Not surprisingly, a discussion of healthcare (or any large piece of social legislation) is going to invite a more philosophical discussion of individuality vs. redistribution and how, in essence, to define fairness in a world that does not give fair starts or fair endings. I think Boston Owl captures the redistribution side very well, and I think Optimistic, Rick, and 69/70/75 capture the individuality side very well. I am very empathetic to both sides, and I am more Boston Owl on some issues (and on some days), and I am more 69/70/75 on others.

But I ask this earnestly (with the caveat being I don't know sh-t about the healthcare debate): Would you guys, especially those on the individuality side, be willing to draw lines somewhat? For example, we essentially have a form of socialized education, in that taxes pay for a "public option" of education. I would assume the general consensus would be against doing away with that and going to an all-private school system. Or are there distinctions you guys see between K-12 education vs. healthcare?

As for those on the empathy/redistribution side of the coin, I will say that my concern here is that, given that legislation generally is all about incentivizing (or disincentivizing) behavior, there may be a lot of unintended consequences to big government programs that require a lot of tax money. When it comes to money, government can't give what it first hasn't already taken. Higher taxes on, say, corporations, don't necessarily mean the government just has more money in its coffers; it oftens means that corporations just move out of the country. It is a fact that there are Fortune 50 companies that, every few years, assess whether it makes more sense to stay in the U.S. or to leave; indeed, some would argue that it is their fiduciary duty to always look at that question (for the sake of the shareholders' bottom line).

Then again, I think of a friend of mine who was an actress in NYC who injured her foot a few years back but was not able to get it treated because, as an actress, she did not have health insurance. She was educated at NYU Tisch School of the Arts and was in Second City improv group (the breeding ground for Saturday Night Live); she was not one of the unwashed and lazy that I think people (not necessarily people on this Board) think of when they think of the millions of uninsured in this country. Her foot eventually healed, but over a much longer time than it should have (I honestly don't know the details of the foot).

But speaking of incentives, do we want a system where the incentive is for all of us to get jobs at big companies just for the health insurance, or is there a healthcare system that can incentivize people to work in the arts or on their own and feel reasonably secure that they can have access to healthcare at a reasonable cost? In a world of limited resources, I know there are no easy choices here.

http://www.theatlantic.com/magazine/arch...r/7617/1/?

The title says one thing, but the author goes into a detailed discussion of the problems with the health care system today and comes up with a solution that I find intriguing. Worth the read.

First, to Amber: Thanks for the info. I was a little suprised to find that I am not in the 28% for 2009, and that is before exemptions and deductions. I guess i am one of the poor now. (joke, y'all). I understand the progressive nature of the income tax. I used 40% because the top marginal rate is, i believe, 39.6%, and because the bottom marginal rate on the death tax is higher than that. Either way, the amount the "dealer" asks the player to pass around is irrelevant to that anaogy. The salient part is the demand to share.

Barrett: For education, I like the voucher system. For healthcare, I think we could do a lot more for more people in ways other than creating the giant government entitlement program. The left cast the debate as Obamacare or status quo, when i think there were other ways out there that would have been much better than either. I haven't seen the article D1 referenced yet, but it sounds like it might be one. Just as something off the topof my head, I think portability of private insurance would be a start. Of course this would require insurance that could cross state lines. If an employer wanted to cover that cost as part of the package, fine - that is a private negotiation. Some additional public assistance to the unemployed so they can keep it - fine. Much cheaper than taking over the country. Pre-existing conditions - I don't see how this will work economically without premiums rising drastically. the primary reason to exclude PECs is to keep rates low, not to pump up the bottom line. Rates are the selling point.

Moot point anyway - the hole has been punched in the dike, and while it will take some time for the dribble to become a torrent, it will, and it is those under 50 or so who will drown.

(03-23-2010 10:22 AM)Barrett Wrote:  Not surprisingly, a discussion of healthcare (or any large piece of social legislation) is going to invite a more philosophical discussion of individuality vs. redistribution and how, in essence, to define fairness in a world that does not give fair starts or fair endings. I think Boston Owl captures the redistribution side very well, and I think Optimistic, Rick, and 69/70/75 capture the individuality side very well. I am very empathetic to both sides, and I am more Boston Owl on some issues (and on some days), and I am more 69/70/75 on others.

But I ask this earnestly (with the caveat being I don't know sh-t about the healthcare debate): Would you guys, especially those on the individuality side, be willing to draw lines somewhat? For example, we essentially have a form of socialized education, in that taxes pay for a "public option" of education. I would assume the general consensus would be against doing away with that and going to an all-private school system. Or are there distinctions you guys see between K-12 education vs. healthcare?

I'm torn on all this, including health care. I understand your point on socialized education. My big gripe there is that it's not working, in particular for the majority of the people in the bottom 25 to 50% on the income level. As I indicated above, I come in contact with kids from this demographic weekly. You see the points made by Owl69/70/75 and Optimistic clearly. Some of the kids are going to be fine. A lot of them are not. Some have behavioral issues that are only going to be resolved with major one-on-one intervention. They've got no concept of respect for personal property or, seemingly, the value of almost anything.

The point is, this translates into their public school setting. It doesn't just impact them, it impacts the other kids who are trying and the teachers who draw the misfortune of trying to handle the "handfuls" in a class of 25 or more.

I certainly understand the need to try with these kids. The solution of many is to flee to the suburbs (increasing their drive times and all that goes with that), where you essentially get your kids away from the issues, but you move the property tax money out, and you further hinder the property values in the poor school districts . . .

So I've stayed put, and on one hand I fully understand the need that my property taxes address (mind you that a disproportionate number of the kids who are behavioral issues and undermine the school sytem come from families that pay no property tax), but at times it's aggravating that as a result parents have to sacrifice greatly (either in tuitions that rise faster than my income, or in commutes that keep the parents away from their kids more) to avoid having their kids potentially hurt (I say potentially, because I want to be clear that the public school do win battles, have good teachers, etc - - they just have a huge disadvantage from the get-go)

Again the big problem isn't just that some things only government's can handle, it's that even when they try to handle them, they fail (poor HISD dropout/grad rates; social security will be broke; so will Medicaid).

I think bureacracy's are too big to really care. All the politicians really do is thrown money at a problem without ever addressing the root causes of the problem, or acknowledging that the job is so big, it by definition becomes impersonal.

Again, (and we never do this), I believe it's easier to get middle class support (and by middle class, I'm obviously addressing the 40% to 96% percentiles who pay for the government programs) if they believe or feel their own standard of living is improving.

Things like Health Care should be addressed incrementally when economy is better. Is that a completely satisfactory answer? No,

But it is common sense. Do we ever handle things that way? Of course not. Had Clinton addressed health care in his second term, instead of the first, he may have had success, particularly if it had been done incrementally. Not that the proponents would have liked that. But would it have been better if an additional 5 or 10 million had health care for the last 12 years?

Given our economy and the world's economy, there is I think, justifiable fear about what the future will hold. I believe that most of Congress that is enacting this, falls in the upper 4%, and are basically exempt from the consequences because of their status as Congressmen and women.

Why wouldn't that concern people or make them angry? (I'm the former,not the latter).

(03-23-2010 10:22 AM)Barrett Wrote:  Not surprisingly, a discussion of healthcare (or any large piece of social legislation) is going to invite a more philosophical discussion of individuality vs. redistribution and how, in essence, to define fairness in a world that does not give fair starts or fair endings. I think Boston Owl captures the redistribution side very well, and I think Optimistic, Rick, and 69/70/75 capture the individuality side very well. I am very empathetic to both sides, and I am more Boston Owl on some issues (and on some days), and I am more 69/70/75 on others.
But I ask this earnestly (with the caveat being I don't know sh-t about the healthcare debate): Would you guys, especially those on the individuality side, be willing to draw lines somewhat? For example, we essentially have a form of socialized education, in that taxes pay for a "public option" of education. I would assume the general consensus would be against doing away with that and going to an all-private school system. Or are there distinctions you guys see between K-12 education vs. healthcare?
As for those on the empathy/redistribution side of the coin, I will say that my concern here is that, given that legislation generally is all about incentivizing (or disincentivizing) behavior, there may be a lot of unintended consequences to big government programs that require a lot of tax money. When it comes to money, government can't give what it first hasn't already taken. Higher taxes on, say, corporations, don't necessarily mean the government just has more money in its coffers; it oftens means that corporations just move out of the country. It is a fact that there are Fortune 50 companies that, every few years, assess whether it makes more sense to stay in the U.S. or to leave; indeed, some would argue that it is their fiduciary duty to always look at that question (for the sake of the shareholders' bottom line).
Then again, I think of a friend of mine who was an actress in NYC who injured her foot a few years back but was not able to get it treated because, as an actress, she did not have health insurance. She was educated at NYU Tisch School of the Arts and was in Second City improv group (the breeding ground for Saturday Night Live); she was not one of the unwashed and lazy that I think people (not necessarily people on this Board) think of when they think of the millions of uninsured in this country. Her foot eventually healed, but over a much longer time than it should have (I honestly don't know the details of the foot).
But speaking of incentives, do we want a system where the incentive is for all of us to get jobs at big companies just for the health insurance, or is there a healthcare system that can incentivize people to work in the arts or on their own and feel reasonably secure that they can have access to healthcare at a reasonable cost? In a world of limited resources, I know there are no easy choices here.

I still think the French system is the best way to address the question. Everybody is eligible for what I'll call the "free" system, that like Canada or the UK controls costs with quotas and queues. If you don't want to queue up, you pay in a system that works pretty much like the US. When my mon got her hip replaced, the hospital in Paris took Blue Cross. There was one big difference--it took less paperwork to get her hip replaced than it takes to get three stitches in an emergency room here. One other difference--it cost 1/3 as much as here.

I'd compare France, Canada, and UK as follows:
Say you develop cataracts and go to the "free" hospital. They tell you that they can give you an aspirin for the headaches caused by the blurred vision, and if you come back in two years they will be able to operate on the cataracts.
In France, you go down the street to the "pay" hospital (whch is cheap because it's where everybody goes) and get it done tomorrow (in fact, if you're one of the 90% with supplemental insurance, you probably go straight to the "pay" system).
In UK, the "pay" system costs a lot more (since UK spends more on the "free" system and expects people to use it, so few buy supplemental insurance for use on the "pay" side) so you either wait or you pony up a lot more cash (or take the chunnel to France or a flight to Mumbai and get it done there).
In Canada, the "pay" option is illegal, so you wait two years (or come to the US and get it done now).

This is based upon (1) personal experience as a consumer in each system, (2) many conversations with friends and business associates in each of the three countries, (3) media coverage, admittedly anecdotal, and (4) what objective and comprehensive studies of the subject I can find (google Euro-Canada Health Consumer Index 2009, for example).

All three have universal coverage (at least 99%). I'll take France.

I really think the system needs to be improved. I really want to see it improved for everyone. I don't think Obamacare will do that; in fact, I think it is a giant step in precisely the wrong direction.

(03-22-2010 06:40 PM)emmiesix Wrote:  There is research suggesting that success is largely random - the myth of the meritocracy - and that the best you can do is position yourself well.

I wouldn't go so far as to say "success is largely random"....no way. However, and more to the point of the $200,000 mark being discussed, I think there indeed is a point reached where wealth no longer correlates to effort or education.

I'd say (off-hand) that for the most part, for incomes up to the $500,000 range, there is a very good correlation to effort, education, and skill development. On the other hand, the extremely rich, though also likely talented and hard-working people too, have gotten to their level largely out of good luck....being in the right place at the right time, etc. The examples are endless. It is this group that may "deserve" higher tax rates in my opinion.

(03-23-2010 11:20 AM)OptimisticOwl Wrote:  I haven't seen the article D1 referenced yet, but it sounds like it might be one.

The guy goes into the details as to why our health care system is failing and then provides his answer. Basically, we should treat health care like anything else and turn the patient into the consumer. We pay for things and can shop around to find the right price. The major stuff (he labels catastrophe) will be covered by private insurance. He goes into detail as to how the plan would work (building Health Saving Account, doing away with Medicare/caid), but it is very interesting idea.

As I said, I recommend reading it (post #62)...the last page of the article is where the plan is laid out.

(03-23-2010 01:22 PM)d1owls4life Wrote:  

(03-23-2010 11:20 AM)OptimisticOwl Wrote:  I haven't seen the article D1 referenced yet, but it sounds like it might be one.

The guy goes into the details as to why our health care system is failing and then provides his answer. Basically, we should treat health care like anything else and turn the patient into the consumer. We pay for things and can shop around to find the right price. The major stuff (he labels catastrophe) will be covered by private insurance. He goes into detail as to how the plan would work (building Health Saving Account, doing away with Medicare/caid), but it is very interesting idea.

As I said, I recommend reading it (post #62)...the last page of the article is where the plan is laid out.

It's a good article. His ideas are much better than what we just enacted, for sure.

(03-23-2010 10:22 AM)Barrett Wrote:  But I ask this earnestly (with the caveat being I don't know sh-t about the healthcare debate): Would you guys, especially those on the individuality side, be willing to draw lines somewhat? For example, we essentially have a form of socialized education, in that taxes pay for a "public option" of education. I would assume the general consensus would be against doing away with that and going to an all-private school system. Or are there distinctions you guys see between K-12 education vs. healthcare?

The French approach that I like is actually a whole lot like our education system. I've described it in those terms. I think it works a lot better than our education system, but it's probably a useful indicator of what our education system could be like if we did it right.

One big concern I have about implementing any European system is this. In Europe, working for the government is a highly regarded occupation, and they get their fair share of the brightest and best. When dealing with a European bureaucrat, you at least get the feeling you are dealing with someone who is competent. We don't have the same tradition of competence in our civil servants. I don't know how much that impacts outcomes, but I don't think it will help. Instead of a European socialist state, we have a very good chance of becoming an incompetent imitation of a European socialist state.

(03-23-2010 10:39 AM)d1owls4life Wrote:  http://www.theatlantic.com/magazine/arch...r/7617/1/?

The title says one thing, but the author goes into a detailed discussion of the problems with the health care system today and comes up with a solution that I find intriguing. Worth the read.

I have no intention of a full re-reading the article at this point, but one of the things that struck me when I read it the first time was this:

Quote:The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system.

The problem with this is that what consumers want, by and large, is comprehensive health insurance. It's the same reason smart consumers who know that an extended warranty on their new Playstation or Fridge is a rip off, will buy it anyway.

(03-24-2010 12:04 PM)texd Wrote:  

(03-23-2010 10:39 AM)d1owls4life Wrote:  http://www.theatlantic.com/magazine/arch...r/7617/1/?

The title says one thing, but the author goes into a detailed discussion of the problems with the health care system today and comes up with a solution that I find intriguing. Worth the read.

I have no intention of a full re-reading the article at this point, but one of the things that struck me when I read it the first time was this:

Quote:The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system.

The problem with this is that what consumers want, by and large, is comprehensive health insurance. It's the same reason smart consumers who know that an extended warranty on their new Playstation or Fridge is a rip off, will buy it anyway.

I just feel like the system he modeled would drive down costs significantly. Would be a pain to try to implement, but it would give quite a bit of freedom.

(03-24-2010 12:04 PM)texd Wrote:  

(03-23-2010 10:39 AM)d1owls4life Wrote:  http://www.theatlantic.com/magazine/arch...r/7617/1/?
The title says one thing, but the author goes into a detailed discussion of the problems with the health care system today and comes up with a solution that I find intriguing. Worth the read.

I have no intention of a full re-reading the article at this point, but one of the things that struck me when I read it the first time was this:

Quote:The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system.

The problem with this is that what consumers want, by and large, is comprehensive health insurance. It's the same reason smart consumers who know that an extended warranty on their new Playstation or Fridge is a rip off, will buy it anyway.

Yeah, but until we change that mentality, exactly HOW are we going to contain costs? How?

By the way, to the extent Obamacare addresses this approach, it moves us FURTHER AWAY from it, not closer to it.

Obamacare will eventually cut costs. They will impose draconian cuts on reimbursements to health care providers. That will drive many of them out of business or offshore. Health care costs will go down because there won't be any health care left.

Then maybe we'll realize that the French social insurance model is better than the single-payer/single-provider model. That's what UK realized about a decade ago. The problem is that they can't work past the entrenched interests to make the change. How will we avoid that problem? I have no idea.

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Baucus Admits ObamaCare Breaks Obama Tax Pledge
Posted on: Tuesday, 23 March 2010, 21:08 CDT



WASHINGTON, March 23 /PRNewswire-USNewswire/ -- Senator Max Baucus (D-Mont.) has admitted that some Americans making less than $200,000 per year will face tax hikes under ObamaCare. Such tax hikes are a violation of President Obama's "firm pledge" not to raise "any form" of taxes on those making less than $250,000 per year.


During remarks tonight on the Senate floor, Baucus said:


"One other point that I think it's very important to make is that it is true that in certain cases, the taxes will go up for some Americans who might be making less than $200,000."


As Americans for Tax Reform has pointed out repeatedly, the healthcare bill signed into law today contains seven tax hikes that unquestionably violate Obama's middle class tax pledge.


Obama's promise remains for all to see at the Change.gov website: "no family making less than $250,000 will see their taxes increase."


"Senator Baucus has formally admitted that Barack Obama's central campaign promise was a lie," said Grover Norquist, president of Americans for Tax Reform. "It would have been nice if Baucus had admitted that ObamaCare raises taxes on families making less than $250,000 before the day Obama signed the bill into law."


http://www.atr.org/baucus-admits-obamaca...-tax-a4690


Americans for Tax Reform is a non-partisan coalition of taxpayers and taxpayer groups who oppose all tax increases. For more information or to arrange an interview please contact John Kartch at (202) 785-0266 or by email at jkartch@atr.org.


.................................................................................................

Looks like BostonOwl will get to enjoy making even larger contributions.

(03-22-2010 11:12 PM)Rick Gerlach Wrote:  ......

Even though I'm "rich", I don't foresee my life getting any easier any time real soon.

this of course is going to make my kids "lucky".

Good point.

I was born in the US rather than Darfur or Cuba (someone elses analogy) because my ancestors crowded onto a boat the size of the MU5TARD bus and sailed thousands of miles hoping to find land. They fought and sweat and suffered and endured for centuries so that I could be "lucky". I do the same for my children.




Owl...
I'm afraid lots of people would rather have a free scooter than a bargain on a Toyota.

(03-24-2010 08:26 PM)OptimisticOwl Wrote:  E-mail Print Comment Font Size Digg del.icio.us Discuss article Buzz up! Stumble It!
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Baucus Admits ObamaCare Breaks Obama Tax Pledge
Posted on: Tuesday, 23 March 2010, 21:08 CDT



WASHINGTON, March 23 /PRNewswire-USNewswire/ -- Senator Max Baucus (D-Mont.) has admitted that some Americans making less than $200,000 per year will face tax hikes under ObamaCare. Such tax hikes are a violation of President Obama's "firm pledge" not to raise "any form" of taxes on those making less than $250,000 per year.

This completely ignores the fact that by forcing insurers to drop caps and cover everyone, the ability to keep premiums low by avoiding the "expensive" policy will cause an increase in the cost of the typical insurance policy. How ELSE are you going to provide higher payouts than to increase the costs?? Obama promises "credits' to help people buy insurance, but iirc, they cut out for a fam of 4 at $88,000... and there is no evidence to say that it would make a dent in the hike. Clearly, this amounts to a "tax" on everyone who buys insurance... at LEAST on everyone who makes more than 88,000 as a family (400% of the poverty line). MUCH less than 250k

(03-24-2010 08:33 PM)Hambone10 Wrote:  I was born in the US rather than Darfur or Cuba (someone elses analogy) because my ancestors crowded onto a boat the size of the MU5TARD bus and sailed thousands of miles hoping to find land. They fought and sweat and suffered and endured for centuries so that I could be "lucky". I do the same for my children.

Some of my ancestors came over to find gold, some came to get free land, at least one came for religious freedom, and one came as a mercenary for the British. Of course, the intervening generations have largely been filled with people who wanted good lives for their children and tried to make the best of whatever situation they found themselves in. Some succeeded better than others.

I have a series of letters written in 1842-44 to one of my ancestors from a cousin. We have no idea today of the difficulties and hardships people then faced. Much mention of disease, death, disappeared family, faith in God. Not one mention of the U. S. Government. FWIW.

I'm actually glad it passed in a way. It makes that much easier to "Clean House"

Because the way they did it has truly pissed off the average American voter, and anyone that participated in this scam and voted for this 2300 page pile of crap will likely get voted out of office in November.

Now the Democrats are going to "double down" and try to railroad through Illegal Alien Amnesty.



I guess if you know that you are Toast in the November elections, you might as well try to pass as much of Obama's Leftist Agenda before the voters dump you out of office on your ear.

Talk about ignoring the will of the People.

The next Congress will spend the first 6 months repealing all the garbage legislation Pelosi, Reid, Obama, and their evil minions have shoved down our throats.

(03-24-2010 10:04 PM)OptimisticOwl Wrote:  

(03-24-2010 08:33 PM)Hambone10 Wrote:  I was born in the US rather than Darfur or Cuba (someone elses analogy) because my ancestors crowded onto a boat the size of the MU5TARD bus and sailed thousands of miles hoping to find land. They fought and sweat and suffered and endured for centuries so that I could be "lucky". I do the same for my children.

Some of my ancestors came over to find gold, some came to get free land, at least one came for religious freedom, and one came as a mercenary for the British. Of course, the intervening generations have largely been filled with people who wanted good lives for their children and tried to make the best of whatever situation they found themselves in. Some succeeded better than others.

My ancestors were sent by the British (involuntarily) to Georgia. Not much place to go but "up" after that.

Something else to consider:

http://www.themedicusfirm.com/pages/survey

I found this survey from here:

http://www.nejmjobs.org/rpt/physician-su...mpact.aspx


Edit: On top of all that, add this:

http://www.aasmnet.org/Articles.aspx?id=1056

http://www.seattlepi.com/local/378492_fewerdocs10.html

Want to know how rich you are on a world scale? Check out

http://www.globalrichlist.com/index.php

Top 4% in the US is nothing.
If you make $200,000 you are in the top 0.01%
richest people in the world. (Calculated to be the 786,570 richest person in the world.)

Being born in the US is certainly winning the lottery.

When friends of mine adopted a baby in China people came up to them on the street and said "lucky baby." They were right.