Here are my views and suggestions for fixing the health care crisis our Nation faces. Let me know what you think.
Health Care Reform:
The rising cost of health care makes it impossible for many people to obtain health insurance. Due to the high premiums employers are shifting the cost of health care to employees or eliminating health care coverage altogether. Health insurance also makes it difficult for companies to compete on in the global market. Those with a pre-existing condition often find they cannot get health care coverage at any price.
People who are uninsured or underinsured are less likely to see a doctor when ill and often end up in an emergency room when they become so sick they can no longer function. This adds cost to everyone. This category mostly comprise of hard working Americans with either low paying jobs or high deductibles for the insurance they have.
Myth #1 is that employers pay most health care cost. The fact is that government taxes pay 60% of all health care cost, 20% is paid by co-pays and deductibles and 20% by private employers. Most estimates exclude the government workers when estimating how much government taxes really pay for health care and how much the private sector pays.
Myth #2 is that cost sharing will drive down cost when in fact the opposite it true. People who do not have the money for the co-pay or deductible will still end up in the emergency room where cost is higher. The other problem with this is that when these people do not pay the co-pay or deductible for the emergency room visit it goes against their credit and cause them to have bad credit even if they are responsible in other aspects of their lives, they just can’t afford the added cost of health care which is the reason then ended up in the emergency room where treatment cannot be refused. This in turn causes health care to rise.
http://www.pnhp.org/PDF_files/ReappraisalofPrivateEmployers.pdf
The Reasons why Health Care Cost is Raising So Fast:
There are several reasons why health care cost is rising at double digit rates year after year. The following factors are the reason cost is rising so fast and no one is the sole reason. I left out the greed factor.
1. Administrative cost is 31% of all health care cost
2. The purchase of new technology that is only slightly better then old technology and the cost associated with the new technology.
3. Prescribing new medications that are expensive and show no added benefit that an older and less costly medication would accomplish.
4. Excess supply of medical procedure equipment which cause under utilization. There are tons of places to go to have x-rays, blood work, MRI, etc. It uses to be you went to the hospital for these test.
These 4 items are the main reasons for the fast growing cost of health care.
Too address the issue of Health Care Reform you must address these 4 factors.
Reform the Health Care System;
1. Start with dividing the country into 4 sections and then set up 4 independent centers to handle all claims within a certain part of the country. That center would bill the individual insurance companies and the government thus reducing administrative cost for these two settings. They would have a list of approved procedures and drugs that need no additional approval and doctors and hospitals would have this list. This would reduce the administrative cost for these two settings.
2. There would be one independent center to handle the approval of any procedure or drug not on the list. Within this center would be a research team that would test the benefits of unapproved drugs and procedures. If a new piece of equipment proves to have no substantial added benefit compared to one that is already on the approval list then it would be denied. The same would hold true for new and expensive drugs.
These two things would address all 4 of the above factors. The insurance companies combined would pay the cost of these centers and it would not cost the government anything additional. Insurance companies would not have the ability to deny coverage to anyone for any reason. Medicaid recipients would be transferred from government run insurance to private insurers with the government paying their premiums. Same would hold true for children run government insurances. With the reduction in cost and cost containment the premiums would be reduced and thus more affordable. Employers and private citizens could obtain insurance at affordable rates. All the basics must be included in any plan and insurance companies would not have the right to deny procedures based on bottom line objectives because that task would go to professionals that are not related to any individual insurance company. Expanded government assistance paid for with the money saved would cover the uninsured and since the basics like doctor visits and medication would be required from the insurance companies no one would be underinsured. It would cut down drastically on waste, fraud and abuse.
This would keep health care in the private sector with some oversight from the government.
Transparency in fees would be needed as well. Hospitals, testing sites and doctor offices would be required to list the price of a procedure or visit. This way the patients will know the cost even if they are not paying in directly. Uniformed drug prices are needed but since there will be a list of approved drugs the combined insurance companies can negotiate for the best price and since the government will not be the provider for Medicaid and S-chip recipients they would not need to worry about negotiating.
If this works, then Medicare and veterans could be added later.
betty327 July 7, 2024
Wow! You hit the nail on the head for many of the issues surrounding health care costs.
You missed a few. One you missed is mandatory spending imposed by government. A good example is the HPV vaccine debate. This should not be mandated. It should be encouraged. It should be available. It should not be imposed.
The next is "the choice". Some individuals choose behaviors that are unhealthy. We currently subsidize this bad behavior. It should cost the individual more, not the group, if an individual chooses an unhealthy behavior. Example - people who smoke or use chew - should pay extra. They should assume the risk not the community. Another is noncompliance with treatment. The reason that TB has become a serious threat is that individuals who are diagnosed and provided treatment, do not comply. They raise the threat for everyone along with the costs for their treatment. Again. failure to comply should mean the individual assumes more of the cost.
It is time to begin a discussion about the erroneous belief that health care providers have a divine power to save everyone no matter how sick the person or how profound the injury. I think it is unconscionable that families are bankrupted in the pursuit of a false hope.
We must disincentivise the the prescriptive action. Many physicians own the facilities that provide the tests. This raises the temptation to prescribe to the bottom line. The only way to pay for, and then profit from, a laboratory, xray machine, ct scanner, or MRI machine is to promote it being used. I worked with a doctor who manipulated the system extensively to push his profits, at the expense of his patients. Because he was a major "admitter" at the hospital and held the head of medicine post, no one would question his behaviors.
Finally, I spent 18 years working in ER's urban, suburban and rural. People who come to the ER inappropriately come because there is no alternative evening medical services in FMD or DO. Medicine has largely failed to respond to the new realities of our society where both parents work and probably cannot take off to get to a doctor's appointment during the day. Routine and preventative healthcare needs to be provided until at least 8pm so that it is readily available to more working people. Some weekend services are also needed.
Thanks, I did a lot of research on this subject and have seen health care change for the worse over the years. I know way too many people without health care coverage and more and more being added every year.
I know I missed a few reasons but I was only pointing out the top 4 which account for more then 55% of the cost. The HPV vaccine will only be paid for by the government and insurance companies if it is mandatory and that is the reason it should be so. If it was not mandatory, then those who want it would have to pay for it, that is unfair. There is also a opt-out part of the mandatory legislation for those parents who do not want there child to have it.
I do not agree with you on bad behavior, for one I do not what the government dictating my behavior and second we should be treating people for addictions like smoking and other drugs, not punishing them. It is quite different in a case like TB and other diseases where one can spread it easily and the ones who do not follow directions can, right now, be quarantined. Neither of these things is causing health care to rise at such a rate. Besides, think about this, if the hpv vaccine can prevent cancer and a person who refuses it, is that bad behavior if they later get cancer. I think we need to be real careful in saying what is and is not bad behavior because we will end up with the moral police and subjected to their version of bad behavior which may not be your version or my version. I don't want to go down that road.
There should be night and weedend hours for doctors. Years ago there was. My plan would take care of doctors like you described and there would also need to be tort reform as well.
Betty McLeod
PA 06
Betty327@ptd.net
This is the kind of "Outside The Box" thinking that this country needs to solve the health care crisis. See The other forum topic Universal Health Care. I totally agree that a public-private joint venture in the provision of medical services in this country is the only way.
I would suggest the following:
1. A Universal Insurance Form is needed.
2. “with the government paying their premiums”
The government premium rate would be based on the average premium of the collective privately
insured groups
3. “insurance companies would not have the right to deny procedures based on bottom line objectives”
In the beginning all procedures should be priced on the average negotiated rates physicians are will to accept from the from the insurance companies now, not the actual rates the try to charge. If the physicians are willing to accept the negotiated rates then these rates are adequate compensation for their services.
4. “Hospitals, testing sites and doctor offices would be required to list the price of a procedure or visit.”
When our son was born thirty-seven year ago, we received a print out of all hospital charges. Now they don’t provide this information, therefore you cannot challenge any costs.
unity08_ct02@yahoo.com
Of course the premiums would reflect the collective premiums private insured group. I also agree with your second point. However, the price for this category would come down once the market can no longer be flooded with unnecessary equipment and drugs. Your forth point goes to transparency, only it goes further then your suggestion by having all fees listed at all sites, Dr. offices, testing sites, drug stores, etc.
I am not sure what you mean about Universal Insurance form. If it is that all sites must use the same form no matter where you live or what insurance carrier you use, then I agree completely and is in fact what I had in mind and did not state very clearly.
Betty McLeod
PA 06
Betty327@ptd.net
Betty,
While your post presents a number of interesting possibilities, it really does nothing to fix the system as a whole. Creating a system that addresses the BIG picture, is the challenge. A common problem with everyone's suggestions for a solution is "getting lost in the details". I applaud your efforts, however, and do not mean to detract from your post!
As far as the big picture goes, my solution is thus:
1)All employers are required to provide full coverage for all employess at all times, even temps. If you have a job, you and all your dependents have FREE health care. This keeps all businesses on an even playing field.
2)No deductibles. No co-pays. No pre-existing condition. No waiting period.
3)Children (under 18) are covered regardless of their parents having a job. Health care for ALL children is just plain free and accessable.
4)Cost Control:
4.a) One standard electronic form for all claims.
4.b) Government regulation of fees.
4.c) No lawsuits allowed. No malpractice.
4.d) Age 65 and up - limits on coverage - 50K per year.
4.e) yearly limit on coverage per person ages 18-64 - 200K per year.
4.f) no limits on coverage for children (18 and under).
4.g) Hospitals MAY turn away anyone without coverage.
5)Quality control - Medical community will monitor self, or face government regulation.
6) Private health insurance is still available, with all the benefits that go with it, if you can afford it. Good luck!
In summary... The basic premise is that there are a lot of factors in cost, not the least of which is an overabundance of expensive new drugs. Lawyers add to the cost. A zillion different forms add to the cost. Illegal aliens add to the cost. Welfare recipients add to the cost. And last but not least... Grandma and Grandpa, their medications, are breaking the bank. My solution is to get the costs down to a reasonable level, and then mandate it. There is no reason for us, as a civilized nation, to not have coverage. But NO FREEBIES! If you're not working, you don't get squat.
Richard H. Clark
Independent Presidential Candidate
www.MiddleClass2008.com
Sorry, I do not agree with most of what you say. One, employers still need to compete in a global market and they are doing away with coverage because of cost and you cannot expect a small business to compete with a giant.
I have address co-pays, deductibles and pre-existing conditions in my suggestion, All Plans That An Insurance Provider Offers Must Have The Basics Covered and No Insurer Can Deny Coverage To Anyone For any Reason. If you read my post correctly you will see that expensive drugs and equipment are addressed and so is Medicaid and Children's' coverage. Administrative cost is a big one and is addressed and my post to answer some one else post states that a Universal form is needed. I agree that my suggestion needs more details but I purposely left out details because I am no expert in implementing such reform. I stated 4 factors that is causing health care to rise so fast and they are not what most people think about. Most people believe as you do, that the old and poor is the reason health care is rising when in fact, it is not.
Talk about cold, you suggestion that the elderly be so limited is wrong. I agree that lawyers add a great deal to the cost and tort reform will be needed but I do not agree that a person should never have the right to sue, in some cases it is legit. No non American citizen should be included in any health care reform, but those not working should get squat, no way would I agree with this. The people who claim one can monitor ones self is just wrong, you need independent entities to monitor any organization and your way adds more government then mine. What I suggest will contain and in fact bring down cost and do it in a humane way. We did not get where we are in a couple of years and we cannot fix everything at once, we will need to work on the problems in a realistic way.
The government has not proved it is any more capable then the private sector is at providing quality and affordable health care. A combination with public oversight is a better solution. Sorry, I just think you way is cold and judgmental. In response to addressing the whole, I believe my suggestion does so merely because it is addresses the main causes of the problem, once they are addressed then you take it further, It cannot be done all at once no matter how much we would like it to be.
Betty McLeod
PA 06
Betty327@ptd.net
Betty,
Again, think BIG picture. Employers will all be on an equal playing field, because they are all hit with exactly the same costs. Employers CAN compete with the global market, because I will enforce "FAIR trade". Everything works together. It's all one big orchestra. You cannot conduct one part at a time. We could never compete with China, nor would I ever want my people to. Buck-a-day labor is not what America is about.
I stated that there were a lot of reasons health care is going up. I did not mention all of them. Patented drugs, for instance. Drug companies over-charging in the USA, for instance.
Yes, my statements could be interpreted as a bit "cold". But guess what... Granny cranks up more in medical bills in just one year than you have your entire life. How are you going to fix that? Simple... You put a cap on it. If HER FAMILY wants to cover the rest, then that is up to them. She is the responsibility of HER FAMILY. She has no inherent right to freebies from the government. No one does. And no one can afford the obscenely expensive drugs that the drug companies are now spitting out like cherry seeds. We're talking drugs that cost over $1000 a day!
I do, in fact, want to keep the government out of Health Care as much as possible. But there are some things that the government does, in fact, do very well. One of those things is regulating prices.
And lastly, yes, it can all be done at once. In fact, it MUST be. All it takes is understanding how all the pieces of the puzzle fit together, how they all work and interact. Then, and only then, is it possible to make the big sweeping changes that need to get done. BIG picture. Our government, our entire history, is littered with half-a$$ed partial fixes to things that desperately need to get ripped out and re-done. Our government, another thing it does so well, is to put band-aid upon band-aid upon band-aid to fix a problem. No one in our government has ever understood how all the pieces work together. I do. Read up on my site.
I hope this post doesn't come across too harsh. I don't mean it to. Sometimes it's difficult to convey "just a lively discussion" in writing... :)
Richard H. Clark
Independent Presidential Candidate
www.MiddleClass2008.com
I did read you site and found IMO it to be more radical then thoughtful. The last I looked it was the older Americans who vote the most and they are also someones grandmas and grandpas and are not likely to vote for someone who is willing to cut them off at the knees. It's just plain wrong to penalize someone for getting old, next you will what to cut someone off because they get cancer, or some other costly disease. That way only the healthy will have health care.
Betty McLeod
PA 06
Betty327@ptd.net
Betty,
Thank you for taking the time to visit my site. Perhaps it is just that you are more moderate than I am committed to large changes. We have different views there. Nothing I can do about that.
Yes, indeed, the older population does vote, and are VERY active. Ask me if I care...
My purpose is to do THE RIGHT THING, which is not necessarily always what the voters want.
For example, we already spend A LOT MORE on the elderly than we do our children. I think that is just plain wrong, wrong, and wrong. I want to invest in our future. What is the point of spending hundreds of thousands of dollars towards keeping Grandma kicking for an extra six months? She has already lived a full life. We could use that money to improve our schools, to make sure our kids, our future, are set for a good life. Six months for Grandma, or a lifetime for a dozen children? You know where my money is going...
I have parents too. When their time comes, I already know I cannot help them. I dont have the money. I do not expect the government to give them the money either. I'm not a heartless b@st@rd, I'm just pragmatic about it.
Richard H. Clark
Independent Presidential Candidate
www.MiddleClass2008.com
Where do you get your research from. Give me some web sites on you numbers.
Betty McLeod
PA 06
Betty327@ptd.net
Here is an idea right up your alley, although I can't take credit for it. Why not just have an open season on anyone over 65 years old. Just think of the extra public money you would have access to, with hunting licenses, taxes on ammunition, etc.
We also spend more on the healthcare of PARENTS than we do on children(most children just don't get sick very often). Let's have a season for them too.
As this is my first post on these forums I would first like to say hi to everybody
A few comments about the discussion,
"If you have a job, you and all your dependents have FREE health care. This keeps all businesses on an even playing field." -middleclass2008
I don't like calling it FREE health care, because in the end your still paying for it, weather it through taxes or if its taken from your salary or through insurance, nothing in this world is free.
"Yes, my statements could be interpreted as a bit "cold". But guess what... Granny cranks up more in medical bills in just one year than you have your entire life. How are you going to fix that? Simple... You put a cap on it." -middleclass2008
"Talk about cold, you suggestion that the elderly be so limited is wrong."-betty327
I think you both have a very good points here, and I think that this will become one of the largest moral issues of our generation. Also your idea sounds somewhat similar to one proposed last year
http://www.usatoday.com/news/washington/2006-12-13-wyden_x.htm
Have you heard of this, if so what are your thoughts?
No, I have not heard of it before but it does not go into much detail so I can't say if it is the same. I think any health care reform must start with identifying the causes as it relates to the fast growing cost. I have identified 4 of those reasons above. 31% in administrative cost is a big one. If you could drop that to 6% that is a 25% savings, combine the others and if you only get say 15% savings they that is a big 40% savings in health care. That would go a long way in health care reform. No body mentions the fact that government employees have the best health care available and you know that cost money and we have a lot of government employees. I see no reason they should not have the same coverage as most Americans. Sorry, I can't see cutting off a person because they get old, it's like saying that you are no longer useful so we really don't care what happens to you. That's cold no matter how you look at it. Remember, they are the ones who helped to make this country great.
Middleclass08 is entitled to his opinion but I find him to be thoughtless and radical in his ideas and that is my opinion. To be honest, I don't know anyone personally who would vote for him.
Betty McLeod
PA 06
Betty327@ptd.net
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"Of course the premiums would reflect the collective premiums private insured group." I am sorry but we are dealing with the DC bureaucrats and for us to assume that they would use the “average premium of the collective privately” is naïve. The insurance lobbyist will be in there convincing congress they need to use the highest premiums in order for the plan to succeed.
Yes, that is exactly what I meant all medical related business Hospitals, Doctors, labs etc. will use the same form.
unity08_ct02@yahoo.com
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You are correct about health insurance. The money for my medical insurance was negotiated by our union as part off our wage package. About $14,000, per member, per year was taken from our wage package to pay for medical premiums.
unity08_ct02@yahoo.com
As this is my first post on these forums I would first like to say hi to everybody
A few comments about the discussion,
"If you have a job, you and all your dependents have FREE health care. This keeps all businesses on an even playing field." -middleclass2008
I don't like calling it FREE health care, because in the end your still paying for it, weather it through taxes or if its taken from your salary or through insurance, nothing in this world is free.
"Yes, my statements could be interpreted as a bit "cold". But guess what... Granny cranks up more in medical bills in just one year than you have your entire life. How are you going to fix that? Simple... You put a cap on it." -middleclass2008
"Talk about cold, you suggestion that the elderly be so limited is wrong."-betty327
I think you both have a very good points here, and I think that this will become one of the largest moral issues of our generation. Also your idea sounds somewhat similar to one proposed last year
http://www.usatoday.com/news/washington/2006-12-13-wyden_x.htm
Have you heard of this, if so what are your thoughts?
TOURS- Test Ordering and Utilization Review Systems: Studies show that an average of $10,000 per patient, per hospital stay is due to unnecessary or clinically irrelevant laboratory testing. Every hospital has a Utilization Review Committee (URC), every month a different area of lab testing can be reviewed, and policies and procedures developed to reduce testing that is unnecessary or contributes little or nothing to a patient‘s outcome. Example: Non-Fasting Lipid Profiles (LP). Lab personnel submit instances of suspected non-fasting lipid profiles (which don’t provide any clinically or scientifically useful data) to the lab TOURS representative, who takes this to the URC and performs a targeted review of the patient’s chart. A simple change in policy, such as regarding every order for a LP as being a fasting order unless otherwise noted by the ordering physician would significantly reduce this cost ineffective procedure.
The next quarter, the study could be of drug levels being drawn and tested, before the drug has had a chance to reach therapeutic levels in the patient’s system, which again provides no clinically relevant data. This is done in cooperation with the staff pharmacist.
Monitoring and controlling clinical laboratory test utilization in a rational, informed manner can have a beneficial impact throughout the healthcare organization.
1. EDUCATION: The provision of education to providers ordering tests can be accomplished most effectively by involving these persons in the development of Consensus-Based, Outcome Oriented Care Maps or Practice Guidelines. Combining data from not only national literature, but site-specific data can demonstrate variations in ordering patterns and their effect on test volume and patient outcome.
2. FINANCIAL: The 80/20 rule states, “80% of the excessive costs of laboratory testing is due to 20% of the orders”. Test utilization and related costs per diagnosis or per patient stay (economic grand rounds) can be valuable information to share with physicians.
It is well known but rarely spoken that about 75% of the health care dollars are spent on the last 30 days of life. How can we have a succesful program if that is going to be our method of operation.. Picture this: an elderly patient is very sick and the Dr. is speaking to the children and outlines a menu of procedures...knowing that these procedures will cost them ZERO DOLLARS they agree to have them done. None of us ever met a Dr. that didn't want to try one more procedure and that is why the Health Care System is affectionely know as a CASH COW in the medical field. We should make sure that the patients are comfortable and pain free but not subject to medical heroics at the age of 81 or thereabout.Aint none of us getting out of this thing alive so we should recognize when it's time to go and leave with grace.There never was a heath care problem in this country until the great LBJ hooked us to this bandwagon and we have been on a ride ever since. We should allways do right by our senior citizens but we cannot seem to define "RIGHT ". LBJ came to Washington as a teacher in a one roon school in a pasture in Texas and left 30 or so years later as a Guzillionaire and us holding the bag.
Easy. Quit taxing people and making business' leave America and soon everyone will have enough money to pay their own way! Stop thinking your government is going to help you - they can't! Stop over breeding and educate people through-out the world on health consciousness. In the words of JFK, ask NOT what YOUR country can DO for YOU - But what can YOU do for YOUR country?
There are some great points in this thread, but I think the most basic problem is being overlooked: we need to get the government completely out of the way. Allow free enterprise to work and costs will come down. Disallow lawsuits and costs will drop further. Eliminate the FDA and prices will decrease. Don't allow the AMA to limit the number of doctors, competition will increase, and doctors will have to compete on price for the basic services. Allow non-U.S. manufacturers to compete to fill our prescriptions. Government control has never worked and never will. Without competition, inefficiency is guaranteed.
If you want to see how well government health care works, talk to a veteran. Research TennCare, the state health care in Tennesse. If you want a government controlled health system, why not do it at the state level so those of us who believe in free enterprise can live in a state that does not believe in socialism.
The real answer to our problems, including health care, is to get rid of the politicians, replacing them with everyday Americans.
The system to make this happen will be announced in two months. Stay tuned. GOOOH!
As a physician on the front line of healthcare issues, I see no proposed or existing system that offers a workable solution. The best arrangement I have seen so far is that organized by Kaiser Permanente. It's not perfect, but it is better than anything else I've witnessed. But if society wants a truly successful and comprehensive healthcare system, it must organize itself to promote it. This includes mandatory public health care measures with elimination of obesity, smoking, or drug trafficking. Mental health services must also be expanded. Think we can't stop drug trafficking? Think again! It could be completely elimintated within a year. How?
An article in THE ECONOMIST (2-17-07) explains the end of the cash era. We are in the midst of a financial revolution and no one is paying attention to it. Cash is already obsolete and will become extinct in the near future. When there is no cash, there can be no drug trafficking, counterfeiting, robbery, kidnappings for ransom, illegal immigration for employment, bribery, and most property crimes (including identity theft and credit card fraud). Unless anonymous cash is available, not one of these crimes can occur.
Any universal health care system MUST require every patient to pay something for every service they consume. This is a natural restraint on fraud and abuse. Caps for catastrophic illness in any one year can protect the really unfortunate ones. But that's a system that would have a prayer of succeeding, if corrupt politicians don't get in the way.
Gary A. Belaga, M.D.
why ban all drugs why not make them legal? some drugs dont do anything to health related in fact most drugs dont if there not made in underground places and not cut with all sorts of stuff. like they are when there illegal. true mdma for example has no known overdose rate a brittish man has done 25 per day for 4 years no problem. legalize it tax it then provide health care problem solved. as for no good health care ha ha ha when i was younger and just had kids i was on medicare it was great the best ive ever seen. and as a doctor you know damn well youd rather bill medicare than blue cross.
There is a sizeable movement to legalize drugs. LEAP (Law Enforcement Against Prohibition)is a good source. They allege that if addicts had access to affordable drugs, there would be no problem. But my experience with addicts is that they cannot function adequately even if drugs are cheap. You have only to look at the alcoholics lying in alleys to see the problem. Alcohol is relatively cheap and available. Would you hire someone who showed up with alcohol on his breath? Would you let him drive a taxi? Heroin, methamphetamine, and crack addicts are not likely to be capable of productive lives even if we give them the drugs.
The argument favoring legalization is unlkikely to gain much traction. Politicians will never agree to it. My point is that at this time, it is a terrible scourge on our society. Eighty-five percent of all property crimes are driven by drug seeking addicts. The cost to our healthcare systrem is stupefying. Addicts get healthcare for free in the emergency rooms. They wind up hospitalized and given welfare support to treat their AIDS, liver, kidney, and brain diseases.
Gary A. Belaga, M.D.
What exactly does drug trafficking have to do with healthcare? I realize you're a doctor, so I'm sure you have a decent amount of "credit", money, and wonderful valued items, and you don't need to have cash around necessarily. Some of us at the lower end of the food chain survive on cash. Some of us don't have any credit, and don't trust banks because of the holes overdraft can dig one into. Plus, if you got rid of cash, people would find a new bartering system. People who do drugs are quite resourceful, and they'll find a way to get what they want.
If you read the article in THE ECONOMIST, you will see the details of why cash will inevitably disappear. The cashless world does not require credit worthiness; it's only imperative is that your source of funds be legitimate. Most States pay welfare recipients with an ATM system. It saves millions of dollars in the cost of printing and mailing checks. The poor do not have to pay check cashing fees, the money is there on time, there is no vigil for the mailman, they cannot be robbed, and they like the system very much. The very poorest among us would undoubtedly be subsidized so that bank fees would not apply. Instead of getting cash, the person would be given a credit on an ATM card. It all works very smoothly. Regardless of whether or not you object to it, the cashless world is coming.
Gary A. Belaga, M.D.
A huge problem with the cost of health care is that doctors, having assumed the mantle of regulating themselves, do a poor job of it. While a relatively small number are responsible for most of the misbehaviour, they are essentially allowed a free reign to misbehave. Doctors kill more people than drugs and guns combined. At times I find it remarkable that a person could go to school for so long and learn so little.
Your assumption that a cashless society would solve criminal problems has a fatal flaw. Since when has a public servant been smarter than a criminal. How do you suggest the certification of "legitimate sources". Even if it were possible, this certification would open the door to a pandora's box of bureaucratic abuse. If the powers that be dislike your behaviour, they merely de-certify your source of income, and starve you to death.
Lots of people come up with the bartering theory to defeat the cashless restraint on crime. It has a simple-minded appeal, but it does not work. That is why money was invented in the first place. It is impossible to run any complex economy with a bartering system. If an addict were to steal an i-pod to offer to his local drug dealer, what would the dealer do with it in a cashless world? The provenance of the item is easy to establish, so if he sells it on e-Bay, the trail back to him remains indelible forever. When the serial number turns up the truth about it's stolen status, what will he say? He might have an excuse for one stolen item, but he's got to process thousands of stolen items. He'll need separate identities for all of them, would he not? And the trail never goes cold. So the dealer and all of his associates are forever vulnerable. The dealer must also have cashless accounts to conduct his smuggling. The trail spreads like a cancer to all of his contacts. If bartering and credit card fraud were workable schemes for drug trafficking, how come none of it operates that way today?
Gary A. Belaga, M.D.
In the theory that there was a cashless world, there would probably be a simple way of doing personal transactions and, I would hope for privacy purposes, the government wouldn't be able to spy on every purchase made. But, they might make a ratification to the patriot act to do so if we keep going the way we're going. Drugs are going to survive. I'm not trying to defend there use or disuse. I just believe that from what history has told, they just tend to seep their way into society whether majority consensus wants them there or not.
p.s. please don't make personal attacks (i.e. simple minded) I'm not taking it personally but i think it's disrespectful to the forum.
without wax,
liberte
I did not intend my remarks to be offensive or to constitute a personal attack. I regret that you chose to presume the worst about me. However, you do bring up a compelling issue about privacy. This was also addressed in THE ECONOMIST which concluded that given a choice between convenience and privacy, consumers overwhelmingly choose convenience. I might add that any illusions you have about privacy at this point in time are not supported by any facts. Unless a person engages in cashless commerce, he is on the fringe of society. One look at your credit report will show that these agencies know more about you than you know yourself. There is no economic privacy today and there never again will be. But the enormous volume of transactions makes it impossible for the government to spy on us randomly. There may already be (and I hope there is) a mindless computer surveying billions of transactions to see who, for example, is buying nitrates for explosives or ephedrine for methamphetamines. Does that make you feel violated? Who among us finds it reasonable to nourish the death and destruction made possible only through anonymous cash in order to nurture his paranoia about the government? Cash does not protect a citizen against a rogue government. Just look at what we have now! Cash didn't save even one Jew from Auschwitz.
Gary A. Belaga, M.D.
I will resist your "Brave New World" at every opportunity. If it cannot be defeated, I hope not to survive the effort.
well,the first thing is to keep in mind that the government cannot even issue passports. and some folks want the government to control your healthcare? its beyond me why. statistically 85% of the people are covered by healthcare insurance. some very good, some not so good. perhaps we need to make free education to the master degree level available at no cost so everyone can have the kind of job that will pay enough for high quality health care insurance. i dont know. but what i do know is that every government program will be wasteful and abused. look at the food stamp program. now its an access card so nobody knows it is food stamps they are using to buy foods that we working people cant afford. get the government out of our lives. that is what we need.
There is likely universal consensus that our government will mismanage anything it touches. That is likely why sizeable numbers of us are looking for an alternative. A universal healthcare system could be made to work effectively and to the satisfaction of the majority, but not with the political opportunists with whom we have been cursed for so long. The government is already heavily involved in our health care, and the forecast is for more of the same. Wishful thinking about shrinking its involvement will not solve the dilemma. Skillful planning that involves the disparate views which need to be reconciled is what is required. Those with health insurance feel abused by the system. Those that have none are lined up at the emergency rooms which are forced to provide services that taxpayers underwrite. Overhauling the present system will take enormous time and effort. But some small steps can be taken to chip away at the Gordian Knot. Accelerating the inevitable trend toward cashlessness is a relatively simple and very cheap strategy. Everyone already is comfortable with cashless commerce and the public must stand up against its corrupt government.
Gary A. Belaga, M.D.
I agree with your consensus. Our government has an uncanny ability to turn most anything they touch into waste,fraud & misuse. Their "constituents" are the medical lobbists-not the American people.
As the spouse of an ill person, I see,firsthand,the financial & emotional toll. My spouse & I are middle-class (if there is such a thing anymore) "baby-boomers" who would like to retire but cannot afford to do so. I am obliged to continue working-not just because of the medical benefits-though it's a major reason-but also for the income. Co-payments to three doctors & for six prescriptions have become a financial & emotional drain. There's always more month left @ the end of the money.
Our elected officials need to stop listening to the health care industry & pharmaceutical companies. I cannot see any reasonable explanation for the escalating cost of health care-except greed. Not pandering to these industries would, most assuredly, mean our politicians would lose lobbists' "contributions". But,perhaps,if they felt the same "pinch" that millions of Americans feel, they'd finally understand.
One can institute any &/or all health care reform plans known to man. But until & unless the greed of the health care & pharmaceutical industries are brought to task it'll only get worse.
I'm also the spouse of a person with a chronic illness and I can also relate to having to put retirement on hold. I will pray for you and all of us that are in a similar situation.
There is one more criminal you can add to your list besides the Healthcare and Pharmaceutical industries, that is the Insurance Companies! When you present to a provider for care, the first thing they ask is about INSURANCE. The answer to that question will determine the quality of care you receive.
Whereas, I would like to see the Insurance companies left out of the equation completely by a single payer system, that is probably not going to happen. So there must be a mechanism put in place that assures every legal citizen in this country has equal access to the highest quality care available, no questions asked!
As the title says, it works in Europe. From what I know, they don't really trust their governments all that much either, but the difference between our 2 continents is that they keep an eye on theirs. Instead of giving ourselves over to the futility of curing the coruption that is consuming our government we should start working on solutions.
Khlect, if the "cashless revoltuion is upon us" as you say than it will eventually surpass us. but it will not define us and it will not define our government. It's much easier to change a few numbers in a computer database than it is to print millions of dollar bills or melt down quarters. Corruption and illegal activities cannot be solved by changing the currency with which they deal. Additionally, the government is not fighting any "cashless revolution"(if you can even call it that). We don't need to roll up our sleeves and fight an apathetic. What we need to fight for is healthcare, which is the topic of this forum.
shadismount@hotmail.com
If a typical citizen cannot see the profound impact of drug trafficking on hea;lth care, then I have to give up.
Gary A. Belaga, M.D.
...."If a typical citizen cannot see the profound impact of drug trafficking on hea;lth care, then I have to give up." says the good doctor.
Well, you can do it in one sentence and so can I. Put your stats up against some other factors, and let's see how they come out.
Doctors kill more people than drugs and guns combined.
If insurance companies were not allowed to deny coverage for any reason, the business would no longer be profitable for them, and they would therefore, have no reason to stay in business. This is the fundamental problem with involving insurance companies in our healthcare system. Their goal is to maximize profit by minimizing payout.
I've posted this before and I really just want to get some other ideas. We don't have a single forum on medical care so I'm posting this on everyone that I think applies.
It's clear, everyone wants everyone to have an equal level of helthcare that is of the highest quality possible. We won't achieve this through the legislature because their are too many people who believe that government control in this area is detrimental to our civil liberties. I happen to agree to a certain extent but we can't live in the richest society int he world and let people die not because we are unable to save them, but because we are afraid to save them.
So what's my solution?
Whether you like it or not, medical care in the USA is a series of private industries. You don't change that with soem good ideas and a pen and paper. You chagne that with dollars. If a cooperative were to be set up with a willing government who's healthcare industry has been socialized we could starve out HMO's nationwide.
I ahve not yet worked out the details but my plan flows something like this: after talks with the partner nation, people would begin to pay into a policy sponsored by the foreign government much as the currently would with an HMO. But instead of a company, driven exclusively by profit, that rejects and denies you would have a system that could readily accept the weak and the injured. Finding a client nation would be difficult but once accomplished the benefits would be undeniable. If the co-op was prooven sucessful, people would leave HMO's by the hundreds. moreover, to all ye naysayers out there who not only think a socialist system is doome dto failure but will not even allow it the oppurtunity to prove itself, you won't ahve to participate.
But this still isn't nationalized healthcare, is it?
No it is not but once this antion is running on another nation's socialist healthcare system, it would become impossible for democrats, republicans and centrists alike to dney the benefits of a nation-wide government-sponsored healthcare system. If scoialism is wrong, then the failure of my idea will prove it. If it works, than our capitalist system will ensure it becomes not only legalized but nationalized. But more important than all of this, it is a unifier: our party's support for this system would only go as far as the system does. It would nto divide because it does not try to put all Americans in a single bubble. Think of it as a gated community: the gate opens and closes perhaps not easily, but easily enough.
It's not perfect, but its practical and definitely achievable.
****As Zappafan has pointed out, getting a client nation will be the hardest thing to manage. Any solutions on thsi topic would be wonderful.*****
shadismount@hotmail.com
Shadismount, I posted this on other threads. I thought it may apply to what you are saying.
I have a suggestion for good or ill depending on how you perceive it. Despite the naysayers and Bush haters the prez had a plan several years ago that was dropped like a hot gall bladder. His plan called for all business employee healthcare deductions removed from the tax code. Any monies employers give to employees as a healthcare benefit would be included in income. Start a healthcare subsidy for all Americans that would be added to employees income. Then install a healthcare credit to the tax code. This credit would be used to offset any health premiums and costs, co-pays etc. and new subsidy. If a policy holder's cost for medical care for a year is say $5000 and he has a credit of $7000 the policy holder could apply the balance of $2000 to his other income. If the policy holder could cut costs by shopping for better plans or lower cost deductibles, co-pays etc. to say $3500 that would allow $3500 credit to be applied to his other income. It would be smart economics for a policy holder to cut personal costs if he would gain an advantage on his taxes. It would also be an incentive to private insurance companies to lower cost and improve services to keep a client base intact. As it stands to day employers are paying for insurance and the patient has no skin in the game therefore there is no incentive to change the status quo.
Basically this would make healthcare costs a wash. Any cost above credit would be paid out of pocket. The theory would be Americans would shop for better plans and better services if they had some thing to gain or lose. This may also reduce costs due to the “ large number theory” used by most insurance companies (large number theory says the more policies in play spreads the risk over a large population, should lower individual costs). This would work as a privatized universal health plan. The naysayers do not want insurance companies involved but the only way this or any system to work is to remove government intrusion.
My suggestion is not primarily about HSA accounts but revising the tax code and providing subsidies to the “working poor” lower income families and individuals not covered by an employer plan. The ability to shop and choose a plan in the free market would provide the catalyst for change.
1) Most individuals would be covered by employer plans.
2) Lower income persons would get subsidies to purchase private insurance instead of government plans
3) Elderly, unemployed. under employed, disabled would still fall under Medicare/Medicaid umbrella.
4) Chronically ill, end of life, long-term care, high risk individuals/ moral hazard would also fall under Medicare/Medicaid.
A small percentage of all taxes could be set aside to provide subsidies for low income citizens and medical savings accounts. HSA would fall under the plans a citizen would choose.
The fly in the ointment is it needs to be mandatory or subsidy and/or income extras need to be denied unless a person actually buys insurance. The uninsured may need to be denied any service if they refuse to buy insurance if available.
Government nor insurance companies should have control of health care. A partnership with consumer oversight is the only solution that will come close to satisfying enough people to get health care reform. Some don't believe we need it at all and the only thing I would say to them is wait until you lose your insurance and then become sick. Experience has a way of changing ones mind.
Betty McLeod
PA 06
Betty327@ptd.net
http://unity08.com/node/1820
This topic is very solution oriented.
Bill"for what we are together"
bill713.unity08@sbcglobal.net