Policy and Politics
I couldn’t improve on Don McCanne and Maggie Mahar’s articles in response to Jon’s ‘pretend’ points of objection to single payer: the questions of cost-setting and choice with regard to risk exposure. So, I’d like to address some of the political and social issues hovering around the policy questions. What, as johnOneOne begins to answer in his comment to my first post, are the rhetorical 'brain freezes' that inhibit this conversation?
In his April 10 post on http://www.health-access.org/blogger.html, Anthony Wright of Health Access, writes, about this discussion, “Like good policy wonks, they skip over the bulk of the book that details the problems and the history of how our health system evolved, and start focusing on the politics of various solutions.”
Dude, I’m not a wonk, I’m a flak, which means I do secondary, not primary, research, trusting people like many of those on the panel to assemble the raw facts. It’s my job to help make social meaning out of data and to translate the findings of economists and sociologists into language that empowers a more general audience to follow and participate in the discussion. So, yes, politics.
With that in mind: our current conversation in the United States about healthcare reform follows three decades worth of intervention in our political discourse by the organized conservative movement, which is simultaneously: 1. pounding the ideological message that government is (a.) not actually capable to represent the governed, no matter what they taught us in civics class and (b.) essentially, metaphysically incapable of doing anything right and 2. striving to defund government to make sure that it really can’t do anything as well as it should.
With regard to cost setting: programs like Medicaid are in trouble, because they’re starved. We can learn from the Canadian example and keep our funding for any public health plan separate from the General Fund—dare I say lockbox—and relatively safe from budgetary raiding. That depends on political will. It will be up to people who work on the political level to make sure that the billions of dollars in administrative costs that single payer will save wind up being spent on patient care, not routed elsewhere.
With regard to rationing—as Ms. Mahar points out, we already have healthcare rationing. It takes place in secret on the premises of for-profit insurance companies whose interest is not in the health of their clients, but in the dividends of their investors. Single payer will not silence those conversations that we, as a society, will continue to have: what counts as necessary medical care; what standard of living promotes our general security and welfare and enables the level of civilization that we require; what treatments are proven, according to evidence-based standards; how do we want to live and how do we want to die (as if we always get to choose)? Single payer will move such conversations into transparent, publicly accessible fora.
By nature, single payer does provide a floor, not a prison—people with lots of money will always find something beyond the package that they want to pay for, if only because they can. Successful single payer would, as Jon indicates, offer solid, comprehensive coverage; including, for example dental and vision care, along with preventive, hospitalization, etc. The greater the risk pool, the more equitably the cost is shared.
But what about the choice to assume risk and, along with it, to opt out of sharing risk with our neighbors? Jon is only pretending, but this question is actually employed by those who advocate so-called ‘consumer-based’ plans. The rhetoric used to sell such plans employs the idea of choice: consumers will be offered a ‘buffet,’ a ‘smorgasbord’ of healthcare options. And that’s not a bad metaphor, because most of us would wind up as we would at a Las Vegas all-you-can eat spread—with too much of what we don’t finish and not enough to nourish us, and, soon enough, much sicker than we ought to be.
Here’s the most pernicious lie at the heart of so-called market-based solutions to the healthcare crisis: We don’t just get what we pay for, we get what we deserve. Single payer advocates are accused of being or protecting ‘bad’ consumers by the very insurance industry that does its best to hoodwink its clients. This idea is very potent at a time when the marketplace has become a secular icon. What if we don’t know how to choose our best option from scores of 15-page health plans written to confuse us? What if we would ‘choose’ comprehensive coverage but can’t afford it? This must be because of our own weakness—it can’t be a matter of inheritance or contingency or luck or bad faith on the seller’s part—and we deserve to be smitten by the invisible hand.
High-deductible insurance plans are usually sold to people who are young enough—or just plain poor enough—to want to roll the bones and gamble that they won’t get sick. But none of us is clairvoyant enough to know whether or not our eyesight will begin to fail or our brains will sprout tumors or we will be hit by a bus. Yes, behavior has a lot to do with our health—exercise, food, not smoking, etc. But so does pure, dumb luck; and so does the condition of being made of flesh. This is why it’s specious to compare health insurance to something like car insurance, much less consumer decisions like what flat-screen TV to buy. If we can’t afford the good car insurance, we have the choice to drive a cheap car or take the subway. No one can choose to do without a body. And bodies have things go wrong with them.
High-deductible plans disincentivize preventive care. Co-pays and deductibles don’t promote ‘wise’ or ‘careful’ decisions; they push people on budgets into foregoing doctor visits for the sort of mild complaint that might indicate a serious condition. Like uninsured people, under-insured people wind up in emergency rooms, because high blood pressure becomes a stroke or untreated diabetes renders them comatose. This is not only dreadful for the individual but also costly for the rest of us—including hospitals which are then forced to provide the most expensive sort of care and eat the cost that their patients can’t meet.
This is one example of why the ideal consumer of conservative imagination, the solitary self who makes individual choices, doesn’t populate the actual landscape of healthcare. We have an interest in the health of our neighbors. To say so is not to advocate the altruism of ‘beautiful souls’ but to address our economic and social interdependence.
Those are all excellent points.
Not to be glib about it, but SP is so much better, a win/win in so many ways, people are sometimes too cynical to believe it.
Wingers will try conjure up imaginary downsides to scare people off it, and pay off groups to oppose it. That's their beginning and ending strategy.
The main obstruction to SP in the past has been ideological. The over zealous anti-socialism cold warrior mindset Podolski alludes to at the beginning prevented people from hearing reason. But, Mahar nailed it when she said why those days are past in the post-Enron, drug scandal, GM layoffs era.
The medical Titanic is finally hitting the iceberg that was predicted years ago, which is tragic, but at least we can be assured people are waking up to the need for action.
Mahar is also totally correct that SP opponents are rushing to create something else which will invariably be as bad as the PartD fiasco and need as much fixing, if not more. But, it's important they can't simply deny the need any longer.
April 13, 2007 9:24 PM | Reply | Permalink
“It will be up to people who work on the political level to make sure that the billions of dollars in administrative costs that single payer will save wind up being spent on patient care, not routed elsewhere.”
Proponents of SP promote it as being good for the economy by reducing health care costs. Why not plow the savings back into the economy rather than spend more on health care? Or are your goals other than cost reduction.
“Single payer will not silence those conversations that we, as a society, will continue to have: what counts as necessary medical care; what standard of living promotes our general security and welfare and enables the level of civilization that we require; what treatments are proven, according to evidence-based standards; how do we want to live and how do we want to die (as if we always get to choose)? Single payer will move such conversations into transparent, publicly accessible fora.”
Isn’t “fora” a euphemism for bitter political battles in congress and at election time among those funding SP, those demanding more and better care, and those providing the care who want better pay for their services all represented by powerful unions or lobbyists?
“High-deductible insurance plans are usually sold to people who are young enough—or just plain poor enough—to want to roll the bones and gamble that they won’t get sick.”
No. High deductible plans are an option for those who have the ability to pay for their own routine care and wish only to insure against unaffordable events. They would not set their deductible above an amount that they could raise in an emergency. No “bone rolling” required, only lower premiums.
April 13, 2007 9:32 PM | Reply | Permalink
That was a great analysis. The opposition to single payer health care is much like the opposition to social security. Both are greed based. People want to keep all of the pennies they earned, and to heck with those who didn't earn that many. Social security is a single payer system, and it works very well. Sure, a lot of retirees don't need the check they get every month, so you could argue that they are being cheated. But, that isn't the case at all. We are all paying for the insurance that is social security, so that those who need to collect can do so. Single payer health care would be the same. We need to bury the Reagan "greed is good" revolution once and for all, and the sooner the better.
Hoppy in Sacramento
April 13, 2007 9:33 PM | Reply | Permalink
She's not advocating spending "more" on health care. She's saying get more care for the same cost or less, by cutting out waste. Any waste that is cut automatically rolls back into the economy, either as additional capital or additional services.
That's mistaken. She's right. Frequently people in poverty including the working poor will set the deductible to be very high so as to reduce the premium to a range they can barely afford, and only use it only for catastrophic health problems, and even then the deductible will often put them into bankruptcy. The result is they're not able to afford preventative care and often go many years without a doctor visit. That obviously has serious health consequences in the long term, creating more disease, more emergency room visits, etc.
So it really is a tragic and vicious cycle of the poor not being able to afford health care and it making them even more sick and costing more in the long run, sometimes becoming destitute as a result.
It's almost a kind of indentured servitude to one's health expenses where one simply can't get out of medical debt. It really is shameful and tragic how much this is happening in America.
April 13, 2007 10:05 PM | Reply | Permalink
“She's not advocating spending "more" on health care. She's saying get more care for the same cost or less, by cutting out waste.”
She is advocating spending the savings from better efficiency on more actual care. That’s fine, but she doesn’t get to also claim that she is going to reduce the overall cost of health care on the economy.
“That's mistaken. She's right. Frequently people in poverty including the working poor will set the deductible to be very high so as to reduce the premium to a range they can barely afford, and only use it only for catastrophic health problems, and even then the deductible will often put them into bankruptcy.”
That is a misuse of a high deductible policy. People who cannot afford to pay for their health care need help from someone else, period. Nothing to do with the purpose of high deductible policies.
April 13, 2007 10:18 PM | Reply | Permalink
You're still not getting it.
Yes, you can:
1) get the same quality or better care
2) cut costs
3) not lose HC jobs and even grow jobs in other fields
If you don't think so, please say why, SPECIFICALLY, and I'll be happy to address specific points. But this endless "just not getting it" is getting tedious.
I'll start you off with a specific example that accomplishes all three goals: drug costs, which are inflated as a direct result of for-profit insurance. Cut drug costs and save money, care quality is the same or even improved in the case of getting bad drugs off the market, no jobs are lost, and reduced medical expenditure unburdens industries to create jobs in other sectors.
Win/win/win. Unless you're a pharma billionaire I guess.
They're poor. They can't afford high premiums, and angels aren't paying for them. So they take a high deductible and get zero preventative care because they can't afford any. They have no choice. What don't you get about that? It's not difficult.
April 14, 2007 1:11 AM | Reply | Permalink
This is what you are missing. Ms. Podolsky clearly states that she wants to capture any savings and spend those savings on additional health care:
“It will be up to people who work on the political level to make sure that the billions of dollars in administrative costs that single payer will save wind up being spent on patient care, not routed elsewhere.”
While this will improve the quality of health care, the same amount of dollars will be spent on health care so the burden of health care costs on the economy will not be reduced. I assume she includes the savings incurred by eliminating the profit on drugs and the elimination of some drugs altogether in your example in “administration” cost.
Let me try again:
There are two components to health care costs: 1) routine, relatively low expenses that everyone expects to encounter for routine care and 2) unexpected, very high expenses that one hopes not to encounter.
The high deductible insurance policy addresses the high, unexpected expenses by allowing one to join a risk pool and pay premiums for benefits that one does not expect to ever collect. The level of the deductible allows one to decide what level of risk one wants to assume for oneself and what one wants to share with others.
People who cannot afford the premiums on a low deductible policy of afford to pay the deductible on a high deductible policy are screwed, as they say in the business. Those people need to have their health care costs subsidized by some mechanism, but that is a different issue than the design of insurance products.
Is that clear? If not, let me know and I will try to dumb it down some more for you.
April 14, 2007 4:55 AM | Reply | Permalink
No, that's not it. There are other ways to still get full health care and save money, such as improving drug cost efficiency, and I've already gone over this with you several times.
You're just repeating the same nonsensical claims, and I've noticed you're MO is attacking SP in other threads too.
LOL. We know what they "need" were're talking about what happens to poor people historically, when they can't afford to pay any higher premiums. HElloooo??
I mean, are you really that confused? Nevermind, I don't want to know. See if someone else can help you, my charity work is done for now.
April 14, 2007 6:13 AM | Reply | Permalink
The issue is what to do with the savings. Perhaps you think Ms. Podolsky misstated her position?
I am not here as an advocate or attacker of SP. I am here to observe and learn the thinking of the advocates. I occasionally challenge their assumptions to clarify their thinking for me. That is not “attacking” in the pejorative sense that you imply.
So what’s your issue? Poor people need to be subsidized. The fact they have not been historically does not mean that if high deductible policies were not available to anyone that they would be any better or worst off. Apples and oranges as we say.
Aw…don’t go away mad just because you got your butt kicked, learn from it.
April 14, 2007 6:50 AM | Reply | Permalink
Actually, you both are communicating quite well. There are many issues here, but I'd like to comment on just two of them: the savings, and high-deuctible plans.
Single payer supporters want to see a well funded health care system that provides all reasonable, beneficial health care services for everyone, a goal on which we fall far short with our current, dysfunctional, fragmented system of financing health care. The efficiencies of the single payer model reduce waste, freeing up funds for use in an improved system of financing health care. During the transition, this reduced waste can be referred to as savings, but the transitional costs will be great and will likely utilize the freed up funds (in spite of the simulation models demonstrating billions in savings).
What is much more important is the new steady state established in which wasteful administrative and clinical practices have been greatly reduced and greater value in health purchasing established. In this new, more efficient financing system the "savings" would be represented by a lower rate of cost escalation than would be projected by continuing with our current flawed system of financing. But the reality is that, long after we've forgotten about the "savings," we would be facing the same political budget battles such as we have with Medicare, but with a financing system that provides greater health care value.
High deductible plans are a problem for two major reasons. Because we haven't been able to control rising health care costs, we have turned our attention to the rising cost of health insurance. To try to keep premiums affordable, large deductibles are being included in plans, and, in fact, is the fastest growing innovation in health insurance today. These deductibles are disproportionately targeted to individuals with modest incomes who otherwise might not be able to afford insurance (especially in small businesses). We agree that creating such financial barriers to care is not sound policy.
But what about higher income individuals who can self insure a large deductible gap and use the plan to cover catastrophic losses? Many contend, with good reason, that this is the real purpose of high deductible coverage. The problem is that, if we are to provide comprehensive benefits for everyone, we need to have adequate funding. This means that the healthy must contribute their full share to the universal risk pool. Because health care costs are so high, an equitable system of funding requires that higher income individuals contribute a larger amount (progressive tax policies) rather than contributing a smaller amount by self insuring larger up front costs. Thus, in a single payer system, large deductibles are inappropriate for anyone.
April 14, 2007 7:03 AM | Reply | Permalink
You are conflating a risk sharing model in which people pay premiums calculated to actuarially cover the cost of their health care over a very long period of time, using risk pools to insure against untimely large expenses with an income redistribution scheme in which high income people are required to pay much more for their health care so that lower income people can have their care subsidized. Apples and Oranges.
April 14, 2007 7:35 AM | Reply | Permalink
The disagreement between kozmik and me is whether that lower cost per unit of health care will result on an overall lower costs to the economy or if more health care will be provided, keeping the overall costs the same or even perhaps higher. I think that is really unknowable since it will rely on the political climate in the country in the decades to come.
April 14, 2007 8:03 AM | Reply | Permalink
We are all Americans. We share the responsibility for the well being of each of us, to some degree. Social Security is one plan that recognizes that. Our health care should be handled similarly. It doesn't mean a thing to say that some people can afford a high deductible, etc. Of course. And some people can afford to pay every single medical expense they will ever have, with no help at all. We do have both extremely wealthy people and extremely poor people, plus all shades of wealth inbetween. The point of single payer health care is that we all share the expenses for all of our health care, so none of us has to do without or even with second rate care. Isn't that "what Jesus would do"?
Hoppy in Sacramento
April 14, 2007 2:32 PM | Reply | Permalink
To weigh in w/another perspective. To me, R Brown comes across as very arrogant and engaged in intellectual masturbation over health reform issues, whereas kozmik comes across as caring about people getting their health care needs met along with not going broke.
I fimly believe that those of us who share kozmik's views and values are teh vast majority, and that those who share Robert B's views and values are the minority but they have more money hence can make more "noise". This applies to us regular people as well as to the politicians and parties who hold these divergent views and values.
The Dems MUST stake their claim to creating universal coverage quality affordable healthcare, based on a non-profit government administered financing mechansim.
Thanks, kozmik; the dueling here is useful for what we advocates and activists come up against fighting for real reforms where we live (I'm in Massachusetts...groan) and there's always room to improve how we deal we these dweebs. ("dumb it down"? who's he trying to kid?!!!)
April 14, 2007 2:48 PM | Reply | Permalink
Brown is just wasting your time. Responding to him diverts you from real communication.
April 14, 2007 3:44 PM | Reply | Permalink
Appreciate the feedback. The real thanks goes to the contributors here who have provided so much useful information, especially Mahar, whose book I'll read, and also all the people who vote on important issues and take the time to educate themselves, for their own good, and our societal good. So, thank you too.
April 14, 2007 6:21 PM | Reply | Permalink
I get very confused whenever someone compares SP to Medicare or Social Security. The latter two programs are intergenerational transfers -- 133+ million workers supporting 42+ million retirees.
I suppose you could think of it as a large pool of the healthy supporting a relatively small pool of the sick, but I still have problems -- doubtless, a lack of intellect -- getting my arms around the asserted equivalences.
April 14, 2007 7:21 PM | Reply | Permalink
Most people have their largest medical bills when they reach old age. Many of them have those bills after they retire. By contrast, as insurance companies have learned, most young people have virtually no medical bills. So, both the single payer health care program and the social security program function primarily to keep the older segment of the population from going without. Both also benefit those who have serious problems when very young, SS paying benefits to SSI recipients. Of course there are major differences, but both use a pool of money, largely from the young, to care for the old.
Hoppy in Sacramento
April 14, 2007 8:14 PM | Reply | Permalink
. . . the single payer health care program . . . function[s] primarily to keep the older segment of the population from going without.
But, that's my very point of confusion: Medicare is in place to solve that problem -- 133+ million healthy younger workers support the health needs of 42+ million retirees. The transfers are intergenerational and will be reimbursed at some future date.
But the SP proposals which have been the subject of this week's posts and comments are intragenerational. Unlike payors into Medicare and Social Security, SP payors/taxpayers can't expect to be recompensed.
How do we distinguish SP from any other welfare plan?
April 14, 2007 10:51 PM | Reply | Permalink
Yikes! I don't know who told you that, but go give them a dirty look! ;^)
SP is going to give everyone the most "recompense" of any system. SP is an insurance program and an incredibly efficient one. In not only treats illness and disease, but also helps prevent disease. Everybody benefits, all the time.
Private medical insurance accounts actually yield less recompense on average, because of the huge overhead inherent inefficiencies. Medicare is great, except it doesn't do preventative while young. Investing in preventative medical care is a sure bet to yield dividends later.
To break the benefits down:
1) peace of mind throughout life.
2) Preventative care, young to old, which prevents disease and saves money in the long term. (which elderly-only programs can't do)
4) Care for accidents, allergies, and other such ordinary illness throughout life.
5) Care for the aging, disease treatment, and continued prevention for old age.
6) Catastrophic care throughout life.
7) negotiated drug prices, which will drive down drug costs to rational levels.
(Medicare hasn't been allowed to negotiate drug prices due to for-profit and Pharma lobbying, but under SP it is automatic. That will force Pharma to reinvest in R&D. Currently they mostly budget marketing, admin, and blockbuster profits.)
Because SP includes those efficiencies inherently, and includes preventative care, payers will actually get much more "recompense" and useful health care, including preventative.
Payers are being "recompensed" throughout life, much more fully if you think about it, as drug costs and procedure costs will be lowered, and a lifetime of peace of mind and quality care including prevention, is made far more efficient.
April 15, 2007 2:30 AM | Reply | Permalink
You are somewhat right to confused since SS can be sold as young people earning an entitlement to SS by contributing payroll taxes all their lives. SP makes no such pretenses it is simply an income redistribution scheme which takes form those with the ability to pay and provides care to those who need it, “from each according to his ability, to each according to his needs”.
April 15, 2007 4:40 AM | Reply | Permalink
"Pretenses" is the right word.
Social Security always took money from workers and paid it out to retirees and the disabled.
Al Gore's "lockbox" was nearly a match for Clinton "paying down the deficit" in hilarity.
Social Security always was and is a "redistribution of income." That makes it bad only if you think society has not obligation to those no longer in the workforce.
The farce of some kind of savings plan is destructive of rational discussion and especially harmful to poor workers and minorities.
Best, Terry
April 15, 2007 7:03 AM | Reply | Permalink
Social Security was always primarily an actuariarly fair self-transfer, with secondary (and relatively mild) redistribution components.
Single payer health finance would have 90-some percent of the population paying more in than they ever "get out" (in terms of h/c utilization).
In comparison to the current mixed system (where Medicare already captures many of our high-cost, high-skew older cases, and Medicaid picks up some of the skew in younger cohorts), only a tiny percentage would seem to be financially advantaged (on a lifetime basis) by SP.
Only a fraction of a percent would be relatively advantage in any given year -- or voting cycle.
SP is the right answer, but "everybody wins" is the wrong argument.
April 15, 2007 7:49 AM | Reply | Permalink
Whether or not Social Security, Medicare, and any SP plan are fair depends entirely on your definition of fairness. Lock 4 people in a room for a week. One has a bag of food. The others have none. One standard of fairness says 3 go very hungry, another standard says all go a little hungry. I prefer the latter. But, I'm not religious either.
Hoppy in Sacramento
April 15, 2007 7:55 AM | Reply | Permalink
OK let's tackle that.
Social security provides more to those who pay less. It takes from the least able to pay and gives to those who need it least. It excludes the richest of all from paying anything at all and will pay nothing whatever to those who are youngest and poorest paid.
Please give us your argument for fairness.
Take your time. We've got a world of time.
BTW I think "we" owe to me and others in the same fix. I am old and long retired and will not burden society forever. The argument is against the vast unfairness of a pure hoax in financing.
Actuarily sound? Hilarious.
Best, Terry
April 15, 2007 8:12 AM | Reply | Permalink
The proper SP analogy would be as follows. 100 people are locked in a room with a bag of food for a year. One guy eats half of it. "Can't help it, it's my metabolism."
That's (approximately) how the luck of the draw operates in health care utilization. That's why we need insurance. That's why adverse selection and cherry-picking are problems. That's why decoding the human genome makes it worse. And that's why US transition to universal health care finance is politically difficult.
April 15, 2007 8:16 AM | Reply | Permalink
RonK: "Social Security was always primarily an actuariarly fair self-transfer, with secondary (and relatively mild) redistribution components." That's right: it's basically a means of making contributions to retirement feasible for all. It's largely irrelevant to health care, where no amount of deferred savings could predict who gets ill when. Some would lose what they set aside specifically for health care, and some would have vast costs that savings could not cover and that would bankrupt them, while all would be discouraged from applying their health savings to routine care. That's why health care is a problem of insurance, and that's why at present there are insurers.
"Single payer health finance would have 90-some percent of the population paying more in than they ever get out." But what I just said is essentially why this is irrelevant. Most of the population pays more in auto and accident insurance they'll never use. Income redistribution is part of the picture, but only because the current system effectively rations care in a detrimental way.
John
http://www.haberarts.com/
April 15, 2007 9:24 AM | Reply | Permalink
Certainly if people get well instead of dying, they continue to be a burden.
Never thought about it that way.
Push smoking instead of taxing it. Provide more subsidies. Ban all medical research instead of just marginal stem cell research. Appoint Ralph Nader head of the FDA. Elect more Republicans Lite and Heavy. That should do the trick.
Best, Terry
April 15, 2007 10:49 AM | Reply | Permalink
I think that RonK’s point was that decoding the human genome makes it easier to identify people that may have expensive health problems in the future and would find it expensive to get insurance.
April 15, 2007 11:01 AM | Reply | Permalink
Not the point. Genomics lets underwriters spot the expensive cases from a safe distance, and avoid covering them. That's why we need a single risk pool (or equivalent policy device).
That's what Hillary was referring to, as was Rep. Jim McDermott in this OpEd.
April 15, 2007 11:05 AM | Reply | Permalink
You certainly have me confused. Everyone who has a job with an employer who follows the law, or who is self-employed and follows the law, pays FICA taxes. Unless they earn more than whatever the top salary for FICA is, they all pay the same percentage of their income in FICA taxes. But, those who earn much less than the maximum FICA top salary end up paying a lot less total in taxes over their working years, and get a lower monthly SS check as a result. That isn't 100% fair, of course, because nothing ever is, but it comes close.
The very wealthy who pay nothing in FICA taxes also collect nothing in SS checks when they retire. That is fair.
As a whole SS is much more fair than pre-Social Security times, when those who were poor either were taken care of by their family or they lived in near starvation during their retirement years. In my opinion our health care system is more like the pre-SS days than it is like today's SS system. Again, the major medical bills most of us face come after we retire, not while we are working. So, a SP plan would be an enhancement of our retirement financial situation.
Medicare is a major step in the right direction, but it has a fatal flaw in that for those of us who live in high cost of living areas Medicare pays a minor part of our medical bills, and we need insurance to cover the remainder of the bills. But, that insurance gets more costly every year, becoming the major chunk of our retirement expenses.
Hoppy in Sacramento
April 15, 2007 1:01 PM | Reply | Permalink
It's those whereases and whatfores that are important.
Remember this is not even a flat tax but a very regressive tax. When the old taxcutter Reagan gave workers the largest tax increase ever, it wasn't even a tax. It was a savings plan or something.
Undocumented workers collect nothing at all if they are on the payroll of legal employers. Young workers have the chance of collecting on promises that we have that Dubya will confess his sins and pull the troops out of Iraq.
Life expectancy determines how much you get. Life expectancy for workers is much less than for the "suffering middle class"(tm) and the upper reaches of society.
Coupon clippers pay nothing at all.
The money does not go into a savings plan. It goes directly to retirees and the disabled. Trust funds have IOU's that can only be redeemed by future taxing.
I can go on and on but the entire scheme is fraudulent when presented as some kind of old age insurance. I don't argue with the motive of paying to provide for the aged, of whom I am one myself, but I most certainly do with placing the heaviest burden on the lowest paid workers and then giving them the least - if anything at all.
This in no way should be presumed to mean I support privatization which offers to make a bad situation worse with a huge new government program and burden on workers and employers. It shouldn't be read as endorsement of libertarianism either though many claim it does. Libertarians seem to think orphans and old folks can work or starve.
Liberals should not be afraid to face the truth - but are. They look down in embarrassment and call themselves progressives so that no one will know.
Social Security is a primary engine of increasing the chasm between income classes - taking from the bottom and giving to the top.
That is good?
I think not.
Best, Terry
April 15, 2007 1:45 PM | Reply | Permalink
Thank you.
I should have known what you were thinking about.
There is just a certain level of frustration on my part with the lack of attention to the science. You are perhaps aware that proteomics attempts to divine why those with "bad genes" may or may not suffer from them. And then there is...
Ah hell, apologize for a stupidity.
Best, Terry
April 15, 2007 1:52 PM | Reply | Permalink
April 15, 2007 2:15 PM | Reply | Permalink
1. Only 5-10 cents on the SS dollar are redistributed (NBER Analysis)
2. This is veering off-topic. Let it rest.
April 15, 2007 2:30 PM | Reply | Permalink
I will make one last comment on this topic. Sorry.
I perused the NBER analysis and I see it is an analysis of the total amount of dollars collected during retirement. I was a bit uncomfortable when the privatizers used the same technique to show that SS was unfair to blacks due to longevity considerations.
Are the total dollars collected during retirement more important than the level of guaranteed income? I think not. But that’s a debate for another time and place.
April 15, 2007 3:33 PM | Reply | Permalink
"How do we distinguish SP from any other welfare plan?"
By focusing on the goal: health. Improving health will increase the length and quality of life and it will keep people productive members of society. This should be a public good not just an individual good.
We pay huge amounts of money treating people over age 65 for chronic illnesses and injuries that may be prevented or minimized by health care received in the first 65 years. If the goal is health, you might well broaden "treatment" to include emphasis on nutrition, exercise, or you might find low cost drugs that used early in life prevent heart disease or diabetes.
For example, it benefits no one - not the individual, not their employer and not the public if a young or middle aged adult is inadequately treated for diabetes and becomes permanently disabled.
April 15, 2007 3:40 PM | Reply | Permalink
As we face economic meltdown in Social Security and Medicare I can't believe this debate you folks are having.
I we do not get serious soon about massive yet compassionate,fair and ethical cost reductions we are indeed blind to the economic realities that lay ahead.
Did you hear the Comptroller General of the U.S. GAO-David Walker on 60 Minutes a few weeks ago?
He's got the data!
Dr. Rick Lippin
Southampton, Pa
http://medicalcrises.blogspot.com
April 15, 2007 4:19 PM | Reply | Permalink
I don’t think that SP can be compared to welfare since everybody will have an entitlement to health care, not just poor people. It is closely analogous to a communist system (non pejorative) as I understand the proposals. People will pay for health care according to their ability to pay and will be entitled to care according to their need. There is no relation between the consumer of health care and payment for the care. Control of the system will be by politically appointed elites supposedly experts in the field.
It differs from communist systems in that hospitals, drug companies and medical equipment manufactures will be allowed to remain in private hands as I understand it.
I guess you could say that the net transfers would be from healthy, high income people to unhealthy low income people, but it depends on the details of how the tax is structured.
Also health care is different than retirement in that there is a large insurance component and most payers will not be recompensed, just as today.
April 15, 2007 4:35 PM | Reply | Permalink
Re: We pay huge amounts of money treating people over age 65 for chronic illnesses and injuries that may be prevented or minimized by health care received in the first 65 years.
I disagree with this. The diseases of age are the diseases of age: they arise from the passge of time and no one can prevent that. Bodies wear out-- that's part of nature whether we like it or not. At best we can delay it, but emphysema or kidney disease or heart disease or Alzheimers are no cheaper at 80 than they are at 65. We really do need to accept our own mortality and the prospect of our inevitable decline (and the huge costs that go with it).
April 15, 2007 7:40 PM | Reply | Permalink
Re: Single payer health finance would have 90-some percent of the population paying more in than they ever "get out" (in terms of h/c utilization).
Nope. Most of us will get our money back when the diseases of age set in and we start running up huge healthcare bills of our own. Sure, some people will die suddenly before that, but that's true of Social Security too: some people die before they collect a dime. Single Payor healthcare functions pretty much like Social Security: the young and healthy pay for the old and ill.
April 15, 2007 7:43 PM | Reply | Permalink
Most of us will get our money back when the diseases of age set in . . . .
We already do; it's called Medicare.
Let's stick to discussion of SP.
April 15, 2007 8:07 PM | Reply | Permalink
I am assuming that SP would absorb medicare.
April 15, 2007 8:20 PM | Reply | Permalink
Nope, and nope. There's huge skew in lifetime h/c utilization, and this remains true in old age.
And time-discounting our utilization costs (as we do for any other stream of expenses or incomes), the guy who comes to an expensive end at 65 is more than 3 times as costly (net present value at birth) as one who meets the same end at 85.
April 15, 2007 9:08 PM | Reply | Permalink
I have heard Walker's talk several times. When you take federal spending out 50-75 years, it can sound like a pretty big number. Walker is misleading.
April 15, 2007 10:09 PM | Reply | Permalink
Oh baloney. You keep saying the most anti-SP things and are an anti-SP phony who won't even make honest arguments. Quit trying to Freeper the thread with Rt wing talking points, you're not fooling anyone.
April 15, 2007 11:35 PM | Reply | Permalink
Duh. Medicare is a form of single payor. And yes it, and Medicaid would simply be absorbed in a national single payor plan.
April 16, 2007 3:51 AM | Reply | Permalink
Re: the guy who comes to an expensive end at 65 is more than 3 times as costly (net present value at birth) as one who meets the same end at 85.
This makes no sense.
April 16, 2007 3:52 AM | Reply | Permalink
Dream on!
April 16, 2007 7:29 AM | Reply | Permalink
“Communism” has a negative connotation after the cold war. But, there is no reason that a communist system could not be made to work on a limited scale. I think SP may be one of those systems. It is not trying to regulate the entire economy as failed communist states are trying to do, but “simply” the delivery of health care services.
April 16, 2007 7:52 AM | Reply | Permalink