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Old 10-09-2007, 01:54 PM   #41
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Brewer,
I agree there are folks in high expense areas and it may/does pose a problem. My point is that the often figure of 47M that is tossed out to justify ripping up the current health care system needs further scrutiny.

Having had this conversation on another thread with Martha and several others, I do not believe that the nations health care situation will be solved between the folks that post here. To some it is a true critical issue that affects there FIRE, to others it is just another political debate.

Will Washington solve this problem? They will try. And, it will lead to many lively conversations on this board.
47MM, 27MM or 67MM, what's the difference? It is still a very large problem. We can all lie with statistics (myself included), but the problem is still "bigger than a breadbox" regardless of whose numbers you use.

Healthcare is probably the #1 obstacle to me getting to ER. Everything else I can or have figured out. Healthcare insurance appears to be an intractable problem.
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Old 10-09-2007, 02:05 PM   #42
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Using the 47M it is 16% of the US population. So maybe a low of 4% and a high of 16%. I think it does matter. Somewhere between 84% and 96% of the US population have health care. I think this was even brought out in a recent poll where a large percentage said they thought health care was a problem, but 75% said it was not a problem for them. So for me, it's not bigger than a breadbox!

So is health care another of those topics that the press has told us is a problem and therefore we accept it as a problem. Too be sure there are people dying because of lack of health care. So do we rip up as system every time someone dies? Cell phones in cars, microwave pop corn, helmets on mopeds and bikes, where does it end?
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Old 10-09-2007, 02:10 PM   #43
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Using the 47M it is 16% of the US population. So maybe a low of 4% and a high of 16%. I think it does matter. Somewhere between 84% and 96% of the US population have health care. I think this was even brought out in a recent poll where a large percentage said they thought health care was a problem, but 75% said it was not a problem for them. So for me, it's not bigger than a breadbox!

So is health care another of those topics that the press has told us is a problem and therefore we accept it as a problem. Too be sure there are people dying because of lack of health care. So do we rip up as system every time someone dies? Cell phones in cars, microwave pop corn, helmets on mopeds and bikes, where does it end?
Healthcare is a problem for more than the people who have insurance. How many people cannot pursue a potentially lucrative opportunity because they are tied to the job with benefits? How many live in fear of losing a job because they will lose access to healthcare?

And then there is the problem of healthcare cost inflation. How large a proportion of GDP would you like healthcare to account for? 25%? 35%? 50%? More? Because at current rates of cost inflation, that is where it is headed, assuming that the vast majority of the population (as you believe) maintains access. More likely, somewhere along the way an increasing number of people will get priced out, and healthcare spending will get reined in as a % of GDP simply because fewer and fewer people can pay the freight.
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Old 10-09-2007, 02:16 PM   #44
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somewhere along the way an increasing number of people will get priced out, and healthcare spending will get reined in as a % of GDP simply because fewer and fewer people can pay the freight.
Then we'll be back to charity patients and 1st year interns polishing their surgical skills without much in the way of bothersome supervision.

Ha
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Old 10-09-2007, 02:18 PM   #45
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Then we'll be back to charity patients and 1st year interns polishing their surgical skills without much in the way of bothersome supervision.

Ha
Sounds like a "top notch healthcare system", does it?
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Old 10-09-2007, 02:18 PM   #46
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Tell me how you propose to FUND this without dramatically increasing taxes, and I am all EARS.........

BTW, Wisconsin's legislature is fighting over this right now. Our democratic governor is proposing "care for averyone", and funding it by raising the payroll tax 3-3.5% for all companies.......

Oh, and the other thing, we would get to move from the EIGHT most taxed state, to Number ONE.........boy am I psyched!!!
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Old 10-09-2007, 02:18 PM   #47
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My view of healthcare is this:

The healthcare system in the US is the best in the world! if you have enough money to afford it that is... If I was a milionnaire living anywhere in the world and I was diagnosed with a rare or terminal disease which required top notch care, I would without a doubt come to the US to be treated. But the problem is not every US citizen can afford to use that great healthcare system and there is no alternative for those people.

In my opinion healthcare is a matter of compassion. It is the moral obligation to help those who suffer when we have the power (and technology) to do so, no matter who they are or how much they make. Cost should never be the first consideration. With a private healthcare system cost is always the first consideration because healthcare companies are not in the business of compassion, they are in the business of making money.
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Old 10-09-2007, 02:21 PM   #48
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Tell me how you propose to FUND this without dramatically increasing taxes, and I am all EARS.........

BTW, Wisconsin's legislature is fighting over this right now. Our democratic governor is proposing "care for averyone", and funding it by raising the payroll tax 3-3.5% for all companies.......

Oh, and the other thing, we would get to move from the EIGHT most taxed state, to Number ONE.........boy am I psyched!!!
I think part of the problem is taht the efforts being attempted now are a state-by-state patchwork. That makes it pretty hard to get any efficiencies and the state program is likely to not be in much of a bargaining position vs. insurers, drug companies and hospital chains. So there is likely room to cover everyone and not have it be terribly costsly. But clearly it will cost something. Dunno about you, but I'd be willing to have a 3% income tax that would solve the healthcare problem. That would be a bargain.
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Old 10-09-2007, 02:23 PM   #49
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I think part of the problem is taht the efforts being attempted now are a state-by-state patchwork. That makes it pretty hard to get any efficiencies and the state program is likely to not be in much of a bargaining position vs. insurers, drug companies and hospital chains. So there is likely room to cover everyone and not have it be terribly costsly. But clearly it will cost something. Dunno about you, but I'd be willing to have a 3% income tax that would solve the healthcare problem. That would be a bargain.
Easy to say when you're not going to be the number one taxed State in the Union............
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Old 10-09-2007, 02:26 PM   #50
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Here's the actual plan, and I was way off on what the costs to employers would be:

http://www.wisconsinhealthproject.or...whpconcept.pdf
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Old 10-09-2007, 02:34 PM   #51
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Easy to say when you're not going to be the number one taxed State in the Union............
Um, I live in NJ. I don't know for sure which 7 states are more taxed than Wisconsin, but I would be very much surprised if one of them was not NJ.
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Old 10-09-2007, 02:40 PM   #52
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I just quickly read through this, but it seems that if employers are actually paying 15% of payroll on average for health care, this may actually be a bargain for them. I see that it also eliminates Medicaid, which should lower taxes.

Frankly, if it were my choice, I would eliminate the insurance companies as well and have the state pay the hospitals/doctors directly.
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Old 10-09-2007, 02:43 PM   #53
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Um, I live in NJ. I don't know for sure which 7 states are more taxed than Wisconsin, but I would be very much surprised if one of them was not NJ.

According to this http://www.census.gov/govs/statetax/05staxrank.html 2005 data from the census bureau, Wisconsin was number 13 in per capita taxation, New Jersey was number 8 and my home, Connecticut, was number 4.
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Old 10-09-2007, 02:44 PM   #54
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Frankly, if it were my choice, I would eliminate the insurance companies as well and have the state pay the hospitals/doctors directly.
That would almost certainly make reform a non-starter. But I think that would be my choice too.
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Old 10-09-2007, 02:50 PM   #55
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Here is an interesting discussion on the pros and cons of free market delivery of healthcare from a consulting firm in the UK. It doesn't seem to matter what kind of system you have, someone will always be complaining about it.

A market solution might be efficient, but I don't think it would be equitable. Our system is a mess. Whether it's more of a mess than the NHS in the UK depends on where you sit. Bottom line: we spend a lot more per capita than anywhere else in the world and have 47 million uninsured.

Quoting from the article:

"Within most societies there exists, in some form or another, a concern that health care resources and benefits should be distributed in some fair or just way"

From where I sit, this should be the starting point for any discussion. If you don't agree with this premise, what do you offer as an alternative starting point other than: It's all about me?
Being someone that was in the British system for a year (and thankfully I did not have to use it) I can say that it is not even close to our system IF you have insurance. I talked to many of my employees who had to wait to get test done, to get operations etc... it seems that rationing was the name of the game...

And surprisingly the biggest growing benefit from companies when I was there in 2000 was health care insurance!!! So you could go to a private doctor instead of the public ones.

A major difference between the UK and the US is the income of a doctor... over there they are paid very little, so the best and the brightest do not become doctors as they are paid like school teachers.


In you article...

Serious problems
What about the criticisms of the NHS? Many people believe that the NHS suffers from serious problems.
  1. The critics argue that insufficient resources have been devoted to health care so that there is less care than consumers would like. This is a consequence of funding the service from taxation - there is no mechanism whereby consumers can signal their willingness to pay more. According to this view the fact that the UK spends less of its GDP on health care than other developed countries reflects a weakness of the NHS rather than evidence of its efficiency. This also explains why the NHS appears to be in continual financial crisis - waiting lists, closed wards and an inability to treat particular patients or particular conditions all reflect a failure to devote sufficient resources to health care.

    2. The system is not sensitive to consumer preferences. Doctors have considerable independence or clinical autonomy. They make decisions about patients' treatment with little reference to either the patients or the managerial structure of the NHS. This has resulted in a system which is unwieldy and difficult to control and not responsive to consumer demand.
  2. The NHS is not as efficient as it could be. Some hospitals need to be closed and the resources transferred into community health care. But opponents, including some doctors, have successfully delayed, and in some cases prevented, such changes from occurring. They argue that the closure of any hospital is a loss of NHS services regardless of how the resources made available may be used to provide other, more valuable, kinds of health care.
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Old 10-09-2007, 02:51 PM   #56
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Dang Brewer, if you'd have joined the military and retired from there, you'd be ER'd by now - and this would be a moot point for you
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Old 10-09-2007, 03:01 PM   #57
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My view of healthcare is this:

The healthcare system in the US is the best in the world! if you have enough money to afford it that is... If I was a milionnaire living anywhere in the world and I was diagnosed with a rare or terminal disease which required top notch care, I would without a doubt come to the US to be treated. But the problem is not every US citizen can afford to use that great healthcare system and there is no alternative for those people.

In my opinion healthcare is a matter of compassion. It is the moral obligation to help those who suffer when we have the power (and technology) to do so, no matter who they are or how much they make. Cost should never be the first consideration. With a private healthcare system cost is always the first consideration because healthcare companies are not in the business of compassion, they are in the business of making money.

Sorry to say I disagree with this opinion... there are many medical procedures that are very expensive and if the person does not have insurance OR the ability to pay they should not be able to get them... I don't think we should be doing heart transplants for the illegal immigrant that wandered into our country.
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Old 10-09-2007, 03:09 PM   #58
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Dang Brewer, if you'd have joined the military and retired from there, you'd be ER'd by now - and this would be a moot point for you

Not old enough to have earned military healthcare benefits. Doesn't that take 20 years? Do veterans benefits cover the rest of the family, or just the vet?

Besides, they would have booted me pretty quickly. I'm not one to take orders that I don't agree with, at least not without complaint.
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Old 10-09-2007, 03:14 PM   #59
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According to this http://www.census.gov/govs/statetax/05staxrank.html 2005 data from the census bureau, Wisconsin was number 13 in per capita taxation, New Jersey was number 8 and my home, Connecticut, was number 4.
Wow... I am in #49, but my amount is much higher than the per capita amount.
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Old 10-09-2007, 03:15 PM   #60
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Sorry to say I disagree with this opinion... there are many medical procedures that are very expensive and if the person does not have insurance OR the ability to pay they should not be able to get them... I don't think we should be doing heart transplants for the illegal immigrant that wandered into our country.
There are always going to be a few situations where people can disagree, even if they think "something needs to be done" to inject more government into health care:
  • Treatment of illegal aliens, particularly expensive and non-preventative procedures
  • Elective and cosmetic surgeries (except, perhaps, to correct a disfigurement caused by accident or necessary medical procedure)
  • End of life "heroic efforts" which cost tens of thousands to prolong an obviously terminal life (obviously, pain management needs to continue)
  • Expensive treatment of conditions caused by self-abusing behavior (i.e. liver transplants for alcoholics)

One can mostly be in favor of health care reform and "universal coverage" but recognize that when the taxpayer is on the hook, some strings have to be attached.
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