spendius
 
  -1  
Reply Mon 21 Jan, 2013 04:15 pm
@georgeob1,
Expecting Frank to not be self-serving is like expecting the sun not to rise tomorrow.
0 Replies
 
spendius
 
  1  
Reply Mon 21 Jan, 2013 04:21 pm
@georgeob1,
Quote:
If anything I was suggesting the futility of government attempts to control the price and quality of services or products of any kind.


I presume you are excluding tariffs, taxes, duties and handling fees.
georgeob1
 
  1  
Reply Mon 21 Jan, 2013 04:27 pm
@spendius,
That is clear enough from the context.
0 Replies
 
Frank Apisa
 
  1  
Reply Mon 21 Jan, 2013 04:31 pm
@roger,
Quote:
Re: Frank Apisa (Post 5232575)
Okay, find me a family physician in Farmington, NM that accepts new patients with Medicare only. My doctor continues to accept Medicare when existing patients move to medicare, and I'll tell you, I worry almost as much about his health as my own.

Oh yeah, the hospital's urgent care operation does take it. Not quite the same, though.


READ what I have written, Roger. I mentioned that Medicare ONLY is not what was being discussed. I have mentioned supplemental insurance several times. I have mentioned that Medicare is not a stand-alone insurance.
georgeob1
 
  0  
Reply Mon 21 Jan, 2013 04:35 pm
@Frank Apisa,
That may have been what you were discussing, but it was not either specified or acknowledged in the comments of others in this communal dialogue.

You appear to be trying hard to cover your tracks.
Frank Apisa
 
  1  
Reply Mon 21 Jan, 2013 04:36 pm
@georgeob1,
Don't even try that, George.

Here is the post that started this discussion:

Quote:
Your priorities are very different from mine and you appear to believe that we could create a single-payer system in this country which would (1) be satisfactory to most citizens and (2) cost half as much as our aggregate spending today. I don't believe that is a possibility in this country, though you appear to accept it as an undeniable fact.

Our current spending on existing government payment health care programs (Medicare, Medicaid and Military) is already vastly higher than what was forecast just a few years ago, and there is no good reason to believe that extending its reach will correct that already existing problem. An additional dose of the same poision is generally not a good treatment. Moreover each of these programs is already highly politicized with well organized lobbying and self-interest groups already in place orchestrating the activities of politicians all too willing to play to their particular grandstands with public money, whenever it is to their advantage. One can readily see that analogous systems in the UK and Canada are fairly constant political issues in their own political discourse, and they, in my view, are far more likely, given their traditions, than are we to make such a public syatem work.

I am Medicare eligible, though I still work full time. One simply can't easily find a medical praticioner here in the San Francisco Area who will accept a Medicare patient. As a result Medicare is (theoretically at least) my secondary insurance. I pay about $7,800 annually in Medicare employment and part B taxes, and doubt that I have ever collected more than $1,000 in any year in benefits from it. Why should I welcome more of that?


I think you are indulging your personal fantasies about a non-existent public health care system, supposing that it will have none of the already existing defects of existing ones in this country and will, at the same time cost far less and deliver better service - in the hands of Nancy Pelosi (whose Father bled the city of Baltimore MD white while his political machine ran the place) and other like-minded "progresseives" who are very sure that they alone know what is good for the rest of us. I don't agree.


There is no doubt what you were insinuating, George.

So...you are saying that Medicare would have to be your secondary insurance???

C'mon.
0 Replies
 
Frank Apisa
 
  1  
Reply Mon 21 Jan, 2013 04:37 pm
@georgeob1,
Quote:
Re: Frank Apisa (Post 5232737)
That may have been what you were discussing, but it was not either specified or acknowledged in the comments of others in this communal dialogue.

You appear to be trying hard to cover your tracks.


Not the case at all, George. Just me taking on another conservative trying to paint the safety net features as ugly as possible.

But nice try.
0 Replies
 
roger
 
  1  
Reply Mon 21 Jan, 2013 04:39 pm
@Walter Hinteler,
I know for an absolute fact that Wetzel Williams no longer has an office on E. Comanche, and hasn't for a number of years. I had him briefly as a doctor, and all I can say is "Good riddance".
Frank Apisa
 
  1  
Reply Mon 21 Jan, 2013 04:52 pm
@roger,
Quote:
Re: Walter Hinteler (Post 5232602)
I know for an absolute fact that Wetzel Williams no longer has an office on E. Comanche, and hasn't for a number of years.


Musta gone outta business because he wouldn't take on new patients.
Frank Apisa
 
  1  
Reply Mon 21 Jan, 2013 04:53 pm
@Frank Apisa,
Nope...he went outta business because he did, Frank.
0 Replies
 
roger
 
  1  
Reply Mon 21 Jan, 2013 07:23 pm
@Frank Apisa,
Maybe he couldn't take on new patients. As I mentioned, I was one of them briefly. Very briefly.
0 Replies
 
JPB
 
  1  
Reply Tue 22 Jan, 2013 08:00 am
Back to finances...

I'm glad to see the May 19th date but this won't get through the Senate with the congressional payroll clause. I'm not against the clause by any means, but there's a constitutional question regarding the ability to modify the pay of a sitting congress. The Rs are claiming this doesn't change it, but that it withholds it. They're using it to push the Senate into passing a budget -- which, of course, they'll then use to hit vulnerable Senate Ds who are up for reelection in 2014. It's still all about politics.

Quote:
House Republicans on Monday unveiled legislation that will suspend the debt ceiling until mid-May, setting the stage for a floor vote as soon as Wednesday.

The House Rules Committee posted the text of the legislation as Washington prepared for President Obama’s second inauguration. In addition to preventing default, the bill would withhold members’ pay if Congress fails to pass a budget by April 15.

The Rules Committee will hold an emergency meeting to discuss the legislation Tuesday, setting up a vote as soon as Wednesday on the House floor. The Hill
Frank Apisa
 
  1  
Reply Tue 22 Jan, 2013 08:20 am
@JPB,
Quote:
I'm glad to see the May 19th date but this won't get through the Senate with the congressional payroll clause. I'm not against the clause by any means, but there's a constitutional question regarding the ability to modify the pay of a sitting congress. The Rs are claiming this doesn't change it, but that it withholds it. They're using it to push the Senate into passing a budget -- which, of course, they'll then use to hit vulnerable Senate Ds who are up for reelection in 2014. It's still all about politics.



Most of them are millionaires...and if the thing should pass, the Dem's should simply let the pay withholding occur. They should embrace the move...and use it to their advantage.

Remember how Obama embraced the term "Obamacare" during the debates? Now you can almost see the pain on the faces of Republicans when they use the term. They now know that a plan that will most likely become a permanent and important part of the national safety net will always have the name Obama associated with it.

Let's see what happens in the 2014 election when the Democratic Party candidates can portray it as, "We were willing to have our pay withheld in order top prevent drastic cuts the Republicans wanted to make to essential programs for the middle class."
blatham
 
  2  
Reply Tue 29 Jan, 2013 08:25 pm
@georgeob1,
Quote:
Your priorities are very different from mine and you appear to believe that we could create a single-payer system in this country which would (1) be satisfactory to most citizens and (2) cost half as much as our aggregate spending today. I don't believe that is a possibility in this country, though you appear to accept it as an undeniable fact.


I bump into this notion quite often from folks on the right - single-payer (some version of) won't work in the US because the US is unique. I'm sure George and the other folks who repeat this notion actually believe it so but for the life of me, I can't see a historical or logical basis to imagine it is true. US citizens consistently support social security, for example, and when polled on the elements of universal medical insurance/delivery show support for those elements as well (when loaded terminology such as "Obamacare" are absent in the polling).

Leaving completely aside here the hugely important matter of financial interests involved, the rather more plausible thesis is that, as a matter of ideological stance and certainty, folks on the right merely wish American citizens broadly agree with the right wing ideological stance or they are reluctant to consider that they are in a minority. The mythology of exceptionalism is a handy presumption used to bolster this (and quite a few other) right wing notions.

But the problem for the right is exactly the reverse of what they claim. It isn't that it would be unpopular but rather that it would be popular. In all other western nations of we call the 'free world' where some variant of government managed healthcare is in place, there is no example to be found of citizens wishing to overturn or dismantle their systems in order to go with a system such as the US has or had in place. And because no such popular sentiment exists, no political party advances this as a platform plank. They know they'd get murdered electorally.

And that is precisely the rationale advanced by Bill Kristol in his '93 memo to Republicans on "Hillarycare" and why it had to be killed.

"December 2, 1993 - Leading conservative operative William Kristol privately circulates a strategy document to Republicans in Congress. Kristol writes that congressional Republicans should work to "kill" -- not amend -- the Clinton plan because it presents a real danger to the Republican future: Its passage will give the Democrats a lock on the crucial middle-class vote and revive the reputation of the party. Nearly a full year before Republicans will unite behind the "Contract With America," Kristol has provided the rationale and the steel for them to achieve their aims of winning control of Congress and becoming America's majority party. Killing health care will serve both ends. The timing of the memo dovetails with a growing private consensus among Republicans that all-out opposition to the Clinton plan is in their best political interest. Until the memo surfaces, most opponents prefer behind-the-scenes warfare largely shielded from public view. The boldness of Kristol's strategy signals a new turn in the battle. Not only is it politically acceptable to criticize the Clinton plan on policy grounds, it is also politically advantageous. By the end of 1993, blocking reform poses little risk as the public becomes increasingly fearful of what it has heard about the Clinton plan." http://to.pbs.org/KkSOtv

Americans would like it. This will do great damage to "small government" ideology - the foundation of right wing or Republican ideas and claims - and would deal a grievous blow to Republican electoral changes for a considerable distance up the road. Citizens would become, again, mindful that government can actually function to make their lives better. Can't let that happen (and let's note that Bill has no apparent consideration at all of anything here other than GOP electoral opportunities and forwarding the small government ideology). People sick and dying. **** 'em.





hawkeye10
 
  0  
Reply Tue 29 Jan, 2013 11:32 pm
@Frank Apisa,
Quote:
Remember how Obama embraced the term "Obamacare" during the debates? Now you can almost see the pain on the faces of Republicans when they use the term. They now know that a plan that will most likely become a permanent and important part of the national safety net will always have the name Obama associated with it

I dont think REPUBS are worried at all, they know that Obama zigged when he should have zagged, that the imparitive was to shrink the health bill that we can not afford not to expand it as Obama did and to get it to be efficient, which Obama made no effort to do. we can not get our fiscal house in order till we fix healthcare, and no one is even talking about doing that.
0 Replies
 
hawkeye10
 
  1  
Reply Tue 29 Jan, 2013 11:52 pm
@blatham,
Quote:
I bump into this notion quite often from folks on the right - single-payer (some version of) won't work in the US because the US is unique.

single payer does not work because it does almost nothing to solve the critical problem, which is that we pay far more than we can afford for a system that provides not very good medical service. in order to fix this we need to cut down on fraud, need to cut way back on care provided in the last years of life, need to completely reform the drug industry and need to attack the 30%+ that is pure waste for unneeded services. We need to make the system at least a little efficient and need to ration services, and we are not interested in doing either. Single payer would not accomplish either.

Quote:
US citizens consistently support social security, for example,
of course, because it is candy.....we get a lot more than what we pay for, so what is not to like? at least till the gravy train dries up and we are forced to be responsible.
Thomas
 
  3  
Reply Wed 30 Jan, 2013 02:31 am
@blatham,
blatham wrote:
I bump into this notion quite often from folks on the right - single-payer (some version of) won't work in the US because the US is unique. I'm sure George and the other folks who repeat this notion actually believe it so but for the life of me, I can't see a historical or logical basis to imagine it is true.

There's no empirical basis either. American seniors are so happy with Medicare that Republicans won the midterm elections of 2010 by campaigning, not against it, but against cutting it. So if the argument against single-payer systems is that America is unique, how come American seniors are not unique? America veterans neither, come to think about it. Customer satisfaction with the VA isn't perfect, but it's better than with private insurance companies. And the VA isn't just a single-payer system, it's a single-employer-of-doctors system like Britain's National Health Service.
Frank Apisa
 
  1  
Reply Wed 30 Jan, 2013 06:10 am
@blatham,
But the problem for the right is exactly the reverse of what they claim. It isn't that it would be unpopular but rather that it would be popular.
0 Replies
 
JPB
 
  1  
Reply Wed 30 Jan, 2013 07:21 am
@Thomas,
That's the point they make, isn't it? Or, at least the point they're making now. We won't touch anyone's benefits, or those of anyone aged 55 or over but everyone else better start saving their nickels. I tend to want just the opposite (I know it will never happen). If today's seniors (and those who will become medicare eligible in the next 10 years) voted for a disfunctional congress who screwed the pooch with their money then THEY should be the one to carry the burden, not their grandchildren. Hospice for ALL (she says only partly in jest).
0 Replies
 
georgeob1
 
  1  
Reply Wed 30 Jan, 2013 01:08 pm
My original contention on this matter was that I don't believe that we in this country, "could create a single-payer system in this country which would (1) be satisfactory to most citizens and (2) cost half as much as our aggregate spending today". Even after reading the posts above, I believe it still.

I suggest that we evaluate this matter with the corresponding qualities of other government operated systems that also directly touch the lives of most citizens in mind. Theoretical constructs should be evbaluated as what they are - surmises based on factors ranging from hope and feat and only occasionally meaningful experience.

Most of the discussion above has centered on the supposed popularity of the system, and the power it would give Democrats in serving identifiable constituencies going forward. I haven't seen any defense ohere of the notion that it could remain popular while, at the same time, reduce our spending by half as its proponents claim. The references to continuing political gains from such a system are themselves acknowlegment of the likely political corruption that will attend it.

My concerns center on just a few factors;
1. Such a system would presumably base its operations of optimizing outcomes for the population as a group (i.e. life expectancy, infant mortality, etc), and not those for individuals. This is an important difference because the two are often in conflict. Consider that the cheapest way to extend group life expectancy is to ration care to those with the lowest remaining life expectancy. It is well also to consider just what incentives such a system would have for inovation at every level from new treatments, medicines, etc. to individual practitioners of the medical art.
2. The consequences of an effort to reduce costs by half, open the door to a host of potential bad side effects, aggrivated by the collective priorities above. I have seen nothing in the recent debates and legislation that would begin to deal with factors related to increasing the supply of lower cost medical praticioners and the diagnostic devices & treatment modalities they use. So far it's only top down price caps; mandated limits on treatment; and the imagined efficiencies that a government-managed system might produce. I think the world has already shown us what such systems really produce - expensive, stale structures that deliver only mediocrity and loss of freedom.
3. Where are the models in current government operations for such services that touch the lives of nearly everyone? Our public schools? The IRS ? Police? Firemen? The military services? Our highly unionized and politicized public school system lags the performance of other countriees by large margins. Why? Cities across the country are discovering the financial burdens imposed on them by Police and Firemen's unions over time with unsustainable job protection, salaries and retirement benefits (same goes for the military, though their benefits are a good deal less than those of Cops & firemen).

I fear that such a single payer health care system would quickly becone unionized, politicized, and intensely bureaucratic. In short a perfect model for increasingly expensive mediocrity. Indeed the speculations above about the political opportunities and barriers (depending on your party perspective) attendant to sush a system are themselves an acknowledgment of this factor. We will quickly see the emergence of well organized lobbying groups representing doctors, nurses, hospital operators, drug companies, etc ... everyone but the patients.

Finally, I don't think any of you can find a comparable example of the government reducing the cost of anything by a significant amount. Please don't roll out the cheap Medicare administration canard. The government doesn't account for cost the way businesses do. Medicare legal enforcement is in the Justice Department budget; much of their office costs are in the GSA budget; they get to use the frank instead of postal stamps; employee health care and retirement costs are separately funded; etc; etc.
 

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