Effect Measure

The idea that if the United States joins the rest of developed nations and finally adopts a universal health care system it will bankrupt itself is not based in reality. The reality is that the US spends a larger proportion of its Gross Domestic Product (GDP) than any other developed nation. By far. Not even close. CDC has just documented it from data collected by the Organisation for Economic Co-operation and Development (OECD) in its 2008 health data yearbook (statistics and indicators for 30 countries). It suggests we are being bankrupted by our lack of a universal health care system:

i-377830997f38959f7121c66bc42f30c9-OECD.health.expenditures.jpg

CDC’s laconic commentary:

In 2006, the United States devoted 15.3% of its GDP to health-care spending (i.e., health goods and services plus health-care infrastructure). Seven other countries devoted >10% of their GDP to health-care spending: Switzerland, France, Germany, Belgium, Portugal, Austria, and Canada. Five countries devoted <7% of their GDP to health-care spending: Czech Republic, Mexico, Korea, Poland, and Turkey. (MMWR, CDC)

Countries whose technical level of medical care is at or above the quality of the US’s (although most people in the US don’t have access to the best care), indeed devote sizable proportions of their GDP to health care (greater than 10%), but still significantly less than the US. For most health indices they are also doing much better for their people than the US.

The simple truth is that one of the major reasons we have such a lousy health care system and receive such bad value for our money in the US is that we placed health care financing into the hands of the same folks who helped make our economic system such a disaster: private insurance companies, who are little more than disguised investment banks with the added incentive not to pay back their depositors (the premium payers).

We don’t need health care reform with a public option. We need one with public financing by default, perhaps with a private option for those who wish to and can pay extra for it.

Comments

  1. #1 M. Randolph Kruger
    April 13, 2009

    Gee Revere, I think you could also turn that around and show the GDP that we spend defending those countries is a much bigger graph than this one.

    Sooner or later they will cut defense spending and there will be a grab for a piece of land, or territory… An oil field and then UHC wont matter as things escalate out of control.

    Healthcare is not a right. Even demanding that someone else pay for someone elses care goes against the Constitution because that portion that receives the benefits, will never pay a dime for it. They never pay income taxes.

    And you talk about investment banks and this and that. Its always been like that and we always have meltdowns and busts. I for one would never, ever let government control another thing in my life. UHC is a control mechanism, not even close to being an attempt to make healthcare available.

    Drank out of any flower pots in the UK lately because you couldnt get water from your UHC hospital? Dumbest thing the have ever done.

    Healthcare for all and all at someone else’s expense.

  2. #2 MissFifi
    April 13, 2009

    Now, while I agree, that the government may not necessarily be the best arm of the land to rewrite health care reform, they are the ones who pull and loosen the purse strings. Watching the health care forum on CSPAN the other night was enlightening and informative. More people need to understand how complex this matter is and what all involved in health care and medical services is up against. It is not about being a Republican or Democrat, it is about understanding what exactly is going on within this industry and not regaling it just Constitutional rights or government control.
    http://www.cspan.org/Watch/watch.aspx?MediaId=HP-A-17243

  3. #3 floormaster squeeze
    April 13, 2009

    This topic has been near and dear to my heart for a long time.

    I am a little distressed that the true reform efforts get sidetracked by blaming health insurers. Health Insurance companies really are not that much of a financial intermediary (they are to some extent but they really are not holding money for that long–not like any other form of insurance where they really are significant financial intermediaries). I think health insurers do a bad job of helping employers/people keep costs down and creating “single payer” power in insurance helps. But that is only a small part of changing the above.

    If you are not willing to look at the massively wasteful and inefficient health care delivery system you will continue to reproduce the above even in a “universal system”. The problem comes in that the waste and inefficiency is most obvious from a health perspective (i.e., in the actual results) and the health care delivery system only wants to talk about health care. Anyway, the health care system has enough inefficiency in it that controlling it will be a big help (even without addressing the health/public health issue) but no one seems willing to take a hit. Any initiative gets the “shrill rhetoric overload” (see MRK drivel above)and hospitals/doctors/etc all do such important work that it is difficult to get rational political discussion of their role (which should be simply to care for us and cure us in the most efficient way).

    Nearly all health care “reforms” that did not address costs in the health care delivery system have failed massively (Maine, and everyone’s favorite Massachusetts). Massachusetts, according to recent released study, increased health spending 25% through their “reform”. Sadly, no one asked the question, is that the best we could do for all that additional billions? (of course, it is not but even simple solutions to get people access to health care were off the table and the “reform” was really about shovelling billions to hospitals and to a lesser extent doctors).

    Another important point that no one talks about (but that goes back to old titans of industry like Lee Iacocca) is that the high cost of health care (largely born privately) is a burden competitively to US industries. It is too bad that ideological concerns trumped bottom-line issues when it came to supporting UHC for US manufacturers.

    A lean efficient health care system is probably a dream but an important vision to have.

  4. #4 KAS
    April 13, 2009

    Re: Kruger

    Agreed. We spend more on our military than we do on health care, and we certainly spend more on our military than other countries spend on theirs. But I think I missed something. I thought we were putting other countries in greater danger – not defending them. I remember a paper called “The Iraq Effect” coming out of NYU’s law school that documents a dramatic increase in terrorism since we invaded Iraq. I don’t know of any evidence that suggests we are “defending” other countries. Maybe in WWI and WWII we could have made that claim, but those wars happened a very long time ago. Maybe I’m naive or don’t know something that you do. Do you have evidence to support that claim?

    Also, point of clarification: revere didn’t said anything about health care being a “right” in this posting – only that uhc makes more economic sense.

  5. #5 natural cynic
    April 13, 2009

    So why doesn’t Kruger whine about the international socialized defense spending racket. Luxembourg, Portugal, and Denmark are using the services of our mighty military in protecting them from their larger neighbors instead of taking care of themselves. Certainly Austria needs so much protection from Slovenia and Switzerland that they should quadruple their defense budget. And the Kiwis should be spending much more on on their navy to defend themselves from the covetous eyes of the Aussies and Japanese. That sucking sound you hear is our money being spent on all these deadbeat countries. Yeah, they should be spending much, much more on defense. Greedy bastards.

    Or maybe maybe they’re just sissies who don’t want to join our “boys who need more toys club”.

    Or maybe some people are deficient in their concept of “insurance”. Want to pay for surgery and chemo out of pocket?

  6. #6 CW
    April 13, 2009

    Ways to know when the health care problem has gone spinning out of control:

    1) Health care for students and those on medicare/medicaid is better quality than for those who work full-time jobs (an example of the rising cost of health insurance for companies).

    2) Young people live with their parents, work a full-time job (make >30K/yr), and still claim medicare (an example of how the system fails by providing aid to those who don’t need it -or- an example of how smart (dishonest) people work the system).

    3) Young people pay rent, work a part-time job, go to school, (make <20K/yr) and are grossly underinsured (an example of how the system fails to provide aid to those who need it). A good example of this is a diabetic friend of mine who can’t afford to buy test strips so just guesses at his BSL.

    4) Young people who work full-time jobs wonder why they’re paying into medicare and social security when they suspect they will never see a dime of that money in their lifetime (what I think about during tax season).

    I know people in each of these situations and find it truly frustrating. It’s enough to make a girl quit her job, have a dozen babies, and live off the government.

  7. #7 MoM
    April 13, 2009

    Randy –

    Even demanding that someone else pay for someone elses care goes against the Constitution because that portion that receives the benefits, will never pay a dime for it. They never pay income taxes.

    Uuh, do you just make this up, or did you read it in some fantasy novel? Many, if not most of the folks without insurance are employed. That means that, unlike rich folks, they have their taxes deducted from their wages. They don’t even get a chance to evade taxes through the use of smart lawyers. (Note the Warren Buffet quote that his secretary pays taxes on her income at a higher rate than he does on his.)
    And,
    I’ve read the Constitution, and I don’t remember a place in it anywhere where it mentions only giving benefits to those who pay for them. I do seem to remember something about promoting the general Welfare and securing the Blessings of Liberty to ourselves and our Posterity, but I’ve gone back and read it again, and don’t see anything about denying rights, protections or services, based on the payment of taxes. About the only thing that comes close is the 24th amendment, which specifically prohibits imposition of a tax as a qualification of something provided by our Government (the ballot).

  8. #8 paiwan
    April 13, 2009

    If we look at the structure of tax income for a government; we understand that there are items are indirectly taxed-like when you consume gasoline-the VAT or business tax is included, and there are income taxes directly from your salary or business profit.

    Any one who goes out to buy anything, to eat and to work are contributing not only to the community, but virtually also is contributing to the tax incomes.

    “They never pay income taxes.” to imply that they don’t pay a dime is an incorrect claim.

  9. #9 Phila
    April 13, 2009

    Nothing says “I am an American patriot” louder than lying about tax issues in hopes that your fellow citizens will continue to be denied timely and effective healthcare.

  10. #10 M. Randolph Kruger
    April 13, 2009

    Its the diff MoM of trying to remember that we have 12 people that will be on this in the near future that cant pay for it because they WONT be employed by anyone but Social Security and supported by 1 younger than 65. Its pure economics. There is a move to move to basic care only under Medicare because it cant cover the numbers now. Holland has delegated it to local authorities to tax and spend as necessary so its cash flow for the locals. They too have a boomer crowd. UK, everywhere and unfortunately its a numbers game. If all the governments collapsed in another world recession what are we going to say, “You dont have a job, but at least you have your health”? No, we actually need more dead people to cover what we have going already. Social Security is going broke and between the two they account for 55 TRILLION dollars in commitments before 2020 and 103 TRILLION estimated now (number likely higher due to inflation) and this bailout crap. Sorry but there simply isnt any feasible way of doing it that results in an outcome. Besides you spend them money, federal money and you are simply putting it into a pine box in the ground in about 73 years on average. This is where the divergence of the right to Constitutional right comes in to play. Paiwan, our taxes that pay for this is based upon income taxes, not consumption taxes. Those here go all local and only a small portion of it comes in as federal taxes. Gasoline taxes? They go to fund federal/state road projects.

    The VAT is already inherent in the system and all of the money thats there for that is spoken for by the tax its specified for. Like 38 cents a gallon that Carter put in for “alternative energy” that goes to the DOE budget specifically. In actuality they steal it for everything else under the sun such as wars, indigent care, scuba gear for the Nevada Highway patrol, the BIG DIG, subsidizing green energy which is already subsidized and bridges to nowhere. Its the earmarks that come up with the real off the budget bullshit… 6800 of them this year and its nothing but a giveaway. Paper money being printed to pay off printed money. Gold standard would have stopped this long ago. In fact, if we had been on it and UHC was voted in then likely it would have been a paid for program. Cant do it with paper because it wont pay for anything anymore outside of the country…resources like oil.

    MoM, the taxes are taken out and then they get them right back as a refund so no, they dont pay any tax. They pay the same consumption taxes like I do but I employ a lot of people so I could also go to employer contributions and the like. But you are talking about a right in your mind, uninsured does not mean no health care. The concept that we owe someone else a living is what you are touting.. . Did you not get that memo in the Constitution. I dont see ENTITLEMENTS (WTF is that anyway), I dont see HEALTHCARE or any of the generally accepted welfare programs that will shut this country down in there.

    The reason its not there now is that its widely accepted that if it gets in front of even a leftist Supreme Court that it will be found unconstitutional and even if it did it would bankrupt the country. Obamas 680 million down payment? Shit, they paid that much last year in the UK with only 60.5 million people in under three months.

    Why knocked down? Because it opens the door to the complete welfare state that will squeeze the productives into non productivity until the system collapses.

    Drinking water from a flower pot… actually happening in the UK now and the assholes ADMITTED IT ! Social welfare at all costs? I think not. 30 years ago maybe, it was examined under Kennedy and each time it came back with a no. Government telling you what you are going to do with your body, determining what companies will run, who will run them. You might understand that this is leading to complete and total control. It likely will end in civil war as it plays out later when people just one day say NO ! Once it leaves the legal arena to the military one it will not come back. You will of course disagree but I have been in a lot of places where I saw the acceleration to this for a lot less.

    CW is pretty much right. I knew in 1978 that I would never see anything productive or to my inurement out of social security. Its better and more effective to live like a leech. Why work? Our government is going to give you food, housing, healthcare and fuckit if someone else has to pay for it. That works right up until the time you run out of the ability to spend everyone elses money. But until then you get to hammer the old class warfare thing that the libs, the leftists pump out. Revere will say you will pay less? Oh, really? Based on single provider which is the UK system to the T, they are paying how much of their income as taxes to support that. Well if you have too many people in the system it doesnt. Doctors are also rationed as is the care/medications itself. A BOARD decides if you can have a procedure or not and if not, well tough titty.

    MoM-It says promoting it, but it doesnt say that you can tax for it anywhere. In fact, about the only place you can find it is in the original base document of the Constitution but it doesnt say what you are posturing. That posture is that its a right. It doesnt give the federal government the right to do what is being done and if its held you might never have to pay for anything beyond the military ever again. Where in the Hell did all of these departments come from? All the federal government does is employ people. Revere covers it well in the FDA onslaught and CDC… Shit, get rid of them. DOE too… No energy. Military? Well we need them. State Dept? Professional negotiators to negotiate our rights away to the UN…. Get rid of them.

    Taxes are control. The limitation of the power of the federal government is what the states sovereignty movement is. They are letting the federal government know that they are not going to come up with massive programs that require even more massive state taxes to create a welfare state. Nope, not going to happen. IN FACT mom I cant find anywhere where it says benefits to anyone. You have the rights to life, liberty and pursuit of happiness… Not that it will be provided to you.

  11. #11 Tom DVM
    April 13, 2009

    Maybe we should look at healthcare as a personal investment…in that the taxes that I pay for healthcare aren’t taxes at all but an investment in Canadian Health Insurance Inc. In this company, all profits and dividends are re-invested .

    I hope that at some time in the near future, my American friends will have the same peace of mind that I have…and I bought my piece of mind with comparably little tax money, in my opinion.

    Might I suggest that those interested come to Canada and examine the Canadian experience for themselves…rather than get their information third hand.

    It is achievable and there is no better gift for children and grandchildren etc. etc.

  12. #12 MissFifi
    April 14, 2009

    So Kruger, for you is it all about, if you make it great, if not you are on your own? I am not being fresh, as email never conveys tone properly, I really want to make sure I get where you are coming from. Is it wrong for me to say you do not want any government involvement in anything? So no CDC, EPA, FDA, etc. just let drugs hit the market without tests, who cares how food is made and well, the EPA lied about the air here in NYC/NJ after 9/11 so they suck too. So do away with them and see what happens kind of thing?
    OR
    would you like a better restructuring of how the taxes are set up? Or is it that the government agencies set up are a front from something? Are you thinking they are better if they are privatized, but then does that not allow bias? I mean, we all know Social Security is practically bankrupt, so what is a good solution?
    Welfare has been a poorly monitored system that should have been set up for temp help and then kicks you out. Sadly, we have families that are generational on it. Saw a fantastic documentary about Appalachian families that even when they try, get no encouragement from the government to leave the system. Messed up stuff.
    Also, when I was a student I had to have health care so I bought the plan from college, trust me, it was as minimal as it possibly could be. So for CW, I am sorry you know those types of people as I would never leech like that.

  13. #13 Kristjan Wager
    April 14, 2009

    When I first started blogging, one of my first blog post was titled Is universal health care affordable in the U.S., where I did a bit of number crushing.

    What I found to my surprise, is that the US is actually ranked 7th in the world when it comes to public spending on health care (4th if you take relative buying power into consideration).

  14. #14 M. Randolph Kruger
    April 14, 2009

    MissF-No you should understand that everyone is equal under the law. That means if I work I should reap the benefits of it. In fact that is NOT the case. The federal government, onerous and large wants to grow larger and take money from me to redistribute it to others. I was saying this long before the current problems so its not something that just came up.

    Interview with a NOLA evacuee last year by one of the local TV stations. There was a guy who was pissed because he was getting thrown out of the hotel.. upscale hotel at that. Whats the problem? His check hadnt arrived before the evac. This guy is about 24-27 max, driving an Escalade. What check the reporter said? My welfare check his reply. The reporter starts to press. “Is this your car?” and the guy responds affirmatively. “So you had to leave your job in New Orleans?” The responds no. “I never had a job” he said. The reporter looks a bit dumbfounded, “Never had a job?” No he says. The camera guy whips over to the E-car and back and forth to the guy and the reporter asks what the guy is going to do. “Have to go to the local shelter and pick up another check.Its not a good one though. Only 1800 for living expenses for a week.”

    I can assure you that someone else picks up this guy and his families living expenses, food stamps, rent and probably is the recipient of the Malcom Baldridge for welfare excellence. Most people just cant get the math of whats coming Tom. IF we had been responsible from the 60′s on then maybe there would have been some sort of health insurance that the federal govt. may have been able to provide to indigents. I can tell you that the state insurance program bankrupted the state in just under five years. The local insurers went out of business and left even the people who could pay, broke. AIG was part of it. The users simply broke the bank in short order. It accounted for the ENTIRE budget of the state in just under 5 years. The Canucks are hurting but good because of their health care system… The Uk is a shambles. But the idea that we should do it in an economic crisis because its just one less thing is pure crap.

    And yes Fifi…This country was made great because of the people who never looked at the government for handouts. There werent any. I see little versions of this all around me. Kids who wont even work because either the govt. or their parents or both are acting as their net. One day soon when the inflation rate rises because of the spending, the game is finally going to be over. Total and complete economic collapse as the Arabs wont be taking paper for the oil. They’ll want gold. Then the big decision comes… do we use food as a weapon? Get back to me… the other though is inevitable.

    You cannot spend your way out of a recession because the backside is that it always causes a deeper one when the bills come due. About two years from now, there is going to be hell to pay. And yes, we will all be on our own. There will be people who will work for just about anything then. End of the game and there will be no UHC, TARP or any other bullshit to go along with it.

    Oh Revere-Now maybe when the Governor of the second most populated state starts saying it openly maybe you guys should start paying attention….. http://www.drudgereport.com/flashtx.htm

    This left wing spendathon is over…. they will soon just simply say no and then its going to get mighty damned interesting. Wonder what would happen if suddenly everyone just said that to the lefties? The new DHS head says that “right wing radicals ” pose a threat to the government.

    Yeah, they were the Founding Fathers. This system is about to evolve into something…What I do not know.

  15. #15 MissFifi
    April 14, 2009

    Kruger – thank you so much for your response.
    Welfare has always been a sore spot I think because of cases like the one you mentioned. It should make everyone ask “Why haven’t there been stricter regulations”? I always think someone abusing the system is taking from someone who may desperately need it. WIC programs came in place to regulate what the baby gets, but it was still not enough. Why don’t we want to wean these folks off the programs? That is a question that I do not think has ever been asked nor answered.
    I am hoping all these discussions can bring us to a good place while looking for solutions. Documentaries like A Crude Awakening, House of Cards and Maxed Out make me wonder if we can really pick ourselves up from this pit we have fallen into. As the Japanese proverb goes “Fix the problem, not the blame.”

  16. #16 Colleen
    April 15, 2009

    First of all, Mr Kruger, everyone pays taxes. You are making the disingenuous argument that the only taxes people pay are income taxes. That is not true at all. Everyone who works pays payroll taxes. Don’t forget sales taxes, car taxes, cell and phone taxes, sin and property taxes. And all the fees that are taxes by another name- like getting your car inspected, registered, and getting your driving, hunting and fishing licenses. Even stamps are a form of taxes. Since the poor are FICA’d on everything they make, the poor probably pay a higher percentage of their income in taxes than most.

  17. #17 Michael
    April 15, 2009

    As a Canadian, let me say that whilst I would not swap our system for yours, there are many things wrong with the Canadian system, and we could both learn from many a European country.

    And if health care is not a right, pray tell me what is. Surely the country benefits from a healthy populace.

  18. #18 Donna
    April 15, 2009

    I have never understood the righteousness of some Americans who believe they are overtaxed and carrying the “burdensome” responsibility of ensuring that other Americans have a safety net. Yes, some safety net programs definitely need restructuring. But don’t tell me that “it’s unfair, it’s unfair! I’m paying for others, constantly.” Prima facie evidence reveals otherwise. Many Americans come up from having little, work to secure wealth, are self-made and thrive. Under the current system! So indeed, the system works FOR them/us, not AGAINST them/us. You only need to look south of the border, to Latin America, where government is stacked against the impoverished masses, for the benefit of the few. There are huge income disparities and societal dysfunction. That, my friends, is the alternative, and I’m saying you wouldn’t want it. My city, Miami, is an amalgam of the two systems, mirroring the mindset of Latin America (a class-based society which functions for the rich at the expense of the poor), but providing the social safety nets, wanting the newly arrived to “process through the system” to self-sufficiency. If we didn’t have everyone looking out for each other, and ourselves, included, we’d have looked like Rio or Mexico City a long time ago.

    As to the taxes, the working poor are the most burdened by taxes, on a per capita basis. Robert Kiyosaki’s Rich Dad/Poor Dad books remind us that being an employee is the least attractive of the alternatives, because taxation is at its highest. Self employed is preferred, because you can discretionarily expense some/much of your income away, before taxes. Owning a business is even better, where other tax avoidance/deferral tools are available for use – not to mention economies of scale for multiple operations, etc. The best of all? Investors, where portfolio and passive income tax codes treat these forms of income preferably. I am a “small business owner”. In truth, I own my job, so I’m self-employed. My husband has been, at various times and sometimes concurrently, an employee, self-employed, a business owner and investor. We do not mind paying our taxes – it’s a privilege to live and work in this country and assist others to maintain their dignity and allow them the chance to improve their lot. My taxes pay for an entire societal system which, yes, needs a bit of tweaking, but generally works. This is what makes us Americans!

  19. #19 Craig
    April 15, 2009

    The best solution is going to be one where we start with the premise that every American is entitled to a basic level of care and catastrophic coverage. People should not face financial devastation because they get sick. That is wrong and unjust. It should not be the American way but it is. Some Christian nation! Letting the insurance companies manage our health should be a criminal act. They have ruined our economy and our health system is on its knees too because of their profits before patients business model. The biggest obstacle to reforming our system is going to be overcoming the corrupting influence these financial shysters have on our government officials. After all the coddling and protection which Mr. Obama has given to Wall St as well as the TRILLIONS of dollars given to banks and insurers I’m not sure that we will see much progress in making our health system work better for the average American. If it is done right then we will have a government option which will not be out to only make a profit off of my health.

  20. #20 JEA
    April 15, 2009

    Yes, the government has done a bang-up job with Medicare and Medicaid. Let’s give it all to them…

  21. #21 Kruger Is Full Of It
    April 15, 2009

    That means if I work I should reap the benefits of it. In fact that is NOT the case.

    Shorter Kruger, “WAH!” Obviously the tax system is SOOOOOO onerous in this country that all wealthy people have all of their money taken away from them. What a crock of s***.

    Interview with a NOLA evacuee last year by one of the local TV stations.

    Here we go. You know of a case where somebody abused a social welfare program, therefore all social welfare programs are bad and should be done away with. By your logic, I know of a bunch of financial institutions that did bad things, so we should shut down all financial institutions. I know of car companies that lied to the public and produced vehicles they knew were unsafe, therefore we should shut down all auto manufacturers. Tobacco companies lied about the safety of their products, so we should shut them all down. (Well, actually we should, but that’s another argument.)

    BTW, to quote an unknown but very wise person, the plural of “anecdote” isn’t “data”.

    I for one would never, ever let government control another thing in my life.

    You say you that, but it’s bulls***. If you own your own business, you’re taking advantage of government controlled infrastructure left and right. Roadways that lead to your business? Power grids? Water? Sewer? Internet? Educated workers? Police? Fire?

    Face it. You haven’t a freaking clue what it would mean to be on your own.

  22. #22 revere
    April 15, 2009

    JEA: I’m on Medicare. Are you? It’s pretty good. As for those on Medicaid. What do you propose we do with them? Abandon them?

  23. #23 dsimon
    April 15, 2009

    It’s not really an honest argument to bring up people drinking out of flower pots in Britain. Just because the British system has some dysfunction doesn’t mean other systems don’t to better or ours isn’t worse in many ways. For instance, I’ve read that wait times to see a specialist in Germany are far lower than here (for those here who get to see one). It depends on how you structure the system and how much money you’re willing to put into it.

    And the data seem pretty clear that Europeans do as well or better on just about all health metrics than we do while spending a little over half per capita. I’m basically a free market person, but I’m not going to ignore the evidence that maybe our system does not put the incentives in the right places for better health care outcomes.

  24. #24 floormaster squeeze
    April 15, 2009

    The problem with health care policy is that most parties refuse to understand what they are talking about. 90% of the comments made, and this includes many knowledgeable people, about Medicaid are simply inaccurate.

    Medicaid is the most lean and efficient health care in the US. Any inefficiency is usually because some concentrated business interest, politically powerful provider, get some state rep to do their bidding. There is little to no administrative overhead (and when there are problems that is usually at its root).

    While most people think of Medicaid as a healthcare entitlement to the poor (which it is in a way but not in any burdensome way really), the care to the poor really is not a fiscal burden to non-Medicaid members. If Medicaid members had NO insurance then they would simply be using the ERs and hospital costs for everyone would go up more than actually paying for care (including preventive care that keeps people out of hospitals).

    But there is an even more fundamental misunderstanding about Medicaid–it is not, as measured by costs, primarily about providing care for the poor. You see, it is insurer of last resort, which means it is primarily a reinsurer for your cheap-ass profit-loving private insurance. When a privately insured person gets really sick and needs all kinds of special care–that person usually gets Medicaid. This most famously happens when you need long term care and why Medicaid pays for 90% of LTC costs (of course, Medicare is also “free-riding” off of Medicaid). It is completely backwards system but Medicaid is EVERYONEs LTC insurance plan whether they admit or not.

    You are getting WAY more benefit from Medicaid than you are paying in taxes (unless you are independently wealthy and actually pay taxes)as LTC insurance is not cheap.

    So if anyone is free riding on anyone it is people with private insurance (and that most definitely includes private LTC). So to be fair to all those poor people without private insurance who have to pay taxes and face limits on their Medicaid I propose a Medicaid Reinsurance Tax.

    Also, I appreciated Kristjan Wager and Michael’s points above.

  25. #25 M. Randolph Kruger
    April 15, 2009

    Craig-wrong and unjust… So I have to tell my kids they cant go to college because some bozo is sick in Poughkeepsie? Donna the righteousness comes from the sweat of my brow that produces my bread for myself and family. Everyone else comes second to that. And lets cover this “morally bankrupt thing” Its not morally bankrupt. The country IS bankrupt with nothing left to fall back on. Stimulus, TARP, carp, crap is what I call it. Its all premised that we need to do something. Its called capitalism and if Revere isnt a capitalist then he should say so. Its fine to be a socialist but I do like to know what pony he is riding in on.

    Socialists keep trying to redistribute the wealth to people who do nothing for it. The effects of taxing high wage earners has a super bad effect on economies. That is borne out by economists. You’ll figure that out later on if you ever make more than 50K a year.

    Floor… Thats based on a premise that is incorrect. If the government provides UHC, then the insurance companies will fold up like cheap card tables. Then the burden for all healthcare will move directly onto the heads of those that meet the cut for being, “high wage earners” as they try to redistribute yet more wealth. Squeezing the productive parts of society to pay for the needs of the unproductive ones. It will also send the productive parts into the toilet just as it did under Carter and his supertaxes on those filthy rich guys. Windfall profits taxes.. You made too much money in our opinion so we are JUST GOING TO TAKE IT ! Disincentives out the ying-yang and well its been done before and the spanking that came out of it against the socialists/leftists/Democrats was huge. MId term elections are 18 months away and frankly Obama is going to get his butt sent back to Kenya on it.

    DSimon… Not a far argument? Okay how about the death rates? If you are past 70 or so you dont get anything but palliative care from the UHC system. Why? Because the UK recognizes as I do that its like I have said before… Money into a pine box. Spend the GDP of a nation just to put it into a pine box after 70 or so years… Nope. Rationing is incredible there right now and you really dont have the right to sue.

    KIFOI-My name is out there son… Why dont you get Revere to give you my email address and phone number. We can have a nice private discussion about economics and where we are headed. Currently at this hour a little over 5 million people have participated in tea parties around the US. That is a HUGE number of people who do not want this spendathon to continue and that would include UHC. In fact, it very likely isnt legal unless a state implements it. Mass started theirs and well, its in trouble in just the three years its been there. Have to raise payments into the system again. The federal government plan, the Obama plan is to use it for cash flow for all of the other spending thats going on. We will not see a benefit one and a degradation of service even faster.

    The entire idea of you having to prove that you have health insurance of your own to get a job is criminal.

    http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=51517

  26. #26 M. Randolph Kruger
    April 15, 2009

    http://www.theobjectivestandard.com/issues/2008-fall/mandatory-health-insurance.asp

    http://www.medicalnewstoday.com/articles/134743.php

    These are not cherry picked either. They want to spend nearly a billion on healthcare in Mass. and are now having to go after new tax sources to pay for the bullshit. Its become a healthcare feeding frenzy… get in there, get that procedure done…Why? Because someone else has to pay for it. Originally it was to be about 560 million, in three years its jumped to almost 900 million. Its just about the same as TennCare was here. Been there and done that. Tennessee was nearly bankrupted by it.

    Full of it? Maybe, but stupid I am not. You cannot spend more than you take in without having both a federal and state government going under or voting themselves enough money to do the programs rather than running a state or federal government. Only a retard puts that up as a sane argument.

  27. #27 paiwan
    April 15, 2009

    Randy,

    This time your turn to masturbate. You are wealthy like Bill Gates? He has a foundation at least. What do you have?

    Eye for eye one time only for your bulls…t. Turkey.

  28. #28 M. Randolph Kruger
    April 15, 2009

    Well Paiwan, its like this. I dont have to sit in Thailand and watch the system disintegrate either. That is for at least the time being.

    Best thing about the US is that they’ll have to cut foreign aid too…That means a lot of countries are going to tip over as a result. The Thai’s maybe for starts. Most people here probably didnt know that its about to go.

    And I have credit rating, unlike a lot of people that I know right now that want money. The Obamagasm continues.

  29. #29 Tom DVM
    April 15, 2009

    Actually, its kind of surprising but up here in Canada, I don’t even notice the price of healthcare.

    The cost is really not that high when risk is spread amongst all citizens and over many years.

    I payed for others healthcare for many years. I didn’t mind because recently, they have been paying for mine.

    Randolph. I respect your opinion as always, but don’t you think at some point, people should not have to live with the risk of losing everything they have to healthcare for a loved one. I saw that as a young person in Canada before nationalized healthcare…I wouldn’t want to ever see it again.

    I can’t think of a greater gift to future generations or a better time to accomplish it anywhere in the world.

  30. #30 Lea
    April 15, 2009

    paiwan: you haven’t got a clue as to what you’re talking about, you never have when it comes to American.
    You want to be American and it isn’t going to happen.
    But then again, the missionaries that convinced you about Christianity ha

  31. #31 dsimon
    April 16, 2009

    Kruger: DSimon… Not a far argument? Okay how about the death rates? If you are past 70 or so you dont get anything but palliative care from the UHC system.

    Once again, you’re picking on one system. That system may be underfunded and dysfunctional in ways that others are not. Again, all the statistics I’ve seen show that Europeans as a whole get just as good or better health metrics as we do (including life span) at a little more than half of what we spend per capita. You don’t seem to dispute these numbers.

    And let’s say there is rationing abroad. Well, there is here too: if you don’t have insurance, you don’t get much in the way of care. Rationing in inevitable wherever there are limited resources (and resources are always limited), whether we choose to call it that or not.

    Finally, I’m personally not opposed to not putting money in a pine box. Our infant mortality rates are at the bottom of our peer group countries. If we had to choose, where would most of us like to see our limited resources allocated?

  32. #32 pft
    April 16, 2009

    The government does not want universal health care, that would allow too many people to reach 65 and collect SS.

    Obviously, universal health care is a no brainer. We could pay for it by taxing wealth and not income, or just use government greenbacks (debt free) and use some mechanism for price controls, or just keep our stupid system and we would still pay less and companies like GM might be able to be competitive again agaisnt global companies who do not have that HC cost burden (GM actually moved some production to Canada for this reason).

    The government already pays 50% of all HC costs anyways. In a sense, since they negotiate the lowest rates for what they pay for, those in the private sector with insurance actually subsidize those who get government paid HC.

    Moreover, the tax law favors employer-based insurance, because employers contributions weren’t considered part of workers’ taxable income. Today, the value of the tax subsidy for employer-based insurance is estimated at around $150 billion a year. So tax payers subsidize HC insurance with higher taxes on taxable income.

    And those without any insurance get charged the highest rates of all, I remember something like 3-7 times what the insurance companies pay. Many of those uninsured folks end up on Medicaid once they develop health problems they can not afford. So basically, in the end we pay for the uninsured as well. But the cost of getting on Medicaid is basically to lose whatever wealth you have to those providing the HC until you qualify as poor enough. Only the insurance is socialized, HC is privatized.

    The cost advantage of public health insurance is clear. First there is lower administrative costs. Private insurers spend large sums trying to identify and screen out high-cost customers, and denying treatments. Systems such as Medicare, which covers every American sixty-five or older, or the Canadian single-payer system, which covers everyone, avoid these costs. In 2003 Medicare spent less than 2 percent of its resources on administration, while private insurance companies spent more than 13 percent.

    Also, the administrative complexity because of differences in coverage among individuals and the struggle between different players in the system each trying to stick others with the bill. Many estimates suggest that the paperwork imposed on health care providers by the fragmentation of the system costs several times as much as the direct costs borne by the insurers.

    The second source of savings in a system of public health insurance is the ability to bargain with suppliers, especially drug companies, for lower prices. Residents of the United States pay much higher prices for prescription drugs than residents of other countries like Canada. Medicaid and the Veterans’ Administration, get discounts similar to or greater than those received by the Canadian health system. Medicare unfortunately did not follow this model.

    If the United States were to replace its current mix of health insurance systems with standardized, universal coverage, the savings would be so large that we could cover all those currently uninsured, yet end up spending less overall.

    For those who want special care, there would always be supplemental insurance where you pay premiums for perks like single occupant tooms, etc.

    Good article here

    http://www.nybooks.com/articles/18802

    But there are always the selfish amongst us who say, but I am ok, so everyone else can go to hell. Then they get sick, find out their insurance does not cover everything, and if they get real sick and don’t die quick enough, they may find out most of their savings and wealth get paid to hospitals and doctors before finally ending up on Medicaid.

    The truly wealthy could give a darn unless they have an interest in insurance companies, because they pay little in taxes anyways. That’s why Bill Gates has his foundation, it’s tax exempt. If you don’t have your own foundation, you are not rich.

    Anyone against universal health care except the neo-malthusians and those with a conflict of interest should rethink it. You might have insurance promised you by your company today, but maybe not tommorow, and the benefits might be eroded over time. Even government employees are finding out benefits are being cut. And even if you can afford it on your own today when you are healthy, heh, heh, just don’t get sick, as those with personal insurance who dare get sick, or get older, find out they are no longer a valued customer and get dropped. You can fight it legally, but when you are sick and the hospital bills pile up, thats no fun.

  33. #33 pft
    April 16, 2009

    MRK

    “This left wing spendathon is over…. they will soon just simply say no and then its going to get mighty damned interesting. Wonder what would happen if suddenly everyone just said that to the lefties? The new DHS head says that “right wing radicals ” pose a threat to the government.”

    Uh, didn’t this start with George W. Bush when the first bail out was made and our wars blew up our debt to 11 trillion. And where were you when it was the left wing radicals who were targetted, which was legalized with laws and EO’s pushed through by the Republicans, and aided by the Dems? Probably said if you don’t do anything wrong, why worry. The rights hypocrisy on this is amazing, as is their poor memeory.

    Actually, many of the things I was saying by way of warning during the Bush years are now being repeated on Fox and by Rush, so I hear. I have gone from being a paranoid socialist conspiracy nut to a right wing radical conspiracy nut, and haven’t changed my point of a view a bit, which I believe is a Patriot pointing out where this country is going wrong. It’s still on the same wrong track, but instead of red party flying the red, white and blue flag we have a blue party, flying a green flag that is really a red one (if ya know what I mean)

    What it’s all about is anyone who does not agree with Big Brother, no matter which party pretends to lead, is the enemy. You and others of your ilk my friend have been royally set up for a rude awakening. Northcom and the DHS have had 8 years to get ready for you all.

    The left was smart enough to content themselves with pounding their keyboards and not do anything stupid to give them the excuse they needed declare martial law and scrap the constitution. The right ain’t so bright, and thats what they want, so Rush, Beck and others are getting the right all riled up as they conveniently forget all of the last 8 years that led us to today.

    Whats coming is entirely predictable.

  34. #34 paiwan
    April 16, 2009

    Randy:
    “And I have credit rating, unlike a lot of people that I know right now that want money.”

    It isn’t about the country rich or poor. It is relating to- as the topic’s pointing to moral / fiscal bankruptcy. Here I need to remind you the part which you have neglected- moral area.

    Paul Krugman is coming to Taiwan which is my country for a speech engagement in May. He praised Taiwan for the health care system. This is not the point here. The point is Taiwan now also a supporting country to many countries.

    Thailand NGOs used to be supported by USA, Canada, Australia, Japan, EU countries and Taiwan. Nevertheless Thailand starts to support the neighboring countries like Lao and Cambodia. So, it is a good cycle. Buddhist says it is a good karma.

    Randy, please don’t feel arrogant, not only the USA has helped other countries, many other countries have done it. Shame on your attitude towards your country people.

    Lea:

    “You want to be American and it isn’t going to happen.”

    Again, we are discussing the issue of the universal health care and is it relating to moral bankruptcy. So, I don’t understand how you’ve related to “I want to be American.” Moreover, many commenters here would not authorize you as a spokeswoman of American which is so diversifying and rich culture. Don’t inflate yourself too much. You are not qualified to speak for other Americans.

    As what I want to be-I feel very good about my being now, but that is my business. You certainly have nothing to do with it.

  35. #35 M. Randolph Kruger
    April 16, 2009

    Paiwan….You have my permission to keep Krugman.

    PFT-But your ideas are based in the idea that healthcare is a right. If there is no government left after a 55 trillion dollar bill comes due in 2018 then its a moot point.

    I do agree with your doomsday assessment though. We are going to have to make cuts across the board. If the Chinese move in with those SDR’s in the IMF we are screwed…They are going to want gold and not the “new currency ” either. Dont blame them. It was good in the 80′s to borrow and spend. Tax revenues increased off the scale….What did Congress do? They spent it. Could have had Revere’s UHC and then some and reduced the debt. Not going to happen now… Cant tax people without jobs… its an income tax. No income, no taxes and the printing presses are still turning it out.

    Oh I got the commie ref PFT…. I believe that I was excoriated pretty well for calling Obama one. But its not just him. Its the RINO’s and of course the socialists/leftists/Democrats as well.

    Tom sorry to hear you are having to cash in your chips on the UHC a bit. You have our support. But, the bottom line is this. We the people are now 122 trillion in both funded and unfunded mandates and they will come due starting in 2013 and then surge until 2030 or so. 25 years of our kids lives down the toilets and all they did was be born. The oldies are going to suck it dry and MOST will be on the existing UHC… Medicare. They will be there anyway. So why spread the disaster? 12 to 1 ratio of old to young starting in 2013. Made worse by economic conditions now. There is no way that an already bankrupt Medicare system can pay for it… nothing going into the system. Add in Social Security and folks its game over… Thats 55 trillion combined.

    WHO IS GOING TO PAY FOR THIS STUFF?

    Feel free to get back with me on that one. I’ll be here from 8-5 Monday thru Fridays, 8-1 on Saturdays.

  36. #36 KeithB
    April 16, 2009

    I think that Universal Healthcare is one of the best things we can do to help the economy. I heard a heartbreaking story on NPR about a couple who would have to abandon a small farm they loved because of healthcare costs.

    Think of all the small businesses that will be started if the owners do not worry about a heart attack bankrupting them.

  37. #37 M. Randolph Kruger
    April 16, 2009

    KeithB-Are you willing to bankrupt yourself and your childrens futures because of someone elses problems. Whose problem is this?

    Answer the question….At what point would you stop funding a program? The answer of course is when it cost too much. I am simply not prepared to give away my money or anyone elses for something not of my making. This is socialism in its highest example Keith. They shouldnt have to lose the farm because of healthcare costs? Look out the window… Who is going to be able to pay for UHC right now? You are out of work and no income…That means someone else has to pay for your problem(s). Did I have your kids? Did I get a heart condition leading to high expenses for you or your family?

    Its yet another tax and they will make only those making above a certain amount pay. Therein lays the Constitutionality issue with this.

    Equal protection, but in a socialist state only someone else will pay for it.

    Harsh… But reality generally is. Free lunch, free everything… Obama… Change that we can believe in. And then the merry-go-round stops.

  38. #38 CAP
    April 16, 2009

    The U.S. does have UHC already; haven’t you heard of the Octo-Mom? She is the proud mother of 14 babies, eight of which were produced via embryo emplants (hence the octo-prefix). Tax payers are paying for her welfare and the welfare for her 14 children. Aren’t you proud to be supporting her children? Don’t you care about their well being? If you don’t care for her God-given right to have babies, fine, which babies should she get rid of? That mother deserves the right to life, just like the US Constitution (and Pro-lifers) says!

    Bail-outs are a form of UHC, too. Don’t you care about the poor CEO’s of runied banks like AIG? They are people, too, and like increasingly more of us are unemployed! We must be sympathetic about CEO misery just as the average Joe; universal health care is for everyone, remember? What if Liddy hurts himself from his limosine to the marble bank and needs a cast? Don’t worry, he will be taken care of the best doctors at your dollar. Isn’t UNIVERSAL Health Care for everyone irrespective of occupation? Of course it is; it’s universal!

    Since it is impossible to have everyone rich, but it is quite possible to make every one poor, is it not to be desired that the Government should redistribute wealth until we are all truly economically equal? Who doesn’t like equality? If we are all universally poor then we are equally poor!

    Every citizen has the right to every other citizen’s pocketbook in a universal system! Octomom has just as much right to your taxes for health care as Liddy does as you do to your own money in a UHC program. If this were not true then the system wouldn’t be universal; it would be inherently biased by segregating the recepient pool into the have’s and the have-not’s, the very subject that outrages people today.

    In summary, the U.S. is a UHC nation. To argue otherwise is to reveal oneself as a fool ignorant of very real examples of universally applied, Government mandated redistributions of private wealth for public good. I now request $1 from every taxpayer because I want to buy some drugs and, after all, your money is my money in this country now!

  39. #39 KeithB
    April 16, 2009

    In the US (and probably *everywhere*) the taxpayers pay for *everything.* I, for one, have no problem increasing my taxes in order to pay for everyones healthcare. I already pay extra every week for my family’s healthcare. It would just shift to my withholding.

    Then at least the costs will not be hidden and healthcare providers will not inflate the costs to the uninsured to make up for the “discounts” the insurance companies get.

  40. #40 M. Randolph Kruger
    April 19, 2009

    Geithners replacement has the plan already in place to fix this….

    http://www.youtube.com/watch?v=2JBsGn6XtaM&feature=dir

  41. #41 revere
    April 19, 2009

    Randy: LOL. That was really hilarious (no snark; ti was really great). I love The Onion. And although we see this differently, we can both laugh. Recommended. Here’s the link again:

    http://www.youtube.com/watch?v=2JBsGn6XtaM&feature=dir

  42. #42 I_Am_Subsidizing_John_Gault
    June 18, 2009

    Kruger, uhc is a form of insurance, with the expensive problem of adverse selection removed. Except in the case of the extremely poor (who already qualify for medicaid anyway), it bears no resemblence at all to a transfer of wealth. It is not some sort of unsustainable entitlement program, like giving away free DVD players. It would cover costs that are already paid, but with far fewer of the present inefficiencies and negative externalities.
    That is why the existing healthcare arrangement in the US is a far greater drain on the US economy than uhc ever could be. it’s simple mathematics, and borne out unequivocally by all the empirical data. that should be glaringly obvious to anyone not blinded by ideology.

  43. #43 Mark Schaffer
    June 18, 2009

    M. Randy Kruger has a little background of being crazy:
    http://www.whydontyou.org.uk/blog/2007/09/08/illogical-ranting-is-wrong/

  44. #44 Moses
    March 5, 2010

    This is a science blog?

    With these two gross mischaracterizations like this?

    [QUOTE]Countries whose technical level of medical care is at or above the quality of the US’s.

    The simple truth is that one of the major reasons we have such a lousy health care system and receive such bad value for our money in the US[/QUOTE]

    There is no such place on earth, if there was-people would flood for the leading care there and not here. If there was medical procedures, equipment and drugs would actually be invented elsewhere from time to time.

    The insureds currently pay for the uninsured,

    the only difference here is creating more government and therefore higher costs and lower availablity.
    Going to make healthcare worse for 90% of the population and you posting about morality. What a joke.

    A 4yo can figure this out but somehow the higher intellects are struggling -somehow they going to toss 30mnillion people on the dole and that is going to lower prices and raise availability-how stupid are you people?

    That is morality for you folks, drag down another entire system for the sake of the liberal scumbags making themselves feel good.

    THere is a moral imperative to create more government to pay for something the insureds already pay for?
    Moral imperative to drive up costs and lower availability all in the name of what exactly? So the government can create an agency to take a cut and drive up prices even more?

    Funny how the simplest **** is perpetually overlooked by the supposed higher intellects.

    BTW hilarious you talking moral imperatives while you destroy every social institution in the country with your immoral social experiments.

  45. #45 moses
    March 5, 2010

    [QUOTE]Many, if not most of the folks without insurance are employed.[/QUOTE]

    HOw stupid are you people? Would you care to bet that this is not even close to true?

    Just invent any old stupid shit, it not like anyone going to hold you or the moron denigrating care for 300million people and calling it immoral accountable at anytime in the near future.

    Must be really ,really stupid because I am total moron,
    and can see the only end game here is higher costs and lower availability for everyone else.

    Technically suckass system that only leads the world in innovation, people come to the US from all these liberal social shitholes for care not like Americans travel to Canada, the UK or Spain for care.

  46. #46 revere
    March 5, 2010

    Moses: I conclude you are a 4 year old and have never been anywhere else. And your characterization of people coming here for treatment from everywhere is false. People go lots of places for good treatment, including Europe and elsewhere. What evidence do you have — evidence in the way of data about health outcomes — that the US has the “best” system. It’s ludicrous to say that on the basis of data. It’s a system that’s good for rich people.

  47. #47 Alice
    April 1, 2010

    Hi, I’m a college student and I was wondering where you acquired the photo graph of how much each nation pays for healthcare? I was also wondering if you could give me permission to use said photo if you made it yourself. Thanks for the consideration!

  48. #48 revere
    April 1, 2010

    Hi Alice: It’s from the OECD Yearbook. There is a link just a few lines above the pic that will bring you there (I try to link all my sources). You can look on that site to see if you need permission. Good luck.

  49. #49 Mark
    December 15, 2010

    I earn over 50k a year and have no problem ensuring that the less fortunate will have the right to LIFE, liberty and the pursuit of happiness.

    Paying for others has not effected my life. I’m not exactly broke. I am fiscally responsible. At the same time, I realize that the world is not black and white. I refuse to blame all of the poor for being poor. Besides, it’s not like I’m personally picking-up the tab for a triple-bybass. I am only paying for a small fraction. Not enough to effect my quality of life.

    I am a liberal, atheist and am glad that my tax dollars are helping others.

    By the way Kruger, what happened to personal accountability? Entitlement programs existed before you decided to have children. Still, you decided to spawn children. Now you are worried about their chances of getting into college? Haven’t you been preaching personal responsibility to your children? Telling them that good grades could get them a free-ride to college? Why are you blaming the government? Don’t blame them, blame your choices.

    Alas, more hypocrisy from the right. Blame the poor and government when your business struggles and your kids cannot go to college.

    Close every overseas military base, bring every troop home and help those in need. Stop dumping money we don’t have into nations that are foreign. Trade with them. Develop positive relationships so we can increase tourism, thus putting money into foreign nations without resorting to war.

  50. #50 Mark
    December 15, 2010

    Actually Moses; Americans do leave the United States to seek cheaper health care. Talk to Canadians and you might be surprised. They aren’t exactly running across the border to have access to U.S. health care.

    Of course Fox News aired one story of a Canadian woman who came to the U.S. for cancer treatment and you all ate it up.

    I find it funny that so many “Christians” are willing to let the less fortunate die.