Guest guest Posted December 23, 2008 Report Share Posted December 23, 2008 Ralph, I am truly sorry about what is happening to you and others in the medical profession. I also know that eventually, idiots will be the majority of the Drs. because rational people will want nothing to do with the profession. I'm afraid there is no good answer. The problem with health care is the abandonment of the free market and the rise on the nanny state. People seem to think they have a right to health care. Unfortunately, they never ask themselves the simple question: who has the obligation to provide it? For those who ask the question and answer that it is you the doctor and I their fellow man, then I have to ask what is their rationale and system of morality is is based on. Bob Dannegger Raleigh, NC > > > > > Subject: Re:Health Insurance > > To: Supertraining > > Date: Monday, December 22, 2008, 10:34 AM > > When it comes to news coverage of the " health insurance > > crisis, " even reputable news > > outlets routinely publish incorrect assertions of fact and > > ideas that aren't well thought out. > > Hence it's no wonder that even among the intelligent > > and informed members of this group > > there are some misconceptions. For example, it was written > > in this thread: > > you make some important points but I don't necessarily agree with you on some of them. As a physician in practice since the early 70s I have seen first hand the evolution of healthcare, both the good and the bad, over these years. The points I made in my post are not based solely on what I read in the newspapers or journals but what I have seen and had to deal in the process. > > > > I could on and on with stories of individuals who are > > uninsured, through no fault of > > their own and who are one major illness from bankruptcy. > > > > > > As an individual it is very difficult to get insurance > > and sometimes impossible at any > > price. > > > > [JMS] True, but why? One reason is that insurance > > companies are regulated by state > > legislatures, and in an effort to improve health insurance > > coverage over the past 30 years, > > the legislators have passed statutes that make insurance > > premiums much more expensive > > by prohibiting insurers from providing policies that cover > > only basic needs such as major > > medical and office visits to MDs. Consumers who would > > rather forego more > > comprehensive insurance coverage in return for more > > affordable premiums have been > > deprived of this choice. > > You are correct with regards the state legislatures and I have often lamented the need for insurance that just cover unusual problems, in the past known as Major Medical insurance. That was the most common insurance in the 70's. That is the kind of insurance that noted she has recieved for $150 a month, (which I consider a bargain compared to what I have to pay for an insurance with a $5000 deductible). That is probably one of the items that has to be addressed when looking at health care reform. > > When I opened practice most people only had major medical insurance and paid for their office visits in cash and paid for their medicines, labs and Xrays but the insurance paid for their operations and hospitalizations. I did not have to deal with claims for office visits, deal with prior authorization for meds or xrays. The patient decided if they wanted to pay for these services and did not ask for the most expensive tests or meds. I only had to submit claims for hospital health care and in many cases the insurance compensated the patient for paying my bill. > > Now the patient pays a co-pay for services and has no idea as to what the real cost is. They want nothing but the best and spare no costs (as long as their co-pay does not go up). They don't want generics because they only have to pay a $15 co-pay for a medicine that costs $150. > > Whose fault is it? Good question. Legislatures, constituents who wanted these, labor union. Unrealistic expectations the public has come to demand because they saw it on TV. > > Somewhere between 1974 and 2008 something went drastically wrong. > > > Another reason health care > > insurance premiums are so > > expensive is that health care costs have risen much faster > > than the rate of inflation for the > > past couple of decades. > > You are correct on this point but you passed on quickly leaving he implication that cost of services have risen faster than inflation for the same service. One of the reasons for the increased premium is the wider array services available that in 1974 would have been considered science fiction. > > We are not practicing medicine the same way we did in 1974. We didn't have MRIs, CT scans, medications to treat cancer, ulcer treatment was non existent, coronary bypass was rare reserved for few medical centers, coronary stents were non existent, cardiac rehab was reserved for patients under the age of 65, renal dialysis was also found in a few major hospitals and only young patients were eligible for consideration, Medicare would not pay for dialysis even when it became more available, kidney and liver transplants were in their infancy and again in a few specialized institutions. If you had arthritis you were given a few aspirins (ibuprophen was still in its experimental phase and tylenol was not available in the US). If you had an ulcer you were given a sippy diet and told to take maalox (Tegamet did was not available until 1997 as a prescription)- helico-bacter cure was unheard of until 1984. > > Alzheimers dementia was a rare occurrence because very few people relative to the population lived long enough to get alzheimers. > > Kidney transplants, liver transplants and heart transplants as well intestinal transplants and lung transplants have become so common as to no longer make the news. Hand transplants no longer make the news. Soon even face transplants may become common place. Of course some people and some politicians could use a brain transplant (now that would really be news). > > If we continued to practice medicine with the same medicines and tools available in 1974 we would be able to keep the costs relative to 1974. > > In 1974 I bought my first new car, a Buick sport hatch back for the astounding price of $4,500- An office visit was $15 dollars and a Colonoscopy was $150. > > Today If I want that same type of car I would have to pay $30,000. I am lucky to get $45 for an office visit, Medicaid pays me $18.00 and Medicare gives me about $30.00. Medicare pays me $180 for a colonoscopy and Medicaid even less. > > Needless to say I can no longer accept Medicaid and many of my colleagues are no longer accepting new Medicare patients. Some of the newer physicians are not accepting any Medicare patients. > > > Yet another is that employers and > > employees are able to take tax > > deductions on medical insurance premiums, but folks who > > have to pay for their own > > insurance can't. > > I am not a tax expert so I am not sure if what you say is totally correct but as I recall when doing my taxes my accountant wants to know what my personal medical bills including my medical insurance premiums are. > > > > I am no defender of the Health Insurance industry. > > [snip] > > > On top of all of that I am lucky if they pay me 60 > > cents on the dollar. > > > > [JMS] That's a business decision made by doctors who > > judge it to be the alternative that is > > financially most sound. The price charged by a doctor is > > like the sticker-price of a car: a > > starting point for negotiations. Insurers have more > > bargaining power than individuals, and > > hence are better able to negotiate a discount from the > > " sticker price, " but in my limited > > experience, I've yet to see a doctor or hospital > > outright refuse to negotiate medical bills > > with uninsured individuals. Hospitals often have a tax > > incentive to do so in order to > > maintain their status as " nonprofit " > > corporations. > > Hospitals may be able to negotiate with insurance companies but as a physician I have no bargaining power whatsoever. The gun is held to my head and I am told that if I want to be able to take care of patients with XYZ insurance I have to accept their payment schedule or they will tell my patients to go to another physician. My fees and my compensation have not gone up in over 10 years while my overhead has gone up every year for the last 34 years. > > You are correct in that hospitals will negotiate with uninsured patients. At present in Connecticut out of 18 hospitals (not quite sure on that number but close) only five are in the black with 4 just barely making it with the rest in the red and several near bankruptcy and one that went bankrupt this year. One hospital is head an shoulders above the rest (Danbury Hospital ) but that is because Danbury is so far from other hospitals that the Insurance companies can't dictate the fee schedule. Danbury can say this is our schedule and if you don't accept it you can tell your insured to drive another 30- 40 miles to the nearest hospital. > > > > > Our country is in dire straits when it comes to health > > insurance. There are 40 million > > (the number is likely to go higher with all the > > unemployment) people out there who > > through no fault of their have no insurance. Most of them > > are middle class people who > > either own a small business or work for someone who owns a > > small business and cannot > > afford to give his/her employee health insurance. > > > > [JMS] A few comments about these widely-reported factoids. > > First, the 40 million figure > > includes illegal aliens and their " anchor > > babies, " who number somewhere between 12 > > million and 20 million. Here's some info on that from > > the Journal of American Physicians > > and Surgeons: > > > > > http://www.jpands.org/vol10no1/cosman.pdf > > As pointed out in the article their babies are receiving medicaid and many of these illegal aliens with fake soc.sec id are also receiving at least Medicaid since they fall below the poverty line. a Medicaid is one of the reasons that hospitals are going bankrupt. > > Medicaid pays 20% of the actual cost of care. Hospitals with a high indigent population and with few people with full insurance cannot sustain this drain and go bankrupt. Hospitals with a high number of people with regular insurance pass the cost on by simply raising their fees to cover the difference and the Insurance companies pay most of the higher fees and pass the cost onto those paying the insurance premiums namely you or your employer. That is real taxation without representation. > > Individuals on Medicaid are not counted as the 40 million uninsured since they have insurance. The uninsured are those whose income is too high to make them eligible for Medicaid. Medicare likewise does not pay its full share of he cost. It pays about 60% of the cost of care. Guess who pays for the difference. Insurance premiums. > > > Second, many of the 40 million are middle class, but we > > should be cautious about > > assuming that they can't afford medical insurance if > > they don't have it. Many choose not > > to pay for health insurance because they're in good > > health and don't think the cost of the > > insurance is a good value for them. My brother, a > > freelance computer programmer, was > > one of them...until he needed an emergency appendectomy in > > 2003 and wound up over > > $40K in the hole. He earns a lot of money in his > > profession. Should we all be taxed by the > > federal government so he and people like him will be > > automatically enrolled in a health- > > care program? Does that seem fair to anyone? > > You are absolutely correct. Young people think they are invincible and will never die and never get sick. If the employer instead of giving the employee insurance gave them a raise most young employees would probably take the money and make a down payment on their new car or truck. > > The only one who really benefits from a tax break would be the employee. The employer can simply take tax break by increasing the wages to the amount of the insurance cost. But that is a whole different discussion with different ramifications > > Your brother in law makes a lot of money as evidenced by his ability to pay the 40K. The free lancer who makes perhaps 40K might not be able to pay 12K a year for insurance (In CT. that is the estimated cost of insurance for a family if an individual tries to purchase their own insurance) to cover his family. He is probably not dining out in a fancy restaurants or taking vacations either. If he gets sick he goes bankrupt the hospital pass the cost on.. well you know the rest. > > > > Third, of the middle-class people who " can't > > afford " health care, it's important to keep in > > mind that they report they're " unable " to > > afford it, but nobody looks further to see whether > > that's really the case. For some it is, but for others > > the insurance is only " unaffordable " > > because the heads of the household choose to spend the > > family's income on other things. > > My late stepfather was self-employed (small business), but > > he and my mother made > > health, life and disability insurance a top priority in > > their budget. That meant they > > couldn't afford vacations, couldn't dine out at > > fancy restaurants, and had to pass up > > buying things like flat-screen TVs and fancy clothing. But > > when my stepfather was > > diagnosed with terminal cancer last year, it meant that he > > received excellent care, and my > > mother wasn't left bankrupt and homeless after he died. > > Does anyone think that we all > > should be paying higher taxes so people like my mom and > > step-dad would be covered by > > a government-sponsored health care program...just so they > > can have more disposable > > income to spend on consumer goods or bigger houses? > > See my response in the above paragraph. > > > I agree that it's a tragedy when anyone truly can't > > afford medical care, but we should be > > careful about believing the information on this subject > > even when it's published by > > reputable news outlets. > > > > Regards, > > > > s > > Ardmore, PA > > I appreciate you views but I am not sure either of us have a complete view of the real problem. Quite frankly I don't think any one does. It is like the parable of the 5 blind men and the elephant. > > However if the problem is not addressed soon one day it will all implode and just as the market and the other companies imploded recently the health care industry will also implode. > > As more hospitals go bankrupt people will be hard pressed to find care. True bankruptcy may help weed out some of the weaker hospitals but what happens when a hospital in the middle of nowhere with the next nearest hospital 50 miles away goes bankrupt and closes its door. > > Fewer young people are looking to enter a medical career and soon there will be lack of physicians. Perhaps then the MDs can turn around and only accept those who can afford to pay in cash and tell the insurance to keep their money. That is already beginning to happen in some of the big cities. > > I apologize for the verbosity of my response but this whole insurance situation boils my blood and I am glad that I am at the end of my career and not the beginning. I can accept lower fees because my children (4) are all grow up and my wife and I only have to support ourselves. > > Wishing you good health > > Ralph Giarnella MD > Southington Ct USA > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2008 Report Share Posted December 23, 2008 Ralph Giarnella wrote: > Young people think they are invincible and will never die and never get sick. If the employer instead of giving the employee insurance gave them a raise most young employees would probably take the money and make a down payment on their new car or truck. [JMS] My brother once worked for a small start-up firm that paid its employees a $5,000 " health insurance bonus " to help them with the cost of health insurance premiums. My brother probably bought another guitar with it, but he certainly didn't buy health insurance. > Your brother makes a lot of money as evidenced by his ability to pay the 40K. [JMS] I have no idea how much he made that year, nor how much of the doctor and hospital bills he paid, but he settled the debts. No matter how much money a person makes, they can always spend more, and people who have those kinds of financial habits also seem to be the type to put discretionary spending ahead of things like insurance and savings. More on that later. >The free lancer who makes perhaps 40K might not be able to pay 12K a year for insurance (In CT. that is the estimated cost of insurance for a family if an individual tries to purchase their own insurance) to cover his family. He is probably not dining out in a fancy restaurants or taking vacations either. If he gets sick he goes bankrupt the hospital pass the cost on.. well you know the rest. [JMS] Well, that's what I was trying to get at (and this is a topic that makes my blood boil). How did it become a foreign concept in America that an adult who is not physically OR mentally disabled cannot afford to feed, house and clothe himself, and afford to pay for his own medical care? If a person is earning $40k per year and can't afford health insurance, then he should do something about it himself. Make more money, find a job that provides a group health policy, move to a different city or state to make that happen, if necessary. That may seem like a harsh reality to some, but it's what a lot of us do. I had a neighbor who ran a small business, putting in ten or twelve hours every week day and working weekends, too. He couldn't afford health insurance with the income from that business, so he got a part-time job at UPS that provided health insurance as a benefit. He had to get up at 3am every day to put in his four-hour shift at UPS, but he did it. My wife has been permanently physically disabled from birth, and she has some serious illnesses that make her a very high risk for health and life insurance, but she has both. She moved from her home town to the Philly area because there was no way she could earn a living in her home town with her disability. Today she changes jobs every few years, and each time she does, health insurance is among the top criteria when she chooses which offer to take. I've kept the same job for sixteen years, one of the main reasons being that it includes great health insurance as a benefit. If my wife loses her job, she would be insured under my employer's policy, and if I lost my job, I could be insured under hers. If anyone is still reading this, bear with me for just a few more 'grafs. My wife and I didn't buy a home until I was 41 years old (she was a few years younger). One of the reasons I lived in apartments for so many years was that I refused to buy a home without having a realistic down payment *and* a nest egg in the bank so that if we both lost our jobs on the same day, we could still pay our mortgage & COBRA premiums, and put food on the table for three to six months. When we bought a home, we bought a twin so we could still " afford " to save money, unlike most of our colleagues who were buying bigger houses and saving nothing. And we had no children at the time, because we believe that nobody should have children unless they've saved up a nest egg so that if they're out of work for a few months they won't lose their home and have to ask the government to support them. After a few more years of working and saving, my wife and I realized that she had adapted so well to her disability that we felt morally obligated to share what we had in a very personal way--not just materially, but our life experience. We decided to adopt a child with a disability. When we adopted our son, we had to buy a " new " car: although our 12- year old mini-pickup truck still ran like new, it wasn't big enough for two adults and a child to ride in. So we bought a used VW and paid for it with cash. Between the VW and the adoption fees that year, we spent 1/3 of our annual take-home income. But we didn't borrow a penny of it. It came out of our savings, and we still had enough left over to cover three to six months of living expenses for the three of us. So here we are, a middle-aged guy who is at this point not disabled and a middle-aged woman who is permanently disabled. And we're able not only to provide for ourselves, but also for our permanently-disabled son. How do we do it? Simple: we spend a lot less than almost anyone else we know with a similar middle-class family income, so we can save a lot more. So when somebody who is not physically or mentally disabled and earns $40k per year tells me he " can't afford " health insurance, I need to know more before I'm willing to accept that as a legitimate claim. Sometimes, through unlucky coincidences, it will be, and that is always a tragedy. For those people, we are willing to pitch in for their basic medical care, food and shelter. (In fact, my wife and I donate to charities that help those who are less fortunate than us.) But other times, the guy or gal who earns $40k per year but " can't afford " health insurance is just not willing to look or relocate for a better job, get a second job, or simply cut back on other expenses. Unfortunately, in America today, too few people are willing to do so, and too many expect the government to solve their problems for them. Well, my wife and I are not in a high tax bracket, but I don't want to be taxed even one penny more in order to make life easier for people who are working and not disabled. The money my wife and I earn is for OUR SON and OUR CHARITABLE CONTRIBUTIONS, not for a single guy who is earning $40k a year. And unless we get to a point where we have had to sell our home, have gone through all of our savings and our retirement funds as well, can no longer afford to rent an apartment, and are about to be thrown out onto the street, we are not about to ask the government to buy us things that we " can't afford. " Regards, s Ardmore, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2008 Report Share Posted December 26, 2008 Hi Dan. I post rarely on this list but, I couldn't stay quiet on this one. I called my 2 Senators and 2 Congressman to strongly urge them to not bail out these thieves that occupy Wall Street. With what has happened here in America with the financial breakdown isn't far from raising the ghost of Maximillian Robespierre. The want of social justice does exist. It may not be heard loudly and clearly yet, but it does exist. Since 1965 , there has been a push to creat a world economy fostered not by, We The People but, by those holding the power beyond what is normally thought of as where power lies. Is there hope? Yes, there is hope. Can we rise above the woes of present day? The answer is yes. Can we use the guidelines of the past to rise? No. Us Americans are quite reziliant, often needing some sort of a dissaster to shine in our brightest light. We aren't perfect but, if all of us open our eyes and truly see, we'll once again be the land of opportunity we know in our hearts we can be. Carson Wood. Westbrook, ME USA. Re:Health Insurance Very nice theoretically, but the reality is that the money you and your wife earn is used ATM to bail out companies (and implicitly executives) who earn no 40k a year, but millions. (saving banks and auto industry). This is where your money are. Saving the greedy ass of " market " capitalists, who whould not hesitate to let you and your wife on the streets should you owe them money. Its interesting that I hear no complains at this, but most of the ppl are horfied at the thought their money can be used to actually save other ppl life. Or do medical state sponsored research , which you happen to hate. Pure market economy you know and love so much is in deep s... right now . It just doesn't work as it should. And whats ironical that your country proved to be as socialist as any other country I know in deciding to bail out those companies. This happens time and again, and the result is that for rich ppl and their companies there is a form of " communism " , and for you there is the harshest market capitalist ever existing. Make no mistake , the same banks which where bailed out with public money would throw you and your family in the streets in a blink of an eye tomorrow if it happens to owe them money. Dan Partelly Oradea, Romania >>The money my wife and >> I earn is for OUR SON and OUR CHARITABLE CONTRIBUTIONS, not for a single guy who is > earning $40k a year. > > And unless we get to a point where we have had to sell our home, > have gone through all of our savings and our retirement funds as well, > can no longer afford to rent an apartment, > and are about to be thrown out onto the street, > we are not about to ask the government to buy us things that we " can't afford. " > > Regards, > > s > Ardmore, PA > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2008 Report Share Posted December 26, 2008 Dan Partelly wrote: > Very nice theoretically, but the reality is that the money > you and your wife earn is used ATM to bail out companies (and > implicitly executives) who earn not 40k a year, but millions. [snip] > Its interesting that I hear no complains at this, Dan, maybe nobody in Romania is complaining about it, but here in the U.S., the majority of the adult population is complaining about it. > Or do medical state sponsored research , > which you > happen to hate. For those who may not remember, Dan is referring to a post I made months ago, indexed at no. 46989 in the Supertraining archive. I never said I " hated " state-sponsored medical research. Rather, I said that it was less efficient and less fair than privately funded research. We're drifting pretty far afield now, so I won't explain here why that is. If anyone wants to know, email me privately. > Pure market economy you know and love so much is in deep > s... right > now . Dan, in my opinion, there is no such thing as a " pure market economy. " Just the fact that a society is willing to enforce a right to private property is in itself a form of regulation. I have no problem across the board with government regulation of private economic transactions or intervention in markets. Regulation and intervention are not *per se* bad or wrong, IMO, even when it results in redistribution of wealth via taxation or otherwise. But for any existing or proposed regulation or other intervention, we should always ask how efficient, effective and fair it is...and upon what criteria those judgments are made. Having studied history and economics, and having published a peer-reviewed paper that advocated government intervention in a largely-private market (vol. 38 Villanova Law Review, p. 571 (1993)), I've formed the opinion that before the government interferes with private market transactions, we should ask what the problem is that the government action is supposed to improve, and whether there are better solutions. If you believe that to be an unreasonable opinion to hold, that's fine with me. Aside to Dr. Giarnella and Krieger: although some of what I've written here is germane to your recent posts (Dr. Giarnella's, no. 48169; Mr. Krieger's, nos. 48165 & 48166), I'll address them specifically in a few days. Regards, s Ardmore, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 27, 2008 Report Share Posted December 27, 2008 Hi Bob I agree that the western world economy is not laissez faire, far from it. in my mind, fundamentally the issue is fractional reserve banking and central bank intervention to sustain that system of banking. Unnaturally low interest rates and inflation are the corner stone to the current system. Often central banks make decisions of politically expediency over economic sensibility (in South Africa this can be very apparent at times). Before every one gets hit up I am not attacking the US, or the UK, we have the same system in South Africa, only unemployment here is nearly 40% so our situation is dire. The question that needs to be asked is why do all entrepreneurs make the same mistake at the same time, this is not intuitive in the free market system as it would be unusual to for so many to make the same mistake all at once, unless as a business you were " forced " by the system to make that same wrong decision. Fractional reserve banking means that banks can lend out more money than they have, they have to cover only around 10% of their loans in cash equivalents, for this to be sustainable inflation is essential and interest rates must be kept low. The intervention by the central banks makes the system not laissez faire, but interventionist. As an aside credit swaps and similar derivatives have a place in allowing banks to share risk, in itself not bad as big investments can be made, but that these are off balance sheet ...... The system then encourages entrepreneurs to make the wrong investment, because investment is measured against a wrong investment basis namely low interest rate. The boom and bust scenario of business cycles is a natural part of the economic system. At some point a confidence crisis or a busting of an investment line causes a calling for cash and since 90% of the value in the system is not real money on deposit then a credit crunch ensues as positions are liquidated into cash. The basis of the economy is the land, labour and use of capital by entrepreneurs. What made the USA great is the efficiency of the people to deploy their land and people in productive business. You have very productive land agriculturally & resource wise, amazing entrepreneurs and productive people, the problem is that wrong business decisions are being made because of the central bank interventionist style economics so prevalent. My thoughts as influenced by Austrian business cycle model. I think that the Austrian model needs some work, I disagree with Von Misses particularly the social commentary especially about Africa circa 1930, but think that they point in the right direction. Regards Nick Tatalias Johannesburg South Africa Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2008 Report Share Posted December 29, 2008 This message responds to Krieger's of 26 December, in response to mine of 24 December. The text quoted from my 24 December message is set off by asterisks. *************************** > [JMS, 24 December] in an effort to improve health insurance coverage [snip] > the legislators have passed statutes that make insurance > premiums much more expensive [snip] > health care costs have risen much faster than the > rate of inflation [snip] > employers and employees are able to take tax > deductions on medical insurance premiums, but folks who have to pay for their own > insurance can't. ************ ********* ****** > Do you have evidence to support these assertions that these > are true > reasons behind high premiums? The reason I ask is that many > people > have put forth their own beliefs as to why they think > premiums are so > high, without any real-world hard evidence to support a > cause/effect > For example, I've heard people blame > skyrocketing > medical costs partly on high malpractice insurance and > malpractice > lawsuits, despite the fact that scientific studies in this > area have > shown that there's absolutely no relationship between > the two. Let's start with your example, . How could there be " absolutely no relationship " between increasing costs for malpractice insurance and the increase in the cost of providing the services that such insurance covers? Based on your example, it appears that no matter how rigorous the factual support I might marshall, you won't be persuaded. That aside, the factual assertions you question are well documented, but they're not widely reported in the mainstream press. In the context of a discussion of health insurance, asking for proof of these assertions is like, in a discussion of modern history, asking for proof that the terms of the 1918 armistice between the Allies and Germany was a major cause of WWII. In other words, these factual assertions are not common knowledge, but neither are they matters of controversy in their respective fields. That they seem novel and " unproven " to you isn't a sign of abnormal ignorance on your part, it's just a sign that the reporting on this issue in the mainstream media has been poor. If you're willing to do some leg work, you can find support for these assertions. If you'd rather just say that I bear the burden of supporting them and I've failed to do that in this thread, that's fair. > ********************** > > [JMS, 24 December] Many choose not > > to pay for health insurance because they're in > good health and don't > think the cost of the > > insurance is a good value for them. > ************ ********* *** > > Do you have evidence for this " many " claim? Your > anecdotal story > about your brother is not evidence of " many " . See above. > ****************************** > [JMS, 24 December] He earns a lot of money in his profession. Should we all be > taxed by > the > > federal government so he and people like him will be > automatically > enrolled in a health- > > care program? Does that seem fair to anyone? > ******************************** > > Should I be taxed when there are roads that people use that > I will > never drive on, yet I pay for? Is that fair? Roads are mainly financed by gasoline taxes, so your tax burden in this regard is roughly proportional to your use of the roads in general. The fact that there's no one-to-one correspondence between the roads you drive on and the road work that your tax money pays for is usually justified on the grounds that there are positive externalities (commerce and national defense) created by our system of public roads. Furthermore (as you point out elsewhere in your post), the administrative costs of collecting a " user fee " for each use of a specific road is administratively impracticable, which in turn gives the system of public roadways some attributes of a " public good. " (If you're not familiar with the terms " public good " and " administrative costs " as they're used in economic jargon, please look them up.) Therefore the most practical way to finance the system of public roads is through taxation. In contrast, neither health care nor health insurance is a public good, and administrative costs don't make user fees impracticable. Therefore your analogy between taxation to support public roads and taxation to provide public health care or public health insurance isn't a good one. Your ignorance of these ideas isn't unusual. They should be taught in a civics course in every U.S. high school, but unfortunately our schools don't teach civics these days, and our society is worse off because of it. > Should I be taxed to pay firemen to put out the fire down > the street > that was the result of a homeowner smoking in his bedroom? > Is that fair? Unless you live in one of the bigger U.S. cities, your local fire company is all- volunteer...and yes, as a civic duty, we should all make annual donations to them. But regardless of whether you support your local fire company through taxation, donation or both, it's in your best interest to do so because fires in your community can have substantial negative externalities. Your contribution to your fire company mitigates these negative externalities. (If you're not familiar with the term " externality " as it's used in economic jargon, please look it up.) Other peoples' illnesses also create negative externalities, so we all have an interest in ensuring that our neighbors have access to a reasonable minimum level of health care. In this sense, your analogy is apt. But the crucial distinction between fire departments and health care (in the context of this conversation) lies in the theory of " natural monopoly. " Within the local region that can practicably be served with the technology available, a single fire company will be a natural monopoly. This means that competition will actually be detrimental to the consumer. The opposite is true of health care and health insurance services. (If you're not familiar with the concept of " natural monopoly, " look it up.) > When you pay insurance premiums, the money you're > paying is going to > be used to pay other people's medical costs if you > happen to be in > good health. Is that fair? Yes, in the sense that my decision to enter the insurance contract is voluntary on my part. If I don't think it's a fair bargain, I don't have to buy the insurance. The average person doesn't realize that the insurance industry has relatively low barriers to entry and therefore the markets for various insurance services are highly competitive (unless the industry is poorly regulated, as it is now). In a well-regulated market, consumers of health care insurance have many choices regarding the scope of insurance, deductibles and levels of customer service, insurers are allowed a reasonable amount of flexibility in setting premiums according to individual risk (except in the case of group policies) and all this increases the chances that a consumer will be able to find insurance that is subjectively " fair " at any given price-point. > The fact is that higher taxes from government-run > healthcare would be > offset by the fact that employers would be able to pay > their employees > more since they wouldn't have to cover healthcare, and > the fact that > individuals would no longer need to pay monthly premiums. True, but this would also be the case if we were to eliminate the tax policies that have effectively coupled employment and health care insurance, and if we were to change the existing regulation of the health insurance industry to restore competition to what it was 30 years ago. The advantage of the private solution over the public solution is that competition in the private markets drives administrative costs down. Government programs typically incur administrative costs of over 30%. In comparison, the rule of thumb for charitable donors is to steer clear of charities that don't spend at least 80% of their total budget on services. By that standard, and compared to private insurance companies, government programs are inefficient, and the excess costs incurred in that sector take away from the good that can be attained by devoting those resources elsewhere. > The bottom line is that, when it comes to living in a > society or > community, there are some things that are more efficient > and work > better when paid by the community as a whole Yes, they're called " public goods, " and health insurance and health care services are not among them. > ************************* > > [JMS, 24 December] My late stepfather was self-employed (small business), > but he and my > mother made > > health, life and disability insurance a top priority > in their > budget. [snip] > But when my > stepfather was > > diagnosed with terminal cancer last year, it meant > that he received > excellent care, and my > > mother wasn't left bankrupt and homeless after he > died. > ************************* > > But what if your late stepfather had been been hit with > terminal > cancer years and years before he had a chance to save up? , it appears that you've confused a couple of the example I gave in my message posted on 24 December. Insurance premiums are typically paid month-to-month, not from years' worth of savings. The reason my mother wasn't left destitute after my step- dad died last March wasn't because he had saved money. It was because he and she made a decision to pay for health-care insurance, disability insurance and life insurance from the income he earned as a furniture repairman. Trust me, the insurance premiums cut deeply into their disposable income, as furniture repair did not make my step-dad a rich man. But even with today's mis-regulated health insurance industry, even a blue-collar artist-craftsman like my step-dad can afford such insurance by maintaining a reasonable amount of prudence, discipline and effort. > What if > you're 25 years old, just out of college, with massive > amounts of > school loans, and you're self-employed? Let's say > you even have some > basic health insurance (because that's all you can > afford...you' ve got > school loans to pay for, remember). You get hit with cancer > at a > young age, or some major accident, and the medical costs > far exceed > what your insurance is able to pay for. I guess you're > just SOL now, huh? Except for the cancer or major accident, that's exactly what my situation was from '86 to '93. (I graduated college in '83.) I had a bare-bones, non-group major medical policy that I paid for out of my own pocket because the small businesses I was working for didn't offer a health insurance benefit. I paid the premiums, and saved up the $500 or $1,000 deductible while working at $8.00 an hour or less and paying off my college loans. But beyond the deductible, my medical care for cancer or similar major illness would have been covered. > Even people with decent medical coverage and who have been > financially > smart can get hit with major medical expenses at the most > inopportune > times...enough to force them into bankruptcy or major debt. Yes, that's why medical debts are generally dischargeable in bankruptcy. > And the > unfortunate thing about medical expenses is that they can > pile up and > up and up depending on the health issue. Yes, that's why I'm not categorically against government aid to people. As I wrote on 24 December, " So when somebody who is not physically or mentally disabled and earns $40k per year tells me he " can't afford " health insurance, I need to know more before I'm willing to accept that as a legitimate claim. Sometimes, through unlucky coincidences, it will be, and that is always a tragedy. For those people, we are willing to pitch in for their basic medical care, food and shelter. " > ************ ********* ****** > [JMS, 24 December] Does anyone think that we all > > should be paying higher taxes so people like my mom > and step-dad > would be covered by > > a government-sponsore d health care program...just so > they can have > more disposable > > income to spend on consumer goods or bigger houses? > ************ ********* ******** > > The argument for universal healthcare has nothing to do > with giving > people more disposable income. It does if it's based on a figure of 40 million Americans being unable to afford health care, because about 20% of the uninsured can afford it but deliberately choose to use their money for other things. > The fact remains > that the > U.S. continues to be ranked very low among industrialized > countries > when it comes to healthcare. That's not a " fact. " It's a value judgment based on a weighted multi-factorial analysis. I disagree with that judgment because I don't agree with the choice of relevant factors and their weighting. One of the reasons I disagree is that there are plenty of people in the who come to the U.S. for medical treatment even though they live in countries with " universal health care. " I have an acquaintance with whom my wife and I get together every spring. He's an American expatriate who has been living in France for about eight years. Every time we get together he lectures us about how terrible the U.S. is, and how much better France is. Fine, vive la difference! He's a likeable guy and I always benefit from learning about his experiences abroad. Last spring his lecture was about how terrible the U.S. health care system is. Seems that while visiting his home town in the U.S., his daughter had an ear ache, his former family doctor was not on duty because it was a weekend. He took his daughter to an ER, and he was billed hundreds for it. He told us how in France he would not have had to go to an ER because the law mandates that doctors' offices have evening and weekend hours. Well, my health insurance company sponsors " minute clinics " -- http://blogs.webmd.com/healthy-children/2008/10/minute-clinic-visit-for-your- kids.html Then he complained that his state-sponsored health care system would not pay for the ER bill. In contrast, my private health insurance would have paid such a bill if I'd had the misfortune to fall ill when I traveled to China in '06 and Australia in 2000. And a cheap supplementary insurance policy covered the additional risk that I would fall seriously ill while abroad and need to be flown back to the States immediately. Finally, he sheepishly volunteered that " some of the medical equipment in the doctors' offices [in France] look like they were manufactured in the 1950s.... " I'll let that speak for itself, except to note that he lives in suburban Paris, not in some remote Alpine village. > ************ ********* ********* > > [JMS, 24 December] I had a neighbor who ran a small business, putting in > ten or twelve > hours every week day > > and working weekends, too. He couldn't afford > health insurance with > the income from > > that business, so he got a part-time job at UPS that > provided health > insurance as a benefit. > > He had to get up at 3am every day to put in his > four-hour shift at > UPS, but he did it. > ************ ********* ********* > > What I find interesting is that your " solution " > here can create the > very health problems that people are trying to avoid. If you go back and read my post of 24 December, I said that people who don't have health insurance can, among other things, " get another job. " That was an ambiguous choice of words, because " another " can mean " a different " (my intended meaning) or " an additional. " It's natural that you and Dr. Giarnella both understood me to mean " an additional " because one of the examples I gave was of my old neighbor who took an additional job for health benefits rather than abandon the small business he was trying to grow. But if you give it a little thought, you can see that a person only needs to hold one job that offers a health insurance benefit in order to have the insurance. I mentioned my part-time neighbor as an extreme case, because he was not willing to give up trying to grow his business nor willing to allow himself, his wife and his kids go uninsured. But after a couple years, he succeeded in growing his business to a point at which he decided he could quit his part-time job with UPS. > ************ **** > The money my wife and > > I earn is for OUR SON and OUR CHARITABLE > CONTRIBUTIONS, not for a > single guy who is > > earning $40k a year. > ************ ******* > > Then why are you in a country where you're paying taxes > at all? Because: (a) I don't object to taxation per se, only to stupid tax policies and inefficient and counterproductive government programs; and ( I don't subscribe to the " America, love it or leave it " idea. Being grateful for all I have here, I would rather choose to stay and exercise my right to vote and to speak on political issues such as these in order to influence legislative policy. > If you do > what you've always done, you'll get what you've > always gotten. Fair point. But it's also true that those who fail to learn from history are doomed to repeat it. One of the clearest lessons history teaches about socialism is that when the government makes something " free, " it becomes very expensive. Run a google search on the name " Rousseau " and the phrase " let them eat cake " to get an idea how far back this knowledge goes. Our founders were well aware of it when they drafted our constitution. Contemporary history also offers some important lessons. Note what is happening in places like Sweden, where the moral hazards of the welfare state are causing increasing numbers of people to complain that too few are working and too many are living off the dole. And note that the projected deficits for the welfare programs of Western European countries make our projected Medicare shortfall look better by comparison. Regards, s Ardmore, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2008 Report Share Posted December 29, 2008 Pure market economy is a theoretical extreme of capitalism, one where many of your kind would like to go. You can find the definition of the concept in an decent economic book, go read one. Now, before you puke, think. Why did the US state had to bailout banks in the first place ? Because banks and their managers in their idiocy and **greed** managed somehow to destabilize the market and crash it. This resulted in intervention (legitimate intervention from government, if you ask me, we could not afford loosing totally confidence in banker systems, is too much at stake) from government to save their sorry asses who tend toward a pure market system. All this with public money. This would not have happen in the first place if government would had previously imposed tighter regulations of credit lines, tighter operation rules for said banks. It is exactly because the system *was* closer to a pure market system it happened. Not enough regulations and monetary politics to prevent this from happening. Now the sad fact is that many ppl cant understand that the week, the stupid and the sick must have protection. Is not an " altruist " system, it's a fair system. Such ppl will probably understand when them or someone close to them will lie on a hospital bed close to dying and doctors don't give a damn because he doesn't have insurance. Hopefully then they wont feel the need to puke, for maybe they'll die drowned. They will understand then. Its weird to me how many ppl gain insight and understanding once the shit hits the fan and the dark side strike in them and their family. Many of them so though before. Diseased ppl imploring doctors, ppl screaming after the police they cursed all along before after they find their wife rapped when they return from work, or after they have their kids killed on some god forgotten military operation theater. Its easy to emit judgments about social order sitting in a safe heaven, with a nice happy life. You state that " only legitimate regulations are those that protect individual rights. " . Indeed. But keep in mind that the right to health is a fundamental right of any being. The right to well being and pursuit of happiness should be fundamental to any being. Hence, it's a small price to pay if you control the banking system tighter, you enforce a better heath system, and so on. Swedish, Norwey, Finland are some of the worlds top democracies, but they learned to care about their ppl, about the nation. Only because capitalism its the best system so far, it doesn't mean it cant be improved. Dan Partelly Oradea, Romania > > > > > > Very nice theoretically, but the reality is that the money you and > > your wife earn is used ATM to bail out companies (and implicitly > > executives) who earn no 40k a year, but millions. (saving banks and > > auto industry). This is where your money are. Saving the greedy ass of > > " market " capitalists, who whould not hesitate to let you and your wife > > on the streets should you owe them money. > > > > Its interesting that I hear no complains at this, but most of the ppl > > are horfied at the thought their money can be used to actually save > > other ppl life. Or do medical state sponsored research , which you > > happen to hate. > > > > > > Pure market economy you know and love so much is in deep s... right > > now . It just doesn't work as it should. And whats ironical that > > your country proved to be as socialist as any other country I know in > > deciding to bail out those companies. This happens time and again, and > > the result is that for rich ppl and their companies there is a form of > > " communism " , and for you there is the harshest market capitalist ever > > existing. Make no mistake , the same banks which where bailed out with > > public money would throw you and your family in the streets in a blink > > of an eye tomorrow if it happens to owe them money. > > > > Dan Partelly > > Oradea, Romania > > > > > > >>The money my wife and > > >> I earn is for OUR SON and OUR CHARITABLE CONTRIBUTIONS, not for a > > single guy who is > > > earning $40k a year. > > > > > > And unless we get to a point where we have had to sell our home, > > > have gone through all of our savings and our retirement funds as well, > > > can no longer afford to rent an apartment, > > > and are about to be thrown out onto the street, > > > we are not about to ask the government to buy us things that we > > " can't afford. " > > > > > > Regards, > > > > > > s > > > Ardmore, PA > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2008 Report Share Posted December 29, 2008 Exactly my point Chad. A tighter regulation would have prevented it. Great post. Thanks Dan Partelly Oradea, Romania > The current predicament in the U.S. was created because certain regulations were allowed to be removed and/or new regulations that were necessary were not added. This allowed all the people in this country (and others) to buy everything on credit, with a good portion of them buying things they couldn't afford and didn't pay back (resulting in banks going belly up; a little more complex than this but this is the basic reason).  Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2008 Report Share Posted December 30, 2008 No its not a unreasonable opinion to hold. But talking and debating in committees results in nothing. Empty words, debates, while ppl are dying. Acting in a timely manner is the key , IMO. Performing surgery on a wooden leg worth nothing. Dan Partelly Oradea, Romania > > Having studied history and economics, and having published a peer-reviewed paper that > advocated government intervention in a largely-private market (vol. 38 Villanova Law > Review, p. 571 (1993)), I've formed the opinion that before the government interferes with > private market transactions, we should ask what the problem is that the government > action is supposed to improve, and whether there are better solutions. If you believe > that to be an unreasonable opinion to hold, that's fine with me. > > Aside to Dr. Giarnella and Krieger: although some of what I've written here is > germane to your recent posts (Dr. Giarnella's, no. 48169; Mr. Krieger's, nos. 48165 & > 48166), I'll address them specifically in a few days. > > Regards, > > s > Ardmore, PA > Quote Link to comment Share on other sites More sharing options...
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