher satisfaction rates for the mothers as well. Britain uses them, and I believe other EU countries as well. If we could set up a standardized accreditation/training structure for them, many of them could be up and practicing in a realtively short time. Like nursing, midwifery could provide an entrance point for poorer women into steady work without as much expense (necessarily) as a standard college degree. Poor women suffer disproportionately from lack of prenatal care, which is something that midwifery excels at.

Actually, there was an article in the Boston Globe Thursday or Friday (which doesn’t seem to be on the site anymore) about how the job losses have been entirely on the male side.  The numbers I recall are that there are 1.something million fewer men working and 12,000 more women.  The idea was that the job losses so far are in construction, manufacturing, and banking, which are all male dominated fields.  The skills in predominantly female fields are apparently more fungible - rather than the job specific skills in more masculine fields.

Of course, this may change.

Al;
lets use an analogy. instead of healthcare, lets think about the military. (as an aside, i am a military brat, am only not in the Navy because of health problems, and really do think we need a military - i just hate our illegal war[s])

so. your arguments appears to be that national healthcare is a waste of money because the vast majority either a)don’t need anything that they can’t pay for out of pocket or b)those who do need more did it to themselves and don’t deserve “christian charity” (i DO NOT think either of these things, i think that this is what YOU mean, Al, and if i am mis-stating what you meant please correct me) (the “christian charity” is a snarky aside, i hate the myth of the “deserving poor”...)

this is VERY similar to the war in Iraq. what benefit do YOU accrue from the war? you are paying (faaaaaaar more than you are or will for health insurance) to POLICE ANOTHER COUNTRY. most of the people in Iraq are a) law-abiding citizens who do not need to be policed (although they probably do need protection; the argument there is from whom do the need protection, including us, and WHY, also including us, because there are several studies that suggest or openly state that much if not most of the current crime in Iraq developed as a direct result of US interference.) the b) here is also a direct correlary to heath insurance - those who do need policed (“policed” as in made to stop commiting crime) deserve it and brought it on themselves.

do you know how much this fucking illegal war has cost? even just a monetary amount, i won’t strain a conservative brain by attempting to make him/her think about intangible such as justice or honor or reputation or safety or the sanctity of non-fetal life.

if you are TRULY a fiscal conservative, BE A FISCAL CONSERVATIVE. attack the needless waste of this war, of military beaureacracy that over-spends on bullshit items ($200 for a cheap plastic toilet seat!) - and then, when lives are what are truly to be counted, builds to spec from THE LOWEST BIDDER - who always either goes over budget or over time (if not BOTH), cannot follow those basic specs, cannot write manuals that actually resemble reality, do not insure proper field testing before mandatory issue - and then blames the user. this is as true for a bayonet as it is for an Abrams.

if you are really worried about your tax dollars being “wasted” look over there, to the Right, which over spends on anything that allows manliness to shine, and not to the Left, which TRIED (and suceeded until the Right gutted the programs) to make ‘welfare” a program that allowed illiterate, ignorant poor people to aquire an education and gave them hope of something more than a starvation wage.
observe “abstinence only” education, the sheer waste of money needed to parrot one line, “don’t have sex until marriage”, and then ended up costing states probably MILLIONS in foodstamps, medi-caid, welfare programs, etc, when all those students went and had sex (just like teens have ALWAYS DONE, read romeo and juliet!) and had babies and then had most of their options reduced.
look to the Right, which tried to run the economy on a positive-feedback loop, lowering taxes for the rich while sqeezing out the middle class and then calling poor people names such as “welfare queen”, “parasites” “leeches” and worse, because the Rich and the Right have removed their access to education, to jobs that pay more than minimum wage, to birth control so that they don’t have more kids than they afford to feed.

if you want to save money, if you don’t want to pay for OTHER PEOPLE’S mistakes or accidents or karma, QUIT SUPPORTING THE VERY FUCKING PEOPLE WHO ORCHESTRATE THE CLIMATE TO CREATE MORE OF THEM!

vote your pocketbook, damnit, vote for your actual self-interest. unless you ARE one of those 1% who are rich - in which case, vote with your feet and move someplace else. Paraguay, maybe, or some other place where the people with money think they are the only ones who count. you should fit in there just fine.

“But to conservatives that it’s aimed at, “frivolous” means “people I don’t believe deserve health or even life getting care”.  Non-white people, gays, etc.—-they’re useful if they’re working, but if they get sick, then they’re suddenly “frivolous”. “

Damn straight.

And it seems illogical to conclude that more blacks and gays will go get tested for HIV because they get free healthcare. This is like saying that fat people will buy better food if they have more money for groceries. Wrong!

lets think about the military.

Speaking of the military, despite funding shortfalls, leaky roofs, and the like, the VA has very low cases of malpractice.  This is apparently because the VA offers standardized care.  It’s not a piecemeal system made up of private and public hospitals, HMOs, insurance companies, and Medicare/Medicaid like the system we civilians are stuck with.  If the government can standardize civilian care to the same degree, we could be saving even more money by bringing down the cost of malpractice insurance.

Non-white people, gays, etc.—-they’re useful if they’re working, but if they get sick, then they’re suddenly “frivolous”.

White, straight people who get sick, burn through their savings, and become ‘a burden to the system’ would be frivolous to people who think like that, too. We must have been very stupid to allow ourselves to get so sick, and we’re just not worth it.

keshmeshi -

that’s a wonderful point i didn’t even think of! you wins the intratubes for the day!

Wars make jobs, Space exploration makes jobs, increased healthcare could also make jobs.

By itself, I’m not sure that universal healthcare will lower costs.  A universal health system that emphasizes higher quality care (i.e., reducing prescription errors and hospital-acquired infections) in conjunction with massive or complete elimination of the profit motive in health reimbursement might lower direct healthcare costs.  Currently, in MA, we have universal healthcare (“Romneycare”)—everyone has to buy healthcare of some kind—and it’s not lowering costs in any meaningful way.

However, since many economic costs of our profoundly stupid healthcare system are externalized (the most obvious being that companies and corporations have to compete in global markets while paying for healthcare), in the worst case, universal healthcare will still yield benefits, but a lot will depend on the details of how it’s implemented.

And to build on Denelian and Keshmeshi, Al, you twit, the VA is standardized care and its recent problems are a lack of funding.  More precisely, a DEfunding by the dang Repubs who claim to revere the military.  The same is true of the Children’s Health Insurance Program.  Remember that vote recently?  Your president vetoed it and the program was defunded.  What do you think happens when programs get defunded?  Dingdingding!  They quit working as well.

And whoever made the point about Medicaid being a loop to keep people from working is right on.  In my state, Medicaid stops when you make over $850 a month.  Try living on THAT and getting your healthcare.  I have a thryoid dysfunction (Al, please tell me what sin I committed that led to that disorder.  Please).  Without going to the doctor and staying on my meds, I will be back to hearth palpitations, joint pain, high body temperatures, tremors, skin rashes, and a whole host of nasty symptoms.  When I finished school and started working (just barely started in my commission-paid field.  Not making very much, mind you.  Certainly not enough to live on) I called the state service office looking for a step-up program, asking about paying partial premiums until I have enough money to get my own insurance (because employers in my field generally don’t offer insurance. HA! Al! I must be an evil person).  None of those programs exist for those on Medicaid.  You either make below $850/month and are eligible, or not.  My caseworker told me about many cases she has where the people would love to work full-time, would love to get off welfare and Medicaid, but they can’t.  Because they wouldn’t make enough to pay for their own insurance because they have (gasp) pre-existing conditions.  From thyroid disorders like mine to bi-polar to a whole host of others.

Tell me how the existing plan is cheaper.  Tell me how the existing plan is better.  I do have health insurance now, but they WILL NOT cover anything have to do with my thryoid.  My doctor is understanding and charges me next to nothing for visits.  Without that, I would be up shit creek.  Our existing system actually makes it a positive for people to stay in poverty and on the federal dime because they can’t get health insurance.  You idiot.

Mike, Romneycare was specifically designed to not cut costs.  It is banned from cutting costs.

So… the right uses it as proof that universal care doesn’t cut costs, and the left points out that it proves you can’t have mandates without cost controls.

Beyond the short-sighted kneejerk free market ideology used by people like Al to justify opposition to universal medical care, it’s important to note that preserving the current broken privatised system serves the neoCon crony capitalist ideal very well: a lack of universal medical care provides them additional barriers to employee mobility and start-up entrepreneurship.

In other words, those for whom preserving privatised health care makes sense are not rubbing their hands together and twirling their moustaches thinking about some combination of Calvin and Malthus and Rand—they’re doing so thinking about employees who are too fearful about losing healthcare to leave dysfunctional companies, and challengers to industry incumbents who have to waste precious time and resources dealing with health benefits.

Going back the Obama’s Keynesian economics agenda, it’ll rest on three pedestals: national infrastructure (including intellectual/educational and technological infrastructure); green technologies (including re-tooling the auto industry); and health care—with cross-overs as appropriate. When I hear what Obama is saying and see what he’s done so far, I see real evidence the sort of systematic and long-term thinking that no previous President in my memory has displayed.

Whether it can survive somewhat intact after inauguration day remains to be seen. But for the moment, it gives a post-Boomer cynic like myself real cause for hope.

The current system is a mess, but the hope and promises of those wanting more government intervention in the healthcare system are not going to improve things. It comes down to rationing, folks. As with nearly any social good, there is more desire for healthcare than we can afford as a society. In the current mess, healthcare is rationed by a bizzare combination of cash money, picking the right employer, and ability to effectively work a bureaucracy. In Britain’s NHS, healthcare is rationed by waiting. There are definitely advantages to Britain’s system (and to the system of other countries with nationalized health care) but it isn’t a panacea.

Amanda’s $1500 splinter removal is a case in point. Amanda would like to have not paid $1500 for that - she’d like for it to have been “Free”. Well, that’s understandable. But the amount she’d have had to pay in taxes to support a healthcare system to provide that “free” care is not zero. Healthcare right now is about 16% of the US GDP. Being really generous, let’s assume that the rationalizations and savings possible by appointing a Healthcare Dictator and instituting a national system cut that down to 10% and keep it there (which it won’t, but let’s pretend). That means (very broadly) that every man woman and child and business needs to pay 10% of their income into the health care fund. Unless Amanda was making less than $10 grand, her $1000 (remember we cut all the costs by 50% through centralization) medical bill is going to require her to pay as much in taxes as she would have paid in buying her care on the market.

Fundamental axiom, inescapable and inexorable: You Cannot Get More Than You Pay For.

We can move some of the expense around. We can tax Warren Buffet a lot more than his health care costs to provide, and use that surplus to pay for care for Cletus and Darleen - and we should do that, and under the current system we do. But we cannot get more out of the healthcare system than we put in, and that means that people who are earning decent livings are going to be paying big whacking tax bills to cover their health care expenses (and the expenses of their poorer neighbors) no matter what kind of system we come up with.

Sorry for the War and Peace comment, but progressives have to understand that while the free market economics aren’t a great fit for healthcare (which does need some, gasp, socialism in the mix to have a decent society), the fundamental principles of economics are true and aren’t going to go away just because health care provokes strong emotions in people. It doesn’t matter how bad we want it; there is no free lunch.

If you are poor or very poor, then a nationalized health care system is going to improve your quality of care and save you money. If you are rich or very rich, then a nationalized health care system is going to keep your quality of care the same (or make it worse, if private choices are outlawed), and cost you money. If you are in the middle, as most of us likely are, then a NHCS is going to make care more predictable (maybe) and more accessible (maybe - these are not easy things to do), but it’s still going to cost you a whole lotta dough. The supply of Warren Buffett is limited; the middle class will still have to subsidize the poor to a large degree.

Nobody with a steady paycheck is going to end up paying less for healthcare under a national model. Math says no.

The current system is a mess, but the hope and promises of those wanting more government intervention in the healthcare system are not going to improve things. It comes down to rationing, folks.

Rationing, like horrific bureaucracy and general inefficiencies, are constants of any health care system, private or public. So TANSTAAFL on those counts, and all things being roughly equal it comes down to a choice of whom we want providing that lunch: a cook whose primary goal is providing tasty and nutritious food for the customers (perhaps increasing prosperity for the pub as a whole); or one whose primary goal is making sure that bar owner pays as little as possible for providing the food (including finding sleazy little ways to deny customers the “free lunch” they’ve been led to expect along with their beer). One way or another, the price of drinks remains the same.

By the way, Dan, I’ll take your sort of reality-based critique of a nationalised health care system over nonsense like Al’s any day. You’re absolutely correct that it isn’t a magic bullet. And people have to understand that the middle class will pay more (in taxes) for public health care. But they also have to understand that their are additional benefits (e.g. not living in fear of one’s employers whims; not having to wait in the E.R. for a real emergency because the uninsured are using it as a substitute G.P.).

Also, you’d think that most businesse owners would jump at the opportunity suggested by a public healthcare system: it eliminates a major cost centre (benefits administration); it shifts the burden of subsidising large-scale health care from themselves to individual taxpayers (because, one way or another, health benefits on that scale are subsidised); and their ability to attract quality employees isn’t dependent on a limited choice of large and powerful vendors run by the incompetent and entitled likes of AIG’s executives.

You’d think that, and then you have to wonder at the real motivations of those business owners who still oppose it.

Dan in Denver’s critique of a national health care plan is…bullshit.  Health care in general has about as much to do with economics as utilities or the military.  As in it’s part of the *basis* of a society and fundamental *to* a market economy.  Just because we pretend that there is a market mechanism for heat, water, electricity and defense, but stop acting that way when general access is threatened, doesn’t mean that these items are at all free market good, leavened with socialism or not.  Everyone is dependent on the large majority of people having ready access to basic necesities.  It does the banker plenty of bad if electricity rates go sky high and people can’t afford lights.  It does the retailer bad when too many people don’t have heat in their homes.  It’s just bad for business to ever genuinely think that any of these necessities can be treated the same way as Pop-Tarts.

Besides confusing single payer and single provider (Medicare for all is single payer, Veterans Health for all is single provider), he believes that national health care would cost the same or more because “it’s simple economics”.  Shheeeeeeeeeeeeeeeeeeeiiiiiiittt
/clay davis

No.
The central problem with health care is that people are not investing any of their products into expanded service, largely because doing so would cannibalize their sales.  Hospitals, private practices, and many kinds of medical equipment are capital intensive.  In this environment, the owners have preferred to not expand facilities for anything but those that provide highly profitable services.  Urban hospitals are failing.  Rural hospitals are gone. 

That means the primary problem with expanding access to health care will be that there aren’t enough doctors, nurses, and beds to accomodate them.  Everyone not insane understands that their taxes will rise to pay for that health care.  People agree that this should be done because the profit incentive has been ruinous in this field.  What people *don’t* realize is that no amount of money will make health care especially accessible to people until massive rebuild and repair project has occured (and in the meantimes, wait-times will be horrendous, just as they are bad *now*, in a mostly capitalist driven system.

yeah, lots of typos and substituted words.  Should have previewed this.

Those are some really good points, Shah8. That might also be a worthwhile argument for having socialized utilities. Of course, my low electric bill courtesy of the city of Lincoln’s socialized electricity is another argument in favor of socialized utilities.

Amanda, I find it odd for you to suggest that in order for women to benefit from a public works program they should pursue traditionally female careers in the healthcare profession. When I went through my IBEW apprenticeship, two of my fellow juniors were women. After I left, as a journeyman, they were both still working regularly and one had graduated to a master and was overseeing several new apprentices.  The last few datacenter jobs I consulted on, I found a number of trades women working. So I don’t believe you can pigeonhole women into or out of a particular field.

Personally, I don’t believe we will archive the healthcare reform which is needed. In order to reduce costs (substantially) and increase coverage we would need to move to a single payer system. This would alleviate the vast overhead and profit taking in the existing system, free businesses from trying to manage coverage, and force a negotiated reduction in costs. Of course, the existing healthcare corporations and insurance companies will fight against this to the bitter end. So instead of getting an efficient single payer / universal system, we will likely get a hodgepodge of regulation on private, for profit, payers which will ultimately fail allowing opponents to claim government funded healthcare to be proven a failure. State reforms, such as MA and HI, don’t work specifically because they depend upon the same private healthcare infrastructure that has created the problems of overhead and coverage inconsistencies which plague the existing system.

kenmishi, if you were thinking about Walter Reed when you mentioned the “funding shortfalls, leaky roofs, and the like”, be aware that Walter Reed isn’t a VA hospital.  It’s an Army hospital, which is under a much different system. 

The seminal article on the VA system is Philip Longman’s “The Best Care Anywhere” in the Washington Monthly.

As it is, my marginal tax rate is about 50%

You have a shitty accountant if you actually pay that much in taxes.

Of course, you don’t. You’re just pulling a Joe the Plumber on us.

Amanda: You don’t have to pay into the system.  Because, just like we do now, you pay for your own plan.

And this is why the thing will become insanely expensive: Averse selection. Everyone young and healthy can get a cheap plan that they will get kicked or priced out of when they get sick. A friend of mine went with privately purchased health insurance—so much cheaper!—while he was in his 30s and single. Now he’s fourty, has stomach troubles and wants to marry a disabled woman, so back into public health care it is. What he paid when he was a good risk sticks to the manager’s pockets, what he costs now that he’s a bad risk comes from the public coffers. Just another round of privatize the profits, socialize the losses.

sjk, I don’t take Amanda to be saying that in order for women to benefit from a public works program they should pursue traditionally female careers in the healthcare profession.  A lot of the stuff in the post is about improving the economic condition of women currently in nursing.  She writes “A move like that would streamline a number of working class women a few rungs up the economic ladder, which would go a long way towards narrowing the pay gap between men and women.”

Max Baucus, the chair of the Senate Finance Committee (which has the power to get health care through without a filibuster because it controls the Budget Reconciliation process) has put forward a very promising outline of what universal health care might look like.  The details aren’t fully spelled out, but it’s basically along the lines of the Edwards / Clinton plan from the primaries, which sets up a universal mandate that can be satisfied by buying insurance through a government program.  If over time, people see that the public plan is a better deal than private insurance and most Americans are signed up for it, it becomes much easier to set up single payer, because you’re not really changing many people’s insurance.

It may not be possible to get more out of a system than you put into a system, but it’s certainly possible to get less out of a system than you put into that system, which is what we’ve done.  We’ve been rope-a-doped into creating and paying for a very elaborate, extensive, expensive health care system which we’re not allowed to use.  That’s what sucks and that’s what has to change.

I’ll come back and do a bigger response later, but: Ben D, if you think a 50% marginal tax rate is impossible, you’re sadly mistaken.  For a single person living in New York City making $160,000 a year, the marginal federal income tax is 33%, the federal payroll is 10.8% (factoring in that social security stops collecting after the first $102,000), the state income tax is 7.375% on every dollar, and the city tax rate is 3.648%.  Add that all up, and that’s just south of 55%.  Towards the end of the year, I work 80 hours a week and get to keep 36 hours of salary.  And then if I do anything with the money—such as buy dinner when I’m still working at midnight—there’s yet more tax. 

[For those about to say that state taxes are deductible from federal income tax, remember that’s no longer true once you’re subject to the AMT.]

So, I’m quite sensitive to programs that will increase taxes, and very skeptical of claims that a new government program will either save me money (single-payer) or won’t impact me at all (Obama’s plan).

As for why I have health insurance, Amanda, I’m unfortunately required to by my employment contract.  It’s out of pocket $100/month for me, and I never use it.  The difference between being required by an employer and being required by a government to do something, of course, is that it’s much easier to change employers.

That should be $170,000 above, not $160,000.  All other numbers are accurate.

(sorry if parts of this show up twice.)

Al, the problem with optimizing health care along monetary lines is that it’s always cheaper to pay the undertaker than the doctor. From a strictly monetary point of view, everything that makes people die young, before the develop chronic, expensive kind-of-treatable conditions is a boon to economy. Driving without a seatbelt, motorbiking without a helmet, smoking, heavy drinkining, not getting vaccinated, letting wounds fester and colds develop into pneumonia, unsafe food—all this saves money. The argument for health care is that people living longer and in less pain is worth spending money on. The argument for universal health care is that the worth of a person’s life does not depend on the depths of their pocket. Another argument for universal health care is that buying in bulk, streamlining processes, cutting the middle men and preventing epidemics also saves money, and that is the argument that comes up here most when cost of health care are discussed. The other two are generally taken as a given.

G. Porgy: Al, if your tax rate is 50% you must be making a pretty good living.  Whey do you people making so much money do nothing but whine and whimper?

Lazyness. They could just get off their well-earning butts, get a minimum wage job and solve all their tax problems, but that would be, like, work. Also, someone else who minds paying taxes less than they mind being poor might snatch up their abandoned jobs, and we cannot have that.

Notorious P.A.T.: because people loooooove going to the doctor, waiting for an hour, taking off their clothes and sitting on a piece of butcher paper,

Word. Getting people to go to the doctor when it cost nothing was like trying to talk a sick cat out of its hiding place. With a fee as low as 10 Euros a quarter it has become twice as hard. If people took going to the doctor as great entertainment, nobody would complain about a fee in the range of two tickets to a matinee.

We trolls have a health insurance plan that rivals that of Congress.

I have the worst health insurance in the world, in that I’ve paid thousands of dollars over the past five years and received nothing in return.  The alternatives—in which I pay even more and still receive nothing—are worse.

Al:

As for why I have health insurance, Amanda, I’m unfortunately required to by my employment contract. It’s out of pocket $100/month for me, and I never use it.

And you never will, if your insurance company has anything to say about it.

See, Al, you’re going about this argument entirely wrong. The problem most of us have with private health insurance isn’t that it’s expensive. It is expensive, but that’s the symptom, not the disease. The problem we have is that private health insurance is a scam. Every health insurance company in the country has an entire department whose sole job is to figure out how not to pay your claims.

Now, of course, you seem to be arguing that you’ll never actually make any claims, because like every other good little Randroid, you seem to be sure that you’re going to die in a spontaneous, easy to remember fireball at the stunningly healthy age of 34, with nary a penny ever spent on anything more complicated than OTC cough syrup.

The difference between being required by an employer and being required by a government to do something, of course, is that it’s much easier to change employers.

Or you could work wherever the fuck you want and not have to worry about health care at all, and pay less for it to boot. Isn’t that less of an impingement of your freedom to be a self-obsessed schmuck with absolutely no regard for anyone other than yourself than to have to waste the time and effort to shop around for a job with the best health benefits? Think about how much time you’d have saved, which you could have spent sitting around opining about how much better you are than everyone else and how little you had to rely on society and the government that is supposed to protect it to get where you’ve gotten in life. Not that you don’t do that anyway, but you’d have been able to do so much more of it if you didn’t have to worry about health care.

Really, who cares if you’re “required” to do it if it’s obviously the better option anyway? I’ve never understood that argument. It’s like people who bitch about having to wear a seatbelt. I mean, is it really worth your time to whine about the fact that the government requires you to do something that you’re just going to do anyways, because not doing it is monumentally stupid? What’s the point of so much mindless mulishness? What can you possibly be gaining from it?

Dan—Among the many fallacies in your post, you seem to be suggesting that my tax liability on a universal healthcare scheme would be less than $1,200 per year (what I pay now).  That’s ludicrous.  Like every American, I pay 3% of my annual salary—about $4800ish, for me—now for medicare, and that only insures people 65+ and with certain disabilities—a fraction of Americans, and a preview of how expensive ‘free’ healthcare is.  I’ve therefore been paying $6000 a year for healthcare for the past five years or so, or $30,000.  And that doesn’t even count the amount of non-payroll taxes that go to health spending.  In that time, I’ve had zero doctor visits, zero emergency room visits, etc.  What a bargain.  It is highly unlikely I’ll ever receive more from the system than I’ve put in.

Really, who cares if you’re “required” to do it if it’s obviously the better option anyway?...What’s the point of so much mindless mulishness? What can you possibly be gaining from it?

Freedom, perhaps?

When someone says something is OBVIOUSLY the better option, that tells me that either they (a) do not understand the diversity of human beings, and how what is obviously a great choice for Frank is often a bad choice for Sally, or (b) they do understand that diversity but they think their own preferences are so superior that other people’s freedom of choice should be overridden.

There are people who think that OBVIOUSLY someone who gets inadvertently pregnant should have the baby, because that’s OBVIOUSLY the better option. Other people feel the same way about every child going to college, or every child learning a skilled manual trade. Other people feel the same way about religious belief, or non-belief. Who gets to be God, and decide which of the OBVIOUS truths everyone must sign on to?

You can surely point to plenty of cases where the people making the “wrong” choice are stupid, ignorant, uninformed, etc. And you’ll often be right - you do have to be a moron not to wear your seatbelt, or what have you. Yet, what is the cost of taking away the right to be stupid? Often, the cost is the right to be SMART - or at least, the right to make the choices that you want to make for your own life.

I think you misread me, Al. Your point is exactly what I was saying: people like you would pay more for universal health coverage.

Al:

I have the worst health insurance in the world, in that I’ve paid thousands of dollars over the past five years and received nothing in return.

Well, cut your leg off, then. Get in a car wreck. Jump off a bridge. Take a vacation at a leper colony.

It seems to me that you’re working from a fundamental misapprehension of just what insurance is. You don’t go to a store and say “I’d like one insurance, please,” then walk home with a box of insurance to hang over your fireplace. It’s not a service or a product, it’s an investment in the possibility of future catastrophe, which you will most certainly not be able to handle out of pocket (if you can handle a totaled car or treatment for pancreatic cancer out of pocket, you have absolutely no right whatsoever to complain about $100/month in insurance premiums; all it’ll get you is a nice, loud “go fuck yourself” from the hoi polloi).

But insurance is just like anything else in that by buying it, you run the risk that you’re not going to get your money’s worth. If you’re so inclined, you can think of it this way: if your house never burns down, your homeowner’s insurance is a waste of money. If you never get in a car wreck, you’re giving Progressive money to sit around twiddling their thumbs. If you die in a plane crash, all your health insurance premiums have gone for naught. Oh, but actually, that’s not the case, because your premiums go into the general claims kitty along with everyone else’s. Now, it seems to me that you’re not the kind of person who would take some satisfaction, no matter how small, in the thought that even if your life isn’t tragic enough to need the direct benefit of your insurance premiums, someone else’s is, and your premium payments helped them out of a bad — possibly life-threatening — situation. But for most people, I would imagine that that’s at least worth something, because on some level, they understand that the whole of reality does not exist solely for their own personal benefit.

Your inability to see the future is not an argument against insurance. It’s an argument basing your entire political outlook on the insistence that you can see the future.

Dan in Denver—I was talking to the other Dan, the one who purports to be the emperor of bananas.  You correctly point out that I’ll pay more for universal coverage, and receive the same amount.  That’s why I’m not interested.

emjaybee
“In healthcare, next to nursing, there is a very large field of women workers who are primed to become part of a national system; midwives. They have struggled with the prejudice of doctors and the AMA for years, and still can’t practice legally, even when licensed, in several states. But there is quite a bit of study that shows them to be safe and cheaper to use for normal births than OBs are, with higher satisfaction rates for the mothers as well. Britain uses them, and I believe other EU countries as well. If we could set up a standardized accreditation/training structure for them, many of them could be up and practicing in a realtively short time. Like nursing, midwifery could provide an entrance point for poorer women into steady work without as much expense (necessarily) as a standard college degree. Poor women suffer disproportionately from lack of prenatal care, which is something that midwifery excels at.”

Nursing is a female dominated field that has been languishing in low pay, long hours and no respect in part because it is considered a low-education job. And those people that are suffering from a lack of health care still suffer some when their nurses have not been university trained in comparison to those that have bachelor or higher degrees. The midwives that have high satisfaction rates for mothers and safer outcomes have at least masters degrees if not doctorates, in the US. In the UK the situation is a little different as their secondary education is more thorough and midwifery is considered separate practice from nursing, as opposed to the US where nurse-midwives are the only players. However, the UK is also finding that higher education results in better outcomes for patients.

Poor women who want careers in health care should have access to higher education, not put on low-education tracks.

Dan:

Freedom, perhaps?

The word “freedom” doesn’t mean anything anymore. Totally empty buzz-word, designed to get the sheeple riled up into voting against their own economic interests.

Let me just boil down the cost argument in a sentence:  Al, why do you think that universal health care will cost you more, when we’re paying way more per capita for health care coverage than any other country, including those with universal coverage? 

(the link is to a pdf with the OECD data backing this up).

Al: I have the worst health insurance in the world, in that I’ve paid thousands of dollars over the past five years and received nothing in return. 

So they never accepted any of your claims?  In which case, ignore the following—you have shitty health insurance.

Or did you never give them an opportunity to? In this case you should hang out more among people with infectious diseases so you can get your money’s worth. Don’t be content with the common cold, try for tuberculosis or HIV if you can get it. For a more long-term strategy, prolongued exposure to carcinogenics can also help you to come out on the winning side. Overconsumption of sugars is more to be recommended for the sugar rush than for monetary efficiency—unless you have the correct genetic predisposition, diabetis is unlikely to develop in time to balance the books.

Sheesh. Why do so many people feel they need to live a miserable life of wealth and good health when alternatives are readily available?

I have a decent insurance plan for a little less than Al pays a month if I don’t go outside of the health system I work for, and even then the cost jumps mightily if I dare to insure my (theoretical) spouse or family. Because they can at least figure that if I’m working for them I’m pretty stable physically, they’ve got no idea about my theoretical spouse or children, and they really don’t want to pay much. Honestly, I think people like Amanda and my darling boyfriend would rather pay $50 or $100 a month in order to make sure the random glass in feet or broken arms or such are not a sudden $1600 chunk out of their pay. Instead, their options are $900+/month (quoted cost for my boyfriend to have continued his last employer’s insurance) for something decent, or cheap policies that would probably take 3 months to reimburse after upfront payment for the glass in the foot and would not bother to cover something like cancer or an ICU-visit worthy car crash or organ transplantation.

Al:

Among the many fallacies in your post, you seem to be suggesting that my tax liability on a universal healthcare scheme would be less than $1,200 per year (what I pay now). That’s ludicrous.

Is that more or less ludicrous than you suggesting that $100/month is a valid number to base your entire argument on? Average individual coverage was $300/month four years ago. Family coverage was more than twice that.

Like every American, I pay 3% of my annual salary—about $4800ish, for me—now for medicare, and that only insures people 65+ and with certain disabilities—a fraction of Americans, and a preview of how expensive ‘free’ healthcare is.

Jeebus. Has it seriously never occurred to you to wonder why health care costs are so much higher in the United States than they are anywhere else in the world? Here’s a hint: it’s not because American health care is just so much better than everyone else’s.

In that time, I’ve had zero doctor visits, zero emergency room visits, etc. What a bargain. It is highly unlikely I’ll ever receive more from the system than I’ve put in.

Congratulations. You’ve figured out that buying insurance isn’t a guarantee of a return. Am I supposed to be impressed that you understand the same things that everyone else does?

Sorry, Al, my bad. (Curse you, Other Dan!)

Honestly, I think people like Amanda and my darling boyfriend would rather pay $50 or $100 a month in order to make sure the random glass in feet or broken arms or such are not a sudden $1600 chunk out of their pay.

It’s called a savings account. They’re not hard to get. You can also open a Health Savings Account, which lets you use pretax dollars for your medical bills; that’s a bit more involved, of course. And, you do have to save the money. Some people would be better off if the government forced them to save the money; whether that’s worth the social costs is an open question.

Health insurance is a terribly flawed way to pay for health care, so you won’t see me defending that.

It is highly unlikely I’ll ever receive more from the system than I’ve put in.

Actually, Al, given the increasing cost and sophistication of medical care, and barring sudden and violent death, you’re almost certain to get more out of a universal coverage system than you put in, because of the legacy debt. To wit, the population goes up, and the young pay for the fabulous expense of the old. Which, when you are old, will be even more ridiculous than it is right now.

Here’s the real question, and one you haven’t addressed. Universal healthcare works. Every nation that has it, spends less of its GDP on illness than we do. Now, you either need to argue that the two aren’t causally related, or admit that universal healthcare is cheaper. At which point your argument becomes: “I’d prefer that society pay more money so I can pay less,” which is in the long run self-defeating.

Dan in Denver:

It’s called a savings account. They’re not hard to get. You can also open a Health Savings Account, which lets you use pretax dollars for your medical bills; that’s a bit more involved, of course. And, you do have to save the money.

If everyone could afford to have money just lying around doing nothing but gaining 2.5% interest annually, none of us would need health insurance. “Let them eat cake” isn’t any more valid an argument now than it was during the French Revolution.

Health insurance is a terribly flawed way to pay for health care, so you won’t see me defending that.

And exactly why do you think health insurance is such a “terribly flawed” way to pay for health care? Do you think it might possibly have something to do with the way that the health care and health insurance industries are structured in this country?

No, it couldn’t possibly be that. There must be something inherently wrong with poor people.

<blockquote?“I’ll come back and do a bigger response later, but: Ben D, if you think a 50% marginal tax rate is impossible, you’re sadly mistaken. “</blockquote>

You don’t get it. That might be the rate, but you don’t actually pay that if you have an IQ over 80 and a decent accountant.

Al—

Part of your income represents your individual work and effort. Another part, however, comes from the social/political arrangements that make it possible for you to have a paycheck to begin with. That is what you pay in taxes. It’s no different than paying your electric bills or car payments.

Oh, and one more thing. I pay taxes for police, firefighters, and the army. Guess what? I’ve never been the victim of a crime, I’ve never had to call the fire department, and I’ve never been under the threat of invasion by a foreign army. But I don’t resent paying for these services that I *never have used*, because 1) having them availible for other people improves my quality of life, and 2)I very well may have to use them someday. Healthcare shouldn’t be treated any differently than police or fire protection.

Ben D.—You appear to be totally oblivious to the difference between public goods and private goods, as used in economic parlance.  You also seem to think there’s magical ways to get around this country’s oppressive tax burden.  I do what I can—401(k) to the max, etc.—but the AMT eliminates most deductions.  I’m guessing you’re only familiar with the regular income tax system, and know nothing of the Alternative Minimum Tax.

Dan [the not-Denver one: Is that more or less ludicrous than you suggesting that $100/month is a valid number to base your entire argument on? Average individual coverage was $300/month four years ago. Family coverage was more than twice that.

I pay $100/month now for my own healthcare, and $500 a month for Medicare—a program that only covers a fraction of Americans. 

As for why we pay more, a big chunk of healthcare costs come within a year prior to the patient’s death.  A big part of the problem is too much care.  It doesn’t make sense to pay $50,000, or even $20,000, to extend an 86-year-old’s life for two months.  Of course, it would be nothing to me if some other person wanted to spend that, but the problem arises because people not only feel entitled to that, but want me to foot the bill too.  If participating in the health insurance system is voluntary and competitive, a variety of options will flourish.  If it becomes a government program, we’ll all be forced to pay in, and only be entitled to receive what bureaucrats tells us we can.  Go spend a day at the DMV (government-run) or the post office (government-guaranteed monopoly), and report back.

I know of the AMT and it was a mistake not to peg it to inflation when it was first passed. You can blame St. Ronnie for that.

You appear to be totally oblivious to the difference between public goods and private goods, as used in economic parlance.

Who makes the distinction between “private good” and “public good”?

o spend a day at the DMV (government-run)

The DMVs where I live work just fine.

or the post office (government-guaranteed monopoly),

I get my mail every day. How ‘bout you?

...Al’s still crying about $170,000 a year? Damn, he can’t be working *that* hard for it. :p

I like how the ideologically blinkered think that private=lean and efficient what government automatically=horrible, horrible service. Haven’t these people every been in a fucking McDonalds before? The worst Post Office isn’t any worse than a typical fast food joint.

Talk about apples and oranges.  You can’t just compare tax liability under the current system to tax liability with universal care, because tax liability isn’t the sole expense.  (Let’s assume for the moment that we’re talking about single-payer care, like the NHS.  As people have pointed out, universal coverage under the current system doesn’t eliminate all the inefficiencies currently in place, so costs won’t change as dramatically.)

If we wave a magic wand and replace the private health care system with a public, single-payer system, the tax increase is in lieu of insurance premiums, not in addition to.  Whether this works out to be a net gain or a net loss for any given person depends on what kind of tax increase we’re talking about, and how much they’re currently paying for insurance.  The last job I had where I was paying for insurance, it was about $90/month, and I was making about $28k/year pre-taxes.  So anything less than a 4% increase in my taxes would have at worst been revenue-neutral for me.  For people paying hundreds of dollars a month to insure their families, it’s really unlikely that taxes would go up enough to outweigh their premiums.  At my current job, I’m not paying for my insurance at all (beyond how it figures into my total benefits package, so if they didn’t pay for my insurance maybe my salary would be higher), so any tax increase would reduce my take-home pay, but you know, I’m fine with that, on account of how I’m pretty much in favor of people not dying just because they’re poor or working in the “wrong” industry.

And then there are all the other costs that are affected… We’re talking about an auto industry bail-out now.  There’s a lot of grumbling about the union contracts and how much that’s hurting the companies.  What condition would they be in if they weren’t on the hook for employee and retiree health care?  There’s money that comes out of your taxes already, which goes to help out hospitals that serve a large number of medically indigent patients.  With universal coverage, poof! That goes away.  Ditto programs like the AIDS Drug Assistance Program.  Employee productivity goes up, because more people can get treated when they first become ill, and people who need expensive medications to be fully functional can get them.  And so on.

Ben D—I get my mail… most of the time.  Eventually.  It’s often mangled.  I’ve twice received notices from the post office that my mailman has been stealing mail, and to run my credit report.  For the definition of a public good, go to wikipedia; I’d link you directly, but the spam filter at this site has a habit of eating posts with links in them.

Bagelsan—I do work that hard for it.  This is my first day off since the Monday before Thanksgiving, including working over the holidays and weekends.  If I’m lucky, I’ll be able to only work an eight hour day tomorrow.  I pull 70 to 80 hour weeks.  After the government is done, it’s like I worked 35 to 40 hours.  As wasteful and pointless as the war in Iraq was, it’s coming to an end.  A universal healthcare scheme, once enacted, would be a politically untouchable black hole of funds.  The amount I would benefit from these two government programs is about the same.

What condition would they be in if they weren’t on the hook for employee and retiree health care?

Thank you. I can’t believe no one in the MSM mentions this. It is the 800 pound gorilla in the room no one talks about—the Japanese and Germans give all their citizens health care—so Toyota, Honda, Mercedes, and BMW don’t have to!. This enables them to make a profit on making small cars—something the big three can’t do in large part because of their health care costs, they can only make $$ on big, expensive cars.

Ben D—I get my mail… most of the time.  Eventually.  It’s often mangled.  I’ve twice received notices from the post office that my mailman has been stealing mail, and to run my credit report.

And my father got surgery at a privately run hopsital. Not only did they give him treatment three hours late, they prescribe the wrong post-surgery medication the first time, and they put in his catheter in upside down. So spare me.

1) Our current health care system is inefficient because there are huge portions of it that suck up money but don’t actually contribute to producing health care.  (The people in insurance companies who verify claims and/or try to get them disqualified, the people in doctors’ offices who have to stay on top of the different insurance companies’ billing processes, etc.  Plus of course the administrators of all the various companies, who would be redundant in a single-payer system, and the money going to shareholders.)

2) Ben D, health care doesn’t at all meet the definition of a public good as the term is used in economics.  Because we have a finite number of providers, it’s rivaled (one person getting care means there’s less for others) and it sure as hell is excludable (it’s possible to keep people from using it, which is the root of all of this trouble.)  That doesn’t mean it shouldn’t be a public system though: education is excludable, but even most people who don’t want universal health coverage support the idea of public schools.

There are problems with the police and interstate highways sometimes, but only an ideologically blinkered, kool-aid drinking moron would suggest privatizing either as a way to “fix” it.

but even most people who don’t want universal health coverage support the idea of public schools.

And I, who is out of school and doesn’t have any children, don’t bitch and moan about how X number of my taxes go to public schools even though I never use them.

Dan in Denver, re: Health saving accounts.

The fun thing with saving in case your house burns down, or you crash your car into a brad new custom made Maserati, or you get sick, is that you can save every damn penny that you do not need to spend on rice, beans, and paying the rent for your bed-sit, and if you are unucky, it won’t be enough. Like the old woman mentioned in the local news some time ago who got run over by a car and had 200K Euro in her bank account, “for emergencies”. Guess why she did get run over by a car? She was blind as a bat, because she didn’t feel she should afford new glasses.

My grandfather went without health insurance his entire life, but he had the amount of small cash needed to pay for three heart surgeries in two years out of pocket without ruining himself and the family into the seventh generation. Of course, he was an M.D. who ran a medium sized clinic, so he knew the difference between a heart attack and having eaten too much rice and beans.

Apart from that, more people depending on good returns on their savings and encouraging the banks to develop fancy new finance products is probably not what we need right now.

Erl: Now, you either need to argue that the two aren’t causally related,

The argument I have most often encounterd in answer to that challenge is that Americans simply cannot do it.

I figured I’d check myself what my tax difference would be.
At about 40k per year (pre-tax, I could only wish to bring home 85k after tax like Al even as a college grad)

My company could afford to pay me $7475 per year, which is $800 more than my withheld tax.
So Single Payer could double my tax burden and it’d still come out a few dollars ahead.
Not to mention I wouldn’t have to worry about the person on the bus next to me giving me SARS or Avian Bird Flu because they’d have access to vaccines and medical.

But then again I’m not a Randite and live in the real world exposed to real people.

Why don’t I believe that some guy who thinks he’s paid $170k per year can’t find a similarly paid job with a company that offers no insurance?  Let’s face it, we know he’s lying because ALL business that offer medical insurance also offer an option to opt-out.

Cynickal—When I started working, I had to sign a form either consenting to have $100ish a month withdrawn from my paycheck to pay for health insurance, or sign a form certifying that I had health insurance through some other means.  I wanted to opt out.  When I talked to HR, they assured me there was no way out of the policy.  I have no idea why they mandate it, but they do.

I should add that my job requires a lot of hours, but no contact with lots of strangers, or conditions that are particularly dangerous.  It’s in stark contrast to when, back in undergrad, I was applying for an internship overseas with the State Department, and I had to demonstrate I had health insurance that included “repatriation of remains.”  Seriously.  Since I was uninsured at the time, I stopped the process right there.

Al:

I pay $100/month now for my own healthcare, and $500 a month for Medicare—a program that only covers a fraction of Americans.

A fraction of Americans that has actual health care needs, as opposed to your merely potential health care needs. If you really can’t understand that no matter what we do, providing health care for the sick and elderly is going to be more expensive than providing health care for the young and healthy, then you don’t have any business discussing health care in the first place.

So you can compare apples to interplanetary nebulae all you want, but you’re never going to be able to digest clouds of dust, gaseous hydrogen and plasma. Your insurance doesn’t cover that, anyway.

I’ll come back and do a bigger response later, but: Ben D, if you think a 50% marginal tax rate is impossible, you’re sadly mistaken.  For a single person living in New York City making $160,000 a year, the marginal federal income tax is 33%, the federal payroll is 10.8% (factoring in that social security stops collecting after the first $102,000), the state income tax is 7.375% on every dollar, and the city tax rate is 3.648%.  Add that all up, and that’s just south of 55%.  Towards the end of the year, I work 80 hours a week and get to keep 36 hours of salary.  And then if I do anything with the money—such as buy dinner when I’m still working at midnight—there’s yet more tax. 

Al, apart from the federal marginal rate (and according to the 2008 tables only the income you make that is OVER $164K is taxed at 33%), you’re not being taxed any differently than anyone else in NYC.  You are throwing every tax you pay into one pile and calling it a “50% marginal tax rate”.  Cut the crap.

It’s called a savings account. They’re not hard to get. You can also open a Health Savings Account, which lets you use pretax dollars for your medical bills; that’s a bit more involved, of course. And, you do have to save the money. Some people would be better off if the government forced them to save the money; whether that’s worth the social costs is an open question.

Health insurance is a terribly flawed way to pay for health care, so you won’t see me defending that.

It’s called having a basic grasp of reality, also not that hard to get.
(Health savings accounts are usually available through employers, once again not useful for people who are self-employed or otherwise don’t have access to employer offered insurance)
As noted prior in the thread, it wouldn’t matter if the boyfriend with his $700/month income put the theoretical $100 of insurance a month into savings if an even moderately bad item happened - appendicitis comes to mind. At around $15,000 a pop if not more (http://www.healthcarefees.com/inpatientSurgery/appendectomy.php) - he’d have to have made sure not to need any health care and consistently saved that $100/month for over 12 years in order to pay for an appendectomy. What if he’d consistently saved that much for two years and hey, there’s that glass in the foot? Not quite good enough, and even if presented with a $1600 bill and you can cover $1200 because of savings, $400 is still a large chunk of income for someone who makes $700/month.

The only people who can really afford to be set without insurance and only savings would be those like the grandfather doctor up thread who uh, probably wouldn’t have much trouble affording private insurance in the first place.

You’re moving the goalposts, Tenya. We were talking about a $1500 medical bill - one which was unpredictable in the specific, but predictable in the general. You know you’re going to run into medical expenses which are within your ability to pay for in the future. Therefore, you can save for those expenses, and should.

You’re quite right that model won’t work for your five and six and seven figure surgeries and conditions, unless you’re quite wealthy. For that, a different model is needed. But let’s not argue for “we have to figure out a way to pay for Alice’s cancer” and justify it with talk about saving Amanda from her $1500 bill. The two types of expense are different both in predictability (just about everyone who takes care of their health will spend $1500 at the doctor sometime in the next decade; few people know they’re going to get cancer) and their magnitude. A system which works smoothly at one end of the spectrum is unlikely to work well at the other end.

I love these people who have some sort of fear of mortality denial or something who actually think a savings account is going to cover all of their potential health costs.  I work with people with disabilities. I see people every single day whose lives changed in an unpredictable instant. Hit by a car and get a spinal cord injury. Wake up one day with cancer. Have a child born with disabilities. Without health insurance, these types of things will wipe you out. Unless you are in the upper 1%, no one has this kind of money to put into savings.

And if you think people in all of these situations are over cared for and should just bow out and die, wait until it is you. See how keen you are on denying yourself health care and comfort measures. Wait till, in one split second, your value to society goes down the tubes…when you still kinda like yourself and still think you could contribute in a lot of ways.

Yeah, yeah about Amanda’s 1500 splinter. Maybe there were administrative costs that could be cut down there. But lets say someone with no insurance and who lived in poverty had a splinter and never sought care for it because of the expense. And say a few weeks later it developed into full-blown MRSA and was completely infected to the point of having to amputate. Now you have someone who exposed countless people to active MRSA, and who needs major surgery and rehab and who might have to go on disability, at least for a while until voc rehab services are used. $1500 just turned into tens or even hundreds of thousands. Guess who is paying for that? You. So, if this really bothers you so much to pay for health care for other people, even when it is less expensive, then just admit that you are a eugenicisist and that you believe that these people should be left on the street to die so you can have a lower tax rate.

National healthcare is something that should happen… 20 yrs ago. DUH. It’s basic common sense.

There is simply no reason why advance country does not have national healthcare.

It’s called a savings account. They’re not hard to get. You can also open a Health Savings Account, which lets you use pretax dollars for your medical bills

Dan in Devner, Health Savings Accounts are meant to supplement, and not substitute for, health insurance. From what I’ve seen, people who have HSAs also have some sort of high-deductible health insurance plan. The savings account is basically a risk-mitigation mechanism for people willing to take on that kind of low-premium insurance.

Without insurance, the entire household savings of a middle class family can be wiped out in a matter of months by a serious illness. And at that point, the hospital is not going to be so impressed by your thriftiness that they’ll let you or your family member stay around.

Oh, and those higher deductibles are a bit harder to pay off when a major part of household income is “on hold” and there are other bills to be paid.

There’s a reason that, outside of single young white collar men and a subset of independently wealthy folks, you don’t find a lot of hardcore libertarians.

As for allowing any citizen to take care of splinters before they turn septic, or to get an annual checkup by a family physician in time to catch a medical problem when it’s still treatable without major surgery, insurance taking care of all those small costs like that result in huge savings down the road. The term for this exotic philosophy, I believe, is called “preventative medicine.” It not only saves lives but also saves money.

The only people who seem unable to grasp this concept are people with MBAs and extreme free marketeers.

Apparently Al can see into the future, which must be how he knows that he’ll never, ever get a major illness or be in a catastrophic car accident.

Al is probably under age 35—when we’re young, we have foolish notions that we’re indestructible (and that we should do our own taxes when we’re making the big bucks and living in Manhattan—although even I wasn’t that foolish when I was in that situation back in the ‘90s).

Guys like Al also don’t yet understand that there is no “away” when it comes to epidemics and other widespread social ills (natural or man-made)—not in a gated community, and certainly not in NYC.

As for why we pay more, a big chunk of healthcare costs come within a year prior to the patient’s death.  A big part of the problem is too much care.  It doesn’t make sense to pay $50,000, or even $20,000, to extend an 86-year-old’s life for two months.  Of course, it would be nothing to me if some other person wanted to spend that, but the problem arises because people not only feel entitled to that, but want me to foot the bill too.

This comment makes me want to vomit on Al’s face. Just out of curiosity, Al, which medications and treatments would you deny the elderly or the terminally ill? It’s often not a matter of actively trying to extend a person’s life, it’s about ensuring people are comfortable and well cared for until the end.

Lexie: Yeah, yeah about Amanda’s 1500 splinter.

One note, I used to have private health insurance in a country with universal insurance, so I got the actual doctor’s bills and had to bully and beg the insurance company to send me the money some time within the year. I had a similar case, glass splinter in the hand. Cost a few hundred D-Mark—nowhere near 1500 USD, neither in today’s nor in 1990’s money. Health care in the US is hellishly expensive.

Stealthy cat: Apparently Al can see into the future, which must be how he knows that he’ll never, ever get a major illness or be in a catastrophic car accident.

Maybe he’s just determined to die before he gets old. I have found that this approach loses a lot of its lustre once the big 4-oh nears…

Now I see the truth, Al.  You are a sociopath.  How about if it were your parents or grandparents dying slowly?  Willing to take the pain medication away from them?  My dad’s uncle died at home, and my dad tried to care for him on his own.  It was physically and emotionally draining.  Eventually, Dad had to call in hospice care (paid for by *gasp* Medicare!) to help him out.  But I guess you won’t ever face that choice, having nicely put a pillow over old ma’s face so she wouldn’t inconvenience you or your paycheck.

And we do have a private system now, moron.  Where are my choices?  I can’t even get INTO the system because I have a hyperactive thyroid.  My doctor has written letters stating the condition is benign and under control.  No dice.  Free market, privatized health care run for profit means that the insurance companies by NATURE don’t want to pay out any money.  They need to line the executives’ pockets.  So people who actually need to use the care can’t get it.  Ass.

Hey Al, I live in England. I’m paying 40% tax, but I get all my healthcare free and I’m willing to bet you my premiums are a lot smaller than you’re paying under your super-good private health insurance. And guess what? England has better health outcomes than your country. I wonder why?

Again about that splinter:

Odds are, the insurance company of somebody with insurance pays about $300 for that treatment, because the insurance company has negotiated a discount. Uninsured patients get charged anywhere from twice the going rate on up, and even the discounted rate has all the administrative costs and a bunch of other slack built in.

When I put a nail through my foot some years back, and my insurance company (which turned out to be a fraudulent enterprise) stiffed the ER on the bill, it was only a few hundred bucks, not because of less treatment, but because I wasn’t paying rack rate.

As for why we pay more, a big chunk of healthcare costs come within a year prior to the patient’s death.  A big part of the problem is too much care.  It doesn’t make sense to pay $50,000, or even $20,000, to extend an 86-year-old’s life for two months.  Of course, it would be nothing to me if some other person wanted to spend that, but the problem arises because people not only feel entitled to that, but want me to foot the bill too.

Yes! If they’re about to die, they had better do it and decrease the surplus population!

A fraction of Americans that has actual health care needs, as opposed to your merely potential health care needs. If you really can’t understand that no matter what we do, providing health care for the sick and elderly is going to be more expensive than providing health care for the young and healthy, then you don’t have any business discussing health care in the first place.

He understands it perfectly well, and has demonstrated that the elderly should not be permitted to incur those costs by, you know, being allowed to go on living. (Past some age he is presumably well-qualified to determine.)

I would like to be the lucky soul assigned to shoot him in the head when, in his Brave New World, he develops an illness.