What kind of person will rule King County - one of the largest county governments in the country? A person who will put the unions first? Or the taxpayers?
Why don't county employees pay anything for their health care?
Politics Northwest at Seattle Times
As the council looks at a 2010 budget shortfall of up to $50 million, more people are asking why county employees don't pay a monthly premium for health-care coverage as most other Washington workers do.A commenter there says that 800 people making over $100,000 and 2000 making more than $80,000 receive full medical benefits without paying. I don't know the source for this number. But why don't people in safe jobs at high salaries pay part?It's a particularly tricky issue for county exec candidates Dow Constantine and Larry Phillips, Democrats who have had cordial ties with organized labor but who are facing candidates who say the county should cut labor costs before asking taxpayers to pony up more money.
They face potentially strong opponents in three "outsiders" -- state legislators Ross Hunter and Fred Jarrett and former TV news anchor Susan Hutchison.
Constantine is trying to get his arms around the problem by proposing that non-union-represented employees pay 2 percent of any earnings above about $60,000 for health coverage.
The county can't impose cost-sharing on union members without first bargaining the issue.
Now Ron Sims, true to form, "did something" about rising costs. He appointed a commission and directed them to stay away from making employees pay. The commission was hard hitting: they commended county efforts. And he formed an alliance. And the result is... higher costs and employees don't take any more responsibility for their own care. Did anyone see anything beyond bold words come out of the 2003 commission or Puget Sound Health Alliance?
I will give the county and its employees credit for taking days off without pay this year. But how about next year? After all, we are electing a leader for 4 or more years.
Posted by Ron Hebron at May 16, 2009 07:36 AM | Email ThisSounds to me like someone does not want to upset their base, but could this tactic be the grounds for a discrimination suit?
Posted by: TrueSoldier on May 16, 2009 08:53 AMAnd in a time of rising unemployment, let's remember what Dino Rossi rightly said: "We shouldn't raise taxes on people who aren't working to give more money to people who are."
Of course, the new county exec could just charge those with bad habits extra up front. :-)
Posted by: Tim on May 16, 2009 09:23 AMOriginally Puget Sound was one city, surrounded by unincorporated areas.
Now we are a ring of independent cities that have their own full featured governments.
I would rather see inaction between these local governments rather than an overarching centralized entity like King County. Their scope and focus needs to be much reduced.
It does not discriminate on the basis of any protected categories, so it would be acceptable.
If a Republican were to make a similar suggestion, they would propose that only employees making UNDER $60,000 per year would pay for their health coverage.
Posted by: Richard Pope on May 16, 2009 10:28 AMAs usual, you are such a dolt. No republican or anyone with reason would ever make a decision based on the criteria you suggest. Your spineless "I am not republican (but once was in name only) liberal color is making you spew out the old liberal twist about republican being against the poor. In your view, paying $1000 for health insurance by someone making over $250K is unjust if someone making less than $50K is paying the same amount. In our view, making one pay more simply because he doesn't join a union is unjust. It just scares me that you are pretending to practice law.
Posted by: DoppioLover on May 16, 2009 10:54 AMAs usual, you are such a dolt. No republican or anyone with reason would ever make a decision based on the criteria you suggest. Your spineless "I am not republican (but once was in name only)" liberal color is making you spew out the old liberal twist about republican being against the poor. In your view, paying $1000 for health insurance by someone making over $250K is unjust if someone making less than $50K is paying the same amount. In our view, making one pay more simply because he doesn't join a union is unjust. It just scares me that you are pretending to practice law.
Posted by: DoppioLover on May 16, 2009 10:54 AMAnyway, I personally think that the only way to curtail the high cost of health care is to do away with all these employer paid insurance, and make individuals responsible for buying insurance or for medical cost for those choosing not to buy one. In order for this to work, I may support a mandated catastrophe coverage with very low premium and reasonably high (say, $20K) deductable. Companies that provide medical insurance can choose to pay the employee the cost of insurance at the same rate they are paying now as group coverage.
By doing so, we bring true competition to insurance industry and medical industry because consumers are also going to be more conscientious of their medical/insurance cost.
Posted by: DoppioLover on May 16, 2009 11:02 AMThis is exactly how health insurance used to work. Then business began giving it as a benefit to entice workers because they could get it cheaper by group discounts.
If the government (fed and state) would allow different ranges of coverage for individuals to purchase (i.e. no mandated chemical dependency, mental health, naturopath, etc), then the price would come down as people would purchase what they need instead of what is mandated.
Ironically, there is one group that is exempt from mandating those coverages in their group plans. It's the state programs like BHP. They did it to keep costs down.
Posted by: Ken on May 16, 2009 11:48 AMGreat! Then I'm assuming universal healthcare would be something that you would want to support, then. Self-employed folks have the most to gain from reforming our healthcare system.
Posted by: demo kid on May 16, 2009 11:55 AMWith an opportunity like I'm positive that the self-employed will be lining up with bells on to adopt the plan.
You don't even need to get into discussion about whether their current healthcare plan is better than one brought to you by the people who brought you winners like the DMV, INS and the IRS.
The question on this mythical reform is pretty damn simple:
Will I get at least the same quality of care as I have today and pay no more than I currently do?
For 90% of people the answer is no but don't let that get in the way of the glory of socialist medicine, it will quite literally "cure" cancer.
tonyg: You don't know what you are talking about.
Anyone paying for health insurance is already paying for the care of other insured pesons. If you're a taxpayer, you are already paying for the care of uninsured persons -- your dollars just aren't being used very efficiently and the coverage for the uninsured is spotty and often inefficiently delivered. Plus, you could easily lose coverage or find large gaps in your existing coverage just when you need it most.
Posted by: scottd on May 16, 2009 02:12 PMYet somehow, scottd and Demokid/Mikeboyscout believe more inefficiently delivered healthcare is a positive for ALL OF US? Only an imbecile would believe that the government can run anything efficiently. To date, not one government program can be pointed to in order to back up that flawed assumption.
Posted by: Rick D. on May 16, 2009 03:48 PMYour screed against reform of this system is based on a dogmatic hatred of government or its involvement in programs of broad social concern -- so I know convincing you otherwise is a lost cause. However, many of us are growing tired of this, mainly because we are seeing the flaws in our existing system through personal experience and we are seeing that many people similar to us in other countries have a better system. For that reason, I think we will see a change.
Remember, some conservative leaders have said they fear this change because they worry that once Americans have universal coverage, they will realize they like it better, and it will be practically impossible for conservatives to ever roll it back. That kind of tells you everything you need to know.
Posted by: scottd on May 16, 2009 04:07 PMWhich I guess explains why Canadiens and other countries whose healtcare is socialized come to the U.S. to pay for their healthcare. They must be masochists or something right, scottd?
Your screed against reform of this system is based on a dogmatic hatred of government or its involvement in programs of broad social concern
Not screed, just fact. Not one Government run program can be pointed to as a success in this country. Maybe you can point us towards just one that would serve as an example of how healthcare could be made better with Government at the helm.
And in case you hadn't figured it out, big-government rationed medicine isn't free. You've only bought the lie that it is. And right now, I understand Medicare is costing more than it's taking in. That sounds like a HUGE problem to me. Obviously, government isn't doing a good job with costs and cash flow, is it? Imagine that on scale with the entire populace. What a mess!
Also, if we are forced into govt. rationed medicine, then we will all find ourselves waiting 8 months to get needed procedures that we all get within days or weeks currently. Or we'll find ourselves like that poor canadian woman who was giving birth to quadruplets AND HAS GOVERNMENT INSURANCE only to be told there was no room for her in Canadian hospitals and had to be flown down to lil' ol Montana where they helped her. Or like the other canadians you can read about WHO HAVE GOVERNMENT HEALTH INSURANCE who die waiting for treatment for several months.
Sorry, but I can see that I'm better off not letting Obama decide how to deliver medical care. After all, he thinks marxism is cool. But you know, Cuba just looks pretty darn sorry to me. And I noticed that Castro-buddy WENT TO SPAIN for his big surgeries. Even HE think Cuban "free" medicine sucks. That might be one the one thing he and I agree on!
OK, Rick, exactly how many Canadians come to the US each year for healthcare. How many US residents travel to Canada for the same reason? If you don't know the answer to those questions, you don't have an argument, just some anecdotes.
Michelle: I haven't said anything about King County employees paying a portion of their healthcare costs, so how can I be wrong about that? I also haven't said universal healthcare would be free -- only an idiot would think that. I just pointed out that for all the money we are already spending, we should be able to get a better healthcare system than the one we have.
I don't think you will get far pointing out the deficiencies in Cuba. Cuba is a very poor country. I think we should be able to do better than that, don't you?
BTW, plenty of people die in the US waiting for treatment and many of them have insurance.
Posted by: scottd on May 16, 2009 04:52 PMWho knows? What is known is that a Canadian that is seeking a private physician in Canada is committing a crime....as declared by the Government in control of its inadequate healthcare system. That's why they come down south for real healthcare. Your thoughts?
How many US residents travel to Canada for the same reason?
Probably none, but feel free to fill in the blanks if you have the answer, scott.
If you don't know the answer to those questions, you don't have an argument, just some anecdotes.
I guess that makes two of us then.
Posted by: Rick D. on May 16, 2009 05:09 PMIf you haven't noticed it, I'm not the one claiming that Canada's system is so messed up that Canadians flee it -- so I don't have anything to prove. Your pointing to isolated anecdotes doesn't prove anything.
Posted by: scottd on May 16, 2009 05:14 PMThe Lancet Oncology, a UK medical journal, published a study in 2008 that shows that the US has a better survival rate in 13 of 16 common cancers than Europe or Canada. A male in America with cancer has an almost 20% better chance of living 5 years than someone from Europe. A woman in America has a 7.2% better chance.
But who cares because with socialized medicine I'm not paying for it - Wahoo (surprise outcomes don't correlate with spending linearly).
A typical family in the US today spends just 5.4% of its income on healthcare. That compares to 18.2% spending on food and 40.8 % on housing. In fact they spend almost the same amount, 4.5% on clothing.
ScottD - Today the uninsured are a drag on private health insurance. They are a massive 1% drain (This is from Kessler's 2007 study into Californian Cost shifting#.
So what you're saying is that I can give the government the money I give private health insurers to get European/Canadian quality healthcare and I'm supposed to jump up and down for the opportunity. I'll need to get back to you on that; I wouldn't wait up for it.
You comment on inefficient spending of tax dollars was somewhat obtuse. Are you really saying that the reason the government spends my tax dollars inefficiently is that they don't have enough tax dollars?
Seriously, that is the best you've got? It's not even snort worthy.
Right now the government public healthcare offerings currently waste $1 out of every $3 #from Dartmouth Institute for Health Policy & Clinical Practice, April, 2008).
So seriously you're asking me to give a program that can't even now clean up its 33% waste more money because with more money the quality fairy will come out, tap her wand and suddenly it'll be efficient?
Normally I'd say I'm surprised at the ridiculous nature of your arguments and at how little you actually know about the current state of the healthcare system but I've been reading here for some time and these things no longer surprise me.
Now you're arguing against yourself Scott. I believe @ 15 that you said the following:
your dollars just aren't being used very efficiently and the coverage for the uninsured is spotty and often inefficiently delivered.
I haven't run from any argument here, unlike yourself, who won't answer which government run program can be pointed to as a success story and could serve as a model for nationalized healthcare in the U.S. Good luck on providing us that model, scottd.
With an average family spending 4.5% on clothing and 5.4% on healthcare would we really say that we have a clothing crisis?
This rate changes as people age. As people get older the percentage of spend they allocate change. When you're 75 would you prefer to buy a 3rd car/Another TV/New Suit/Etc or another year of life?
I'm pretty sure that most people would go the life extension. This is one of the reasons that the percentage of GDP spent has risen - People can make that spend and they are electing to.
Posted by: TonyG on May 16, 2009 05:35 PMAs for my comment that healthcare dollars aren't being used efficiently, my support for that is our per capita spending that is much higher without achieving measureable improvement in outcomes while leaving many people without coverage or with incomplete coverage. Poorer results at much higher cost -- I think that's a pretty good example of inefficiency.
TonyG: Please read my comment more carefully. I didn't say that private insurance was paying a significant part of coverage for the uninsured. I said that people with private insurance were paying for care of other insured persons which is definitely true because that's the way insurance operates. I said that taxpayers were already paying for the care of uninsured persons -- and that is also certainly true.
Are you really saying that the reason the government spends my tax dollars inefficiently is that they don't have enough tax dollars?
No.
Posted by: scottd on May 16, 2009 05:40 PMHis basic point is that his healthcare plan costs $3,600 a year (and he has a pre-existing condition) so, if you just took the 47 million uninsured at face value (which to be clear it isn't anywhere near that once you take people making the choice to be uninsured out of it) then you could provide them with coverage for $169 Billion.
So which plan would you want to adopt?
The "universal healthcare" which will cost $2 trillion dollars, well actually $3 trillion given the 33% waste, or the $169 Billion one?
I'd vote for no changes myself but if I had to pick one then, I'd say "let's try out the one that costs only 6% of the other".
Posted by: TonyG on May 16, 2009 05:48 PMMaybe the problem is that Government is involved? Get Government out of insurance and I'd wager you'd see costs slow down or even reverse.\
HOPE AND CHANGE!
Posted by: Shanghai Dan on May 16, 2009 05:50 PMWrong. I made no such assertion. What I did say is that Canadians are coming to the U.S. for their healthcare. This is a fact, even if it conflicts with your theoretical world, scott.
Unless you can show that the number of Canadians doing so is significant, you haven't made your case.
It doesn't matter what the number is. The reality is that some Canadians have decided that rather than wait on their own inefficient "government run healthcare plan", they would instead come to America for their healthcare needs. Bury your head in the sand all you like scott, these facts are undeniable and we both know it.
Now, about that model we can turn to as an example for efficient government run national healthcare? Will that be forthcoming, scott?
Posted by: Rick D. on May 16, 2009 05:52 PMMedian household income in the US is about $50K, yet it certainly costs more $2700/yr (5.4%) to provide healthcare to the average family. In many cases, part of that care is paid by employers. Someone who was unemployed, between jobs, covered by a stingy employer, or self-employed would have to pick up the entire tab -- and that is much more than $2700/yr for a family -- especially when co-pays and deductibles are added.
Your comparison of $2T to $169B is also sloppy. Estimates of Obama's plan run around $1.5T to cover the uninsured for 10 years. This works out to $150B/yr, roughly the same as the $169B you offered as an example for paying for individual coverage for 47 million uninsured people.
Posted by: scottd on May 16, 2009 06:03 PMEvery private health insurance group pays to cover people in it's group, as you said that is how insurance works.
Right now everyone in that group pays the same amount to recieve the same coverage. There is no way that can happen in a single-payer model. Either I will pay more than I'm paying now so that other people can have coverage or I'll recieve less care than I get now.
That was the basis of my original comment. I'm happy to concede the point of a lack of clarity in my first comment.
However the point remains that a single payer or universal model will result in either an increase in what I pay now to bring people into my coverage group or a decrease in my level of care, which I view as paying more for less.
Let me know if that doesn't help provide the clarity I lacked originally. I don't think it changes the point of my comment just the amount of snark in it.
Posted by: TonyG on May 16, 2009 06:05 PMIn scottd's world of theoretic impossibilities, employers will continue to subsidize their employee's healthcare, which of course, they won't since healthcare would now be "nationalized".
Why this reality is lost on so many of the proponents of "nationalized healthcare", I don't know.
Posted by: Rick D. on May 16, 2009 06:15 PMIt doesn't matter what the number is.
Make up your mind. If the number is very small, then it doesn't mean anything. If it's large, then prove it. You're the one arguing that there is something wrong with the Canadian health care system -- you just haven't shown it. A few anecdotes doesn't prove a thing about a system that successfully cares for millions.
Now, about that model we can turn to as an example for efficient government run national healthcare? Will that be forthcoming, scott?
I've already provided an example of nationalized health care that is more efficient than our own system. In Canada, the per capita cost is almost half of ours and the statistical measure of Canadian health is no worse than ours. In some measures, it's better and they cover nearly everyone. That's more efficient. You may not like it for other reasons, but on average, it is more efficient.
Tony: Thanks for the clarification and no problemo with the snark -- it flows both ways :-)
I'd like to respond in more detail, but I need to run for now...
Posted by: scottd on May 16, 2009 06:16 PMLet's deal with the first. There is a healthcare crisis because of the amount people spend on healthcare.
The typical American household spends 5.4% on healthcare (Greg Scandlen, The Reason Foundation, Jan 2007). So the statement that "There is a spending crisis on healthcare" is provably false. Currently there is as much a household spending crisis as there is a clothing crisis.
The second point is that the argument that there is a crisis because of the amount of uninsured that exist in the US and therefore we should change the entire system. This is where the the comment on the $169B versus the proposed change comes from.
Obama propose spending anywhere from 1.6T (Urban Institute and Brookings Institution, Tax Policy Center, updated September 12, 2008) to 6T (Health Systems Innovations Network, August 21, 2008). the 2 trillion value seems to be the consensus number (ignoring the waste problem inherent in government programs).
Under the rosiest economic analysis of his plan he will reduce the 47 million uninsured to 20.4 million (Lewin Group, 2008).
This 2T spend doesn't even solve the problem that is claimed to exist so that the solution is needed and where are you actually going get this 2 Trillion from? The deficit is already approaching 2T, the bond markets have just required higher interest rates to finance the bonds. The news is reporting that the US may lose its AAA rating.
We can do one of 2 things:
Swallow the entire 2 trillion dollar plan upfront because you're spending that money (r4egardless of the 10-wave hand wave) or you could actually just go out and buy the uninsured healthcare for a year and see how it goes.
I personally would prefer to commit on 6% of the spend to see what happens then commit the entire 100% with no assurance that the costs won't go up.
There is certainly math problem, my mistakes not withstanding, and the problem is in the single-payer plan/universal coverage. You just can't work the figures to make it a cost beneficil change.
Posted by: TonyG on May 16, 2009 06:43 PMI simply stated a fact. Whatever you took from that is your interpretation, not mine. Do you contest the fact that Canadians are coming down here for their healthcare?
You're the one arguing that there is something wrong with the Canadian health care system -- you just haven't shown it.
If there is nothing wrong with the Canadian government run healthcare system, would there be Canadians fleeing to the states for their healthcare, scott? I think not.
A few anecdotes doesn't prove a thing about a system that successfully cares for millions.
Tell that to the Canadians that turn to the states to provide a free market healthcare system.
I've already provided an example of nationalized health care that is more efficient than our own system.
No you haven't
In Canada, the per capita cost is almost half of ours and the statistical measure of Canadian health is no worse than ours.
I must have been vague. I thought it was implied that I wanted a U.S. government run model and you still have yet to provide one- your thoughts, scott? Pointing to Canada's failed "government controlled health" system is hardly making your argument for it here any more credible.
In some measures, it's better and they cover nearly everyone. That's more efficient.
Then it shouldn't be a problem pointing to a U.S. program comparable to what you'd like to see happen with 'nationalized healthcare'. I still hear crickets,scott.
You may not like it for other reasons, but on average, it is more efficient.
That's not what you said @ 15 scott. Should we review your own words?
____________________________________________
Scottd's confused world of logic at a glance:
@ 15: "your dollars just aren't being used very efficiently and the coverage for the uninsured is spotty and often inefficiently delivered."~ scottd
@ 35: In some measures, it's better and they cover nearly everyone. That's more efficient. You may not like it for other reasons, but on average, it is more efficient.~ scottd
So inefficient and "sloppy" coverage of 100 million would somehow miraculously become "efficient" once an additional 200 million are added to the system.
The idiocy in this logic is simply mind boggling.
Posted by: Rick D. on May 16, 2009 06:44 PMhttp://www.ibdeditorials.com/IBDArticles.aspx?id=270338135202343
and
http://physicianonhealthcare.blogspot.com/2008/03/httpwwwthenewstribunecomopinioninsights.html
The second link from from an editorial posted in the News Tribune about two years ago.
We do not need a 'Single Payer' health care system
Posted by: Tim on May 16, 2009 06:47 PM33 million people live in Canada. Currently there are 800,000 on waiting lists for surgery etc. 15 Years ago in Canada the time between referral from GP to specialist was 9 weeks. It is now more than 18 weeks. (Brian Day, past president of the Canadian Medical Association said "is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.").
The OECD rates Canada as 24th out of 28 in terms of doctors per 1000 people. Before the government took over the healthcare system they were 2nd.
Today 10% of all Canadians are unable to secure a GP. It has gotten so bad that Nova Scotia has instituted a lottery to allocate GP slots for people.
Canada is 13th out of 24 in access to MRI machines and 18th out of 24 in access to CT Scanners.
I don�t know how many people come over the border for health care but these details seem to make the statement that the system is pretty poor.
Rick: You're really having a hard time keeping track of things.
Here's what you asked for:
Now, about that model we can turn to as an example for efficient government run national healthcare? Will that be forthcoming, scott?
I even posted it directly above my response to make things easier for you. I responded by providing an example of efficient government run national healthcare. If you wanted something else, you are going to need to ask for it more clearly, but you'll need to do it some other day because I've run out of time.
Posted by: scottd on May 16, 2009 07:11 PM"I've already provided an example of nationalized health care that is more efficient than our own system. In Canada, the per capita cost is almost half of ours and the statistical measure of Canadian health is no worse than ours. In some measures, it's better and they cover nearly everyone. That's more efficient. You may not like it for other reasons, but on average, it is more efficient."
Canadian Doctors at the links I provided have already derailed your preferences. Do you have any others?
Posted by: Tim on May 16, 2009 07:19 PMPerusing the threads I found:
@18: Not one Government run program can be pointed to as a success in this country. Maybe you can point us towards just one that would serve as an example of how healthcare could be made better with Government at the helm.
@ 25 [Unlike scott], who won't answer which government run program can be pointed to as a success story and could serve as a model for nationalized healthcare in the U.S.
TonyG's provided some good statistics as to how failed the Canadian system is, scottd. Your thoughts if we attempt to increase those numbers tenfold when 304 M are under a "single payer" system?
We all saw the failure of our wounded warriors at Walter Reed and some of us vets have seen how bad the VA can be up close and personal and if that is not enough ask any military spouse about their experiences with the military health care system.
Posted by: TrueSoldier on May 16, 2009 07:37 PMTime to quit obfuscating, scott. We're all grown ups here. If you can't answer the question, then just say so.
Posted by: Rick D. on May 16, 2009 07:42 PMRanking the number of MRIs per capita doesn't tell you much either. Does Canada have enough MRI machines? If they don't have enough, why doesn't that seem to have a negative impact on life expectancy or disease rates? Would they have enough if they spent as much per person as we do in the US?
And, of course, there are other statistics that you did not mention. For example, what is the percentage of uninsured persons in Canada vs. the US?
Quoting some physicians in Canada who do not like their system can easily be countered by finding similar essays written by Canadian physicians who think their system is fine.
I guess my point is that there are plenty of arguments to be made either way. You have the opinion that Canada's system is a failure, but many others disagree. The problem conservatives are having is that their old argument that everything is fine here is becoming less and less persuasive to more and more Americans because their own direct experience contradicts this. (This is certainly true for me and many people I know.) The same is true for more and more American employers because they have to bear much of the rapidly escalating costs for a system that is satisfying fewer and fewer.
You can argue all you want about the number of MRI machines in Nova Scotia, but more and more people aren't going to care because the current system is not working for them. I also think that trying to convince people that Canada and Western European citizens are living in some kind of healthcare catastrophe is becoming less persuasive because we can see with our own eyes that their citizens are not living shorter, more diseased lives. And, we can also see for ourselves that one of the major causes of personal financial insecurity in the US is simply not an issue in these other countries.
I'm not trying to convince you otherwise. As I've said, you have your own opinions. But, if you are wondering why this issue is gaining traction in the US, you might consider what I have written.
Posted by: scottd on May 16, 2009 08:19 PMFalse. 96% of Americans have some form of health insurance. Many of those without health insurance have opted out (young and stupid) and would rather have the additional cash in their paycheck.
Posted by: Rick D. on May 16, 2009 08:33 PMSince your posts at 15 and 35 contradict your own point, I'm not sure why you continue to stand by your flawed assumptions.
There's a good chance we may wind up with some kind of healthcare reform soon. Maybe it will be single payer. I hope it at least includes a government sponsored option similar to what is provided to members of Congress and other govt employees. I don't mind paying for this either directly or through taxes. I understand that I will pay for it one way or another. This reform may come to pass, or it may not, for now. Arguing with you isn't going to affect the outcome one iota.
If you are interested in why so many people are pushing for this, you might find my opinions interesting. If not, that's fine with me, too.
Posted by: scottd on May 16, 2009 09:01 PMThe problems mentioned in the links I provided are primarily that medical care in Canada (and other 'single payer' countries) is rationed because the governments do not have enough money to pay for everyone's coverage and timely care. As I mentioned @43, we do not need a nationalized health care system similar to Canada as that system has proven faults and that hopefully, the President and Congress will take the best of health care systems worldwide to create a workable system for the United States which will not be a 'single payer' rationing system.
I sincerely hope that they can come up with a system that will work within a reasonable budget so health care is not rationed and that we will not spend Trillions of dollars doing so which will only cause hyperinflation and will also result in the US currency being devalued to the point we are no longer a world leader.
Posted by: Tim on May 16, 2009 09:09 PMStill no answer about your model, scott? That speaks volumes as to its viability.
If you are interested in why so many people are pushing for this [nationalized healthcare], you might find my opinions interesting.
So "many people pushing for this"? Apparently you live in a dreamworld, scott...and no, your views are hardly "interesting".
Posted by: Rick D. on May 16, 2009 09:12 PMI disagree with you regarding single payer -- but I also think there are alternatives to single payer that will still be better than what we have now. I certainly agree with your hope that the President and Congress will take the best of systems worldwide and create a workable system for us.
Here's to good luck for all of us!
Posted by: scottd on May 16, 2009 09:18 PMon average, govt workers make MORE than their private counterparts, have MORE time off, retire earlier, have BETTER insurance, and I could go on....
govt worker class.....its like Russia anymore.....
Posted by: lee on May 16, 2009 10:31 PMon average, govt workers make MORE than their private counterparts, have MORE time off, retire earlier, have BETTER insurance, and I could go on....
govt worker class.....its like Russia anymore.....
Posted by: lee on May 16, 2009 10:31 PMYour comment "Ranking the number of MRIs per capita doesn't tell you much either. Does Canada have enough MRI machines? If they don't have enough, why doesn't that seem to have a negative impact on life expectancy or disease rates? Would they have enough if they spent as much per person as we do in the US?"
This hits the exact point that I�m making, on every truly objective statistic the US healthcare system out performs the Canadian & European ones.
As I said earlier in the thread, if I had cancer I would have a 20% better chance of living 5 years in the US system than the others. Survival rates for breast cancer in the US are 83.9%, in Britain only 69.7%. For prostate cancer the rate in the US is 91.9% and in Britain a meager 51.1%. You are 35% more likely to survive colon cancer in the US than in Britain.
Once you account for homicide and car accidents, both not healthcare issues, people in the US outlive every other western country (Robert L. Ohsfeldt and John E. Schneider, AEI Press, October 3, 2006).
The two issue most commonly used to say the outcomes are better elsewhere are the WHO ranking of overall healthcare and infant mortality are both willfully misleading. The WHO study gave 25% of its value to "fairness" of treatment. It was more important to treat people fairly rather than well. With infant mortality it is highly dependent on the definition of live birth. In France for example any baby born at less than 26 weeks is automatic registered as dead. In Switzerland any baby less than 30 cms long is defined as dead. The US uses the WHO definition of any baby showing breathing or other signs of life as live. These babies of course have an exceptionally high mortality rate and that borks the statistics.
Now to be clear, I agree with you � I think there are huge problems in the US system that need to be corrected but that correction can only come from less government interference in the system not more. A move to single-payer/universal healthcare will further reduce the quality of care in the US not enhance it.
A great example of this is laser eye surgery - This is a procedure that is generally not covered by either the government or private health insurance. In this case the free market has reduced the price of the surgery nearly 40%. The free market drives costs down; a government controlled market drives prices up and introduces artificial scarcity.
I would characterize the current debate as being one where people expect to get the same quality of care but just not pay for it. Once people experience the realities of socialist medicine they�ll rapidly wish for the system to return to where it is. Much like the governments of Britain and Quebec that are now looking for more private involvement in their systems and thus are moving away from the socialist model.
There are many ways the US healthcare market can be improved and I'd love to see it happen. The path that Obama and the Democrats are taking is guaranteed not to deliver that.
http://www.statistics.gov.uk/cci/nugget.asp?id=861
http://www.cancer.ca/canada-wide/about%20cancer/cancer%20statistics/canadian%20cancer%20statistics.aspx?sc_lang=en
give you fundamentally different answers, and are actually sourced from the agencies collecting the data.
But even those interpretations can be wrong, given differences in demographics. So instead, if you take a look at this study:
Michel P Coleman, Manuela Quaresma, Franco Berrino, Jean-Michel Lutz, Roberta De Angelis, Riccardo Capocaccia, Paolo Baili, Bernard Rachet, Gemma Gatta, Timo Hakulinen, Andrea Micheli, Milena Sant, Hannah K Weir, J Mark Elwood, Hideaki Tsukuma, Sergio Koifman, Gulnar Azevedo e Silva, Silvia Francisci, Mariano Santaquilani, Arduino Verdecchia, Hans H Storm, John L Young and the CONCORD Working Group, Cancer survival in five continents: a worldwide population-based study (CONCORD), The Lancet Oncology, Volume 9, Issue 8, August 2008, Pages 730-756.
which adjusts mortality rates for differences in ethnicity and age, you get a different picture.
In fact, what is first quite noticeable in this study is that Britain's survival rates for pretty much EVERYTHING are crap. You'd be better off in Italy, in fact! Britain is probably the worst out of the ENTIRE batch in Western nations, and only useful if you're making a comparison to prove that "socialized" medicine is bad -- even if the system in Britain is substantively different than those in other countries, and those reforms proposed for the US. So given that conservatives aren't too willing to compare the US to Japan, I would say that the British comparison is more tinkering with the data than making an actual honest analysis.
For colon and rectal cancer, if you look at countries like France, Canada, Japan, Australia, and others, you notice comparable or superior five-year adjusted survival rates. With breast cancer for example, the US survival rate (83.9%) is reasonably comparable to those in Canada (82.5%) and Japan (81.6%). Both have "socialized medicine". Japanese men have greater survival rates than American men for colon and rectum cancer, and French women have greater survival rates than American women for colon and rectum cancer. France also has "socialized medicine", by the way.
With prostate cancer, yes, the survival rates in the US are much higher than anywhere else in the world, meaning that it is also the perfect statistic to tag if you're interested in bringing down the idea of government-sponsored healthcare. Of course, the highest adjusted survival rates are in places like Michigan (~100%), Seattle (95%), and Utah (93.7%), while the lowest on the other hand are in New York City (81.6%) and San Francisco (89.5%). These lower rates are still comparable to rates in British Columbia (89.3%), for instance.
The question as to why prostate cancer survival rates are so high can be answered with one thing: the prostate-specific antigen (PSA) test. It is much more common in the United States than in other countries, and early detection can have a positive impact on survival.
That's fine... but at what cost? The PSA test has a high false positive rate, and in many cases even if a man has prostate cancer it may not be a problem during his lifetime. With more invasive and aggressive testing and treatment, there may be some pretty substantive costs, physical and financial, involved with the American approach. So saving an extra 30,000 lives or so every year may be great, but does it make for an efficient public health outcome? Boiling it down to a single number just doesn't jive with what may be going on with real outcomes.
But the biggest problem, though? You're basing your comments about the success of the American system on a sample of ONE. Find me an equal sample of countries that follow an idealized libertarian model, including those with incomes comparable to, say, Estonia, compare those outcomes with ones in countries WITH socialized medicine, and then we can talk about how the free market is a factor for success. On the other hand, we have problems within our system that can be addressed in part by reforming the role of government in healthcare in ways that other countries have been doing for years. Taking lessons from those successes seems better than assuming that the "invisible hand" of the market is always automatically a better caretaker.
Posted by: demo kid on May 17, 2009 02:37 AMAnyone with a brain knows someone will pay BIG TIME for any government social program, and it won't be college students, old-money limousine liberals, welfare recipients and illegal aliens. It WILL be those who work for a living and pay taxes. So it would be simply another case of those who DO NOT have to pay for social programs having the most to gain from their implementation.
So, raise your hand if you've grown weary of paying for government handouts to non-producers.
Posted by: Saltherring on May 17, 2009 07:28 AMAnd I sure don't need a union with thuggish fat cat leadership to force politicians and taxpayers to pay me way more than my services would otherwise be worth.
As long as Democrats continue to create a culture of entitlement with emphasis on driving away private business, while simultaneously growing government, the cost equation will only get worse. Some people just can't get it through their heads that real value has real costs. Why do we expect people to pay for a new computer, but don't expect them to pay the premiums on a health care policy? If everyone simply paid in to a reasonable insurance model to cover themselves, there would be more than enough money to cover healthcare. All of these government employees need to start making $100K a year, minus their portion of their healthcare expense.
Because eventually there won't be enough people like me, to pay for the people in this article. And then where will the Democrats go to find more money to fund their buy vote schemes?
Posted by: Jeff B. on May 17, 2009 07:50 AMThat study found that cancer survival was up to 10% better in the US than Europe. IN fact the conclusion of the investigators was that the difference in survival rate was attributable to the spending on healthcare difference rather than statiscal capture methods.
Doesn't say what you think it did does it. No suprise there.
It's also interesting that rather than comment on the demographic controlled paper by those two economists, who take great pains to point out that the raw data is influenced by things other than helathcare, you want to cite the raw data so that you can use that difference to make your point.
Even you conceed that the British model, which looks a lot like the end game for "universal healthcare", is wrong but yet you're desperate to head straight to it.
Posted by: TonyG on May 17, 2009 08:49 AMWhy should employees have to pay at all?
Why not freeze/cut pay at King County offices versus closing offices and not offering services to King County residents like Seattle where Greg Nickels closed the librairies oover Christmas break when there use would increase by families?
We really need to consider mandatory health insureance like we have auto insurance
Since hospital ERs cannot turn people away and we end up subsidizing the write off, it may be less expensive to have the govt pay for the these inviduals preventive care
These individuals could then "pay" for their insurance in CCC and other types of programs
Medicare/aid insurance payments are processed by insurance companies like "The Blues", Nationwide, Aetna, et al based upon competitive bidding hence if you put in "nationwide" insurance, the insurance companies would hire more people to process the claims thus creating jobs and tax revenue
Katomar: Obesity appears to have greater medical related costs than smoking so what is the difference between "penalizing" people who smoke vs overwieght people?
Michelle: What type of small business do you run? Is it reputable or a multi level marketing deal? Do you pay FIT and State and local B & O tax?
Pope: Thanks for posting. I don't always agree w/ your comments, but they are withwhile
Ron: Thank you for raising the question. My only concern was it became a 40 comment "duel" between 4 posters
No, what I am saying is that you outlined statistics from sources that are not reliable and derived from exactly that perspective. This paper not only presents reasonable one-to-one comparisons with a peer-reviewed publication, it can also describe why some outcomes are different.
And I'm not claiming that the US system is BAD. I agree with you that personally, I'd much rather be in the US than Britain for any type of medical care. My argument though is that it is a flawed comparison without the proper context, and you're not proving what you think you're proving.
That study found that cancer survival was up to 10% better in the US than Europe. IN fact the conclusion of the investigators was that the difference in survival rate was attributable to the spending on healthcare difference rather than statiscal capture methods.
Again, I agree, but you're ignoring that: a.) increased spending on care is only possible if you have the increased money to spend, b.) "up to 10% better" doesn't mean "consistently 10% better across all categories" or that the system is efficient, c.) some of that difference has to do with protocols rather than expenditures, and d.) you haven't presented a good counter-example where a socialized system pumps in as much money into healthcare as the US does and gets worse results.
Doesn't say what you think it did does it. No suprise there.
On the contrary. When you quoted studies above, you state that "if I had cancer I would have a 20% better chance of living 5 years in the US system". Now, you're stating that it's "up to 10% better". You're using statistics from Britain to disprove that government-supported healthcare is a solution, I'm stating that Britain is an outlier compared to France or even Italy. You're using one cancer as proof of the success rate of an entire system, I'm explaining why there is a vast discrepancy in survival rates with that ONE type of cancer.
You're the one inflating faulty statistics to make a point.
It's also interesting that rather than comment on the demographic controlled paper by those two economists, who take great pains to point out that the raw data is influenced by things other than helathcare, you want to cite the raw data so that you can use that difference to make your point.
That's a mess of a claim, and I'm not sure which "statement" you're referring to. I'm arguing that for higher healthcare costs, we're not getting grossly higher outcomes except in certain situations where it is more a matter of differences in protocol. If you're truly concerned about healthcare, and not whether one type of cancer is treated better in the US than anywhere else, diverting resources to prostate cancer screenings over, say, prenatal care seems like an inefficient use of money.
Even you conceed that the British model, which looks a lot like the end game for "universal healthcare", is wrong but yet you're desperate to head straight to it.
Let me repeat this again: the British model has not, and will not, be proposed in the United States. Ever. The US is NOT proposing to nationalize the healthcare industry.
Posted by: demo kid on May 17, 2009 12:17 PMSure it is. What reality are you living in?
@72 - The claim @67 that "give you fundamentally different answers, and are actually sourced from the agencies collecting the data.
But even those interpretations can be wrong, given differences in demographics."
Demographics was the point I was making. The study the economists conducted corrected for demographic differences. Once that correction was undertaken the life expectancy of someone in America exceeds those in Europe.
So there is provable differences in outcomes based on the analyzed data that is 180 degrees different from what the uncorrect data shows.
--
From @72 "No, what I am saying is that you outlined statistics from sources that are not reliable and derived from exactly that perspective. This paper not only presents reasonable one-to-one comparisons with a peer-reviewed publication, it can also describe why some outcomes are different."
These are two differrent issues. The raw data you quoted shows must be corrected for demographic differences. As above once that is done the US outcome is better.
The issue that is addressed in the paper you quoted is the claim that you need to correct for the different statistical methods between the US and other countries to have a fair comparison.
That paper found, once you made that correction that again the US system provided an up to 10% higher survival rate for the US over over countries.
Both studies were published in the same peer reviewed publication. I haven't seen any study that attempts to meld the two works together. let me know if you have.
--
As for your quote @72 "You're the one inflating faulty statistics to make a point", the original work I quoted showed a male had a 20% better chance of surviving post diagnosis in the US than in Europe. A woman has a 7.2% chance. You chose a different study to claim "which adjusts mortality rates for differences in ethnicity and age, you get a different picture.".
Yes the different picture in this study says men and women have an up to 10% better outcome rate than every other country in the world.
So the "different picture" is that the US is still better just maybe not as much. I think that pretty much backs up the claim that the US system provides better outcomes that any other system in the world.
--
Now let's get to the point I think you were trying to make in the first post but wasn't clear to me until your clarifying one.
Do the differences in costs for the US system over others appear justified by the differences in outcomes.
I think you're making the bang for buck agrument.
As I said in @24, outcomes don't follow spending in a linear fashion. The authors of the study you quoted also support that point saying that the improved outcomes in the US come from the larger spending the US does.
Once you get down to this the positions we hold are "I don't think the spending is justified so we should limit it" and "I think the outcomes justify the cost".
As I said above I think the US system can be improved, however doing so doesn't mean move government involvement but less.
--
Finally I use the British system as an example of where socialized medicine will end up, the British didn't start to design the worlds worst healthcare but the inevitable outcome of socialized medicine certainly forced them there.
That is the danger this proposed change faces.
Posted by: TonyG on May 17, 2009 12:54 PMNow I see that you're getting your statistics from ONE source:
http://www.fmaonline.org/pages/news/pwr/020209.html
And as I said, they're incorrect.
Demographics was the point I was making. The study the economists conducted corrected for demographic differences. Once that correction was undertaken the life expectancy of someone in America exceeds those in Europe.
No, you're arguing that factoring out motor vehicle accidents and homicides means that life expectancy rates are higher in the US than in other countries, NOT that demographics have been controlled in the study. Fine... but why just MVAs and murder? Why not suicide, for example? And how MUCH different are life expectancy rates then? This all seems too selective and convenient, and I have to admit that I'm a little suspicious of the accounting from a book published specifically by a right-wing thinktank.
So there is provable differences in outcomes based on the analyzed data that is 180 degrees different from what the uncorrect data shows.
Until you can link to the methodology, pardon me if I don't trust your source. I'm not going to buy their book to make your argument for you.
These are two differrent issues. The raw data you quoted shows must be corrected for demographic differences. As above once that is done the US outcome is better.
They ARE corrected for demographic differences, and yes, no one is denying that the US outcome is close to the top in most categories of cancer survival rates on average. No one is denying that. But that's only part of the story: looking at health expenditures, differences in income, equitable treatment, and so forth are all important. You cannot run effective policy simply by looking at the average alone, especially when comparable survival rates for African-Americans in the US are drastically lower.
That paper found, once you made that correction that again the US system provided an up to 10% higher survival rate for the US over over countries.
"Up to" a 10% survival rate, yes. But AGAIN, how do French women survive breast cancer at virtually the same rates as in the American system?
Both studies were published in the same peer reviewed publication. I haven't seen any study that attempts to meld the two works together. let me know if you have.
No... it's EXACTLY THE SAME STUDY. Look at that Pipes pamphlet, and the list of references. Overall, she does a great job in saying that the US is on top... it's just that she doesn't tell you by how much.
So the "different picture" is that the US is still better just maybe not as much. I think that pretty much backs up the claim that the US system provides better outcomes that any other system in the world.
"Outcome" measured in what way? I'm certain that if we were to allocate 50% of our resources to health care, we'd get markedly improved results even over this... but we'd be neglecting plenty of other issues as well. Health policy needs to consider efficacy and equity as well as raw numbers.
As I said in @24, outcomes don't follow spending in a linear fashion. The authors of the study you quoted also support that point saying that the improved outcomes in the US come from the larger spending the US does.
True; they don't control for income. But they're also looking a ONE health issue too, don't forget.
Once you get down to this the positions we hold are "I don't think the spending is justified so we should limit it" and "I think the outcomes justify the cost".
No. What I'm saying is that you can get better outcomes if you throw enough money at any problem. On some level, that's fine; I don't care if you spend all of your life's savings on a hyperbaric chamber or preventative surgery. But if you're looking at the DISTRIBUTION of outcomes, both health-related and financial, there are problems. Likewise, averages make for a poor assessment of the true impacts of medical issues.
As I said above I think the US system can be improved, however doing so doesn't mean move government involvement but less.
And I think that relying on the free market will be a nightmare. A "well-functioning market" depends on sufficient regulation and government oversight. Are current institutions "well-functioning"? Definitely not. They should be reformed. But assuming that an unfettered free market is the only way to medical salvation is just that: an assumption.
Finally I use the British system as an example of where socialized medicine will end up, the British didn't start to design the worlds worst healthcare but the inevitable outcome of socialized medicine certainly forced them there.
Again, cherry-picking. Why not compare the US to France, or Switzerland for that matter? It's easy to pick on the outlier, but Britain is NOT a comparable situation.
Posted by: demo kid on May 17, 2009 02:20 PMI appreciate the arguments that scottd are making. He is truly intellectually honest and not interested in labeling things like other posters here.
Conservative commentators: the entire country believes there is a health care crisis. Simply put, you cannot deny it without seeming out of touch (see Frank Lutz memos).
This talk about a single-payer system is cute but irrelevant. No one will be proposing a single-payer system anytime soon.
The health care reform plan is still being constructed but here will be the major parts:
- Maintaining choice: if you like your current health care plan, then keep it. Keep your doctor.
- Electronic records and other effectiveness to decrease health care's cost growth
- Sane limits on medical malpractice suits
- An individual responsibility to acquire health care so taxpayers don't have to cover the uninsured's hospital bills
- Because insurance companies will insure more folks, the risk will be pooled and shared leading to lower premiums for everyone
- Subsidized health care plans for the poor
- Health insurance can no longer discriminate coverage based on pre-existing conditions
- A public plan available to everyone. Anyone who isn't poor will have to pay full, market-rate
- The health care plan will be revenue neutral -- no deficit spending.
We can bemoan the Democrats all we like, but clearly the overwhelming majority of King County voters want nothing to do with the potential benefits of a Republican led government.
Shall we blame the voters for Republicans not being competitive? Shall we blame John McKay for not indicting Sims?
Or maybe Washington conservatives can take an honest look at themselves and realize we need to first get our s__t together?
Cripes, even New York city was able to finally oust corrupt and ineffective Democrats in the mid 90s!
John - your comment:
"The health care plan will be revenue neutral -- no deficit spending."
means
health care rationing which has proven not to work in Canada
Posted by: Tim on May 17, 2009 04:11 PMWhat does Canada have to do with anything?
Posted by: MikeBoyScout on May 17, 2009 04:17 PMhttp://www.kcgop.org/sitemax/Portals/0/documents/KCGOP_Platform_2008.pdf
Yeah! This is going to fire up people who have been voting for Democrats all their lives and get them to change!!! It is poetry i tell you! ;-)
Posted by: MikeBoyScout on May 17, 2009 04:42 PMNever saw that webpage before - However it appears that this page is just a write up of the event. You can read their research free of charge here.
I'm sure you wouldn't want to spend the time reading that so can you provide a citation that shows their analysis is wrong? Until then we'll just have to work assuming that it's your opinion that they're wrong.
Your quote "They ARE corrected for demographic differences" - No they are not. The first link you provided to the British numbers doesn't even mention the US - These numbers have not been corrected to provide a comparable basis.
The second link you provided is also not corrected. They are Canada numbers only - Again the USA is not mentioned at all in the PDF.
Now we know you undertand this because your quote ""Outcome" measured in what way? I'm certain that if we were to allocate 50% of our resources to health care, we'd get markedly improved results even over this... but we'd be neglecting plenty of other issues as well. Health policy needs to consider efficacy and equity as well as raw numbers."
If the data backed up your claim you would not need to make the outcome/spend argument.
So to summarize, you took country specific raw data and compared it to a corrected result set to claim that the spend doesn't generate better outcomes.
You then took a peer reviewed paper to challenge another peer reviewed paper when the one you used specifically said that the US has better outcomes and that outcome is a function of the healthcare spend.
So your argument is exactly what I said it was, you don't think the level of spending is justified for the outcome that is achieved.
Happy to disagree with you there - Your personal opinion - Fine, glad you have it. What you haven't shown with any supporting statistical data is that the healthcare system spending in the US generates no benefit above the smaller spending in other countries.
What has been shown, especially through your thoughtful provision of a second peer reviewed study, that the the quality of healthcare outcomes depends on spending. Descreasing spending decreases outcomes (who knew what you could find in Lancet Oncology).
As for total "free market", I also agree that there needs to be appropriate governmental involvement in the system but our ideas of "appropriate" are wildy different.
If the current US system was reformed to remove the distortion placed on it by the government it would perform much more efficiently. This is just my opinion. Much like your desire for universal care is your opinion.
Posted by: TonyG on May 17, 2009 04:56 PMCanada has everything to do with this subject as they are trying to be revenue neutral and as a result are only rationing their health care.
John's comment:
"The health care plan will be revenue neutral -- no deficit spending."
needs a lot better explanation as to how he expects the government to be revenue neutral and how he is planning to 'TAX' everyone to pay for medical care for everyone.
So please add a lot more details to your comments and have John do the same thing as to how you think we can be 'revenue neutral'?
Thanks!!
No, that isn't what it means. Revenue neutral means new revenue will offset the additional spending. This new spending will insure the uninsured. Right now, when an uninsured person enters a hospital he is provided the care he needs -- taxpayers, hospitals, and health insurance companies eat the loss. Insuring these folks will not only create a more equitable and safe America, it will also lower health care costs for everyone and lower costs for employers who provide health insurance. Like King County or Boeing.
I'm insured by Blue Cross/Blue Shield, and I'll be keeping my plan after the new health care legislation passed. How would the government ration health care provided by a private insurance company? It wouldn't. How has Medicare rationed health care? It hasn't.
You're using scare tactics to explain an issue you don't understand. You should go read up on the plan and come back when you have an appreciative understanding. This health care legislation is nothing like Canada's system.
needs a lot better explanation as to how he expects the government to be revenue neutral and how he is planning to 'TAX' everyone to pay for medical care for everyone.
That is not what the health care plan does. Taxes will not pay for everyone's health care. My employer will still pay for my health insurance in a manner that is unsubsidized by taxpayers.
You simply don't understand the plan proposed. You think it's a single-payer system and you are completely and utterly misinformed. No single-payer system is being proposed. Whether single-payer/Canada is good or not is another debate unrelated to the current health care legislation.
Do you think that health care in America is perfect? Why are tens of millions of people uninsured okay with you? We're the richest nation in the world, we can afford to have every American within reach of quality, world-class health care.
Posted by: John Jensen on May 17, 2009 05:49 PMWhere will 'New revenue' come from?
"Revenue neutral means new revenue will offset the additional spending."
How do you know that Blue Cross will even exist after new legislation passes?
"I'm insured by Blue Cross/Blue Shield, and I'll be keeping my plan after the new health care legislation passed. "
I am not using scare tactics but only asking very simple questions as what changes are being planned with the Federal Government planning to centralize health care.
Do you have a link to support your comment at:
"That is not what the health care plan does. Taxes will not pay for everyone's health care. My employer will still pay for my health insurance in a manner that is unsubsidized by taxpayers."
Do you have a link to support your comment at:
"You simply don't understand the plan proposed. You think it's a single-payer system and you are completely and utterly misinformed. No single-payer system is being proposed. Whether single-payer/Canada is good or not is another debate unrelated to the current health care legislation."
No our health care is not perfect but a single payer system similar to Canada would be worse. You mentioned several instances but no links to suppport your comments - please do so! As I mentioned in previous posts - "Hopefully, the President and Congress, if they proceed down the health care road, will take the best of health care systems worldwide to create a workable system for the United States which will not be a 'single payer' rationing system."
What are you proposing and what links support your comments?
Posted by: Tim on May 17, 2009 06:14 PMIt is not completely specified yet since there isn't some legislation.
I want you to keep something in mind: a plan is going to have elements to criticize, and while a complete lack of action may have less elements to criticize it would be disastrous to our nation and particularly our budget over the long-term to not address rising health care costs. Medicare will bankrupt our government without changes, and it is simply not an option to stop covering seniors in a nation where health care is tied to employment.
The taxation options may be some of the following:
- A changing the deduction from 35% to 28% for charitable contributions and mortgage interest rate for families making over $250,000
- A cap on the amount of health care benefits provided by employers that is tax-free. Actually, very similar to the suggestion in the OP for people earning > $100k to pay 2% of their health care. For most people this won't mean anything, but if your health plan costs your company $12k per-person then we may say that the top $2k should be taxed.
This provides an incentive for companies to choose lower-cost health care plans while also providing a revenue stream from the "gold-plated" sort of CEO health care plans that cost $100k. The cap would obviously be set high enough where most middle-class families wouldn't see it for obvious political reasons. John McCain supporting tax the entirety of the health care benefit amount during the election, btw. NY Times: "Some politicians of both parties, as well as many economists, say the tax break is inequitable because its benefits go disproportionately to people with higher incomes."
Further, note that the administration has hardly signaled it is a fan of this approach but is probably open to most options that provide serious health care reform.
- Perhaps some sort of tax on candy and soda, but I think that's just a rumor.
- Large companies that don't provide coverage to their employers can either provide coverage or contribute some money to the government, effectively to pay for covering their employees.
- Equivalent to revenue is saved money. A significant amount of money can be saved by making Medicare more efficient and using its dollars smarter.
- ??? There isn't a bill yet. It isn't possible to know where the revenue comes from. We have a general idea of what things would cost.
There, isn't there plenty for you to criticize? It's frankly dumb, though, because inaction isn't a problem. And I have no idea how you could fix health care without spending money. We are talking about insuring tens of millions of people. That is the greater good, and it will save us all money in the long run.
What are you proposing and what links support your comments?
I'm not going to do your basic research for you; just Google "obama public plan". The HELP committee in Senate is working on the bill right now. It simply isn't a single-payer system.
The plan is a combination of health insurance regulations such as eliminating "pre-existing coverage" denials, funding for health IT improvements and other long-term efficiency gains, a "personal responsibility" to get health care coverage, Medicare efficiencies, and a public health care plan that anyone can choose to join. Most importantly, choice is retained: if you like your current health care plan, you'll keep it.
The public health care plan will also provide subsidized coverage for those who cannot afford health insurance. Also, because it will likely be a large insurance company the costs for individuals and small businesses will be -- simply put -- a hell of a lot cheaper than typical insurance companies. Small businesses will benefit greatly by lower health care costs.
No our health care is not perfect but a single payer system similar to Canada would be worse.
We will not have a single-payer system in this country after the health care plan is passed.
I don't want to compare everything to Canada. The life expectancy and per-capita health care costs in this country are outrageous by any measure. We are paying much more and getting much less. It makes no sense. I'd rather talk about the very serious health care problems this country faces than something myopic like "omg revenue! taxes!" People die in this country because of our expensive health care system -- people with "Cadillac coverage" and those making over $250k can afford to spend a little bit more to make this country stronger and healthier.
Posted by: John Jensen on May 17, 2009 07:14 PMThanks for the source... but I'm even less convinced.
As far as the findings you quote, the model in Table 1-5 that you keep referring to takes out all of those factors that reflect negatively on the mortality rates in the United States, but there is no sense that the remaining effects are all associated with quality of medical care. Also, these are MEAN effects, and don't provide insight into distributions of outcomes amongst the population. Finally, the adjusted outcomes for the highest countries are NOT substantively different as listed here. Claiming that the US is number one is fine, but may not be rational given the errors in the model. It's cherry-picking models and then misinterpreting the results slightly to cast the best light on the conclusions that you had when you started.
With regard to the statistics I quoted, yes, those are raw numbers... but you quoted raw numbers to begin with, and those were wrong. The Lancet article has numbers that ARE adjusted for ethnicity and age breakdowns (and more up-to-date numbers, I might add), and I quoted those adjusted numbers above. And note again that this paper is QUOTED BY YOUR OWN SOURCES. But again, with the exception of prostate cancer, the fact is that for many countries the outcomes are pretty comparable. The difference in prostate cancer survival rates at this point are not because American healthcare is automatically better, it's because there are different protocols that are used, and doctors will get sued if they don't test men of a certain age.
A main objection that I have at this point is that MEAN values do a poor job of outlining the DISTRIBUTION of outcomes. Rich folks in the US can certainly afford the best care, and there are more millionaires in the US than in Sweden. But what about the folks at the lower-end of the distribution? In a number of categories, African-Americans might as well move to Europe, given that their specific survival rates tend to be lower. If you can assume that this is a proxy for socio-economic status, you might as well have a situation where mean survival rates in the US are distorted by richer people that can throw much more of their own money at the problem and get substantively better outcomes, but folks on the lower end are left out to dry.
And yes, cost effectiveness does come into play! I think that if folks want to spend $100,000 on proton treatments for prostate cancer, they should be allowed to do that. However, if all of our apparent advantages in healthcare are associated with really rich people paying exorbitant amounts of money for only marginally better outcomes, while the poor are suffering from a lack of adequate care, that needs to be addressed.
Heck, you can make the case that if you were to support lower-income and uninsured folks in a two-tiered system, outcomes would in fact be higher across the board! This, coincidentally, is the objective of "universal coverage" in the US, NOT widescale replacement of all private options with public ones.
Posted by: demo kid on May 17, 2009 07:30 PMKing County's politiburo is in favor of Government-run health care. They have also shown that they don't care if they have to resort to cramming it down the people's throats, whether they like it or not.
Posted by: KDS on May 17, 2009 08:26 PMThe vast majority of health insurance companies will still be private. The plan would create one public insurance company.
Hospitals will still be private.
Doctor's offices will still be private.
If you like your health plan, of course you can keep it. This is all about choice.
How in the world would anything be rationed with that sort of plan? Someone explain it to me, I'm simply not getting it. Health insurance companies and hospitals will still decide how much everything costs! And if a hospital doesn't want to accept the public plan or Medicare, it doesn't have to.
Medicare right now is unsustainable. We need to reduce health care costs to insure our seniors who have no other source of health care insurance.
Anything that would involve compromise and additional research is unacceptable to the current criminals in congress.
Right. Who would want research into something important like health care? This is truly what the GOP is afraid of becoming: Anti-science, anti-health care -- no to everything and anything. Truly the party of no.
Wake up. There's a health care crisis. The minority party can call politicians criminals or participate in the process and create a plan that's a good compromise.
Posted by: John Jensen on May 17, 2009 08:51 PMYour paragraph "How in the world would anything be rationed with that sort of plan? Someone explain it to me, I'm simply not getting it. Health insurance companies and hospitals will still decide how much everything costs! And if a hospital doesn't want to accept the public plan or Medicare, it doesn't have to." supports that idea because if "Health insurance companies and hospitals will still decide how much everything costs!" and the costs are too high then they will go out of business because the government will not support them - eventually we will all be on a 'medicare' system which already has funding problems and does not provide appropriate payments to hospitals or Doctors.
We can get back together on the first of June over the next five years to compare notes to see the results.
Posted by: Tim on May 17, 2009 09:10 PMOne aspect of the public plan is that it will likely not be able to bargain as freely as a private plan would be able to. In other words, there will likely be controls such that a public plan wouldn't simply set prices much cheaper than a private plan even though it could because it will have a much bigger clientele and thus a larger risk pool. Without these controls, the public plan will not pass the Senate.
I think it is a fair criticism to say that a public health care plan may morph into a single-payer system some. However, for that to take place hospitals and the public would have to gravitate toward a plan that is more efficient (cheaper) and delivers better care. If the government proves it can run health care insurance (not hospitals) better than the private sector, just as we've decided the government can run highway projects, police forces, and firefighting duties better, then I'm not sure that a massive evil will have been committed. Employers and the public will use private plans if the public insurance option begins to have queues and quotas and the other faults that are dubiously assigned to Canada's system. The core is choice.
We have public colleges and private ones. The mere existance of public schools doesn't put the private ones out of business, and I'm not convinced that a public insurance plan that allows the government to prove affordable insurance to the working class without subsidizing profits and CEO salaries is going to put private insurance out of business.
and the costs are too high then they will go out of business because the government will not support them
The private sector should then lower health care costs through efficiencies, electronic records, and industry-wide comparative research so that the right procedures are performed. "Rationing" would be a hospital choice in theory. In reality, a hospital that doesn't do everything possible for its patients will likely be breaking the law or at least exposing themselves to serious medical malpractice. In that sense, yes hospitals will have to adapt. But that is no different than private insurance company saying, "Charging $20,000 for an MRI is ridiculous. We'll pay $400." If the hospital can afford it, it will have to accept. If it can't (yet), it will have to adapt slightly and work with the insurance provider perhaps reduce payments over time while still providing the best health care possible.
The public plans cost schedules should absolutely be insulated from government pressures. An independent agency like NASA or a public company like the Post Office should be set up to make these important decisions. Congress deciding cost schedules would be a nightmare, just like having congress decide what military planes to buy is absurd.
I think the whole "Medicare prices are too cheap for doctors" is just BS. Medicaid does have that problem and it is unfortunate and will have to be addressed. The public plan will be different than both since it will cover more than just the old and the poor -- there will be a bigger risk pool.
This is a very complex problem, of course. I think we need to have an open mind. To your credit, Tim, you seem like you're open to listening and learning. Even if you don't like the final plan, it is important to know and understand our current problems and the proposed fixes. I look forward to discussing the plan here once it is proposed in early June.
Posted by: John Jensen on May 17, 2009 09:39 PMThat is ridiculous and laughable. If health care costs are unsustainable in the future, it will be rationed - duh ! BTW - the GAO made that assessment, so that shoots down your partisan argument. I await your evidence to refute this, and just because Limbaugh and the GOP said that doesn't cut it, dude.
"The vast majority of health insurance companies will still be private. The plan would create one public insurance company."
Hospitals will still be private."
Doctor's offices will still be private."
There are 45 million Americans not covered, probably 1/3 of them are non-citizens. That is the part that bankrupt us. Even if hospitals and doctor's offices are private, the government will be able to get its nose under that tent and will run those private entities, much like the banks and auto companies are being run by the government, except unlike these which are supposedly temporary, this arrangement will be more of a permanent nature.
Posted by: KDS on May 17, 2009 09:55 PMThat is completely unacceptable. Every person in this country has access to health care. When someone uninsured has an injury or illness, we pick up their tab.
That is the part that bankrupt us.
I have not seen that illustrated. The plan will cost about $150bn a year according to congressional estimates. That's a lot of money, certainly, don't get me wrong. But we can afford it. The bill will identify funding sources.
Health care inefficiencies are already bankrupting the government and the people. We need to fix this system.
Even if hospitals and doctor's offices are private, the government will be able to get its nose under that tent and will run those private entities
That's false. The government may regulate the health care industry, but this isn't something like making CD players -- health care is obviously important and just like Wall St. needs regulations so does St. James. Regulation is hardly similar to running a hospital.
Posted by: John Jensen on May 17, 2009 10:11 PMWhy should King County employees receive "free" healthcare when private and federal employees pay a considerable share?
Posted by: Saltherring on May 18, 2009 07:25 AMIf we did this across the entire country for all citizens, and opened up the insurance market to competition with some enhanced regulation, this would be both an appropriate use of government, and go a long way towards solving the problem of healthcare financing.
Doctors do not work for free. Healthcare has real costs. Those costs should be understood and paid by consumers with the assistance of insurance, just like we do for auto insurance. This spreads risk, encourages personal responsibility, etc. By removing the buyer-seller relationship, costs go out of control, individuals seek "free" healthcare, and the corruption of government wants to get in on the game.
There's no free lunch. Put the pay back in healthcare for everyone, and the problem is solved.
Posted by: Jeff B. on May 18, 2009 08:57 AMYou had it right in the first sentence. Anyone that works for "the public" should be doing their share to carry the burden for the cost of health insurance. They're a largely overcompensated group pay wise as it is compared to the private sector so it's time they started getting weened off the gravy train. Especially in particularly hard times like the state is going through now.
I think it's a little ridiculous for us to dictate what is an acceptable quality of life for another group of people just because they work in the public rather than the private sector.
How do you figure? As "public" employees, they are accountable to the public in their job capacity. If they don't like the fact that they need to contribute a portion to their health insurance like the rest of us do to assuage the cost, they can join us in the private sector and we'll welcome them to a little thing called REALITY.
Posted by: Rick D. on May 19, 2009 08:38 AMWhy? Because you say so?
This is not standard practice in the private sector. If you drain the public sector of appropriate salaries and benefits, you will have an ineffective public sector.
They're a largely overcompensated group pay wise as it is compared to the private sector so it's time they started getting weened off the gravy train.
That is laughable. Government pay is far lower than equivalent private sector pay. You're completely out of touch with reality.
You may be thinking of union benefits, but this pay cut would target only non-unionized employees.
As "public" employees, they are accountable to the public in their job capacity.
Yes, and they should be judged on job performance and not on your unjustified resentment.
If they don't like the fact that they need to contribute a portion to their health insurance like the rest of us do to assuage the cost
I have never heard of anyone in my life paying a percentage of their income over $60k to their employer. This is not a common practice.
I don't think it's an undue burden and I don't particularly object to it. What I do object to is the general sense of entitlement a lot of conservatives have to have no taxes, pay government employees at no where near competitive levels, and then get baffled when government services aren't strong.
You wonder the value of unions? Well, they don't have to face random paycuts and for the employee that is a pretty good deal. If my employer started to take away 2% of my earnings above $60k, I would be furious even though it wouldn't amount to much per paycheck.
Posted by: John Jensen on May 19, 2009 11:54 AMBecause it's presumptuous to assume that some other group that isn't related to you can take a pay cut. Why aren't you volunteering for a pay cut, Rick? After-all, most companies are struggling right now. I bet you can afford a pay cut.
These are real people who have families to support. Maybe you shouldn't be so excited for them to have less money.
Posted by: John Jensen on May 19, 2009 11:56 AMPeople in the public sector pay the same taxes as the those private sector.
If I buy a lot of Hershey's bars, it doesn't mean I should get some perverse happiness when employees of Hershey get a pay cut. "Oh joy, thank goodness that someone is getting a pay cut! My unjustified resentment succeeds in punishing another family!"
Posted by: John Jensen on May 19, 2009 11:59 AMNo, because that is the role of a public servant. Why am I not surprised you've lost touch with reality as to who the public sector serves, much like our governor.
Government pay is far lower than equivelent private sector pay.
Depends on the position. Besides, I thought you went into public service to, well, serve the public. Not because it provided equivelent pay and benefits compensation of that in the private sector.
You may be thinking of union benefits, but this pay cut would target only non-unionized employees.
Doesn't matter. They should be helping to assuage the cost of receiving those benefits, just like many of those in the private sector have to do for theirs. No free rides.
Yes, and they should be judged on job performance and not on your unjustified resentment.
I don't have unjustified resentment, but feel free to project all you'd like. Just stating a reality that some in the public sector feel they're above pulling their weight in a bloated at a time when government spending is out of control and cost need to be reigned in. Chris Gregoire increased spending 8 billion in her first term and low and behold, we have an 8 billion dollar deficit in the budget 4 years later. This isn't rocket science here JJ.
I don't think it's an undue burden and I don't particularly object to it.
Then why all your caterwauling in defense of it?
If my employer started to take away 2% of my earnings above $60k, I would be furious even though it wouldn't amount to much per paycheck.
In this case, the public is the "employer" and we need to change with the changing time as to how to help share the rising cost of health care coverage. Spread the pain around so to speak.
Because it's presumptuous to assume that some other group that isn't related to you can take a pay cut.
You're forgetting that they work for us. When we're in the hole 8 Billion because of out of countrol spending, there's going to have to be some purse tightening. There is plenty of fat in the government, so it's only logical to start there.
Why aren't you volunteering for a pay cut, Rick?
Because I'm not in the public sector and my employer isn't responsibile for an 8 Billion dollar deficit. You confuse public servants with the private sector entirely too much.
I absolutely pay for my benfits and vacations in the form of lower salary.
A conscience decision you've made.
I have the same licenses/certifications as those I regulate and I take home about 50% of their average annual earnings, closer to 35% of the best in the field.
Again, a conscience decision you've made.
I am not complaining, but don't compare my apples with your oranges without telling the whole story.
No one told you to make those conscience decisions, least of all me.
I think it's a little ridiculous for us to dictate what is an acceptable quality of life for another group of people just because they work in the private rather than the public sector.
I changed private to public and vice versa; that still hold true? Should the Government attempt to cap wages and dictate what is an acceptable quality of life?
That is laughable. Government pay is far lower than equivalent private sector pay. You're completely out of touch with reality.
Unfortunately, the facts don't support your position...
I love this little line from that last link:
Yep, twice as much for the average Government worker as a private worker! And you tell me they can't chip in for their own health costs (which pretty much everyone on private industry must do)?
I have never heard of anyone in my life paying a percentage of their income over $60k to their employer. This is not a common practice.
No, the employer just cuts your pay across the board when they have a budget deficit; either that or lay people off. Funny, neither of those are really considered by the biggest employer in the Nation - Government! They simply demand their customers pay more, regardless of whether or not the customer wants to (via taxation).
If my employer started to take away 2% of my earnings above $60k, I would be furious even though it wouldn't amount to much per paycheck.
Yet I'm sure you ALL FOR increased taxes for those evil "rich", meaning taking another 10% or more above a certain level...
Hypocrisy, thy name is DEMOCRAT!
HOPE AND CHANGE!
Posted by: Shanghai Dan on May 21, 2009 01:11 AM