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Source: (consider it) Thread: Purgatory: Health Care
Crœsos
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quote:
Originally posted by New Yorker:
One other thought before I depart. Here if you call an ambulance it comes to get you and then you or your insurance are billed. The Canadian doctor meant that if you are having a heart attack and ring for the paramedics they won't come!

Sort of like the way it is here when an insurance company denies certain treatment. You are still free to obtain the treatment and pay for it yourself. In socialized systems if you are denied, that's it.

This is essentially arguing that there are no ambulances in Canada. Sure, you can call for them but they'll never show up, so it's the same as not having any. If that doesn't set off your bullshit detector, I don't know what will.

Here's an account by a Canadian of his encounter with the Canadian medical system. An excerpt:

quote:
Late that night, unable to sleep because of a splitting headache, I got up to take some strong headache medication. The last thing I remember was reaching up to the cabinet containing the pills. My wife then heard a crash as I hit the floor. I had collapsed and gone into a convulsion.

This is the point where we discovered just how fast and effective our health system could be. The complaints you hear directed at Canada's health system about waiting times for treatment are simply without foundation. As you will see from what happened next, my experience says quite the opposite.

The next thing I recall I was being carried downstairs by some fire fighters who responded to the 911 call and had made it to our house ahead of the ambulance. I was taken immediately in the ambulance to the Mount Sinai Hospital emergency. I drifted in and out of consciousness and don't remember much from that period, but a CAT scan done in the wee hours of Thursday, April 22 revealed a large mass in my brain.

Now New Yorker and Dr. Day (who, according to his Wikipedia entry, is sometimes called "Dr. Profit") would have you believe that this could not possibly have happened, that since the Canadian system doesn't cover ambulance service no ambulance could possibly have taken this man to the hospital, i.e. there are no ambulances in Canada. Now I personally never needed an ambulance on the one occasion I was in Canada, but to imply they don't exist strains credulity.

quote:
Originally posted by tclune:
Hostly Hat ON

This post is wildly inappropriate. We do not attack the honesty or integrity of posters in Purgatory. Either take it to Hell or change your comment to the Purgatorial "Bollocks" or equivalent. A point may be full of crap, but the posters in Purgatory are not.

--Tom Clune. Purgatory Host
Hostly Hat OFF

I have some policy-related questions about this which are better addressed over in the Styx.

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Humani nil a me alienum puto

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Leaf
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New Yorker: I did not see the interview with the former head of the CMA, so cannot say what was said or how it has been interpreted. But if you think that in Canada, "if you have a heart attack and ring for the paramedics, they won't come" that is simply, completely, totally false. I can say this with assurance because I have been present on occasions when 911 was called - the ambulance comes, even if it's to where the taxis won't go. The paramedics do not ask for proof of payment or insurance before treatment or transportation. They treat the person and take them to the hospital if needed.
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Soror Magna
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quote:
Originally posted by New Yorker:
One other thought before I depart. Here if you call an ambulance it comes to get you and then you or your insurance are billed. The Canadian doctor meant that if you are having a heart attack and ring for the paramedics they won't come! ...

Well, if that's what he meant, he's wronger than a wrong thing with wrong sauce on National Wrong Things Day. I've called an ambulance for a student with a tummyache and it came. They came, although we waited for almost 20 minutes. The response was much, much faster when I called an ambulance for a service worker who fell down the stairs and had a head injury and a broken arm. The calls are prioritized. And yes, there's a bill, and it's reasonable considering you're getting much more than a taxi ride, and a lot of people have extended health benefits which cover all or part of the cost to the rider/patient. Perhaps the good doctor was confused -- it's not beyond the realm of possibility that he's never actually had to call an ambulance. OliviaG

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"You come with me to room 1013 over at the hospital, I'll show you America. Terminal, crazy and mean." -- Tony Kushner, "Angels in America"

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ToujoursDan

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My mother, who at that time was unemployed, divorced and in dire financial straits, had a heart attack in her home in 1989, called the ambulance and they were there in 10 minutes. They brought her to a small nearby regional hospital, but they were not equipped to do the kind of open heart surgery she needed and chartered a helicopter to fly her to a larger hospital to do the surgery. I made to hospital and saw her for a few minutes and then the doctor told me that the helicopter was here and that I needed to drive to the other hospital and wait. So I left. It was going to be about an hour's drive.

I stopped by my house to get a book and some supplies for the long night ahead of me when I got a message. Sadly, she died of an aneurysm soon after I left.

We weren't billed for any of it.

If people think doctors (or anyone else in Canada) don't have agendae, then they are incredibly naive. If something doesn't sound right, it is OUR responsibility to do a fact check before repeating it as if it were truth.

If ambulances weren't showing up like this there would be stories about it all over the internet. Wouldn't there? Wouldn't there be news stories asking why Americans get ambulances and we don't on TV and on the internet? Wouldn't something like this outrage people? Wouldn't they say and write something about it? If Canadians are anything we're obsessed about how we are different than Americans, both good and bad, so wouldn't something like this get a lot of play in the Canadian press?

Shouldn't the fact that there isn't raise a red flag? Isn't this the point where people actually wonder if things aren't what they're being told? Isn't this the point where we take responsibility for what we are saying and NOT say something unless we are sure it's factual?

It's this moral and intellectual laziness that really gets to me.

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"Many people say I embarrass them with my humility" - Archbishop Peter Akinola
Facebook link: http://www.facebook.com/toujoursdan

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Ricardus
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quote:
Originally posted by tclune:
Hostly Hat ON

This post is wildly inappropriate. We do not attack the honesty or integrity of posters in Purgatory.

As I said in the Styx - I didn't mean to accuse New Yorker personally of lying, only to suggest that the allegations which he is repeating are lies. However, I appreciate that's not how it came across, so I apologise.

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Then the dog ran before, and coming as if he had brought the news, shewed his joy by his fawning and wagging his tail. -- Tobit 11:9 (Douai-Rheims)

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Hawk

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quote:
Originally posted by ToujoursDan:

It's this moral and intellectual laziness that really gets to me.

I think that's the most frustrating part of the whole situation. This complete unquestioning swallowing of the most blatent barefaced lies while facts and extensively researched information are scoffed and sneered at and rejected out of hand.

It is a common human trait unfortunately. Terry Pratchett, in one of his treatises on the human condition (The Discworld books), wrote that there is a type of person who won't believe the sky is blue if presented with a sworn affidavit signed in triplicate by a line of priests and scientists, but will happily believe anything whisperered to them by a stranger in a pub.

Unfortunately, like attracts like and by natural gravitation the Republicans seem to have gained a monopoly on this type of person.

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“We are to find God in what we know, not in what we don't know." Dietrich Bonhoeffer

See my blog for 'interesting' thoughts

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Crœsos
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quote:
Originally posted by Hawk:
quote:
Originally posted by ToujoursDan:
It's this moral and intellectual laziness that really gets to me.

I think that's the most frustrating part of the whole situation. This complete unquestioning swallowing of the most blatent barefaced lies while facts and extensively researched information are scoffed and sneered at and rejected out of hand.

It is a common human trait unfortunately. Terry Pratchett, in one of his treatises on the human condition (The Discworld books), wrote that there is a type of person who won't believe the sky is blue if presented with a sworn affidavit signed in triplicate by a line of priests and scientists, but will happily believe anything whisperered to them by a stranger in a pub.

Unfortunately, like attracts like and by natural gravitation the Republicans seem to have gained a monopoly on this type of person.

Oh sure, all you coastal elites believing in things like "the sky"! The so-called 'sky' just a wild conspiracy theory spun by out-of-control leftists! [Big Grin]

(Please note that while 'the sky' is a falsehood spun by a shadowy conspiracy to further a nefarious agenda, I in no way consider it 'a lie'. [Yipee] )

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Humani nil a me alienum puto

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Otter
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quote:
Originally posted by Hawk:
quote:
Originally posted by ToujoursDan:

It's this moral and intellectual laziness that really gets to me.

I think that's the most frustrating part of the whole situation. This complete unquestioning swallowing of the most blatent barefaced lies while facts and extensively researched information are scoffed and sneered at and rejected out of hand.
You sure this post wasn't meant for the Zeitgeist thread? [Big Grin]

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The plural of "anecdote" is not "data", YMMV, limited-time offer, IANAL, no purchase required, and the state of CA has found this substance to cause cancer in laboratory aminals

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Sober Preacher's Kid

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quote:
Originally posted by RadicalWhig:
I'm confused about the Canadian system. Some posters refer to "in Canada". Others say, "in [Province]". Which parts of the Canadian system are federal and which are provincial? To what degree does the level of care and cover (and costs) vary from province to province?

'Cause you're you and I know you'll appreciate it, here goes:

The responsibilities of the Federal Government and Provinces are outlined
here in Sections 91 and 92 of the Constitution Act, 1867.

The Provinces have responsibility for most "local services", including hospitals. Due to historic development, the Federal Government has always transferred funds to the Provinces and controls most of the income tax base and half the sales tax base. Every province gets at least a third of its revenue from federal transfers, often more.

The Feds pay for about half of national medicare costs under terms of the Canadian Health Act, which says that doctors and hospital services are the primary covered benefits. The act also bans extra billing by fining the extra amount from the provincial transfer.

Essentially we have national funding and local implementation. Most hospitals are owned by their local community, a charitable foundation, or a religious order. St. Joseph's Hospital is an extremely common name around here.

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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.

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RadicalWhig
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Thanks, SPK. I always appreciate your explication of things Canadian.

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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)

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New Yorker
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This thread has dropped to page 2. I don't know that it should be revived but I did want to answer Josephine.


quote:
But the Scriptures have something to say about people who look at the poor and say, "Go on your way. Be warmed and fed."
Yes they do. And, as an RC I have a strong belief that one's charity towards the poor and less fortunate will be reviewed on Judgment Day. I do not think anyone (or at least not many) on my side of the debate want anyone to die for lack of care. We just don't like the plans being formulated by the Democrats. Health care reforms? Yes. The current House plan? No.
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RuthW

liberal "peace first" hankie squeezer
# 13

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quote:
Originally posted by New Yorker:
I do not think anyone (or at least not many) on my side of the debate want anyone to die for lack of care.

You're wrong, because people are dying for lack of care every day and people on your side of the debate can't be bothered to even propose a solution.
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New Yorker
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quote:
Originally posted by RuthW:
quote:
Originally posted by New Yorker:
I do not think anyone (or at least not many) on my side of the debate want anyone to die for lack of care.

You're wrong, because people are dying for lack of care every day and people on your side of the debate can't be bothered to even propose a solution.
On the contrary, the GOP has proposed solutions but the press doesn't bother looking into them and the Democrats don't need GOP support so they are DOA.
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tclune
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quote:
Originally posted by New Yorker:
On the contrary, the GOP has proposed solutions but the press doesn't bother looking into them and the Democrats don't need GOP support so they are DOA.

Unfortunately, I suspect that any proposal that means-tests Medicare benefits would be DOA anyway. I think that it needs to be done, but I don't think that very many congressmen from either party would actually vote for it unless they were planning on retiring anyway.

Instead, we'll get a steady drip-drip-drip of poorly-targeted cuts, like the freeze in Social Security benefits for everyone for at least the next two years.

But you should not feel guilt-free about this -- hysterical cries that "The death panels are coming" help insure that serious issues are not discussed honestly. We really do need to come to a consensus of what most of us are willing to pay for and what we are willing to forego to revamp our broken medical and retirement systems.

As long as people think that there is a political advantage in demagoguery, there will be no realistic possibility of coming to such a consensus through public discussion and debate.

--Tom Clune

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This space left blank intentionally.

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cliffdweller
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quote:
Originally posted by Hawk:
[QUOTE]Originally posted by ToujoursDan:
[qb]

It is a common human trait unfortunately. Terry Pratchett, in one of his treatises on the human condition (The Discworld books), wrote that there is a type of person who won't believe the sky is blue if presented with a sworn affidavit signed in triplicate by a line of priests and scientists, but will happily believe anything whisperered to them by a stranger in a pub.

Unfortunately, like attracts like and by natural gravitation the Republicans seem to have gained a monopoly on this type of person.

Reminds me of a speech by Harold Ockengae (first president of Fuller Seminary) in which he described an atheist and a fundamentalist walking in a garden. The atheist points to a flower and says "that's a rose". The fundamentalist hears "that's a not-made-by-the-triune-God rose".

Makes dialogue really, really challenging.

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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner

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Crœsos
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quote:
Originally posted by tclune:
Unfortunately, I suspect that any proposal that means-tests Medicare benefits would be DOA anyway. I think that it needs to be done, but I don't think that very many congressmen from either party would actually vote for it unless they were planning on retiring anyway.

--Tom Clune

Well, the other problem is that when a group that has always maintained that certain programs shouldn't exist anyway (like Republicans with Social Security or Medicare) advocates cuts to that program, it will inevitably be seen as an attempt to weaken or undermine that program with an eye towards its eventual elimation. Especially if the group in question has publically advocated a tactic descriptively named "starve the beast".

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Humani nil a me alienum puto

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Honest Ron Bacardi
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I'm not sure how relevant this is to the discussion in hand, but since this thread is the closest...

There was an interesting programme here on BBC R4 this morning. Robert Peston (BBC economics specialist) was interviewing a leading American hedge fund manager. The discussion centred around shorting (i.e. short selling) and its part in the recent collapse of stock markets worldwide.

The interviewee (sorry - I've forgotten his name) pointed out that the whole financial market apparatus is based upon constant verification and confirmation. The successful hedge fund manager tunes all that out and looks for serious anomalies. It was hedge funds that spotted that Enron's highly-lauded business model was predicated on complex financial structures that turned hypothetical future profits into real profits today - and in any event lots of this profitability was gained by trading on favourable terms with wholly-owned subsidiaries. Once that was spotted, it became clear that the whole business was a ramp, so they went short on it. Yes, it crashed, but it would have crashed anyway, and it was not actually hedge funds that brought about its demise. Indeed, it could be said that it was better it crashed when it did, rather than it being allowed to suck even more cash from the gullible.

Likewise it was hedge funds that ceased to believe the rhetoric of the housing bubble, and the dependence of the ever-more-leveraged banks upon it. To blame the hedge funds for causing banks to crash by shorting them ignores the fact that the banks' business model was increasingly unsustainable, and that is what the true source of the problem was.

All very interesting, and no doubt arguable. But the really interesting bit came at the end, when Robert Peston asked what his tips were on the next big thing likely to get the shorting treatment. The interviewee pointed out certain things to look for - unsustainable finance being an obvious one, but others included increasing drifts from reality, unsustainable future projections, rhetoric unlinked from the real world... He then suggested a prime candidate would be American healthcare insurers.

I pass this on in case you might have any investments in this sector, but it is also interesting in relation to the discussions here.

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Anglo-Cthulhic

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Honest Ron Bacardi
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(missed the edit window)

Just having looked it up, the interviewee was Jim Chanos.

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Anglo-Cthulhic

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RuthW

liberal "peace first" hankie squeezer
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quote:
Originally posted by New Yorker:
quote:
Originally posted by RuthW:
quote:
Originally posted by New Yorker:
I do not think anyone (or at least not many) on my side of the debate want anyone to die for lack of care.

You're wrong, because people are dying for lack of care every day and people on your side of the debate can't be bothered to even propose a solution.
On the contrary, the GOP has proposed solutions but the press doesn't bother looking into them and the Democrats don't need GOP support so they are DOA.
That's a summary -- there is as yet no bill, so I stand by what I said.

Furthermore, I can see two major problems just from skimming through the summary.

1. What's going to make insurance companies participate in the exchanges? It's going to be the people who are racking up the medical bills who will be looking for insurance through those exchanges, and insurance companies will just opt not to participate.

2. The notion the $2300 per person rebate is going to be enough to cover a health insurance premium for someone buying individual health insurance (as opposed to getting it through an employer) is ludicrous. They think somehow that $2300 will be filled out with higher wages due to tax cuts, which is also laughable, especially considering that this is coming from the side of the Congressional aisle that's moaning about the size of the deficit.

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New Yorker
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Ruth, here is a link to the bill itself. I am told that Pelosi is anxious to move it forward! (Right.)
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RuthW

liberal "peace first" hankie squeezer
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Busted link. Who told you Pelosi is anxious to move this forward?
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New Yorker
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This link should work.

Sorry. I was joking about Pelosi.

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3M Matt
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As far as I can see, Healthcare is something which just very naturally lends itself to a single state run system, free at the point of need.

It stands to reason that a private system will be concerned with making profit. By and large, any company which makes a profit does so by A) convincing you to buy a product and B) persuading you to pay more for it than it actually costs

In my view, all private healthcare systems do this. They persaude people to spend money on things they don't need. (e.g. On British TV at the moment there is frequently an advert for a company who will do a whole-body MRI scan "check up" on you just to make sure nothing is wrong..an extremely unneccessary check which is likely to generate all sorts of false diagnosis)

Second you will pay over the odds. Witness the advertising of drugs on american TV which aim to convince you that a newer (i.e. More expensive) drug is better than the cheaper one you are already taking.

For healthcare to work well, profit has to be taken out of the equation, and that essentially means a state run service in my view.

As for people not getting as much "choice" as they want in the NHS, I personally can't work out what choice it is that people want.

As a doctor, I can confidently state that nearly every patient I ever see gets the appropriate treatment for them. Not neccessarily as quickly as I would like, not necessarily in as pleasant surroundings as I would like, but, none the less, they get it.

If the NHS doesn't offer you a treatment, it's overwhelmingly likely it's because that treatment is not actually proven to do you any good...rather than just because we are being tight with the cash.

Of course, any private system is subject to market forces like product promotion and advertising, so there are vast numbers of americans out there who believe that they know what will do them good, and want to be able to choose it. (Regardless of the fact they have probably just been sold a lemon by the drugs company)

The main problem we have with the NHS financially, in my view, is "overspill" of our services into social services. Far too often the NHS plays "babysitter" for what are really social problems. (i.e. Old lady languishing in a £500 a night hospital bed for weeks because she needs a meals-on-wheels service made available for her at home)

The other problem is having a target driven healthcare system. Targets are wonderful for politicians, because it gives you quotable soundbites. "We've reduced X disease by Y percent in the last 5 years".

The problem is that anything which doesn't lend itself to statistical analysis and target setting is roundly ignored.

However, I cannot begin to imagine how you could have a private system which in any way functioned as well, and as fairly as a state run system.

Another point is the question of doctors in training. A state run system has a vested interest in training junior doctors. A private based system only has an interest in employing fully qualified exeperienced doctors.

That is why British medical schools are still considered amongst the best in the world.

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3M Matt.

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Jane R
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3M Matt said:
quote:
As for people not getting as much "choice" as they want in the NHS, I personally can't work out what choice it is that people want.
I don't want "choice", which is in any case a nonsense unless you live in a big city like London or Manchester and have several hospitals within easy travelling distance. I want to be able to rely on my local GP and local hospital to give me the appropriate treatment for any ailments and/or injuries I have, referring me on to specialist centres where necessary.

Politicians are trying to introduce "choice" into the NHS because they think it will keep voters happy without significantly raising costs. I think they're wrong on both counts. Firstly, because most people who have just been told they have a life-threatening condition do not want the hassle of working out which of the many hospitals in the UK they would like to be treated at, and secondly, because all this extra "choice" introduces more bureaucracy. Which costs money.

Jane R

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Timothy the Obscure

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On Fresh Air yesterday, Terry Gross interviewed T.R. Reid , a foreign correspondent who has lived in several countries with different health care systems and is able to discuss them both as a professional observer and as a patient. Well worth listening to.

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When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.
  - C. P. Snow

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Pretty Butterfly
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I've just been referred to a specialist by my GP (NHS) and have been sent a letter informing me I can choose from five different centres in the county! I have no idea what to pick. I'm not especially fussed about choice, I'm just glad I get treatment free at the point of use, a speedy referral and a short waiting time.
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Josephine

Orthodox Belle
# 3899

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quote:
Originally posted by New Yorker:
This thread has dropped to page 2. I don't know that it should be revived but I did want to answer Josephine.
quote:
But the Scriptures have something to say about people who look at the poor and say, "Go on your way. Be warmed and fed."
Yes they do. And, as an RC I have a strong belief that one's charity towards the poor and less fortunate will be reviewed on Judgment Day. I do not think anyone (or at least not many) on my side of the debate want anyone to die for lack of care. We just don't like the plans being formulated by the Democrats. Health care reforms? Yes. The current House plan? No.
Thanks for answering, New Yorker.

You'll forgive me for pointing out that, in the rhetoric from the Republicans and their supporters on this issue (and I'm afraid that includes you), I hear very, very little concern for the poor. I don't even hear much that sounds like concern for fiscal sustainability. What I hear is:
quote:
We have the best system in the world already. We can see whatever doctor we want, whenever we want, and we can have whatever treatment that we decide, together with our doctor, that we want. It's great! But if you let the Democrats have their way, they'll take all that away. There will be long, long lines for any kind of treatment. And what's worse, you won't have any choice about what doctor you see or what treatment you get. You will have government bureaucrats making all your medical decisions for you -- and we know that's bad, because the government will be sure to make decisions that kill all the old folks and and everyone with disabilities. People like the littlest Palin boy and Steven Hawking and your own grandmother won't have a chance.
That may not be what the Republicans are saying, but it's what I'm hearing (and I'm deliberately leaving out the crazies are saying).

If you believe that taking care of the poor is a significant goal of health care reform, it would perhaps be a good idea to make that one of your significant talking points -- both why the current system has failed, and how the proposals by the Republicans would be better.

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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!

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tclune
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# 7959

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Just curious -- do people thinkt hat Sen. Kennedy's passing will increase the likelihood of getting a health care bill passed, be the final nail in its coffin, or have no effect?

--Tom Clune

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Posts: 8013 | From: Western MA | Registered: Jul 2004  |  IP: Logged
cliffdweller
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quote:
Originally posted by tclune:
Just curious -- do people thinkt hat Sen. Kennedy's passing will increase the likelihood of getting a health care bill passed, be the final nail in its coffin, or have no effect?

--Tom Clune

I think it will make it more difficult-- he had excellent legislative instincts and, despite a reputation as a more extreme liberal, was a true bridgebuilder who was able to build coalitions across the aisle. I don't think it will be the "final nail" in health care reform-- pray that it won't be cause I don't think the economy will recover w/o it-- but it will definitely be a harder task.

It is sad that he passed away before being able to see health care reform pass-- something he'd worked for since the 60s.

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Luigi
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Just listened to the TR Reid interview - worth listening to. For me the NHS has always been excellent. Don't really understand what so many Americans are petrified of. I just pray that in Britain we never adopt anything like the American system. From what I can gather, I could pay for health care - but not everybody I care about could.
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tclune
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quote:
Originally posted by Luigi:
Just listened to the TR Reid interview - worth listening to. For me the NHS has always been excellent. Don't really understand what so many Americans are petrified of.

I think the concerns that aren't just political posturing are often centered around the will of people to continue on the given course. We are facing huge problems with Social Security (our retirement money that the government provides) and MediCare (the medical insurance that the government provides for all retirees). There have to be huge changes in these systems. People basically know that, and are worried about what those changes will look like.

Adding a lot of people into a health insurance program just seems to be making the problem worse. The idea that folks will have to get insurance isn't a problem for most folks. But the government is going to be helping a lot of them to pay for the insurance under any of the plans that have been discussed. Where will that money come from? We are going to run somewhere between 7 and 9 trillion dollars in the red as a government over the next decade. That's even a lot of money for the US government.

Compounding the problem is a generational divide. Young adults are looking at the huge cost of their parents' retirement benefits and not getting warm fuzzies about it. The post-WWII "baby boom" generation is huge, and we didn't have the usual 8.7 kids, so the number of young folks who would be paying for the retirement benefits of the baby boomers is not a lot more than the number of retirees. Oddly enough, our kids are just good enough at math to worry about that...

We have had a tendency to provide benefits without means-testing to make them more palatable to the recipients. Social Security is provided to the people who got those $100 million dollar bonuses on Wall Street as well as to the guy who worked in a blue-collar job that didn't pay enough for him to save for retirement. Medicare is provided to every wealthy blue-haired widow in Florida.

One effect of this is that the older generation is, as a group, better off than any other in the US. So our kids, again, look at the idea of "splitting the cost of health care" with granny and decide that that isn't really a great deal for them. Furthermore, the kids firmly believe that none of these programs will be there for their retirement, so they feel the need to save for their own old age.

All this put together makes for political dynamite.

--Tom Clune

[ 26. August 2009, 17:54: Message edited by: tclune ]

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Posts: 8013 | From: Western MA | Registered: Jul 2004  |  IP: Logged
Crœsos
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# 238

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Social Security is not facing "huge problems", it's facing minor long-range difficulties that could be corrected fairly easily (at least compared to other programs). It tends to get lumped in with Medicare and Medicaid under the general term "entitlement programs", but there's no program called SocialSecurityMedicareandMedicaid. Medicare and Medicaid are having what could accurately be called "huge problems" mostly having to do with the large inflation in U.S. medical costs, but Social Security is doing all right. The idea that a system can be supported if 63% of the population is working age (18-65), according to Census Bureau estimates for 2005, but is horrendously unsustainable if only 57% of the population falls into this category, as estimated for 2035, when the youngest of the Boomers will be at least 70, seems counterintuitive. Perhaps tclune can explain why those particular six percentage points are the critical ones?

The main argument against means testing is that programs for poor people tend to be poor programs. One only has to look at the common American perceptions of Medicare (which serves all senior citizens regardless of wealth) and Medicaid (which is geared towards poorer Americans). The former is seen in a fairly positive light, while the latter is villified as unjustified handouts to shiftless layabouts. It should also be noted that it has historically been much more politically feasible to cut Medicaid than it has Medicare, largely because of this disparity in popularity.

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Humani nil a me alienum puto

Posts: 10706 | From: Sardis, Lydia | Registered: May 2001  |  IP: Logged
RuthW

liberal "peace first" hankie squeezer
# 13

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quote:
Originally posted by New Yorker:
This link should work.

I still think it's a recipe for disaster, and am no more convinced than before about the Republicans being at all concerned about people's wellbeing. Eliminating tax breaks for companies who offer health insurance to their employees and instead giving $2300 per person ($5700 per family) to people to buy health insurance is insane. Have these people even looked at what health insurance premiums are these days? This proposal would make things even worse than they are now.

quote:
Originally posted by Croesus:
The main argument against means testing is that programs for poor people tend to be poor programs. One only has to look at the common American perceptions of Medicare (which serves all senior citizens regardless of wealth) and Medicaid (which is geared towards poorer Americans). The former is seen in a fairly positive light, while the latter is villified as unjustified handouts to shiftless layabouts. It should also be noted that it has historically been much more politically feasible to cut Medicaid than it has Medicare, largely because of this disparity in popularity.

Is Medicaid unpopular because it's a bad program or because it serves the poor?
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tclune
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# 7959

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quote:
Originally posted by Crœsos:
The idea that a system can be supported if 63% of the population is working age (18-65), according to Census Bureau estimates for 2005, but is horrendously unsustainable if only 57% of the population falls into this category, as estimated for 2035, when the youngest of the Boomers will be at least 70, seems counterintuitive. Perhaps tclune can explain why those particular six percentage points are the critical ones?

No, I can't. But that is because you have posed the question in a way that fails to capture the problem. It is simply not the case that Social Security was doing fine in 2005.

If you actually want to understand the problems that Social Security is facing, you can consult the Social Security Agency itself. No-one can accuse them of over-hyping the problem. Many respectable economic evaluations will show a considerably worse problem. Also, the SSA FAQ fails to include the most recent forecasts from the economic collapse, which move the date that the trust is exhausted up by more than a decade (if memory serves) from their much-quoted 2037. Here's their FAQ. BTW, their assertion that benefits will continue to go up each year has already been given the lie. This week a two year freeze on SS COLAs was announced.

(And yes, you are right that MediCare is a bigger train wreck. But they are both massive problems with no good answers in sight.)

--Tom Clune

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Posts: 8013 | From: Western MA | Registered: Jul 2004  |  IP: Logged
cliffdweller
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# 13338

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quote:
Originally posted by tclune:
[QUOTE]
Adding a lot of people into a health insurance program just seems to be making the problem worse. The idea that folks will have to get insurance isn't a problem for most folks. But the government is going to be helping a lot of them to pay for the insurance under any of the plans that have been discussed. Where will that money come from?

I don't know if I'd say "most folks" don't have a problem getting insurance-- 45 million seems like quite a lot of folks to me. Add to that those who are insured but struggling to pay their premiums, and the companies going bankrupt under the weight of rapidly escalating benefits costs.

The reality is, we can't fix those other problems you mention w/o fixing health care. It's all inter-related. We can't fix the economy, deal with medicare or social security, if we continue to spend 2x what every other country is spending on health care. Yes, it's going to be a VERY rough AND costly transition, and yes, it's going to add to the massive debt inherited from the last administration. But there simply is no other way to get there.

In terms of the government taking on the cost of the uninsured, that happens already. We are already paying for the cost of the uninsured on all three levels of government (federal, state, and local) through government assistance programs and through our ERs. And we (the insured) are paying through it through higher insurance premiums to cover the cost of that ER care. The problem is that we are providing that care (for the uninsured) in the most expensive and least effective way possible-- through the ER.

So the question isn't really will we provide health care for the uninsured. We already do that, and of course will continue. The question is will we do so in a way that is both extraordinarily costly while at the same quite ineffective (leading to worse outcomes, including premature death), or will we do so in a way that is cost-effective and results in saved lives and improved quality of life? To me the choice is obvious.

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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner

Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008  |  IP: Logged
RuthW

liberal "peace first" hankie squeezer
# 13

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And another thing: Sen. Enzi (R-Montana) has admitted that he's not negotiating in good faith. Quoth Enzi:

quote:
If I hadn't been involved in this process as long as I have and to the depth as I have, you would already have national health care.

...

It's not where I get them to compromise, it's what I get them to leave out.


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tclune
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# 7959

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quote:
Originally posted by cliffdweller:
I don't know if I'd say "most folks" don't have a problem getting insurance-- 45 million seems like quite a lot of folks to me.

I failed to communicate my point. I didn't mean that most folks have insurance, but that most folks don't have a problem with the idea of insurance reform that requires everyone to get insurance. Sorry for the confusion.

--Tom Clune

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Posts: 8013 | From: Western MA | Registered: Jul 2004  |  IP: Logged
Crœsos
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# 238

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quote:
Originally posted by tclune:
No, I can't. But that is because you have posed the question in a way that fails to capture the problem. It is simply not the case that Social Security was doing fine in 2005.

If you actually want to understand the problems that Social Security is facing, you can consult the Social Security Agency itself. No-one can accuse them of over-hyping the problem.

Actually, many economists do accuse them of doing just that, for largely technocratic reasons. In order to 'err on the side of caution' the Social Security Administration routinely assumes substandard economic growth in its projections. On the other hand, if we assume growth levels more in line with the past thirty years the revenues are quite sufficient to maintain Social Security.

quote:
Originally posted by tclune:
Many respectable economic evaluations will show a considerably worse problem. Also, the SSA FAQ fails to include the most recent forecasts from the economic collapse, which move the date that the trust is exhausted up by more than a decade (if memory serves) from their much-quoted 2037. Here's their FAQ. BTW, their assertion that benefits will continue to go up each year has already been given the lie. This week a two year freeze on SS COLAs was announced.

The Trustees Report on which those FAQs were based was issued in May of 2009 and most certainly did include the recent economic collapse. That was what moved the exhastion of the Social Security surplus from 2041 to 2037.

As for the question of COLAs, no one ever promised that "benefits will continue to go up each year". It's been promised that benefits will remain constant in terms of purchasing power, which is what the COLAs are supposed to accomplish. The COLA for 2009 (which was set in mid-2008, before the economy went under) was 5.8%, a significantly larger "raise" than most workers got for 2009. Given that the change in the U.S. cost of living was actually negative from the beginning of 2008 to the beginning 2009, setting next year's Social Security COLA at 0% doesn't seem tremendously unreasonable, given that negative COLAs are forbidden by law. In short, the "COLA freeze" is not a cost-saving measure but rather an acknowlegement of the reality that the change in U.S. cost of living is relatively flat right now.

quote:
Originally posted by tclune:
(And yes, you are right that MediCare is a bigger train wreck. But they are both massive problems with no good answers in sight.)

--Tom Clune

Maybe you and I have different definitions of "massive problem", but a government program that may, if economic growth is bad for the next few decades, be forced to cut back benefit levels to 74% of their current levels in twenty-eight years does not seem like a pressing crisis. It seems more like a back-burner issue that shouldn't distract from a health care system that seems to be imploding right now.

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cliffdweller
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# 13338

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quote:
Originally posted by tclune:
quote:
Originally posted by cliffdweller:
I don't know if I'd say "most folks" don't have a problem getting insurance-- 45 million seems like quite a lot of folks to me.

I failed to communicate my point. I didn't mean that most folks have insurance, but that most folks don't have a problem with the idea of insurance reform that requires everyone to get insurance. Sorry for the confusion.

--Tom Clune

Ah! much better.

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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner

Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008  |  IP: Logged
tclune
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# 7959

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quote:
Originally posted by Crœsos:
As for the question of COLAs, no one ever promised that "benefits will continue to go up each year".

Maybe you're saying something that I'm misunderstanding, but the very first question on the FAQ I linked to says: "No, there are no plans to cut benefits for current retirees. In fact, benefits will continue to be increased each year with inflation." That was what I was responding to in my post, and my twisted little mind tends to distort the bolded text into something that says that benefits will continue to be increased each year.

As to the COLA being an inflation index, that's just intellectually dishonest. It has NEVER been that, no matter what the claim. It has always EXCEEDED the cost of living index AFAIK. The notion that inflation has been negative this year is also dishonest, if your major costs are medical and heating. Indeed, the reason the COLA has been so much higher than the inflation index is precisely because the things that seniors spend most on have routinely exceeded the inflation index.

Even if all of that is wrong-headed, it doesn't explain how the SSA has been able to see into the future enough to say that no COLA will be needed for TWO years. That was done because of monetary problems, which is the point I was raising as to people's anxiety levels with the government's management of the retirement programs.

--Tom Clune

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Posts: 8013 | From: Western MA | Registered: Jul 2004  |  IP: Logged
Crœsos
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# 238

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quote:
Originally posted by tclune:
quote:
Originally posted by Crœsos:
As for the question of COLAs, no one ever promised that "benefits will continue to go up each year".

Maybe you're saying something that I'm misunderstanding, but the very first question on the FAQ I linked to says: "No, there are no plans to cut benefits for current retirees. In fact, benefits will continue to be increased each year with inflation." That was what I was responding to in my post, and my twisted little mind tends to distort the bolded text into something that says that benefits will continue to be increased each year.
I guess it depends on what you consider an "increase". For example, say you get a voucher for $20 worth of gasoline per month when gasoline is $2/gallon. Now suppose the following year your voucher increases to $25/month but gasoline is $3/gallon. In purely numerical terms your benefit has "increased" from $20 to $25, but in real world terms you've gone from something that's equivalent to 10 gallons of gasoline to something equivalent to 8.3 gallons. The modifier "with inflation" above seems to me to indicate an increase in numerical value while holding steady with regard to the rate of inflation.

quote:
Originally posted by tclune:
As to the COLA being an inflation index, that's just intellectually dishonest. It has NEVER been that, no matter what the claim. It has always EXCEEDED the cost of living index AFAIK. The notion that inflation has been negative this year is also dishonest, if your major costs are medical and heating. Indeed, the reason the COLA has been so much higher than the inflation index is precisely because the things that seniors spend most on have routinely exceeded the inflation index.

It may be true that a "senior adjusted" CPI would be different (and potentially higher) than a general CPI, but since the general CPI for the last year has been about -4% and since 0% is still higher than than that, it still holds true that the Social Security COLA is outstripping general inflation.

quote:
Originally posted by tclune:
Even if all of that is wrong-headed, it doesn't explain how the SSA has been able to see into the future enough to say that no COLA will be needed for TWO years. That was done because of monetary problems, which is the point I was raising as to people's anxiety levels with the government's management of the retirement programs.

--Tom Clune

Given that the freeze is a projection and not a plan set in stone at this point, I'm not sure what your objection is. It certainly seems ridiculous to accept (as you seem to) that the Social Security trustees can predict the performance of the U.S. economy through at least 2037 but can't predict inflation in 2010. Either you accept that the SSA can make economic predictions or you don't.

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Posts: 10706 | From: Sardis, Lydia | Registered: May 2001  |  IP: Logged
Luigi
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Thanks Tom for that response. Will try to respond further in the morning.
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tclune
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quote:
Originally posted by Crœsos:
quote:
Originally posted by tclune:
Even if all of that is wrong-headed, it doesn't explain how the SSA has been able to see into the future enough to say that no COLA will be needed for TWO years. That was done because of monetary problems, which is the point I was raising as to people's anxiety levels with the government's management of the retirement programs.

Given that the freeze is a projection and not a plan set in stone at this point, I'm not sure what your objection is. It certainly seems ridiculous to accept (as you seem to) that the Social Security trustees can predict the performance of the U.S. economy through at least 2037 but can't predict inflation in 2010. Either you accept that the SSA can make economic predictions or you don't.
No, that is not the only set of choices. I may also mean what I said -- that whatever the ability of the SSA to predict the economy, they are eliminating the COLA for reasons that are based on the fact that they are going broke.

The SSA is very near to the time when it will be taking money out of its trust instead of adding it. That money buys more T bills than even the Chinese do. When they stop doing that, we are going to be in big trouble. Slowing that day of reckoning down is undoubtedly a high priority for the government, and that seems to me to be what is being done.

Whatever the real motivation, there is a great disturbance in the force, and voters are worried about how the federal government is running these programs that average people depend upon. You may not believe that. But it really is true, and as I indicated to Luigi, that is why Americans are more on edge about this set of reforms than seems warrented to an outside observer.

--Tom Clune

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Posts: 8013 | From: Western MA | Registered: Jul 2004  |  IP: Logged
romanlion
editorial comment
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As a means of tying the SS news back to the thread topic, two things about social (in)security are clear...

Any CEO/CFO that managed an employee retirement fund in the way that SS is managed would be run through and hung in the square.

Any participant who had taken the same percentage as SS from every check they ever earned and invested it in the markets would have retired wealthy years before SS eligibility. Only Big Brother could steal 6%(+/-)* from you for retirement for your entire life and leave you with ZERO value should you die prior to reaching the ever higher age for benefits.

Anyone who honestly thinks that this kind of management and return on investment is what our healthcare system needs is, IMNSHO, daft. As someone totally opposed to the idea all I can say at this point is thank goodnes for Barack Obama!! We all knew he was a rank amateur, but his lack of political skill surprises even me. Under the same circumstances that dropped election in Obama's lap, Bill Clinton would have had his plan through well in time for summer recess.


*Up to the soon to be removed "limit" of course which has always been a lot more than I earn.

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"You can't get rich in politics unless you're a crook" - Harry S. Truman

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tclune
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quote:
Originally posted by romanlion:
As a means of tying the SS news back to the thread topic, two things about social (in)security are clear...

Any CEO/CFO that managed an employee retirement fund in the way that SS is managed would be run through and hung in the square.

Have you been paying attention to the private pension funds at all??? They are all broke, and most have defaulted so that the government (thanks to Republican sleeze under the arch-fiend Reagan if memory serves) bails them out to the tune of 50 cents on the dollar. On a personal investment level, my own 401(k) tanked with the economy. Given all that, I'll gladly stick with the government. They may not be doing well, but they're outperforming the alternatives nicely.

quote:
Originally posted by romanlion:
As someone totally opposed to the idea all I can say at this point is thank goodness for Barack Obama!! We all knew he was a rank amateur, but his lack of political skill surprises even me.

I'm coming around to this view (from the other side of the street) with great reluctance. I had high hopes that a Democratic president with a Democratic congress would really be able to accomplish things that needed doing. And Obama is clearly the smartest man in the room, whatever the room. I was really hopeful that Dems would retake power and actually govern. I was even hoping they'd push through a strong single-payer health care system that would be able to revamp our totally broken health care and restructure Social Security for the long haul.

Now, I will be amazed and appreciative if they just manage to push through a Massachusetts-style universal health insurance plan. It's really disappointing.

--Tom Clune

[ 27. August 2009, 01:17: Message edited by: tclune ]

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Posts: 8013 | From: Western MA | Registered: Jul 2004  |  IP: Logged
Crœsos
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# 238

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quote:
Originally posted by tclune:
No, that is not the only set of choices. I may also mean what I said -- that whatever the ability of the SSA to predict the economy, they are eliminating the COLA for reasons that are based on the fact that they are going broke.

If you say so. If that's the case, what is the proper, non-zero value for 2010's COLA, and how did you arrive at that number?

quote:
Originally posted by tclune:
The SSA is very near to the time when it will be taking money out of its trust instead of adding it. That money buys more T bills than even the Chinese do. When they stop doing that, we are going to be in big trouble. Slowing that day of reckoning down is undoubtedly a high priority for the government, and that seems to me to be what is being done.

That's pretty much by design. The 'trust fund' was proposed by Alan Greenspan in the 1980s to deal with the retirement of the Boomers. It was never meant to be a permanent institution and was supposed to expire around the same time the last of the Baby Boom generation does. Despite apparent notions to the contrary, the Boomers will eventually die.

Either Social Security is separate from the General Fund or it isn't. If it's separate then the T-bill market is an irrelevancy as far as Social Security is concerned, a reflection of the desire of the U.S. to sell more debt than the market has confidence in, and thus really a problem of the U.S. Government as a whole. If they're not separate then there is no funding crisis particular to Social Security since funds can just be transferred over from the General Fund. In this second scenario there can be a General Fund crisis, but not a Social Security crisis.

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Posts: 10706 | From: Sardis, Lydia | Registered: May 2001  |  IP: Logged
Crœsos
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# 238

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quote:
Originally posted by romanlion:
Only Big Brother could steal 6%(+/-)* from you for retirement for your entire life and leave you with ZERO value should you die prior to reaching the ever higher age for benefits.

Whereas you can still spend money in private savings if you're dead? [Confused] The fact that you can't take it with you is more a function of Grim Death itself rather than some government conspiracy. I guess your heirs would miss out. If only Social Security paid survivor's benefits. Oh wait, they do!

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Humani nil a me alienum puto

Posts: 10706 | From: Sardis, Lydia | Registered: May 2001  |  IP: Logged
tclune
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# 7959

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quote:
Originally posted by Crœsos:
The 'trust fund' was proposed by Alan Greenspan in the 1980s to deal with the retirement of the Boomers. It was never meant to be a permanent institution and was supposed to expire around the same time the last of the Baby Boom generation does. Despite apparent notions to the contrary, the Boomers will eventually die.

Ah, I understand! This situation that the SSA describes as a "big financial problem" is by design! And since the trust fund will be exhausted before the last boomer even retires, I presume part of the plan is for them to die before that, too. Death panels live! That certainly puts my mind at ease...

--Tom Clune

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Posts: 8013 | From: Western MA | Registered: Jul 2004  |  IP: Logged
Crœsos
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# 238

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quote:
Originally posted by tclune:
quote:
Originally posted by Crœsos:
The 'trust fund' was proposed by Alan Greenspan in the 1980s to deal with the retirement of the Boomers. It was never meant to be a permanent institution and was supposed to expire around the same time the last of the Baby Boom generation does. Despite apparent notions to the contrary, the Boomers will eventually die.

Ah, I understand! This situation that the SSA describes as a "big financial problem" is by design! And since the trust fund will be exhausted before the last boomer even retires, I presume part of the plan is for them to die before that, too. Death panels live! That certainly puts my mind at ease...

--Tom Clune

Only if we assume that the last boomer (born ~1962) won't retire until she's 75 years old (in 2037). And quite frankly, if you assume that the Baby Boom generation is going to work ten years longer than is assumed in the Trustees' Report, then you've just restored solvency. Problem solved!

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Humani nil a me alienum puto

Posts: 10706 | From: Sardis, Lydia | Registered: May 2001  |  IP: Logged
tclune
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# 7959

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quote:
Originally posted by Crœsos:
Only if we assume that the last boomer (born ~1962) won't retire until she's 75 years old (in 2037). And quite frankly, if you assume that the Baby Boom generation is going to work ten years longer than is assumed in the Trustees' Report, then you've just restored solvency. Problem solved!

The "normal retirement age" has not been 65 for some time. For the last of the boomers, it is currently pegged at 67. While the notion of when the baby boom ended is plastic, few sources push it as early as 1962. In fairness, few also push it as late as 1970, either...

--Tom Clune

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Posts: 8013 | From: Western MA | Registered: Jul 2004  |  IP: Logged



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