The Huffington Post describes the administration’s health care proposals as a work in progress. Sheri and Allan Rivlin write:
Some voters may believe the criticisms from the Republicans that the Democrats are plotting a government takeover of health care, while other voters may be lamenting that such ambitious plans have now been taken off the table. The irony is that Obama’s much maligned strategy of letting Congress hammer out the details of health care reform is just now starting to look quite sensible.
After several ideas have been floated only to sink from the weight of too large a price tag, there continue to be negotiations in both the Senate and the House where liberals and moderates are slogging through the messy details and making progress toward a set of incremental reforms that actually have a chance of passage and could make a real difference in improving the life and health of millions of Americans. Rather than criticizing incremental reform as half measures and sellouts, this is just the kind of progress progressives should be ready to embrace.
That side-steps the question of what their respective “visions” for health care are, which you can define as what the health care system would look like if either the conservatives or the liberals had their druthers. Tigerhawk has had three posts in a row on the subject of what he thinks the administration is up to. 1, 2, 3. Tigerhawk’s latest post says:
If you do not believe conservatives who say that the “public option” is a trojan horse for a single-payer health care system, you’re always free to believe the liberals. Obviously that’s the reason for it. There is no other even theoretical justification that makes sense.
I think it is fair to say that captures what at least some of proponents of “health care reform” are working for. It’s a fact that some want a “single payer system”. It may not be what they can achieve, but maybe its what they want. Surely that is a legitimate goal to work for. However, Barack Obama argued that suspecting such an agenda even existed was an “illegitimate concern”. Why should it be any more illegitimate to believe that advocates for a single payer system exist than it is to advocate it? Or are there some things that people are allowed to work for which we are not allowed to think they’re working toward?
When the Huffington Post tells “progressives” not to worry about a “sellout” while “other voters may be lamenting that such ambitious plans have now been taken off the table” doesn’t that translate to “don’t worry if we don’t get a single payer system this time around”? Well I don’t know. But I hope it’s not illegitimate to wonder.
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It’s not all that “murky.” It’s going to pass (Grassley, and the majority of the Republicans want it more than the Democrats. They’re chomping at the bit to “make a deal.”)
Twenty, or thirty Million American Citizens are going to have health insurance that can’t afford it, or qualify for it, today.
They’re all going to run to the Doctor as soon as it passes, just like they did in Mass. It’ll be a mess.
The quality of your care (wait times) will deteriorate a bit, and your costs (taxes) will go up.
In 5 years everyone will be “Proud” that we have health care for everyone.
It’ll be Grreat. Except when it isn’t. Next.
Oh, and thank God we didn’t nominate Romney. He might have lost, and we would have ended up with Obama, and National Healthcare.
See how smart we are?
OT, but very interesting story
Pardon me for being obtuse, but I’m from Australia and don’t really understand how the US health insurance market works. Once you have bought insurance, are the premiums regularly reassessed, or do they stay more or less constant, even after the diagnosis?
Does the company just offer you a standard package based on age and a questionnaire? Is this regulated by law, or are the companies free to demand, say, full monthly medicals?
The health market is fundamentally unlike others. It is that rare market in which you cannot (when you have a tube up your nose) refuse to buy the product, whatever the price, and you have no real ability to assess the value of what you are buying.
I am therefore of the tentative opinion that a market solution may not be optimal.
A government solution would be inefficient bothersome and expensive (as here in Australia), or it might be efficient convenient and staggeringly expensive. Is there a middle ground? A synthetic marketplace of some kind to soak the healthy and subsidise the sick without sticking the bill to the grandkids or letting Government run the fine detail?
Re-read that – I almost sound like a leftist troll. I’m not – just seeking opinion. Read daily, rarely butt in.
And my appreciation to wretchard. Thank you.
Sorry about the name in #3
I am Son of Max, rest his soul.
Son of Sam, this Wikipedia article on US health care may help. There is also this interesting post by Bala Ambati, who I linked to recently.
Just as Australia has a mixed public/private system, so does the US. About 28% of the population is covered to some degree by the public system. I was rather surprised to learn from Dr. Ambati’s article that nearly fifty percent of all spending on health is already from the government funding. As Wikipedia puts it, “public spending accounts for between 45% and 56.1% of U.S. health care spending.” The other interesting thing is that while the US system does very well at some things (like high end care and medical innovation) it lags in other areas (like primary health care). In fact one of the reasons why it is so hard to do apples-to-apples cost comparison with other health care systems is that the US system has different outputs. As Dr. Ambati puts it, “And, most importantly, our research, development, and innovation is unsurpassed – indeed, there is a good argument for saying that Americans subsidize other countries’ populations by allowing drug companies free rein in price-setting here (other countries have price controls, while we do not, which allows companies the breathing space for investment in R&D).”
But it’s not all about doctors and medicine. One point that Dr. Ambati repeatedly makes is that because of the tort system, a hefty percentage of your bill isn’t for doctors or medical services at all, but for lawyers. The world’s “most expensive” health care system is that because the lawyers are all over it, so there is some natural suspicion toward the politician-lawyers who are now trying to “reform” it.
So when the politicians “frame” the debate in pastel colors, there are really a lot of nuances. It’s already a hybrid government-market system, but again that’s misnomer in some respect. The market part of it is flawed. Many of Ambati’s proposals are really aimed at not only getting the lawyers out of the system but restoring competition; by breaking up the oligopolies of health insurance coverage. While it’s true that there will probably exist areas of market failure in which a government role may be required, many of the cost problems really arise not from a surfeit of market behavior, but from a lack of it.
In my opinion, the health care system isn’t exclusively about delivering “health” so much as about satisfying a number of very powerful interest groups, all of who make money off the current system. The question one has to look for in “health care reform” is how these groups will fare under the “reformed system”, which you could cynically characterize, from one point of view, as a re-architecture to distribute spoils. I think it is unlikely that there will be order of magnitude improvements in health even under the most optimistic scenarios offered by the health care “reformers”; in fact the focus is on costs. President Obama isn’t promising you an extra five years of life; he’s selling savings. His primary pitch is that reform is needed to save the economy from the current ‘wasteful’ practices.
Cost is one of the major points around which the debate revolves. Will Obama’s proposals lead less expensive care? There are some empirical datapoints, including that of the Commonwealth of Massachusetts, which can help resolve that issue. But one factor which has been given relatively little weight is to game out how the “reformed” health care system will function with the existing set of actors aboard. Cui bono? is a question that has to be asked now, more than ever. It’s the essential context. and I think it is not very helpful to imagine America with a Canadian, British, French, or Australian health care system as if by adopting that or the other system it would behave the same way; it would not because the actors running the borrowed system will be the same old constituencies, some enlarged and some diminished, and so it will behave differently from its putative model. I think it may actually be more helpful to start with the current set of actors now involved and choose a formal system in which their worst instincts will be most mitigated. Ultimately, I think that the health care debate is ultimately as much a political question as it is a medical one.
Max-
The problem with U.S. healthcare is actually quite simple. Purchasing decisions do not exist at the same level as the actual exchange of goods and services, so market forces which would keep costs down are not brought to bear.
In essence, you allow your employer to purchase your health care coverage using your pretax income from an insurance company. Your money changes hands without any influence from you.
Then, when you use health services, the insurance company pays your doctor/hospital. Again, you have very little to do with that decision.
So, essentially, the person purchasing health care and the person/company providing it have no direct financial interaction. Ergo, no true market forces.
The solution to our health care mess would be a very simple one – large deductible individual/family health plans which gave coverage for what people REALLY need insurance to cover (catastrophic injury/illness) and leave the mundane, everyday stuff like checkups and broken bones and stitches for a small cut to a business relationship between the doctor/hospital and the patient. However, this would remove the bulk of the expenditures on health care from the purview of the insurance compnies, and they couldn’t siphon off their 12-20%, so they have literally no financial incentive to offer plans like that on any large scale.
Health “reform” should come in the form of government enabling new companies to offer these high deductible plans to compete with the larger companies who offer low deductible plans. But that won’t happen with Democrat-controlled government, either.
Max, my two cents worth: Problem started in World War II when (unecessary) wage and price controls kept employers from paying like they should. As a dodge, they started paying health care insurance premiums for their employees.
As no mo uro noted, throwing money at insurers almost blindly has resulted in drastic cost increases above and beyond those necessitated by long-term dollar value and developments in the medical field.
A quick fix that would endure would be for employers to stop paying premiums and instead give their employees health care vouchers and let the employees shop for their own needs.
In 2008 my employer and I combined were paying over $300 a month to give me 80% coverage with a $3000 deductible. At age 63 I could have gotten on my own 80% coverage with $5000 deductible for $187 a month. Or I could have gotten 100% coverage and $5000 deductible for $387 a month.
A voucher system would a least stabilize costs for all and for the most troubled firms like General Moteors enable up to 60% saving
in their costs.
Rufus;.
Oh, and thank God we didn’t nominate Romney. He might have lost, and we would have ended up with Obama, and National Healthcare.
Or he might have won and we’d end up with Romneycare on the way to National Healthcare.
Sounds like the man who admitted that he was warned that if he voted for Goldwater we would end up in a land war in Asia and by gum they was right.
We need National Law care with lawyers assigned to locations based on an impartial government agencies determination of need and their pay to be based strictly on objective criteria of productivity with no lawyer making more then double the average income in their SMSA. Also public rights to claim damages for any harm arising from a lawyer’s acts as determined by a review board staffed by government clerks.
No mo uro writes: “Purchasing decisions do not exist at the same level as the actual exchange of goods and services, so market forces which would keep costs down are not brought to bear.”
Except in some areas such as lasix and cosmetic surgery, where market forces keep driving down costs.
OK, surely the fact that they created an instant fiasco with the Cash For Clunkers program doesn’t mean they can’t come up with a complex, effective and efficient health delivery and funding system, does it? I mean, if HuffPo likes it, it can’t be all bad, can it?
Why are we even talking about HuffPo? Because that’s the nature, and the measure, of modern politics.
0bamaCare is nothing but an old insurance scam where you force healthy people to join a insurance pool of sick people. The healthy people then subsidize the sick people the pool.
Naturally, 0bama will not be joining 0bamacare – nor will his cronies. They will enjoy their lush perks including their own health care system.
People are starting to see 0bama as a fast talking swindler. Hopefully, people will become angered enough to stop 0bamaCare. But, Chicago Thugatics is a potent tool. It will take a lot to stop it.
Thank you wretchard and others for your long and thoughtful replies. I wish that I could think as quickly or with such consideration as you can type!
I asked about the financing of health care, given that our purchases of it are variable, unpredictable, often pressing and usually uninformed. Could a solution of sorts derive from separating the purely (essential) medical from the non-essential or non-medical costs? I wonder who could unravel that knot??
Is this the classic contest of finite resources and infinite wants? How much are the ‘wants’inflated by lawyers, bureaucracies and suchlike. Peel away the epiphytes, how much left is tree?
Anyway, please pardon me, but it’s bed-time here in Canberra. I hope you’ll keep the thread open another 24 hours. I really appreciate the time you’ve given me.
blogstrap,
The fact that the HuffPo or The Daily Show have any standing in a conversation among adults is a system flaw. They provide a wedge from the Left for making people comfortable with accepting arguments delivered via Saturday Night Live and Late Night. In my opinion there are equally discreditable sources on the ostensible Right, such as Donofrio’s blog, that serve only to muddy the waters and prevent meaningful discussion. In the distant past a more conservative and self confident culture was comfortable with gatekeepers enforcing standards on who was considered a credible source. This demanded a highly self critical stance on the part of the providers of information. That ethical sense was internalized, as an expression in a mature society of what Max Weber called “Organic Solidarity” and is a mark of professionalism. The loss of that quality among Journalists is partly a function of shifting market forces and more a result of the termite like destruction of key institutions, academia, law and journalism, for over a century. This began long ago, certainly by the time of the Fabian Society of Sidney and Beatrice Webb and has accelerated under the label post-modernism.
Such an agenda is an “illegitimate concern” because no one will admit whose baby it is. We not only don’t have a father to confess to the blessed event, we don’t even have a mother.
And I think just about everyone is missing the point. The Medicare and Medicaid system is unsustainable, and this fact has been known for some time. In the 90’s Newt Gingrich suggested a new system that would allow Medicare to “wither on the vine” because everyone would prefer the new alternative. He was excoriated for it, and the Medicare Wither statement was used as a talking point for the Democrats for years thereafter.
What Obama and the Democrats are really trying to do is force the private sector to pay for an expanded Medicare and Medicaid system but without making the increased taxes obvious. If the “Farm Vehicles” line at the Dept of Motor Vehicles is short and the “Private autos and trucks” line is too long and people complain about this fact, then simply require everyone to buy a Farm Vehicle and the lines will be equalized; the problem disappears.
It is as if the Government decided to respond to a lack of funding for the Food Stamps program by requiring everyone to use food stamps and then collect all of the money you would normally pay for food to pay for the food stamp program. And with those Food Stamps comes all of the restrictions that accompany them on what food you can buy.
Last thing for the night – I agree that once you’re given ‘universal health care’ you’ll never be rid of it. Our last government was staunchly conservative on most things but Medicare (the Oz, not American version) was inviolate.
Whatver it cost.
Personally I believe that every licensed hospital should receive a flat subsidy from their local government, amount based on the size of the catchment area, to provide basic stabilization and referral emergency services for ambulatory patients. The anticipated costs of basic services should be displayed and information should be provided to a patient prior to service being rendered as to the anticipated costs that they might be facing. These estimates should be based on a historical record of fees generated in similar cases and should be available for the top 50 basic walk in conditions. That does not apply to catastrophic injuries or complex infections or cancers but does apply to many simple cases. If someone walks into an ER as I did with a cut finger the Nurse should say to them “We can bandage you and send you to the County Hospital for free (or $50) or if you need a stitch it will cost you $200.” What should never happen is their saying “Don’t worry about it Let’s take a look.” followed by their rinsing it with water and putting a bandage on and then sending a bill for $1,100, as happened to me.
“But I hope it’s not illegitimate to wonder.”
—
It is, but what the heck, we only live once,
might as well live dangerously.
—
A Bennet caller attended the townhall featuring Spector and Sebilius:
She said the T-Party Crowd was loud and proud.
She carried in her John Boehner’s Chart of the nightmare and based her statement to the Senators on that.
—
Reported that
SPECTOR SAID IF HE HAD HIS DRUTHERS WE’D HAVE SINGLE PAYER!
—
Bennet asked York why in the World he would say that, and Byron replied that there is a large bloc of Dems who desire single payer. The Dems cannot totally alienate them, thus they send out signals/hints to get across the point that Public Option is indeed the foot in the door that will not ever let the door close again.
…if the financial situation weren’t so bad they probably would have gone directly to single payer, given they own the House, Senate, and Whitehouse.
Life of the mind,
What are you crazy? You went to a medical facility to inquire about a medical problem? What were you thinking?
No stitch required. But I am projecting that you couldn’t know that until someone competent took a look. But then instead of exclaiming “Pish posh big boy, go put a band aid on” for a less then $5.00 treatment you got the works. Did they give you any aspirin for the pain associated with looking at the bill?
The difference is under Obama-like care your cut is viewed as “income generation” or maybe an “investment opportunity”, while under a reasonable, rational and ethical system of care, it is just a minor cut.
Wadeusaf,
I sat in a chair while an Intern or Resident washed it off, he called it “irrigating”, put a new bandage on and gave me two small tear off containers of Bacitracin&Trade;. I walked in and asked them to look and tell me if I needed to go to County. That was about it, no works, no blinking machines. I sincerely hope we all live as long as it will take them to see any money.
All this talk of health “care” is making me sick. Can we believe anything that comes out of the mouth of a politician? Call me jaded Joe.
Lifeofthemind:
My brother is a pharmacist and he has explained to me how it works. Say that a pharmacy pays $9 for a standard dose of a drug. They plan to sell it for $12. Then someone comes in with a prescription for that drug and they fill it but have to file with the patient’s insurance company or Medicare or Medicaid. The insurance company, or especially Medicare or Medicaid then says “That’s not worth $12. We will only pay you $9.” And of course, to even get the $9 they have to fill out the required paperwork, which is more work than just taking the money. So they have done more work and made no profit and not even covered the salary of the pharmacist and the cost of electricity for the store.
So then one day Mr. Life F. Mind comes in with a prescription. He is just going to pay for it himself, no insurance or Medicare or Medicaid. Do they charge him $12? Do they charge him $9? No, because they deserve to have their expenses covered and make some profit and have to make up the losses for the guy who got it for $9.00. So they charge Mr. Mind $20.
Now, multiply that by every service in the hospital and by multiples of freebies who are not even covering the costs of the product for everyone that is, and you can see where the $1100.00 comes from.
So how is this gonna work if everyone is a freebie? I can’t imagine how it can.
My job as a research scientist at a local College of Pharmacy evaporated last year due to reduced NIH funding. Almost all research and science positions there are soft money, unless you are a professor.
My concern is, once we have a “new and improved” system for health care – will there be ANY medical research conducted?
Who’s going to invest in R&D if there’s no market? Will there be any efforts to address new challenges (creative development)? or will it be all about dividing scarce assets to constituencies (politics)?
Rufus could not be more out of touch with events if he was living on Mars, but maybe it’s the heat in Mississippi that’s got to him.
Republicans would be committing political suicide to side with the socialists.
(Snow and Spector being exceptions, Spector is likely a dead man walking politically, anyway)
If deals are made they will be made to pass muster/give the Dems sufficient cover to crow victory, but not give them their road to single payer.
Grassley will get an earful as are all the rest of the Senators having Townhalls.
(Bennet’s Senator’s [Cardin?] “Townhall” is by invitation only!)
Another gave his quick and without notice to the public…
Overreach, corruption, and cramdowns are not real tasty fare for the American Public.
If we end up with Socialized Medicine, it will come via Obama assuring the Bluedogs that he and ACORN will have them covered in ’10, they’ll get Amnesty, and a permanent majority.
RWE:
Here’s a real world example illustrating your point. On May 6, I was out for an evening walk and was bitten on the arm by a pit bull. I wasn’t horribly mauled, but I received a deep puncture wound above the elbow. I went to the emergency room and had it cleaned and dressed, and got a tetanus shot, after a four hour wait. The Medicare Summary Notice form came Saturday. The total for the visit was $907.50. The “You May Be Billed” amount was $24.45.
I expect that Mr. Mind would have been billed the full $907.50 to help cover the other people in the emergency room who had no way or intention of paying.
Also, it’s been almost three months and I still haven’t been billed. The mills of the bureaucracy grind exceeding slow.
I remember we went thru this in another post.
Medicare only covers ~80% of costs. Indigents generate costs with no compensation. Lawyers take a rent payment. MedMal insurance is huge for the doc and distorts the treatment regime. Insurance (both Govt and Private) admin overhead for the doc is a chunk. And we havent bought the first bandaid. So by the time LOTM shows up with an injury the bill is $1100 for which $200 may be direct cost.
A twisted and distorted market is an ugly, ugly thing. But not as ugly as the NICE.
The “healthcare” Rufus says we’ll be “proud of:”
“physician aid in dying”
SPRINGFIELD, Ore. – Barbara Wagner has one wish – for more time.
“I’m not ready, I’m not ready to die,” the Springfield woman said. “I’ve got things I’d still like to do.”
Her doctor offered hope in the new chemotherapy drug Tarceva, but the Oregon Health Plan sent her a letter telling her the cancer treatment was not approved.
Instead, the letter said, the plan would pay for comfort care, including “physician aid in dying,” better known as assisted suicide.
“I told them,
I said,
‘Who do you guys think you are?’
You know,
to say that you’ll pay for my dying, but you won’t pay to help me possibly live longer?’”
Wagner said.
Absent an economic recovery based on sound economic principles, we shouldn’t be surprised that the government will have less revenue to fund the increase in the number of people who will need to turn to Medicaid (which currently covers 20% of Americans, according to NPR:
http://www.npr.org/templates/story/story.php?storyId=106824862&ft=1&f=1003).
Let the downward spiral begin:
e.g., via Health Care Finance News:
“As the U.S. economy has deteriorated, Dayton Children’s has seen a “significant and rapid shift” in its payer mix toward Medicaid, Miller says. Almost 50 percent of patients at Dayton Children’s are Medicaid patients.
“While a larger percentage of Medicaid patients is common in the community of children’s hospitals, the increase in Medicaid patients that Dayton Children’s experienced in late 2008 was “historic,” Miller noted.
“Medicaid pays only 76 percent of our costs,” said Miller. “Every 1 percent increase in Medicaid patients costs us about $1.2 million. We had a net revenue problem develop very rapidly. You just can’t run a hospital on Medicaid alone.”
“Miller believes that the federal government and the states need to put more money into the Medicaid system and increase payments to providers.”
Hope its safe to post here. Does anyone know what caused the troubles? Can I expect a knock at my door in the dead of night…..wait who are you….I don’t want to go for a ride…
26 and 27 have at least two major prongs of this dilemma right.
As a healthcare practitioner, my clientele has moved back toward the public sector in the past few years. The squelching of that source of funding, which is imminent as managed care practices permeate that portion of the market, will definitely create a decline in my organization’s productivity, if not encourage me to throw in the towel and open a falafel shop.
Collectivist schemes will only make things worse. I haven’t done Medicare in years other than as a loss leader. The elderly have always represented an ideal place for our services, but there has never been a way to make, rather than lose money, so it can’t be done in my field (psychology/ psych assessment). The loss of a service that could distinguish dementia from other etiologies of problems in the elderly is significant from a quality standpoint, but that is exactly the kind of “frill” that public healthcare drops as too expensive.
From a macro standpoint, we are fighting the same battle that we are on abortion. Obama said in his inaugural address what was going to happen when he said “all people are equal.” That is that same as saying the state is to control things, not the individual, which makes the individual life dispensable at the whim of the tyrant.
That is why there will be blood on the floor eventually unless we tie them down like the Lilliputians did Gulliver, while they’re intoxicated by what they think they can control and can’t.
Many lives are at stake if we fail.
Look at it this way:
The new health care system is either going to be like putting everyone on Food Stamps or it is going to be like a healthcare version of the Community Reinvestment Act.
Either the Fed Govt will be deciding who gets to eat what and how much or else the government will be telling private firms that they have to provide healthcare for a price they specify.
The next step will be when people find out that you can take your money out of your pocket and buy healthcare directly with no middleman. And this will bring screams because “it’s not fair.” This is already happening in Canada, where doctors are breaking the law by setting up private pay as you go clinics and people are complaining that this simply removes capability from the publicly provided system.
Son of Max,
Does the company just offer you a standard package based on age and a questionnaire? Is this regulated by law, or are the companies free to demand, say, full monthly medicals?
…
I am therefore of the tentative opinion that a market solution may not be optimal.
There is no standard package, it is not regulated by law, the price is adjusted annually depending on costs (“tiers”), and I suppose they are free to demand whatever they can dream up.
I agree, market forces are not sufficient here as it would shut half the population out of most healthcare, and that’s just not political viable.
Our basic model is still the employer-based insurance policy system based on the GM/UAW model worked out by politicians and economists in the 1950s.
The tort issues are significant, but if all the lawyers became honest tomorrow it would not change the underlying problems much, though perhaps all costs would drop 25-30%. The basic problem is infinite demand for resources not entirely allocatable by market forces.
Excellent comments thread
One aspect has not been mentioned – State regulatory agencies. Each of the 50 States regulates health insurance policies within their borders. First, these regulations are heavily influenced by local constituencies. Second, it is unnecessarily complex to offer products across State lines.
This leads to mandated coverages – things like chiropractic and pregnancy services.
Unravelling this knot is a major political problem.
Doug, Grassley is a Hero in Iowa. He might be the “Safest” Senator in America. The whole deal with him, and the other “Corn State” Senators is an “Ethanol” deal.
They want the 15% Ethanol “option,” and the death of “Indirect Land Use Change.”
Plus, be careful of the “sound chamber” feedback effect. Health Care reform isn’t nearly as unpopular in the hinterlands as some of our more rabid “conservatives” would have us believe.
The most informed care debate I’ve seen yet. i am an American who has lived in Perth Australia sinc3e ’76 and I think Wretchard’s point is critical that you can’t just impose a foreign solution on the US because the interested parties are extremely entrenched and will be fighting to maintain their take. That said, I think it is worth repeating the cost comparison, commonly made in the press here in Australia, that he US spends 16.5% of GDP on medicine while Australia spends 8.8% (2005 via Wikipedia). While it is fun to point that out, I am under no illusion that the US could cut their figure almost in half by simply imitating Australia. I agree with Wretchard that because the US does not control the price of drugs the US public carries more than its share of big pharma’s r&d costs. I don’t have any data to compare how much Australia contributes to medical research in comparison the the US but for a small (25 million) country we do make a real contribution. I also have MD friends here and their malpractice insurance has gone up but is not nearly as high as it is in the US. Nonetheless I shudder to think what the public will end up with given the relationship between Congress and those who are now making that nearly 8% of GDP.
Barack Obama argued that suspecting such an agenda even existed was an “illegitimate concern”.
Noticing the little man behind the curtain in “progressive” palaces is considered to be rude. But, just like only White people can be racists, only non-progressives are capable of being rude.
Double standards are so nice–they often provide a convenient alternative to thinking.
Some are mentioning that uninsured patients pay more. I have had the opposite experience. I was getting orthotics for my shoes. These things help me a lot, and I was willing to pay a couple of hundred dollars even though for me that’s serious money. The guy filling out the forms said, “It’s $250. Does your insurance plan cover it?” I told him no. He said, “We hate that. OK. $125.”
I inferred from this that sometimes providers send very high bills to the insurers, hoping to get the maximum possible, but that they don’t need that much. In other words, I inferred that providers set the “sticker price” very high so that they never leave money on the table, but in fact the real cost is often much lower. (Sort of the way American colleges charge enormous tuition prices because there are a few rich people who really can pay it, but many students get significant discounts.)
If that’s right, then if you receive a huge bill for something that you have to pay, you should try negotiating with the provider.
But then again this was about five or seven years ago–perhaps insurers are now much more aggressive about refusing to pay high bills.
Anyway, the next time my orthotics wear out, I’m going to invest $15 in over-the-counter orthotics, which I didn’t know about back then.
I hope it won’t try the patience of BC readers if I offer some observations and an alternative way to improve our health care.
1. We have a doctor shortage. We have built only 2 new medical schools in the past 30 years. As our population has aged and grown by more than 50 Million, the number of physicians we are graduating has remained about the same. In addition we have added millions of immigrants (BTW, I am very strongly in favor of increasing legal immigration) many of whom are here illegally. Many of those illegal immigrants come here with health problems that adds greatly to the total number of patient visits in the US.
Furthermore, 30 years ago the overwhelming majority of graduates from medical school were male. Now women constitute nearly 50% of those graduating from medical school. Given that I am married to a physician and hope my daughter will be going to medical school, and that my principal doctor is a woman, I obviously favor the idea that women should have equal opportunity to go to medical school. However, this does have consequences.
Male physicians put in more patient hours during their lifetime career than do female physicians. This is largely because women physicians reduce their hours of practice during their mommy years. It is also because quality of life typically matters more to women than to men, who on their part are more driven, as a generalization (lots of exceptions) to make more money and to rise to higher positions. Whatever the reason, it is nevertheless true that the number of patient hours over a career that you get out of a male physician is significantly greater than the number of patient hours you get out of a female physician over a career.
The implications of this are clear. We have reduced the total number of patient hours our medical school graduates can provide while at the same time the population has grown larger and older. The ratio of need to resources has worsened over the past three decades.
My proposal is to triple the number of people who graduate from medical school over the next 20 years and quadruple it over the next 30. By 2040 we should be graduating four times as many physicians as we do today. This will lower costs by increasing competition, make for more available patient hour slots for our aging and growing population, thus simultaneously improving quality of care and lowering costs.
Yes, there is a front-end cost. Medical schools claim that the costs of four years of medical education exceed tuition by about $50,000 per student. So for each additional physician we educate we will add $50,000 to the bill. But this will be more than recuperated by the reduction in costs down the line.
Another potential unintended side effect of my first proposal is that we will have a hard time finding enough qualified students. I strongly doubt this. There are tons of students who are excluded today because they don’t fit the demographic profile the schools seek but who are otherwise highly qualified.
Still another potential unintended side effect might be that with declining incomes, fewer people will seek to become physicians. This is indeed a possibility. But there will still be great prestige in a medical degree and there will be plenty of currently under served areas where new doctors can go, with reduced costs of living, and a good life style.
I would also extend this tripling to RN’s, Nurse Practitioners, Physician’s Assistants, and all other patient care medical personnel.
2. Restore the number of specialists to prior levels. Willie Brown, once the most powerful person in California when he was Speaker of the Assembly, revealed his total ignorance of economics when he slashed the number of specialists trained in California. Because he learned that specialists charge more than general practitioners, he decided to cut the number of specialist residencies in the UC system. When I was a resident at UCLA in 1971-4 we had 20 residents in my class at the main hospital plus 10 more at the VA for a total of 30. Thanks to Willie Brown we now have 14 in the combined program — a reduction of more than 50%. Does anyone want to guess how many neurosurgery residents graduate each year from UCLA? Well, thanks to Willie Brown the answer is 1 — yes, just one.
What has been the result? There are fewer and fewer specialists just as medicine is getting more and more complex. And with fewer specialists, the fees for the reduced supply plus the increased demand goes where? Up. Even Willie Brown couldn’t repeal the law of supply and demand.
So the answer is to graduate plenty of generalists but also plenty of highly qualified specialists. That way rural areas and certain neglected urban areas will have a sufficient number of specialists to serve the needs of their patients.
3. Unlink health insurance from employment. The linkage of health insurance with employment is an accident of the wage and price controls of World War II. Companies could not offer their employees raises so they offered them “fringe benefits” instead. But why should health insurance be linked to employment? No other insurance is so linked.
Make health insurance more like car insurance and life insurance. Return it to the individual. Certainly, for economy of scale and bargaining power, let folks create other collectives, such as fraternal organizations, churches, etc, if they want. That way they will carry their insurance with them even when they change jobs. And that way they will not have to be reevaluated every time they move to a new employer.
In addition, job linked health insurance creates the illusion that the subscriber does not pay for health care. “The insurance company pays.” Or sometimes, “the insurance company doesn’t pay.” But most consumers do not link their premiums to the benefits and therefore don’t realize that they indeed do pay — albeit through an intermediary which takes its cut along the way.
Furthermore, when a claim is denied most patients say, “The insurance company won’t let me have thus and such procedure” or “The insurance company won’t let me have this or that medication.” This is not strictly intellectually honest. No insurance company can order you not to buy a medication or not to have a procedure. All they can do is say they won’t pay for it. This is another way the current system distorts our thinking.
4. Allow generous medical savings accounts to promote wide use of self-insurance. There should be a very high upper limit on the amount of money a person may put into a tax advantaged medical savings account. Somewhere between $25,000 and $100,000 seems right to me. At first, younger people might only be able to put a few hundred dollars into such an account each year. But this is during the years they generally require very little health care. As they reach 40 and start to utilize more care, many will be able to have considerable money in such an account and can then buy catastrophic insurance with, say, a $10,000 deductible. By the time they are 60 many will be able to reduce their insurance costs by switching to a $25,000 catastrophic policy.
By self-insuring, patients will avoid frivolous medical expenses, will have low insurance premiums, and will be in much greater control of what they spend and how they spend it. And the additional bonus should be that unused funds at the end of life can be passed on to heirs tax free into their medical savings accounts. Thus we will have, over 40 years, a greater proportion of self-insured, giving less control to the insurance companies and creating less need for government intervention.
Perhaps such accounts should be voluntary, perhaps a minimum amount should be mandatory. I haven’t fully worked that part through. But the favorable tax treatment of health savings accounts and self-insurance will make things far better over time.
5. But what shall we do over the next 20 years while the increase in doctors and the accumulation in the medical savings accounts ramp up? Good question.
Right now there are wildly different estimates of the number of uninsured in America. The highest figures most Democrats in Congress use are in the neighborhood of 46 million. Of these, about 10 – 12 million are illegal aliens. Whether we should be providing them government paid health insurance is a different matter that I will discuss later.
Of the remainder, it is estimated that between 5 and 10 million actually do have insurance but don’t know it. The 46 million number is based on surveys asking people whether or not they are insured.
Of the remaining 30 million or so, some are transiently uninsured because they are between jobs. They usually remain uninsured for less than a year, though that may be longer during this recession. Others are voluntarily uninsured. Many young folks from their late teens until marriage abstain from buying health insurance because they don’t think they will get sick and would rather have that money for other things. We don’t know the accurate number of the voluntarily uninsured, though some conservatively estimate it at greater than 5 million, though probably less than 10 million. That leaves the involuntarily uninsured. That number is probably closer to 20 million than the 46 million number usually thrown around.
So if we take the involuntarily uninsured plus the transiently uninsured we get a number somewhere between 20 and 25 million. It would be cheaper to give each of those people a check for $10,000 and tell them to use it to buy their own insurance. 25 million times $10,000 = $250,000,000. Isn’t that a whole lot cheaper than the President’s plan?
We can insure the involuntarily uninsured for a tiny fraction of the cost of the so-called “reform” plan now before Congress.
6. What about the voluntarily uninsured and the illegal aliens? That is a very tricky issue. Right now there is nobody who can be denied acute care. Sure, there are occasional incidents in which a patient is turned away from an emergency room, but those are a very tiny percentage. The real questions are, “What is the moral hazard?” and “What is the extent of our obligation to people who are here illegally?”
As to the first, a moral hazard is a situation in which, by enabling irresponsibility, we promote irresponsibility. By taking care of those who voluntarily decided not to get health insurance we encourage more people not to get insurance. It is very similar to the enabling that occurs with alcoholics and addicts. By shielding them from the consequences of their decisions we encourage more bad decisions.
One solution is to require that everyone establish medical savings accounts and to then lump the voluntarily uninsured in with the involuntarily uninsured. Another is to bill the voluntarily uninsured and place liens on their income or property to reimburse for costs. The most draconian, which is hard to support, is to deny care to the voluntarily uninsured. Basically we do that with car insurance and life insurance. If someone elects not to have life insurance, we do not give their heirs benefits out of compassion. They made their decision and they have to endure the consequences of that voluntary decision. Likewise, if someone voluntarily chooses to get bare minimum car insurance and then wrecks their car, they will have to pay out of their own pocket for whatever their insurance company doesn’t cover. We do not reimburse them out of compassion.
Right now there is absolutely no consequence for those who are voluntarily uninsured. And that is a problem.
Regarding illegal aliens, the problem is even more complex. If we deny them care, they may linger in illness, some of which may be communicable, and the general public health might be menaced. And if their children are sick, is it fair to withhold care from them? After all, they didn’t choose to enter illegally; it was their parents’ decision. On the other hand, should we be the free clinic for the world? Especially when doing so drains resources from our own citizens?
Some of the answer to this lies in how you feel about citizenship and nationhood. Those that believe in sovereignty tend to value citizenship more highly and tend to want to accord citizens more privileges than illegal aliens. Others that see nations as arbitrary entities that interfere with humanity in general, tend to want to treat citizens, legal aliens, visitors, and illegal aliens the same. This is not an easy issue.
Nor is the solution of treating the illegal alien and then deporting him an easy choice. But how much are we willing to divert our resources to the health care, schooling, and general welfare of illegal aliens? (Remember, I am strongly pro legal immigration but also strongly anti illegal immigration.) I don’t have an answer for this right now.
7. All parts of my plan have to be adopted in order for it to work. Just taking one part will unbalance the system. But if we are willing to take care of the next 10 to 20 year transition phase while allowing the increase in physicians and other health care folks to ramp up, and to have the medical savings accounts and self-insurance ramp up, and restore control over medical decisions to the patient and the doctor, eliminating the insurance intermediary except for catastrophic situations, we will have solved the great bulk of the current problem without distorting the system or introducing a “one size fits all” government algorithm.
Right now we have the best health care system that has ever existed anywhere — geographically or historically. Yet it needs to be improved. I believe the current plan before Congress will make things much worse in some fundamental and profound ways.
When I was a kid and had to go to a hospital, we went to the COMMUNITY HOSPITAL. Maybe I don’t have all the facts, but if I understand correctly, from the late 19th century to about the 1970′s a lot of communities opened non-profit hospitals by bond issues or some such thing, where the hospital was owned by the community and doctors had operating privileges, and if they had offices, they paid rent for those.
Sometime starting about the 1970′s a lot of communities began selling those hospitals off. Some went to for-profit corporations, others to non-profit groups. Unfortunately, a non-profit group does not equate to charitable or even necessarily well-intentioned. There are some of the non-profit medical groups that are pretty darned cut-throat and have gone into regions and quietly but systematically bought up a huge proportion of hospitals, clinics, out-patient care, convalescent homes, and general and specialty practices. Once they control enough of the market in a region, some of these groups have then abruptly closed specialized trauma facilities (too expensive; there’s another one within a 20-minute helicopter flight – too bad the family has to drive two hours one way…) and other services serving a very small group of folks.
Non-profit merely means the company distributes its income revenues as salaries and on facilities. Doesn’t mean they charge any less than the for-profit facilities.
… necessarily.
I would welcome someone offering alternate views, especially with specifics.
My experience with Kaiser-Permanente in Northern CA was extremely positive. It’s a big health-care organization that has medical personnel on payroll- Pharmacists, Orderlies, LPNs, Nurse-Practitioners, Lab Techs, Histologists, Oncologists, Pulmonary Therapists, Ophthalmologists, Cardiologists, Psychiatrists, etc. Billing and records are all handled internally, not out-sourced to a separate Insurance company, which in turn out-sources its paperwork and IT and accounting to various third-world companies.
I’m sure they will be lined up and shot when the “public option” health care system gets bolted to our ankles.
I’ve heard of the methods other tyrants have used to terrorize their subjects into submitting to forced collectivization.
I, for one, do not doubt there are people in this country who think they are entitled to use any measures no matter how violent or brutal, to impose their will on those who disagree with them.
The things to look for — the things that IDENTIFY THEM —- by definition include things like, oh, stuffing ballot boxes, registering deceased voters, intimidating voters at polling places, preferential law enforcement, and blatant violations of law to reward patrons and loyal supporters.
As much as anything else, those acts are meant as TESTS to see whether they can get away with’em. If there’s no protest – or no effective protest – there’s no reason to stop, and much justification for escalating.
Hitler’s generals – those who survived WWII – confirmed years after the event that if there had been the slightest show of resistance by France or England to Hitler’s troops when he marched them into the Sudetenland, the German General Staff had been ready to arrest and depose him. When the Victors of WWI meekly capitulated and let Hitler take over Czecho-Slovakia, the German generals were astonished, and resigned themselves to Hitler’s leadership and all that followed.
That lesson seems increasingly appropriate to the present contentions.
Sythianeedle @ 38 The Kaiser system initially worked because they were living in a “fool’s paradise” in which all their subscribers were employed and therefore among the healthier part of the population. As their population aged, and as they opened enrollment to others, their balance sheet stopped looking so great.
They make money by denying or delaying care. For years they did not offer epidural anesthesia for child birth because it was too expensive. Now they have a system in which you have to go through your primary doctor to get referred to specialists, frequently with a long waiting period.
On the other hand, things got better at Kaiser because starting about a decade ago, their physician salaries were equal or greater than what many doctors could earn in PPO medicine. So whereas it used to be that the best doctors went into private practice, lately many excellent doctors prefer to work at Kaiser. Furthermore, life style for the Kaiser doctor is easier. When you walk out the door you hand responsibility over to the next doctor, unlike the way things used to be with private practice.
Kaiser monitors each doctor’s utilization of services. If you are deemed a renegade physician who does too much for your patients, you can get in trouble with the administration. Just imagine how things would be if it were the government that was in charge of monitoring all services rendered and disciplining doctors who do “too much” for their patients.
And regarding the general topic of this post, yes, I believe Obama is trying to move us to a single payer system. And yes, some diluted version of his plan will probably pass this calendar year. And yes, in the years to come we will slid slowly but surely into the quicksand of single payer.
Batman 37,
Thanks very much as that was as good an explanation as I have seen on this issue.
The problem is, our current President went to the same school of economics from which Willie Brown graduated from.
He is not only omitting the need to increase the supply of trained medical personnel, but he is oblivious to the fact that many of his ideas are likely to reduce the number of people who choose to work in your profession.
I can’t believe with all of the intelligent, hard-working people that we have in this country that the electorate was willing to put forward such an arrogant, although very well spoken, economic moron.
In many rural areas, the problem is finding any doctors at all. Any health care reform that doesn’t address this issue will be meaningless to millions of Americans.
If, for the purpose of promoting preventive medicine, the government gave out vouchers to each American (or each American earning less than $250,000) for $500 worth of health care, I think I could go along with that. The problem comes with trying to micromanage an entire sector of the economy. Without clear, concise, and readable guidelines that allow state and local governments at least a minimal degree of latitude with their health care budgets, any federal “health care reform” becomes a fiasco.
..
Batman,
Well put. Son of Max, pay attention to his post!
I have a friend (female) who is a doctor, who DOES NOT fit your profile (no children), but we both know that she is the exception to the rule (her sister, who is also a doctor, fits your profile). One the doctors at the practice I go to is also a woman in her late 30′s, early 40′s, who also has reduced her hours to be a mom (she’s a good doctor). There is nothing wrong with that, but it just confirms your hypothesis.
I would only add that medical liability is compelling many doctors (especially OB-GYN) to leave medicine early (in their forties) because of escalating insurance costs. At some point in time, it just becomes too costly to maintain a private practice.
If the AMA would actually police their own (identify bad doctors, which do exist), and there was some reasonable limitation on legal liability on doctors (instead of being all classified as cash cows to be milked or slaughtered), there would not be as severe a shortage as you describe, especially among specialists.
Too true about the limited number of seats at medical schools. I went to college with a host of people that wanted to become doctors, but were just a little short on the academic side (gpa a little low). And many that were denied had a great attitude about serving and the dignity of the healer.
Alexis #41
That’s been my point exactly.
WHAT WE NEED IS MORE DOCTORS
SPEND THE MONEY ON THAT
Here in Idaho, we still don’t have a medical school, and Boise could handle one.
Hey, look, if my brother can be a doctor, and I know the classes are tough, and he’s a better man than I, I’m telling you, we can do this, we have to spend the money right.
Spend the money on something sensible.
Ernie G,
How’s the dog?
My suspicion is that hospitals are carrying phantom bills to the uninsured as a health care version of the “toxic assets” that ate the housing industry. Eventually someone is going to have to balance the books.
steeple,
During his years teaching across the Midway at The University of Chicago Law School did Obama ever visited the Economics Department, at that time directly across from the Law Quad in the top of Social Science Research? My belief is that he only would have been there if he got lost looking for a bathroom.
We were down 5 docs here, from what we need. Just last week, another defection, we are now down 6.
I’m having trouble getting a simple physical exam.
We’ve got a beautiful building, all sorts of equipment, a helicopter, plenty of money, but we are losing our doctors.
Create more doctors.
Perhaps the key metric is not the number of doctors but rather the ratio between the numbers of doctors and lawyers?
This grrrrr system is making me retype all the boxes everytime and now I see in the last one I put a comma instead of a period where I meant to say blogspot.com for the URL. There is no way to go back and fix that.
Batman No. 37 said “Male physicians put in more patient hours during their lifetime career than do female physicians.”
Really, I always thought the female doctors were much more pa-…
What?
Oh.
Never mind.
There are four versions of health care on the table:
1. Liberal version (60 votes in Senate)
2. Moderate version (60 votes in Senate)
3. Liberal version, using reconciliation process (50 votes in Senate)
4. Moderate version, using reconciliation process (50 votes in Senate)
As of this point, #1 has been pretty much defeated.
Therefore as we look into the murky future, we need to figure out if #2, #3, or #4 will pass (or none).
I would game theory these as follows:
#1: Liberal version – 5%
#2: Moderate version – 25%
#3: Liberal version, reconciliation – 15%
#4: Moderate version, reconciliation – 45%
#5: None of the above: 10%
For those that want the health care system left alone, our best hope is actually #3:
Liberal Version, using Reconciliation process in the senate.
If this passes, which I hope it does; it will cause a disaster, which will probably be reversed in a few years.
For an example of this see the Medicare catastrophic coverage act of 1988 (“The Medicare Catastrophic Coverage Act of 1988, the largest expansion of the program since the enactment of Medicare, included an outpatient prescription drug benefit and a cap on beneficiaries’ out-of-pocket expenses, and expanded hospital and skilled nursing facility benefits.”), which was reversed after 18 months by Congress – See: http://www.kff.org/medicare/timeline/pf_85.htm [The Medicare Catastrophic Coverage Act was passed as a normal 86-11 vote in the Senate, and did not use reconciliation; I am using it as an example of how a bad act gets reversed]
Anyway I am hoping for #3; although #5 is also an acceptable outcome.
The most likely result, a moderate version of the health care plan (either normal or via reconciliation), will be slightly bad for America, but not too bad.
bob, there’s some rural communities that make contracts with pre-med entrants, to come serve in the community for a certain number of years in return for paying the way thru med school.
For what it is worth, before my Colonscopy, we asked the out patient clinic if we could just pay cash. Sure, and they came back with number we could live with. We tried to schedule, and the Nurse & Doctor refused stating that our Insurance company REQUIRED us to use the insurance. We fought it but ended up paying deductible after a weeks worth of wrangling with the Doctor.
Thanks, Batman!
Your posts have been some of the best I’ve seen for making sense of the challenges and possible solutions. Thanks to everyone for sharing your brain pulp with us slowpokes.
Batman, I would like to pass along some of your comments to some other folks. Is permitted?
By the way, your analysis of Kaiser seems to have captured the key points. But I would add that being officially unemployed does not always mean the same thing as being without resources. I remember spending some time in a large Midwestern city known for its casual ethics and over-ripe politics. One day I needed to deposit my pathetic little paycheck at an ATM. The person ahead of me appeared to be homeless, or living on the street – wildly disheveled hair, stained army jacket, ragged tennis shoes, huge duffel bag, only the vaguest familiarity with personal hygiene. But the guy had a wad of cash that would have choked a Megatherium.
It struck me that if one is able to shift a little away from the standard expectations of the middle class, a lot of possibilities for independent living open up.
To quote from Disney Pictures’ “Ratatouille”…
“If you can muscle past the gag reflex…”
I am a physician. I would like to add to this post and enlighten the debate. I would like to be able to say what the problem is. I would like to tell you how it can be fixed.
Alas it is not really about medical care but more so about the best way to pay for medical and social problems that are lumped together under the rubric ” Health and Human Services”. As such it is a political debate. This is what it should be and always has been.
It’s OK to characterize the poles as big government and small government. It’s OK to define one’s moral high ground as the right choice. In the end though it’s about your money and somebody else using it or your money and you using it.
You should be able to buy reasonable insurance but you can’t buy a ticket to the moon for 4,000 dollars. You should not have to buy insurance for someone else. A modest safety net should do the trick.
Most of us buy into equal opportunity but draw a line at the right of equal income. That is the goal of those who push these health agendas. It isn’t about health care but health care is a wedge. It is a potent intellectual weapon for the vanguard of those who want to take us to their vision of the society that the 1960′s painted in their radicalized prophecies.
Sorry but I don’t want to get on their bus. At least I know who they are and what they want. They are not patients,physicians,or families; but like Hamas they hide behind the innocents and naively misguided. They are lawyers, politicians,and bureaucrats of all stripe and make. They are just continuing their game of the culture wars. They are now on level 5 and want to get to level 6. It’s a game to the worst of them and the worst of them are those who are the most desperate to win at any cost.
At every town hall meeting, we should tell Congress that we will only except Obamacare if all federal and state employees, congress and the president also are forced on the program…of course they will never agree to that. The power elite wont accept not having “choice” while they shove “no choice” single payer down our throats. The hypocites always wave the abortion rights “choice” flag, but when it comes to health care bye bye choice.
The problem with US healthcare is that almost no one is spending their own money, so there are no price signals. If people were ‘provided’ through tax exemptions or subsidies $2000 a year for minor medical costs -and- they were allowed to keep the rest in a 401k, they would ask how much is the doctor visit before they went. Couple this with insurance against catastrophic bankrupt-inducing illness and limitations on pain and suffering lawsuits and things would be much better. But too many ‘special interests’ like things the messy way they are, and would rather preserve the status quo than risk getting screwed in any new system.
This is an addendum to some excellent proposals already made in this discussion. I think it is not in conflict with them.
Summary: My major approach would be to reduce the cost of medical care by promoting health, thus decreasing the number of patient office visits and hospital days because there would be fewer patients–fewer persons sick at any one time.
There are three general areas of health care: public health, which includes activities such as water purification, sewage disposal, pollutant control in the air, food safety, product safety, and crime (especially violent crime) prevention; personal health care, which includes what and how much we eat and drink, our physical activities and non-activities; and medical care, which includes direct care of sick persons by the various medical professionals, immunizations, medicines, and medical devices.
My goal for health care is that each persons lives a longer, healthier, and more productive life–knowing that there is not a necessary trade-off between length of life and good health, knowing that on average those who live the longest have the shortest period of disability at the end. My goal also includes accomplishing that and still being able to have good schools, good basic infrastructure, a good law enforcement system, and a strong national defense. Consistent with these goals, much of my approach is focussed on reducing the number of medical care patients.
As a general principle, I see no way of decreasing the cost of the medical care aspect of health care, while giving the kind of medical care that the vast majority of sick persons will want, without decreasing the number of persons who are medical care patients (sick or injured persons) at any given time. But that goal of diminishing the number of medical care patients coincides completely with the goal of a longer, healthier, and more productive life for everyone.
It is a consensus among health care experts that the greatest factor in the improved health and longevity over the past two centuries has been improvements in public health, especially safe drinking water and sewage disposal. I favor continuing work in this area of health care. There is good evidence, for example, that a lot of pulmonary and cardiovascular disease is caused by micro-scale particles in the atmosphere, those so small that they do not even reduce the clearness of the atmosphere. I favor stronger restrictions on behavior that endangers others. I would incarcerate violent crime perpetrators even longer. (An aside: I would decriminalize recreational drugs, which would decrease greatly the burden on the law enforcement system and decrease drug-distribution violence, even though it may increase some the cost of drug treatment and education.) I would outlaw completely the use of electronic communication devices of all kinds while driving. Even use of the least dangerous of these makes the driver as dangerous as when under the influence of 0.08 level of alcohol, and text messaging by truck drivers increases their accident rate 22 times. On the other hand, I am not in favor of a nanny state that requires seat belts, helmets. Nor would I favor a diet consultant visiting the home and checking the refrigerator to try to promote better eating. (I have read that something like this has been proposed in England–so hard to believe, I am not sure it is true.) I will deal with the question of self-destructive behavior that does injure or endanger others later.
There is also a consensus that poor personal health care accounts for about half of all medical care costs. This area includes what we eat and drink, whether or not we smoke or use recreational drugs, whether we engage in risky sexual behavior, how we drive and whether we wear seat belts, and what we choose for leisure-time activities. As a general principle, I would have persons bear the financial pain of poor personal health care. There is already a lot of information about how much various kinds of bad personal health care increases the cost of medical care. There are two ways I can think of to shift the financial cost of poor personal health care from the general public to the individual who does not care for himself or herself. One would be to charge a higher insurance premium to cover all of the actuarially-determined increased costs that that person’s poor personal health care behavior imposes on the medical care system. Another would be for the insurance company to pay only part of the cost of treatment for those illnesses caused in part by poor personal health care. For example, if a certain behavior or ‘life-style’ doubled the chance of a particular illness, then the patient would be reimbursed for only half of the cost of the treatment for that particular illness. (This is how I would deal with problems like not wearing seat belts.)
This shifting of the costs of medical care onto the persons engaging in poor personal health care would have three benefits. One is that the general public would not have to bear that added medical care financial cost. A second is that is would decrease the impulses to make us more of a nanny state. And a third is that there would be a strong economic incentive to take better care of oneself, which would help achieve the goal of fewer medical care patients. There is certainly the hope that persons would behave in a more healthy way, but it is not the nanny approach of intruding into their lives and nagging them to change. Rather, it is one of holding them responsible for the consequences of their behavior. And if, as we are told, that half of all medical care costs arise from bad personal health care, there is a huge potential for shifting costs away from the public sector and, eventually through the economic incentive, eliminating the extra medical care costs caused by poor personal health care.
Be in good heath,
Jim
In the shadows, in the dark
They lurk in hidden mist
They know that we’re the redneck mark
They know they’ve got the fist
And when by chance they’re in the light
And somehow truth they speak
We see at once that we were right
Their purpose is to sneak
Their socialist agenda on
Us unsuspecting slobs
Who will not know that freedom’s gone
Along with all our jobs
But 2010 will soon be here
And with it a new day
We’ll sweep the bastards never fear
And see them on their way
Batman is right on when it comes to Kaiser…
Twenty years ago I had a serious injury to my shoulder, and for a couple of years after that injury my Kaiser doctor would regularly take a ballpoint pen across my upper back and neck, making little ‘x’ marks. He’d then inject me with cortisone and lydocaine (or some such caine), one little ‘x’ at a time. After two years of this, he tells me that he thinks the pain I’m suffering is “all in your head” and prescribes me anti-depressants.
I was seeing red…I walked down the hall until I found the orthopedic surgeon who had recently worked on my Grandmother (I knew him because I’d take Grandma to appts).
He saw me (and the look on my face) standing in his doorway, and told the person on the other end of the phone “Um, I’m going to have to call you back.” After he and I chatted, he moved my shoulder around, took xrays, and within half an hour introduced me to the surgeon who, withing two weeks, had removed cartilege, shaved bone, and fixed up tears in my rotator cuff.
Freakin’ Kaiser.
It’s a system where you have to know what you need- have to be well-versed in medical options, treatment, and the body- and you have to be very very pushy, demanding, so that you get the treatment that you need.
Not that there aren’t a lot of good people that work for Kaiser, but the system is maddening.
Oh, hey, let’s let the gubmint take over!
The goal of the Obamacare proposals is to:
1. Provide political patronage, particularly the “talented tenth” per WEB Dubois and Hispanic elites, via AA pressure to vastly increase the number of Black and Hispanic Doctors. [Currently, according the AMA website, 4% of all US Doctors are Black.]
This patronage will not help that of say, Joe Average in South Central LA, but will allow say, Henry Louis Gates daughter to attend Medical School in a free-ride, with lower standards for grades, MCATs, and of course board certification.
2. Provide pork patronage by creating a lucrative middle-men position for oversight, and so on, keeping a vast amount of Democratic interest groups (ACORN, etc.) employed to “oversee” (i.e. dole out care to political specifications to politically connected groups i.e. Blacks, Hispanics, etc.) and thus provide a permanent financial advantage for the racially-based hard left. Ayers, Obama, and Axelrod, in other words. Plus a heaping helping of Farrakhan and Wright who no doubt will be in on the pork.
What is interesting is that Keith Ellison, aka Keith X, a protege of Farrakhan and the only (Black) Muslim in Congress, faced a hostile and nearly all Black crowd in Minnesota when he returned post-Break to address the (supposedly friendly) crowd. He was asked directly if he would enroll his family and himself in the public plan instead of his “Cadillac” plan. He evaded the question (no). That got a very hostile response.
Poor Blacks receive no patronage opportunities. Even ACORN types need a middle class background to take advantage of the traditional spoils that Obama plans. What we are seeing, as we saw with White Women (who figure Obamacare = greatly increased probability of death by Breast Cancer) is the fracturing of the spoils coalition that existed from around 1965 to 2008.
Just like the thieves in “the Big Knockover” by Dashiell Hammett, the coalition succeeded in looting the treasury, (by winning the election) but the fact remains the same, the fewer the people in the cut, the more money for the rest.
Since Dubois’s Time, back in the early 20th Century, Blacks have embraced his arguments that “the talented tenth” i.e. a Black Aristocracy will act as their tribunes, agitate for concessions and wealth transfers to Blacks from a racially oppressive White society (which in fact, it was, and then some) and provide both political and economic power. That model has broken down: Whites are by and large no longer racist (it’s taboo to even express such sentiments in public among an all-White group), they don’t feel guilt, are tired of accusations and finger-pointing, and just as importantly, with capture of the White House by a member of the Talented Tenth, poor Blacks feel they are getting the shaft in the cut. This does not mean that Blacks will vote Republican (ever) but does mean diminished support. Obama’s coalition was fragile, as Joel Kotkin suggested, it was constructed mainly on the very explicit notion of transferring wealth from Red to Blue America. To the extent it’s occurring, only the Talented Tenth and Ayers-like allies are getting a taste of the money.
This is basically why Obama’s power and polling is collapsing.
First, thanks to all of the medical professionals who have weighed in here; we can’t hear enough from you.
Jim Nicolas, great ideas but there is no room for personal responsibility in this debate. While many health problems are caused by personal choice (I apologize in advance to any that I am about to offend), it is non-PC to be seen as “lecturing” to those who are chronically overweight, abuse drugs or alcohol, smoke, or engage in risky sexual behavior.
These forms of behavior drive some of our biggest health problems, but all we hear from Speaker Pelosi is how evil the insurance companies are. And our President wants to make sure that we have a government run health option to keep the insurers honest. Good thing that the Federales own two auto companies; that way we can make sure that Toyota stays honest and doesn’t start slipping shoddy cars onto the lot.
tremendous, tremendous thread. just wanted to add one small oddment, that the insurance industry gets dissed for weak preventative care thinking –but the key to that is that Americans change jobs every 6+ years –meaning that if you are Company A the benefit of your effort in this regard will accrue to competitor Company B. I know, macro, it should wash –but that isn’t actuarially subject to performance analysis, i guess. wild card –insurance folks no likee.
50. buddy larsen:
bob, there’s some rural communities that make contracts with pre-med entrants, to come serve in the community for a certain number of years in return for paying the way thru med school.
Buddy, that is exactly what my brother did, in the Wiche program. He was supposed to give two years here.
Do you think he did?
Nah, took off for the green fields of Southern California, never looking back, like all the others.
I mentioned this to my doc, last time I was able to see him, and he says, “That’s what most all of them do.”
I think my brother is a rich man, by now.
And, here I am in the snows of Idaho, facing death and taxes.
By the way, if you are going under the knife, get a damned good gas passer, that’s what my brother says. Actually more important than the knife wielder, according to him.
We are all born.
We all die someday. Mr. Nicholas, all your points are good, but it can only put off that final day (or year), not prevent it.
The most expensive year of medical care is, for most people, the year you are born, and the year you die. Sometimes you can even narrow that down to days.
There are profound questions of “access”. There are not so profound questions of quality, although there are definite problems there.
Post natal care is always more expensive if pre-natal care is slight or non-existent.
If we really knew when you were going to die, “rationing” care for the truly terminal ill might actually be logical; not necessarily desirable or charitable, but logical.
But down this road lies serfdom; the road to “single payer health care” that Batman eludes to is surely the slippery slope to the erosion of “negative rights”, i.e., limits on the government infringing on our liberties, and the elevation of “positive rights”, the eternal promise of a chicken in every pot, “free” health care, a car in every garage, an I-pod in every ear, broadband internet for all, big screen TV’s, and on, and on.
Moo, moo.. We are cows.
E. Nigma/65;
“the fault, dear Brutus, lies not in our stars but in ourselves that we are underlings.”
–Cassius
The goal of the Obamacare proposals is to:
1. Provide political patronage, particularly the “talented tenth”* per WEB Dubois and Hispanic elites, via AA pressure to vastly increase the number of Black and Hispanic Doctors. [Currently, according the AMA website, 4% of all US Doctors are Black.]
*Per WEB Dubois statement that a “talented Tenth” of aristocratic Blacks like himself would lift Blacks out of oppression during Segregation.
This patronage will not help that of say, Joe Average in South Central LA, but will allow say, Henry Louis Gates daughter to attend Medical School in a free-ride, with lower standards for grades, MCATs, and of course board certification.
2. Provide pork patronage by creating a lucrative middle-men position for oversight, and so on, keeping a vast amount of Democratic interest groups (ACORN, etc.) employed to “oversee” (i.e. dole out care to political specifications to politically connected groups i.e. Blacks, Hispanics, etc.) and thus provide a permanent financial advantage for the racially-based hard left. Ayers, Obama, and Axelrod, in other words. Plus a heaping helping of Farrakhan and Wright who no doubt will be in on the pork.
What is interesting is that Keith Ellison, aka Keith X, a protege of Farrakhan and the only (Black) Muslim in Congress, faced a hostile and nearly all Black crowd in Minnesota when he returned post-Break to address the (supposedly friendly) crowd. He was asked directly if he would enroll his family and himself in the public plan instead of his “Cadillac” plan. He evaded the question (no). That got a very hostile response.
Poor Blacks receive no patronage opportunities. Even ACORN types need a middle class background to take advantage of the traditional spoils that Obama plans. What we are seeing, as we saw with White Women (who figure Obamacare = greatly increased probability of death by Breast Cancer) is the fracturing of the spoils coalition that existed from around 1965 to 2008.
Just like the thieves in “the Big Knockover” by Dashiell Hammett, the coalition succeeded in looting the treasury, (by winning the election) but the fact remains the same, the fewer the people in the cut, the more money for the rest.
Since Dubois’s Time, back in the early 20th Century, Blacks have embraced his arguments that “the talented tenth” i.e. a Black Aristocracy will act as their tribunes, agitate for concessions and wealth transfers to Blacks from a racially oppressive White society (which in fact, it was, and then some) and provide both political and economic power. That model has broken down: Whites are by and large no longer racist (it’s taboo to even express such sentiments in public among an all-White group), they don’t feel guilt, are tired of accusations and finger-pointing, and just as importantly, with capture of the White House by a member of the Talented Tenth, poor Blacks feel they are getting the shaft in the cut. This does not mean that Blacks will vote Republican (ever) but does mean diminished support. Obama’s coalition was fragile, as Joel Kotkin suggested, it was constructed mainly on the very explicit notion of transferring wealth from Red to Blue America. To the extent it’s occurring, only the Talented Tenth and Ayers-like allies are getting a taste of the money.
This is basically why Obama’s power and polling is collapsing.
45. Lifeofthemind:
Ernie G,
How’s the dog?
He’s an elderly dog who is normally kept indoors. His stomach was upset, so his owner’s son let him out into the front yard. He saw me as a threat as I passed the gate in the dark, and he gave ma a little nip on the arm. He’s a sweet dog and I didn’t have the heart to have him put down.
good show, Ernie G. since you could’ve but didn’t take revenge, he’ll probably protect you in the afterlife. nice thought and who knows.
dogs are like the Harmoniums in Sirens of Titan –only two phrases in their language –”I’m here” and “Glad you are”.
Whiskey, that’s the best thing I’ve seen you write.
Batman @ 37: Let me add my praise for this post. I will forward your comment to my husband and my brother, both of whom blog. I’d like to make it into a brochure and paper the country with it!
Thank you all for a most educational thread.
Buddy, those who have never loved a dog or been loved by a dog will not understand.
Help me understand the logic of bashing insurance companies. It seems to me that we should be bashing our employers who contract with a particular insurance company for a specific policy design. I work for a very large company and imagine that our HR department does intense negotiation about what’s in and out of our coverage and what level of service we will receive. For an extra $5k per year of cost per employee, I’m sure we could get gold plated coverage that would be the envy of everyone but the UAW and Congress. (I know our executives have special coverage where they just charge any medical expenses for their family to their company credit cards). And if our company cared it could set up a group to interface with the insurance company and advocate/overcome problems and deal with special cases – we must have tremendous leverage with 100k+ employees. Am I totally delusional in thinking this?? Is the blame in the right place? Is the better path to good coverage for management employees to unionize (or something similar) and demand better coverage from employers? There is a vibrant market for health insurance…unfortunately we aren’t participating directly and our employers’ interests aren’t necessarily aligned with our’s.
i second #70, parts 1, 2, & 3
Thanks all. The most informative comments thread I’ve read for a long long time.
I’m thinking about getting a dog for my dying days.
They are wonderful creatures.
I had two Brittany Spaniels earlier on, father and son.
Father was an s.o.b.–would always run out ahead and flush the pheasants out of range.
Son was perfect, don’t know where he got it. Never did try to train him. Could make a little motion with the barrel of my shotgun, he’d go over there, check it out.
A little motion with my fingers would bring him back right in range, where I wanted him.
Perfect dog.
With the son, I think there was real bonding. He was a puppy and slept with me, growing up
A boy and his dog.
Social Security will be in the red before Obama leaves office and instead of fixing that he wants to add a brand new entitlement program on top of the $1.8 trillion deficit he’s already running this year. The man is mad as a hatter. Whatever is not sustainable wil not be sustained. That is the iron law of nature and to follow this March hare down the rabbit hole ought to be an indictable offense.
We can’t overcome the RAF or cross the English Channel so lets open a second front. Lets attack the Russians. BO isn’t a NAZI or guilty of genocide but he is just as nuts as Hitler. If congress follows him up to the punch bowl full of grape KoolAide it will be the end of one or both political parties in this country.
All good reasons to get a dog, and live by oneself in one’s declining years.
A question, using smoking as an example.
It’s always assumed that smokers are responsible for increased health care costs, which is probably true.
But, we also know that smokers live shorter lives, on average, than non-smokers.
So, has there ever been a study investigating what offset is provided, if any, to overall spending to support smokers vs. non-smokers in their declining years?
Meaning, if smokers live shorter lives, they are not collecting social security, using gov’t programs, etc. for as long as non-smokers do. It’s stated many times above that the bulk of the health care services used will be used during the last year of a persons life. Is the number significantly higher for smokers vs. non-smokers? Do smokers require more expensive treatments than people who are dying but have lived what are generally considered healthy lives?
In other words, taking everything into account, do smokers use enough additional health care services in their lifetimes, that the decrease in other spending they represent due to their shorter lives does not offset the increase in medical spending on them?
There has to be a study somewhere on this topic. Anyone know of any?
Joe Hill @ 76:
Bingo!
Now convince this “Rufus” Guy @ 1,
who seems to be similarly cerebrally compromised by Mercury.
A couple of observations,
The decline in the number of Physicians has been offset partially, by the introduction of the PA. It is not a perfect solution but better than nothing at all. How does this class of Health Care Provider affect insurance costs? Has that program increased or improved the patient to Dr. ratios? (I hope I haven’t given any lawyers any ideas!) Rural communities have a declining as well as an aging population. The current practices at hospitals that require residence within a certain distance or practice within a certain distance to the hospital make health care practice impractical. This has not been addressed and if anything it has been made worse not fixed.
With the increase of the availability of the communications and the computer, especially in rural but also in urban settings the ability to monitor multiple patients at a distance has increased. I know there are issues there but it seems that the distance care would reduce the number of beds required at any given time.
As a practice the use of tobacco by the WWII generation up to the current one is still not illegal. While insurance can and ought to discriminate on the grounds of unsafe practice, the funds available on for remediation of additional care have been set aside, (and no doubt raided like the Social Security laugh box) by various court decrees. Have those amounts been figured into the costs of health care?
Jim Nicholas, I know this puts a twist on your thoughts here but that requirement for seat belts and helmets saves lives. It also increases the heath care required to return a body to a functional state. Are you suggesting that more death (and the resulting gore is a good thing?) or that PIP Auto coverage minimums need to be increased?
Well, the bottom line is simple: will America reject socialism, or not? If we will reject it, then the next question is when? Then the next question is one of by how much we will reject it?
I rather doubt that there will be a flat-out rejection at the ballot box next year. there are just too many of the State’s clients around, there is literally no major opposition to it at the level of the national parties and the whole intellectual and propaganda machinery of the Left will have this.
So the question becomes one of what will it take to undo it all once it is in. Given that we are still struggling with the New Deal programs yet today, It does not look good for the opponents of socialism. I think that the fate of social security is the model. I should point out that CRA is still in place and Fannie and Freddie are still in business. Eventually if this path is taken the USA must decline as a power and a force for light, liberty and freedom. That would seem to be the point. I personally believe that that is a very real intent of the Democrat Party.
It is a much more complicated issue than health care: The root of it is the monstrous intrusion of government into our lives. Either the state is beholding to us, or we are to them. Either we are a nation where individuals struggle to be free–and this of course means economic freedom, and self employment–or we are a nation of serfs beholden to the State. There are no two ways about it.
I imagine that it cannot be turned around until the last Baby Boomer is in her grave. If the 1960′s was the first “boomer revolution” this is the second. As this cadre ages it will just get worse.
All this may seem so obvious that like beating a dead horse, but this is really the truth of the matter.
They will get their health care “reform”, it will be a disaster. It will be hard to undo. Conservative must be in it for the long hall as it will take many years and much national humiliation and ruin to turn it around.
America could well look like Mexico, Brazil or the UK in a handful of years.
I have to wonder if we could even magically place the electorate in some sort of time machine and momentarily transport them to this future if they would turn from it upon their return.
Perhaps. Of course the politicians have to move fast. It is as clear as it could be, as is their treason.
We live in a time when the vast majority of “people in power” are wholly irresponsible, and willfully so. They mean to undo all that this country has been, is and should be. The greatness of America is too much for them; it humliates them.
They must destroy it. They cannot live up to its great history.
What is to stop them?
“The People”. Well one has hopes, but the tea party people better get ready for some i>real oppressive tactics and not just misrepresentations and slander by the likes of CNN. “Our betters” mean to rule us as a new “Nomenkalatur” and a new “Acient Regime”. Have no doubt about it.
For a great many of us the future will be one of returning to 19th century conditions (or even earlier) but this time without the traditional American frame work there to facilitate self improvement.
Historians generations hence will just be befuddled by this all. How did a nation at the height of her success come to decide to immolate herself? Why did we choose suicide when faced with the best of worlds?
Why are we doing this to ourselves?
The answer is buries somewhere in the New Deal, the Cold War and the boomer generation.
That was
“The People”?
Wadeusaf: the authority of the PA has been gutted by the doctors. They do not offset cost today as was originally plan when this role was created. It would be a good thing to revisit this though, and you are certainly have the right idea.
long hall = long haul
(well considering what is happening, maybe both)
dtmack @78
This is a link to a 1992 study comparing life-time medical care costs for smokers and non-smokers, updated for inflation and more recent methods of treatment. http://www.tobaccofreekids.org/research/factsheets/pdf/0277.pdf
In summary, the conclusion is that there is an excess of life-time medical care costs of $17,500 for smokers and an excess of $8000 for former smokers. These excess medical care costs would be off-set by reduced Social Security costs, to what extent I do not know.
This is a link to an abstract of a study of lifetime medical care costs, beginning at age 45-54 for 5 obesity-related diseases: hypertension, hypercholesterolemia, type 2 diabetes mellitus, coronary heart disease, and stroke.
http://www.ncbi.nlm.nih.gov/pubmed/10527295
In summary, the total discounted lifetime medical care costs for the treatment of these 5 diseases are estimated to differ by $10,000 ($29,600 vs $19,600). The life expectancy at this age was reduced by one year. These added medical care costs are for these 5 diseases only and do not take into account the added medical costs of increased accidents, orthopedic disabilities, and cancer rates nor do they take into account the costs of the decreased occupational productivity associated with obesity.
Wadeusaf @ 80
There is no question that the use of seat belts saves many years of productive lives and prevents much suffering. However, failure to use them does not injure others except to the extent that others bear the financial costs of treating the resulting injuries. (Admittedly, I leave out the non-economic injuries to loved ones.) The problem, of course, with my proposal–of making those who fail to take care of themselves be financially responsible for the consequences of that failure–is that the injured person who was not wearing a seat belt will not be denied treatment until the ability to cover the cost of treatment is proved; and often he or she will not have that ability. And so, in spite of my attempts to avoid nanny state legislation, I could be persuaded to accept seat belt and cycle helmet laws to protect others from having to bear the financial costs.
My plan of of having persons bear the financial costs of poor personal health care might work with obesity, but even there I do not know if there is the public will to enforce it.
TxProl @ 72, your company’s HR department should have at least one person who is a specialist in understanding the insurance companies’ offers and negotiating the best plan the company can get. Those offers are determined by many factors, of course. Here are a few. The insurance companies hold internal meetings where the actuarial department says, “For what they want and their mix of employees, we’ll have to charge this much in premiums to make any money,” while the marketing department says, “We can’t make the sale at that price, so we’ll have to charge less.” The marketing department usually wins while the actuarial department is generally right, and this is one reason health insurance premiums go up every plan year to make up for last year’s miscalculation. Many state insurance regulators require that all policies offered within the state must include specified coverages that your fellow employees may neither need nor want, but must pay for. In general, the bluer the state, the more such coverages. There are many other non-transparent factors that go into setting premiums. For example, if your company employs a large number of young people your premiums will be significantly higher to cover all the babies young families produce. It only takes a preemie a couple weeks in the NICU to make everyone in the group’s rates soar.
You’re not delusional in thinking your company should have some patient advocates. They’re called the HR department. That’s another hat the insurance specialist would wear. I’m surprised they don’t already do this for you.
I will say this: an additional $5K per employee per year is a whale of a lot of money, half a million dollars for a company of 100. I suspect that unless your company is in a very lucrative business, it will have to take that $5K from the employees’ compensation, or have a layoff, or indefinitely postpone its expansion plans….maybe that’s what happened to your patient advocate(s). If not and they want to hire one, let me know!
Unfortunately, this may be the only way.
Dear people, wherever you may be,
I’ve just finished rereading Atlas Shrugged for the third time. The first two times (a long time ago) I applied its lessons to the collapse of the Soviet Bloc. Now Ayn Rand’s work seems more pertinent than ever due the events unfolding in my homeland.
The reason I say my homeland is because I’m an expatriate American English teacher living in South Korea. I’ve been living and working in the ROK for twelve years, but I still send in my absentee ballot for presidential elections every four years.
What I’ve been seeing taking place in the USA since January 20 is making me more upset by the day. The mounting deficits, the growing and dangerous dependence on China (many South Koreans are very jittery about China) to finance those deficits, the talk of instituting new (VAT and a big one at that) taxes to help cover those very same deficits, the bailouts of GM, and particularly Chrysler, the attempt to remove choice and private enterprise from the U.S. health care system, the stimulus that went mostly to government drones rather things that would really stimulate, and above all, the despicable behavior of the mainstream media in covering up Obama’s real Chicago background. I had to go and find the red star at the top of William Ayers website all by myself!
All these things have made me very alarmed concerning the future of my country. So I’ve reached one overriding conclusion: it’s time for Americans to revolt against royal authority for the second time in 234 years.
I say this because I don’t believe the traditional legislative process can stop my country’s slide towards the comfortable euthanasia of West European-style socialism. With the idiocy of Bush to guide them, the Republicans have done a very creditable job of taking Dirty Harry’s 357. and pointing it at least at their feet, if not their heads.
So it’s time to revolt. This will be a difficult idea for many Americans to grasp. After all, we are the product of a culture that has been based on the rule of law from its very beginnings back in medieval England.
What I’m talking about is starving the Government Beast. Come next April 15, 2010 don’t send in your tax forms. Refuse to pay! If you’re a small businessman don’t pay your state (If you live in California, New York, or New Jersey, this applies especially to you) or federal business taxes. Don’t pay your licensing fees! When the Bush tax cuts expire in 2011, don’t file! Simply don’t feed the Beast!
If you’re worried about prosecution, there’s safety in numbers. If ten million Americans refuse to pay, the looters can’t possibly oppress more than a very small number of people. If ten million small business people refuse to knuckle under to the New Jealously Class, then the Beast will be truly crippled and will be forced to beg for mercy. View your refusal to pay blackmail to the looters as a civil rights issue along the lines of what inspired Martin Luther King during the civil rights movement of the 1950s and the early 1960s. IT IS NOT YOUR PATRIOTIC DUTY TO PAY HIGHER TAXES! In fact, it can be considered a form of treason to file on April 15, 2010.
Anyway, this has happened before. What most Americans don’t remember or never learned is that in the run-up to the American Revolution the British backed down twice over the issue of taxes. Parliament repealed both the Stamp Act and the Townshend Acts in the face of fierce colonial protests. Remember, the looters don’t have the mighty Royal Navy behind them, or ranks of hard fighting British Grenadiers, all they have in their favor is the willingness to submit of a people who have been comfortable for far too long.
If you don’ think this is too wacky, PASS IT ON!!!!
Michael G. Gallagher, Ph.D.
Seoul, Korea
sauruman56@yahoo.com