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Ken M
Mountain climber
Los Angeles, Ca
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The philosophical backdrop of social programs comes down to: "personal responsibility v we're all in this together."
Should disabled people get preferred parking?
Should the gov't take care of the elderly poor?
Should people unable to pay for healthcare be denied care?
"Social Security is currently the largest social insurance program in the U.S., constituting 37% of government expenditure and 7% of the gross domestic product[6] and is currently estimated to keep roughly 40% of all Americans age 65 or older out of poverty
http://en.wikipedia.org/wiki/Social_Security_(United_States);
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WBraun
climber
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At age 62 Locker will receive free glue from govt warehouse ......
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WBraun
climber
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Assyria the militaristic society
"We live in a modern-day ‘pleasure Palace’ that has narcotized its victims into a "dim witted" people who can't see beyond their Phallus or bank accounts. We accumulate wealth to buy even greater pleasures, while the chains of mental slavery grow stronger."
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apogee
climber
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Well, madbolter, I don't know what to say...you strike me as a classic uncompromising, idealistic libertarian who sees no value in any other ideologies. That's a pretty tough place to be, because you are never going to be satisfied with much of anything that happens in politics and government, and relegates you to seeking the very few cohorts in reclusive locations as far from society as you can get.
Like your extremist Repug counterparts, you are likely to forever see any view that doesn't fit within your exceptionally narrow, atypical view to be Socialist/Communist/Hippy/Wacko. Never mind the fact that, for all of the current problems of SS & Medicare, millions and millions and millions of citizens have benefitted from them. You and your fellow extremist, uncompromising libertarian/Repugs have always opposed such a system, and were overwhelmingly outnumbered by supporters of these systems (and ironically, even with the current woes to the systems, you still are)- now that the systems are broken, you see it as the perfect opportunity to say 'told you so' and try to put a stake through the heart of them forever.
Hope you manage to find solace when this doesn't happen.
(By the way, your posts are still way, way too long!)
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apogee
climber
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"You need to bring the cost structure down for basic medical care so that average people can pay for it themselves without having to take out costly insurance to do this."
"As to Social Security, there is NO way to do this abruptly....Younger people on the other hand need to be taught how to invest and take care of themselves."
Skip, I think you would find near universal agreement on these points. Healthcare, insurance, Medicare: none of these things should cost as much as they do- we are a fabulously innovative country with some of the smartest people in the world, and with a shift of priorities towards problems like this, it would seem quite solvable.
Healthcare costs need containment, and people need to learn to save and invest wisely- no argument there. With all due respect, though, these are ideals that should guide our actions, but are never wholly achievable. Medical care costs will always increase, and even the most diligent savers and investors can easily be wiped out by the whim of a capitalist system such as ours. (I'm sure we both know quite a few people of late who were reasonable in their future planning using contemporary saving and investment tools, only to be crushed by the recent downturns.)
I am not at all an advocate of a nanny-society where individuals suckle from the initiative of others. There is, however, reasonable middle grounds that strives towards the ideals you state, yet acknowledges and acts on some of the realities of our system. An example: a minimal healthcare coverage system that provides reasonable care for catastrophic emergencies. Those who wish the highest levels of care (i.e. fattrad's oft-repeated 'gamma knife' procedures) pay for them on their own one way or another. Looking around the world, Canada seems much closer to a practical solution than we are.
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happiegrrrl
Trad climber
New York, NY
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"I recently learned where every boy in the high school in my local area has to wear some stupid devise which simulates pregnancy for a specified time period and then be physically chained to some robot baby which he has to take care of. I would much rather he, instead, learned the kind of hard core money management skills we are addressing right here."
.....yes - teach them the money skills, and instead of the pregnancy simulation(I wonder how that works; is it just a weight to carry? can't possibly be imposing hormones....), take 17%* of their allowance away each and every week. Send that allowance to a children's organization and tell the kids they are welcome to go visit those kids and develop relationship with them(not a required part of the class, of course....).
But it's of no use. Boys will be boys, and sometimes grown men will be boys..... Hey Lois! You've hijacked your own thread!
*I believe that is the amount of a person's income required for child support with one child.
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happiegrrrl
Trad climber
New York, NY
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I did say "sometimes," Locker.
If you ever had a guy whining about being asked to use a condom, and then suggest you were *trying to trap him* when you said you didn't see abortion as a viable birth control device, maybe you'd think differently!
Uh oh...I think Lois' thread is on the derail....
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happiegrrrl
Trad climber
New York, NY
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"I wish we could get the rest of these gals out of the kitchen, washing and drying the dishes, and back out into the living room where the important stuff is being discussed."
Oh.
dear.
Locker - I wish I had been around camp. You must have come by in the short window of time between 11-3, when the sun was out! Man, what a screwed up trip this one was.... But still very nice.
If you are in Woodstock - we MUST climb together! I am hoping to get the cabin again for 2010...will find out some time in March I think.
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Ken M
Mountain climber
Los Angeles, Ca
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It seems that there is no one who feels that our current US system should remain, as it is. The question is, where to go. It seems to me that there are clear examples of ways to do this, we don't need to invent things from the ground up. We need to be open to how things work, and have been demonstrated to work over time, elsewhere. Here is an example:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/
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United Kingdom
Percentage of Gross Domestic Product (GDP) spent on health care: 8.3
Average family premium: None; funded by taxation.
Co-payments: None for most services; some co-pays for dental care, eyeglasses and 5 percent of prescriptions. Young people and the elderly are exempt from all drug co-pays.
What is it? The British system is "socialized medicine" because the government both provides and pays for health care. Britons pay taxes for health care, and the government-run National Health Service (NHS) distributes those funds to health care providers. Hospital doctors are paid salaries. General practitioners (GPs), who run private practices, are paid based on the number of patients they see. A small number of specialists work outside the NHS and see private-pay patients.
How does it work? Because the system is funded through taxes, administrative costs are low; there are no bills to collect or claims to review. Patients have a "medical home" in their GP, who also serves as a gatekeeper to the rest of the system; patients must see their GP before going to a specialist. GPs, who are paid extra for keeping their patients healthy, are instrumental in preventive care, an area in which Britain is a world leader.
What are the concerns? The stereotype of socialized medicine -- long waits and limited choice -- still has some truth. In response, the British government has instituted reforms to help make care more competitive and give patients more choice. Hospitals now compete for NHS funds distributed by local Primary Care Trusts, and starting in April 2008 patients are able to choose where they want to be treated for many procedures.
Japan
Percentage of GDP spent on health care: 8
Average family premium: $280 per month, with employers paying more than half.
Co-payments: 30 percent of the cost of a procedure, but the total amount paid in a month is capped according to income.
What is it? Japan uses a "social insurance" system in which all citizens are required to have health insurance, either through their work or purchased from a nonprofit, community-based plan. Those who can't afford the premiums receive public assistance. Most health insurance is private; doctors and almost all hospitals are in the private sector.
How does it work? Japan boasts some of the best health statistics in the world, no doubt due in part to the Japanese diet and lifestyle. Unlike the U.K., there are no gatekeepers; the Japanese can go to any specialist when and as often as they like. Every two years the Ministry of Health negotiates with physicians to set the price for every procedure. This helps keeps costs down.
What are the concerns? In fact, Japan has been so successful at keeping costs down that Japan now spends too little on health care; half of the hospitals in Japan are operating in the red. Having no gatekeepers means there's no check on how often the Japanese use health care, and patients may lack a medical home.
Germany
Percentage of GDP spent on health care: 10.7
Average family premium: $750 per month; premiums are pegged to patients' income.
Co-payments: 10 euros ($15) every three months; some patients, like pregnant women, are exempt.
What is it? Germany, like Japan, uses a social insurance model. In fact, Germany is the birthplace of social insurance, which dates back to Chancellor Otto von Bismarck. But unlike the Japanese, who get insurance from work or are assigned to a community fund, Germans are free to buy their insurance from one of more than 200 private, nonprofit "sickness funds." As in Japan, the poor receive public assistance to pay their premiums.
How does it work? Sickness funds are nonprofit and cannot deny coverage based on preexisting conditions; they compete with each other for members, and fund managers are paid based on the size of their enrollments. Like Japan, Germany is a single-payment system, but instead of the government negotiating the prices, the sickness funds bargain with doctors as a group. Germans can go straight to a specialist without first seeing a gatekeeper doctor, but they may pay a higher co-pay if they do.
What are the concerns? The single-payment system leaves some German doctors feeling underpaid. A family doctor in Germany makes about two-thirds as much as he or she would in America. (Then again, German doctors pay much less for malpractice insurance, and many attend medical school for free.) Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds.
Taiwan
Percentage GDP spent on health care: 6.3
Average family premium: $650 per year for a family for four.
Co-payments: 20 percent of the cost of drugs, up to $6.50; up to $7 for outpatient care; $1.80 for dental and traditional Chinese medicine. There are exemptions for major diseases, childbirth, preventive services, and for the poor, veterans, and children.
What is it? Taiwan adopted a "National Health Insurance" model in 1995 after studying other countries' systems. Like Japan and Germany, all citizens must have insurance, but there is only one, government-run insurer. Working people pay premiums split with their employers; others pay flat rates with government help; and some groups, like the poor and veterans, are fully subsidized. The resulting system is similar to Canada's -- and the U.S. Medicare program.
How does it work? Taiwan's new health system extended insurance to the 40 percent of the population that lacked it while actually decreasing the growth of health care spending. The Taiwanese can see any doctor without a referral. Every citizen has a smart card, which is used to store his or her medical history and bill the national insurer. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country's single insurer, Taiwan's health care system has the lowest administrative costs in the world.
What are the concerns? Like Japan, Taiwan's system is not taking in enough money to cover the medical care it provides. The problem is compounded by politics, because it is up to Taiwan's parliament to approve an increase in insurance premiums, which it has only done once since the program was enacted.
Switzerland
Percentage of GDP spent on health care: 11.6
Average monthly family premium: $750, paid entirely by consumers; there are government subsidies for low-income citizens.
Co-payments: 10 percent of the cost of services, up to $420 per year.
What is it? The Swiss system is social insurance like in Japan and Germany, voted in by a national referendum in 1994. Switzerland didn't have far to go to achieve universal coverage; 95 percent of the population already had voluntary insurance when the law was passed. All citizens are required to have coverage; those not covered were automatically assigned to a company. The government provides assistance to those who can't afford the premiums.
How does it work? The Swiss example shows that universal coverage is possible, even in a highly capitalist nation with powerful insurance and pharmaceutical industries. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. They can make money on supplemental insurance, however. As in Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government.
What are the concerns? The Swiss system is the second most expensive in the world -- but it's still far cheaper than U.S. health care. Drug prices are still slightly higher than in other European nations, and even then the discounts may be subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits. In general, the Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them.
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bvb
Social climber
flagstaff arizona
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Excellent, post, Ken and very informative.
way to go ken! the leb seal of approval!
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bvb
Social climber
flagstaff arizona
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You need to be reading my response because it is important.
even if she does say so herself. i'm sure the rest of you agree.
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madbolter1
Big Wall climber
Walla Walla, WA
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I'm with skipt. Outta-here. The lines are clear, and NEITHER side will move:
FORCE the "better off" to pay for the overall lack of personal responsibility in this country vs. ALLOW people to enjoy ALL the fruits of their decisions.
We all know where we stand, and, again, nobody is moving. And, OF COURSE I'm in the minority. Just as this nation once was a minority among the national philosophies of the world.
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bvb
Social climber
flagstaff arizona
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I'm with skipt. Outta-here.
oh thank god.
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apogee
climber
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"I'm with skipt. Outta-here."
Does that mean...
a) you're done with this thread
b) you're done with ST
c) you're done with all matters political (including voting)
d) you're leaving the country
???????
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Binks
Social climber
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"We don't allow people who have made bad decisions to starve to death - and neither do we feed them sushi and fillet mignon or give them coupons to dine at five star restaurants at tax-payer expense. Using my metaphore, we provide persons who are down on their luck."
Uh, yes we do. The bankers, insurers, and wall street criminals made terrible mistakes and yet we "feed them sushi and fillet mignon" and multi million dollar bonuses no matter what they do, out of our taxes. If they screw it up they will just asked to be bailed out again. They are allowed by us to profit endlessly from our misery and we get no guarantees whatsoever from them. They should have been allowed to starve.
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Norton
Social climber
the Middle Class
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Let's talk about the "unfunded liabilities" of SS and Medicare:
Fatty's "The Sky Is Falling": NOT
The notion of "unfunded liabilities" in certain programs is based on the arbitrary assumption that certain designated revenue sources should pay for certain classes of government expenditures. The story that Social Security and Medicare should be paid for out of payroll taxes and their trust funds is not a recent creation of critics of those systems. It has been around for decades. But why? Revenues and expenditures are "fungible," meaning that a dollar is a dollar is a dollar. In fact, today's Social Security surplus flows right into the pot with other revenues, while a significant portion of Medicare costs already are paid for out of general revenue. The real question is not "will the designated revenues be enough to pay for the designated programs" but "will we have enough income to afford to keep the promises we have made?"
There is no question that the nation's gross domestic product will be sufficient to meet all of our Social Security promises forever, leaving lots of income for increasing the prosperity of the young. In general, the outlook for economic growth is good. Our average income per person in 100 years is likely to be much, much higher than it is today (more than four times as high). Social Security benefits are predicted to rise from about 4.5 percent of our GDP to about 6.6 percent over the next century. Even though such long predictions are very uncertain, this one should leave us sanguine: if incomes in 100 years are only twice their present level, and incomes of the old rise from 4.5 to 6.6 percent of income, that still leaves us with $1.96 for every dollar we have today, after Social Security obligations are taken care of. We can continue to keep our modest Social Security promises, and young families still will be much better off than families are today.
There also is no question that, if health care costs continue to rise as rapidly into the indefinite future as they have in recent years, medical expenditures will soak up a much, much larger share of our overall income than they do now, leaving a smaller and smaller share for other uses. Unlike Social Security, this could indeed become a grave problem.
What's Generational Accounting Got to Do With It?
Although the notion that we are headed for a fiscal train wreck is stated in the language of scientific prediction, there is a moral element as well. Building on the idea of "generational accounting," those who foresee a catastrophe are implicitly using the ethical standard that people should take care of themselves over their lifetimes-not rely on government transfers from others (including from other generations). The idea is that it is unfair for old people as a group to get back more than they paid into the public trough (using appropriate interest rates).
This is a very odd notion. Why is it that young people in general will be better off than their parents? Fundamentally, it is because of the information and technology that earlier generations produced, the engine of modern economic growth. If the older generation levied fees on all the intellectual property they created, that could amount to an enormous claim by older people on their children: "We invented the transistor and financial derivatives, which is what makes you so productive. Pay up."
There is no need to charge rent on the intellectual property the young inherit from earlier generations. Instead, we can use our common sense. If the old are a growing proportion of the population, and the pie we all have to share is much bigger than it was, we should give a larger slice to the elderly.
Don't Worry, Be Happy
Imagine if in 1950, someone had calculated the costs of educating the baby boomers in public institutions through their college years. What an immense, unmanageable burden! And nothing-not a penny-had been set aside by 1950 to cover the costs of public universities in the 1960s and 1970s! Using the logic of unfunded liabilities that has fueled alarmist media stories, public universities should have been closed; education should have been left to the private sector.
Yet nobody ever claimed in the 1950s and 1960s that the education of the Baby Boomers was an excessive burden our society, or that our public institutions could not afford to accept the challenge. When we needed more schools, we built them. Why should the Boomers' retirement be unmanageable? We need to strengthen social insurance for old people, and we will be able to afford it.
http://www.socsec.org/publications.asp?pubid=496
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apogee
climber
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I dunno, Lois, Skip has become much more rational and interesting to dialogue with in the last month or so than he used to be- I'm not sure what brought about the change, but it's noticeable. Still, every once in a while, you can tell Skip has something else going on in his life, and he gets real snippy here.
Truth be told, it happens to me, too, and I'm sure for most everybody else that contributes to these threads.
As far as madbolter is concerned...he's pretty clearly in the extreme of his ideology, and while he's trying to rationally communicate it, he's pretty far out there and is always likely to have his knickers in a twist about one issue or another.
Of course, I used to think the same thing about Skip, and I was proven wrong. Go figure.
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Norton
Social climber
the Middle Class
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Republican Lawmakers FLIP FLOP on "Socialist" Healthcare Spending:
WASHINGTON — Democrats are troubled by the inconsistency of Republican lawmakers who approved a major Medicare expansion six years ago that has added tens of billions of dollars to federal deficits, but oppose current health overhaul plans.
All current GOP senators, including the 24 who voted for the 2003 Medicare expansion, oppose the health care bill that's backed by President Barack Obama and most congressional Democrats.
The Democrats claim that their plan moving through Congress now will pay for itself with higher taxes and spending cuts and they cite the nonpartisan Congressional Budget Office for support.
By contrast, when Republicans controlled the House, Senate and White House in 2003, they overcame Democratic opposition to add a deficit-financed prescription drug benefit to Medicare. The program will cost a half-trillion dollars over 10 years, or more by some estimates.
With no new taxes or spending offsets accompanying the Medicare drug program, the cost has been added to the federal debt.
Some Republicans say they don't believe the CBO's projections that the health care overhaul will pay for itself. As for their newfound worries about big government health expansions, they essentially say: That was then, this is now.
Some conservatives have no patience with such explanations.
"As far as I am concerned, any Republican who voted for the Medicare drug benefit has no right to criticize anything the Democrats have done in terms of adding to the national debt," said Bruce Bartlett, an official in the administrations of Ronald Reagan and George H.W. Bush. He made his comments in a Forbes article titled "Republican Deficit Hypocrisy."
Bartlett said the 2003 Medicare expansion was "a pure giveaway" that cost more than this year's Senate or House health bills will cost. More important, he said, "the drug benefit had no dedicated financing, no offsets and no revenue-raisers. One hundred percent of the cost simply added to the federal budget deficit."
The pending health care bills in Congress, he noted, are projected to add nothing to the deficit over 10 years.
Other lawmakers who voted for the 2003 Medicare expansion include the Senate's top three Republican leaders, all sharp critics of the Obama-backed health care plans: Mitch McConnell of Kentucky, Jon Kyl of Arizona and Lamar Alexander of Tennessee. Eleven Democratic senators voted with them back then.
http://www.huffingtonpost.com/2009/12/26/gop-lawmakers-flip-flop-o_n_403870.html
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Karen
Trad climber
So Cal urban sprawl Hell
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Lois, I've read this entire thread but have not responded, felt you guys were way over my head.
I do have some questions though, however, unrelated to why we need health care reform, but rather, why some types of services are not included in current health care.
For example, why doesn't Medicare nor Medicaid pay for dental care? or, at the very least offer reduced prices for these services? My neighbor who is retired and on a fixed income cannot afford a root canal (he has medicare) told me it does not cover any dental work. I just don't get this?
Why does Medicare cover some services are not others?
I like your ideas Lois, a lot of the ideas on both sides of this issue seem to have merit, both pros and cons. This is very complex and I feel to compare our country to say Sweden is too simplistic. But who am I to say, I am no expert.
It just seems our Country is too different and set up differently than either Canada or Sweden so not sure if their system could ever work here, but I agree some sort of change is needed.
Especially when one gets their hospital bill and reviews the various charges for items and finds outrages prices are charged for things, I am sure you know what I am referring to.
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bvb
Social climber
flagstaff arizona
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Now back to health care.
schoolmarm is ordering y'all back to the chalkboard. so step it up, fanboys.
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