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Old 02-21-2009, 08:10 AM   #161
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In the school my son goes to, there is a form to qualify for free/reduced cost regular lunches. There is also a back door. If a student's account goes into the negative for more than three meals the student will receive a minimal lunch for free. IIRC it is a PBJ sandwich, a fruit, and a carton of milk. Personally, since it is a back door and a government program I think the money should be diverted to other parts of the required taxes for the parents, like registering a car, or taken out of any tax refund. If the person goes through all of the trouble to fill out the forms and apply for the free/reduced lunches then they get the benefit, but if they use the back door then they should have to pay.
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Old 02-21-2009, 10:24 AM   #162
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Originally Posted by ERD50 View Post
Free lunches.

I'm all in favor of providing free meals to kids in need. The problem I see is, if you do that in isolation, you won't solve the underlying problem - why the parent is not providing meals for that kid.

If it is to get over a short term bump in the road, fine, that problem will take care of itself. If it is because the parent can't provide, something long term needs to be done, there are deeper problems. And if the govt just provides regardless of the reason, some people are going to use that as a crutch, why earn the money for lunch if someone else will pay for it?

It is frustrating for me. We live in a fairly well off community, but like most there are some needy people. Because of privacy issues and the source of my info (someone who sees this first hand), I can't really say anything, but lets just say I am aware of some families that have plenty of money, take fancy vacations etc, but still are on the free lunch program in our district, which also waives the fees for most activities.

I know Martha doesn't like to hear this, she claims that it is too hard for people to qualify for this stuff, but it just isn't so, in my experience. I got curious about it, so I looked at the forms you need to fill out to apply for free lunch programs. They are very vague, they don't ask for any hard numbers like what is on Line such-and-such of your 1040 or W2, they just ask you to enter a monthly income. Now, is that earned income, investment income, pension, SS? Doesn't say. I suppose I could qualify by filling out the form, our earned income is pretty low. If questioned, I could (honestly) claim that I thought they meant wages/salary. I really don't know. But I don't think that someone with $1M/year in dividends should be able to get free lunches for their kids on my dime.


I am not aware of any efforts to validate these numbers. This is what gets some of us upset when we see govt handouts. Fine, do 'em where needed, but be responsible with *our* money.

-ERD50
I'm not sure how the "socialized medicine" thread morphed into "free lunch", but I did some research anyway.

According to the National Center for Education Statistics, 41% of 4th graders get "free or reduced price" lunch. Percentage of 4th-graders eligible for free or reduced-price lunch and percentage distribution of students in the school eligible for a free or reduced-price lunch, by race/ethnicity and school location: 2005

The income cutoff is supposed to be 130% of the poverty level for "free" and 185% for "reduced". The federal poverty "guideline" for a family of four in 2008 is $21,200. 2008 Federal Poverty Guidelines Multiplying by 185% gives $39,220.

I suppose you can get a personal gut feel for the amount of cheating by guessing whether you think 41% of the 4th graders (in four person families) come from families with less than $39,220 income. Note that the median income for four person families is around $70,000. When I compare those numbers, I have to adjust between two-parent and one-parent families.

This article gives a rationale for why school districts might want to be very loose about granting free lunches: Free Lunch: Title I's formula for determining aid -- and its recipe for fraud. - Reason Magazine The argument is that the real money for the district isn't in the lunch program, but in other federal programs where the formula is tied to the number of students getting free lunch.

Finally, my personal anecdote. We were the "responsible adults" for a niece while she was in high school. I was surprised by how quickly the school official picked up on the fact that she might be eligible for free lunch, and encouraged us to apply. Maybe I understand better now.
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Old 02-21-2009, 01:24 PM   #163
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Wow Independent, that article was an eye-opener for me. Here's the key phrase, and my bold explains how this applies to any other social programs like medicine:

Quote:
Though the lunch program is designed to provide food to low-income students who might otherwise go hungry, its guidelines do not require schools to verify the parental income of students who enroll. The process to qualify for a free lunch comes down to parents self-reporting their income on a form that is turned in to their local school.

Federal free-lunch program administrators argue that the program has little potential for abuse because "the worst that happens is a kid gets a free lunch."

Federal free-lunch data, however, are used as one of the main poverty indicators for school districts and are linked to many other local, state, and federal funding streams. So any fraud in the free-lunch program is quickly multiplied.
These things are so poorly administrated (no verification of the income? and as I said, no real definition of income on the form I saw), and they grow far beyond the original intent.

Quote:
... the Clifton school board in Bergen, New Jersey, voted 5-4 to report that exactly 20.16 percent of public school students were poor enough to qualify for free lunches, instead of the actual number, which was 19.19 percent. The difference was significant: If the number dropped below 20 percent the district would lose $4 million in aid.



.... board president Wayne Demikoff said, "I cannot, in good conscience, vote for something that is going to devastate the budget."


Strangely, the board did not necessarily break the law by reporting the higher number.
So a free lunch program turns into lies that influence another $4Million in government spending! At one school district!

[MODERATOR EDIT]

Look at the mismanagement of this one. Look how they use it to take money from one stated goal and apply it to others w/o our knowledge. This is why I am so skeptical of a 1400 page Stimulus Bill or any other govt program. An awful lot of places to hide in 1400 pages. What else will hide in any Heath Care bill?

-ERD50
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Old 02-28-2009, 12:03 AM   #164
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In Canada, we have universal health care. We need to go to the doctor - make an appointment and go. In an emergency, we're treated in the emergency room of the hospital. Emergency surgery or treatment for life-threatening condition - immediate attention. Elective surgery -- you are prioritized and yes, there will be a wait time ( no queue jumping in Canada). I don't think the quality of health care differs significantly between our countries. I understand that per capita health care costs are much less in Canada than in the U.S. Of course, we pay more in income tax for health care. But most Canadians proudly consider our universal health care coverage as one of the most important benefits our citizenship and something we would never give up.

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Old 02-28-2009, 09:15 AM   #165
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Why do we need Universal Health Care? We are 50 States. If UHC is so desirable, why not start it at the state level?
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Old 02-28-2009, 09:23 AM   #166
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Why do we need Universal Health Care? We are 50 States. If UHC is so desirable, why not start it at the state level?
For starters, we can watch Massachusetts.

To almost no one's surprise, they were more successful at getting the lower-income people to sign up for little or no cost to them, while non-compliance from people with higher incomes (who paid full price) was quite a lot higher.

Who'da thunk it?
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Old 02-28-2009, 01:03 PM   #167
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For starters, we can watch Massachusetts.

To almost no one's surprise, they were more successful at getting the lower-income people to sign up for little or no cost to them, while non-compliance from people with higher incomes (who paid full price) was quite a lot higher.

Who'da thunk it?
But, is this really an argument against state-centric (as opposed federal) taxpayer-funded medical care? The same thing could happen at the federal level if it were structured the same way.

To me, the three prime arguments against state-centric solutions are:
-- Complexity/cost of 50 different plans
-- Reduced ability to relocate. E.g. A person receiving taxpayer-funded treatment for cancer in Massachusetts would not be able to relocate to a state that did not cover this care/
-- Higher taxes leading to an exodus of people/companies. The same potential problem we'll have if we do this nationally.
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Old 02-28-2009, 01:10 PM   #168
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But, is this really an argument against state-centric (as opposed federal) taxpayer-funded medical care? The same thing could happen at the federal level if it were structured the same way.

To me, the three prime arguments against state-centric solutions are:
-- Complexity/cost of 50 different plans
-- Reduced ability to relocate. E.g. A person receiving taxpayer-funded treatment for cancer in Massachusetts would not be able to relocate to a state that did not cover this care/
-- Higher taxes leading to an exodus of people/companies. The same potential problem we'll have if we do this nationally.
True. One point I intended to make above -- but forgot -- is that as states work on their own solutions, we can observe what works reasonably well and what's a disaster. Without more strict enforcement mechanisms to make sure there is true universal participation, the Massachusetts model is unworkable. Maybe they can tweak it and make it better, and all other states (and the feds) should be watching the results in terms of costs and quality of care.

Having said that, I don't know if it's clear yet whether Massachusetts employers have seen their health care costs go up more or less than the other 49 states or the nation as a whole.

And to your first point, this is a problem we have today: we have basically 50 different state laws and 50 different sets of state mandates that insurers have to follow. That can't be good for overhead costs. That's one advantage of Medicare: federal law trumping state laws, Medicare can basically be run using one playbook instead of 50 different ones. And to me, ultimately, that would be the payoff for a federal-level program over 50 different sets of state-level mandates.

One thing, at least, is fairly clear to me: if it's going be possible to cover the sick, the old and the folks with chronic conditions affordably and with no exclusions while avoiding adverse selection, there must be a universal mandate that is enforceable, where the younger and healthier subsidize the sicker and the older. And that has its own set of moral hazards, especially where subsidizing unhealthy behavior is concerned.
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Old 02-28-2009, 03:07 PM   #169
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Yes. If you live in Mass. you may not be able to move to Texas and have the same health ins. follow you. Nor will it follow you to Canada, England, Russia, Italy, Greece, Germany, and on and on. Life is not perfect. So should we have truly Universal Health Care? Let's see you get all the countries of the world to agree. I'll just hide and watch.
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Old 02-28-2009, 03:44 PM   #170
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Here's what I think would work to let everyone obtain care and keep things affordable. It's not what I think the country should do, but it is better than the alternative I believe we are headed for.

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

There. The market helps provide cost controls (especially by giving consumers a stake in reducing their use of medical care and in picking insurers with the lowest costs). Provides consumers with feedback on medical care so they can make an informed choice. The "Cadillac" plans would be expensive because they cover a lot and because of adverse selection (that's the policy type the sickest people would choose), so people would be "incented" to select plans with higher co-pays, which helps drive down costs. Everyone gets the cost-effective preventative care provided in a cost-effective way, everyone is protected against catastrophic medical costs, the free market is preserved, medical costs are de-coupled from employment (which would be good for our economy as a whole), and the very poor pay nothing for their care (due to vouchers). And, if you want to take some risk by self-insuring to a larger degree, you are allowed to do it.
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Old 02-28-2009, 04:01 PM   #171
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So should we have truly Universal Health Care? Let's see you get all the countries of the world to agree. I'll just hide and watch.
Well, the 27 European Union countries already have that. So it's certainly not impossible. As a citizen of the EU, I get treated the same as a citizen of another EU country, when I'm in their country temporarily using the European Health Insurance Card. If I move permanently to another EU country, I'm entitled (in Germany for instance - required) to join that country's public health insurance. No problem with pre-existing conditions as everyone is accepted.

In the EU countries I'm aware of, you can opt of public though and go with private insurance if you're well off.

No reason the 50 different states couldn't do something similar.
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Old 02-28-2009, 06:07 PM   #172
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In the EU countries I'm aware of, you can opt of public though and go with private insurance if you're well off.

No reason the 50 different states couldn't do something similar.
It's a question of WILL.
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Old 03-01-2009, 06:55 PM   #173
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If you need anything done - new knee, new hip, bypass, whatever ... get it done now. The day [MODERATOR EDIT][Universal health] care arrives 47,000,000 people will be calling for appointments. There will not be enough to go around. Rationing will begin on day 1.
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Old 03-01-2009, 07:00 PM   #174
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Judging from the prior post it is more a matter of fear than of will.
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Old 03-01-2009, 07:04 PM   #175
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Constructive ideas!
Old 03-01-2009, 07:16 PM   #176
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Constructive ideas!

These are good ideas.

Requiring everyone to buy insurance is very important. We can't have people choose new car payments instead of health insurance and then show up in the ER expecting free care and badmouthing the system.

I think it may be a good idea to require insurance companies to sell policies to everyone who applies.

Write the policy and the coverage, set the price where you want, but then anyone can buy the policy at that price.

The government or a mandatory private pool fund will have to help underwrite the high cost patients at first.

There will need to be some tweaks for age so low paid healthy
twentysomethings are not paying as much as highly-paid, overweight, MI-having, fiftysometings but everyone has to pay - one way or the other.

There are no easy solutions.



Quote:
Originally Posted by samclem View Post
Here's what I think would work to let everyone obtain care and keep things affordable. It's not what I think the country should do, but it is better than the alternative I believe we are headed for.

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

There. The market helps provide cost controls (especially by giving consumers a stake in reducing their use of medical care and in picking insurers with the lowest costs). Provides consumers with feedback on medical care so they can make an informed choice. The "Cadillac" plans would be expensive because they cover a lot and because of adverse selection (that's the policy type the sickest people would choose), so people would be "incented" to select plans with higher co-pays, which helps drive down costs. Everyone gets the cost-effective preventative care provided in a cost-effective way, everyone is protected against catastrophic medical costs, the free market is preserved, medical costs are de-coupled from employment (which would be good for our economy as a whole), and the very poor pay nothing for their care (due to vouchers). And, if you want to take some risk by self-insuring to a larger degree, you are allowed to do it.
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Old 03-02-2009, 11:30 AM   #177
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In Canada, we have universal health care. We need to go to the doctor - make an appointment and go. In an emergency, we're treated in the emergency room of the hospital. Emergency surgery or treatment for life-threatening condition - immediate attention. Elective surgery -- you are prioritized and yes, there will be a wait time ( no queue jumping in Canada). I don't think the quality of health care differs significantly between our countries. I understand that per capita health care costs are much less in Canada than in the U.S. Of course, we pay more in income tax for health care. But most Canadians proudly consider our universal health care coverage as one of the most important benefits our citizenship and something we would never give up.

Rob
Except all those nice Canadien folks who come to the US and pay CASH to get operated on, because they don't want to wait a couple years........
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Old 03-02-2009, 11:33 AM   #178
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I think the doctors in this country are going to see a HUGE decrease in personal income once the health system gets nationalized. The last specialist I saw was one of the top surgeons in Egypt, and his top income year there was $40,000 a year. I am pretty sure he's making over $250K here.........
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Old 03-02-2009, 12:47 PM   #179
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I think the doctors in this country are going to see a HUGE decrease in personal income once the health system gets nationalized. The last specialist I saw was one of the top surgeons in Egypt, and his top income year there was $40,000 a year. I am pretty sure he's making over $250K here.........
I don't know that the specific numbers will be what you mentioned but my prediction is that the very high reimbursement subspecialties (radiology, ophthalmology, orthopedics and a few others) will take a hit, while primary care (internal med, pediatrics, family med) will be relatively spared; the latter are already at a treacherous point.

Some will try the conceirge approach and other work-arounds. There will be some departures, fewer trainees in the $$ specialties but that will settle out over 10 years.
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Old 03-03-2009, 03:25 PM   #180
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We are short of primary care providers; I think that we need to encourage people to go into primary care instead of the high dollar specialties. There is evidence that the number of specialty procedures increase as the number of specialists increase, per capita, without better outcomes.

Obama has said that his mind is open to any and all proposed solutions and he is meeting with both parties to discuss reform, now that he has a team together. We will see where it goes.
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