Friday, May 20, 2011

Coming Soon to America: Increased Wait Times?

GUARDIAN -- "Doctors in the U.K. are blaming financial pressures on the National Health Service (NHS) for an increase in the number of patients who are not being treated within the 18 weeks that the government recommends. New NHS performance data reveal that the number of people in England who are being forced to wait more than 18 weeks has risen by 26% in the last year, while the number who had to wait longer than six months has shot up by 43%.

In March, 34,639 people, or 11% of the total, waited more than that time to receive inpatient treatment, compared with 27,534, or 8.3%, in March 2010 – an increase of 26% – Department of Health statistics show. Similarly, in March this year some 11,243 patients who underwent treatment had waited for more than six months, compared with 7,841 in the same month in 2010 – a 43% rise."

469 Comments:

At 5/20/2011 2:35 PM, Blogger morganovich said...

"According to the statistics for the 15 of the most common diagnostic tests carried out by the NHS, the average waiting time for any of the tests is seven weeks, while three quarters of the tests are carried out by 13 weeks"

It also said it had met its “18 weeks” waiting time target, whereby patients referred from a GP for further treatment start that treatment within 18 weeks. The target became the operational standard for the NHS from January 1 2009. Today’s announcement confirms that the deadline was met.

The average wait for treatment for patients admitted to hospital is now just 8.6 weeks.

these are just jaw dropping.

they are excited about a 2 month wait for a hospital and a 3 month wait for tests.

the average wait to even see a GP is 5 weeks.

18 weeks is 4.5 months.

oh, and once you are seen, the service is TERRIBLE.

the NHS is a failed institution. it needs to be wound down.

 
At 5/20/2011 2:45 PM, Blogger Jason said...

This comment has been removed by the author.

 
At 5/20/2011 2:45 PM, Blogger Jason said...

They've replaced money with time for customer costs.

 
At 5/20/2011 2:57 PM, Blogger Larry G said...

something to consider.

1. "wait times" for those without access to the health care system are significantly longer than even the worst govt-run systems.

2. - "wait times" for govt-health care does not mean you cannot buy better quality care if you can afford it.

the "wait times" are for the basic health care that covers universally.

In Germany, and Singapore and many other heath care systems,nothing prevents you from buying better care if you are unsatisfied with the basic care.

Even in the US... you are free to pursue more/better care outside of your plan or even Medicare.

It is listed in your bill as "services not covered" by your plan.

In Medicare (for instance) if you get a screening test more often than what it will pay for - it does not stop the test, but you do have to pay for it.

They give you a form at the time of the test for you to sign that acknowledges that your test may not be covered and you will be responsible for it.

 
At 5/20/2011 3:06 PM, Blogger juandos said...

What do you mean by, "coming soon" since its already here?

Yet another lesson on being careful what one wishes for...

The following is from Peter Suderman of Reason dated May of 2010: ObamaCare Puts Strain On Emergency Rooms, Bans Expansion By Doctor-Owned Hospitals

 
At 5/20/2011 3:13 PM, Blogger juandos said...

"Even in the US... you are free to pursue more/better care outside of your plan or even Medicare"...

Hmmm, are you sure you'll have the choices Larry G?

 
At 5/20/2011 3:17 PM, Blogger Larry G said...

guy - you are CONFUSING Doctor-owned hospitals with primary care....

It's TRUE that more people seeking primary care will put a strain on primary care but where do we think these folks get their medical care right now?

at ERs..that's where...

If we switch people from ERs to Primary CAre - even if it causes some shortages in Primary care is that ultimately a better thing than more and more people relying on the ER for their primary care?

 
At 5/20/2011 3:22 PM, Blogger juandos said...

Funny how Larry G is forgetting his OWN previous comment: "guy - you are CONFUSING Doctor-owned hospitals with primary care"...

No Larry G, I'm not...

Did you forget this comment by you? "Even in the US... you are free to pursue more/better care outside of your plan or even Medicare"...

Doctors' hospitals ARE all about choice...

 
At 5/20/2011 3:27 PM, Blogger PeakTrader said...

Larry, you're citing reasons why government should be out of U.S. health care.

 
At 5/20/2011 3:29 PM, Blogger Larry G said...

re: " Doctors' hospitals ARE all about choice.."

not any more or any less than any other kind of health care facility guy.

Virginia REQUIRES a Certificate of NEED for ANY Hospital...for ANY MRI or ANY major diagnostic facility.

Va's approach is not uncommon.

But you STILL have CHOICE about paying more to get more.

Neither the Feds nor the State wipe out ALL choices...

In our area - we have hundreds/thousands of choices with regard to primary care physicians and dozens of choices with regard to hospitals.

The narrative you are pursing is just plain not true.

 
At 5/20/2011 3:31 PM, Blogger fboness said...

"Even in the US... you are free to pursue more/better care outside of your plan or even Medicare"

Uh, no. If you decline Medicare A then your SS benefits will be cut off completely. This is a gift from Bill Clinton in 1993 recently affirmed in Federal court.

 
At 5/20/2011 3:36 PM, Blogger Larry G said...

@peak trader - maybe but name another industrialized country in the world that does not have it's govt involved in health care.

As I've said before, if we were REALLY serious about our govt being involved in health care - we'd NOT have EMTALA which basically guarantees that our govt will be involved in health care - from that point on.

agree?

 
At 5/20/2011 3:39 PM, Blogger morganovich said...

larry-

"wait times" for those without access to the health care system are significantly longer than even the worst govt-run systems."

nope. not true at all. you can walk right in and pay cash. i used to do it for years when i was young. insurance looked like a bad deal to me. i never saw doctors. when i did (for a torn ligament or some such) i paid them. it was cheaper than insurance. even if you had a $1000 ER trip ech year, it's much cheaper than $250/mo in premiums.

the uk system is a case study in what not to do.

generally, you can get 2 of three from good, fast, cheap.

NHS has hit an astounding ZERO of 3.

it's slow, it's terrible care, and it's really expensive.

as you point out, lots of people have private care. but they still pay taxes for NHS. it's something like 2:1 paying taxes to usage.

even in inflation adjusted terms, the cost of the NHS tripled from 1998-2011. (35bn to 119)

that's astounding growth. 10% per year (compounded) above inflation.

it is suffering from severe shortfalls.

to get one of "good fast cheap" is poor performance.

2 is good (and 3 amazing - think kindle).

but to get none is horrible. that's just rank incompetence.

i think we can all agree on good and fast.

let's look at cheap.

the money spent by NHS is 119bn pounds a year.

there are 61mn people in the UK.

that's 1950 pounds a year per citizen. that's about $3200 per year per citizen in costs.

let's say only 1/3 have private care (a conservative assumption).

that makes the expense per user $4700/year.

for $4700 in the US, you could buy EXCELLENT insurance if you are of average health. you'd have good care and no lines. (my insurance doesn't cost half that and is top notch)

this is why i say the NHS is a total failure.

it's as big an embarrassment as US public schools, and for many of the same reasons.

you think the US teacher's unions suck? try the NHS unions in the UK. (like unison)

 
At 5/20/2011 3:40 PM, Blogger Larry G said...

" "Even in the US... you are free to pursue more/better care outside of your plan or even Medicare"

Uh, no. If you decline Medicare A then your SS benefits will be cut off completely. This is a gift from Bill Clinton in 1993 recently affirmed in Federal court. "

Not true for Medicare Part B which you have to sign up for and pay premiums for.

Part A is hospitalization.

Part B is everything else including doctors

You can STILL buy physicians and surgeons services.. even if they are done at a hospital.

For instance, plastic surgery or oral surgery.

I'm not advocating one way on the other here... but I think we need to keep the truth... and not spread disinformation as a pretext to a philosophy.

 
At 5/20/2011 3:44 PM, Blogger Larry G said...

you are not restricted for paying for health care even if you are govt or private health care.

It's just wrong to claim that govt health care will limit you to only on level service.

Govt health care provides a MINIMUM level of service - a basic level of service.

You can always buy up from there.

the idea that if we get Obama_Care that we will be forced into longer wait times is no more true than it is with countries that have universal care

You can ALWAYS buy better if you want better.

 
At 5/20/2011 3:46 PM, Blogger morganovich said...

"but where do we think these folks get their medical care right now?

at ERs..that's where..."

nope. not true at all.

this endlessly repeated liberal canard has no basis in fact.

http://www.ncpa.org/commentaries/uninsured-emergency-room-use-greatly-exaggerated-health-care-news

the uninsured have a 7% chance of using an emergency room vs 5% for those with private insurance. the huge users are the federally insured. medicaid recipients have a 15% use rate.

the difference between private insureds and uninsured is pretty minimal.

it's certainly not enough to back up nonsense claims about "using the ER as primary care".

sorry larry, but you are way off on that claim. i know the newspapers like to blare about it a lot, but that's just agenda driven propaganda.

 
At 5/20/2011 3:47 PM, Blogger PeakTrader said...

Larry, if you're poor and need a lawyer, you can't afford a high-powered lawyer.

A lawyer will be appointed to you, but it won't likely be the lawyer you want.

That's just the way it is. Accept it.

Of course, lowering costs, while at least maintaining quality, should be objectives.

Personally, I think, there are too many JDs and too few MDs.

 
At 5/20/2011 3:57 PM, Blogger Larry G said...

" More than half of all emergency room care in the U.S. now goes uncompensated. "

a b The Uninsured: Access to Medical Care, American College of Emergency Physicians, accessed 2007-10-05

" The National Center for Policy Analysis (NCPA) is a nonprofit, nonpartisan public policy research organization, established in 1983. Our goal is to develop and promote private, free-market alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial
private sector."

they say this:

" A new report from the National Center for Health Statistics (NCHS), the nation's chief health statistics agency, suggests the longstanding perception uninsured patients are clogging the nation's emergency rooms (ERs) is a myth."

where is the report?

 
At 5/20/2011 3:59 PM, Blogger Larry G said...

" Larry, if you're poor and need a lawyer, you can't afford a high-powered lawyer.

A lawyer will be appointed to you, but it won't likely be the lawyer you want.

That's just the way it is. Accept it.

Of course, lowering costs, while at least maintaining quality, should be objectives.

Personally, I think, there are too many JDs and too few MDs. "

that's the same deal with universal health care.

You DO get care but it may not be the best nor what you want but if you are poor that's the deal.

If you are not poor - you have more options...

 
At 5/20/2011 3:59 PM, Blogger morganovich said...

"you are not restricted for paying for health care even if you are govt or private health care."

but you are required to pay for it anyway, making your ultimate healthcare expenses MUCH higher.

in the UK every man woman and child pays $3200 a year in taxes for the NHS. it's likely $5k per actual taxpayer.

that's a big cost.

let's say a great private plan costs $4000. you'd much rather have that. but you can't afford it because you've already been forced to pay $5k for a plan you don't want. you pay for the expensive bad one at gunpoint, so you cannot buy the cheaper, better one.

to buy a $4k plan, you have to be able to spend $9k a year on healthcare. the cost is more than doubled.

the average UK household makes $31k a year. having to pay an extra 4k for private care is 13% of income. add in the 5k paid for NHS and you hit 29% spent on healthcare.

so, while a private plan might be in reach sans the NHS tax, with it, not bloody likely.

 
At 5/20/2011 4:01 PM, Blogger juandos said...

"not any more or any less than any other kind of health care facility guy"...

Geez! If it isn't happening in Larry G world, it isn't happening?!?!

"Virginia REQUIRES a Certificate of NEED for ANY Hospital...for ANY MRI or ANY major diagnostic facilit"...

Obviously people in Virginia get the government they deserve...

Thankfully not all states are as messed up as Virginia, hence there actually is some choice still left out here in some of the other states...

"The narrative you are pursing is just plain not true"...

You Larry G are living in 'Obama fairy tale land'...

Do some homework and make sure you follow the links...

Here's some more homework for you for what might the coming strangulation of choice...

 
At 5/20/2011 4:02 PM, Blogger Larry G said...

" but you are required to pay for it anyway, making your ultimate healthcare expenses MUCH higher."

that may (or may not) be true but saying that you have no choice but the bottom tier is NOT true.

re: " that's a big cost."

uh huh...so.....

" let's say a great private plan costs $4000. you'd much rather have that. but you can't afford it because you've already been forced to pay $5k for a plan you don't want. you pay for the expensive bad one at gunpoint, so you cannot buy the cheaper, better one."

you pays your money and makes your choice but you are guaranteed basic coverage.

" the average UK household makes $31k a year. having to pay an extra 4k for private care is 13% of income. add in the 5k paid for NHS and you hit 29% spent on healthcare.

so, while a private plan might be in reach sans the NHS tax, with it, not bloody likely. "

some will be able to pay more and they will.

others will not and will have as their only recourse the minimum care.

That is STILL BETTER than NO CARE or ER CARE.

 
At 5/20/2011 4:06 PM, Blogger Larry G said...

juandow, et al.

I'll debate the issues tooth and nail by personal attacks will not be tolerated.

keep to the issues or I'll not respond to your posts.

I'm not going to tolerate this escalation to pejoratives against the person.

play polite or go away.

 
At 5/20/2011 4:07 PM, Blogger PeakTrader said...

This comment has been removed by the author.

 
At 5/20/2011 4:08 PM, Blogger morganovich said...

"" More than half of all emergency room care in the U.S. now goes uncompensated. "

um, BS.

now you have really lost the thread.

according to the AHA ALL uncompensated hospital care (which includes all charity work) is 5.8% of total expenses.

thus number has been flat to slightly down since the mid 80's.

you are just regurgitating a bunch of false talking points.

http://www.aha.org/aha/content/2008/pdf/08-uncompensated-care.pdf

further, your math cannot possibly be correct.

there are 60 million medicade patients in the US. they use ER's with over 2X the frequency of the uninsured.

thus, even if NO privately insured patients EVER used the ER, to get to 50% uncompensated, you need 120 million uninsured.

you need to check your facts larry.

you are swallowing some real nonsense.

 
At 5/20/2011 4:08 PM, Blogger juandos said...

You all might recognize the guy in this Daily Markets posting: Trend Toward Concierge Medicine + Obamacare With A Flat Supply Of MDs = Pending Doc Shortage?

 
At 5/20/2011 4:09 PM, Blogger Larry G said...

" Everyone will pay too much for the "free" lawyer, whether they use him or not. "

not if you look at the health care costs in other industrialized countries including Singapore...

Health care in this country is 16% of GDP. in Singapore.it is 3%

 
At 5/20/2011 4:10 PM, Blogger juandos said...

"play polite or go away"...

Oh boo! hoo!

 
At 5/20/2011 4:12 PM, Blogger PeakTrader said...

I'll put it in better context:

If you're poor and need a lawyer, you can't afford a high-powered lawyer.

A lawyer will be appointed to you, but it won't likely be the lawyer you want.

That's just the way it is.

Of course, lowering costs, while at least maintaining quality, should be objectives.

Universal health care appoints lawyers for you, and if you don't like your lawyer, then you have to forgo the "free" lawyer and pay for your own lawyer.

Everyone will pay too much for the "free" lawyer, whether they use him or not.

 
At 5/20/2011 4:13 PM, Blogger morganovich said...

"you pays your money and makes your choice but you are guaranteed basic coverage."

you have also guaranteed that the middle class CANNOT afford private insurance by taking the money they would have used for it and forcing them to spend it on something the don't want.

more expense for a worse outcome is not something to aspire to.

"
some will be able to pay more and they will.

others will not and will have as their only recourse the minimum care.

That is STILL BETTER than NO CARE or ER CARE."

no. this is a huge logical fallacy. sure, the bottom 10% of the population might be better off, but the middle 60% will not be. that's an awful lot of people to penalize.

how would you feel about being taxed 125% of your mortgage or rent payment and getting to live in a project for free so that the bottom 10% of people could live next to you?

would you feel great about "having an option to trade up?"

 
At 5/20/2011 4:18 PM, Blogger PeakTrader said...

Larry, what percentage of GDP is the entire U.S. health care industry?

Singapore's health care industry isn't as advanced.

 
At 5/20/2011 4:19 PM, Blogger PeakTrader said...

And U.S. health care is too expensive because of government.

 
At 5/20/2011 4:21 PM, Blogger Larry G said...

In Germany, people can have employer-provided health care.

The universal care is for people who don't have such options and cannot afford their own.

It's the same way in many other countries including Singapore.

 
At 5/20/2011 4:23 PM, Blogger Larry G said...

Larry, what percentage of GDP is the entire U.S. health care industry?

Singapore's health care industry isn't as advanced.

16% for the USA.

are you SURE than Singapore is not "advanced"?

their GDP share is 3% but they rank in the top 5 in the world on mortality ....

 
At 5/20/2011 4:23 PM, Blogger juandos said...

"The universal care is for people who don't have such options and cannot afford their own"...

Which obviously means that the government steals from the productive in order to spare itself from the whining of those who are less productive...

 
At 5/20/2011 4:24 PM, Blogger morganovich said...

you know why singapore spends less on healthcare: because they don;t have insurance.

in singapore, it's pretty much all HSA. that puts the price signal back into costs and stops inflation.

i don't think you understand how singapore works.

"More details on how Singapore's system works:

* There are mandatory health savings accounts: "Individuals pre-save for medical expenses through mandatory deductions from their paychecks and employer contributions... Only approved categories of medical treatment can be paid for by deducting one's Medisave account, for oneself, grandparents, parents, spouse or children: consultations with private practitioners for minor ailments must be paid from out-of-pocket cash..."
* "The private healthcare system competes with the public healthcare, which helps contain prices in both directions. Private medical insurance is also available."
* Private healthcare providers are required to publish price lists to encourage comparison shopping.
* The government pays for "basic healthcare services... subject to tight expenditure control." Bottom line: The government pays 80% of "basic public healthcare services."
* Government plays a big role with contagious disease, and adds some paternalism on top: "Preventing diseases such as HIV/AIDS, malaria, and tobacco-related illnesses by ensuring good health conditions takes a high priority."
* The government provides optional low-cost catatrophic health insurance, plus a safety net "subject to stringent means-testing.""

the reason that no "all you can eat" plan can ever contain costs is that the users have no incentive to care about price or to limit usage.

get rid of insurance int he US altogether and prices would drop like a rock as they do in cash pay procedures like lasik.

the problem with obamacare is that it goes in the wrong direction. it puts everyone on all you can eat and even eliminates many HSA's and high deductible plans.

that will make it MORE, not less expensive by upping inflation for healthcare.

you want to be like singapore, move to entirely cash pay.

 
At 5/20/2011 4:26 PM, Blogger Larry G said...

" Which obviously means that the government steals from the productive in order to spare itself from the whining of those who are less productive.."

that would be TRUE if we did not have EMTALA....

but because we all pay for those without health care and we pay about 4 times as much than if we paid for primary care... isn't it in our best interests if we ARE going to pay for those without health care that we do it in the most cost-effective way?

 
At 5/20/2011 4:27 PM, Blogger Larry G said...

Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services in the country" to keep costs in check;

 
At 5/20/2011 4:29 PM, Blogger Larry G said...

In other words... Singapore has a very heavy govt involvement an the result is costs that are 4 times less than ours.

 
At 5/20/2011 4:31 PM, Blogger morganovich said...

bottom line: health care is a technology business.

costs should be dropping. if we had avoided the outlandish inflation caused by our insurance structure, our spending WOULD look like singapore.

us per capita health expense was $2814 in 1990. in 2009, $8160. if the costs were flat (not even deflating) and we take into account the doubling of US per capita GDP over that period, we too would have single digit per capita healthcare expenditure. and we could likely do much better than that.

 
At 5/20/2011 4:32 PM, Blogger PeakTrader said...

Juandos, 3% of GDP is not much. Perhaps, the rich get 2.9% of the health care and the poor get 0.1%%.

 
At 5/20/2011 4:35 PM, Blogger morganovich said...

"In other words... Singapore has a very heavy govt involvement an the result is costs that are 4 times less than ours"

wow, no. you are completely missing this.

singapore has a market system. we do not. HSA savings are compulsory, but their expenditure is driven by each individual taking the price of services and their likely benefit into account. this keeps prices low. (that and the lack of ruinous malpractice insurance fees due to a broken tort system)

in the US, we have massive cost inflation (as does the uk etc).

this is because our users do not care what a procedure costs.

once you pay your premium and copay, who cares?

 
At 5/20/2011 4:37 PM, Blogger Larry G said...

okay....

so you'd be okay with a Singapore type HC system in the US?

take your time. I'm off to dinner at friends for a couple but will return...

remember... be polite...

:-)

 
At 5/20/2011 4:37 PM, Blogger juandos said...

"that would be TRUE if we did not have EMTALA"...

Sorry but EMTLA is the perfect example of the federal government expropriating the private wealth of others to finance a socialist dream...

"isn't it in our best interests if we ARE going to pay for those without health care that we do it in the most cost-effective way?"...

No! What's in our best interests is to let those who think like you and your fellow travelers do is for you to pay for this program with your own voluntary donations of your personal wealth...

Personally I see this as a, 'states' right' situation and NOT a federal problem...

There is nothing in the Constitution mandating the federal government should steal from those who produce to give to those who can't fend for themselves...

If the voters of a city, county, or state want such a program well then that's a different story altogether...

 
At 5/20/2011 4:40 PM, Blogger Larry G said...

well..we'd both agree as to the impact of EMTALA so we are making progress, eh?

but you've got a problem.

I don't know of a single elected including both Ron and Rand Paul who advocate repeat of EMTALA...

not a one of those who oppose ObamaCare would agree to also repeal EMTALA,

right?

back in a few...

 
At 5/20/2011 4:42 PM, Blogger juandos said...

"Juandos, 3% of GDP is not much. Perhaps, the rich get 2.9% of the health care and the poor get 0.1%%"...

And the point is what PT?

Questionalable expropriation is just that regardless of the amount or the percentage, right?

 
At 5/20/2011 4:52 PM, Blogger morganovich said...

"so you'd be okay with a Singapore type HC system in the US?"

yes.

i've been advocating that for ages.

our problem is not that too few are insured, it's that too many have insurance that creates perverse incentives.

i think it ought to be voluntary as opposed to compulsory, but the fact is that no market system not based upon users pays can ever work.

there is no way to control costs.

i'd much rather put my "medi" taxes from fica into an HSA every year.

you save money, you pay when you need to. you have cheap, high deductible insurance (ded paid from hsa) to cover catastrophe.

note, however, that singaporian catastrophe insurance is nothing like as good as the US in many cases. premmie babies die at a much higher rate. cancer survival is considerably lower.

i'd prefer not to have signapores limits on what i can spend it on either (us HSA's can go toward preventative and lifestyle like a gym membership).

however, i doubt we'd get singapore style results in everyhting. the US is fat, eats poorly, and does not exercise.

fixing that would make a big difference as well, but that comes down to personal choice and culture.

 
At 5/20/2011 4:56 PM, Blogger Methinks said...

"wait times" for those without access to the health care system are significantly longer than even the worst govt-run systems.

2. - "wait times" for govt-health care does not mean you cannot buy better quality care if you can afford it.


Are you on crack?

1.)Nobody in this country doesn't have have access to the health care system. Show me these individuals who cannot walk into a doctor's office and pay for care (which is what you suggest they do if they find themselves on a government wait list).

2.) Do you not understand the sheer idiocy of being forced to pay for a broken government system and then pay AGAIN for private care because the government system is broken?

 
At 5/20/2011 4:58 PM, Blogger PeakTrader said...

I wonder what percent of GDP U.S. health care would be without people like Michael Jackson and Dolly Parton?

 
At 5/20/2011 4:59 PM, Blogger morganovich said...

also worth noting:

singapore is not "universal care". it's "forced savings and a market for care".

those are to entirely different animals.

absent a market, you get a system like the UK which costs $4500 per payer and gives lousy, slow care.

singapore is quite possibly the most market oriented country in the world.

that's why they are one of the richest per capita and have been so successful despite having no natural resources or any real arable land.

do note though that they are a TINY country. they have fewer people than manhattan.

it's much easier to manage a system for a small population, especially one that is nearly all urban. the whole country is 20 miles across.

 
At 5/20/2011 5:06 PM, Blogger Ron H. said...

"play polite or go away."

What a crybaby!

 
At 5/20/2011 5:29 PM, Blogger morganovich said...

""play polite or go away."

What a crybaby!"

actually, i think he has a point.

it's fine to disagree or even ridicule ideas, but there is really no reason to be rude or personal (well, except maybe for benji who is so obnoxious that he brings it on himself)

that said, i don't really see the personal attacks he's talking about either.

the worst i could find was an accusation about "living in fairyland" which, while not precisely polite, is hardly a scalding personal attack either.

so, i guess i'm agreeing with both of you.

larry makes an excellent and valid point about ad hominem, but i think he may be being a bit oversensitive in this case.

bottom line:

this will be a more pleasant place to debate and argue if we are all civil.

 
At 5/20/2011 6:25 PM, Blogger Che is dead said...

Hospital emergency rooms, the theory goes, get overcrowded because people without health insurance have no place else to go.

But that's not the view of the doctors who staff those emergency departments.

The real problem, according to a new survey from the American College of Emergency Physicians, isn't caused by people who don't have insurance —it's caused by people who do, but still can't find a doctor to treat them.

A full 97 percent of ER doctors who responded to the ACEP survey said they treated patients "daily" who have Medicaid (the federal-state health plan for the low-income), but who can't find a doctors who will accept their insurance...."The results are significant," said ACEP President Sandra Schneider in prepared comments. "They confirm what we are witnessing in Massachusetts —that visits to emergency rooms are going to increase across the country, despite the advent of health care reform, and that health insurance coverage does not guarantee access to medical care."

Emergency Room Doctors Say Health Law Will Make ER Crowding Worse, NPR

 
At 5/20/2011 6:49 PM, Blogger kleht said...

"Increased Wait Times"?

DejaVue!

The same thng was said about HMO's in the U.S. when they started out years ago. I started with Kaiser Permanente (an HMO) 40 years ago. Its reputation was not very good at the time. However, my personal experience has been that the hype and actuality are not the same thing. I've had great results over the years - never a delay.

Many things need advance appointments, which is easy to do online or by telephone. Need necessary medical attention today? Talk to an advice nurse and I'm on my way - usually the next day. Non life-threatening, but emergency issue -Just drop in. Don't like the doctor? Make the change - easy.

The U.K. example is something to avoid. Is it coming soon to America? Hardly. Americans are much more independently minded. Such systems would not work here.

Obama-care does not bother me. There may be some parts I would not care for, but in reading over the changes coming over the rest of the decade, I found nothing would affect me all that much.

I regard Obama-care for what it is - a start. This country has a great ability to adjust things as we go along - perhaps too much so (witness the tax code). But it is a start. American enginuity will make proper changes as we go along.

Obama-care is expensive? We already have the single most expensive medical system in the industrialized world - and still skyrocketing. And still millions without coverage. And government does have the power to play hardball with vendors.

I have confidence this country can come up with something sensible. We do have problems with medical care. Unfortunately, the biggest impediment is Congress.

 
At 5/20/2011 6:54 PM, Blogger Che is dead said...

We don't just pay for government run health care once, we pay for it over and over and over again:

U.S. employers can expect an 8.5 percent increase in their medical costs next year due in some part to the healthcare reform law, the consulting firm PwC said in a report Wednesday. ...

Increased cost-shifting to private plans as Medicare and Medicaid rates fall further behind the rates private plans pay to providers

Private health plans generally pay above costs, while Medicare and Medicaid pay below costs to hospitals and physicians. For example, in 2009, on average, Medicare and Medicaid paid about 90 percent and 89 percent, respectively, of cost to hospitals, while private payers paid 134 percent of cost to hospitals. Medicare accounts for about 42 percent of hospital inpatient days; Medicaid accounts for about 11 percent. Both shares have been increasing and thus pushing uncovered costs onto a smaller base of private payers. Medicare and Medicaid rates are expected to decline relative to private payment in 2012 because of the impact of the PPACA on Medicare payment rates and the impact of the recession on Medicaid.

The Hill

Saying that if you do not like the terrible health insurance that the government forces you to buy, you can always buy a private plan, is just gibberish. Most socialized systems, including our own, use the existence of private insurance as a way to shift costs. This allows the socialists to understate the true costs associated with government run health care while they are decrying private care as too expensive. The cost of health care would decline and the quality of care would improve if the government would get out of it entirely.

 
At 5/20/2011 7:14 PM, Blogger Che is dead said...

"I regard Obama-care for what it is - a start."

Yeah, it's a start alright.

"And government does have the power to play hardball with vendors."

Wow, Socialism and/or monopsony. You're a peach. Here's hoping that the government finds a way to "play hardball" with the industry in which you make a living that way you'll be able to take advantage of that other great government service - welfare.

 
At 5/20/2011 8:32 PM, Blogger VangelV said...

the NHS is a failed institution. it needs to be wound down.

It is typical for a national healthcare system. Socialized medicine has no market signals so the only way to keep costs down is to limit resources by rationing.

 
At 5/20/2011 9:42 PM, Blogger Ron H. said...

morganovich

"this will be a more pleasant place to debate and argue if we are all civil."

I agree, but it's sometimes extremely frustrating to deal with someone about whom you, yourself, said:

""wow. ok. you really are this stupid""

 
At 5/21/2011 4:53 AM, Blogger Larry G said...

" "Juandos, 3% of GDP is not much. Perhaps, the rich get 2.9% of the health care and the poor get 0.1%%"...

And the point is what PT?"

well ours is 16% and projected to double in 10 years. Can any economy devote 30% of it's output to health care?

 
At 5/21/2011 4:59 AM, Blogger Larry G said...

re Singapore and "free market"...

It just looks to me that Singapore is pretty much soup to nuts controlled by Govt including prices and availability of services.

Singapore looks to be even more govt controlled than Japan and some of the European countries.


1. they make you set aside 20% of your income via payroll taxes, a govt dictate

2. a govt-dictated nationalized catastrophic health insurance plan,

3. "actively regulating the supply and prices of healthcare services in the country"

4. Govt subsidies for those who have low incomes.

so what makes this a 'free market' system?

 
At 5/21/2011 5:02 AM, Blogger Larry G said...

" 1.)Nobody in this country doesn't have have access to the health care system. Show me these individuals who cannot walk into a doctor's office and pay for care (which is what you suggest they do if they find themselves on a government wait list)."

....if you want to pay out of pocket...

.... and I'm suggesting that SAME option applies to people in other countries who have money and want to buy down the wait time.

The govt does not prevent them from flying to the US or Mexico or India to get more/better treatment if they have the money.

If they do not, they have to be satisfied with the govt system which is what we do over here if you don't have money and don't have insurance.

agree?

 
At 5/21/2011 5:04 AM, Blogger Larry G said...

I wonder what percent of GDP U.S. health care would be without people like Michael Jackson and Dolly Parton?

you'll find - for instance, that those on Medicare in this country can buy "gap" policies to pay for more/better health care including getting coverage for some things that Medicare won't cover.

these are not "rich" folks just people who can afford the pay more if they want more.

 
At 5/21/2011 5:07 AM, Blogger Larry G said...

" this will be a more pleasant place to debate and argue if we are all civil. "

Thank You.

I actually believe I can LEARN MORE ABOUT your point of view, perhaps things I did not know, etc,,, AND VICE VERSA if we are willing to converse ON THE ISSUES without it degenerating into a philosophical food fight.

I'm always game to debate -on the merits but I have no patience for Ad Hominem games.

 
At 5/21/2011 5:09 AM, Blogger Larry G said...

" The real problem, according to a new survey from the American College of Emergency Physicians, isn't caused by people who don't have insurance —it's caused by people who do, but still can't find a doctor to treat them."


where is the report?


I do not trust sites that extract information from reports but don't give you the link so you can go read the WHOLE report and decide for yourself if that is what they are saying

 
At 5/21/2011 5:13 AM, Blogger Larry G said...

" We don't just pay for government run health care once, we pay for it over and over and over again:

U.S. employers can expect an 8.5 percent increase in their medical costs next year due in some part to the healthcare reform law, the consulting firm PwC said in a report Wednesday. ...

Increased cost-shifting to private plans as Medicare and Medicaid rates fall further behind the rates private plans pay to providers "

I don't know how many of you folks have employee health care but virtually all employee health care forces you into Medicare when you retire.

The Federal Govt does that with their heath care plans.

They "invite" you to continue paying premiums to keep you policy in force as a "gap" policy but Medicare becomes the Primary.

In that regard - don't you think that Medicare is SUBSIDIZING private insurance costs?

What would happen to retirees under employer-provided healthcare if there was no Medicare?

 
At 5/21/2011 5:16 AM, Blogger Larry G said...

" Saying that if you do not like the terrible health insurance that the government forces you to buy, you can always buy a private plan, is just gibberish. Most socialized systems, including our own, use the existence of private insurance as a way to shift costs. "

Singapore has private health care - right?

read this:

" None of these countries [ Netherlands, Germany and Switzerland ]uses a government-run, Medicare-like health insurance plan. They all rely on purely private, nonprofit or for-profit insurers that are goaded by tight regulation to work toward socially desired ends. And they do so at average per-capita health-care costs far below those of the United States — costs in Germany and the Netherlands are less than half of those here."

http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-public-plan-the-german-model/

 
At 5/21/2011 5:24 AM, Blogger Larry G said...

" I agree, but it's sometimes extremely frustrating to deal with someone about whom you, yourself, said:

""wow. ok. you really are this stupid"" "

that concept works both ways.

none of you folks initially understood that Medicare Part A an part B are different from each other in major ways with different funding mechanisms.

How can you have an "intelligent" opinion about something when you are ignorant of the facts?

when you debate "politely"... information you are unaware of can be provided - from both perspectives - WITHOUT calling the other "stupid".

I have similar thoughts about you but I won't call you "stupid" because of it at the beginning an at some point when things DO degenerate into calling names - nothing is gained at all.

The purpose of dialog is to understand other points of view even if you don't agree and to develop a better understanding o WHY others feel differently.

That kind of dialog can lead to compromise positions - to move forward on things that can be agreed on... and to recognize things that are harder....

otherwise there is little point to debate, it just becomes a verbal pissing contest.

 
At 5/21/2011 6:21 AM, Blogger Larry G said...

" this endlessly repeated liberal canard has no basis in fact.

http://www.ncpa.org/commentaries/uninsured-emergency-room-use-greatly-exaggerated-health-care-news"

WHERE IS THE STUDY? Why do ALL of the anti-Obama_Care sites references the results of the study but do not provide a link to the study itself?

Here is the ACTUAL STUDY SUMMARY:

"Summary
EDs provide a critical service to persons in need of immediate, often life-saving, treatment and are a major component of the health care system. One fifth of the civilian noninstitutionalized population had at least one ED visit in 2007. The percentage of persons with at least one ED visit varied according to sociodemographic characteristics and respondent-assessed health status.

Persons with Medicaid coverage were more likely to report at least one ED visit and multiple ED visits in a 12-month period than those with private coverage or the uninsured. This finding may reflect higher rates of disability and chronic conditions among persons with public insurance, including Medicaid, relative to the uninsured (3). However, uninsured persons under age 65 were more likely to have multiple ED visits in a 12-month period than those with private insurance. The data also show that persons without a usual source of medical care are not more likely to have an ED visit than those with a usual source of care, and that uninsured persons are not more likely than others to access the ED for nonurgent visits. Future work should focus on untangling the complex interactions among the sociodemographic, health status, and health care access factors that appear to be associated with visits to the ED"

http://www.cdc.gov/nchs/data/databriefs/db38.htm


here is the NCHS interpretation of the result:

" Persons with Medicaid coverage were more likely to report at least one ED visit and multiple ED visits in a 12-month period than those with private coverage or the uninsured. This finding may reflect higher rates of disability and chronic conditions among persons with public insurance, including Medicaid, relative to the uninsured (3)"

and this:

" Future work should focus on untangling the complex interactions among the sociodemographic, health status, and health care access factors that appear to be associated with visits to the ED"

but the most important thing NOT RECOGNIZED is THIS - " Who pays for the ER visit for the MedicAid folks"?

Do you think the MedicAid program pays for these ER visits?

If MedicAid PAYS for the ER - WHERE DOES THAT MONEY comes from?

Taxpayers - right?

If MedicAid does NOT pay or these ER visits - do you think the Hospital will bill these folks with any expectation of them paying if they are already on MedicAid?

The problem that I have here is

1. - cherry-picking...

2. - not proving a link to the original study

3. - not showing the conclusions of the folks who did the study

4. - coming up with different conclusions based on their own interpretation of the data while implying that these are also the conclusions of the people who actually did the study.

5. - at other times actively DISCREDIT the same organization for studies they do not agree with.

6. - advocating abolishment of the organization that keeps health care statistics at the same time they cherry-pick data they like.

7. a fundamentally dishonest and biased approach to the issue in general.

 
At 5/21/2011 7:12 AM, Blogger VangelV said...

It just looks to me that Singapore is pretty much soup to nuts controlled by Govt including prices and availability of services.

I do not think so. The main thing that the meddlers in Singapore do is force people to set money aside for their own health care. Because people spend their own money the prices are under control as providers have to compete for consumer spending against each other across the board.

so what makes this a 'free market' system?

It isn't a real free market system. But it is a lot closer to a free market system than in the US where consumers are not spending their own money. I guess that you don't really understand how incentives work.

 
At 5/21/2011 7:18 AM, Blogger Larry G said...

" so what makes this a 'free market' system?

It isn't a real free market system. But it is a lot closer to a free market system than in the US where consumers are not spending their own money. I guess that you don't really understand how incentives work. "

nope. I do understand but making that comment tells me you don't want to engage the issue but instead use personal pejoratives

I asked you a simple question.

Tell me the specific ways that the Singapore model is more "free market" than our system.

I did not ask your opinion of my understanding of "incentives".

Please answer the original question without using pejoratives against my understanding.

I'm actually giving you a chance to explain to me what you say I don't understand.

so do it.

 
At 5/21/2011 7:19 AM, Blogger VangelV said...

....if you want to pay out of pocket...

.... and I'm suggesting that SAME option applies to people in other countries who have money and want to buy down the wait time.


This is not true. If I have the money I can't walk into a clinic in Toronto and get an MRI. I have to wait in line until everyone before me gets one. Of course, the law does not prevent me from using my money to do an MRI for my dog using exactly the same equipment. The law only prevents line jumping for people. The technicians and doctors are free to sell their services and use the equipment for the benefit of pet owners in off hours. Such is the logic of living in a country that tries to level all playing fields.

 
At 5/21/2011 7:21 AM, Blogger VangelV said...

The govt does not prevent them from flying to the US or Mexico or India to get more/better treatment if they have the money.

If they do not, they have to be satisfied with the govt system which is what we do over here if you don't have money and don't have insurance.

agree?


Only an idiot would agree. There should be no laws that prohibit doctors from selling their services in the open market. Period. End of story.

In may countries where socialized medicine has been tried there is a second tier private system which is used by most people with means.

 
At 5/21/2011 7:25 AM, Blogger VangelV said...

I do not trust sites that extract information from reports but don't give you the link so you can go read the WHOLE report and decide for yourself if that is what they are saying

That is very wise. But it is a pity that you don't really do what you claim to. If you had, your idiotic positions on health care or unfunded liabilities would never have been taken by you.

It looks to me that what you seek is support for your preferred positions and, like many other people who have the same preferences, you are capable of spinning most observations into a narrative of support no matter how silly that narrative may be to the rational observer.

 
At 5/21/2011 7:28 AM, Blogger Larry G said...

" Only an idiot would agree. There should be no laws that prohibit doctors from selling their services in the open market. Period. End of story. "

the CURRENT REALITIES are that doctors can and do offer fee-for-service, non-govt care - for a price in countries like Germany, Switzerland, and the Netherlands.

 
At 5/21/2011 7:33 AM, Blogger Larry G said...

"That is very wise. But it is a pity that you don't really do what you claim to. If you had, your idiotic positions on health care or unfunded liabilities would never have been taken by you. "

again you are playing with pejoratives here...

my positions are no more or less "idiotic" than yours except in your own mind.


"It looks to me that what you seek is support for your preferred positions and, like many other people who have the same preferences, you are capable of spinning most observations into a narrative of support no matter how silly that narrative may be to the rational observer. "

I ALWAYS try to give the references for YOU to DECIDE whether or not I am "spinning" a study.

It's a dead giveaway when someone or some entity says that some study "shows" something but they do not provide the reference.

I use the criteria against ALL sites that do this - no matter what their policy position is.

It's a sign of dishonestly to not provide the references.

This is the keystone of Wiki - copious footnotes to the sources - for YOU to decide if what Wiki is saying is substantiated or not.

they provide you with the means to decide.. not hide it which is often an indication that they seek to influence you but not inform you.

 
At 5/21/2011 9:35 AM, Blogger juandos said...

Larry G says: "not a one of those who oppose ObamaCare would agree to also repeal EMTALA"...

I don't know, I've not asked them and since most of the public is abysmally ignorant of how their extorted tax dollars are spent I'm pretty sure most politicos won't touch it either...

Larry G is bound & determined to forget where the problems of high cost medical care start: "well ours is 16% and projected to double in 10 years. Can any economy devote 30% of it's output to health care"...

It wouldn't even be 16% if the federal government didn't interfer...

 
At 5/21/2011 1:11 PM, Blogger morganovich said...

"Tell me the specific ways that the Singapore model is more "free market" than our system."

easy.

in singapore patients take their own cash and use it to shop for medical treatment. they face the prices directly and therefore have incentives both to shop for the best price and to avoid unnecessary expenses.

this forces doctors to compete with each other and become efficient and prevents all manner of unneeded treatment or treatment whose price/benefit ratio is too high.

best of all, the patients make their own decisions about price benefit.

the US market is nothing like that because most people have insurance. if obambi has his way, we all will and there will be no high deductible plans permitted.

that is the exact opposite of a free market. you are forced to buy insurance, and insurers are horribly limited in terms of the plans they can offer.

this leads to massive over-consumption and price spirals.

consider a test for a disease you have a 1% chance of having. it costs $5000.

if it's you're own money, you'll probably say no.

if you have a $200 deductible that you expect to hit anyway, well why not, better safe than sorry.

if it's your own money, you may make a few calls to see who has the cheapest MRI. if it's insured, who cares? you just go to whatever's close or whoever has free parking.

worse, because the MRI provider knows you will not ask the price, they have no incentive to offer a deal, so the costs to everyone, even someone wishing to pay cash, are all wildly out of line.

imagine if car insurance worked like this.

you wreck you car, and you can go to any car lot in america and buy whatever replacement your "GP care sales adviser" recommends. you pay $500, the insurer covers the rest.

first, imagine the car you'd choose. i'll bet it's different from the once you'd buy for cash.

second, imagine what the car dealer would charge given that he knows you don't care.

this is EXACTLY how our medical insurance works.

it's the equivalent of having a grocery subscription that lets you eat anything you want. for you own money, you might eat hamburger, but under the subscription service, why would anyone eat anything other than prime rib eye?

that is nothing like a free market, it is a free buffet once you pay the price to get in. no one fills up on rolls at the ritz buffet and goes easy on the cracked crab to save the ritz money.

i'm kind of stunned that you are not seeing this larry.

there is very little about the US system that has anything to do with the free market.

everything about singapore is free market except for being forced to save, and extreme catastrophes.

unlike the US, in singapore, if you run down your HSA, oops, no more care unless you pay cash.

that incentivizes people to choose wisely and make cost/benefit decisions.

 
At 5/21/2011 1:15 PM, Blogger morganovich said...

"This is the keystone of Wiki - copious footnotes to the sources - for YOU to decide if what Wiki is saying is substantiated or not."

perhaps in an ideal world, but in reality, the keystone of wiki is willful distortion for partisan reasons. if you doubt the wikis have editorial slant, try editing a global warming article on wikipedia to include skeptical information.

citing a wiki is a cop out. they are often distorted and flat out wrong.

cite the sources and quote them directly. use data, not manipulations of data.

 
At 5/21/2011 1:29 PM, Blogger morganovich said...

This comment has been removed by the author.

 
At 5/21/2011 1:31 PM, Blogger morganovich said...

you know why you have so many choices for well priced DVD players or washer dryers with a variety of features? the free market price signal.

it does not exist in US healthcare. you buy, someone else pays. all your costs are up front. (if you even face any. medicare patients are the most aggressive users of care in the nation and they pay nothing) once you have paid, your only incentive is to get as much as you can.

why would you ever not have a $5000 test performed that has a 1% chance of being relevant if YOU ARE NOT PAYING?

once you hit your deductible/out of pocket, care becomes free.

you tell me larry, what happens to demand when price goes to zero?

this is not so in singapore. you spend your money down, and then you are out. no more care. you need to spend cash.

this keeps their demand in check.

the difference in expense just shows 1. that we consume a great deal of unneeded care, 2. that our care is much more expensive, and 3. that us patients have no incentives to fix these things.

 
At 5/21/2011 3:36 PM, Blogger VangelV said...

Tell me the specific ways that the Singapore model is more "free market" than our system.

People spend their own money in a competitive health care market. That makes it a lot more free market than your system.

 
At 5/21/2011 3:42 PM, Blogger VangelV said...

the CURRENT REALITIES are that doctors can and do offer fee-for-service, non-govt care - for a price in countries like Germany, Switzerland, and the Netherlands.

In some countries they do. But in countries like Canada, where idiot lefties want all playing fields leveled, doctors cannot offer healthcare to those that can afford it. If they did the voters would rebel because of the very long wait times and relatively poor service.

 
At 5/21/2011 4:05 PM, Blogger Che is dead said...

"Neutral" Wikipedia Editors. Ever wonder what they look like?‏

 
At 5/21/2011 4:11 PM, Blogger Che is dead said...

The government purchases far more drugs than any other entity. So it can effectively dictate the price it will pay. Such price controls may seem like an effective way to cut spending--but they'll actually reduce the supply of available drugs. Pharmaceutical firms will simply stop selling their wares if the government forces them to take a loss on every transaction.

Consider the drug benefit administered by the Department of Veterans Affairs. The VA pays about 40% less for prescription drugs than Medicare Part D, so many pundits have held it up as an example of how the feds can effectively rein in drug spending.

But the VA has only been able to deliver those savings by covering fewer drugs.

Health care economists Austin Frakt, Steve Pizer and Roger Feldman recently compared the VA's drug benefit with Medicare Part D at the request of the Department of Veterans Affairs and the Robert Wood Johnson Foundation. They found that the average Medicare Part D plan covered 85 percent of the nation's 200 most popular prescription drugs--while the VA formulary covered just 59% of those drugs. ...

Forbes

 
At 5/21/2011 4:17 PM, Blogger PeakTrader said...

VangelV, according to Larry's math, we're expected to believe everyone in Singapore can afford a $50,000 one-size-fits-all Cadillac SUV, because they sell for $10,000, thanks to a government controlled system.

 
At 5/21/2011 4:47 PM, Blogger PeakTrader said...

Che, they look like people too ugly to be librarians :)

 
At 5/21/2011 4:59 PM, Blogger Ron H. said...

"And the point is what PT?""

His point is the same as yours, Larry, that the poor don't have adequate access to medical care.

This is a classic example of your not understanding what others write. When others point out this failing to you, you say: " Be polite, don't use "pejoratives."

It isn't pejorative if it's accurate. If you, in fact, don't know what you're talking about, and someone points that out, you're not being insulted.

"I actually believe I can LEARN MORE ABOUT your point of view, perhaps things I did not know, etc,,, AND VICE VERSA if we are willing to converse ON THE ISSUES without it degenerating into a philosophical food fight."

But this hasn't been happening. I doesn't appear that you have learned anything at all from reading other's comments or following references. Your position appears to be exactly the same as when you started.

You have stated positions and opinions, and tried supported them with references that don't really include what you think they do, and when someone points out the problems, you accuse them of bias.

On the other hand, when others provide you with references, you dismiss them out of hand as "right-wing blather butt sites" or "cherry pickers", and refuse to consider any view but the one you already hold.

This isn't "debate", Larry, it's insisting your viewpoint is the correct one. "Don't bother me with facts, I know I'm right."

You have asked : "where's the study?", but you can then cite something like the incredibly communistic opinion piece on the "Economix Blog" in the NYT.

Where's the study for that one, Larry? Where is the support for all those opinions and unfounded assertions? You are being dishonest and hypocritical.

From the article:"Second, these nations try to tailor the individual’s contribution to the financing of health care closely to the individual’s ability to pay."

"From each according to his ability..." Hmmm: where have I heard that before? If, in fact, you advocate communism, be honest enough to say so, instead of things like "I'm in favor of free markets, BUT..."

And, then there's this: "...on the theory that children are not the human analogue of pets whose health care should be their owners’ (parents’) fiscal responsibility. Instead, children are viewed as national treasures whose health care should be the entire nation’s fiscal responsibility."

Wow! I've seldom read a more collectivist view than that. Children are the responsibility of the state, not their parents?

And these unsupported claims:

"Many Americans oppose such a mandate as an infringement of their personal rights, all the while believing that they have a perfect right to highly expensive, critically needed health care, even when they cannot pay for it."

Based on what? Absolutily nothing.

"This immature, asocial mentality is rare in the rest of the world. "

Based on what evidence? More stuff pulled from ass.

"none of you folks initially understood that Medicare Part A an part B are different from each other in major ways with different funding mechanisms."

That's just sad. How can you assume people don't know something as basic as that? Is this some recent knowledge for you? Not everyone is as limited in their understanding as you are. Is that pejorative? Well, I can't think of a gentle way to put it, Larry, it is what it is.

If you really wish to debate, you must be willing to read and consider what others write, and read and consider their sources, without filtering it through your preconceived notions. You should consider the possibility that you could actually be wrong and others right. Otherwise, as has been the case so far, you are wasting everyone's time.

 
At 5/21/2011 5:13 PM, Blogger Ron H. said...

"Please answer the original question without using pejoratives against my understanding.

I'm actually giving you a chance to explain to me what you say I don't understand.
"

And, he HAS explained. You don't understand how incentives work. The very fact that could ask the original question, indicates to anyone with any amount of economic understanding, that you don't, in fact, understand human nature, and incentives.

Is that rude? Is it pejorative? It is what it is, Larry, If you wish to understand how incentives work, you might consider learning some economics.

 
At 5/21/2011 5:32 PM, Blogger Larry G said...

" perhaps in an ideal world, but in reality, the keystone of wiki is willful distortion for partisan reasons. if you doubt the wikis have editorial slant, try editing a global warming article on wikipedia to include skeptical information"

Wiki acknowledges up front when there is disagreement....

it warns you from the get-go when the narrative is controversial.

AND it PROVIDES the two points of view....

AND it gives foot notes.

No right/left wing blog does any of that.

At the end of the day.. it's not WIKI.

WIKI is a directory...

it's up to you to follow the source and VETT the information to tell the difference between info promoted by a biased source and info that comes from credible organizations who do not have policy advocacies on either side of the issue but instead are dedicated to collecting the data and showing the statistics... and disclosing the sources of their data and the methods of analysis...

you just don't get any of that from clearly biased sites who are advocating a particular viewpoint.

 
At 5/21/2011 5:33 PM, Blogger Larry G said...

" once you hit your deductible/out of pocket, care becomes free.

you tell me larry, what happens to demand when price goes to zero?"

huh? for private insurance?

Medicare?

I don't think so guy.

 
At 5/21/2011 5:44 PM, Blogger Larry G said...

" But the VA has only been able to deliver those savings by covering fewer drugs.

Health care economists Austin Frakt, Steve Pizer and Roger Feldman recently compared the VA's drug benefit with Medicare Part D at the request of the Department of Veterans Affairs and the Robert Wood Johnson Foundation. They found that the average Medicare Part D plan covered 85 percent of the nation's 200 most popular prescription drugs--while the VA formulary covered just 59% of those drugs. ..."

Veterans can buy supplementary plans including Part D.

The VA care is a DEFINE LEVEL of MINIMUM care available to all Veterans who qualify.

They are not restricted to ONLY VA care.

They HAVE THE FREEDOM to utilize the free market if they want more/better.

I think there is a misunderstanding as to what the purpose of universal health care (or VA care or TRICARE) is.

It's NOT a soup-to-nuts, we pay for everything plan.

Even Medicare has a hefty deductible - that effectively prevents some who cannot afford it from getting everything they want.

 
At 5/21/2011 5:46 PM, Blogger Larry G said...

" VangelV, according to Larry's math, we're expected to believe everyone in Singapore can afford a $50,000 one-size-fits-all Cadillac SUV, because they sell for $10,000, thanks to a government controlled system. "

Nope. It's like a LOT of care that has Govt controls.

In this country...in Canada, in Europe... if you want MORE than you plan - private or pubic covers - you have to pay extra to get it.

But in those countries - you do have universal access to the basic health care.

 
At 5/21/2011 5:46 PM, Blogger Larry G said...

"
Che, they look like people too ugly to be librarians :)"

geeks?

 
At 5/21/2011 6:03 PM, Blogger Larry G said...

" This is a classic example of your not understanding what others write. When others point out this failing to you, you say: " Be polite, don't use "pejoratives.""

that's 100% horse manure.

in my view YOU do not UNDERSTAND... but saying that over and over about you is not conductive to any kind of reasonable exchange of ideas.

it's a bomb-throwing words intended to insult and choke of reasonable dialog.

take responsibility for YOUR Behavior.

" You have asked : "where's the study?", but you can then cite something like the incredibly communistic opinion piece on the "Economix Blog" in the NYT."

I have cited a wide, wide variety of sources - all of which you claim are unreliable.

ha ha ha

and you rely on totally biased..OBVIOUSLY biased sites that cherry-pick data..often don't reference the data they are presenting ..and not that infrequently add their own commentary - in a way that makes it sound like the study they referenced (but did not provide links to) proffered that opinion.

You apparently do not believe what is in WIKI, WHO, OCED, NHS, the CIA FACT BOOK, and dozens of other authoritative accepted by most of the world except those who believe there is a massive worldwide conspiracy network of organizations to lie about statistics.

" "From each according to his ability..." Hmmm: where have I heard that before? If, in fact, you advocate communism, be honest enough to say so, instead of things like "I'm in favor of free markets, BUT"

in your own mind perhaps

virtually every industrialized country in the world from Australia to Japan to Singapore is "communist" by your definition, eh?

" "none of you folks initially understood that Medicare Part A an part B are different from each other in major ways with different funding mechanisms."

That's just sad. How can you assume people don't know something as basic as that?"

Because you clearly did not.

You did not reference the trustees report nor the OBM spreadsheet showing the numbers for SS, Medicare, etc..

instead you cited your right-wing blog sites....

that say asinine things like SS is a ponzi scheme that will go broke when it's simple not the truth.

If we do NOTHING AT ALL - SS will CONTINUE to pay out at 78% of original stated benefits.

That's not broke.

When you are taking in in FICA taxes damn near the same amount that income taxes are - you are not "broke".

Unsupported claims of a 107 trillion dollar unfunded liability - and never showed how....

because.. you don't know the numbers... you only know what you read in the right wing blogs... not authoritative publications like the ANNUAL Trustees Report - that has been published for DECADES an gives the straight skinny on SS finances..

Not you. Not me can understand the realities if all you want to believe is the blather put out by obviously biased sites at the same time you think there is a world-wide conspiracy of other organizations to lie.

in other words, who do you believe for your "facts"?

 
At 5/21/2011 6:07 PM, Blogger Larry G said...

" And, he HAS explained. You don't understand how incentives work. The very fact that could ask the original question, indicates to anyone with any amount of economic understanding, that you don't, in fact, understand human nature, and incentives.

Is that rude? Is it pejorative? It is what it is, Larry, If you wish to understand how incentives work, you might consider learning some economics."

bull hockey.

I understand incentives as well as youse guys.

Ya'll don't live in this world.

you talk in theoretical incentives.

I talk in the realities as they currently exist.

It's called pragmatism.

 
At 5/21/2011 6:12 PM, Blogger Larry G said...

Youse guys look at a totally govt-controlled HC system like Singapore and say it is a "free-market" model we should follow.

They have a 33% payroll tax - mandatory and subsidized health care for those who cannot afford it and catastrophic insurance for all... paid for by the govt..

and ya'll are getting on me about not "understanding"?

ha ha ha ...

ya'll are a riot!

 
At 5/21/2011 6:22 PM, Blogger Larry G said...

in singapore patients take "their own cash and use it to shop for medical treatment."

the 20% of their wages that the govt takes out in payroll taxes?

"they face the prices directly and therefore have incentives both to shop for the best price and to avoid unnecessary expenses."

does the Govt control prices?

"this forces doctors to compete with each other and become efficient and prevents all manner of unneeded treatment or treatment whose price/benefit ratio is too high."

" Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services"

"best of all, the patients make their own decisions about price benefit."

Isn't Singapore an example of a govt-controlled system that allows private providers?


"the US market is nothing like that because most people have insurance. if obambi has his way, we all will and there will be no high deductible plans permitted."

Everyone in Singapore has insurance... everyone....right?

and it is means-tested...more govt influence...right?

split...

 
At 5/21/2011 6:23 PM, Blogger Larry G said...

...continue

I understand your logic but I don't think what you are saying is the way it works in Singapore.

"if it's your own money, you may make a few calls to see who has the cheapest MRI. if it's insured, who cares? you just go to whatever's close or whoever has free parking."

Guy.. how do you know it' an MRI you need? who tells you that?

"worse, because the MRI provider knows you will not ask the price, they have no incentive to offer a deal, so the costs to everyone, even someone wishing to pay cash, are all wildly out of line."

Do you think you can buy an MRI without a doctor's orders?

"imagine if car insurance worked like this.

you wreck you car, and you can go to any car lot in america and buy whatever replacement your "GP care sales adviser" recommends. you pay $500, the insurer covers the rest.

first, imagine the car you'd choose. i'll bet it's different from the once you'd buy for cash.

second, imagine what the car dealer would charge given that he knows you don't care.

this is EXACTLY how our medical insurance works."

your logic is acknowledged but our health care system does not work that way. You cannot get the MRI without a Doctor ordering it and he won't order it unless he thinks it is the RIGHT diagnostic.

Do you think you can just go buy an MRI?


it's the equivalent of having a grocery subscription that lets you eat anything you want. for you own money, you might eat hamburger, but under the subscription service, why would anyone eat anything other than prime rib eye?

that is nothing like a free market, it is a free buffet once you pay the price to get in. no one fills up on rolls at the ritz buffet and goes easy on the cracked crab to save the ritz money.

i'm kind of stunned that you are not seeing this larry."

I see your logic but you're describing a theoretic concept not the reality of the way health care works - in just about ANY country.

"there is very little about the US system that has anything to do with the free market."

Do you think people in Singapore can "buy" an MRI for low bid?

"everything about singapore is free market except for being forced to save, and extreme catastrophes."

are we reading the same description of their Health Care System?

No..right-wing blog descriptions.. please...

have you read this:

" “The private healthcare system competes with the public healthcare, which helps contain prices in both directions. Private medical insurance is also available.”

Private healthcare providers are required to publish price lists to encourage comparison shopping.

The government pays for “basic healthcare services… subject to tight expenditure control.” Bottom line: The government pays 80% of “basic public healthcare services.”

http://healthcare-economist.com/2008/01/14/singapores-health-care-system/

hey.. you are CORRECT about having to publish their prices! Kudos!

but read the rest..heavy govt involvement...

HECKFIRE - it's the Government that forces them to publish prices - not competition....in the free market...in the usual way.

Would they publish the prices if the govt did not make them?

Can you really call it a "free market" if the govt is directing the market?

"unlike the US, in singapore, if you run down your HSA, oops, no more care unless you pay cash."

what about the govt subsidies for the poor?

"that incentivizes people to choose wisely and make cost/benefit decisions. "

I understand why you want to see and agree it's not here, nor in Singapore.

Their health care system is run by Govt Fiat.

 
At 5/21/2011 6:29 PM, Blogger Larry G said...

A "free-market" HC system would have ZERO Govt involvement.

The market would offer whatever it would offer an people who could afford it would participate and people who could not - would not.

The only countries in the world that actually work this way ...DO NOT HAVE, by definition - Universal Health Care which is by-definition a govt critter.

So.... OF THE COUNTRIES that DO NOT HAVE - Universal Health Care - give me YOUR best system.

Singapore has Universal Health Care guys.

It's a govt run system.

It "works", in my estimation because it is:

1. - govt run

2. - proves that a govt run system can produce lower costs.

show me a country where the govt is not involved in HC and the free market provides it...

that you would advocate as a model for this country to follow.

batter up.

 
At 5/21/2011 6:32 PM, Blogger Ron H. said...

"you tell me larry, what happens to demand when price goes to zero?"

huh? for private insurance?

Medicare?

I don't think so guy.
"

You are misunderstanding this, Larry, Read it again and include the answer to the following:

- demand by who?
- price for who?

(hint - its the patient))

 
At 5/21/2011 7:10 PM, Blogger Larry G said...

demand by who?
- price for who?

(hint - its the patient)) "

how many times have we heard that insurance "will not cover" or that the coverage ran out... or that someone switched jobs an cannot obtain ANY Coverage.

Similar deal with Medicare - but govt covers everyone and won't dump you for being too expensive.

but they WILL ....DENY you coverage ... for things they do not believe have efficacy or a poor cost-benefit..they will deny or require higher co-pays.

remember the "death panels"?

:-)

but I actually AGREE with you ESPECIALLY with regard to Medicare Part B which will pay for outrageous things like $5000 MOBIITY scooters for person who has half a million in assets and is pay a $100 a month premium.

This is DESTROYING Medicare.

but it's not only Medicare.

Private insurance is going up an average of 10% a year ...doubling every decade... because people DO get things that are "covered" and have too little skin in the game.

So... we actually agree!

how about that?

:-)

 
At 5/21/2011 7:56 PM, Blogger Ron H. said...

Calm yourself, Larry, you're going to blow a gasket if you're not careful.

Let's look at this a little bit at a time.

"in my view YOU do not UNDERSTAND... but saying that over and over about you is not conductive to any kind of reasonable exchange of ideas."

There's no exchange of ideas here, Larry, there's just your views, others trying to educate you, and you plugging your ears and whining "blather-butt, blather-butt".

It's too late for a meaningful exchange of ideas with you, Larry. You've indicated that you already have all the ideas and opinions you will ever need.

"I have cited a wide, wide variety of sources - all of which you claim are unreliable.

ha ha ha

and you rely on totally biased..OBVIOUSLY biased sites that cherry-pick data...
"

Do you see what I meant? Your cites are good, those others cite are bad. That leaves no room for a serious discussion.

"You did not reference the trustees report nor the OBM spreadsheet showing the numbers for SS, Medicare, etc"

Gee, Larry, I didn't think it necessary. That's pretty basic, well understood stuff. I thought we all had a common understanding, but you proved me wrong. You needed more.

"that say asinine things like SS is a ponzi scheme that will go broke when it's simple not the truth."

What would you call a scheme that has never had any real assets, but relies on a constant supply of suckers entering at the bottom to support those at the top?

The jig is up, Larry, The supply of new workers is now growing more slowly than the number of retirees pouring out of the top. It can't be sustained any longer without serious cuts.

Everyone can now see that it's a scam, and just another welfare program, not an insurance or retirement program at all, and without drastic action, will cost workers much more than they planned, in the form of higher income taxes.

"When you are taking in in FICA taxes damn near the same amount that income taxes are - you are not "broke"."

Well, I don't know about broke, but it tells you that the cost of SS and Medicare are nearly as much as all other government spending combined, and increasing. I don't know why you think this is a positive sign.

"If we do NOTHING AT ALL - SS will CONTINUE to pay out at 78% of original stated benefits."

I'll bet this figure relies on that pesky trust fund, am I right?

"Unsupported claims of a 107 trillion dollar unfunded liability - and never showed how...."

There are various numbers suggested for the value of unfunded liabilities, ranging from $60-114 trillion, mostly for Medicare & Medicaid, depending on assumptions about future economic performance and health care costs.

I haven't cited any sources, and don't plan to unless you're seriously interested, because you've ignored any reference anyone has given you in the past. There's no point wasting time getting something you won't use. As I've said, I don't believe you are serious about having an actual discussion, or learning anything at this blog. This is your loss, not mine.

 
At 5/21/2011 8:10 PM, Blogger Ron H. said...

"how many times have we heard that insurance "will not cover" or that the coverage ran out... or that someone switched jobs an cannot obtain ANY Coverage."

This has nothing to do with the original question. My hint didn't seem to help. Let me restate the original question:

Here's the original:

"you tell me larry, what happens to demand when price goes to zero?"

Here's the question after I put training wheels on it:

What happens to patient demand when the price paid by the patient goes to zero?

 
At 5/21/2011 8:27 PM, Blogger Ron H. said...

"but I actually AGREE with you ESPECIALLY with regard to Medicare Part B which will pay for outrageous things like $5000 MOBIITY scooters for person who has half a million in assets and is pay a $100 a month premium."

Without exactly saying so, you seem to imply that a person with assets shouldn't get the same benefits a person with no assets gets.

If that's the case, and if you consider Med B to be a welfare program, then OK, but if you consider it insurance, you need to explain why someone paying the same premium shouldn't get the same service.

If you do consider it a welfare program, then you must be OK with penalizing those who have accumulated assets over their lifetime, and rewarding those who have not.

 
At 5/21/2011 8:32 PM, Blogger Larry G said...

here's the simple truth about SS:

" The 2009 Social Security and Medicare Trustees Reports show the combined unfunded liability of these two programs has reached nearly $107 trillion in today's dollars!"

" That is about seven times the size of the U.S. economy and 10 times the size of the outstanding national debt."

The unfunded liability is the difference between the benefits that have been promised to current and future retirees and what will be collected in dedicated taxes and Medicare premiums."

Here's the part to pay attention to:


"Social Security versus Medicare.

Politi­cians and the media focus on Social Security's financial health, but Medicare's future liabilities are far more ominous, at more than $89 trillion [out of the 107 trillion].

Medicare's total unfunded liability is ....

more than five times larger than that of Social Security.

In fact, the new Medicare prescription drug benefit enacted in 2006 (Part D) alone adds some $17 trillion to the projected Medicare shortfall -

...an amount greater than all of Social Security's unfunded obligations.

If Medicare Part B (physician services) and Part D are included, the total Social Security/Medicare burden will climb to 37 percent of payroll by 2054 - one in three dollars of taxable payroll, and twice the size of today's payroll tax burden!"

http://www.ncpa.org/pub/ba662

Now here's what the trustees say:

" In other words, to bring the program into actuarial balance over the next 75 years, payroll taxes could be immediately increased by 1.8 percent of taxable payroll and kept at that higher rate, or scheduled benefits could be reduced by an equivalent amount. That estimate is similar to the most recent estimate of the long-range actuarial deficit reported by the Social Security trustees."

http://www.cbo.gov/ftpdocs/88xx/doc8877/Chapter3.6.1.shtml

this would increase the 15.3% to 17.1% TOTAL - both employer an employee.

Singapore has a 33% rate. 20% + 13% and you guys say it's a superior system.

Keep in mind - we are talking about the FUTURE 75 years of SS as opposed to the CURRENT 1.5 trillion deficit an 14 trillion debt which you guys have ZERO to say about fixing...

Instead you focus on a FUTURE problem that has a half dozen identified options to fix - if implemented in the next 5-10 years.

Here's the truth.

You are on a dishonest anti-SS narrative - using obviously biased sites who do not support their data and do provide references - just their own "interpretations" of unreferenced data.

And you guys PARROT this disinformation .....

The simple truth is that SS has functioned for over 60 years and has had a number of changes made to it - to maintain it's solvency.

here are a few:

http://www.justfacts.com/socialsecurity.asp#impact

so let's review.

you favor obviously biased sites who misrepresent the facts to achieve their philosophical opposition to the CONCEPT of Social Security.

and you believe that CREDIBLE sites that deal with facts are engaged in a conspiracy .... sites like OBM, Social Security and Medicare as well as the two deficit commissions...

and you say that I "refuse" to "learn" from you.

ha hahahahahahh bahahahahh

lord o'mighty

 
At 5/21/2011 8:35 PM, Blogger Larry G said...

" Without exactly saying so, you seem to imply that a person with assets shouldn't get the same benefits a person with no assets gets. "

it should be an insurance program that means tests benefits if you use MORE than you paid into the system.

it's insurance for those who don't have the assets ...just like the Singapore system guy.

are you opposed to the Singapore way of doing this?

 
At 5/21/2011 8:50 PM, Blogger Larry G said...

this, by the way is the way that SS disability INSURANCE works.

Your disability benefit is based on what you paid into the system unless you fall below the poverty line.

The Medicare Part B premium of about $100 a month is paid for by MedicAid if you fall below poverty thresholds.

Without it - many older, frail people living in nursing homes could not afford to stay in the nursing home.

You have such an ideological approach to the whole issue and you have taken so little time to read credible fact-based sites that much of your info that you provide is basically not correct or worse - just flat out misinformation.


The Medicare part B premiums themselves are means tested.

" Effective January 1, 2007, the government will start determining the Medicare Part B premium based on a person’s income. Assuming that the base Medicare premium continues to grow at the same pace that it has since 2002 (about 11.6% per year) here’s what premiums will be for 2007, and what they may look like for 2008 and 2009 as the government begins “income relating” or Means Testing."

http://www.tscl.org/NewContent/102589.asp

this is similar to the way that Singapore does it.

 
At 5/21/2011 9:05 PM, Blogger Ron H. said...

"not authoritative publications like the ANNUAL Trustees Report - that has been published for DECADES an gives the straight skinny on SS finances.."

Write about the Medicare Trustees Report. How does that look?

 
At 5/21/2011 9:16 PM, Blogger Larry G said...

http://www.cms.gov/ReportsTrustFunds/

 
At 5/21/2011 9:49 PM, Blogger Larry G said...

The thing that is not well understood and viciously demagogued and just plain misrepresented by those who basically are OPPOSED to the CONCEPT of SS and Medicare is this:

There are THREE PARTS:

1. Social Security
2. Medicare Part A (called HI)
3. Medicare Part B (called SMI)

1 & 2 are funded by FICA taxes - which generates almost as much revenues as income taxes.

3 is financed by income taxes and by subscriber premiums.

Of the 3 - it is 3. Medicare Part B that is in the most serious trouble and will have the biggest immediate impact on the budget/deficit because it is financed/subsidized from Income Taxes.

and the reason why is the same reason why ALL health care in the US is escalating in costs no matter whether it is the Federal Employees Plans or the Military's TRICARE or MedicAid or Private Care.

Of the so called 107 trillion "unfunded liability" - 89 trillion is Medicare part B.

Medicare Part A is next after B in terms of being in trouble.

it pays for hospitals but the costs are also escalating and without changes in FICA and/or benefits it will get into major trouble around 2017... give or take.

Social Security of the 3 is the LEAST in trouble and the most easily fixed.

But the right-wing narrative over and over attacks Social Security... as an "unsustainable Ponzi Scheme" even though the NUMBERS show clearly that it is Medicare Part B that is the biggest problem.

the right wing is Philosophically opposed to the CONCEPT of Social Security

but rather than admit this - they are engaged in a disinformation campaign to convince the folks in the middle of the electorate that it's SS that is going bankrupt and to allow their elected to basically abandon it.

It's totally dishonest.

The data, numbers and facts from the Social Security Trustee, the Medicare Trustees and OMB and others tells the truth.

ONE OPTION for MEDICARE...IS Ryans option to basically walk away / abandon Medicare and convert it into a fixed subsidy/block grant.

There are OTHER options.

We could do what SINGAPORE does and have a 20% (33% total) FICA Tax that would in all likelihood keep Medicare Solvent until 2075 and beyond.

We could do a COMBINATION of increasing FICA taxes and/or removing the 106K cap and require the same percentage FICA no matter the income.

and/or we could FURTHER means-test the PREMIUMS AND THE BENEFITS an REQUIRE Higher co-pays for procedures that are not mandatory.

but then if we did that - the right wing would come back an cry "death panels".

Because..in the end.. those on the right are opposed to the CONCEPT of SS and Medicare.

They opposed both programs when they were created in Law.

The "problem" is the American People by about a 75% margin do not agree so the right's primary strategy has been to attack the finances so as to shake the folks in the middle ..to convince them that the programs will fail anyhow thus giving cover to those elected who will kill the programs if they think voters would not turn them out and overturn their vote.

 
At 5/21/2011 10:20 PM, Blogger VangelV said...

VangelV, according to Larry's math, we're expected to believe everyone in Singapore can afford a $50,000 one-size-fits-all Cadillac SUV, because they sell for $10,000, thanks to a government controlled system.

I don't think that logic is Larry's strong suit.

 
At 5/21/2011 10:25 PM, Blogger VangelV said...

In this country...in Canada, in Europe... if you want MORE than you plan - private or pubic covers - you have to pay extra to get it.

Not always. In Canada you can't pay for an MRI and must wait until your turn comes up, often weeks after you needed it. That is true even as the technicians use MRI equipment to check pets in off hours. To jump the line you have to know someone, be a politician, or travel a long way to a remote location where equipment may be available sooner because an opening came up. (Often because some patient died before he could get a diagnoses.)

 
At 5/21/2011 10:27 PM, Blogger PeakTrader said...

Larry says: "Singapore has a 33% (tax) rate. 20% + 13% and you guys say it's a superior system."

So, to lower health care costs to 3% of GDP, we need to raise taxes substantially.

 
At 5/21/2011 10:28 PM, Blogger VangelV said...

the 20% of their wages that the govt takes out in payroll taxes?

Yes, consumers use their own money to purchase their own care. Because they have more choices costs are better controlled than under the US system.

 
At 5/22/2011 12:04 AM, Blogger Ron H. said...

"here's the simple truth about SS:

" The 2009 Social Security and Medicare Trustees Reports show the combined unfunded liability of these two programs has reached nearly $107 trillion in today's dollars!
""


You previously rejected this number as an unsupported claim from a right wing blog. Have you now changed your mind? Is the NCPA now a trusted organization? Keep in mind how they describe themselves:

"(NCPA) is a nonprofit, nonpartisan public policy research organization, established in 1983. Our goal is to develop and promote private, free-market alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector."

That sounds pretty blather-butted to me.

Please clear this up. Is $107 trillion in unfunded liabilities for SS & medicare/medicaid now a good number? If you now accept this number, I can explain why drastic changes are necessary.

 
At 5/22/2011 7:19 AM, Blogger Larry G said...

" In this country...in Canada, in Europe... if you want MORE than you plan - private or pubic covers - you have to pay extra to get it.

Not always. In Canada you can't pay for an MRI and must wait until your turn comes up, often weeks after you needed it. That is true even as the technicians use MRI equipment to check pets in off hours. To jump the line you have to know someone, be a politician, or travel a long way to a remote location where equipment may be available sooner because an opening came up. (Often because some patient died before he could get a diagnoses.) "

there are private providers in Canada and Canadians are free to come to America to buy "more and better".

You and your friends keep implying that people have no choice but to accept ONLY the minimum-provided care and that's simply not the truth in the vast majority of countries that provide universal care.

The universal care is a MINIMUM level of care that everyone gets - it's NOT the limit of what you can get.

 
At 5/22/2011 7:25 AM, Blogger Larry G said...

" Larry says: "Singapore has a 33% (tax) rate. 20% + 13% and you guys say it's a superior system."

So, to lower health care costs to 3% of GDP, we need to raise taxes substantially. "

No. As usual you're confusing Advocacy with facts and figures.

What I point out is the facts and the facts are that people in Singapore pay 33% in payroll taxes - a mandatory system to prepare for health care - and as a result they spend 3% of GDP on health care and have one of the best systems - statistically, in the world.

these are facts.

I point them out.

I also point out that the Singapore model is a Govt-run system from soup-to-nuts.

If you read the literature, it runs just about everything expect it allows private providers but even they are controlled in terms of price and availability - and SIGNIFICANTLY in providing price lists.

That's not "free market" outcome .. it's a govt-dictated outcome.

without govt, the so-called "free market" would NOT provide the prices.

I point these things out - separate from a specific advocacy.

Just as I point out that every country in the world that has a govt-directed health care system - spends less than we do on a per-capita basis - including Singapore.

 
At 5/22/2011 7:25 AM, Blogger Larry G said...

" the 20% of their wages that the govt takes out in payroll taxes?

Yes, consumers use their own money to purchase their own care. Because they have more choices costs are better controlled than under the US system. "

the KEY WORD here is "controlled".

WHO "controls"?

 
At 5/22/2011 7:39 AM, Blogger Larry G said...

" You previously rejected this number as an unsupported claim from a right wing blog. Have you now changed your mind? Is the NCPA now a trusted organization? Keep in mind how they describe themselves:

"(NCPA) is a nonprofit, nonpartisan public policy research organization, established in 1983. Our goal is to develop and promote private, free-market alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector."

That sounds pretty blather-butted to me.

Please clear this up. Is $107 trillion in unfunded liabilities for SS & medicare/medicaid now a good number? If you now accept this number, I can explain why drastic changes are necessary. "

I rejected the providing of the number by anti=SS people with no supporting info showing where the number came from.

I DID PROVIDE the breakdown of the 107 trillion in a previous post:

here's the simple truth about SS:

" The 2009 Social Security and Medicare Trustees Reports show the combined unfunded liability of these two programs has reached nearly $107 trillion in today's dollars!"

" That is about seven times the size of the U.S. economy and 10 times the size of the outstanding national debt."

The unfunded liability is the difference between the benefits that have been promised to current and future retirees and what will be collected in dedicated taxes and Medicare premiums."

Here's the part to pay attention to:


"Social Security versus Medicare.

Politi­cians and the media focus on Social Security's financial health, but Medicare's future liabilities are far more ominous, at more than $89 trillion [out of the 107 trillion].

Medicare's total unfunded liability is ....

more than five times larger than that of Social Security.

In fact, the new Medicare prescription drug benefit enacted in 2006 (Part D) alone adds some $17 trillion to the projected Medicare shortfall -

...an amount greater than all of Social Security's unfunded obligations.

If Medicare Part B (physician services) and Part D are included, the total Social Security/Medicare burden will climb to 37 percent of payroll by 2054 - one in three dollars of taxable payroll, and twice the size of today's payroll tax burden!"

http://www.ncpa.org/pub/ba662



split

 
At 5/22/2011 7:42 AM, Blogger Larry G said...

continue.....

Of the 107 trillion - less than 20% is SS and this is a 75 year projection of a system that in that SAME TIMEFRAME WILL FUND more than 75 trillion in revenues.

This is WHY when the fund, without changes, reaches balances, it WILL STILL PROVIDE 78% of benefits.

In other words - over 75 years there is a deficit that amounts to 20-30 billion per year that can be handled in a number of ways including the single option of raising the FICA tax by about 1.8%.

This is not at all the " SS is broke ..right now... and cannot be fixed and will destroy the country's economically" narrative.

BLATHER that is being promoted.

The BIG GORILLA is Medicare Part B that is not funded from FICA but from Income Taxes and the costs (and impacts to taxes and the deficit) are going up more than 7% a year.

But it's not just Medicare Part B that has this problem.

It's ALL of healthcare including the govt plans AND private plans.

If you did the "unfunded liabilities" test on Private Health care and basically held them to the same standard that hey had to keep their premiums fixed but continue payouts...

the 107 trillion would be chump change.

The "unfunded liabilities" of private health care projected 75 years into the future would be horrendous since it already consumes 16% of our GDP and is projected to top 30% in 10 years...

this is the real problem.

but the right-wing blather butts are so messed up on their ideology that they're pretty much worthless on the issues.

 
At 5/22/2011 7:50 AM, Blogger VangelV said...

the KEY WORD here is "controlled".

WHO "controls"?


The consumers do. Service providers who charge too much do not get enough customers and have to drop prices or go out of business. Margins are kept in check by a competitive market place. Health care providers should not be any different than the providers of groceries, clothing, housing, etc. If the government gets out of the way and lets providers compete while consumers are given choices the prices will be controlled by the willingness of those consumers to spend at any particular price level.

You are still confused and seem to prefer a world of top-down planning and decision making. The advocates of unhampered markets argue that bottom-up decision works better and leads to a wealthier society. History is on their side, not yours.

 
At 5/22/2011 8:00 AM, Blogger Larry G said...

" he KEY WORD here is "controlled".

WHO "controls"?

The consumers do. Service providers who charge too much do not get enough customers and have to drop prices or go out of business. Margins are kept in check by a competitive market place. Health care providers should not be any different than the providers of groceries, clothing, housing, etc. If the government gets out of the way and lets providers compete while consumers are given choices the prices will be controlled by the willingness of those consumers to spend at any particular price level.

You are still confused and seem to prefer a world of top-down planning and decision making. The advocates of unhampered markets argue that bottom-up decision works better and leads to a wealthier society. History is on their side, not yours. "

hha hhahaaah

the GOVT MAKES YOU SAVE 33%

the GOVT MAKES YOU pay ADDITIONAL taxes for low income people and other subsidized health care like catastrophic issues.

The Govt - MEANS TESTS how much you pay.

and the Govt - FORCES providers to list their prices - not the vaunted "free market".

there is NOTHING "free market" about Singapore that the Govt itself did not FIRST set the rules for.

It is the Govt in Singapore that REQUIRES Universal Access - NOT the free market.

this really does go to show you how you guys look at the world in a really convoluted way that denies obvious realities - all so you can "believe" in the "free market" even when it's a joke.

 
At 5/22/2011 8:07 AM, Blogger VangelV said...

Larry says: "Singapore has a 33% (tax) rate. 20% + 13% and you guys say it's a superior system."

So, to lower health care costs to 3% of GDP, we need to raise taxes substantially.


Actually, you don't. The total tax burden on the productive class in the US is higher than it is in Singapore. I think that the Index of Economic Freedom tells the story on this front. Singapore is number two on the list while the US is number nine and falling. The overall tax revenue as a percentage of GDP for the US was approximately 27% percent, which is almost double Singapore's 14.2%. And, unlike the US, Singapore does not have massive unfunded pension and health care programs that will consume most of the government's spending in the next few decades.

 
At 5/22/2011 8:16 AM, Blogger Larry G said...

If it was proposed in this country that we have 33% FICA Tax to pay for SS and universal health care and reduce equivalently the income tax rate...the right wing would go berserk!

the right wing is unalterably OPPOSED to the CONCEPT of FICA, SS, Medicare and Universal Health care - all a govt-imposed mandate in Singapore.

It's truly bizarre how the free market folks point to Singapore as an example of the "free market".

What YOU GET in Singapore is an level playing field for consumers of health care - but the free market did cause that - the Govt did.

If we proposed to do in this country what the Govt did in Singapore, the right wing would blow a gasket.

Truth! Admit it!

 
At 5/22/2011 8:17 AM, Blogger VangelV said...

there are private providers in Canada and Canadians are free to come to America to buy "more and better".

As I wrote, if you want to get a diagnosis done you have to wait because the private providers are not permitted to offer it to people who pay. And if you have to leave the country to get treatment you can't call the system adequate.

You and your friends keep implying that people have no choice but to accept ONLY the minimum-provided care and that's simply not the truth in the vast majority of countries that provide universal care.

No, that is not what I have said. I have had minor procedures done in China, Thailand, and Hong Kong so I am quite aware that there are options for those who can afford it. The problem is for the poor slob who is given so-called 'free' health care that is pretty good but very costly in terms of time. When something serious comes up that poor slob is forced to wait for weeks or months and may die unnecessarily if not diagnosed in time. That person has no option of getting on a plane and seeing a doctor in the US, Hong Kong, or Singapore. Only rich people have such options. Of course, by prohibiting rich people from purchasing their own care in the country the authorities unnecessarily clog up the system and increase waiting times for everyone, including that poor slob with few options.

 
At 5/22/2011 8:23 AM, Blogger VangelV said...

The Govt - MEANS TESTS how much you pay.

and the Govt - FORCES providers to list their prices - not the vaunted "free market".

there is NOTHING "free market" about Singapore that the Govt itself did not FIRST set the rules for.

It is the Govt in Singapore that REQUIRES Universal Access - NOT the free market.


Again you are confused. Nobody claims that Singapore has a free market. The point is that it has a far freer market than the US because consumers get to choose where to buy their health care. By having far more options than Americans they keep their system's costs lower and quality higher.

A perfect example within the US is the sector of the health care industry that is not covered by third party insurance. If you take a look at the cost and quality in the cosmetic and eye surgery areas you find a much better performance than the rest of the sector? Why? Because people have to use their own money to get their eyes fixed or to remove that double chin. When they do, they shop around for price and look at the quality of output by the practitioners. Even as the quality has exploded the cost of getting an eye corrected has fallen substantially.

 
At 5/22/2011 8:27 AM, Blogger Larry G said...

" As I wrote, if you want to get a diagnosis done you have to wait "

you have to wait if you ONLY want the Govt to do it.

" The problem is for the poor slob who is given so-called 'free' health care that is pretty good but very costly in terms of time. "

do you mean the "poor slobs" who have INFINITE wait times ?

" When something serious comes up that poor slob is forced to wait for weeks or months and may die unnecessarily if not diagnosed in time"

and what happens to those who wait for longer because they have no options at all?

I'll admit that wait times are longer in many of these countries when compared against the SUBSET of people in this country who DO have affordable access to HC.

but you're comparing apples to oranges.

Universal Health Care ...IS...FOR those "poor slobs" you talk about.

It is THEIR safety net.

and it CAN be done cost-efficiently in terms of time and dollars as demonstrated by a number of countries including Singapore.

Universal HeathCare does NOT ..IMPOSE a single minimum standard on EVERYONE nor does it prevent those who can afford better...shorter wait times... quicker MRIs etc from getting them.

This is a canard.

Universal Heath Care is CHEAPER primarily because when "poor slobs" have some level of access to regular screenings, etc.. disease is discovered and treated cheaper.

Singapore clearly demonstrates this in my view.

 
At 5/22/2011 8:31 AM, Blogger Larry G said...

" Again you are confused. Nobody claims that Singapore has a free market. The point is that it has a far freer market than the US because consumers get to choose where to buy their health care. By having far more options than Americans they keep their system's costs lower and quality higher. "

it has MORE GOVT CONTROL than we have...

it has HIGHER PAYROLL TAXES that we have.

Their Govt FORCES you to hand over 20% of your paycheck...

the govt FORCES you to buy catastrophic insurance AND to pay taxes to subsidize those who cannot afford it.

I can go on..but how in the world can you actually READ these aspects of Singapore healthcare and claim that is is:

1 - a more "free market".

2. that the Govt is not the entity that dictates that "market".

it's just plain bizarro...

every since the Heritage folks printed that editorial and the other conservative sites parroted it.. it's as if you guys take it on face value without every really thinking about the actual specifics of their system.

It's a Govt-RUN system, guy.

 
At 5/22/2011 8:33 AM, Blogger VangelV said...

If it was proposed in this country that we have 33% FICA Tax to pay for SS and universal health care and reduce equivalently the income tax rate...the right wing would go berserk!

I agree. A government run universal system would be inefficient and of low quality. People would certainly not want to give up one third of their earnings for another government run scheme.

the right wing is unalterably OPPOSED to the CONCEPT of FICA, SS, Medicare and Universal Health care - all a govt-imposed mandate in Singapore.

I agree that quite a few on the right do not want government imposed healthcare.

It's truly bizarre how the free market folks point to Singapore as an example of the "free market".

They don't because the government still has too much say in the delivery of health care. What they point out is that the Singapore system is freer than in the US because people spend their own money. Why that is so hard for you to understand is somewhat of a mystery. My guess is that you need a straw-man to knock down because you can't justify your preference for top-down planning in which a few bureaucrats make decisions for the general population.

What YOU GET in Singapore is an level playing field for consumers of health care - but the free market did cause that - the Govt did.

Choice caused it. All the government really did was force people to set aside money for their own pensions and health care. It did not tell the people how to spend that money. Compare that to the failed US system. The government took in taxes from workers and their employees and spent it all for general operations. There has been nothing set aside for the workers who made the contributions and expected SS and Medicare payouts when they qualified. The burden to look after those workers has been shifted on younger workers who have yet to qualify. As time passes the unfunded liabilities go up significantly faster than the economic growth and tax revenues. That means that the system in the US will go bankrupt. But that is not the case in Singapore where the people have invested their pension and health care contributions in stocks, bonds, commodities, and other assets that qualify. When they get old and need health care they will be able to use the money set aside to acquire it.

 
At 5/22/2011 8:40 AM, Blogger VangelV said...

If we proposed to do in this country what the Govt did in Singapore, the right wing would blow a gasket.

Truth! Admit it!


That is not exactly true. When Bush proposed that the SS system be reformed it was the Left that blew a gasket about personal savings accounts.

 
At 5/22/2011 8:48 AM, Blogger Larry G said...

" I agree. A government run universal system would be inefficient and of low quality. People would certainly not want to give up one third of their earnings for another government run scheme. "

isn't this Singapore?

" I agree that quite a few on the right do not want government imposed healthcare."

are these the same folks who champion the Singapore system?

" They don't because the government still has too much say in the delivery of health care. What they point out is that the Singapore system is freer than in the US because people spend their own money. "

Van..is that your name?

Do you think that the FICA Tax in this country is their "own money"?

" Why that is so hard for you to understand is somewhat of a mystery. My guess is that you need a straw-man to knock down because you can't justify your preference for top-down planning in which a few bureaucrats make decisions for the general population. "

because of the obvious inconsistencies in the arguments.

We have a payroll tax. They have a payroll tax.

They do have a "fund" to spend but the govt steps in when that fund is exhausted..and subsidies - especially those with low incomes.

We do something similar. We ALSO means test as Singapore does.

" Choice caused it. All the government really did was force people to set aside money for their own pensions and health care."

Govt is who provided the environment for "choice".

Would you want the Singapore model for our FICA tax?

" the government really did was force people to set aside money "

this is at it's heart an Individual Mandate.

The govt is FORCING YOU to set aside money for your future needs.

If the Govt did not force you to do this - what would happen?

Would people have money to spend on HC later on?

 
At 5/22/2011 8:50 AM, Blogger Larry G said...

" That is not exactly true. When Bush proposed that the SS system be reformed it was the Left that blew a gasket about personal savings accounts. "

true but it was supposed to "voluntary" no FICA right?

when Obama proposed the individual mandate - which walks and talks like Singapore - the right went ape-shit.

despite the fact that people like Dick Armey and New Gingrich supported the individual mandate in 1993.

 
At 5/22/2011 9:11 AM, Blogger Larry G said...

Aren't you REALLY saying that out of all the govt-run universal health care systems in the world that Singapore has the best?

If we take all counties that have Govt-imposed approaches to Health Care which country would have the BEST... TRULY "free market" system and would that system provide universal access?

Don't you need to admit that there are no true "free market" health care systems in the world that provide market-driven, no govt involve, universal access?

Are you not, essentially saying that the Singapore system is the best govt-run healthcare system AND that the "free market" folks in the US would NEVER agree to a Singapore model in the US?

 
At 5/22/2011 9:39 AM, Blogger morganovich said...

"Aren't you REALLY saying that out of all the govt-run universal health care systems in the world that Singapore has the best?"

no.

1000 times no.

you really do not seem to be getting this larry.

the whole point of the singapore system is that, the government does NOT run it.

all they do is force you to save.

apart from that, it's pure consumer sovereignty. you take your money and spend it where you choose and make your own cost/benefit decisions.

doctors are forced to be responsive to this and offer competitively priced care of high quality.

the prices for every service are made clear up front, and you make you own choice just like you would buying a car or a toaster.

singapore is one of the most free market economies in the world, and their health care system is too. it is precisely because the government does not do insane things like mandate coverage, set prices, determine what care can be offered, etc that the system works. the people don't have "insurance" like we think of it, just savings that they spend for checkups, tests, and most non catastrophic treatments.

when you run out of HSA money in singapore, you have to spend you own, this causes everyone to make rational consumption decisions.

in the US, the more you spend, the less you pay. care is free once you hit your deductible or your out or pocket max (or just flat out free in the case of many government programs)

this drives demand WAY up. if price = zero, demand goes to absurd levels.

something that costs $10,000 and has a .0001% chance of mattering still makes sense for you to consume because there is always positive cost benefit if cost = 0.

i don't think you are thinking this through larry. singapore has about the most free market health care system of any developed nation.

show me any other country whose % of cash pay is nearly so high.

that is what makes the system work.

 
At 5/22/2011 9:49 AM, Blogger Larry G said...

Okay... what is it about this statement that is wrong?

" Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services"

I see this as a further example of how you guys focus on ONE aspect of something and refuse the acknowledge the rest of the facts and realities in context.

" when you run out of HSA money in singapore, you have to spend you own, this causes everyone to make rational consumption decisions."

when you run out of money, the Govt "rescues" you with subsidies.

admit it guy.


" that is what makes the system work"

and if that system was proposed for this country - the free-market folks who go ape-shit.

admit it guy.

How can you cite it as an example of "free-market" HC but ten turn right around and vociferously oppose it here?

this is not a lack of "understanding" guy.

this is a clear example of the double-standards and inconsistencies in the positions of those who oppose Govt healthcare.

it is so Bizarre that you cite another govt-run system as a "better" ...."free market" approach when THAT system is much more similar to the other industrialized countries than our system.

You have NO TRUE free-market system Model for the US to adopt.

Admit it.

There is no country in the entire world that has a true free-market system that provides universal access.

none.

nada.

zip.

so you latch on to an existing system that has heavy, heavy govt involvement and cite it as the paragon of free market health care - and the PROOF of this - is that the same folks who tout this system - like yourself ...would NEVER AGREE to use that same system here.

 
At 5/22/2011 10:00 AM, Blogger morganovich said...

regarding your point about the US, i think it's a bifurcation.

the HSA idea has been starting to catch on, but obamacare will do away with it.

it's clear that the left in this country wants to emulate the failing systems in europe, only with a much worse starting point because the EU has nothing like our malpractice costs.

would we do much better under a singapore system? yes.

do we have the political will to move to it? i doubt it.

we are heading that way in another fashion though.

fewer and fewer doctors will take medicare patients as they almost always lose money on them.

more and more doctors (especially top notch specialists, but increasingly GP's as well) do not take insurance at all.

this parallel system is going to fill the role of the market.

my doctor doesn't take insurance. you pay when you go. he'll gove you a full 30 minutes. he knows yo and pays attention instead of trying to jam you through in 6 minutes.

it's worth it.

even at $100/visit, it's MUCH cheaper than insurance which would cost 2-3X that monthly.

then you can just buy inexpensive high deductible insurance ($5k ded) to cover a catastrophe. it works better and it costs less.

if you can drop you insurance from $300 to $100/mo, that's $2400 in savings a year. if you go to the doctor 3 times a year (and you likely don't) and pay $300, you're still at $1500 for the year vs $3600, a 58% savings.

of course, obamacare will make this illegal. i will be forced to buy insurance with with a low deductible because all the high d and HSA plans will be illegal.

thus, i am forced to spend a lot of money on insurance that will not pay for the doctor i want to see.

that is national care in a nutshell. forced costs for limited choices and poor service.

it's like saying you have to buy a ford taurus when you car shop even if you want to buy a BMW. hey, you can still buy the BMW, but we're going to tack the an extra $25k onto the price.

 
At 5/22/2011 10:02 AM, Blogger morganovich said...

"when you run out of money, the Govt "rescues" you with subsidies.

admit it guy."

you are just talking nonsense.

got any backup for your claim.

admit it guy, you are just making stuff up.

 
At 5/22/2011 10:02 AM, Blogger VangelV said...

it has MORE GOVT CONTROL than we have...

No. People spend their own money. They have far more choices.

it has HIGHER PAYROLL TAXES that we have.

The total burden on employees and employers is smaller.

Their Govt FORCES you to hand over 20% of your paycheck...

No. You have to set it aside in your own account. Unlike the US, the contributions you make are your own, not spent by the government.

the govt FORCES you to buy catastrophic insurance AND to pay taxes to subsidize those who cannot afford it.

Yes it does. But that is not very different than the US where workers subsidize those that do not work and do not make any contributions towards health care.

I can go on..but how in the world can you actually READ these aspects of Singapore healthcare and claim that is is:

1 - a more "free market".


Because people keep their money and spend their own money. They have more choices.

2. that the Govt is not the entity that dictates that "market".

It does not dictate because it does not do the spending. Individuals do that.

it's just plain bizarro...

Yes, your inability to understand that more control and choice by consumers means a freer market is plain 'bizarro.'

every since the Heritage folks printed that editorial and the other conservative sites parroted it.. it's as if you guys take it on face value without every really thinking about the actual specifics of their system.

Not true. It is clear that the government of Singapore meddles too much. But by insisting that people save for their own retirement and health care it ensures that people have more choices and that they take more responsibility.

It's a Govt-RUN system, guy.

As I said, people save their own money and spend their own money. Unlike the US, the government does not steal their retirement contributions and replace them with a promise to tax later to replace what was stolen.

 
At 5/22/2011 10:06 AM, Blogger morganovich said...

"do you mean the "poor slobs" who have INFINITE wait times ?"

more made up nonsense.

i used to not have insurance. i never waited for anything.

you seem to have this idea that no insurance means you cannot get healthcare.

that's ridiculous.

you are arguing from a very emotional, illogical place and making the same fallacious claims over and over. we've debunked that one about 3 times so far on this thread.

then you make up crazy facts like the uninsured use the emergency room as GP, which the AMA debunked.

for someone who questions the references of others, you sure seem to spew a great deal of unsubstantiated nonsense.

perhaps you should take your own advice and check your facts before you speak.

 
At 5/22/2011 10:08 AM, Blogger Larry G said...

" regarding your point about the US, i think it's a bifurcation.

the HSA idea has been starting to catch on, but obamacare will do away with it.

it's clear that the left in this country wants to emulate the failing systems in europe, only with a much worse starting point because the EU has nothing like our malpractice costs.

would we do much better under a singapore system? yes.

do we have the political will to move to it? i doubt it."

the question is are the self-avowed free-market people in this country ADVOCATING to go to a Singapore type system?

What are they advocating for right now?

If the free market folks don't advocate for a Singapore type system then what does that mean?

 
At 5/22/2011 10:10 AM, Blogger Larry G said...

" of course, obamacare will make this illegal. i will be forced to buy insurance with with a low deductible because all the high d and HSA plans will be illegal."

you are so bound up against ObamaCare.

Your guys shot down Clinton's attempt...

then the Conservatives like Gingrich and Armey SUPPORT the Individual mandate in 1993.

Then the Republicans had control to the Presidency and Congress for a number of years and what did they do about HC?

They passed Medicare Part D - a govt subsidized plan that accelerates the demise of Medicare as a viable program.

Your side has NO ANSWERS - only "ideas" and ideology.

 
At 5/22/2011 10:15 AM, Blogger morganovich said...

"and if that system was proposed for this country - the free-market folks who go ape-shit."

more nonsense conjecture.

many have been championing it.

where do you thing the HSA movement came from?

it is not the "free market crowd" that is shutting it down, it's the command and control left.

don't lose sight that fascism is a leftist doctrine and not all that different from socialism.

larry, you seem like you are just making up facts and conjecture and throwing it out because you know the actual facts do not support you.

your posts are becoming increasingly emotional, illogical, and unsubstantiated.

your comment is provably logically false.

if the free market folks oppose a free market, then they are not free market folks, are they?

you might be able to argue that there are not enough free marketers in the US to overcome the left, but that is not the same argument and not what you said.

 
At 5/22/2011 10:18 AM, Blogger Larry G said...

" Patient subsidy will be based on the average monthly income received over the last available 12-month period including bonuses for salaried employees.
Services such as Day surgery, A&E services, Specialist Outpatient and polyclinic visits will not be means tested and standard subsidies rate applied to citizens and PR as usual.
People with no income, such as retirees or housewives, will have their subsidy rate pegged to the value of their homes.
All unemployed residents of HDB flats excluding those in executive condominiums (EC) will be entitled to full subsidy."

http://en.wikipedia.org/wiki/Healthcare_in_Singapore

To illustrate an example, Mr. X who is a Singapore citizen earns S$4,167 a month. He is then hospitalised where he chooses to stay in a Class C ward. Below is a breakdown of what he can expect to pay and what he can expect to be subsidised under two different scenarios:"

http://www.guidemesingapore.com/blog-post/singapore-life/introduction-to-healthcare-in-singapore

 
At 5/22/2011 10:25 AM, Blogger morganovich said...

larry-

now you are just erecting straw men and arguing against a position we have not put forth.

who precisely is "my side"?

i am not a republican.

i am a libertarian.

i am equally disgusted with republicans and democrats alike.

i do not live in your world of only 2 sides.

"my side" does have answers and a plan.

it's very simple:

completely deregulate health insurance. allow nationwide consumer choice and flexibility in policy offerings.

this will push people toward HSA's and high deductible plans, because it wind up being much cheaper. but hey, if you want to buy the old kind of insurance, you are free to do so if you can find someone to sell it to you at a price you find attractive.

or, you can have no insurance at all, but no one is obligated to treat you if you cannot pay. there is no such thing as a right to healthcare. a right that cannot exist if you are alone on a desert island is not a right. a right to healthcare is a kind of slavery as you have a right to compel my unpaid and possibly unwilling labor.

all medi programs become cash grants. you get x dollars, spend it as you like. there is no more "all you can eat" buffet.

reform medical tort law. doctors are paying insane malpractice insurance and that drives the cost of healthcare WAY up. many docs work 3-4 months of the year just paying malpractice insurance.

bingo, the system works.

it's a free market, freer even than singapore. you don't need the government to make sure that new CD's a re priced well and have good music. the market does that.

far from being too important to trust to the market, healthcare is too important NOT to trust to the market.

 
At 5/22/2011 10:27 AM, Blogger Larry G said...

"it has HIGHER PAYROLL TAXES that we have.

The total burden on employees and employers is smaller."

33% of your paycheck is quite a bit higher than the 28% rate in this country, eh?

And it's a WHOLE LOT HIGHER than they in the lower tax brackets.

"Their Govt FORCES you to hand over 20% of your paycheck...

No. You have to set it aside in your own account. Unlike the US, the contributions you make are your own, not spent by the government."

that's totally wrong. The govt in this country GUARANTEES You HC when you retire...

I will agree that HOW you spend it in the US encourages over-consumption but this is a much worse problem for income-tax subsidized Part B not the FICA-financed Part A.

"the govt FORCES you to buy catastrophic insurance AND to pay taxes to subsidize those who cannot afford it.

Yes it does. But that is not very different than the US where workers subsidize those that do not work and do not make any contributions towards health care."

so on that particular aspect.. what is different?


"I can go on..but how in the world can you actually READ these aspects of Singapore healthcare and claim that is is:

1 - a more "free market".


Because people keep their money and spend their own money. They have more choices. "

they have the choices the GOVT has provided them - NOT the free market.

"2. that the Govt is not the entity that dictates that "market".

It does not dictate because it does not do the spending. Individuals do that."

It DICTATES how much you save, how much you pay in taxes to subsidize others... how much private providers can charge and makes private providers provide their prices.

All of this is DICTATED by the Govt - not the free market.

"it's just plain bizarro...

Yes, your inability to understand that more control and choice by consumers means a freer market is plain 'bizarro.'"

it's the GOVT that provided the benefits you TOUT - NOT the free market.

The GOVT set the environment for competition by FORCING the free market to operate according to Govt Rules.

You say I "don't understand"

HA .. I know the difference between a govt run system and one that is not.

"every since the Heritage folks printed that editorial and the other conservative sites parroted it.. it's as if you guys take it on face value without every really thinking about the actual specifics of their system.

Not true. It is clear that the government of Singapore meddles too much. But by insisting that people save for their own retirement and health care it ensures that people have more choices and that they take more responsibility."

and you'd support that same approach here to get the same benefits?

Be HONEST!

stop playing both sides of the fence.

do you or do you not support the KIND of system that Singapore has ...in this country ...???

Don't you think it is hypocritical to Tout a system in another country and oppose that system here at the same time?

 
At 5/22/2011 10:29 AM, Blogger Larry G said...

" you seem to have this idea that no insurance means you cannot get healthcare.

that's ridiculous."

you can get healthcare but it's too late for many whose could not afford to have it looked at when it was cheap and stoppable and by the time it got bad.. they had to get charity care and it gets billed to others via cost-shifting.

 
At 5/22/2011 10:30 AM, Blogger morganovich said...

"Admit it.

There is no country in the entire world that has a true free-market system that provides universal access."

i don't believe anyone ever claimed there was.

you are just histrionically jousting at straw men again.

but that's no reason not to try.

also:

a free market system for healthcare doe not mean that no one gets assistance.

it means that assistance is cash, not an entitlement to services.

if you get a welfare check and spend it on turnip, that does not mean there is not a free market for turnips.

 
At 5/22/2011 10:30 AM, Blogger Larry G said...

" for someone who questions the references of others, you sure seem to spew a great deal of unsubstantiated nonsense.

perhaps you should take your own advice and check your facts before you speak. "

I provide FAR MORE references from a wide variety of sources than you guys do...

you cite the same old right-wing propaganda sites who themselves do not provide references to their assertions.

 
At 5/22/2011 10:31 AM, Blogger Larry G said...

" "and if that system was proposed for this country - the free-market folks who go ape-shit."

more nonsense conjecture.

many have been championing it.

where do you thing the HSA movement came from?"

this is not conjecture.

I am asking YOU!

and I am asking you to provide links to the free-market sites that have advocated the Singapore system for this country.

I have seen NONE but if they exist, I'd like to see them.

 
At 5/22/2011 10:33 AM, Blogger morganovich said...

"you can get healthcare but it's too late for many whose could not afford to have it looked at when it was cheap and stoppable and by the time it got bad.. they had to get charity care and it gets billed to others via cost-shifting."

that's a foolish argument for several reasons:

1. it's always personal choice. having insurance does not mean you will go get looked at early, nor does being rich.

2. as i showed you earlier, the uninsured do not act as you claim. their emergency room use is barely higher than those with insurance.

3. you take the concept of cost shifting as a given.. it's not. it's a bad policy and should be done away with. you can't walk into a grocery store, fill your cart, and then tell the checkout clerk you have no money and take the food anyway.

 
At 5/22/2011 10:33 AM, Blogger Larry G said...

" it is not the "free market crowd" that is shutting it down, it's the command and control left."

that's truly Bizarre.

Most "left wing" folks would WELCOME the ENTIRE Singapore model but opposed the cherry-pick right-wing approach.

I have YET TO SEE - ANY "free market" or Libertarian group that advocates the Singapore approach.

I'm not saying "admire" it.

I'm saying ADVOCATE FOR IT!

 
At 5/22/2011 10:34 AM, Blogger Larry G said...

" don't lose sight that fascism is a leftist doctrine and not all that different from socialism.

larry, you seem like you are just making up facts and conjecture and throwing it out because you know the actual facts do not support you.

your posts are becoming increasingly emotional, illogical, and unsubstantiated.

your comment is provably logically false."

more horse manure bluffing

can you not defend the obvious issues without being a coward?

 
At 5/22/2011 10:36 AM, Blogger Larry G said...

" you might be able to argue that there are not enough free marketers in the US to overcome the left, but that is not the same argument and not what you said."

I'd argue that there are not enough "free market" folks who support the Singapore model to overcome other "free-market" and right-wingers.

Most liberal folks would LOVE the Singapore Govt-dictated approach.

Most left-wing want explicit Universal Access.

Most right-wing run away from that.

 
At 5/22/2011 10:38 AM, Blogger Larry G said...

" now you are just erecting straw men and arguing against a position we have not put forth.

who precisely is "my side"?

i am not a republican.

i am a libertarian."

you might be but you have no chance to effect change without folks who think similarly and it is the Republicans who most closely align with you.

You have to find enough allies if you are truly interested in change.

Otherwise, admit that you really are only interested in an ideological view and not real change.

 
At 5/22/2011 10:39 AM, Blogger Larry G said...

" completely deregulate health insurance. allow nationwide consumer choice and flexibility in policy offerings."

is that ANYTHING LIKE the Singapore approach?

There seems to be ONE SINGLE ASPECT of that system that you support - and that's it ..nothing else.

true?

 
At 5/22/2011 10:40 AM, Blogger morganovich said...

"
I am asking YOU!

and I am asking you to provide links to the free-market sites that have advocated the Singapore system for this country."

no you weren't. there was no question in you comment. now you are just lying and trying to wiggle out of having said something stupid by attempting to push the burden of proof onto me. yo made a claim and cannot back it up.

the best policy is to admit you were wrong and move on.

google "us health savings account advocacy" yourself.

if i paste more than 1 link in here, it tends to trigger the spam filter.

if you have searched for this and not found it, then you are not very good at search.

perhaps you noticed the congressional debates on this topic. see who shouted it down.

 
At 5/22/2011 10:42 AM, Blogger Larry G said...

" bingo, the system works."


only in your ideological theory dreams...

you can't name any system in the world that works this way and provides universal access.

you cannot find more than 10% in the electorate nor elected that will sign on to what you seek.

you're dead in the water on even moving towards a better system.

you have a black & white approach.

Kill the current system and recreate one in your 10% vision.

that's not realistic.

that's not dealing with the realities.

there is no future in your approach.

 
At 5/22/2011 10:43 AM, Blogger Larry G said...

' it's a free market, freer even than singapore. you don't need the government to make sure "

and there is no country in the world that does this except for 3rd world countries where the majority of the population gets virtually NO healthcare.

 
At 5/22/2011 10:45 AM, Blogger Larry G said...

" There is no country in the entire world that has a true free-market system that provides universal access."

i don't believe anyone ever claimed there was."

You strongly implied that Singapore was close.


" a free market system for healthcare doe not mean that no one gets assistance"

but you cannot show one that "works"?

none out of the 200 countries in the world?

isn't you "plan" a purely ideological one with no basis at all in any current realities?

 
At 5/22/2011 10:46 AM, Blogger Larry G said...

" "you can get healthcare but it's too late for many whose could not afford to have it looked at when it was cheap and stoppable and by the time it got bad.. they had to get charity care and it gets billed to others via cost-shifting."

that's a foolish argument for several reasons:

1. it's always personal choice. having insurance does not mean you will go get looked at early, nor does being rich.

2. as i showed you earlier, the uninsured do not act as you claim. their emergency room use is barely higher than those with insurance.

3. you take the concept of cost shifting as a given.. it's not. it's a bad policy and should be done away with. you can't walk into a grocery store, fill your cart, and then tell the checkout clerk you have no money and take the food anyway.
"

Your arguments have been rejected by 40 other countries including Singapore.

your arguments are theories - not practice.

 
At 5/22/2011 10:48 AM, Blogger morganovich said...

"There seems to be ONE SINGLE ASPECT of that system that you support - and that's it ..nothing else.

true?"

false.

your reading comprehension seems terrible. if you cannot see the similarities, then you do not understand this issue.

the reason signaopre works is it has a price signal.

i'm taking that idea and making it even more free market. the structure is the same: HSA and high deductible disaster insurance.

the only real difference in structure is i don't believe any one should be compelled to participate or that other plans need to be banned.

singapore is a police state full of all manner of terrible invasions of liberty.

hell, chewing gum is illegal.

i see no reason to emulate the reductions of liberty in which they engage. it is not needed to get the benefits of their system.

we have already seen that it works.

the costs of cash pay procedures in the US have been decreasing for years.

my system will work as well or better than theirs and maintrin much greater freedom.

freedom includes the freedom to make bad choices, but that's life. it maximizes overall welfare. the sorts of command and control systems you seem to favor all cause deadweight losses.

 
At 5/22/2011 10:48 AM, Blogger Larry G said...

" I am asking YOU!

and I am asking you to provide links to the free-market sites that have advocated the Singapore system for this country."

no you weren't. there was no question in you comment."

I am asking you - and you are evading an answer.


I'm asking ANYONE who admires the Singapore system if they would advocate it - as is - here in this country.

you are running away from the question.

 
At 5/22/2011 10:49 AM, Blogger Larry G said...

" yo made a claim and cannot back it up.

the best policy is to admit you were wrong and move on.

google "us health savings account advocacy" yourself.

if i paste more than 1 link in here, it tends to trigger the spam filter."


ha hahahaha bahahahahah

more excuses..fella...

where is your personal responsibility?

 
At 5/22/2011 10:52 AM, Blogger Larry G said...

" your reading comprehension seems terrible. if you cannot see the similarities, then you do not understand this issue.

the reason signaopre works is it has a price signal.

i'm taking that idea and making it even more free market. the structure is the same: HSA and high deductible disaster insurance."

You can call it what you want but it's clearly not the Singapore approach.

it's a "roll-your-own" that you are claiming is "inspired" by Singapore.

I did not ask you about what you do't like about Singapore.

What I asked you is in the Singapore system that provides universal health care at 4% of GDP is a system that you'd advocate for here... not a different one that you put a name on.

 
At 5/22/2011 10:53 AM, Blogger Larry G said...

" my system will work as well or better than theirs and maintrin much greater freedom."

your system does not exist.

it's in your own mind.

there are no countries in the world that come even close to what you propose.

When no other country on the face of the earth has any kind of a plan that comes close to what you are proposing, what does that mean?

 
At 5/22/2011 10:55 AM, Blogger morganovich said...

"
Your arguments have been rejected by 40 other countries including Singapore.

your arguments are theories - not practice."

this is just gibberish.

what countries rejected those arguments. there is not even a shred of logic in what you are saying.

can you show me even one country that has rejected this:

"1. it's always personal choice. having insurance does not mean you will go get looked at early, nor does being rich."

no? didn't think so.

"2. as i showed you earlier, the uninsured do not act as you claim. their emergency room use is barely higher than those with insurance."

i have already shown you that this is true in the US, which is the system we are discussing. that's what matters. that said, you are again just making stuff up. please provide a list of countries that claim this is not so.

"3. you take the concept of cost shifting as a given.. it's not. it's a bad policy and should be done away with. you can't walk into a grocery store, fill your cart, and then tell the checkout clerk you have no money and take the food anyway. "

certainly, there are other countries that practice cost shifting, but so what? that says nothing about it being a good idea. it just shows preference/prejudice.

there was a time when most countries practiced slavery too. would you find that a valid argument against an abolitionist?

your logic and facts here are a mess.

you seem to think that practice trumps theory. so where then, does progress come from? how do bad practices get overturned? think back to that slavery arguments and you'll see how stupid the claim you just made is.

 
At 5/22/2011 10:58 AM, Blogger morganovich said...

"When no other country on the face of the earth has any kind of a plan that comes close to what you are proposing, what does that mean?"

it means they are making bad choices.

before the US was founded, there was no nation EVER that has a government based upon the inalienable rights of the individual.

did that means it was stupid and would never work?

history says it worked pretty damn well.

your argument is ridiculous.

no one ever flew before the wright brothers either.

no one tried democracy before greece.

you seem to be arguing that anything that has not been tried cannot work.

what a lamentable, Luddite world view you have.

 
At 5/22/2011 11:06 AM, Blogger VangelV said...

when you run out of money, the Govt "rescues" you with subsidies.

How many people 'run out of money' again? If you buy catastrophic insurance you do have a great deal of protection. And when you spend your own money you do not engage in low return defensive medicine that run down your healthcare savings plans. You certainly do not take drugs that are not necessary and try to look after yourself better.

and if that system was proposed for this country - the free-market folks who go ape-shit.

The way I remember it, it was the left that went 'ape-shit' when Bush proposed a Chile style SS program. The right would have far less trouble with the Singapore system than your Marxist pals because it is a much freer system than what is in place today.

this is not a lack of "understanding" guy.

It is a sign of lack of 'understanding' on your part when you claim that a system in which health care and pension contributions are stolen by the government is freer than one in which they are controlled by those making them.

There is no country in the entire world that has a true free-market system that provides universal access.

That is not true. In a free market if you have money you have access to healthcare just as you have access to food, clothing, and anything else that you choose to consume. Markets never place artificial barriers to access because they are motivated by selling goods and services to those that want and can afford to buy them.

 
At 5/22/2011 11:09 AM, Blogger VangelV said...

fewer and fewer doctors will take medicare patients as they almost always lose money on them.

more and more doctors (especially top notch specialists, but increasingly GP's as well) do not take insurance at all.

this parallel system is going to fill the role of the market.


Do not underestimate the stupidity of statists. They can simply pass laws to prohibit doctors to offer private care services to people that are superior to those of the nationalized system. (See Canada for how this works.)

of course, obamacare will make this illegal. i will be forced to buy insurance with with a low deductible because all the high d and HSA plans will be illegal.

thus, i am forced to spend a lot of money on insurance that will not pay for the doctor i want to see.

that is national care in a nutshell. forced costs for limited choices and poor service.


You do see the problem. It is difficult to see how it gets resolved properly.

 
At 5/22/2011 11:11 AM, Blogger VangelV said...

you are arguing from a very emotional, illogical place and making the same fallacious claims over and over. we've debunked that one about 3 times so far on this thread.

That is all he has. If he tried looking at the facts and being logical he could not hold the position that he does. This is an example of the product of our failed education system.

 
At 5/22/2011 11:13 AM, Blogger Larry G said...

" this is just gibberish.

what countries rejected those arguments. there is not even a shred of logic in what you are saying.

can you show me even one country that has rejected this:"

I would suggest that EVERY country that has Universal Health care - has REJECTED your approach.

" "2. as i showed you earlier, the uninsured do not act as you claim. their emergency room use is barely higher than those with insurance."

it's been credibly shown that the ones who are uninsured or on MedicAid are sicker and did not get care when they should have and now need much more intensive an expensive care.

"i have already shown you that this is true in the US, which is the system we are discussing. that's what matters. that said, you are again just making stuff up. please provide a list of countries that claim this is not so."

you showed the conclusions of a right-wing site that did not provides links to the actual report - which provides the broader demographics of those who are uninsured or on MedicAid that go to the emergency room.

Here's the study:

Neither YOU nor your right-wing site bothered to provide it:

http://www.cdc.gov/nchs/data/databriefs/db38.htm

this is what neither you or your right wing site provided as the context to the sound-bite blather:

" Persons with Medicaid coverage were more likely to report at least one ED visit and multiple ED visits in a 12-month period than those with private coverage or the uninsured. This finding may reflect higher rates of disability and chronic conditions among persons with public insurance, including Medicaid, relative to the uninsured (3). However, uninsured persons under age 65 were more likely to have multiple ED visits in a 12-month period than those with private insurance. The data also show that persons without a usual source of medical care are not more likely to have an ED visit than those with a usual source of care, and that uninsured persons are not more likely than others to access the ED for nonurgent visits. Future work should focus on untangling the complex interactions among the sociodemographic, health status, and health care access factors that appear to be associated with visits to the ED."

You and the right wing site assert a conclusion...

the NHS cites the broader issues and that more investigation is required before drawing conclusions.



"3. you take the concept of cost shifting as a given.. it's not. it's a bad policy and should be done away with. you can't walk into a grocery store, fill your cart, and then tell the checkout clerk you have no money and take the food anyway. "

 
At 5/22/2011 11:14 AM, Blogger Larry G said...

" certainly, there are other countries that practice cost shifting, but so what? that says nothing about it being a good idea. it just shows preference/prejudice."

it shows realities also not theories.

 
At 5/22/2011 11:15 AM, Blogger Larry G said...

" you seem to think that practice trumps theory. so where then, does progress come from? how do bad practices get overturned? think back to that slavery arguments and you'll see how stupid the claim you just made is. "

acknowledging the practices and understand why is the first step to change.

When you don't understand why and look into comparative systems and advocating a pure theory with no examples and a 10% support - you don't get change.

 
At 5/22/2011 11:17 AM, Blogger Larry G said...

" it means they are making bad choices"

it might be but 40 other countries CURRENT PRACTICES, including Singapore - challenges your pure theory ideas.

especially when you seem in favor of complete abandonment of current systems and replacing them with things not proven in practice and not supported by anywhere near a majority of people.

You do't get change this way.

 
At 5/22/2011 11:20 AM, Blogger morganovich said...

larry-

your whole argument is internally inconsistent.

on the one hand, you argue that our system doesn't work. on the other, you argue that "that's the way countries do it, so a new idea must be wrong".

you argument is equivalent to saying "mr ford, everyone in the world builds cars by hand, your 'assembly line' idea is just a theory. if it's such a good idea, why aren't people already doing it"

one could certainly argue that singapore's health system works better than ours. but to take the next step and argue that that makes it the "right" system or the "best" system is pure fallacy.

in 1910, the model t may have been the "best" care in the world on a price/performance basis. that does not mean it could not be improved upon.

the entire history of progress is based on new theories of how to do things.

no nation has ever practiced purely free trade either. this does not prove it's a bad idea. it proves that governments (including democracies) make bad choices and choose to favor preferred constituents over maximizing overall welfare.

it shows that people love to vote themselves free stuff that others pay for.

the fact that you have resorted to the "this is how we do it, so this is how we should do it" argument demonstrates just how bankrupt and indefensible your ideas are.

i need to go catch a plane.

good luck untangling the terrible fallacies and contradictions in your ideas.

 
At 5/22/2011 11:23 AM, Blogger morganovich said...

"especially when you seem in favor of complete abandonment of current systems and replacing them with things not proven in practice and not supported by anywhere near a majority of people."

not proven?

markets are not proven?

how do you buy groceries or clothing?

besides, markets in healthcare HAVE been proven. look at the cash pay treatments in the US. the price of lasik drops, the treatment gets better, no one waits.

if you think markets are an unproven way to distribute and allocate goods and services, then you really are beyond the reach of reason.

 
At 5/22/2011 11:27 AM, Blogger Larry G said...

" what a lamentable, Luddite world view you have."

I'm ALL FOR CHANGE including all the advances we have seen in all the areas you mentioned but those changes were gradual and incremental ... not "trash everything and start over" approaches.

LUDDITE?

Luddites DON'T want to know about the realities guy.

they are anti-knowledge.

they want the status-quo

I have more chance of seeing changes made that agree with my preference that you do because more people want the kinds of changes that are NOT what you want.

The vast majority of people in this country do not want your approach.

More than 50% ALONE want some kind of universal access that means everyone has access to affordable insurance and regular HC.

75% SUPPORT the idea of the FICA/Individual Mandate Social Security and Medicare.

Ask the Republicans about this.

If you are further to right of Republicans on this issue - you are in a very, very small group.

Not even Ron and Rand Paul advocate what you advocate for and neither of them advocate for the repeal of EMTALA - which pretty much guarantees access to health care but in the least-cost-effective way possible - 4 times what it would cost than if they got care earlier and much worse outcomes than countries that have universal access.

You doubt the numbers ... for the other countries .. but not for Singapore?

why the double standard?

The same entities that provide statistics for Singapore - you believe but you disbelieve the same entities when they provide statistics for other countries?

 
At 5/22/2011 11:32 AM, Blogger Larry G said...

" How many people 'run out of money' again? If you buy catastrophic insurance you do have a great deal of protection. And when you spend your own money you do not engage in low return defensive medicine that run down your healthcare savings plans. You certainly do not take drugs that are not necessary and try to look after yourself better."

this is GOVT MANDATED guy and it is subsidized with taxes over and above the payroll taxes.

" The way I remember it, it was the left that went 'ape-shit' when Bush proposed a Chile style SS program. The right would have far less trouble with the Singapore system than your Marxist pals because it is a much freer system than what is in place today. "

this is nutty guy. You are saying that in effect the left would be opposed to a Singapore type system because they were opposed to a Chile-type system.

WTF?

" It is a sign of lack of 'understanding' on your part when you claim that a system in which health care and pension contributions are stolen by the government is freer than one in which they are controlled by those making them. "

in BOTH SYSTEMS - the Govt FORCES YOU to set aside money. IN any other reasonable world this is recognized as an "individual mandate"..

you are saying, in effect, that because the way the money is spent means it is not mandated.

It's Govt mandated, guy.

" There is no country in the entire world that has a true free-market system that provides universal access.

That is not true. In a free market if you have money you have access to healthcare just as you have access to food, clothing, and anything else that you choose to consume. Markets never place artificial barriers to access because they are motivated by selling goods and services to those that want and can afford to buy them. "

I asked you to provide examples.

the only example you provided - Singapore is a govt-run system in virtually anyone's book.

I asked you again - for ANY country that does not mandate Universal Care that operates as a free market without govt involvement.

 
At 5/22/2011 11:34 AM, Blogger VangelV said...

Thanks for the link. It shows exactly what the advocates for patient choice argue. Suppose you have major surgery in Singapore and compare it with that in the US. You have no insurance and have to pay out of your own pocket.

A Heart Bypass that would cost $140,000 in the US comes out at $25,000 before any government subsidies. A hip replacement, at $13,000 is less than a third of the US cost of $45,000. This happens because the hospitals run by the government have to compete against privately owned companies that offer hospital care and because consumers of health services have huge incentives to control costs.

 
At 5/22/2011 11:35 AM, Blogger Larry G said...

" Do not underestimate the stupidity of statists. They can simply pass laws to prohibit doctors to offer private care services to people that are superior to those of the nationalized system. (See Canada for how this works.)"

what do they do in Singapore?

or for that matter any of the 40 countries that offer Universal Care?

What's the reality?

" of course, obamacare will make this illegal. i will be forced to buy insurance with with a low deductible because all the high d and HSA plans will be illegal.

thus, i am forced to spend a lot of money on insurance that will not pay for the doctor i want to see.

that is national care in a nutshell. forced costs for limited choices and poor service.


You do see the problem. It is difficult to see how it gets resolved properly. "

does this describe the govt-run Singapore system?

 
At 5/22/2011 11:36 AM, Blogger Larry G said...

" you are arguing from a very emotional, illogical place and making the same fallacious claims over and over. we've debunked that one about 3 times so far on this thread.

That is all he has. If he tried looking at the facts and being logical he could not hold the position that he does. This is an example of the product of our failed education system. "

blah blah blah

more grade A horse manure from those that choose pejoratives over dealing with the issues

this says far more about you than I guys.

 
At 5/22/2011 11:42 AM, Blogger Larry G said...

" your whole argument is internally inconsistent.

on the one hand, you argue that our system doesn't work. on the other, you argue that "that's the way countries do it, so a new idea must be wrong"."

huh?

I said that the other countries were much closer to Singapore than us

AND I ASKED YOU if you supported a Singapore type system here and you evaded the answer.

My argument is totally consistent.

Our current system is less-cost-effective than any other country in the world that have govt-sanctioned health care.

I advocate going to a system more like those systems as a way to improve the cost-effectiveness of our system.

That's a TOTALLY CONSISTENT argument.

Youse guys on the other hand argue that Singapore is better but we can't use their model....

and we can't use any of model in the world that already exists

and you think the US govt and the world entities that collect statistics are engaged in a massive conspiracy to obfuscate the facts that you refuse to acknowledge.

 
At 5/22/2011 11:48 AM, Blogger Larry G said...

" markets are not proven?"

the markets you are advocating for in HC - do not exist in practice.

once again - you're deep into theories and not realities.

" besides, markets in healthcare HAVE been proven. look at the cash pay treatments in the US. the price of lasik drops, the treatment gets better, no one waits.

if you think markets are an unproven way to distribute and allocate goods and services, then you really are beyond the reach of reason. "

I'm looking at the current realities.

There are about 250 countries in the world and I have asked the free-market folks here to name the ones that best reflect the theories you advocate for and the best you have done is to name a gov run universal care system.

 
At 5/22/2011 11:50 AM, Blogger Larry G said...

" Thanks for the link. It shows exactly what the advocates for patient choice argue. Suppose you have major surgery in Singapore and compare it with that in the US. You have no insurance and have to pay out of your own pocket.

A Heart Bypass that would cost $140,000 in the US comes out at $25,000 before any government subsidies. A hip replacement, at $13,000 is less than a third of the US cost of $45,000. This happens because the hospitals run by the government have to compete against privately owned companies that offer hospital care and because consumers of health services have huge incentives to control costs. "

Guy - it's a Govt-RUN system not a "free-market" system.

Their govt has dictated a health care environment that gets the results they want.

Their system is not the result of a "free market" without govt involvement.

Why you continue to say this PROVES that free market approaches "work" is bizarre

 
At 5/22/2011 11:55 AM, Blogger Larry G said...

" Why you continue to say this PROVES that free market approaches "work" is bizarre"

ESPECIALLY WHEN - you would likely OPPOSE that system here.

you guys say my reasoning is "inconsistent".

Lord O'Mighty

Consistency would be to actually show a true "free-market system" that has no govt involvement and youse guys choose one that has major govt involvement and because their govt-controlled system ALSO controls prices and availability.. you argue that this is a "free market".

GAZOOKS!

Then.. I ask.. "would you support that wonder free-market system - as-is - here in this country...

and what do I get?

evasion...and equivocating...

and then of course.. the charge from youse boys that I am the one who is inconsistent...

LORD!

 
At 5/22/2011 11:56 AM, Blogger VangelV said...

33% of your paycheck is quite a bit higher than the 28% rate in this country, eh?

And it's a WHOLE LOT HIGHER than they in the lower tax brackets.


The Singapore government takes less in taxes than the US government does. (Remember that for an equivalent rate you have to look at city, state, and federal taxes for Americans.) And the government does not take the funds from you. It tells you that you have to set them aside in your own savings and healthcare accounts.

If you can't tell the difference between money in your account and money that has been taken from you and spent it is you who has a problem with understanding, not those that are trying to teach you.

that's totally wrong. The govt in this country GUARANTEES You HC when you retire...

Does it? I hear all kinds of calls for means testing, which means that some people who contributed will not see their money back. And given the fact that the Medicare and SS programs have unfunded liabilities of more than $100 trillion the guarantees are not worth very much. Do you really think that Greeks should be expecting all the things that they were promised? If yes, how will those promises be funded by a bankrupt government. If no, then why do you expect that Americans should be expecting all of the things promised to them?

Obama has already promised SS and Medicare cuts. So have the Republicans.

so on that particular aspect.. what is different?

When I buy cheap catastrophic insurance with a high deductible I pay for myself. When you cover some uninsured individual who has no catastrophic insurance to pay the bills you pay for him, not yourself. There is a difference that even a Marxist like you should be able to see.

they have the choices the GOVT has provided them - NOT the free market.

No. The hospitals compete for their cash. They have gotten so good and so efficient that they now attract foreign patients. It is not unusual for Canadians who go to Asia to stop off for a day or two and get a full checkup done at one of the hospitals. They get the results rapidly and are given choices if there is some kind of issue that pops up. For the cost of postage a copy of all the medical information goes to their GP at home. The $350 to $500 cost for everything is much cheaper than taking time off work to do all kids of tests in different facilities and waiting days to get everything together.

I will agree that HOW you spend it in the US encourages over-consumption but this is a much worse problem for income-tax subsidized Part B not the FICA-financed Part A.

It is a structural problem with third party payment schemes. Add to that the defensive medicine that doctors are forced to practice and costs for Americans are significantly higher than they would be in a system where people spent their own money for their own care. (See eye correction and cosmetic dentistry costs as perfect examples.)

It DICTATES how much you save, how much you pay in taxes to subsidize others... how much private providers can charge and makes private providers provide their prices.

All of this is DICTATED by the Govt - not the free market.


I do not claim that Singapore pays too little in taxes or has too few subsidies. You do that. All I point out is that it has a much freer system than what you see in Europe and the US. I think that Lee Kuan Yew who pointed out that one of the big problems for the US was the approach used. In the US the politicians set up the system to benefit the political class and its sponsors in big business. In Singapore the system was set up to maximize the benefits to the voters/consumers.

 
At 5/22/2011 11:59 AM, Blogger VangelV said...

The GOVT set the environment for competition by FORCING the free market to operate according to Govt Rules.

You say I "don't understand"

HA .. I know the difference between a govt run system and one that is not.


You are either one of the dumbest people around or just plain deceitful. When you look at the delivery of health care in Singapore you see a very competitive system, which is a far cry from nationally run health care systems such as you see in the UK, Spain, Greece, or Canada. From what you have been writing you obviously want the US to be a lot more like the UK or Canada than Singapore.

 
At 5/22/2011 12:06 PM, Blogger VangelV said...

stop playing both sides of the fence.

First of all, I see both the Left and Right as statist idiots who have no idea about how markets work and how much liberty matters. So let us stop playing the 'you are a right winger' game.

do you or do you not support the KIND of system that Singapore has ...in this country ...???

Over Obamacare? Yes I would. Tell people to put their own money in their own pension and health care accounts where the government can't touch it. Have them buy catastrophic insurance provided by private insurance companies who offer a wide variety of choices. If they choose high deductibles the cost will be very small.

Of course I doubt that the Left would take kindly to a scheme where the decision making power is taken from government bureaucrats and put into the hands of individuals. This is why it attacked Bush in 2005 when he proposed a private pension scheme like the one in Chile.

Don't you think it is hypocritical to Tout a system in another country and oppose that system here at the same time?

Who is opposing? If the choice is between Obamacare or the Ryan plan on one side and the Singapore approach on the other I would support the Singapore system.

 
At 5/22/2011 12:08 PM, Blogger VangelV said...

you can get healthcare but it's too late for many whose could not afford to have it looked at when it was cheap and stoppable and by the time it got bad.. they had to get charity care and it gets billed to others via cost-shifting.

In Canada you will be on a waiting list that may be so long that it is bad by the time you get to get a diagnoses. Nationalized health care means rationing. And the last time I looked charity hospitals used to be funded by contributions, not taxes. As usual you are very confused.

 
At 5/22/2011 12:11 PM, Blogger Larry G said...

" 33% of your paycheck is quite a bit higher than the 28% rate in this country, eh?

And it's a WHOLE LOT HIGHER than they in the lower tax brackets. "

It IS, make no mistake a 33% MANDATORY TAX and I have asked you if you favor that kind of approach here and what did you say?

" that's totally wrong. The govt in this country GUARANTEES You HC when you retire...

Does it? I hear all kinds of calls for means testing, which means that some people who contributed will not see their money back. "

any more or less than the Singapore "free-market" approach?

" And given the fact that the Medicare and SS programs have unfunded liabilities of more than $100 trillion the guarantees are not worth very much. Do you really think that Greeks should be expecting all the things that they were promised?"

ha ha ha

if we had a 33% payroll tax verses a 15.3% FICA - would Medicare be more solvent?

do you FAVOR a LARGE FICA TAX to FUND Medicare like Singapore does?

" If yes, how will those promises be funded by a bankrupt government. If no, then why do you expect that Americans should be expecting all of the things promised to them?

Obama has already promised SS and Medicare cuts. So have the Republicans"

If they advocated a 33% FICA TAX to pay for Medicare, would you support it?

" When I buy cheap catastrophic insurance with a high deductible I pay for myself. When you cover some uninsured individual who has no catastrophic insurance to pay the bills you pay for him, not yourself. There is a difference that even a Marxist like you should be able to see."

again the cheap shot. what a jerk.

Do you think the catastrophic insurance in Singapore is "Marxist"?

" they have the choices the GOVT has provided them - NOT the free market.

No. The hospitals compete for their cash. "

ha ha ha...

the Govt Hospitals UNDERCUT the private ones to make the private ones compete....

otherwise the private ones would charge as much as they could get away with like any free-market system would.

" They have gotten so good and so efficient that they now attract foreign patients."

Nope.. it was this:

" 3. Foreigners no longer receive any subsidies at public hospitals since 01-Jan-08."

http://en.wikipedia.org/wiki/Healthcare_in_Singapore

" It is a structural problem with third party payment schemes. Add to that the defensive medicine that doctors are forced to practice and costs for Americans are significantly higher than they would be in a system where people spent their own money for their own care. (See eye correction and cosmetic dentistry costs as perfect examples.)"

how come the other 40 countries don't have this problem including Singapore?

" I do not claim that Singapore pays too little in taxes or has too few subsidies. You do that. All I point out is that it has a much freer system than what you see in Europe and the US. I think that Lee Kuan Yew who pointed out that one of the big problems for the US was the approach used. In the US the politicians set up the system to benefit the political class and its sponsors in big business. "

but I don't ... I have never said they pay too little.

I point out that they pay a LOT AND they GET A LOT and that their overall health statistics prove it.

" In Singapore the system was set up to maximize the benefits to the voters/consumers."

You continue to avoid the truth and the reality ...

In Singapore - the GOVT set up the system - NOT the free-market.

It's a govt run system and it works very, very well and completely undermines your basic position that govt cannot do it.

 
At 5/22/2011 12:13 PM, Blogger Larry G said...

" You are either one of the dumbest people around or just plain deceitful. When you look at the delivery of health care in Singapore you see a very competitive system, which is a far cry from nationally run health care systems such as you see in the UK, Spain, Greece, or Canada. From what you have been writing you obviously want the US to be a lot more like the UK or Canada than Singapore. "

It's a govt-run system by virtually any standard except the "deniers".

Canada or the UK.

I've asked you over and over would you support a Singapore system... and you evade the answer and then have the nerve to call me dumb or deceptive.

I'm totally up front.. and I'm asking you... and you are a very weasel...

 
At 5/22/2011 12:17 PM, Blogger Larry G said...

"
First of all, I see both the Left and Right as statist idiots who have no idea about how markets work and how much liberty matters. So let us stop playing the 'you are a right winger' game. "

are you not the one who is using the "liberal" and "Marxist" pejoratives?

" do you or do you not support the KIND of system that Singapore has ...in this country ...???

Over Obamacare? Yes I would. Tell people to put their own money in their own pension and health care accounts where the government can't touch it."

Thank you!

"Have them buy catastrophic insurance provided by private insurance companies who offer a wide variety of choices. If they choose high deductibles the cost will be very small."

did you mean have the Govt FORCE YOU to buy it like they do in Singapore?

"Of course I doubt that the Left would take kindly to a scheme where the decision making power is taken from government bureaucrats and put into the hands of individuals. This is why it attacked Bush in 2005 when he proposed a private pension scheme like the one in Chile."

The "left" would totally support the Singapore plan...believe me....

You're dreaming if you think the opposition to a Singapore plan would come from the left and not the right.

The right would go totally ape-shit and you know it.

 
At 5/22/2011 12:18 PM, Blogger Larry G said...

" Don't you think it is hypocritical to Tout a system in another country and oppose that system here at the same time?

Who is opposing? If the choice is between Obamacare or the Ryan plan on one side and the Singapore approach on the other I would support the Singapore system. "

The Singapore system - as currently practice without major changes to it -right?

 
At 5/22/2011 12:23 PM, Blogger Larry G said...

"you can get healthcare but it's too late for many whose could not afford to have it looked at when it was cheap and stoppable and by the time it got bad.. they had to get charity care and it gets billed to others via cost-shifting.

In Canada you will be on a waiting list that may be so long that it is bad by the time you get to get a diagnoses. Nationalized health care means rationing. And the last time I looked charity hospitals used to be funded by contributions, not taxes. As usual you are very confused."

you'd be wrong as usual:

" Since the January legal opinion by Attorney General Ken T. Cuccinelli, state officials have scrambled to secure public funding for nonprofit groups that form the backbone of the state’s public-health safety net for low-income residents — free clinics, community health groups and the Virginia Health Care Foundation.

State officials say they will need to write new contracts with at least 14 such organizations, an approach that lawyers for Cuccinelli (R) agree is legal and will allow funding for health-care groups to continue. Also, some funds briefly frozen for the groups after Cuccinelli’s opinion that the state constitution prohibits the funding will now flow with the new contracts, they said."

http://www.washingtonpost.com/local/politics/cuccinelli-legal-position-may-end-virginia-funds-for-cultural-historical-groups/2011/05/19/AFeYls7G_story.html

these would be tax dollars paying for charity care...

it's pretty common across the country....

FYI - part of the ObamaCare was to establish a system of community health clinics for those who could not get access to private doctors.

We actually do this now but it's hidden from view.

 
At 5/22/2011 12:23 PM, Blogger VangelV said...

You are making crap up again. It was the Left that opposed the privatization of Social Security, not the Right. It is the Left that wants government to control health care spending, not the Right. The Right keeps arguing for choice in health care, education, pension planning, and other areas, not the Left.

 
At 5/22/2011 12:28 PM, Blogger VangelV said...

You have to find enough allies if you are truly interested in change.

Why? It is easier to get richer by betting that most people are as stupid as you are and get rich from the mess that they are creating.

Otherwise, admit that you really are only interested in an ideological view and not real change.

He is a libertarian and wants change. But, unlike you, he is not stupid. He knows that there are too many statists on both the right and the left so that the best strategy is to be on their continued stupidity.

If I can make an extra million or two from your stupidity I can afford a few extra grand here or there to pay for private healthcare abroad if I really needed it.

 
At 5/22/2011 12:28 PM, Blogger Larry G said...

" You are making crap up again. It was the Left that opposed the privatization of Social Security, not the Right. It is the Left that wants government to control health care spending, not the Right. The Right keeps arguing for choice in health care, education, pension planning, and other areas, not the Left. "

The LEFT.. WANTS FICA and govt control...

the RIGHT wants to KILL FICA and have personal accounts like HSAs.

The LEFT wants Universal CARE guaranteed by the Govt.

The RIGHT is opposed to this.

The LEfT SUPPORTS the FICA approach to SS and Medicare and usually advocates for HIGH FICA taxes LIKE Singapore to pay for HC for all.

The RIGHT is OPPOSED.

The LEFT wanted a FICA-financed Medicare for ALL.

The RIGHT was vociferously OPPOSED.

The LEFT would totally support a FICA-type approach LIKE Singapore than GUARANTEED Universal Access and help from the govt if you ran out of your personal account (on a means-tested basis).

truth.

 
At 5/22/2011 12:30 PM, Blogger Larry G said...

" You have to find enough allies if you are truly interested in change.

Why? It is easier to get richer by betting that most people are as stupid as you are and get rich from the mess that they are creating."

If you truly think we have a bad system and want it to be better..you'll want change.

If you really don't care and it's all about ideology...you won't.

"Stupid" is saying we have a terrible system but you are so locked in to an ideological position that you won't even compromise for incremental reforms and insist on slash&burn tactics that never are accepted and so that kind of change never happens.

 
At 5/22/2011 1:00 PM, Blogger VangelV said...

I'm asking ANYONE who admires the Singapore system if they would advocate it - as is - here in this country.

you are running away from the question.


What you ask is not possible because Singapore has different institutions. That make the exact system implementation in a country like the US impossible.

Stop with the straw men arguments and start with facts and logic. When a system responds to price signals set by a competitive market it will do much better than one that has no access to free market price signals because consumers do have choices and do not spend their own money. It is as simple as that. It is all about being able to plan properly and about who plans.

 
At 5/22/2011 1:06 PM, Blogger VangelV said...

It IS, make no mistake a 33% MANDATORY TAX and I have asked you if you favor that kind of approach here and what did you say?

When the money goes in your account it is not a tax in the way that when your money is spent by the government. Why do you have trouble understanding that?

It IS, make no mistake a 33% MANDATORY TAX and I have asked you if you favor that kind of approach here and what did you say?

No. I oppose giving the government money for health care or pensions. Why don't you? People should control their own contributions.

 

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