Governement Healthcare...

Don't forget about Medicare covering the SSI disabled which is also a very expensive population.

One issue I have with more Medicare is the customer service or getting help with billing issues. By and large, my MIL and FIL have had very few issues come up. But when they did...OMG, what a nightmare. You have to call different service centers depending on whether it is A or B coverage, those two don't communicate, have different requirements, etc. Oy. Phone trees to get any where and wait times so long that the answering system will just hang up on you if the queue is too backed up. I think that is among the reasons that the administrative costs are so low (certainly not the only reason) and nothing to aspire to. (ETA: I mean to say the issue I have with holding Medicare as an example of low administrative costs for delivering healthcare, not specifically adding people to it).

I heard today on the radio that it looks like this insurance reform will not be completed by the end of August because of the Senate. Personally, I think this is great not because it shouldn't happen but because it is a lot of change that also costs a lot of money. Some time to sort it out seems like a good idea. I don't think it will make an appreciable difference, in a bad way, if that happens in the next 4 weeks versus the next 4 months.

[DCJenn]

I can tell you what happened in Maryland when they decided to close the Intermediate Care Facilities for the Mentally Retarded (hereafter known as the ICFs/MR) and go w/ the Medicaid Waiver option (which has a 50% federal match).

At first everyone was all excited because the Federal regulations for ICFs are cumbersome and really not applicable to 'most' people with MR - such as the requirement that there be a Medical Director, an RN, a dietician, etc. The Waiver required that people used community based providers- i.e. your community GP, etc.

Well, everyone made the switch and Maryland closed all of its ICFs except the one unit on the grounds of the mental hospital for those who were adjudicated to a that unit- aka the criminals with MR (which is a huge civil rights violation that the DOJ has been all over)

Anyway lo and behold, the first people snapped up by the providers were- no shock- the least sick and needy people. You know, the Corkys of the world. The providers had to be forced by the state to take those clients with severe and profound retardation because they're (duh) much more expensive to care for- even in the less restrictive environment of home based care. The company that I worked for specialized in people with the diagnosis of mental illness and mental retardation and honestly the only way we broke even was to have a very large population base so that we could spread out costs. (for example, for those who only needed drop-in supervision once a week averages out those people who need 24/7 nursing care)

That's what has to happen in our health care system as a whole. Only insuring the sick and the poor by default will increase costs because 1) we're not providing preventative care and 2) those populations are the least likely to be able to access services in the first place. ETA: and they're more likely to get sick and stay sick.

It's like my standard soapbox issue of most states not providing dental care under medicaid but covering emergency dental surgery. Hmmmm, which is worse- and more costly. (Of course, the argument could be made that if you allow people's teeth to rot out then eventually they won't have any dental care needs but I'm hoping that we as a society haven't become that cynical)

Jenn

[PrincessFiona]

Jenn (DC), I agree wholeheartedly with your last two posts. Even though I sound like I don't want healthcare reform, I do. I do believe that basic health care should be a right for American citizens. I also think that people should have the option available to purchase private insurance if they are able. That's how it works in other countries with *socialized* medicine as well.

Some of the problems that I am having are that there is no tort reform being discussed...the costs of medical education are also not on the table...and the issue is being framed as a rich/poor issue instead of an american problem. It sounds (from the rhetoric) that many people want this reform as long as the *rich* pay for it.

Where are the discussions about Americans demanding MRIs for every ache and pain, and antibiotics for every virus? There isn't much talk about personal responsibility.

Also, why aren't we cracking the nuts of big pharma? Seriously, these people spend millions every year researching the best name for a drug, more millions advertising to the public and then more millions making sure that they get doctors in their pockets. They also sell the drugs to Mexico and Canada...hell..the entire rest of the world...for a fraction of what they charge Americans (who finance the basic science research through NIH grants etc...)

Where is this talk?

I want reform, but I want the real problems addressed and not just a band aid.

I am also up for the tax increase, believe it or not...

Hell, if I could get accepted to medical school tomorrow I would promise to work for next-to-nothing! LOL

Kris

Some of the problems that I am having are that there is no tort reform being discussed...the costs of medical education are also not on the table...and the issue is being framed as a rich/poor issue instead of an american problem. It sounds (from the rhetoric) that many people want this reform as long as the *rich* pay for it.

Where are the discussions about Americans demanding MRIs for every ache and pain, and antibiotics for every virus? There isn't much talk about personal responsibility.

Also, why aren't we cracking the nuts of big pharma? Seriously, these people spend millions every year researching the best name for a drug, more millions advertising to the public and then more millions making sure that they get doctors in their pockets. They also sell the drugs to Mexico and Canada...hell..the entire rest of the world...for a fraction of what they charge Americans (who finance the basic science research through NIH grants etc...)

Where is this talk?

ITA.

I think the Medicare D coverage specifically prohibits negotiate on drug price. What the heck? Medicare decides and changes the rates paid for everything else, why not medication?

As far as the personal responsibility, I agree with a point you made earlier Kris about everyone having to pay something. That would either be in taxes or in co-pays or some sort of cost-sharing for patients (and I'm not sure how this applies to current ideas because I'm not keeping up enough ).

[Sheherezade]

The Big Pharma stuff drives me batty, too. (Sorry Lily!) When I was in intellectual property classes in Boston (so 5 years ago?), I was taught that the drug companies are required to sell their products at a discount in other countries by the laws passed in those countries. USA doesn't believe in price controls....and as a result we get stuck with prices that make up for the losses they incur in other lands. I wish the price issue was managed globally if the drug is to be distributed globally. It isn't fair as it stands. They don't want Americans buying in Canada because our dollars here subsidize the lower costs there. I'm not sure if that lecture was accurate - I'd love to here yay or nay from someone "in the know" about the global pricing.

As DH and I hashed through the plus/minus of current legislation tonight, I think we may have hit on WHY the tax is only on the rich (besides, you know, tradition ). DH was saying he couldn't see why anyone would buy private insurance if they were already paying a tax for a government insurance program. He'd think that if that tax was coming out of his paycheck, he'd view it as a premium and just use the government option. At this point I mentioned that the people most likely to use the program would not be taxed....only the top 1%....and I wouldn't pull our good insurance offered through his work to enroll in a government plan just because we'd been taxed for it. This is the luxury of money and good benefits. I'm wondering if that isn't part of the logic as well. The middle tier -- with under 250K good jobs and private insurance will not be tempted to dump their insurance to make good on a new tax payment, the wealthy will stick with their private insurance because they can afford it (even if they grumble about the tax) and the unfortunate benefit-less lower middle class will have an insurance option. Just a thought. It might help keep private insurance as a thriving industry and lower the number of people taking the government option.

I have downloaded the summary of the HR3200 from OpenCongress. Hopefully, it will help me understand what is *currently* being discussed and what is media mythology.

[McPants]

http://spennypost.blogspot.com/2009/...faux-news.html

If the U.S. adopts public health care, it will apparently lead to a rise in terrorism according to Fox News.

[DCJenn]

Apparently everything Obama does will either turn us into Nazi Germany or a haven for terrorists, or perhaps both.

Jenn

[GrayMatterWife]

Apparently everything Obama does will either turn us into Nazi Germany. . .

Yeah, I am really with you on that one. I am tired of people employing the word "fascism" and doing so with absolutely no idea what it actually means.

A "fascist" is not someone who simply imposes his will on people without regard to their desires; it isn't someone who is really mean or someone who does something you don't like. Bush was not a fascist (he was actually the opposite in most respects). Your third-grade homeroom teacher who wouldn't let you chew gum during the Pledge of Allegiance was not a fascist. Etc. A fascist is someone who believes that all rights and privileges afforded to the individual in society come from and through the state, and that society should be focused on state empowerment for the betterment of society. Fascism is not a necessarily immoral theory of striving toward an improved society. It depends on how the State extends and denies the privileges it is theorized to control that makes its use of fascism a good or bad thing (don't get me wrong--I think fascism is an inherently inferior theory on how to improve society or understand how men receive their rights. I much prefer the theory of liberal democracy).

Hitler's fascism was evil because it was a racial fascism: Hitler believed in creating a state that awarded (and denied) rights and privileges based on race (most notably, a state denying privileges, including the "privilege" of life, to Jews, who he viewed as a race). That is different that, for example, fascism under Mussolini in Italy.

I happen to believe that Obama is a fascist. From everything I have seen of him and read about him, he believes that rights and privileges should come from the state (in his case, the federal government), and he believes that the awarding and denying of rights should be based on a theory of social and economic "equalization." But that is NOT Nazi fascism. Obama's version of fascism is not facially immoral (inferior, in my view, but not immoral). I do not endorse it, but I do not equate it to Nazism. And, I am pretty sure six million slaughtered Jews wouldn't, either.

So, I think, both sides need to stop screaming Nazism. It's ridiculous. Someone--I think McPants, maybe?--commented on this (the abusive misuse of the term "Nazism" by politicians) a couple months ago. It had a good webpage link to Wikipedia, if I remember.

Rant over. Sorry. The accusation of someone being like Hitler or evoking Nazi Germany just really pisses me off. When it is aimed at anyone. Other than Hitler--the actual, real guy.

[Momo]

Apparently everything Obama does will either turn us into Nazi Germany or a haven for terrorists, or perhaps both.

Jenn

A swastika has already has shown up on the office sign,of an Atlanta area congressman,who is in support of the president position.

[GrayMatterWife]

A swastika has already has shown up on the office sign, of an Atlanta area congressman.

My first thought was that it sounds like it was done by some nut who SUPPORTS the Congressman, trying to "help him" by making his "enemies" look nuts.

Hey, I found the McPants post from earlier that I referred to: Godwin's Law...

http://en.wikipedia.org/wiki/Godwin%27s_law

[MrsC]

I have heard this so many times...having a government run healthcare system is what makes you a communist country, a Nazi, a facist. Try telling that to the residents of the nations listed below.

All of these countries have a universal healthcare system. Either two-tier or single-payer. Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, the Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Ukraine and the United Kingdom, (virtually all of Europe)
Argentina, Brazil, Canada, Chile, Costa Rica, Cuba, Mexico, Panama, Peru, Uruguay, Trinidad and Tobago...to name a few.

The systems in each coutry vary greatly but it is proof that this can be done in varying degrees and can be successful. The general consensus by developed nations is...it's a good thing!

[DCJenn]

Well, the general consensus of all of the other industrial nations is that mandatory paid vacations are probably a good investment in the long term health of their citizens, too.

We're such a bunch of hypocritical puritans that it just annoys me to NO end. Everyone wants something as long as it doesn't impact THEM in their own little insulated NIMBY worlds.
I just don't understand the isolation mentality-

and it's not just political isolationists, it's everywhere. Litter is bad- as the cigarette goes out the window. Obesity is the scourge of the nation- but don't tax sodas. Children should be healthy- but I'm not innoculating MY kid. I want my road paved- but don't raise my gas taxes to pay for it. I want community policing- but don't want MY income tax increased.

It truly sickens me how little the citizens of this country are so free about spouting off about the Constitution and what their 'rights' are that they've completely forgotten about their responsibilities.

Everything has a price.

Jenn

[Rapunzel]

I have to admit that the growing nationalization of major industries (banking and automobile come to mind) along with the emphasis on "social and racial struggles" suggests the formative years of fascism. The addition of the healthcare industry to that list of nationalized formerly-capitalist entities would definitely strengthen the direction towards fascism.

Something that I don't think a lot of people understand is that "fascism" is not something that can be adequately equated with so-called far right or far left American politics. "Fascism" is a description of a particular ideology that could embrace either "side". While communism stands in almost direct ideological opposition to capitalism, fascism is not quite as easy to define and has, in fact, taken variable forms. Indeed, monarchies have also been accused of fascism (the old Iranian monarchy comes to mind in those accusations).

So, while ignorant people might automatically associate fascism with Hitler and Nazis (swastikas included) the reality is that Nazi fascism was just one form that fascism took in the last century. With Hitler it was a type of socialist fascism. And, that makes it quite possible to examine Obama's political actions and point out that his nationalization of major industries appears to have a fascist bent/ideology behind it. Additionally, I don't think any leader who has had fascist leanings has ever looked in the mirror and said, "I am a fascist!" This stands apart from such political forms of government such as socialism (and its devolution to communism), monarchy, and democracy (with its oft-accompanying economic system of capitalism).

I would submit that the direct opposite of fascism is anarchy. So, in many respects we continually walk a balance between the two.

[PrincessFiona]

Well, the general consensus of all of the other industrial nations is that mandatory paid vacations are probably a good investment in the long term health of their citizens, too.

We're such a bunch of hypocritical puritans that it just annoys me to NO end. Everyone wants something as long as it doesn't impact THEM in their own little insulated NIMBY worlds.
I just don't understand the isolation mentality-

and it's not just political isolationists, it's everywhere. Litter is bad- as the cigarette goes out the window. Obesity is the scourge of the nation- but don't tax sodas. Children should be healthy- but I'm not innoculating MY kid. I want my road paved- but don't raise my gas taxes to pay for it. I want community policing- but don't want MY income tax increased.

It truly sickens me how little the citizens of this country are so free about spouting off about the Constitution and what their 'rights' are that they've completely forgotten about their responsibilities.

Everything has a price.

Jenn

I agree. And these thoughts are probably exactly why a lot of these tax increases now stick in the back of my throat. I have never been opposed to paying taxes for health care, roads, social programs...you name it...and I'm still not. But I truly resent the idea that many people have that 1. as long as the tax increases don't affect them then they don't care how much the taxes are raised and 2. taxes should be raised on anyone earning above a certain threshold and lowered for everyone else.

Let's DO this with health care...and raise everyone's taxes by the same percentage...then I'm in. I'm tired of hearing about how greedy doctors are (but then having the same people call me at 11pm on a Saturday night asking if my dh can prescribe a narcotic for them over the phone without laying hands on them and then being angry when he feels they should be seen first). I'm just basically tired of a debate being framed as us against them. My husband made a choice to go to medical school, do years of residency and fellowship and work his butt off post-training. That does make us now higher income earners, but we have both worked for it. My brother, for example, made a choice to drop out of high school and eventually become a home inspector. Good for him for getting a trade and supporting himself. I'm proud of him...but....the fact that he now comes to me and says that it isn't fair that Thomas earns more and we should have to pay more while he pays less....wrong.

sigh...

nothing constructive to add, really...

[SuzySunshine]

Kris, I think that is constructive - people want this but they don't want to pay for it.

My DH has told more then one person in the last month how he doesn't see an issue with cutting some specialties salaries and to an extent I agree with him. Whether he takes a job starting at $150K or $700K (which he won't) we're going to be comfortable and he's going to be doing what he loves. Other people are just as happy making less then $30K and doing what they love - just because DH's choice took years of training and thousands of dollars doesn't diminish either choice. But it also doesn't mean that we should have to pay a huge percentage more in taxes, a higher total yes, but a much larger percentage not so much.