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Old 01-23-2015, 07:12 AM
 
221 posts, read 266,374 times
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If you did not understand that "capitalist pig" was written the way I wrote it to start with, for the reason that I think referring to anyone working in the industry that way is wrong, and people don't understand how many of us really don't just think we need to crush everyone, then I really see no need to continue this conversation.

And just to clarify things, I don't work for any firm. I trade for myself, in my home office(when I am not driving all around the state for our business). That is also where my capital to start our business came from.

Last edited by Oriz; 01-23-2015 at 07:21 AM..
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Old 01-23-2015, 03:26 PM
 
30 posts, read 34,283 times
Reputation: 39
Quote:
Originally Posted by Oriz View Post
If you did not understand that "capitalist pig" was written the way I wrote it to start with, for the reason that I think referring to anyone working in the industry that way is wrong, and people don't understand how many of us really don't just think we need to crush everyone, then I really see no need to continue this conversation.

And just to clarify things, I don't work for any firm. I trade for myself, in my home office(when I am not driving all around the state for our business). That is also where my capital to start our business came from.

Good answer. I've been paying taxes in this country for more than 30 years and I believe in our Constitution. I've also placed my own life on the line to defend that Constitution and to protect civil rights, not to mention other service. In other words I've DONE my duty and I continue to do my duty, I don't just blow hot air about it with other people's money.

I believe that in order to preserve temporary safety nets so they're available when otherwise "able" people fall down, and to preserve funds for long term assistance to those who are UNable, we need to act financially responsibly, and not choose the of path socialist states (most of which have either gone or are going bankrupt) and whose people have, or will have, to flee the country due to extreme poverty.....and then migrate here.

At the rate we are going people who have been working hard and paying social security taxes all their lives won't be able to get their social security payments because reckless people came along and gave the store away to people who didn't FEEL like doing things to earn their way. That's a lot of BULL. THis country cannot afford to provide for everyone who claims a RIGHT to things that are not provided for ANYWHERE in our Bill of Rights.

I don't advocate reckless spending and I don't advocate reckless and mindless policies like the notion that healthcare should be provided with no strings attached regardless of a person's need and regardless of how much personal responsibility they take in their own lives, or that people have a "right" to remain where they are BORN and be catered to by others who have gone out and made their own way in life........ and I think I've earned the rights to my opinions.

Oh, and if anyone wants to see how the flagship state of across the board healthcare is doing, you can check out Massachusetts where healthcare now comprises a whopping 25 percent of the ENTIRE state budget. Soaring Medicaid costs raise profound questions: Editorial | masslive.com

Last edited by BS Walks; 01-23-2015 at 04:05 PM..
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Old 01-23-2015, 06:33 PM
 
809 posts, read 678,655 times
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"4. Every person in every state is the business of the states not the business of the US Government. "

Anybody who's non-white in a state like Mississippi is not likely to agree with that.

The Preamble to the Constitution states, "...to promote the general welfare..."

As health care is not like any other good or service-- one can live quite well without owning a car or a brassiere-- it is a Constitutional mandate for the federal government to supply the defects of a state, as it used to do with things like education, highways, air transportation, child safety seats and water quality, in order to promote the general welfare.
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Old 01-24-2015, 05:33 PM
 
221 posts, read 266,374 times
Reputation: 375
Quote:
Originally Posted by BS Walks View Post
Good answer. I've been paying taxes in this country for more than 30 years and I believe in our Constitution. I've also placed my own life on the line to defend that Constitution and to protect civil rights, not to mention other service. In other words I've DONE my duty and I continue to do my duty, I don't just blow hot air about it with other people's money.

Not sure what exactly that means, care to explain?

I believe that in order to preserve temporary safety nets so they're available when otherwise "able" people fall down, and to preserve funds for long term assistance to those who are UNable, we need to act financially responsibly, and not choose the of path socialist states (most of which have either gone or are going bankrupt) and whose people have, or will have, to flee the country due to extreme poverty.....and then migrate here.

And I agree. I am not a socialist. I don't believe in govt intervention in MOST walks of life, like I have said several times before I make the distinction when it is something physically harmful to others. So, for instance, I have been and will continue to be against useless social programs, but not the useful ones. I don't think people should be able to keep collecting unemployment forever if they make no real efforts to find a job. I have been and will continue to be against govt bailouts. Against the ponzi scheme that is called central banks. Nor do I believe it is the govts job to "create jobs" and they are bad at doing that anyway. I do, however, think the govt has a role in making sure we are all able to take care of our illnesses in an affordable way. BTW, there are many socialist countries that actually have happy people living in them that really don't want to migrate to the US. Take a look at Scandinavia for instance. I'm not a fan of what they are doing and it's definitely not for everyone. Not my cup of tea. I would not be happy paying their income tax. But they obviously are so whatever works for them.

At the rate we are going people who have been working hard and paying social security taxes all their lives won't be able to get their social security payments because reckless people came along and gave the store away to people who didn't FEEL like doing things to earn their way. That's a lot of BULL. THis country cannot afford to provide for everyone who claims a RIGHT to things that are not provided for ANYWHERE in our Bill of Rights.

I don't advocate reckless spending and I don't advocate reckless and mindless policies like the notion that healthcare should be provided with no strings attached regardless of a person's need and regardless of how much personal responsibility they take in their own lives, or that people have a "right" to remain where they are BORN and be catered to by others who have gone out and made their own way in life........ and I think I've earned the rights to my opinions.

if you think a sick person can just up and leave and move from state to state time and time again in order to chase whatever will be most affordable for their health care, you obviously do not know what being sick is.

Oh, and if anyone wants to see how the flagship state of across the board healthcare is doing, you can check out Massachusetts where healthcare now comprises a whopping 25 percent of the ENTIRE state budget. Soaring Medicaid costs raise profound questions: Editorial | masslive.com
.
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Old 01-25-2015, 04:05 PM
 
809 posts, read 678,655 times
Reputation: 1333
So, here's an idea of what would work in Vermont:

1. Doctors will know they will be paid
2. Patients will know that their co-pays are going to be consistent and affordable.
3. Doctors will determine the course of treatment for their patients.
4. Hospitals will know what their annual revenues will be.
5. Pharmaceutical and medical supply companies will compete with one another to land the business in the state (driving costs down, by the way).
6. All providers will negotiate biennially with the state to cover costs and make a reasonable income.
7. The entity which administers the entire program will be held to 2%, per Medicare Part A. No "cost plus" clause in the contract.
8. Everyone who is a resident of the state will be covered, both in state and when out of state.
9. All therapeutic treatments and services will be covered for both body and mind.
10. As with the public roads, both the worthy and the unworthy will have the same unfettered access to the system.
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Old 01-28-2015, 11:42 PM
 
13,923 posts, read 7,416,674 times
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I think this thread kind of misses the point. I have lots of younger health friends who got slaughtered on health care costs with ACA. Before, it was affordable. Now, the young, healthy people who can least afford it are propping up older high risk and unhealthy people who were previously uninsurable. There is a cap on the spread insurers can charge high risk people so they're effectively decoupled from risk. It's no longer "health insurance" by any rational definition of insurance. It's a managed health care fee with health people subsidizing the unhealthy.

Personally, I think that private health insurance should go back to being private health insurance. Tie premiums 100% to risk. If you smoke, drink heavily, do drugs, are obese, or any of the other litany of issues, you pay more. At some point, the insurance company can refuse to insure you. I'd do a dramatic reform to single payer Medicaid and open it up to the uninsurable with means-tested premiums, deductibles, and co-pays. The reform part is the critical piece. Today, Medicaid patients are almost 100% non-compliant with anything a physician tells them to do. Lose weight? Nope. Quite smoking? Nope. Cut back on alcohol? Nope. Medicaid people end up with self-inflicted health problems and won't change their behavior one bit to mitigate the issue. Why should society foot the bill for that behavior? I think that non-compliance should cause diminishing coverage. You're obese and pre-diabetic? If you don't start losing weight, your coverage declines. You have liver issues and you drink like a fish? Coverage for that condition starts declining. Ask any physician about Medicaid patients and no-showing office appointments. There's no cost so they no-show all the time. With reforms, if you no-show, you're S.O.L. unless you cough up the hefty cancellation fee like the rest of us do. While you're asking about that, ask about any Medicaid patient accepting an appointment before 11am? 8:30am??? Are you kidding? I'm still in bed! Using the ER as a medical walk-in is another reform that needs to happen. For the rest of us, our insurance company has a cow if we go to the ER with a trivial issue and insists that we pay for a big slice of it. They want us to use a medical walk-in or call the 800 number/use the internet service to get an Rx. Even worse, Medicaid people use the ambulance ride as free transportation because they can't be bothered to find alternate transportation to a doctor's office. Right now, the EMT and ambulance service doesn't care. They get paid for an ambulance ride to the ER to treat a hangnail or splinter. Or the 2am Saturday night Emergency Room visit saying "I've had a toothache for a week and I can't stand it anymore." Really? The rest of us pay for this nonsense. I'd rather that money go to pay for people with serious health problems who can't get private insurance coverage and who follow all the physician's recommendations to try to get themselves healthy. I'm a firm believer in the safety net but there has to be some effort on the part of the recipient of the services to comply with what the physician is telling them to do.
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Old 01-29-2015, 03:26 AM
 
46 posts, read 45,954 times
Reputation: 61
Quote:
Originally Posted by GeoffD View Post
I think this thread kind of misses the point. I have lots of younger health friends who got slaughtered on health care costs with ACA. Before, it was affordable. Now, the young, healthy people who can least afford it are propping up older high risk and unhealthy people who were previously uninsurable. There is a cap on the spread insurers can charge high risk people so they're effectively decoupled from risk. It's no longer "health insurance" by any rational definition of insurance. It's a managed health care fee with health people subsidizing the unhealthy.

Personally, I think that private health insurance should go back to being private health insurance. Tie premiums 100% to risk. If you smoke, drink heavily, do drugs, are obese, or any of the other litany of issues, you pay more. At some point, the insurance company can refuse to insure you. I'd do a dramatic reform to single payer Medicaid and open it up to the uninsurable with means-tested premiums, deductibles, and co-pays. The reform part is the critical piece. Today, Medicaid patients are almost 100% non-compliant with anything a physician tells them to do. Lose weight? Nope. Quite smoking? Nope. Cut back on alcohol? Nope. Medicaid people end up with self-inflicted health problems and won't change their behavior one bit to mitigate the issue. Why should society foot the bill for that behavior? I think that non-compliance should cause diminishing coverage. You're obese and pre-diabetic? If you don't start losing weight, your coverage declines. You have liver issues and you drink like a fish? Coverage for that condition starts declining. Ask any physician about Medicaid patients and no-showing office appointments. There's no cost so they no-show all the time. With reforms, if you no-show, you're S.O.L. unless you cough up the hefty cancellation fee like the rest of us do. While you're asking about that, ask about any Medicaid patient accepting an appointment before 11am? 8:30am??? Are you kidding? I'm still in bed! Using the ER as a medical walk-in is another reform that needs to happen. For the rest of us, our insurance company has a cow if we go to the ER with a trivial issue and insists that we pay for a big slice of it. They want us to use a medical walk-in or call the 800 number/use the internet service to get an Rx. Even worse, Medicaid people use the ambulance ride as free transportation because they can't be bothered to find alternate transportation to a doctor's office. Right now, the EMT and ambulance service doesn't care. They get paid for an ambulance ride to the ER to treat a hangnail or splinter. Or the 2am Saturday night Emergency Room visit saying "I've had a toothache for a week and I can't stand it anymore." Really? The rest of us pay for this nonsense. I'd rather that money go to pay for people with serious health problems who can't get private insurance coverage and who follow all the physician's recommendations to try to get themselves healthy. I'm a firm believer in the safety net but there has to be some effort on the part of the recipient of the services to comply with what the physician is telling them to do.
This pseudo-rationalist argument is a good example of the corrosive effects of capitalism on community. Note the heavy emphasis on punishment. Note the outlandish claims without any real data to support them and, moreover, without any sense of the actual cost to the taxpayer of recipient behavior either compared to the general population or to providers (e.g. Medicaid fraud). There is little regard for these facts or the facts of life for those who are poor. Not long ago, Maine's Department of Human Services published a small book on the unavailability of dental services for the poor. That is a national phenomenon. Why do they wait a week with a toothache? They can't afford the dentist? Do you know how low income must be to be Medicaid eligible? The ER will give them a drug to ease the pain (have you ever experienced a bad toothache? About the same as natural childbirth) or pull the tooth. We know the poor by their teeth (or the absence of them).

Now, if you are a young, healthy American, you will pay more for health insurance, and why should you? Well, there are a few elders who think along the same lines, and they'd like to know why they have to pay taxes for public schools. If you are that young and that healthy, you have already been the beneficiary of community. And I won't speculate that you were a Saturday morning lay-a-bed when my Vermont grandfather was out tilling the stony soil at the age of twelve after his father died. There was no time for school. He taught himself to read. We could bring back sweatshops for kids. Then, we wouldn't have so many young and healthy adults to objectify and make "other" the recipients of "charity." But we won't bring back those workhouses (with some lingering exceptions) because we consider ourselves " enlightened."
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Old 01-29-2015, 07:17 AM
 
13,923 posts, read 7,416,674 times
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Without capitalism, there would be no community. You can't prop up the unwashed masses with social programs if you don't have affluent people paying for it. Capitalism rewards behavior that is personally profitable. That principal needs to be applied to health insurance the same way it is applied to automobile insurance. If you insist on driving drunk, crash your car all the time, and drive at high speeds collecting speeding tickets, your automobile insurance will spike. Eventually, your insurance company will cancel your policy. The rest of us would object to having to subsidize those people's behavior. Why should health insurance be and different?

It hardly matters. Do the math. The United States is about a decade away from an economic upheaval driven by unrestrained spending on defense, Social Security, Social Security disability insurance, and single payer health care (Medicare, Medicaid, and CHIP programs). It's not sustainable and the economy will collapse unless something changes. The effective tax rate on the affluent people who fund those programs is 39.6% (the top Federal tax bracket) + 2.9% (Medicare tax) + state/local taxes. Vermont collects 8.95% on those people. That's a 51.45% tax rate and other states like California and New York have even higher rates. You can tax those people at 100% and you still run out of money. Old people vote and everyone knows they will become an old person some day requiring public services so it's hard to believe that Social Security and Medicare will be cut anytime soon. Every Congressional district in the country has pork barrel defense spending. It's difficult to imagine any of that being cut. That leaves Medicaid and SSDI where those people rarely vote and there is the public perception that there is an enormous amount of waste and fraud going on. There will be much less pushback for slashing those programs so those will be dramatically cut first.

You can attack me as being a heartless capitalist but that's what is going to happen. When the United States does a Greece in about a decade, Medicaid and CHIP get slashed first. At the state level, it's the same problem. Vermont spends an astounding 25.3% of their $5 billion budget on Medicaid. If you back out the Act 68 state property tax portion of tax receipts and distributions (31.1% of the budget), it starts approaching 50% of the state budget. Medicaid only pays about 60 cents on the dollar so any physician, medical complex, or hospital that takes Medicaid is doing it at a loss. The rest of us prop up Medicaid far beyond the taxes we pay. We also pay for it with higher insurance premiums. Nationwide, we're seeing more and more physicians and practices refusing to take Medicaid patients because they'd go bankrupt otherwise. Their being squeezed by the for-profit health insurance companies and they have no option. There is really no option but to dramatically reform Medicaid since it's not sustainable.
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Old 01-29-2015, 07:46 AM
 
809 posts, read 678,655 times
Reputation: 1333
GeoffD:

Trust me: You will get sick. If you are lucky, you will get really old before you get sick, but you will get sick and it will kill you.

However, you might have something really bad happen to you before you stop being young-- getting hit by an uninsured driver, falling off a ladder, blowing out your knee playing soccer, getting cancer:


https://www.youtube.com/watch?v=wT_fguJwaIo


This is what health insurance coverage is about-- protecting you against the possibility that the sword is dangling by a thread over your head. People have found it makes sense to unite to protect themselves. It's always been better to circle the wagons at night than have them scattered all over the prairie, even if it means having to put up with the loud snoring coming from the next one.

You pay now for coverage you don't need, and your money goes to help those who do need care. In your time-- and that time will come-- the money of others will help you in your need.

What you don't want is someone to take $1,000 of your money and give $850 or less of it to somebody who needs care. However, that is precisely what for-profit insurance companies do. (Medicare Part A, a government-adminstered program, will take that much of your money, but spend $980 on someone's care. Medicare Part B, administered by for-profit companies regulated by the government, only pays from $890 to $930. There's a lesson here.) They also have ways of paying even less: very high co-pays, denial of payment because of a pre-existing condition, telling the doctor a certain treatment is not authorized and so on.

As for "personal responsibility," that can't be a valid argument generally until babies can choose their parents. For the most part, our choices are determined by the norms of our environment. In America, to be overweight is to be normal, and in some families to be obese, to smoke, to do nothing but watch TV are normal choices.

So, man up! Accept that your payment into a health care system is an engagement in a social contract that will in time care for you. But do your part to educate others at risk for morbidity that they have the power to re-evaluate what is "normal" for them.
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Old 01-29-2015, 08:07 AM
 
13,923 posts, read 7,416,674 times
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Quote:
Originally Posted by cgregor View Post
You pay now for coverage you don't need, and your money goes to help those who do need care. In your time-- and that time will come-- the money of others will help you in your need.
You are mistaken. My employer pays for coverage I do need and I pay a slice of the premium with pre-tax dollars. Because it is corporate health insurance, it is 100% coupled to the demographic risk of the group. I'm paying a somewhat inflated premium because part of my health care dollars prop up physicians, medical centers, and hospitals to compensate for the loss they run treating Medicaid patients but that is relatively small. I also have long term disability insurance. If I can't work, I don't become a ward of the state subsisting off SSDI, Medicaid, Section 8 housing, and food stamps. I have private insurance for all that. I receive those benefits from my employer because I've made myself valuable to my employer. They are more profitable having me and all my expensive pay and benefits on staff than they would be without me. That evil capitalism rearing its ugly head again. In my lifetime, my employers and I have paid far more into the system than I could ever pull out in benefits, and that is ignoring any kind of investment return on that money other than adjusting it for inflation. I'm fine with that. I think progressive taxation is a good thing. I'm affluent and benefited from the infrastructure that society provided. It's only fair that I pay a much higher amount to society than someone less fortunate than I.

You don't address the fundamental issue here. What the United States, and Vermont in particular, are doing is not sustainable. Health care public spending cannot be infinite. It needs to be rationed and it will be in the very near future no matter how much people scream in anguish. It's totally unfair that services are completely decoupled from compliance. The costs to society for self-inflicted health problems that linger for decades that are caused by obesity, excessive alcohol consumption, cigarette smoking, and drug abuse are enormous. As we're running out of resources and have absolutely no choice but to ration health care, how can we possibly not use compliance and the willingness for patients to take the proper steps to get themselves healthier as one of the metrics for rationing?
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