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Old 01-29-2015, 09:51 AM
 
221 posts, read 265,971 times
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Quote:
Originally Posted by GeoffD View Post

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.
While theoretically it could happen, in practice the US can and will never do a Greece. The US can do what most European countries can't(as per their silly agreement to be part of the EU) and that is print money. Make no mistake I am not an advocate for printing money or for borrowing more debt and I have already in several threads made my view on the ramifications of that clear, and it does have ramifications and I believe in the very very near future(possibly even by the end of this year) we will see another big crisis. But all that belongs in a different thread. Anyway my point is the US will never default because it will just print more money. Eventually it will cost interest rates to rise, it will cost other economic turmoil, but not a greece, or a spain, or an italy. That's just an impossible situation for the US to be in, practically.
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Old 01-29-2015, 03:01 PM
 
809 posts, read 676,769 times
Reputation: 1333
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Originally Posted by GeoffD View Post
. . .

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?
Congratulations on having such a sound insurance setup for yourself! Is your income is somewhat around the median for Vermonters-- $28,875-- or the state's median household income, $52,977? If so, then clearly at least half of Vermont households should be able to afford what you have. Problem solved for half of us!

As for the fundamental issue, the most expensive country which has a health care system better than the United States is Norway, which costs less than $5,000 per year, while our care-- not as good as theirs-- costs over $7,000. Clearly, if we reduced our spending level to theirs, running out of resources would be far less of a problem. Do you think that perhaps we could learn something from Norway or the other 36 countries which have better health care systems than we have?

Last edited by cgregor; 01-29-2015 at 03:10 PM..
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Old 01-30-2015, 10:31 AM
 
46 posts, read 45,887 times
Reputation: 61
Default The Unwashed Masses

Quote:
Originally Posted by GeoffD View Post
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.
"The unwashed masses"? Really? Is that because "let them eat cake" is no longer available? Or, in this case, "let them eat carrots"? My goodness! My first and primary point is that you must be very careful not to objectify the "other." History demonstrates how far down that road can go. And how efficiently.

Secondly, I'm glad you have those benefits. Right now, you can't envision a way you're not covered for some disaster. I've met so many who thought the same --before disaster struck. We think we're in control. We think we've got all the bases covered, and when disaster strikes, we think we are resilient. We know we are very bright --and hard workers. Yet, somehow, it's all taken out of our hands, and when we turn for help, we're met by folks who think they're better off because they're better than us, after our loss. I will never forget the old lady in Maine who refused to apply for food stamps because she was ashamed -- of being poor. Imagine a shame so deep you'd rather go hungry. What kind of community is that?

Now, I understand that there are those who do as you suggest and cheat the system, but I'm saying it's not okay to tar with one brush all these other folks, who have so little without fault. I often think of the bankrupts who feel horrible about filing when we regularly see CEOs lecturing us about the benefits of capitalism, the same who have "reorganized" more than once. I believe you have misidentified the problem, and if you would take the time to dig deeper, you would turn your attention to those who would far prefer you scapegoat the poor and disabled.

And it's not just disaster that leaves people in a ditch. Some people start off this way. They start with a deficit -- of talent, of gifts, of environment, and they work twice as hard as most. They will never get what you got. They'll walk miles through a snowstorm to scrub somebody's floors. They really do -- legals and illegals. They are not less valuable than you are.

Some never have a job, and that, itself, is a loss because work can be its own reward. I see too many young men hanging around day and night with nothing to do.

I heard an old interview of former Governor Cuomo the other day. He was asked how a kid of immigrant parents did so well. And he said, "I got lucky." And I wondered, "When did we lose the sense of how lucky we are?" Maybe it's because Americans have to work so hard. We forget that luck, and an unwarranted sense of entitlement takes root.

So, what I meant about capitalism and the corrosion of community is that our value is not what we earn. If you lose everything you own tomorrow, if you lose your capacity to be "productive" to those who would use you to produce more capital, you are still entitled to our concern.

Finally, just as a matter of treatment standards, I don't think that shame and punishment are effective in addressing the primary behaviors about which you complain. In fact, I think shame and punishment make those disorders worse. I'm not asking you to take my word for anything I post. You can research it, and hopefully, take care to find as neutral sources as possible. Then, maybe you'll change your mind Or, maybe not. But I appreciate the honest debate, and I am so proud, as a damn Yankee watching from the South, to see Vermont having it.
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Old 02-01-2015, 11:54 AM
 
13,872 posts, read 7,381,208 times
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Quote:
Originally Posted by cgregor View Post
As for the fundamental issue, the most expensive country which has a health care system better than the United States is Norway, which costs less than $5,000 per year, while our care-- not as good as theirs-- costs over $7,000. Clearly, if we reduced our spending level to theirs, running out of resources would be far less of a problem. Do you think that perhaps we could learn something from Norway or the other 36 countries which have better health care systems than we have?
Aaah. Norway. Let's look at the cost side with a quick Google search. In the US, a nurse makes $3,168 per month working 33 hours per week, on average. In Norway, a nurse makes $2,229 per month working 37.5 hours per week, on average. In European socialized medicine, health care workers are often government employees making a heck of a lot less than the US pays in the private sector. What else should we look at? Rx drug costs? Physician salaries? Anesthesia costs? Cost of a CT scan or MRI? Hospital administrator salaries? Percent of medical spending lost to "overhead"? Anywhere you look, you'll see a similar disparity. In the US, the medical cartel sucks about 20% of GDP out of the economy. It is enormously profitable and those profits buy enormous political influence. This is why ACA did absolutely nothing to address the cost side of the problem.

Do you think that the politicians in Washington, D.C. have the political will to push away all that money and enact European-style socialized medicine? I don't. And an individual state can't go solo and deal with the cost side in a vacuum because all their health care workers would pack up and leave. Kind of like retail and industry on the Vermont side of the Connecticut river valley. It's pretty easy to do the budget math and predict the outcome. The national debt continues to rise. Interest rates rise. Interest payments become a dominant part of the Federal budget. Defense isn't going to be cut because every congressional district benefits from it somehow. Social Security and Medicare are sacred cows. That leaves Medicaid as the easy target.
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Old 02-01-2015, 04:19 PM
 
809 posts, read 676,769 times
Reputation: 1333
Quote:
Aaah. Norway. Let's look at the cost side with a quick Google search.
I don't believe you have income figures that are adjusted for PPP (purchasing power parity). The WHO and CIA figures for national health care costs ARE adjusted for PPP, so despite the numbers you found, Norway is providing better health care services for 5/7ths or so of what it costs each American. Or to look at it another way, that Norwegian nurse's salary adjusted for PPP comes out to around $3,184.

Vermont happens to be larger than some of the countries (e.g., Iceland, Malta, the Bahamas) which either have adopted universal health care or (in the case of the Bahamas) are switching to it. Vermont's per capita State Domestic Product happens to be greater than the GDP of 16 of the 36 countries which have universal health care-- we are even ahead of France's, which happens to have the best health care system in the world.

You have a very valid point about the politicians. Thanks to Citizens United, Buckley v. Vallejo, etc., the would-be plutocrats are bypassing the major parties and in effect running their own candidates. The Republican and Democratic parties used to be viewed by candidates as "the bank" (thus, switching parties was actually just switching banks and slightly modifying one's positions), but now they are simply conduits. And as long as the Koch brothers don't get screwed over by Humana, their candidates will fight any sort of rational and universal health care system.
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Old 02-04-2015, 07:19 AM
 
130 posts, read 240,783 times
Reputation: 148
Like I wrote, the conversation is all wrong and this thread now proves my point.
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Old 02-04-2015, 03:01 PM
 
809 posts, read 676,769 times
Reputation: 1333
Well, I was the first to reply to you and was, I feel, on topic, but you know how threads can turn into a game of Telephone. . . However, you can re-focus it by proposing some solutions to the problem as you see it, and we can discuss those.
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Old 02-08-2015, 02:45 PM
 
Location: Inis Fada
16,833 posts, read 29,091,856 times
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Quote:
Originally Posted by cgregor View Post
You certainly touched on a complicated subject! There are several very significant factors involved: 1) A distribution of income which requires over half of the households to have no parent with time to stay at home and prepare nutritious meals; 2) an oligopolistic food supply chain which markets foods on the basis of profitability rather than nutrition; 3) a food processing industry which prepares products meant for the "no time to cook; Dad and I are off to our second jobs" demographic; 4) commercial advertising which influences children to demand unhealthy foods; 5) largely irrelevant (and unfortunately so) home economics programs in the primary and middle school years, rendered so by processed foods; 6) children of the demographic described in 1, who are left to their own devices to prepare breakfast; 7) medical providers who are paid for treating the sick rather than curing them; 8) a regulatory system which cannot assure food quality; 9) school lunch programs which far more often than not depend on low-cost but unhealthy meals to stay within a skimpy budget.

So, who wants to address that can of worms?
It's a big can o' worms!

Add to the points you've made the fact that dollar stores selling processed foods with little nutritional value can accept (the program formerly known as) food stamps. I noticed that farmers markets are accepting benefits now, but if someone is hard-pressed and trying to stretch their benefit, they're going to buy the 99 cent can of salt-laden corporate brand beans over the farmers market fresh picked beans.

Home economics courses did teach cooking as well as budgeting years back. Today's courses have shied away from budgeting and balancing checkbooks and do rely more on processed foods than they did back when I rode my dinosaur to school.

Some of the items you list, though, people have control over. I know plenty of single parents who spend their day off preparing healthy meals to serve through the week. I've seen local food shelves which have fresh produce. The Chester-Andover family center is one. Soups can be made from dried beans (which are inexpensive), fresh vegetables, and small amounts of meat or vegetarian style. Some of this can go to self-discipline, and learning how to budget.
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Old 02-08-2015, 03:27 PM
 
809 posts, read 676,769 times
Reputation: 1333
Quote:
Originally Posted by OhBeeHave View Post
. . .

Some of the items you list, though, people have control over. I know plenty of single parents who spend their day off preparing healthy meals to serve through the week. I've seen local food shelves which have fresh produce. The Chester-Andover family center is one. Soups can be made from dried beans (which are inexpensive), fresh vegetables, and small amounts of meat or vegetarian style. Some of this can go to self-discipline, and learning how to budget.
Absolutely! But how can that sort of conduct get established as a community norm? It sounds like a real "Each one, teach one" task...
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Old 02-11-2015, 06:48 AM
 
Location: Boston, MA
238 posts, read 253,942 times
Reputation: 223
Quote:
Originally Posted by Lily6271 View Post
I suggested you disclose some authoritative data such as I offered you.
I'll jump in here and respond to this one particular point. Personally, I don't care what Vermont does in terns of its own healthcare policies. My concerns involve national policies and their efficacy. I think Vermont should provide whatever social and health options that they choose to offer in their state. But Vermonters should also be the ones paying for it. I have serious issues with national healthcare such as that laid out in the ACA. There are many reasons for my concerns but below are some facts which support my concerns:

1) Our Federal debt is now at 18 TRILLION and rising.

2) The Congressional Budget Office shows our current federal health spending at about 5 percent of our GDP. By 2035 they will be 8 percent. That means entitlement programs are now about 14 percent of GDP. "CBO estimates that growth in health care spending per person (after adjusting for demographic changes) has outpaced growth in GDP per capita by an average of 1.5 percent per year since 1985. Key factors contributing to that faster growth have been the emergence and increasing use of new medical technologies, rising personal income, and the expanding scope of health insurance coverage"

3) You can't necessarily keep your plan. "CBO and JCT project that, as a result of the ACA, between 6 million and 7 million fewer people will have employment-based insurance coverage each year from 2016 through 2024 than would be the case in the absence of the ACA."

4) Obamacare reduces the incentive to find and keep a good job.

5) The CBO says that in 2024 31 million people in the US will be without health insurance.

6) The CBO’s projections of hours worked represents a decline in the number of full-time-equivalent workers of about 2.0 million in 2017, rising to about 2.5 million in 2024. Although CBO projects that total employment (and compensation) will increase over the coming decade, that increase will be smaller than it would have been in the absence of the ACA.

7) As someone pointed out earlier, Massachusetts now spends 1/4 of it's total state budget on healthcare.

8) The percentage of GDP spent publicly and privately on healthcare in the US is 18 percent, and higher than everyone. Health expenditure, total (% of GDP) | Data | Table

9) Entitlement programs including healthcare, social security and similar programs comprise 1/2 of the ENTIRE federal budget. The High Cost of Staying Well - US News



Again, Vermont can do what it wants but Vermont (and other states that choose to implement policies with questionable budgetary efficacy) need to pay for them. I think the Federal government needs to return to a more state-centered approach on a lot of these issues so that local residents can craft policies that make sense for THEM and the residents of their state. This one-size-fits-all national approach to these issues is clearly not working and government was never intended to work that way. Vermont---like all other states-- should be responsible for the government they create and the Federal government needs to return to dealing with the traditional national security, border security, military issues it was created for. This becomes more and more evident each day as we see our elected Federal leaders unable to reach enough agreement on issues to get things done and/or to get them done efficiently.
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