Health care is not free.

[Cessna Invesco Palin]

I'm posting this in response to the large number of threads expressing shock - SHOCK! - at Hillary suggesting that providing health care for all might not be free, and that it might require "garnishing" wages (another euphamism for higher taxes.) Let us be clear on something: health care costs money. A LOT of money. And providing health care for every person in the country is NOT going to be free. It is not going to be cheap. Anybody who claims that they can do it without putting added financial burden on at least the middle and upper income brackets is trying to sell you something that is not health care (a bridge, perhaps.) I live in the UK. You know those lovely western European universal health care systems that everyone here raves about? We PAY for them. It is not cheap, especially for middle class people like me. I don't have the exact figures, but tomorrow I'll reply in this thread with exactly how much it costs me per month. It is not cheap. It is not free. So let's dispense with the idea that any universal health care system (single payer, whatever, I don't care how you label it) is not going to have any impact on your average middle class tax payer. It will. But let me just say this: As a user of the NHS, I could not conceive of a worthier cause to which I could give money. The fact that any and every person in this country can get exceptionally high-quality health care, of the same standard I as an upper-middle class earner can get, fills me with pride. It is worth EVERY PENNY.

End rant.

[mikelgb]

1. "it's costs folks like you and me"

[napi21]

2. THANKS for posting that info! I think a lot of people in the US

THINK that somebody ELSE pays for HC in a universal HC system. I'd bet if you asked them "Who IS that somebody else?" they'd stammer, stutter, and finally say "I don't know, but SOMEBODY, just not me!"

I watched a TV program a week or so ago on our public network about Where is the happiest place on earth. I was a bit surprised that it was Denmark. They admit they do pay high taxes, but they are very happy with the results. http://news.bbc.co.uk/1/hi/health/5224306.stm

I'm not really sure the Americans are quite ready for anything like that, and I KNOw the politicians aren't! If the entire program was explained to everyone in a way they could fully understand it, I wonder if the majority really WOULD like the idea?

[tblue37]

30. Part of the reason why Americans are not ready to pay high taxes to provide for everyone

as Denmark does is that "everyone" in America includes "them"--"the Other." Republican politicians and media blowhards constantly demonize the poor, especially when they are also members of minority groups (remember Reagan's "Welfare Queens," driving their Cadillacs down to pick up their welfare checks?). Many people in our country are so filled with spite that they are willing to do without guaranteed healthcare themselves rather than allow someone they consider "undeserving" to get something, too.

And, of course, just as the words "liberal" and "liberalism" have been demonized by the RW media (i.e., the entire corporate media), so too has "socialism," but that smear has been going on far longer than the smear against "liberalism." It is true, of coruse, that government sponsored single-payer healthcare would be socialism. But then again, so are Medicare, Medicaid, AFDC, WIC, unemployment insurance, and many other benefits most people take for granted and would hate to see undone.

[xchrom]

3. recommend

[lumberjack_jeff]

4. It should be. In fact, truly universal care should cost us less

We pay much more for partial coverage than every other industrialized country pays for universal coverage.

[Cessna Invesco Palin]

5. That doesn't mean it's free.

That's just economies of scale at work. It IS NOT free. Nor should it be. Unless you'd like your doctor to go without pay.

[lumberjack_jeff]

7. Universal health care is not free, just less than you're currently paying.

So, the incremental cost of providing health care to everyone, is for most people, a negative number.

Only those who are currently relying upon the kindness of strangers would find an increased cost.

[Timmy5835]

6. Simple math

If you just took half the money spent on Iraq it would more then cover universal health care. Think about it.

[democrat2thecore]

51. But - it's STILL not free. That money comes from US! -nt

[NC_Nurse]

8. K&R

You are SO right. I'm tired of all the posts about this too.

[LeftishBrit]

9. As another UK-dweller

I would like to ardently endorse everything that you've said!

National health care isn't free, but it's one of the best investments a country can make.

I'd much rather that my taxes went on health care, than on the Iraq war and such-like.

[Hieronymus]

45. France, #1 in health care .......

May 20, 2004

FRENCH HEALTHCARE....The Economist provides a capsule summary of healthcare in France:

Its hospitals gleam. Waiting-lists are non-existent. Doctors still make home visits. Life expectancy is two years longer than average for the western world.

....For the patient, the French health system is still a joy. Same-day appointments can be made easily; if one doctor's advice displeases, you can consult another, a habit known as nomadisme médical. Individual hospital rooms are the norm. Specialists can be consulted without referral. And while the patient pays up front, almost all the money is reimbursed, either through the public insurance system or a top-up private policy.

For family doctors too, liberty prevails. They are self-employed, can set up a practice where they like, prescribe what they like, and are paid per consultation. As the health ministry's own diagnosis put it recently: “The French system offers more freedom than any other in the world.”

And despite the Economist's scary headline, which proclaims that "crisis looms," the French system provides this service to everyone in the country and does it for less than half the cost per person of the U.S. Even if they decide to raise taxes to cover a growing deficit in their healthcare fund (the subject of the Economist's article) their costs will still be less than half ours per person.

Now, there are undoubtedly drawbacks to the French system. They probably have fewer high-tech machines than we do, and the comparative cost figures may be skewed by the American love of elective procedures. Still, there would have to be a lot of drawbacks to make their system less attractive than ours.

So why not adopt it? Well, that would be socialized medicine. Can't have that, can we? After all, everyone knows that when you socialize something it automatically declines slowly into anarchy and uselessness. Right?

[Hieronymus]

46. I posted France #1 ... didn't mean it as response to your post but to ...

the original post. All industrialized nations have decent health care except for the US.

[avaistheone1]

48. If we are the greatest nation on earth, why are we not providing health care to our citizens?

Especially when our competitors are doing so.

[JVS]

10. If we could afford healthcare, we'd already have already.

[Zynx]

11. Damn straight.

[Name removed]

12. Deleted message

Message removed by moderator. Click here to review the message board rules.

[MonkeyFunk]

20. you think spamming this in every thread

makes you look smart?

[adapa]

13. If everyone in the US would pay 5% of their income to healthcare...imagine

5% of 30,000 = $1500 divide by 12 =125 a month
this is a no brainer folks

[sandnsea]

17. per family, or per person?

:shrug:

And by the time people who earn $2500 a month pay their bills, it can be awfully hard to come up with another $125 a month, or more if it's per person.

[adapa]

23. I would assume the payment would be based on a family unit

There are clear methodologies in place with regards to how much a person/family can afford. The SCHIP program in NH takes into consideration the entire familys income, & expenses; 1)for child support paid to another party 2)daycare 3) adultcare).

I have to think the plan that comes out of both the presidents office & congress will be as reasoned especially if both are Democrat controlled.

[sandnsea]

24. And most of the time

The amount they decide families can afford does not match reality at all. SCHIP has done a pretty good job, but child support and day care have not done as well.

[adapa]

28. In the NH SCHIP program income is reduced by daycare, elder care & child support payments.

[sandnsea]

14. It's the lower income people who are concerned

Who are going to have their wages garnished with the promise of some unknown tax credit at the end of the year.

[adapa]

18. if the medical insurance is based on a percentage of income with a bottom limit ~ 300% of povery

see my above post for the math

also there are a number of ways of getting the tax credit back to people who truly need them the year
refundable credits, earned income credits etc

[sandnsea]

19. Well sure

which is why you figure all that out BEFORE you mandate anything, which is the truth of what Edwards was going to do. Obama puts the premiums on a sliding scale and that's the best way to do it. People can't wait around for tax credits.

[adapa]

27. It is up to the individual to increase their exemptions so that they keep more of their paycheck.

The tax relief is refundable so even if they don't paytaxes in to the system they get $ back. Plus premiums are based on a percentage of income.

Frankly Obama's plan of reducing health care premiums by $2500 will do squat for me. My health care premiums have incresed from $3600 in '97 to $10,900 in '07. if they're reduced to $8400 in '08, they'll just inflate back to 10,900 in a couple of years cause not everyone is covered.

[sandnsea]

52. That's not the subsidy part

He'll provide an income based subsidy to help pay premiums.

If you're paying $10,900 a year for insurance, you are in an income bracket where the health insurance debate is only theoretical. Working income people don't even think about insurance that costs that much. It's up to the individual to increase their exemptions??? What good do you think that will do on a $10 hr paycheck? Tax refund? Like the $1,000 college tax credit that was supposed to enable everybody to go to two years of college? Premiums based on percentage of income? What percentage? 6%? 12? We don't know.

Education costs $6-10,000 per student per year. Look what teachers make. Before we can get costs down, we're going to have to get expenses down. When we stop having multi-millionaire doctors, medical sales teams, CEO's, Administrators, etc., we can start reducing costs. Low income people are not going to get on board with having huge chunks of their income taken until some of these other changes happen. Let the wealthy make the sacrifices first for a change.

[no name no slogan]

15. No, but the "insurance" system is grossly inefficient and wasteful

Health care itself is relatively affordable, but the overhead associated with our current insurance system makes sure that it remains unaffordable.

Until you get rid of the insurance industry middleman, you will NEVER control costs.

[Ravy]

34. I would look for some not-for-profit entries into the insurance industry if

it was mandated for everyone.

[KittyWampus]

Well, if my wages are going to be garnished, let it be for Single Payer

[avrdream]

16. I was saying the same thing in another thread.

People are delirious if they think it is going to be free.

The Australian system is fantastic (I am an American doctor working here) but they pay higher taxes here. That is what income tax in the states should be used for. Garnishing wages = tax. It is how our country has run for a long time. Hillary is working out the expenses so that you shouldn't have to have an increase in your tax but I am sure this is what she is referring to.

The people crying about this have obviously never needed much for the health care system.

[Solon]

21. No shit, but it matters WHERE that money goes, if it doesn't go into a single payer system...

then its not too far from theft.

[Bluerthanblue]

22. your post reminds me

of something my father would write-

He was an awesome man. A very generous, respected, learned, responsible man. He was a WWII vet who never took his exemptions- got his education (PH.d.)on the GI bill, while working and beginning a family- and spent his life trying to make the world a little bit better for everyone.

He often defended programs that he didn't use, but which benefited society saying that paying for them was part of the dues we pay for living in a civilized society- And shared MLKjr's view that we should measure our success as a nation by the quality of lives of our least well off citizens.

Thank you for being a voice of reason and compassion. and for the memories you triggered.
:hi:
peace~

[Blue State Blues]

25. "Freedom isn't free"

It's a shame that there isn't a pithy, catchy slogan like that for universal, single-payer health care -- the above statement generally being used to justify unbridled militarism and the tremendous investment of tax $$$ and lives in the name of "defense."

Alas, I fear the "they'll garnish your wages" argument will strike fear into the heart of most working Americans who live at or beyond their means as it is. Especially since those statements are being circulated independently of any promise of significantly decreasing the cost of coverage. Garnishing wages to pay for-profit insurance premiums and grossly inflated insurance excecutive salaries is not the same as as progressive tax to pay for "commons" ownership of a non-profit program. Whether accurate or not, the threat Amercans will hear in the "garnish wages to pay for health care" stament is the former. The media can be depended on to confuse the issue rather than clarify it.

For the record, since it seems to matter on DU these days, I'm an undecided yellow dog who desperately wants a universal, single payer system.

[Prophet 451]

33. "Don't pick on the sick"?

Call me old-fashioned but I think there's something morally offensive about making a profit off of sick people.

[Raster]

26. No, health care is not free. Like most of life's necessities, there is a price to be paid.

The difference between the health care systems in the UK and most of the civilized world and that of the United States is that in the UK a large majority of the cost goes to running the health care system. The government oversees the heath care system, making sure fair prices are charged for drugs and services and that access is available to all. In this country, the majority of the funds spent on heath care ends up in the pockets of the stockholders of the insurance companies, medical for profit institutions and big pharma, which together effectively control every aspect of the health care system. We in the US spend more per person on health care and receive mediocre health care DIRECTLY CONTINGENT on the amount of money in your bank account. A poor person in the US receives poor heath care. An extremely poor person receives extremely poor health care.

Unfortunately Senators Clinton and Obama, even though they have both put forth their token health care initiatives, still kow-tow to the medicine-for-profit juggernaut. Neither has the courage to suggest that the United States completely revamp the shameful and immoral way health care is dispensed in this country.

[cbayer]

29. Previously posted (but i got NO response)

The system is sick on so many levels.

And since each party blames the other, I can't see how it can be fixed without a complete overhaul (which should have been done years ago).

1) Doctors and hospitals aren't changing their practices and procedures fast enough despite convincing evidence that things need to change drastically (see http://www.ihi.org/IHI/Programs/Campaign /). This feeds #4.

2)Medical insurance companies are mostly for profit entities who are beholden to their stockholders and executives.

3)Medical malpractice insurance companies - ditto to number 2.

4)The legal system is out of control in terms of the kinds and numbers of malpractice suits filed by trial lawyers ("Has your loved one died in a nursing home? If so, call me! I'll get you the money you deserve") and the awards granted by juries. This leads to defensive medicine which feeds #1 and #5.

5)The general public believes that everyone should have everything even if it is futile, has no evidence to back it up or there are less expensive alternatives, which feeds #1 and #4.

6)The government run system is so poorly run that it pretty much feeds all of the others, is going bankrupt and makes it very difficult to embrace a single payer system that would be run like the system is run now.

And since none of these parties are willing to take the risks involved in making substantial changes in the system, it just gets worse and worse.

So, who do you think has the best plan to fix this disaster? This is not a rhetorical question. I really want to know.

[Prophet 451]

32. Your point 4 is rubbish

The spectre of an out-of-control tort system is one drummed up by right-wing "tort reformers" as a way of protecting companies from their own misdoings. Are there abuses of the system? Sure but few of them make it to open court and even fewer are won. The actual cost of frivolous lawsuits is miniscule.

[cbayer]

35. Can you give me any data or links?

[Prophet 451]

36. Sure

- The Congressional Budget Office found that less than 2% of healthcare costs are attributable to malpractice claims (http://www.bmj.com/cgi/content/full/330/7484/164-b)

- The US Institute of Medicine found in 1999 that only around 2% of the victims of medical errors actually sued (same article)

- National Center for State Courts shows that filings of tort lawsuits were actually declining between 1992 and 2001 (http://www.ncsconline.org/D_Research/csp/2003_Files/2003_SubCivil-TORTCON.pdf)

- The DoJ found in the same time period, that the average award for all tort cases (inflation-adjusted) dropped by 56.3% (http://en.wikipedia.org/wiki/Tort_reform#Dispute_over_.22litigation_explosion.22_claims)

- A study by Price Waterhouse Coopers in 2002 showed that malpractice costs amount to less than 1/14th of the increase in health insurance costs (can't find the link right now).

I think that'll do to demonstrate my point. Although the cost of malpractice insurance is going up, the cost of malpractice itself is actually declining. Where's the money going? To the insurers, of course, either to make up for losses in stock market speculation (yes, insurance companies play the markets too) or adding to their profits through simple greed.

Incidently, you may have heard one of those rumours giving ridiculous lawsuits. Snopes does a good job debunking some of them at these two links:
http://www.snopes.com/legal/lawsuits.asp
http://www.snopes.com/legal/legal.asp

[cbayer]

38. Good data

I am aware that there has been a substantial decline. But the system has had a significant impact on doctors and the way that they practice.

Please take a look at this from the American College of OB-GYN and give me some feedback.
http://www.acog.org/from_home/publications/press_releases/nr11-03-06.cfm

I think if you break down the problem, there is a lot of responsibility to go around. I do not wish to point a finger at any one party. That's my point. But if each party becomes defensive when they are asked to share the responsibility for the entire mess, we will get nowhere.

[Prophet 451]

40. Defensiveness is not always unwarranted

Having looked at this debate in detail (I did my training in law so I can follow the technicalities better than most laymen), the lawyers have a right to be defensive. They've been demonised on the "tort reform" issue on the basis of claims which are largely exagerations or outright lies.

Now, with regard to the article:
I have little doubt that some ob-gyns are forced out due to absurdly expensive malpratice insurance, the costs of which continue to rise. I have no doubt of that at all. However, as the articles previously linked show, the cost of malpractice insurance bears little to no relation to actual malpractice costs. Equally, I'm sure that many ob-gyns have made changes to their practice or even left the field due to fear of malpractice suits. Given the numbers of actual cases and winnings though, one has to question whether their fear is justified or, like the "Satanic Panics" of teh Eighties, the result of a hyperbolic media and professional hysteria.

The claim that 89% of ob-gyns have been sued for malpractice strikes me as high to the point where I have to question it's accuracy (which doesn't necessarily denote a deliberate lie but their methodology may be flawed and looking at those numbers, I would think it has to be). As previously noted, less than 2% of victims of medical error file suit (and that's file, not necessarily win or settle). The quote from Dr. Hale of "I can't underscore enough that the high number of liability claims does not indicate a high rate of medical wrong-doing" is a flat lie, as any lawyer can tell you. A few sociopaths aside, people do not file suit just for the hell of it. In fairness though, his later claim that, in such an emotional area, people hold their doctor responsible for a less than perfect outcome, might well be reasonable. That might well cause the number of suits to be skewed far, far higher than the average (although even so, the number quoted is absurdly high).

It's also worth noting one very important statistic toward the end of the article: "67.4% of claims against ob-gyns are dropped by plaintiffs' attorneys, dismissed, or settled without payment" (my emphasis). Again, that means that the actual cost of such suits is far lower than the number filed would lead one to believe. As I said, frivolous suits are filed, no-one disputes that but few make it to court and even fewer are won.

Certainly, there's plenty of blame to go around here but the facts and the numbers say that very little of it can be directed at trial lawyers. A certain amount can be directed at plaintiffs, a little toward negligent doctors and the vast majority toward an insurance industry which benefits from scare stories about malpractice costs (and obviously, it is then in their interest to keep those stories going). Admittedly, a little can also be directed at a media who tend toward reporting the extremely unusual as the average and relying on fear to keep their ratings/sales up.

[cbayer]

41. You are right, defensiveness is sometimes justified.

I greatly appreciate your thoughtful response and will respectfully agree to disagree.

I have a different perspective based on my personal experience. It's not just the malpractice insurance costs or settlement amounts. It's the demoralizing, career ruining impact of an unfounded suit. It's the impact on how physicians practice. And defensive medicine (one of those cases where defensiveness may well be justified) is not an efficient, effective or moral way to practice medicine.

I agree wholeheartedly that the insurance industry bears the bulk of the responsibility for the financial mess, but just fixing that will not address the overreaching failures of the entire system.

And certainly if we were going to have group of people who were going to look at overhauling the entire system, you would want the trial lawyers at the table.

[Prophet 451]

31. According to the figures I have on hand

I'm pulling much of this from the Guardian but according to the figures I have, the NHS has an annual budget of around £62 billion. Since our population is around 60 million, that works out at around £1000 per person, per year. Assuming an average wage of slightly over £20K and using my schoolboy maths, that works out at around 5% of the average family income.

Of course, our NHS has been under-funded and mis-managed for years. The French (generally accepted as having the best system of national healthcare) pay an average of 7.5% of their annual income with employers contributing another hefty chunk of change.

Contrast that with the current American system. According to the best figures I could find, the average US family of four pays around $90K a year (£45, 791 by today's exchange rate) and that's if they can get insurance in the first place.

Incidently, I had a conversation with a couple of well-read, left-leaning Americans the other day who both agreed that even 5% of their income was (direct quote) "outrageously high". Is it just me or are Americans insanely taxophobic?

[paulk]

37. thank you

[ileus]

39. 1 Trillion a year wouldn't cover everyone in America.

[Jed Dilligan]

42. Garnishing wages is NOT a euphemism for higher taxes.

Garnishing wages is what it is: forcing people to buy a product they may or may not want. This is a regressive policy. A progressive policy would be to tax the rich more, and the middle class less. Not to mention the fact that we could get a significant portion of the needed funds out of the money Defense wastes.

[Cessna Invesco Palin]

50. You can't pay for universal health care without taxing the middle class.

Sorry, it just can't be done. Again, look at any European system. The tax burden on the middle class is much higher than it is here. As I just posted at the end of this thread, in the UK (where I work) my contribution to NI is approximately 10% of my pre-tax pay, and I'm definitely "middle class."

[Jed Dilligan]

54. Taxes are fine with me

Premiums are not.

Why? Because my income is irregular and it's a struggle to service any monthly bill. Tax me on what I earn. Once I have an account with a company, I'm pretty much screwed, based on past experience.

Also, the UK's Ministry of Defence doesn't waste trillions of dollars a year. Until that stops happening here I am very leery of any plea for more taxes.

[f the letter]

43. About the figures on health care..

The united states spends far more on health care per capita than the UK and has inferior health care.. ditto for most other industrialized nations. Health care isn't free, but we're paying more than we should be and getting less, thanks to the insurance industry.

By the way, her health care plan is totally inadequate. Anything short of single-payer universal is useless at this point.. gut the insurance scam that is our health care system, replace it with taxpayer-funded public medicine. There should be no compromise on basic human needs

[eridani]

44. Of course not. But that doesn't matter since we are ALREADY PAYING

--for universal health care--we just aren't getting it.

[Hieronymus]

47. We're paying double what universal care would cost and not getting much.

[Cessna Invesco Palin]

49. As promised, the numbers:

Upon reviewing my paycheck, my contributions to national insurance total approximately 10% of my pre-tax income.

[OneBlueSky]

53. "health care costs money. A LOT of money" . . .

yes, it does . . . but it costs a hell of a lot less than we're spending on the ILLEGAL war in Iraq, and on a "defense" budget larger than that of all other nations combined . . . it's all a matter of priorities, and neither candidate is willing to acknowledge that universal, single payer healthcare is indeed possible if two things happen: 1) we re-allocate a small portion of the money we're currently pissing away on military endeavors to something useful, and 2) we cut out private insurers and HMOs that contribute nothing to effective and efficient healthcare yet take a huge portion of our healthcare dollar as profit . . .