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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 60020  
Subject: Health Care: We're missing the big picture, IMO Date: 7/9/2007 10:20 AM
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In recent weeks we've been discussing health care quite a bit, and the related issue of who pays for it, and how we pay for it. Some want less government intervention in the market place; others think it should be 100% financed by tax dollars. Still others (myself included) see flaws in both models and wonder if there's a better way, perhaps some sort of hybridization.

Be that as it may, I think we're not seeing the forest through the trees here. What has turned health care into something arguably considered a crisis (and certainly a potential one if not an actual one yet)? Rampant, uncontrollable inflation in health care.

Folks, if we can't stop 8% to 10% annual inflation (or worse) in health care, it doesn't matter WHO pays. Either the status quo is mostly maintained and shuts more people out of adequate coverage, or the government foots the bill and taxes escalate to economically unsustainable levels. Neither of these is an acceptable outcome!

As I just mentioned in another thread, arguing over who pays right now is like rearranging the Titanic's desk chairs. Because if we don't tackle the underlying cause for the problems -- runaway medical inflation -- we're screwed no matter which way we go.

Personally, I think THAT battle needs to be fought first. Then we can figure out how to pay for it. If costs are brought under control -- in line with inflation (or at worst, GDP growth), it shouldn't become an increasing crisis with the passing of each year.

#29
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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7938 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 10:41 AM
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<<As I just mentioned in another thread, arguing over who pays right now is like rearranging the Titanic's desk chairs. Because if we don't tackle the underlying cause for the problems -- runaway medical inflation -- we're screwed no matter which way we go.

Personally, I think THAT battle needs to be fought first. Then we can figure out how to pay for it. If costs are brought under control -- in line with inflation (or at worst, GDP growth), it shouldn't become an increasing crisis with the passing of each year.

#29
>>



Yes, I think that's true.

People forget that it was Teddy Kennedy who originally promoted HMOs, with the idea that they would TELL people what kind of health care they would get. Democrats couldn't stand the heat of that and wound up attacking their own creation.

Another option would be to have primary care providers who would provide significantly less than stand of the art care, provided by caregivers with much less training, and with much less intensive care.

Laws passed by Dems only permit gold plated medicine, so that isn't possible.


In my view, Democrats have been manufacturing much higher medical costs for decades now, with the aim of crushing the private health care system by making it unaffordable, and imposing ever more costs from public heal care on private health care. That plan is working beautifully.

Of course, if Liberals ever get their single payer system, they will begin watering down the quality of care provided for pretty much everyone immediately.




Seattle Pioneer

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Author: cliff666 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7939 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 11:09 AM
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As I just mentioned in another thread, arguing over who pays right now is like rearranging the Titanic's desk chairs. Because if we don't tackle the underlying cause for the problems -- runaway medical inflation -- we're screwed no matter which way we go.

Personally, I think THAT battle needs to be fought first. Then we can figure out how to pay for it. If costs are brought under control -- in line with inflation (or at worst, GDP growth), it shouldn't become an increasing crisis with the passing of each year.

#29

Any suggestions? Are you Libertarian? How can the gummit control this inflation, short of producing more physicians, RN's and hospitals (A little supply and demand imbalance exists today.)? I would maintain that we cause at least part of it, by running in to the physician's office for every nosebleed and hangnail, for frivolous malpractice suits, and for letting the drug company advertisements to influence us to demand the latest drug. But I don't know how to change that behavior.

cliff

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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7940 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 11:21 AM
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>> How can the gummit control this inflation, short of producing more physicians, RN's and hospitals (A little supply and demand imbalance exists today.)? <<

There's a Catch-22 situation with nurses today. Pay for nurses today is quite good as opposed to a couple decades ago (partially fueling the inflation, I guess), and anyone with an R.N. and a pulse can get a job pretty much anywhere. Despite the higher pay, one of the reasons more people don't go into nursing is because of crappy working conditions and hours. But until hospitals are adequately staffed with nurses, they have to impose lousy working conditions on them because that's the only way they can remain staffed.

>> I would maintain that we cause at least part of it, by running in to the physician's office for every nosebleed and hangnail, for frivolous malpractice suits, and for letting the drug company advertisements to influence us to demand the latest drug. But I don't know how to change that behavior. <<

I would agree with all of these. The first one (going in for hangnails and nosebleeds) would likely get worse if the patients going in are completely unexposed to the cost.

Another problem is that most other countries put pretty strict caps on what they will pay for new drugs, and that forces the manufacturers to extract most of their profits from American patients and insurers. Placing similar caps here sounds good, but it could severely reduce the incentive to create new blockbuster medications and probably cause all work on marginally profitable medications to stop completely.

I think there are a lot of simple conditions that probably don't really need an MD. Indeed, we're seeing more PAs and NPs handling that, and "escalating" more serious and/or baffling conditions. In terms of cost containment that might be a good trend as well. An NP or PA can handle a "hangnail" type issue just as well as an MD.

These are all difficult issues; if they weren't we would have solved this a long time ago. I don't have answers, really, but I think asking the right questions is a start. And I think the right *first* question to ask is, how can inflation be brought in check? I don't know what the answer is, but I'm pretty sure "100% government" and "100% free market" aren't among the candidates.

#29

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Author: crassfool Big funky green star, 20000 posts Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7944 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 11:37 AM
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ziggy29 says

Be that as it may, I think we're not seeing the forest through the trees here. What has turned health care into something arguably considered a crisis (and certainly a potential one if not an actual one yet)? Rampant, uncontrollable inflation in health care.

Folks, if we can't stop 8% to 10% annual inflation (or worse) in health care, it doesn't matter WHO pays. Either the status quo is mostly maintained and shuts more people out of adequate coverage, or the government foots the bill and taxes escalate to economically unsustainable levels. Neither of these is an acceptable outcome!

As I just mentioned in another thread, arguing over who pays right now is like rearranging the Titanic's desk chairs. Because if we don't tackle the underlying cause for the problems -- runaway medical inflation -- we're screwed no matter which way we go.

Personally, I think THAT battle needs to be fought first. Then we can figure out how to pay for it. If costs are brought under control -- in line with inflation (or at worst, GDP growth), it shouldn't become an increasing crisis with the passing of each year.


Well, that position guarantees that nothing at all will be done. In fact, it's all one problem, because the way we pay for health care is one of the causes of the inflation.

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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7952 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 12:05 PM
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>> Well, that position guarantees that nothing at all will be done. In fact, it's all one problem, because the way we pay for health care is one of the causes of the inflation. <<

In some ways, maybe. In some ways I'd say the "government-pays" (or "taxpayers pay") model is also problematic in that it subsidizes people going in with sniffles. In other ways, the private insurance model adds unnecessary overhead.

Also, real Medicare spending per recipient is rising a lot faster than inflation too, so the "no for-profit insurance overhead" argument only carries so much water. The CBO's own data suggests that combined federal Medicare and Medicaid have risen from 3.7% of GDP in 1997 to an estimated 4.8% in 2007...to roughly 6% of GDP (based on an average of several projected revenue/spending models) in another ten years! If Medicare costs weren't also escalating far faster than inflation, that wouldn't be happening. (Yes, some of this can be attributed to an aging population, but not nearly all of it.)

The CBO also shows that Medicare and Medicaid spending doubled from 1996 to 2006, from a combined $283.3 billion to $553.4 billion. Even after normalizing for inflation and population growth, that's a pretty steep increase given the low-inflation environment of that time period.

So hopefully, you'd advocate a way of paying for it that hasn't been tried yet, because medical inflation is pretty bad -- exceeding inflation and GDP growth -- almost everywhere. Clearly, not much that's being tried today -- from the U.S. model to the most socialized models -- is working.

#29

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Author: crassfool Big funky green star, 20000 posts Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7957 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 1:04 PM
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ziggy29 says

... In some ways I'd say the "government-pays" (or "taxpayers pay") model is also problematic in that it subsidizes people going in with sniffles.

There's no reason it has to.



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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7958 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 1:10 PM
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>> >> ... In some ways I'd say the "government-pays" (or "taxpayers pay") model is also problematic in that it subsidizes people going in with sniffles. << <<

>> There's no reason it has to. <<

I agree, and for the most part it probably shouldn't. But there are extremes in this discussion; one of them being the hard-core free market libertarians who want virtually complete separation of medicine and state, and the other being that health care should always be available to anyone and no one should ever see a bill. The example above is why I think the "100% government" solution would be prone to increasing inflation in that respect.

#29

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Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7959 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 1:14 PM
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cliff666 writes,

Any suggestions? Are you Libertarian? How can the gummit control this inflation, short of producing more physicians, RN's and hospitals (A little supply and demand imbalance exists today.)? I would maintain that we cause at least part of it, by running in to the physician's office for every nosebleed and hangnail, for frivolous malpractice suits, and for letting the drug company advertisements to influence us to demand the latest drug. But I don't know how to change that behavior.

</snip>


Actually that's a Rush Limbaugh myth. The biggest drivers in healthcare costs are people with chronic problems like diabetes, asthma, high-blood pressure, etc., not the provebial patient who shows up in the doctor's office with the sniffles. Insurance companies are now learning that the high-deductible/low benefit plans promoted by Bush and his crowd are costing them money. Patients tend to delay going to see a doctor or fill a perscription if the out-of-pocket cost is equal to a month's rent. Delaying care may mean an expensive hospitalization that more than meets the annual deductible and costs the insurance company money.

Some insurers are now covering the full cost of maintenance items like insulin and glucose meters and providing periodic check-ups with low copays for patients with diabetes to forestall more expensive problems down the line.

intercst


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Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7963 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 1:36 PM
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ziggy29 writes,

The CBO also shows that Medicare and Medicaid spending doubled from 1996 to 2006, from a combined $283.3 billion to $553.4 billion. Even after normalizing for inflation and population growth, that's a pretty steep increase given the low-inflation environment of that time period.


From 1996 to 2006, my conservative-approved, private health insurer more than quadrupled my monthly premiums while raising deductibles and copays. If only they could have operated with the efficiency and cost-effectiveness of Medicare and merely doubled them, I'd be estatic.

intercst

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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7966 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 1:44 PM
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>> From 1996 to 2006, my conservative-approved, private health insurer more than quadrupled my monthly premiums while raising deductibles and copays. If only they could have operated with the efficiency and cost-effectiveness of Medicare and merely doubled them, I'd be estatic. <<

For one thing, you were ten years older in 2006 than in 1996. I'm sure that accounts for some of the increase you saw, assuming you're not in a group plan.

For another, Medicare has raised deductibles and copays as I understand it. Hence the increasing "Medicare supplement" industry. They may not be as high as some private health plans, but they are there and they are rising, too. Even with Medicare we're paying more than ever and getting less than ever in return.

And finally, just because the "conservative solution" may be failing in a lot of ways doesn't mean the "liberal" (since we're throwing labels around) alternative is the panacea. There are aspects of it that are working well, but there might be plenty of ways to make it better. Going on and advocating what we should NOT do doesn't help us determine what we *should* do.

There has to be more than just a "conservative solution" and a "liberal solution," I think. And I also think the longer we think of these as the only two options -- either one or the other -- the longer the system will remain broken.

#29

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Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7968 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 1:50 PM
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ziggy29 writes,

>> From 1996 to 2006, my conservative-approved, private health insurer more than quadrupled my monthly premiums while raising deductibles and copays. If only they could have operated with the efficiency and cost-effectiveness of Medicare and merely doubled them, I'd be estatic. <<

For one thing, you were ten years older in 2006 than in 1996. I'm sure that accounts for some of the increase you saw, assuming you're not in a group plan.


A lot of peoiple on Medicare are ten years older and their premiums haven't quadrupled.

intercst



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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7970 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 1:57 PM
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>> A lot of peoiple on Medicare are ten years older and their premiums haven't quadrupled. <<

You seem to be comparing individual plans with what is inherently a group plan, which is totally apples and oranges. The individual plans are heavily age-based in the general case, whereas group plans aren't.

If the *average* age of a Medicare recipient went up 10 years in a 10 year period -- pretty hard to do when people are turning 65 every year -- you might have a better argument.

The average age of a Medicare recipient may be going up very slightly over time with increased life expectancies, but many of the oldest are dying off as new "young'uns" (65-year-olds) become eligible.

#29


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Author: ravvt Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7976 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 2:17 PM
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Folks, if we can't stop 8% to 10% annual inflation (or worse) in health care, it doesn't matter WHO pays. Either the status quo is mostly maintained and shuts more people out of adequate coverage, or the government foots the bill and taxes escalate to economically unsustainable levels. Neither of these is an acceptable outcome!…#29


… The inflation rate for healthcare is exaggerated wrt to the normal CPI for a number of reasons. IMO, the two largest factors are: 1) “someone else” pays and 2) new technology, i.e. new drugs, new equipment and new procedures.

For the first factor, whether it's the gov't or an insurance company paying the bill, the natural tendency would be for most consumers of healthcare to demand “everything possible” to cure their medical problem. Unless or until some form of rationing is imposed, this tendency will continue to drive costs well above the normal inflation rate because the patient isn't paying the bill and, as such, is much less sensitive to the cost ramifications of demanding the “best”.

For the second factor, i.e. the new technology factor, if you consider healthcare as a product and ask yourself how that product is priced, just look at the pricing model for any other product. Take for example, HD televisions. Three yrs ago, any HD TV on the market was priced significantly higher than the equivalent sized non-HD TV. Over time, as the product becomes more popular, competitive and mfg scale components begin to show up and there is a dramatic price decline curve. As a consumer, you can choose to stay with an older model TV while you wait for the price decline curve to match your spending patterns and pocketbook.

With healthcare, do you want subject yourself or a loved one to “older” technology while you wait for the “newer” technology to become more affordable? … I didn't think so…

As a consumer of healthcare, just ask your docs to use the older generic drugs, the older monitoring equipment and the outmoded surgical procedures and you can help control the growth of your healthcare costs but until the majority of patients do the same thing; the cost pressure of “new” technology will continue be a significant factor in the medical inflation rate and one which will continue keep healthcare inflation well above the normal CPI …


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Author: Volucris Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 7983 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 4:35 PM
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Sicko and health care were discussed on Fresh Air today, Monday, July 9th. There was a pretty good guest today. You should give it a listen.

http://www.npr.org/templates/story/story.php?storyId=11826524

Volucris

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Author: buzman Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8002 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 7:06 PM
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People forget that it was Teddy Kennedy who originally promoted HMOs:

Seattle Pioneer
------------------------------------------------------------------------

Well, not exactly.

Actually Nixon signed the law during the early 70s after a chance encounter with an insurance executive.

Do you really believe all the things you post?


buzman



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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8004 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 7:27 PM
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>> >> People forget that it was Teddy Kennedy who originally promoted HMOs: << <<

>> Well, not exactly.

Actually Nixon signed the law during the early 70s after a chance encounter with an insurance executive.
<<

I'd say partial credit to both of you.

My understanding is that the term "health maintenance organization" originated from a left-wing professor, and Kennedy, while a freshman in the Senate, promoted it.

Nixon actually built on Kennedy's idea and pushed the HMO Act which Congress passed in 1973. It is also true that Nixon was pressed, through John Ehrlichman, by the son of the founder of Kaiser Permanente so they could expand their business model.

So really, it was the efforts of two men from two parties. A (now prominent) Democrat first pushed the idea and a Republican president urged Congress to act on it.

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8009 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 8:37 PM
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<<People forget that it was Teddy Kennedy who originally promoted HMOs:

Seattle Pioneer
------------------------------------------------------------------------

Well, not exactly.

Actually Nixon signed the law during the early 70s after a chance encounter with an insurance executive.

Do you really believe all the things you post?


buzman
>>



Thank you for the improved information.

The following links provide some additional history of HMO type organizations, including a Wikipedia article citing $.50/month as the premium for health care coverage in 1910.


http://www.tmci.org/downloads/BriefHist.pdf

<<The earliest form of HMOs can be seen in a number of prepaid health plans. In 1910, the Western Clinic in Tacoma, Washington offered lumber mill owners and their employees certain medical services from its providers for a premium of $0.50 per member per month.>>

http://en.wikipedia.org/wiki/HMO





Seattle Pioneer

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Author: XCgeoff Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8010 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 8:49 PM
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… The inflation rate for healthcare is exaggerated wrt to the normal CPI for a number of reasons. IMO, the two largest factors are: 1) “someone else” pays and 2) new technology, i.e. new drugs, new equipment and new procedures.



I think you hit the nail on the head and your HDTV example is great. I bought an HDTV last year for $3500 after it had come down from $5500 and I thought I got the greatest bargain in the world. Of course today I could buy the same tv for $2000 - $2500.

Back to the topic...I think that health care reform is going to be very tough for the reasons that you stated. I would propose that if we go towards a single payer (government) system, that it would provide everyone a basic, but low level of care. It won't cover the latest and greatest new technology, the latest and greatest blockbuster drugs, or extensive end of life care. It will be cheap, but everybody will have basic coverage. In addition, there will probably be a parallel system where people can buy private insurance or have employer provided coverage that can supplement the current system.



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Author: hockeypop Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8013 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 10:12 PM
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I think that you ziggy, intercst and others are closer to at least defining this problem together.

I think that you're both right about costs. We've exponentially increased our capacity to fight disease which has made our costs also increase far beyond inflation.

We have also increased our ability to prevent disease (although I agree not so quickly), but our healthcare system, not being designed for prevention, but rather for cure, hasn't kept up with any savings. As someone pointed out deductibles make us scrimp on prevention until we're really sick and can use the "wonders" of science. For about 45 million uninsured neither prevention nor cure is readily available.

Medicare, while not perfect, has much greater provision for prevention, which may partially explain the lower increases in cost.

As I pointed out, in the Wharton article there will have to be some means for a system that is uniquely American, although I'd also like to know more about the systerm in Singapore.
http://knowledge.wharton.upenn.edu/article.cfm?articleid=1761

I'm actually not interested in universal healthcare as most define it, but am interested in healthcare readily available to all. I understand that many could disagree with that.

I'd personally like the ability to opt-in to Medicare on a full-cost basis, but I'd also like the ability to have private firms compete for my business. Frankly, eventually that competition will be global too. However, some combined effort of liberals and conservatives (just as with HMO's under Kennedy/Nixon) will need to be put together to accomplish it. I appreciate the varied thoughts on the issues, not the ideology here.

More than anything else now I'd wish for some resource for unbiased data on Medicare, Medicaid, private health programs, cost of hospital provisions to the uninsured, and perhaps the healthcare programs of other countries.

I obviously have several "dogs" in this fight. Just to add another, I learned today that our projected health insurance increase for 2008 is 35%. 2004 is catching up to us. While I hope that my experience isn't remotely "typical", there should be plenty of room for a bipartisan effort. Again, I appreciate learning from the discussion.

Hockeypop


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Author: ogrecat Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8014 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 10:12 PM
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Patients tend to delay going to see a doctor or fill a perscription if the out-of-pocket cost is equal to a month's rent. Delaying care may mean an expensive hospitalization that more than meets the annual deductible and costs the insurance company money.

Some insurers are now covering the full cost of maintenance items like insulin and glucose meters and providing periodic check-ups with low copays for patients with diabetes to forestall more expensive problems down the line.


I have insurance with a $2000 deductible but am allowed a free annual physical.

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Author: alan81 Big gold star, 5000 posts Old School Fool CAPS All Star Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8015 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 10:56 PM
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I think your characterization of the problem as "inflation" is somewhat incorrect. What we are doing is investing more and more of our money on health care rather than on other things. We are not just getting the same health care, but we are getting BETTER health care. People are living longer healthier lives. There are many positive benefits to society for this, primarily a longer productive life of highly trained people. We spend a lot of money educating people these days and getting more years out of that education is a positive result. Getting fewer sick days is also a good thing.

Personally, given a choice of spending incremental money on having more "stuff" versus living longer and healthier lives, I would choose the second... and I think as a society that is what we are doing.

I think the crisis is created by the confluence of two factors. As a society we are spending a higher and higher percentage of GDP on health care. In addition, the GINI index tells us that a higher and higher percentage of GDP is going to the top earners, and a lower percentage to the middle and the bottom.

It seems crystal clear to me that the only solution is additional progressive income taxes to pay for medical care. The alternative is rationing medical care, chosing who lives and who dies. That doesn't seem like a reasonable thing to me.
--Alan

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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8017 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 11:05 PM
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>> Personally, given a choice of spending incremental money on having more "stuff" versus living longer and healthier lives, I would choose the second... and I think as a society that is what we are doing.

...

It seems crystal clear to me that the only solution is additional progressive income taxes to pay for medical care. The alternative is rationing medical care, chosing who lives and who dies. That doesn't seem like a reasonable thing to me.
<<

The problem here is, when does it stop? Eventually, health care taxes as a percentage of GDP can only get so high before it takes down the whole economy and effectively shuts down our ability to pay it. If you truly believe that neither quality of care nor accessibility to all can be compromised, the only rational result is costs spiraling out of control and taking up an ever-increasing percentage of GDP that probably never stops if you insist on universal access to state of the art care.

Can we keep a strong economy with 15% of GDP on health care spending? How about 20%? 25%? At some point I think economy reaches the breaking point, especially in a globalized economy, and makes us less able to even provide a lifeline level of care.

I don't think it's realistic, though it's an admirable goal, to provide unrestricted, Cadillac-level state of the art health care to all people in all circumstances. If I could wave a magic wand, it would be. But I just don't see it.

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Author: alan81 Big gold star, 5000 posts Old School Fool CAPS All Star Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8019 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 11:26 PM
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The problem here is, when does it stop? Eventually, health care taxes as a percentage of GDP can only get so high before it takes down the whole economy
I am not sure I "get" the take down the whole economy thing. How is buying health care different than buying a big screen TV? Are you worried about the amount we spend on capital, and perhaps education? As I mentioned earlier, health care spending actually improves our investment in education. With regards to spending on capital, I do think we need to keep that growing at least constant with GDP growth, and make sure incremental health care spending comes from consumption rather than investment... of course a BIG piece of health care spending is fancy new big capital for doing health care.

In terms of "cadillac" health care versus normal, I am not sure how to draw that distinction. I think there needs to be a hurdle for everyone to get a given procedure, and the hurdle needs to be consistent with that persons ability to pay. They can then make an informed decision if it is worth it or not to do the procedure. It appears some systems do this by charging a "time penalty" and making people wait. I would prefer some sort of monetary cost. I do think that if there is a procedure that can save somebodies life, and the person wants that procedure, they should be able to get it. I also think we need to increase preventitive care to reduce downstream expenses. I switched health plans this year to one with both a higher deductible and a higher copay, but at significantly reduced premiums. Interestingly enough, the copay for my cholesterol medicine stayed the same and the cost of a doctor office visit dropped.

I do think energy costs are going to have an impact in the next short while, and perhaps we will need to slow down growth in health care spending to fund increasing energy costs and development of new energy sources, but I think that is a different conversation.
--Alan

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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8021 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/9/2007 11:36 PM
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>> I am not sure I "get" the take down the whole economy thing. How is buying health care different than buying a big screen TV? Are you worried about the amount we spend on capital, and perhaps education? <<

In some sense, buying health care and buying a big screen TV are identical, and in some ways very different. The problem comes when health care inflation reaches the point where we are no longer talking about a choice between a "luxury item" and health care. Hell, for a lot of people we're there already.

As for education spending, that's for another board, but it's arguably more out of control than health care spending with nothing to show for it. In particular, look at the constant dollar outlays per pupil:

http://nces.ed.gov/programs/digest/d05/tables/dt05_167.asp

>> In terms of "cadillac" health care versus normal, I am not sure how to draw that distinction. I think there needs to be a hurdle for everyone to get a given procedure, and the hurdle needs to be consistent with that persons ability to pay. They can then make an informed decision if it is worth it or not to do the procedure. It appears some systems do this by charging a "time penalty" and making people wait. I would prefer some sort of monetary cost. I do think that if there is a procedure that can save somebodies life, and the person wants that procedure, they should be able to get it. I also think we need to increase preventitive care to reduce downstream expenses. I switched health plans this year to one with both a higher deductible and a higher copay, but at significantly reduced premiums. Interestingly enough, the copay for my cholesterol medicine stayed the same and the cost of a doctor office visit dropped. <<

Pretty much agreed here. I'd even go a little farther: "ability to pay" should only matter in two situations I can think of: (a) purely elective procedures and (b) end-of-life care for obviously terminal patients beyond pain and discomfort relief.

>> I do think energy costs are going to have an impact in the next short while, and perhaps we will need to slow down growth in health care spending to fund increasing energy costs and development of new energy sources, but I think that is a different conversation. <<

Yeah. As I've said elsewhere, I wish I could buy TIPS and I-Bonds which tracked energy and health care inflation.

Hey, try me. I may have a libertarian ideology, but I have a pragmatic/realist streak that outplays it.

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Author: alan81 Big gold star, 5000 posts Old School Fool CAPS All Star Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8022 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 12:03 AM
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The problem comes when health care inflation reaches the point where we are no longer talking about a choice between a "luxury item" and health care. Hell, for a lot of people we're there already.
We are already there for many, many people. As individuals, there is no way the bottom half can afford their health care bills. However, as a society we can. It really comes down to the position of believing we should let people die if they can not pay, or having those that have the means pay for those who don't. We have already developed treatments that cost well beyond what the bottom half can afford... we have treatments available to those who can't afford it or not? So far, we have decided we will. As the wealthy invest in new means so they can live longer, are we also going to make those means available to the bottom half? If so, health care costs are going to go up. If not, I fear for us.

So, yeah, the difference between health care and big screen TV's is we are willing to let the poor go without big screen TV's, but not without health care. The question is, are we willing to take the big screen TV's from the wealthy to pay for health care for the poor?
--Alan

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Author: sykesix Big gold star, 5000 posts Top Recommended Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8023 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 12:03 AM
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The problem here is, when does it stop? Eventually, health care taxes as a percentage of GDP can only get so high before it takes down the whole economy and effectively shuts down our ability to pay it. If you truly believe that neither quality of care nor accessibility to all can be compromised, the only rational result is costs spiraling out of control and taking up an ever-increasing percentage of GDP that probably never stops if you insist on universal access to state of the art care.

I'm not particularly worried about that. For one, as intercst keeps point out the system as it exists is enormously inefficient. Straighten those out and you have a huge cost savings right there.

Another area of big savings would be widespread access to preventative care, or health care in the early stages of a condition, which is usually far cheaper than waiting until the problem is severe.

And another area that we need to have a national discussion about is the amount of care provided in the final months or weeks of life, which every often exceeds the cost of health care an individual has received in their entire lifetime up to that point. The reflex is to always err on the side of life, but the reality is sometimes you wind up with a case like Terry Schiavo where there is no hope and all the King's doctors and all the King's men can't do anything. In those cases you are not doing anyone a favor--including the victim--by pouring money at the problem.

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Author: ariechert Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8024 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 12:07 AM
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The problem here is, when does it stop? Eventually, health care taxes as a percentage of GDP can only get so high before it takes down the whole economy and effectively shuts down our ability to pay it. - ziggy
----------------------

How much we are willing to spend on health care is directly proportional to our fear of death.

The cheapest, easiest, and probably the best thing is to just go ahead and die; but very few people are bold enough to take that route.

Arthur


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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8025 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 12:13 AM
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<<So, yeah, the difference between health care and big screen TV's is we are willing to let the poor go without big screen TV's, but not without health care. The question is, are we willing to take the big screen TV's from the wealthy to pay for health care for the poor?
--Alan

>>


The market solution, were one permitted to operate, would be a class system in which people would receive various amounts and quality of health care depending on their ability to pay for it.

Regulation of health care has resulted in gold plated health care that many can't afford.

What we ought to have is various kinds of docs in a box where people would be able to buy treatment they can afford. Those who want and can afford more and higher quality care would pay more.


There is also a role for government in providing health care with the county hospital model that was common for decades. Counties would fund health care clinics for low income people, who would get the care the county offered.

But the left insists upon gold plated health care in very inappropriate places, such as using emergency rooms for primary health care. This is a stupid policy by any measure.



Seattle Pioneer

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Author: alan81 Big gold star, 5000 posts Old School Fool CAPS All Star Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8026 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 12:15 AM
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I couldn't disagree more...
While everything you say is logical, it is not rational.
--Alan

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Author: ariechert Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8028 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 1:01 AM
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But the left insists upon gold plated health care in very inappropriate places, such as using emergency rooms for primary health care. This is a stupid policy by any measure. - Seattle Pioneer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

No the "left" doesn't? I consider myself to be slightly left of center and I in no way, shape, or form insist on gold plated healthcare for everyone. I believe that everyone is entitled to minimal healthcare, but I don't believe in "gold plated" healthcare for everyone.

I think old people who are in the process of dying should be allowed to die with dignity and I think it's selfish to keep preemie babies alive who are going to suffer severe health problems all their lives, and I'm not even really big on heart transplants, and think end stage 4 cancer sufferers should be encouraged to seek hospice care.

What is it with certain people's needs to make broad sweeping generalized statements about what artificial (non-existent) groups of people think or believe? Groups which they theselves dont' even claim to belong to?

It's like the Nazi's propaganda machine making stupid statements about Jews. It would almost be funny if it weren't so tragic. Please stop making these broad sweeping statements about what people think or feel. It's rarely true. They truth is that you don't know what any one person thinks or feels. If you were married you'd understand. I didn't stay married for 34 years by telling my wife what she thinks or feels.

Art


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Author: 0x6a74 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8029 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 1:39 AM
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What is it with certain people's needs to make broad sweeping generalized statements about what artificial (non-existent) groups of people think or believe? Groups which they theselves dont' even claim to belong to?

It's like the Nazi's propaganda machine making stupid statements about Jews.



yup

it's partly if you MUS about others, they're easier to hate.

and partly ,in the context of TMF, about just being annoying as possible.


=
..... and it's alot of what caused this board.

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Author: markr33 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8030 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 1:51 AM
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<<How can the gummit control this inflation, short of producing more physicians, RN's and hospitals (A little supply and demand imbalance exists today.)?>>

There's a Catch-22 situation with nurses today. Pay for nurses today is quite good as opposed to a couple decades ago (partially fueling the inflation, I guess), and anyone with an R.N. and a pulse can get a job pretty much anywhere. Despite the higher pay, one of the reasons more people don't go into nursing is because of crappy working conditions and hours. But until hospitals are adequately staffed with nurses, they have to impose lousy working conditions on them because that's the only way they can remain staffed.


It's even worse than this because nurses that have a decent level of experience have lots of other opportunities outside of direct patient contact. For example, my mom went to work for a large pharmaceutical company (Pfizer) in a role (adverse effects tracking) mandated by the FDA (and they have lots and lots of such roles!). The pay was better, she got to work at a desk in an office, and she didn't have to lift heavy patients from cart to bed and back. So after about 15 years of hard work as a hospital nurse, she opted for an easier better paying job.


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Author: hockeypop Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8031 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 7:30 AM
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To add a little fuel to the discussion, from today's New York Times (free subscription required) on statewide healthcare attempts and differences:

http://www.nytimes.com/2007/07/10/health/policy/10health.html?_r=2&th=&adxnnl=1&oref=slogin&emc=th&pagewanted=1&adxnnlx=1184066657-tRy4qb0zs+kxtRdYlFynvA

Hockeypop

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8033 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 9:23 AM
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<<What is it with certain people's needs to make broad sweeping generalized statements about what artificial (non-existent) groups of people think or believe? Groups which they theselves dont' even claim to belong to?

>>



I appreciate that this is not a part of the agenda of the left which you support, Art. But requiring every hospital in the country to be used as a primary health care provider is and has been a policy of the left for decades.

There are elements of the conservative agenda to which I object too, but that doesn't mean there isn't a conservative agenda too.



Seattle Pioneer

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Author: XCgeoff Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8035 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 10:09 AM
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Pretty much agreed here. I'd even go a little farther: "ability to pay" should only matter in two situations I can think of: (a) purely elective procedures and (b) end-of-life care for obviously terminal patients beyond pain and discomfort relief.


How do you define purely elective. If my 75 year old grandmother has an arthritic hip and wants it replaced, is that elective? It isn't going to kill her, but it is uncomfortable. If she can't afford it should we pay for it? Should we pay to give all the old people scooters from the scooter store? I tend to agree with your position, but how do you determine the grey area issues when thinks aren't black and white?

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Author: AngelMay Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8037 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 10:17 AM
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I am not sure I "get" the take down the whole economy thing. How is buying health care different than buying a big screen TV?


Most people don't buy a big screen TV every single month.

AM

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Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 10:23 AM
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What is it with certain people's needs to make broad sweeping generalized statements about what artificial (non-existent) groups of people think or believe? Groups which they theselves dont' even claim to belong to?

It's like the Nazi's propaganda machine making stupid statements about Jews. It would almost be funny if it weren't so tragic. Please stop making these broad sweeping statements about what people think or feel. It's rarely true. They truth is that you don't know what any one person thinks or feels. If you were married you'd understand. I didn't stay married for 34 years by telling my wife what she thinks or feels.

Art



People make these broad, sweeping statements because it relieves them of any guilt they may be feeling about their heartless attitudes toward others. They would rather people just lie down and die instead of having to pay a few dollars in taxes to save them.

Also, they can't back down from a position previously held - because that would somehow be.... un-macho or something. And god knows, we certainly don't want to be un-macho. Whatever is the world coming to?

AM

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Author: AngelMay Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8039 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 10:30 AM
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Should we pay to give all the old people scooters from the scooter store?


Not all "old people" are unable to walk.
Some of them are out surfing in the Caribbean.
Some of them are in Austria skiing down the slopes.
Some of them are out every other night of the week dancing.
Those who cannot walk, in order to retain some level of dignity in being able to move about and live an actual life -- yes! Give them the damned scooter and be happy it's not YOU confined to one.

Sheesh.

AM

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Author: sofaking6 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8040 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 10:41 AM
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But requiring every hospital in the country to be used as a primary health care provider is and has been a policy of the left for decades.


I'm not sure I'm familiar with that law?

6

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Author: cliff666 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8042 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 11:17 AM
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Hockypoop: To add a little fuel to the discussion, from today's New York Times (free subscription required) on statewide healthcare attempts and differences:

http://www.nytimes.com/2007/07/10/health/policy/10health.html?_r=2&th=&adxnnl=1&oref=slogin&emc=th&pagewanted=1&adxnnlx=1184066657-tRy4qb0zs+kxtRdYlFynvA

"Mr. Rendell is learning, however, that to contain costs is eventually to pluck dollars from someone's pocket. His plan has incited protest from hospitals, doctors, insurers and small businesses, each of them finding something to detest."

Aye, there's the rub. Too many folks make a very good living from the present system, and they will resist changes because they might not then enjoy the benefits they do now. In particular, the insurance industry likes it the way it is. They don't have to pay to take care of poor people, and they don't have to pay to take care of sick people (and if you get sick, they will remove you from their rolls immediately.)

As I see it, we either have to co-opt the insurance industry (to an extent) or we have to steam roller them. The latter is tough, seeing as they own a number of congress critters.

cliff

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Author: hockeypop Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8045 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 1:36 PM
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Hockypoop: To add a little fuel to the discussion, from today's New York Times (free subscription required) on statewide healthcare attempts and differences:

http://www.nytimes.com/2007/07/10/health/policy/10health.html?_r=2&th=&adxnnl=1&oref=slogin&emc=th&pagewanted=1&adxnnlx=1184066657-tRy4qb0zs+kxtRdYlFynvA


"Mr. Rendell is learning, however, that to contain costs is eventually to pluck dollars from someone's pocket. His plan has incited protest from hospitals, doctors, insurers and small businesses, each of them finding something to detest."

Aye, there's the rub. Too many folks make a very good living from the present system, and they will resist changes because they might not then enjoy the benefits they do now. In particular, the insurance industry likes it the way it is. They don't have to pay to take care of poor people, and they don't have to pay to take care of sick people (and if you get sick, they will remove you from their rolls immediately.)

As I see it, we either have to co-opt the insurance industry (to an extent) or we have to steam roller them. The latter is tough, seeing as they own a number of congress critters.

cliff


Well, as I said, it will be a bipartisan effort. Excerpted from Congressional Quarterly (I don't think you can get a free subscription):

<snip>
CBO: Trimming Health Cost Growth Will Be Key
By CQ Staff
If health costs continue to grow as they have in the past four decades, income tax rates will have to rise dramatically by 2050 if they are the mechanism used to pay for those added outlays, according to an analysis released Monday by the Congressional Budget Office. Based on the current rate of health cost growth — 2.5 percentage points per year higher than the growth in the Gross Domestic Product — the tax rate in the lowest tax bracket would have to climb from 10 percent to 26 percent. In the next bracket, it would climb from 25 percent to 66 percent, and in the highest bracket, it would have to rise from 35 percent to 92 percent.

But if health cost growth is held to one percentage point above GDP, the rate in the lowest bracket would rise to 17 percent instead of 26 percent; in the middle bracket to 43 percent instead of 66 percent; and in the highest bracket to 60 percent instead of 92 percent. “Given the nature of the nation's long-term fiscal challenge, constraining the growth of federal health care costs seems a key component of reducing the deficit over the next several decades,” the CBO said in an analysis prepared for the top Republican on the Senate Budget Committee, Judd Gregg of New Hampshire.


Maybe the lesson we leaned with the original Clinton program (and the 45 or more alternatives that were submitted during that time), is that change will have to occur through the states. Scary national statistics though that can be used to confirm everyone's view. From my perspective they also apply to business and others who will have to deal with health cost growth.

Hockeypop



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Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8048 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 3:23 PM
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Hockeypop posts,

To add a little fuel to the discussion, from today's New York Times (free subscription required) on statewide healthcare attempts and differences:

http://www.nytimes.com/2007/07/10/health/policy/10health.html?_r=2&th=&adxnnl=1&oref=slogin&emc=th&pagewanted=1&adxnnlx=1184066657-tRy4qb0zs+kxtRdYlFynvA


From the article:

Small-business owners are protesting his call for a “fair share assessment” — a 3 percent payroll tax on employers who do not offer insurance, with the proceeds dedicated to covering the uninsured. And insurers are working to defeat proposals that would prohibit consideration of preexisting medical conditions in rate-setting and require that at least 85 percent of premiums be spent on health care costs as opposed to administrative overhead.

</snip>


Like I keep saying, if we remove for-profit insurance companies from the healthcare equation we can save a lot of money. Even the 15% limit on overhead that insurance companies oppose is price gouging compared to the 2% to 3% overhead in Medicare.

intercst



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Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 6:06 PM
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...Maybe the lesson we leaned with the original Clinton program (and the 45 or more alternatives that were submitted during that time), is that change will have to occur through the states....

Hard to see how an effective reform would do that with the biggest, by far, consumers of health care in this federal group and of course a huge wave about to enter that group.

2006 MEDICARE TRUSTEES REPORT

Where this is considered the "good news" :)

.....Compared to last year's Trustees Report, projected net Medicare spending for Part D from 2006-15 is roughly 20 percent lower. Over the long-term, income and expenditures for the Part D account are projected to grow at an average annual rate of 11.5 percent for the 9-year period 2006-2015, reflecting enrollment growth and per capita drug cost increases.
http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1846

Ignorning the usual assinine high-ball and low-ball expectations game so beloved by this bunch, under any set of reasonable assumptions the math for the kiddies who'll be paying is horrendous. I don't know what Bush's (with a lot of bipartisan support) motivations really were but if one wanted to trash Medicare that would be one great way to do it.

Until many more Americans see the financing of that as maybe the moral issue of our time, like David Walker of the GAO does, hard to see much real progress being made. Even the biggest fools should be aware that the first thing to do is stop digging and maybe think on it a bit. Yep, how many of the thousands of candidates for Prez have said a word about any of this? Roughly---zero (0). +/-

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8054 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/10/2007 7:42 PM
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<<Like I keep saying, if we remove for-profit insurance companies from the healthcare equation we can save a lot of money. Even the 15% limit on overhead that insurance companies oppose is price gouging compared to the 2% to 3% overhead in Medicare.

intercst
>>



What I noticed in the article is that as soon as government gets control over health care, they immedietely want to end the gold plating that is responsible for a lot of the costs that dog health care and make it unaffordable for people.

Government regulation has added enormously to health care costs.




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Author: markr33 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8058 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 1:51 AM
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Most people don't buy a big screen TV every single month.

But they do make their SUV payment every single month. And they buy lots of gasoline for that SUV every month. And they do buy a bunch of their favorite tunes every month. And they do go out to dinner quite a few times every month. etc.


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Author: hockeypop Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8059 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 6:01 AM
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Interesting information and link. Here is the information for the 2007 report.

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=2120&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=false&cboOrder=date

The entire website is interesting.
www.cms.hhs.gov

Hockeypop

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Author: AngelMay Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8062 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 9:55 AM
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Most people don't buy a big screen TV every single month.

But they do make their SUV payment every single month.


I don't.

And they buy lots of gasoline for that SUV every month.


I don't.


And they do buy a bunch of their favorite tunes every month.



I don't.

And they do go out to dinner quite a few times every month. etc.

Not "quite a few", but 4 or 5 I admit -- and it's more like lunch rather than dinner.

So since the first person to respond to your claims doesn't fit into them, think how many other people there are out there who don't fit into them either. Exactly where are you getting your statistics on this one?

AM
....and even their SUV would be paid off at some point. Healthcare insurance just keeps on keeping on -- and increasing and increasing and increasing....

Here's my new hero:

http://www.huffingtonpost.com/michael-moore/exclusive-huffpost-live-c_b_55659.html


One day we will have universal healthcare -- paid for through taxes, up front, so that no one ever gets a bill from a doctor or a hospital. Someday. Someday we will wake up and realize that the PEOPLE are far more important than the insurance companies. Someday. Maybe a lot sooner than would please you --- It's coming.



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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8063 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 10:06 AM
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>> One day we will have universal healthcare -- paid for through taxes, up front, so that no one ever gets a bill from a doctor or a hospital. <<

If you think health care inflation is bad now, you ain't seen nothing yet if this is implemented.

This is the best way I can think of to assure that taxes keep spiraling higher and higher out of control. Either that or severe rationing would result if prices charged were artificially capped. There's no better way to induce demand for something than to make it seem "free" to those who use it.

Can you imagine how much auto insurance would cost if we all had zero deductibles, where every time a pebble scuffed the paint or caused a small dent, insurance paid every dime? IMO, that's what completely shielding the consumer from direct expenses would do.

#29

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Author: AngelMay Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8064 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 10:20 AM
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This is the best way I can think of to assure that taxes keep spiraling higher and higher out of control. Either that or severe rationing would result if prices charged were artificially capped. There's no better way to induce demand for something than to make it seem "free" to those who use it.



Exactly where are you getting YOUR stats?
I've never heard so much "Stuff Made Up" as on this board.
Or so much jumping to conclusions based on nothing.

I can afford to go to the doctor.
I have lots and lots and lots of twenty dollar bills to plop down for my current co-pay. But that fact has not increased my demand to see doctors. In fact, my best friend has to lecture me to go to the doctor even when I NEED to go. What makes you think people will go to the doctor (when they don't need to) just because it's free? Is that what YOU would do? If it's not what YOU would do, why do so readily assume that it's what OTHER people would do?

This isn't the first time I've ever heard an unsupported argument like this. A coworker once was all bent out of shape because Alabama was considering allowing a lottery in the state. He made idiotic statements about people spending all their paycheck on lottery tickets while their families went without things they needed. I asked him if that was what HE would do. Of course not, he tells me. Then why, I asked him, do you think other people would do that? Why do you think it is incumbent upon YOU to police what other people do?

He had no answer. Just like you have no answer.
I doubt very seriously that you would be down at the doctor's office every day just because you cut your finger in the kitchen slicing tomatoes. And no one else would be, either.

But there are people -- including you -- who need to see a doctor for valid reasons. We need preventive care. We need care when we are legitimately ill. And we need care for catastrophic illnesses that now bankrupt whole families and ruin the lives of everyone closely associated with the seriously ill person.

We don't have to cover elective procedures -- how many times does this have to be said? -- but we should cover normal preventive visits to physicians and we should cover real medical situations that happen because we are human beings.

Well, most of us are human beings.

AM

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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8065 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 10:36 AM
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>> Exactly where are you getting YOUR stats? <<

I didn't quote any stats. This is very basic economics. Governments do this all the time: When you want to encourage an activity, subsidize it. This is nothing new and certainly not unique to health care.

Do you deny that when you increase the demand in a situation where supply is constant, the natural tendency is higher prices?

You really don't see how shielding every one -- regardless of ability to pay -- from all direct costs of health care would likely be very inflationary given what we know about economics?

>> I've never heard so much "Stuff Made Up" as on this board. <<

I didn't make anything up -- I stated an opinion based on common-knowledge economic principles. Opinions are not facts.

>> But there are people -- including you -- who need to see a doctor for valid reasons. We need preventive care. We need care when we are legitimately ill. And we need care for catastrophic illnesses that now bankrupt whole families and ruin the lives of everyone closely associated with the seriously ill person. <<

I completely agree. And I do think there needs to be serious changes in how we deliver and pay for care. And first and foremost (this is opinion that can't be "cited"), we need to control the inflation of health care costs. Without that, NOTHING we try will be long-term viable.

I don't agree with how you think it should be funded, but to a significant degree I would agree with the end result -- that people shouldn't be shut out of preventative care or medically necessary procedures because of a genuine inability to pay.

>> We don't have to cover elective procedures -- how many times does this have to be said? -- but we should cover normal preventive visits to physicians and we should cover real medical situations that happen because we are human beings. <<

Now you're "making stuff up" if you believe I implied this had to include "elective procedures." Two can play that game, and frankly, the witch-hunt for "making stuff up" is reaching epidemic proportions here. Opinions are not facts, so it's ridiculous for someone to "cite" an opinion.

Honestly, why do you have to be so hostile to everyone who doesn't agree with you 100%, even when they weren't being hostile and personally insulting to begin with? Do you think everyone who doesn't completely agree with you is a mortal personal enemy?

#29

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Author: cliff666 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8066 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 10:45 AM
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#29: If you think health care inflation is bad now, you ain't seen nothing yet if this is implemented.

This is the best way I can think of to assure that taxes keep spiraling higher and higher out of control. Either that or severe rationing would result if prices charged were artificially capped. There's no better way to induce demand for something than to make it seem "free" to those who use it.


AM: Exactly where are you getting YOUR stats?
I've never heard so much "Stuff Made Up" as on this board.
Or so much jumping to conclusions based on nothing.


No, no, AM. Ziggy is right. That's why England, Germany, France, Spain, Italy, and Japan all spend so much more per capita on health care than we do. Don't you see? Sheesh!

Oh, they don't? They spend less on health care than we do? Well, that is obviously just liberal propaganda. They must be getting much poorer health care than we do. Well, ok, they have lower infant mortality, longer life expectance, and they are less overweight on average than we, but that's just more liberal propaganda. But the Brits all have bad teeth! Refute that, if you can!

cliff

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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 10:51 AM
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<<One day we will have universal healthcare -- paid for through taxes, up front, so that no one ever gets a bill from a doctor or a hospital. Someday. Someday we will wake up and realize that the PEOPLE are far more important than the insurance companies. Someday. Maybe a lot sooner than would please you --- It's coming.


>>



I'm sure you will be as unhappy with any government health care system as you are now. When you or your husband have a health care problem, you will wind up being unhappy when the gfovernment tells you they will only do certain things for you and no, you aren't permitted to do more yourself. They will certainly continue to tax you heavily while not doing much for you though.


Seattle Pioneer

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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8068 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 10:54 AM
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>> No, no, AM. Ziggy is right. That's why England, Germany, France, Spain, Italy, and Japan all spend so much more per capita on health care than we do. Don't you see? Sheesh!

Oh, they don't? They spend less on health care than we do?
<<

These aren't mutually exclusive. Heck, Medicare's "inflation" isn't as bad as it has been for private insurance, and I freely grant that. But under the sheets it's not quite that neat and tidy...be that as it may, I'll grant the point.

These other nations don't always have every penny of care paid for by taxes. In some cases, those who can pay, do -- at least to a point, primarily through payroll deductions in some cases which are sliding based on income. This is really not what I interpreted AM's model to be. This is a form of directly paying for one's health insurance -- it just comes from payroll taxes according to perceived ability to pay (based on income levels). If this is what she meant by "no bills" and some such, then maybe my concerns aren't as great.

I'd think it better, personally, to look at income levels and issue an insurance card which determines the levels of one's co-payments and deductibles, which could be set to zero for folks with no means to pay (but higher for those who can). At least if people who can afford it have to pay *something* for a visit, it's less likely to be abused.

As long as that's the case, it prevents people from seeing it as "free," at least to a point.

>> Well, that is obviously just liberal propaganda. <<

Where have I called this "liberal propaganda?" I'd appreciate it if you wouldn't put words in my mouth or associate me with others who are trying to stir the pot by using the "L-word" in a disdainful manner.

Bottom line is that on this issue, I am a pragmatic moderate for whom a practical solution is more important than any ideology.

#29

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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 10:54 AM
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<<>> One day we will have universal healthcare -- paid for through taxes, up front, so that no one ever gets a bill from a doctor or a hospital. <<

If you think health care inflation is bad now, you ain't seen nothing yet if this is implemented.

This is the best way I can think of to assure that taxes keep spiraling higher and higher out of control. Either that or severe rationing would result if prices charged were artificially capped. There's no better way to induce demand for something than to make it seem "free" to those who use it.
>>



You have to relaize this is an Angel May fantasy. "After the Revolution, no doubt they will all sing in key," as they said in "Dr Zhivaho." They never sang in key, and the whole system became a nightmare.


But no matter ---Angel May has her fantasies.



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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 10:55 AM
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Now you're "making stuff up" if you believe I implied this had to include "elective procedures." Two can play that game, and frankly, the witch-hunt for "making stuff up" is reaching epidemic proportions here. Opinions are not facts, so it's ridiculous for someone to "cite" an opinion.

Honestly, why do you have to be so hostile to everyone who doesn't agree with you 100%, even when they weren't being hostile and personally insulting to begin with? Do you think everyone who doesn't completely agree with you is a mortal personal enemy?

#29



Sorry if you thought I was treating you as an enemy.
Obviously you are not since I'm reading your posts.
We obviously disagree on this issue.
I believe that if we can afford to provide a military through our taxes, then we can afford to provide healthcare through our taxes.
A healthy population is absolutely basic to the health of the nation AS a nation. And people should not have to worry about whether or not they can afford to pay for it should they get sick and need hospital/doctor care.

If we can provide education for everyone, why not healthcare?
Health, education, safety.

If other nations can provide this -- and provide it well -- why can't we? Why?

Why do we have to have insurance companies skimming $$$ off the top? Why do we have to have insurance companies canceling policies when people actually begin needing them? (This one happened to my father.) Why should people have to worry about becoming bankrupt over something they have little control over? It's not like people choose to get cancer or some other horrible disease.

I don't believe that people would be lining up to go to the doctor when they don't need to go - just because it's "free". If that kind of "human nature" were in play you would never see anyone drop out of public schools. After all, they are "free" and so people should be squeezing every ounce of learning they could from them. Does that happen?

Oy.
We will simply have to agree to disagree.
But I tell you true -- Universal healthcare is coming.
So you might just as well get ready for it.
Whether you like it or not.

AM

AM

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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 10:56 AM
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<<
Exactly where are you getting YOUR stats?
I've never heard so much "Stuff Made Up" as on this board.
Or so much jumping to conclusions based on nothing.

I can afford to go to the doctor.
I have lots and lots and lots of twenty dollar bills to plop down for my current co-pay. But that fact has not increased my demand to see doctors. In fact, my best friend has to lecture me to go to the doctor even when I NEED to go. What makes you think people will go to the doctor (when they don't need to) just because it's free? Is that what YOU would do? If it's not what YOU would do, why do so readily assume that it's what OTHER people would do?
>>



Take a look at the impact of preventing hospitals from screening out people from emergency rooms based on their ability to pay. The result has been that quite a lot of people use this very expensive service as their primary health care provider, plugging up the system and causing increasing numbers of emergency rooms to be closed.


But in your fantasy land, I guess such things never happen.



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Author: cliff666 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8072 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 10:58 AM
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Where have I called this "liberal propaganda?" I'd appreciate it if you wouldn't put words in my mouth or associate me with others who are trying to stir the pot by using the "L-word" in a disdainful manner.

Bottom line is that on this issue, I am a pragmatic moderate for whom a practical solution is more important than any ideology.

#29

Sorry. I couldn't resist the temptation. I have not observed you personally bashing "libs".

cliff

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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:00 AM
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<<I believe that if we can afford to provide a military through our taxes, then we can afford to provide healthcare through our taxes.
>>


By this logic, I suppose that if we can pay for roads and highways through our taxes, then we can afford to pay for wars in Afghanistan, Iraq and Iran as well.


Don't you find this kind of argument silly?




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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:03 AM
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AM: If we can provide education for everyone, why not healthcare?
Health, education, safety.

Ouch! Not a good argument, AM. Our edumcation doesn't seem to edumcate everybody.

Ziggy is also correct that in France and Germany, at least, the individuals or their employers pay most of the freight for health care. I have no issue with that. I would, however, like to make the insurance companies a bit more responsive and responsible, and to keep them from cherry picking only the young and healthy.

cliff

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Author: AngelMay Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8075 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:06 AM
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Ziggy is also correct that in France and Germany, at least, the individuals or their employers pay most of the freight for health care. I have no issue with that. I would, however, like to make the insurance companies a bit more responsive and responsible, and to keep them from cherry picking only the young and healthy.

cliff



I would like insurance companies removed from the picture altogether with regard to healthcare.

AM

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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8076 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:07 AM
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>> I believe that if we can afford to provide a military through our taxes, then we can afford to provide healthcare through our taxes. <<

National defense is a specific Constitutional power of the federal government; health care is not. Having said that, yeah, with the amount of money we spend on playing GloboCop, a lot of other domestic needs (or -- gasp -- reduction of the national debt) could be met.

>> . And people should not have to worry about whether or not they can afford to pay for it should they get sick and need hospital/doctor care. <<

Never disagreed with this. I think those who genuinely can not pay should not, at least with respect to preventative care and medically necessary procedures.

>> If other nations can provide this -- and provide it well -- why can't we? Why? <<

To some degree, different cultures and different founding principles. That's the only thing I can think of.

>> Why should people have to worry about becoming bankrupt over something they have little control over? <<

In the general case, okay. But I also don't believe that smokers have "little control" over whether they get lung cancer. I don't believe someone who is morbidly obese (except when caused by other medical conditions) has "little control" over getting heart disease and diabetes. And I don't believe alcoholics have "little control" over the fact that their liver is shot and needs a transplant.

I think shielding these groups from at least some of the costs of their choices is a mistake.

>> I don't believe that people would be lining up to go to the doctor when they don't need to go - just because it's "free". If that kind of "human nature" were in play you would never see anyone drop out of public schools. After all, they are "free" and so people should be squeezing every ounce of learning they could from them. Does that happen? <<

Well, it would "enable" hypochondriacs for one. (And yes, I know they are a small minority of the population.) As for your public school analogy, yes, some people do drop out of "free" public education. But I can pretty much guarantee you if you charged $5,000 a year per student for it, a lot more would drop out. The degree of cost to an individual does influence the entire group's consumption of those goods and services. It may not affect some individuals, but it will have an impact on the group's demand.

>> We will simply have to agree to disagree. <<

We don't even completely disagree, but you seem to focus on that rather than our points of agreement. Personally, I think that's why it's so hard for us to reach national consensus on things -- we focus too much on where we differ instead of where we're of like mind.

>> But I tell you true -- Universal healthcare is coming.
So you might just as well get ready for it.
Whether you like it or not.
<<

As someone who plans to retire early, depending on implementation it could be one of the best things that ever happened to me. But again, depending on implementation, I do worry about the long-term viability. Many of the nations providing health care that serve as a "model" for some advocates are in an extreme crunch due to rising expenses. And there's only so much you can raise taxes.

#29

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Author: cliff666 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8077 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:10 AM
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I would like insurance companies removed from the picture altogether with regard to healthcare.

AM

Sadly, you and I don't own any congress critters. The insurance companies own lots of them.

Politics is well described as "the art of the possible."

Fight only the battles you can win.*

cliff
*I feel the same way about gay marriage. Settle for the possible (civil union) instead of fighting for the impossible.

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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:12 AM
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cliff
*I feel the same way about gay marriage. Settle for the possible (civil union) instead of fighting for the impossible.



If everyone felt that way, Blacks would still be riding at the back of the bus.

AM

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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:14 AM
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I'd think it better, personally, to look at income levels and issue an insurance card which determines the levels of one's co-payments and deductibles, which could be set to zero for folks with no means to pay (but higher for those who can). At least if people who can afford it have to pay *something* for a visit, it's less likely to be abused.


I would definitely vote for a system like this.

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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:14 AM
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If everyone felt that way, Blacks would still be riding at the back of the bus.

AM

non sequitur.

cliff

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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:24 AM
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<<I'd think it better, personally, to look at income levels and issue an insurance card which determines the levels of one's co-payments and deductibles, which could be set to zero for folks with no means to pay (but higher for those who can). At least if people who can afford it have to pay *something* for a visit, it's less likely to be abused.


I would definitely vote for a system like this.

>>


Any reason you wouldn't support means testing of Medicare on the same basis?





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Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:28 AM
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>> Any reason you wouldn't support means testing of Medicare on the same basis? <<

As long as it weren't draconian and created an excessive disincentive for saving for your own retirement, then yes. Same as with Social Security, actually. I don't think means testing should be so punitive that there's little incentive to provide for your own retirement. But in moderation it can be a part of cost-containment.

#29

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Author: AngelMay Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8083 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:29 AM
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If everyone felt that way, Blacks would still be riding at the back of the bus.

AM

non sequitur.

cliff



Nope. Exactly to the point.
If we always settled for what we CAN do - for what is possible - we would never discover that sometimes we can do the "impossible".

Never settle.

And I'm REALLY surprised that you would "settle" with someone ELSE's rights by giving in to this current theocratic regime on the subject of Gay marriage. Since when do they deserve fewer rights than the rest of us? That may be the way it is, but it is not the way it SHOULD be. And if we don't demand that they get those rights, they never will get them.


AM

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Author: cliff666 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8084 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:32 AM
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Never settle.

And I'm REALLY surprised that you would "settle" with someone ELSE's rights by giving in to this current theocratic regime on the subject of Gay marriage. Since when do they deserve fewer rights than the rest of us? That may be the way it is, but it is not the way it SHOULD be. And if we don't demand that they get those rights, they never will get them.

AM

To quote that famous philosopher, Dad 666, "Sometimes half a loaf is better than no rest at all."

cliff

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Author: whafa Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8085 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:33 AM
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Any reason you wouldn't support means testing of Medicare on the same basis?


Isn't that exactly what we're talking about? If it would be a good idea for Medicare, why not extend it to the whole system?

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Author: whafa Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8086 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:35 AM
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To quote that famous philosopher, Dad 666, "Sometimes half a loaf is better than no rest at all."


Grandpa whafa used to say, "Don't throw out the bad water until you have some good water."

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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8087 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 11:36 AM
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>> And I'm REALLY surprised that you would "settle" with someone ELSE's rights by giving in to this current theocratic regime on the subject of Gay marriage. Since when do they deserve fewer rights than the rest of us? That may be the way it is, but it is not the way it SHOULD be. And if we don't demand that they get those rights, they never will get them. <<

I think individuals need to ask themselves whether they think principle is more important than pragmatism. (This isn't a trick question and there's no right or wrong here.)

If they value principle more highly, they would hold out for "all or nothing," accepting that this could reduce their chances of getting anything (or at least delaying the political victory, possibly by a long time).

If they value pragmatism, they'd accept something rather than nothing, knowing that at least having *something*, it's possible they can get "the rest" later as social values continue to evolve.

On this issue, there are quite a few people who are not opposed to a civil union but balk at calling it "marriage." Whether someone values pragmatism or principle more would indicate whether they garner the support or the opposition of this group -- which could be enough to gain passage of an incremental reform -- or cement the failure of an all-or-nothing proposal.

#29

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Author: amuseing Two stars, 250 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8088 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 12:14 PM
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>> I don't believe that people would be lining up to go to the doctor when they don't need to go - just because it's "free". <<

From my experience as a doc I would refute this. Years ago I worked at a multi-doc clinic in Berkeley where we each took night call for the whole clinic several nights a month. For a reason I never understood ( other than it being Berkeley) , it was free for patients to call in with emergencies at night. It was awful! It was one of the reasons I gave when I finally decided to leave and open my own practice. I'd get woken up all hours of the night because someone's hemorrhoid was hurting or cause they couldn't sleep or cause their 3 year old had a cough ( which they'd had for 4 days and hadn't come in even though appointments were available). After I left they initiated a small fee for after hours calls and a colleague told me the number of calls decreased quite a bit.

On a national level I don't know what the answer is but I always felt that patients would be more responsible if they had some connection to the costs they were incuring. People put much more value on their toys and vacations than they do on their health care unless they become critically ill. I used to give people breaks in their fees if I thought they had financial hardships. But I learned my lesson when those same people would show up in the winter with a tan from their 10 day vacation in Hawaii or come in for a sprained wrist that they suffered at the tennnis club....

V.


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Author: LtUhura Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8089 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 12:26 PM
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*I feel the same way about gay marriage. Settle for the possible (civil union) instead of fighting for the impossible.

Gay marriage is legal in Massachusetts and has been for a couple of years, which means it is not impossible.

Uhura

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Author: AngelMay Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8090 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 12:34 PM
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*I feel the same way about gay marriage. Settle for the possible (civil union) instead of fighting for the impossible.

Gay marriage is legal in Massachusetts and has been for a couple of years, which means it is not impossible.

Uhura



But do they get the same tax breaks (and penalties) as hetero marrieds do?

There lies the rub. Equal rights means EQUAL rights.
We should never settle for less than that.

AM

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Author: LtUhura Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8091 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 12:38 PM
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People put much more value on their toys and vacations than they do on their health care unless they become critically ill. I used to give people breaks in their fees if I thought they had financial hardships. But I learned my lesson when those same people would show up in the winter with a tan from their 10 day vacation in Hawaii or come in for a sprained wrist that they suffered at the tennnis club....

Blanket statements like this always piss me off to no end. For several years I worked three jobs with no days off except Federal holidays because the family health insurance offered by my full time employer cost 7 times more for support staff than it did for lawyers who were paid a minimum of 5 times more, and the deductibles were higher for support staff. The alternative would have been to leave my child uninsured. Hawaiian vacations and tennis (spelled with 2 n's, not three, Doc) clubs had nothing to do with anything.

Uhura

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Author: LtUhura Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8092 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 12:40 PM
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But do they get the same tax breaks (and penalties) as hetero marrieds do?

Yes. According to my fabulously married friends, they enjoy all the rights, responsibilities and penalties of marriage.

Uhura

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Author: AngelMay Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8093 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 12:41 PM
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But do they get the same tax breaks (and penalties) as hetero marrieds do?

Yes. According to my fabulously married friends, they enjoy all the rights, responsibilities and penalties of marriage.

Uhura



At the Federal level?

AM

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Author: whafa Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8094 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 1:03 PM
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There lies the rub. Equal rights means EQUAL rights.
We should never settle for less than that.


What if that means never achieving your goal? I think incremental change is superior to no change at all.

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Author: markr33 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8095 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 1:20 PM
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<<<Most people don't buy a big screen TV every single month.>>>

<<But they do make their SUV payment every single month.>>

I don't.


Nor do I, but you cannot deny that SUV's, despite the higher gasoline prices are still the most popular class of vehicle in the USA.

http://www.carlist.com/autonews/2005/autonews_202.html

But that is slowly changing.

<<And they do buy a bunch of their favorite tunes every month.>>

I don't.


Again, not everyone does, but lots and lots of people do, including some of those that choose not to have health insurance.

<<And they do go out to dinner quite a few times every month. etc.>>

Not "quite a few", but 4 or 5 I admit -- and it's more like lunch rather than dinner.


Restaurant meals take a record level of the "food dollar" in the USA. And this level has been increasing for probably 15 years or so.

So since the first person to respond to your claims doesn't fit into them, think how many other people there are out there who don't fit into them either. Exactly where are you getting your statistics on this one?

http://www.cspinet.org/reports/dineat2.html
http://www.libraries.psu.edu/business/industryguides/restaurants.htm
http://goliath.ecnext.com/coms2/gi_0199-4279511/Restaurant-industry-facts-Restaurant-Industry.html
http://goliath.ecnext.com/coms2/summary_0199-3521027_ITM

....and even their SUV would be paid off at some point.

Isn't that usually when the lease or loan starts for the new SUV (or other vehicle) :-)))

Healthcare insurance just keeps on keeping on -- and increasing and increasing and increasing....

That's true, and that is the essence of the problem. I am not convinced that single payer will reduce the growth, sure it might cut out the insurance company profits (15% or so), and sure it might increase efficiency somewhat, but I don't quite see how it will reduce the growth.

Here's my new hero:

http://www.huffingtonpost.com/michael-moore/exclusive-huffpost-live-c_b_55659.html

One day we will have universal healthcare -- paid for through taxes, up front, so that no one ever gets a bill from a doctor or a hospital. Someday. Someday we will wake up and realize that the PEOPLE are far more important than the insurance companies. Someday. Maybe a lot sooner than would please you --- It's coming.

I think I agree that it will happen someday, likely someday soon. If it's done right, it might even please me...


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Author: 0x6a74 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8096 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 1:22 PM
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And I'm REALLY surprised that you would "settle" with someone ELSE's rights by giving in to this current theocratic regime on the subject of Gay marriage. Since when do they deserve fewer rights than the rest of us? That may be the way it is, but it is not the way it SHOULD be. And if we don't demand that they get those rights, they never will get them.

AM

To quote that famous philosopher, Dad 666, "Sometimes half a loaf is better than no rest at all."



oy <g>


sometimes yes.
sometimes "half a loaf" isn't the choice.

often the Other Side is even less willing to compromise


=



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Author: 0x6a74 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8097 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 1:27 PM
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But do they get the same tax breaks (and penalties) as hetero marrieds do?

Yes. According to my fabulously married friends, they enjoy all the rights, responsibilities and penalties of marriage.


even at the federal level?

they can file joint-return if they want?
and not be jerked around by the IRS??


that would be way cool


=j

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8098 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 1:28 PM
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<<*I feel the same way about gay marriage. Settle for the possible (civil union) instead of fighting for the impossible.

Gay marriage is legal in Massachusetts and has been for a couple of years, which means it is not impossible.

Uhura
>>



Only until the voters get a chance to repeal it.



Seattle Pioneer

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8099 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 1:33 PM
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<<But do they get the same tax breaks (and penalties) as hetero marrieds do?

Yes. According to my fabulously married friends, they enjoy all the rights, responsibilities and penalties of marriage.


even at the federal level?

they can file joint-return if they want?
and not be jerked around by the IRS??

>>


I'd be perfectly glad to join with Angel May in postponing gay marriage rights until the right to polygamy is established at the same time.

Mustn't have anyone riding in the back of the bus, and until we prohibit anyone from riding back there, the status quo should remain.



Right, Angel May?



Seattle Pioneer





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Author: tenworlds Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8100 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 1:52 PM
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I'd be perfectly glad to join with Angel May in postponing gay marriage rights until the right to polygamy is established at the same time.
-----

When polygamists demand the same rights, go for it. I'll be right there with you.

Until then, sit down, you're just making noises to be annoying. Kinda like a four year old.






ten

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Author: amuseing Two stars, 250 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8101 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 2:00 PM
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>Blanket statements like this always piss me off to no end. For several years I worked three jobs with no days off except Federal holidays because the family health insurance offered by my full time employer cost 7 times more for support staff than it did for lawyers who were paid a minimum of 5 times more, and the deductibles were higher for support staff. The alternative would have been to leave my child uninsured. Hawaiian vacations and tennis (spelled with 2 n's, not three, Doc) clubs had nothing to do with anything.

Uhura <

Well most of what I said was not a blanket statement but specific examples from my own experience of which I have many more than I shared. Given what you said about yourself I would have probably given you a hugh break in fees. One of my first suggestions though as far as preventive care would be some anger management for you.

V.


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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8102 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 2:06 PM
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<<I'd be perfectly glad to join with Angel May in postponing gay marriage rights until the right to polygamy is established at the same time.
-----

When polygamists demand the same rights, go for it. I'll be right there with you.

Until then, sit down, you're just making noises to be annoying. Kinda like a four year old.






ten

>>


Well polygamists have been demanding that right for 150 years or so now in the United States, and a good many have died over the issue.


But of course I was illustrating the futility of Angel May's all or nothing political views. Some times compromise and settling for half a loaf is a good political strategy, other times it is not.

It's abundantly clear that gay rights groups have settled for half a loaf many times while advancing their issues and agendas on various issues, and that's been a smart strategy. Angel May Puritanist unwillingness to compromise is a formula for defeat, not reform. That being the case, I applaud her unwillingness to compromise.




Seattle Pioneer




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Author: 0x6a74 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8103 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 2:15 PM
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Blanket statements like this always piss me off to no end. For several years I worked three jobs with no days off except Federal holidays because the family health insurance offered by my full time employer cost 7 times more for support staff than it did for lawyers who were paid a minimum of 5 times more, and the deductibles were higher for support staff. The alternative would have been to leave my child uninsured. Hawaiian vacations and tennis (spelled with 2 n's, not three, Doc) clubs had nothing to do with anything.


one of the Cool Things about the 'healthcare puzzle' is there's enough 'special interests' involved they can each blame someone different ...

liberals blame the Ins.Companies who blame the hospitals who blame the nurses

conservatives blame the lawyers who blame the doctors who blame the patients..


=b
...... firmly in the Pogo-AM-Cliff camp wrt blame

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Author: 0x6a74 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8104 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 2:18 PM
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Until then, sit down, you're just making noises to be annoying. Kinda like a four year old.


four year-olds everywhere are somewhat offended.


=b

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Author: ziggy29 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 8105 of 60020
Subject: Re: Health Care: We're missing the big picture, Date: 7/11/2007 2:20 PM
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