Originally Posted by Xer H

I would say, too, that they live much more simply. They don't have large homes and all the trappings that come with them. You'd never find a television in every room. They don't worry about having two cars. Their closets are tiny, so they don't buy a lot of clothes. Etc. As you pointed out, Deb, Americans would have more money if they didn't spend it needlessly, too.

They also have longer vacations, and they use them.

I've never been in Europe, but I have heard the stories: if people have less they are still more secure. People have less square-footage per person (although that might reflect that we Americans have lower population densities except in parts of California and the Northeast; land is damn cheap in parts of rural America).

I have noticed rather few physicians who have emigrated to the US from Europe to enjoy the lower levels of taxation and higher pay. Maybe they have heard about our insurance companies. Language barriers? Germans tend to learn English easily.

What goes with a "TV in every room" is typically some video game or video playback unit or computer. By extension one also has the software.

We probably get an excuse for the large wardrobes, especially in our "fire-and-ice" Dfa climates (basically anything between a lines from about Wichita through Indianapolis, Pittsburgh, New York City, and Martha's Vineyard in the south and another through the Twin Cities, Grand Rapids, Buffalo, Albany, and Boston) with brutal summers and Arctic winters. Multiple cars? Look at the condition of mass transit in most American cities.

We use housing as an excuse for running away from social problems that poverty itself intensifies even if it doesn't create.

Originally Posted by pbrower2a

They also have longer vacations, and they use them.

Sorry, PB. The point I was trying to make is that Americans would have more savings, more "wealth" if we didn't live high on the hog. Yes, Europeans take more vacation, but they also spend less doing it.

So, while they pay higher taxes, they have higher savings not necessarily just because healthcare, education, etc are "free" but because they also live more frugally.

Like most things, it's a matter of choice. Would you rather pay so everyone can have free healthcare and education, or would you rather keep your money to spend on televisions, cars and other disposable items? And do you prefer the option to make that choice for yourself, or do you prefer to have someone tell you what to do?

I'm guessing there are different responses for just about everyone on the board.

Originally Posted by Xer H

Sorry, PB. The point I was trying to make is that Americans would have more savings, more "wealth" if we didn't live high on the hog. Yes, Europeans take more vacation, but they also spend less doing it.

So, while they pay higher taxes, they have higher savings not necessarily just because healthcare, education, etc are "free" but because they also live more frugally.

Like most things, it's a matter of choice. Would you rather pay so everyone can have free healthcare and education, or would you rather keep your money to spend on televisions, cars and other disposable items? And do you prefer the option to make that choice for yourself, or do you prefer to have someone tell you what to do?

I'm guessing there are different responses for just about everyone on the board.

I concur with you. As for 'living high on the hog', much of it is 'retail therapy'. Bored? Scared? Then go to the glitzy mall and buy something, and while you are there, go to the fake carnival of the fast-food place and have some overpriced fast food bad for our health because it is loaded with sugars and saturated fats. Can't get a raise despite rising productivity and technological innovations? Then buy it all on a credit card and really go into debt. Don't bother with a union; your employer will of course move the operation to some place where people are thankful to have Third World wages. Americans have debt instead of savings -- or more precisely, debt has Americans under its control.

We Americans would be better off with more union cards and far fewer credit cards. Indeed, America was in many respects a better place when union cards were the norm and credit cards were all American Express, Diners' Club, and Carte Blanche intended for traveling salesmen and for executives who took clients out to dinner and entertainment.

The TVs, video games, and video playback devices ordinarily do little to enrich the mind; if anything they tend to numb it. Kids would be better off with books to read and with musical instruments to play instead of the arcade games and R-rated movies that they use. Better Goethe than fart jokes? In the words of the immortal (ahem!) Sarah Palin, "You betcha!"

Sure, high-quality education is elitist. But there are people who really can get something from exposure to the high-level creations of the mind and those who can't. That said, even with tracking that denies the highly-unlikely hope that some late-bloomer in grade school might become a university professor or an attorney, the German system makes money and parents' social status not an issue. What's better? A solid apprenticeship that leads to a middle-income blue-collar career or matriculation through some diploma mill that prepares someone for nothing that one couldn't have gotten straight out of an American high school (like fast-food counterperson, janitor, or domestic servant) without a huge burden of debt from school loans?

Good public transit makes a second car (and related costs) a non-necessity for a family.

Originally Posted by pbrower2a

I concur with you. As for 'living high on the hog', much of it is 'retail therapy'. Bored? Scared? Then go to the glitzy mall and buy something, and while you are there, go to the fake carnival of the fast-food place and have some overpriced fast food bad for our health because it is loaded with sugars and saturated fats. Can't get a raise despite rising productivity and technological innovations? Then buy it all on a credit card and really go into debt. Don't bother with a union; your employer will of course move the operation to some place where people are thankful to have Third World wages. Americans have debt instead of savings -- or more precisely, debt has Americans under its control.

We Americans would be better off with more union cards and far fewer credit cards. Indeed, America was in many respects a better place when union cards were the norm and credit cards were all American Express, Diners' Club, and Carte Blanche intended for traveling salesmen and for executives who took clients out to dinner and entertainment.

The TVs, video games, and video playback devices ordinarily do little to enrich the mind; if anything they tend to numb it. Kids would be better off with books to read and with musical instruments to play instead of the arcade games and R-rated movies that they use. Better Goethe than fart jokes? In the words of the immortal (ahem!) Sarah Palin, "You betcha!"

Sure, high-quality education is elitist. But there are people who really can get something from exposure to the high-level creations of the mind and those who can't. That said, even with tracking that denies the highly-unlikely hope that some late-bloomer in grade school might become a university professor or an attorney, the German system makes money and parents' social status not an issue. What's better? A solid apprenticeship that leads to a middle-income blue-collar career or matriculation through some diploma mill that prepares someone for nothing that one couldn't have gotten straight out of an American high school (like fast-food counterperson, janitor, or domestic servant) without a huge burden of debt from school loans?

Good public transit makes a second car (and related costs) a non-necessity for a family.

There is a wide spread myth in America about trickle down economics. That myth needs to be exposed for what it is, keeping people disenfranchised. The alternative that has been brought to a needed attention in this thread, is that when there is social uplift, everyone wins.

Even if we just focus on one issue, say better education. Pointing to the facts that educated people, who learn skills, and can support themselves and their families, is a social uplift that will in the long run save money and lives. As we all know, there is just way too much of a class divide in education. I look at the crumbling school systems in the inner city and wonder how anyone could learn in such an environment. Then we wonder why so many kids are wandering aimlessly, getting into trouble and ending up in prison. That very system that sucks up tons of money that could have been used for social uplift. Vicious cycle.

Holding up the values of less consumption, and more fair sharing for the common good, is a crucial but difficult task. The wealthy will oppose it at every turn, because as I alluded to before, social uplift will raise a social class that they can't continue to exploit.

Health Care State Waiver Bill Introduced

The Vermont congressional delegation today introduced legislation to let the state implement a single-payer health care system that could become a model for the nation.

Sens. Bernie Sanders (I-Vt.) and Patrick Leahy (D-Vt.) introduced a Senate bill and Rep. Peter Welch (D-Vt.) filed legislation in the House that would let Vermont and other states provide better health care at less cost beginning in 2014.

All three members of the delegation joined Gov. Peter Shumlin at a Statehouse news conference one week ago and pledged to help the state secure federal waivers needed to implement sweeping health care reforms.

Sanders said, "It is my strong hope that Vermont will lead the nation in a new direction through a Medicare-for-all single-payer approach. At a time when 50 million Americans lack health insurance and when the cost of health care continues to soar, we must do all we can to lower the costs and improve the quality of care."

Leahy said, "This is a bill to give Vermont and other states the choice to go above and beyond the national standard by letting states devise their own reforms. Vermont has always been a leader in health care quality and access. This bill would keep the ball in Vermont's court, giving us the flexibility we want to offer Vermonters the best care and coverage while controlling costs."

Welch said, "Vermont has long led the charge in providing better health care at a lower cost. Providing Vermont and other states the flexibility they need to innovate will strengthen health care throughout the nation."


Dr. William Hsiao, a Harvard consultant to the Vermont Legislature, said in a recent report that that state could improve health care and save $2.1 billion by 2025 if the needed federal waivers were obtained.

Under the Vermont delegation proposal, states would be able to seek waivers from the U.S. Health and Human Services Department three years sooner than allowed under the new federal health care law. States could qualify for waivers only for plans that are at least as comprehensive and affordable as the federal model and cover at least as many people. States could not offer lower quality or less affordable coverage.

The waiver provision also requires HHS to create a coordinated process so states in a single application also could seek waivers already available under Medicare, Medicaid, and the children's health insurance program.

By Don McCanne, MD

Physicians for a National Health Program

One of the advantages of a single payer system, as envisioned by PNHP, is that hospitals can be placed on global budgets. They are paid periodically a flat budgeted amount based on legitimate operating expenses, just as other public service institutions, such as the fire department, are funded. This relieves the hospital of the high costs and administrative burden of itemizing a multitude of charges for each individual patient - not to mention that it does away with the $15 charge for a Tylenol or $35 charge for a Band-Aid.

Considering the efficiencies of global budgeting it might seem that the decision of Blue Cross Blue Shield of Massachusetts to switch to global payments for hospitals is a giant step toward single payer. It might seem that, but it isn't.

Under a single payer system, all legitimate costs are budgeted (with separate budgeting of capital improvements), and payments made accordingly. With a global payment made by a single insurer in a multi-payer system, it is difficult to decide which costs should be allocated to that insurer. Furthermore, the insurer really doesn't care.

A large insurer like Blue Cross Blue Shield will use its leverage to negotiate down its global payments in a secretive, proprietary process, while leveraging risk adjustment to its own advantage ("our privately insured patients are healthier than your sick Medicare patients"). Smaller insurers would be at a competitive disadvantage because of a lack of leverage and an excessive administrative burden per beneficiary. Public payers such as Medicare and Medicaid would continue to do what they already do, regardless of any agreements the hospitals work out with the private payers. Thus the inefficiencies, inequities, and administrative excesses of our current, fragmented, public and private financing system would be perpetuated.

We keep hearing that if we don't do this, or if we don't do that, we are going to have single payer. The problem is that if we do this, or do that, anything as long as it isn't single payer, we're only going to delay the inevitable. Wouldn't it be much smarter to end the suffering and hardship now by enacting a single payer system, especially since it's inevitable anyway?

Originally Posted by Deb C

Health Care State Waiver Bill Introduced

The Vermont congressional delegation today introduced legislation to let the state implement a single-payer health care system that could become a model for the nation.

Sens. Bernie Sanders (I-Vt.) and Patrick Leahy (D-Vt.) introduced a Senate bill and Rep. Peter Welch (D-Vt.) filed legislation in the House that would let Vermont and other states provide better health care at less cost beginning in 2014.

All three members of the delegation joined Gov. Peter Shumlin at a Statehouse news conference one week ago and pledged to help the state secure federal waivers needed to implement sweeping health care reforms.

Sanders said, "It is my strong hope that Vermont will lead the nation in a new direction through a Medicare-for-all single-payer approach. At a time when 50 million Americans lack health insurance and when the cost of health care continues to soar, we must do all we can to lower the costs and improve the quality of care."

Leahy said, "This is a bill to give Vermont and other states the choice to go above and beyond the national standard by letting states devise their own reforms. Vermont has always been a leader in health care quality and access. This bill would keep the ball in Vermont's court, giving us the flexibility we want to offer Vermonters the best care and coverage while controlling costs."

Welch said, "Vermont has long led the charge in providing better health care at a lower cost. Providing Vermont and other states the flexibility they need to innovate will strengthen health care throughout the nation."


Dr. William Hsiao, a Harvard consultant to the Vermont Legislature, said in a recent report that that state could improve health care and save $2.1 billion by 2025 if the needed federal waivers were obtained.

Under the Vermont delegation proposal, states would be able to seek waivers from the U.S. Health and Human Services Department three years sooner than allowed under the new federal health care law. States could qualify for waivers only for plans that are at least as comprehensive and affordable as the federal model and cover at least as many people. States could not offer lower quality or less affordable coverage.

The waiver provision also requires HHS to create a coordinated process so states in a single application also could seek waivers already available under Medicare, Medicaid, and the children's health insurance program.

It would be great for a state to try this experiment. Then we would have data instead of just more opinions.
I still prefer a Govt manged system like the one for Federal employees. Then a limited number ( 12 to 20) of insurance companies , employee associations, etc. could provide national plans and compete for the customers. Need some rules such as all citizens in the pool( no exceptions), coverage broad enough to achieve political concensus, national coverage, and maybe a few more rules. The Govt. retains oversight , but does not do day to day administration. And , I prefer to maintain some competetion( In the federal system, employees have annual option to switch providers).

Originally Posted by radind

It would be great for a state to try this experiment. Then we would have data instead of just more opinions.
I still prefer a Govt manged system like the one for Federal employees. Then a limited number ( 12 to 20) of insurance companies , employee associations, etc. could provide national plans and compete for the customers. Need some rules such as all citizens in the pool( no exceptions), coverage broad enough to achieve political concensus, national coverage, and maybe a few more rules. The Govt. retains oversight , but does not do day to day administration. And , I prefer to maintain some competetion( In the federal system, employees have annual option to switch providers).

I have read where a single payer system would most likely still involve the insurance industry. As long as the industry has over sight to make sure they're administrating the program honestly and provides quality care for all, I see it as a workable compromise. Hence, a combination of a social and capitalistic ideas making for a needed paradigm change.

GOP invokes 1700s doctrine in health care fight

They are introducing measures that hinge on "nullification," Thomas Jefferson's late 18th-century doctrine that purported to give states the ultimate say in constitutional matters.

This article was one of several in response to the question "Where should Obama start if he is serious about making all companies pay their fair share?" published on February 1, 2011 by the New York Times' Room for Debate blog.


The Trouble With Corporate Taxes: Start With the Drug Companies
By Dean Baker

The marginal tax rate for corporations is 35 percent. This is one of the highest tax rates among wealthy countries, which makes it a great talking point for anti-tax conservatives. However, corporations typically pay less than a quarter of their profits in taxes, making the U.S. a relatively low tax country.

Having a high tax rate and then filling the code with loopholes is a way to support the loophole industry, it is not good economic policy. It makes much more sense to lower the rate and eliminate the loopholes, so that the marginal tax rate is also the rate that businesses actually pay. Ideally this should be done in a way that raises some additional revenue, since we will need more money once the economy recovers.

There is a long list of ill-conceived tax breaks that have been put into the tax code over the years, but the best place to start is with the drug industry’s credit for research. As a result of this and other tax breaks the pharmaceutical industry pays just 5.6 percent of its profits in taxes. This puts it just above the biotech industry, which pays 4.5 percent of its profits in taxes.

It is bad enough that the drug industry manages to earns its tens of billions in annual profits largely tax free. However, much of this research spending does little to advance public health. Much of this money goes to develop me-too drugs of little medical value. Some of the research is effectively marketing, as the drug companies try to promote the use of their drugs under the auspices of doing post-approval trials.

The result of this system is that we often end up paying hundreds or even thousands of dollars per prescription for drugs that would sell for just a few dollars in a competitive market without patent protection. The government already spends more than $30 billion a year on bio-medical research through the National Institutes of Health. It would make much more sense to directly finance the research by the industry, eliminate the tax breaks and let all drugs be sold as generics at Wal-Mart for $4 per prescription.

Would some of our anti-national-healthcare folks explain something to me?

Ya'll are against "forcing" everyone to participate in any kind of a national insurance scheme, right? And several states are in the process of suing the federal government to not do that, right?

Yet, when your 28 year-old uninsured kid wraps his motorcycle around a park bench, and his leg is nearly severed, and he has catastrophic brain injury, you still want us to scrape his sorry ass up, haul him to the taxpayer supported trauma center, spend a couple hundred thousand dollars stitiching him up and then another bunch of megabucks of taxpayer money to rehab him and perhaps support his ongoing care for the rest of his life?

Any of you see any internal contradictions in that?

::::::::I'm not holding my breath waiting for a coherent answer:::::::

Last year when I indicated that the Health Care reform was really a handout to the insurance industry, I received many responses, that at least it was a start. In my opinion, and numerous National Health Care proponents, was that when we ask for little, that is exactly what we get, very little. Even though the single payer system has been discussed for years, it has always been upstaged by the corporation. Nothing new here in the negotiations last year for Obama's reform.

A clue to where our health coverage was headed was when Obama invited the insurance industry to the table, and in spite of his promise to make all negotiations transparent, he made back room deals.

Here is one result of our settling for less than what we deserve.

Massachusetts reform hasn’t stopped medical bankruptcies: Harvard study
March 9, 2011 by Healthcare-NOW!

Skimpy health insurance policies are likely culprit in continuing problem; findings indicate national reform law won’t stop bankruptcies

From Physician for a National Health Program –

The percentage of personal bankruptcies linked to medical bills or illness changed little, and the absolute number actually increased in Massachusetts after the implementation of its landmark 2006 law requiring people to buy health insurance, a Harvard study says.

The new study, which appears in today’s American Journal of Medicine, found that between early 2007 and mid-2009, the share of all Massachusetts bankruptcies with a medical cause went from 59.3 percent to 52.9 percent, a non-significant decrease of 6.4 percentage points. Because there was a sharp rise in total bankruptcies during that period, the actual number of medical bankruptcy filings in the state rose from 7,504 in 2007 to 10,093 in 2009.

The findings have national implications because the Obama administration’s health law is largely patterned after the Massachusetts plan, including its individual mandate. One of the administration’s arguments in support of the new federal law was that it would significantly reduce medical bankruptcies nationwide. The findings in Massachusetts cast doubt on that claim.

For more:
http://www.healthcare-now.org/massac...harvard-study/

Originally Posted by Deb C

Last year when I indicated that the Health Care reform was really a handout to the insurance industry, I received many responses, that at least it was a start. In my opinion, and numerous National Health Care proponents, was that when we ask for little, that is exactly what we get, very little. Even though the single payer system has been discussed for years, it has always been upstaged by the corporation. Nothing new here in the negotiations last year for Obama's reform.

A clue to where our health coverage was headed was when Obama invited the insurance industry to the table, and in spite of his promise to make all negotiations transparent, he made back room deals.

Here is one result of our settling for less than what we deserve.



For more:
http://www.healthcare-now.org/massac...harvard-study/

I would like to see a National plan, with government oversight, but so far I have not seen a ‘single payer’ approach that I am comfortable with.
We do need to put all US citizens on a single insurance pool (no exceptions) and then allow companies, associations, unions, etc. to compete for the insurance business at a national level (no cherry picking) with robust coverage. There should be an annual open season so that individuals could change plans if desired. This should eliminate plans with poor coverage.
I propose that this be done in several steps, starting with a system design. Then move to the funding issue after we have a real health care insurance system design.

Originally Posted by radind

I would like to see a National plan, with government oversight, but so far I have not seen a ‘single payer’ approach that I am comfortable with.
We do need to put all US citizens on a single insurance pool (no exceptions) and then allow companies, associations, unions, etc. to compete for the insurance business at a national level (no cherry picking) with robust coverage. There should be an annual open season so that individuals could change plans if desired. This should eliminate plans with poor coverage.
I propose that this be done in several steps, starting with a system design. Then move to the funding issue after we have a real health care insurance system design.

Why would you waste any of our precious HC dollars providing profits to insurance companies? We have a functioning system in Medicare. It's very low load. Let's simply reset the coverage age to zero and go from there.

Originally Posted by Marx & Lennon

Why would you waste any of our precious HC dollars providing profits to insurance companies? We have a functioning system in Medicare. It's very low load. Let's simply reset the coverage age to zero and go from there.

Perhaps if you mandate that doctors must accept Medicare patients & Medicare payments. Some local doctors are opting out of Medicare now. The patients are left to fend for themselves. In addition, the primary costs for health care are in the health care system itself and not the insurance providers. Not that the insurance companies should not improve. It is just that we need to somehow get the waste and fraud out of the entire system.

If you look at the current federal worker health care insurance, you will see that the health care insurance providers include unions and employee associations, in additon to several insurance companies. There are several national level plans open to federal employees regardless of what agency they work for. The companies only get business if they provide a better value.

Originally Posted by radind

Perhaps if you mandate that doctors must accept Medicare patients & Medicare payments. Some local doctors are opting out of Medicare now. The patients are left to fend for themselves. In addition, the primary costs for health care are in the health care system itself and not the insurance providers. Not that the insurance companies should not improve. It is just that we need to somehow get the waste and fraud out of the entire system.

This is why Single Payer proponents are working for an improved Medicare for all. They realize that the current payments are not efficent.

Not only will a Single Payer result in less fraud, it will make the patient the priority, not profit for exorbinate salaries for CEO insurance executives and their stockholders.

Originally Posted by The Rani

I hate to burst your bubble, but Medicare/Medicaid fraud is about the easiest thing in the world to get away with. Nobody is checking. I even tried reporting someone once ... no dice.

The costs of administering the Medicare program remain at less than two percent of program expenditures. From what I understand, a single payer system could afford more resources to drastically cut down on fraud.

I will look for some links to that information.

Originally Posted by radind

Perhaps if you mandate that doctors must accept Medicare patients & Medicare payments. Some local doctors are opting out of Medicare now. The patients are left to fend for themselves. In addition, the primary costs for health care are in the health care system itself and not the insurance providers. Not that the insurance companies should not improve. It is just that we need to somehow get the waste and fraud out of the entire system.

Doctors will not opt-out of the only game in town. Even a two-tier system will be 90% public and 10% private. None of this is intended to argue that Medicare won't see major changes over time, but it is a functioning system today. We can all start using it within a few months, if we choose to do it.

Originally Posted by The Rani

Hospitals also eat the losses that they take on Medicare/Medicaid, counting on private insurance payments to make up for it.

Of course they do. But then, hospitals are stuctured to manage numerous insurance regimes, so they do none of them really well ... even Medicare.

FWIW, they have a legitimate argument about Medicaid.

Originally Posted by Deb C

Originally Posted by The Rani

I hate to burst your bubble, but Medicare/Medicaid fraud is about the easiest thing in the world to get away with. Nobody is checking. I even tried reporting someone once ... no dice.

The costs of administering the Medicare program remain at less than two percent of program expenditures. From what I understand, a single payer system could afford more resources to drastically cut down on fraud.

I will look for some links to that information.

Fraud isn't restricted to the Federal programs. Given half a chance, fraudsters will bilk insurance companies too. As always, the Willie Sutton standard applies. The bigger the program, the greater the opportunity.

Originally Posted by The Rani

Private companies are a lot more on top of it, because after all they ARE greedy bastards.

The big healthcare corporation I retired from was fined $160 Million for Medicare "irregularities. Smith-Kline also got nabbed. One of LabCorp's executives went to jail, plus they got fined. This was all back in the '90's.

When I retired in '07, we were still screwing the insurance companies. Legally, of course.

Originally Posted by Marx & Lennon

Fraud isn't restricted to the Federal programs. Given half a chance, fraudsters will bilk insurance companies too. As always, the Willie Sutton standard applies. The bigger the program, the greater the opportunity.

Indeed, fraudsters will always find a way to play their games. Even if we didn't reduce fraud in large numbers, a single-payer system would still save tons of money.

I wish more US citizens understood the high cost of private insurance. As you and I have attempted to explain at various times, our current health care system is overly expensive, yet doesn't meet the needs of millions of people. According to the Physicians For A National Health Care, the reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay.

Originally Posted by Deb C

Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay.

Not only that, but the healthcare companies have to hire marketing departments, billing departments and excessive financial systems to deal with the bs from the insurance companies. It's a death spiral.

Originally Posted by Marx & Lennon

Why would you waste any of our precious HC dollars providing profits to insurance companies? We have a functioning system in Medicare. It's very low load. Let's simply reset the coverage age to zero and go from there.

IMO a socialized healthcare system is the only one that is truly fair. The reason many people look upon it as an evil boogyman is because generations of ideological brainwashing have made "rationing" a dirty word, even if availability by ability to pay is itself a form of rationing. the Haves need to get over the sh*t notion that they should have a "right" to more healthcare simply because they have the money.