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Pipe dream? Obamacare
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pueno



Joined: 03 Mar 2007
Posts: 2573

PostPosted: Thu Apr 04, 2013 12:56 pm    Post subject: Reply with quote

Mr. Fick-shun wrote:

Such as the vaunted VA electronic record system, which lost all my records twice? If I hadn't obtained and kept (against regulations at the time) all my VA and USAF records, I'd have lost man-years of effort and most of my VA services, maybe permanently.

I repeat: twice.

Did it ever occur to you, Mikey, that they actually threw away your records hoping to be rid of your sniveling?

Maybe the third time will be a charm. Laughing Laughing Laughing
.
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coboardhead



Joined: 26 Oct 2009
Posts: 1915

PostPosted: Thu Apr 04, 2013 12:59 pm    Post subject: Reply with quote

mrgybe wrote:
coboardhead wrote:
It will cost us now to save later on.

Unfortunately, it will not cost us now. We will continue to run large deficits, in part caused by ACA, we will borrow the money to fund those deficits, and enough people will continue to profess that debt and deficits don't matter. I've been responsible for a number of large scale reorganizations in my lifetime. I have a very bad feeling about this one both from an economic and from an organizational perspective.


The biggest problem within our deficit spending is health care costs. Our system is too expensive for the lower income WORKERS to afford health care. Employers (Walmart for example) are not providing this health care and the taxpayer is picking up the tab with, or without, the ACA. What about Medicare outgrowing our GDP growth now...and more to come as we age? Currently, 45% of health care costs are financed by governments and have been increasing (pre-ACA).

I would like to think you could reorganize health care as a business, but how would a business deal with a fulfilling a contract in a market that is out of their control that is such a large part of the total economy? Seriously, I am asking a question.
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isobars



Joined: 12 Dec 1999
Posts: 13801

PostPosted: Thu Apr 04, 2013 1:49 pm    Post subject: Reply with quote

coboardhead wrote:
I would like to think you could reorganize health care as a business, but how would a business deal with a fulfilling a contract in a market that is out of their control that is such a large part of the total economy? Seriously, I am asking a question.

That's what we've had for centuries, and what the GOP wants, but the Democrats think the government can do a better job of it.

Yeah ... seriously ... despite the failures of the VA and the UK.

Why wouldn't "enough people continue to profess that debt and deficits don't matter", when that's all they hear from Pennsylvania Avenue, Wall Street, and the left wing media? How can anyone smart enough and informed enough to see the fallacy in that support the party espousing it? And that's a serious question.
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boggsman1



Joined: 24 Jun 2002
Posts: 3472
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PostPosted: Thu Apr 04, 2013 2:07 pm    Post subject: Reply with quote

Here's a little quote from 11 years ago from a famous "left wing media" figure, Dick Cheney....right before he fired Paul O'Neil, then Treasury Secretary:

Mr Cheney cut him off, according to the interview posted on the Time website yesterday. "Reagan proved deficits don't matter," he said. Cheney continued: "We won the midterms (congressional elections). This is our due."
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coyotewindsurf



Joined: 03 Apr 2006
Posts: 1268
Location: SF Bay

PostPosted: Thu Apr 04, 2013 2:19 pm    Post subject: Reply with quote

coboardhead wrote:
The biggest problem within our deficit spending is health care costs. Our system is too expensive for the lower income WORKERS to afford health care. Employers (Walmart for example) are not providing this health care and the taxpayer is picking up the tab with, or without, the ACA. What about Medicare outgrowing our GDP growth now...and more to come as we age? Currently, 45% of health care costs are financed by governments and have been increasing (pre-ACA).


For these reasons and more, I think the benefits of a single payer program outweigh most arguments against it.

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mrgybe



Joined: 01 Jul 2008
Posts: 2541

PostPosted: Thu Apr 04, 2013 2:34 pm    Post subject: Reply with quote

coboardhead wrote:
I would like to think you could reorganize health care as a business, but how would a business deal with a fulfilling a contract in a market that is out of their control that is such a large part of the total economy? Seriously, I am asking a question.

To have reasonable assurance of success in a reorganization of this scale, several key elements have to be present..........1) buy-in from all, or at least most, of the significant stakeholders or complete ability to enforce the proposed changes regardless of the opinions of the stakeholders. 2) those who will be impacted understand what the impact will be and what they are tasked with doing. I currently see none of this. With only a few months to go a significant number of states have declined to construct exchanges (and Federal contingency planning seems lacking), businesses are confused, and the vast majority of the general public has no idea what to expect or what they will need to do. Perhaps all this will work itself out in the next few months. I'm not optimistic and would not be surprised to see a delayed implementation.

A well run business would have regarded the enormous uncertainties and lack of control in this venture as far too risky to tackle so comprehensively and in such a short time. They would not have undertaken it in this fashion. They would have attempted to introduce change in a phased manner learning as they went along.
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boggsman1



Joined: 24 Jun 2002
Posts: 3472
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PostPosted: Thu Apr 04, 2013 3:06 pm    Post subject: Reply with quote

“A lot of us are in disbelief that this is happening,” he said. “It’s a choice between seeing these patients and staying in business.”
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coyotewindsurf



Joined: 03 Apr 2006
Posts: 1268
Location: SF Bay

PostPosted: Thu Apr 04, 2013 3:22 pm    Post subject: Reply with quote

“I’ve never seen anything like it in 81 years of life. They’ve dug their own snare!” He was referring to Congress and the $1.2 trillion sequestration cuts that were then about to bite. “They put it there because they knew they’d never be stupid enough to let that happen. Well, every day that goes by proves that they are. So that’s the difference right there. It doesn’t matter whether we go over the cliff or under the cliff. These guys have put their nuts in a vise.”
Former Senator Alan Simpson

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mac



Joined: 07 Mar 1999
Posts: 4962

PostPosted: Thu Apr 04, 2013 4:15 pm    Post subject: Reply with quote

This misunderstanding has been repeated here by the left and the right:

Quote:
Misperceptions of Benefits Make Trimming Them Harder

By JACKIE CALMES

Published: April 3, 2013

WASHINGTON — President Obama had Senate Republicans nodding in agreement during a recent ice-breaking dinner as he described a basic problem for the nation’s fiscal future: For each dollar that Americans pay for Medicare, they ultimately draw about $3 in benefits. What’s more, he added, most people do not understand that.

By his point that evening, the president was referring to the widespread and incorrect view, especially among older Americans, that Medicare recipients get only what they have paid for through taxes, premiums and medical co-payments. Now that misperception is making it all the harder for politicians to consider trimming those benefits or raising out-of-pocket expenses as they seek to restrain Medicare spending that is rising unsustainably while baby boomers age and medical prices increase.

There has long been similar confusion about Social Security, although the current generation of new beneficiaries is roughly breaking even.

Late in 2012, for a sixth straight year, Medicare trustees issued a warning required by law whenever more than 45 percent of the health program’s costs must be covered by general revenues from all taxpayers.

To date, Mr. Obama has mostly proposed cuts to payments for health care providers, like hospitals. He has supported reducing benefits or raising costs for higher-income beneficiaries, but has made any broader benefit changes contingent on Republicans’ agreeing to additional tax revenues from wealthy individuals and corporations.

Even so, Republican senators said they were heartened by Mr. Obama’s dinner comments on the growing imbalance between Medicare’s benefits and taxes. If they could not yet agree on solutions, agreeing on the problem was a start, said Senator Ron Johnson of Wisconsin who was among the diners.

“I suggested it would be immensely helpful to reaching solutions to these problems if he would utilize that bully pulpit and start conveying to the American public the full extent, the full depth, of our problems,” Mr. Johnson said.

He added, “I’ll know President Obama is serious about working with us when I start hearing him tell the American people what he told us in private.”

Administration officials said that Mr. Obama, in speaking of a 3-to-1 ratio of Medicare benefits to taxes, was referring just to Medicare’s Part B coverage for doctor and outpatient services.

Older Americans pay about 25 percent of Part B costs through premiums, deductibles and coinsurance (high-income beneficiaries pay 35 percent to 80 percent). The rest comes from general revenues — income taxes and other levies. The ratio is similar for Medicare’s prescription drug benefit: While beneficiaries’ premiums cover about a quarter of costs, the rest comes from general revenues and borrowed money.

“They are heavily subsidized by the federal government, and the trend is getting worse,” said Robert D. Reischauer, a former director of the Congressional Budget Office and now one of two public trustees for Medicare and Social Security.

Medicare payroll taxes finance only the program’s Part A coverage for hospital costs.

While Mr. Obama apparently was speaking only about Part B, analysts say that it is roughly true for all of Medicare that beneficiaries on average pay about $1 for every $3 in benefits.

Analysts frequently cite Gene Steuerle, an economist at the Urban Institute, a policy research organization, who calculates average payroll taxes and benefits for Medicare as well as Social Security over the lifetimes of various types of individuals. Those figures vary by income, health, longevity, marital status, children and other factors.

For example, his October update showed that a single male who earned the average wage ($44,600 in 2012 dollars) and turned 65 in 2010 had paid about $61,000 in Medicare taxes and could expect $180,000 in benefits.

Social Security is a different story these days. That same single male, Mr. Steuerle calculated, paid about $300,000 in payroll taxes, excluding the portion for disability benefits, and could expect a bit less, $277,000, in retirement benefits. (Married couples do better than single people because many of them receive spousal and survivor benefits.)

Social Security and Medicare benefits are greater on average for women because they generally live longer than men.

The idea among Americans that they get back what they paid for, with some rate of return, dates to President Franklin D. Roosevelt’s legislative marketing of Social Security nearly 80 years ago. When Medicare was created in 1965, new payroll taxes were assessed to cover only Part A hospital insurance.

“That was sort of a foundation argument that F.D.R. popularized when the Social Security Act was passed — that this was a fiscally responsible program because people were going to pay in and, as a result of their payments, be entitled to benefits,” said Mr. Reischauer, the public trustee.

Yet Social Security has always been a pay-as-you-go system, with workers’ taxes going not to some actual trust fund for them but directly toward benefits for retirees. Initial beneficiaries paid little or nothing into the system, but “all of the first generations got windfalls,” Mr. Steuerle said.

For decades until the 1980s, workers paid a Social Security tax rate much lower than the current 12.4 percent (split between employers and employees) and on a smaller share of their wages, even as Congress expanded benefits. Only now are new Social Security claimants roughly breaking even and likely to get back about what they paid in. But young workers today can expect fewer benefits for their taxes.

“The bottom line is that the older you are, the more likely that your Social Security benefits exceeded your contributions,” said Charles Blahous, the other public trustee and a former adviser to President George W. Bush. “The younger you are, the more certain it is that your tax burden will exceed what you ever get out.”

As the fiscal debate rages, even the word “entitlement” — long part of the budget lexicon — has come to be seen as a pejorative among Americans who fear that benefits are threatened.

“Social Security and Medicare are both earned and paid for through our salary taxes,” a reader of The New York Times wrote recently. “A better term for these two programs is ‘earned benefits.’ It more accurately describes them without giving them a sense of negativity and welfare.”

Robert Keith, a budget historian formerly at the Congressional Research Service, said the term entitlement first appeared in the 1950s to describe Social Security and veterans and education benefits, and was in common use by the 1970s, after Medicare and Medicaid were created.

It describes programs that automatically provide benefits to those who are “entitled” because they meet certain criteria — like age and payment of payroll taxes — and cannot be changed except by a new law. In contrast, most other federal programs are called “discretionary,” because Congress can add or subtract annually in its appropriations process.

As the past two years have shown, that makes discretionary programs far more vulnerable than entitlement programs when Washington is focused on deficit reduction — though it is the fast-growing entitlement programs and insufficient tax revenues that are driving the projections of mounting debt.


In response, mrgybe says we should let a minority veto benefits for the poor and let them continue to use emergency rooms. Of course this is what he said then, in 2008:

1. Allowing health insurance companies to compete across state lines is not insignificant, it is huge. Buyers would have the option of buying from thousands of companies rather than a handful which is usually the case. Competition would drive price down. Tort reform.........ask any physician or hospital administrator if they consider tort reform to be insignificant.

Asked and answered here. Tort costs are not significant in the fact of double digit increases. And did I misunderstand that competition across state lines, "huge", is in fact an insurance exchange? Which the Republicans suggested and are now fighting? But rest assured, it is all Obama's fault. Why any oil executive could figure out a better way.

On a less snarky note, when the Democrats proposed a Republican scheme for health care reform, Medicare was already the largest player in the health care scene, and the cost increases were not sustainable. The US was having trouble competing with countries where the single-payer systems in place meant that the general populace, not the business, covered health care costs. Local governments were being swamped by the rapid increases in emergency room and employee insurance costs. The Republicans had just added a drug benefit to Medicare that guaranteed huge profits for Big Pharma. And the substantive Republican suggestions for dealing with these problems was? I'm waiting.
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beaglebuddy



Joined: 10 Feb 2012
Posts: 651

PostPosted: Fri Apr 05, 2013 1:33 am    Post subject: Reply with quote

pueno wrote:
Mr. Fick-shun wrote:

Such as the vaunted VA electronic record system, which lost all my records twice? If I hadn't obtained and kept (against regulations at the time) all my VA and USAF records, I'd have lost man-years of effort and most of my VA services, maybe permanently.

I repeat: twice.

Did it ever occur to you, Mikey, that they actually threw away your records hoping to be rid of your sniveling?

Maybe the third time will be a charm. Laughing Laughing Laughing
.

This is the kind of childish nonsense that needs to be no part of the forum.
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