AMERICAN ISSUES PROJECT

Before I comment, let me just say that I'm a Democrat (moderate), and I am fairly convinced that Obama's healthcare plan is going to fall to ***.  I know too many people in too many other countries who have "Universal Healthcare" to be convinced that it will work any better here.

That being said, I wanted to comment on one of the paragraphs above:

<blockquote><i>"So what kind of businesses might fit Company A's profile? How about a small restaurant or a neighborhood grocery store? Many franchised convenience stores could meet that description, as could any number of local insurance companies, construction companies, and contractors."</i></blockquote>

A restaurant or a grocery store is very unlikely to pay their worker bees $10/hr.  The worker bees at a restaurant are typically the waitstaff and kitchen help.  Kitchen help typically makes minimum wage, and waitstaff makes about half that or less (in some cases, about $2.25/hr or so).  Waitstaff is expected to make up the balance in tips, and the business makes up any difference that the tips don't cover.  If a member of the waitstaff consistently is unable to make enough tips to bring their total up to at least minimum wage, they're likely to lose their job anyway.  I've never heard of anyone paying a dishwasher more than minimum wage, and these jobs are usually filled by high school or college kids or immigrants (not always legal).  And these are almost always part-time jobs, which I believe in most states aren't required to provide health insurance at this time.  Also, most of these jobs make little enough that those employees can get reduced-cost health insurance through their state if they're not otherwise covered.

It's typically the same in convenience stores, or even grocery stores.  At least in the Northeast.  Most employees are part-time, paid minimum wage (maybe a little more, if the store is desperate for help).  If it's a chain, the office staff may be paid more.  

Not to mention that most public hospitals will admit a person into the ER, even if they don't have health insurance.  If they can't afford to pay, they will typically have the option to apply for free care through the hospital billing office.

Nearly every state, as far as I know, provides free or reduced-cost healthcare for children if their parents don't have and can't afford health insurance.  It's not a perfect system, but it's not screwing everyone else in the process.  Many of these states also provide the same for the parents, as well as for other adults who, for whatever reason, are either unemployed or aren't making enough money to pay for their own health insurance.  There are health insurance companies out there who specialize in working with state governments to provide health insurance for these individuals and their families.  And in most cases it's very good insurance.  I think that even the people who benefit from state-covered health benefits would suffer under the Universal Healthcare plan, and these are the people that it's meant to help.

"I were running that business, I'd say the easiest way to solve my problem would be to fire one of the worker bees. That would reduce my payroll to escape the fine and it would leave me with more money as well. Sure, my business would be less productive, but it's not terribly difficult to get make up for that one lost employee by having my other six work a little bit harder."

That makes NO sense.  If you could make more money with six employees than you could with seven, you *already* should have fired the seventh employee and therefore the payroll tax would have no impact.  People who cost their company more money than they bring in do not survive.  The only way it would make any sense to lay off the seventh employee is if your profit margins are so small that you can't take the added impact of $10k in taxes per year.  Frankly if that's going to break your business, you probably aren't doing that well anyway.

So your "Real Faces" is a bunch of made up scenarios?  Are you trying to be stupid, or do you think your sheeple won't notice?

As with the war, and everything else on the right, this is just hypotheticals and scare tactics.  Thankfully, you have no power any more.

"lets put some real faces on the casualties of obamacare"- by making them up? That will be just like real faces!

Perhaps someone should explain to the author what 'real' is.

As a small business owner that would fall under the Obama plan, let me speak up as a real real face.  I have lost business because a major client moved their offices to Canada to escape the cost of American health care.  Even as owner of a business I am unable to insure my own family because of cost and pre-existing conditions.  I know numerous small business people who are crippled by the current health care mess, potential entrepenures unable to leave jobs they hate to start their own business because of lack of health care options.  The Obama plan addresses that.  I would gladly pay a bit more in taxes if my employees could then access a government run public plan.  In a heartbeat.  It kills me that our current system does not allow me insure my employees or my own family.  Unless you are a huge corporation with thousands of people in your risk pool, current insurance options are, frankly, worthless.

Real enough for you?

You are missing the point. Let's assume that one of the worker bees gets fired.  He gets to collect unemployment, free medical care, and a whole host of other subsidies the other poor saps can only dream about.  While they are working extra hours, he gets to kick back and drink margaritas.  Isn't that something to hope for? If those others want to work and go to their tea parties, and protest the injustice we get to relax and chill.  And we'll never run out of these saps, because by the time they are worn out, their children can start working.  That is the beauty of socialism, and it seems like conservative minds simply can't grasp this.  So let them work, while we play.

We can use real scenarios. Like why is Canada's Health system broke if it is so great. Socialization sounds great on paper because everyone is equal and happy, but we live in a less than perfect world so when applying it in a real situation it fails. People that support Universal Healthcare will only find reality when we are under a failing system. Equality is a pipe dream because humans are not perfect.

Head count. Reducing head count is the quick and dirty way for companies to cut costs because employee salaries make up the biggest percentage of overhead in most businesses. So, when other costs go way up, when the economy is...

That is why socialism doesn't work. Because everyone will do less and because of that you get less. I will provide for my family, hand outs are for incompetent people. While you play conservatives will get tired of carrying you and all the slackers of the country and they will quit and you can play no longer because where is your money going to come from. So much for your dreams of sorriness.

Thad makes an excellent point. If he has pre-existing conditions that make health insurance too expensive, why should he have to pay that cost by himself. It is time to spread the wealth!

Jimmie,

I hate to bring up the obvious issue here but what is your carbon footprint? I mean come on: you must be consuming at a rate equal to a whole village in sub-saharan Africa.  How can you even consider talking about cost of health care, when you produce so much polluting CO2?  When we'll get the all our bills through, you will learn the real face of tolerance!

It's not clear why those businesses who don't currently offer health insurance should dictate policy.  

The hypothetical business owners take advantage of their lower cost structure to compete against others who have made the financial commitment to offer their employees at least minimal health benefits.  We should reward those businesses that pawn off the health care costs of their labor force onto society in general, or onto the businesses who pay higher premiums that must cover both the insured and the uninsured?  

You conservative types simply do not get it.  We hate your guts.

Here's my "real" scenario.

Businesses that already provide benefits for their employees and value such a thing as being American and Christian in moral value will keep on doing the same, and people who run outfits whose business plans are predicated on treating employees as lousy as legally possible will have to go kick rocks. Businesses that are good to employees will then pick up the slack in the economy and the Scrooges can "go Galt" en masse, then write to us from Somalia and keep us updated on how awesome their tax-free existence is.

This is what the republican party and conservatism has been reduced to. If a problem can't be solved with tax cuts or an illegal war you pretend it doesn't exist. Is it any wonder republicans are less popular than the clap?

Yea flounder, lets deport them all.  They like protests....let them protest in Iran.

Jehosophat sounds very intelligent. Usually when someone can't come up with a good argument they resort to anger and insults. Keep it up, it makes everyone else feel better about the their views.

What happens if all my workers are independent contractors?  i.e. not "employees".

Start packing Allen.  I hope you like Somalia.

The point was to put some real-world scenarios to the hypotheticals currently being debated in Congress. There are people who don't fully grasp the numbers when they're debated, because they don't think that they'll be affected. The idea here is that there are real-world consequences for piling costs on to a small business. The costs don't function in a vacuum. If you raise the costs on a business, they'll make choices- close, reduce headcount, or relocate. New York State operated on this premise for years, and business after business relocated to the South and the Southwest, while population mass-migrated elsewhere. ObamaCare sounds all warm and fuzzy, but when you start applying the costs and looking at outcomes, what you'll be left with is a system that offers less choice and inferior care while paying more for it.

Another good thing about Obama's care proposal is that it allows NP's and PA's to function as MD's.  When these doctors are forced to compete with nurses, physician assistants and natural medicine practitioners for patients, they will have to accept lower fees. They can sing all they want about their cost of education, loans,....But if I can get my antibiotic prescription from a nurse for 1/2 as much, I will go to that nurse.  Besides, these doctors don't know anything anyway.

Somalia, I've been to worse places and shot at. You are just clueless to how good you have it hear. A day over there and you'd be crying to come back to a Democracy.  

My Father owns a general contracting business in NY, where the taxes are already through the roof.  As his office manager I see exactly how much money it takes to keep a company with just eight employees afloat.  While some on this message board seem to think that you are not doing well as a business if you would rather fire an employee than face fines for not providing health insurance, I would have to say that these individuals have never run their own company.  

Small businesses don't make huge profits and there are personal relationships that don't exist in larger companies.  We are more like a family.  Sure, we could fire an employee now, make everyone work a little harder and save the difference, but these people aren't just a social security number on our payroll.  Our employees have been with us for years, we know their families, we have summer BBQ's together.  When the construction boom came to a halt last year we bent over backwards to keep everyone working by lowering profit margins and taking every odd job we could get our hands on.  

Regardless, if it comes down to paying a massive fine or letting one of our people go then we'll just have to reduce the number of employees on our payroll.  In our business we can always hire sub-contractors to fill a void.  We don't want to do it, but we may have no choice.  The economy already forced us to tighten our belts and there really isn't any wiggle room left.

Many realities of modern economies cost "everyday, average people their jobs." Such as trade policies that have gutted the nation's manufacturing base and the good paying manufacturing jobs with them, a strong dollar policy that lowers the cost of Chinese imports versus domestic production, and failing to enforce restrictions against employers who routinely hire illegal immigrants.  Those economic policies, of course, increase profits to owners, if not of small businesses, then their big brother behemoths that dictate policy at the national level.

Part of the reason employers must employ a low wage, no benefit labor force is their competitors have increasingly become overseas entities that pay subsistence wages, face few environmental rules, etc,  U.S. employers and workers are competing against a lowest common denominator labor standard.  Fix that and employers can afford to offer healthcare, or the wages sufficient for even part timers to buy their own.  

PA's can't function as MD's. They have to be overseen by an MD. Nurses can't write Rx's. Do some homework before saying such ridiculous things.

Go cry me  a river Colleen.   Just pay the fine, or start packing.

This was an interesting article. As a small business guy who owns a single medical office, Company A could be me. We have six employees, and we're on the bubble. I already know who's going to be laid off; it's not something I look forward to, but there has to be enough money left to pay all the bills, and that someone is me.

Jehosophat - I've simply stated some facts of life for small business owners.  At the end of the day we'll survive as a company.  It's just ashame that others have to lose their jobs.  Your compassion is astounding.  

Glad to see that Jeosophat is willing to see workers laid off just to achieve some health care pipe dream. Those of us in the real world have to take such costs into consideration. Actions have consequences. In the Bible, Jehosophat was lauded for creating prosperity. On this blog, Jehosophat is ruining prosperity.

That's what those doctors say: "Nurses need to be overseen." But, we know these doctors are don't know nothing.  Uder the new health care bill, NP's and affiliated health care technologists can run primary care clinics and prescribe whatever they want.  Look if a school nurse can take care of your kids, why do you think she can't take care of your parents?    I say, lets put one of these nurses in costco, and let her prescribe what we want.  The beauty of this plan, if this goes to Costco, will also be free samples.  Now they give out free pieces of cheese and dips, but under Obama's  care you can get free samples of birth control pills.  This way you can try and see if it works for you.

In the future, nurse Rachet will be able to do everything you do. She will deliver your babies and perform abortions all at the same time.

NP's can already run clinics, and many do. Nurses can't prescribe because they lack the requisite education. School nurses do not fully treat patients, and can't even dispense over the counter meds. It would be like having the school aide replace the teacher in a classroom. The same goes for PA's- they can prescribe, but their work needs to be overseen by a physician. And, doctors "are don't know nothing"? I see your English is as bad as your logic.

You're going to make a big deal about a typo?  That's the extent of your logic??? NP's will be given greater authority and they certainly will be prescribing your meds, and doing your kids' aborions in the future.  

Check out pages 461-464.  

edlabor.house.gov/.../AAHCA-BillText-071409.pdf

Nurse practitioners and physcian assistants will have the authority to be in charge of primary health care. The term health care provider can mean either of above, and doesn't mean doctor.  So get ready for clinics run by nurses, staffed only by nurses, and who needs doctors anyway!

<i>Let's assume that one of the worker bees gets fired.  He gets to collect unemployment, free medical care, and a whole host of other subsidies the other poor saps can only dream about.  While they are working extra hours, he gets to kick back and drink margaritas.</i>

Jehosophat: Your problem isn't that you lack faith in systems, but that you have a curdled view of humanity.

p463

"The term 'primary care' means health care that is provided by a physician or nurse practitioner who practices in the field of family medicine, general internal medicine, geriatric medicine, or pediatric medicine."

p480

"(3) Primary care practitioner defined--In this subsection the term primary care practitioner A) Means a physician or other health care practitioner (including a nurse practitioner) who specializes in family medicine, general internal medicine, geriatrics, or obstetrics and gynecology."

That is already the definition of a primary care provider. And NP's already do prescribe meds. Nothing is changing. The law doesn't make PA's stand-alone practicioners. They will still need supervision from a doctor. And you can't have a clinic staffed solely by nurses. They lack the education and training.People complain now about having to see a mid-level practicioner. Do you think that they're going to be happy to be forced to one? What is so hard to understand? You're struggling to understand basic concepts here. Perhaps that is wh you fell for Obama's rhetoric. And, it wasn't the typo- it was the choppy structure, possibly endemic of a larger problem.

It's absolutely appauling that I am reading so many people admit that they are more than willing to accept handouts from other people instead of working to achieve the things that you want.  It's unconscionable that there are people that have a voice who believe they should be able to rely on the hard work of other to get by in their lives.  You should be ashamed of yourselves.  It makes me sick to my stomach to think of where we are headed.  I could vomit....

In response to those people who think real universal health care is 'too expensive'... the opposite is true.  Failing to cover everyone is costing us billions.  Poor and middle class uninsured people must often let easily treated conditions go untreated until they inevitably end up in an emergency room where hospitals legally must render treatment.  At that point, something that might have been handled with inexpensive preventative instead requires surgery costing tens or even hundreds of thousands of dollars.  That cost is passed on to the rest of us in higher costs.  That is one major reason that countries with universal coverage pay far less per person yet yield better results than the US (life spans, infant mortality, cancer survival rates ... look up the stats).

Add to that the lost productivity from unnecessary sick days and the lost job creation when entrepreneurs close or never start a business because they lack health care options.

But more than that even, is the moral argument.  Is health care a privilege or a right?  We accept that police should protect all citizens regardless of how rich or poor, no matter how much they pay in taxes... why is health care different?

If you knew that paying a few percent more in taxes (and only on the income over and above the first quarter million) could stop a terrorist attack 10 times larger then 9/11, every year, year after year... wouldn't you as a patriotic American do it to protect your fellow Americans?  That is the scale of suffering and death of our current health care crisis.  It can be so easy to hide behind comforting shield of statistics and abstract numbers... but you are one lost job, one denied claim, or one rescinded policy away from you or a loved one becoming part of that abstraction.  The moment your future projected health care costs exceed the revenue from your premiums, you will be dropped.

I used to think like many of the people on this blog, until it happened to my family.

To: Hardworking_Veteran

How is it 'accepting handouts' to receive services for the taxes we pay?  Are you receiving a handout if the police or fire department respond to a call at your house?  Should only the houses of the richest people who can afford to pay a private security firm be protected?  Should the military in which you proudly served only protect the wealthiest parts of the country, or does it defend all citizens regardless of how much tax they pay?  Why is health care, something people literally need to pursue life, liberty, and happiness, treated differently than these other basic protections?

Please, honestly, I'm trying to understand how some people see this issue so differently.

Thad, the savings from preventive care is often overblown, - the CBO stated that earlier this year. If we were to emphasize preventive care, you'd see the cost of diagnostic testing and such rise, as we'd be performing more tests to prevent potential disease. And, it is actually less expensive to treat the uninsured at ER facilities than it is to institute some form of socialized medicine. As to your point about other contries health statistics- cancer survival is better here than elsewhere. Life expectancy rates are a bit skewed, as it doesn't account for factors such as inner-city violence, morbidity and mortality in homogenous vs. heterogenous populations, or even miles driven (americans drive more often, thus raising the number of highway fatalities). Other countries pay less because they ration care, not because they have figured out how to deliver better care at a lower price. For example, places like Canada and Great Britain rarely perform cardiac procedures on those over 65. Wait times to see specialists or have tests performed can take weeks or even months. Roughly 40% of British cancer patients die before seeing on oncologist. This isn't superior care. It's inferior care, and it is costlier than what we're currently doing.

Simply put, having medical care is a basic right. What is so hard to understand about this?  Aren't Americans entitled to have a roof over their heads, being able to feed their families, and be treated when they become ill?  And if these doctors don't want to do it, the nurses will  take care of our needs. I say deport all the doctors to Somalia and that will really bring down our cost of healthcare!

Let me put another real face on display.  When I purchased my small business, there was a staff of three and no health insurance.  We were losing money ($40,000 the first year, which came out of my family's savings.)  Eight years later, we have a staff of 5, health insurance, and are making a profit.  I have not drawn a salary yet since I am still trying to grow the business and have other income, but I still have to pay income taxes on the company profits that I use for new equipment, computers, etc.  My business could survive these new regulations this year,  but would have probably gone under had it been the rule when I started.  

My physician husband is an ER doc and when our combined income hits that $350,000 limit, one of us is going to cut back; either he on his hours, or me in growing my business.  Obamacare is a perfect way to make sure we don't have a robust recovery AND get a physician shortage instead.

A free-market solution would be to allow small businesses to join a pool for premiums and let us choose the covered benefits.  I have to pay for maternity coverage for my employee who has had a hysterectomy, since she is still of childbearing age.  How stupid is that?  And we want the people who run such profitable and efficient enterprises as the Post Office, Amtrak, Fannie & Freddie to do better than Blue Cross?

Shame on you spudmom for discriminating against employees who are of childbearing age.  Would you deny me maternity leave too, just because I don't have a uterus? It is my right to bear children, if I want to.

I agree that emergency room care is not where all the cost containment is to be found (though I think the inherently cautious CBO understates the issue). The larger issue is skewed incentives in our fee for service system.  We need to find a way to reward results and not just delivery of services. Easier said than done, though we have some useful models to look at in places like the Mayo Clinic. The question is how to encourage that behavior without being over intrusive.

As for your characterization of the British system, I'm curious where you get your information.  While the US scores a bit better in a few narrow areas, the Brits outrank us in almost every measure, including overall

cancer survivability.  This is backed up with my own experience... I have  a lot of relatives living in England.  They have to wait a few weeks longer for some non-critical elective surgery, but in everything else they

have it way better.  They get same day service for appointments I've waited days or weeks for.  I've had two relatives with cancer that had all of their treatment completely covered, no hassles at all.  Long term therapy, covered, never a questions or argument with a bureaucrat.  My father-in-law has lived in both America and England for many years and he laughs when he hears reports of the 'horrors of socialized medicine'.  It is not perfect, but people in England really like their National Health Service.  In fact, the quickest way to kill your political career in England is to threaten to privatize the NHS and turn it into something more like the US system.

To: spudmom

A marginal tax is only on the ADDITIONAL income ABOVE the margin, so if you plan on cutting back your income to avoid the higher bracket, you are throwing your money away.

And if you are paying income tax on money you are spending on equipment, you need to fire your accountant and get a new one.  Those are deductible expenses.

Hey Jehosophat,

You seem very well versed on your RIGHTS.

Any thoughts on your obligations for the well being of our nation?

How many JOBS have you created in your life so that those employees can make a living and also have the  RIGHT to health care?

From your passion here on this thread, I can tell that you are the DEPENDENT on others for your job!

Right now, I am self employed, with no employee in my service business. I carry my own EXPENSIVE private insurance. In my business, I can use part time hired  help.

If the employee is going to cost me more than the decent wages I am willing to pay, heck, I can use some relaxation in front of TV.

You might want to think twice before you go out to eat and 80% of the restaurants in the US.  McDonalds has reoccurring episodes of Hepatics case’s spreading to their customers and general public stemming from an uninsured employee.  My I suggest that you not go to a Convenience Store where employees are more and more serving the food consumer eat.  

Then again a recent report showed 70% of Hairdressers and Barbers are without healthcare?  Wow how many people allow other to touch them with out health care?  Buying a car I guess one must not shake anyone’s hand.  

The world will not end if health care is passed.  We all just might benefit from an equal playing field.

spudmom. There are a few aspects that you, and probably the majority of anti-"Obamacare" conveniently overlook: If all employers within the guidelines have to furnish health care that DIDN"T before, that increases the number of covered employees, citizens, whatever you wish to call them. If that is coupled with real choices including a public option, the free market's, supposedly, big draw kicks in. Competition. That would drive down, not up, the costs of coverage through whatever plan/company/choice you as an employer want since both supply and demand increase. It wouldn't be your business that would have to live on small profit margins. It would be the insurers who's profit margins would shrink. You have a problem with that? Why do you think they are throwing so much money at ads and congress right now?

The alternative is that fewer and fewer people would have rock solid coverage - like pols and board room denizens - and the rest of us can go eat cake.

BTW, I'm in the VA health care system, you know, that govmint socialist commie pinkpo system designed to help the veterans that I distinctly remember the GOPpers loved more than anybody else in the  whole wide world loves us, not too long ago. Funny how times change. I can tell you that compared to a lot of private programs the VA works just fine. And I know of few vets that complain about it.  It's even got a computerized medical records system that the private sector wishes they could emulate, but competition being what it is each private hmo has got to have a  different system because, well, just because. This kind of administrative inefficiency drives up the costs of HC.

Having also run a small business I don't quite understand how you would be paying the IRS on profits that you use for buying capital improvements, like computers and new equipment.  Capital expense and depreciation, you're doin it wrong.

So, instead of giving us actual examples -- real faces on the casualties of Obamacare -- you just make some up. Uh-huh, you really nailed it buckaroo.  

Hey guys, look over here, I'm going to give you some really real live examples using no real people at all. Aint it brilliant!?

The biggest problem with the current health care legislation is that it tries to do far too much and deviates extensively from what the original goal was supposed to be. Just knowing that it is now a 1,000 + page bill that is likely only to get bigger should be all anyone needs to know. The second biggest problem is trying to do it too quickly.

The original intent was to provide health care coverage to those who now have no formal coverage (as opposed to the many "informal" public hospitals and clinics where they can still receive treatment). It is already known that millions of these folks are already eligible for medicaid while millions more are illegal aliens who we are unlikely to want to cover and who won't likely seek coverage themselves in any case.

This should have led to two initiatives: One should have been to provide minimum primary care to those who currently have no insurance and can't afford it on their own. At the same time, an attempt should have been made to determine how many among the uninsured can afford to pay for all or part of their own coverage. Secondly, there should have been an education campaign undertaken to encourage those currently eligible for existing plans to enroll.

Once these things were done, and assuming some success in expanding the numbers of those who ARE insured, we could have then considered our next steps. There are many innovative ways to address the problem and some have been introduced already.

In Oregon, for example, a Dr. Bliss provides 7 day a week, 12 hour a day primary care for $50 a month for individuals and $100 a month for families. His clinics take no insurance and they encourage patients to buy relatively inexpensive catastrophic health care insurance to cover a possible major illness. He notes that 80% of what most of us need most of our lives is primary care that can be provided at a reasonable cost, while special supplemental plans covering major illnesses and prescription drugs can be purchased for an incremental price keeping overall health care within the range of most Americans. Dr. Bliss has testified in Congress and met many legislators face-to-face but it seems there is little interest, certainly among Democrats, for anything other than a massive piece of legislation that is directed not only at those without coverage but with redesigning the entire health care system.

There is too much emotion and usual politics coming from both sides to address such a vital issue that affects each and every citizen in the nation in a literal and extremely personal way. We need to slow down before trying to fix a problem that has been growing for decades. We need to recognize in the most fundamental way that we really, truly and absolutely can not afford the Medicare program as it is currently designed on any type of long-term basis, and from that comprehend that adding a an entirely new entitlement will not solve our problems.

Why are these basic things so difficult to grasp? We need to work on what are, or should be, clearly bipartisan issues in a bipartisan way, understanding that they can be addressed little by little rather than in a way that simply paralyzes and divides us.

To: Jehosophat

OK, its obvious you are joking when you draw comparisons of health care to food and shelter, but lets look that comparison seriously for a moment.  Food and shelter are recurring expenses with rather fixed, predictable amounts.

The need for health care, like police and fire protection, is much more randomly distributed among the population.  That is why we spread the cost of those services out using insurance or by making them a government service.  The argument some people are making is that the cost of health care is more

efficiently and fairly handled through taxes and a unified risk pool (like police and fire protection) than

through the private insurance method.  The catastrophe that is our private insurance based health care system only reinforces that argument.

Thad, when looking at 5-year cancer survival rates (the usual measure), the US surpasses Great Britain in virtually all areas. Survival rates here are higher due to the fact that patients are able to receive care sooner and have access to more modern therapies. Being in a border town, I watch Canadians come by the busloads for all types of medical procedures that they can't get  in Canada due to long wait times. Jehosophat, you're becoming a joke. If you insist on saying something, try and string together an intelligent thought. Ship all the doctors to Somalia? And, if you're going to criticize someone, make sure your facts are straight. A patient who has had a hysterectomy has had they're uterus removed, meaning that they are unable to bear children. She's right- why shoud she have to pay for maternal coverage for someone unable to have kids? Milt, the public option won't drive costs down. It will crowd out private insurance while rationing care. Don't even get me started on the VA- it's shamefully sub-standard. After watching what they've done to my grandfather, no one should have to suffer in that system. There is nothing about the VA that the privte sector wishes to emulate.

Rick:

I doublechecked, and I believe you are correct on the cancer issue.  America tops most European countries largely because we have focused heavily on early diagnosis of breast and prostate cancer.  It should be noted these studies are from the 90's and England in particular has improved since then, but I expect they still have ground to make up in that area.

On the other hand, None of my Brit relatives have ever been denied any necessary care when they were diagnosed with cancer, and in most other respects their care sounds superior.  Now compare that to my family.  Our insurance was dropped when my wife became seriously ill.  We are now effectively un-insurable and being driven toward bankruptcy.  After we lose our house, our business, put all our employees out of work, and end up on medicaid, we will hopefully get the care she needs... if she doesn't die first.

So yeah, we have great medical care in America... if you can afford it.

Please understand, I am not suggesting we should create a National Health Service just like England.  But we do need to change the way we pay for our privately delivered service.  Right now, most people have junk insurance (and don't realize it) or no insurance.  It is crippling our productivity and destroying families.  It has to change.  What would you suggest as the way to do that?

Thad, the US healthcare system does need reform. However, heavily taxing people to pay for what will turn out to be rationed care isn't the way to go. Perhaps allowig people to buy insurance across state lines, allowing small businesses to band together to purchase plans, etc. will allow more people to obtain coverage. I'm not comfortable with a system that makes as much use of actuarial tables as it does medical info.

Rick:

What you suggest would do nothing for my family.  The insurance companies would still deny claims and refuse coverage because of our pre-existing conditions.  That is our personal experience with insurance companies.  My wife, upon hearing about a suggested plan to require an insurance mandate forcing people to buy private insurance, nearly wept.  She compared it to forcing a rape victim to marry their rapist.  Strong language, but that is how betrayed she feels by the insurance industry.  They took her premiums for years and then cast her aside as soon as her care became too expensive.

That is why we demand a non-profit, public health care option to compete along side private insurance.  I'm not even asking for a subsidy, you can make it revenue neutral and funded by 'premiums' deducted right from my paycheck along with my taxes. Just give me an option other than a private insurance company that sees my wife as only a financial liability and not as a person needing medical care.  You can still buy private insurance if you want, just give the rest of us another option.

What is so wrong with that?  If a public health plan would be so horrible, then insurance companies should have no problem competing with it, right?  Or is it more likely that they are spending nearly half a billion dollars a year lobbying congress because they know competing with a real public plan would force them to make real market reforms and start delivering on their promises (and cost them billions in profits).

As for increased taxes... that is only necessary to subsidize the premium cost of expanding coverage to everyone, a separate issue from whether or not we offer a public option.  I personally think raising the taxes by a few points on the wealthiest Americans is a fair trade for extending coverage to virtually all Americans, and I will feel that way even when I am the one paying that tax.

Rationed Care.  People love to bring up that scare word, as if we don't have rationed care now.  Insurance companies make money when they raise premiums.  They lose money when they provide care.  Consequently, they find every excuse possible to deny claims or even drop coverage.  My parents have had far less hassles with Medicare than I had with our private insurance, and they have needed treatment for cancer, high blood pressure, blood clots, and a shoulder replacement... and those are just the problems I know about.  I wish our insurance had treated us half as well (and don't get me started again about British NHS).  Given a choice between the two, I think I'll take the government rationing over the insurance company rationing.  At least then I know the decision will be made using consistent rules and not by an insurance bureaucrat who gets a bonus based on how much they squeeze the 'medical loss ratio'.

If you're concern is lack of care due to a pre-existing condition, how does a public option solve that? If we have a system modeled after Canada and Britain's, then physicians will be required to assess the cost-benefit ratio for providing such care. If the cost is perceived to exceed the benefit (i.e. additional years of life), then care will be denied. What you want is for the private market to be destroyed in an attempt to solve your issue. A public option won't have the same constrictions as the private market- a public option can undercut private insurers due to government subsidies. A public plan won't have to worry about paying state taxes or adhering to state mandates, as private plans have to do. And , why should businesses and individuals be expected to subsidize insurance for others? If a business has to pay to do so, they will cut costs elsewhere, most likely by letting employees go. As for the rationed care perspective, a government plan focused on cost reduction isn't about to allow patients access to necessary tests, specialists, etc. If you think the British NICE does such a good job, you are free to avail yourself of that system. However, a board that won't allow treatment for macular degeneration until sight is lost in one eye (among other denials) isn't one I'm willing to import. If you think that private insurers can be difficult, wait until the government is the sole source of isurance. No avenue for appeals, no way of having decisions reviewed. And, if they're covering your health care, what does that give them the pretext to mandate? I don't think you've thought this through fully.

I'm confused on scenario 1. Why wouldn't the owner just cut their salary by $12k and instead take that $12k as a distribution?

For scenario 2; any company that has 11 employees employed at $35+/hr should be providing healthcare benefits. The fine makes complete sense in that scenario, and the fine is a relative drop in the bucket compare to revenue for any of the hypothetical companies.

Rick:

Your information regarding Canadian and British health systems is completely wrong.  They do not deny people for pre-existing conditions.  Ever.  It is not a concept that makes sense really, as citizens are covered cradle to grave.  There can be problems with a shortage of specialists and a longer wait for some procedures, but I know for a fact that in England, if a doctor decides the procedure is medically necessary, it is done.  Period.  Heck, if my wife was old enough to be in Medicare she would immediately be treated, yet our wonderful private system has abandon her.

We are actually trying to get my wife a British passport (which might be possible because her father is British) because we have been told her current condition would be fully covered the moment she steps on the Island and gets her NHS card.  Unfortunately it is not certain we can go this route, but we are trying everything we can.

You keep trying to convince me that government funded care would somehow be so horrible compared to private insurance, yet all my experience says the opposite.  You say a public option would destroy private insurance, but how would that even be possible if it was so horrible and always denied care?  Yes, I've thought this through.  Free market forces do not work for funding health care.  Delivery of services?  Sure.  But on the funding side, the entire incentive is to withholding service.  You are the one letting your ideology cloud your thinking.  We have decades of experience watching private insurance drive our health care system off a cliff, numerous other countries to look at, and data from our own Medicare system, not to mention the personal experiences of millions of families like mine.  Private insurance may have a legitimate roll to play in the area of supplemental policies, but it has failed in all other respects accept returning profits to shareholders.

I am done with this thread.  I know I won't convince you.  You wont change your mind until it happens to your family.  I pray that never happens.

Thad,  Canada and Britain may not deny her "access", but they may deny care based on cost-benefit. Look a the situation with Natasha Richardson. There was a facility that had a CT machine closer to the ski resort, but a cost-benefit scenario disallowed going to that facility and forced the longer drive. Recently, there was a story about an Ontario infant who was brought to the US for NICU treatment due to a shortage of beds at Ontario NICUs. I don' think any American could imagine an entire state having so few beds at NICU facilities that someone would have to leave the country for care. Again, the reason a public option would ruin the private market is not solely based on quality. It is based on cost. Some employers would off-load employees into the public option to save money. A public option could undercut private insurers, as they (A) would not be required to make a profit (and likely costing the taxpayer more), (B) would not have to pay state or other taxes and would also not be bound by any state mandates, which can drive up costs for private insurers, (C) would not have to negotiate rates with hospitals, doctors, etc.. However, this will lead to closure of hospitals and fewer physicians practicing. Finally, as a cost containment measure, care will be rationed. Not that it will matter, because there will be fewer hospitals and doctors available for treatment. If your complaint is that the private market has failed in delivering service, how will a public option- one where its advocates have already made cost containment its goal- succeed where its private counterpart failed?

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On the subject of rights:

http://www.pjtv.com/v/2176

Thad, read the animal farm, It may be your last hope.

Barack Obama fooled the American people to become our President. Now the American people are slowly coming around to see the real Barack Obama. However, I believe it is too late for our country to turn around.

There are so many things that could be said but space and time limit the expression.  This is why it's crucial for people to search things out for themselves and be honest, not partisan.

It's been stated that the children of those who work to support these programs can replace those who leave the work force... Not even close, as we see with Social Security.  There are no longer enough 'workers' in the work place nor enough future workers being born.  This is just a fact, not a pro or con statement.  If one is serious about a work force to support certain things it may well necessitate the change in ones pro or con though.

Thad (upstream) has confused medical conditions that are covered (British system even now cutting 'coverage of condition due the unsustainable aspects of national coverage, as is the case wherever it's been implemented, bar none) with 'immediate care'  when there is no such thing as immediate care in these systems. He seems to be willing to push his wife from what he deems to be the frying pan into the fire. Further, if one is able to get a bed in one of their hospitals, the chance for infection of virus and other such problems is a huge issue in those systems. Do your own research. Being unbiased may mean life or death.

Our medical systems are already greatly socialized. To look at the areas already socialized (medicaid, medicare, veterans...) we can see that it is not more cost effective with better care, nor does it reduce waiting, regardless of what is covered. To reduce cost, get better care, have less waiting, we need less Government take over.

While considering cost, it isn't a valid comparison to compare our cost to 'theirs' because we must factor in that you get what you pay for: Research, technology, equipment, facility conditions, number of doctors and scientists ... These things greatly influence the outcome of patient recovery also. As we can see, choosing to not pay for something doesn't mean we can assume that one has chosen to not want what they're not willing to pay for.  We can see this in various ways,  do the research and read upstream. Further, saying that those who 'can't' afford insurance are part of this problem is a confusion/misleading as we already have programs for this, and even without participating in a program they can't be turned away from emergency treatment, but one could have an inteligent conversation for ways of improving this situation also. A sign of intelligence (and sanity) would be to not keep trying the same failed system (national care) expecting different results.

Someone upstream said something about "no taxes" as if more taxes equates to a better life for all. Our tax burdens are already astronomical. Regardless, saying  "no taxes" is a confusion. It would be fine to call 'taxes' by a different name but having "no taxes" isn't suggested by anyone I know or anyone reputable. Therefore, it's a 'straw man' statement as well as tiring and unproductive.  We can do better then this!

It seems to me that the question is whether one is unreasonably attached to their dogma, party line rhetoric, or is desirous of solutions that work.  

We probably all remember who said, "We must all hang together, or assuredly we shall all hang separately."

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