One thing I don't understand is the equivalence, such as in this Roll Call article today, between the health care debate and the climate bill that was passed by the House a couple of weeks ago. There are 48 Congressional Districts that were won by John McCain and that currently have a Democratic Representative. Most of those districts are rural and blue-collar. On the climate change bill, this might give those Representatives ample reason to vote against the initiative: 38 of the 48 have per capita carbon output rates above the national median, and 36 of the 48 have an above-median concentration of jobs in the manufacturing and agricultural sectors. But something the opposite holds true on health care.
Throughout last year, Gallup included a module on health and well being in their standard tracking surveys. This meant they had tens of thousands of interviews between all 435 Congressional Districts. One of the questions on the well-being module was about whether or not people had health insurance. Eric Nielsen at Gallup was kind enough, a while back, to send me these results broken down by Congressional District.
The median Congressional District has an uninsured population of 14.6 percent, according to Gallup's data (the average is slightly higher at 15.5 percent). Of the 48 McCainocrat districts, 31 (roughly two-thirds) have an above-median number of uninsured. A complete list follows below (actual Blue Dogs are denoted in ... you guessed it ... blue):
The bottom line is that the health care bill, among other things, is designed to help out the poor and the uninsured, and somehow or another will tax the rich in order to do so. I can understand if, say, Jason Altmire from PA-4 wants to vote against the health care bill. His district is suburban and pretty well off, and almost everyone there has health insurance. But Mike Ross of the Arkansas 4th, where almost 22 percent of the population is uninsured? This is a bill designed to help districts like his. And the same goes for most of the other Blue Dogs. A lot of the time, these guys are stuck in a tough spot between their party and their constituents. Here, those interests are mostly aligned. If a lot of the people on the top half of this list are voting against health care, first check the lobbying numbers, and then check to see if they're still in office four years hence.
7.14.2009
Blue Dog Districts Need Health Care More than Most
@ 10:24 AM
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Cmon Nate have you seen the latest polling on healthcare. Its pretty much 50/50 now. In these purple districts at least half of them should be voting no.
Its time for another polling analysis. Oh thats right when they aren't favorable to Democrats you don't talk about them
Heres the link
http://politicalticker.blogs.cnn.com/2009/07/01/cnn-poll-americans-worry-obama-heath-care-plan-will-increase-costs/
http://www.npr.org/templates/story/story.php?storyId=105871242
Hey nova, that CNN article is from 2 weeks ago and the NPR one is over 3 weeks ago. A time when NO ONE knew how the remainder of the bill would be paid for - do you have anything else, perhaps something a little more recent to support your hypothesis?
If you don't like Nate and 538's take on things don't read his blog. It's a free country and a big Internet. Might I suggest Hannity or Limbaugh? They might be more to your liking.
One would think that the sort of baseline of selfish, stupid politics would be simple self-interest. Sadly, Americans can't even make it that far.
Feel free to post something more current. Thats the most reputable ones I can find. There was the Republican one with very bad numbers today but I take that with a large grain of salt.
Look I know most of the commenters worship every liberal democrat
However this is about Nate and his utter hypcrosiy of refusing to analyze or post about ANYTHING that is NEUTRAL. He only posts and spins FAVORABLE DEMOCRATIC information.
And the red states need health care most of all.
Wait, you mean politicians aren't voting with the best interests of their constituents at heart? Are you really that surprised? Seriously, it's not the crooked politicians that need to be replaced so much as the broken system that put them there. Also, don't you think it's time we all admitted that voting against poor people doesn't hurt politicians? The main infraction that hurts you in politics is voting against or otherwise embarrassing the folks who bankroll your propaganda machine, and I don't see enough of that in your article to understand why you think it's even an issue.
Ok here you go
Its officailly a dead heat at best
http://www.politico.com/news/stories/0709/24884.html
There is tons of material in here
http://www.usatoday.com/news/washington/2009-07-13-poll-health-care_N.htm
This is what I take away personally
"The dilemma is that Congress is trying to solve two problems simultaneously: save money and insure more people," says Robert Blendon, a professor of health policy at Harvard. Those focused on costs are likely to have little tolerance for paying higher taxes to cover the uninsured, he says.
In the poll, 52% choose controlling costs as more important; 42% cite expanding coverage.
And how much pharmacutical and insurance money do those particular outlets get on a regular basis Nova?
Bottom line: A public option saves this country money.
But hey, let's let children continue to die because they're not getting proper health care, right?
The government can't do anything right, right? Way to trash our military.
Nice analysis, Nate.
It's true that increasing coverage to 100% of the population will cost more -- and the pharma and medical companies and suppliers also stand to benefit from this.
At the same time, the medical service providers and insurers dont' want to be squeezed on prices and profits.
They are hoping for a double benefit: get the government to guaranty more health care and 100% insurance coverage, but don't take away the profits that come from some of their current practices including cherry-picking healthy patients, excluding those with prior conditions, etc.
Whatever is done, given Nate's analysis, to reduce the number of uninsured, is likely to benefit the Blue Dog districts (and, as STepper points out, the core of the Red ones as well in the poor poor states of the South). But this is the time to eliminate the stranglehold of the big insurance companies on the supply of health care as well as to eliminate their oligopolistic pricing.
I note that the current surveys - according to the Politico and USAToday articles - are about whether people support "the current plans" (I'd like to see the actual questions asked - the descriptions I've read are pretty fuzzy).
When you ask whether people support "a public option", or if they support "universal health care", the answers are overwhelmingly in favor.
What the current polls reflect is the effectiveness of the right-wing propaganda machine, which is making people doubt that the "plans currently being considered" will be universal, affordable, and include a public option. These polls are awfully premature, because no "plan" even exists yet. Neither the House nor the Senate actually has a bill under consideration.
Let's see what the polls show when there are actually proposals to look at, and after a few of the Republicant lies have been answered.
Where's Dennis Moore (KS-3) on this? He's a Blue Dog in a district McCain won...
USA Today / Gallup has some fascinting data http://www.usatoday.com/news/washington/2009-07-13-poll-health-care_N.htm (still very fuzzy - it would be good to see the full list of questions and crosstabs) -
"Do you favor or oppose Congress passing a major health care reform bill this year?" - 56% favor, 33% opppose, 12% no opinion. Overwhelmingly in favor.
"Do you favor or oppose requiring employers to pay a fee if they do not provide health insurance for their employees?" 61% favor, 35% oppose, 4% no opinon. Overwhelmingly in favor.
"A third of those surveyed [30%? 33%? - it doesn't say] say they trust him and congressional Democrats most when it comes to changing health care, compared with 10% who choose congressional Republicans. Another 45% trust doctors and hospitals the most."
I note only a tiny fraction (if any) trust the insurance companies, who are in charge of it today. Since the Democratic / Obama proposals give the doctors a lot more say as compared to the insurance companies, there are potentially (30% + 45%) about 75% who would trust the Democratic proposals as compared to about 10% + who would trust the Republicants and insurance companies.
Overwhelmingly, the public seems to think healthcare reform is on the right track.
Public Education? Check.
Public Housing? Check.
Public Transportation? Check.
Public Health care? Getting there.
Sure its crappy, but it's cheap!
Brought to you by the Democratic Party. Promoting one-size fits all, ill-conceived solutions to public problems since the 1790s.
Poor rural people voting against their interests? That's a surprise?
Market Crashes? Check.
Complete dismantling of meaningful regulation? Check.
Abject hypocrisy while accusing others of being hypocrites? Check.
Dismissal of war crimes? Check.
Mockery of the less fortunate? Check.
Revisionist History attempting to redeem Nixon and McCarthy? Check.
Brought to you by the Republican Party. Promoting one size fits all, ill conceived free market fairy Jesus Died for Lower Taxes idiocy since the 1920's.
Yet the Republican Party, since Reagan, have been the party of big-government in practice and have spent more money than a New York crack whore with a stolen credit card.
The spending policies of Reagan and the Bushes is the principal reason so many limited-government conservatives have left the Republican Party, at least one of whom (Eric Massa, NY-29) is mentioned in this list. When Barry Goldwater of all people tells them, "Do not associate my name with anything you do. You are extremists, and you've hurt the Republican party much more than the Democrats have," the Republicans should know that they've lost their way.
The main difference in economic policy between the Republicans and Democrats is that while both want to expand the size and power of big-government to previously unheard levels, the Democrats will tell you this up front. The Republicans will still make the claim of being the party of small-government but no long act as such when in power.
lol goldkngt55. I don't like the Republicans either. I'm a libertarian. I do think there is a large amount of hypocrisy on all sides of this issue.
You make two very bad ASSUMPTIONS:
1. You assume that the heath care delivered by the government will be of the same quality that we expect it to be now. That is why a lot of people oppose it, even some uninsured.
2. You also assume that everyone who is uninsured is so because they cannot afford insurance. There are a lot of young, single people who can afford insurance, who have it offered from their employer, but who make the informed decision that the cost of insurance is not worth it due to their perceived good health.
If I make a decision that buying something for myself would be wasteful, but then the government comes around and buys it for me, what is that? WASTEFUL! Quit trying to make my decisions for me. I'm an adult.
Ah yes, the typical "I'm a libertarian" dodge on the issue. No party that believes government is the problem and not potentially the solution will ever use it effectively. Furthermore, libertarians still by and large disbelieve in Anthrogenic Climate Change and they certainly don't believe in meaningful government regulatation.
And as for assumptions, the assumptiosn YOU are making.
1. You are assuming that the current course of action is an acceptable alternative.
2. You are assuming I am assuming that everyone who is uninsured cannot afford insurance.
I am well aware that there a lot of healthy libertarians out there in their 20's and 30's who can afford insurance. They often change their mind when they go bankrupt from a serious illness.
And quit trying to make my decisions for ME. If I WANT a government insurance program so I can have insurance and not be a slave to the private health care ghouls, quit spreading your lies about socialized medicine.
If you don't want me to lump you together with Republicans, quit using memes generated by the Heritage Foundation.
Public Education? Check.text
Lobbied for by business interests at the beginning of the industrial revolution, because of the need for more educated employees.
Private education available for those who don't want it.
Public Housing? Check.text
For people who can't afford decent housing otherwise.
Public Transportation? Check.text
Is there something wrong with having public transportation?
Public Health care? Getting there.
Already there - Medicare already covers the most elderly and the disabled.
Sure its crappy, but it's cheap!
So why are people NOT healthier in the US than in Canada or Australia?
Plenty of third world countries that don't have any of the stuff you're complaining about? CHECK!
One way tickets available? CHECK!
You probably plagiarized your comment from Mallard Filmore? CHECK!
You said before in an earlier post that the two biggest problems with getting the uninsured affordable healthcare are 1.) The enormity of the barriers into the industry and 2.) The monopoly of employer-based health care.
I believe the Blue Dogs would agree with you that "plans that can remove market distortions and lower costs without a public option...deserve a fair hearing."
Are you suggesting they throw their ideology out the window because the bill is waiving money for their constituants in their face??
I have MUCH greater respect for those who will stick by their ideological guns than vote for a bill they don't believe in.
Clearly they have the interests of their ENTIRE constituancy in mind, not just 20% of it.
That sounds nice, but when 'sticking by their ideological guns' means being moronically opposed to anything proposed by the party in power, and giving budgets without numbers, never compromosing and thumping their chest like baboons, or in the case of certain Blue Dogs, 'making sure you get some respect' then you're part of the problem, not part of the solution.
@goldkngt55,
Your decision impacts me, because you want me to pay for your insurance. So yes, I will get involved in that discussion!
BTW, I am a conservative Republican with some libertarian leanings, not a pure libertarian. The government can work efficiently in some situations, but I do not trust it to run my life.
Yes I do. Guess what? I want you to pay for my defense too.
I also want you to pay to make sure my environment isn't poluted, that criminals get prosecuted, that children are protected and fed, that large businesses do not grow too large and that technology is promoted.
And you are welcome to your opinion. I disagree with most Republican positions with a passion, but I will defend to the death your right to say it.
And I no longer trust the "Free Market" to run my life either. A balance between government and the market is always required, and right now there is not a balance, only ghoulish companies that make a profit on the suffering of others. Slavery was a free market system for those that participated in it.
when you posted "check to see if they're still in office four years hence," you really meant two years (well 18 months actually), right?
just sayin'
Bert -
Your decision impacts me, because you want me to pay for your insurance. So yes, I will get involved in that discussion!
I find this inaccurate.
It implies that you would pay for another's insurance, yet receive nothing. That is an omission and a distortion.
Fire departments are publicly funded. This does not mean that some citizens pay for "my" protection from uncontrolled fires, while receiving nothing. It means that we all pay for each others protection. Although some people are at greater risk of being in a fire than others, we can all conceivably be caught in a fire at some point in our lives. A few of us could probably afford private fire departments of our own, but over time, almost everyone has come to satisfied with the public model.
Feel free to oppose public cooperation all you want, whether for health care, basic education, law enforcement, or anything else, but please describe your position accurately.
Look at where those districts are. I see a lot of districts in states where I would wager there is a sizeable minority population.
How many of the above median states are in the southwest or the south? All but 5.
How many of the below median states are in that part of the country? Just 4 (and Utah's second is mostly white).
The uninsured are disproportionately, black or hispanic voters that any blue dog can take for granted. They are voting on the basis of what will win them the white swing voters that are key to re-election.
Finally some actual discussion again.
I like the fire department example alot.
If your neighbors liked playing with fireworks and the fire department had to show up once a month would you be ok with paying the same rate for fire protection.
Should someone who maintains a helathy weight and exercise pay the same as someone who watches five hours of tv a day and eats nothing but ding dongs and beer. Should the helathy person subsidize the decisions of the unhealthy person.
@ goldkng55
Nice slavery blast. Comparing modern "ghoulish" corporations to slave-owners is irresponsible at best.
Nova, you don't think you already do subsidize that person regardless...Except right now, not only do you subsidize him, but you also get the added bonus of paying for the CEo's yacht, the company trips to Vegas, the lobbying for less regulation...It makes no sense...All so when you do get sick, they DROP you like a bad habit...It's such a scam, perpatuated by their ability to negotiate far lower prices on things than you can get for care, as to make it impossible for you to just say no (most cases they pay a rate 4-5 times lower than you do as a private uninsured individual, is that"fair"). This issue tends to cut across need, though, as people making 30-50K in these districts have all thus far gotten tax cuts too, yet manage to scream "tax and spend" liberals...You can't unteach stupid, contrary to popular belief
Bert…
Who (besides you) said anything about “government delivered health care”? This is the Great Red Herring that the right always throws into any discussion of health care reform. It’s right out of the Newt Gingrich playbook—
♦ If you can’t answer a question, change the subject!
♦ Lie!
♦ Distort!
♦ Call your opponents liberals!
nova_far-right_man…
The fire department will continue to exist, and require taxes to subsidize its existence, regardless of how stupid or careless your neighbors (or you, for that matter) are.
Am I the only person who's been denied an insurance claim by their insurance provider? Am I the only person that's had a healthcare decision made for me by a paper pushing bureaucrat under the existing system? Every argument I see from the right or libertarians seems to imply that it's only the government is capable of withholding legitimate care. I picked the better of the two insurance options given by my employer and was denied treatment for a legitimate medical problem, which I ended up paying for out of pocket (to the tune of about $1K - enough to hurt, but not bankrupt me). Apparently they would have paid for it if I had done the same exact thing using a slightly different method (which I would have been fine with, had I known), but this was a good excuse to deny my claim. Why does this never come up? Why does it not count when insurance companies are making the decision? I don't understand the fear that there's a chance that the government will screw up in some regards when it comes to healthcare. For me, there's 100% chance that private insurance will. If there's only a 90% chance with the government, in my view, I'll take that chance. If there's a chance that it's both better and cheaper, how exactly is that bad?
I also don't understand the "I don't trust the government to make health related decisions" meme. News flash, they already do. If you use any legal drugs, drink water from a source shared by more than a few people or buy food in a grocery store, you're health is already dependent on government controls. They're already deciding what you put into your body. The government along with case law already fills books full of regulations on how your doctor must act to remain licensed, what decisions they must make under certain circumstances to avoid lawsuits, etc. I don't see how universal healthcare coverage creates this big fundamental change to the care you receive that is being professed. And it's not like there aren't plenty of other countries to look at and see that there really isn't a big downside. How anyone but the most extreme on the right doesn't see this is beyond me. More than half of the Republicans should support this, much less all Democrats.
Really? Well lets see here...
Rich European powers had access to technology and weaponry that enabled them to enslave people from cultures without access to that weaponry or technology. Or, their more advanced economics allowed them to bribe other more primitive cultures to do their dirty work for them. People died in the millions and suffered with no choice in their actions.
Meanwhile, for profit insurance companies have access to resources and technologies that the average person cannot afford on their own. They are often forced to choose between economic slavery, death or indentured servitude to a job that they do not want to have access to technologies that will save the life of themselves or their loved one.
Tobacco companies made a profit selling cigarettes knowing they caused cancer. For profit health insurance companies make money by making as many people needlessly suffer or die from lack of health care as possible.
At least with tobacco companies you can point to prohibition and see how outlawing a good that people want is economically infeasable, but who in this country is going to complain if suddenly we outlaw for profit insurance?
Maybe Republican Ghouls and rich people, but that's about it. And they're not even talking about outlawing the ghoulish For Profit Health Insurance companies, they're just talking about giving people a choice besides slavery or death.
I have a friend who lives in Canada. Her health care is far better than ours: she waits less than I do, she's covered for more than I am, and she pays (yes, they have to pay for it) $100 a month for a family of four. No co-pays, it covers everything. The only thing Canadians come to the US for in the way of health care is for cosmetic surgery.
the doctors in Canada are independent businesses: they do NOT work for the government. It is the insurance that is from the government, not the health care.
The rural etc people who are so adamant that they don't want to pay for someone else's health care have been brainwashed to look at it that way: they have that "every man for himself" attitude because the right wing media has been pushing that Satanist idea for forty or fifty years now. Not wanting the government to gather our resources together for the good of all is the essence of lack-of-civilization.
Nova_Middle_Man -
I like the fire department example alot.
If your neighbors liked playing with fireworks and the fire department had to show up once a month would you be ok with paying the same rate for fire protection.
Should someone who maintains a helathy weight and exercise pay the same as someone who watches five hours of tv a day and eats nothing but ding dongs and beer. Should the helathy person subsidize the decisions of the unhealthy person.text
I think that is a good question, actually (I'm taking it at face value).
First, let me concede that having any social program that provides benefits inevitably involves providing said benefits to some who "deserve them more" and some who "deserve them less". Perfection is impossible.
Second, though, let me point out, as others already have, that this is a separate issue from whether health insurance should be public or private. It's not as if the current system is strongly rewarding people for healthy behavior.
Let's continue with the fire department example. The local government can and ALWAYS DOES discourage such behaviors in ways that don't involve denying anyone fire department services. There are always fire regulations, with fines and other punishments for violating them. Of course, there are still elderly people who smoke in bed, and so on, but much can be done to discourage gross irresponsible behavior, or make it cost, without denying anyone coverage.
Also, people will be irresponsible whether there is a fire department or not. Fires can spread. You may be well off now, but you never know what the future will bring. You are still FAR better off with a public fire department that serves everyone in a professional way, even if your neighbors do "deserve it less", than you would be without it.
So with regard to health care, yes, I believe in tax-funded universal health insurance even for overweight idiots who smoke while speeding on their bald-tired motorcycle in the rain, to McDonald's. I think that everyone is still better off with a universal system.
That doesn't mean that we are powerless to encourage healthy behavior, in ways that don't involve denying someone's coverage.
Just because "they" need healthcare doesn't mean that "they" are stupid enough to believe that the US Government ought to be involved in mandating it. Maybe "they" are not so stupid after all.
Isn't it just remotely possible that every now and then a member of Congress will vote his or her conscience - vote against national health care if (s)he thinks it's a bad idea for the country, or in favor of it if (s)he thinks it's a good idea - even if that vote is contrary to the short-term interests of the district (s)he represents?
Sure its possible.
But which is easier to believe...that they're voting their conscience, or that the well funded corporations that reliably donate to their election campaigns have more access or that they're voting their conscience?
Or even better, that the staffers, who are promised sweet lobbyist jobs TELL the legislators that they should vote their conscience on the bill because they've read it and the legislator hasn't?
Focus #1: Jobs
Focus #2: Jobs
Focus #3: Jobs
Focus #4: Insuring The Poor
Middle-Class Independants wanna hear more about how Health Care Reform is 'Cost-Reducing', 'Job-Saving', and 'Good-For-The-Economy'. All with easy to follow data points.
Its the task of Congressional Leaders and the President to sell the center on this.
"We estimate this will SAVE/CREATE [x] jobs over the next 10 years."
"On average, each small business will SAVE [x] dollars per year."
"The average household will SAVE [x] dollars per year."
Use the bully-pulpit, Mr. President. Stand in front of the American people from inside the Oval Office, look directly in the camera lens, and lay it all out to the public in plain, truthful terms.
Our economy is still hurting. Friends and family are still losing their jobs. The unemployment rate still rises, while home values and retirement funds still plummet. What will Health-Care Reform do to address these issues? Sell us on it, Mr. President. Sell us on it, and you will HAVE the center's support.
Dennis Moor, KS-3, while definitely a Blue Dog in a very red district, is also in suburban KC. Actually, he's in the richest part of KC. I don't think- and I could be wrong- that too many ppl there are lacking insurance. He consistently runs- and wins- on the I'm not Phill Kline ticket.
I'll get to Harold in a second
The post above hits the nail on the head for me. I go back to the stats on the original article and reality.
Fact a majority are fine with their current health care
In fact
Just 12 percent of those surveyed said their own health care coverage would get better if the reform plan was passed; 39 percent said they expected that their coverage would get worse and 36 percent said it would stay about the same.
Fact not counting the 35% give or take who don't pay any taxes give or take (I hate these nonsequiters but just work with me here) people will be paying more for healthcare via taxes if nothing else
I'm willing to give people the benefit of the doubt but for me and millions of other middle to uppermiddle class American moderates and indpendents the current policies don't make a whole lotta sense.
What me and a majority do support because yes the current system is broken (In the poll, 52% choose controlling costs as more important; 42% cite expanding coverage.) A streamlining and updating of the outdataed buraucratic malaise that currently exists under medicare and medicaid. Why should I or anyone else think government will run this public option any better.
I quote again
"The dilemma is that Congress is trying to solve two problems simultaneously: save money and insure more people," says Robert Blendon, a professor of health policy at Harvard. Those focused on costs are likely to have little tolerance for paying higher taxes to cover the uninsured, he says."
Harold I'll get another post up with the fire example next.
Harold
I see where you are coming from and I agree there should be some basic level of service ala medicaid of some sort. Like I hinted at above my main issue is increasing efficiency and I don't see any indication of that occuring. Remember the only solid numbers are Billions upons billions of dollars for around 20 million now covered. Isn't is easier to put thsoe 20 milllion on Medicaid and be done with the coverage part.
Then we can focus on the real issue IMHO combating waste and inefficiecy in the entitlement programs before they eat us alive.
Tough choices will need to be made a balance between yes in all likely hood some form of greater revenue along with hoepfulyl incentives for good behavior and yes even tough decisions about what operation are truely necessary especailly as you approcah the last two years of life which can count anywhere form 25-75% of total healthcare costs.
Anyway back to the fire example here are some more points for discussions more than anything really.
At what point does the fire department give up on trying to save a house. (Thats the terminal care question)
What happens if the fire department quality starts to slip (Thats the lack of competition argument) You hinted at this next part earlier but then there would be fire militais. A real option as a possible two tier system comes into existance with those able to afford private insurance getting a higher class of service. Ironically creating an even greater probelm than already exists.
Ok thats enough for now
There are many possible reasons why people will act against their best interests. Here's three:
1. Altruism
2. Ignorance
3. Pride
I don't think altruism is at work here, so that suggests ignorance or pride.
Often, people do something that is ultimately harmful to themselves or those they care about out of pride. In other words, they know it's going to hurt them, but they'll be d*mned if they're going to change.
I suspect a lot of that is in play right here.
But the really big player here is, IMHO, ignorance.
If so, then the solution is obvious: we need to give them access to the truth.
Why is it so hard to understand that many folks go without health insurance as a matter of choice?
Even through an employer plan, it is expensive and if you are on the south side of 50, you are most likely to be pretty healthy and will be an economic loser if you buy insurance.
Here is what is in the latest House Bill: http://tinyurl.com/lfmhvv
Most troublesome is that the so-called public plan will reimburse providers at the same rate as Medicare. That's the problem we are in now!
Private sector healthcare costs are rising because the government programs (Medicare, Medicaid and SCHIP) are underfunded. Thus providers demand from the private system (patients and their insurance companies) a premium over the cost of care so that they can be sure to cover costs and earn a reasonable profit.
By pegging the public option to Medicare, the deck will be stacked against the private system -- it will be called upon to meet even more of the government’s burden till finally they are unable to compete and everyone switches over to the public option.
At that point the whole system will collapse as providers (and those who provide capital to them)exit the market, unwilling to accept such low reimbursement and not having a private alternative to make up the shortfall. This is essentially the shape Medicaid is in now – Medicaid patients cannot find doctors to treat them and it is the indigent poor on Medicaid who are clogging Emergency Rooms, not the uninsured.
This is what has happened in Canada and in the UK and elsewhere where there is a single payor and it accounts for the long lines and the lack of options in terms of care.
Why can't we just fix Medicare and Medicaid first?
Failing to do will insure the failure of ALL healthcare in the US, even if there is so-called "universal" coverage. It will wind up covering very little.
This is going to be a ruinous issue for the Dems. Obama is trying to rush it though because he feels the heat of scrutiny. He sees this as his legacy and he is not going to let it slip away for reasons of mere public disapproval – Obama know much better than we do what is good for us!
Lord, save us from his wisdom!
I hope he fails!
petekent01 (on twitter)
There are many possible reasons why people will act against their best interests.
Keep in mind that this is your opinion of people's behavior with regards to their own self-interest, which is likely skewed by what you think people's priorities are or should be.
Some people prefer - and even find it in their best interest - to not have the government interfere with their health coverage - or lack thereof - as opposed to having better coverage but having the government be in the middle of just one more facet of their life.
I think, for the most part, people should be allowed to determine what is and is not in their own best interest, provided they are consenting adults (of age) and not mentally handicapped. When we start dictating what the best interests are of other people and craft legislation accordingly, we have laid the foundation of fascism.
I actually agree there is a ton of ignorance on this issue. Its extremly complex. There have been people working on this issue for deacades coming up with multiple intricate solutions.
If it was as simple as everyone who makes over 100k pay 100 bucks a year 1 million pay 1000 bucks and say 1 billion pay 10000 bucks I think it would fly through.
The problem is its not that simple. There are real serious issues with the way medicaid and medicare are run. Putting another system on top of that just adds that much more complexity.
YOu also have to look at the political climate. The economic stimulus up to this point to most Americans has been a failure. That more than anything IMHO is what is eroding support for another massive government intervention this time in healthcare.
Interesting Read in the Journal Today that summarizes alot of this
http://online.wsj.com/article/SB124724606979424337.html
Nova,
The irony in your statement is that medicare and medicaid are more efficient then most private health insurers.
If you enjoy subsidizing those people who have money money then they will ever need, go ahead and defend the status quo.
whoops, should say "..have more money than they will ever need"
How many of the 47 million people who do not have health care prefer to go without health care at any cost? This is a canard -- unless there is concrete data.
(I've never seen anyone refuse it who gets it provided by their employer or their school. I think someone choosing betweeen starvation and buying health insurance might spend their last dollar on food. But what does that prove?)
How many people who don't have health care end up showing up in emergency rooms -- and how many of those "preferred" not to have health coverage?
Again, it's a canard.
Heres the canard
What is stopping these 47 million people from
1. Signing up for Medicaid
2. Signing up for Medicare
You do those two things you are down to around 24 million
Believe it or not there are some people that choose not to have health care lets say 4 million
Like I have said all along. Put those remaining 20 million on Medicaid.
Then put all of your effort on reforming and improving medicaid and medicare. The bigger problem in all of this.
With all due respect to nova_middle_man, Silver never argues in this post that health care reform is polling highly in these states. What he does argue, and the facts bear him out, is that these states need health care reform. A rather large percentage of the citizens of these states are uninsured. Doesn't that need fixing?
A mystifying fact about a lot of Americans in the South and rust belt, and here I'm referring to the "typical" white, protestant, lower middle class citizen, is that they do not vote in a way that would rationally serve their own interests. This has been the case since certainly the Nixon era, when Republicans became focused exploiters of this group of Americans.
I'm a white southerner myself, and, as much as I hate to say it, I think a large portion of my brethren don't seem to know what's good for them. They have allowed themselves to by exploited by ideology. Namely, bigotry, xenophobia, and know-nothingism. This is why plenty of people in a state like Oklahoma can say they don't want health care reform, even though one out of every four Oklahomans is uninsured.
I think there is a lot of blame to go around for this, but I would single out two power groups that I think have done more than any other to perpetuate this problem. The political class I have already mentioned, and although Republicans bear most of this, plenty of Democrats have taken this cowardly route as well--blue dogs indeed. The other group that I blame for stoking WASP foolishness for their own gain is, sad to say, the Christian church. Yes, Christianity does many good things, but its legacy in America is a destructive one in many ways. As long as preachers continue to stoke their congregations' fears and prejudices, and as long as they train them to distrust their own minds and believe in the unprovable, politicians will have an easy sell.
A mystifying fact about a lot of Americans in the South and rust belt, and here I'm referring to the "typical" white, protestant, lower middle class citizen, is that they do not vote in a way that would rationally serve their own interests. This has been the case since certainly the Nixon era, when Republicans became focused exploiters of this group of Americans.
I'm a white southerner myself, and, as much as I hate to say it, I think a large portion of my brethren don't seem to know what's good for them. They have allowed themselves to by exploited by ideology. Namely, bigotry, xenophobia, and know-nothingism. This is why plenty of people in a state like Oklahoma can say they don't want health care reform, even though one out of every four Oklahomans is uninsured.
I could do one of two things here, if not both. First, I could reiterate my point above, but with more clarity and detail, as to why "we" shouldn't be in the business of determining the "best interests" of others, unless they are under the age of 18 or mentally handicapped. Or I could go into detail with a story commensurate to your "Republican exploitation since the days of Nixon" with one of my own about "Demcoratic exploitation since the days of LBJ" and how they've done the same thing to lower and middle-class blacks, and to an increasing level to Hispanics in recent years, to pander to their vote even though they've done little to nothing to advance the self-interests of those groups.
The grass cuts both ways. In any event, I won't waste time going into gory detail because I'm sure you - and if not you, a chorus of the other faithful on here - will shout me down, call me a troll, and do the proverbial sticking their fingers in their ears while yelling "BLAH BLAH BLAH" at the top of their lungs as they do their best to ignore anything but the reality they've created for themselves that couldn't be further from the actual truth.
Why the Rasmussen tracking is so different from other polls?.
Now Obama is at -8. That´s true?.
In Gallup is at +20.
Why the Rasmussen tracking is so different from other polls?
I thought you knew by now, Dario, that Rasmussen was a little bit of a GOP sympathizer, so most of what he releases is going to skew a little bit in favor of Republicans and/or conservatives. That's not to say that he is altogether or always wrong or that the others - such as Gallup, NBC/WSJ, etc. - are always right, but it is what it is.
Anyone want to show some data on how many of the 47 million actually don't want health care?
A lot of what's being argued here ignores the fact that health care for the uninsured is ALREADY subsidized.
Look, if you can afford a Cadillac and I can't even afford a car, nobody feels sorry for me. If you can eat at the best restaurants and I have to stand on line at a soup kitchen, so be it. If you can afford a million dollar home and I have to sleep under a bridge or in a city shelter, few have a problem with that. Certainly nobody would argue that I should get a CADILLAC, or an expensive restaurant meal, or a million dollar home, as a matter of right. This is true of everything in our society.
EXCEPT HEALTH CARE. If I crawl out from the bridge I'm living under and show up at an emergency room with a heart attack, I'm going to get the expensive operation I need, plus the hospital stay afterwards, plus the drugs I need, etc., etc. And nobody except for a handful of Ayn Rand hard asses will object. These are the values of our society, and unless you want to challenge THEM, then the entire basis of any discussion of health insurance needs to change.
Who pays for the health care of the uninsured NOW? There are two answers. MOST of it is paid for by the insured in the form of higher fees charged by doctors and hospitals which translate into higher premiums. SOME of the rest is paid by higher taxes to fund state and local municipal hospitals. The balance is paid by those who pay out of pocket for their costs because they're either uninsured but have the money, or because they are insured but are hit with co-payments.
In essence, then, every time you pay a health insurance premium or a co-payment, you're being hit with a tax which goes to subsidize the uninsured. This tax is similar to a sales tax, in that it is paid for services rendered rather than based upon income.
What a national health insurance program will do is to shift the tax burden from this unseen "sales tax" and from state and local taxes onto the federal income tax system, which is progressive and therefore hits the upper income brackets harder than the lower.
You now understand ALL about why the party which speaks loudest for the monied interests in this country opposes national health insurance. It's going to cost rich people more money to support the uninsured than it does now. Of course, they never say that. Instead, they try to convince you that the quality of medicine will decline, or the Communists will take over, or some such twaddle. They'll also try to pretend that the cost of subsidizing the uninsured is something NEW, but of course it isn't.
The only issue is the slices of the pie chart. If you believe everyone is entitled to health care, and in the philosophy which underlies the graduated income tax, there's nothing else to discuss. And Nate's point here is that the people who will benefit MOST from a national insurance program -- the low-income people whose "tax" burden to subsidize the uninsured will be reduced the most, should be pressing their representatives to pass this.
On the reluctance of some to pay for "other people's healthcare" - perhaps such people do not understand how insurance works. We all already pay for "other people's healthcare".
Insurance works because people throw money into a big pot. If someone gets sick or injured, they get some of their expenses paid. Every who did not get sick or injured pays their bills.
If you object to paying for "other people's healthcare" then do not have any insurance. Pay your own medical costs out of your own pocket as you incur them. Or else stop griping about it.
The idea with universal healthcare, or with a public option, is that it will lower costs for each of us as individuals - because there will be more people putting money into the pot - and it will improve our nation. If you don't love your nation enough to improve it - especially when you are going to personally benefit by doing so - then perhaps another nation might suit you better. Perhaps one of those third-world dictatorships that doesn't provide universal healthcare.
Bert said-
1. You assume that the heath care delivered by the government will be of the same quality that we expect it to be now. That is why a lot of people oppose it, even some uninsured.
2. You also assume that everyone who is uninsured is so because they cannot afford insurance. There are a lot of young, single people who can afford insurance, who have it offered from their employer, but who make the informed decision that the cost of insurance is not worth it due to their perceived good health.
If I make a decision that buying something for myself would be wasteful, but then the government comes around and buys it for me, what is that? WASTEFUL! Quit trying to make my decisions for me. I'm an adult.
Regarding your first point, I think most people feel they are underserved by their insurance company already. Mine is inefficient in the extreme. There is a drug I can take to boost my white blood cell production during chemotherapy. My insurance will only cover it if my white count falls below 1.8. However, when my blood count goes that low, I have to go to the hospital and be placed in reverse isolation. The drug costs about $200 an injection but the hospitalization for three days while it rebounds is about 10k (insurance company's reduced rate). How hard could it be for the government too top that level of care, for less money? The only thing that makes my hospital stays bearable is knowing that my insurance company is paying through the nose for their stupidity. Unfortunately, instead of learning and operating in the long term, they just make stupid decisions and raise premiums.
2. Who cares if some people don't want insurance because they think they are healthy? Just because I think I am a good driver doesn't mean I don't have to get auto insurance. If someone doesn't have insurance because they think they are a good driver and hits my car, I have to pay (actually my insurance company does and everyone pays with higher premiums). The same goes with if someone thinks they are young and healthy and don't need health insurance then hit a light pole and require surgery and hospitalization, I (and my employer) have to pay for that with higher premiums.
Yes, Bert, the government does sometimes have to force people to do things they don't want for the common good. If you don't like it, find an uninhabited island somewhere, because your wants do not get to override the common good.
Harold, you should run for office. You are very eloquent and persuasive, I would absolutely vote for you. I really appreciate your contributions to the comment section.
Bert, I may not agree with you, but I do appreciate the civility with which you discuss the subject. It is a refreshing change from some of the other conservative posters, so thanks.
@Darío
Rasmussen decided, after the 2008 election, to report its daily approval tracker as a difference between "Strongly Approve" and "Strongly Disapprove." I'll leave it up to you to ponder why the switch was made, but the real approval number for today is 53%, which you can see if you go to pollster.com. Gallup's approval for today is 60%, and the CBS News poll released today shows a 57% approval. So Rasmussen is down on the President, as always, but not that far off.
"The dilemma is that Congress is trying to solve two problems simultaneously: save money and insure more people," says Robert Blendon, a professor of health policy at Harvard. Those focused on costs are likely to have little tolerance for paying higher taxes to cover the uninsured, he says."
This is a false choice, falsely presented.
According to the USA Today article, "In the poll, 52% choose controlling costs as more important; 42% cite expanding coverage." This does not mean that 52% are opposed to expanding coverage, nor that 42% are opposed to controlling costs. The question was, "Which do you think is more important?" not "Which one are you opposed to?"
I'd imagine the vast majority of people polled want both controlled costs and expanded coverage - which is exactly what the Dems and Obama are working toward. In fact, by expanding coverage, the cost for each person will clearly be reduced.
By the way, on the canard about how "bad" the Canadian system is - the last poll I saw showed 91% of Canadians prefer their system to ours. Their average lifespans exceed ours, their infant mortality rate is less than ours. They do not have "long lines" for healthcare - that is simply a lie. Emergencies are treated more quickly and efficiently with better outcomes - than the average in the US. And they do it for far less, per capita, than we pay.
A recent poll sought to find out who Canadians most admire from Canadian history. It wasn't the Prime Minister, nor any of the nation's founders or early explorers. It was the guy who pushed for, and got instituted, their system of health care.
So let's stop this nonsense about how awful the Canadian system is, okay? It's a lie, pure and simple.
PeteKent: "Why is it so hard to understand that many folks go without health insurance as a matter of choice?
Even through an employer plan, it is expensive and if you are on the south side of 50, you are most likely to be pretty healthy and will be an economic loser if you buy insurance."
Are you serious?
Of course you're likely to be a loser when you purchase insurance. That is the entire point of insurance. Medical insurance companies don't pay benefits out of a magical pot of leprechaun's gold, they pay it out of the premiums that everyone else pays. If people on average made more money off the insurance companies than they put in, the companies would be bankrupt.
You pay for insurance so that in the unlikely event that you are stricken with huge medical costs, you can pay. You're simply saying, "If you're unlikely to incur large costs, you shouldn't have to pay them if you do." This is a ludicrous proposition.
Indeed, Pete, this is part of why the current health care system is so messed up. The people who are most likely to not have health care are in fact the most profitable people to the insurance company, because they're least likely to get sick.
In turn, this means the private insurers are more likely to do everything they can to kick out the unprofitable people, because they have so few highly profitable people. In turn, these unprofitable people are forced onto the government health care system, making those systems ever more unprofitable.
That's why we need a single risk pool, or at least allow insurers to diversify their risk pool. We can no longer simply allow people to "decide" to let other people pay their medical expenses.
nova: "Should someone who maintains a helathy weight and exercise pay the same as someone who watches five hours of tv a day and eats nothing but ding dongs and beer. Should the helathy person subsidize the decisions of the unhealthy person."
See above - this is how insurance works. In particular, this is exactly how employer-based health plans work at present. Insurers offer plans at the same rates to everyone by simply averaging the risk. Thus I end up paying exactly as much as my fat, old office neighbor despite the fact that he has a far higher risk of illness.
I will say, Republicans seem more uninformed on this issue than on any other. I love the idea that you can ever make a reasoned, informed decision to not carry health insurance.
Mule Rider: "to pander to their vote even though they've done little to nothing to advance the self-interests of those groups."
I always love how the Republicans claim Democrats giving out handouts to shiftless minorities caused the meltdown... and then insist the Democrats never do anything for the minorities.
I always love how the Republicans claim Democrats giving out handouts to shiftless minorities caused the meltdown... and then insist the Democrats never do anything for the minorities.
Let's get two things straight before I address your NON-response to what I posted. First, I'm not a Republican. Second, I'm not one who claimed that "handouts to shiftless minorities" caused the meltdown. So your response, the comical but un-informative "I always love how..." does little to advance your argument as it doesn't apply to me in the least.
You're taking two different arguments you've heard from within the "conservative circle" that seem incongruous and are using that as a comeback against me even though I never tried to make the both/and proclamation of each. I don't know which "argumentum ad..." that is, but it's a logical fallacy either way, and you're distorting my position by attributing arguments you've heard from others to me.
It's only fitting that I do this then...
I always love how, in rebuttal to a point made by a single conservative, liberals go out of their way to dredge up several incongruous statements they've heard made by multiple conservatives and attribute them all back to that single conservative in an attempt to make them look out of step with reality and discredit their point, when in fact they're attributing things to that one person that were never said in the first place.
How's that for an "I always love how..." moment?!
Blah-
Dennis Moore's district, KS-3, actually went Obama 51-48, as per http://innovation.cqpolitics.com/atlas/district_08 , which is why he's not on this list.
To the point though...
I fully acknowledge that Democrats have paid lip service to minorities to make it look like they've done "something" to advance their cause. By pandering to blacks, they've sealed up their vote. +95%, right?
However, where does the black community stand in economic development now with the rest of society compared to where they did in 1969? Has there been any improvement? Doesn't look like it from where I sit.
At what point does the fire department give up on trying to save a house. (Thats the terminal care question)
What happens if the fire department quality starts to slip (Thats the lack of competition argument).
Are you joking? The quality of a fire department does not depend on competition.
Do you prefer to have people who make more profit to decide whether you live or die?
All your lame talking points that you are parroting are proven false when reality is factored in-medicare, medicaid, countries with single payer, etc.
At what point does the fire department give up on trying to save a house. (Thats the terminal care question)
What happens if the fire department quality starts to slip (Thats the lack of competition argument).
Are you joking? The quality of a fire department does not depend on competition.
Do you prefer to have people who make more profit to decide whether you live or die?
All your lame talking points that you are parroting are proven false when reality is factored in-medicare, medicaid, countries with single payer, etc.
Do you want the truth. You can't handle the truth.
I'm tired of trying to convince people and play nice
A majority of Americans are going to see their healthcare costs increase under this plan proposed by the liberal democrats.
Thats it plain and simple. Its stupid and asinine.
Thankfully this liberal house dem plan won't pass and cooler heads will prevail.
Mule Rider:
Then I don't know where you are sitting.
In 1969 there was still plenty of institutional racism and even where it was newly illegal blacks couldn't walk into a Denny's and expect to get seated in the same room as whites.
In 1969 there were very few blacks on college campuses, the few who owned small businesses were basically in the business of providing things to black customers only and at best there was 'tokenism.' A company would hire one black person to sit in a highly visible position but otherwise it was business as usual.
Communities still practiced de facto segregation and there were certain neighborhoods where blacks just couldn't even look at a home. And if their kids got on a court ordered bus to the school there the bus would be pelted with stones (as would the kids when they got out.)
Since 1969 a significant black middle class has developed (something that was an oxymoron in 1969.) Today black professionals (including doctors, bankers, lawyers and managers) are pretty common and not something remarkable anymore.
It's attitudes like yours, suggesting that blacks haven't made any economic gains since 1969 that keep 95% of blacks voting for Democrats. To conservatives, even black professionals are still invisible.
"You're taking two different arguments you've heard from within the "conservative circle" that seem incongruous and are using that as a comeback against me even though I never tried to make the both/and proclamation of each"
Heh... got all the way through this post and then remembered you hadn't actually responded to the point, huh? Tell us again about how we're all hypocrites because we bash each other instead of discussing the facts?
"I fully acknowledge that Democrats have paid lip service to minorities to make it look like they've done "something" to advance their cause. By pandering to blacks, they've sealed up their vote. +95%, right?"
Yup, about 95% of black people voted for Barack Obama. It's amazing how the Democratic party can pull that support just with lip service! I'd love to hear your opinion of what the African-American support for Obama would have been without the constant pandering. 20%? 10%?
"However, where does the black community stand in economic development now with the rest of society compared to where they did in 1969? Has there been any improvement? Doesn't look like it from where I sit."
That is because you are simply assuming totally ludicrous 'facts' to suit your argument. In 1969, according to the book "Poverty in the United States", the black poverty rate was 35.7%, while the white poverty rate was 10.3%. In 1999, the black poverty rate had descended to 26% while the white rate had inched down to 9.5%.
If it doesn't look like blacks are doing better than they were in 1969 "from where you sit", then I can only suggest that you need to pull your head out of where you sit.
I'm tired of trying to convince people and play nice
A majority of Americans are going to see their healthcare costs increase under this plan proposed by the liberal democrats.
Thats it plain and simple.
Good thing you gave up trying to convince people, since "because I said so" usually doesn't work.
Now take your toys and go home like the tone of your post suggests you want to.
"@goldkngt55,
Your decision impacts me, because you want me to pay for your insurance. So yes, I will get involved in that discussion!"
You drive, don't you? So you got car insurance, don't you? Are you paying for MY insurance? or am I paying for yours?
Wrong questions!
In an insurance pool, each and everyone pays for its own protection, but this is possible only if everyone in the pool pay.
So, fell free to discuss the basic unfairness of the concept of insurance if you wish, but in real life, that's how it works.
Francois,
You also fail to note that goldbricker is already paying for other people's insurance (i.e. the veterans administration, medicare and medicaid.) Now granted as a gopper he probably would just as soon throw the poor, the elderly and the vets out in the cold so he could get a tax cut, but it's amazing to me to see Republicans saying they don't want to pay for other people's health care and they don't realize that they already are.
And the best part of it is they may not realize it because medicare, medicaid and the V.A. all have lower overhead costs (not to mention the need to not make a profit) than any private plans.
harold said...
Public Education? Check.text
Lobbied for by business interests at the beginning of the industrial revolution, because of the need for more educated employees.
Most reputable historians state that the industrial revolution didn't begin in the US until the early 19th century, and some state it wasn't until near or even after the Civil War (mid-19th century).
Ever hear of the "Ordinance for the Government of the Territory of the United States, North-West of the River Ohio" passed by the Continental Congress on July 13, 1787, then affirmed with slight modifications by the US Congress under the Constitution on August 7, 1789 (in other words, an Act passed in the late 18th century)?
Didn't think so.
The Northwest Ordinance (as it's commonly called) was the most prominent act of government in establishing the concept of public education, to the extent that all townships in all counties in the states formed in the Northwest Territories were required to set aside a specific and certain amount land to support public education, the basis for the 'one room school house' in most of the less-populated townships.
OK, now you can go back to your Palin-worship.
Mike in Maryland
My Blogger ID is http://www.blogger.com/profile/02848893412251095965
Harold,
Take the "OK, now you can go back to your Palin-worship" out of my last comment, as I didn't read the rest of your message until after I posted the above.
That 'Palin-worship' comment should be applied only to the TROLLs that we are too accustomed to here at 538.com. After reading the rest of your message, I realize that you are definitely NOT in that category.
Sorry about the too-fast response.
I still stand behind my comments about the Northwest Ordinance, though.
Mike in Maryland
My Blogger ID is http://www.blogger.com/profile/02848893412251095965
persuter:
Thanks for the stats.
That's essentially the point I was trying to make. There is still a long way to go in terms of ending racial disparity but only an ignoramus would stand there and claim that no progress has been made.
Either that, or someone whose whole agenda has been to oppose every program and policy that has helped enable the progress that has been made so therefore they are obliged to claim there has been none. Sort of like Republicans on the stimulus. I know of a project paid for with stimulus dollars in my county. There are real people who have been hired to work on it, who would otherwise be out of a job. But since Republicans all voted against the stimulus they are obligated to claim that what exists, in fact does not exist.
@MikeinMD:
I like a lot of what you write, but with your attack on harold, you've jumped the shark again. Any cursory reading of harold's posts indicates that he is NOT a "Palin-worshipper".
He may have been a bit late in tying the timing of the origins of Public Education in the U. S. to the Industrial Revolution. For Europe, he may actually be correct, but I'm not a historian.
Just be careful when you throw around terms like "Palin-worship".
Keep in mind that AZ-1 includes most of the reservation lands in Arizona, accounting for a good percentage of Kilpatrick's uninsured. Those on the reservations tend to be covered by the Indian Health Service, which might be an interesting model to examine in the debate to overhaul our health care system.
Persuter quoted me above and then remarked, "If people on average made more money off the insurance companies than they put in, the companies would be bankrupt."
Thats true but the extent of the loss for the young and the hale is the point. They lose thousands, so they are rational in avoiding the loss. But those who think they need it buy it and by the premiums en masse they pay for it plus a profit for the insurance company.
The problem to focus on is competition and transparacy in the insurance market.
But beyond that we need to fix Medicare and Medicaid or Universal Coverage will fail like they are failing.
It seems stupifying to me that Obama actually wants a bill on his desk by the end of the week!
What is he trying to pull?
petekent01 (on twitter)
polls_apart,
It might be good if you noticed that I saw my own mistake a few minutes later, and posted an apology to harold.
As to the timing of the beginning of the Industrial Revolution in England, it was, according to most historians, somewhere around 1760 to 1780. Since the industrialists would have needed a bit of time to realize the need for higher educated workers, then to implement that policy, we can probably add 15 to 20 years to the beginning of public education in England. That would make it 1775 to 1800. Since England was the first nation in the world to have an Industrial Revolution (as we define it now), that revolution occurred later in other countries.
AND
The US was in the forefront of the push for public education, as evidenced by the Northwest Ordinance. You might want to view http://en.wikipedia.org/wiki/History_of_education_in_England for more information.
Why do I seem to know quite a bit about the Northwest Ordinance? Because it was an extremely important Act in the creation, and history, of the state of Indiana, the state where I was born, raised, and educated (in a public school system). As a result, there is quite a bit of emphasis on the Northwest Ordinance when the history of the state is studied (or at least when I attended school) in Indiana.
Mike in Maryland
My Blogger ID is http://www.blogger.com/profile/02848893412251095965
Mike in Maryland
My Blogger ID is http://www.blogger.com/profile/02848893412251095965
Sarah Palin steps out and takes apart the fallacies underlying Cap n' Trade http://tinyurl.com/ludeob
A brilliant first step by Palin. Of course, Cap n' Tax is low hanging fruit.
There's another branch dipping from the tree. It contains the rotten apples of healtcare reform.
The President actually had the audacity to call for a bill to be on his desk by the end of the week!
What is he trying to pull?
A fast one on the American people?
Obama is afraid of scrutiny. So much for transparancy.
Our President is such a great communicator, are we wrong to ask for a "teaching moment" on all this, instead of another hacked rush job like the Stim-u-Less Bill?
petekent01 (on twitter)
Picked up on WaPo: Ur Worst Nitemare --
BORN IN THE USA?
Eligibility Arguments To Get Court Hearing
'For 1st time, we have a judge who's listening'
Posted: July 13, 2009
In what ultimately could prove to be a turning point in the legal challenges to Barack Obama's eligibility to be president, a federal judge in California has planned a hearing on the merits of a federal court case raising those questions...
http://9sling.newsvine.com/_news/2009/07/14/3025081-obama-eligibility-case-to-be-heard-by-court
I can't wait for the unmasking!
petekent01 (on twitter)
Republicans should position the Democrat plan as a big tax on the young, because that's what it is. Actuarially, cost of health insurance for the young is extremely low. But the Dem plan, with its mandatatory coverage and no pricing bias for pre-existing coverages, would necessarily price insurance too high for young people.
Massachusetts, which also has mandatory coverage but can't enforce it, has seen how doing actuarially-unsound underwriting has polluted the pool, raising rates for everybody, especially the young.
Once details like this start getting more exposure, support for this ill-conceived scheme will drop like a lead balloon, just like in 1993.
Q: Why isn't there a price list in a doctor's office?
A: Because he's a DOCTOR.
Q: Why can't I find out my doctor's lawsuit or settlement history?
A: Because he's a doctor.
"Thats true but the extent of the loss for the young and the hale is the point. They lose thousands, so they are rational in avoiding the loss. But those who think they need it buy it and by the premiums en masse they pay for it plus a profit for the insurance company."
You start off with "That's true but" and then just repeat your point. They are not making a rational decision, they are making a criminal decision. They are making the conscious decision to allow someone else to pay for their medical expenses.
It is only a loss for (let's say) 90% of people. 10% will get seriously ill or injured, and require medical expenses beyond their ability to pay. If they can't pay, then guess what? It gets thrown onto your doctor bill and your X-ray bill and your pharmacy bill because you can pay.
People who fail to carry medical insurance are simply deciding to let other people pay for their medical care. That is not a rational decision.
"But the Dem plan, with its mandatatory coverage and no pricing bias for pre-existing coverages, would necessarily price insurance too high for young people."
How do you figure? What about the system would "necessarily" price insurance "too high"?
Because if some people can get cheaper insurance than actuarials would suggest, the others necessarily pay more. The shell game here is to force the healthy (young) people into the system, whether they want insurance or not, so as to spread the cost of the unhealthy. So, the cost to young people is higher than it should be if the insurance were actuarially sound.
When I was in law school, about a million years ago, I advocated selling mandatory auto insurance via the gas pump. That way, everybody would participate, everybody would be covered. And if you wanted more than minimum coverage, you could buy that separately.
Everybody in my torts class thought I was nuts. (However, I did get the highest grade and a Bancroft-Whitney book award. Ironically, it was for "Automobile Insurance" AmJur2d. Totally useless today.)
I believe that we should have a single payer plan and that minimum (or catastrophic) health insurance should be paid out from sales taxes. No evading it then. And if people want better health insurance, they can buy it. But at least everybody can be (and will be) covered.
Once again, I am crazy. But, I am also old. And next year when I turn 65 I am going on Medicare (and buying whatever the hell the extra insurance is for old codgers like me).
IIRC, a fair number of the McCainocrat districts listed in the post are located in areas where Democrats are successful, but minority candidates are not. I think there was in-depth analysis of race in the election on 538, and it might be interesting to pull it up and identify red herrings where McCainocraticness(?) might be an indication of issues of race and not issues of fiscal ideology.
STepper --
I believe that we should have a single payer plan and that minimum (or catastrophic) health insurance should be paid out from sales taxes. No evading it then. And if people want better health insurance, they can buy it. But at least everybody can be (and will be) covered.
Sales tax is not usually a good way to pay for things, because it unfairly taxes the poor. the poor spend all of their income on necessities, while those with "discretionary income" will do other things besides buying goods. Thus, poor people are taxed on everything, while richer people are taxed on a fraction of what they earn. If you must have a sales tax, it should be a luxury tax, that taxes luxury good only, but there are probably better ways to provide the money for health care.
STepper -- Sherri? The author?
If this were true:
"The dilemma is that Congress is trying to solve two problems simultaneously: save money and insure more people,"
Then they would go for single payer universal health care with the payer being the government paid with taxes.
That is not the case. What they are trying to do is keep the private vulture insurance companies in business, while lowering the cost and insuring enough people so we won't squawk as loudly as we are now. They are fine with 15-30 million going without health care.
Something akin to what STepper suggests would be a good first step, in my opinion.
Put a focus on getting minimum/catastrophic coverage for everyone. Do that first. Then work to remove inefficiencies, waste, fraud, and abuse from the system. That should make additional coverage more affordable and accessible to millions more.
Jen -
Just back to respond to responses.
Harold, you should run for office. You are very eloquent and persuasive, I would absolutely vote for you. I really appreciate your contributions to the comment section.
Thanks. For better or for worse, I don't think I'll be running for office any time soon, lol. Too much other stuff going on.
Mike in Maryland -
You seem like a decent guy, but you might want to read things more carefully.
Thanks for the excellent point about public education. I didn't mean to imply that business interests were the only advocates of public education.
Single Payer removes any incentive to take care of yourself
This bigger trand is quite scary. It seems the solutions to most problems are tax the rich.
Whatever happened to personal responsibility. The environment and healthcare require changes/adjustments in personal behavior for longlasting imapct.
Getting back to the politics of some of these districts...
I talked to one of the representatives on that list who described people standing on line looking for work (and this was before the economy really tanked). And I said that some of us are trying to get them health care and they don't seem to want it. The congressman shook his head and said he didn't understand it either.
I think a large part of the resistance is just ideology. It doesn't matter that there are many countries out there that have shown one can get comparable health results at close to half the cost. Some people think that government just shouldn't be involved, and that ends the discussion.
I wish facts and evidence mattered more, but to a lot of people, they don't. And those representing those more ideologically conservative districts have to take that into account.
When then nova, why don't you be responsible for yourself and pay for everything including health care out of your own pocket?
When you buy and use insurance, you are leaning on others to help you out. In short you aren't being responsible nor are you being independent.
The sheer stupidity, cold heartedness, and outright corporate dick slurping by you right wing lunatics is astounding.
You jackasses would cut off your own arms if it helped out corporate profits.
The sheer stupidity, cold heartedness, and outright corporate dick slurping by you right wing lunatics is astounding.
Civil discourse at its finest!
Thanks for providing the perfect example of the kind of dialogue we so often hear from the left.
Not to get side-tracked from political name calling, but the whole idea that people vote their economic self interest just doesn't play out that well empirically. At the broadest level, red states tend to be net recipients of federal largess support cutting spending, while the net donors in blue states vote to give away more money.
"Thanks for providing the perfect example of the kind of dialogue we so often hear from the left."
Whereas I suppose claiming blacks are as well off now as they were in 1969 is the kind of well-thought-out discourse we can expect from the right?
Whereas I suppose claiming blacks are as well off now as they were in 1969 is the kind of well-thought-out discourse we can expect from the right?
@Persuter,
I didn't resort to name-calling, vulgar language, or an angry tone in what I said. I simply stated an opinion, which is based on both facts and impartial evidence.
Part of your rebuttal centered around the mere advancement of civil rights. While I agree those were worthwhile and necessary steps for economic progress in the black community, and there is empirical evidence to suggest that poverty rates may be going down to some degree, there are other alarming statistics within the black community to suggest that they are not making progress and are, in fact, sliding backwards.
Take crime, for instance. Both in terms of victim and criminal. Blacks are far more likely to be the victim of crime and are far more likely to be incarcerated for their crimes. I don't have the data in front of me, but I'd venture a guess that this is something that has only gotten worse over the last 40 years, and not better. Incarceration rates are very high in the black community. Care to discuss that. What about ballooning out-of-wedlock births in the black community or teen pregnancy?
You can quote one statistic all day long that proves your point, but there are plenty others that suggest progress has been slim, if there's been any at all.
And that is civil discourse. I'm not yelling, using an angry tone, or being ugly with what I said. Just making a case based on what I've seen and what's happening in the real world.
That should say "anecdotal" instead of "impartial."
To be fair, Persuter, I found an article that supports what you are saying. It suggests we are "freer" now than we were 40 years ago. And that is especially true for blacks. I never disagreed with that notion. You fail to understand the substantive portion of my argument, however.
http://www.reason.com/news/show/129964.html
nova_middle_man -
Single Payer removes any incentive to take care of yourselftext
You can't be serious.
You can do better than that.
Obviously, if that assertion were true, we would see a pattern or reckless behavior in other rich countries, and a pattern of great attention to preventative health care in the US, which would surely be reflected in public health statistics.
So people in Canada and Australia never take care of their health?
Why worry about suffering and death if you have guaranteed health insurance?
The only reason to avoid diving into a shallow pool is worry about health care bills? Who cares about cancer, as long as the chemo and radiation is free?
Indeed, according to this logic, people in the US with very good health insurance would have no incentive to avoid disease and injury.
Your argument that universal health care would necessarily cost more was a similar denial of easily checked reality.
An excerpt from a Weekly Standard article that backs up the argument I'm trying to make. Of course, I'm sure since it has the 'Weekly Standard' name attached to it, you'll discredit it as nothing more than neo-con gibberish. If that's the case, don't expect me to get all excited when you link to something on DailyKos.
Regardless of where this article was written, much of its contents are indeed factual and are statistics cited by the Department of Labor and National Center for Health Statistics. There is other peer-reviewed research to support the data. So attack the source all you want, but facts are facts.
http://www.weeklystandard.com/Content/Public/Articles/000/000/014/923fdspn.asp
In 1963, according to the famous Department of Labor report issued by Daniel Patrick Moynihan two years later, the out-of-wedlock birth rate among blacks was 23.6 percent while the rate among whites was only 3.07 percent. By 2005, according to the National Center for Health Statistics, the out-of-wedlock birth rate among non-Hispanic whites had jumped to 25.3 percent and the rate among non-Hispanic blacks stood at nearly 70 percent.
In other words, the black out-of-wedlock birth rate was lower in 1963--on the eve of the Civil Rights Act, when Jim Crow policies were still an ugly reality in the American South and white racism was far more widespread than it is today--than the non-Hispanic white rate was in 2005. While Moynihan was right to raise the alarm, the numbers show that African-American families proved remarkably durable through decades of repression and racism following Reconstruction. The most severe "erosion of black families" in the 20th century occurred in the years after the civil rights movement reached its apotheosis, when black economic opportunities were expanding rapidly. What explains that?
Broadly speaking, American society underwent a cultural revolution in the late 1960s and early 1970s. Since then, out-of-wedlock birth rates among both blacks and whites have shot upward. But blacks were starting from a much higher base, and the spike among blacks was more precipitous than the spike among whites. As Heritage Foundation scholar Robert Rector has noted, the black out-of-wedlock birth rate ballooned from less than 25 percent in the early 1960s to 49 percent in 1975 and to 70 percent in 1995. The white rate increased from less than 5 percent in the early 1960s to 25 percent in 2005.
The connection between family breakdown and child poverty is well established. In a 1991 American Sociological Review article, David J. Eggebeen and Daniel T. Lichter estimated that if black family composition had remained constant from 1960 to 1988, the black child poverty rate in 1988 would have been 28.4 percent instead of 45.6 percent. If black family composition had remained constant from 1980 to 1988, Eggebeen and Lichter said, the black child poverty rate in 1988 would have been 40 percent instead of 45.6 percent.
"This implies that changing black family structure in the 1980s accounted for roughly 65 percent of the increase in official poverty among black children," they noted. "Black family shifts in the 1980s also accounted for 51 percent of the increase in deep poverty, and about 90 percent of the growth in relative child poverty." Family breakdown also had an intensifying effect on the child poverty rates of whites, but it "had a much greater effect on the child poverty rates of blacks."
In 1960, according to the Eggebeen-Lichter analysis, racial disparities in child poverty "had very little to do with racial differences in family structure." Yet by 1988, this was no longer true. "Racial differences in child poverty cannot be explained by racial differences in family structure alone," they wrote. "At the same time, the changing family structure among black and white children has clearly exacerbated long-standing racial differences in child poverty. Indeed, in the absence of widening racial differences in family structure, the 1960-1988 period would have brought substantial convergence in racial differences in official, deep, and relative child poverty."
More recently, a 2002 study by Rector and two of his Heritage colleagues concluded that "if marriage were restored to 1960 levels," the black child poverty rate "would fall by nearly a third." A separate 2002 study by Urban Institute economist Robert Lerman, which relied on data from the Survey of Income and Program Participation, found that "married couple households were much more likely to avoid poverty than all other types of households," and that "the apparent gains from marriage are particularly high among black households.
Jen
Try haveing an original thought
Beavis
I'm paying thats the point. I'm not a freeloader. If anything I'm getting a raw end of the deal. I don't use anywhere near what I'm putting in.
Say we go to singlepayer I make too much to qualify for it. So for me and millions of other Americans out there are preimums will reamin the same or go up.
I'd be happy to go for total user pays. Its really the only fair way to go.
In summary its an agree to disagree okay. Its a different view on the role of government vs the role of individuals.
Harold
You got me I'm not perfect ok. Its tough when its at least 5 to 1here. There still aren't any hard numbers out there on how much this this will cost and what it will actually accomplish. I'm talknig specifics.
What type of procedures will be covered.
Who will qualify (income requirements, preexisting condition requirements etc).
What will the premium rates be and what will be the coverage level options.
All of these arguments reminds me of the "cheap, fast, good" cunundrum where you can have something that is two of the above (cheap and fast; cheap and good; or good and fast), but never all three. I think most people would agree that our current system is not cheap. Some may argue whether it is even "good" or "fast" too. I believe all the reports I have read about other countries' systems of queing up for health care delivery suggests we are probably faster in our delivery of health care than most countries. As for good, it is debatable. Living in Baltimore, I am quite aware of the number of wealthy and connected individuals who travel from other countries (yes, all those countries with single-payer systems) to visit Johns Hopkins Hospital for their health care needs. So, at least one of our prominent health care providers in this country can be rated as "excellent," and I'm sure others would right rate up there as well. Is the system as whole good? Probably for the poorest people, the answer is "No," but for a majority of people, the health care they receive in the U.S. would probably be considered good (I think this is nova's point). So, if we want to make the system better for the poor, we will likely make it more expensive. If we want to reduce the costs of the overall system, it will only be done by either rationing health care or by reducing the quality, or combination of the two. Therefore, despite the claims of Obama and the Democrats, you are never going to get a health care system that is good, cheap and fast. There must be tradeoffs.
Well said, Richard, and I think that sums it up. I hadn't injected myself into the health care debate on this thread, but I think you presented a very cogent and insightful opinion piece on the matter. Thanks!
The Economy is crumbling and Obama wants to waste trillions, and tax millions while letting Medicare and MCaid go broke. He's a fool.
Read Zuckerman's piece from yesterday on why things are so bad. It's all about jobs, stupid!
http://tinyurl.com/nw53vb
Obama’s healthcare reform, just like Cap n’ Trade are job killing bills. Worse his Stim-u-Less legislation is a failure.
As Zuckerman say, yes, the administration inherited the problem, but then it failed to understand how ineffective its solution would be.
For such ineffectiveness there will be high price to say.
Could it be Congress and then the White House?
petekent01 (on twitter)
Richard: Is the system as whole good? Probably for the poorest people, the answer is "No," but for a majority of people, the health care they receive in the U.S. would probably be considered good...
I'm not so sure about that, at least for the money we're spending.
Study after study shows that overall health outcomes in the US are not substantially different from many of our peer countries, yet we we spend nearly twice as much as some of them. I think that's powerful evidence that even if all of those systems are "good," ours is tremendously less efficient.
And with the increasing costs of health care, that trend is unsustainable. Premiums are increasing far faster than inflation. Fewer employers are offering insurance to begin with. So I suspect that the numbers who think that their own care is "good" will only drop over time unless something is done.
If we want to reduce the costs of the overall system, it will only be done by either rationing health care or by reducing the quality, or combination of the two.
Again, I think the evidence in other countries show that the above statement isn't necessarily true. In addition, all systems ration. The only question is how. We ration right now by providing care according to income: the wealthy can spend all they want to get the care they want, and the poor don't and so don't get the care they need. The term "rationing" is just a way of avoiding the recognition of both the policy choices that we are making today and considering whether other policy choices might work out better.
I highly recommend this David Leonhardt article on the subject of rationing: http://www.nytimes.com/2009/06/17/business/economy/17leonhardt.html
nova_middle_man: Single Payer removes any incentive to take care of yourself
Harold rightly criticizes this assertion. It's an attempt to import the "moral hazard" problem to a situation where it probably doesn't apply.
Providing flood insurance without restrictions can encourage dumb activity, like building in flood plains. But having fire insurance doesn't encourage people to be careless and burn down their houses even though they'll be compensated for the loss. Getting sick is pretty miserable, so I think health insurance falls into the latter category. Who is going to get sick just because they won't have to pay out of pocket for treatment?
When there is no additional cost for a service, there is a danger that the service will be subjected to overuse and so run up unnecessary expenses. If I don't have to pay out of pocket, why shouldn't I go to the doctor every time I think I may be sick, even when I don't really need to? But that issue already exists in today's system, and insurers reduce overuse by requiring modest out of pocket expenses: co-pays. There's no reason a government plan couldn't do the same.
"Single Payer removes any incentive to take care of yourself"
I'm glad you explained this to me. This explains why the people in Europe are fatter and don't live as long as we do.
Er, wait a minute.
Nova_Middle_Man -
What type of procedures will be covered.
Who will qualify (income requirements, preexisting condition requirements etc).
What will the premium rates be and what will be the coverage level options.
Those are excellent questions. I have no problem whatsoever with asking those questions. In fact they need to be asked.
Now I have a question for you, a more general one -
If a single payer system similar (not necessarily identical) to Medicare, the Canadian system, or some other reasonable model was proposed, if it would ultimately save the vast majority of people at all income levels money, if it was beneficial to health care providers, if it would give many more people access to health care without harming anyone's current level of care, in short, if a fairly ideal system could be proposed -
Would you support it? Or would you be opposed to a universal system on ideological grounds, regardless of pragmatic outcomes?
If a single payer system similar (not necessarily identical) to Medicare, the Canadian system, or some other reasonable model was proposed, if it would ultimately save the vast majority of people at all income levels money, if it was beneficial to health care providers, if it would give many more people access to health care without harming anyone's current level of care, in short, if a fairly ideal system could be proposed -
Would you support it? Or would you be opposed to a universal system on ideological grounds, regardless of pragmatic outcomes?
I know this question wasn't posed to me, but I'll answer. Yes, emphatically I would support it.
The problem is that I don't see anything the Democrats/liberals have pushed forward thus far in Congress as potentially meeting most, and certainly not all, of the criteria you mentioned.
"An excerpt from a Weekly Standard article that backs up the argument I'm trying to make."
Your argument is that black people have enjoyed no economic improvement between 1969 and now. You yourself have admitted that the poverty rate has decreased.
Unless you can show where this article suggests that black people are economically worse off now than they were in 1969, you clearly lose.
Honestly, Mule, there's a difference between arguing because you think you have a valid point and arguing just to argue. You change your claim every single post as it becomes clear that your claim is ridiculous. First you made the claim that Democrats don't do anything concrete for blacks - the minute I mentioned Barack Obama, that little gem disappeared. Then you made the claim that blacks aren't economically better off now than they were in 1969. Even five minutes of research would have put the lie to that - you yourself admit now that it's not true. Now your entire claim is that something bad happened to black people at some point between 1969 and 2009 - a point which I am certainly not going to argue against.
By the way, the article clearly supports my position, not yours. "Indeed, in the absence of widening racial differences in family structure, the 1960-1988 period would have brought substantial convergence in racial differences in official, deep, and relative child poverty." That makes clear that overall black economic development was improving, otherwise widening racial differences would not have prevented convergence. You're simply trying to totally change your argument.
Not to mention that the argument is bizarre anyway. Black people were five times more likely to have out-of-wedlock children than whites in 1969, they are now three times more likely, and you are somehow trying to spin this as a change for the worse?
Yes I would but theres alot of ifs in there. The devils in the details.
No, Persuter, you're the one who created that argument out of thin air and put words in my mouth. I responded to this original statement:
A mystifying fact about a lot of Americans in the South and rust belt, and here I'm referring to the "typical" white, protestant, lower middle class citizen, is that they do not vote in a way that would rationally serve their own interests. This has been the case since certainly the Nixon era, when Republicans became focused exploiters of this group of Americans.
I'm a white southerner myself, and, as much as I hate to say it, I think a large portion of my brethren don't seem to know what's good for them. They have allowed themselves to by exploited by ideology. Namely, bigotry, xenophobia, and know-nothingism. This is why plenty of people in a state like Oklahoma can say they don't want health care reform, even though one out of every four Oklahomans is uninsured.
And my response was:
Or I could go into detail with a story commensurate to your "Republican exploitation since the days of Nixon" with one of my own about "Demcoratic exploitation since the days of LBJ" and how they've done the same thing to lower and middle-class blacks, and to an increasing level to Hispanics in recent years, to pander to their vote even though they've done little to nothing to advance the self-interests of those groups.
I was wrong later to suggest there had been no economic improvement, but as you can see in my initial post, that wasn't my argument. I was merely pointing out that Democrats do the same thing as Republicans but with different groups of people. The argument was that Republicans exploit the white, southern vote despite not always acting in their self-interest. I said, which may be an arguable point but isn't completely unfounded, that Democrats do the same thing with blacks and increasingly with Hispanics. They exploit their vote - and boy do they ever and have succeeded at getting over 90% of it - but don't really do a heck of a lot for that community.
Any advancement in the black community has come in spite of those misguided efforts by Democrats.
Not to mention that the argument is bizarre anyway. Black people were five times more likely to have out-of-wedlock children than whites in 1969, they are now three times more likely, and you are somehow trying to spin this as a change for the worse?
Are you freaking serious with this comment? Are you serious? You must have a fundamental lack of understanding of statistics, but you have a perfect understanding of how interpreting a set of numbers can be manipulated to look good when all signs point to something being much worse.
Do I really need to explain?! The black out-of-wedlock birthrate ballooned from less than 25% to 70% over a span of 30 years. That's bad. No matter how you slice it. It's nearly tripled you are somehow trying to spin this as a change for the better? And simply because the white out-of-wedlock birthrate skyrocketed by fivefold in the same time period? That's irrelevant information and an erroneous comparison. All it means is that out-of-wedlock birth rates were skyrocketing across the board over that time period.
I can't fathom how you can argue that because the ratio was once 5-to-1 but is now 3-to-1 that somehow that is a good sign, when the o-o-w birthrate has tripled and stands at 70% or more now.
You seem to be making a play on that old statistics anecdote...the one where people in Group A leave and join Group B and the average IQ of both groups goes up. It's a statistical anomaly that happens sometime that doesn't seem plausible. But sometimes people try and use it in real world situations to make an informed assessment and they're really come off looking ignorant. You did just that with your argument that blacks were better off because their out-of-wedlock birthrate is now only 3 times as much as whites, whereas it was once around 5 times as much, even though that rate has tripled to 70% in just a 30-year time period.
dsimon:
First, with regard to US health outcomes, I would say it is inconclusive whether US has worse health outcomes. This detailed study (http://www.openmedicine.ca/article/view/8/1) found "that Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent." Another study (http://ideas.repec.org/a/kap/ijhcfe/v6y2006i1p3-23.html) found that most of the differences in US outcome results were due to "...poor lifestyle choices, particularly obesity." Furthermore, I point to Johns Hopkins as probably the best hospital in the world and I ask whether this fabulous hospital would be as good under the reforms currently being offered or under the systems that are employed in other parts of the world. I may be wrong, but I don't think so. When there is no or little monetary incentive to do the valuable research that occurs in our country at these hospitals, all countries that depend on these innovations will realize worse outcomes. I often get the sense that Democratic policies (at least, liberal-socialist democratic ones) are intended to make everyone equally worse off, rather than making everyone better off, even if some make out better than others.
dsimon, As for rationing, I agree with David Leonhardt that rationing already does and must occur with regard to health care and that "[i]t is the process of allocating scarce resources." I believe we differ on who does and should do the rationing. He would favor a bureaucrat, probably somehwere in Washington, making the decision whether patient "A" gets a particular treatment based on a whole set of so-called "rational" or "scientific" factors that most people will be unable to explain, let alone be able to understand. I would favor a different system. I would favor patient "A" deciding what level of insurance is best for him/her, based on his/her lifestyle, paying for the actual costs of that insurance and then if a particular treatment is covered under the policy, then the decision to undertake the treatment is made by the patient in conjunction with his/her doctor. If the treatment is not covered, then ptient "A" must decide whether to foot the bill or not. This may sound harsh, but the other way is just passing the actual costs of poor lifestyle choices onto society, which has been occurring in a limited fashion under our current system.
MuleRider is right to point out that the black family structure has undergone a severe blow since 1969, which led to higher teen pregnancy rates and many of the other things he cites.
What he doesn't say, because he probably doesn't know it, is WHY the black family structure has undergone such a disaster. The answer is that when it became clear that the Federal government was indeed going to enforce desegregation laws in the South (which was, until about 1969, a very real question), millions of blacks were evicted from the land upon which they had raised families virtually since the Civil War, albeit as second class citizens. These people went north, because they no longer had any means of making a livelihood in the South and because the safety net systems in the north were far more generous than in the south.
They arrived at precisely the moment that the postwar boom years were ending, leaving them to compete with white workers in a shrinking jobs pool and with educations which were woefully insufficient (thanks to seperate-but-NOT-equal Southern schools) for them to compete effectively. In strange surroundings, in an enforced poverty from which there was little hope of escape, and separated from the communities which had nurtured them for generations, the black family began to fall apart, just as it did with every immigrant group before them.
So what MuleRider and the snobs at Weekly Standard are saying is how awful it is that the black family fell apart, even though they stand four-square behind the same forces that CAUSED that breakup -- namely, the racist reaction to desegregation.
Eventually, the safety net which was provided in the North, plus the enforcement of civil rights laws, did begin to alleviate the poverty of blacks.
And blacks know the truth of what I'm saying here. They know that it's not the safety net that caused families to break up, but the racists allied with those who oppose the safety net. And they vote accordingly.
...millions of blacks were evicted from the land upon which they had raised families virtually since the Civil War, albeit as second class citizens.
Do you have evidence to support this. Or did you just pull that out of the air? Millions? Really? Funny thing that they don't talk about anything quite like that when they revisit the old civil rights battles of the 1960s...even on PBS.
I want to see something that states uneqcuivocally that "millions" of blacks were evicted from the land they had lived on for generations. Until you can prove that little factoid, I'll have to dismiss the rest of your diatribe as nothing more than a hyperbolic rant.
I agree that there were countless atrocities and boundless racism at that time, much of which lingers today, but there were not millions of black people evicted from their land and driven north.
Give us facts. Not hyperbole.
"I was wrong later to suggest there had been no economic improvement, but as you can see in my initial post, that wasn't my argument"
It was the only evidence you provided for your argument. You now admit the evidence is incorrect. You further provided your article on birth rates vis-a-vis child poverty rates to continue with your argument that there had been no economic development.
Further, you later said "Part of your rebuttal centered around the mere advancement of civil rights. While I agree those were worthwhile and necessary steps for economic progress in the black community..."
And:
"It suggests we are "freer" now than we were 40 years ago. And that is especially true for blacks. I never disagreed with that notion. You fail to understand the substantive portion of my argument, however."
As such, economic development was clearly not just part of your argument, but, by your own words, "the substantive portion" of your argument.
"They exploit their vote - and boy do they ever and have succeeded at getting over 90% of it - but don't really do a heck of a lot for that community."
I'll simply ask you again -- how many African-Americans do you think would have voted for Barack Obama if they realized how little the Democrats were doing for them?
"Are you freaking serious with this comment? Are you serious? You must have a fundamental lack of understanding of statistics, but you have a perfect understanding of how interpreting a set of numbers can be manipulated to look good when all signs point to something being much worse."
Oh good, glad to see you're keeping away from the name-calling and angry statements as usual, Mule.
"Do I really need to explain?! The black out-of-wedlock birthrate ballooned from less than 25% to 70% over a span of 30 years. That's bad"
Yes, but again, I am not going to argue against the trivial claim that something bad happened to black people between 1969 and 2009. (It just occurred to me that maybe this was the argument you were claiming I made up. However, since your entire argument above is that the oow birth rate increasing is "bad", that is clearly your argument.)
Your argument is that Democrats do not do enough for black people. How the fact that black people's out-of-wedlock birth rates increased more slowly than white people is even a bad thing for black people, much less the Democratic Party's fault, is totally beyond me, and you certainly have made no attempt to explain. Indeed, you angrily ask whether you even need to explain! You're simply hanging onto a single point that isn't even relevant to the argument you claim you're making.
"It's a statistical anomaly that happens sometime that doesn't seem plausible. But sometimes people try and use it in real world situations to make an informed assessment and they're really come off looking ignorant."
Well, it happens sometime that I are really come off looking ignorant. Guess I'll just have to live with it.
slasher14, it sounds like you're referring to the Second Great Migration (and maybe the First). However, that was more or less voluntary. I agree with you that it was caused by racism and that it has led to a lot of the problems the African-American community faces today - but saying they were "evicted" by the millions is a bit over-the-top. Black people voluntarily moved out of rural Southern areas (along with many whites) to urban Northern and Western areas. A famous example would be Michelle Obama's family, who moved from South Carolina to Chicago in the First Great Migration. They were not "evicted" in any way, shape, or form, and indeed, moved back there, as did many black people.
Oh good, glad to see you're keeping away from the name-calling and angry statements as usual, Mule.
I didn't call you one name in the paragraph you quoted and responded to...I did later refer to you as ignorant, but due to your absurd interpretation of the data, that's the only logical conclusion. And labelling ignorance isn't necessarily name-calling. You probably can't help it that you don't understand mathematics as well as you should. And I didn't mean to sound "angry." I was maybe a bit biting and sarcastic, but not angry.
Your argument is that Democrats do not do enough for black people.
No! My argument is that Democrsts do the same level of pandering to blacks Republicans do for southern whites. There's little difference between the two. It's not to say that either political party does nothing, or not enough, for those groups...it's saying that they do more lip service to extract their vote (which they're good at, look at the numbers - blacks for Dems and southern whites for Reps) and fall well short on action. Which, to most people, brings to mind the word "exploit."
That is/was my argument.
How the fact that black people's out-of-wedlock birth rates increased more slowly than white people is even a bad thing for black people,
You're getting hung up on the rate of increase while I'm trying to harp on the rate itself. It's at 70%! That's over two-thirds. It's an incredibly high rate for anything and especially troublesome for an issue that has been pinpointed as a leading indicator of other troubles down the road - i.e. poverty, crime, lack of education, etc.
The fact it increased fivefold in the white community is also very bad. But it's still "only" 25%. That's way too many but at a 1-in-4 rate, it's much more manageable. Looking at a relative increase in out-of-wedlock birthrates between blacks and whites is about as relevant as looking at the rate of aging between a grandmother and her grandson over a 5-year period. Assuming the kid was 5 and the grandma was 50 at the beginning of the "study," five years later you would say the kid's age doubled, or increased 100%, whereas the grandmother's age increased only 10%. So freaking what. The kid's now 10 and hasn't even hit his "peak" years while the grandmother is entering her senior years and likely to experience additional health problems, despite her much less rapid "increase" in age.
Does that make sense now? Even talking about the "rate of increase" is an irrelevant topic.
much less the Democratic Party's fault, is totally beyond me, and you certainly have made no attempt to explain.
I didn't try and lay it at the feet of the Democratic Party. I'll go back to my original point/argument that the Democratic Party simply does more to pay lip service to blacks and extract their vote than what they actually do to improve their livelihood. I concur that they do something. They have to or otherwise blacks wouldn't support them with such vigor. However, I made no connection to failings in the black community being one party's fault.
You exhaust me.
Yeah, I did a quick search on wiki - and other places - and Persuter is spot on...black migration may have been spurred by racism and other problems but to suggest they were "evicted" by the "millions" is indeed over the top.
http://en.wikipedia.org/wiki/Great_Migration_(African_American)
Richard (and all the other FACT-deniers),
One area of medicine where the US is better than most of the rest of the world is corneal transplants.
In the US, a surgeon can set a date with the patient days, weeks or even months in advance, and perform the transplant on that date. In the rest of the world, the patient is usually informed the day prior to surgery of the date of surgery.
But why? The US has a better medical system?
NO
The US has a much higher rate of organ and tissue donation that ANY other country in the world.
Corneal tissue can be stored for up to a week. The US has a system of Eye Banks.
THAT is about the only reason that, for instance, Canadian citizens might (notice the word might?) consider going to the US for a corneal transplant. And even then, the Canadian insurance system most likely will pay for the surgery - every bit of it, not the 50% (or 75%) of the 'usual and customary' fee of $10,000 to $25,000 for such an operation. And most of them would NOT go to JHH, but rather to Portland, Oregon; Indianapolis, Indiana; Fr. Myers, Florida; San Francisco, California; or other locations that were performing newer corneal transplant techniques YEARS before JHH stared to perform those newer techniques.
Mike in Maryland
My Blogger ID is http://www.blogger.com/profile/02848893412251095965
Mule Rider - "The problem is that I don't see anything the Democrats/liberals have pushed forward thus far in Congress as potentially meeting most, and certainly not all, of the criteria you mentioned."
Have you looked at HR676?
Mike in Maryland, Before saying I'm a FACT denier, please provide me with at least one link to a study that supports the notion that the quality of health care in a country with a single-payer SYSTEM is better than the quality of health care under the U.S. system. I provided two links of detailed studies that concluded that if there is any difference at all in health outcomes, it isn't due to the system of health care provision, but rather, due to the poor lifestyle choices made by individuals in the U.S. This is a simple notion in systems analysis research. If you have a higher quality item going into the system, then that system will have better outcomes than a system with lower quality items.
The socialist-liberals make this same argument when comparing suburban schools to urban schools. Rightfully, they point out that the students in suburban schools are better prepared than the students in urban schools going in, so it is only natural that the suburban school students are likely to have better "outcomes" on standardized tests. The real analysis of the educational system (this analogy should be used in evaluating health care systems too) should be with how far each system broght the child along. For example, if the average child going into an urban high school has a fifth grade reading level and the school brings that student up to an eigth grade reading level by the end of the ninth grade, is it better or worse than a suburban school system that brings an average student from an eigth grade reading level up to a ninth grade reading level at the end of the ninth grade? If you just looked at outcomes, you'd say that the urban school is failing. Why not use this analogy when comparing health care systems? Of course, the good studies will do this. The ideological studies will leave that part out.
Richard: I would say it is inconclusive whether US has worse health outcomes.
But the point wasn't whether the US has worse outcomes than our peer nations (and I believe I said that the outcomes were comparable, not necessarily worse.) The point is the expense: that we spend almost twice as much as other countries while getting only comparable results. If we're spending so much more, is it a good deal to get results that are only marginally better?
And yes, there may be lifestyle differences. But how much of such a vast disparity in spending can it be responsible for? Even if lifestyle results in less healthy Americans, I have a hard time believing that we can attribute our nearly 100% greater expenses to it.
I would favor patient "A" deciding what level of insurance is best for him/her, based on his/her lifestyle, paying for the actual costs of that insurance and then if a particular treatment is covered under the policy, then the decision to undertake the treatment is made by the patient in conjunction with his/her doctor.
I don't believe anyone is proposing anything that would prevent this scenario. What is being proposed is an alternative for those who can't get insurance to begin with, and an option for those who might prefer a different plan.
Even if the dubious notion that a public plan will "crowd out" private plans turns out to be true, anyone would be free to purchase supplemental insurance to provide the freedom you describe.
This may sound harsh, but the other way is just passing the actual costs of poor lifestyle choices onto society
I don't think so, because those costs are already being passed along to society. People who don't have access to health care services get sick, miss work, and go to emergency rooms. Those costs are already socialized. Having real health care and regular access to a doctor may encourage better lifestyle choices and reduce those costs.
Moreover, many people who have insurance today make poor lifestyle choices, so there wouldn't seem to be much difference between a public and private system in that respect.
Finally, your proposal would seem to me to exclude anyone with a preexisting condition. The costs of treatment for many people make them essentially uninsurable. That's one huge problem with private insurance: the incentive is to insure only people who are healthy, and deny care whenever one can arguably do so. A public system does have different kinds of problems, but at least there's no profit motive in the process. (And, as I wrote before, those who are concerned about "rationing" and can afford it can buy additional insurance.)
dsimon, I was trying to separate cost, quality and speed/access issues (please read above) and I conceded that the US system is too costly (I believe the high cost is mostly due to the disconnect between the payment of insurance and the actual cost of the health service provided, which leads individuals to use more health care than they would, if they knew what the actual cost are). I was trying to show that we can never get the "perfect" system, that there will always be tradeoffs. If you want to bring down costs of the system, which I think we both agree upon, then there must be a tradeoff with either quality or speed/access issues. If you want to increase speed/access, which most of the reform proposals coming from Congress seek to do, then they are being disengenuous that the costs will not go up for a majority of people or that the quality will not suffer. I know everyone thinks Obama is "Superman," but he is not going to get it all. Tradeoffs have to be made. The Dems just don't see this or, more than likely they do, but don't want to speak honestly about it to the public.
I was trying to show that we can never get the "perfect" system, that there will always be tradeoffs.
And I was trying to show, through the hard evidence provided by other countries, that those tradeoffs need not be significant compared to what we have now, which also involve tradeoffs.
If you want to bring down costs of the system, which I think we both agree upon, then there must be a tradeoff with either quality or speed/access issues.
The stubborn fact remains that some of our peer nations have been able to get comparable results while we spend almost twice as much. And their populations certainly have greater access. And from what I've read, the speed issues are greater for some things but less for others (while, again, spending far less). I don't think that the examples provided by other countries has been fully addressed.
Tradeoffs have to be made. The Dems just don't see this or, more than likely they do, but don't want to speak honestly about it to the public.
Again, tradeoffs are being made right now, but some of those against reform don't want to speak honestly about it to the public. If our system is as inefficient as it appears to be, then we should be able to consider more efficient tradeoffs than the ones we're making today.
By the way, on lifestyle choice: it's not clear that all those choices cut in the same direction. Yes, Americans are generally fatter, but I think Europeans smoke more. Also, one should be able to sort out the per capita health care costs of various subgroups (obese, smokers) in each system. I could be wrong, but I suspect our costs would still be vastly higher with not much effect in outcomes.
It's useful to look at at the New Yorker piece from last month. Even communities with similar demographics have wildly different health care expenditures with little difference in outcomes.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
dsimon,
The pre-existing issue is definitely a cunundrum. If insurance companies have to take anyone with a pre-existing condition, then why would anyone pay for catastrophic insurance before they needed it? A rational person would just simply wait until they had a condition before obtaining insurance. This is the reason why Hilary Clinton was being more honest than President Obama on the campaign trail. She was arguing that insurance would have to be mandatory for all individuals because of this issue. Obama was campaigning for insurance companies covering pre-existing conditions too, but not requiring that health care insurance be mandatory for all. He has changed his position now, but, again, I find it disengenuous at best.
dsimon, I believe we will need to agree to disagree. I just don't see the "hard evidence" that you posit. There are a lot of reasons we spend more than other countries on health care, some due to inefficiencies in some parts of our system (always room for improvement), but I believe it has more to do with other factors that are not being addressed in what is being offered by the Congress in this package of reform measures.
For those of you here who keep saying that everyone will still have a choice of a public or private option after the Democrats "reform" health care, I would recommend you either read the bill or this article: http://www.ibdeditorials.com/IBDArticles.aspx?id=332548165656854. Per the legislation, everyone will be stuck with whatever insurance policy they have now. Any new private insurance policy will be prohibited after the date the new legislation becomes law.
Also, just read a news article that reported that Congressional Budget Office ("CBO") Director Douglas Elmendorf stated that "the legislation that he has seen so far would raise costs, not lower them." Senator Kent Conrad, D-ND asked Elmendorf whether the bills being considered in Congress would "bend the cost curve." Elmendorf responded: "the curve is being raised. Subsidies to help uninsured people would raise federal health care spending, which is already growing at an unsustainable rate." This is from the Democratically appointed Director of the CBO! Who are the FACT deniers now?
Richard: This is the reason why Hilary Clinton was being more honest than President Obama on the campaign trail. She was arguing that insurance would have to be mandatory for all individuals because of this issue.
That's one reason, but not the only one and not necessarily the most important one. Another reason for an individual mandate is to pool risk and bring down costs.
There are a lot of reasons we spend more than other countries on health care, some due to inefficiencies in some parts of our system (always room for improvement), but I believe it has more to do with other factors that are not being addressed in what is being offered by the Congress in this package of reform measures.
I agree that other measures need to be addressed. Hence the New Yorker article I referenced. But I just don't see how those "other factors" could possibly result in a nearly 50% reduction of costs that other countries seem to get. Still, I gather that we agree that other nations get comparable results at far less cost, though we may disagree about why that is. Again, the New Yorker article is instructive on why costs vary so widely even among comparable populations in the US.
Also recommended: the Frontline episode "Sick Around The World" which looks at the health care systems of some selected other countries.
Also, just read a news article that reported that Congressional Budget Office ("CBO") Director Douglas Elmendorf stated that "the legislation that he has seen so far would raise costs, not lower them."
Costs to whom? Of course subsidizing the uninsured would raise costs to the federal government. But it might reduce costs in premiums. And the figure that I thought was important was the per capita cost of heath care. Just because federal spending goes up does not mean that overall per capita heath care expenditures will go up. If federal expenditures go up but overall expenditures go down with the same health results, that's a more efficient and less expensive system.
Also, if the rate of federal health care spending is "unsustainable" and the number of uninsured is growing (after all, the costs are increasing to private employers who are choosing to shift expenses to employees or not offer health benefits at all), what's the solution? As Obama has said, the status quo is not sustainable--unless one wants to deprive an increasing number of people of decent access to medical care, which is of course a form of rationing.
This is an awfully big reform package that is being rushed through the Congress to be unsure whether "it might reduce costs in premiums." Show me one study that suggests that "overall" per capita health care expenditures will be reduced. Believe me, if they had a study, they would be trotting it out about now, given their own CBO is telling them costs will increase, not decrease. My prediction is that the House will pass a bill, but the bill won't get out of the Senate this year. (New Yorker article not available)
Got New Yorker article now. Must have been something on my end.
The New Yorker article, combined with this article by John Stossel (http://www.reason.com/news/show/134684.html) and chart: (http://blogs.abcnews.com/.a/6a00d8341c4df253ef011570a5b478970c-pi) explains most of the reasons why health care cost are higher in the US.
To your amazement, I probably agree with much of what is said in the New Yorker article, especially this:
"Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world."
Stossel and the New Yorker article both agree that insurers and insurance, whether private or public, is not the answer. Like the New Yorker suggests, I'd rather have the medical communities making decisions, in conjunction with patients, but that is not what is being done with this so-called health care reform. Unfortunately, the reform package being offered is about more insurance and puting the public insurers in charge. It contradicts what the New Yorker suggests is necessary.
Richard: Stossel and the New Yorker article both agree that insurers and insurance, whether private or public, is not the answer.
No, I think that's not the conclusion. It's that insurance is not the only part of the answer. It is probably a part of the answer. Just look at administrative costs here versus administrative costs in our peer country groups. Again the Frontline "Sick Around The World" program says they spend only a few percentage of costs on administration (as does Medicare), as opposed to over double digits with our private insurers. That's nothing to sneeze at.
On thing other countries have in common is competitive but non-profit insurance, some with a public option and some not. Seems to work for them.
Show me one study that suggests that "overall" per capita health care expenditures will be reduced.
Can't know for sure. But can't know that they won't be reduced either. Again, I may be wrong but I don't think the CBO is tasked with computing overall health care expenditures.
Frankly, the Stossel article is off on several points. As I mentioned in a post above, co-pays can take care of the overuse problem. Shame he doesn't even mention it. Moreover, he says there's something wrong when women are healthier than men yet go to doctors more often. Did he stop to think that maybe they're healthier because they go to doctors more often, like when they're getting sick, or for preventative care? I don't know, but there's no effort to separate correlation from cause. That's seems really sloppy to me.
And really when Stossel says "When politicians interfere with free markets, unintended consequences harm everyone," that's pure ideology at work. Has he seen the wonder of the unfettered free market at work in the financial markets? How does he think we got here, by too much regulation?
Now, I'm basically a free market person. But I'm not going to ignore evidence that an unfettered free market doesn't always get the results we want, in which case some modifications are called for.
dsimon, here is a Washington Post article on what Elmendorf said yesterday: http://www.washingtonpost.com/wp-dyn/content/article/2009/07/16/AR2009071602242.html
From the article: Some provisions of the bill have the potential to trim spending further, Elmendorf said, but "the changes that we have looked at so far do not represent the sort of fundamental change, the order of magnitude that would be necessary, to offset the direct increase in federal health costs that would result from the insurance coverage proposals." I think that answers your question on overall health care spending.
I would be in favor of reform if Congress adopted Elmendorf's two suggestions: (1)changing the way Medicare reimburses providers to create incentives for reducing costs (I believe Obama supports this); and (2) ending or limiting the tax-free treatment of employer-provided health benefits, which is a federal "subsidy" that encourages spending on ever-more-expensive health packages (basically John McCain's proposal, which the unions are against). I also think they need to strike the provision in the current legislation that prevents private insurance from writing insurance policies after the date the legislation is passed. I'd also decrease the level where the government is subsidizing people to pay for health insurance, which the current bill has at 400% above the poverty line, which is an individual making $88,000 a year. Do individuals making $88,000 a year really need a subsidy to pay for health insurance? I'd suggest $75,000, but also make it adjusted to where you live ($75,000 in DesMoisne is more than $75,000 in San Francisco).
I'd support the health care reform package if all of those were part of it. I'll stick by my prediction--bill passes the House, gets stuck in the Senate, no health care reform this year. I do think that is a shame (those opposed to the current bill are not all "obstructionists," some just want a better plan). I think the one area we both agree upon is that what we have now is unsustainable.
The Louisiana rep gains nothing from health reform as Louisiana operates a statewide charity system already. Its very good. We even do heart transplants for the indigent.
The feds proposal would offer substantially less than we offer now.
I would be in favor of reform if Congress adopted Elmendorf's two suggestions: (1)changing the way Medicare reimburses providers to create incentives for reducing costs (I believe Obama supports this); and (2) ending or limiting the tax-free treatment of employer-provided health benefits, which is a federal "subsidy" that encourages spending on ever-more-expensive health packages (basically John McCain's proposal, which the unions are against).
I have no problems with either of those proposals, so that's another area of agreement. The problem is that Obama kind of boxed himself in on the second one during the campaign, so it's going to be hard for him to reverse himself no matter how sound the policy reasons are.
As for the CBO, I don't want to grasp at straws, but the NY Times article says: "The budget office, in its calculations, cannot take into account — or 'score,' to use Congressional budget lingo — many of the savings that Democrats say will result from their legislation because those savings fall outside the direct control of federal law." So the CBO may not be the last word on the subject.
Still, some cost control measures are needed. The House bill won't be the last word either. There's still a long ways to go.
I think (and this is mostly speculation) that something will get through if only because it would be too devastating to Democrats and Obama to fail to pass anything. I would not predict what the final form of that something would be, though.
And from a political point of view, it seems that Republicans see no electoral benefit in providing a single vote for reform. I'd guess that if something does pass, it will be without any Republican support. Sad that politics takes precedence over substance, but that's the way the game is played.
@ vonwerder
Louisiana’s charity system will care for uninsured indigent people. However, Louisiana’s working families can’t use the charity system until they cease being “working” and become “indigent”. So if an unemployed indigent person can theoretically show up at a Louisiana hospital and get that heart transplant, working people will have to bankrupt themselves and their families before the charity system kicks in. But being forced to declare medical bankruptcy isn’t that difficult in Louisiana, according to Healthcare for America Now. I paraphrase for brevity:
*Health insurance premiums for Louisiana working families increased 75 percent from 2000 to 2007. The average annual combined premium for family health coverage for employers and employees rose from $6,536 to $11,455. The full cost of employer-sponsored insurance in Louisiana now equals 29 percent of median family income. Without meaningful health reform, that number will grow to 60percent in 2016. The full cost of employer-sponsored health insurance is projected to grow at an annual rate of 7.9 percent, compared to a negative 0.2 percent growth rate for income.
*For family health coverage in Louisiana, the average employer’s portion of annual premiums rose 76 per cent from 2000 to 2007, while the average worker’s share increased 74 percent. From 2000 to 2007, the median earnings of Louisiana workers increased 23 percent, from $20,467 to $25,147.
*Sixty-one percent of the total non-elderly uninsured population in Louisiana are working adults.
In Louisiana 10.5 percent of working adults spend 20 percent or more of their income on out-of-pocket health care expenses in 2004, a 33 percent increase from three years earlier.
*A recent report estimated that 62 percent of bankruptcies were directly related to medical bills; in Louisiana there were 14,945 non-business bankruptcies in 2008.
Louisiana’s working families need healthcare relief. Or else they can stop working, go live under a bridge, and let the charity system absorb them. Sounds like a plan! ;)
http://healthcareforamericanow.org/page/-/affordability%20reports/affordability%20fact%20sheet/Louisiana.pdf (includes sources)
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