My Two Cents Worth
Social Security. Medicaid. Both taken out of your paycheck, no choice or questions asked. They are government programs decided upon by our lawmakers long before anyone thought to call it socialistic. Or then again, maybe they did. Do you really care? Nope, me either.
In North Carolina, at my pay scale (which I wish were grand enough to encourage distain), FICA is approximately the same amount as my state income tax. Of course, I'm likely to not see a penny of it when I reach retirement age - which keeps getting farther and farther away. But I pay into it each and every week.
Medicaid is a smaller percentage of my gross, less noticeable. Yet it is a thorn in my side. I honestly would not mind nearly as much if I were paying towards Medicare. I might even embrace it with a big hug and a smooch. Simply because Medicare helps everyone of a certain age and above who needs it and is a simple, straightforward form of government insurance. Debatable, I know. But if you're looking for a debate, let's move on to Medicaid.
Even though you may spend every year of your healthy, working life paying into it - you are allowed to touch it only if you are destitute. It makes no difference if you've worked one year or twenty, paying in that slight amount every payday. If your needs transcend Medicare, and even good private insurance, kiss any and every thing you own goodbye. Your car. Your home and property. Your savings account. Literally everything. If you're lucky, you have family members to whom you can give your assets. If not? Sell everything - then you can access the program into which you've been paying without choice. Nice.
You might be thinking that I disagree with single-payer healthcare. You'd be dead wrong. I want my taxes to cover not only myself, but others who need it. I don't care who they are, any more than I care who's benefiting from my Social Security tax dollars. I just want it, like SS, to be there when it's my turn. And I believe that if it's run like Medicare, yet regardless of age, it will be.
But not if I have to abandon everything I've worked for just to be eligible for a Medicaid wannabe. I'm worth what I've accomplished, and I deserve to keep it even if I need help. So far, it's not me. But it was my stepfather.
*Gosh! Finally got the time stamp right ... I forgot that it doesn't keep up with my slow pace when writing.
















Missy: I'll be back; I'm looking for a quote a conservative 30-something sent me, which sent chills down my spine, reflecting as it does the same mentality that was in play when these regulations were written -- that anyone needing these services must necessarily be shiftless, a layabout, and therefore must be stripped of any asset, no matter how modest, to satisfy the "haves" who truly believe that they are carrying the burden, etc..
July 20, 2009 8:29 AM | Reply | Permalink
Here is the quote I was sent by the 30-something to explain why, in his view, we should not have universal health care of any kind, much less Medicaid:
“You cannot legislate the poor into prosperity by legislating the wealthy out of prosperity. What one person receives without working for, another person must work for without receiving. The government cannot give to anybody anything that the government does not first take from somebody else. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend, is the beginning of the end of any nation. You cannot multiply wealth by dividing it."*
* Adrian Rogers, 1931*
Disgusting. But then, no one with this mentality can envision the day when he, or she, might be in circumstances requiring help.
July 20, 2009 9:41 AM | Reply | Permalink
That's a great summary of the conservative frame of mind. The ersponse to this sort of notion is to determine whether the 47 million living without healthcare, and the other population with inadequate health insurance. I forget what figure is commonly accepted for those people. I am also a bit vague about who decided how much insurance is enough. But I suspect that those beyond healthcare may, in, fact, be working. Those "underinsured" are probably also working. And of those who are not working, we should find out what their work history was, what percentage of their life were they working as they may simply be unemployed.
It doesn't show up on a esume, but it may be apparent at an interview. Is the candidate healthy? Chronic illnesses are observable without a professional medical diagnosis, most times. Appearances are not favaorable when someone is constantly hindered by poor health. We need to get this country healthy in order to be more productive and sustainable. I think part of that is our national mental health. Refusing to recognize how crucial healthcare is for another and denying any effort to help another is not a reflection of a vigorous confidence, but of a fral and withering fear. As FDR proclaimed, "the only thing we have to fear, is fear itself."
July 20, 2009 11:54 AM | Reply | Permalink
A simple rewrite:
But you *can* legislate the rich into prosperity by nickel-and-diming the poor. What one person receives without working for, another person must work for without receiving. The government cannot give to anybody anything that the government does not first take from somebody else. When one-tenth of the people get the idea that they do not have to work hard because the other nine-tenths are going to do the hard work, and when the nine-tenths figure out that it does no good to work hard because somebody else is going to get what they work hard for, that my dear friend, is the beginning of the end of any nation. You can create great wealth by skimming it from the workers - but once you've bled them dry, the party is over.
July 20, 2009 2:31 PM | Reply | Permalink
Nicely done, Donal. Your re-write says what they really think, which for obfuscation purposes must be turned inside/out.
July 20, 2009 2:40 PM | Reply | Permalink
Yes Donal, just excellent!
July 20, 2009 2:53 PM | Reply | Permalink
Yet again, proof we need to be able to rec comments as well as posts.
July 20, 2009 6:21 PM | Reply | Permalink
Perfectly done.
July 20, 2009 6:34 PM | Reply | Permalink
"and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for"
This perfectly describes the situation as it stands with regard to those who work and produce in society vs the parasitical rich who do little or nothing and take most of the fruits of the working person's labor. It's called capitalism. Now, if we only could get most working people to realize that their enemy is not the person who is poorer than them but the rich people who own 90% of everything, then we will make progress on lots of fronts.
July 20, 2009 3:39 PM | Reply | Permalink
The rich aren't my enemy - they are my competitors. I suppose that's splitting hairs, but it seems to me that pundits can complain about class warfare, but they can't complain about competition.
Right now, we're competing to get the same benefits as the rich.
July 20, 2009 4:04 PM | Reply | Permalink
Or to turn Phil Gramm's saying inside out, "It's time for the rich to get out of the wagon and start pushing it out of the ditch with the rest of us."
July 21, 2009 9:35 AM | Reply | Permalink
Thank you for taking the time to find this. It is revolting, yet all too revealing.
July 20, 2009 3:53 PM | Reply | Permalink
Well all the conservatives/republicans want is to be left alone. Will I for one am all for it.
I vote they be the first to settle on the Moon or Mars or someplace.
C
July 20, 2009 9:45 AM | Reply | Permalink
I just read something earlier today were the government is looking for volunteers to make the trip to Mars. The only draw back is it's a one way trip. Obviously, it's the perfect get-away the repuglican, conservative, religious right extremist have been looking for ... a place were they can set their own rules without a government telling them what they can and cannot do and everyone is a willing participant.
July 20, 2009 1:44 PM | Reply | Permalink
BF-This is how it works in other countries--the SS and medicare tax you pay now is covering your social safety net now. Makes it much easier to take.
As for the republicans: their whole attitude can be summed up as "I got mine, screw you." They do not believe in the idea of community at all.
July 20, 2009 9:58 AM | Reply | Permalink
You better believe I care. You should look at the percentage growth of FICA over the years. SS is not based on any set of actuarial sound principles. Instead, it is a government mandated Ponzi scheme whereby new payers are feeding the people pulling money out of the system. This is the reason for the increases.
I think it's time for TPM to become familiar with Hauser's observation that despite fluctuating tax brackets, the amount of money into the system as a percentage of GDP has been the same. In other words, wealth distribution has been and continues to be occurring in the country.
The real problem is that corporations do not pay the same type of taxes as individuals. This is accomplished by applying aggressive accounting with various loopholes.
Moreover, I'm tired of people from certain states wondering why tax increases are such a big deal elsewhere. So, here is a set of numbers to ponder:
Now compare to CA:
And this doesn't include sales taxes (which went up this year in many parts of the state).
Let's not even get into the situation of the fact that CA is a border state with a special set of problems where tax dollars are applied to medical care for people who are illegal (or undocumented if you prefer) aliens.
So, as you see, some of us are already paying quite a bit more in taxes than others. If you really feel like it doesn't matter to give your money away, please do give to charity. But that's no reason to cavalierly talk about tax increases.
July 20, 2009 11:48 AM | Reply | Permalink
CT here in IL we have a flat 3% state income tax. Same for corporate tax. One of the most regressive in the nation. We have a $9 billion budget deficit and the chickenshits in Springfield, even with the governor's leadership, can't bring themselves to do the right thing and raise them. This is resulting in massive cuts to social service agencies that serve the poor, the elderly, and those with special needs.
When you say "that's no reason to cavalierly talk about tax increases" I wish you'd say that to the grandmother who collapsed into tears when telling me the world of good the 12 hours a week therapy her 12 year old autistic grand daughter gets, that she now won't get, does for the child.
And speaking of corporate taxes how many of those
making over $100,000 a year do you think incorporate and write off everything from their car payments to dining out?
July 20, 2009 2:18 PM | Reply | Permalink
It's not just the tax rate, it's where the brackets start. I suggest you compare NC and CA again. IL very much hurts the very poor, clearly. On the other hand, it's already a better deal than in CA if you are earning $17K a year! So again, I point out that some of us are paying a lot more in taxes than others -- and we aren't millionaires... or even six-digit income earners.
One thing in this debate that tends to get lost: people will continue to explore "choices" the more medical care is available. For example, siring children much later in life comes with it a huge increase in problems (like autism). As another example, teenagers having child after child by different fathers. People need to be more aware of the consequences of their actions.
I find it fascinating how nurses who work in hospitals or paramedics who deal with injury tend to be more conservative about what medical care is available. These people are in the front lines and see, on a daily basis, the various abuses of the system. Or perhaps we believe that nurses and paramedics are more callous than people here? I didn't think so.
Privilege and responsibility go hand in hand -- a concept that isn't cited too often here at TPM.
Dipping into the tax revenues collected is not a right, and so I stand by my statement that tax increases should not be so cavalier. And I say this as a member of the middle class -- the class who really bears the burden of the society we create.
July 20, 2009 2:43 PM | Reply | Permalink
Privilege and responsibility go hand in hand just as rights and responsibility go hand in hand CT.
I'd suggest you look more at the wealthy who have an ever bigger piece of the pie than the poor, sick and medically challenged in society for the source of your tax woes. As a nation we give back very little of our taxes to the poor or middle class while those who have it made get most of the perks and tax breaks. The more money you have the more you discover ways to hide and protect it from the evil revenuers.
July 20, 2009 2:57 PM | Reply | Permalink
I still don't think you are getting my point. At TPM people like to divide things into the "poor" and "wealthy". The fact is that most of us reside inbetween - in the middle class - who, as you see, can be paying quite a lot already in some states and counties. So when someone talks about "not caring" what the government takes out of the paycheck it does tend to frost some of us.
July 20, 2009 3:07 PM | Reply | Permalink
If the "someone" to whom you refer is me, let me make a small point. I said I didn't care if the programs were considered socialist. I never said a word about not caring what the government takes out of my paycheck.
July 20, 2009 3:45 PM | Reply | Permalink
Upon rereading -- and with your addendum -- I can that I thought you wrote something else.
Nevertheless, I appreciate the opportunity to bring up where these "two cents" are coming from.
July 20, 2009 4:06 PM | Reply | Permalink
Additionally (different topic), those of us in CA providing healthcare to the illegal/undocumented aliens are subsidizing your food. How? A large percentage of the aliens are in CA are there to work in the fields -- so that your food costs are down. But in CA, it's illegal to deny medical service to anyone. So I daresay that more of my tax dollars are already going to the healthcare of the poor (percentage wise) than yours -- and to your (food price) benefit! Just another way that the system is a bit more complex than the general theories put forth.
PS In Los Angeles county, sale tax is already 9.75%... just another bite out of things. This is not a rich/poor issue. We are close to a real breakdown where hard decisions about what will and will not be provided. And now add to that new taxes? I think you can understand why the middle class is justifiably upset.
July 20, 2009 3:14 PM | Reply | Permalink
I think you need to fire your governor and overhaul your stupid Libyan style referendum for every goddam little thing election code.
BTW there's millions of Californians who go to Mexico for healthcare and prescription drugs because they can't afford USA prices.
July 20, 2009 7:22 PM | Reply | Permalink
You may recall this Governor got his job when the previous Governor was fired.
As far as going to Mexico -- that doesn't address the situation here in CA that I bring up.
July 20, 2009 8:40 PM | Reply | Permalink
Grey Davis got railroaded out of office because Enron and rest of the electrical generators gamed the stupid deregulatory laws another idiot Republican governor signed into law before him with the complicity of Dick Cheney and George Bush.
And why doesn't the fact that millions of Californians have to go to Mexico for healthcare because they can't afford it in the US pertain to this discussion?
July 20, 2009 10:26 PM | Reply | Permalink
Excellent point.
July 20, 2009 11:53 PM | Reply | Permalink
Actually it's not... and it's not correct. But I'm sure people at TPM like it because it shifts the blame to the GOP. More sophistication is needed here. See my response to find the real issue at the time.
July 21, 2009 3:25 AM | Reply | Permalink
Actually, it is. I was referring to his comments re Californians going to Mexico for healthcare/medication, etc.
July 21, 2009 4:44 AM | Reply | Permalink
Um, not true.
Grey Davis admitted the budget had a huge deficit in it, and he admitted it after being elected to office.
Enron is a convenient meme, but wasn't the issue in the election at all. Anyone who was in CA at the time knows this.
That's the irony. Schwarzenegger is now facing the same exact issue.
July 21, 2009 3:24 AM | Reply | Permalink
Maybe you should fax him.
July 21, 2009 7:39 AM | Reply | Permalink
Nice.
July 21, 2009 9:22 PM | Reply | Permalink
Thnx
July 21, 2009 10:18 PM | Reply | Permalink
Davis admitted the budget had a huge hole in it? Any fool can tell now and could tell in 2001 CA has been spending more than it taxes for decades because of Howard Jarvis's insane Proposition 13 in 1978. Property owners haven't payed their fair share of taxes since. None of that was news in 1999 when Davis was elected or recalled in 2003.
July 21, 2009 9:32 AM | Reply | Permalink
I don't mind there being a system that takes something from everyone if something then devolves to everyone in turn when it's needed. That's called being a part of a society, and recognizing that a society is best provided fro by seeing that there is a point below which no one can fall.
The rub is providing the type and amount of help needed. Too little, or the wrong kind, is tantamount to teasing someone. Too much is clearly going to provide disincentives to those able yet unwilling (for whatever reason) to be full participants. And full participation means that even the "screw you, I've got mine" folks have to realize that their best interest also lies in their neighbors being well enough taken care of.
And yes, to toss in one more point, there is clearly something amiss with Medicaid and its requirement of utter penury. The single workable solution is to replace it wholesale with Medicare for everyone. Let the private insurance carriers fall and crumble to dust.
July 20, 2009 2:05 PM | Reply | Permalink
Ya had me til "Medicare for everyone" OG. Medicare is bankrupting the government. If you don't want to see reform keep using that phrase.
July 20, 2009 2:49 PM | Reply | Permalink
"Medicare is bankrupting the government."
It's not in good shape right now, because it's underfunded. Let's take, oh, something out of the defense budget - the "on the books" amount alone of which equals the entire rest of the world's military expenditures combined - say, 30% or so, and allot that to Medicare.
We'd also see an end to the giant sucking sound (thank you, Ross Perot, you were good for something after all!) of close to 20% of our entire economy going to health insurers, pharmaceutical houses, and hospital holding companies.
Not having health care for all is bankrupting this entire society.
July 20, 2009 6:19 PM | Reply | Permalink
Were it not for Perot, GHWB probably would have beaten Clinton in 1992. Perot had stated at one point that he was willing to spend $60M of his own money to prevent Bush from a 2nd term in the White House.
July 20, 2009 6:54 PM | Reply | Permalink
Not true. (a) We still haven't "found" the "new" money to pay for any of the proposed health care. (b) We are already bankrupt.
July 20, 2009 6:55 PM | Reply | Permalink
Just go the fuck away already. Never, and I mean never, post a reply to a comment of mine again.
You are dead to me.
July 20, 2009 6:58 PM | Reply | Permalink
It's just that sort of enlightened thinking that make independents believe there is little difference between the left and the right.
You really don't represent your position well, Old Grouch. Shall I send you a copy of Dale Carnegie?
July 20, 2009 7:21 PM | Reply | Permalink
Now, see, maybe it's just me....but if I was told to stop posting comments to somebody? I'd stop posting comments to them.
Things that make you go "hmmmmmmm...."
Just sayin'.
July 20, 2009 7:33 PM | Reply | Permalink
Old Grouch has claimed to post in the past just to call me names and for sport. Hard to take him seriously after that. Sort of like any bully, when someone actually pressures him with logic, he collapses like a house of cards.
I am surprised, however, that you seem to approve of dictatorial edicts. Hardly very liberal.
PS I've been "dead to him" multiple times.
July 20, 2009 7:58 PM | Reply | Permalink
To my knowledge, you still are "dead to him". He only comments back to you with that statement after you comment to him.
I don't need to drag that dead horse out, again, do I?
July 20, 2009 8:03 PM | Reply | Permalink
Every time he thinks he can play Don Quixote by "protecting" his faves here, his head pops up. Usually with something as substantive as this comment. And that's the joke. He rants and raves... and says nothing.
July 20, 2009 8:35 PM | Reply | Permalink
Well....gosh, I could say so much here, right now, about that....
Other than to you, and trolls, Grouch keeps his comments thoughtful and polite and insightful. He adds to the conversation, and he does so with respect. If he disagrees with something, he also does to with respect, other than to you and trolls.
Now, I follow you, CT, so I see all your comments, whenever you make them, and to whomever you make them to.
And, quite frankly, I don't see you treating anyone with respect except rarely.
There's the difference. You hang around TPM long enough and follow people long enough, you see patterns. Yours is quite a pattern.
July 20, 2009 8:40 PM | Reply | Permalink
If you really understood patterns, you wouldn't constantly come on and try to police things.
Grouch begins with a nasty invective. Over and over again. And that, my dear, is where it starts. You are an apologist. Pure and simple. I find it interesting that he has you defending him. Are you saying it's okay to say "shut the f*ck up" to someone here?
I didn't think so.
Grouch is wrong. There is *no* justification for his behavior. None. Period.
THE END
July 20, 2009 9:05 PM | Reply | Permalink
Whatever, Clear. Good night.
July 20, 2009 9:11 PM | Reply | Permalink
I've read your three replies to him, and reread just to be sure. I don't see the logic you're claiming to have put forth.
Perot?
Disagreeing that the lack of healthcare is bankrupting our society?
Something about Dale Carnegie?
July 20, 2009 8:22 PM | Reply | Permalink
He brought up Perot and neglected history in his comment.
I am pointing out (with others) that the fiscal soundness of the situation hasn't been shown (we are already hopelessly in debt).
I'm happy to send you a copy of Dale Carnegie too. Wouldn't want you to feel neglected!
Please re-read my comments. They are connected to the discussion. Even if you don't agree with them.
July 20, 2009 8:38 PM | Reply | Permalink
Come on, Clearthinker.
His remark about Perot was a throwaway comment in parentheses. Historical context was hardly necessary.
The fiscal soundness of the situation. Hmm. How does that equate to the lack of healthcare bankrupting our society? Not economy, Clearthinker - although the lack of healthcare can arguably be equated to that, as well - but society. That was, indeed, his point in response to Markg8.
Thank you for the offer, though I rarely feel neglected. Especially by you.
I've reread for a third and final time, and stand by my opinion.
July 20, 2009 9:42 PM | Reply | Permalink
I think careful thinking is always appropriate. That way wrong memes (like mark's one about Enron) won't become "common knowledge". In fact, it's this type of sloppiness that allows FNC to confuse people.
You are welcome to stand by your idea, but it's too bad as it doesn't fit here.
July 21, 2009 3:27 AM | Reply | Permalink
You're too funny sometimes. Aren't you the one always complaining that people don't respond directly to the point? Pot - meet kettle.
July 21, 2009 4:50 AM | Reply | Permalink
No OG it's not underfunded. It'll bankrupt the government because it has little to no cost controls.
From the Center for Budget and Priorities:
Medicare spending is growing rapidly for the same reasons that private health spending is growing rapidly — increases in the cost and use of medical services. For several decades, increases in Medicare costs per beneficiary have mirrored the increases in costs in the health system as a whole. Between 1970 and 2006, Medicare spending for each enrollee rose by 8.7 percent annually, and private health insurance spending rose by 9.7 percent per person per year.
With those rising costs we baby boomers are going to break the bank. We must have cost controls that reward best practices instead of mindlessly paying for tests, procedures and therapies we don't need or that don't work. Last year we spent $391 billion on Medicare. That's with a tiny proportion of baby boomers in the system. Next year we'll have to dip into the Health Insurance Trust Fund and by 2019 if not sooner it'll be depleted.
Paying doctors for every test they order is like paying a baseball player for every swing of the bat. A better method is paying for better medical outcomes, just like it's better to pay a ball player for higher batting average, rbis, games won etc.
July 20, 2009 7:06 PM | Reply | Permalink
It's these types of numbers that convince me it doesn't matter what type of medical coverage is passed. Within a few years, the economy will be so wrecked none of this will matter. (Just imagine if we get to hyperinflation -- which is not so far fetched.)
July 20, 2009 7:24 PM | Reply | Permalink
That's what the GOP would like you to do. Just throw up your hands and quit. We can turn this around with smart policy, something they will do everything in their power to stop. For at least a decade now they've figured if they can't convince the American public to reject all government programs they'll bankrupt it - starve the beast - and then claim they don't work and there's no money for government programs anyway.
July 20, 2009 10:53 PM | Reply | Permalink
You are reminding us of the neocon position, of course. Unfortunately, they have been helped by a fiscal policy that the country was drunk on "free" credit -- only now the bill is due.
Economic growth has been part and parcel with cheap energy greasing the entire works. If energy isn't cheap, you won't get the growth. As we are now past peak oil, it's going to be quite a scary ride.
So, despite the neocons wanted to drown the baby, they were helped by larger forces that they had nothing to do with. Therefore, just because they wanted us to think in a certain direction, it doesn't mean that it's wrong to do so.
It took the high-tech boon of the Internet buildout that allowed revenues to rise under Clinton, much like electrification in the 1920s. This did a lot of alleviate the debt of the Reagan years. Those types of infrastructure buildout are quite rare. I see nothing on the horizon (including alternate energy) that will provide that type of boost.
July 21, 2009 3:21 AM | Reply | Permalink
You are reminding us of the neocon position, of course.
Well no, "neocon" refers to the chickenhawk war monger wing of the Republican party led by Wolfowitz, Cheney and Rumsfeld. I am describing the anti-tax, anti-government wing of Goldwater, Reagan and GW Bush.
Unfortunately, they have been helped by a fiscal policy that the country was drunk on "free" credit -- only now the bill is due.
Actually "fiscal" policy refers to the spending side, "monetary" policy deals with credit. It's was the monetary policy of the US government over the last decade to encourage the use and abuse of that not so "free" credit, under Greenspan and Bush, to gin up false prosperity.
Economic growth has been part and parcel with cheap energy greasing the entire works. If energy isn't cheap, you won't get the growth. As we are now past peak oil, it's going to be quite a scary ride.
All the more reason to make public investments and encourage private investments in 21st century energy technology. This is decades overdue. We took a huge step backward when Reagan scrapped Carter's energy initiatives and we've been behind ever since.
So, despite the neocons wanted to drown the baby, they were helped by larger forces that they had nothing to do with. Therefore, just because they wanted us to think in a certain direction, it doesn't mean that it's wrong to do so.
Not sure what you mean here. As I see it the American people voted in a bunch of people who hated government. In the first iteration under Reagan they were happy with phase one, gutting federal revenues. Reagan might have had more success gutting federal spending if he hadn't unwisely tried to means test Social Security. He got his butt handed to him in the 1982 midterms because of it. He and Tip O'Neill set up a commission, headed by Greenspan to solve what was then a very real Social Security solvency crisis.
In 1983 Reagan signed into law the doubling of FICA taxes. That solved the SS solvency crisis, by not only providing enough money to pay off current recipients but build up the Trust Fund to cover the baby boomer bulge.
It took the high-tech boon of the Internet buildout that allowed revenues to rise under Clinton, much like electrification in the 1920s. This did a lot of alleviate the debt of the Reagan years. Those types of infrastructure buildout are quite rare. I see nothing on the horizon (including alternate energy) that will provide that type of boost.
That internet boom should have continued along the lines we had in 2000 which was much like the competitive structure in France. It would have under Gore. Bush said the net was "full of dark dungeons, ready to ensnare our children". He didn't much believe in competition and his FCC and the conservative courts turned the internet over to the few big baby bells and cable providers who have slow walked technological innovation preferring to monopolize regional markets so they can maximize their own profits. Letting the marketplace decide with small players on a level playing field with the big boys would have been a much better use of all that money foreigners were willing to throw at us here rather than bursting that bubble and ginning up credit and real estate ones predicated on the ability of the American consumer to shoulder unsustainable amounts of debt. Would have helped CA a lot too if Silicon Valley didn't suffer the worst. A lot of $100,000 engineering and programming jobs (and the income tax revenue) went bye bye in 2001-2003.
This did a lot of alleviate the debt of the Reagan years. The 1990s job boom associated with the tech boom is what drove down the debt. Of course once it became clear you could pay people in Bangalore or Manila much lower wages to work in your back offices using the new communication tech than even North Dakota on Friedman's flat earth it drove American jobs overseas. And there's no way to get any of those jobs back or create new ones unless we lower the cost of doing business in the US. To do that we must cut in half the 17.5% of GDP we spend on healthcare.
Those types of infrastructure buildout are quite rare. I see nothing on the horizon (including alternate energy) that will provide that type of boost.
Pessimist. There were actually some folks in the late 1900s who suggested we close the Patent Office because they thought everything that could be invented already had been. I suggest you look at all the technological innovation that has taken place in the last century. A century from now those achievements will be dwarfed by several magnitudes. Are you satisfied with today's level of alternative energy technology? Transportation? Medicine? Food production? Global warming? You shouldn't be because it's not sustainable. There's millions of people at work on solutions for these problems and the ones who invent and commercialize the breakthrus are gonna get rich saving the vast majority of humankind from ruining our home planet and falling back into the dark ages.
The Energy and Healthcare bills are a start in preparing the USA to lead that revolution.
July 21, 2009 10:35 AM | Reply | Permalink
"Paying doctors for every test they order is like paying a baseball player for every swing of the bat. A better method is paying for better medical outcomes, just like it's better to pay a ball player for higher batting average, rbis, games won etc."
I don't get your point, Mark. How do you foresee a better medical outcome with less tests? Many are superfluous, I agree. Mostly brought about by the fear of malpractice lawsuits and the padding of insurance claims by questionable physicians/hospitals. Yet, that's a different issue entirely. If a life can be saved, or a diagnosis confirmed with an additional test, would that not create a better medical outcome?
We're not playing baseball here. Any more than we're attempting to make orange juice out of apples.
July 20, 2009 8:09 PM | Reply | Permalink
In a few specific cases, yes, but my probably not on the average. How much are those few specific cases costing us? What is a reasonable risk and what is that worth to us? I'm afraid that these are discussions we're going to have to face whether we like it or not.
Just coincidentally one of the new "correspondents" over at the Atlantic, Dr. Abraham Verghese, recently had a post on this issue.
http://correspondents.theatlantic.com/abraham_verghese/2009/07/medical_tests_does_it_work_matters_less_than_does_it_pay.php
For anyone who's interested in healthcare issues, he's got several pretty good posts so you might be interested in perusing his pasts entries. My personal favorite is the one entitled "TO THE AMA: IT'S NOT ABOUT YOU."
July 20, 2009 9:07 PM | Reply | Permalink
I don't get your point, Mark. How do you foresee a better medical outcome with less tests? Many are superfluous, I agree. Mostly brought about by the fear of malpractice lawsuits and the padding of insurance claims by questionable physicians/hospitals. Yet, that's a different issue entirely. If a life can be saved, or a diagnosis confirmed with an additional test, would that not create a better medical outcome?
Barefooted, first of all I'd like to agree with your comment above, we are bankrupting our society, not just the economy with our current system.
Second, read this article for how providers are bilking the system with way too much "care" in some instances:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
Most of the over testing, prescribing and procedures isn't because of lawsuits. That "people suing their doctors at a drop of a hat" is a ruse that insurance companies have been selling with the GOP for decades. There is not now nor has their ever been a wave of frivolous lawsuits resulting in jackpot jury awards driving doctors out of business. What there has been is monopoly control of med mal insurance in most states - just like health insurance - and a sweet little racket that allows them to jack up doctors' rates every time their Wall St. investments don't pan out. If you want to fix that mess we need a public option for medical malpractice insurance too.
You can read this article to learn more about that scam.
http://www.washingtonmonthly.com/features/2004/0410.mencimer.html
July 20, 2009 10:47 PM | Reply | Permalink
I see your point, Mark, and thank you for making it. Yet I ask you: what is, in your opinion, the answer to the following question that you ask?
"If you want to fix that mess we need a public option for medical malpractice insurance too."
A public option for malpractice insurance? Outside of government controlled single-payer insurance which would then (I'm assuming here) make it more difficult to sue with little cause I don't know what you mean. But I look forward to your reply.
July 20, 2009 11:26 PM | Reply | Permalink
You really need to read those articles Barefooted. Once again, there never has been a wave of frivolous liability lawsuits, for medical malpractice or any other reason. Even so a whole host of states have already passed "tort reform". It hasn't resulted in lower medical malpractice insurance rates for doctors. The decades long dishonest PR campaign by the insurance cos and the GOP, aided and abetted by the media has largely succeeded. You even seem to believe them.
Doctors claim they order extra tests because of the threat of lawsuits. Well that's one reason but they don't know any better than that either. They also get paid for every test they order and the incentives are all skewed toward ordering the most services they can get Medicare or insurance companies to pay for, not what's best for the patient. There's plenty of studies that show more of this kind of "healthcare" is as likely to kill you as less.
I'd say ask my mother but you can't. She died in 2006, 6 months after being admitted to our local heart surgery mill hospital for a bladder infection and getting scared into having a triple bypass she was in no condition to recover from. Between the hospital and the 17 doctors who got a piece of the action, most of whom I never saw, they made half a million dollars off her "care" from Medicare and Blue Cross. Fee for service has to go. They recognize that in the House bill and have all kinds of demonstration projects set up, there's $2.9 billion in the stimulus bill to institute a robust nat'l electronic record keeping system that in part will be used by a beefed up MEDPAC to data mine for best and worst practices and then pay according to what works.
A medical malpractice public option amendment can be incorporated into any bill, or even pass as stand alone legislation. I think it'd lower med mal insurance rates for most doctors tremendously because most of those premiums are pure profit for insurance companies. I haven't seen it in any bill yet but I'm telling every congress critter's receptionist I talk to about it, be they Repub or Dem. As long as we're changing everything else, we might as well get that on the table too.
July 21, 2009 11:55 AM | Reply | Permalink
"They also get paid for every test they order and the incentives are all skewed toward ordering the most services they can get Medicare or insurance companies to pay for, not what's best for the patient. There's plenty of studies that show more of this kind of "healthcare" is as likely to kill you as less."
Would that not be considered padding claims? Perhaps "padding" is the wrong word in this case. You make an excellent argument against one of the biggest problems that privately run healthcare has to offer: the circle-jerk of insurance, physicians, hospitals and pharma companies. Just turn on the television - you need this new drug because you have this new whatever and without it you'll be lacking what you don't know you need! Tell your doctor now! We'll file the claims for you!
July 21, 2009 9:43 PM | Reply | Permalink
Well the good news is there's lots in the Tri-Committee bill that breaks up those cozy little relationships.
July 22, 2009 1:01 AM | Reply | Permalink
"I'm just a bill, only a bill ..."
Here's hoping that it becomes more than that, but like everything else on the Hill - we'll see.
July 22, 2009 4:32 AM | Reply | Permalink
WAR is bankrupting the government, not Medicare! If we would stop having wars (which seems to be the only thing we are good at these days) and start doing something productive we COULD have Medicare for all. Other countries manage it!
July 20, 2009 9:47 PM | Reply | Permalink
The fact is we're spending 17.5% of our GDP on healthcare and that's unsustainable. Other countries use all kinds of systems. Some have public/private plans like Germany and the Netherlands. Some have single payer like Taiwan and Canada. Some have government run hospitals like the UK. Almost all of them spend from 8 to 11% of GDP and are eating our lunch economically. We need to cut our expenditures in half and anybody who thinks we're going to do that without vast changes to the whole system including Medicare, Medicaid and SCHIP is kidding themselves.
That doesn't mean we'll have worse care, it means we'll have more sensible care. For instance anybody who thinks we'll pay for a alzheimers drug that is effective on 8% of patients 9% of the time is out of luck. It'll stop Hinsdale hospital from giving everyone who walks in the door a chest x-ray whether they need it or not. It may stop your doctor from prescribing an antibiotic for that viral chest cold you can't shake. And it'll stop him from a getting a kickback from the pharma company when he does.
Yes if we had single payer we'd have enough money to cover everybody in the stupid provider system we have today. But our businesses and workers would still be too expensive to make and sell anything to the rest of the world.
And what makes you think we're so good at war?
July 20, 2009 10:13 PM | Reply | Permalink
As I mentioned, I would much rather pay taxes for Medicare than Medicaid. It makes more sense to pay directly into a program to benefit everyone than one that takes my money for years and then requires that I have nothing just to make use of it. Much like being able to pay for car repairs through your automobile insurance only if you first sell your car.
July 20, 2009 6:22 PM | Reply | Permalink
I’m puzzled about what tax you are objecting to paying. Federal tax withholding includes FICA Social Security and Medicare, but as far as I can tell not Medicaid. At least I’ve never seen it on my pay stub and I don’t find it listed in any table for federal tax withholding. Does your state withhold something for Medicaid?
(Topic 751 - Social Security and Medicare Withholding Rates - www.irs.gov/taxtopics/tc751.html)
July 20, 2009 10:48 PM | Reply | Permalink
Yes. Federal, State, FICA and Medicaid. All amounting to approx. 30% of my gross.
I'm not actually objecting to paying any taxes, I'm objecting to the way Medicaid is handled. Strongly objecting.
July 20, 2009 11:45 PM | Reply | Permalink
But on my pay stubs that's Federal Income, State Income, FICA (which means the Social Security part), and Medicare - no Medicaid. And I can't find anything on the IRS site that shows any Medicaid withholding or tax on individuals. So I don't understand where your Medicaid tax is coming from. Medicaid is an entitlement program that is jointly funded by the federal and state governments. For Social Security and Medicare, individuals have specific taxes withheld for the programs.
I do have to agree that Medicaid isn't well handled, though.
July 21, 2009 5:03 AM | Reply | Permalink
On my stub, on my timecard, in my payroll accounting software for the state of NC - Medicare is not deducted from my pay (as a specific entity), but Medicaid is.
July 21, 2009 9:50 PM | Reply | Permalink
As a civilized society,yet to be achieved shouldn't we be working towards taking care of all the people?
What the hell good does it do to allow massive accumulation of wealth when people are dying because they can't afford food?
History at some point must look back and denounce what we have achieved this far in time as abominable.
How for instance can the catholic church preach against the effects of war and poverty while accumulating and holding assets estimated fairly I believe, at 32 TRILLION dollars.
The inhumanity and the arguments that sustain it all are mind boggling.
July 20, 2009 2:29 PM | Reply | Permalink
Couldn't agree with you more, JadeZ, in general and, in particular, about the Catholic church. The astounding beauty of the paintings and sculpture in the Vatican museum is tainted by the obscene amounts of it, testimony to its avaricious accumulation and the hoarding of it. As many of the most beautiful, and therefore most valuable places in the world are owned by the church. How about turning some of that wealth into education and health care?
July 20, 2009 3:52 PM | Reply | Permalink
Not surprising that those who write the histories label themselves as bringers of "civilization", while defining as "savages" the societies and peoples they subjugated and whose ancient civilizations they destroyed.
July 20, 2009 5:56 PM | Reply | Permalink
Bless you, Missy. If we are not our brothers' keepers, then we have succumbed to moral bankruptcy.
Kudos on a fine post! :)
July 20, 2009 9:42 PM | Reply | Permalink
Moral bankruptcy. A perfectly exact description of where we are headed ... and sadly may see far too soon if nothing changes.
Thank you, Thera.
July 20, 2009 10:06 PM | Reply | Permalink
Also.
July 20, 2009 11:07 PM | Reply | Permalink
And a perfectly nice sentiment -- but totally impractical as resources are finite.
Once again, we are at the standard impasse. It's too bad that many here don't understand that most normal people have empathy. That is not a dividing point in the least. The difference comes when you have to actually make the situation work.
I find it fascinating how those that have the least experience in setting up and running a real business (not a private consulting firm, but a real organization) always have nice idealistic ideas -- and are very upset when challenged in how to reduce them to practice.
As I pointed out above, the middle class is slowly breaking under the weight of being a "brother's keeper". And you know what? Not everyone has the same ambition or the same drive. People should be allowed the same opportunity, but not the same lifestyle. At some point, the issue of finite resources kick in.
And I do not believe for a moment take anyone seriously who will not tackle the difficult issue of population growth. What we find is that all of a sudden these "idealists" become just as entrenched as anyone else when they are asked to make a real contribution to the effort.
July 21, 2009 3:35 AM | Reply | Permalink
Sigh.
I run the office where I work, including payroll. I am responsible for the daily and monthly auditing; the outside accounting firm comes to me with questions. It is a million dollar + per year incorporated business.
I deal with both legal and illegal aliens and the government procedures having to do with each and every new hire. I have plenty of empathy but can not let it interfere with legal responsibility.
So save your breath, Clearthinker. How I feel about having children is none of your business, and my overall thoughts re population growth will wait for another time. Depending upon my interest in engaging you on the subject.
July 21, 2009 5:19 AM | Reply | Permalink
As I pointed out above, the middle class is slowly breaking under the weight of being a "brother's keeper".
Um, no. The middle class is breaking under the weight of stagnant wages that don't allow us to maintain the lifestyle to which we've become accustomed. For the last decade Americans were encouraged to borrow against the house to pay for the kids' education, a new SUV, widescreen teevees, the $10,000 out of pocket expenses for your cancer surgery, whatever.
You could open the Sunday real estate section and see the house you bought in 1970 for $40,000, 1980 for $60,000 or 1990 for $120,000 was now worth $400,000. We were told only a fool wouldn't tap into that equity to use for the "necessities" of life. And not only a fool, but an unpatriotic one at best, as our president told us our contribution to the war effort in 2001 was to go shopping. Keep that consumer spending portion, which is 70% of the US economy going strong folks. Just don't read the fine print on your credit card statement or your new Alt A mortgage. And don't worry about things you don't understand like currency manipulation, trade policy or healthcare costs as % of GDP that increasingly mean no matter how good you are at what you do or how many hours of unpaid overtime you're willing to put in a kid in India with the right software package or one in China with a wrench can and will do your job for a fraction of what you can afford to live on.
That's what's killing the American middle class CT. Not the pittance of our taxes that goes to being our brother's keeper. A whole lot of Americans are seeing the American dream die and only fools blame it on the powerless below them, who they are on the verge of joining, rather than those in power who have used us like pawns in a game.
July 21, 2009 11:09 AM | Reply | Permalink