This week’s Washington Post health care column is on the question of whether we can afford health care reform – meaning whether we can afford to subsidize poor and middle-class people who cannot otherwise pay for health insurance. This has a different meaning depending on you interpret “we” as the U.S. economy in general or the federal government, but in either case we think the answer is “yes.” Or at least, as far as the federal government is concerned, the answer is that we can’t afford not doing some form of health care reform, although it’s not certain that the reforms currently on the table will be sufficient to solve our government’s long-term fiscal problems.
In summary:
“If you are for fiscal discipline, you should be for health-care reform. If our government cannot produce some kind of reform, that will only reinforce the perception that our political system is incapable of resolving our largest, most difficult problem — and that is what will make investors think twice about investing in America.”
By James Kwak
The Baseline Scenario 
Why won’t anyone admit that we are already subsidizing them in the most inefficient way possible? Do you really think your medical costs reflect the amount that YOU incurred?
To put it another way, this article seems to be refuting arguments coming from some parallel alternate universe.
and that is what will make investors think twice about investing in America.
Because the investors will pass up lucrative opportunities to fleece Americans because the government screwed them over on health care?
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In the hyper partisan acrimonious political atmosphere of today, reasoned debate about reasonable proposals to reduce healthcare cost may be impossible. For sure, the Democrats have not put forward any proposal that would reduce cost without severely rationing care.
If by healthcare reform, you mean rationing of healthcare services and subsidizing the uninsured, I think you will find by most polls, that most Americas want no part of what you call reform. It would only mean greater government control of people’s lives, tyranny, socialism and in the end a healthcare system that does not work anywhere near as well as the one we have now.
There are many proposals for reform, like tort reform to name one, that would help control costs and give the public a better healthcare system, but the Democrats don’t seem to be interested.
Why do we only have a choice between opposing basic protection for the uninsured and supporting a trillion dollar giveaway to vested interests, funded by blackmailing the healthy?
Calling for tort reform to control health care costs is a red herring. The cost of the medical liability system is less than one half of one percent of our medical costs, hence no significant savings would be realized. The belief that tort reform would reduce the highly speculative cost of defensive medicine, i.e. unnecessary tests and procedures, has been discounted by many studies. Surely we should maintain accountability of health care providers as we adopt a new health care system.
What’s the debate about?
Of course America (still the richest country on Earth) can afford health-care reform. We can even afford a universal, single-payer health-care system a la Canada, without adding a dollar to the deficit.
First, let’s cut the military budget. (OK, we can’t do that.) Well then, let’s stop wasting money on drug enforcement and jails. (OK, we can’t do that either.) Then how about raising taxes? (No way!)
On second thought, maybe America CAN’T afford health-care reform.
Paul if we can only work hard to defeat reform we can create a society that no one will want to live in. Then we win!
If we adopted single payer, it would save money while covering everyone. We’re not talking a few cents here and there, we’re talking a significant percentage of GDP. The only question is how we can afford not to do it.
You’re absolutely right. But you know what? It doesn’t matter. Doctors don’t want to be responsible for their negligent care, and insurance companies want yet another way of not paying for medical negligence.
I can already see some doctors writing in saying, “oh but juries can make me responsible for non-negligent care and out-of-control trial lawyers will take their case on a contingency so the patient’s family pays nothing unless they win, and the case usually settles out of court even if it’s bad.” The sad thing is that it almost never happens that bad medical malpractice cases are filed despite what the insurance industry wants you to believe. And most patients’ families walk away with far less than what anyone could consider adequate compensation for the medical negligence (especially after the contingency fees are subtracted). The bias is already very strongly against patients who are injured by doctors.
“Any way you look at it you lose.”
I have heard that malpractice costs are less than 2% of costs. Do you have other information. I am a Democrat who favors realistic tort reform, especially reform that would take frivolous lawsuits and have the losing plaintiff pay the defendant’s legal fees, IF after loss the suit is deemed to be frivolous.
Here’s a little something
http://www.press.uchicago.edu/Misc/Chicago/036480.html
This lengthy article (10,000 words) is the first in-depth, non-partisan evaluation of the benefits of universal care and the way to pay for it over the long term.
http://www.theatlantic.com/doc/200909/health-care
He seems to feel it’s realistic for an average person to having savings of thousands if not tens of thousands per year to use solely for their HSA. This amid a negative savings rate for the bottom 90% of Americans.
The American political system is too hopelessly broken and this generation of policy makers far too compromised to take on a problem with as many disparate stakeholders as health care. The thing will just continue to plod along in its own grotesque way, awaiting the arrival of some distant future generation to come along and fix it. You can bank on this.
The existing medical malpractice system is a failure by any reasonable measure.
The majority of suits that are failed are either dropped before trial or lead to a verdict in favor of the physician. While this doesn’t prove that the suits were frivolous to start with, it suggests that the contingency fee system does not really deter lawyers from bringing weak cases. And though they may be the exception rather than the rule, there are unquestionable, crystal clear instances of juries punishing exceptionally good care just because the outcome, fault of nobody, was bad.
On the other side of the coin, studies have shown that the vast majority of medical injuries unquestionably attributable to provider error, never culminate in malpractice suits. They just get covered up and the patient never knows what’s been done to them.
It’s also clear that malpractice litigation does nothing to improve the quality of care. It provides care providers and institutions with strong incentives to cover up their mistakes (which the evidence suggests they do with great effectiveness) rather than admit them as a first step towards fixing things. While I do not think “defensive medicine” occurs on a large enough scale to materially contribute to the outsize costs of our health care system, it is still a bad outcome of the tort system. After all, even if the defensive medicine had no monetary costs, extra procedures are just extra opportunities for patients to be injured.
Truly, the only people that really benefit from this system are the attorneys.
What we need is a fair system of administrative compensation for all medical injuries on a no fault basis, probably funded from hospital and physician revenues. We also need accountability for care providers–but on a different basis where all providers’ performance is subject to continuing review and quality improvement initiatives. And for those who truly can’t cut it, limitation or revocation of the license to practice. This would be the sensible way to deal with medical malpractice. But it won’t control health care costs. In fact, it would probably be very expensive given the known large amount of negligent injury that currently goes entirely uncompensated.
Perhaps you should change your handle to Rosy Scenario. What reason is there to believe that a future generation will eventually fix it?
That this is the debate highlights how poor the Democrats’ strategy has been.
There are two issues at play here:
a) the cost of care for the covered population is high and growing rapidly;
b) many people are uninsured/underinsured.
In the name of not scaring people by doing anything that might change their coverage, the Democrats refused early on to either implement single payer or allow the public option to compete with employer-provided care. So naturally, everyone currently on Medicare or receiving employer-provided care assumes that he receives no benefit and only expense.
Furthermore, the focus on a plan available to the uninsured makes people think of health care reform as an expansion of the social safety net, and the heuristic is “greater safety net = higher cost”.
We have a public that is virtually incapable of grasping at this point in time that the public option is designed to INCREASE competition and DECREASE prices throughout the medical service provision chain. So the perverse outcome is that we are debating whether we can afford something that will save us money.
People are dumb, and health care may always be too complex for the bulk of the population. But the good guys (with the exception of Anthony Weiner) haven’t even bothered making the case.
A small contribution to paying for universal heath care would be to abandon NASA’s Manned Spaceflight Program. It is a big boondoggle – lab coat wellfare.
Actually it’s not the first. But it is the first one that has made the mainstream media. And it is undoubtedly the best written that I have seen. This article should be required reading for everyone! It is the clearest explanation I have seen of most of what’s wrong with the health care system.
I don’t, however, think his proposed solution would work very well. I think it would be, at first, a substantial improvement over what we have. But I think that it would be quickly subverted, and in a short time we’d be back more or less where we are now, or even worse.
Can you imagine if when threatened with crisis our politicians had asked, “Yes, the world is at war, but can we afford to build up the military and fight the Nazis?”
Since when was the common good something to be haggled over? There was no haggling over the cost of waging the war in Iraq (though there should have been) because it was to save lives from the threat of WMD (Yes, it was a lie but it still sold the war).
So, the real question is: When is human life protected at any cost, and when is it expendable?
it suggests that the contingency fee system does not really deter lawyers from bringing weak cases.
It could also suggest that doctors really are that good at covering up.
You may be interested in the link I posted above CBS of the West, where the author of that book takes a different view on whether malpractice liability improves medical care.
He also makes the point that many patients bring malpractice suits as a way of finding out what’s been done to them. That seems pretty messed up don’t you think?
Debating if we can afford something that will save us money seems like a common theme in politics. Just look at energy reform, finance reform, military reform, etc…
The problem is, in saving money for tax payers and average citizens we would be cutting into profits of major corporations – many of which either own our major news sources or advertise heavily on them. If we were to rid the nation of insurance companies, war profiteers, energy monopolies and their kind who would pay for all the lobbyists and election campaigns?
What reason is there to believe that the human race will survive that long?
No it was to bring democracy to those poor Iraqis.
Canadian businesses are more efficient and more competitive because they are not burdened with either (1) having workers with no health care, or else (2) payinge for employee health insurance.
Are there independent studies showing how American business would be affected by universal health care?
No it was neither of those things, but we were in too deep to withdraw.
All of this debate about health care costs and health care coverage is moot. This problem was solved weeks ago by the visionary Republican Senator Chuck Grassley. He has worked for the federal government (as a congressman/senator) for decades and found the solution to this problem many weeks ago, in a moment of epiphany, while talking to voters in Iowa. Watch Republican Senator Chuck Grassley’s solution to the health care problem on the link below.
By the way all Senators and Congressman INCLUDING REPUBLICANS have their health subsidized by the federal government. Republican Senator Tom Coburn of Oklahoma and Republican Chuck Grassley believe that when the government subsidizes THEIR health care, it’s an extremely efficient way.
So, the real question is: When is human life protected at any cost, and when is it expendable?
Here is a quick guide:
oligarchs: protected at any cost.
everyone else: expendable.
I should have said sponsored, not subsidized in my above comments……..but I think you get the idea.
Or we could stop buying useless aircraft and defense systems for the military. Or we could stop shoveling money to big banks. These would make it very affordable too without taking away from some of the valuable research that comes from NASA.
Why cut a program that has been responsible for numerous extremely important innovations in our everyday life?
What we need is a fair administrative system for all medical injuries on a no-fault basis…
Good luck! All of the administrative systems currently proposed envision panels of medical experts replacing jurors as the deciders!! By no stretch of the imagination would such a system be considered fair by injured patients. A jury of ones peers is the best and only place victims can be sure they will receive a level playing field. Next, none of the plans are no-fault. They all require that the patient prove negligence and causation. No-fault plans are universally opposed on grounds that they would let in so many more injured patients the costs would be prohibitive. Finally, all of the proposals include some sort of scheduled benefits that would drastically reduce compensation and make the providers’ carriers payers of last resort. That means that ones health insurance would have to pay first before any recovery could be realized from the medical liability insurers. In essence these proposals are really ways to shift costs to victims, their health insurers or taxpayers. How would that reduce the costs of health care??
It was always a sham just like the most every war and military intervention in the past 60 years.
Remember how protecting the Kurds from Saddam was so important until the Turks wanted to bomb them in 2007? Saddam can’t kill them but we’ll let our allies bomb ’em.
Thanks! Always useful to have a simple guide for these complicated issues. :)
It’s much worse than that. They might have to *gasp* work for a living.
An old buddy once summed it up nicely:
“The more you help people the less you’re paid, the more you hurt people the more you’re paid.”
I’m not sure it counts as independent, but here’s one:
http://www.cfr.org/publication/13325/
James seems obsessed with any change – for better or worse.
I gave money and voted for BO. I now see that for what it is: a mistake. Things are no different than before.
1. Obama received more money from the health insurance lobby than any candidate in history. Why is our “solution” to mandate insurance for everyone? Why don’t we add food, gas, air, and water insurance too so no one goes hungry, thirsty, or is stranded in their Escalade at the Mikey D’s? Answer=lining the pockets of the dirtbags in the insurance industry.
2. Obama also received more money from the trial lawyers than any candidate in history. TORT REFORM IS OFF THE TABLE, he says. For the naive who state that malpractice does not contribute to healthcare costs, I encourage you to peruse http://www.sickoflawsuits.org. The US has 5% of the world’s population and 70% of the world’s lawyers. As a physician, I can guarantee you that the threat of malpractice makes EVERY physician order unnecessary tests every day. That’s not a fraction of a percent.
3. We are all complicit in the healthcare problems. Insurance, hospitals, physicians, pharmaceutical, lawyers, and patients. I’d love to hear an explanation why only 4 of the 6 are being targeted in this so-called “reform”.
4. The only way things get cheaper is if the consumer becomes hesitant to consume. With an incredible obtuse and complicated healthcare system and a population of 33% obesity, mandates aren’t going to cut it. Cutting reimbursement isn’t going to cut it. Telling insurance companies they can’t exclude for “preexisting” isn’t going to cut it. Until Americans realize how much they are paying and what they are getting for it – AND they stop stuffing their faces with happy meals the costs will continue to go up. Speaking of costs, our federal government spends 2x on defense what they spend on medicare + medicaid. If healthcare is a “right”, why are we spending 2x more on killing foreigners than saving our own?
Sorry for the rant, but the woeful lack of perspective of many involved in this debate is very frustrating.
Peace,
Brian
The healthcare system works well now? Really? Its gonna bankrupt the country pretty soon, and the US pays twice what the rest of the world pays for poorer quality care. I don’t consider this working well.
I agree on the Tort reform, but that is a minor part.
In the end though, as long as Americans continue to treat their bodies as they currently do, there is no amount of doctors visits that can save you.
In a act of amazing symbolism, during a debate on healthcare a commercial came up for that KFC sandwich with fried chicken as bread. America, put down the fat, the pills, and get off your a$$ and maybe your healthcare cost will go down. Continue using your body as a sujar receptile, and your sunk.
Mr. Kwak-
You are a quack.
You’re stretching, at best.
You must be feeling punked also. It’s a rather large club and getting larger all the time. Obama knows better. There is a special place in hell for this type of behavior.
Dr Bill,
You say 33% of Americans are obese and they need to “stop stuffing their faces with happy meals”. This description seems rather unkind from a trained physician. I would suggest — tobbaco — is more of hazardous to health than junk food.
Notably you did not talk about Big Tobacco, smoking addiction, and the health costs of smoking related illnesses, such as cancer and cardio vascular disease.
Why the omission?
“While I do not think “defensive medicine” occurs on a large enough scale to materially contribute to the outsize costs of our health care system…”
Have a look at this study by PricewaterhouseCoopers’ Health Research Institute, which conclusions can be read here:
http://money.cnn.com/2009/08/10/news/economy/healthcare_money_wasters/index.htm?section=money_news_economy
“What counts as waste? The report identified 16 different areas in which health care dollars are squandered. But in talking to doctors, nurses, hospital groups and patient advocacy groups, six areas totaling nearly $500 billion stood out as issues to be dealt with in the health care reform debate.
Too many tests
Doctors ordering tests or procedures not based on need but concern over liability or increasing their income is the biggest waste of health care dollars, costing the system at least $210 billion a year, according to the report. The problem is called “defensive medicine.””
Even if median award for medical malpractice cases have decreased in recent years, the fact is that physicians have this deeply entrenched reflex of ordering more tests, “just in case”. And the incentives to do so are also financial.
That sounds like a lot of money (and it is), but it’s still just a small fraction of the trillions spent on health care.
Yes, and why not alcohol too. Doesn’t that do something to the liver, brain, pancreas and oral/pharyngeal areas?…not to mention other effects on pregnant mothers and diabetics, “accidents” caused by intoxication, and it’s role in heart disease and obesity.
You missed the crucial part about his HSA proposal. The author suggested to GIVE to everyone a (rather significant) starting capital in their HSA instead of keeping spending willy-nilly in the screwed-up non-system we now have.
“Anyone with whom I discuss this approach has the same question: How am I supposed to be able to afford health care in this system? Well, what if I gave you $1.77 million? Recall, that’s how much an insured 22-year-old at my company could expect to pay—and to have paid on his and his family’s behalf—over his lifetime, assuming health-care costs are tamed. Sure, most of that money doesn’t pass through your hands now. It’s hidden in company payments for premiums, or in Medicare taxes and premiums. But think about it: If you had access to those funds over your lifetime, wouldn’t you be able to afford your own care?”
Sheesh!
What if…Spartacus had a Piper Cub?
This “lab coat welfare” as you so ineptly called it gave us all the basic scientific knowledge and engineering to develop the personal computer industry, the GPS…among many other things.
How many billions upon billions did the country as a whole made out of this “welfare”?
J’ai dit!
He is right about one thing. I’m going to pay the health insurance companies millions during my life.
That should settle any question readers of this forum might have had.
don’t you have the right to get your doctor’s/surgent’s record shown?
having lived in a rather remote very small village with a savvy general practioner I have concluded that doctors quite often use more tests to be performed for psychological effect.
Rare seems to be the patient who accepts test results and says “Ok whatever it is, it is something I better learn to live with” i.e. easing the discomfort but not being able to get rid of it (example dry eyes). Additional tests in these cases seem to be quite effective in soothing the patient and abating his/her anxiety.
Yes, but when something goes horribly wrong and is covered up, only the legal system offers a hope of finding out the truth about what happened.
My main concern is the government being able to get this right. There seems to be a lot of special interest all getting what they want. How can you come up with a cost effective program.
The real question is why other advanced countries can afford near universal health care and we cannot. A major part of the answer is that 50% of our government spending is devoted to military and defense expenditures. No other country even comes close. Military spending is not limited to the Dept of Defense: nuclear weapons are included within the Dept of Energy, veterans health benefits are administered by the VA (which is a government-run health program), military retirement benefits are handled by the Treasury Dept, et al. The various spy agencies (CIA, NSA, etc – and why on earth do we need 16 different spy agencies?) consume a huge amount of resources. The author and scholar Chalmers Johnson has documented this in numerous articles and books. Johnson rightly refers to the amount squandered by the US military and defense establishments as ‘insane’. If we could bring our military spending under control, then we could easily afford universal health care.
I’m not sure I follow this argument. These other countries pay 7% of GDP, we pay 15% going on 25%. We could pay 7% too if we adopted their superior systems.
We could use the other 8% to beef up military spending even more if we wanted to.
You’re missing this point. Cigarettes are taxed tremendously right now anyway. How about taxing unhealthy foods to help offset the increased healthcare costs associated? I do not believe in mandates – people should be free to smoke or eat fatty foods if they want. However, don’t ask me to help pay for the increased healthcare costs associated with someone’s bad habits.
I think that eliminating medical malpractice tort litigation would be a good thing. But it won’t make more than a tiny dent in overall health care expenditures. And a truly fair system (assuming one could be implemented–see Barry Broughton’s comments below) would in fact probably be very expensive since most medical injury attributable to provider error currently goes undiscovered by patients, unlitigated, and uncompensated.
Assertions based on doctors’ self-interested impressionistic appraisals of how it influences their practices simply doesn’t cut it as evidence of the economic impact that tort reform can have. Check out J Health Econ. 2009 Mar;28(2):481-91. They looked directly at the impact of tort reform on health care expenditures among medical beneficiaries by comparing what happened in states that had tort reform with those that didn’t. Now, I can think of several criticisms to level at the execution of this study. But it sure beats self-serving anecdotes as a level of evidence. And the findings are very consistent with numerous previous studies using similar or different empirical approaches. Malpractice is a huge irritant to the profession, and I agree it serves only the lawyers’ interests–but it is only a drop in the health care expenditure bucket.
Truth in blogging disclosures: I am a physician. I have been named as a defendant in two malpractice suits during my career–both were dropped after discovery. My current career is as a researcher and one of the topics I have researched is alternatives to medical malpractice litigation. That said, I have no financial conflicts of interest that might influence my opinions in this matter.
It’s a good idea. Make fatty foods pay for their burden on society. Then do the same thing to alcohol, driving motorcycles, owning guns, and anything else where normal people end up subsidizing the true costs of risky and unhealthy behavior.
And I think we should include meats, dairy, eggs, anything containing grains that are non-whole grain, anything with added sugar (in any form) or added salt, and anything sprayed with pesticides, containing alcohol or containing added preservatives. These products should bear in equal measure the entire health care costs associated with bad diet.
~ WHEN THE LAUGH OF $ATAN WA$ HEARD IN THE PEOPLE$ HALLS OF U$ CONGRE$$ ~
THIS OLD WORLD ORDER OF ABUSE AND NEGLECT OF OUR POORER AMERICANS NEEDS ENLIGHTENED POLITICAL MINDS AND HEARTS TO VIEW GOD DIFFERENTLY THEN $$$…. NO MATTER WHAT THEIR POLITICAL PARTY AFFILIATION ???
WHEN WILL OUR WEALTHY ELITE AMERICANS ABATE THEIR ASSAULT ON POORER AMERICANS WITH THEIR MONETARY CONTROL OF OUR IVORY TOWER U.S. CONGRESSIONAL LEADERS OF THE NEW WORLD ORDER ???
THERE ARE NOT MANY MORE DISTRACTIONS LEFT WHICH ARE AVAILABLE FOR OUR WEALTHY ELITE AMERICANS TO HIDE BEHIND IN NOT TAKING PROPER CARE OF ALL OUR AMERICANS IN A HUMANE FASHION !!!
RALPH NADER ATTEMPTED TO EDUCATE AMERICAN VOTERS ABOUT U.S. CORPORATE POWER IN AMERICA AND HOW THEY CONTROL OUR CONGRESSIONAL PEOPLE THROUGH THEIR POCKET BOOK (POLITICAL DONATIONS). * WITHOUT THE DOUGH $$$ THESE U.S. CONGRESSIONAL LEADERS OF THE FREE WORLD DO NOT GET RE~ELECTED TO CONGRESS.*TO STAY IN POLITICAL OFFICE IN AMERICA,ONE HAS TO BARTER YOUR VOTES IN CONGRESS AND REPRESENT POWER INTERESTS IN RETURN FOR THE BUCK$.
POORER AMERICANS HAVE NEVER HAD THE $$$ LOBBY TO INFLUENCE THIS CORRUPT POLITICAL CONCEPT (of horse trading political votes for political contributions) TO ACHIEVE PROPER HEALTH ~CARE OR LEGAL REPRESENTATION FOR ALL OUR MIDDLE ~ CLASS AND WORKING POOR AMERICANS.
AMERICAN IVORY TOWER U.S.CONGRESSIONAL LEADERS OF THE FREE WORLD HAVE PASSED FEDERAL LEGISLATION IN WASHINGTON DC TO SPEND 50 BILLION AMERICAN TAX $$$ ON THE INTERNATIONAL FIGHT AGAINST AIDS OVER THE NEXT FIVE YEARS WHILE THEIR OWN AMERICAN CITIZENS ARE BEING TOLD BY THIS SAME U.S.CONGRESS THAT NATIONAL HEALTH CARE AND PROPER LEGAL REPRESENTATION FOR MIDDLE CLASS AND WORKING POOR CITIZENS IS UNAFFORDABLE.
*** WEALTHY ELITE AMERICANS (WHO ARE ONLY 1% OF OUR USA POPULATION) SADLY ALSO CONTROL HOW OUR U.S.CONGRESS SPENDS THEIR BUDGET TRILLION$ AND HAVE OBVIOUSLY FOUND MORE WORTHY INTERNATIONAL CITIZENS THEN OUR OWN DESPERATE AND NEEDY POOR TO ASSIST !!!
~Poorer Americans Nationwide only get 400 million $$$ per year for legal representation allocated them by CONGRESS~
Middle Class and Working Poor Americans are unable to afford proper legal representation in their Civil, Criminal and Family Courts of law all across America causing tremendous hardships nationwide,but these great minds and callous hearts in our American Congress have found others Worldwide more needy then their own citizens who are being falsely incarcerated,wrongfuly executed,losing their homes or apartments,losing child custody or visitation with their children etc�
Not being afforded proper legal representation by our U.S. Congress has created a total breakdown of the American judicial system for our poorer Americans because the our U.S. Courts punish all of us little people if we are not assisted with proprer legal counsel.*It is a known fact that our average Middle Class and Working Poor Americans without proper legal representation in all of our American Courts of law lose their legal cases to the better financed who are able to afford lawyers.
Lawyers For Poor Americans is now actively in the hunt for International Countries and Leaders Worldwide to help raise 5 Billion Dollar$ for our slighted poorer Americans who have had their own American Congress turn their backs on their desperate needs in not affording them proper legal representation.
Troy Davis and Mumia Abu ~ Jamal are 2 perfect examples of American citizens who never had proper legal representation or defense investigations afforded them by our U.S. Congressional Leaders Of The Free World in their initial criminal trials in (Georgia and Pennsylvania) who might very well have to pay the ultimate price of possibly being completely innocent and falsely executed in the near future.
These two poor Americans are among tens of thousands of legal cases nationwide that never were afforded proper legal representation or proper defense investigations at their initial trials……**We the public really have no idea if these men are innocent or guilty until they both are given fair legal representation at their new future trials.
Improper murder trials take place in Third World Countries all the time. *** Why should average Middle~Class and Working Poor Americans in the Wealthiest Country Of The World be treated as if they are living a Third World Life Style ??
This is the first of many www International pleas by Lawyers For Poor Americans for other leaders and countries to help raise the needed monie$ to correct these blatant injustices that have been inflicted on poorer Americans for the last few decades.
Lawyers For Poor Americans has many other written articles that can be viewed with any www search engine by our name or our telephone number.
Lawyers For Poor Americans is a www lobby group of volunteers that sing out about the decades old neglect,abuse and injustices being inflicted on our poorer Americans that have become Crimes Against Humanity issues for the International World Court to investigate.
lawyersforpooreramericans@yahoo.com
(424-247-2013)
Actually, I have followed the debate, bills, solutions, press coverage, etc., and the only realistic solution IS the single payer system instituted in Canada. The reason why we don’t hear very much about it, is that it works. The entire medical community in Canada IS private, and the only thing the government does is collect taxes and pay for care for EVERYONE!! They don’t interfere in the system, and there is less rationing than is foisted upon us by the American non-healthcare system (mostly by insurers rationing on the basis of profitability).
Yes, we do need tort reform, but only to protect physicians from the fear of failing to do 20 tests intead of 2, and from overprescribing medications. Single payer works because it keeps the government completely out of the business of providing services and setting bogus pricing, by trying to control the costs in the out of control systems of medicare and medicaid. Single payer completely simplifies things, and lets the system work.
Thousand of pages of legislation will only complicate matters dramatically, and cause the system to become even less efficient. Health care is a human right, not a right for the insurers, drug companies, and corporate providers to make huge profits while America’s health deteriorates even beyond its present state as compared to 37 other countries that have better outcomes than we do.
Also, we need to, as a correllary to the single payer system, decriminalize (not legalize) all drugs (vis a vis Portugal), which would save us billions in law enforcement, prisons, court systems, attorney’s charges, etc., and lead to a much lower overall usage amongst the populace. Their decriminalization program has had amazingly positive results, and has been going on now for more than six years.
This is a comment not so much for you Bayard, as for Uncle Billy who I hope will run with it ;)
Have you ever noticed that as the U.S. steps up its fighting in Afganistan, Afganistan gains a greater share of world opium production?
http://en.wikipedia.org/wiki/Opium_production_in_Afghanistan
It’s not hard to find out much more.
Over the course of my life, I have on 2 occasions had to “live with” significant orthopedic problems for YEARS, each, because the standard tests didn’t show a problem. So where were the excessive tests? The conditions didn’t improve over the time involved – one equilibrated and the other deteriorated. When they finally did these tests YEARS after the injuries, the problems were diagnosed and addressed.
I blame the insurance companies for a cumulative decade of pain and suffering. If the original doctors been able to spend more time on the initial office visit, rather than find the most common diagnosis in 15 minutes or less, they probably would have either figured out the injury or punted to the specialist. In both cases, the doc who took the time to get to the bottom of years of complaints (probably pro bono after the first 15 minutes) found the problem and treated it.
I apologize for my rant, but my experiences do not conform to how all y’all see care being administrated. Single payer might have helped, since the docs may have been able to spend more time making a careful diagnosis for the money. There was no malpractice, since the particular problems were/are difficult to diagnose. Excessive testing, in my case, would have led to a much better outcomes since the “excessive” tests would have identified the problems when they were most treatable.
Single payer:
eliminates the payroll tax for Medicare, Medicaid.
eliminates the employer and employee premium payments.
This puts more money in the pocket of the wage earner. When determining an individual cost, these benefits do not appear to be factored in to the calculation.
Single payer still requires funding. Since need for basic health care is not dependent on income, it only makes sense to have everyone pay for it, not just the rich. So fund it with a sales tax, which will also address illegal immigrant use.
“However, don’t ask me to help pay for the increased healthcare costs associated with someone’s bad habits.”
the more you want to shield your own sin-free impeccable life from the evil behaviour of degraded sinners like myself the more you will experience the necessity to install cameras, listening devices and other means of surveillance
– how else are you going to keep the drunk driver from the part of the road financed with your money.
– and btw where do you draw the limit for sports accidents – is the kid throwing a ball in the back yard covered but the sprained ankle while playing soccer not? (btw soccer in Germany is said to supply the highest percentage of sick leave days due to injuries in Germany – so my kid doesn’t play soccer I do not want to pay for such injuries?)
Of course anybody leading a blameless life totally in sinc with the commanding Zeitgeist does not have to fear even the strictest surveillance – if they decide strolling along the water seam of the sea is increasing skin cancer you will immediately refrain from doing such a bad thing or don a burka for the walk
BTW let me assure you I distinctly remember a time when Spaghetti and Potatoes were just as much maligned as fat is today. But of course today we have reached the final stage of wisdom which will never ever again have to be corrected and those who proclaimed once upon a time with equal certainty that carbohydrates are devil incarnate belong to a long forgotten aera when people were too benighted to see the truth.
and these days it may not even be the truth of decades ago that gets the benighted-stamp it may be the truth of an hour ago and all of them always get the stamp final – now we’ve got it – all have to live by the now revealed wisdom
Life is a se..xually transmitted desease that always ends with death (Leben ist eine s..xuell übertragbare Krankheit, die immer mit dem Tod endet)
well – to think about it – that probably is getting more and more old-fashioned
“Assertions based on doctors’ self-interested impressionistic appraisals of how it influences their practices ”
I have repeatedly been told in the 60s an 70s that American gynecologists had a nurse present during examination to be safe from claims of improper behaviour.
Even though I have experienced unwelcomed “padding” from doctors (fortunately not gynecologists) I continue to want to be alone with my doctor during examination. I much rather have an occasional bad experience than an overall climate of mutual mistrust.
After all I am old enough to slap him hard and switch to another doctor.
we “old Europeans” with remnants of a social conscience feel uneasy about financing via sales tax because it takes percentage-wise the highest toll on the incomes of the poorest – to a rich one it doesn’t manage if the price of shoes goes up by x% …
It does that indeed. In this case, however, basic health coverage is more like a head count and is one of the few cases IMO that a regressive tax would be appropriate. In addition, it addresses the political issue of illegal immigrants using the system since they need to buy stuff. To make it a little easier, exempt groceries and clothes from the tax.
It may cause poor people to be slightly more so, but they will have access to health care that isn’t based on emergency rooms and should cause cheaper care for everyone else. Besides, the last 30 years have seen wages drop so what’s a little more – another leak in the boat?
So many stones to turn over, and so many creepy crawlers attached thereto.
But why on a health care reform post?
If you have the right kind of disease opium is really beneficial and a lot cheaper than lots of fancy pills …
fo example if I look at old pictures from opium smokers they are all pretty slim – no obesity to be found there …
now how do I get that argument to make sense
o yeah!!! – the US is fighting to get the Taleban to take care of opium farming, the same guys who once used to be very successful at prohibiting it … therefore the ideal guys to run efficient farming of the stuff i.e. with no workers delaying successful harvest by smoking the stuff themselves
Employer Tax Deduction for Employee Health Insurance Must End
There is one issue in this health care debate that has gotten almost no press. When the issue of the HIGH COST of health insurance and the high cost of health care and drugs are discussed there is never any mention of the employer tax deduction for employee health insurance. My understanding of the effects of this tax deduction is that this is the primary cause of the high cost of insurance and care. The fundamental reason is that the individual citizen (i.e. the employee) is separated from his health care dollars. Each employee is not allowed to “vote” with his dollars for the most cost-effective health insurance, and indirectly health care, that meets his/her needs. Because of this there is no market place for health insurance. Instead the health insurance companies have complete control of the health insurance market through employer paid health insurance, which is subsidized by taxpayers through this tax deduction. Health insurance companies, and American Big Business in general, do not want an active, critical, citizen/employee-based, market place. When someone else (i.e. taxpayers) is paying part of the bill there is no reason for the purchaser (i.e. the employer) to strike the very best bargain.
Without this tax deduction there would be no reason for employers to provide health insurance. Without this tax deduction we would have a true health insurance market place at the citizen level. As long as this tax deduction is in place there will be no significant improvement in the cost of insurance and care. I do wonder why economists do not focus on this tax deduction in their many analyses of the economics and cost of health care. My speculation is that conservative economists don’t mention it because they believe eliminating this tax deduction would be bad for health insurance companies, and American Big Business in general, while liberal or progressive economists don’t mention it because they believe that eliminating this tax deduction would work against the individual employee/citizen because they believe the employer would not increase wages by their current cost of health insurance. So what I suggest we have here is a case of a very unhealthy co-dependency on a tax deduction that has driven health insurance and care costs to their highest possible levels. A co-dependency not unlike a drug-centered co-dependency. And of course there is the co-dependency between members of Congress and the health insurance industry.
I’m well aware this is not a trivial issue. The employer tax deduction for employee health insurance is the single largest tax deduction, significantly larger than the tax deduction for home mortgages. A solution would be for Congress to eliminate this tax deduction by reducing the deduction by an equal amount over five years. This would allow employers, health insurance companies, and employees/citizens to develop a new cost-benefit equilibrium over the next five years. Of course members of Congress currently receive considerable sums from the health insurance industry. Eliminating this tax deduction would serve to reduce those campaign contributions and lobbying efforts considerably since the health insurance industry would no longer have to “protect’ this tax deduction. In summary, we currently have high cost health insurance and care and drugs because Congress has given away, and continues to give away, tax-payer dollars via a tax deduction. This would constitute REAL CHANGE in our political and corporate cultures.
I am in support of a single-payer non-profit health insurance company. If that is not politically possible, then I am in support of a public non-profit health insurance company to compete with for-profit health insurance companies. Under NO circumstances should there be a law REQUIRING every citizen to purchase health insurance, which I think would be UNCONSTITUTIONAL.
Well, it’s a response to someone who said money could be saved (and used for health care) if we stopped the drug war…or should I say “wars”?
Illegal drugs also account for a certain amount morbidity and mortality.
Unfortunately the situation in Afganistan is very sad. You will see by simply googling for it, that what you said is no longer the case.
Yakkis
the situation in Afghanistan is bound to be sad for all number of reasons – not the least of them being that a Lysistrata-style revolt is probably impossible http://en.wikipedia.org/wiki/Lysistrata
– if you read Churchill on his time with the Malakand field force you realize that then the local leaders were never incentivized by considerations for the well-being of their tribes. Nothing I have read about our times signals to me that anything substantial has changed in the more than a 100 years since and why should it? a hundred years are nothing in an ancient society …
Should they be given services before they pay?
Some may be interested in my bipartisan approach to health care. It can be found at:
http://www.plan.bipartisanhealthplan.com
It has some features in common with the Wyden-Bennett bill but is more radical, involving government supplemented Health Funding Accounts and private guaranteed-renewable health policies from birth to death. These replace all other government health plans, including Medicare, Medicaid and SCHIP.
The approach, by design, solves the perplexing problems inherent in pre-existing conditions, guaranteed issue, community rating, and market competition which have been on view in town hall meetings this August and which have frustrated politicians and citizens of both parties.
~ HAVE AMERICAN RELIGIOUS LEADERS HEARD SATAN LAUGHING IN THE PEOPLES HALLS OF U.S. CONGRESS ~
**THIS OLD WORLD ORDER OF ABUSE AND NEGLECT OF OUR POORER AMERICANS NEEDS ENLIGHTENED POLITICAL MINDS AND HEARTS TO VIEW GOD DIFFERENTLY THEN $$$… NO MATTER WHAT THEIR POLITICAL PARTY AFFILIATION ???
**WHEN WILL OUR WEALTHY ELITE AMERICANS ABATE THEIR ASSAULT ON POORER AMERICANS WITH THEIR MONETARY CONTROL OF OUR IVORY TOWER U.S. CONGRESSIONAL LEADERS OF THE NEW WORLD ORDER ???
**THERE ARE NOT MANY MORE DISTRACTIONS LEFT WHICH ARE AVAILABLE FOR OUR WEALTHY ELITE AMERICANS TO HIDE BEHIND IN NOT TAKING PROPER CARE OF ALL OUR AMERICANS IN A HUMANE FASHION !!!
**RALPH NADER ATTEMPTED TO EDUCATE AMERICAN VOTERS ABOUT U.S. CORPORATE POWER IN AMERICA AND HOW THEY CONTROL OUR CONGRESSIONAL PEOPLE THROUGH THEIR POCKET BOOK (POLITICAL DONATIONS).*WITHOUT THE DOUGH $$$ THESE U.S. CONGRESSIONAL LEADERS OF THE FREE WORLD DO NOT GET RE~ELECTED TO CONGRESS.*TO STAY IN POLITICAL OFFICE IN AMERICA,ONE HAS TO BARTER YOUR VOTES IN CONGRESS AND REPRESENT POWER INTERESTS IN RETURN FOR THE BUCK$.
**POORER AMERICANS HAVE NEVER HAD THE $$$ LOBBY TO INFLUENCE THIS CORRUPT POLITICAL CONCEPT (of horse trading political votes for political contributions) TO ACHIEVE PROPER HEALTH ~CARE OR LEGAL REPRESENTATION FOR ALL OUR MIDDLE ~ CLASS AND WORKING POOR AMERICANS.
**AMERICAN IVORY TOWER U.S.CONGRESSIONAL LEADERS OF THE FREE WORLD HAVE PASSED FEDERAL LEGISLATION IN WASHINGTON DC TO SPEND 50 BILLION AMERICAN TAX $$$ ON THE INTERNATIONAL FIGHT AGAINST AIDS OVER THE NEXT FIVE YEARS WHILE THEIR OWN AMERICAN CITIZENS ARE BEING TOLD BY THIS SAME U.S.CONGRESS THAT NATIONAL HEALTH CARE AND PROPER LEGAL REPRESENTATION FOR MIDDLE CLASS AND WORKING POOR CITIZENS IS UNAFFORDABLE.
*** WEALTHY ELITE AMERICANS (WHO ARE ONLY 1% OF OUR USA POPULATION) SADLY ALSO CONTROL HOW OUR U.S.CONGRESS SPENDS THEIR BUDGET TRILLION$ AND HAVE OBVIOUSLY FOUND MORE WORTHY INTERNATIONAL CITIZENS THEN OUR OWN DESPERATE AND NEEDY POOR TO ASSIST !!!
~Poorer Americans Nationwide only get 400 million $$$ per year for legal representation allocated them by CONGRESS~
**Middle Class and Working Poor Americans are unable to afford proper legal representation in their Civil, Criminal and Family Courts of law all across America causing tremendous hardships nationwide,but these great minds and callous hearts in our American Congress have found others Worldwide more needy then their own citizens who are being falsely incarcerated,wrongfuly
executed,losing their homes or apartments,losing child custody or visitation with their children etc?
**Not being afforded proper legal representation or by our U.S. Congress has created a total breakdown of the American judicial system for our poorer Americans because the our U.S. Courts punish all of us little people if we are not assisted with proprer legal counsel.
**It is a known fact that our average Middle Class and Working Poor Americans without proper legal representation in all of our American Courts of law lose their legal cases to the better financed who are able to afford lawyers.
**Lawyers For Poor Americans is now actively in the hunt for International Countries and Leaders Worldwide to help raise 5 Billion Dollar$ for our slighted poorer Americans who have had their own American Congress turn their backs on their desperate needs in not affording them proper legal representation.
**Troy Davis and Mumia Abu – Jamal are 2 perfect examples of American citizens who never had proper legal representation or defense investigations afforded them by our U.S. Congressional Leaders Of The Free World in their initial criminal trials in (Georgia and Pennsylvania) who might very well have to pay the ultimate price of possibly being completely innocent and falsely executed in the near future.
**These two poorer Americans are among tens of thousands of legal cases nationwide that never were afforded proper legal representation or proper Defense Ivestigations at their initial trials.We the public really have no idea if these men are innocent or guilty until they both are given fair legal representation at their new future trials.
**Improper murder trials and needless deaths due to lack of healthcare take place in Third World Countries all the time.*** Why should average Middle~Class and Working Poor Americans in the Wealthiest Country Of The World be treated as if they are living a Third World Life Style ??
lawyersforpooreramericans@yahoo.com (424-247-2013)