As Congress has left for their August recess, legislative pressure and speculation have been sprouting up and around the Health Care Bill, a key component of President Barack Obama’s campaign platform. However, as it is a large and expansive bill, there has been a lot of room for nit-picking, skepticism and general confusion, which conservative legislators, pundits and special interest groups have been zeroing in on. The current point of contention is Section 1233, a section of the proposed health care bill that focuses on end of life matters.
Republicans have been pointing toward this section, claiming it to be a mandate for government directed euthanasia, in which so called government “Death Panels” will have the power to end the life of your beloved grandma or grandpa. Democrats, on the other hand, have dismissed the criticism as untrue, hyperbolic and a distortion of the fact. That leaves we the public to figure out who’s telling the truth and who’s not and what’s really at stake.
So let’s look at the issue. First up, what is Section 1233? Susan Larson, a registered nurse at the Mayo Clinic, responds in the Post Bulletin saying, “In regard to Section 1233 of the proposed health care bill, medical caregivers are instructed to have discussions with seniors about their end-of-life care, at least every five years, or yearly if the medical condition of the patient makes significant changes or they develop a chronic illness.” This means, that doctors will talk to their patients about end-of-life issues such as end of life directives and living wills. That is, the patient is given the choice as to how there last days will be spent, before their last days are upon them and they are no longer in a state to answer for themselves.
If the patient wants all the medical treatment they can receive, then that’s what they get. However, if they don’t want to rack up bills for their relatives, they can also choose to forgo expensive treatments, that are less likely to be effective. For example, expensive surgeries that may expand a patient’s life by a few weeks. Some patients would want them anyway, some would not. With Section 1233, the patient is given these options and then able to make the choice that they want.
Pulled from an interview with Republican Senator Johnny Isakson by Ezra Klein from the Washington Post, the Georgia legislator notes that a large chunk of health care costs come during the last sixty days of life. What this bill does, is direct doctors to give patients a counseling session to help bring awareness to their end-of-life options. He also notes that the counseling is voluntary, and patients can opt out if they so wish. As to the euthanasia claims?
“How someone could take an end of life directive or a living will as [euthanasia] is nuts. You’re putting the authority in the individual rather than the government. I don’t know how that got so mixed up.”
Thanks, this helps clear matters up a bit. Although I can see the concern that a doctor might use this counseling session as an opportunity to push for less expensive procedures, when you actually think about it, it doesn’t really make sense. They don’t really have any incentive to do so (especially as they would get paid more if the patient opted for more treatment), plus most doctors are more interested in saving lives than ending them.
Anyway, as you mentioned, when it comes down to it, it’s the patients choice. They get to decide what they want or don’t want. That sounds like freedom and liberty to me.
You cannot have treatments if the Gov. runs out of money.
The Germans printed money like we are doing and ran into an economy mess like we are in. Who do you think is going to get treatment in the hospital when you are sick and no money is available? Look to history and the Nazis to learn what the future holds. I also lived in Chile when they promoted a communist mentality, I still remember as a child how the stores turned empty. Even though we had money, all the food was gone. Beware and look up what Obama Czar believe in, they already have a chart that a child and adult over 40 are less valuable in life. God have mercy on our Country. By the ways, Chile did become a communist country till many people died in revolting.
Umm, we are not Chile, Communist, or Nazi. Also, what does any of that have to do with this post?
I think Eva’s point is that we are heading down the same road–the same road she watched Chile head down. When the government gets involved, they seek to control more and more of your life until you have lost all your freedom.
As it relates to this post, you can naively read section 1233 and tell yourself that the power won’t be abused, but that would not be consistent with the history of our government or the history of the world. I’m not sure where you people get all your trust. Haven’t you learned from history at all?
If all of this is a patients choice, why have it in the bill at all? Why not let patients pro-actively seek out this council if they so choose? Why not simply state that end-of-life care is covered under the public option? I know what I think, but I suspect you would think I was paranoid …
There are millions of U.S. citizens with chronic diseases, many of which can eventually lead to death if left untreated. Each of those patients will come in contact with many health care professionals who according to the bill will be required to discuss end-of-life with the patient. Imagine being one of those patients and every time you have a new caregiver they ask what your are doing to work out your end-of-life issues. For many, the message would be that you are near the end of your life so why go for expensive treatments, with no requirement that mention be made that those expensive treatments might add years to your life.
A destructive way to approach medical care. Sensible doctors already know when it is time to discuss end-of-life issues which makes it clear that the proposed bill is really designed to put additional pressure of patients to pull the plug on expensive treatments. Not what I want from my doctors!!
Thank you to Eva Mark and Stan
It is a treacherous lie to say people who are raising concerns about this bill are claiming there is a clause approving euthanasia. They are saying the government is going to decide whether an individual gets treatment or not. Refusing treatment is not euthanasia.
Howard “The Scream” Dean is the one who brought the term into the debate, as a straw man, intentionally diverting the discussion. Shameless.
When a woman mentioned her mother received a pacemaker at age 100 and was still doing well at 105 and asked if the plan would allow a pacemaker for people like her mother, Prez Oblahblah started talking about the fact we have to tell some people that the surgery won’t add much to their lives so maybe they should just take a pill for the pain. Anyone want to lie over his words here? Or create a new straw man argument? Demonize the average folks who are protesting?
Wow! Liberals can actually criticize protestors! As long as they’re not protesting war, attacking people at economic summits, throwing things at people wearing fur, or strutting around half-naked in outrageous costumes interrupting church services to demand rights as gay people, liberals can see that protestors are disruptive. Hypocrites. Appalling.
So this is nuts. Last time I checked it was my choice if I wanted to continue to see a docotor for treatments that I was aware would only prolong my life for a day or two and just rack up bills that would be owed apon my dismiss from this earth body. So tell me what the deal is because they perposing that this is a new idea when in the end ive got the control.
To Mary in regards to Eva and her concern about us becoming like Chile,
She has given us a warning! We are on the path to what happened in Chili because we are not standing up to our government that is trashing our Constitution. Our government is heading the same way because we stand by and watch our freedoms and Liberty being flushed down the toilet by those in power.
By the way, will those that vote for this health care takeover actually be covered by the same as us? NO! They will not give up what they have, and I WILL NOT give up what I have without a fight. Nobama, send you thugs to try to stop me.
A few things.
To Eva – The government isn’t running out of money. We’ve had higher deficits in the past and likely will again in the future. Sure it is high now, but that is the nature of recession spending. You have to spend some money to get things started again. That is unless you believe President Hoover had it right at the beginning of the Great Depression. Besides, the Health Care Bill currently making it’s way through the House looks to be budget neutral within 10 years. Last point (relating to money matters), the status quo is unsustainable and it will, quite literally, bankrupt us if nothing changes, as health care costs are expected to double within the next 15 years. So while you might disagree with aspects of the current Health Care Bill, it is still a much better solution than doing nothing. Doing nothing will ruin our economy.
As to that chart you mentioned, care to share it? I have not seen it. Also, comparing Obama to Nazis is an ugly distortion. Do you really believe he is similar? Really? If so, please explain. Point out policy similarities. Or worldview similarities. Or anything really.
Third, we are not on the path to Communism. Lots of non-Communist countries throughout the world have similar health care systems. Taiwan, Germany, Japan, Finland, Sweden, etc.
Now onto Mark – LaCrosse Wisconsin already has this policy and so far it has worked great. Here’s an ABC look into it, if you’re interested:
http://www.washingtonmonthly.com/archives/individual/2009_08/019440.php
As to the reason for this bill? Well, truth be told, a lot of patients are not aware of all their end-of-life options. Furthermore, they typically are not thinking about the issue in advance, giving them less time to make the choice before it’s too late. What this does is give them the opportunity (they can decline) to hear their options, to become informed. From there they can make whatever decision they want. It’s not the government or the doctor making the choice, it’s the patient.
Stan – Part of the stimulus package passed last winter was a provision to fund computer upgrades for hospitals in the US. That is, instead of having all your medical information in filing cabinets, it will all be accessible by computer, allowing hospitals and doctors to share information and better be informed about the patients they are receiving, what past problems and treatments they have received and so forth. It will also allow doctors to see if their patient has had one of these counseling sessions.
No where in the bill does it say that it will be repeated by every doctor you come in contact with. Rather, it mentions that the session will only happen once every five years (less than that before a certain age).
The Ram – While it is certainly true that some of those raising concerns about the bill don’t believe it will euthanize your grandma, it’s not true for all. Sarah Palin, for example, got the ball rolling on this current rumor when she suggested that Obama’s health care bill would kill her grandma and new baby via “Death Panels”. This has also been repeated by many conservative pundits: Rush Limbaugh, Sean Hannity, etc. etc.
T. James Simmons – I’m not sure why this is thought to be a new idea either. It’s not really, and it shouldn’t be that controversial. The only thing new – on a national level at least – is that doctor’s will be reimbursed for this counseling session, making it more likely. To me, more information seems like a good thing. If you disagree, let me know why.
Nobama – Explain to me how we are becoming like Chile. Or how our Constitution is being trashed. Thanks.
As I understand it from reading the proposed Bill HR3200 and researching it on the web, the effect of the amendment is to add “end of life counseling” to the list of services eligible for Medicare reimbursement. Federal law already encourages such counseling, but does not allow Medicare providers to receive compensation. If this law passes, such counseling session would be assigned a reimbursement code, and the Medicare provider would receive payment (although it’s not clear what that amount would be). The bill does not mandate counseling every five years; instead, the Medicare provider may not receive payment for such counseling *more* than once every five years.
Karen,
Please explain why those in favor of the bill talk in generalities and consistently refuse to go into the details proposed in the current version of the bills. Even President Obama is doing this except for his “mis-statement” that AARP has endorsed the health care reform bill.
BTW, Medicare is going broke because the congressional liberals refused to correct the financing when President Bush pushed for reform at the beginning of his first term, about 8 years ago.
Stan,
The bill is large and, for most, confusing. This is, in part, why politicians will typically talk in generalities about it. It is hard to talk about the details without spending between five minutes (for specific parts) to an hour or more (to discuss the entire bill) doing so. And, unfortunately, our current media landscape doesn’t do well with that either. They prefer short soundbites that sound good to their viewers. The rub, of course, is that Health Care is far from a short soundbite. Which is the main reason, I feel, that there is so much confusement and room for distortion on the issue.
Anyway, what issues in particular are you wondering about? Perhaps, I could help you out. Or point you to a news article that does so – there are some that actually take the time to discuss the topic.
As to the Medicare issue, are you talking about the Medicare Modernization Act Bush signed into law in 2003? From my understanding that was a Republican initiative that made Medicare even bigger and more expensive. However, I could be confusing things, care to help and expound on what you mean?
And Diana, thanks for the thoughtful response. From what I’ve read, that looks to be about right.
Also, I’d like to mention that this particular issue – Section 1233 – was a non-controversial issue that had bipartisan support until this last week or so. As the above article notes, Georgia Senator Johnny Isakson was, in part, responsible for putting this provision in the Senate’s Bill. And he’s no moderate! It also has had the support of quite a few other Republican Senators in the past and present: Lisa Murkowski, Susan Collins and Richard Lugar.
From my view, it wasn’t until Michelle Bachman, Sarah Palin and others distorted the picture – making up euthanasia claims and death panels – that it became controversial at all.
You might not like different aspects of the Health Care Bill – although I’d be interested to hear what, in particular, these complaints would be (the more detail the better!) – but it’s hard to see how this specific point is all that controversial.
This already happens. And has for a while. All that’s changing is that the government will reimburse doctors for it. And even that is not entirely new. It is for Medicare, sure, but several private health insurers already do this – depending on your plan, etc.
One last point for Stan. Another reason why there has been little in the way of specifics vs. lots of generalities, is that currently there is no one single bill being pushed around from which to draw specifics from. There are something like three bills in the House and two bills in the Senate – one of which is still being worked on. So, it’s hard to talk details, when you’re not sure which details are going to make it to the final bill and which will be left on the committee floor.
But once all the bills do come together, then liberals – and the current Administration – will have something concrete to defend and promote rather than whatever boogieman conservatives decide to throw at them (i.e. death panels).
Karen,
I’d argue that based on the reaction of seniors in this debate, they are plenty informed and do not need the government showing up every 5 years.
I realize the service can be declined, but I think that’s we part ways on how our trust/distrust for the government–I’ll quote Charles Lane (an Obama supporter) from the Washington Post:
“Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.
Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic.”
Regarding your link, I followed it, but did not see a reference to the Wisconsin success story.
I’ll put this question out there again (and re-phrase it): please tell me what history says about government run social programs? Are they generally a success or failures?
Mark,
As I’ve mentioned in subsequent posts, this isn’t really all that new of a policy – making it a bit strange that it is receiving so much focus. The only change this section of the bill is calling for is to reimburse Medicare doctors for this session. Which you – and Charles Lane – are right about, does give doctors incentives to take part in the counseling session. However, other health care providers (besides Medicare) already do this and have done so for quite some time. It’s really not that controversial. Plenty of Republicans have supported the policy in the past, and some still do. The only reason it became controversial is because rumors were started that this would some how euthanize your grandma and that there would be “death panels”. Those rumors, however, are completely untrue.
As to my above link, sorry I wasn’t more specific. But the link has a video from ABC that talks about the issue. Two minutes or so into the video, it talks about La Crosse Wisconsin.
But, you’re right, at the end it comes down to whether or not we trust the government in our health care. Me personally, I would prefer the government to corporate insurers (as much as the DMV may suck, try talking to BlueCross or another health insurance provider – not fun!).
Anyway, as you mentioned seniors don’t want the government messing with their Medicare. Why? Because they love it and they don’t want it to change. And of course, Medicare is a government run program. Same as the VA, which has recently been ranked the best health care provider the US. Medicaid is also very popular for those who qualify.
As to your question of great government social programs, I’d mention – besides my above examples – Social Security (actually in much better condition than most would like to believe), unemployment, food stamps, and so on.
Anyway, this particular issue isn’t really all that much about the government getting involved. It’s more about Medicare getting reimbursement for a good policy.
Karen,
What makes section 1233 suspicious is that it is mentioned in the context of controlling health care expenses. Combine that with the fact that there will be a medical review board that decides what is covered and what is not, and people will connect the dots and conclude that this will likely lead to the rationing of health care. You are asking me to trust that this will not happen–but the current language of the bill allows for it.
I for one would never trust the government over private insurance companies. I’d rather deal with Anthem than deal with any entity like the IRS. If I don’t like Anthem, I can search for another provider and let my dollars do the talking.
Case in point: My family was covered under medical mutual. Their rates were cheaper than Anthem, but they would not cover a particular condition I have. Anthem would–so I switched. I pay more, but it’s worth it. What do I do if the government option decides not to cover my condition?
As for your examples of successful social programs, I think you must be nuts to claim Social Security is a success. It’s in far more trouble than people realize–not less. Also, my parents are retired military, and I think they would disagree with your assessment of the VA health care system.
This whole thing is (supposedly) about reducing health care costs while providing more coverage to more people. I don’t see how this happens without printing more money, rationing, increasing taxes or all of the above. Add to that the fact that the government has NEVER been more efficient or cost effective when compare to private industry. So what gives?
Mark,
You make some good points. You’re right that Section 1233 is in the bill to reduce costs. And as per the Wisconsin example, it shows that it works. It does reduce costs. However, the idea that it is done maliciously or what not, seems a little unfounded to me. Doctors are doctors, that is, it is very unlikely that they are going to be pressuring senior citizens to give up care. Especially as they are currently paid per procedure, meaning the more procedures they recommend, the more money they get. So while they would have incentives to have these sessions, they also are given incentives to continue expensive surgeries. So for the few corrupt doctors who are looking for a bigger paycheck, they would want to do the session and also recommend their patients continue the life-extending procedures.
And as I said before, this is no different than when private insurers pay doctors for these sessions. Just Medicaid would be joining in too.
As to rationing, well it already happens. Except the rationing is done by the insurance companies, not the government. And the insurance companies incentive is to increase profits, not improve health. Whereas the government would have checks and balances, some transparency and ideally a public check (via elections), insurance companies have no one to answer to but their board of directors. Who are looking to get more money.
As to losing health care options, there’s no chance of that. Trust me, liberals learned their lesson with Clinton, and this time around the plans are designed specifically so that you can keep your current plan if desired. So if you do trust the insurance company over the government, you can keep on using the insurance company. No problem. However, if you don’t you’ll get another choice.
Remember, the public choice is increasing your options, not limiting them.
As to Social Security, I’d rather not get in to that argument – a little too off topic – so let’s sideline it for now, but let’s just say I disagree. Maybe later when I have more time I’ll get into it.
With the VA though, here’s an article from 2006 on the subject:
http://www.washingtonmonthly.com/features/2005/0501.longman.html
To your final point, you’re right some changes are going to have to happen. Printing more money doesn’t seem to be one of them, but increasing taxes could be on the table. However, there is a lot of fat in the system as of now, so right there by cutting costs we can save a bunch. But yes, there will be a form of rationing. However, as I said above, rationing is already happening. Just with the government the rationing would be built around what works and is effective versus what makes the most money.
And finally, I’m a liberal and I’d assume you’re a conservative, so yeah, we disagree on how much the government should be involved in things. Though, I would like to point out, that the private market hasn’t exactly been a great example of success in recent days. After twenty to thirty years of deregulation we found out that the markets don’t always act logically or efficiently. I don’t know, that’s at least what I got from our current situation. Maybe you can explain it to me a different way.
Quick point – currently, under Medicaid, if your grandma wanted to get end-of-life counseling, she would have to pay for it out of pocket, as it is not currently covered. Under Section 1233, it would be covered.
So again, this is increasing options, not taking them away.
Karen.. in response to your quick point I will mention that our expoerience with both my mother and my mother-in-law, both covered by Medicare, the nursing facility only asked that a doctor sign a statement for DNR and there was no charge for that. End of life decisions were then made by our families without further approval by any physician.
Our only significant problem was prior to that tiime when one family member wanted to have the nursing home pull the plug, presumably to save some inheritance. The nursing home resisted and with good justification as presented to the family by nursing home staff at no charge.
As I read Sec. 1233, a doctor will provide “an order” to benefit not only the patient but the patient’s family. Placing the financial interests of the family ahead of a patient’s right to choose how to spend their own money on their continuing life seems somewhat “evil” as Sarah Palin said.
Thanks for the response Karen. Let me go point by point (I apologize if this gets too long):
“Doctors are doctors, that is, it is very unlikely that they are going to be pressuring senior citizens to give up care”
I’m not worried about the Doctors. I’m worried about the panel that will decide what is covered and what is not. I trust my Doctor–I do not trust a government run panel.
“As to rationing, well it already happens. Except the rationing is done by the insurance companies, not the government”
True, but with private insurance companies, I have a choice. Take my example in a previous post: my current provider had rationed away coverage for my condition to save money (which was passed onto me in the form of a lower premium). So I switched to a company that did cover it, albeit at a higher cost. I was able to decide for myself the cost/benefit of the rationed service and whether or not it was worth it. With the government plan, I don’t have that choice.
“As to losing health care options, there’s no chance of that”
This is the key issue–and the biggest myth being propagated by supporters of the bill. They point to the fact that the bill doesn’t explicitly state that private insurance options are eliminated, however, any honest read of the bill reveals that it will lead to the elimination of private insurance. Again, using my personal experience as an example, I currently have an HSA. Under this new bill, my insurance would not meet the criteria for acceptable private insurance, and thus, I would be forced to pay a 2.5% income tax penalty. There would be strong incentive for me to drop my current plan and pick up the government option. Likewise, businesses would be penalized to the tune of 8% for carrying non-qualifying plans. So they too would push their employees towards the government option. This reflects exactly why you see all the anger at these town hall meetings–the bill is disingenuous at best. While the elimination of private insurance is not explicitly stated, the nasty side effects of public policy are rarely explicitly stated and are always a product of too much government tinkering. In this case, this will drive out private insurance over time and we will be left with the government option alone–at least as a practical economic matter.
“Printing more money doesn’t seem to be one of them”
This is happening now due to record debt levels. This will pile on more debt (per the CBO if you don’t trust me). This debases the dollar and causes inflation–which robs the poor. It reduces their standard of living by reducing their purchasing power. Inflation is an evil tax on the poor and its driven by (among other things) creating record debt.
“but increasing taxes could be on the table”
Not could be, it is. The bill has a surtax for the ultra-rich. Personally, I like the ulta-rich–they create jobs which provide health care coverage. I don’t want to punish them.
“However, there is a lot of fat in the system as of now, so right there by cutting costs we can save a bunch”
Agreed that there is a lot of fat–a lot of it can be addressed in tort reform, which for some reason is not on the table.
But since when has the government provided the model for trimming fat? Further, you would ask me to accept the following premise: The Government will cover more people and provide better coverage all while lowering the overall cost without increasing the national debt. That seems like a stretch to me.
Perhaps we can at least agree that if this were plausible, that it would be the first time in our nations history. Or any nation’s for that matter.
“After twenty to thirty years of deregulation we found out that the markets don’t always act logically or efficiently. ”
I would argue that while there are problems, we also have the world’s best health care system. I reject the notion that we do not. People travel to the U.S. to get state of the art care. I do not see people running to Canada to get treated. But I do see Canadians coming here because their hospitals can’t handle the volume or the waiting lists are too long.
And more generally speaking, the private markets have been a great success–they have helped build the greatest nation on earth in just over 200 years. Recently, the private markets have been polluted by too much government intervention: the Federal Reserve’s manipulation of the interest rates being the worst. The promotion of sub-prime loans and the propping up of Fannie Mae and Freddie Mac being just as deplorable. These manipulations have brought us to the economic down turn we have now, which also means more people are now losing health insurance as they lose jobs.
We should be talking about putting more money back into the tax payer’s pockets, specifically cutting corporate tax rates, so that we can create jobs and bring more people under the umbrella of coverage already available in the private sector, rather than creating more government bloat and further debasing the dollar.
Karen, before I forget, I’d like to thank you for keeping this debate friendly and polite. This is exactly the sort of debate that fuels good policy. Its exactly why it was wrong for the administration to try to force a vote so quickly. Let the American people read it, understand it and debate it before radically changing our system.
Mark, I agree. I’ve had “debates” on the internet before, and they rarely go this well. So thank you too. Now, on to your points.
Your main concern – and correct me if I’m wrong – seems to be the worry that the Public Option will take over the private market. Or would have the possibility to. To which I have a few responses.
First, yes, it might. And that is certainly the hope of some liberals – though certainly not all. However, for that to be true, a number of things would have to also be true. To start, it would have to attract enough users to out-compete the existing insurance companies. This would not happen unless the government option was a much better choice and it proves to perform well. But if the government is unable to run things well – as you would suggest – then there is no chance of this.
After all, it will be competing on the same market as private companies, and will have to win in the same manner. If it does win out in the end, it would seem to me that that would suggest it be the best option. Correct?
That said, that is not the end result most liberals are hoping for – or at least me. What I’d prefer to see is the public option garner support, do well – which would only happen through good governing/policy/programs/etc – and force the private insurance companies to compete. That is, to increase competition, lowering costs and bringing forth better outcomes for the public.
While some don’t like the idea of public and private companies competing, it’s not, actually, all that bad. For example, Social Security has not forced out private pensions. Nor has public universities brought an end to private universities. Likewise for the Postal Service (vs. Fedex & UPS), FHA insured loans (vs. non-FHA loans) and so on.
As these examples show, a public option provides both competition and choice. If you believe a private university is better for your teenager, then you have that choice. However, if you can’t afford that, then there are the public universities – which are much more affordable. In this way the public options work to provide a floor for their particular sectors, but not a ceiling. You can go to Harvard (the ceiling, so to speak) – so long as you have the grades, finances, etc. – but if you can’t make it there, you also have the choice of a UCLA or – for a cheaper alternative – a Long Beach State (to pull examples from my state).
In the same way, the public option would provide a bottom, not a ceiling to health care. It would define the minimum care we would receive, not the maximum.
On that topic, Canada is an example of a health care system that does have a ceiling. There is a max to what you can receive. And that’s why you see Canadians coming to the US for health care. However, we are not aiming for a Canadian system. While, I might argue for a few parts from the Canadian system, it is not one that I would want the US to model. And it’s not a system that liberal legislators are looking at either. There are definitely some big problems with what they have – as you have noted.
Rather systems like what France or Germany have, which are hybrid models – in which there is a guaranteed bottom, but no ceiling – prove to be better examples of what we might want. In their systems, the government provides a minimum amount of care that everyone can afford, but allows other private options for those who want – and can afford – even more. I think we should aim for this.
As to deficits and printing money, I pretty much agree. We don’t want to continue on that path. However, the current increase in spending, part under Bush’s last days – the first stimulus plus TARP – and part under Obama – the second stimulus – are due to the recession and trying to fight back against it. As Hoover clearly showed, cutting spending, from the Government at least, during a recession can lead to a depression.
That said, Obama is definitely concerned with deficits. More so actually than some on the left would like. For that reason, he has promised – repeatedly too – that the Health Care plan will be budget neutral within 10 years. Which, of course, has brought some trouble to the question of paying for it. No ideas have proved to be all too popular, but yeah, one of them is to increase tax rates on the wealthiest of us. Another idea is to cap the Employer Tax Exclusion – an idea I might add that was brought to the public’s attention by John McCain during the last election. Still, nothing is concrete yet on this issue.
(And while I’d rather not enter this argument, at this point at least, I personally don’t think higher taxes on the rich would stop economic growth – as seen during the nineties. But feel free to disagree)
Last point, for now. The status quo is not sustainable. Without reform, worker premiums are expected to double by 2019 which would also expand the ranks of the uninsured by around 23%. And, after that, it will get only worse. Left unchecked, it would eventually bankrupt our nation and our markets. (Stats taken from the Robert Woods Johnson Foundation: http://www.rwjf.org/pr/product.jsp?id=42970 )
And to end this a little more on topic, here’s an excellent article from today’s New York Times on the death panels:
http://www.nytimes.com/2009/08/14/health/policy/14panel.html?_r=1&hp
Come to think about it, a better example of public vs. private and floors vs. ceilings would be high schools. As, in that case, the public (floor) is guaranteed and is free and does provide a minimum (unlike public universities which are not free or guaranteed). The rest of the analogy should hold the same though, with the private school being another option for those who have the resources to attend.
Well, the problem with public schools is similar to the problem with the health care options in this bill: you have no choice but to pay for public schools, even if you don’t want to send your kids there.
If people want more options for their kids, they have to fork over extra money to send their kids to private schools. This ultimately leaves most of us settling for the public option, while a few privileged families enjoy the benefits of the higher quality private education.
Mark,
For one reason or another my above long post (right before my “Come to think about it…” post), has been disappearing from time to time. Not sure why. Anyway, just wanted to make sure you had read it – as it took me a little bit of time!
As to your recent post. It is true that you have to pay for public schools and if there is a Public Plan in the health care bill, that you would pay for that too (although, it would appear the bulk of those costs would go toward those who can afford private schools and top-rate health insurance). And again, I realize this cuts to the biggest difference between conservatives and liberals (government vs. market – to over simplify). But, for me at least, it’s worth it to pay more in taxes so that everyone in the US can receive a high school education. Likewise with Health Insurance.
Currently 47 million Americans are uninsured, which I, personally, think is immoral and unjust. Especially considering we are the world’s wealthiest nation and can afford it. And so, for me at least, it doesn’t seem all that unreasonable to pay a little extra in taxes (which is one of several suggestions to pay for reform) so that they can have health insurance.
But, just for the record, would you prefer we didn’t have a public school system? Not sure if I’ll further argue this point – a little too off subject – but I am curious. Thanks.
Karen,
I indeed did not see the other post until now, thanks for pointing it out. I’ll revisit it in a bit.
Regarding the 47 million uninsured, I think if we are intellectually honest, we know that number is misleading–the breakdown of people in this 47 million is:
- 18 million with incomes of 50k or more that simply choose not to carry insurance. (Young people)
- 12 million illegal immigrants
- 8 million are under the age of 18. There are plans already to cover the young if the parents can’t afford it.
- 8.4 that are lower income and uninsured–or 3% of our population.
These numbers are based on the Census Bureau. The 8.4 million that are left are typically people who would be covered under Medicare or Medicaid if they would just sign up.
Regarding the public school system, I personally don’t mind public mandates and funding for our schools—so long as it’s handled at the local levels. I do not think, however, that they should be publically run.
I personally live in a town with “good” schools, and they have passed new levies every year for the last 11 years. They are grossly inefficient when it comes to money and always put our children on the chopping block before their own pay increases–cutting busing; sports or whatever else they figure will “hurt” the parents and bully them into passing the levy.
I would much prefer that all the schools be privately run and that I could redirect my money to a school of my choosing. I believe that sort of competition would create truely “excellent” schools in our city.
Finally, I cringe when I hear “we can pay a little extra in taxes”. A little extra in taxes when all these socialist programs began was 1% on the top 1%. Now we are all taxed, at multiple levels (federal, state, local, sales, corporate, luxury, death, etc) with a top rate of 35% federal and as high as 10.3% in California. I think most of the people who say “we can pay a little extra” really mean “I can pay a little extra, and that guy over there can pay a lot more.”
Our Federal government currently rakes in nearly 3 trillion dollars in tax revenue each year. $3,000,000,000,000! And they continue to run deficits—huge deficits. Do you really think the issue is not enough tax revenue? Or could it be too many social programs run by a historically and always inefficient government. Let’s not throw another log on that fire.
No, I think I would rather our government give us our money back so that we can decide how to best spend it. Let congress make law, not scheme for ways to grab power and money through dreamed up social programs.
Thanks,
Mark
Karen,
I’d like to reply to your previous post. You contend that the only way the private insurers would be run out of business would be if the government option were better.
“After all, it will be competing on the same market as private companies, and will have to win in the same manner.”
This is entirely not true. If you read HR3200, you will see that the bill penalizes those who carry “non-qualifying” insurance. The categorization would force many people to give up their current plans or pay the price, making the private options less attractive by rule.
Further, the government will be able to provide a “qualifying” insurance plan because it is subsidized. How does a private insurance company that must make a profit compete with a public option that is subsidized by tax payer dollars? It’s not a level playing field.
The same can be said of the examples you cite—the costs of these programs are hidden in the form of our tax dollars. We act as though these programs are free—but they are not. They are costing the tax payers billions of dollars and most are bankrupt. And these programs do not have mandates that would run the private competition out of business like HR3200 does. Thank goodness for the private options!
With HR3200, these private options would begin to disappear. What happens when the private insurers are gone? What competition will there be for the government option?
And like all government run programs, the public option will quickly become a bankrupt failure—with or without the private competition—a sinkhole for our tax dollars. You would be hard pressed to convince me otherwise. I need only point to history and precedence, not just here in America, but world wide.
Regarding your Universities example, this is a bit more complex. Many private universities have higher tuitions, but provide more grants and scholarships to offset the cost. Still, more people are attracted to the lower cost public option when they might otherwise have put their money towards a private school. The public Universities are artificially low because they are subsidized with tax payer dollars. Endowments don’t hurt either. Private research grants, private donations—numerous other private income sources all help.
And in the end—not everyone gets a college education. It still costs money. And the expenses and complexity of a college education are no where near the complexity of healthcare—and nowhere near as far reaching into our private lives and personal decision making.
Back to health care systems, I confess, I don’t know much about the French or German healthcare systems. I did find this article which I find intriguing:
http://www.examiner.com/x-11804-Health-Care-Examiner~y2009m7d21-The-French-health-care-system-is-universal
So perhaps we could agree on taking a closer look at the French Healthcare.
Regarding deficits, yes, Bush disappointed me with TARP—I disagreed with his spending then and now. But Obama eclipsed his spending—not just a continuation, but eclipsed it. His “concerns” over the deficit are lip service. His actions—and the CBO—do not back it up.
Regarding your reference to Hoover and the depression, I would suggest you read the book “Meltdown”. I think you’ll get insight into the mistakes that were made that led up to—and prolonged (FDR)—the great depression. The blame lies in the manipulation of money supply.
I agree the Status Quo may not be acceptable—but I think the real answer lies in Tort Reform and deregulation of the insurance markets. More cost transparency, and making individuals more responsible for their health care costs. These things will drive down costs. Not more government spending.
I’m sorry, I haven’t click on the NY Times link, but I had to laugh when I read “… here’s an excellent article from today’s New York Times”
As you can imagine, I’m not a fan the NY Times. But I’ll choke it down for the sake of argument.
Thanks,
Mark
By the way, don’t look now, but Social Security is being cut–no cost of living adjustments for the next 2 years. It was announced today.
Another fabulous government social program. Please give me my 15.3% in taxes back.
I have to say i had no idea this was part of the decusion going on in the health care bill fight now. I have worked in the health field and have seen first hand this problem. I think it is good and right for our loved ones to have a say in this matter, I have seen a lot of suffering prolonged by dr and family members thast do not realize that in will not do any good in the end except cause more spending and pain but have no good effect in the long run. And to be onest some times our loved are tired of fighting alements.
Hey folks, seems to me that “KAREN” is a government agent posing as a common everyday citizen leaving comments on this site. Possibly in the employ of the White House! Has happened before, in fact actually recently, since the White House started it’s own internet propaganda sites en mass. As all good American’s know this scheme from the failed american left is nothing more than a power grab on the false fairy take of eternal life granted by the federal government. Well since they have killed our “CREATOR” who gave us our inalienable rights, they can substitute the power of the central government to grant us all we may ever need! hehehehe What pathetic human trash! From this retired 30+ year Police Commander, be ever vigilant in protecting and controlling your own life, liberty and freedom. There are many who will use the power of the central government to control you!