Full Version: Taxes for Health Care?
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Why are so many people willing to pay through the nose for provate health-care and medical insurance, yet most people hate the idea of the higher taxes necessary for governments to provide free health-care and so make private insurance unecessary?
This is one of the areas in which my views can be seen as moderate, because I agree with the assertion that many make about not wanting the government to run healthcare. I hardly think that those same people who bring us such wonderful organizations as the DMV, and the FCC are eminently qualified to control something as important as healthcare. The government is not exactly known for streamlined efficiency... 
As to the taxes... What I fear is that we'd be paying double what we pay for private health-care, and the result would be a mind-boggling amount of red-tape and overall ineffectiveness. I wouldn't mind paying additional taxes to ensure health-care universally, as long as plans remain privately administrated. This to avoid the formation of yet another startlingly enormous government agency with no clue as to what it is doing.
As to the taxes... What I fear is that we'd be paying double what we pay for private health-care, and the result would be a mind-boggling amount of red-tape and overall ineffectiveness. I wouldn't mind paying additional taxes to ensure health-care universally, as long as plans remain privately administrated. This to avoid the formation of yet another startlingly enormous government agency with no clue as to what it is doing.
I have to agree with Stefan on this one. The last organization I want in control of health care is the gov't. We have state run health care in my state called TennCare and it is an absolute nightmare. As far as taxes go, how much more should I have to pay? I already pay over $1100 a month in Federal and Medicare and S.S. taxes, maybe $1500 would cut it? I do not want to see more and more control over our lives turned over to the gov't. Again it all goes back to the fact that only 50% of the people in this country even pay income taxes, so are you proposing that the other 50% start paying income taxes? I do not think that would go over too well, since a lot of politicians love to scream about the "rich" paying their fair share. The problem in our health care lies in the relationship between the business (doctor,hospital, etc) and the consumer, i.e. there is none. Insurance escalates the cost of things because most people never see what they are charged since "insurance will pay for it." If we had a more direct relationship, there would definitely be more people shopping around for the best price. Look at people w/out insurance but who have MSA's. They are paying out of their pocket so they are going to find the best price. If companies started offering Wal-Mart insurance, where instead of paying the bill each time, you paid the insurance companies $300 a month and you did not pay for your food, 2 things would happen: 1) People would start going to Wal Mart a lot more than necessary and 2) Wal Mart would raise its prices. And don't get me started on the Drug Companies, that is another thread entirely. But I digress.
First of all, I should thank all of you. Our income comes entirely from the Indian Health Service, so your taxes paid for this computer, and everything else in our house!
There needs to be some level at which health care is not a "for-profit" private enterprise. We have lived on two reservations, and before that, in a very rural, remote area. Take our present circumstance, as an example. The nearest decent-sized town is two hours from here, Port Angeles. We live in a very small fishing village. As with most reservations and extreme rural settings, the population is mostly quite poor. Unemployment is high. These are people without a lot of wealth. Without an IHS-run clinic here, what would be the incentive to have a health care facility here at all? It's doubtful that it would be profitable, in fact I am sure it would not be. So our entire population would be two hours from the nearest hospital. That's OK for primary care, perhaps, but what about an emergency? Even with the small clinic that IS here, my wife has to send people out by helicopter to Seattle on a regular basis.
Private practices tend to gravitate to where the money is. So if private practice is all there was, who in their right mind would set up a health clinic in a place where they know most people cannot pay them? The idea of universal health care is to me not an issue of "dumbing down" health care. Those who can afford to go to "Dr. Fancypants Clinic" should be allowed to. Universal health care is about access, not for those who have it already, but for those who have little or no access.
The other problem with "pay as you go" for everyone, is that it hurts the poor. People with less money are likely to pass up important treatments if they feel they cannot afford them. A doc might say, "you really ought to get an angiogram, it costs $150." Well, the guy just shelled out $75 for the visit, he might decide that financially he's just going to have to take the risk of NOT getting the angiogram. Patients would be making sometimes vital (and uneducated) choices about their health care based solely on their current financial situation. Even those of us with plenty of money would be encouraged by such a system to question treatments. Not that we shouldn't question our doctors, we should. But are we going to agree to what MIGHT be vital testing when we're not SURE of a pathology?
There's a huge grey area in medical science. If your arm is broken, you take steps A, B, and C and it's fixed. But what about more nebulous, unspecified problems? With insurance, a health care provider can say, "this could be a precursor to heart disease, I want you to get X and Y tests done." The context of possible heart disease would enable insurance to (probably and hopefully) cover the testing. Eliminate that, and you have people making uninformed choices that roll back the ideas of preventive care by decades. There are a lot of areas in medicine where the pathology is not obvious.
Universal health care would lower the cost, because uninsured people would not have to resort to ERs as a primary care facility, or wait until they practically fall apart to seek medical attention, again from an ER. If primary and preventive care were universal, there would be fewer people needing to be treated for preventable diseases and conditions, and the cost of health care would come down.
Please excuse my long rant!
There needs to be some level at which health care is not a "for-profit" private enterprise. We have lived on two reservations, and before that, in a very rural, remote area. Take our present circumstance, as an example. The nearest decent-sized town is two hours from here, Port Angeles. We live in a very small fishing village. As with most reservations and extreme rural settings, the population is mostly quite poor. Unemployment is high. These are people without a lot of wealth. Without an IHS-run clinic here, what would be the incentive to have a health care facility here at all? It's doubtful that it would be profitable, in fact I am sure it would not be. So our entire population would be two hours from the nearest hospital. That's OK for primary care, perhaps, but what about an emergency? Even with the small clinic that IS here, my wife has to send people out by helicopter to Seattle on a regular basis.
Private practices tend to gravitate to where the money is. So if private practice is all there was, who in their right mind would set up a health clinic in a place where they know most people cannot pay them? The idea of universal health care is to me not an issue of "dumbing down" health care. Those who can afford to go to "Dr. Fancypants Clinic" should be allowed to. Universal health care is about access, not for those who have it already, but for those who have little or no access.
The other problem with "pay as you go" for everyone, is that it hurts the poor. People with less money are likely to pass up important treatments if they feel they cannot afford them. A doc might say, "you really ought to get an angiogram, it costs $150." Well, the guy just shelled out $75 for the visit, he might decide that financially he's just going to have to take the risk of NOT getting the angiogram. Patients would be making sometimes vital (and uneducated) choices about their health care based solely on their current financial situation. Even those of us with plenty of money would be encouraged by such a system to question treatments. Not that we shouldn't question our doctors, we should. But are we going to agree to what MIGHT be vital testing when we're not SURE of a pathology?
There's a huge grey area in medical science. If your arm is broken, you take steps A, B, and C and it's fixed. But what about more nebulous, unspecified problems? With insurance, a health care provider can say, "this could be a precursor to heart disease, I want you to get X and Y tests done." The context of possible heart disease would enable insurance to (probably and hopefully) cover the testing. Eliminate that, and you have people making uninformed choices that roll back the ideas of preventive care by decades. There are a lot of areas in medicine where the pathology is not obvious.
Universal health care would lower the cost, because uninsured people would not have to resort to ERs as a primary care facility, or wait until they practically fall apart to seek medical attention, again from an ER. If primary and preventive care were universal, there would be fewer people needing to be treated for preventable diseases and conditions, and the cost of health care would come down.
Please excuse my long rant!
I agree with some of your points but there are a few things I disagree with. Here in TN, we have TennCare, which is basically socialized health care. The problem is that since the people in this plan do not have to pay for anything (copays, etc) they run to the ER anytime they want to, instead of making an appt. with their doctor. A visit to the ER is much more expensive than a doctor visit, but since they are not paying, they go. I agree that certain service may be passed up if a person does not have the $$$, but I think your point about not being so much "for profit" is a good solution to the issue of cost. Last time I had to go the ER, the bill was over $4,000 and I was there for about 6 hours. I had a bladder infection but they gave me an MRI to make sure it was not kidney stones. The MRI cost $2100, I mean, that is ridiculous. And also, one antibiotic pill was $8. But hey, insurance paid for it, so the hospital can keep charging these outrageous prices, and that is what hurts poor people. A big problem I have is that %50 of the people in this country do not pay income taxes, so if Universal Healthcare came about, half of the country would paying for their health care, plus the other half that does not pay taxes, and that is not fair at all.
I see where you're coming from, stotty. I have a couple of responses:
Can we agree that a segment of the population will not be able to afford health care or insurance?
If we agree that is the case, we need some sort of solution. I do not think that all health care should be free, but if universal health care were to be in the area of primary care and preventive health, we would see fewer people needing expensive treatments for preventable diseases and conditions, and fewer people treated for maintainable conditions getting out of control (ie: diabetes).
Even if healthcare was paid for by a payroll tax instead of an income tax, there is the issue of unemployed people, who would obviously not be contributing to that. Some may conclude that poverty is one's own "fault," and that therefor these people would just be SOL, but I don't think that's a defensible position. The idea of not refusing care to those in need is part of a medical ethic that goes beyond political ideologies. Can anyone logically defend a system in which a gunshot victim is refused treatment due to lack of insurance? Should he or she bleed to death outside the locked doors of an ER? I'm not, by the way, implying this to be your belief!
If we can grant that no person should be denied all medical treatment, then it makes the utmost sense to focus our efforts on primary care. One problem with this, however, is the immense power of groups like the AMA. Doctors want to preserve their monopoly of health care. An intelligent application of universal primary and preventive care would focus on Nursing, with Nurse Practitioners at the top of the primary care ladder. This would be cost-effective, and nursing is already geared towards the holistic ideas of preventive medicine. My wife is a Family Nurse Practitioner. She does everything a primary care doctor does, from prescribing medicine to advanced trauma life support, and yet she gets paid less, and has less expensive malpractice insurance. She has been through 8 years of schooling, too, including an RN, MSN, and an NP. In my opinion, NPs are the most under-utilized part of the health care equation.
Can we agree that a segment of the population will not be able to afford health care or insurance?
If we agree that is the case, we need some sort of solution. I do not think that all health care should be free, but if universal health care were to be in the area of primary care and preventive health, we would see fewer people needing expensive treatments for preventable diseases and conditions, and fewer people treated for maintainable conditions getting out of control (ie: diabetes).
Even if healthcare was paid for by a payroll tax instead of an income tax, there is the issue of unemployed people, who would obviously not be contributing to that. Some may conclude that poverty is one's own "fault," and that therefor these people would just be SOL, but I don't think that's a defensible position. The idea of not refusing care to those in need is part of a medical ethic that goes beyond political ideologies. Can anyone logically defend a system in which a gunshot victim is refused treatment due to lack of insurance? Should he or she bleed to death outside the locked doors of an ER? I'm not, by the way, implying this to be your belief!
If we can grant that no person should be denied all medical treatment, then it makes the utmost sense to focus our efforts on primary care. One problem with this, however, is the immense power of groups like the AMA. Doctors want to preserve their monopoly of health care. An intelligent application of universal primary and preventive care would focus on Nursing, with Nurse Practitioners at the top of the primary care ladder. This would be cost-effective, and nursing is already geared towards the holistic ideas of preventive medicine. My wife is a Family Nurse Practitioner. She does everything a primary care doctor does, from prescribing medicine to advanced trauma life support, and yet she gets paid less, and has less expensive malpractice insurance. She has been through 8 years of schooling, too, including an RN, MSN, and an NP. In my opinion, NPs are the most under-utilized part of the health care equation.
I agree with you about the NP's. Too often people go to the doctor and are there for about 2 mins and get charged $200, when again they say: "hey I only paid 5 bucks, insurance covers it." I do agree that people should not be refused health care either, although I am not sure how to go about it. That being said, I will have to ponder solutions some more as I have to go to work so I can pay for my insurance. 
I wonder if the Government gave money to insurance companies to cover those not insured if that would alleviate medicare woes. I mean, they pay now...I wonder if there would be any cost savings?
Darcaine
Darcaine
Darcaine,
That's frighteningly similar to what I suggested in my prior post... Could we possibly be agreeing on something? 
That's frighteningly similar to what I suggested in my prior post...
Could we possibly be agreeing on something?
I am ready to give up on private health care. I am ready for strict regulation of the health, insurance, drug, and hospital industries at the very least. What we have isn't working. Our physician Senate Majority leader comes from a family that helped lead the way to make nearly all hospitals for profit and their chain of hospitals (HCA i believe) had to pay a billion dollar plus fine for cheating medicare.
I was where Stefan is now when Clinton placed his wife in charge of the drive to create a national health care system. Ten years later things are much much worse and I am sick of watching Enron type scandals and hearing people talk about bringing business efficiency to government. (and this comment comes just days after the bipartisan-ly embarrassing pork package omnibus appropriations bill)
It is time for a major change in the health industry.
I was where Stefan is now when Clinton placed his wife in charge of the drive to create a national health care system. Ten years later things are much much worse and I am sick of watching Enron type scandals and hearing people talk about bringing business efficiency to government. (and this comment comes just days after the bipartisan-ly embarrassing pork package omnibus appropriations bill)
It is time for a major change in the health industry.
QUOTE(Eeyore @ Feb 20 2003, 09:02 PM)
Our physician Senate Majority leader comes from a family that helped lead the way to make nearly all hospitals for profit and their chain of hospitals (HCA i believe) had to pay a billion dollar plus fine for cheating medicare.
Perhaps you should do a bit of research regarding HCA, Inc. before designating them in need of further regulation. After the Medicare settlement of which you speak, the federal government DID enact regulations regarding physician referrals and hiring practices. See 42 USC Section 1395nn commonly known as the Stark II Regulations. For profit hospitals are now STRICTLY monitored by the federal government.
So more regulations have been enacted and the system is still screwed up. Government can't solve this problem. I hope this is settled in the market.
The problem with the market in this case is that it is inverted. People who pay insurance or get insurance than seek the most coverage under their policy. There is not a clear market incentive to drive down costs here.
I also do not trust the profit motive to bring about the best overall health care system. Curing a disease for good has a lousy return, but developing an expensive treatment for something can be worth billions of dollars.
I did not specifically want to reform HCA, I am ready for a state health care system.
The doctors, drug companies, hospitals, insurance agencies, and HMOs have left me feeling that even the government can do better.
The market has had a long run at this and things are spiralling out of control. Individual Americans need assurance that they can gain and keep access to health care. Individuals should have access to the same rate of insurance as large corporations. Let's just call us all one group and let ourt health coverage be mobile.
This way more of us can move on to better job opportunities or start up businesses without having to weigh the impact of health coverage for ourselves and our loved ones in the process.
There is not a true market in health care and capitalism in medicince is a mechanism to extract the most profits not create the best medicine and health care.
I also do not trust the profit motive to bring about the best overall health care system. Curing a disease for good has a lousy return, but developing an expensive treatment for something can be worth billions of dollars.
I did not specifically want to reform HCA, I am ready for a state health care system.
The doctors, drug companies, hospitals, insurance agencies, and HMOs have left me feeling that even the government can do better.
The market has had a long run at this and things are spiralling out of control. Individual Americans need assurance that they can gain and keep access to health care. Individuals should have access to the same rate of insurance as large corporations. Let's just call us all one group and let ourt health coverage be mobile.
This way more of us can move on to better job opportunities or start up businesses without having to weigh the impact of health coverage for ourselves and our loved ones in the process.
There is not a true market in health care and capitalism in medicince is a mechanism to extract the most profits not create the best medicine and health care.
Here in Soviet Canuckistan, as I'm sure you're all aware to a degree; we have socialized medicine. Now as anyone who has seen Bullworth knows, health-care costs are extremely lower in a single-payer system... but then again I doubt this is the Bullworth crowd, so let me see if I can find a good source.
Medical Care - Canada That is a persistent link from the EBSCO database so I'm not entirely sure how well it will work or for how long.
But my main point when considering "private" care is actually completely different. I'm not sure where the idea that in the American system you're not paying for somebody else comes from, but it seems very strange to me. Insurance rates are determined by an insurers cost, which is of course not tied in to one customers demand, but the demands of everyone in that company. Furthermore, when someone who is uninsured needs emergency care and the hospital provides it; that money will eventually be recouped in their costs by billing more to an HMO.
On edit: My link didn't work so here is the source information - Source: Washington Monthly, Jun98, Vol. 30 Issue 6, p8, 4p
Medical Care - Canada That is a persistent link from the EBSCO database so I'm not entirely sure how well it will work or for how long.
QUOTE
There are various ways to answer the question of public health care costs. One way is to look at the cost of health care goods and services exchanged as a percentage of all goods and services exchanged -- the Gross Domestic Product (GDP). In 1995, Canada spent 10 percent of GDP on health, compared to 14 percent in the United States. In 1995, Canada spent $2,049 per person, or about 55 percent of what Americans spent per person.
A much better way to look at the Canadian system is to focus on public costs and the share paid for from the public purse. In 1995, Canada's governments spent just under 7 percent of the GDP on health, a figure that is not very different from the 6.6 percent that comes from tax dollars in the United States. Although the proportion of public money spent in Canada and the United States is very similar, Canadians get much more for their health dollar and many more Canadians receive care from these public expenditures. This public money covers every Canadian for a wide range of services. In contrast, fewer than 30 percent of Americans are covered by government Medicare (13 percent), Medicaid (12 percent), and military (4 percent) care plans combined.
A much better way to look at the Canadian system is to focus on public costs and the share paid for from the public purse. In 1995, Canada's governments spent just under 7 percent of the GDP on health, a figure that is not very different from the 6.6 percent that comes from tax dollars in the United States. Although the proportion of public money spent in Canada and the United States is very similar, Canadians get much more for their health dollar and many more Canadians receive care from these public expenditures. This public money covers every Canadian for a wide range of services. In contrast, fewer than 30 percent of Americans are covered by government Medicare (13 percent), Medicaid (12 percent), and military (4 percent) care plans combined.
But my main point when considering "private" care is actually completely different. I'm not sure where the idea that in the American system you're not paying for somebody else comes from, but it seems very strange to me. Insurance rates are determined by an insurers cost, which is of course not tied in to one customers demand, but the demands of everyone in that company. Furthermore, when someone who is uninsured needs emergency care and the hospital provides it; that money will eventually be recouped in their costs by billing more to an HMO.
On edit: My link didn't work so here is the source information - Source: Washington Monthly, Jun98, Vol. 30 Issue 6, p8, 4p
Am i right in thinking that, in America, the welfare net only provides emergency treatment for the uninsured? If you have, for instance, cancer, it will not get you Kemo-
therapy. Do I have it right?
therapy. Do I have it right?
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