Several states are trying to extend health coverage to the growing number of uninsured, but all of them are struggling with where to find the revenues to pay for subsidizing health insurance for those least able to afford rapidly rising insurance premiums. So far, however, the states appear to be looking in all the wrong places, and it’s not clear how they can solve this without progressively raising income taxes and challenging the role and costs of insurance companies.
This post Monday discussed the effect of using mandates to force companies to offer or individuals to purchase health insurance. I noted the incentives companies and individuals have to move to the state subsidized insurance pools, creating much higher state funding requirements than states anticipated.
As Tuesday’s New York Times article also explains, Massachusetts is facing an additional $150 million in costs for subsidized insurance coverage, and it’s not clear where the Legislature will find the funds. In California, Governor Schwarzenegger and Assembly Speaker Nunez are proposing a much larger version of Massachusetts’s mandatory insurance approach, while seeking approval for a variety of funding sources:
It would raise money to subsidize policies for low-income residents through what Mr. Schwarzenegger calls shared responsibility — a tax on hospital revenues, a hefty increase in tobacco taxes and assessments on employers who do not contribute to their workers’ health care.
In a California innovation, the assessment rates would be graduated according to the size of the company. If the Senate passes the measure, voters will be asked to approve the revenue measures in a November referendum that would become the truest test of public support for change.
While California’s funding approach remains uncertain, plans in other states are already blocked by opposition to higher taxes:
Illinois’ Democratic governor, Rod R. Blagojevich, got nowhere with his proposals to pay for universal access to insurance by taxing gross business receipts and assessing employers who do not offer coverage to their employees. He then instigated a fight with his legislature and provoked a lawsuit by using his executive authority to widen eligibility for state-subsidized insurance programs.
In Pennsylvania, Gov. Edward G. Rendell, also a Democrat, failed to persuade his politically divided legislature to cover the state’s 900,000 uninsured through an employer assessment. Like the California leaders, Mr. Rendell has now proposed increasing cigarette taxes, as well as raiding the surplus in a state fund designed to help doctors pay for malpractice insurance.
Taxing businesses who don’t provide coverage or taxing cigarettes are common solutions, but even these relatively "safe" taxes are encountering strong opposition at the state level. In Congress, Democrats were unable to gather enough Republican votes to override Bush’s SCHIP veto, partly because Bush and his Republicans opposed higher cigarette taxes. Yet as the Times article notes, states were counting on expanded SCHIP funding — now dead until 2009 — to extend coverage to the growing number of uninsured children, making it easier to fund the remaining uninsured population.
Notice what’s missing. None of the states is considering progressive income taxes. Nor are the states directly challenging the central role of the insurance industry, even though it’s a major cause of rising administrative costs. In contrast, allowing the Bush tax cuts for the wealthiest to expire is a key part of the funding proposed by some of the Democratic presidential candidates for their respective plans.
Beyond providing universal care, one of the goals of a national health care system should be to relieve businesses of a rising cost burden that their foreign competitors don’t face. That’s a major reason why the auto industry is trying to shed its health benefits and agreeing to union-spoonsored health care trusts. That means giving up on higher corporate taxes and finding some other revenue source, as well as taking on the insurance industry about its growing administrative costs. All of the private insurance-based plans seem structured to drive people inexorably towards the public subsidized pools, making the funding and cost-control issues even more important.
The Republicans show no interest in solving any of these difficult problems and will vigorously oppose any tax hikes. So all the heavy lifting will be left to the Democrats, and as they ask for support for higher taxes, they’ll need to be clearer about where the reforms are ultimately heading. We’re in for some bruising battles, no matter who is President.
Photo by willem velthoven
Related posts:
- Sen. Kennedy Releases Draft of Health Care Reform Bill; Obama Pushes Reforms
- Didn’t We Just Have a National Referendum on Obama’s Health Care Plan Last November?
- Health Care: Public Option Opt-In Not the Same as State-Based Public Plans
- Snowe’s War on States’ Rights in the Health Care Debate
- More for Health Care, Less for Insurance Execs? Rockefeller Demands 90% Loss Ratio
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Me!!!!!
Damnit.
Good morning Scarecrow!
Scarecrow,
Nice post but still misses the fundamental underlying inherent corruption of the present system in Assashusetts…………
Columnist Gene Pickham’s November 23, 2007 article, “Mandatory Health Care? Now That’s Sick,” wickedlocal.com states:
[Mod Note; Edited by Mod for length. To help keep the FDL servers running smoothly and to avoid any copyright issues, please do not post entire articles — include a link instead. Thank you. ]
“If national healthcare reform is similar, pack it up and go home. We need some good independent journalistic reporting here. It is a Trojan horse by design where perceptions have little nexus to reality.”
Do news media outlets have any money in budgets to conduct truthful, informative investigative jounalistic pieces anymore. Guess not!!!
The City of San Francisco under the leadership of Supervisor Tom Ammiano is providing health insurance for its residents.
Remember in just a few years a big wad of the population will starting receiving medicare and then it is just a step a way to covering everyone.
Single payer bitches!
Repubs are crowing about how Oregon voters voted down a constitutional amendment to raise the cigarette tax to fund kids’ health insurance. This doesn’t seem to be the best funding source. But as long as Republicans say these programs should benefit the poor, people won’t go along with a tax increase for that — poor people? Forget it. Any expansion of programs beyond the poor gets slammed as socialistic – usually with success. It’s a tough sell.
How to provide high-quality healthcare is no great mystery. There are studies of healthcare in the 30 or so most industrialized nations. The U.S. is at the top in cost per resident: twice the average and 50% above Switzerland, which is second. In terms of quality as messured by outcomes and health statistics, the U.S. ranks near the bottom. I’m told that all of the rest have more direct government involvement in the delivery of medical care, but the exact mechanisms vary from country to country.
The Commonwealth Fund publishes a lot of studies on such matters.
Good morning everyone. Hope everyone got lots of boxes yesterday. Today is box day, or something like that.
I did not post the entire article, justy a portion of it! I gave credit to the author and put in quotes his statements. I included my opinion in the post which was my own work. How about adressing the issues i raise instead of bullshit!
I think the oregon vote should be considered in light of the amount of money spent by the cigarette people to defeat the measure.
Ron Wyden D Oregon has an excellent health care proposal.
Good morning JamesJoyce. You might be surprised to find lots of folks here willing to listen, but without the yelling.
Boxing Day in GB, St Stephens in Republic of Ireland ;-)
Scarecrow,
I’m not yelling. I’m half blind and capital lock was on. It is not my fault that people just do not get it!!!!!!!!!!!!!!
A couple of quick comments:
1. The Republican base hates any health care reform. But Americans generally don’t. He’s been quiet about it so far, but if he secures the GOP nomination, Mitt Romney will suddenly be running on the “strength” of the Massachusetts program, as a “reformer with results” or some such nonsense. (I believe that this was the whole point of his support for the program from the very beginning.) The earlier the troubles with the program are recognized and publicized, the better. The irony is that the program recapitulates the essential error of the Hillary plan of the 90’s: trying to preserve a role for insurance. It then goes on to make a number of other errors (primary among them: letting businesses buy their way out of the mandate for $300 annually per worker) which are leading to the funding situation.
2. A comment on the accounting of health care costs for businesses. Actually, you didn’t make this error Scarecrow, but I’ve seen it enough places it’s worth keeping in mind. Often people will say, “GM pays X thousand dollars per worker, but Toyota pays nothing” for health care. This is not really right. One way or another, Toyota (or its workers) are paying the annual cost of health care (in taxes instead of insurance), and that’s getting priced into the car. The important point is that, on a per-capita basis, Toyota is paying X/2.
3. Preview works now! Sorry, I’m sure everyone else knows this already, but it was exciting to me.
Just watched Sicko with the family. I think we have some new converts for universal health care.
One aspect of the U.S. healthcare system that isn’t mentioned sufficiently often is that the U.S. already offers universal healthcare in the form of emergency rooms that take in everyone. A large fraction of emergency-room bills have to be written off by the provider. Ultimately the costs of providing that care are offset by some combination of state subsidies and higher prices to those who do pay.
True. it was a ton of money. i thought i posted a link about that — guess not. Oh well. I can always quote the whole article in a later comment.
I didn’t know Wyden at all until that recent FISA debate and he imnpressed me.
How large a fraction? I mean, a fraction of what?
If that’s universal health care, then I’m a Hottentot.
Important point about how the costs of health care eventually get reflected in the costs of products, one way or another. But I’m not sure the same cost gets reflected the same way. Why wouldn’t the structure of the tax system influence that?
Here is a link to the Wyden Heath Care Proposal
http://www.standtallforamerica…..are_reform
Also although the cigarette tax is not perfect –it is good pubic policy to use it to get people to stop smoking, The AMA makes the argument that the tax rate for cigarettes has lagged behind others and is the best incentive for people to stop smoking.
Maybe, if I could suggest, not accusing anyone of yelling, it puts the other on the defensive for what may be or not be actual yelling.
Instead, the request not to HEADLINE an entire comment would be more appropriate approach; last year one commenter had visual deficits that required communicating and that seemed acceptable then for them. HEADLINING isn’t personal.
Just a suggestion, All the best…….
Scarecrow,
I would like some help in getting this out. I have sent countless letters to editors, my elected officials, had my posts censored on Findlaw.com just to make facts availible. Obtain a listing of all public charities in your state. State AG should have a state public charities listing. You will get sick to your stomach. 501 c3 tax exempt status is being misused by these corporations to insulate themselves from change via tax code incentives and disincentives. Americans have been subsidizing these corporations for decades. Now the tax code is used against the citizen taxpayer insured?
Give me a beer………
OT. Just gag me:
The funding problem is going to be serious. People cannot see the benefit of taxes to support health care, because so many do not pay for health insurance themselves. It looks like supporting business to increase taxes to workers, because the benefits go to business, which won’t have to pay for insurance any more.
i think the situation in massachusetts is much more complicated than that.
yes – it is a massive subsidy for insurance companies…. but that was used as the carrot in negotiating new policies with the insurance co.s – and not just for those policies that are part of the system. i’ve told my story before – about how my insurance policy with bcbs changed this year – i now have a lower monthly fees and my policy now covers prescription medications (which for me are about $500/mo). so it’s not all horrible – and some people can get insurance that previously had none.
typical third way politics – instead of addressing needed fundamental change, let’s try to buy off the corporations by subsidizing a flawed market structure while attempting to make marginal improvements for some of the population.
….
overall, i don’t see how anyone thought the books would balance – my impression was that the state tried to get the best deals they could (within the constraints of the third way politics above) and worry about paying for it after it was implemented and a supportive constituency was built.
… i do have sympathy for the state policy makers – i just don’t see how any program can work at the state level, at least for states as small as MA (maybe CA could pull off a single payer system)…. and my hope is that by attempting to take some action (even if fundamentally flawed and unsustainable) these state actions will help get the country thinking about fundamental change – and provide a laboratory for what doesn’t work so we don’t make the same mistakes on the national level.
sadly, with what’s on offer now by our three top presidential candidates, i’m not very hopeful that the answers will come from any of them. but i’m grateful to edwards for getting the ball rolling.
Since when is the printed word considered yelling anyways. Seem a tad bit PC to me!!!
I don’t have the statistics, and of course it varies by neighborhood.
It’s universal in the sense that they are legally required to care for the anyone who shows up sufficiently ill. Among other things, it is horribly cruel and inefficient to wait until someone is mortally ill to treat them.
Nobody in their right mind would consider this a good system. All I’m saying is that (1) it exists, and (2) it is being paid for (by definition).
In detail, you are probably right; the prices may get reflected a little differently. But I assume that those are 2nd-order effects, i.e. if per capita spending is 50% as much in Japan, the cost captured in the vehicle might be 40% or 60% as much as the price in an American car. But in gross it is likely near the per-capita ratio; and it’s surely not near zero. (Again, just bringing up a point I’ve seen in many of these relative-health-care cost discussions, not yours!)
I need to understand the point about tax exemption better, because my views probably are not what you assume (since I never explain myself completely). So let’s start with the assumption that an HMO is tax exempt. If a care system, were state owned — e.g., the Veterans Hospitals — it would also be exempt. Or if the government paid for universal care, the administration of the payment and cost control systems would also be tax exempt as would any govt. agency. It would operate on a cost basis. So the fact that something is tax exempt doesn’t strike me as an inherent problem.
If, on the other hand, your point is that the HMO really doesn’t operate on a cost basis, whereas the VA does, then I’d need to know more about that. And to help me, I need it in bite-size chunks.
“Sadly, with what’s on offer now by our three top presidential candidates, i’m not very hopeful that the answers will come from any of them. but i’m grateful to edwards for getting the ball rolling.”
Selise you are correct on this one, however:
“…and provide a laboratory for what doesn’t work so we don’t make the same mistakes on the national level.”
Great experiment……….. at my expense!!!
OK, just one question, given your comment at 15: how many exclamation points do you use when you yell?
All hmo’s are tax exempt! They are 501c3 in every state!
i don’t object to a cigaret tax – i object to health care being financed by it as i don’t like the institutional incentives it creates by making the whole system depend on people continuing to smoke.
I had a disagreement with an elderly woman in my water aerobics class the other day about universal health care. Several of us were talking about how badly this country needed it and this woman pipes up and says in a scathing voice, “Socialized medicine has been a total failure in every country where they have tried it. People are coming here from Canada all the time to get health care because they can’t get it in their country. They are crossing the border in droves.” I suggested mildly that maybe the people who were crossing the border in droves were actually Americans trying to get medications from Canada at reasonable prices. She went off on me. One of the other women abruptly asked her if she was on Medicare. She paused mid-tirade and said “Of course I am.” The other woman just shook her head and smiled. “Then you are already benefiting from ‘Socialized Medicine,’ Dear. Most of us here do. All we are asking is that the rest of the country get the same opportunity.” She stomped out of the pool in a total rage. This was the same woman who was bragging a few days earlier that her Medicare HMO paid her YMCA membership.
This is the kind of idiotic and narrow-minded thinking that we have to overcome. It is widespread, especially with people 65 years old and older who had employer paid health care their entire working lives and Medicare once they retired. They honestly can’t imagine what the fuss is all about. They also refuse to believe that insurance companies refuse to give insurance at any price to someone who is self-employed with a pre-existing medical condition like a heart attack or an expensive chronic disease like arthritis.
Mornin’ Children! There are a number of important points to remember when speaking of this issue. First is that health insurance companies are for-profit pimples on the ass of the healthcare system. Always beware of programs that purport to provide Universal Health INSURANCE. That’s just a fancy way of saying that we’re going to vastly increase pouring our healthcare dollars into the pockets of the scam artists who run insurance companies so that they can continue to skim 25% to 35% off the top for their shareholders. We absolutely need a better healthcare system in this country for everyone, but we’re not going to get it by assuming that the for-profit insurance industry has a right to any of out healthcare dollars. The government can provide direct payment to healthcare professionals for much less cost to the taxpayer, while at the same removing the profit-driven motive for driving up healthcare costs while providing less care. And that’s NOT “Socialized Medicine”, because all that’s happening is the government is paying your healthcare bills, it is not taking over and owning healthcare facilities and businesses.
Great story! Thanks for sharing it.
all i can say is that it’s better than making the same mistakes at the national level.
of course, none of this justifies making stupid mistakes anywhere.
and
Not my doing. Just trying to change a convention, that’s all. Maybe to one a little more civilized to keep conversations going at a lower level of emotion.
This is the AMA argument for the use of cigarette tax for SCHIP
http://www.ama-assn.org/ama/pu…..17693.html
I kind of understand what you are saying but I like the symetry of the two public policies working together…
:)
In addition to state-by-state experiments, we have the benefit of a few dozen industrialized nations, all of which have more efficient systems than ours (in cost per citizen per year).
Yes Wigwam, A dear friend of mine is married to an Austrian. They have had all three children born in Austria. He stated, “In Austria healthcare is about people and getting people healthy, not money!”
yeah – me too.
but in the end, taxes aren’t just about making us feel good. they are, i think, about 1) revenue for gov. spending and 2) creating/modifying incentives 3) redistribution in order to maintain a strong middle class (and maybe more that i haven’t considered).
in the long run #2 is really, really important.
Good Morning Scarecrow!
as Lou Costello says “caw CAW!!!“
Thanks for having the guts to tell it like it is
And especially for helping to get others to reevaluate their stale thinking on this mess.
(sorry to be late for class, was too merry yesterday :)
Krugman has pointed out repeatedly that our current scheme of multiple private for-profit payers will never work well, since the payers compete economically by minimizing their expenditures, i.e., by denying coverage to those most in need of it. That simply cannot work in the sense of achieving the societal objective of seeing that everyone is cared for.
Per this chart http://www.infoplease.com/ipa/A0934556.html Austria spend about half as much per citizen for their universal health care.
Scarecrow, for example of Tax exempt health entities w/ tax exempt status:
Blue Cross Blue Shield
Harvard Community Health Plan
Tufts Health Plan
Fallon Health Care
Kaiser Healtcare
All Hospitals
Countless Providers
These organizations pay no property taxes, no excise taxes , no corporate income taxes. When have the American people been told this???
silly me.. your comment just made me realize – we’re going to have the examples of:
1) successful programs in other industrialized countries
2) failed programs tried by our states to address our overal national failure.
3) medicare, which seems to be a pretty good program (although it should get more funding and the prescription drug program is just stupidly designed).
when are we gonna learn?
I feel like the blind guys describing parts of the elephant. I’m urging Ian to give us a seminar on how to think about these issues.
Thank you, Wigwam! My point exactly! Even with rules limiting their ability to deny coverage to prevent this avenue to profit driven competition, the healthcare insurance corporations would still be making a guaranteed profit in return for NO useful contribution that the Gov’t couldn’t provide better and cheaper!
Krugman has been absolutely excellent on that point.
I think that health insurance is one of his favorite topics, because it so clearly refutes Reganomics. The “miracle of the marketplace” simply doesn’t work there, nor can it.
Pretty depressing stats. Could it be that tax exempt status does not exist within these countries for health care organizations? Do these countries have a mechanism to to control costs??
even if the insurance co, hmo, hospital, etc is not for-profit… the same problems exist unless members really do control management (as, i think, JamesJoyce is trying to point out).
now-a-days too many non-profits and for-profit co.s alike are being run for the benefit of their CEOs (and other top executives and board of directors) and not shareholders, and certainly not customers, employees or the communities where they operate.
digg this post because we need to get the healthcare discussion going in the right direction.
Thank You Selise,
You nailed it!
Would Americans mind paying taxes if they had good health care? Only a good advertising campaign could begin to change their mind. I heard a right winger howling about Dems raising taxes…but what if it bought them good care.
I haven’t seen proposals for how to solve the accountability problem. I certainly don’t see the VA as model for that. Good examples?
JamesJoyce, I think you are confusing a lot of different issues here. Some HMOs are 501(c)3, and others are not.
Here’s a link to a writeup of a 2003 tenth circuit court of appeals case where an HMO, that describes how a provider tried and failed to meet the various standards that would gain them that status.
There is no blanket “every hospital, every HMO” is a tax-exempt charity. Confusing matters even more, some HMOs (like many for-profit businesses) have set up foundations that are tax exempt, while other elements of the organization remain fully taxable. (Whatever the accountants figure that out to be.)
I have a suggestion!
By reducing the per capita cost of energy in America via a comprehinsive energy policy designed on reason, we could “earmark” those vast fortunes leaving America, to reduce healthcare costs!!!!!
Preview is my friend . . .
That should read: “Here’s a link to a writeup of a 2003 tenth circuit court of appeals case that describes how an HMO tried and failed to meet the various standards that would gain them that status.”
Link above.
The Point is, “us Right Wingers” don’t want the government “providing good care”. We’ll do that for ourselves…we want taxes lower and the government off our backs.
I understand, but lets use the tax code on them to effect desired change for the benfit of the citizens of our country by controlling cost with tax incentives and disincentives. Government uses the tax code on US all the time!!!!
“We’ll do that for ourselves…we want taxes lower and the government off our backs.”
One certainly hopes this is not a flexible ethic.
Ok. Gotcha. I thought maybe you were saying that was enough.
LL you do listen to that junk! Arguments to drive a truck through. Provide it yourself? Even the insured cant get care. I cant get my head around making a profit from sick people, no matter who the are. White or black or brown.
Obtain Public charities listing from respective state AG’s Public charities divisions. You will vomit! Sad that it needs to be litigated when the IRS makes the determination, yet fails to enforce their own rules when dealing with tax exempts in the health service industry!
Do you consider this woman a friend? I need to know. I don’t want to call your friend a knucklehead. That would be rude.
From what I’ve read, there is a wide variety of structures in these other industrialized nations. In some, doctors are state employees. In others there are a mixture of public and private providers.
The question of exactly where the money goes in our system is quite complex. I recommend this Health Affairs paper “It’s The Prices, Stupid: Why The United States Is So Different From Other Countries” by Gerard Anderson of Johns Hopkins.
Good Morning all. Health Care is currently organized around controlling reimbursments. Insurors attempt to limit reimbursements (denials, rate reductions, increased out of pocket expenses) while providers try to increase them (aggregation for contracting, unbundled billing, billing key services as non participating provider/facility). No “reform” proposal that does not address the decades of reorganization into vertical delivery systems to control contracting and lock well insured populations into a single delivery system of service is no reform at all. Ironically the only way I can see to create a truely competetive and value driven system of health care is to have a single payer system with inducements to break up these big multispecialty chains that are currently controlled by business interests with an eye to maximizing reimbursements in the death struggle with insurance companies.
Please know that Medicare has been underfunded for so long that, as a Medicare provider, the idea of a national medicare solution is a huge turn off. Lets say that by creating a national single payer system we save medicare rather than emulate it.
I work and have a decent policy through my employer. A lot of others should learn to do the same.
The free-market capitalists in the US have spent the last 50 years teaching Americans that Socialism and taxes are the greatest evil there is. By now it’s a mindless belief — look at Maretta’s acquaintance who is denouncing the evils of socialized medicine while she is benefiting hugely from it.
If progressives are to bring the health care system in the US to sanity, we have to change the narrative. Do not try to change that ingrained belief system; we don’t have time or the power to do so. What we need to do is play on the fact that relying on the private health insurance industry for basic care is making US business uncompetitive in the Global Economy.
Call it “Basic Health Care”. Attach it to Medicare. Call it “tax relief for American Business”. Talk about how funding it will reduce the burden on small businesses, who have been so hard-hit by health insurance premium increases, whereas now they’ll only pay a small fixed fee per employee to support the program.
Remind the big corporations of how much they’re spending per employee for medical insurance. Cut that amount by half, and get them to pay into the basic health care system. They can buy their executives all the fancy high-priced supplemental insurance they want…in fact, I suspect that the insurance companies would come out ahead on that deal, too.
Change the frame. Talk about corporate bottom lines.
If a Republican is predisent it will be a give-away more than a battle.
me neither… was just trying to say that i don’t think non-profits are the answer.
… and isn’t this a symptom of a much wider problem in corporate governance – not just limited to the health care industry?
in germany and france, i think, some largish (1/3 to 1/2?) of the board of directors must represent employees. don’t know if there is community representation also…. but maybe some way of getting all stakeholders represented on the corporate boards?
i really don’t know, but do think it’s a problem … and maybe there are somethings that can be done. like your idea of looking for models (why reinvent the wheel?), i just haven’t done it.
knucklehead is as knucklehead does.
I see it exactly the opposite. I see the healthcare as the battering-ram issue to bring this whole mythology of Reaganomic crashing down.
Lotta people work and don’t get good policies or any policies or work almost full-time (even at multiple jobs) but not enough hours to get bennies. No solution, in my view. And as health care costs continue to skyrocket it becomes another excuse to stiff you outta that raise. And to ask you to contribute more.
thank you. looks like a great link for future reading.
And we have to stop overusing “narrative, meme, kabuki. . .”
good points– remember that providers are controlled by the business executive of their IPO/ HMO all the time. Consumers are controlled in their choice of provider, their choice of facility etc by costs associated with netork or insurance decided by employer.
until you have a health crisis that prevents you from working. which prevents you from getting that excellent health insurance.
My employer stiffs us all out of raises…the IT industry is terribly competitive. But I’ve been doing it for 35 years. Fact is, that anyone can get a job with health insurance. It may require a move or something unpleasant, but that’s what freedom is about–the ability to get what you want and make choices.
Blue Cross Blue Shield used to be all tax exempt. In many States it no longer is.
If providers are “tax exempt” – how does that happen? Nobody told me about that! I pay my taxes!
……………………
As for raising taxes to pay for universal health care, call it “premiums.” People seem to understand the need to pay for “insurance,” so explain any increase as “health insurance.” But have the govt do that, like Medicare.
Yes, many people have wrong-headed ideas. Even using Medicare, they continue to have them.
We can do this! And we must do this. In yesterday’s NY Times there was an article in the business section about a woman who has degrees in both theology and law. While many will not be swayed by her views, she has an interesting angle and we should join in her cause. She has written that many states (and the feds, I’m guessing too) “violate biblical law” in burdening the poor with high taxes and providing them with fewer services. The article was on taxation and spiritual values. And I do agree that people who care about other humans want them to have healthcare, among other things, and would see that as a moral good. (in her work she has literally listed the states that violate biblical principles the worst… and the one, MN, that most closely adhere to them)
Here’s the url: http://www.nytimes.com/2007/12…..25tax.html
We need to grab hold of anyone who “gets” that we all need to work together as a society. That the rich need to help the poor (using any and all logics toward that end!). And this, of course, includes healthcare.
I urge you to take a look at the article. Because if people are fundamentalists, you need to use those arguments. If they’re Buddhists, use an “all life is sacred argument.” And so on! (and for the sociopaths, use a stick!)
That has very nearly happened to me. We do have a short and long term employer provided disability program to supplement the government programs.
That too. And also, the coverage may be good for what’s out there but that may still leave alot of stuff uncovered.
yes indeed. a problem that is at least as big as the problem of health care in this country. *g*
Of course, a lot of other have. But, that option is not open to everyone.
I totally agree with your comments. “change the narrative.”
And, I might add, the narrative needs to adjust to whatever your hearers value most. Persuasion does not need to be the same for all groups. It’s best to “change the narrative” to suit your audience. That does not mean you lie. You just use their lingo, their mind-set.
That is a fantasy.
unless you opt out. I’m out of all networks. Yes, that means less work. But it also means less intrusion. And I have a catastrophic policy only, but it gives me the freedom to see any provider.
You don’t have to work within the system if the system works against you. I urge more providers to opt out. Take the financial hit… but don’t go along with the current system!
Or a pre-existing condition that keeps you in a job you hate. Or those that are self-employed. This Neil Bortz argument that those without insurance are lazy and stupid isnt worth the fight.
A healthy nation would spend so much less on care for the uninsured.
Strangely, the Reaganomics narrative is so deeply embedded that if the wording on workers pay stub were changed from “health insurance deduction” to “health tax deduction” and the amount deducted were cut in half for the same care, they’d object that the government was screwing them.
Oops, I forgot to be serious!
Exactly. The cost of care to you reflects the unpaid medical bills that the provider had to write off.
You say:
1. You need to ask whether a “battering ram” method is productive and what exactly do you mean by that?
2. Who is going to do this battering? If you could organize a big enough block of people to use such a method, then why choose that method?
3. Personally, in a civil society, I think the “change the narrative” method is a better strategy than a “revolutionary” type of message.
Yes, there are problems with adequate funding and reimbursement for medicare services. Important to remember that the problem comes from the profit driven competition of the health insurance corporations driving up the costs of delivering healthcare, Not the Medicare system itself. Eliminate the insurance companies grasp on healthcare profit and your costs will cease rising so rapidly. Damn near everything that’s wrong with our healthcare delivery and payment system is directly attributable to those insurance companies. Medicare’s major problem is the system allows Republican free marketers to fiddle with the funding and reimbursement regulations in an effort to cause it to fail.
Only partly. Far more, the costs reflect the high salaries and corporate profits of the insurance industry.
You can’t please everyone. That’s for sure. But you persuade those you can persuade and tell the others they can opt out if they prefer.
Medicare. You can opt out. So let them opt out if they don’t like it. You’ll see how soon they change their mind, regardless of what the language is.
I don’t have that response @ 83. But you’re right. It’s not a “fact” and even if it were people have pointed out why that’s not enough – assuming the person gets coverage at all. And you can lose it.
As I see it, it’s not just corporate governance. If you replace the insurance industry with a govt agency, you have to solve the same problems, but under a different incentive system, which may make it even harder. To over-simplify for a moment, we think of the insurance companies as having an incentive to deny claims, as a way to control costs, increase profits. But a govt health agency must also have incentives to control costs, on behalf of taxpayers. Which services should be provided? Which medications/treatments work? Which are most cost-effective. How do you build in the incentives to make wise decisions about these issues, while meeting the goal of providing quality care to all?
I deal with regulated monopolies that function as quasi-government entities — to keep your lights on — and creating the right incentives for them to do their jobs efficiently, but reliably, is a real challenge.
Healthcare needs to be viewed like education. It is a necessity. It is a social good. We don’t ask people to pay for education “insurance.” We just set up schools and people pay taxes for that.
Call it what you will, but tie healthcare to things like education, fire depts, roads, and other infrastructure types of things that we all use and count on.
wigwam — thanks for that link. I’ll check out the article.
But better govt making such decisions, where at least citizens have input, than insurers, where they are looking out for shareholders, not the patients who need the care.
Of course in a society we will have to limit some things. We don’t all get garbage collection daily. Mail comes once a day, not twice. And so forth. We need to adjust our sights as a society and not expect the moon!
Know where you can get alot of studies, analyses and crunched numbers on health care issues? Kaiser Family Foundation website. I found it helpful during the SCHIP debate.
Your sins are forgiven.
Nobody ever promised us “easy”. Of course it’s complicated, if it wasn’t, everybody would be doing it! Oh, right, they are! Other nations have their governments handle the complications, some better, and some worse. But I’d rather have my government, through my elected officials whom I can complain to, dealing with my healthcare than an insurance company whose only interest in me is how much profit they can make off my illness.
Great mindz think alike!
That is an excellent story. We can learn from it. I hope your group continues to work on this person, maybe we can get a vote from her eventually.
all good points. and, frankly, one of the reasons i am not a big fan of any of the main plans on offer – i just don’t think we currently have the gov. (or other) institutional structures in place to get good policy/regulation. but maybe we need to implement one of the plans in order to create the motivation for institutional change.
and while i was addressing only one small bit of the picture, i don’t even know that it would help…. do you think the regulation in electricity industry is significantly affected by lobbying, etc of corporations in the industry? would creating rational regulation be made easier (or harder) by changed in corporate governance?
i have way too many questions without answers, and i’m sure to be missing many of the most important questions…
As a person ages, they become ever more a liability to their insurer, who of course hopes they die soon. I’m not saying that denial of care ever occurs with that in mind, but the early death of a liability has a positive impact on the bottom line. I’m just sayin.
Blue Texan has the next thread ready. You didn’t buy enough stuff.
One of the intriguing fact about our method of providing health care is that much of it is a huge cottage industry, with one, two, or three partners per practice. But the paperwork has become so extensive that each practice needs about three office staff per physician. That doesn’t seem very efficient.
So, if you had any gumption, or “the right stuff” to pass your genes, you would hop over to some profession that isn’t a dime a dozen so you don’t get stiffed by your employer? Is your theme that natural selection will continue to improve the human race if social welfare schemes don’t intervent, or that God rewards to protestant work ethic? I mean, you seem to think we had progressed too far in terms of promoting the general welfare and need to work our way back to the beginning of the industrial revolution or some earlier time.
’snot efficient. Big problem.
There is tremendous lobbying by the electric industry — from both vertically integrated utilities (think, Southern Company, which serves lots of people in several southern states) and from independent generation companies, who own power plants all over. In addition, large industrial customers lobby heavily in both Congress and the FERC, as do municipal utilities and their association.
The utilities want FERC to stay out of how they run their systems; the independents want the utilities to open up their systems; the large customer groups want the systems to give them cheap power, and pass costs to smaller consumers. State regulators are in the act, confusing everything. Municipal utilities want to avoid being regulated by FERC, but they want the national government to force the investor-owned utilities to given them access to their transmission, but shift costs elsewhere. Small consumers are barely represented, as usual, and don’t understand how the system works. It’s a mess. Now for the really bad news . . .
Reference please.
Can you identify the states where BCBS is no longer Tax exempt?
Health insurance is and was a benefit to attract qualified worker for employers. There is no law requiring that employers provide healthcare benifits in my state until the Legislature……….. “mandated it.”
There’s a logical fallacy at work here: Even if it were true that “anyone can,” it would not follow that “everyone can, simultaneously.” It is a fact that millions of companies do/can not afford to offer, and so their employees do not have, health insurance.
And then we have Toshiba, which wants to install a nuclear reactor per apartment building: http://www.nextenergynews.com/…..2.17b.html
Sheeeeeet! Thanks for the thought on that one, what do the kids say “I don’t think so”.
We should just all live in glowing yellow submarines.
Now that is one way to reduce the overall cost of energy, until the product liability suits line up………….
My Theme is that individuals acting with their God-given abilities can do more than any government can.
Check your local employment ads. In my city in FL, many advertisements for paid health insurance.
But what if God didn’t give me any abilities?
I believe that the Creator has given even Liberals some abilities, Elliott. I know it’s hard to find sometimes.
And that’s exactly how the government created the Internet.
Ummm, I think it had a lot more to do with the Bill Gates, and Googles of the world than Algore ever did. Arpanet had the original internal network, but it looked nothing like the network topology of the internet.
I’ll double check with Pat Robertson, but I think it means you’re evil and damned to hell twice over.
I live in an urban area in Fl and salaries and benefits suck.
Gotcha. The Ur and the other Mesopotamian civilizations sorta messed up the garden with production and storage of surplus grain. It’s all been downhill since.
Two quick ways to fix the mess and cover ALL Americans (with a French-style system preferably): First, cut the military down to “Peace Dividend” size – I was part of that original, VERY short-lived, Peace Dividend reduction of military forces. I was RIF’d (Reduction in Force) after Gulf War Episode I and the Berlin Wall went bye-bye. I expected that dividend that was all the talk at the time, but it never really came did it? Excuses were sought (or generated from thin air) as to why military reductions just wouldn’t do. It hurts the defense industry too much and one can’t have that. Now our military spending is 30% higher than it was during Ronald Raygun’s term in office! WTF!? All to deal with poor, raggedy bands of criminals in the sands of the ME? Sheesh! Second, you remove for-profit health insurance from the national healthcare system. A central, universal healthcare system has NO ROOM for for-profit insurance. All they are about is maximizing shareholder value and CEO perks, which means lots of denied drugs, treatments, operations, doctor restrictions, etc. Unacceptable. It must go.
Between those two actions you would be able to provide truly world-class healthcare to all Americans, probably with money left over to invest in education, clean energy, etc.
Libertylee,
Any “trusts” enable your liberty? Come work with me for a day and see if you survive the experience. Liberty is a great concept, if your not a indentured servant and/or have a silver spoon affixed to your mouth at birth, like the shrub…….
An acquaintance in Wisconsin send me occasional e-mails regarding efforts in his state addressing universal health care and campaign reform. Any analysts care to take at look . . . at any of these sites/newsletters?
http://www.ThrowTheRascalsOut.org
http://www.WiCleanElections.org
http://www.BusinessCoalition.net
http://MoneyedPoliticians.net
Apparently the newbies need better hand-holding.
I confess I don’t know a lot about them, but I thought they were like corporations or limited partnerships.
Hmmm.
So, just how would one describe their organization and relationship to health care providers and and other health care industry businesses (pharmaceuticals, equipment manufacturers, etc.)?
Then they obviously wouldn’t mind a federal law which forbids denying care to someone with a pre-existing condition.
I wonder if it will be possible to move CHIPS into a new state-run health care plan such as Edwards suggests. Running everything from the federal level could be a huge headache.
If we’re going to have several government plans and some will be aimed at low-income people, then CHIPS would obviously be a fundamental part. Simply moving it into the new system would avoid causing anyone to lose coverage and it would keep the administration employees working throughout.
I’m guessing whomever is made the first administrator of this new program is going to have to have a good bit of leeway in setting it up — state by state with coordination from the federal HQ.
Who would be good to run such a program? To get it off the ground?
I think that the Edwards plan, which leaves our current health care system in place, wouldn’t have to raise taxes as much as they fear. If you’re going to cover everyone, then the only question is what kind of basic plan can you offer and what would it cost. There is where you’ll find the Devil in the details.
Secondly, if this idea works it will hold down costs throughout the whole health care system by providing competition which the market lacks (to some degree) now.
Of course, it shouldn’t be ignored that by providing a better health care system it should be possible to cut back on a lot of unnecessary care, tests, paperwork, etc. and that will cut costs. How much nobody yet knows.
It would be nice if we could ease into this thing with a couple of states here and then a couple there. Given a bit of feedback we could get the rough edges worked off before shipping this product nationwide.
There are probably also a lot of people in each state who are working in this area and would need to be moved into the new system (as I suggested with CHIPS in another post). It’s gonna be a big move and we shouldn’t rush it.
Are you calling for the elimination of the military or the police or the FBI or the FTC or the OTHER “care” agencies? If so, then you’re in the trivial minority.
If we could see the free market system working for health care, then maybe there wouldn’t be any sense of necessity. But, look, even small city governments like where I live are near bankruptcy. It’s a disaster we have to face now.
Even as things stand it’s going to take a while for this to be fully implemented.
Oh fantastic! When are you going to solve the Iraq and Al Qaeda problems for us then?
Ummm, I think you don’t know what you’re talking about.
Gates & Google had NOTHING to do with it.
Al Gore sponsored legislation to open it up to the public. That was a nice step forward.
Gates’ Windows operating system just opens it up further for all the hackers of the world.
Google helps everybody find things, except for where the governments of this world say “NO”, then they close it down.
The first browser (Mosaic I think) was a freebie invented by a scientist geek and given to the world for free!
The first search engines came long before Google.
TheraP: I understand the argument to opt out of networks. But then one is only serving a small subset of the population (those who can afford cash payments) and then you too are part of a system that is organized around reimbursements as opposed to being organized to be of service.
I have read your comments w pleasure. Are you a PT?