Editore"s Note
Tilting at Windmills

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January 24, 2007
By: Kevin Drum

STEALTH CONSERVATISM UPDATE....One of the favorite tricks of the Bush administration is to enact policies that have moderate effects today but substantial effects in the future. These future effects develop at a barely noticable pace, but the long-term goal is to set the stage for the eventual emergence of movement conservative "solutions" like school vouchers, Social Security privatization, and "consumer directed" healthcare. Some examples are here.

In the New York Times' account of President Bush's new healthcare proposal this weekend, I noticed this sentence:

The cap would rise with some measure of overall inflation, but would not necessarily keep pace with the costs of medical care and health insurance.

The "cap" (actually a tax deduction) is $15,000 per family. Above that level, employees would have to declare the value of the insurance they receive from their employer as income and pay taxes on it. Today this has only a small effect since very few health plans are worth more than $15,000 per family. But medical costs are growing faster than overall costs, so eventually this will have a big impact. Brad DeLong explains:

The deduction would indeed worsen the finances of only 20% of those with employer-sponsored coverage in 2009. But it would worsen the finances of about 50% of those with employer-sponsored coverage in 2019. And 90% of those with employer-sponsored coverage by 2030.

In a sense, this doesn't matter because congressional Democrats are unlikely to spend much time on Bush's plan. It's DOA. But it does give you some insight into what Bush is really after. If his goals were what he says they are, he'd propose indexing the cap to the rise in medical costs. It's a healthcare plan, after all, and there's no reason to index a healthcare plan to the overall CPI. The fact that he didn't demonstrates that what he really wants to do is make it less and less attractive over time for employers to offer decent healthcare plans to their employees. It slowly but surely reinforces the already growing trend for employers to cut back or eliminate their healthcare plans and replace them with cheaper conservative nostrums like HSAs and high-deductability policies.

And you'll hardly even notice it's happening. Which is, of course, the whole idea.

UPDATE: Changes made to the fourth paragraph to (hopefully) make things clearer.

Kevin Drum 12:41 PM Permalink | Trackbacks | Comments (98)

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Comments

Sounds like he's doing everybody a favor.

Who among these three people would you prefer to make your healthcare decisions?
A) Some HR Flack
B) Some bureaucrat in Washington
C) You and your doctor.

Not a hard choice. Free market healthcare for all.

Posted by: American Hawk on January 24, 2007 at 1:19 PM | PERMALINK

Also posted this on the previous medical thread; whether here or there, have at it:

Ok, this is simplistic, and overly so at that, I am sure. It is also not a novel suggestion on my part. But why not expand Medicare to everyone of all ages. Doctors still get paid, although maybe not quite as much, but still a very lucrative income. Patients still have choice. Most aspects of private market based competition economics still apply to the process, i.e. each provider decides his own office location, cost negotiates his labor, supplies et. Providers benefit from not having to subsidize non-paying patients with their paying ones, so, overall, they may be just as well off as they ever were. Lastly, individuals that want additional (Premium Gold Plated!) coverage can buy supplementary policies like Medicare members have for years. The effectiveness of this system, relatively speaking, has been demonstrated over a long period of time. I know that there are many of you out there who know a lot more about this than me and are chomping at the bit the carve this idea up. That is why I set it forth, I genuinely want to know. We have to do something, this is the best I have so far. Thanks.

Posted by: bmaz on January 24, 2007 at 1:24 PM | PERMALINK

D)the insurance company that figures it'd be more profitable to kill you than treat you.
E)the hospital that lets you die because you don't have a few hundred K for a transplant
F)the only doctor you can afford -- Nick Riviera

Posted by: Dan-o on January 24, 2007 at 1:26 PM | PERMALINK

Is their any plan that Bush has not tried to sell to us by hiding his and his cohorts' real motives? Stealth conservativism is too benign a characterization of this sort of despicable behavior.

Posted by: gregor on January 24, 2007 at 1:27 PM | PERMALINK

But why not expand Medicare to everyone of all ages.

Because Medicare is on the verge of collapse as reported by the National Review.

Link

"By contrast, the Medicare system is on the verge of collapse, according to a new government report."

"However, the Medicare deficit is twice as large: $24.6 trillion, an increase of $9.6 trillion from 2003."

Adding more people to Medicare would create even more problems. We should find a way to eliminate Medicare due to it debt problems not expand it.

Al

.

Posted by: werppp on January 24, 2007 at 1:28 PM | PERMALINK

Sounds like he's doing everybody a favor.
Who among these three people would you prefer to make your healthcare decisions?
A) Some HR Flack
B) Some bureaucrat in Washington
C) You and your doctor.
Not a hard choice. Free market healthcare for all.
Posted by: American Hawk

Yes, sounds like but actually isn't. That's the point.

And in attempt to respond to the "merits" of your arguement: why should I let a corporate drone in an insurance company make my decisions for me?

How is it that the private company doesn't come between me and my doctor in your strawman arguement but the government bureacracy does?

Posted by: cyntax on January 24, 2007 at 1:29 PM | PERMALINK

Adding more people to Medicare would create even more problems. We should find a way to eliminate Medicare due to it debt problems not expand it.
Al

No, we should stop throwing billions of dollars down the money hole that is Iraq.

Posted by: cyntax on January 24, 2007 at 1:30 PM | PERMALINK

I'm in an HMO, been there for 27 years. My doctor and I have always made my health care decisions.

The question isn't who decides, it's how you pay. Will you pay through a large insurance pool and spread costs out. Or will you go to a free market take-your-chances scheme and pay out of your own pocket. That's fine if you stay healthy all your life. But if you get hit by car you're going to wish you were in that insurance pool.

Posted by: tomeck on January 24, 2007 at 1:32 PM | PERMALINK

Adding more people to Medicare would create even more problems. We should find a way to eliminate Medicare due to it debt problems not expand it.

If it wasn't for Medicare, millions of elderly Americans would needlessly die an earlier death than otherwise. So let's cut the crap about eliminating it.

Posted by: David W. on January 24, 2007 at 1:39 PM | PERMALINK

Yet again, Bush and the Repukeliscum promote a solution which is wonderful for the fat cats, hurts the middle class, and is totally useless for the poor who need it.

Tax credits are useless if you are poor. If you are poor, you pay no taxes.

For middle class people like me, it's an immediate loser.

And any fucking bozo troll like Al who quotes National Review is just a moron. National Review is a bunch of lying slanted hacks, not reporters.

Posted by: POed Lib on January 24, 2007 at 1:40 PM | PERMALINK

Sort of like the budget deficit. The debt to GDP ratio rises slowly over time - but one day, Federal bonds face default risk. Just when the Baby Boomers expect payouts from the Social Security Trust Fund - which holds ... you guess it - Federal bonds!

Posted by: pgl on January 24, 2007 at 1:40 PM | PERMALINK

Stealth is a good way to describe using health care to attack Social Security and maybe even Unemployment Insurance. For low income workers excluding this much in payroll taxes would significantly reduce future benefits.

"Families with health insurance will pay no income or payroll taxes on $15,000 of their income. Single Americans with health insurance will pay no income or payroll taxes on $7,500 of their income."

If there were nothing else wrong with Bush's proposed health plan, this should be enough to kill it.

Posted by: Emma Zahn on January 24, 2007 at 1:43 PM | PERMALINK

Some facts for rebutting the Al and crew's memes about health care (here's the link
-warning pdf-to the paper this was taken from which was written 2003):

    • There are now more than 45 million Americans without health insurance,
    in itself an important key to adequate access to care (8).
    • Almost 60 million Americans lack health insurance at some point during
    the year (9).
    • About 20 million American families, representing 43 million people, had
    trouble paying medical bills in 2003; many had trouble gaining access to
    health care and paying for other basic necessities—rent, mortgage payments,
    transportation, or food (10).
    • Twenty percent of the uninsured cannot afford health insurance even if offered
    by their employers (11).
    • About two-thirds of the uninsured have no regular physician and have costrelated
    barriers to physician visits, prescription drugs, and necessary care (12).
    • About one-half of the non-elderly U.S. population earn less than $50,000 a
    year, and have major problems in affording health care (13).
    • In 32 states, a parent working full-time at a minimum wage of $5.15 an hour
    is ineligible for Medicaid and cannot afford health insurance (14).
    • Americans with above-average incomes have more access problems
    than patients in Canada, the United Kingdom, Australia, and New Zealand

How can Bush's proposal address these issues?

Posted by: cyntax on January 24, 2007 at 1:46 PM | PERMALINK

American Hawk,

The problem with your notion of "free market healthcare" is that a huge % of our population can't afford it. They can barely pay the rent and buy food and clothes. So who picks up the tab for a poor person who needs a $20,000 life-saving surgical procedure and another $10,000 worth of post-surgical care? The taxpayer, that's who. And thus you have precisely the kind of welfare system that you conservatives hate so passionately. Dumbass.

Posted by: global yokel on January 24, 2007 at 1:47 PM | PERMALINK

So, Kevin's complaint is that the Bush plan would effectively raise taxes too much? But of course he supports efforts to roll back Bush's tax cuts. Hmm. I think the common denominator here has nothing to do with taxes -- it has to do with consistently being against Bush, no matter what he proposes.

Posted by: Shelby on January 24, 2007 at 1:49 PM | PERMALINK

(from the earlier thread)

I also agree with bmaz's plan:

I think that one powerful, outspoken hero could change everything. It's not like it would be that hard.

We've got the agency: Medicare. Just raise the tax. And add everything that's covered in our Congressional plans. And

Cover Everyone.

Tweak if necessary.

Did I leave something out?

Posted by: katiebird on January 24, 2007 at 1:53 PM | PERMALINK

But it's always hard to say with Bush. He might intend to force a showdown over employer-provided health insurance years after he's gone. On the other hand, he might have just thrown together some half-assed, last-minute scheme. Remember how the Idiot Prince barnstormed the country for Social Security "reform", and after a while it became apparent that the fuckwit didn't even really know what he wanted to do?

Posted by: sglover on January 24, 2007 at 1:55 PM | PERMALINK

Health care is not an easily marketed private good, because of several things: 1. our public health is dependent on the health of each individual (review some science on disease vectors and how poor health aggravates and increases the likelihood of epidemics); 2. private goods are usually easily measured in some fashion, which makes them easily dispensable,(miles traveled, gallons of gas, KW of power etc) so how do you measure health care? extra years of life? ability to work? 3. somethings like health care, education etc are basic to the proper functioning of a society. Should you decrease the availability of these goods by privatizing them, you instantly increase the instability and stratification of the society. Can you imagine a society without public education?

A lot of this requires thoughtfulness, which doesn't seem to be high on the list of what right-wing conservatives do. Honestly, privatizing health care even more than it already is decreases the well being of society: look to thrid world countries where all health care is privatized. Then look to the first tier industrialized countries (which does not include the US because its measures of human well being are definitely second tier, comparable to Russia) and you will see the health and well being of those countries is commensurate with the increasing public funding of public goods.

Posted by: Carol on January 24, 2007 at 1:57 PM | PERMALINK

"I think the common denominator here has nothing to do with taxes -- it has to do with consistently being against Bush, no matter what he proposes."

Is this the new rightwing meme (it's all over the blogs this morning)? You guys sue for peace quicker than the French. But we're still not letting your Trojan Horse inside, so whine all you want, bitch.

Posted by: brewmn on January 24, 2007 at 1:59 PM | PERMALINK

What the Conservamorons leave out is that the health care system is just going to get worse and worse and worse. What is coming next is genetic discrimination - the insurance companies will refuse to cover breast cancer if you have the breast cancer susceptability genetic markers.

Posted by: POed Lib on January 24, 2007 at 2:01 PM | PERMALINK

No discussion of health care is complete without a link to this short story which originally appeared in Analog. (And yes, that's my brother).

btw, why even ask for a URL when you expose our e-mail addresses in comments, but don't ever use the URL?

Posted by: don Hosek on January 24, 2007 at 2:04 PM | PERMALINK

It has to do with the anti-middle class policies of mendacious and cruel Republicans in general and the stupefying incompetence of the Bush administration in particular. If we held Bush to a corporate standard of governance he would have been out long ago. Maybe Enron is his model.

Posted by: bellumregio on January 24, 2007 at 2:04 PM | PERMALINK

"If you are poor, you pay no taxes."

Sure you do, just not the taxes that are effected by income tax deductions.

Posted by: jefff on January 24, 2007 at 2:04 PM | PERMALINK

So, Kevin's complaint is that the Bush plan would effectively raise taxes too much? But of course he supports efforts to roll back Bush's tax cuts. Hmm. I think the common denominator here has nothing to do with taxes -- it has to do with consistently being against Bush, no matter what he proposes.

If you are not against every single thing Bush proposes, you are a braindead moron.

Every single policy he has proposed has been in the long-term Repukeliscum plan of destroying the middle class, and taking all the money for his rich fat cat buddies.

Posted by: POed Lib on January 24, 2007 at 2:05 PM | PERMALINK

global yokel, you're missing the big bonus in AH's plan. The poor can't afford health care and die off, reducing welfare costs. What's more, we can take their bodies and turn them into Soylent Green.

Posted by: don hosek on January 24, 2007 at 2:07 PM | PERMALINK

I posted this basic thing over at Tapped (in Ezra’s mea culpa thread):

How in the holy hell is a tax break given in, say, 2008, going to help me pay for my monthly premiums throughout 2007?

I realize you can adjust withholding to make up some of that, but with the average family plan cost of $11Kish, and the average family income of $40K, no amount of fudging on a W-4 is going to make up that amount.

This is just another asinine idea from an asinine administration that doesn’t give a damn about anyone making less than a mid-six figure salary.

And as someone who pays $400+ a month in premiums, makes decent money, yet still has nearly $15K in medical bills over the past three years (two back surgeries), I can tell you from personal experience that the current system is broken. Big time.

Posted by: Unholy Moses on January 24, 2007 at 2:11 PM | PERMALINK

Kevin wrote: But it does give you some insight into what Bush is really after.

What Bush is "really after", and has always been "really after", is class warfare -- enriching and empowering America's already ultra-rich, ultra-powerful, hereditary neo-fascist corporate-feudalist ruling class at the expense of everyone else.

Posted by: SecularAnimist on January 24, 2007 at 2:12 PM | PERMALINK

I think the common denominator here has nothing to do with taxes -- it has to do with consistently being against Bush, no matter what he proposes.
Posted by: Shelby

No, the common denominator here is that Bush has come up with another bad plan.

If you don't believe that to be true, then by all means make the case that the issues being raised on this thread either don't matter or will be addressed. Good luck.

Posted by: cyntax on January 24, 2007 at 2:15 PM | PERMALINK

Speaking of stealth conservatism,

if Diebold really is a conspiracy, would they actually be this dumb?

http://www.bradblog.com/?p=4066

Posted by: cld on January 24, 2007 at 2:19 PM | PERMALINK

A few responses:

D)the insurance company that figures it'd be more profitable to kill you than treat you.

At some point, under national medical care, maybe the government would, too. And the alternatives would be long gone.

...we should stop throwing billions of dollars down the money hole that is Iraq.

The $100 billion a year Iraq is costing right now would fund Medicare for about three months. Twenty years from now, the Iraq war will be a distant memory. Medicare will still be costing well over a billion dollars a day.

...any fucking bozo troll like Al who quotes National Review is just a moron. National Review is a bunch of lying slanted hacks, not reporters.

Maybe you'll take it from the 2006 Medicare Trustees Report. Start on page 3.

Posted by: clark on January 24, 2007 at 2:20 PM | PERMALINK

Hey Clark

How much do Americans pay insurance companies for health care insurance each year?

Posted by: Ron Byers on January 24, 2007 at 2:24 PM | PERMALINK

And as someone who pays $400+ a month in premiums, makes decent money, yet still has nearly $15K in medical bills over the past three years (two back surgeries), I can tell you from personal experience that the current system is broken. Big time.

I remember reading somewhere that Denny Hastert believed that "middle class" 2-earner families made $ 125,000 on the average.

I don't doubt it for a minute. These fucking retards are so stupid that they probably believe that plumbers take home $100/houre.

Posted by: POed Lib on January 24, 2007 at 2:25 PM | PERMALINK

cyntax: the common denominator here is that Bush has come up with another bad plan

You have to admire his consistency though. Even the worst of players usually gets a hit sometimes, but a .000 average? Amazing.

Posted by: alex on January 24, 2007 at 2:27 PM | PERMALINK

Somebody here has to start doing a better job of driving a stake in my expanded Medicare idea or I am going to keep coming up with reasons it is a brilliant idea, and I know from experience that such thing rarely emanate from my brain. So here are some further thoughts:And the automakers can help lead this battle; A) They are huge and still have a powerful voice.Tthey already are making the whine that health costs are the biggest reason they are non-competitive, and B) it was the automakers that were the root of how we came to have employer based health policy to start with. A wonderfully ironic full circle, but to everyone's benefit. I know there are a myriad of details to be negotiated and worked out, but no fatal ones that I see yet. It also really takes the wind out of the "socialized medicine over my dead body" crowd because it retains patient/consumer choice. The only real losers here are the bloody predatory health insurance carriers, but they are not totally wiped out because there will be a market for supplementary policy coverage. Why wouldn't 90% of people go for this? Everyone has parents or grandparents etc. and they have all survived and prospered under Medicare (for the large majority anyway). As for the one poster who said Medicare is a broke system; not true. It is limping because its funding has been raided at times (tax cuts for all the best billionaires!), the funding has not kept up with health cost inflation and because consevatives have consistently tried to kill it from within as part of their starve the beast self declared genius. All correctable.

Posted by: bmaz on January 24, 2007 at 2:31 PM | PERMALINK

Wow - the pretzels they're willing to twist and knot themselves into in their vain attempt to save the insurance industry, while attempting to make it look like they're helping the American People.

So; if we all paid cash for routine care, and insured only catastrophic care - what do you suppose the market's reaction to this would be?

Prices for "catastrophic care" technologies and procedures would rapidly increase even more. All industry investment would be in this "profitable" segment (it's profitable because it's effectively subsidized).

Doctors (and Healthcare Conglomerates, like Fristypants' HCA) would flee in terror from the dropping prices and profitability of the Basic Care segment of the market.

This will reduce supply of basic care providers, and thus raise costs, to the point where we'll be right back where we are with 30% of Americans not being able to afford routine medical care.

Market based solutions will not work for healthcare, because it is not an optional commodity. Like food, shelter, and energy, people can not choose not to have necessities - if they choose not to have these necessities, they die.

Folks who insist on market based solutions for vital necessities are the real "Culture of Death" in this country.

Posted by: Extradite Rumsfeld on January 24, 2007 at 2:34 PM | PERMALINK

One method of keeping costs low is to control the number of employees over 40 - Google keeps five physicians on staff at company headquarters, but how many employees there are over 40 and have serious medical problems?

And speaking of medical problems, is there any word from George Washington Medical Center on the attempt to remove Rep Michelle Bachmann's, (R-MN) hand from Shrub's shoulder? Her "catch and release" style is long on catch and very slow on release.

Posted by: thethirdPaul on January 24, 2007 at 2:35 PM | PERMALINK

Maybe you'll take it from the 2006 Medicare Trustees Report. Start on page 3.

Truly un-fucking-belivable.

I got to Page 2. That told the entire story. You see, Page 2 is the list of the trustees.

They are all Repukeliscum enemies of Medicare.

So, do I read a report by a bunch of political hacks? I am not an idiot like you. I have no interest in reading agitprop crap like this report.

Posted by: POed Lib on January 24, 2007 at 2:35 PM | PERMALINK

The "cap" is $15,000 per family. Above that level, employers aren't allowed to deduct the cost of employee healthcare, thus making it a more expensive benefit for cost-conscious corporations to provide.

Forgive me, but this is incorrect, right? Currently employer-provided health care is both deductible by the employer AND not includible in the income of the employee. I think, going forward, employer-provided health care will still be deductible by the employer, but above a certain level it will be includible in the income of the employee. This was my impression; does anyone know better? I didn't think this plan would touch the employer deduction.

Posted by: DJ Ninja on January 24, 2007 at 2:36 PM | PERMALINK

bmaz: It sounds great to me. I know we'd have to raise the tax rate to cover everyone and offer broader benefits -- but so what?

I'd rather pay a tax for complete & portable health care than a premium for a plan that I lose if I leave my job.

Posted by: katiebird on January 24, 2007 at 2:36 PM | PERMALINK

I can't help but wonder sometimes, if this administration had used its power for the good of humanity, instead of for the good of itself, what it might have been truly capable of.
The length, breadth, height of its drive to help itself to more money, more power, and more self-absolution is just astounding, imagine what they could have done with such drive for purposes a bit less selfish and a bit more authenticly democratic.
This administration has done too many pathetic, dangerous, and criminal things for sympathy but I do lament the heights that Bush and Co might have acchieved for the good of an entire planet, rather than the depths they chose.

Posted by: Zit on January 24, 2007 at 2:36 PM | PERMALINK

But it does give you some insight into what Bush is really after.

This has been said better before. The goal of "compassionate conservatism", also called "conservative progressivism" is to achieve some of the goals that liberals/conservatives want, while simultaneously preserving as much of individual liberty (choice, initiative, autonomy, responsibility) as possible. Compassionate conservatism aims to reward people who make better choices, whereas liberalism aims to end inequities that arise when some people make better choices.

You could see this in the SS debate. Bush's plan was to reward people whose self-portfolio-management would be better than average, whereas the opposition came from people who wanted to protect those whose self-management would be below average.

Public policy debates almost always revolve around balancing incommensurable goals. Balancing security with individuality is almost the classic "apples vs. oranges" problem, with the extremes always focusing on one or the other, and with the rest of us seeking a workable balance.

Posted by: calibantwo on January 24, 2007 at 2:37 PM | PERMALINK

bmaz: It is also not a novel suggestion on my part. But why not expand Medicare to everyone of all ages.

It is a good place to start the discussion. Next two questions:

1. what is not covered?

2. what alternatives (freedoms) are available to those who want and can afford them?

Partial answer to question #1: bone marrow transplants, experimental drugs not approved by FDA, marginally better drugs still on patent where off-patent generics are available, repair of sports injuries.

Partial answer to question #2: nothing is prohibited except opting out completely from the common plan. In other words, no restrictions on "medigap" insurance.

Posted by: calibantwo on January 24, 2007 at 2:43 PM | PERMALINK
I remember reading somewhere that Denny Hastert believed that "middle class" 2-earner families made $ 125,000 on the average.

For the love of Christ ... if The Mrs. and I earned that kind of money, I'd do a happy dance for a week.

Of course, that'd cause such severe pain in my back that we'd be forced to spend half of it for my hospital bill ... but still ...

It does show their mindset, though, and why so many in our government are incredibly out of touch -- most already have money and don't remember what it's like to struggle each and every day ... to juggle bills around to find out how to pay them ... to "work the float" with a bill you send out Tuesday, figuring it won't be opened until Thursday and the check sent to the bank Friday ...

They. Just. Don't Get. It.

Posted by: Unholy Moses on January 24, 2007 at 2:45 PM | PERMALINK

Public policy debates almost always revolve around balancing incommensurable goals. Balancing security with individuality is almost the classic "apples vs. oranges" problem, with the extremes always focusing on one or the other, and with the rest of us seeking a workable balance.

I don't disagree with your comment, but you leave out one thing. A powerful driving force for the Repukeliscum is the democratization of risk. They believe that everyone should be at risk, and that this will promote better choices. Of course, this is totally idiotic.

They believe that if your retirement funds are at risk, you will make good choices, and maximize your returns. This is truly stupid. Making good choices which beat professionals takes.... a professional. I am a professional at one thing, and do not have the time to be a professional at two things - my job and managing my funds.

So, the Repukeliscum want us to be professionals at

1) our retirement funds

2) our health care

3) our school choice

So, to summarize, in the Repukeliscum paradise, I would be responsible for making 4 important sets of decisions. This is so fucking stupid that it just makes me crazy.

Of course, what they will tell me is "You don't have to make those decisions. You can pay US to make them." And so, we see the final answer. They are trying to make us all responsible for making these decisions, so that we can turn around and pay Repukeliscum experts to make the decisions.

Posted by: POed Lib on January 24, 2007 at 2:45 PM | PERMALINK

This is too easy.Get rid of healthcare for profit.I mean if the rich want to stay in this plan that's fine.They can pay 20-30% over cost so the guy running some hmo can collect 1.3 billion dollars from you.I would rather pay 2-3% over the cost and have the doctors and nursing staff make better money(you know the ones that do the work and take the risks)Better hospital equpment,Bigger hospitals.That way you and your doctor can decide whats best instead of some board diretors who need to make 30% profit and would skimp on your care for more profit.EASY !!!

Posted by: john john on January 24, 2007 at 2:46 PM | PERMALINK

Skull and Bones has given him his orders. John Kerry has announced that he will not run in 2008.

Posted by: R.L. on January 24, 2007 at 2:49 PM | PERMALINK

calibantwo: The goal of "compassionate conservatism"

A laughable term, thanks in no small part to the people who've popularized it.

also called "conservative progressivism"

An oxymoron.

preserving as much of individual liberty (choice, initiative, autonomy, responsibility)

As long as the King (oops, Unitary Executive) is free to secure the realm by dispensing whenever he wants with silly guarantees of Liberty like Habeas Corpus.

Compassionate conservatism aims to reward people who make better choices

Like W's choice of being born into a rich, politically connected family? Yeah, I should've done that too.

You could see this in the SS debate. Bush's plan was to reward people whose self-portfolio-management would be better than average

Uh, you already have that with IRA's and 401k's (you know, the Democratic policies that Republican's tried to eliminate), and any other savings and investments you care to make.

whereas the opposition came from people who wanted to protect those whose self-management would be below average

Oh, you mean the actual purpose of Social Security, to provide a very low risk safety net in your old age (or disabilty)?

Posted by: alex on January 24, 2007 at 2:52 PM | PERMALINK

bmaz: That is why I set it forth, I genuinely want to know. We have to do something, this is the best I have so far

bmaz, as I wrote, I think that what you have is a start of a discussion, not the result of the discussion.

zit: I can't help but wonder sometimes, if this administration had used its power for the good of humanity, instead of for the good of itself, what it might have been truly capable of.

zit, to repeat my theme, "the good of humanity" requires preservation of individual liberty, and with liberty comes the fact that some people don't do as well as others. Calling that "for the good of itself" misses the intermediate policy in between treating everyone exactly the same and complete laissez faire. The progressive response to the 19th century was based on the evaluation that the US constitution was over-balanced in favor of laissez faire, permitting unfair concentrations of power. The libertarian response to the 20th century is the evaluation that current US policy is overbalanced toward trying to guarantee equal results to everybody, permitting unhealthy restrictions on individual autonomy.

The president's health plan wants to preserve as much autonomy as possible. Any plan that has any hope of passing the Senate and House will have to preserve autonomy as well, the questions being how so?, and how much?.

Posted by: calibantwo on January 24, 2007 at 2:55 PM | PERMALINK

Caliban - Excellent questions. I don't have ready answers, but neither looks to be a bar to consideration. I wasn't kidding when I said I wasn't a genius and had not thought this through all the way. You have already started to answer one of the questions; if all our fine friends here pitch in, my guess is we can flesh this out. I am in and out due to work on my not so fun real job, which is clearly a drag on fixing the nation's healthcare crisis. I'll be back in awhile, but when you start asking coverage and exclusionary details, there are probably others better suited than me. Help anyone?

Posted by: bmaz on January 24, 2007 at 2:56 PM | PERMALINK

You have to admire his consistency though. Even the worst of players usually gets a hit sometimes, but a .000 average? Amazing.
Posted by: alex

Credit where credit is due: it is a perfect record.

Posted by: cyntax on January 24, 2007 at 2:59 PM | PERMALINK

What a disgraceful liar the commenter named clark is. How many times have right wing commenters here lied that the United Kingdom does not have private health insurance ("the alternatives would be long gone"), and how many times have they been corrected? The UK has a small but thriving private health insurance industry for those who can afford it and want it. It's thriving because it's not illegal or suppressed (despite the lies of the aforesaid commenter and others) and some people want it. It's small because nobody here actually needs it.

This is the great fear of the right wing: that the American people will find out that private medical insurance can stay available even in a country with good universal public health care. That would take away one of their most powerful scare tactics. So they just lie about the facts.

Posted by: derek on January 24, 2007 at 3:02 PM | PERMALINK

So who picks up the tab for a poor person who needs a $20,000 life-saving surgical procedure and another $10,000 worth of post-surgical care? The taxpayer, that's who. And thus you have precisely the kind of welfare system that you conservatives hate so passionately.

Ha! No, you don't get it. See, the key is, no one picks up the tab. That worthless person, who after all isn't a Bush Pioneer (and maybe not even a Republican at all!), proceeds to die, thus decreasing the surplus population. Who needs a welfare system?

Posted by: Alek Hidell on January 24, 2007 at 3:03 PM | PERMALINK

Alex, I support SS as it is, not as Bush proposed to make it. Your comment about 401(k) and so on, though snarkily expressed, is fundamentally correct. Because they exist, SS need not be changed. I did not even hint that the opposition to SS reform was mistaken; what I said was that it emphasized the other goal that must be considered in a public policy balance.

POed Liberal:

So, the Repukeliscum want us to be professionals at
...
1) our retirement funds
...
2) our health care
...
3) our school choice

I think that what you call the Repukeliscum position is that people capable, on the whole, of voting, of serving on juries, of choosing their spouses and colleges and professions, and of choosing their own homes, and of making decisions in their professions, can make good choices in those areas of life that you list. The analogy with SS is that some provision be made for people who make poor choices, or have bad outcomes for other reasons, ought to be made, but not by overly restricting the liberty of everyone else.

Posted by: calibantwo on January 24, 2007 at 3:07 PM | PERMALINK

Free market healthcare for all.

Just like they have in Iraq.

Posted by: Disputo on January 24, 2007 at 3:08 PM | PERMALINK

The president's health plan wants to preserve as much autonomy as possible. Any plan that has any hope of passing the Senate and House will have to preserve autonomy as well, the questions being how so?, and how much?.
Posted by: calibantwo

Frankly, I find the issue of autonomy to be a bit of canard. People have concerns about autonomy, and that makes sense, but do any of the alternatives to Bush's plan really impinge on autonomy or is that a conservative smoke screen.

For now I'm going with smokescreen.

Posted by: cyntax on January 24, 2007 at 3:08 PM | PERMALINK

derek: That would take away one of their most powerful scare tactics. So they just lie about the facts.

Wingnuts, lie? No, that's far too harsh. By definition lying is deliberately and knowingly telling a falsehood. What scares me is that most of these people actually believe what they say. Ignorance is strength.

Posted by: alex on January 24, 2007 at 3:09 PM | PERMALINK

Caliban - Crikey, I never said I had a finished product, thought I made that extra super duper clear! I am totally prepared to see the idea eviscerated, in fact expected that; but I haven't seen it yet so i think it is worth exploring and fleshing out further. For the record, I hae yet to see any better finished product plan, so let's see. Pitch in brother!

Posted by: bmaz on January 24, 2007 at 3:09 PM | PERMALINK

Sounds Republican. When it comes to finance, they can turn a public program into a bucket shop right before your very eyes. Foreign policy, they turn our destiny over to a third rate con-man like Chalabi and think they're Evelyn Baring.

Posted by: Steve Paradis on January 24, 2007 at 3:15 PM | PERMALINK
Stealth is a good way to describe using health care to attack Social Security and maybe even Unemployment Insurance. For low income workers excluding this much in payroll taxes would significantly reduce future benefits.

Um, Bush isn't proposing a new tax deduction. Bush is proposing to limit an existing exemption that already exempts employer-paid life and health insurance from income and payroll taxes without limit.

So, in fact, this plan would increase payroll tax contributions.

Posted by: cmdicely on January 24, 2007 at 3:15 PM | PERMALINK

bmaz: Excellent questions. I don't have ready answers, but neither looks to be a bar to consideration. I wasn't kidding when I said I wasn't a genius and had not thought this through all the way. You have already started to answer one of the questions;

The comment about excluding bone marrow transplants was based on the decision by the legislature of the state of Oregon to exclude those from coverage (this was years ago, and I do not know whether they changed.) And this introduces the federal issue: the answers do not have to be the same for every state, but I do think it best if some freedom for states to do things differently is preserved.

Alek Hidell: That worthless person, who after all isn't a Bush Pioneer (and maybe not even a Republican at all!), proceeds to die, thus decreasing the surplus population.

Every nation has a system where not every sick person gets every available treatment in a timely manner. You might as well discuss in advance what remains uncovered by a federal universal system.

Posted by: calibantwo on January 24, 2007 at 3:18 PM | PERMALINK

cmdicely: "Um, Bush isn't proposing a new tax deduction."

Bush SOTU: "First, I propose a standard tax deduction for health insurance that will be like the standard tax deduction for dependents. Families with health insurance will pay no income or payroll taxes on $15,000 of their income. Single Americans with health insurance will pay no income or payroll taxes on $7,500 of their income"

Posted by: Emma Zahn on January 24, 2007 at 3:22 PM | PERMALINK

They believe that everyone should be at risk, and that this will promote better choices.

Not really. That's just their cover story.

You see, all crypto-fascists have a cover story.

The real goal is that - with everyone at risk, certain folks will not be at risk. (ie. the ultra wealthy). Right? Because they won't be at risk.

They are afraid of the alternative, because then they lose their special privilege and have to stand in line with the unwashed rifraff.

Posted by: Extradite Rumsfeld on January 24, 2007 at 3:22 PM | PERMALINK

The real goal is that - with everyone at risk, certain folks will not be at risk. (ie. the ultra wealthy). Right? Because they won't be at risk.

They won't be at risk, because they have enough money to hire the experts. I don't.

Posted by: POed Lib on January 24, 2007 at 3:25 PM | PERMALINK

bmaz: Caliban - Crikey, I never said I had a finished product, thought I made that extra super duper clear!

Sorry, I meant no insult. I hadn't read your response to my first post, and I was just elaborating.

cyntax: Frankly, I find the issue of autonomy to be a bit of canard. People have concerns about autonomy, and that makes sense, but do any of the alternatives to Bush's plan really impinge on autonomy or is that a conservative smoke screen.

To the best of my knowledge, and this issue is certain to be clarified during Congressional hearings, alternatives to Bush's plan are too vague for your question to be answered. We'll know the answers when they discuss particular bills.

Posted by: calibantwo on January 24, 2007 at 3:27 PM | PERMALINK

Quick summary from Physicians for a National Health Program site on how single payer would work and why it's good [emphasis added]:

    Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.

    Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

    Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.

    A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled though negotiated fees, global budgeting and bulk purchasing.

Posted by: cyntax on January 24, 2007 at 3:31 PM | PERMALINK

cyntax: I find the issue of autonomy to be a bit of canard

No, you just don't understand the lingo. In Libertopia words like "autonomy" and "liberty" all mean the same thing: "freedom" from taxes and any form of economic regulation.

Of course they occasionally pay lip service to things like civil liberties, but if they spent a tenth the time complaining about things like suspension of Habeas Corpus or classifying how much toilet paper Dick Cheney uses, I'd be amazed.

People have concerns about autonomy, and that makes sense, but do any of the alternatives to Bush's plan really impinge on autonomy or is that a conservative smoke screen.

Only Canada restricts private purchase of healthcare. But of course, as with ER wait times, they'll always pick the outlier.

For now I'm going with smokescreen.

Correct choice. You win self respect.

Posted by: alex on January 24, 2007 at 3:33 PM | PERMALINK

cyntax, from one of the pnhp websites: Universal, Comprehensive Coverage
Only such coverage ensures access, avoids a two-class system, and minimizes expense

This plan prohibits what I called "medigap" insurance, thereby restricting personal autonomy. That may be an acceptible restriction on autonomy, but it is a restriction.

pnhp purports to pay for all "medically necessary" health care, but does not seem to list any procedures that are not "medically necessary", or provide for physicians who disagree on what is "medically necessary", or allow for the possibility that a procedure "might work". A frequent scenario that is dramatized on "E.R." is where only one doctor wants to proceed; is the judgment of "medically necessary" made by an on-the-spot vote? If you know a bunch of nurses, then you know that this situation happens many times per year.

Also, I don't see why a tax-funded plan should cover any expenses that result from sports accidents: if rich people want to be covered against SCUBA diving, skiing, and horseback-riding accidents, then they should pay extra, even though that does introduce a multi-class system. If you can afford the SCUBA equipment and tank-filling fees, skis and lift fees, horse and horsefeed, then you can afford the extra premium to cover you against accidents that occur in those sports. Just as model airplane fliers buy liability insurance when they join clubs.

however, like medicare, pnhp is a good start for a debate.

Posted by: calibantwo on January 24, 2007 at 3:52 PM | PERMALINK

alex: Only Canada restricts private purchase of healthcare.

Is that still true? I read that their parliament was proposing to change that, but I do not know the result.

Posted by: calibantwo on January 24, 2007 at 3:55 PM | PERMALINK

calibantwo: Is that still true? I read that their parliament was proposing to change that

Possibly as a result of a law suit that alleged that the restriction violated their Constitution. I don't know the state of it. If they do change it, then I won't know of any countries with such a restriction. That reinforces my point.

Posted by: alex on January 24, 2007 at 4:01 PM | PERMALINK

Emma, I was referring (as the context I quoted made clear to anyone paying attention, I would think) specifically to the exclusion of payroll and income tax on employer-provided healthcare, which the post I was responding to treated as a new exclusion which threatened payroll-tax funded programs, but which in fact is a limitation on the existing exclusion of such taxes and would increase payroll tax revenues (all other things being equal).

Posted by: cmdicely on January 24, 2007 at 4:10 PM | PERMALINK

This plan prohibits what I called "medigap" insurance, thereby restricting personal autonomy. That may be an acceptible restriction on autonomy, but it is a restriction.

Why does what you call "medigap" insurance matter? What is it's purpose?

A frequent scenario that is dramatized on "E.R." is where only one doctor wants to proceed; is the judgment of "medically necessary" made by an on-the-spot vote? If you know a bunch of nurses, then you know that this situation happens many times per year.

How are these determinations made now?

Also, I don't see why a tax-funded plan should cover any expenses that result from sports accidents

Sorry but this just seems terribly short-sighted of you. What if someone injures themself while jogging or doing some other sport that will actually increase their healthfulness and thus make them less of a burden on the system? Should we discourage healthy behaviour?

Besides, other than your own personal desire to restrict what you see as frivilous behaviour, do we have data on what financial impact sports related injuries would have?

I may be misreading you but you're throwing up a lot of what seem on the face of them to be less than substantive concerns.

Posted by: cyntax on January 24, 2007 at 4:10 PM | PERMALINK

cyntax:

I was told by "derek" in somewhat spittle-laced terms that nationalized health care would not prohibit private health insurance. Either this is true, or it isn't.

Which is it going to be?

Posted by: clark on January 24, 2007 at 4:19 PM | PERMALINK
I was told by "derek" in somewhat spittle-laced terms that nationalized health care would not prohibit private health insurance. Either this is true, or it isn't.

Actually, it is neither true nor false. National universal-coverage health care systems can exist with or without allowance for private health insurance, as is demonstrated by the wide variety of systems in which such coverage exists.

Some proposals for such a system in the US rely on private insurers, some allow private supplemental insurers, some either prohibit them or leave nothing for them to do.

Posted by: cmdicely on January 24, 2007 at 4:26 PM | PERMALINK

I was told by "derek" in somewhat spittle-laced terms that nationalized health care would not prohibit private health insurance. Either this is true, or it isn't.
Which is it going to be?
Posted by: clark

Since I'm not reponsible for what "derek" tells you, I'm not sure why you're asking me to resolve any differences between us.

The obvious answer is that depending on exactly how you implement national health care, you could do away with private insurance or not.

Posted by: cyntax on January 24, 2007 at 4:27 PM | PERMALINK

"Besides, other than your own personal desire to restrict what you see as frivilous behaviour, do we have data on what financial impact sports related injuries would have?"

Well... indirectly it is reasonably common for businesses and governments to attempt to incentivise thier employees to excercise in an attempt to reduce health care costs. Presumably they have run the numbers and found that if they can get people excercizing whatever sprains and broken limbs they might have to deal with will be more than offset by other problems they will not have to deal with.

Posted by: jefff on January 24, 2007 at 4:33 PM | PERMALINK

alex: If they do change it, then I won't know of any countries with such a restriction. That reinforces my point.

Yes it does. I made a similar point above. Note that the PNHP, cited favorably by cyntax, does advocate a restriction, in order to avoid a two class system. At the time Sen. Kennedy made his strongest push for a system similar to Canada, it did have the restriction, so opposition to the Canada system of the time is more than merely citing an outlier.

Back to my favorite example, bone marrow transplants. A majority of states now have at least one bone marrow transplant center. If there is to be a national standard, I think that we can count on the doctors and nurses of those centers to advocate strongly to their senators and representatives that bone marrow transplants be covered. The states of NY, WA, IL, and CA have two Dem senators each, and quite prominent bone marrow transplant centers. That's just the beginning of a hypothetical vote count. I think we can depend on any plan that passes the senate to have federally funded coverage of bone marrow transplants. Extrapolating from that example, I think it likely that the Democrats will pass a plan without explicit exclusions, and that the actual exclusions will be effected by waiting lists.

Posted by: calibantwo on January 24, 2007 at 4:34 PM | PERMALINK

...alright, gotta run, but cmdicely is more than qualified to field as many questions as he's inclined to.

Posted by: cyntax on January 24, 2007 at 4:38 PM | PERMALINK

"Also, I don't see why a tax-funded plan should cover any expenses that result from sports accidents:"

You know what would be even better? Lets not cover any injuries incurred while in a car that cost more than $10,000 or while on a job that pays more than $100k, or while eating any food that costs more than $20 a pound.

Posted by: jefff on January 24, 2007 at 4:38 PM | PERMALINK

cyntax: Why does what you call "medigap" insurance matter? What is it's purpose?

medicare does not cover all expenses. Medigap insurance is extra insurance you can buy to cover those non-covered expenses. It matters if you want those non-covered expenses to be covered.


cyntax: Besides, other than your own personal desire to restrict what you see as frivilous behaviour, do we have data on what financial impact sports related injuries would have?

There are data on the financial impacts of sports injuries, I just don't have them. The sports that I mentioned have features built into them that can easily be elaborated to collect relevant insurance premiums: you have to sign wavers to indemnify facilities against lawsuits in case of accident, for example, buy expensive equipment, or provide proof of eligibility; for example, in the US you need a sport diving certificate to buy air for scuba diving. My preferences should not, as you say, be the basis of the law, but the law should clearly exclude some coverage.

How are these determinations made now?

Inconsistently, but people without insurance coverage are not treated. "E.R." presents a variety of situations enhanced or chosen for dramatic effect, and is not representative in any sense. If a formal proposal like PNHP claims to have "dramatic" cost savings, in needs to take into account the scale of the problems that it brushes aside, in my opinion. Once money becomes available, every "optional" treatment becomes "necessary" in order to preserve the "opportunity" for the sick body to heal itself.

Posted by: calibantwo on January 24, 2007 at 4:51 PM | PERMALINK

jefff: You know what would be even better? Lets not cover any injuries incurred while in a car that cost more than $10,000 or while on a job that pays more than $100k, or while eating any food that costs more than $20 a pound.

Not with taxpayer money, perhaps. We surely don't need another plan that transfers money to the upper middle class from the lower middle class. If upper and lower middle class pay about the same premiums, and the upper middle have more frequent or more costly injuries, then we would have a system that was transferring wealth from the lower middle to the upper middle class. In case you think this is irrelevant, recall that it is the lower middle class that is treated most harshly by the system that we have.

Posted by: calibantwo on January 24, 2007 at 4:59 PM | PERMALINK

A national single payer plan could easily be set up with a method for getting a sports rider for a year. Especially for young persons 18-35, injuries from sports are found, are not common, and can be easily managed using actuarially sophisticated methods.

Posted by: POed Lib on January 24, 2007 at 5:09 PM | PERMALINK

You could see this in the SS debate. Bush's plan was to reward people whose self-portfolio-management would be better than average, whereas the opposition came from people who wanted to protect those whose self-management would be below average.

You must be thinking of a different Social Security debate than the one I remember. In the one I remember, Bush went around the country touting his "reforms", but when he was finally cornered and asked about specifics, it was plain that his plan had the same attention to detail that's made our Iraq adventure such a success.

Your comments suggest that you believe that there's some underlying philosophy to the administration's actions, when six years of history indicate that their thoughts don't go much beyond, What can we con the yokels into this time? It's all expedience, all the time, with Bush.

Posted by: sglover on January 24, 2007 at 5:24 PM | PERMALINK

sglover: Bush went around the country touting his "reforms", but when he was finally cornered and asked about specifics, it was plain that his plan had the same attention to detail that's made our Iraq adventure such a success.

It did not in fact enhance autonomy very much.

POed Lib: A national single payer plan could easily be set up with a method for getting a sports rider for a year.

Sure, and there are lots of mechanisms, such as a surtax on scuba tanks (they are registered with the Federal DOT anyhow), and too many more to mention. The issues are whether they will be required in order to get medical attention, and whether the result is a multiclass system.

A lot of things that could be easily done will not in fact be done by Congress.

Posted by: calibantwo on January 24, 2007 at 5:45 PM | PERMALINK

calibantwo: PNHP, cited favorably by cyntax, does advocate a restriction, in order to avoid a two class system

From their FAQ:

Everyone has to be included in the new system for it to be able to control costs, reduce bureaucracy, and cover everyone. However, business and anyone who wants to can purchase additional private insurance that covers things not covered by the national plan

So what they're opposed to is an opt-in plan, not supplemental insurance. For good reason:

if allowed, patients would enroll in the private system while they were healthy (and their premiums were low), and enroll in the public system when their care (and private premiums) became expensive. This, in fact, is what we saw happen to Medicare and HMOs. There, patients needing expensive care, e.g., a hip replacement, were encouraged to drop out of their HMO so traditional Medicare would pick up the tab. However, while they are healthy they enroll in the HMO for the modest additional dental and drug benefits
Posted by: alex on January 24, 2007 at 5:47 PM | PERMALINK

calibantwo: there are lots of mechanisms, such as a surtax on scuba tanks (they are registered with the Federal DOT anyhow), and too many more to mention. The issues are whether they will be required in order to get medical attention, and whether the result is a multiclass system. A lot of things that could be easily done will not in fact be done by Congress.

Clearly you're concerned about these mechanisms in order to control costs. Then answer this: if such mechanisms are so important, how do countries with UHC, and without any such silly additional taxes or restrictions, manage to provide health care for all their people at a much lower cost than the US spends to provide it for "most" of their people.

When it comes to cost control, you're obsessed with speculative concerns, and avoid the overwhelming empirical data.

Posted by: alex on January 24, 2007 at 5:55 PM | PERMALINK

I'm late to the party again (traveling), but a couple three comments:

(1) Bush's plan is also a slap in the face to unions, who typically negotiate better health insurance coverage than what is offered to their non-union brethren. More evidence that Bush repudiates the basic human right of workers to collectively bargain in selling their labor, which the UN and the Vatican have both acknowledged is an essential human right.
(2) Not that American Hawk is generally worth responding to, but since he had the first post on this thread, here goes: If you think you have (c) currently, you are a fool, AH. There is no "free market" for health care in America. Remove medical insurance companies like United Health and others from the equation, if you truly want to negotiate medical costs with your doctor. It ain't happenin' now!
(3) If you want to know what conservatives vision for health care in America, Google "Golden Rule insurance Gingrich" and do some reading. It will open your eyes.

Peace,

TCD

Posted by: The Conservative Deflator on January 24, 2007 at 6:22 PM | PERMALINK

alex: Clearly you're concerned about these mechanisms in order to control costs.

No, my principle concern is that people with less risky lifestyles (and inexpensive sports) should not subsidize the health care of people with more risky lifestyles (and expensive sports.)

if such mechanisms are so important, how do countries with UHC, and without any such silly additional taxes or restrictions, manage to provide health care for all their people at a much lower cost than the US spends to provide it for "most" of their people.

These mechanisms are not so important, just possible. the countries that I know most about provide for the opportunity for people to buy additional coverage. In Switzerland and in Germany there are indeed "restrictions". Whatever it is that people purchase with their additional insurance, that health care is restricted to those who have paid the insurance premiums. Another note about Switzerland, there is increasing dissatisfaction with the system as it is, and more people yearly buy the additional insurance.

So what they're opposed to is an opt-in plan, not supplemental insurance.

Their very first faq, which I quoted, calls for the end of a two class system. If there is supplemental insurance, then there is a two class or multiple class system.

When it comes to cost control, you're obsessed with speculative concerns

I don't think I have addressed the issue of "cost control" at all. Let me address that now. If there are mandated cost controls in the federally financed system, and there are options for supplemental insurance, then there will be a two-tiered system. That may not be bad. Medicare works like that now.

Posted by: calibantwo on January 24, 2007 at 7:42 PM | PERMALINK

Today this has only a small effect since very few health plans are worth more than $15,000 per family.

Not true, Kevin, unfortunately. Many small company plans are running $1500/month now for $20/copay plans. Although most companies don't pay 100% of the costs, a lot of Silicon Valley startups do, providing good benefits to compensate for lower pay. That means taxes on $3000 of income, and sometimes the startups don't pay all that well.

Posted by: Spike on January 24, 2007 at 7:48 PM | PERMALINK

calibantwo: No, my principle concern is that people with less risky lifestyles (and inexpensive sports) should not subsidize the health care of people with more risky lifestyles (and expensive sports.)

That is a concern for cost control.

These mechanisms are not so important, just possible.

Ah, so you want to create additional complexity and bureaucracy and increase administrative costs (the source of much of this country's inflated health care costs).

Or maybe you just prefer discussing unimportant aspects. If you get mail from our new UHC system, what color should the envelopes be?

In Switzerland and in Germany there are indeed "restrictions".

On being treatment for injuries because you got them playing a sport?

Their very first faq, which I quoted, calls for the end of a two class system. If there is supplemental insurance, then there is a two class or multiple class system.

Your logic, not theirs.

I don't think I have addressed the issue of "cost control" at all.

Of course not. You only talked about how certain procedures shouldn't be covered, and how their should be special taxes to cover the medical costs related to scuba diving.

Posted by: alex on January 24, 2007 at 8:37 PM | PERMALINK

cmdicely: So, in fact, this plan would increase payroll tax contributions.

But let's be clear... There would be a net cost to the treasury. There would also be a reduction in payroll tax contributions if people factor it into their W-4's (which they would, in short order). Somewhere to the tune of $40-50B a year until the promised payoff (*cough*) appears in 5-10 years.

Posted by: has407 on January 25, 2007 at 12:29 AM | PERMALINK
…Compassionate conservatism aims to reward people who make better choices…. calibantwo at 2:37 PM
I have never seen anything but pure Republicontarian cant from the right and there's never been anything compassionate about it.
…in favor of laissez faire…calibantwo at 2:55 PM
This is another of those terms like compassionate conservatism and free market that does not refer to anything in the real world. There has never been laissez faire in the US just as there is no such thing as a free market.
…can make good choices in those areas of life that you list…calibantwo at 3:07 PM
Do you understand that the problem here is full transparency, i.e. the full availability of data to the consumer of health plans, school data, doctor stats, mortgage and closing costs etc.? In general, industry is dedicated to keeping all the relevant facts from the consumer because that is what makes profits. Do you think Enron or World Com ever showed sufficient information so a stock buyer could make an informed choice? Can you read, understand and compare insurance contracts? Do you think without Consumer Reports companies would put studies of the effectiveness of their products in the public domain?
A lot of things that could be easily done will not in fact be done by Congress…. calibantwo at 5:45 PM
The US has the best government money can buy.

Remember, this deduction is like the Standard Deduction: you subtract it from your gross income to derive net income. Your actual tax savings will probably be in the vicinity of 3 000. Meanwhile, California residents can get quotes for private insurance plans here. If the cost is over $300 per month you lose.
The Bush plan is one of the lamest. It favors healthy young well-to-do applicants and provides a disincentive for employers to furnish insurance.

Posted by: Mike on January 25, 2007 at 12:52 AM | PERMALINK
But let's be clear... There would be a net cost to the treasury.

Yes, I would expect so.

. There would also be a reduction in payroll tax contributions if people factor it into their W-4's (which they would, in short order).

Huh? There would be a reduction in income tax witholding if people who don't have employer-sponsored insurance factored the deduction into their W-4s, but no effect on payroll taxes, but payroll taxes are generally flat rates on covered income (up to a limit for some taxes) and not affected by W-4s in any relevant way.

Posted by: cmdicely on January 25, 2007 at 11:46 AM | PERMALINK

clark, if you feel a universal health care plan that comes with a law making private health insurance illegal is unacceptable, it's perfectly legitimate of you to object to that specific plan. But it's dishonest of you to claim that universal public health care rules out private health care at the discretion of the consumer; that just isn't true, as has been pointed out in this blog before. It's especially dishonest of you to use the particular country that you cited in the link, as an example of private health care being unavailable. There may be countries where that's the case, but if so, you should pick one of them as your example, and not the UK.

Posted by: derek on January 25, 2007 at 12:27 PM | PERMALINK

calibantwo: No, my principle concern is that people with less risky lifestyles (and inexpensive sports) should not subsidize the health care of people with more risky lifestyles (and expensive sports.)

alex: That is a concern for cost control.

I don't think so. I think that it is an issue of fairness that is independent of costs.

Posted by: calibantwo on January 25, 2007 at 1:55 PM | PERMALINK

"Who among these three people would you prefer to make your healthcare decisions?
A) Some HR Flack
B) Some bureaucrat in Washington
C) You and your doctor."

Forget D) Some insurance company hack.

That's what's happening now.

The only way you and your doctor can make your healthcare decisions is if there is a single payer, (i.e. socialized medicine) as only then is the economic component removed from the decision.

Posted by: Cal Gal on January 25, 2007 at 3:56 PM | PERMALINK

"This is just another asinine idea from an asinine administration that doesn’t give a damn about anyone making less than a mid-six figure salary." Right on. They don't KNOW anybody who isn't in the top income bracker. I don't think they really know that there ARE people for whom an income tax deduction is worthless.

As to "medicare does not cover all expenses. Medigap insurance is extra insurance you can buy to cover those non-covered expenses." That's not correct. Medigap insurance covers only what Medicare covers, but Medicare generally pays only 80%. Medigap insurance covers the other 20%.

Thus now that Medicare Part D covers prescription drugs but has a donut hole, Medigap policies cannot cover the donut hole. You are "outside" Medicare for that period. Having said this, I understand that some Medigap programs have found a way to cover the donut hole, but I can't see how and have been told that that is NOT allowed by Medicare.

Posted by: Cal Gal on January 25, 2007 at 4:12 PM | PERMALINK

cmdicely: Huh? There would be a reduction in income tax witholding if people who don't have employer-sponsored insurance factored the deduction into their W-4s, but no effect on payroll taxes, but payroll taxes are generally flat rates on covered income (up to a limit for some taxes) and not affected by W-4s in any relevant way.

The W-4 is the basis the employer uses to compute allowances, and is used to deterimine payroll tax witholding. While you can't make the W-4 allowance negative, I'd expect that most people would include it in their W-4 calcuations (should Bush's plan be adopted), as it could have a significant impact on their payroll witholding (e.g., Deductions and Adjustments Worksheet, lines 1 and 4) . And, if the administration's rhetoric is to be believed, 80% of those with employer-provided healthcare benfits could add another 1-2 allowances, thus reducing their payroll--or income-tax--witholding.

Posted by: has407 on January 26, 2007 at 4:31 AM | PERMALINK

cmdicely -- Ok, on second reading, I agree that there would be no effect on payroll taxe rates. Obviously, as this is a glued-on tax deduction. However, the net effect is that both effective payroll tax rates and payroll tax witholding would decrease.

Posted by: has407 on January 26, 2007 at 4:42 AM | PERMALINK




 

 

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