On Healthcare – one mo’ time

George Rebane

Before any serious discussion of America’s healthcare ensues, we must first come to grips with the answer to this question –

What right does any American have to draw on his neighbor’s pocketbook to pay for the repair of his health, the preservation of which he may or not have taken any prudent steps to safeguard?  (At this point we can cite the horrendous stats that describe the behaviors with which we Americans knowingly and willingly damage ourselves.  Take what you will, knowing that you, and not me, will pay the price.)

In this light Rebane Doctrine recommends the following (neither comprehensive nor sufficient) attributes for our healthcare industry.

• Patients choose their own physicians and participate in their own medical decisions to the extent that they and/or their supporters can afford the care.
• No one has the right to demand another to pay for his healthcare.
• The spectrum of health professionals is expanded greatly to allow practitioners of all skill levels and training to participate in delivering health related services.
• Tax policy is reformed to permit both private and institutional health savings accounts that belong to individuals and their designees – e.g. family healthcare account.
• Tax policy supports the founding of non-profit healthcare service corporations (NPHSCs) for the poor that are owned and operated by for-profit companies.
• FDA policies on drug acceptance greatly simplified, especially for the release of drugs and treatments for cases in which the standard of care provides no relief from certain death.
• Health insurance can be sold as any other product that comes under the aegis of the Constitution’s ‘commerce clause’ (Art 1, Sec 8, Clause 3).
• Catastrophic care will be provided by private charities or NPHSC’s where available. Where such care is not available, the federal government will provide for hospice care to alleviate end-of-life suffering.

Comments

[Account Deleted]

A great start for a conversation on health care.
Of course, starting with basic principles will send a lot of folk off with their hair on fire. The left's mantra is that health care is a 'right'. And a large and growing number of our population nod in fervent agreement. Add to that a mention of moral hazard being a necessary component of the discussion and you have now lost another large percentage of citizens who might have other wise gone along with your views.
Then there is the area where the feds can help by re-shaping the tax structure and at least 1/2 of all Americans' eyes glaze over as they pay no taxes or just don't care about taxes.
I'm off to move 3 dump truck loads of topsoil around, so I don't have the time right now to even begin to delve into the various regions of what is lumped all together as simply 'health care'.
I'll check back to see how this topic goes at lunch time.

[Todd Juvinall]

Let the free matket alone and no mandates. We can help the poor and Medicare as we paid in to it.

[Paul emery]

Have a good dump run Scott at our taxpayer subsidized Nevada County dump.

[Paul emery]

Of course it doesn't apply to you today but it gets the idea out that we take it vantage of government subsidies for all kinds of things

[fish]

Posted by: Paul emery | 30 May 2017 at 10:29 AM

Have a good dump run Scott at our taxpayer subsidized Nevada County dump.

....that would be quite the drive from Idaho to use the taxpayer subsidized Nevada County dump.

Of course it doesn't apply to you today but it gets the idea out that we take it vantage of government subsidies for all kinds of things

Yeah......and it is in large measure why we're in the straights we are in today! Because nobody knows what anything costs.

But hey when you're out there "buying the vote" cost is no object.....eh Paul?

[Gregory]

PE 1028/9

A bizarre concept you have there, that the idea of "government subsidies for all kinds of things" needs to get out, triggered by the words "dump truck", leading you to think about the transfer station follies despite the transfer station not being referenced.

GR
A decent enough start but I'd think something like "heath insurance or other subsidized care from an employer (including public employers) shall be considered taxable income" really needs to be in the mix, too. Folks who should know better think of health care as manna from heaven there for the taking.

[Gregory]

"Yeah......and it is in large measure why we're in the [straits] we are in today! Because nobody knows what anything costs."

dingdingdingdingdingdingdingdingdingdingdingding
give that fish a cigar

[ScenesFromTheApocalypse]

. Should people be forced to buy into Medicare?
. Should those with Medicare get a government subsidy (the amount paid in is only a fraction of the real cost).
. Should ERs and hospitals be forced to accept people who don't have cash or insurance?
. How should patent law be applied to drug companies? Should they be allowed to pay-off producers of generics? Should life saving drugs with monopolies be priced at what the market will bear?
. Should non-poor people pay full-tariff insurance even when unaffordable?
. Why should health insurance be attached to employment?
. How does your model bring down pricing? Are there real world examples?
. Should insurance companies be regulated at all so long as they honor their contracts?

just offhand...

[George Rebane]

Messrs Gregory and Scenes - good points all. But the "manna from heaven" notion, now firmly ingrained across the land, is fundamental and goes back to my original question above.

[jon smith]

I actually agree with many of your components BUT there would need to be concomitant policies to release the stranglehold the insurance and pharmaceutical companies currently have. States should have the right to negotiate drug costs and consumers should be free to purchase pharmaceuticals outside of US borders for starters. Insurance companies and Medicare must publicly disclose the negotiated costs of their payments so consumers will have a wild idea what the hell medical costs actually are. A friend recently inquired about the real cost of her upcoming hip replacement and neither the hospital or her doctors could provide an up front menu of what her expected expenses would be.

[Account Deleted]

Wow - just got back from throwing away $600 dollars worth of clean topsoil at the McCourtney Road transfer station and boy is my pickup tired! Ha ha - and it was FREE! Well - Paul had to pay, actually.
Paul was the one that wanted this discussion and all he can come up with is uninformed snot-nosed snark.
All good points about health care. Although what we know would work the best (most efficient and cheapest) isn't what would ever see the light of day as legislation.
As it is with a lot of public policy these days, there's what I want to see happen and there's what I expect to see happen.
Another big factor in the cost of health care that can be changed to reduce costs would be to severely curtail the legal profession's entanglement in our nation's health care system. The lawyers make tens of millions, doctors over prescribe tests to protect themselves from malpractice suits and we all pay the insurance companies to cover the whole mess. It always seems to be conveniently left out of the conversation when referring to the nirvana of Euro-style health care that if they cut off the wrong leg, you don't get to live in a new condo on the beach in Hawaii afterwards.
Oh - have the kids in Sacto found the funding mechanism yet for Kali's new free health care for everyone?

[Gregory]

scenes 1210

. Should people be forced to buy into Medicare?
. Should those with Medicare get a government subsidy (the amount paid in is only a fraction of the real cost).
. Should ERs and hospitals be forced to accept people who don't have cash or insurance?

Should the young be forced to "buy into Medicare" and the old get an unearned subsidy? No, but that train left the station long ago, starting with the concept that young workers pay into their Social Security accounts in a pact between generations. Which is, in essence, the same sort of contract between generations that underlaid feudal societies... yes, your father's father agreed to these terms and you are bound by his word.

ERs and hospitals will be forced to let into their doors people who can't pay full freight... but it isn't the ER/hospital that is generating the bills. It's high time MDs and technicians become salaried employees of the ER/hospital that they are operating from, with customers/patients shuttled here and there for diagnostics and therapies, or, like the "respiratory therapists" who ply their semiskilled trade going from room to room and will generate yet another bill.

. Should non-poor people pay full-tariff insurance even when unaffordable?
. Why should health insurance be attached to employment?

I think scenes needs to define what "full-tariff insurance" is in this statement of his. If it is a confusion of insurance with pre-paid health care packages such as those being delivered to employees, income tax free, let's break them apart.

No, health "insurance" shouldn't be attached to employment... and the only reason it remains so seven decades after the inflation spiral began with WWII (companies could lure in workers with "fringe benefits" that weren't taxed, and Kaiser Heavy Industries' solution to the wage and price controls of the time was company provided doctors and hospitals), is that it was popular amongst employees... imagine, someone else is paying for *your* health care and you don't have to pay income tax on the proportion paid by the someone else.

All good, unless of course you don't have an employer providing you with that untaxed and undeclared income, and are forced to buy that "coverage" with after tax dollars you've earned and/or saved.

Is that "full-tariff insurance" you're referring to related to those Obamacare insurance policies that mimic employer "insurance" benefits? You pay upfront for all that care some bureaucrat decided you should expect from an employer, and a lesser benefit was just not quality care? Buy it with your own money or pay a penalty at tax time? Oh, and a lesser policy that just meets your needs won't be available?

. How does your model bring down pricing? Are there real world examples?

It's what we used to have. If that isn't real world enough for you, I can't help. The #1 problem from which all others flow in the USA is that person A has their medical bills paid by insurance company B, chosen by their employer company C as an untaxed "fringe benefit" and that as one comes into the door of their physician for whatever reason, they have no way to shop for the best pricing. No price signals, no way for the individual to know what they're in for.

Here's an extra bonus question: Should ERs and hospitals be allowed to shift costs from mediscare/medicaid/indigent patients onto patients who have insurance (and are able to afford the deductibles and other non-covered billings) once the bills start rolling in? I suspect that's the largest part of the growth of the cost of health care to the non-indigent younger than 65 patient.

[Gregory]

"jon smith" 1241

"States should have the right to negotiate drug costs and consumers should be free to purchase pharmaceuticals outside of US borders for starters".

Gawd, NO, to the first, ummm, no to the second, mainly because that works against the 1st.

One, why are the States part of this process? Are you suggesting price controls for each State, with a "negotiated" price cap and if a drug company doesn't make it available, you can't buy it here, there or everywhere? So, can I go to Reno and buy it there? Or go across national borders north or south, east and west?

Other countries have lower drug costs partially because of a quirk in the patent laws... other countries are not bound by them except by treaty. So we have the prospect of foreign countries speaking softly and carrying the big stick of "lower prices or we accept generics before the patent runs out".

Other drivers of drug costs in the USA include the Byzantine structures of drug distribution networks.

If it's the cry that Medicare should be able to negotiate drug prices, pushing up the price for the private payer as a (possibly) unintended side effect... no. State actors should not "negotiate" anything because it's not a negotiation in any usual sense of the word. It's the state A negotiating with provider B about how much they can shift the cost of care to the patient C to patient D, who isn't a part of the negotiation.

[Bonnie McGuire]

Anyone who has been poor knows that when you're poor there's nothing to give to charities. If you're able to make a decent living you're now able to donate to less fortunate people. Not long ago I had a marvelous experience with someone regarding this subject. I mentioned that it cost $4,725 per month for someone in a cheaper nursing care home. She exclaimed that Golden Empire was cheaper where someone she knew had lived. I said that it was closer to double the cost if you weren't on Medicaid. Her nice little apartment was around $400 per month compared to another friend's $1,300 for a former motel room...converted to senior living. If you don't have much money Medicaid will help you. For veterans $30,000 in the bank will allow you some aid. Years ago $10,000 was all you could have in order to get help. Most poor people who behave themselves get aid from those who have to pay because that's how the system operates. The problem is the economy, many young addicts, lack of housing, and ignorance. My friend was shocked when she realized those who have more than $30,000 in the bank are paying for those who don't.

[ScenesFromTheApocalypse]

"I think scenes needs to define what "full-tariff insurance" is in this statement of his."

Nothing tricky. Full cost, no preexisting condition, unsubsidized health insurance.

I just looked up a non-ACA plan for Nevada County. Married couple at age 60. 20% coninsurance with $5000 deductible. It's roughly $18,000 per year.

My guess is that most self-employed (or unemployed) people in this county in that age range simply can't pay the bill.

[ScenesFromTheApocalypse]

"It's what we used to have. If that isn't real world enough for you, I can't help."

No point in being snarky, it's merely a question.

It seems to me you'd have to go back some time to have anything like price signaling in medical care. Obviously,pre-ACA insurance was much like post-ACA, minus the addition of sick people being able to buy insurance + non-means based subsidies.

Frankly,I see no clear answers to the problem presented. My guess is that people with strong opinions on the matter neither work in that industry or have fully thought through implications of their theories.

[ScenesFromTheApocalypse]

"States should have the right to negotiate drug costs and consumers should be free to purchase pharmaceuticals outside of US borders for starters. I"

JS @ 12:41

That appears to be a central point. Does a monopsony produce better pricing than a free market. The next logical step is to have all drug R&D done by the government itself. Is that preferable? You'd also see an advantage in that research might be directed towards bonafide health problems and away from baldness cures. Do you think that R&D generally should be government run?

I wouldn't count on buying outside of the US. My best guess is that, given the importance and size of the US market, the drug companies would merely crank up their pricing in Canada. Stage two might well be Canada making it illegal to export drugs.

[George Rebane]

Given the gazillions that the feds pay for all kinds of programs of dubious worth, is there anything stopping them from doing pharma research on "bonafide health problems"? Why haven't progressives in power thought of that?

[Account Deleted]

re George's question about the feds paying for pharma research. Well - Kali tax payers have spent how many millions on stem cell research and what is there to show for it?
The fed govt is even better than Kali at throwing money at problems and coming up with zilch. Based on their track record I'd have to say no thanks.

[Paul Emery]

George

If it is the desire of the American people to assign the responsibility of creating and managing a national health care system then is it not appropriate that it should be done?

[Bob Hobert]

PE 04:00 PM. And if we don't...?

[George Rebane]

PaulE 400pm - Yes, a democracy should always have the right and the means of destroying itself.

[Paul Emery]

That is an extension of the question Bob. I contend that most Americans do want some form of national healthcare. Do you see a massive desire to eliminate Medicare for example?

[Gregory]

Scenes 247 and 253

"Full cost, no preexisting condition, unsubsidized health insurance"
Individual market or employer based? If the latter, there already was "no prexisting condition" taken into account... except an employer looking at a graying workforce was also looking at rising health care assessments from their insurer.

Time to hire a stable full of younglings with H1 visas?

Preexisting conditions is one of those loaded words... and the use Scenes' is using it is to blur the line between "portability" where someone was diagnosed with a disqualifying (for old style individually underwritten policies) condition *while* they were insured. That could have been dealt with easily... "no one whose underlying disqualifying condition was first diagnosed and treated while insured may be denied insurance coverage and said condition cannot be used to charge them more".

How much more they might be charged for going naked and for how long could have been on the table without conflating policy portability with "preexisting conditions" held by people who just didn't (for one reason or another) figure out how to make enough money to care for themselves and their family.

"Obviously,pre-ACA insurance was much like post-ACA, minus the addition of sick people being able to buy insurance + non-means based subsidies"

No, it wasn't. There were choices as to what the goodies would be. A wide network of available MD's who charged more vs a narrow network of, umm, less desirable service providers that would make you wait but would accept less for the same codes? All but free annual physicals whether you needed one or not?

And regarding that married couple aged 60 with a standard policy... that $1500 a month policy covers childbirth, doesn't it? Wow! Along with other free goodies that are the care that any sentient being would want in a quality healthcare package, doesn't it? They'll pretty much pay for an MD to shove a fiber optic probe up the most private of one's orifices to take pictures and do a snip snip trimming of growths you-know-where that look like trouble to the artist at the controls.

It all comes down to risk pools... and insurance companies in the USA grew risk pools around the employer's people, whether a handful or 50,000, only because those employers could buy insurance for employees who bore no cost for that policy. That is the original sin of employer based health care insurance and the one sin that the Obama administration kept their hands off... they split off separately taxing "Cadillac" plans for the future and never did a damn thing.

http://money.cnn.com/2015/12/18/news/economy/obamacare-cadillac-tax/

Note that the 40% tax would have been levied on policies that cost over $27500 for a family. Currently tax free to the recipient.

Contrast this with making all employer paid health care taxable income, with a one time adjustment of the tax tables to make it revenue neutral to the federal government. Then, after you see what the plan your employer chose for you would actually cost you in taxes, you can instead choose to take that subsidy as income and choose a less expensive individual plan (with a risk pool say, roughly the size of a congressional district or larger) that gave few freebies but encouraged you to shop as carefully for care as one does for a mattress on Amazon.

[Gregory]

PE 400pm

"If it is the desire of the American people to assign the responsibility of creating and managing a national health care system then is it not appropriate that it should be done?"

It surely is appropriate, Paul. First thing that one might require going forward is a constitutional amendment that cedes the necessary powers to the Federal government to coerce health care providers to do so only under the new system, possibly as employees of the Feds or of the many states. Deal?

[Account Deleted]

I see that Paul has once again suddenly decided to embrace pure democracy. Funny how that only works when 'the people' want what the left wants.
If 'the people' knew govt run health care would mean crappier service, no choice, higher costs and more govt control over your life, then I doubt they would choose that sort of deal.
Kali is raring to go with their govt run health care - why don't we let them and see what happens?
We really need to think about first principles here.
Modern health care, even if we manage to trim costs, is still going to be very expensive. We seem to be headed for an acceptance of a permanent class of citizens that produce nothing of value. Do Americans really want to pay for their own health care and that of those who refuse to work?
I don't see anyone on the national stage who will bluntly ask these necessary questions. It's always platitudes, quotes from the Bible and pandering to the non-informed.

[Gregory]

PE 459pm
"I contend that most Americans do want some form of national healthcare"

I contend that they do not, besides Mediscare and Medicaid, and it would be best to roll back the "manna from heaven" financial model most people seem to have for the care they receive... nothing like paying taxes on an extra $3K a month of income as a reality check if one chose a cadillac plan for their employer paid plan.

[Paul Emery]

George after reviewing your criteria for a health care plan you must be terribly disappointed in what Trump and the Republicans have proposed

[Don Bessee]

Why not just post that to begin with po' ol' PE @549, that was what you were wanting post all along. ;-)

[Paul Emery]

The question was not for you don.

[Gregory]

Paul, 549pm

are you even listening, or are you just looking for a soft spot to land a wimpy counterpunch?

No need to answer the question, the answer is obvious.

I'll chime in with Don B, why not just post your 549pm to start? If you want to pose questions and not attract the biting flies asking the obvious, I'd suggest you just post your question via the Rebane back channel... I assume you have his email address.

[Don Bessee]

But my 605 was for you ya po' ol' pollhead. ;-)

[Paul Emery]

taking it back to Scott this morning at 7:41 I don't believe healthcare for all is a right but I do believe it is a responsibility of a modern culture

[Don Bessee]

What? The fakenewsman has a back channel! Call Maxine Waters, Schiff, Schumer and the rest of the gang, film at 11.
;-)

[Account Deleted]

from Paul - "...but I do believe it is a responsibility of a modern culture"
Paul also thinks Americans want govt run health care.
OK - let's go ask Joe Sixpack down the street. He just got home from busting his ass working out in the weather all day.
"Say there, sir! You know the house around the corner where a woman and her 2 bratty kids live with her umteenth unemployed boyfriend?"
"You mean the place where they play loud music all night and he sits around on the porch drinking beer all day?"
"Oh yes, that's the one. They need health care, so I'm taking up a collection from everyone in the neighborhood to pay for all of their insurance as well as paying for their office visits and the ER room visits 'cause they rarely supervise their kids and the little imps seem to be injuring themselves an awful lot. And the woman will need a lot of meds and health care as she ages due to her smoking and all of the crappy sugary junk she eats. And of course, this is on top of the money they get from you for food stamps and sundry other freebies they get from the govt.
So - how much should I expect you'll be paying every month for this worthy cause?"
(sound of door slamming)
Get the picture, Paul? A 'responsible' society involves the responsibility of everyone. Not just the suckers that pay for all of the left's brilliant ideas.
You want the govt to define and regulate responsibility?
You have a swell time with that.

[Gregory]

"but I do believe it is a responsibility of a modern culture"

What, exactly, is it that is a responsibility of a modern culture?

A clean and pleasant place to die, with pain well managed?

Access to the same medical services as the wealthy/stinking rich, with the same immediacy of action and resulting care? No sitting in lines waiting for that brain transplant for Paul E?

No bills to the recipient?

Free settings of broken arms for the young but no dialysis for old folks whose kidneys are no longer functioning?

In other words, Paul, do you want the illusion of the same care for all, or do you want the reality that care will always be rationed based on the ability to pay? Take your time answering.

[Paul Emery]

Well the opposite of reasonable health care for all is unfortunate people suffering and possibly dying of treatable conditions because they cannot afford to pay. Is that what you want Gregory and Scott?

[George Rebane]

PaulE 743pm - uncounted people are already dying under single payer systems from being either denied treatment (by death committees), or delayed treatment (from long wait times which is the functional equivalent of treatment denied). These deaths of the "unfortunate" are not attributed to single payer systems, and are not suffered by those who in EVERY country with single payer systems are well off enough to avail themselves to private healthcare. With the demonstrated acumen of our government's bureaucracies, we, if anything, will do much worse than the Europeans.

[Paul Emery]

George

I actually agree with many of your suggestions as to how we can lower the cost of health care and provide financial assistance. This one bothers me perhaps you can elaborate

"Catastrophic care will be provided by private charities or NPHSC’s where available. Where such care is not available, the federal government will provide for hospice care to alleviate end-of-life suffering."

Does "not available" mean if not available under support from NPHSC’s the health condition will be untreated leading to end of life without assistance except for the final suffering? I need a little help understanding your position on this.

[Todd Juvinall]

Liberals always have the best intentions as long as they can use other people's money. Looking at California's stab at this and the cost of 400 billion a year, one has to wonder how we remain a b=viable country.

[Paul Emery]

What is your solution Todd for sick people who can't afford doctors and don't have insurance ? Somebody's going to pay for it or else they'll just stay sick and maybe die

[Account Deleted]

from Paul - "Well the opposite of reasonable health care for all is unfortunate people suffering and possibly dying of treatable conditions because they cannot afford to pay. Is that what you want Gregory and Scott?"
First of all, when did I ever indicate I wasn't for 'reasonable' health care?
And as usual - if you disagree with a leftie it always boils down to them claiming that you want people to suffer and die. It's their go-to defense when you point out that they are factually wrong and their plan for health care doesn't work.
People suffer and die in all kinds of health care systems. Emotion is not a good tool for devising a plan of action to lower the cost of health care and try to provide as much coverage as possible for as many as possible.

[Bill Tozer]

Ah, the ole "you want people to die!" card. Folks get sick and die....with or without insurance. Heck, folks die in the hallways of the VA waiting there turn. Hmmm. Seems I have heard this tune before. Sounds so familiar.

https://m.youtube.com/watch?v=-usmvYOPfco

[jon smith]

"No one has the right to demand another to pay for his healthcare."
"Catastrophic care will be provided by private charities or NPHSC’s where available. Where such care is not available, the federal government will provide for hospice care to alleviate end-of-life suffering." . . .

These two attributes are completely at odds with one another. Why should the federal government have the right to demand another to pay the cost of hospice care if it can't demand another to pay the cost of health care? Why is one type of socialized care acceptable and the other not? Who pays for funeral expenses when hospice is over?

Explain this plan to a young mother with a child who has a very curable but privately unaffordable disease like leukemia. Off the top of my head I don't know of another modern, 1st world society who would even consider this.

[Gregory]

Paul, I hate to break it to you but people are denied treatments that *might* provide relief every day... and in Cancerland, most all will die despite throwing gobs of money at bleeding edge therapies whether or not they can be funded by some 3rd payer. If one is independently wealthy, they might get a few extra months or even years... like Steve Jobs' last days as a pancreatic cancer statistic. Does everyone in the prime of life deserve the same m

How much of other people's money should be thrown at a terminal condition, Paul, trying to prolong life that just can't be prolonged? What is "reasonable"?

Sometimes, you just have to give up the idea of "fair". Life isn't fair from start to finish. What we had before Obamacare was sustainable and mostly fair. What Obamacare wrought wasn't fair or sustainable. Built on the lies that were used to sell it to American voters... if you like your doctor you can keep your doctor, if you like your insurance plan you can keep your plan, and we'll all get $2500 a year savings.

What have you been spending your $2500 yearly savings on, Paul?

[Bill Tozer]

@10:21 pm
Ah, end of life care. Then funeral expenses. Who pays for the tomb?
No doubt the big health care expenses accure when one has one foot in Wrinkle Village and the other in the Marble Orchard. Medicare alone is 15% of the Federal Budget. That's mostly used by old geezers and the disabled. The number crunchers say we all will live longer and longer, been going up by a year every five years for quite awhile.

http://kff.org/medicare/issue-brief/10-essential-facts-about-medicares-financial-outlook/

It ain't getting cheaper. Guess the Want List is for great health care for everybody with all the bells and whistles and latest equipment and miracle drugs and we all life happily ever after. World class care for everybody, rich or poor, outhouse or penthouse, Yale or jail. And cheaper! Cool. Why even bother with HSAs? It's all good. Sounds more like a Wish List to me.

Poor get Medicaid. Cripples and the grey headed get Medicare. Blue collar working stiff can't save for retirement because they responsibly pay the monthly insurance premiums. Kids and all that stuff. They can afford it, but their disposal income just got cut in half...or more. What, gotta live on $600 bucks a month after rent and utilities and health insurance? What about gas and Little League and.........forget taking on a car payment. Those than can "afford it" are pissed cause it's too darn high. If their premiums go up anymore, they will be broke. So, they want it affordable. If you are poor, affordable means free. Poor also means poor service, po folk care. If you are not poor, your insurance premiums are fast approaching what you pay on your monthly mortgage. Those who make more are lucky cause they pay a smaller percentage of their income on health care than the unwashed.

So, everybody wants it what they deem affordable, better choices, better facilities, better bad ass cheap healthcare......run by the same folks that.......well, I will quote (by memory) what Newt said during the Republican Revolution or whatever it was called in Bubba's term.

"If the Government decided to study the North American Bison, they would have five prople sitting in Washington DC and two field agents in Montana."

So, where's the magic wand that will make it great and cheaper and bigger and better and as Obama promised, won't cost the government one red cent and will reduce the deficient. Pay for itself and kick money back into the Treasury!!! A win-win.

Just one little detail. "Everybody in, nobody leaves".......a great Fish line from the past.

[Bill Tozer]

Guess Tort Reform gets brought up each time business climate reform and health care makes the rounds. Nothing happens. Don't mess with the Sacred Cow lawyers. John Edwards made a bundle suing...er.....working his fingers to the bone on those Class action lawsuits. It's gets so darn complicated and political. Alas.

https://www.facebook.com/PatriotPost/photos/a.82108390913.80726.51560645913/10154752633020914/?type=3&theater

[George Rebane]

PaulE 907pm – Yes.

Jons 1021pm – Your logic is flawed. The two cited attributes are totally consistent since government can and does provide support (in this case favorable tax environment for corporations that own and operate NPHSCs) activities and enterprises where no rights exist to receive such support. And there are always various kinds of socializations which are acceptable while others (still) are not. The world is not the black and white that it may appear to you. We should do what we can without driving the country into a brick wall or worse. (Your funeral expense question was a joke, right?)

[Paul Emery]

Gregory

If I may ask do you have health insurance?

[Paul Emery]

Geiorge

Do NPHSCs currently exist as you describe them?

[Paul Emery]

George, I don't recall making a funeral expense question, Can you refresh me with a time reference? As far as " We should do what we can without driving the country into a brick wall or worse." Single payer is the way to go. The numbers are in. it is much more efficient than our mish mash of bloated corporate execs and fat preditor lawyers feeding off the scraps. Most national health systems do not allow malpractice lawsuits for example. Here's a list of GNP rates of countries with naional health care. This chart will give you ag ood comparison with other modern countries all of which have national health care programs.

http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/

[George Rebane]

PaulE 956am++ - No NPSCs exist that I am aware of since I introduced the concept in 2009.
http://rebaneruminations.typepad.com/rebanes_ruminations/2009/05/republicans-need-a-new-strategy.html

You weren't accused of making a funeral expense question; read more carefully. And your cost comparisons are both apples/oranges and incomplete since performance is not factored in. All single payer systems are not alike, and governments play with their budgets to assign healthcare related/supported costs to other sectors.

Such comparisons, as by National Propaganda Radio, are specious per se. They admit that US is a "rich country", yet dun us for the amount we spend on healthcare. As a rich country we probably also spend a lot more than others on such as infrastructure, national parks, sugary foods, law enforcement, education, ... . This doesn't say we necessarily spend such monies wisely, just that we can and do, since our system generates enough wealth to support the spending.

[Gregory]

PE 951

Despite not answering any of my questions, you already did.

[Paul Emery]

I have no idea what you're talking about Gregory

[Paul Emery]

So George until we have NPSCs then the first order of business to enact your health care system is to get them going. Any progress by Trump in that direction?

[Gregory]

PE
Read your 951 then my 1040. Cut and paste if needed.

[fish]

Posted by: Paul Emery | 31 May 2017 at 11:06 AM

So George until we have NPSCs then the first order of business to enact your health care system is to get them going. Any progress by Trump in that direction?

Honestly George I don't know why you indulge Paul in these Matlock like antics that he enjoys so?

[Paul Emery]

George

Currently we have around 40% of the US population on some form of Government insurance-Medicare, medicaid, Military Health Care. Under you're plan would you keep those systems or change them?

[George Rebane]

PaulE 1106am - None, he doesn't consult me on such matters ;-) Recall that the above post reflects my druthers on healthcare - no more, no less.

[Paul Emery]

OKay Let me try again Gregory do you have any health insurance and who provides it?

[Gregory]

I already provided you with an answer, Paul. Run with it,or not.

Running with it might include going back and answering one or more of the questions I asked you.

[Paul Emery]

Gregory

Let me qualify my question to you. Do you have health insurance? Is it Private or Government insurance? No need to be specific just choose a category.

[Paul Emery]

I will ask myself that question Paul do you have health insurance? Yes I do-Government insurance-medicare ( you don't have to answer that part (Medicare) . Easy answer

[Gregory]

Paul, that was asked by you last year, and I answered it. Is there some reason you want a new answer? What sort of one-two punch are you imagining?

[fish]

Posted by: Gregory | 31 May 2017 at 11:52 AM

What sort of one-two punch are you imagining?

The one where he tricks the defendant into confessing on the stand just before the commercials from Metamucil, Colonial Penn term life insurance, and some flavor of walk in bath tub start rolling.

A brief epilogue, next weeks preview, and a closing shot of the Quinn-Martin production logo follow.

[Account Deleted]

from Paul _ " Single payer is the way to go. The numbers are in. it is much more efficient than our mish mash of bloated corporate execs and fat preditor lawyers feeding off the scraps. Most national health systems do not allow malpractice lawsuits for example."
Ah - now we're getting somewhere. Paul claims Americans want nationalised health care. Do they know about the fact that they can't sue for millions when the wrong leg is cut off? Do they know their waiting times for procedures will go up? A lot.
Do they know there will be death panels? Are they told how much extra they'll have to pay for deadbeats that refuse to work?
No - I didn't think so.
Paul, you go tell Americans the facts about 'free' health care and it's support will vanish.
Paul is back to getting rid of '...bloated corporate execs and fat preditor lawyers...' What? You mean if they went on a diet you'd be OK with them?
And of course, the crowning glory of single payer - "The numbers are in."
Oh Paul, you'd better check those 'numbers'.
In Kali the cost is double the current budget.
That's the budget that even now isn't sustainable.
Govt run health care isn't going to be efficient.
Nothing the govt does is efficient. Yes, there are things we can do to streamline health care and lower costs. Turning it over to the govt isn't one of those things.

[fish]

Posted by: Scott Obermuller | 31 May 2017 at 12:18 PM

And of course, the crowning glory of single payer - "The numbers are in."
Oh Paul, you'd better check those 'numbers'.
In Kali the cost is double the current budget.
That's the budget that even now isn't sustainable.
Govt run health care isn't going to be efficient.
Nothing the govt does is efficient. Yes, there are things we can do to streamline health care and lower costs. Turning it over to the govt isn't one of those things.

Yes.....and the Medicare that he references above.....already projected to go belly up. It won't go in a huge mushroom cloud....they'll just start stretching things out like you mention! Then they'll start eliminating procedures......looks like the new knees that a former local newspaper man will need soon, well lets just hope he's saved some money so he can fly to India to have them installed. There will likely be some type of "Death Panel" just like Sarah Palin mentioned for Odummy Care. The left knows these things are coming. They just need the recognition to come at a reasonable pace to allow time for the adjustment of expectations!

The crime of it is that Paul will have probably shucked this mortal coil before he gets to see much in the way of changes.

PS: Scott...your 30 May 2017 at 06:53 PM....first rate post!

[Bill Tozer]

Fish penned @ 12:28 pm

"The crime of it is that Paul will have probably shucked this mortal coil.....". Ah, poetry in motion. But, Fish, you fell into the trap. Busted. You really do want to see people die! You just handled Punchy more stuffing for his Strawman.

All this talk about Healthcare is making me ill. Thanks to the last several posts, I now feel much better....and enlightened. All this time I thought Dr. Rebane has a hotline to the God-Emperor Trump. Apparently he claims not too. Or so he says. Learn something new everyday. Unless, of course, Dr. Rebane lied about his hotline to the Oval Office. Hmmm. I am not so sure. Wonder what Dr. Rebane is hiding? How many people will die because of this lie? The plot thickens.

Its all Trump's fault. He is throwing Momma off the train. He hates po folk.

https://patriotpost.us/articles/49377

It's all Trump's fault. The whole Affordable thang may crash and burn on his watch!!

https://patriotpost.us/posts/49282

Forget the article. I just liked the picture.

https://patriotpost.us/articles/49343

[Gregory]

BT you missed a good one, cultural appropriation is a serious charge!
https://patriotpost.us/memes/49378

[Bill Tozer]

@ 1:02 pm

Gregory, pleazze! I am trying to stay on topic (focused and disciplined), but good one nonetheless. I shall overlook your transgression (and mine) and remind the reader that my thoughts on the comedian's prop just got posted in the proper place, aka, The Sandbox, for all the world to see.

Good one Gregory. :). Now, back to the multitudes dying in the streets on a daily basis while inconvenienced passerbys impatiently wait for the meat wagon to haul the sorry caucuses away.

[fish]

Posted by: Bill Tozer | 31 May 2017 at 12:59 PM

"The crime of it is that Paul will have probably shucked this mortal coil.....". Ah, poetry in motion. But, Fish, you fell into the trap. Busted. You really do want to see people die! You just handled Punchy more stuffing for his Strawman.

Look around Bill......Punchy is surrounded for miles in all directions with straw with which to stuff full his rhetoric! He hardly needs any more from me!

And no I don't want to see people die.....I merely observe that he will likely go before his favorite government program does.

[Bill Tozer]

Fish, I really did not really think you want to see people die. Punchy threw that mud on Todd and Scott. I just ran with it with that mortal coil shucking stuff. I don't want to see people die either. No thanks, I have seen enough. Better to read about it than witness it. Nah, strike that. I don't actually want to watch people die, but some I will not miss. :)

[George Rebane]

For the interested - the 'single payer' discussion can also continue under the next post 'Single Payer Siren Song'.

[Bill Tozer]

Famous Dem activist and knowledable leader speaks. She wants old Democrats to die. Geeze, dying is just part of life.

Money quotes:

“The Democrats f*cked up so bad in their message, and how old [the leadership] is,” Cher said. “You’ve got to pray that old people die before young people can get involved with the party.”

"The president is cheating and getting away with it, and using the White House to make money, and he’s going to take health care away from people, and people are going die. It’s outrageous,”

This one sounds familiar. Sounds like....The Punch Drunk One. Music types are strange birds, I reckon.

"Earlier this month, Cher compared Trump to a “mad King George III president,” called Republican House members “inhumane,” and predicted millions of people would die as a result of the recently-passed American Health Care Act."

Pssst, Music types. The Senate has not even considered the "recently-passed American Health Care Act" yet. Stupid is as stupid does.

http://www.breitbart.com/big-hollywood/2017/05/19/cher-on-the-election-the-democrats-fucked-up-so-bad-in-their-message/

[Paul Emery]

Okay crew. A good friend of mine adopted two brothers at a young age that have cystic fibrosis, a genetic disease of the lungs. She has received government assistance to raise the boys and they have had their medical needs taken care of by federal assistance They are now in their early 20's. They have been informed that they will likely lose their medical coverage since they are over 21 and will likely not qualify for insurance because of pee-existing conditions if Obamacare is repealed. Do you believe it's an appropriate use of "other peoples money" to assist those boys while growing up with their medical and caregiver neesds and what advise do you have for them if they cannot purchase insurance under Trump care. This is real stuff happening in our community.

[Bill Tozer]

Punchy:
Trump said, as most all other legislators have said repeatedly, that preexisting conditions coverage will remain entact. Is that so hard to wrap your mind around?? Your operative word here is "if". But since you feel so strongly about your friends of friends, by all means cut a check for the family as a token of putting your money where your mouth is. Then start a GoFundMe page and use any influence you have at the little radio station to raise community awareness (and good ole Yankee Dollars) and start one of those KVMR fundraisers for your friends of your friends. Think Globally, Act Locally and all that stuff. You can do it Punchy. No time to gab, get on it. We are all counting on you. Don't be a miser either. Cut that family a big fat check. Lots of zeros on it. Be our example and make us proud or we are all going to die!

Then run over to Dr. Rebane's newest post and tell us how Single Payer will cure all ills.

[George Rebane]

PaulE 508pm - If that 'other people's money' is just laying around doing nothing and has no alternative value to its owners, we could consider using it to continue the boys' health care coverage. However, if those same 'other people' had different goals and aspirations that the money was being saved for, then you'd have to talk to those other people to see if they would volunteer their funds for the afflicted you describe. Or would you suggest taking the money in any case at gunpoint?

[Account Deleted]

"They have been informed..."
By whom?
As Bill pointed out - what's the problem with all of the millions of 'compassionate' Americans that Paul claims can hardly wait to spend thousands of dollars a month to help others?
from Paul -
crickets

[Paul Emery]

George these are lifelong conditions. To abandon people who have genetic illnesses to A life of begging for maintenance healthcare is cruel beyond my comprehension

[fish]

Posted by: Paul Emery | 31 May 2017 at 07:20 PM

So if we were to restrict government interference to those with lifelong genetic disorders that would be acceptable? We could do away with medicare....after all life is eventually fatal....palliative care only! ObamaCare....goes away and we throw it to the market?

[Don Bessee]

Po' ol' PE's problem is that sanity has broken out in the country and socialism sucks. I hope madam liar liar pantsuits on fire keeps on her they all lost her entitled election tour. Great show of the leadership in demland.

Bloomberg comes out and says the President is on the way to reelection. I did not see that one coming from the nanny state mayor. ;-)

[Gregory]

Paul, one word... bullshit.

The House bill as I understand it allows portability without a surcharge for existing conditions and folks with existing conditions who hadn't been insured recently could still enroll with a hefty but still reasonable surcharge for a year or so.

Please, enough with the fake news.

[Paul Emery]

So Gregory any speculation how much insurance could cost? The regular treatments for folks with that disorder are very expensive and involve hospitalization for three or four days at least a couple times a year. The treatments have increased the life expectancy for that affliction from less that ten years to low 50's as long as they have regular treatments.

What insurance company would take on covering such an affliction? Any ideas how free market health care would handle this condition?

[fish]

Posted by: Paul Emery | 31 May 2017 at 09:22 PM

Always asking.....never answering!

You never disappoint.

[Bill Tozer]

Punchy @ 5:08 pm:
And if bullfrogs could fly, they wouldn't bump their rumps on a log.

Oh Punchy, I just love your incredulous indignation, moral outrage, and justifiable disgust with us. Oh, please, lay it on thick and hit me with that rhythm stick.

Kind of changes things when you put a face on it, eh? I do remember the same outcry and righteous outrage you went on and on about over Chris Stevens and those other three handsome faces that were neatly swept aside in the prime of their lives insome place called Benghazi.

Who could ever forget how upset you were and carrying on so. Just ask the boys here. They all remember your justifiable anger and moral condemnation of tired Hillary going to bed, Obama hatching the story that those men died because of an internet video that did not go viral, and Honest Susan Rice from the UN carrying the water on all the Sunday shows 50 days before the election.

Yep, it all changes when you put a face on it and it hits close to home. Funny how that works. Come to think about it, all I heard from you was crickets, "I did not vote for Hillary", and nothing to see here.

We remember.

[Gregory]

Paul, there is a will, there is a way. Some will always be in some sort of high risk pool, or an extension of medicaid.

Or the House and Senate bills will go nowhere and Obamacare will continue to melt down, only without Dems in charge at the ready to pour Single Payer into place.

[Bill Tozer]

Gregory, hard to reason when the other party is running on fear. Fear: False evidence appearing real. But nice effort trying to comfort the unconsolable. It's the thought that counts.

https://www.facebook.com/lastamericapatriots/photos/a.235087906641439.1073741826.235086849974878/859431284207095/?type=3&theater

That isn't the same friend that Punchy took to the ER to remove a solitary tick, is it?? I certainly hope not.

Back to we are all going to die.

[Paul Emery]

Didn't vote for Hillary bill Look out you're starting to dribble

[Bill Tozer]

Paul, we all know you did not vote for Hillary. You have made that clear. Nobody is asking you to defend her. Nobody. What leaves me in bewilderment is that you withhold condemnation of one side (crickets) and condemn another side with abandon, mostly reckless abandon.

We all know you did not vote for Obama the 2nd time around. What used to puzzle me is that you slammed Bush on every occassion possible with impunity, but withheld the same moral outrage for Obama when he pushed the envelop further than Bush. Silence on Obama spying on millions of American citizens, silence on Team Obama colluding with Russia, silence here, silence there, everywhere silence. Nobody is asking you to defend Obama. Just would be nice if once in a blue moon you would exhibit the same shock and horror for both sides. Otherwise you come off as a one trick pony, just another partisan hack which you apparently are, were, and always will be.

Did your friend survive the harrowing experience of going to the ER to have a tick removed? It's a jungle out there, Punchy.
Stop the presses. Bush did it too! And McCain (whom you voted against) said this and that about Trump. It must be the gospel. He's unhinged....McCain that is.

Did notice that the House Intel Committee has subpoenaed 3 key players of the Obama Inner circle in the unmasking affair. Crickets. Nixon's boys broke into an office. Obama's crew was spying on a whole opposition campaign for months. Crickets. Bush did it too! Not.

Not defend, just be an equal opportunity condemner. Use the two edged sword every so often. Might help with your credibility issues. Or, not.

[fish]

Posted by: Bill Tozer | 01 June 2017 at 08:33 AM

......shhhhhhh.......don't blow it for the "Green Libertarian™" If he loses his superhero cloak of impartiality we won't take him seriously.

[Paul Emery]

Bill the Dribbler

Lets continue this discussion elsewhere. This post is about health care. What does Benghazi have to do with the topic at hand. You always do that, change the subject when cornered.

[Bill Tozer]

Lol! Yes, Punch Drunk One, I strayed off topic. Merely comparing your " to abandon people who have genetic illnesses to A life of begging for maintenance healthcare is cruel beyond my comprehension." with you response to abandoning our American citizens (one a life long Lefty) in Benghazi. One response is cruel beyond comprehension, the other is "I didn't vote for Hillary." But, of course I strayed off topic. I must be cornered. Gotta get up pretty early to get one over on you.

Oh, who is kicking your friend's two sons to the curb? Remember, we are still 100% under Obamacare and nothing has changed. But, if, if, if, what if?? Guess we will cross that bridge when we get there. Until then, your friends' friends are under Obamacare, aka, The Patient Protection and Affordable Care Act. Patient protection and affordable! What more could you possibly want? Your friends are covered, all those guests of the Hospitality House are covered, everybody is covered. Sure, some refuse to sign up and get with the program, but there are always those types in every crowd. They will be dealt with later I reckon.

Hopefully there will a smooth transition from Obamacare to whatever is next over a couple of years with much debate and transparency and preparation. No surprises is best. Tell you friend that she (assuming her gender is female, but you never know nowadays)....er...tell your friend that the US Senate had not even considered any health care bill to date, so nothing has changed that is not already the law of the land. Explain to her that until it passes both the Senate and the House of Representatives and is sitting on Trump's desk, then signed by the President of the United States, nothing changes. That should help relieve her fears and fretting about all the "what ifs" and put an end to her stressing over hypothetical situations.

So, how was that trip to the emergency room to remove the tick? I assume all went well. Bet it cost a fortune. BTW, nowadays the doctors and CDC say to pull out the tick yourself with a steady straight pull, put it in a plastic bag for the doc to identify (and its legs), then schedule an appointment to come in and get some antibiotics if necessary if a bullseye looking red rash appears in a couple of days or so. Boy, they don't panic about ticks like they used to.
Guess that is why they call it practicing medicine. Yesterday's fire alarm is today's yawner.

[Paul Emery]

The story behind the emergency room tick was to illustrate the bloated costs hospitals pass on to insurance companies for medical services. She was concerned about Lymes disease and went to the emergency room. It was on a Sunday and being a few years ago Yuba Docs was not open on Sundays. She had the tick removed and was at the emergency room for around two hours total. Being a school teacher she was covered by Blue Cross. when she got the bill passed on to Blue Cross it was for a whopping $1350. That expense was paid by insurance but what a rip off. Bloated profits for the hospitals and insurance which probably got a cut on the deal.

A couple years ago I had a tick bite and went to Yuba Docs. Total cost $165. End of story. No wonder insurance is so expensive.

[Paul Emery]

By the way Bill as a boxer I would have won my last fight but the referee stepped on my hand.

[fish]

Posted by: Paul Emery | 01 June 2017 at 01:40 PM

Bloated profits for the hospitals and insurance which probably got a cut on the deal.

Actually.....the excessive costs are more to cover freeloaders who go to the ER and then skip out on the bill.

[Paul Emery]

That's what happens when there is no universal healthcare insurance.

How come Yuba Docs doesn't charge that?
I appreciate the bad position the hospitals are in on this situation. What are they supposed to do when someone is dropped off with a broken leg or a heart attack?

This is a conversation we should be having Fish

[fish]

Posted by: Paul Emery | 01 June 2017 at 02:09 PM

This is a conversation we should be having Fish

Why?

The discussion will always come back around to you insisting on a top down, government administered single payer health care system. You will accept nothing less and can see no other option. Health care costs started spiking, not coincidentally, when the government insinuated itself into the mix. Used to be able to have a baby in a modern hospital and pay for it with two weeks wages. Now after 75 years of government health it costs 80K and that's if nothing goes wrong.

Why doesn't Yuba Docs charge that.....probably because they've minimized the receipt of government money for the work they do. No gov money...no gov hoops to jump through. Cut their paperwork and reporting burden by 90%.

That's just a guess though....why don't you ask them Paul?

[Gregory]

Paul, you're not having a conversation with anyone, just the usual jabbing and punching.

A couple years ago I had a tick bite me. I removed the tick, swabbed the area with betadyne, watched for the tell tale sign of a Lyme infection over the next few days. Cost was virtually zero.

Yubadocs doesn't charge $1k plus because an ER doc isn't sitting there ready for an ambulance to drive up with a couple of gunshot victims or a heart attack victim, or drug overdose, or .... ER... meaning Emergency Room. Don't go unless its an emergency.

[Paul Emery]

This happened several years ago and at that time the word was have it taken out and take some pills. The story just illustrates one example of Emergency Room healthcare as recommended by Mitt Romney four years ago.