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  • #2204923

    In regards to medical care, what would happen if. . . . .

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    by maxwell edison ·

    ….. the Magic Santa snapped his fingers and made all “comprehensive” insurance coverage (see note) just vanish from the face of the earth (or for the sake of this question, from the USA), and all medical insurance sold was for catastrophic coverage only (acknowledging that catastrophic coverage will have to be defined), while the every-day, run-of-the-mill medical care was paid for out-of-pocket by the consumer (anything from normal check-ups, to cuts and scrapes, to broken arms); and the premiums previously paid for by one’s employer (or one’s own self) suddenly became income for the employee – but it was tax-free income to be placed in a medical savings/spending account, which could be carried-over from year to year, out of which the aforementioned every-day, run-of-the-mill medical care and catastrophic insurance coverage could be paid for; and, for those folks who required catastrophic medical care, but who either could not or would not buy catastrophic-only medical insurance – or who could not even afford every-day, run-of-the-mill medical care – could apply for “medical financial aid” (similar to college financial aid) – the funding for which is a side-issue – and be evaluated as to their ability to pay, perhaps being granted the aid, or perhaps being denied aid because they have the means (either present or future) to pay for the medical care received (again, similar to college financial aid); and, there was legislation passed for significant tort reform so that the competent medical providers did not have to pay exorbitant fees for malpractice insurance, and/or exorbitant settlements, and/or not be forced to provide what might be called “CYA” care; and, considering all the aforementioned conditions, the medical providers in question were free to set their own rates, not being dictated to by third-party payers, and the consumer could choose to either pay such rates or not, perhaps shopping around for better price and/or value?

    Note: Comprehensive medical insurance coverage is defined as that which will pay for ALL medical care delivered (minus deductibles, co-pays, etc.), regardless of what it might be, or regardless of how large or small, or regardless from whom or what it’s received – usually paid for by a third-party payer, either an insurance company or the government.

    “Medical financial aid”, as a side-issue: How might it be funded and/or administered? (Keeping it similar to college financial aid, the only difference, perhaps, is that it might be – indeed, probably would be – applied for after the fact instead of before, but not necessarily always being the case.)

    Define “catastrophic coverage”, in regards to both delivery and insurance coverage.

    Considering that question (or questions), what might happen to the cost, the affordability, and the availability of medical care for most, if not all Americans, if the consumer and medical providers were the decision makers, per se, instead of the insurance industry and/or some other third-party payer?

    (I think that might be the longest question I’ve ever written!)

    Edited only for the following:

    Merry Christmas to all my TR peers!

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    • #2834045

      Well, Max

      by nicknielsen ·

      In reply to In regards to medical care, what would happen if. . . . .

      When you ask a question, you really ask a question.

      Definitions aside, I think it would work if given a chance. At first glance, the only people who come out on the short end are the insurance companies and their CEOs. But that’s only my first glance. I’ll have to take some time with a more in-depth answer.

      • #2834039

        Nick – at “first glance”, I would agree with you.

        by maxwell edison ·

        In reply to Well, Max

        Moreover, do you think it’s a good start to presenting a viable alternative to what’s being debated in Congress today?

        The premise being this: the consumer and/or the individual, and/or the free-market system is the better facilitator of providing medical care than any government controlled – or insurance controlled – system? (And a government, by the way, is one being controlled be either political party.)

        • #2822835

          The tough question is the gray area

          by theprofessordan ·

          In reply to Nick – at “first glance”, I would agree with you.

          If I comprehend your post correctly, what you are saying is that maybe what we should have is insurance that only covers catastrophic events. If that is what you are saying, I do agree that people do abuse their coverage. As much as I hate paying them, the co-pays do work as a deterrent from those people that go to the doctor because their toe hurts or because they need pain pills. The issue is how do you deal with preventative medicine things like mammograms and prostate checks? It has been proven that there are many steps that can be taken to prevent medical issues like colon and breast cancer. Or how do you deal with people that need to have things monitored? My wife has a blood condition that requires her to see a doctor to be monitored or she could potentially throw a blood clot that could kill her.

        • #2822794

          See my post below

          by nicknielsen ·

          In reply to The tough question is the gray area

          for what could/could not be covered.

          http://techrepublic.com.com/5208-6230-0.html?forumID=102&threadID=323209&messageID=3219141&tag=content;leftCol

          The advantage to having everybody pay for preventive tests such as mammograms, cervical smears, or PSA tests, is that the prices can probably be set lower since there will no longer be those who don’t pay. The disadvantage, of course, is that some preventive tests (colonoscopy, for example) cost a good bit more than others.

      • #2834034

        P.S. ” . . . .the only people who come out on the short end. . . . “

        by maxwell edison ·

        In reply to Well, Max

        “….. are the insurance companies and their CEOs”…..

        ….. AND the government know-it-all nannies who want to ride roughshod over both our lives and the whole system.

        Agree or disagree?

        • #2822832

          I agree

          by theprofessordan ·

          In reply to P.S. ” . . . .the only people who come out on the short end. . . . “

          I think that the center of all of the public frustration is that we have watched the government screw up over and over and we don’t want to watch it anymore. I find it amazing that there has been such a public outcry against healthcare reform and our “representatives” are doing it anyways. I read somewhere that this will probably cost Harry Reid his seat and I feel that it should. Your constituents told you no. Do they really think that this would go unnoticed? The sad part is that the senators and members of the house that lose their seats will be put up as Martyrs instead of the piles of crap that they are.

    • #2834026

      It’s late, I’m wiped, and I will read this more carefully in the morning

      by tig2 ·

      In reply to In regards to medical care, what would happen if. . . . .

      But I am currently living with the failure of this country to comprehend that solving the medical insurance issue is significantly deeper than legislating pie in the sky solutions- like the ones we were given by the Senate for Christmas.

      I live with someone whose care will completely destroy every dime he has saved and invested for over 30 years. What are the choices? Well, after he is destitute, we might be able to get some support- but we have to be homeless and cash out every dime we own first. Even then, the support we MIGHT be able to get will be based on his ability to live for a set period of time after receiving care. Lovely system.

      Here’s the thing- the problem wouldn’t have reached a crisis point if tort reform as regards medical care had only been addressed long ago. It wasn’t and the “Medical Reform” ca-ca doesn’t bother to address that.

      I am not saying that someone legitimately injured as a result of faulty medical care shouldn’t have the ability to be compensated. But while we have that ability today, I am forced into a system where, if I am not a complete b*tch most of the time, my partner stands the VERY good chance of being irreparably harmed. I am CONSTANTLY told BY OUR HEALTH CARE PROVIDERS that we have no choice but to be our own advocates.

      It sucks when you have to tightly question a doc to ascertain if what he is practicing is medicine or DEFENSIVE medicine- often not covered, even poorly, by insurance. I want the best possible care for my loved one but I am swiftly developing more current knowledge in the area of his disease than the specialists. Frankly, had I not insisted on discontinuing one med and reducing another by half, he’d be dead and malpractice would not have been an option because “best practices” were being followed.

      Max, as usual, you field no easy questions. That I have a high level of emotion regarding this one is a given. But the current system is seriously flawed and the crap they are beating to death on the House and Senate floors will NOT remotely solve it. Realistic expectations would go a whole lot further.

      • #2822788

        If you’re sure about that

        by delbertpgh ·

        In reply to It’s late, I’m wiped, and I will read this more carefully in the morning

        If you’re positive he will be wiped out financially by medical bills, and will then proceed to Medicaid, there’s a way or two to shelter some of that money.

        Medicaid allows you to keep your house and your car (on the grounds it would be unfair to throw you out of your home, and you need a car to get a job, if you are ever to work again.) Assuming he has a mortgage and/or a car loan, he could pay off a bunch of the principal. He can also pay down credit cards. If you pay off debt and go broke, it’s better than paying doctor bills and going broke, because you have a better balance sheet at the end.

        If you’re down to choosing between crummy outcomes, it may be reasonable. Good luck.

    • #2823045

      Cable TV Model

      by thechas ·

      In reply to In regards to medical care, what would happen if. . . . .

      Max,

      Merry Christmas and best wishes for a great New Year.

      Aside from not being able to conceive that some of your postulates could ever happen, I think a deregulated medical industry would soon devolve to the cable TV model.

      That is, some company would move in and consolidate all of the medical services in an area get control of key medical resources and set some pretty high prices. In order to assure a revenue stream, they would likely set up some sort of subscription model where subscribers pay a monthly fee and get reduced charges for services.

      Still, all in all the overall cost for health care would rise for all.

      True, those who had no need to use the health care system would see the value of their HSA rise. But, what would happen to that money if they never used it?

      Finally, what happens to the people who show up in the hospital ER with no coverage and no means of paying?

      Would you allow hospitals and health care providers to deny treatment to an accident or crime victim who could not pay?

      How about someone suffering a heart attack or other life critical health event who had no coverage or means to pay when they are wheeled into the ER?

      I think the number that has been thrown about is that around 40% of workers in the US have no employer sponsored health coverage. Unless they qualified for your aid grants, they would have no source of additional income to fund their HSA accounts.

      Do I think our present system or the health care reform legislation making it’s way through Congress is a perfect or even the best solution? No in either case.

      One thing missing from your proposal is meaningful limitations on mergers and consolidation of services. Unless there is significant competition in all areas of health care the cost will rise dramatically for services.

      Even under the present system, you have situations where if a doctor is not part of a specific group he cannot treat his patients if they are in that groups hospital. If a company were to control all or even just the for profit hospitals in an area that would all but eliminate the concept of an independent physician.

      It would also be interesting to see how this would work for the people who strive to spend down any benefit provided. What new health care options would be created so that people who want to spend down their HSA each year would be able to?

      There is no perfect health care system. What works best for you is apt to be very different from what would work best for me or even more so my extended family.

      Looking just 1 layer deep in my extended family, only 3 out of 15 working age people would benefit from your plan versus the present system.

      Chas

      • #2823034

        Chas – Merry Christmas to you too

        by maxwell edison ·

        In reply to Cable TV Model

        I agree with you. The chances of anything I outlined seeing the light of reality lies somewhere between slim and none – and as the saying goes, Slim is hurriedly packing his bags, as we speak, to leave town. There are simply too many people (politicians) who have worked too long and hard to gain control over the population and the medical care system, and too many others (voters) who have willingly given it to them. The trend is not likely to reverse any time soon.

        However, the premise of my plan (I suppose you could call it a plan) is two-fold. First of all, if I had to name the one thing that’s contributed the most to all the current problems we see accessing and affording medical care, it would be that some third-party has been empowered to pay for its delivery – whether that third-party be insurance companies or government. If a third-party is empowered and/or obligated to pay for anything, then the only direction for costs to go is up, and the only direction for quality and access to go is down. I believe the history of our medical care system has shown this to be true.

        The second thing is that it might force the medical care consumer to become more price conscious and price savvy. If we all had to pay for the smaller stuff out of our own pockets, we’d be less inclined to run to the doctor’s office (or emergency room, in many cases) for every little thing, which only places a burden on the whole system. Moreover, it would generate price competition in the industry. The way it is now, the collusion between insurance companies actually sets the prices that can be charged. Sure, some doctors and clinics might try to initially charge prices higher than the previous limit, but that new savvy consumer wouldn’t be so quick to be a paying customer. I believe the result would be fewer people using the over-all system. Just look at your GP’s office. It’s most likely overflowing with people who otherwise wouldn’t be there if they had to pay for some minor aches or pains out-of-pocket instead of not caring what their insurance company is billed. (Okay, Mr. Jones, go home and take two aspirin every 8 hours. That will be $100, please.) Doctors would have to sell all those empty chairs in order to make a profit. They’d be clamoring and competing for the customer.

        As to legitimate emergency room care, I wouldn’t propose, as you suggested I did, [i]that hospitals turn away accident or crime victims who could not pay, or someone suffering a heart attack or other life critical health event who had no coverage or means to pay when they are wheeled into the ER.[/i] I’m not suggesting that at all. To the contrary, I’m not opposed to the current laws placing a mandate that such emergencies be treated. Treat them first and consider payment options later is something that’s fine with me. If, after the fact, the emergency patient is either unable to pay the bill and/or has not purchased the catastrophic insurance coverage, then request for payment goes to some sort of medical financial aid organization for consideration. (And as I said, the details and funding for such a thing is a side-issue.) That organization will pay the medical bill, but whether or not it should be repaid would be a matter for further consideration.

        Have you ever applied for college financial aid for your kids? Regardless of the college in question or the amount of aid being sought, you have to submit all your personal financial information to a sort of clearinghouse, who then determines whether or not financial aid is warranted, and if so, how much. In theory, it could work in a similar way, but just after the fact instead of before. An engineer making 100k per year, for example, who ran himself into a tree while skiing in Aspen, and chose to not buy catastrophic insurance might have to repay the costs over a set amount of time. A single-mom waitress with three kids making only 30k who took a nasty tumble on the ice might be awarded full aid, not having to ever repay. Such a system could cover those who truly cannot afford catastrophic insurance, and it would be motivation for those who can afford it to actually buy it. I’d also concede that such a medical financial aid system would have to have the force of law behind it. That engineer WILL pay that money back – with interest.

        I further believe that most doctors and medical delivery people are good, honest, caring, and compassionate people – in fact, I know it to be true. I think doctors would treat some people for free, and that free clinics would pop up in poorer neighborhoods. Why do you think many hospitals are called St. Something? Because they were initially created – and funded – by charitable religious organizations. St. Jude’s never has, nor will it ever, turn away a needy child. There are such facilities in nearly every major city. I don’t consider medical providers in this country greedy bastards, but rather caring and compassionate people. I personally know of doctors and nurses who volunteer their time for charitable causes. I want a system that will allow them to do it instead of one that forces everyone into an already flawed insurance-run system.

        In my opinion, medical insurance companies (including government-run medical insurance) got us into this mess in the first place. As such, we need less of it, not more. If the collective consumer actually competed with the insurance companies – instead of being dictated to by them – I believe the cost of receiving medical care would plummet, and I believe access to care would open up to significantly more people.

        Our current national debt is 12 trillion dollars and climbing fast. Out-of-control entitlement systems, in my opinion, bear 100 percent of the blame. Social Security and Medicare will eventually collapse under the weight of their own obligations. Expanding entitlement systems will only make it worse and cause the collapse faster. As the saying goes, if we keep doing what we’ve been doing, we’ll keep getting what we’ve been getting. And it’s time we stop this insane third-party payer system.

        Contrary to what you’ve suggested, if we put more control, power, and responsibility onto the individual medical care consumer, in my opinion, we’d see lower prices, better care, more competition, and higher availability. And like you said, there is no perfect medical care system. What works for you may or may not work for another. As such, why are we trying to put all people under the same umbrella of care?

        However, like we’ve both acknowledged, we’re all on a run-away train we call the health care system, and while people like me are pulling like crazy on the brakes trying to slow it down, others are stoking the fire trying to maintain and expand a full and permanent third-party payer system. Unfortunately, the burden of facing the looming disaster will fall squarely on the shoulders of our kids – the ones who will assume all of this entitlement debt that we’ll leave to them when us old farts are dead and gone.

        (Edited to fix all those nagging apostrophizes and dashes that turned into question marks.)

        • #2822958

          Basic Care / General Practitioner Will Become Scarce

          by thechas ·

          In reply to Chas – Merry Christmas to you too

          I still see no reason to expect that free market forces will bring any substantial long term price reductions to the medical industry.

          Yes, much like when AT&T lost the anti-trust case, we will see initial competition and reduced prices. But, just like communication services, the medical industry will quickly see that the lower prices come at a loss of income and profits. They will find ways to sell the general public on procedures and services that are profitable, and limit the availability of basic health care.

          After all, we already have mall based clinics that offer MRI and other services to those who wish to pay for tests their physician and health plan will not authorize.

          While it might take 5 or 10 years for the consolidation and marketed services to mature, once the new profit formula comes into vogue the days of the general practitioner with a family practice will be numbered.

          Right now, what makes up the bulk of the patients at your family physicians office? Not the ones with the minor complaints that they might be able to treat themselves. No, the bulk of the people are those there for preventive care such as an annual physical or those with a serious condition, but they need to be referred by their primary physician before they can see a specialist. Take away the gatekeeper function of the PCP, and there won’t be enough patient volume left to pay the rent and utilities, let alone the staff and record keeping.

          On the other hand, without the gatekeeper function of the PCP and health insurance company, the hypochondriacs and those convinced they need the latest new medication on the market just might keep the doctors in business.

          Even if the cost structure goes more the way you envision than the way I expect, I believe one of 2 things will happen.

          Either, the amount of time the doctor spends with you will be even less if the cost per office call drops. Or, for the standard $100 office call, the doctor might spend 7 minutes with you instead of 5.

          Over 20 years ago, the HMO was going to control health care costs and keep care affordable. The net result of that change was the near elimination of doctors in private practice. Once most of the doctors in an area became members of group practices, up went the prices and costs.

          And, it is not that I do not trust the free market, or believe that an individual cannot make their own choices. I just see far too much evidence that advertising and marketing have become so sophisticated and effective that the choices that people make are not based on informed viewpoints as much as peer pressure and what is hip and cool.

          Chas

    • #2822983

      My shot at defining catastrophic coverage

      by nicknielsen ·

      In reply to In regards to medical care, what would happen if. . . . .

      Catastrophic coverage, in general, covers any illness or injury resulting in more than two nights in hospital. Outpatient, reconstructive, prosthetic, and long-term care required as a result of such an illness or injury is also covered.

      Specific inclusions:
      – Emergency care required as the result of an accident or illness. Includes any required surgery, such as an emergency appendectomy or reducing a compound fracture.
      – Emergency care for a life-threatening condition (e.g. asthma or heart attack).
      – Inpatient and outpatient treatment for malignant neoplasms (cancer).
      – Inpatient and outpatient treatment as a result of myocardial infarction.
      – Childbirth, including labor, delivery, and immediate post-natal care.
      – Cosmetic surgery when required after illness or injury (e.g. facial or dental reconstruction).
      – Long-term care required after injury or resulting from chronic or genetic illness.
      – Outpatient treatment for chronic or genetic illness when such treatment is required more than twice in a month (e.g dialysis).
      – All medication prescribed as the result of a qualifying hospitalization or specifically included illness or injury, except as excluded below.

      Specific exclusions:
      – Outpatient and preventive care, except as specifically included.
      – Injuries that do not normally require treatment by medical professionals.
      – Non-life-threatening illnesses like colds, coughs, and low-grade fevers that could reasonably be treated in an outpatient visit to a doctor’s office.
      – Elective surgery, including cosmetic surgery not necessitated by accident or illness.
      – Prescriptions for branded medication when a generic equivalent exists, unless patient allergy or demonstrated lack of effectiveness preclude generic medication.

      I’ve probably missed stuff and don’t doubt that the wording in some cases is not as clear as it could be, but that’s as far as I’ll go for now.

      edited for type-oh!

      • #2822732

        Excellent post

        by theprofessordan ·

        In reply to My shot at defining catastrophic coverage

        I am thinking that you put some time into that post. Your layout of the definitions relating to type of coverage is excellent. The question is that we have opened pandora’s box in regards that people are so accustomed to going to their doctor and requesting medication. My wife’s medical doctor actually prescribes depression medicine. No disrespect to my wife’s doctor but why is a family doctor prescribing depression medicine? I am not saying that the meds are the issue but for us to drastically change the current health care system, mind sets are going to have to change both from the doctors and the patients.

    • #2822869

      Catastrophic

      by tonythetiger ·

      In reply to In regards to medical care, what would happen if. . . . .

      Something that will cost more than a certain percentage of your income to overcome. As that amount would change according to income, so should the premium for guarding against it.

      • #2822860

        Catastrophe should not be income-based

        by delbertpgh ·

        In reply to Catastrophic

        Donald Trump should have a fair opportunity to buy catastrophic care insurance, even if he is a rich old goose.

        What’s a devastating financial blow to a person is often not shared by people of differing circumstances. For Pedro, getting sick and losing his home is a disaster. If I get sick and have to pull my kid out of college, that’s a disaster. For Pedro, if he never imagined sending a kid to college, the terms of my catastrophe might seem like a big-deal-so-what. For an actress, a mildly disfiguring scar across the face would be far more of a disaster than for me. Liquidating your retirement savings would be a catastrophe, though to some eyes, they would seem like money available to pay bills.

        • #2822842

          Think about it… what are you insuring?

          by tonythetiger ·

          In reply to Catastrophe should not be income-based

          The financial loss caused by the injury or illness, right?

          I’d think that a $15,000 hospital bill would be pretty catastrophic to someone who made $30,000 a year, but not so much to someone who made $30 million a year; so yes, the definition of catastrophic would be based based on income. That’s not to say that two people with the same income would define it the same… A person who had no savings, a mortgage and a kid in college might not be able to absorb that loss, but someone who already paid off their mortgage and the kid’s college might be able to, the only thing affected being the kid’s future inheritance 🙂

          That’s why I think choice needs to be a big part of it… people with identical incomes can have vastly different situations.

          (I’d also like personal responsibility play a bigger part. Someone who smokes, or participates in particularly risky activities (skydiving?) should pay more, and people who take care of themselves and minimize risks should pay less. To make ME pay more for insurance because YOU refuse to take care of yourself isn’t fair.)

        • #2822810

          I don’t think that buying a catastrophic policy can be a choice

          by delbertpgh ·

          In reply to Think about it… what are you insuring?

          Guaranteeing you will not become a burden to the state, should you fall to some whopper of a condition, should be an obligation that everybody has to pay. Like social security tax.

          It is not an option to let uninsured people curl up and die (even if you think so, Tony;) a huge majority of Americans believe the opposite. If somebody in the prime of life thinks he can get by without insurance, and then gets creamed in an accident, and needs $300,000 in care to become productive again, does the government say no? The idea that charitable hospitals will fill the void for anybody who wants to game the system is not economically realistic. Also unrealistic is the idea that you slap the guy with a bill and garnish 25 or 50 per cent of his wages for the next 20 years, as his deserved punishment. Some people wouldn’t work. Some would move away. Some would pay, and get behind when they get laid off, and pay again, and make their families slaves to the government for 30 years. It’s bold sounding rhetoric, but it won’t work.

        • #2822778

          Uh.

          by tonythetiger ·

          In reply to I don’t think that buying a catastrophic policy can be a choice

          [i]Guaranteeing you will not become a burden to the state, should you fall to some whopper of a condition, should be an obligation that everybody has to pay. Like social security tax.[/i]

          I don’t have to pay social security tax!

          [i]It is not an option to let uninsured people curl up and die (even if you think so, Tony;) a huge majority of Americans believe the opposite.[/i]

          Please. I know people who went uninsured for over 90 years and never died from it!

          A huge majority are going to be in for a big disappointment, because we’re all going to curl up and die, all the money in the world won’t change that.

          And the government will be the FIRST one to decide what’s a burden… In fact they already do it in some places! They decide not to put a trauma center or a rapid response team in certain areas because “there aren’t enough people there” to justify it”, so people near that location are already thought less of by your beloved government! And if the government can feel that way, so can I. I should be allowed to decide what I think is worthy of MY support!

          [i]If somebody in the prime of life thinks he can get by without insurance, and then gets creamed in an accident, and needs $300,000 in care to become productive again, does the government say no?[/i]

          And if someone can guarantee that he won’t become a burden, by having enough to cover his own needs, why should he have to buy insurance?

          [i]Also unrealistic is the idea that you slap the guy with a bill and garnish 25 or 50 per cent of his wages for the next 20 years, as his deserved punishment.[/i]

          Nah, he’ll just do what the other deadbeats do… file bankruptcy. (by the way, child support can get you for up to 55%)

          [i]Some people wouldn’t work. Some would move away. Some would pay, and get behind when they get laid off, and pay again, and make their families slaves to the government for 30 years. It’s bold sounding rhetoric, but it won’t work.[/i]

          NOTHING will! That’s what the bleeding hearts don’t get.

    • #2822858

      Great potential for applying consumer choice to medical care costs

      by delbertpgh ·

      In reply to In regards to medical care, what would happen if. . . . .

      This country now spends a disastrous amount of money on medical care. It’ll ruin us if it gets much worse. Ideas like this have the opportunity to reduce the amount of money we spend on health care by re-introducing consumer choice into the game.

      Under the current system, doctors are paid by insurance companies for services they provide to patients, and patients receive insurance as a benefit from their employers. The people who pay for the care have little power to influence the choice of providers or the structure of the care; the patients are usually not even made aware of what the care costs; and the doctors have no fear of losing customers based on cost decisions. In fact, the more expensive care becomes, the more essential insurance seems.

      Keep in mind that catastrophic coverage would be insurance under the old model, where consumer cost decisions are not a factor in service design or pricing. The kick-in point for insurance would need to be high, because everything above that point would have ungoverned costs. Maybe a percentage co-pay would have to be included on some cost categories, to keep consumer choice in the game.

      Keep in mind that America believes people should not die or suffer because they can’t afford coverage, and it believes they should not be reduced to poverty to make them eligible for assistance. These are the unavoidable policy requirements of any successful scheme. Defense against illness and against poverty caused by illness are both objectives in which the country almost universally believes.

      Keep in mind also that the country spends two trillion dollars a year on health, about half of it channeled through the government and about half through employer-contracted insurance companies. And lastly, keep in mind that for every billion dollar reduction in spending, we will eliminate about 15,000 health-related jobs and bankrupt a couple of hospitals. Saving real money will mean kicking over a lot of rice bowls. It will be difficult, politically and economically.

      Getting the third parties out of the payment process will have wonderful consequences. Structuring the deal so that the objectives of cost and care can be met, and holding on to that structure while millions of health workers lose their jobs, will be essential.

      • #2822834

        A lot of the cost is

        by tonythetiger ·

        In reply to Great potential for applying consumer choice to medical care costs

        due to OUR expectations…

        [b]We expect[/b] a well equipped life-flight helicopter to be within a few minutes of the scene of a serious accident.

        [b]We expect[/b] that if our doctor orders an MRI, we won’t have to wait two months and drive hundreds of miles to get it.

        [b]We expect[/b] that when we go into labor, that the hospital will have a bed for us, so that we don’t have to give birth in the hall.

        [b]We expect[/b] every pharmacy to be fully stocked with every medicine anyone might need, at all times.

        [b]We expect[/b] a lot of things that cost a lot of money to keep at the ready.

        • #2822833

          And what you get with your “top notch” American private insurance is…

          by jck ·

          In reply to A lot of the cost is

          A medical system that is resigned to taking 17-53% of their normally charged rates, rather than 100%, because of “group insurance contracts”.

          A medical system that, even though you have great, comprehensive medical insurance coverage, you have to wait 5 hours in a bed in a waiting area to be admitted for a broken neck.

          A medical system where hospitals have to cut corners and can’t afford to keep a fully qualified technician for their MRI system on site to keep it from disrepair to properly diagnose patients who need it.

          A medical system who can’t do their job, because insurance carriers tell them it’s not “allowed” medical care.

          A lot of the cost in medical care isn’t in medical expenses. Most people don’t need $126k of medical care in year like I had to have.

          But, it’s not because of the process of the medical practice that’s driving cost. Most cost is driven by the supposed “supply and demand” and pharmaceutical and medical supply manufacturers driving the prices up to silly amounts to drive their profits.

          Trust me, I remember paying out-of-pocket years ago for an antibiotic: 14 pills – ~$130.

          You don’t see hospitals and doctors getting rich anymore like you used to. The only huge profit centers now in medical are insurance companies and pharmaceutical manufacturers.

          Oh, and the medical malpractice attorneys.

          P.S.- I live in a town of about 100,000 people.

          The nearest “lifeflight” helicopter from me is over an hour away.

          So, where’s my “minutes away” service? 😉

        • #2822825

          That’s a good thing, isn’t it?

          by tonythetiger ·

          In reply to And what you get with your “top notch” American private insurance is…

          [i]A medical system that is resigned to taking 17-53% of their normally charged rates, rather than 100%, because of “group insurance contracts”.[/i]

          Otherwise, your premiums would be 47-83% more, as well as your out-of-pocket costs.

          And what is “normally charged rates”? Do you know someone who really pays that? I don’t. My doctor gives a substantial break if he doesn’t have to fill out insurance paperwork…

          [i]Trust me, I remember paying out-of-pocket years ago for an antibiotic: 14 pills – ~$130. [/i]

          I still do. So what’s it worth to you to get rid of an infection… $130 seems pretty cheap to me.

          [i]You don’t see hospitals and doctors getting rich anymore like you used to.[/i]

          administrative costs… regulation compliance costs… billing costs…

          [i]P.S.- I live in a town of about 100,000 people.

          The nearest “lifeflight” helicopter from me is over an hour away.

          So, where’s my “minutes away” service?[/i]

          Maybe you’re not demanding enough… or “over an hour” can be a few minutes… depending on what you compare it to 🙂

        • #2822731

          Another side

          by tig2 ·

          In reply to That’s a good thing, isn’t it?

          My partner takes a medication twice a day that costs us nearly $4000 a month. He will take it for the rest of his life- something we have gone to great lengths to prolong. We will continue to do that for as long as it makes sense. When it no longer makes sense, we will chose to implement his end of life planning and at that point will have to discuss with his pulmonologist if it will continue to make sense to stay with that medication.

          In my experience- proven by multiple medical records- tests were run and rerun for no purpose that is ascertainable. The critical test- the biopsy- was done once. There are fees attached to each test and not all of them are covered by the insurance that we, NOT an employer, pay for.

          EMTs can be at my house in about 10 minutes… unless it is snowing or has recently snowed. Our last emergency was two weeks ago. I was terrified that he would die in my arms after going through so much to live for another year or so.

          I get what you are saying, Tony. I also get what jck is saying. Here’s what I’m saying.

          I am living with the worst possible medical picture. The man I love has a terminal disease that very literally has us discussing life and death on a very personal basis like most people talk about the weather. He has insurance that we pay a ton for that covers SOME of the cost of this catastrophic reality in our lives.

          Along with the monetary costs of his care, we also have to consider when it is time to just give up- insurance or no.

          In addition, I have a heart problem that we don’t have the ability at this time to deal with. I do not have insurance because I was not the principle wage earner. Keeping the wage earner alive seemed like the best choice when two reasonably healthy people had to balance finances against health care.

          Here’s my point- at a personal level, there are simply no easy answers. But at a collective perspective, there are things that need to be under consideration.

          When is it acceptable for me- a jobless and uninsured person- to demand that you or your children pay for my care? At what point should my beloved choose to reduce his care because his needs have blown the actuarial tables and continuing to support him will result in raised costs to others?

          In my opinion, none of us have all the answers. That includes Obama and the theoretical Health Care Reform.

          My situation may be singular here. It is certainly not the first or only.

        • #2822713

          I know, Tig

          by tonythetiger ·

          In reply to Another side

          We are individuals, have individual situations, and we have to come up with our own individual solutions. As unfair as it may seem, we don’t have an inborn right to burden others with it against their individual wills.

          I’ve seen a spectrum… I watched Dad’s failing health and death… My niece’s baby drowned 12 years ago, but she didn’t completely die… she can’t communicate or move, and my niece feeds her through a tube… forever? And I had an acquaintance who has two children (the second against doctor’s advice) with Gauchers… which is costing a quarter million a year to treat!

          I know life can be full of tough questions, and I suspect that will always be true, whatever we do or don’t do. Life’s not supposed to always be easy… There is no one-size-fits-all answer. Sometimes there is no answer at all in this life… Sometimes all we can do is love each other when we survive our struggles, and love each other when one of us doesn’t.

        • #3012859

          Exactly, Tony

          by tig2 ·

          In reply to I know, Tig

          And much of the reason that a ridiculous piece of legislation should not be condoned and SHOULD be questioned.

          Regardless of the challenges that we are facing, WE ARE FACING THEM. You should NOT be facing them except in that you listen when I need to vent about the stupidity of a system that seems to be insisting on adding a new layer of stupidity.

          I know that life is what happens when you are busy making other plans. And that it sometimes isn’t fair. All we can do is get through it as best we can and move along. Thankfully, I have great friends who reach out and pray me through the tough times.

          I don’t want or support the current “Christmas present” that the Senate found necessary to gift us with. I want to see reform that is something more than re-packaging the same old crap with a new bow. And I have to question the “leadership” of the person who has demanded this.

        • #2822717

          Having worked in the medical industry

          by jck ·

          In reply to That’s a good thing, isn’t it?

          I can answer certain things.

          [i] Otherwise, your premiums would be 47-83% more, as well as your out-of-pocket costs.[/i]

          Actually if private insurance wasn’t involved, there would be no contractual negotiations or rates set that are “allowable” for physicians to charge.

          You could shop around for a doctor based on credentials and cost, not based on what doc your HMO considers “in-network”.

          As well, it’s all a cat and mouse game. For instance, my dentist has 2 rates: insured and cash customers.

          His rate for a dental exam for insureds: $105

          His rate for a dental exam for cash payers: $48

          It’s all hocus-pocus because he can’t charge what he wants and get his normal fee through an insurer, so he has to setup higher rates to meet a fee level that will pay his staff and expenses in operating.

          [i] And what is “normally charged rates”? Do you know someone who really pays that? I don’t. My doctor gives a substantial break if he doesn’t have to fill out insurance paperwork…[/i]

          Yes, I did pay “normal” rates when I was a cash customer. They aren’t on an inflated scale so the doctor’s contracted allowance through insurers doesn’t bankrupt his business.

          And actually, your doctor charges substantially less for cash because of one, very certain thing: contract allowed percentage of procedure fees. Doctors get a percentage of their “insured fees”, and that’s why they are so high compared to those for cash patients. It’s not about filing insurance.

          As for it being because of paperwork? That’s all done electronically. They stick a procedure number, date, choose your patient record ID, and click a button. About 5-10 seconds of work. Maybe $.25-.40 of labor involved. That’s not the barn burner in cost.

          [i] I still do. So what’s it worth to you to get rid of an infection… $130 seems pretty cheap to me.[/i]

          $130 is cheap? For common medication? Yeah right. With insurance, that med was $10. I didn’t have insurance at the time. You’re telling me that it was really a $130 value and that the pharmacy was willing to take $10 plus whatever the insurer would pay for a common drug?

          [i] administrative costs… regulation compliance costs… billing costs…[/i]

          Actually in the medical industry, billing costs have gone down in the past 20 years with the advent of electronic billing and automated systems. Saved the company I used to work for about 58% of their original budget to buy computer systems, put them online, then lay off about 1/3 of their billing staff and stopping the costs of dealing with so much paperwork.

          Less paper to file and pay storage on, less floor space needed to pay for, etc etc.

          Regulation costs have always been there. Always be there.

          Are you saying the medical industry should not be regulated?

          As for administrative costs, go look at what has driven the costs up in administration. It isn’t increased amounts of patients.

          [i] Maybe you’re not demanding enough… or “over an hour” can be a few minutes… depending on what you compare it to[/i]

          Um.

          Time for bayflight to come, get me, and take me to a big hospital in the metro: about 3 hours

          Time for an ambulance locally to pick me up, transport me to that same big hospital where bayflight originates: 2 hours

          I’d say “lifeflight” is not as efficient, as well as not as common, as you assume it to be across America.

        • #3023207

          No,

          by tonythetiger ·

          In reply to Having worked in the medical industry

          [i]$130 is cheap? For common medication? Yeah right.[/i]

          $130 is cheap compared to what you may be out if you DON’T get rid of the infection.

          [i]I’d say “lifeflight” is not as efficient, as well as not as common, as you assume it to be across America. [/i]

          But it’s the [b]assumption[/b] that feeds the expectation.

        • #2822806

          A lot of what we expect we can get, and get cheaper

          by delbertpgh ·

          In reply to A lot of the cost is

          You can get drugs and beds at the ready, and you can pay as much as you want for the fulfillment of your wishes. Maybe not as little as you want, but certainly if you hold your wallet open, vendors will do more and more less efficiently. That’s the way things work now. Insurance companies say “we will pay what things cost” and consumers say “pay for it all.” Remember when Ma Bell ran the phone system as a regulated monopoly, at a cost plus 10% rule? AT&T/Bell managed to employ 900,000 Americans, and was the largest company in the U.S. Deregulation showed it didn’t have to cost that much, phone service did not suffer, and prices dropped steadily year after year.

          Competition can reduce prices, but it requires end user driven choice. Some people will want to buy more and others less, and some will demand a higher degree of luxury than others, but all will want to pay the lowest price for what they find acceptable. Vendors will design services and find ways to make savings that will allow price points and quality standards to be met, or will go out of business. The secret to making it all work, though, is to put the pain of cost and the power of choice in the hands of the people who use the service. It fails otherwise.

          Imagine a mail order bride business, where your employer to paid somebody else to send you a wife. What kind of woman would you demand, in circumstances like that? What would you settle for, if your choice were something you had to pay for? Maybe that’s a bad analogy, considering half of us get divorced. But you see my point.

      • #2822798

        You make some excellent points

        by maxwell edison ·

        In reply to Great potential for applying consumer choice to medical care costs

        Like you said, reinstating full and total consumer choice – and consumer responsibility (my words, not yours) – is the key to making something like this work.

        You said, [i]”Keep in mind that catastrophic coverage would be insurance under the old model, where consumer cost decisions are not a factor in service design or pricing. The kick-in point for insurance would need to be high, because everything above that point would have ungoverned costs. Maybe a percentage co-pay would have to be included on some cost categories, to keep consumer choice in the game.”[/i]

        You’re exactly right about that, so “catastrophic insurance and/or catastrophic medical care” would have to be pretty well defined. I believe, however, that its cost could be similar to term life insurance – $500 to $1,000 per year instead of that amount per month. Also consider this. Catastrophic coverage might be defined a bit differently for different age groups and different risk groups. After all, generally speaking, older people have higher medical costs than younger folks; and smokers, overweight, etc. are a higher risk.

        I think the keys would have to include the following:

        Drop the nonsense of medical insurance being an employee benefit paid for by an employer. We all know that employers consider that cost a part of a total employment package anyway, so just pay employees the extra $$ that would have otherwise been spent on insurance, establish a savings system that would still count those dollars as tax free (similar to a 401k distribution), mandate that those funds can ONLY be used for medical expenses, and allow for annual carry-over.

        Consider this: $500 per month for medical insurance equals $6,000 per year. There’s no way most people spend anywhere near that amount in actual medical care. Even a broken ankle, or something like that, could be fixed for a couple thousand. Some people go years and years without spending anything (other than the small stuff). And then, if you carry-over $6,000 per year for 30-40 years, upon a person’s golden years – when medical costs rise dramatically – there could be a quarter of a million dollars in that medical savings account. That would go a long way to providing medical care when it’s needed the most.

        What I outlined isn’t perfect, but it’s an alternative way of thinking. I shake my head in disbelief when the goal of “making medical care affordable” always seems to be a code-word for making other people pay for it. I seldom see ideas that actually look at the big-picture to identify what makes it unaffordable in the first place. Insurance does absolutely nothing to deliver medical care; all it does is pay for it (with the consumer’s own dollars – minus the fee for writing the check). It simply adds to the overhead – a HUGE overhead – by creating a third-party payer.

        If the medical insurance industry is just as large as the medical care industry, for example, and if all medical care is routed through medical insurance plans, then by definition, its mere existence doubles the cost of providing medical care.

        The biggest downside of something like this is that all those people who are employed for the sole purpose of administering medical insurance (both those in the insurance industry and the medical industry) would suddenly find themselves unemployed. But this outcome actually illustrates the lunacy of the whole system. Why would a person want to pay someone else to simply write a check to pay one’s own expenses – especially if the difference is probably close to double?

        Example: I write the check for $100; OR, I pay someone else $200 to write that $100 check.

        • #2822797

          If we are saddled with

          by santeewelding ·

          In reply to You make some excellent points

          The Department of Education, then fold it into the soon-to-be Department of Healthcare, enabling our succeeding young.

          Just an other alternative way of thinking.

        • #2822791

          Actually, you pay $125 for a $100 check for something that should cost $50

          by delbertpgh ·

          In reply to You make some excellent points

          I’ve read in several places that the overhead of the health insurance companies is about 20% of the money they process. That doesn’t count the mispricing of the service that results from using “insurance” as a payment medium. I’d guess THAT doubles the cost.

          The problem with putting the employer contribution straight into the employee’s hand is that many employees would spend what he need for prudent health care. Catastrophes would be covered, but not routine care, like vaccinations for the kids and hypertension treatment for dad. There’s a lot of incentive to make bad choices. It’s in the country’s interest to encourage (but not require) better decisions.

          The better route would be for the employer to put the money, tax free, into a health savings account. After two years of contributions are accumulated, let the employee draw out any surplus, paying taxes on it as though it were income. Which it would be, at that point. It makes it easier to decide to buy health care, since you don’t have to put it on a credit card if you’re otherwise broke, and you still have the incentive to economize, because you’ll get to keep most of it. When you’re cheap, you force your doctor to be cheap, and draw alternative delivery services out of the woodwork. (Wal-Mart is already a medical service provider in some locations.)

        • #2822789

          Another “bottom line”

          by maxwell edison ·

          In reply to Actually, you pay $125 for a $100 check for something that should cost $50

          People are responsible for their own lives – PERIOD – regardless of the curve-balls thrown their way. Do you agree or disagree?

          Before you answer, consider this. If you answer no – people are not responsible for their own lives – then by definition, you’re suggesting that OTHER people are responsible for those lives.

          Which premise are you building upon?

        • #2822785

          You’re responsible for everybody

          by delbertpgh ·

          In reply to Another “bottom line”

          So am I.

          Doesn’t mean that we have to waste money discharging our responsibilities. Doesn’t mean we can ignore other responsibilities in the service of some, either.

        • #2822774

          Show me

          by tonythetiger ·

          In reply to You’re responsible for everybody

          the theory that beholds me to be responsible for someone else (fruits of my loins excluded).

        • #2822709

          Here’s one example of what not being responsible for others has done

          by jck ·

          In reply to Show me

          Remember in the 1950s and 1960s, when another adult could grab the arm of the child who was doing wrong and take them to their parents for reprimand? Crime and mischief weren’t as prevalent then.

          Now if you touch someone else’s kid, you’re labelled as abusive and a cretin and almost certainly going to be charged with something. And if the kid decides to pull a knife or gun on you, you’ll still get charged but their likely not to be even if they shoot/stab and mortally wound you.

          It should take a village to raise our children. Otherwise, they end up like the majority of the children in this nation have ended up now: most have no idea of self-discipline, self-control, or doing what is right.

          Need examples?

          Just look into the video that was on YouTube for a while of the cheerleader who got beat up by other teens because they didn’t like her.

          Look into the case of Matthew Shepard, and how he was beaten to death by two young men all because he was gay.

          Look into the rash of video taped crimes of teens and young adults across America who made a “sport” out of beating homeless people.

          Think America doesn’t have a problem from not working as a community to be responsible for one another?

          If you do, I’d beg to differ.

        • #3012836

          That’s not responsibility

          by nicknielsen ·

          In reply to Show me

          [i]Remember in the 1950s and 1960s, when another adult could grab the arm of the child who was doing wrong and take them to their parents for reprimand? Crime and mischief weren’t as prevalent then.[/i]

          That’s community. The adult who took the arm of the child doing wrong was not taking responsibility for the child, but protecting society. Although most people accepted it, such action was as much forcing the parents to take responsibility for the “fruits of their loins” as it was protecting the community.

          Unfortunately, those societal mores have long since disappeared.

          edit: clarify

        • #3012794

          It’s also responsibility

          by jck ·

          In reply to Show me

          [i]That’s community. The adult who took the arm of the child doing wrong was not taking responsibility for the child, but protecting society. Although most people accepted it, such action was as much forcing the parents to take responsibility for the “fruits of their loins” as it was protecting the community.

          Unfortunately, those societal mores have long since disappeared.[/i]

          Community is a responsibility on the part of all to have a common good, and to look out for not only yourself, but for your neighbor.

          Community = being responsible for each others’ well-being.

          And yeah, unfortunately that mentality has disappeared from most places in our country. You can still find it in some communities, but it is more and more rare with the “me me me” syndrome most people have taken in today’s fast-paced lifestyle.

          One reason I loved Ireland so much: people there just seemed to care more about being human and good, both in places like Tipperary as well as Dublin.

        • #2820940

          Hell,

          by tonythetiger ·

          In reply to Show me

          [i]Remember in the 1950s and 1960s, when another adult could grab the arm of the child who was doing wrong and take them to their parents for reprimand?[/i]

          In my old neighborhood they never had to grab anything… they said “Go home and tell your Dad I said to bust your ass.”… and I did! 🙂

          But that is something a responsible person takes it upon himself to do, not something that is REQUIRED.

          You can’t change a heart through legislation.

        • #2820799

          you’re right, Tony

          by jck ·

          In reply to Show me

          But, you sure as hell can define “incompetent” or “negligent” under law in regards to parenting, and take children out of neglectful homes that have incompetent parents.

          So, you can legislate parental responsibility.

          Want to be a bad parent? Nope. We’ll take your privilege of parenting away, and give your kids to someone who’ll teach them to act like humans rather than rabid animals.

          That’s what you do. Plus in some cases, that will take the kids from welfare parents and then you can cut off their WIC food, Medicaid free medical, etc.

          There’s your cost savings through doing what’s right for children.

          How about that for an idea? Hm? Save your tax dollars through putting kids in better homes.

          Me for President 2020 🙂

        • #2820646

          I’m all for it

          by tonythetiger ·

          In reply to Show me

          [i]How about that for an idea? Hm? Save your tax dollars through putting kids in better homes.[/i]

          but I think the benefits would go far beyond money. Knowing that there are people who care for them will turn these kids into caring adults.

          [i]Me for President 2020[/i]

          Go for it! 🙂

        • #2822756

          I take issue with that

          by maxwell edison ·

          In reply to You’re responsible for everybody

          You and I are responsible for everybody? I don’t think so.

          That’s just a good-sounding platitude. What you suggest is simply not possible, even if we wanted to be.

          One is responsible, first and foremost, for one’s self. People are then responsible for children they create. And in a circle-of-life kind of way, those children should take responsibility for their aging parents.

          If and when it’s not possible for one to take responsibility within that circle, then – and only then – should others assume such responsibility.

        • #2822718

          Platitudes lie thick on the ground

          by delbertpgh ·

          In reply to I take issue with that

          We’re certainly responsible for ourselves and our children, and they for us. I don’t see much point to life if I’m not capable of helping my family, either now or in the future. It’s in my nature to carry burdens, and not to be one. I’m not sure how I’ll play the end game. However, that’s about me, and not about society.

          Society is a big complicated machine, and energetic people step up to take leadership positions within it and move it forward. They get paid well along the way, partly as the result of their ambition and drive, but also because the big machine exists as a network in which hundreds of millions of people can create wealth. Pull away the complex network, and you remove most of the wealth. Our individual prosperity, our reward for our productivity, is granted us by the munificence of the machine and by the other working drones who occupy all its other places. We owe the society, and we owe the people in it, without whom we’d have little. That’s what I mean by my responsibility for everybody.

          Within your “circle of life” system of child/parent responsibility, when it is only moral to reach out of that circle when it is not possible to meet needs from within, what are the limits? Would you as a husband and grandfather first sell your home and destroy any comfort in your retirement to save a 20-year-old uninsured grandson, before feeling qualified to insist that somebody else ought to be there? Would you expect the same from him in return, when you become infirm? This exchange of benefits requires that you exhaust yourself and everyone you love if you don’t have coverage, or if you discover that your solid gold policy has a false bottom. It happens frequently. Something like a third of bankruptcies are medical-related. I don’t like American stories that end like that. It seems unjust to me.

          There’s another aspect to this health care problem, and that is rationality. The social machine is big, bigger than any network of personal relationships, and as such it has to be rational to be fair. The set of rational solutions is bounded by popular expectations, by what is actually effective, and by return on money invested. Any policy solution has to meet larger demands, and not just address a small set of issues revolving around personal responsibility and the drama of individualism.

          People want health care, and they don’t want to go broke getting it, and they don’t want to be denied more once they are broke. Many may not want to pay for their fellows and may not want pay in to insurance, but nearly everybody wants those benefits for themselves.

        • #2822711

          What happens

          by tonythetiger ·

          In reply to I take issue with that

          [i]I don’t see much point to life if I’m not capable of helping my family, either now or in the future.[/i]

          When you become not capable of taking care of your family BECAUSE OF what was taken from you by a stranger?

        • #2822707

          I disagree with that, Max

          by jck ·

          In reply to I take issue with that

          Why should I be responsible for my parents?

          Do I owe them simply because they chose to have me? Am I responsible to pay them back for what I didn’t ask for?

          As for being responsible for your children, we also need to be responsible for at least monitoring and mentoring others’ children. The lack of enforcing discipline on children nowadays has turned a lot of them into little miscreants and some into full-blown criminals.

        • #2822703

          I have an even better question, Tony

          by jck ·

          In reply to I take issue with that

          [i]When you become not capable of taking care of your family BECAUSE OF what was taken from you by a stranger?[/i]

          No stranger has ever directly or indirectly compromised my ability to care for myself…or anyone I have opted to help or care for.

          You imply that a personal, social contribution is some absolute ruin to your way of life unless your stamp of approval is on it.

          No form of government will ever be sufficient, simply because no form of government can ever meet the needs/wants/desires/demands of people like you who feel it’s your right to have all things for self and not have to contribute to a greater cause than to give to those outside of your bloodline.

          So if it’s so wrong for a stranger to take from you, then is it right that your child jeopardizes you even though you didn’t raise them to act in such a manner as to do so?

          I have 2 sisters who have been the cause for my parents financially unstable retirement. Is it my parents fault they love their children, tried to help them, and got burned for $100ks of dollars in debt?

          Being responsible based on genetics isn’t always a good thing either. Trust me.

        • #3012974

          You can’t even grow roses with that, Tony

          by delbertpgh ·

          In reply to I take issue with that

          We’re spending two trillion a year on health already. That’s like a 16% tax on just staying alive. One way or another, that money’s already being taken from you.

        • #3012957

          I willfully contribute to the common good.

          by tonythetiger ·

          In reply to I take issue with that

          meaning infrastructure. Individual liberty demands individual responsibility. Those who do not take their individual responsibility do not have the right to take from those who do. If you choose to give, fine!

          [i]No stranger has ever directly or indirectly compromised my ability to care for myself…or anyone I have opted to help or care for.[/i]

          Lucky you. Too bad everyone cannot say the same thing.

          [i]So if it’s so wrong for a stranger to take from you, then is it right that your child jeopardizes you even though you didn’t raise them to act in such a manner as to do so?[/i]

          You’re responsible for them until they are adults. You MAY be responsible for them after that, at least morally, if because of your irresponsibility in teaching them, they do not become productive adults. If, as you say, “you didn’t raise them that way”, then they are on their own, unless someone CHOOSES to help them. Often it’s more loving, especially with kids, to NOT help!

          My stepson recently pulled a boner… got caught driving a friend’s car without a license. They took him to jail. They asked him if he wanted to call his parents. He said “You can call them to tell them where I am and that I’m OK, but they’re not coming to get me.”, and he sat there all weekend until he saw the judge Monday morning. He pleaded guilty, got a fine, and worked his ass off to pay that fine plus his incarceration costs. He learned that things have consequences in a way he couldn’t have read in a book. He is going to be a better person… a more RESPONSIBLE person… from now on because [b]we let him fail![/b]

          So many people can’t or won’t see that… They’ve so cushioned their children against failure (by making sure EVERY kid gets a trophy) that they grow up not knowing how to handle it when they have a “grown-up setback”! Personally I think all those parents who molly-coddled their children are negligent. (and I’d like to slap every damned one of them!) The same thing is true of adults… Stop molly-coddling them… you have to let them fail so that they can learn how to succeed!

          Society’s continuing refusal to hold people personally responsible for what they should have complete and total ownership of is going to lead to society’s complete and total breakdown! If that’s what you want, keep doing what you’re doing… it shouldn’t take long!

        • #3012948

          things…

          by jck ·

          In reply to I take issue with that

          Tony:

          1) Please define “infrastructure”. I would like to know what it is okay and not okay for you to have to contribute to.

          Is that just roads? Military? Police? Fire? EMS? Sewer? Water? Natural Gas? Oil industry who makes the gas that goes in your car? Power company that pushes voltage to your alarm clock?

          2)

          “Individual liberty demands individual responsibility. Those who do not take their individual responsibility do not have the right to take from those who do. If you choose to give, fine!”

          So if I am responsible, I should be able to take from you. Nice.

          I’ll expect a 20% cut of your net income in 2010. Thanks.

          “Lucky you. Too bad everyone cannot say the same thing.”

          Please show me where paying a government-imposed tax, tariff, fee or fine has totally ruined your life.

          “You’re responsible for them until they are adults. You MAY be responsible for them after that, at least morally, if because of your irresponsibility in teaching them, they do not become productive adults. If, as you say, “you didn’t raise them that way”, then they are on their own, unless someone CHOOSES to help them. Often it’s more loving, especially with kids, to NOT help!”

          Again, look at my example. I was raised by the same parents as my sisters. I end up fine. One sister ends up a liar, con and thief and horrible parent. The other ends up spending 25 years dawdling around doing nothing.

          I agree with the not help thing. Once I have kids, my kids will learn to do for themselves, ask when unsure, and think about what they do before they do it.

          “My stepson recently pulled a boner… got caught driving a friend’s car without a license. They took him to jail. They asked him if he wanted to call his parents. He said “You can call them to tell them where I am and that I’m OK, but they’re not coming to get me.”, and he sat there all weekend until he saw the judge Monday morning. He pleaded guilty, got a fine, and worked his ass off to pay that fine plus his incarceration costs. He learned that things have consequences in a way he couldn’t have read in a book. He is going to be a better person… a more RESPONSIBLE person… from now on because we let him fail!”

          Bravo to you.

          Now a newsflash: You are one of an INCREDIBLY RARE SPECIES OF PARENT.

          Case in point: Recently in my neighborhood, a young man drove his parents’ Cadillac so fast down a street while sucking on cans of compressed air to get high, he slammed into my neighbor’s house and van…totalling a really nice van and damaging the exterior of their home.

          His mother arrived at the accident scene, and she looked at us who were there and lived there and said “What? Never seen an accident?”

          The whole time, she was giving the cops grief, was swearing audibly from 500 feet away on her phone, and was talking off and on to the family lawyer.

          She is the type of parent who needs a smack in the head and to be told:

          “Listen, princess. Not only is your son a drughead, but he’s one because you didn’t discipline him and teach him that he was gonna roast his brain doing it. Now, he’s as stupid as his mother.”

          “So many people can’t or won’t see that… They’ve so cushioned their children against failure (by making sure EVERY kid gets a trophy) that they grow up not knowing how to handle it when they have a “grown-up setback”! Personally I think all those parents who molly-coddled their children are negligent. (and I’d like to slap every damned one of them!) The same thing is true of adults… Stop molly-coddling them… you have to let them fail so that they can learn how to succeed!”

          Holy $hit…we agree. Smack the living hell out of parents who don’t…PARENT.

          Just one thing tho about letting adults fail, Tony:

          If you fail as a kid and get arrested, you go to jail and get out and get to start over.

          You fail as an adult and can’t earn an income and feed yourself, you starve and die.

          There’s no coming back from dead.

          You take away grants that foodbanks and charities across this country use to run, you’re dooming some good, honest people who get down on their luck for a time to end up a tragic side effect of your means to keep more money in your pocket.

          “me me me” syndrome again.

          “Society’s continuing refusal to hold people personally responsible for what they should have complete and total ownership of is going to lead to society’s complete and total breakdown! If that’s what you want, keep doing what you’re doing… it shouldn’t take long!”

          Nope, but I don’t like the idea of contributing to an underlying support system for all people as being “stealing” or “violating rights”.

          Besides, it is that focus on individual and that “me me me” attitude that has this country in ruins.

          Otherwise, CEOs would be held to uphold not only profits of companies but to maintain their assets and resources at a similar level…instead of all basically getting buddy-approved contracts that let them be robber-barons.

        • #3012903

          Infrastructure:

          by tonythetiger ·

          In reply to I take issue with that

          [i]Is that just roads? Military? Police? Fire? EMS? Sewer? Water? Natural Gas? Oil industry who makes the gas that goes in your car? Power company that pushes voltage to your alarm clock?[/i]

          That about covers it.

          [i]So if I am responsible, I should be able to take from you. Nice. [/i]

          I didn’t say that, although if I see that you are trying to be responsible, I am more likely to offer to help if you’re in need.

          [i]Please show me where paying a government-imposed tax, tariff, fee or fine has totally ruined your life.[/i]

          What’s with the extremes? I didn’t say “ruined my life”, but money taken from me and given to a scammer leaves me with less to do for those I KNOW are deserving.

          [i]You take away grants that foodbanks and charities across this country use to run, you’re dooming some good, honest people who get down on their luck for a time to end up a tragic side effect of your means to keep more money in your pocket.[/i]

          You’re assuming that people are going to pocket the money they save in taxes. They aren’t. They’re going to invest it, donate it, or spend it, all of which will create opportunity…

        • #3012796

          no…please…

          by jck ·

          In reply to I take issue with that

          [i][b]Is that just roads? Military? Police? Fire? EMS? Sewer? Water? Natural Gas? Oil industry who makes the gas that goes in your car? Power company that pushes voltage to your alarm clock?[/b]

          That about covers it.[/i]

          No, I wasn’t asking for “about”. I really want to know your definition of all things that are infrastructure to you.

          I can’t debate you on what is an infrastructural item (a needed thing) vs. just something that is a convenience item you want to have for your own benefit… when you haven’t defined that which is “infrastructure” in your mind, and yet had claimed that so much in government is unneeded and you shouldn’t be paying for it.

          So please, I ask you to be specific on this. It is the core item of your standing of what is right to pay for and what is not in regards to provided government services (i.e.- infrastructure) and how it violates your rights as an American.

          [i]I didn’t say that, although if I see that you are trying to be responsible, I am more likely to offer to help if you’re in need.[/i]

          A) You’ll never see me in need, because you live 1100 miles from me.

          B) The chances if you did see me suffering and picking up cans along a road to get money because I hadn’t been able to get another job, you probably wouldn’t just pull over and give me a $10 and say “Keep your chin up.” I doubt you have done that more than a few times, if at all, in your lifetime.

          C) Okay, here’s what you said:

          [b]”When you become not capable of taking care of your family BECAUSE OF what was taken from you by a stranger?”[/b]

          So, I’ll rephrase my question less sensationally:

          When has your having to paying taxes, paying a fee, paying a tariff, or paying a fine to any government entity, forced you to not be able to take care of your family?

          Has your family starved because of it?

          Has your family been homeless because of it?

          Has your family been without clothing because of it?

          Again, please give me a specific example of such.

          I don’t think your family has ever “suffered” because of taxes at all, and it surely hasn’t affected your prosperity or ability to provide.

          Otherwise, you (like I) wouldn’t have an internet connection or a computer to utilize it.

          [i]You’re assuming that people are going to pocket the money they save in taxes. They aren’t. They’re going to invest it, donate it, or spend it, all of which will create opportunity…[/i]

          And, you are assuming that people are going to invest, donate, or spend it.

        • #2820931

          OK.

          by tonythetiger ·

          In reply to I take issue with that

          [i]No, I wasn’t asking for “about”. I really want to know your definition of all things that are infrastructure to you.[/i]

          I doubt I could think of “all things”. Infrastructure is simply a pathway to allow us to get the things we need. For example, the water pipe is a conduit but the water in the pipe is not. Likewise, the wires are infrastructure, but the electrons consumed are not. The road is a conduit but the groceries in the trunk of the car on the road are not.

          Now as far as paying for infrastructure, there are two costs… access and usage. Everyone should pay equally for the access part, but the actual usage should be charged to those who use it. For example, We all pay to build new roads, but people who drive more miles or drive heavier vehicles should pay more road tax. Another example, we all pay for the EMS units but those who use them should pay more.

          Except for parent-child, no individual should be required to pay for another’s USAGE of infrastructure.

          [i]I can’t debate you on what is an infrastructural item (a needed thing) [/i]

          Your definition is not the same as mine. The “needed thing” is transported on or through the infrastructure, it is not the infrastructure.

          [i]When has your having to paying taxes, paying a fee, paying a tariff, or paying a fine to any government entity, forced you to not be able to take care of your family?
          [/i]

          I didn’t say “I” had, but I can easily see where it could happen. If you need two things and only have enough money for one, and that one is “paying taxes”, well, you can figure it out. Hell, last year I had to postpone a brake job to pay the feds! That could have been disastrous!

          [i]And, you are assuming that people are going to invest, donate, or spend it. [/i]

          Unless they’re completely stupid they’d better! Holding money while more is being printed is the dumbest thing in the world to do. Its value will evaporate right before their eyes! Somehow I find it hard to believe that people talented in acquiring money don’t know that. People who STEAL it certainly do!

        • #2820791

          replies

          by jck ·

          In reply to I take issue with that

          [i]I doubt I could think of “all things”. [/i]

          Me either.

          [i]Infrastructure is simply a pathway to allow us to get the things we need. For example, the water pipe is a conduit but the water in the pipe is not. Likewise, the wires are infrastructure, but the electrons consumed are not. The road is a conduit but the groceries in the trunk of the car on the road are not.[/i]

          Actually, infrastructure consists of two components: facilities and services.

          Power companies, for example, provide both facilities (plants, lines, towers, transformers, meters) and services (power through the line, billing, energy monitoring and savings programs, repair).

          [i]Now as far as paying for infrastructure, there are two costs… access and usage. Everyone should pay equally for the access part, but the actual usage should be charged to those who use it. For example, We all pay to build new roads, but people who drive more miles or drive heavier vehicles should pay more road tax. Another example, we all pay for the EMS units but those who use them should pay more.[/i]

          There is one other component to public infrastructure you’re forgetting to charge for: maintenance

          Usually, it’s wrapped up into one of the other two, but it’s a distinct component usually accounted for in expenditures.

          With trucks, they pay higher tag fees and use more fuel. So in essence, they are paying more.

          We already pay for EMS that way here. Base fee on property tax, plus a fee whenever they come to your house.

          [i]Except for parent-child, no individual should be required to pay for another’s USAGE of infrastructure.[/i]

          So, why then:
          – do I pay federal taxes that go to fund public schools…when I have no children?
          – do I pay federal taxes that go to economic recovery projects in your state?

          Are you saying taxes and fees should be “a la carte”, and do you know the amount of complexity and bureaucracy that would create? Not to mention the added expense of keeping track of who qualifies for what, how to calculate it, having to audit it, etc?

          [i]Your definition is not the same as mine. The “needed thing” is transported on or through the infrastructure, it is not the infrastructure.[/i]

          If you need electricity, you need a means to get it there. Unless of course, you’re going to build your own power plant. :^0

          [i]I didn’t say “I” had, but I can easily see where it could happen.[/i]

          I can see where anyone making near poverty level in this country gets a) free food, b) free clothing (from places like SA, Goodwill, etc), c) free housing (HUD programs), d) free transportation (most municipal bus systems grant poor people free/super cheap passes).

          I can’t see where the system fails to let anyone suffer, unless they just won’t get off their butt to go get things. In fact, I’ve seen where people who live making $20,000 a year with 3 kids live better than people earning $55,000 because they can go and get everything paid for, pay no taxes, and all that cash can be used to get new cars and other frills.

          [i] If you need two things and only have enough money for one, and that one is “paying taxes”, well, you can figure it out. Hell, last year I had to postpone a brake job to pay the feds! That could have been disastrous![/i]

          Must have been a heck of a brake job. I usually only pay no more than $200 or so for one. And, I could put that on a credit card and pay it the next month and accrue no interest.

          [i]Unless they’re completely stupid they’d better! Holding money while more is being printed is the dumbest thing in the world to do. Its value will evaporate right before their eyes! Somehow I find it hard to believe that people talented in acquiring money don’t know that. People who STEAL it certainly do![/i]

          Hm. Lots of dumb people then.

          And, smart people didn’t have their money in housing or banking investments the past few years. Otherwise, they lost their butt.

          Still, infrastructure is needed. I could debate that having programs to help people get jobs is a needed part of infrastructure. I can even say that having public assistance (but IMHO, in a WAY different form than it is now) is needed because putting money in someone’s hands…even he who doesn’t get off his butt…keeps them from robbing, hurting, or killing people for what they want.

          Also, I don’t see it as government’s role to back things like power and water, unless government wholly owns and operates the utility and turns its profits back to the people in the form of money or improved services.

          Government should not fund private enterprise. That’s why I thought GM and Chrysler should have been allowed to rot along with AIG, Merrill Lynch, Bank of America, Chase, and Goldman Sachs.

          But, I guess those $10Ms in campaign monies they give to politicians gets them all the corporate handouts and tax breaks they could want to bolster their profits and balloon executive compensation packages.

          Sad when money overrides the common good.

          “For the love of money is the root of all evil: which while some coveted after, they have erred from the faith, and pierced themselves through with many sorrows.” – 1 Timothy 6:10

          Just a little post-Christmas thought for ya there 🙂

          Happy New Year too 🙂

        • #2820632

          Indeed!

          by tonythetiger ·

          In reply to I take issue with that

          [i]So, why then:
          – do I pay federal taxes that go to fund public schools…when I have no children?
          – do I pay federal taxes that go to economic recovery projects in your state?[/i]

          Why DO you? Or why do the tax moneys go to say, school sports programs, when your kid can’t play? (personally I think all schools should be tuition based, and all “extra-curriculars” pay-to-play. The “economic recovery programs are just another way for the government to get it’s paws on the wealth of others. Some states pay the same as they get, so the only reason for it is so Uncle Sam can get a cut.

          [i]Are you saying taxes and fees should be “a la carte”, and do you know the amount of complexity and bureaucracy that would create?[/i]

          With roads it would be easy. You know the weight, and you know how many miles you drove. Most people are honest, so they could just give the registrar the odometer reading when they get their license plates renewed. Audits would be few… take the reading at accident scenes, and whenever the vehicle is sold.. put it in the computer, and anything way out of line could throw up a flag for auditing. Other things would have to be examined, but I’m sure a lot of them could be metered.

          [i]I can’t see where the system fails to let anyone suffer, unless they just won’t get off their butt to go get things. In fact, I’ve seen where people who live making $20,000 a year with 3 kids live better than people earning $55,000 because they can go and get everything paid for, pay no taxes, and all that cash can be used to get new cars and other frills.[/i]

          And that’s a problem, in my opinion. The “free stuff” is a disincentive to working harder to get what you want.

          [i]Must have been a heck of a brake job. I usually only pay no more than $200 or so for one.[/i]

          I just paid $538 for 4 rotors and 4 sets of pads (and I had a $50 coupon). I REALLY need a set of tires (cords showing in one)…. but it’ll have to wait.

          [i]And, I could put that on a credit card and pay it the next month and accrue no interest.[/i]

          People who are close enough to be severely affected by a brake job probably don’t have a credit card, or if they did, it’s maxed out.

          [i]Hm. Lots of dumb people then.

          And, smart people didn’t have their money in housing or banking investments the past few years. Otherwise, they lost their butt.[/i]

          I would never have done it personally. I do not view a home as an investment. It’s just something to keep me warm and dry. Betting on financials is just that, betting. A good investment, in my opinion, is in something that you think will create opportunity… Expanding a plant, for example… invest in actions… not in things…

          [i]Still, infrastructure is needed. I could debate that having programs to help people get jobs is a needed part of infrastructure. I can even say that having public assistance (but IMHO, in a WAY different form than it is now) is needed because putting money in someone’s hands…even he who doesn’t get off his butt…keeps them from robbing, hurting, or killing people for what they want.[/i]

          Sounds like paying protection to the mob… 🙁

        • #2822777

          And since people don’t die from being well,

          by tonythetiger ·

          In reply to You make some excellent points

          well care should not be covered at all! 100% out of pocket.

        • #2822773

          Tell me, Tony

          by santeewelding ·

          In reply to And since people don’t die from being well,

          Your thumbnail photo-avatar…

          Is that a stack of CDs, or a Uniroyal tire?

          I am retarded in these things. Help me out.

        • #2822741

          Tape

          by nicknielsen ·

          In reply to Tell me, Tony

          A Scotch® brand.

          Speculating it might be electrical…

        • #2822712

          Duct tape.

          by tonythetiger ·

          In reply to Tell me, Tony

          Like me, repairs anything!

    • #3012893

      Almost a good idea

      by jackofalltech ·

      In reply to In regards to medical care, what would happen if. . . . .

      But the real problem is the COST of medical care in the first place and that is caused, in a large part, by the cost of medical malpractice insurance. My wife alone, in the span of just 10 years, lost 3 OB-GYNs because they just couldn’t afford the insurance anymore and retired.

      What should be done is multi-part:
      1) Suits should only be allowed in the case of negligence or gross incompetence. A panel of medical experts to do Triage. Accidents happen – that’s what YOUR insurance is for.

      2) A cap of US $1 million on any single award if the case does go to court and the defendant is found guilty.

      3) As much as I hate govt intrusion, there MUST be price limits imposed as already done on Utilities. US $10 for one aspirin while in Hospital is egregious.

      • #3012890

        You tilt

        by santeewelding ·

        In reply to Almost a good idea

        As they do all, at technical windmills.

        • #3012835

          Muchas gracias…

          by nicknielsen ·

          In reply to You tilt

          …Sancho…

          😉

        • #3023299

          Por Favor

          by jackofalltech ·

          In reply to Muchas gracias…

          Would you please tell me what, specifically, you were thanking him for? I don’t understand anything he says.

        • #3023297

          You do, at least, understand

          by santeewelding ·

          In reply to Por Favor

          That, if you have to ask, you can’t afford it.

      • #3023210

        Agree with the sentiment

        by tonythetiger ·

        In reply to Almost a good idea

        [i]1) Suits should only be allowed in the case of negligence or gross incompetence. A panel of medical experts to do Triage. Accidents happen – that’s what YOUR insurance is for.[/i]

        Agreed.

        [i]2) A cap of US $1 million on any single award if the case does go to court and the defendant is found guilty.[/i]

        Actual damages could top that… So I’d recommend no cap for actual damages and any punitive damages be charged only to the “actual person” who was negligent or incompetent. (intentional acts should be treated as crimes, and dealt with by the criminal justice system).

        [i]3) As much as I hate govt intrusion, there MUST be price limits imposed as already done on Utilities. US $10 for one aspirin while in Hospital is egregious.[/i]

        Unfortunately, they have to recoup the $7,000 cost of the life flight when the patient can’t pay.

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