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David…. While I can understand your point about the need for health care reform I have to wonder about a statement you make….
“…I have little confidence that Congress actually WILL address those problems and in the meantime people are dying and (worse) suffering needlessly.”
So am I to understand that you have no problem with letting the the same folks in Washington that are ignoring the Social Security and Medicare problems now be permitted to create another program destined for disaster to have future politicians ignore it when it goes bad? It make little sense to me that these folks be TRUSTED with any task in creating another massive government program while they are let off the hook for fixing that which needs repair NOW! Let’s fix what’s broken before we take on more challenges… and UNDERSTAND HOW it’s going to be paid for, how it’s going to work, and who’s running the show before we drink the Kool-aid. Or we all might very well be drinking the Kool-aid from which there is no return!
Edited on Aug 17, 2009 20:17
Somebody smarter than me (it’s a long list) has observed that “politics is the art of the possible”. I think you do what you can do and work on what you may or may not be able to do later.
I’m amazed by your (and others’) characterizations of what’s proposed as doomed to failure. If all that “health care reform” accomplishes is to open up Medicare or a Medicare-like system to more people, or if it creates a VA-like system with it’s very high satisfaction rate, or if it constrains the ability of private insurance companies to ration care (don’t kid yourself) and exclude the most medically needy (don’t kid yourself) and charge exorbitant rates (don’t kid yourself), or if it creates community primary care clinics like the thirty-nine that operate in Vermont and many more around the country, or if it enables us all to make considered decisions about our end-of-life care, if those things and more are all that health care reform accomplishes then it will be applying nothing more than tried and proven solutions to very, very pressing problems.
You and others are absolutely correct, and I join with you in your concerns about deficit spending and the national debt. These have the potential to bring the American economy to its knees. There’s no doubt.
What I don’t understand, however, is why there was no outcry about these financial considerations during the great Reagan deficit runup (remember, “deficits don’t matter”?), or why the fiscal conservatives in Congress were so anxious to drive down federal revenues with the early Bush tax cuts and never made adjustments when the deficits soared to fund Bush’s optional war in Iraq.
Nor do I understand the lack of Congressional outrage (or yours) about the pattern of no-bid contracts that has characterized the Iraq and Afghanistan campaigns. Look at what Haliburton has been paid. Look at Blackwater. Look at the prohibition against U.S. service members doing their own laundry in Iraq but instead sending it out to a Haliburton facility at $80.00US per load. And look at the cost of the mess halls that Haliburton runs.
My point simply is that there are many, many holes in federal spending through which staggering amounts of money disappear to no human advantage. Sure, corporations do wonderfully and so do their executives (and maybe even their stockholders), but what about Americans in need? Should Congress plug these holes? OF COURSE! But while Congress dithers, American citizens are suffering needlessly for the lack of health care. They put off routine care, which they cannot afford, and get sicker and sicker. Then, if they’re lucky, they end up on Medicaid, as do the vast majority of nursing home patients, for example. Their palliative care costs much more than the preventive care would have, productivity is lost, tax revenues from their productivity are lost, and whatever contributions they may make to their communities are threatened.
Sure, there are lots and lots of problems to be faced, and they should be faced. But if there’s the will to address one problem and not another, why wait? What you and others propose is akin to saying to the sedentary, obese diabetic that he shouldn’t start getting some exercise until he gets his blood sugar under control. Fixing part of the problem is a lot better than doing nothing. If Congress abandons health care reform without passing something meaningful, all that will have been accomplished is to free up more of their time to yap meaninglessly about flag burning.
Great points as always David… but there are a couple of issues in what you said and didn’t say.
First off… am I to understand that you believe the VA medical system is one which serves those that have served and is something we should be striving to duplicate for the masses??? I think we can open a wonderful discussion about how the VA medical system has FAILED miserably to provide quality caring and timely service to the men and women that have served our country! And if this is the kind of system of care our politicians are now proposing… we should all be VERY CONCERNED! I’ll leave it up to some of our veterans to chime in and tell us if the care they get is what was promised!
You might want to read this article about the “quality” care our veterans are receiving.
http://menshealth.suite101.com/article.cfm/philadelphia_va_hospital_botched_92_treatments
And mind you… this wasn’t a cutting edge medical procedure… it was an accepted, widely performed procedure, that has been around a while!
And as for all the other PROBLEMS that government has running the show right now… all points well taken… but rather than look at those as you have look at it from the other side… the side that tells you that if government has screwed these things up so badly… and at this point doesn’t seem to want to fix them…. WHY IN THE WORLD WOULD YOU ENTRUST THEM TO TAKE ON MORE? You’ve pointed out a number mistakes and problems that government itself has created, and has failed to address…. yet you seem content to give them free rein to now take over health care! That’s not my idea of rewarding someone with a history of success with more important responsibilities!
It’s like lending your car to your junkie cousin after his sixth trip to rehab… after he’s already stolen your jewelery in the past to support his “lifestyle” and has totaled your car before… do you think it’s a good idea or is it because he tells you he’ll have it tuned up and gassed while he’s out?
We need health care reform… but why bother if folks won’t be able to afford to live when SS goes down the tubes? We need health care reform… but why allow Washington with it’s record of creating programs that are not well thought create ANOTHER MONSTER Program at a time they don’t have the ability to fund it? We haven’t solved hunger in the US… it would seem that FEEDING people might be just one of MANY problems that might be a bit more important right now…
Edited on Aug 18, 2009 08:33
imx, it isn’t ME who sez that the VA system is so great, it is the majority of veterans who use it. Personally, I’ve always been skeptical of the VA medical system and I would propose that veterans have total freedom to choose where to get their care. I fully agree that there are many problems at the VA, but the preponderance of vets, as reported in the media, at least, seem to be pretty satisfied.
In the current environment, no one is suggesting that the government take over management of health care, as it does in the VA system, but rather only that the government PAY for health care, as it does now in the Medicare, Medicaid and TriCare systems, at least. Now it’s abosolutely true that those three (and maybe others) won’t pay for some procedures, but that limitation applies at least as much to each and every non-governmental medical care insurance program or policy. And those three do not impose limitations such as those on pre-existing conditions, annual and lifetime payment limits, etc that private insurers do.
Something that’s important to understand is that the costs of the government-run systems are dramatically lower than those of the private sector. Medicare, for example, pays out about 98% of all its revenues to health care providers. Medicaid isn’t far behind. And why is this? Well, for one Congress limits how much administrative money is in their budgets. Further, no Medicare or Medicaid program chief executive earns anything like the salaries paid to private insurance company executives. Medicare exists in the Department of Health and Human Services. The Secretary of that Department is, rightly, paid less than the President who earns (I think) $400,000 per year. Some insurance company executives are being paid twenty-five times as much. The private insurers all pay out much, much less as a proportion of revenue to health care providers than the public payers.
Please don’t misunderstand . . . I too am skeptical of the government undertaking vast new programs. All this talk of going back to the moon and then on to Mars leaves me very uncomfortable. And I’m not so sure about the government’s newfound influence over General Motors. But paying (paying) for health care is hardly breaking new ground for either the federal government or the states. They just aren’t doing it for enough of our citizens.
Once again David I enjoy your points and your ideas! You’ve always been one to see the big picture and think out all the angles…. so don’t EVER sell yourself short saying there’s quite a list of folks smarter than you!
I’m just very concerned when a president and a party seek to push through a major government program on a Friday afternoon before a month long vacation. There needs to be some REAL discussion on this agenda and ALL parties need to be heard.
I, as most folks opposed to the current rush, know there needs to be changes made in the way the health care system works in the US… but as much as I know there needs to be change…. I refuse to allow Washington to push through another government program that’s well intentioned… but unfunded and ill conceived. All I want are answers to the basic questions that apply to any situation… Who, what, where, when, and HOW is it going to be paid for? We’ve heard lots of talk about this program NOT raising the (income) taxes of anyone making below $250,000… but do you think that’s reality? Remember where SS and Medicare (FICA) taxes started… and the promises made about their levels… and take a look at the REALITY of where they are now! Over 12% between employee and employer for SS… and Medicare is also out of control! I also don’t really think the current government medicare or medicaid programs are very well run or efficient.
And does Washington these days seem concerned about the viability of SS or Medicare for the next generation (or even those retiring in the next few years)… the answer seems to be NO! Once again I don’t feel that letting Washington off the hook for the problems with the programs they run now and allowing them deeper into our pockets it reasonable or the right thing to do!
imx, you are, of course, welcome to your own set of anxieties and priorities, as are we all. And I dispute little of what you say. But I do wonder how your stance might change if it were you, maybe, waiting in an urban Emergency department for hours or days, throwing up your bloody guts, in the hope of getting what turns out to be your own stomach cancer diagnosed and treated.
It’s easy to generalize about “them” and “their” problems. But it’s only valid to do so when we put ourselves into their shoes. Me? I’m not willing to wait while congressmen on both sides of the aisle fool around. I want a resolution soon (read: immediately). Truth is, we’ve had a health care crisis in the U.S. for decades. Then-President Harry Truman recognized it and tried to do something about it in the late 1940s. And subsequent Congresses and administrations have been admiring the problem ever since. (Roosevelt recognized it, too.)
So here’s my offer to you and everyone on this forum and elsewhere who shares your sentiments: You agree not to seek medical care for any condition whatsoever ’til “they” have medical care too and I’ll believe that your heart is where your words are. This generous offer extends to all your families as well.
Now let’s hear the enthusiasm.
P.S. Congress should be the very first ones to give up their health care insurance and that of their staffs. I’ll bet gridlock on this issue could be broken by lunchtime.
P.P.S. While I have had no direct contact with Medicare, I did work closely with Medicaid in Michigan and its partner, the Children’s Special Health Care Services (Title V) program for a number of years. While they certainly do not function perfectly, they really do work pretty well — and cheaply. If you wish, I’ll share my favorite Blue Cross/Blue Shield horror story. Just ask.
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Nice idea David… but but do “they” really lack coverage at the moment? I’m not sure what your experience is with the uninsured but I can tell you from mine in NY that NO ONE (with or without insurance) is missing out on medical treatment. On Long Island NY it’s a simple call to 911… an ambulance arrives a short time later for whatever ails you… and it’s a lights and siren ride to the hospital for treatment no matter if you can pay for it or NOT! In fact the patient’s BILL OF RIGHTS by law is posted right in the emergency room in both English and Spanish explaining that you CANNOT be denied care for any reason (lack of insurance, ability to pay). I can tell you stories that would have you spinning about the “medical” conditions folks use this system for. And how NORMAL folks would have NEVER used the system for MOST of the reasons “they” go to the emergency room!
The idea that folks are dying in emergency rooms waiting for, or being denied treatment just isn’t happening in my experience.
As for your challenge…”So here’s my offer to you and everyone on this forum and elsewhere who shares your sentiments: You agree not to seek medical care for any condition whatsoever ’til “they” have medical care too and I’ll believe that your heart is where your words are. This generous offer extends to all your families as well.”
Perhaps we should extend your challenge to include NOT being allowed to retire to Costa Rica until EVERYONE can… or OWNING a nice home until EVERYONE can… or driving a nice new CAR until EVERYONE can….or enjoying the fruits of years of hard work and sacrifice until EVERYONE can (even if they chose to NOT to work hard and sacrifice)… are you willing to give up all the nice things you have to level the playing field? It’s a nice idea to provide for others… no matter how much they may or may not deserve it… but are YOU willing surrender all the things YOU have to give it to someone else?
Since medical coverage for everyone is so near and dear to your heart I don’t see why you’d have a problem giving up all the “extras” (Home in Costa Rica, New car, rental properties, pension and so on) to provide the basic “right” of health insurance you champion… it only seems fair doesn’t it?
After all.. to the folks without insurance you’re living like a king! LOL
Edited on Aug 18, 2009 15:07
Truth is, imx, that I am quite willing to make significant sacrifices in order to correct a lot of problems. I would be quite prepared, for example, to pay a surcharge on my income tax if it were directed exclusively to reduction of the national debt. I’d happily pay a percent or two more to bail out Medicare and Social Security. For years, my wife and I, living in Michigan, had our thermostat set at 60 degrees when we were up and 50 at night and when we were gone both to save money and to leave some natural gas for your grandchildren, and I drove 50mph for many years to leave them some petroleum. If you and the others will do it, so will I.
Neither you nor I have to give up everything we’ve worked for, and I would never suggest that everyone be treated equally in all matters. For the foreseeable future, the U.S. and most other countries (Britain may be an exception) will have a multi-tiered health care delivery system. All I’m suggesting is that the availability of health care has enormous and pressing implications for those who go without and for the rest of us, and seeing to the needs of those in need doesn’t have to impoverish any of us. And it cannot wait another sixty years while we admire the problem some more.
I also worked in emergency medical services, both as a planner/administrator and in the back of an ambulance and I know you’re right. No one can, by law, be denied the care necessary to stabilize them in an emergency situation. But that’s not the totality of what health care is about.
If you’re living on Long Island now, try this simple experiment. Dial 911 and tell them that it’s time for your annual digital rectal exam (I’m assuming that you’re a man here) or maybe your annual Pap smear. Then time (1)how long it takes for the ambulance to arrive and (2)what your wait time in the Emergency Department is. Then, as a check, after you’re home (next week sometime, if in fact you ever leave the house), do the same experiment but tell the 911 operator you need your cholesterol checked.
I’m a longtime follower of this forum, so I’ll be here in February when you have results to share with us.
Health care is about more than emergency care.
As always a great reply David! I’m aware that health care consist of more then emergency room visits… and our county does have medical clinics which those without insurance can use for the preventative care you speak of… also our local hospitals back in NY have mobile units (specially equipped motor homes) that do prostate screening, breast care exams, blood donation and screening as well as other services throughout the area. They park the units on an announced and posted schedule at various locations… banks, post offices, supermarkets and other well traveled areas. And I never see a line of folks waiting!
I know we agree on the problem, and the need to fix it. Might we agree that there needs to be a clear PLAN and METHOD explained on how we’re going to make it work and fund it BEFORE we just jump in and HOPE it all works out in the future? With all that natural gas and petroleum you saved for your grand kids it would be a shame if they can afford neither because they’re being taxed to death paying for yet another government plan that fails because of poor planning!
Edited on Aug 18, 2009 19:37
First off, a point of clarification. The gas I saved was for your grandchildren, not mine. One of the finest things I’ve done in my life is not father children to inherit this mess.
I would be interested to know if the mobile units you describe make it as far as the neediest parts of The City or do their routes ends at the bridge? Are you saying that the ongoing medical needs of inner city folks as well as the 47,000,000+ uninsured are covered by these types of services? Nobody else seems to think so.
I should also point out that serving the uninsured, even just through the Emergency Departments, is a major financial strain on virtually every hospital in the land and one of the reasons that a significant number of hospitals have closed or are on the verge of doing so.
If you actually listen to what President Obama has said repeatedly, he makes a pretty good case for how he proposes to fund expanded health care. I can’t repeat all the details, but included are, indeed, a modest tax on the very wealthy and elimination of a $177 Billion(!) subsidy now paid to insurance companies to provide virtually nothing additional to Medicare beneficiaries. That’s not the end of it, but the point is that he has thought this out. It’s not just a pipe dream.
As for the method, I’m not quite sure what you’re looking for, but rest comfortably in the knowledge that the federal and state governments do have a wealth of experience in both paying for care (provided by others) and in providing care directly. This isn’t new ground they’d be breaking; it’s an expansion of existing efforts albeit perhaps with new labels.
By the way, I have thought for years that there’s a much simpler approach to the provision of health care to individuals and families and have actually written it up. Problem is, I can’t find anybody influential who’ll read it.
My preference would be for Congress to start small and simple and embellish as needs appear, but I’m afraid that contained in 1,200 pages of text is a lot of detail and complexity. Maybe that’s a good thing; maybe not.
Imxploring,
Your comments concerning the VA were right on point. I am one of those Philadelphia VA patients. More often than not, I use my private health insurance to receive treatment for my service-connected disabilities. The VA healthcare system, is a national disgrace. During my six years of treatment at the Philadelphia VA hospital, I have only encountered one professional and caring doctor!
Hey Soldier… Thanks for joining the conversation David and I are having! I guess we all know that there’s a serious need for health care reform in the US… the real question is do we want Uncle Sam running the show… and from where I sit and from what I’ve seen and experienced the answer is NO!!! I’m sorry that Uncle Sam has failed to live up to the promises he’s made to you and other veterans for the service you’ve provided to this country, I pretty much knew that. David had pointed to the VA medical system as an example, one with which folks had a high satisfaction rate… I felt otherwise and that it is yet another example of a FAILED system the government is throwing money into without providing quality service! Thanks for chiming in!
Perhaps we should look at Uncle Sam’s current programs… Social Security, Medicare, Medicaid, and the VA health system before we allow an organization with a record of FAILURE from taking over yet another function. Perhaps these should be fixed before we start spending money on another program for which we have NO PLAN…. and NO MEANS TO PAY FOR IT!
Sure David… now you tell me your concerns about this health care plan end with your time on this rock!!!! LOL
As for the mobile services I was talking about… they’re County services, NYC has their own that are used to provide similar services. As for your comment…
“Are you saying that the ongoing medical needs of inner city folks as well as the 47,000,000+ uninsured are covered by these types of services? Nobody else seems to think so.”
Perhaps you should read the news and see the response that Obama and the crew are getting at the town hall meetings they’re running trying to float this plan… it seems I might not be the only one concerned about Uncle Sam running the show. There’s a large and very vocal movement for change… but NOT the kind Uncle Sam is talking about… and this isn’t the fringe players… these are working folks that have real concerns, as I and many have, about the idea that we should ignore Uncle Sam’s failures and allow him to take on another challenge that our (well my) grandchildren will be paying dearly for!
As for paying for the proposals… please tell me EXACTLY how it’s going to be paid for… you see David I’ve made a career out of listening to people, what they say and don’t say… and have become rather good at hashing out the TRUTH… and I’ve heard a LOT of proposals on how this is going to be funded… and the next day a change in how that’s going to be achieved… can you perhaps point me to ONE central source of the Obama plan that CLEARLY and COMPLETELY explains to simple little me how this program is going to be paid for?
Yes I know… a tax on the rich… and savings here and there… fees charged to employers… but I WANT INCOME PROJECTIONS, Charts…. graphs…. expense projects… a BUSINESS PLAN…. just like if I was a small business at the local bank trying to get a loan or line of credit! To date I have not seen ANY of this during the Obama proposals! Lot’s of vague proposals… concepts… ideas… all of which seem to change from day to day! You have to know David that when the income isn’t there, there’s two ways Uncle Sam fixes it if he wants to keep the plan alive… he raises TAXES…. or starts PRINTING MONEY… both of which have gotten us into the mess we’re in now… and I DON’T think that’s going to work much longer, our creditors are getting very nervous! And when Uncle Sam looses that SS tax money he’s been living off and has to start paying it back… watch out!
I have to guess some egghead in government has the “business plan” with all the documentation I’m talking about…. right? If such documentation would be required for the local shoe store to get a bank loan to buy inventory I think it’s only fair the American people deserve the same and have a good idea what they’re getting themselves into, don’t you?
Uh huh! So the mobile clinics that provide everyones’ medical care so comprehensively are services of the county government, in your neighborhood, and the City in the City of New York? Sounds to me like government must be doing something right after all (at least in your estimation). I wonder what else government has succeeded at . . .
As for the funding, the Administration’s Office of Management and Budget and Congress’ Congressional Budget Office work these numbers all the time. They’re the ones that came up with the financial feasibility “proofs”, for example for the Bush Medicare drug plan, as they do for every other proposal that surfaces.
I don’t hear any screaming about the budget numbers for our little adventure in Iraq, which has cost billions we can never count as well as over 4,000 American battle deaths, several times that number of serious injuries, who knows how many non-battle related casualties, and the deaths and maimings of untold numbers of Iraqis. But when it’s proposed to do something to actually benefit human beings, then all of a sudden we start whining about fiscal responsibility.
Now, last Saturday (most recently) the President stood before a crowd of ordinary citizens and a bank of network television cameras and delineated in broad strokes what the OMB and CBO have worked up in detail. You seem hellbent on denying that he’s gone over this ground or that the OMB and CBO projections exist, so I won’t ask you to take my word for it. For the sake of this exchange, I’ll stipulate that Congress and the Administration haven’t the vaguest idea how they’ll finance universal health coverage much less what the costs might be.
Feel better?
Again, for the sake of this argument, I’m prepared to stipulate that no unit of government from your local library board to the U.S. federal government or the United Nations has ever done anything successfully. The U.S. has never prosecuted any war successfully. That’s why we’re still British colonies and we speak a mix of German and Japanese.
The U.S. has never developed a national or regional infrastructure such as the Erie Canal, the western hydroelectric developments, or the Interstate Highway System. And the Brooklyn Bridge was never built.
The U.S. has never supported the eradication of any disease including smallpox and polio. The U.S. has never successfully run multiple systems of hospitals including those which do not serve veterans, those which do not serve our active duty armed forces personnel, and the hospitals of the U.S. Public Health Service. Likewise, the U.S. has never operated any ongoing system from the national cemeteries to the air traffic control system or the national parks.
In like fashion, your local sewer and water systems, your local fire and law enforcement agencies, and your local schools are all a total bust. When you flush the toilet, no water flows and you end up with a mess on the floor. Your local library has no books and you can’t see outside at night because your street lights don’t work. Everything the government has ever done and everything it might ever undertake is a complete and total failure.
Feel better?
And finally, I’m prepared to stipulate, for the purposes of this exchange, that every problem that mankind encounters should only be addressed in the order in which it arises. We should fix Social Security and Medicare before we fix health care. If a stop light fails and a motorist broadsides your car, the stop light should be not fixed before the fire department fails to extricate you. And likewise, you and I should get down to our recommended body weight and get our blood pressure under control before we next brush the plaque from our teeth.
Feel better?
Oh, and I’m also prepared to stipulate that YOUR CAPS LOCK KEY WORKS.
Edited on Aug 19, 2009 09:48
Well David it seems you’ve made my argument for me in most of what you’ve said! LOL Bad programs milking us dry… and no effort to address them. Budget and accounting people and an administration that have no true idea of cost or how to fund this monster…. But yet you still want to trust these same fellows to now take on the BIGGEST (sorry the cap lock key was feeling neglected)… most EXPENSIVE… and least THOUGHT OUT government social program Uncle Sam has ever attempted.
I too have been listening to the President… and all this underlings… what they’re saying and NOT saying. With all their talking points and sound bites I was hoping for one simple website that would explain this new health plan and how it will work and be paid for… but instead it seems they’re more intent on spending $24 million on an ad campaigns that will push this, and I’m quite sure will be lacking the HARD (sorry it was nagging me again to be used) information on execution and cost that I, as well as many other folks, are asking for! Take a look at this!
http://news.yahoo.com/s/politico/20090819/pl_politico/26240
Funny…. the US government managed to put together a great website (Cars.gov) to explain the “Cash for clunkers” program that allows you to see if you’re eligible… how the program works… what the rules are… what type of car qualifies for trade in… which qualify for purchase… how much money is in the program… and a ton of other useful information. Yet have we such a wonderful resource to explain this proposed health plan? I’m guessing the $24 million in ads will be shells of reality… showing sick kids and dying old people… any thing that gets public opinion rolling along with the agenda!
Just direct me to a resource as clear and comprehensive as the “cash for clunkers” site and I’ll be happy to look it over and form my opinion as to this proposed program. Isn’t health care more important than taking some clunkers off the road and putting some new ones on?
You’ve pointed to some great successes… and we’ve discussed some real disasters… just give me the honest and complete truth about this “program” before you try to shove it down my throat!
Edited on Aug 19, 2009 21:07
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