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Tuesday, July 31, 2012

Everyone is entitled to healthcare - FB conversation

A FB friend posted this:

Just paid the Dr. for my surgery. Thank God for insurance! More bills to come.

K.J.: Yes, health insurance is a necessary thing - everyone should have it.

Me: Some people are uninsurable.

K.J.: So, what then? Their bills have to be paid somehow.

Me: Who should pay them?

K.J.: Yes, that's the question.

Me: What would be your answer?

K.J.: Well, I asked you first, but okay: I believe that a single payer system is the answer.

Me: Just so I'm clear. You first mentioned that everyone should have health insurance, but now you want universal health care. The two are not the same. In our case, we have health insurance, but we will still be facing over $5000 in expenses not covered. How will universal healthcare pay bills not included in health insurance?

K.J.: It won't. There is no such thing as totally free-for-all, not in the real world. But the $5,000 won't ruin you whereas having nothing covered for a major disease might.

K.J.:And yes, a single payer system would provide universal health care.

Me: How do you know what size of unreimbursed medical expenses is bearable? Why should anyone have to pay anything for something as important as the right to health care?

Me: The average size of a medical expense bankruptcy is $27,000, which is not a hard number to get to. 40% of all medical bankruptcies are from people who are on government healthcare of one form or another (medicare, medicaid, state health plans, etc).

K.J.: There is a crisis in our health care "system" (or lack thereof), and that's a fact. Chances are that part of that $5,000 you'll owe is going to return on investment for shareholders and huge executive compensation. That right there is part of the problem.

K.J.: As to the 40% of medical bankruptcies being for people on Medicare, Medicaid, etc., please cite your sources. And are you saying that their financial difficulties are because of those programs?

K.J.: Let me add here a personal anecdote. As I'm sure you know, when your wife's father died after years of large medical expenses and coverage through Medicare, Medicaid and the Veterans Administration, he left behind a bill from the state for $250k, for which the taxpayers will be responsible. What's the solution? Have him die on the streets in his wheelchair? I don't honestly know. As we Boomers get there it will be scary indeed.

Me:http://www.connectsouthside.org/Portals/2/CVHPA/Breaking%20Down%20Financial%20Barriers%20to%20Healthcare%202005.pdf No, I'm saying that being on government healthcare did not reduce their financial difficulties due to health expenses.

Me: Average profit level of health insurance carriers is 1.75%.

Me: I did not dispute that there is is a crisis in health care.

Me: Your account of my wife's father sorta proves my point. Here's a man on gov't healthcare who left large bills. How is more gov't healthcare going to solve the problem?

K.J.: So, I ask again - what's your answer?

K.J.: Average profit level of health insurance carriers - AFTER all sorts of large expenditures for things I would consider unnecessary or exorbitant. What is their average expense ratio? Executive compensation packages?

K.J.: Good document that you linked, from what I can see at a glance. The first thing I notice is "In 2001, 1.9 – 2.2 million Americans experienced bankruptcy due to burdensome medical expenses, and 75.5% of these individuals had insurance."

Me: An insurance company is a private entity. What they spend their money on is their business. You were making the point that obscene profits were being made, but when I pointed out that the profits were not so obscene, you move the goal posts.

Me: And again, the quote from the document makes my point. Having coverage, whether private or public, does not solve the financial burden people are faced with due to their health care.

K.J.: Okay, two things. My original statement that I'm in favor of a single payer system would make moot your point about private entities. Is it right for people to get rich while many, through no fault of their own, are being bankrupted? Your ideal society supports that dog-eat-dog mentality? And, again, what is your solution?

Me: My answer is to deal with the problem and not the symptoms. Healthcare is expensive. Why? Because the external pressures on the industry have messed up supply and demand to the point where healthcare is not even close to being affordable. What are those pressures? 1) Defensive medicine. Doctors cannot practice medicine without fear of frivolous lawsuits, and as a result medical malpractice insurance is expensive. 2) Prior to ACA, gov't spent 46 cents per dollar spent on healthcare. This unbalances healthcare cost which causes cost shifting. 3) Preventative care is not an insurable exposure. We don't ask our car insurance to pay for an oil change, because the principle of indemnity is not at work.

K.J.: I agree that malpractice insurance costs are an issue. How to solve that? Don't understand your second point. Health care is not car insurance. Driving is optional. Preventative medicine is ESSENTIAL to cost control (not to mention health and welfare).

Me: ‎4) Peoples' healthcare expectations have increased, and they want the latest and greatest techiniques and procedures. 5) 60% of a ll health care dollars are spent at the last 6 months of life. People live longer, expect more, and doctors are willing to provide anything and everything.

K.J.: Agree to 4 and 5. Cost controls are necessary for 4 (and the rich will always get better health care). As to 5, again I ask what to do. Let people die in the streets? Euthanasia?

Me: ‎"Is it right for people to get rich... while many are being bankrupted?" Is it right for you to live in a beautiful house while there are so many homeless? Is it right for you to eat whatever you want when your neighbor might well be eating dog food? C'mon. Those kinds of faux correlations are beneath you, and I greatly respect your intellect.

Me: Preventive medicine has been proven to not lessen the need for healthcare. But I did not say that people should not obtain preventative care. I simply pointed out that it is not an insurable exposure.

K.J.: Well, thank you Rich. But it's a matter of degree. Destabilizing society with wealth inequities is not good for anybody.

Me: Nor is destabilizing society by creating envy and hatred for people based perceived wealth.

K.J.: I totally disagree with your statement that preventative medicine has been proven to not lessen the need for healthcare! Please back up your assertion! And again, it might not be insurable by private companies, who also have a disincentive to insure sick people.

K.J.: Please, look at the facts. Some may be guilty of what you accuse, but most of us just want to be able to work and make an honest living.

Me: http://scienceblogs.com/purepedantry/2008/02/19/preventive-medicine-is-not-alw/ http://www.cnn.com/2009/HEALTH/03/17/preventive.care.costs/index.html http://prescriptions.blogs.nytimes.com/2009/08/18/the-problem-with-prevention/

Me: Insuring a risk that has a near 100% chance of a claim is not insurance, it is welfare.

K.J.: Is Medicare welfare? I'm willing to pay taxes for something that is for the betterment of society.

K.J.: The article you linked says that some preventative medicine IS cost effective. It's complicated stuff and doesn't lend itself to an all-or-nothing approach.

Me: What a rich guy makes has no effect on my quality of life or my income. The economy is not a closed system, it is dynamic. Again, we need to abandon faux correlations that sound plausible but aren't real.

Me: Agreed, not all or nothing. However, you were on the "all" side, and I was on the "nothing" side, so we're both wrong.

Me: Medicare is not insurance, since insurance is 1) Accidental/unexpected. A known or imminent loss is not insurable.
2) Large enough to cause hardship to the insured. The purpose of insurance is to transfer risk.
3) Predictable. The loss arises out of a homogenous group large enough that the insurance company can estimate the total potential for loss.
4) Can be priced affordably in relation to the potential severity of loss. Some losses are so frequent or severe that the insurance premium would be very high. That is why there are exclusions in insurance policies – it is to make premiums affordable.
Medicare violates #4. The people in medicare are being subsidized by people who are not in the pool, so medicare recipients are the benefiaries of someone elses'wealth.
K.J.: Disagree with your statement about faux correlations that sound plausible but aren't real. I, for one, am not satisfied with allowing money and power to snowball. The Koch brothers love having "regular folk" argue on their behalf.

K.J.: In your discussion about how Medicare operates, it seems as if you're stuck on the idea of having private insurance companies fund health care costs. I am not. And again, I am in favor of taxation for the good of society. That includes closing corporate loopholes and having fair tax laws for individuals. You and I should not be paying higher tax rates than Romney. I don't buy the idea that if we tax capital gains at higher rates it will discourage investment - the wealthy are going to to what they do regardless of whether they pay a few points higher in taxes or not. It is really beyond my comprehension that people defend such a regressive system.

K.J.: But I digress - this is supposed to be about the health care system. Still, taxation is definitely an issue when discussing the possibility of single payer.

K.J.: By the way, Rich, I respect your intellect, too, and am enjoying our conversation. The lack of reasonable discourse these days is regrettable, in my opinion. I am fine with disagreement, as I can usually understand where a rational person is coming from. There are things I'm hearing lately that I really don't get, though, so I'm hoping that this kind of discussion can help bring me to a better understanding. I certainly don't feel like I have all the answers.

Me: Time for you to cite evidence yourself. So, establish your case. 1) Name one social program instituted by government that has solved the problem it was created for. 2) Almost $7 trillion has been transfered via taxation from the worker to the poor. Name any metric at all where the poor are better off than they were in 1965. Crime? Illegitimacy? Nutrition? housing? Health? Intact families? 3) The top 1% of earners pay 39% of al income taxes, the top 25% pay 86% of all income taxes. Please explain how this is regressive. 4) Please specify how a rich person making money damages you in any way. 5) Please explain how the government will be successful in providing healthcare to everyone given the present state of Social Security and Medicare.

Me: Actually, I haven't defended health insurance companies as providers of healthcare at all. On a pure insurance basis, health insurance companies have failed miserably. Of course, they've had a lot of help. Peoples' expectations, government mandates, the economy, and ill-advised investments have all contributed to our present debacle.

I mean, can you imagine? I am forced to purchase maternity coverage. Again, on a pure insurance basis, there is no rational reason to mandate coverage in insurance policies in order to further a social agenda. And that is precisely what is happening. More and more, business is pressed into the service of government's social objectives. This ought to appall any thinking person.

The real solution here is to dismiss all thrid parties out of peoples' health care purchases. Prices will come down real fast, and care will improve. A few lawyers, bureaucrats, and insurance agents might be out of business, but I consider that a good thing.

K.J.: I was thinking about the fact that you would assume (legitimately, because of my failure to communicate effectively), that I was making the claim that government programs solved problems. That is not at all what I was trying to say. Effective programs help to mitigate circumstances and help people to get into better position. Of course, many programs are abject failures, especially at the second part. That doesn't mean we should quit trying. And many of the social programs today fail miserably because they are so drastically underfunded (I'm thinking of state DSHS programs).

"Almost $7 trillion has been transfered via taxation from the worker to the poor." What a loaded statement! Right, we've just ripped $7t out of the wallets of good, honest working folk and handed it over to the poor. Again, this is a much more complex issue than you make it out to be, and I'm sure with time and effort (can't right now as I have an assignment due at 11) I could cite all kinds of evidence that whatever money has gone to fund programs for the poor has not been entirely wasted, or even mostly wasted. What about the trillions of dollars transferred from good, honest working folk to the S&Ls in the 80s, or to bankers in this decade?

When I finish my assignment I'm going to listen to the rest of tonight's Fresh Air. Heard snippets of it when I went to pick up my husband from the train - timely! http://www.npr.org/2012/07/31/157610155/facing-the-fiscal-cliff-congress-next-showdown

K.J.: Ha! And I'm forced to pay for Viagra, when birth control isn't available. What the heck is THAT about? Oh, right. Silly me.

Me: I love your delightful prose, but I need direct answers. You see, I can stand on a street corner and throw a wad of $100 bills into the air and some people are going to be helped. I want to know about a single government success in solving a social problem.

You mentioned underfunding. You are assuming, of course, that "adequate" funding will somehow change the equation. But you have precious little evidence to support such faith. First, show me the successful program. If there are no successes, I would suggest to you that it is irrational to expect that single payer will work.

K.J.: Alright, this will be controversial, I'm sure, and I don't have statistics at hand - I'm basing this on personal experience only. And, as I said before, no problems are SOLVED, only helped. Help is good. Some problems will never be solved, as they are part of the human condition. DSHS has done a lot of good for victims of domestic violence. When we were young this help was not available. The criticism DSHS takes is largely a result of underfunding - caseworkers are overloaded beyond any hope of having the ability to handle cases as they should be done. It was like that in the early 80s, when I volunteered as a Guardian Ad Litem, and it's far worse now.
In my experience as a volunteer, I used ALL my paid vacation time and many, many hours to work on the couple of cases to which I was assigned. When I hear people regularly say that social problems should be solved by volunteers, it makes me crazy. There are lots of good people who would love to devote their careers to doing the good work, but as a society we choose less and less to pay for it, so that those who DO go into social services soon burn out.

So many problems in our society can be helped if there is assistance available for those in need, especially for children. And no, I don't have statistics, although I'm sure I could find them if I were inclined to spend the time on it. It's common sense and common decency, and I would think that would suffice.

Me: By your criteria I can justify any amount of government intervention into society predicated on the idea that it will help, even a little bit. But what happens when your beneficent government, endued with all manner of power, turns against your agenda and starts using that power in a way you don't like? What remedy do you have? You can't put that toothpaste back in the tube.

Yes, there are lots of people who would love to do good work. That is not the same as government doing it. Government isn't compassionate, people are. Government inserts itself into the compassion equation, takes money from people with or without their permission, and redistributes it to others it deems worthy, including big business. That has nothing to do with compassion, common sense, or decency.

You said earlier that you are happy to pay more taxes in order to help. What's stopping you? Why do you take your deductions on your tax return? Send them more. There is even a website where you can send money to the government.

Or, why not simply help those in need directly and not depend on a capricious, wasteful, and arbitrary government to act as your compassion surrogate? Why is the "we" in "we have to help" have to be "we = government?" especially when they have failed so completely. This government you so love has waged illegal wars in foreign countries, has given sweetheart deals to big corporations, and has oppressed and enslaved peoples. Why are you so enamored with government?

You have to explain it to me, because it makes no sense at all. I admit that I'm not the brightest bulb on the Christmas tree. I really don't want anecdotes or sob stories, I want to hear it as a systematic philosophy.

K.J.: You have a paranoid and cynical view of government, as is your right. I'm cynical, too, but have more faith in government efforts than I do in for-profit private ventures. What evidence do you have for any tendency towards totalitarianism in our government (other than the fact that such an obscene amount of money is required to be elected to high office that a corporatocracy is an inevitability)? And I'll have to go back to find your 5 questions - you have a tendency to throw in non-sequiturs and I have a tendency to ignore them. If these 5 are not among them, then I will respond.See More
K.J.: ‎1) Name one social program instituted by government that has solved the problem it was created for. ANSWERED

2) Almost $7 trillion has been transfered via taxation from the worker to the poor. Name any metric at all where the poor are better off than they were in 1965. Crime? Illegitimacy? Nutrition? housing? Health? Intact families? ADDRESSED - Do not agree with your premise. Society has changed a lot since 1965, even just in pure numbers.

3) The top 1% of earners pay 39% of al income taxes, the top 25% pay 86% of all income taxes. Please explain how this is regressive. Have you seen the numbers on the wealthiest's percentage of ownership? In regards to how much they have, the tax numbers are low. Also, it is my belief that those who can afford should pay a higher rate, but I recognize this as a legitimate difference in philosophy. The reality is that if you make $1 and it costs 99¢ to live, then you have 1¢ in disposable income, whereas if you make $10 then you have $9.01. Expecting the same percentage of tax contribution for those two scenarios is regressive, and usually the latter is being taxed at a higher rate than somebody making, say $2 (yes, the $1 earner gets a break in this regard - SLACKER).

4) Please specify how a rich person making money damages you in any way. Are you kidding??? The concentration of wealth at the top is SO damaging and destabilizing to society. Higher rates of poverty and crime, less access to decent education, higher infant mortality - I can go on and on. Not to mention the fact that our economy is DEPENDENT on a strong middle class to consume it cannot be sustained by a small number of people buying luxury items. I have to say that this fact does not make me happy - materialism and consumerism is largely to blame for a whole lot of other problems.

5) Please explain how the government will be successful in providing healthcare to everyone given the present state of Social Security and Medicare. Again, you are looking at things in black and white. I never said that a single payer system would solve all of our problems. We have some huge issues now, with more to come and getting huger. I said that I thought it was the direction to move, because I do not believe that health care should be a for-profit corporate venture.

Me: There is no need to call me names. Paranoid and cynical are pejorative terms designed to impugn and divert.

Me: What evidence do I have? Really? I quote myself: "This government you so love has waged illegal wars in foreign countries, has given sweetheart deals to big corporations, and has oppressed and enslaved peoples." To this I add The Patriot Act, Dred Scott, warrantless wiretapping, guilty until proven innocent with the IRS, no knock entry into private property, outlawing children selling lemonaid on a street corner... gawd, do I really need to go on?
Me: Medical marijuana forbidden, RICO statutes allowing seizure of property without due process, Gitmo, declaring a person a terrorist means they forfeit their constitutional rights...

Me: The most a corporation can do is overcharge me, but the go'vt can put me in jail, deprive me of my rights, and even put me to death... all legal, all by the book.

Me: Totalitarianism is your word, not mine. A government is oppressive by degrees, and must be restrained. That is not only reasonable, but prudent. Whatever happened to the anti-establishment sentiment of the 60s? You all seem to have sold out to the Man.

K.J.: A diversionary tactic is to accuse somebody of name-calling when they are just commenting on the nature of your remarks.
K.J.: It's still a democracy. If we don't like the laws being made, we are supposed to have the power to implement change - that is, if we are an educated and rational populace. Antiestablishmentariansim in the 60s was more aimed at the corporatocracy. It's time to bring it back.

K.J.: and when that corporation has too much power, it does more than overcharge you - it controls the government.
 
Me:  I see. So it's just fine to call someone paranoid? Conversation over.

K.J.: That's fine for the conversation to be over. I do apologize for calling you paranoid. You're right that it is not in keeping with civil discourse. I have to say, though, that you can be quite the bully in these discussions (yes, I've read others), but are very quick to act injured if there is any hint of personal attack on you. It strikes me as a diversionary tactic. But there I go again with the personal attacks. It's too bad, because I HAVE enjoyed our dialogue.

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