My friend Kerry introduced me to that warped version of the Golden Rule. It jumps to mind when I read Democratic Presidential candidate John Edwards's proposal to mandate preventive care as part of his universal health care plan [Amy Lorentzen, AP writer, "Edwards Backs Mandatory Preventive Care," Yahoo News, 2007.09.02].
"It requires that everybody be covered. It requires that everybody get preventive care," [Edwards] told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. "If you are going to be in the system, you can't choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK."
Stunning, and disturbing. We don't require Medicare and Medicaid recipients to submit to doctor's examinations on a regular basis. Canada and other nations that have adopted single-payer universal health care don't force citizens into the doctor's office. Why would Edwards think a similar system to cover all Americans should require such examinations? Many readers who register their opposition to this blog's support for a single-payer system fear government control; Edwards is stoking those opponents' fears and not helping his (or this blog's) cause.
There lies one problem with some universal health care proposals, a problem this universal health care advocate will grant. If we taxpayers are shelling out the gold, then we taxpayers have a claim to making some rules to keep costs down. Cost cutting is one of the prime reasons the Madville Times supports universal health care. Cost cutting is one of the biggest advantages of HR 676 by Democratic Presidential candidate Dennis Kucinich, who proposed universal, single-payer, not-for-profit health care back in 2004, when Edwards remained silent on the issue.
But notice that the Kucinich proposal cuts costs without forcing citizens to submit to medical examinations. Edwards, in his apparent adherence to the warped Golden Rule, makes universal health care look like classic nanny-state politics, the kind of proposal that will allow the right-wing naysayers to scare everyone away from a more efficient and just health care system.
Kucinich follows a better path, showing that universal health care can actually follow the original Golden Rule, providing assistance to everyone else the way you would have them assist you.
As the Zaniya Project prepares its final report for the Legislature, let's hope they listen less to Edwards and the chorus of Limbaugh-parroting lambasting his mandatory preventive care proposal will elicit and more to Kucinich and his proposal for taking the immoral and deadly effects of profit out of the system and putting the care back in health care.
"the kind of proposal that will allow the right-wing naysayers to scare everyone away from a more efficient and just health care system"
ReplyDeletePlease explain again to me how exactly you consider it just to take (by force) $10 from one person and $1000 from another, and give both of them the same level of health care. How does that fit the (original) Golden Rule? I apologize for being such a slow learner... you keep saying things like this but I must have missed the post where you explained how universal health care is unquestionably moral.
The same way society justifies taking $10 from one taxpayer and $1000 from another to pay for roads that everyone uses equally. The same way society justifies the same differing tax assessments to provide equal police protection to every citizen. I continue to welcome questions about the morality of universal health care. I contend it is certainly more moral than a system that judges the worth of a life by how much money one has and what pre-existing conditions can be used to exclude one from coverage. Universal health care: everyone pays, some more than others, and everyone gets service, some more than others. If that system is immoral, then so is the rest of the social contract, and we might as well head for the forests and fend for ourselves.
ReplyDeleteSo would you favor universal health care if it were funded solely by sales tax? Would you prefer funding it by sales tax rather than income tax?
ReplyDeleteI'd have to think about that one. I'd want to analyze whether the harm of increasing the regressive sales tax would outweigh the benefits of creating a universal health care system.
ReplyDeleteOf course, it may not matter, since Kucinich's health care plan saves money. Whatever funding source we use -- sales tax, income tax, blogger tax -- we'll have more money in our pockets thanks to getting rid of the 20% overhead insurance companies create through their free-market bureaucracy and profiteering.
Definition: A regressive tax is a tax imposed so that the tax rate decreases as the amount to which the rate is applied increases.
ReplyDeleteHow is sales tax regressive? It's a flat percent based on the amount of the purchase.
Pushing preventative care is a lot more likely to reduce the cost of healthcare than a single-payer system. The claim by Kucinich of 350 million in administrative savings, even if true, would be a pebble in the pond of $1.9 trillion (2004 US heathcare expenditure) A number which would only go up under that plan (even if only by 1% that would wipe away those administrative savings). By socialized medecine's very nature you would be removing all incentives for improving medicines and treatments, as well as the incentive to reduce costs. Your blinding yourself with your goal of equality.
ReplyDeleteI get very tired of the backbiting humorless old ladies in my office who are always getting upset over some perceived injustice. They care more that everything is fair than they do about actually doing a good job. So screw equality when it comes at the cost of a success that helps everyone. Equality is not the highest ideal.
Profit must stay in the system because all people aren't by nature altruistically driven. The world isn't perfect and it is insane to try a healthcare plan that could only work in one that was.
Phaedrus: Insurance already destroys incentives, as people figure "the insurance company" pays for it. Universal health care is no worse, possibly better on that account, since it's no longer a third party profiteer but our own government (don't forget: the government is us!) footing the bill.
ReplyDelete"removing all incentives"? Oh, Phaedrus, settle down. What about the incentive of reducing suffering, being healthier, and staying out of the hospital? People aren't that eager to go to the hospital and take drugs. Researchers aren't that eager to drop their research and go work on Wall Street.
David:
ReplyDeleteRegressive Tax
definition: "a tax such as a sales tax that applies equally to every purchaser but which results in taking a larger percentage of income from a low-income person than from a high-income person"
definition: In an absolute sense, this is a tax in which the rate falls as the taxable base increases, as with early Social Security. In a relative sense, it is a rise in total taxes paid as a percentage of one's income, as with most property and sales taxes.
definition: Tax with a ratio of taxes to income that reduces as a person's income increases. Poor people therefore pay a larger proportion of their income in taxes then richer people.
Correction to Phaedrus: Kucinich finds savings of $350 billion, with a b, enough to fund another 29 months of the Iraq occupation.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteDefinition: A tax that takes a larger percentage of the income of low-income people than of high-income people.
ReplyDeleteDefinition: Tax that takes a larger portion of income from low and middle income earners, than the wealthy individuals.
Definition: A tax system that provides that average tax rates decrease with increases in individuals' income brackets.
Definition: Average tax rate decreases as a taxpayer's income increases.
Definition: A tax system that provides that average tax rates decrease with increases in individuals' income brackets.
Definition: A tax the rate of which increases as the taxpayer's income decreases.
Sales tax is not, by definition, a regressive tax. The percentage of tax that a poor person pays on his bananas is the same as the percentage a rich person pays. The argument, if I understand it correctly, is that the 6 cents paid for banana tax is a higher proportion of the poor man's income than the rich man's income and therefore sales tax is quasi-regressive. A flat sales tax is definitionally, a proportional tax... as the retail value on a product increases, so does the tax. A true regressive tax would be like an income tax that taxes poor people 20%, but rich people only 15%.
But I'm not buying the argument that a sales tax is even quasi-regressive. Money is used to buy things, and the rich person will pay 6% on his new mansion, just like the poor person will pay 6% on his banana. Both purchase according to their means. Both pay 6% tax on their purchases.
Basic necessities I could see being exempt from sales tax... milk, bread, rent, clothes from Goodwill, and anything in the produce aisle (ie bananas). Sales tax should be collected off of non-necessity purchases... and if we're funding health care, we should collect more from unhealthy purchases (cigarettes, liquor, scuba equipment) than from healthy ones.
When essentials are taxed (and they are in SD), you have to grant that the sales tax is regressive. Think of it from the perspective of an increase in the sales tax: an extra penny sales tax hits rich and poor alike. Consumption is not necessarily proportional to income, especially on basics like food. Even Bill Gates can only eat so many bananas.
ReplyDeleteSuppose a poor guy's family eats $5000 worth of food a year, while Bill and Melinda Gates eat $10000 worth. A 1% increase takes $50 more from the poor guy's family and $100 more from the rich guy. But that $50 for the poor guy means one less trip to the restaurant and the movies for his family, and if he's poor, he may already limit family outings to just a couple special occasions a year. That's a much bigger hit on his budget than the rich guy's loss of $100. Smaller amounts are still more precious for poor guys. That's the heart of the regressivity.
By your analysis Cory, because the poor people spend such a high proportion of their income on basic living expenses, any tax applied equally to them will be regressive. We would have to tax the rich enough to eliminate all of their money beyond their living expenses before it would have an "equal" impact. But what does that matter when your social contract is there to make everything better :P
ReplyDeleteI'll agree that insurance can inhibit incentive as well. But that is usually when it is provided to people through their job "at no extra cost" I do not think it does anything of the sort when people actually pay for their insurance.
ReplyDeleteDefinition: $350 Billion = Somewhere over the rainbow
Definition: Kucinich = The Wizard
Ok. So exempt (real) food. Exempt Goodwill clothes. Exempt rent. Problem solved. Now will you back a sales tax based universal health care solution?
ReplyDeleteAlso... (and more importantly)... if the government is so great at administering health care, then how about instead of forcing everyone into a single-payer system, why don't we just let the gov offer their own voluntary insurance plan and have them compete in the free market against the private insurance companies? People can choose (or not choose) the Fed's Health Plan and sign up for extra income taxes. Doctors can evaluate the Fed's reimbursements and decide if they want to accept Fed Health patients or not.
ReplyDeleteIf this voluntary government-run health plan really is superior in administration, reimbursement, and customer service, it will quickly become a de facto universal health system merely by running the private companies out of business by fair competition.
What do you think?
David: A sales tax with a basic exemption -- now you're talking! It would certainly be an improvement over SD's current system. Assume everyone needs $10,000 for basic survival. Exempt certain sales, or simply send every citizen an annual "refund" check for $700, whichever costs less to administer. I can work with that, especially if it funds universal health care.
ReplyDeleteDavid: Universal health care with govt competing in the market -- I welcome further analysis on that proposal! I think some candidates do propose letting private citizens buy into the federal employees' health care plan. Of course, part of the cost savings Kucinich calculates come from eliminating the bureaucracy for hospitals of dealing with 300-odd different coverage providers. The govt already is one of those providers through Medicare/Medicaid and FEHBP, so your proposal wouldn't increase paperwork, but it wouldn't produce the same savings as the single-payer system. Interesting....
Phaedrus: no tax is perfect. Being rich will always have perks (and should). But we can make the system fairer.
"your proposal wouldn't increase paperwork, but it wouldn't produce the same savings as the single-payer system. Interesting...."
ReplyDeleteIf the government plan truly is the best plan, most people will cross over to it from private plans, most private plans will disappear or consolidate, hospitals will have fewer payers, and thus less paperwork. My proposed voluntary Fed Health plan should have every administrative advantage of your proposed involuntary Fed Health plan... and if it truly is a better system it will beat the insurance entrepreneurs at their own game. But the gov plan must only be funded by the voluntary taxes they take in from their plan participants (which would have to be either an income or property tax). They can't be allowed to cheat using tax money from non-plan participants. They also can't be allowed to cheat using laws to force doctors to participate in their plan.
Then if the private insurance administration rate of 30% is actually exorbitant (as you suggest with undocumented allusions to Porches and yachts), the gov should easily be able to put out a health insurance product with just as good customer service and provider reimbursement at a better rate.
I would be much happier to see the free market cleaned up using honest competition rather than using force of law to deny citizens the liberty to spend their money (and take care of their bodies) the way they see fit.
And that parenthetical remark sounds like something you said to me not so long ago in a different topic.
"undocumented allusions to Porsches and yachts"?!?! Arrgghh!! How many links do I have to include in my previous posts to outdo the various Anonymi still evidencelessly fighting the Cold War against socialism to prove my point? Anyone clicking on the "health care" label in the sidebar can count for themselves which side of this debate provides more evidence, if that count matters.
ReplyDelete"Anyone clicking on the "health care" label in the sidebar can count for themselves which side of this debate provides more evidence, if that count matters."
ReplyDeleteI agree you do document your stats better than your commentators. Now how about addressing the substance (rather than the parentheses) of my last post?
I'm so tired of the whining that the poor pay a bigger percentage of their income in taxes than middle class or rich. Ha! Given the perks they receive for being poor (earned income credits, subsidized housing, free or reduced daycare, free or reduced school lunches, Medicaid, Chips program, no federal income tax, no alternative minimum tax which BTW is starting to affect more and more middle income people), they don't pay much in taxes. Some are poor by their own choice, laziness, etc.
ReplyDeleteAnd now I heard that if the Chips program is expanded the way some want, people who earn enough to get hit by the alternative minimum tax will also be eligible for the Chips program (free medical care for kids)! This makes NO sense whatsoever.
"the perks... for being poor" -- oh, so true! That's why everyone is flocking to throw away their money and live in poverty, right?
ReplyDelete...not to be accused of lacking references...
ReplyDeleteNonnie, are you also poor? Your rant sounded an awful lot like whining ;P Although I agree that they, the poor and middle-class, have little cause to complain about taxes from the federal government. State and local taxes can be destructive for them sure, but other than social security withholding, the Feds don't take much of anything...and if you want to eliminate that part for them I'm all for it. It isn't like SS is solvent anyway.
Since Cory and David are talking about a sales tax I have to know what you think of the Fair Tax. This becoming law would make me even happier than if we had gotten private retirement accounts =)
Also, returning to the subject of universal healthcare, I would like to know what you think of this interesting plan. I just stumbled on it and it actually reflects some of my own thoughts.
Maybe perks isn't the correct word. But consider this. A couple gets married very young, has a baby after being married five years, so that much is good.
ReplyDeleteBut in these intervening five years the guy goes to college part of a year, quits, goes again and gets poor grades and drops out after having charged ookoods of his cost of schooling on his credit card. He refuses to get a job that pays well or has benefits. His wife only wants to work at a daycare with also no benefits and low pay. They move back to their hometown, take identical low end jobs with no benefits by choice. He then decides to go to college again and this time will probably complete a degree but isn't in any hurry to get it done. Their credit is below zero because of their huge credit card debts which they are not paying BTW and don't intend to.
Now they have a baby. OK, baby and mom are on Medicaid/welfare. Child care is free as she works there plus are so low income that she doesn't have to pay anything. They pay no income taxes, never have, and at this rate never will. But they will probably get back an earned income credit.
Now this couple has by choice worked at low end jobs with no benefits, have squandered their credit rating with no intent to repay those charges, planned a baby at gov't expense, and are poor as a result of their own decisions.
I'm sorry if I see something wrong with this scenario. They choose to live the way they do, and they are being subsidized by those of us who choose to work harder and make better decisions. In this case it's not a case of bad luck, it's a case of choice. And pardon me if I don't feel sorry for people like this.
And now you want me to subsidize their complete health care too? I don't think so.
Phaedrus: A national sales tax that replaces all the other federal taxes is worth considering, especially with the built in "prebate" to ease the regressivity. I'm open to discussion of various funding sources for universal single-payer health care, although let me say again, we may not need additional funding, since universal health care takes less of a bite out of GDP than the private-profit system.
ReplyDeleteBlandford's plan:
Good: rebates for choosing less expensive procedures (currently prohibited by SD law, as we discovered when we asked for ground ambulance instead of more expensive air ambulance and saved the insurance company $5000 and asked for a cut of the savings)
Bad: expectation that patients in emergency situations will have wherewithal to take a few minutes to go online, review price lists from several medical facilities, and rationally choose the cheapest locations and procedures to get a rebate from the insurance company.
Bad: HSA/HFA -- current system, at least, doesn't help low-/middle income folks who take bare-bones high-deductible plans because they don't have the budget for higher premiums, let alone investing significant chunks in savings.
Good: $2000/yr until age 21 from govt into each indiv HFA. Will that be enough?
Alternative: Blandford leaves sick kids at disadvantage, since they burn up their HSA by age 21 and don't have that nice nest egg to start with. Why not SCHIP every child until 21 (or 18, or college graduation), then put one lump sum in HSA, so every adult starts at same level, regardless of youth health history?
Curious: why exclude auto accidents from catatrophic insurance?
Questionable: Blandford's reliance on market forces in a field where market forces do not/can not play out normally. People break legs, get cancer, even have babies independent of rational decision-making or response to marketing. And in South Dakota, in most towns, there isn't choice. Just like school-voucher talk, much of this plan sounds like big-city talk, lacking small-town, rural perspective.
Good: taking responsibility for coverage off employers -- global competitiveness (also an advantage of universal single-payer)
Good: "The patient could use any doctor or hospital in the US" (also an advantage of universal single-payer)
Good: requiring price lists -- such data is practically impossible to obtain from the immediate health care providers now
Questionable: what good is a price list when patient is unconscious?
Silly: "Having the MA pay from the HSA only up to the 50th percentile reduces the possibility that some patients would rapidly spend their voucher mostly for the prestige of being attended to by famous doctors or by expensive 'society' doctors. In addition, this mitigates the possibility that some doctors might purposely raise their rates to attract such poor customers and thus, indirectly, raise the overall costs of healthcare." -- name one famous doctor in South Dakota to whom folks from Edgemont to Peever would all flock for the prestige of a touch from her/his healing hands (Jud "The Godfather" Bergan doesn't count).
Lots to read... I need breakfast!
Hmm... mandating 5% savings rate. What impact does that have on an economy surviving on consumption fueled by a negative savings rate? Any different from the impact of high medical care/coverage costs, or transferral of insurance premium costs from private industry to govt tax?
ReplyDeleteHSAs -- still basically a gamble, and when you gamble, the house always wins. Under the private-profit insurance system, insurance CEOs are the house. Under universal single-payer, we are the house.
No, Phaedrus, I’m not poor. Not rich, but definitely not poor. I might be whining, but it’s not whining because of being poor. My whine is directed toward those who constantly chant the mantra that the poor pay too much in taxes. My point is that they don’t. They also have some responsibility to pay for the services we all use which are provided by the gov’t for the common good, but they don’t pay much for those either.
ReplyDeleteI like the fair tax BTW. Of course, that probably doesn’t fall in line with the left’s plan for socializing the country and raising taxes (but not on the poor of course!) What happens when the people who pay the taxes in that case get tired of doing so and quit working so hard and making money and paying taxes? What happens when no one wants to work?
And I was very much in favor of taking part of the Social Security contributions and putting them in private accounts. Federal employees already have this option. My hubby is retired from federal service and his private contributions earned far more toward retirement than his Social Security contributions. It’s too bad that the politicos denied this to the rest of the general population. My kids are not planning to retire on Social Security; they are contributing to their own IRA’s etc as they don’t think that Social Security will be there for them. They will be OK, but most young people don’t think that far ahead.
"What happens when the people who pay the taxes in that case get tired of doing so and quit working so hard and making money and paying taxes? What happens when no one wants to work?"
ReplyDeleteNonnie, have you been reading Atlas Shrugged? :-)
Nonnie: "What happens when the people who pay the taxes in that case get tired of doing so and quit working so hard and making money and paying taxes? What happens when no one wants to work?"
ReplyDeleteFrance
Cory: "HSAs -- still basically a gamble."
ReplyDeleteHow on earth is it a gamble? The government doesn't get that money, insurance companies don't get that money, nobody touches that money but you. You are only restricted from spending it on anything other than medical care. When you reach age 65 you can use it like a 401k. The only risk is the gap between the amount of HSA funding you have and the insurance deductible. Once I have $5000 in my HSA my medical expenses are 100% covered under many plans that are quite affordable to those middle-class families you say would not benefit. By my logic they are far superior to regular insurance policies, especially those provided by the employer, where the cost of the premiums paid by that employer and to varying degrees by the employee, exceeds what would otherwise be spent. The HSA returns insurance back to what it is supposed to be: coverage for the unforeseeable disaster in life that might happen, instead of what it is now: A lottery ticket that somehow should by moral necessity manage to give more to everyone than anybody ever pays for it. And better than a singe payer system would make it into: A security blanket entitlement that people get for "free" from the government. Bereft of any broad motivating factors for improvement. It's like Soviet Marxism at its worst.
Russia BTW still has some of the worst health outcomes in the industrialized world, their healthy life expectancy is actually lower than North Korea.