Rachel Maddow has this 7 min segment discussing how the crazies are now coming out to say that health care reform is simply a backdoor to assisted suicide of the elderly. Seriously. That’s what’s being debated on the floor of the House. And on right-wing talk radio. The idea that Obama wants to kill old people.
The whole debate is getting rather annoying, honestly. There are all kinds of proposals being put forward from the Left, yet the Right is stopping at “tax cuts and stopping companies from denying you because of pre-existing conditions.” Sure, they’ll keep you and give you insurance, but jack up your premiums to high heaven to account for it. And if that’s all that they’re really proposing, then they have no comprehensive plan. Tax cuts and that simple regulation aren’t enough to fix the problem(s).
Reform needs to happen and we need to work together to get something useful passed. In my opinion, a Public Option should be included, but at the very least a LOT of regulations need to be imposed upon the private insurance industry if I plan on being able to afford health care in 10 years. Even if a Public Option isn’t included in the final bill, profits need to be reigned in at these health care companies, and I seriously doubt that any Republican-backed plan would suggest that.
Spreading fear and doubt about the existing ideas (i.e. “this plan will kill you!!”) is simply not helpful, and if anything, prevents anything from getting done. Much like back in 1993 when we tried getting something done, and it was stopped by similar tactics. And by “we,” I mean the Left. Because the Right is apparently just fine with where things stand.
There just aren’t words. After the next election there may not be any Republicans left. People must see through this stuff, yes?
Nope. They don’t. Because most people are stupid. And don’t think.
That said, I’m sure there are parts of the proposed plan that are worthless and shouldn’t occur. While I want a public option to be there, I also don’t want that to be abused and be TOO over-competitive with the private industry, as that would probably stifle innovation. There should be limits on what this public option would be capable of (i.e. using the power of the government, hypothetically, we could just tax everyone a little bit more, while printing more money, and just insure everyone for free…and that would be pretty dumb…).
Again, I’m all for healthy debate with actual options being presented (as opposed to what most Republicans are doing, which is saying “we don’t want that and we don’t have an alternative…we just don’t want that”… It’s like your Mom asking you why you threw the football at your sibling’s head and you simply answer “because?”).
But somehow saying that this plan is trying to kill old people? Seriously…
As a centrist, I find it hilarious that the far right believes this. they’re referring to page 425 of the Health Care Reform bill which basically says government will assist you in creating a will, and advise you on end-of-life services like hospice. Pretty standard stuff…
But, there’s a lot I don’t like about the bill like fixing doctor’s wages and forcing citizens to pay a 2.5% tax on gross income if they somehow find themselves uninsured. Taxing small to midsize businesses quite heavily (up to 8%) if they don’t offer a public option. Bottom line, is thing thing should not be hasty and they do need to work together to come up with something that will actually REFORM health care. Reform takes time, so I can only hope they revise this bill and trim all the fat…… the government is already taking way too much of my money, they don’t need to be stealing another 2.5% and then possibly more when their penalties trickle down from my company. There are so many ways the current proposed plan could fail and the taxpayer will be stuck footing the bill. Just look how well Social Security is doing… anyway, it scares me a bit to think that healthcare decisions could be made by bureaucrats; those who make decisions based on lobbyist pressure instead of actual needs of the individual. So, a good first start, but needs further revision and input from the Public.
And those, Ryan, are realistic concerns that should be hashed out. I haven’t heard much about fixing doctor’s wages, however… Doctors are paid way too much, honestly, but at the same time, they need to make a lot of that solely because of medical school costs. That kind of thing will require much more reform than simply on health insurance, however.
On a related subject, this bill is supposed to focus on rewarding preventative medicine, which means more demand for primary care physicians (e.g. family practice). From what I understand, primary care physicians are paid much less than specialists, even though, arguably, primary care is “more important.” Hopefully, reform in those areas should shift the balance away from specialists, meaning that we’ll get more primary care physicians that “make a little more than they do right now” and fewer specialists that will then “make a little less than they do right now.” Just a redistribution of salaries. Then, the fixing of wages shouldn’t be as big of an issue, as it’ll affect less people.
In either case, those are real concerns that can be debated. And I just wish more Republicans would actually talk about THOSE concerns on TV, and not how Obama is killing old people.
Andy, I agree with pretty much everything you say, except that I’m a Commie bastard, and so I think we should just nationalize the whole damn industry and be done with it.
That said, I have issue with the idea of a government “taking/stealing too much of my money.” First off, it’s not taking or stealing any more than it’s taking or stealing when your landlord charges you rent under a lease. You’re exchanging a portion of your income for services provided under a social contract. If you don’t like having paved roads, electricity, infrastructure, and a military, then I think you’re onto something with the “not paying taxes” deal. But I don’t understand why everyone seems to understand that you can’t get something for nothing except when the government’s involved.
I’m also irked by the “bureaucrats making health care decisions” argument. First of all, the vast (and I do mean vast) majority of implementation of any policy is handled by actual bureaucrats who have absolutely no contact with “lobbyists.” Do you honestly think that anyone other than the figurehead of a department has any interaction with any kind of interest groups? Bureaucrats are concerned with doing their jobs the way they think their jobs should be done, not with lobbying.
Even if “bureaucrats” weren’t straw men, what alternative do you propose? Clearly the private model’s working really well. I can tell you, I am glad every time I come face to face with the fact that there’s an HMO between me and my doctor, because I can just tell that they have my best interests at heart.
Do I think the bill’s perfect? Hardly. But you don’t wait to pass a bill until all flaws are removed. If that were the system, nothing would ever get done. You pass a law based on two criteria: one, it addresses the problem as best as it can, and two, you can pass it. That’s the way the system works. Deal with it.
As I enjoy discussing many things, including politics (some would cringe), I’m glad, Mike, that you spotted a few points of discussion. I certainly know that much of my taxes go towards worthy causes as you have described. But based on what Obama has stated previously, I don’t recall him telling us that he’s going to tax us 2.5% of our gross income if we were somehow to become uninsured. I’ve been uninsured in the past, it’s expensive, I wouldn’t need another 2.5% out of my pay. So that’s why I consider that “taking”, as I don’t like the idea of a penalty. The DMV once tried to charge me $500 because there was a 1 day discrepancy in changing my insurance from one account to another. As to the bureaucrats making healthcare decisions, I’m mostly concerned about their focus. As Andy said, “his bill is supposed to focus on rewarding preventative medicine”. I’d like to see individual incentives for healthy folks (tax credits, perhaps). They certainly don’t struggle to find ways to penalize. You could argue that that’s what it will take to change the face of Health Care. Perhaps. There will undoubtedly never be a perfect bill, but in this new Obama era, I want to see something a little bit more polished. You may be irked by some of those comments, but I’ll tell ya, I’m definitely irked by “…I’m a Commie bastard, and so I think we should just nationalize the whole damn industry and be done with it”. I don’t think we could find much common ground and that same problem is what’s creating the stir on Capitol Hill.
For starters, I was mostly being ironic with that last statement you reference. In retrospect, however, there is virtually no way for you to be able to determine that based on the entry. For clarification, I tend to classify myself as a Social Democrat – that is, as falling to the left end of the spectrum of the Democratic party, particularly with regards to economic issues. I don’t favor nationalization, necessarily. I do favor substantial government intervention in the economy to prevent exploitation, which I think is particularly relevant to the current discussion.
As for the 2.5%, I think the general reason there is a refutation of the
(Blast it, I accidentally hit the submit comment button. Continued!)
…idea that provision of universal health care incentivizes people to not work and be a burden on the state. In other words, the 2.5% is less a tax than it is paying a mandatory insurance premium for your public-funded insurance policy, so the burden doesn’t fall entirely on other people. I don’t know what other alternative there is, though – you can either charge people for the service, or not. And if you don’t, you can either deny them service (which puts us pretty much back where we started), or you can give it to them for free, in which case there’s no reason for anyone to pay for insurance and you’ve effectively nationalized the industry.
I am also 100% in favor of providing positive incentives to healthy individuals – indeed, I just a few weeks ago wrote a paper for the research group I work for discussing how communities can encourage their occupants to be healthier. But the issue is that that has very little to do with the health care industry. According to the American Heart Association, 145 million Americans are either overweight or obese according to the body-mass index (which is a terrible measure, but that’s for another time), and I can guarantee you that every one of those people knows, at some level, that their weight is a health risk. People have plenty of incentives to be healthy – lower risk of heart disease, attractiveness, not being winded when they have to go up stairs – but incentivization doesn’t seem to be helping, and I don’t think that adding a tax credit would create some kind of eureka moment where any substantial number of people would start losing weight.
If you want to create healthier people, you need to make some very substantial changes to some pretty fundamental things, like improving physical education and nutrition in schools, developing infrastructure that encourages self-powered transportation (mass transit, bike lanes, walking trails, etc.), and development of housing in logical places that are accessible to the aforementioned infrastructure improvements (instead of ever-increasing, indiscriminate urban sprawl). However, none of these things fall even remotely within the scope of what the bill is dealing with. Rather, preventative care in this situation has less to do with incentivizing people to behave in a healthy fashion and more to do with getting people access to a doctor before their flu turns into pneumonia.
I don’t think the healthy-guy-tax-credit is not so much a good idea because it’s an incentive to be healthier, but rather a reward for not burdening the system. If everything were nationalized 100%, I woudn’t cost anyone a dime because I don’t require any health care. I realize that I should pay something because there is a risk that I would cost something if I broke my leg or something, but just like I only have to pay a dollar for fifty thousand dollars in life insurance because I’m young- I should be rewarded each year I don’t use any of the system.
That said- people like me are going to have to pay for people who get sick.
Honestly- I don’t know a whole lot about this health care thing yet and I feel bad for not having educated myself, but I will say that right now I get “free” health care from my employer and I’m still willing to be taxed more so that we can have something in place that helps out folks who need helped out.
Now, see, this is actual discussion on an issue…good show, boys!
That 2.5% increase in taxes… I don’t know much about that, or the proposals being batted around, but I guess I’d be fine with it as long as my health care costs (monthly ones…) are relatively low. As I understand it, this would be a government-run program that we would still have to pay a monthly premium for, not just some “free thing” we use that is solely paid for in taxes.
So yeah, if I’m paying 2.5% more in taxes, but I’m also only paying $200 a month for a family of four, I think I’d be fine with that. Right now, my insurance coverage is paid for through SLU, but we have to pay $540 every quarter for buying Brooke into the program. So yeah, that’s $2000+ a year for once person. Let alone throwing kids into that mix.
But if I had a marginal tax increase, balanced by a decreased cost in my monthly premium… Yeah, I’d be fine with that.
Either way, Mike, I agree that this bill can really only deal with tax incentives for healthier living. There are other things that are well beyond the scope of this bill (example: reforming education as a whole, is an entirely different matter, but is completely related to all of this. Re-doing our infrastructure with more public transportation is related to this, but will be dealt with as an energy security issue). A tax credit would be good to get the ball rolling, and could be thrown into this.
Personally, I think that people that have destroyed their health from the beginning (read: smokers, the morbidly obese, etc.) should be paying more for their health care so I don’t have to foot the bill for their irresponsibility. I realize that probably won’t happen, but oh well…one thing at a time! 🙂
[But seriously, thanks for the excellent, well-mannered discussion. Continue!]
It is refreshing to be able to post opinions without a flame war like on random forums. Sorry for the delay in responding further, I’ve been super busy at work today. Mike, I’m glad to hear you’re not a commie bastard! 🙂 Good points on the 2.5% tax. But, in such a blanket tax with no provided appeal system, a random circumustance (see my DMV experience above) could stick you without insurance and paying 2.5% of your gross income. For anyone making over $40k a year, that’s additional tax of $1000+. But, you’d be surprised the motivation people get when money is involved. The incentive for health is low because the return on the effort takes a lot of time while you shed the weight and get healthier. Cash money can motivate anyone. But I agree, we need to fix some fundamental American “values” in order to really fix the problem which is indeed outside the scope of the proposed bill (although maybe they can squeeze something in). Just think how P.E. has changed from our generation (80s child) to the current state of P.E.
But further within the scope of this bill, other areas of concern are universal benefits extending to non-resident aliens. I think the bill needs to address this more specifically. There’s only 2 mentions on the topic. I’m surprised this isn’t more of a “hot topic” than the Euthanasia of the Elderly…
How tax-payers Medicare/Medicaid payments will transfer to the new system; the language seems to indicate it will suffer as there are many clauses that seemingly prepare for it. What about payments already made to those by us under-65 folks? Are we credited in the new system? That might be buried somewhere in the bill, but I haven’t found it.
Ultimately, it seems the bill is seeking a lot of control of the healthcare system. We need much better regulation as the Private Sector is getting out of hand (see uninsured costs of medical care or interactions with HMOs and think the previous state of the housing market), but we don’t need to hand over full control to the government because of our dismay. I think if this bill were to pass in its current form, the next step will be Constitutional validity.
I will sign off today with 2 further thoughts. From Page 203 of the bill:
13 ‘‘(4) NOT TREATED AS TAX IMPOSED BY THIS
14 CHAPTER FOR CERTAIN PURPOSES.—The tax im-
posed under this section shall not be treated as tax
16 imposed by this chapter for purposes of determining
17 the amount of any credit under this chapter or for
18 purposes of section 55.’’.
This is a good example why the bill needs to be revised further.
And finally, to further my “bureaucrats statement”, see this:
http://news.yahoo.com/s/ap/20090731/ap_on_re_us/us_nj_corruption_arrests_mayor
Drives me insane to see how these folks make their way up our governmental chains………
Listen. Ultimately I think paying our high school biology and chemistry teachers $100,000 a year starting salary would fix all our problems.
….it was just a joke. I didn’t mean to kill your discussion, Andy.
I suppose I wouldn’t need the 100 G’s a year if we had captured that creature of mystery by the cliffs in Tennessee.
No, no, you didn’t kill it. Obama did! With the old people!!!
I was out of town (in Columbia) this weekend, and I know Ryan is on vacation this week. Maybe less will get discussed!
Either way, one thing I forgot about, and I heard discussed on Science Friday (NPR) a few weeks ago: one thing that could make a huge difference is simply to pay doctors on salary. Right now, unless you’re at Mayo or Cleveland Clinics, you are paid almost on commission (it isn’t called that, but it’s kinda similar). That’s what they mean about being “incentivized” to do more, rather than to do less. If they were simply paid on a salary, they wouldn’t have the incentive and would only do what was needed. That, and the money made could be redistributed to the doctors that should be doing the real work (read: primary care physicians) rather than the ones making the money (read: specialists).
That said, Tennessee still haunts my dreams. 🙂
Great discussion. It’s nice to see a place where the wingnuts (from both sides) aren’t bantering about. I started a discussion on my FB page about this subject, and got some interesting responses from people who are against reform. They are mainly based in fear, which I pointed out ad nauseum, but the people who share that view seem so deep in the fear cycle that they can’t even see it. Check it out if you like, I’d love to hear your thoughts on the discussion. Just send me a friend request. Thanks
Well thank you, Mr. Hall. 🙂
We (in St. Louis, MO) just had an event for our representative, Russ Carnahan, last night to discuss aging and the health care crazies came out in full force. 6 people got arrested.
http://www.stltoday.com/stltoday/news/stories.nsf/nation/story/5420430FDF2036F08625760B00136BBC?OpenDocument
The whole thing is going to hell in a hand basket.
But, either way, I also appreciate the excellent discussion on this particular post. I know some reasonable people! 🙂
Doctors get paid too much? Did someone really say that? Seriously?
I’m not a doctor nor even close, but I have a few friends that are and health care costs are frequently talked about.
Some points.
1. Doctors do not make any money on tests unless they are private practice.
2. Doctor DO run too many tests and they will absolutely ALL openly admit it.
3. They run more test firstly to protect themselves from lawsuits, which are out of control
4. More tests do occasionally catch more diseases
5. Take a look at a few doctor’s offices… some are great. Some are embarassing… why? Anybody ever seen the costs of an x-ray machine let alone advanced equipment? It’s tough.
Anyone here know how much debt a doctor has out of school? Lots. Could you imagine having $250,000 worth of debt and starting your work at nearly 30 years old in many cases?
One of the biggest costs of healthcare is because people want it to be easy to go through the process of getting checked out, have a doctor on every corner, see a specialist at any time, and have their health insurance pay for it all. And, they want to go whenever they feel like it, take their kids because they have a runny nose, and fix them when they’re fat.
We overmedicate ourselves with doctor’s assistance all the time. We try every medication to fix every little problem we have.
ADD/ADHD… new philosophy, let’s medicate. Higher blood pressure, let’s medicate… now we need even more medication to fix what the blood pressure meds broke.
Wait, the United States is a bunch of fat slobs with no exercise. Hmm… anyone think the causes a HUGE health risk? Anyone? Anyone? Example… a TRUE example.
I am 5’6″ and I used to be 270 lbs and held it in my gut. I had horrible skin, rashes, got fungus, had high cholesterol, a very high heart rate, sleep apnea, couldn’t breath as well, and bad knees.
I am now 155 lbs and 10% bodyfat, and workout. Guess what? It’s ALL gone and have 3x the energy and motivation. The last time I had my blood pressure checked it was 95/55. It was previously 140/100.
And those fat, out of shape people, do you guys think they need more care throughout life? You bet they do. And at the end of their life? Oh yeah.
Anyone want to talk about our cancer rates here in the US compared to the rest of the world? I think there’s something we’re doing differently, don’t you? I don’t know if it’s herbicides or pesticides or something else we do to the food or something altogether different but it’s something. Anyone know how much is costs to treat cancer? Look it up.
And even WITH all the sickly, out of shape, cancer and disease infested people, we’re trying desperately to keep alive, our amazing increases in technologies and medicine are keeping people alive much longer than in the past (though lower than other countries). All those fun years in a wheel chair or sucking air out of a tube costs money.
Of course, we expect the government to pay for all or most of that. Geez, we can’t be expected to fit any bill…. we haven’t saved any money all these years living off the american dream of overspending and credit card ridiculousness.
Dont take this all that negatively, but we need to open our eyes at this mess and not blame ANYONE. Because at this point, it’s all about survival… and we sure do know about that…. I mean, someone will pay for it but not us?
Thanks, CWL, for the thoughts!
Yes, many doctors (not all) get paid too much. Some of that is because of all the training they need to do (neurosurgeons, for example), but a lot of it is build into the fact that a). medical school costs a lot, and b). we value specialists more than general practice doctors. Medical school costs don’t need to be as high as they are (I’m a graduate student at a medical school, I have the same teachers and the same facilities, yet my tuition is thousands less and I actually get paid to go here along with my fellow students…wtf?). Now, I’m all about rewarding doctors for doing good work, but dermatologists and plastic surgeons, who MOSTLY do elective work, shouldn’t get paid that well. I’d rather have the ER doc getting that $500,000 a year. They don’t get near that amount of money.
I agree, though, a lot of over-prescription is going on, especially with things like ADHD. And, extra tests get done to ward off lawsuits. These are things that need to be resolved, as well! If things like that were taken care of, some costs would be reduced. But only SOME. There are more things that could be done. And I also agree that people that don’t take care of themselves shouldn’t get rewarded for it with low premiums.
Just keep in mind that the private industry is already doing that, however. The insurance costs I spend are helping smokers fight off lung cancer, and fat people fight off heart disease. That would have to be changed for private industry, as well as on a public option. However, I bet you many Republicans would be opposed to that kind of regulation…as they frequently abstain from regulating private industry at all.
You make some good points, sir!