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View Poll Results: To address the budget deficit, what mix of new taxes/spending cuts would you pick?
100% from higher taxes, no cuts in federal spending 2 2.50%
80% from higher taxes, 20% from cuts in federal spending 3 3.75%
60% from higher taxes, 40% from cuts in federal spending 9 11.25%
40% from higher taxes, 60% from cuts in federal spending 23 28.75%
20% from higher taxes, 80% from cuts in federal spending 12 15.00%
No higher taxes, 100% from cuts in federal spending 31 38.75%
We don't have a problem, keep both taxes and spending where they are now 0 0%
Voters: 80. You may not vote on this poll

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Old 11-13-2010, 03:58 PM   #41
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Yes, and what I'm saying is that when you work through the details of actually making that work, you end up with something that looks a lot like the reform that was just passed (which doesn't look much like a "free market" at all).

So lets look at the Swiss system . . .
1) Individual mandate - check
2) Basic insurance policy coverage dictated by the government - check
3) Price controls on the basic coverage - check
4) Subsidies if basic insurance premiums are above a certain % of income - check
5) Private supplemental insurance available - check

That sounds almost identical to the legislation that just passed. Surprise, surprise.
The Swiss system didn't have all the rest of the junk that is in that bill, so much stuff that we were told we couldn't even tell what was in it until they passed it (is THAT really how laws are to be produced? What happened to "understand what you sign"?). I'll skip the popular names for the various pay-offs, but you know what I mean.

How it "looks" or "sounds" depends a lot on what kind of glasses (hearing aids?) you are looking through I guess. I think it's safe to say we take a different lens prescription

-ERD50
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Old 11-13-2010, 04:20 PM   #42
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http://www.fiscalcommission.gov/sites/fiscalcommission.gov/files/documents/CoChair_Draft.pdf


The above link is for the specifics of the commission'sdeficit reduction proposal.

Health care cost reduction starts on page 31.
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Old 11-14-2010, 06:35 AM   #43
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The Swiss system didn't have all the rest of the junk that is in that bill, . . .
How can you be so sure?

But even if that is true, your complaint is then only about peripheral issues (this senator got bribed with 'x' which shouldn't have been in the bill). I agree. That stuff can and should get striped out. What I don't see is an explanation of how we can avoid the big picture elements of the legislation: 1) Individual mandate 2) Mandatory issue insurance with prescribed minimum coverages 3) Prohibition against price discrimination 4) Subsidies . . . all of those elements have to be part of any reform, or the whole thing falls apart.

And if all of those things are part of reform, what we end up with is a system where individuals are forced to buy a Federally prescribed product at a heavily regulated price from a seller who's required to sell it. That may technically be a "market" but I wouldn't call it "free." Thus, my assertion that there isn't a "free market" solution to health care delivery. I'm still waiting for someone to propose a viable alternative (especially from the 'repeal and replace crowd'), but unfortunately, it doesn't exist.

Which leads to the question I asked of Samclem, why are we pretending that there is a free market alternative? And if one exists, why can't anyone describe it in detail?
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Old 11-14-2010, 02:34 PM   #44
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How can you be so sure?
Here you go.

http://www.admin.ch/ch/d/sr/8/832.10.de.pdf


It's in Swiss German, though. 59 pages, but... There are an additional set of laws that apply, from the original Swiss laws a century ago that set up federal regulation of the health insurance industry, to various attached bills, and amendments over the past 15 years.
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Old 11-14-2010, 03:02 PM   #45
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Here you go.

http://www.admin.ch/ch/d/sr/8/832.10.de.pdf


It's in Swiss German, though. 59 pages, but... There are an additional set of laws that apply, from the original Swiss laws a century ago that set up federal regulation of the health insurance industry, to various attached bills, and amendments over the past 15 years.
Those Swiss, so efficient. Somehow they crammed our 2000+ page law into 59 pages, plus attachments. But, it's in German, so their 59 pages have 20 times as many words longer than 10 letters than our law does.

Hey, I see how they did it. Their document includes a link back to this post, the accompanying text says "Implement the plan at this link": Socialized Medicine

The other 58 pages appear to be devoted to a chocolate recipe. . .
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Old 11-14-2010, 03:04 PM   #46
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Whack the ever living cwap out of the defense budget would be a good start.
+1

It's amazing that most politicians seem to think that the defense budget is off limits. Why is that?
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Old 11-14-2010, 03:46 PM   #47
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+1

It's amazing that most politicians seem to think that the defense budget is off limits. Why is that?

.......campaign contributions from the defense industry lobby?
.......the all volunteer armed forces?
........American yahooism?
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Old 11-14-2010, 05:51 PM   #48
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The other 58 pages appear to be devoted to a chocolate recipe. . .
Why chocolate protects against heart disease

Finally, a health plan we can all agree on!
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Old 11-14-2010, 06:24 PM   #49
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As there is some interest in the Swiss health care system; I though I would give a few links:

http://www.nytimes.com/2009/10/01/he...s.html?_r=1&hp

Best Buy: Privatised Healthcare Systems in Europe | The Brussels Journal

I saw a tv show last last year on the various systems in the world. I recall that the Swiss system is via private insurers. There is a boiler plate set plan that the private insurers provide on a nonprofit basis. Where the private insurers make their profit is the sale of additional boarder coverage.

Oops! One more link:
http://www.civitas.org.uk/pdf/Switzerland.pdf
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Old 11-14-2010, 06:48 PM   #50
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+1

It's amazing that most politicians seem to think that the defense budget is off limits. Why is that?
I think because politicians are, well politicians. They don't want to be seen as weak on defense and well, there is a WAR going on. It is mind boggling the amount of waste in the defense budget, much of it put there by the politicians.
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Old 11-14-2010, 06:48 PM   #51
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As there is some interest in the Swiss health care system; I though I would give a few links:

http://www.nytimes.com/2009/10/01/he...s.html?_r=1&hp

Best Buy: Privatised Healthcare Systems in Europe | The Brussels Journal

I saw a tv show last last year on the various systems in the world. I recall that the Swiss system is via private insurers. There is a boiler plate set plan that the private insurers provide on a nonprofit basis. Where the private insurers make their profit is the sale of additional boarder coverage.

Oops! One more link:
http://www.civitas.org.uk/pdf/Switzerland.pdf
Thanks for posting this....America could be well on its way to solving its debt problems if we would agree on a way to get our arms around healthcare costs.
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Old 11-14-2010, 06:56 PM   #52
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Which is why it's such a bad thing that the deficit commission punted on health care costs, and why the much maligned Health Reform legislation is such an important first step in fixing our structural budget imbalances.
It fixed the problem? How can you empirically prove it when the CBO can't? I guess Paul Ryan just makes up numbers out of the thin air?
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Old 11-14-2010, 09:43 PM   #53
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I'm a little surprised by the way the poll has turned out so far.
-- 84% of those answering believe most or all of the deficit reduction should come from spending cuts
-- 16% believe most or all of the deficit reduction should come from increased tax revenue.

The composite average response: Spending cuts should constitute 73% of the deficit reduction, tax increases should account for 27% of the deficit reduction.

As it happens, the ideas publicized by the Debt Commission co-chairs were of a very similar ratio: 3/4 from spending cuts, 1/4 from higher tax revenues.

Maybe there's a general consensus about the very biggest issue, anyway.

I would have guessed a more even split between "more taxes" and "less spending" votes. On the other hand, maybe the LBYM culture of the board plays into this. When new posters come to the board with debt issues, most answers seem to focus on the need to reduce expenditures rather than on ways to earn more money. Maybe we'd give this same kind of advice to our indebted Uncle Sam.
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Old 11-15-2010, 02:24 AM   #54
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The composite average response: Spending cuts should constitute 73% of the deficit reduction, tax increases should account for 27% of the deficit reduction.

As it happens, the ideas publicized by the Debt Commission co-chairs were of a very similar ratio: 3/4 from spending cuts, 1/4 from higher tax revenues.

Maybe there's a general consensus about the very biggest issue, anyway.
Interesting, but I am not to surprised, most of the folks praising the Commission use words 'they are acting like adults'. Most of the folks on the board are also adults. Unfortunately many politician and certainly the loudest and most extreme folks on both sides aren't adults.

Lord of the Flies has taken over America
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Old 11-15-2010, 05:17 AM   #55
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Which leads to the question I asked of Samclem, why are we pretending that there is a free market alternative? And if one exists, why can't anyone describe it in detail?

apparently Sam is more interested with his poll numbers...
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Old 11-15-2010, 07:07 AM   #56
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apparently Sam is more interested with his poll numbers...
GfG has read brief proposals from me and others (one of them linked in a previous post) about how we could use competition to reduce the cost and improve the quality of health care in the US (the same way we depend on it for every other facet of our economic existence--food, shelter, services, etc). But, I haven't written a 2000 page prescriptive text.

You've posted to this thread 8 times, some of them loosely related to the topic. But I don't know where you stand on the issue because you haven't said and you haven't voted. Are you just a sniper?
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Old 11-15-2010, 07:28 AM   #57
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Yes, and what I'm saying is that when you work through the details of actually making that work, you inevitably end up with something that looks a lot like the reform that was just passed (which doesn't look much like a "free market" at all).

So lets look at the Swiss system . . .
1) Individual mandate - check
2) Basic insurance policy coverage dictated by the government - check
3) Price controls on the basic coverage - check
4) Prohibition against discriminating because of age, or medical condition - check
5) Subsidies if basic insurance premiums are above a certain % of income - check
6) Private supplemental insurance available - check

That sounds almost identical to the legislation that just passed. Surprise, surprise.
Okay:
- Are employers the "first choice provider" of health insurance? Not in the Swiss system. Another useless layer of complexity driving up costs, adding complexity, and blurring the critical distinction of "who is the customer."
- Is government single-payer insurance for aged participants (Medicare) part of the Swiss system? No. Medicare is our biggest "budget buster" and the present US legislation retains it almost without change. We'll have a series of "mega doc fixes" in the future. Government cannot provide the cost discipline and cost control supplied by a market. In the US, government now buys over 50% of all the health care we get, and it will increase under the new legislation. The Swiss government share is much less, and most of it is provided to consumers (as subsidies) for their use in making individual decisions on the purchase of insurance.

They aren't "almost identical." We could improve on the Swiss system by relying more on competition and less on some of the government cost controls they have in their system, but it's much better than the proposed US plan. The Swiss spend 1/3 less of their GDP on health care and get more for it.
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Old 11-15-2010, 10:20 AM   #58
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They aren't "almost identical." . ..

- Are employers the "first choice provider" of health insurance? Not in the Swiss system.
- Is government single-payer insurance for aged participants (Medicare) part of the Swiss system? No.
I really don't understand. Maybe that is deliberate on your part, or maybe I'm just dense.

But what you seem to be saying is that legislation that moves us substantially in the direction of the Swiss system is bad because things that existed before that legislation was enacted are bad (medicare and employer-centric health insurance)? That doesn't make the legislation bad, just too timid. If that is really your chief complaint, then the solution is to move everyone on to the exchanges, including Medicare recipients and folks with employer-provided health insurance.

But I have trouble reconciling the implied desire here to extend the scope of the legislation with previous comments indicating that the whole thing should be replaced with something else (which is still undefined). Thus, my confusion.
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Old 11-15-2010, 10:51 AM   #59
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GfG has read brief proposals from me and others (one of them linked in a previous post)
Again, this is me being dense. But I don't see how that proposal is substantively different then the reform we have. The big picture things you suggest are all included. Why, then would you not support the legislation generally, while saying there are many specific things that still need to be fixed. I happen to share that view.

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1) Mandatory Coverage: Everyone must buy a policy.
2) Government vouchers based on need. (Just as food stamps do for nutrition)
3) Private policies of four or five standardized types. A limited number of policy types greatly enhances price competition. Label them A-E and require that the insurers call them by that label.
4) No underwriting: If an insurer elects to sell a particular type of policy, the insurer must accept all applicants. Differences in price arr allowed based on geographic area. But--citizens can change policy types only once every 5 years (reducing the "hey-I've got a bad disease, I'm gonna go with the Cadillac policy now" syndrome)
5) All policies (of the 4 or 5 types) would cover preventative care that serves to reduce medical costs overall (Pap smears, immunizations, prenatal care, annual checkups, etc). Policies would differ by the co-pay amounts, private vs semi-private rooms, types of perscription drugs covered, degree of "doughnut-hole" that the insured would cover largely on his own, etc). All policies would feature catastrophic coverage based on the insured's household income--maybe all medical costs over 30% of income would be covered.
6) A government-run clearinghouse with with medical/consumer information. Provides info on customer satisfaction with various insurers by policy types, information on outcomes by procedures for various hospitals/centers, average out-of-pocket costs incurred by consumers in each state for each type of insurance, etc). This helps promote consumer knowledge and informed decisionmaking.
7) Individual purchase of medical care is allowed. Unlike some countries which prohibit individual purchase of medical care, it would be allowed in the US. In addition, if you want to purchase an additional medical policy to cover cosmetic surgery, experimental treatments, nursing home care, daily electroshock therapy, in-home aromatherapy, accupuncture, etc, that would be okay, too
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Old 11-15-2010, 07:31 PM   #60
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But I don't see how that proposal is substantively different then the reform we have. The big picture things you suggest are all included. Why, then would you not support the legislation generally, while saying there are many specific things that still need to be fixed. I happen to share that view.
In theory, the new health care law could usher in some needed changes. For example, the exchanges might work to improve competition. But the law carries over so many bad parts of the present system, and fails to incorporate so much change that is desperately needed, that I just can't see how we can call it an enhancement.

1) The continued involvement of employers in how people get their health care is no small thing. People can't elect to go to the exchanges (or, maybe, can't get the subsidies) unless their employers don't offer coverage. If your employer offers coverage--that's what you get. Want a different policy? Quit your job. What kind of houses would we be living in if our employers bought them for us?

2) Medicaid: The new program expands this government single payer program. We should be going in exactly the opposite direction.

3) Medicare: A continuation of the proven ineffective top-down centralized government price control scheme. The part that had some degree of patient choice in selecting an insurance provider (the far-from perfect Medicare Advantage program) was gutted as a billpayer. Again, it's not like the new law made a specific decision to address those under 65 and to leave Medicare alone. I could understand that--"We're taking on a lot here, let's tackle Medicare after we get the other stuff running, maybe we can let Gramps shop for his insurance on the exchanges, too". But, that's not what happened, the new law is a step backward from the direction we should be going.

4) Florida, Nebraska, Louisiana--need anyone say more? Symptoms of the dishonest process by which this law was spawned, and of the large and small abscesses that lurk within it.

The new law seems so poorly conceived as to prompt questions about the real intent of the legislation. In 2004, Barrack Obama said that we couldn't move to government-controlled single payer health care in one step, that we'd need to transition from private employer-sponsored insurance over 15-20 years. Well, if the new "reform" does enough damage to businesses (through fines and expensive mandated high coverage levels), it's entirely likely businesses would call for a takeover of the whole mess by the government. That would please a lot of people.

We can have a better system. We can dump employer involvement. We can allow people to make choices in selecting insurance providers. We can hold costs down by assuring the recipients of a service have incentives to consider costs and effective means to control them (through a choice of services and objective information on various options). Government has a role to play, for sure.
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