sicko (in Debates)

I just watched this yesterday for the first time. Now, whilst I chuckled at his editing techniques I did seriously wonder about his main point. Why don't the US have universal healthcare like other established western countries? Is there some fatal flaw that I'm not seeing? I'm from Australia and we've got universal healthcare. The examples of france and england seemed pretty convincing and mainly factual.

KGO.

The problem is health care companies slip or government leaders too much money for them to want universal healthcare... plus the rich people in the US don't need it and feel they will end up paying all the bills so the poor can have healthcare

I did some reading and the common criticism is waiting line/lists? Whilst they exist, why don't people get private health cover and then jump the queues by using their actual money?

Also, wouldn't it be reallocating taxpayer's money? Rich people would already be paying these taxes regardless?

Flamey,

If you think universal healthcare is so great, cheap and easy to access, please go to Cuba the next time you need Surgery. *sarcasm*

Just like Mike Moore did.

There are many reasons the US does not have "universal healthcare" and most of them keep the US having the best medical system in the world. One can quote the UN, as anti-US it currently is. Or one can look at cancer, heart disease, lung disease and neonatal survival rates. Of which the US is at or near the top in every major meaningful category. IE, the statistics the UN quotes on newborn death rate is such a crock of poop. Other countries do not count those newborns less than 33 weeks in their statistics. The US counts every neonate no matter how old if they have 1 breath. Frequently 26 week births die but in the US they are counted unlike other counties. This is just one example of how statistic can be very misleading.

However, we can get into a more detailed discussion if you want to move your questions to debates.

I myself watched Sicko and got violently sicko from watching it. The utter twisting of facts throughout the film just to try to move a specific political point of view.

However, here are just a few of the reason we do not have universal coverage:

1) Unlike in countries such as your Australia or France/England, medical school is not free. Doctors frequently come out of school with 200k+ in debt. Leading them to have to earn to pay back those loans. Leading to a massive shortage in specialists. In any universal care system, price controls on physicians are in practice. Nobody would go to medical school if they cannot make enough cover expenses. If we really wanted universal coverage medical school has to be free. However it will not be.

2) I do not know for a fact, but I have heard that in universal healthcare countries, nurse practitioners and other peripheral helpers see patients. In America we prefer to see a physician.

3) The malpractice problem in other countries is nothing like America. I typical OB/GYN in S. Florida, where I live, pays 200k a year in premiums for 250k/750k coverage. This leads to a lot of defensive medicine. People on the other side of the aisle dismiss defense medicine and malpractice reform, but it is essential to being able to have universal coverage. As a Radiologist, 25-33% of my practice is defensive medicine. Also, if we move to the European method of malpractice trials, that is the loser pays for the winners lawyers/court costs, things would be very different. But the trial lawyers have the Democrats in their pockets so this will never occur.

4) Americans have expected instant access. Someone goes to an orthopedist with back pain and expect to get an MRI that day. And most do. If they do not, they sue. Even though they frequently do not win, it is time and effort that goes into defending oneself. Not to mention lawyer expenses. In other counties, non essential MRI/CTs are not done for weeks. And if pathology is delayed in the diagnosis, it is part of having universal free care.

5) The overall tax burden in other countries are higher. Money is needed for comprehensive care. America has the most progressive taxes in the world. That is the highest earners pay the highest percentage. In other countries, everyone pays federal income tax. In the US right now, if you have 2 kids, are married, you pay 0 federal income tax if you make 50k or less. Just unbelievable in my opinion. If we really want universal coverage, it is too much to expect everyone to contribute, rather than just the "rich"? Until we as Americans figure this out, universal coverage will be something that is very difficult to enact. But not for lack of jamming something down our throats. There is now chat of a VAT tax in America. More taxes=more money=less overall country growth.

6) With universal coverage comes rationing. At my hospital we just did a quadruple bypass on a 90 year old. Something that would never happen outside of America unless they payed for it. This patient may live another 5-10 years. But in other countries, they are just simple classified as too old by actuarial tables to qualify for the surgery. Same with other surgeries. Do not get me started on chemotherapy and cancer patients. For basic chemo, they get treated, but for experimental or cutting edge therapies, no go.

7) Innovation. When you do not have a capitalistic type of system, innovation dies. The reason we have new medicines and new technology is the American system. Companies know they can get paid to do research. It typically costs 100M+ dollars to research a new drug and bring it to market. If the US system goes to a universal coverage, this would slow down to a crawl.

Basically with universal coverage there are some benefits and some negatives. In America most people like their coverage and the way they are treated by their physicians. I say most not all since there are always some people who want and want and want without paying for it. As there are in all countries. However in America we have a nice portion of the country who think they are entitled to what others have sacrificed for. This is not as true in other countries where there is a common sense of unity.

But when a country is as diverse as America, little national history of unity unless it was a world war, you get people who just want to live off others. *soapbox moment over*

The first word of my point 1) should be "Unlike"

Thanks for the long reply, it's nearing bedtime so I shall reply in a brighter state.

it is highly likely that any topic based on a michael moore movie should automatically go in the debates / discussion forum! ; )

Fixed.

Also, thank you for your reply, Ranger. It is the first time on CB I saw a post on healthcare that was worth reading. You stuck to the facts, you didn't attack anyone on CB, you explained your arguments in a well thought out way... That's the Ranger I dearly miss. Thank you for it.

I'm guessing this thread will eventually go the way of most, but no one can say it did not start off in what is really a fantastic way. That's a very good setup for an actual kind of debate that I believe OB imagined when we created the forum.

Also, it's good to get your insight into the matter in a way that is both approachable and readable. There are a number of things in your post that I just didn't realize about the issue, and I appreciate the information.

John Q.

why does supporting universal health coverage automatically equal wanting something for nothing? can someone really be so blind to assume that is the only motivation?

Good post Ranger, I agree with some points and disagree with others.
Just a couple of quick comments:
1) Med school is not free in Canada or the UK, less expensive to be sure, but not free. This is the case for all university/college studies I believe. There are Canadian med-school students who graduate with 100k in debt... not as bad as the 200k you mentioned but crappy enough.


I can't speak authoritatively on this one, having not seen any medical personnel in at least 5 yrs. The physicians/100,000 persons only differs by 1 or 2 between the US and UK/Canada. Cuba has over double the number of doctors per capita that the US does. I suspect that is a result of med school costs (I think it is free there).

3) Ah malpractice... I honestly am amazed by some of the lawsuits I hear of in the US... the current system needs to be changed.

Oops, running out of time,

Just out of curiousity, how was the 90 yr old's bypass surgery funded?

Ranger spurting verbal diarrhea yet again.
It is not free for our doctors to get their qualifications, e are grants available to help those that deserve them but the debt for these is still astronomical.
We also have strict entry rules for university, no trust fund kids here getting a job they can't do.
Finally, like I said in the last healthcare thread, the overall quality of our NHS and most other European healthcare systems put the majority of the US to shame.
Just because 1% of your doctors may be better than anywhere else, 90% are underassessed. European doctors and definitely UK doctors have quality service drilled into them and you'll be hard pressed to find anyone of a substandard.

that should have never been said, while you are entitled to your opinion, you shouldn't degrade others.

And yet I get the blame when these threads go bad?

Ignorant slander of foreign policy to protect your profession is asking for recoil

Zog, if you want people to listen to you as a person, then you need to not put people down... pay attention to the thread, make VALID counterpoints not spout off against a person, but their points.

I made the points, they're clearly there to read.

my point is: make your point without putting someone else down, if you want to be entitled to your opinions and points, don't degrade others.


In other words: don't be a prick

Ranger, you won't get the blame for this one.

I agree that a purely capitalistic system would most likely have more investment into research but that research wouldn't necessarily be into the best of things. Research ends up going into the most profitable not the best solution. A more targeted less expensive research may actually get more results where it really counts.

Zog

You are welcome to your opinion.

But foreigners do not go to Europe for care if they want the best.

The come to the US.

While you may think care is best in Europe, the stats show the best heart disease and cancer survival rates in the US.

But each system had it's benefits. As a physician I prefer mine. I speak with foreign medical grads everyday who also prefer mine.

BTW. Medicare paid for the 90 year olds surgery. With AARP supplimental coverage.

"But foreigners do not go to Europe for care if they want the best.

The come to the US."

That is a hilariously blinkered view and highly incorrect.
Maybe those from the Americas and maybe some parts of Asia would but I can guarantee that Germany, Switzerland and UK are the main destinations for most others.
For both this is going to be due to location as to be fair nobody would pay the travel costs either way on top of the medical fees for what is essentially the same thing.

Rich people come to the states to get better health care. Poor people, mainly only ones who live near the Canada border, tend to leave the country for better health care they can afford.

Because of the way out health care system is setup I am looking at having to pay $40,000-$50,000 for what I want/need to get done. I would much rather pay for it over a long period of time as higher taxes rather than pay up front like I will have to. The only reason I will be able to afford it at all is because I spent a year in Iraq and saved every bit of the money I made.

Ranger, to my understanding Medicare is very similar to the Canadian health care system in that it is a government financed single payer system. The only difference is that it is limited to a certain section of the population.

As far as cancer survival rates, you are correct on the overall measures. Interestingly an international study identified the 5yr breast cancer survival rate actually being highest in Cuba, followed by the US and Canada....

As for level of care measures:
The fact is I think that some of this variation can be chalked up to simple spending differences. The OECD numbers for 2007 list US health care spending at 16% of GDP vs 10.1% in Canada and 8.4% in the UK.

Not this time. That trophy falls to Zog, who now has zero credibility in this thread (and most likely others by extension.) Further, if he continues to post like an imbecile, I or another admin will send a nice pile of cash to Tourney Prizes on his behalf.

Oh, btw, that's an indirect warning in disguise. I highly suggest, Zog, that you heed it. Highly.

As dudemus pointed out to me in a CM, I never actually moved this thread to Debates. Sorry, did it just now.

I'd really like to see Ranger's 7 points debated in an actual debate style. Until now, I hadn't ever seen all of those things gathered together concisely. It would make for what would actually be a legitimate debate.

Yes and no. Seniors have a choice actually of Medicare or using the money towards Medicare to something called Medicare Advantage. Something about 1/4 of seniors do. But with the new health plan MA is going to be essentially dismantled as a "savings" program.

As far as survival rates, here is the best article I have seen so far, however, it does not include Cuba:

http://www.firstthings.com/blogs/secondhandsmoke/2009/07/21/most-cancer-survival-rates-in-usa-better-than-europe-and-canada/

Yes, the US spends the most, but has the best results for most of the big illnesses: Heart disease, lung disease and cancer.

However, we spend countless money on unnecessary defensive medical tests for which I can write for hours on. I see this everyday being a Radiologist.

Included in the numbers for health care expenditures (according to most articles I read) is malpractice premiums. I personally pay 56k a year for 250k coverage. Many doctors here in South Florida go bare but I unfortunately cannot due to my hospital contracts. As I stated before OB/GYNs can pay upwards of 200k a year. Neurosurgery is about that and Orthopedics a bit less.

Any progression to a universal care has to include tort reform, however with the trial lawyers being staunch Democratic supporters, this will not happen unless a real bipartisan law is made.

Now to another point:



It does not automatically equal wanting something for nothing but we do have mechanisms for those who cannot afford healthcare to get it.

ERs cannot turn away those who need care. Medicaid is for those who cannot afford true care. Free clinics are everywhere. Google "Free Medical Care" and you get tons of search results.

My company writes off millions in unpaid charges each year. About 20% of what we do is free work.

However, it is very disheartening to see someone cry they cannot afford to pay their bills when they come in to our office with gold chains around their neck, a new Iphone with the latest ring tones, and smoking a cigarette.

As I stated earlier, instead of taxing the rich more and more, why not make everyone pay for governmental services. Right now those with a family of 4 making 50k pay ZERO federal income tax. I have stated earlier in the thread that the US is the most progressive tax country in the world. That is the rich pay the highest percentage of the total tax burden.

http://www.nypost.com/p/news/opinion/opedcolumnists/tax_hikes_forever_2R6zNvMXNQTfgwbaICmuBJ#ixzz0l6Ai96hL

I would not be so adverse to universal care if the correct bill/law was made. One that actually addresses the problems in medicine including tort reform rather than jamming a poorly crafted, not read bill down our throats. But such a bill needs to address many interwoven points I discussed above. Including people needing to learn to accept long wait times for non essential services and rationing as one ages.

A few facts from Mass which has a state run universal health care:

1) ER visits have went up 18% since it was enacted
2) It has the highest insurance premiums in the nation
3) The cost is 2.5x what it was projected. And this is just 3 years after enactment.

But I believe we have a huge difference in opinions on one key fact:

I do not believe healthcare is a right but others on the liberal side do.

To me a right is something someone gets that does not effect another person. IE the right of free speech. The right to worship in peace. The right to choose your religion. The right to vote for who you want in private.

Healthcare does not fit this parameter. For someone to get free healthcare someone else has to pay for it. Whether money or time.

So once get get over this "Healthcare is a right" then we can move to actually chatting about ways to insure more people properly.

One can chat about social justice, but that is just another set of verbiage for a socialistic type of society. I will not say it is right or wrong. That is for another thread/discussion. However, right now America is a capitalistic society, and from the reaction to the recently passed law I think we can accept that.

Here is the perfect article on that subject:
http://www.commentarymagazine.com/viewarticle.cfm/what-kind-of-socialist-is-barack-obama--15421?page=all

Ranger, one of your points was that you didn't want to have to pay for other people to receive healthcare, right? I can't find the actual quote, so bear with me. Wouldn't universal healthcare be a reallocation of tax money? If the US were to introduce such a system, do you see taxes rising? Would taxes rise? If so, by how much?

Comparing tax rates of Australia and US, the US appears to be taxed less so in the higher brackets which is what you were talking about.

Re: Education Costs
In Australia we have HECS. This means you can get tertiary qualifications without having ANY savings at all. The Govt pays for your degree and you pay them back progressively based on your income after you graduate. At the very least we pay 4.5k/year for national priorities (nursing, education) and around 10k/year for non-priorities (law, some sciences) (1 AUD = 90c USD). Do you have an issue with this sort of education? It seems that many many talented/intelligent individuals miss out on education in the US because they can't get a scholarship and they don't have the savings.

Sorry for going too far off topic, but I also believe that education is a problem over there. I suppose that's for another topic.

Ranger, I have to commend you on making some very respectable points. It was a good read. While I disagree with your conclusions, it's more of a matter of philosophy. The majority of your reasoning is perfectly sound.

I'll do a quick summary of my take.
1st post
1. Very good point. Completely agree.
2. I've actually found it frustrating to have to go to a full doctor for even minor procedures that I know a nurse could perform. To me it has always seemed like a waste of the doctors' time.
3. Completely agree.
4. I don't see why nonessential MRI's are so important. I've actually been put through an MRI multiple times 'just in case'. Again, it seems like a waste to me.
5. I would disagree that the United States has the most progressive system. "That is the rich pay the highest percentage of the total tax burden." I feel like this is a false measure of the progressiveness of the tax system considering the United States is the richest country. Class disparity increases this too, yet does that make a society more progressive? I guess it's debatable.
6. True. Though again I only disagree, that it's necessarily a bad thing.
7. I recognize it costs a lot to get a drug to market. However, with universal coverage, I would expect more to be spent on drugs. However, you are correct less would be spent on certain types of drugs. IE hail-Mary cancer drugs etc. I agree this could be a bad thing.

I'm glad to hear a coherent argument as well as glad to hear you say that there are good and bad things to both sides because it's very true.

we are pretty much damned if we do and damned if we don't. trusting corporate america gets us this:

http://www.reuters.com/article/idUSTRE63M5D420100424
http://www.reuters.com/article/idUSTRE62G2DO20100317

the pendulum then swings to where we give more power to the government as we are seeing now with both the health bill and the financial reform.

finding a way to get rid of frivolous lawsuits but allowing people like those mentioned in the articles above legal recourse for legitimate issues is a tough nut to crack just like every other aspect of these debates.

Quick point of clarification on numbers...

This is to Ranger:

56k a year for 250k coverage. Are those numbers correct? You can cover yourself after 4 years... The 250K is either WAY low, or I must have no idea at all how often *every* doctor gets a lawsuit that must be deflected.

How many lawsuits does the average doctor face per year? (Understanding that most all of them would get thrown out, of course).

Dude,

I see your points about corporate America. However, the government is just the Devil you do not know as well. Having practiced at a VA hospital, there are things the government does that equals or excels the private sector.

I guess one huge difference in philosophy we have is that I believe in private enterprise to manage things better than the government. Due to the ability to make profit, the private sector can eliminate waste and fraud easier than the government. They also have the need for much better customer service than the government. Firing incompetent employees is much easier in the private sector, especially if there are no unions involved. The government now has more union members than the private sector. And that is growing.

Medicare, Social Security, construction, the wars we currently are in are all extremely over budget. Even Medicare Part D, the prescription coverage is way over budget. And as I pointed out earlier in the thread, Rommeycare is now 250% over budget in its 3rd-4th year.

We have had plenty of examples of the government being no where near their estimate on how much things will cost. Then the bureaucracy of the government. We can discuss that for days. At least the time we would wait at the DMV.

Of course, 100%, the government has to have regulation to prevent abuse by the corporations. But not enough to be intrusive and tell companies how to do their business. But again, I am sure we disagree on this point.

Yes, I pay 56,000 a year to an insurance company so they will cover the first 250k in damages per act of "negligence". The insurance company does pay lawyer fees which can run over 100k in defense alone, especially is multiple expert witnesses are needed.

The 750k number is as an "aggregate". My insurance company will not pay out more than $750,000 in any one year, regardless of the number of negligent acts or claims.


I hear the average doctor has 3-5 lifetime lawsuits. But that is just what I have heard and cannot quote a source.

I have one pending at this time after being in practice 15 years. Something that is complete crap and I have quite a few expert witnesses on my defense. It is just that I do have insurance where I practice so I get sucked into the lawsuit having read a couple of films.

But going through all the crap so far, not even at my deposition yet, I can see why physicians practice defensive medicine. One lawsuit can put quite a lot of stress on someone. Hence quite a lot of unnecessary tests. Physician have no idea who would sue or who will not, so everyone gets subject to the defensive medicine practice line.

Do not get me wrong, there are physicians who are truly guilty of Malpractice, but most I hear about are more Bad Outcome rather than true Malpractice. It is just you read and hear about those real mess ups and not all the other garbage suits that lawyers attempt to settle for a payday/shakedown.

I would easily give up a nice portion of my income for true malpractice reform to mimic that of other countries, like Europeans

OK, I'll address point for point from Ranger's initial, well-made post:

1) Good point. Perhaps we should be looking at education reform, as well, to help overcome this issue. (Also, this issue doesn't really relate to health care quality, but as to why a certain system may or may not be in place).

2) First off, if you don't know it for a fact, then it is hearsay. Who said these were solid debate points? But I'll allow it. Whether or not people in the USA _prefer_ to see a physician is immaterial. _Do_ they, is the question? My wife went in for a recent check-up, and didn't see a doctor at all. Actually, that's probably smart/efficient in many circumstances. If an issue requires seeing a physician, then a physician should be seen. If not (allergy shots, basic blood tests, admin, etc.), then not. All I care about is feeling better. Wanting a doctor just because "I want a doctor!" isn't a reason for anything. In fact, it sounds like an entitlement mind-set.

3) Good point, and malpractice (like education, in point 1) needs to be addressed in concomitant fashion with universal health care.

4) This is an amalgam of points 2 and 3. I don't care what Americans expect, nor should expectations ever dictate policy. Because Americans also think Ke$ha has talent. Immaterial. If Americans expect whatever test they desire, and can still sue when they don't get it, then yes, this is an issue. The legal system around universal health care (and expectations) needs to be managed.

5) Sounds like a debate on tax reform, no necessarily health care. I won't provide a response on the grounds of topic-sprawl.

6) I am fine with rationing. I fully believe those tough questions about care should be dealt with. And yes, that goes for my own relatives, friends, and person. This point is more of a debate on medical philosophy instead of being specific to universal health care. This also goes back to expectations. Just because someone expects to be able to hang on tooth and nail, spending millions of dollars in the process, doesn't mean it should be so. Nowhere in the constitution does it say any amount of money is OK to spend on any amount of life quality. A mindset that believes that to be the case is an entitlement mindset.

7) Indeed. It is good to know I will be able to keep my hair and maintain an erection as I grow older. Thank goodness for capitalism. This point has nothing to do with universal health-care, it is a philosophical economic debate far larger than health care, so again I will reply with a no-answer on the basis of topic sprawl.

1: Totally incorrect. Medical School isn't free over here.

2: See patients in what capacity? Over here, we see Nurses primarily prior to being treated by a Doctor. Sometimes Nurses or other practicioners deal with aliments they are trained to trat, to ease the burden off of the Doctors.

3: I dislike America's 'claim/blame culture', but it seems to be carving out a nice foothold over here. Alongside Gun crime. ;)

While the problme might not be as bad as America's is currently, it probably won't look too different at all soon...

4: The 'Claim/Blame' Culture again. ;) If you want to skip the NHS's waiting lists, you pay and go Private.

5: Incorrect again.


That's exactly how it works here...

6: Did the 90 Year Old not have to pay for that surgery?

I'm sure over here, while it probably wouldn't have been done on the NHS, they could have found a Private practice to do it fo them. For a Fee.

But is that any different?

7: So we don't invent any new stuff over here?

I'm noticing a lot of people using the word "here". It might be wise to state just what that means. People have posted in this thread from all four hemispheres, so I think some country policies will definitely cross.

All my here's equal the UK. ;)

"But foreigners do not go to Europe for care if they want the best.

The come to the US."

I'd agree that's a blinkered statement. For the 'best', people go to where ever the pioneering surgeon is. Be that America, Switzerland, the UK or Japan. And you usually pay through the nose for it. No matter where you go.

We do get a hell of a lot of foreigners that come to the UK just for our health service. Mothers who fly across Europe while expecting to ive birth in our maternity wards for example.

We are supposed to track down the healthcare provider in thier home country to bill for the expense, but it rarely happens as it's too hard to do.

In fact, due to the relaxed borders of the EU, I'll posit that we receive more foreigners for medical treatment than the US does. Just down to the ease of transport to get to us.

1) Yes, I was wrong, it is not entirely free. However the government in the UK limits all public universities to charging ﾣ3,225 at the moment, and this is exactly what the vast majority of universities charge. Compared to the 40k+ most private medical schools in the US charge. I was wrong but 5k vs 40k per year is a huge difference so I would assume my first point is still valid although stated wrong in my first post. Other countries such as France and Canada may have a similar price structure. Not free but heavily subsidized by the government. And nothing like the high costs in the US.

2) Nurses are a great adjunct to a physician but should in no way replace a physician. There have been quite a few cases I know of where a nurse thought something was a cold and it turned out to be something worse, like leukemia. Physicians are trained in medical school. There is an old saying: If a nurse wants to be a doctor, go to Medical School.

3) I do believe most people, except those on the left and controlled by trial lawyers, would agree malpractice reform would be needed in any universal healthcare situation.

4) While it is possible in the UK to skip the waiting lists by paying, is not a universal healthcare plan supposed to treat everyone equally and not let those with money skip to the front of the line? Is this not a double standard? But in American, the 85% of the population that actually has insurance go to the head of the line already. Why would they want to change it so they now have to pay more in a more private sector to jump anew?

5) GL, I think you missed my point. The rates at the top ends may be the same, however the overall burden in percentage paid is heaviest in the US, that is total revenue paid by the top earners. The lower incomes in Europe do pay something. The lower earners in the US, even those up to 50k a year can pay 0 federal income tax. If more money is needed, should not everyone pay and not just the "rich"?

6) As in my point 4, why should we now have to move to where a 90 year old has to privately pay for the surgery when right now it is paid for by Medicare or Medicare Advantage. That is like taking 2 steps backwards for 1 forward in the US. I do not know of many 90 year olds that have 50k for heart surgery.

7) I do not know. I have not heard of any new breaking drugs coming out of the UK research centers. Or new technology. However, I do hear about the same from the US. But please feel free to post some links to the UK's research of new medical technology/drugs to prove me wrong.

To Sut,

You keep on stating in your post that "I don't care what Americans expect, nor should expectations ever dictate policy."

However, I do care what Americans expect. It is what makes us American and not European. Our wants are different than other areas of the world and therefore we have our system in place.

Could it use better tuning? certainly!
Do we need to blow it up and enact a universal healthcare model? No way!

I guess we differ on what we expect from our government. I expect it to leave me alone to my own choices. I want my government to listen to my voice and respect it. I do not want a government that thinks they know what is best for me and ignores my voice.

An early Google hit for Medical Discoveries 2009 UK.

"Scientists' stem cell breakthrough ends ethical dilemmaExperts in Britain and Canada find way to make stem cells without destroying embryos"

"Sir Ian Wilmut, who led the team that cloned Dolly the Sheep and heads the MRC Centre for Regenerative Medicine at Edinburgh University where the work was done, said: "This is a significant step in the right direction. The team has made great progress and combining this work with that of other scientists working on stem cell differentiation, there is hope that the promise of regenerative medicine could soon be met."

Probably not what you're after though.

Adding onto what Ranger said, I think Tocqueville says it well here:

"Americans are so enamored of equality that they would rather be equal in slavery than unequal in freedom."

I think that still stands true today, for a large part of the country.

"While it is possible in the UK to skip the waiting lists by paying, is not a universal healthcare plan supposed to treat everyone equally and not let those with money skip to the front of the line? Is this not a double standard? But in American, the 85% of the population that actually has insurance go to the head of the line already. Why would they want to change it so they now have to pay more in a more private sector to jump anew?"

It does, the skipping ahead isn't anything to do with the Universal Care.

It's people deciding to go *outside* the Universal Care, and pay for private care.

No double standard. It's thier personal choice. Much like travelling to Japan to see a specailist is still thier own choice, or making do with home treatments they administer themselves.

As for your seocnd part, that's for your Univseral Care / Government to work out. You should (and I've no idea how this is going to work) be expecitng to pay *less* per month on your Universal Care, than you do on your current Insurances.

If this isn't the case, it's not a faliure of Univseral Care, as other countries can show.

Not sure how factual this is, but I was recently told of an American quote about anti 'Obamacare', and how if Steven Hawkings was still alive, he'd have been much better off under America's current system, than somethng like the UKs.

Which would be fine and all, but he's still alive and has been quoted as saying he owes his life to the NHS.

Or something like that. Anyone know if it's factual at all?

In my opinion, no, UHC is not intended to treat everyone equally. It's intended to guarantee a basic level of care to all.

The current US system only guarantees emergency care to all. For those with chronic illnesses, the ER may be a revolving door as they don't have the means to prevent another emergency. And I'm sure you're aware that those without healthcare coverage end up flooding the ER with non-emergency problems so they can actually get some level of treatment.

GL,

I think you misunderstand.

Why would we want to go to a system that is know for rationing and waits when we have a system right now in place that 85% of the population has no waits or rationing? The skipping ahead costs extra money. Why should anyone have to pay that? Is that not what universal coverage is for? Treating everyone equally to the best of the nations ability.

We certainly can pay less for universal coverage, but is that as good a coverage as 85% of the population has? No waits, no rationing? You pay for what you get. In Europe they decided to go along the universal route. In America we go along the capitalistic route.

Both have advantages and disadvantages. But do not tell me that universal healthcare is the bomb. It is not.

I guess we have different ways of thinking. I think that if you contribute to society you deserve to be treated appropriately. If you contribute nada, you should be about that-nada.

There are people who, through no fault or laziness of their own, cannot contribute and we have mechanisms to treat those people. These include Medicare, Social Security and public/private charities.

I personally like my health coverage. Why would I want to change to a system where I have to pay for universal coverage and then have to pay even more to go to the private sector?

People need to take responsibility for themselves and not expect to be taken care of by the government.

That certainly is news to me. I guess then when someone in the UHC is denied chemotherapy that is fine? What constitutes basic care?

Having crippling arthritis in ones hip so severe you cannot walk and need a replacement to do normal activities of live. Is that basic care? Suffering for months to years waiting for a possible replacement?


Then how do you explain the situation in Mass? Since Rommeycare was instituted ER visits have increased 17%. I thought UHC was designed to stop people from using the ER for care.

As we all know, those with insurance use the resources far more than those without. UHC included.

To Ranger,

While the original debate question "Why doesn't the US have universal healthcare?" may, in fact, be simply wondering why we don't currently have it, I took it to mean, "What aspects of it are deemed unacceptable enough that universal health care has not been implemented in the United States?" Flamey can correct me if I am wrong, but both topics are valid:

-- Why doesn't the US currently have universal health care?
-- What makes the idea of universal healthcare in the US so unpalatable to so many people in the United States nation?

Let's back up so we can talk about the second of those two points. Start with my sentiment: "...nor should expectations ever dictate policy." Do you agree or disagree with that? I agree with it, obviously, because I am saying that just because people expect something doesn't make it right, smart, or feasible (and sometimes "none of the above"). So, I fail to see how what people expect has any bearing on what the best decision is for the nation. Less than 200 years ago, many people in the South (for very good capitalist, economic reasons) thought absolute violation of human rights was fine (and that was a mere 200 years ago). The expectations of cotton plantation owners did not (necessarily) mean anything in regards to doing the right thing, and our nation had a civil war over it.

Note: "not dictating" is not the same as "having no bearing upon." I didn't say people's expectations should not be CONSIDERED in policy, but they should not be allowed to DICTATE policy. That is the point I was trying to make (and by the way, I only said it twice, so I'm not sure how that means "keep on stating...") I can think of about fifty more historical, factual situations where what the people wanted was a very wrong thing for this nation as a whole. And, being honest, I can think of examples that are the exact opposite. That's proof positive on desires/passions often being very disconnected from reality (that's why they shouldn't dictate policy).

Does something you think Europeans don't have expectations? The line, "It is what makes us American and not European" makes it sound like choice, for the sake of choice, should be exalted above all, and those Europeans just don't know what they're missing (yes, my interpretation). America is also fat, on average. That "makes us American." Are you defending that as a good thing? All I'm saying is that if your answer to Flamey boils down to, "Because we're us and you're you," it isn't very illuminating for the "us" or the "you."

We actually differ very little on what we expect of our government, except that I might actually expect LESS than you. I, like you, believe central government (read: admin) should be tiny. Government should not be controlling women's bodies, defining what marriage is, deciding what I choose to smoke/shoot-up, how I secure my children in my car, what I eat, or how I pursue life/liberty/happiness (as long as it isn't hurting anyone). I am fairly certain my views on what government should be taking a role in (in regards to how I live my life) is more personal-choice based than you realize (perhaps even more personal-choice based than you yourself believe). However, I fail to see what that has to do with universal healthcare. Your points are an economic/philosophical debate more than a health-care debate. And while that may very well be the reason universal health care has not been implemented here, it is also a good illustration of "no common ground" polarization. If you are convinced it's essentially your-way or no-way, there isn't much to talk about (and you will have abundantly answered Flamey's question via example).

Where am I getting a "no common ground" vibe? Well, even in your most even-keeled, open-minded conversational tone, you still tend to fall back on things like false dichotomy (and I am more and more convinced you just don't realize it). Example:


That's a false dichotomy. You state only two sides to things, and I'm on the wrong one. I didn't realize there were only two choices (because there are many, many more), and I never advocated "blowing up" the current system. Furthermore, recent health care changes are not a "blowing up" either (I just drove by the hospital yesterday, and it was still there. It was even taking care of people, judging by the parking lot.) So why are you saying we have to either "tune" it or "blow it up"? Isn't there a veritable infinity of choices between those two ends of the spectrum?

Then you would just be a BUPA pateint over here (the UK), and pay for a Private Health cover.

Wouldn't effect you in the slightest.

Ranger, you state:


Something is inconsistent here. You're all for the government subsidizing care for a 90-year-old woman, spending a great deal of money and resources on someone who cannot afford it? Then why are you against the government spending money to make sure basic health care covers the current millions of uninsured folks, including many children? Just like the 90-year-old woman, a child can't very well have the money to get care. And unlike the old woman, they would have never even had the chance to amass that sort of wealth. Taking your hard-line small-gov't personal-choice viewpoint to its logical conclusion, shouldn't the old woman be able to care for herself at that age? She's had 90 years of choices to save up, right? Sounds like she made some bad ones, and I know you don't like footing the bill for others poor judgment.

Can you clarify your stance?

As far as Stephen Hawking and the NHS, lots of Google hits. Here's one:

Link

Not sure if that is what you were referring to, and I had always assumed that Hawking's resilience against ALS was from having lots of money of his own and being able to fight with it. News to me that even part of his care has ever been NHS in nature...

What constitutes basic care is too broad for me to answer without thorough knowledge of every medical procedure. But since you chose chemo as the example, Iﾒll follow suit. In my opinion, chemo is basic care that should be covered by UHC; unproven treatments are not basic and should not be covered. If a patient wants to gamble with an unproven treatment, then he or she can go private. If a cancer patient is ever turned away from chemo because the person doesnﾒt have insurance, then weﾒve failed at balancing priorities.


Iﾒm not sure I follow your point. You seem annoyed that UHC might delay the treatment, but you could very well be annoyed that the public would pay for the personﾒs hip. Regardless, I see basic care as whichever analgesic or steroid is proper in the meantime and replacement when it becomes truly necessary.


Then add a steep penalty for going to the ER for non-emergency needs.

Small clarification: There will always be rationing under any system. What we disagree on is the distribution of that rationing.

I have to agree with that Cube.

I think that's it exactly Sute! :D

I agree with Cube as well. That's why I assumed the original question was more of a, "Why don't the States embrace the idea like some other nations have?" rather than , "Do they not know how to do this?" The reservations people have about universal health care are as valid, accurate, and allowed as those who support the idea.

Sute, you were right in wondering about my initial questioning, however I might have to disagree with the following point. "Do they not know how to do this?". As I read Ranger's post I'm seriously questioning whether he or other Americans knows what is involved with universal healthcare. Ranger, you seemed taken aback when GL (I think) mentioned private health insurance. Could I also add that in Australia you can pay a lot for private health insurance and you can be admitted in to private hospitals where you pay a lot for quality and for service.

Doctors in these private hospitals get paid A LOT more than those in the public, UHC hospitals. I just thought I'd say that as you were concerned about money. Please also note the education costs. Note that most countries (Don't we to be all assuming) that have UHC have Universal Education and this means that the initial fees for university are lower and they don't have to pay up front or have interest on their loans. I understand wanting to make a lot of money if you have to pay back something that is 200k + interest, however in these countries I don't see fees going much higher than ~50k with no interest.

Your example of being denied chemo and the arthritis in the hip. Do you think these people could afford to pay for it in the US? If so, there's absolutely nothing stopping them from private health insurance in UHC countries.

So, is money that important if initial costs are low? If you were after more you could specialise in the private industry. Also, are waiting lines an issue if you can afford private healthcare and skip to the front of the line?

i distrust government and corporations about equally. from what i have seen in my life though if the government screws up and hurts someone it is not due to a conscious effort to do so. those links i posted above though show that corporations are more than willing to put profit before the lives or health of customers.

they also knew what they were deliberately doing and tried to cover up the fact. this makes me wonder how many other actions by those companies or by others we will never know about.

Flamey, thanks for the response. I didn't think you were going for the "Don't they know how to do this" at all, so we're on the same page there.

But even with the "go ahead and pay more to get better care", there are plenty of folks here in the States who will be hesitant. Here's why: if there's going to be a "pay" option, why not make it ALL pay. Why waste the admin dollars to have a full, nationalized health system AND a "pay more" system atop that? Just have it all be pay (capitalist), and let the market sort it out. No matter how much that might be failing now, to whatever extent, a hard-core capitalist is going to want to go that route. A route I fully understand.

That's the thinking, anyway. I don't personally agree with that viewpoint, even while understanding -- I see why a full, nationalized system with some capitalism atop it can work. Why? Because history is showing over and over how it can, and your original question makes clear that, hey, other nations can do it, so why not the US?

But Ranger's points about education cost and litigation cannot be ignored. If other nations came to the universal health care game while having less litigation and cheaper education in place to start, then there's your difference. We're coming at from the other direction (as we Yanks so often do!) How can there be a pure capitalist layer atop the nationalized care if everyone in that capitalist layer is a quarter-mill in debt and fearful of getting sued?

That's where Ranger's economic and philosophical points get teeth. And they're not dentures. That's real threat, some real game-changing dynamics.

Can we get a UK POV on that? If docs in the UK had huge debts and large fear of being sued for malpractice, could this whole "pay more for above-and-beyond-care" even work? And without that, would the "haves" be satisfied with the situation? Would you?

I don't think they're being ignored. It may just be that most of us agree with the basic idea that something needs to change. Now if you actually post an idea of what those changes are, then you'll have another debate.

Anyone who actually believes offer and demand can and should apply to something as fundamental as healthcare just does not understand how offer and demand works...
The idea is to be able to put a finite value on the desired economic product, but when someone asks you how much you would be willing to pay for your life, it does not add up.

Our cost of living is far greater than yours mate. We get debts just from that. ;)

Doctors getting sued is on the increase, but this is a general trend we're adopting from you guys. Only yesterday I was reading how a mother found a cigarette in her MacDonalds Happy Meal, and when she approached the youths that served her, they laughed her off. Upset, she spoke to the Manager who apologised, but that wasn't enough. she complained to Head office who offered free food. That's not enough.

She's now suing Macdonalds...

As for Private care, I wouldn't as a whole, as I generally trust our health system, and it's never let me down.

That being said, claire and I did pay for a Private Scan when Claire was pregnant with Emma (at 8 weeks), as we wouldn't be a 'risk' until after Claire's third miscarriage, and the NHS wouldn't offer us a scan until the usual dating ones (12 and 24 weeks). So we went private for peace of mind.

But, the care Claire received through her pregnancy and previous two miscarriages was impecable. Even her seocnd one, when she was away from home, and needed to be admitted on Christmas Day.

All the care she needed, without worry about payment.

Other end of the scale for waiting. I cuy myself just above the eye playing badminton, and after seeing the triage Nurse in A&E, I had to wait for 4 hours to see a Doctor. By which time the cut had sealed anyway, and didn't need stiches/superglue.

Emma recently feel over in a soft play, and couldn't walk on her ankle. We took her to A&E and were again initially seen by a Nurse quite quickly. We then had to wait for 4 and a half hours before seeing a pediatric Doctor, who then sent us to wait (luckily by then, there was no queue) for an X Ray. Thankfully, there was no damage.

Both times, although we had to wait, care was there for us, as we needed it, without the added worry of cost on top of the worry caused by the incident/illness itself.

I'd be interested to know the average costs for various medical treatments in the US.

For instance amongst my circle of friends and family in the past two months we've had the following:

3 births, one with a months stay in hospital due to complications.

1 heart bypass (relative aged 72). Two weeks in hospital for recovery.

1 operation to remove a tumour in the intestine. Age 87 - then spent two months in hospital due to complications.

1 repair of a broken tooth.

1 treatment of adult chickenpox, including a two week course of antivirals.

A visit to casualty resulting in stitches.

Out of the people involved only I am working, and thus paying National Insurance, which is our 'tax' to pay for our healthcare. I pay the equivalent of about 150 USD a month. So in effect you could say I'm paying for all the above to get their treatments.

What would our bill have looked like in the US?

I'm very curious about what JW said.

Also, we get toher things for our NI 'tax', not just the UHC benefits.

Stuff like;

ﾕcontribution-based Jobseeker's Allowance (Class 1 National Insurance contributions only)
ﾕIncapacity Benefit (if you can't work for long periods due to illness or injury)
ﾕcontribution-based Employment and Support Allowance (ESA)
ﾕState Pension
ﾕadditional State Pension (Class 1 National Insurance contributions only)
ﾕWidowed Parents' Allowance
ﾕBereavement Allowance
ﾕBereavement Payment

And probably more stuff.

Of interest to me in this discussion is also the following.

Current estimates for life expectancy (from the CIA of all sources..) rank the US at number 34 worldwide for overall life expectancy. The UK is ranked at 25 and Australia and Canada are ranked higher still.

Obviously there are so many other factors. Violence and diet factor heavily in this. (Guns And Burgers - good name for a band)

In Ranger's initial post he talks about infant mortality rates and how they're classified in the US compared to other countries (like Cuba). Should be his first, if I'm not mistaken, JW.

Also, JW, we should leave LERs out of this as soooo many things attribute to them. Like the extreme obesity in the US which has little to nothing to do with the health care system.

From wikipedia on Infant Mortality.

Again from the CIA World Factbook 2009, it lists;

Sweden as number 3, the UK as number 32 and the US as number 46.

Sweden and the UK (and most of the EU as shown above) uses the same reporting criteria as the US for infant mortality.

Another correction for Ranger;






Same thing over here.

I think you should go back and revise your OP in this debate thread, taking on board what Sute's asking. There's not many of the points you laid out that aren't either incorrect, or subjective assumption.

obesity isn't a representation of healthcare though is it?

No one listens to Titan? Talking about life expectancy is ridiculous.

I wasn't talking about life expectancy, but just discussing a specific point that was bought up earlier about infant mortality.

LE isn't realy appicable to discussions about a UHC, I agree! ;)

I was thinking about life expectancy because of something Ranger said:

"However, I do care what Americans expect. It is what makes us American and not European. Our wants are different than other areas of the world and therefore we have our system in place."

I'm interested to know what those wants from a healthcare system are.

Personally I want to know that I can get medical care and help without it bankrupting me. I want to know that ALL my family and friends can do the same regardless of circumstance.

That might be the European view as far as Ranger is concerned. But I also want to know that we are using the best medicine (by that I mean drugs and surgery and anything else that might come under that term) that is available to us. I also want the research carried out to make some illnesses non-existent - to improve(with the correct lifestyle choices) my life expectancy.

So in that context I think life expectancy is relevant. Or am I alone in thinking that medical advances should not be connected here? Are Americans happy in paying large amounts for the best healthcare that means their average life expectancy is one of the lowest in the Western world?

A UHC can't cure gun crime! ;)

It's stuff like that, that skews LE's.

JW, I'd say it has something to do with we as Americans being obsessed with fairness when determining who gets what.

Define 'fair'. Personally I think it's fair that if I can afford healthcare that I help those who can't.

On the other hand if somebody thinks it's fair to think 'if you can't afford then tough luck, I'm not paying for you', then it's pretty obvious that we're not going to agree on what's what. ;)

As stated earlier by Cube, there will be rationing under any system, if there wasn't we wouldn't be having this debate. I would say (just guessing here) that most Americans, if not most at least some, would prefer that a health care system be used that does three things:

1) Covers as many people as possible, while not harming the actual care that is being administered.

2) Allocates this care to the people in society who contribute the most in society, there-by rewarding those who work hard to become doctors/pharmacists, scientists, etc.

3) Doesn't cost this country such an extensive amount of money, so much that the negative effects of the system, out weigh the good gained by it.

Who contributes what? How much worth is there, and who is worth what?

Is a Doctor worth more than an Artist, who should jump to the head of the queue? An Actor? A Politician? A Builder?

It's why we have a system of capitalism GL, contributing to society is determined by the market.

Obesity has a great deal to do with healthcare, Flamey, inasmuch as it is the precursor to a huge number of disease states. Preventive medicine, including lowering obesity, is less expensive per outcome dollar than continuing to pay for things like lifelong diabetes treatment (with follow-ons for everything from blindness to amputations), lifelong heart conditions, joint replacements, etc.

This is one of the points used by one side to support lowering overall healthcare costs and by the other for fearmongering. One side speculates that getting a larger number of people covered for preventive measures means how much we spend on health "fixing", per person, over a lifetime, will drop significantly. The other side warns that UHC means obese people and smokers and base-jumpers will suck up all the resources meant for the impoverished MS sufferer and bankrupt the system. Or, seemingly more likely, private insurance companies will have even more incentive to refuse (regardless of premiums) to cover anyone whose "lifestyle choices" make them bad bets, which will send all those with no other option into the UHC system (bankrupting us all).

It's ok, this high payers can purchase private healthcare insurance.

(as an aside, I get paid really well. For various reasons. And while I'm good at my job, I'd be hard pressed to pursuade anyone I'm 'worth' more to society than a Doctor, Nurse, Plumber, Social Worker, etc.)

You could lower health care a good deal Bast, and we'd still be fat in America, that's not a solid debate. There is much more than preventative medicine that adds to obesity. Hell, China's way under weight, I'd say the don't use much preventative medicine either.

A word about what a laundry list of procedures would cost in the US... Heh.

It's called "repricing" for a reason. That's what gets done by insurance companies and managed care companies. They "reprice" your EOB (explanation of benefits), line by line, with algorithms more complex than space shuttle launch checklists. There are charged rates, contracted rates, per diems, network rates, occurrence caps, extra fees, and that's even before getting into FSA territory.

It's a house of cards built on quicksand.

That's why "managed care" is both exalted and reviled (usually reviled, in my experience). Managing a network of physicians and controlling costs is good for the bottom line and for reigning in skyrocketing costs, but it puts a burden on the "end user" when trying to understand who is going to pay for what.

Truth be told, do you really know what the procedures cost in the UK? I'm not talking out-of-pocket. I'm talking real cost. That's the stickler. The triad of out-of-pocket, actual costs, and charged costs is an unholy triangle wherein the most devilish details reside.

No, we don't. ;)

But we don't have too, as we get it irregardless of cost. We don't even need to think about these things. ;)

That may be. But I bring it up because proponents of managed care will sometimes talk about how they can bring REAL costs down by making sure prices aren't being raised by an artificial insurance-escalation effect (higher prices-->higher premiums-->higher prices-->higher premiums, rich insurance companies). Managing things, and adding transparency can be considered an attempt at keeping the whole system honest as opposed to it being more like price-fixing.

So, has managed care in the UK brought actual costs of care down and streamlined processed? That's just another angle to discuss.

No idea. Don't know how we'll even beging to study that, as we've had the NHS for years.

I do know that there is now more bureaucracy and red tape, and more of an emphasis on targets. Which all impact service.

But I don't think that's inherantly an issue of the UHC, but rather a change in our style of government.

(Quick Google on the istory of the NHS)

Doh. Missed out the year. 1948...

Capitalism wants recurring payments, a maximization of profits. A healthy body means you are fixed up as quickly as possible and sent back to live. Those are not the same thing.

Preventive care isn't focused on here in America precisely because because it isn't good for business, even though it would be much better for the average person.

This sort of thing happens often with capitalism and isn't limited to health care by any means. If something is not profitable even if it is much better than anything existing it will never be produced and used.

Before people get all worked up about the big bad insurance companies, realize they make a 2-4% profit. Something Toys-R-Us beats handily.

The cost of the health system in America has to do with expectations of the people. Instant care, every possible test done, every possible therapy given.

It is certainly possible to lower health costs IF everyone gets involved. From hospitals to lawyers to physicians etc..

However what we have now with Obamacare is so wrong for so many reasons. It will do little to lower costs but will do one thing well, increase government intrusion into our health decisions and employ a lot more government workers.

It is one thing to have preventive care, another to have people actually use it. Obesity is one example. There are plenty of weight loss clinics, seminars, and help. However most people have little desire to lose weight and would prefer to just eat their Big Macs all the time and sit on their butthole.

"The cost of the health system in America has to do with expectations of the people. Instant care, every possible test done, every possible therapy given."

Ranger you can do this in our countries if you pay for private health insurance.

BUPA (Private Health Insurance) covers;

most extensive private cancer cover available in the UK
access to quality treatment from consultants and specialists
a straightforward claims service that puts you first
access to over 400* clean and comfortable recognised hospitals
access to groundbreaking drugs and eligible treatments
a 24-hour nurse healthline offering medical guidance

Sort of exactly what you're after.

I suppose the next question would be;

"Why do I have to pay more/twice for something I alreayd get?"

Becuase as above, our NI contributions to our UHC include other benefits, and you don't have to go Private.

Here's something interesting on Fee's in todays Metro.

A Trainee Vet faces nearly ﾣ95,000 in fee's to get her qualification. Uni fees are normally capped at ﾣ3,200 a year, but she faces annual charges of ﾣ18,900 for her 5 year course.

Because, leaving school at 16, she decided to get a qualification as a Veterinary Nurse. Now she's going for Veterinary Surgeon, the Government see this qualifiaction as the same level (both BSc), so she has to pay the full, uncapped price herself.

this is what the sheep/naive miss... they don't realize the government is accessing their bank accounts...literally.... able to deduct $ from YOUR account if you fail to abide by their stipulations. Does that happen in Europe??????

Also..the increase in Government jobs... a MAJORITY of the jobs that are being created are in the IRS. 100% scary.

What do you mean?

We pay a NI contribution (on top of Taxes), that comes out of our paychecks before we see it, and that can globally change.

But they don't change it month by month, or take varying amounts from it.

Not paychecks, GL. Your actual bank account. The US government is making it legal to have access to your bank account and take whatever they want if you don't abide by the health care stipulations.

Paychecks here of course are the same, social security, health, federal, state, etc... are deducted. Some states are way worse than others....

No one touches my bank account, apart from the missus! :P

kevlar, can you post a link to wherever you heard the Federal government can access a bank account (without permission, as in, that was where the person agreed to pay from in the first place, and opened up the account at that juncture).

Since not everyone even has a bank account, I can't imagine how the gov't can access my account with permission. There is no law that can force me to have a bank account, so there can't be any law where direct access to a bank account is a requirement.

Now, if I default on some sort of tax or penalty payment, and there is an instant judgment levied against me (which is what a tax warrant essentially is), then of course the gov't can access my bank account. It's called a bank garnishment (also known as a non-wage garnishment, or third-party CDA in some states). That's not new, and has nothing to do with recent health care legislation.

I'd like to see where you got the information just to make sure this isn't another "death panel" type of word-twisting (not by you, this is not any sort of indictment upon you, kev):

-- New health care laws can lead to new required taxes/penalties.
-- The gov't can issue a tax warrant on those monies if you don't pay.
-- A tax warrant can lead to the the gov't and/or collection agency levying a bank garnishment against you, the debtor.
-- OMG! The new health care laws give the government direct access to my bank account!

I'll check back here for a link. I appreciate the help!

First hit I got when searching Google for "healthcare reform direct bank account" is below:

Link

Is that what you were referring to, kevlar? That issue was debunked many, many months ago.

(the stuff I said about bank garnishment is still true, but applies to ANY debt -- it has no specific relation to health-care reform...)

Link:
http://www.washingtonexaminer.com/politics/Health-bill-could-allow-government-access-to-personal-financial-records-8093377.html

However, I could not find one that states the government could actually go in and take money out of your account. Just that they can look into it and see how much money you have.

Thanks, Ranger...interesting link. Yes, the privacy issues and talk of a national ID card are of concern. I need to do a little more research on that, especially since talk of a national ID card has been around for as long as I can remember, as have ideas to standardize medical records. Always a touchy subject.

The gov't WILL be able to set up electronic transfers to personal bank accounts in the same way any number of EFT-based systems can set that up. One has to agree to have that set up, and then from there, the transactions have to have a reason. That's just like anything. Wells Fargo has access to my bank account once a month, too. But they aren't allowed to grab whatever they want any more than the gov't will be able to. Every time someone sees my credit card, they could remember enough information to try to steal from me, electronically. I don't see how the health-care bill provisions are any different than that.

If someone doesn't want that even being an option, don't set up an account like that for payment. The gov't cannot automatically take your money any more than it can automatically search your house. Sorry that isn't a nice, sexy, sensationalized headline, but it's the facts. It sounds like the statement, "Obamacare will let the gov't take all my money any time they want!" ranks right up there with the lies about death panels. It simply isn't true.

Sut, just like everything with the Obama administration... and JUST like the pre-healthcare reform passing... you won't see ANYTHING until it happens. This is why a vast majority of people are very on edge with the current system and policies being instilled.

http://scaredmonkeys.com/2010/03/21/barack-obama-finally-has-jobs-bill-16000-new-irs-workers-will-be-needed-for-obamacare/

I don't know if this is a left/right site so don't go all LB on me for googling and posting because I don't have time to dissect. But, damn well best be sured you better watch your wallet... even if you don't have a 'bank account'.

Quick note, kevlar... Using superlatives like "everything" will get you ignored entirely by me, pretty quickly.

The Obama administration is just like every administration before it. saying any aspect of it is "everything", "all", "never" or "always" is hyperbole. Hyperbole should be avoided, if at all possible.

As far as my wallet, I will keep a steady eye on it as I have done with every employer, restaurant, store, site, or administration. In fact, I'm not sure I've ever taken my "eye" off my wallet ever since there was something in it to watch. And I don't feel one bit sorry for anyone not watching with the same vigilance. In the same breath, I can state honestly that the current Presidential administration has not caused me to watch it any more closely.

As to the link...it is not opening for me, but from the headline, 16,000 new IRS jobs? I don't see why that is surprising...

First, some good journalism is in order (and perhaps the link already handles that). The first question is: Is 16,000 a lot? How many people currently work at the IRS? Well, around 80 or 90 thousand. 16K on top of 90K represents an increase of about 18%.

Considering that health-care is being made more national, and that it is funded by taxes (with all the rules that entails), a payroll increase of less than one-fifth does not seem too crazy to me. How many actuaries, adjusters, re-pricers, and medical-network staff are there in the country now? My guess is WAY over 16,000. So, it doesn't seem odd to me that the IRS is increasing that much.

As far as that affecting my wallet -- haven't we been over this? I hear about debt, children's lives being financially ruined, etc. etc. ad infinitum. This is part of that. I don't need to hear about each little thing that is already figured into that expense. I get it. It's pricey. But if I get a large bill at an expensive restaurant, I don;t sit there stating, "And look at how much this escargot was! Twenty bucks! What an outrage!" I already _know_ it is expensive. Any further gnashing of teeth or wringing of hands is essentially double-dipping in the spectacle pool.

Was able to check out the link when I got home... I'm not even going to give a ludicrous site like that creedence, seeing as how hyperbole and spectacle appear to be what they consider rigorous analysis and even-headed discussion. Sorry, Scared Monkeys. Looks like you're scared because you want to be.

Oh, and everything I state above about the 16,000 jobs (even before I had seen the site behind the link) still stands and makes complete, non-sensationalist sense.

Sorry (tired from mowing)... I'm not saying the site doesn't tell the truth -- 16,000 jobs ARE being added. Absolute fact (thus far, anyway). That's not the worth I'm (de)meriting. I'm talking about the interpretation.

If you want to read/listen to sites based on hyperbole and scare tactics, be my guest. It's your Constitutional right (well, the ones left after Bush/Cheney had their way with them). But if you think it is some sort of important point or decisive, eloquent dissertation on the situation, then I've not a lot more to say (mostly because there would be more point -- I can't debate against stupid).

Good lord, Sut.

It's not about the site, it's fact that the Government is empowering the IRS namely due to the increased manpower it is going to take to regulate the healthcare reform. When it happens I guess that will be the only time you will say something not in rhetoric riddle.

The IRS already have a great deal of ostensibly unchecked latitude, and yet somehow our nation hasn't imploded yet. If you dislike the IRS being empowered in individual affairs, I assume you have already joined forces with the folks who refuse to pay taxes, stating income taxation is illegal, as in:

http://www.paynoincometax.com/

If you haven't, I'm curious. Why not? You have very strong feelings about all of this, especially where gov't has some very specific ways to control personal finance and behavior. I should think you really, really dislike the fact that the IRS has been empowered to take a chunk of your hard-earned income, and can resort to all sort of unseemly actions should they deem you as resistor (audits, tax warrants, etc.) What sort of action does your dislike of all that translate into? Bottom line: I know how tough the IRS is. After all, they took down Capone when no one else could! THAT'S power!

I'm not sure why you are "Good Lord"ing me -- you have your opinion and I have mine. You appear to be quite worried, thinking things are going way too far overboard, and I don't (at least not any more than usual -- the hand-basket is invariably full as far as I am concerned, and it's destination interminably downward). Would a "Good Lord" apply just as sensibly to you? I'm asking that rhetorically, because I don't think your deserve a "Good Lord". I think you are entitled to your opinion, and was merely trying to state why I don't think this is as big a deal as you (and apparently half of America) think it is. The sites and people (like Scared Moneys and Rush Limbaugh) I see reporting on this are distorting the facts, sensationalizing mundane things (to gain traction and volume), and just all around needlessly rabble-rousing. Which is absolutely their right. But a fairly astute fellow recently stated:

"Now, we've seen this kind of politics in the past. It's been practiced by both fringes of the ideological spectrum, by the left and the right, since our nation's birth. But it's starting to creep into the center of our discourse. ... The problem is that this kind of vilification and over-the-top rhetoric closes the door to the possibility of compromise. It undermines democratic deliberation. ... It makes it nearly impossible for people who have legitimate but bridgeable differences to sit down at the same table and hash things out. It robs us of a rational and serious debate, the one we need to have about the very real and very big challenges facing this nation."

I happen to agree with that eloquent elucidation, which is why I don't immediately assume "more people on IRS payroll" = bad, nor "Gov't having ability to access bank accounts" = "Gov't will come and take my money whenever they want." Maybe I've missed something, but it does appear that those are the sort of direct conclusions you are drawing, and I've yet to understand your reasoning behind such deductions other than, "This is bad. Watch my wallet. Gov't is bad."

As the same man I quoted above said in regards to government:

"When our government is spoken of as some menacing, threatening foreign entity, it ignores the fact that in our democracy, government is us."

(By the way, I'm still waiting for that link about the gov't being allowed to take my money out of my bank account any time they want, or are you conceding that is not the case and that web sites espousing such twisted facts are incorrect?)

Hmm.. Kevlar's link doesn't say anything about the government taking money from bank accounts. It's also pretty outlandish and sensationalized. However, it DOES cite references, and when I see cited references, I usually ignore the thing in question and go right to the source. It's actually a quick trail:

kevlar's link leads to:
http://camp.house.gov/News/DocumentSingle.aspx?DocumentID=177007
which leads to:
http://camp.house.gov/UploadedFiles/HC_Overhaul_Dangerously_Expands_IRS_Authority.PDF

That latter PDF is a short read, 9 pages, and comes from the official government website of an actual congressman (Dave Camp). What I'm showing here is that if nothing else, the source material has more credibility than most things.

Looking at said source material is interesting. First, it explains how this 16,500 number is calculated. It's actually just an estimate taken by spreading the CBO's estimated $10b over a number of years, yielding $1.5b for the last 6 years. From there, it's just a simple ratio of the $1.5b divided by the average cost of employees.

Second, regarding the IRS' newfound abilities to acquire money, there is hinting that they will take their payments out of an individual's tax refund if said individual owes money on the IMT. This is not really unusual.

There are several other things in this pdf that I do find very interesting, however, including the immigration issues.

All in all, I see this source material as interesting, though not very exciting nor out of the ordinary. I further do not see any link to an ability of the IRS to withdraw money from my bank accounts. YMMV.

Thanks for the link, NS! Reading material for my lunch hour! (I lead such an extraordinarily exciting life! *smile*)

I read the PDF Nightstrike found. There are some things I agree with, disagree with, and need to think about further. But certain lines are fairly simple to analyze right out of the gate...

I'll start with his line:

"Democrats prohibit the IRS from imposing these taxes and penalties on illegal immigrants."

At first, this didn't seem to make sense to me from either side. How can Democrats prohibit something that is an impossibility in the first place? Of course the IRS can't confiscate refunds or dole out penalties to folks who aren't even on the books. So what does this line mean? Were the Democrats actually silly enough to put a provision in the bill about that, and were the Republicans silly enough to make a big deal out of it? There is no way the IRS can find, analyze, or audit non-citizens anyway.

But the reason it is of concern is because even a non-citizen can show up at an emergency room, getting the free care. On the back-end, though, there is no way to collect for that via the enforced-coverage penalties. My summary of this? Caring for illegal immigrants is still an issue, and this still needs work. If an emergency room is still required to help everyone, yet no funds can be gathered via the national plan (because the illegal immigrants simply cannot be penalized/taxed), how is that going to work? Care for illegal immigrants is still going to be subsidized by valid payers. Like I said, this situation is no different than the current situation, but I appreciate that the PDF makes clear we still have an issue here. Ideas?

Some other lines (I'm not cherry-picking here, these lines are already bold-faced in the PDF, so it is clear I am supposed to take note of them):

"Democrats will have vastly expanded the responsibilities of the Internal Revenue Service (IRS) and fundamentally altered the relationship between the IRS and taxpayers."

Yes, the IRS will have more "powers", because they will have more to manage. I'm curious -- would Republicans rather have a NEW administrative entity handle this? Where they see something "fundamentally altered", I see it as being "efficiently handled". Why not have the IRS work this functionality into what is already a national, financial system (tax administration)?

"Democrats make the IRS the chief enforcer for a new government-run health insurance system."

Yes. So what? Disclaimer: I like the IRS. They have never done anything to burden me, I have been able to find information on their web site, and they appear to be getting leaner in recent years, leading me to believe they are properly utilizing technology to save on staff (you can look up estimated IRS employment figures by Googling). Are they cutting-edge in terms of technology? No. They plod, like any large bureaucracy, but they are getting there. In fact, I have read articles wondering why a large portion of Americans can't have their tax filing and refunds totally automated (i.e. not even any need to file). The IRS already has all the payroll figures. That's why e-filing can already get you your return so quickly, something that was not true just ten years ago.

"...the IRS would be in charge of verifying that every American taxpayer has obtained acceptable health coverage for every month of the year."

Again, I see no problem with that. The IRS already has all that sort of periodic information from payroll figures (at least for a large portion of Americans). I ask again, why would we NOT have the IRS do this, too? It sounds like a good, smart fit.

"...the IRS would be charged with tracking the monthly health insurance status of roughly 300 million Americans."

...the way they already track the incomes of millions of Americans via monthly payroll figures.

"...the number of additional examiners, agents, and other employees could reach 16,500."

Note, "could reach." Could. As I state above, the IRS estimated employment figures have gone DOWN in the recent decade. Between 2001 and 2007, the workforce size went from around 94,000 to around 84,000, a drop of more than 10% (it did spike up a bit again in 2008, not sure why). This "could" is, as NS has already pointed out, arrived at by doling out the projected budget increase for the IRS across an estimated number of new employees required. I'll go back to my previous question -- would Republicans rather the new system depend on a brand new entity with all new infrastructure and staff? We're going national, so that means more national employees to administer the system. That seems like common sense to me, and I am sure every other country that has implemented nationalized health care has seen rises in government employees required to run the system (at the very least, a spike in required personnel to get the system started).

"They [the IRS] canﾅ offset peopleﾒs refunds. Now, 80 to 85 percent of taxpayers get refunds in their income tax returns. So, if youﾒre expecting something, you may not get it."

If someone does not pay enough into federal income tax currently (it isn't hard, just jack up your number of exemptions -- there's nothing stopping you from doing that...), the IRS will withhold money at tax time. In fact, they'll even charge you, tacking on penalties if you owe too much! It's called paying taxes. This new system is being handled in the same way. If a person under the plan does not keep their ducks in a row in regards to medical coverage, they will lose money out of their tax refund up to and including the point of even having to pay. So why is this an issue? I see an irony here. By and large, the Republican viewpoint is, "Keep the government out of my affairs!" But here, a bullet point in a Republican-drafted document is saying, "Oh no! If an individual doesn't keep track of their finances and take responsibility for their portion, the big bad IRS is going to come and blow their house down!" Well, which is it? Do we hold people personally responsible for watching their taxes and finances, or don't we? If someone can't get their money issues figured out, and they get penalized for that, it sounds like the system is working as designed. Like I said, the IRS has never caused me any problems. I pay my taxes correctly and on time, and stay organized. Even in complicated years involving marriages, divorces, investment clubs, home buys/sells, and moving, preparing my taxes hasn't been an onerous task (and I don't even need an accountant for it). I imagine this will be the same. Pay for your health care and everything is going to be fine (at least as fine as it already is for taxes).

"When social program delivery is grafted to traditional IRS activities, there arises a potential conflict with the IRSﾒs traditional mission [of revenue collection]"

I agree with this, at least as a cause for further thought and analysis. Even if the IRS is a place where these duties seem to fit, is there a conflict of interest here? Is someone going to watch over this? Change is hard, and this is definitely a non-traditional role for the IRS.

"In other words, the individual mandate would create millions of captive customers for health insurance companies, with the IRS acting as the enforcement agency for those companies."

I'm not sure I understand the use of "captive" here. Aren't we already "captive", as in, we need health care? I'm no more captive to health insurance as I am captive to the atmosphere for air. I need it, and should pay for it. Are the points of power and "captivity" now being moved? Yes. Because we just implemented national health care. Of course the players are changing. As The Who sang, "Meet the new boss, same as the old boss." I don't think there's anything to see here.

"...nearly half (46%) of the IMT collected by the IRS would be paid by households earning less than 300% of the Federal Poverty Line ($66,150 for a family of four) ﾖ violating the Presidentﾒs pledge not to raise taxes on families earning less than $250,000 per year."

This does seem like a cause for concern. But I'm not quite sure about percentages here. Wouldn't 46% of the IMT be getting collected by folks under 66K simply because that is where 46% of the money/care is? Whether or not that violates a Presidential promise seems entirely semantic to me. If my taxes increase by the same amount as my current health insurance premiums go down, I haven't really been taxed, have I? Now I understand why there is such a bruhaha over whether or not things are called taxes, or fees, or penalties, or premiums... The bottom line is that the Republicans want to call it a tax so they can call Obama a liar, and Democrats want it called something else so that Reps can't call Obama a liar. My thought on all that? Who the frack cares? It's a mole-hill issue being blown up into a mountain by both sides. Annoying. Money is money. I don't care what you call the bucket holding the filthy stuff.

What I still don't know from this document is whether or not the mentioned 10 billion budget increase for the IRS has already been accounted for in the huge figure of debt folks bandy around for the overall system. If it's already figured in, don't double dip. More IRS employees isn't news, on that front, because the money has already been mentioned. And if this is 10 billion above and beyond the stratospheric figures we've all been hearing, why doesn't this document make that more clear (or did I just miss something)?

Ever been audited?

I have and it is more painful than having a pineapple shoved up your arse. And once they make their "findings" there is no recourse to appeal. Their word is final.

I am lucky to only have been found to be $3600 in debt to the IRS which I was able to pay.

But I know of quite a few people that have been found guilty without trial by the IRS and have had their wages and bank accounts garnished.

The tax system and the IRS are both woefully broken. To give the IRS more power while still not having controls on their abilities is wrong.

And while, in the new healthcare law, people are supposed to be taxed if they fail to buy health insurance, if these people do not get a refund, the IRS can do nothing to enforce the penalty.

As I understand right now, they can withhold refunds but cannot go after you for the penalty.

Ranger,

No. As I stated, I have never had a problem with the IRS, so that would include no auditing (obviously, I thought).

There's really no point to go "anecdote-for-anecdote" on the IRS, is there? If I had had a bad experience with a doctor, for example, would it be fair for me to say I think you, Ranger, suck as a doctor, as do all doctors?

For everyone who has been audited, how many people have had little or no trouble with the IRS? Better yet, how many wrongdoers have been caught by auditing? Perception is a powerful thing. How many times do you notice someone driving erratically on the road? In contrast, how many times do you notice the hundreds of drivers driving safely? And yet, the number of safe drivers is vast in comparison. Odd, that (or not odd at all, once you understand how we crazy humans operate, perceive, and think).

The simplest anecdotal rebuttal I have (if we are doing this) would be to list the number of negative stories I have heard in regard to how insurance companies currently manage benefits and coverage. I worked at a collections law firm where we did a lot of medical collections. Were most debtors simply people who couldn't pay, where we would work with them on payment plans and settlement amounts? Yes. But there were plenty of claims we had to dismiss because of inaccurate carrier data, errors, and administration mistakes. On top of people being sick and/or broke, this poor segment of people had to deal with red tape involving large hospitals, goliath insurance firms, and our pesky little law firm.

Will the IRS have all those same problems in this new arena? Yep. That's not a compelling reason to be against it, though. As I asked above, would you rather there be a brand new administrative office handling all this? Maybe we could have Homeland Security run it? Or FEMA? Those folks sure seem competent.

You just made my point about the whole new law.

The government is not qualified to undertake this. From Homeland Security to FEMA they do nothing right.

This new law creates 100s of new committees, groups, and administrative offices.

As bad as the private insurance industry can be, the goverent is just a multitute times worse.

At least one can appeal an insurance industries decision. One cannot appeal when the government hoses you.

I have never had a problem with a health insurance company. So I think they are doing a great job. Like you experience with the IRS. However, I do realize that there are numerous problems and admit that.

I was hoping we were beyond the whole: "This is bad and shouldn't happen!"

It HAS happened. Past tense. I was under the assumption that this debate thread is about the current state of affairs, not what you (or anyone) wish would have happened.

That's what my little analysis (of that particular document) was meant for, to discuss the current state of affairs and how we move forward. I don't want to go all the way back to, "Drat, why did this happen!" but do want to point mis-information that isn't necessarily helping any.

Folks can get on board with this or can keep talking about how they still don't want it to happen (even though it has). Which do you think is more helpful? Which is a better topic for debate? National health care works in other nations. Two big differences between the United States and some of these other countries, as you have pointed out, are:

-- Big debt for doctors, so they need big bucks when they get out.
-- Immigration: still an issue, old system or new. Is this an issue in other nations with nationalized health care?
-- Lawsuit/tort reform.
-- Quality of care: we have several people (including Stephen Hawking!) saying national care is fine (and that you can still pay more if you want better care), and have people saying it's all going to Hades in a proverbial basket. This point is probably not something either side can convince the other about.

I'd like to stay on topic (and fruitful debate), and discuss the above issues rather than "I'd rather this whole thing hadn't have happened even though that horse is already out of the gate."

"Two" ended up being "four".

Awesome reply Ranger! I was talking to people the other day about this and we were talking about this very same thing, the cost of schooling, and the rationing and all of that. I was just sitting there wondering, how exactly could you improve this system? It seems that to make it work for an entire country you need to implement some hybrid capitalist and socialist system, but it's a pain to find the right balance of each to make it continue working without consuming too many resources.

Disclaimer: I haven't read through the entire thread, just the top couple of replies. Once I get through them all I'll reply again, if I have time. I'm quite busy today.

Ignore the thread and work on CB! :)