More Republican Congressmen Face Town Hall Backlash Over Tax Breaks For Wealthy And Medicare Privatization

[twa]

WOW ...that CBO report Bac linked earlier ......garbage in garbage out

http://www.washingtontimes.com/news/2011/apr/21/cbo-declares-war-on-ryan-budget-plan/

the Ryan plan offers low-income seniors an additional $7,800 annual medical savings account to help with out-of-pocket expenses, bringing the average benefit for low-income seniors to $22,800 before inflation adjustments. Amazingly, the CBO authors confess omitting this from their calculations. Their dire warning that low-income seniors would suffer is completely baseless.

In truth, only wealthy seniors will have to pay more out of pocket under the Ryan proposal. The top 6 percent of earners among Medicare beneficiaries will get less help with premiums.

[DRSmith]

How many people stay on welfare that can actually go out and get a job?

My brother-in-law was jobless for a while and on unemployment. When he finally found a job, he was bringing home after taxes less than he was bringing home on unemployment.

Thankfully he found a better job and is now making more money, but they're by no means financially secure.

Again, in a flat-tax system, If I make more than you, I still give more money in taxes than you do. 20% of 100,000 is a whole lot more than 20% of 40,000.

What you seem to have a hard time understanding is those who make less need more of their check to get by those who have more need a smaller percentage of their check, funny how many people have said they have no problem with the higher taxes it is those who pay the talking heads on am radio that complain and get the not so thinking masses to go along with them.

[Larry]

You trust the govt to administer single payer yet question whether they will deprive the elderly with vouchers?

The Ryan plan assumes that the government will deprive the elderly with vouchers.

Depriving the elderly is listed as one of the advantages of the system*. "Look how much money I'll save, if we just don't pay for their medical care, like we do now!"

* Well, that and taking a government program and replacing it with one where (more) corporations can make a profit from the money. Cause that's really the biggest problem with Medicare right now: Not enough companies making money off of it.

[twa]

No ,it assumes competition will enable lower cost and better service ,while giving choice

the MSA is a nice touch,strange how that was left out of the CBO report

[Larry]

No ,it assumes competition will enable lower cost and better service ,while giving choice

No, that's the slogan for why he's adding another layer of corporate profit to the system.

Now, maybe he assumes that adding another layer of big corporations will cause better health care while prices go down. But there's an awful lot of history that says the exact opposite is what actually happens.

(Let me guess, now. Time to trot out the "but the government has never, ever, completely ceased to exist, therefore I can (and will) claim that all of the past history is the government's fault" line?)

[twa]

Has the current Medicare scheme reduced costs?

Do you believe reduced payments to providers will result in the same benefits?

[Stillers6SB]

I think the confusion arises from whether "ending Medicare" means "eliminating health care assistance for the elderly", or whether it means "replaced by a means-tested system of rationed health care". The first is something I haven't heard anyone propose, while the second is essentially what Ryan is pushing.

Whoa....DEATH PANELS!!!!!

[Larry]

Has the current Medicare scheme reduced costs?

Do you believe reduced payments to providers will result in the same benefits?

(Assuming this was a response to my post).

Nope. And Nope.

But I don't see anybody claiming that they want to increase the deficit, right now, and we can afford it because costs are going to magically go down, later, so we can afford it, either.

I have to say that, I now it sounds scary, but the only way I see medical costs for the elderly going down, is if we stop paying for some things we're paying for now. We may have to rethink the idea that we have to do anything to keep Grandma (nominally) alive, no matter what the cost.

My Dad has been in a nursing home for five years. It's possible that he may be in one for another five years. The government's not paying for it, Dad is. (Well, I am. But I'm paying for it by writing chacks from Dad's bank account.) But if Dad didn't have as much money as he does, (or if he'd done what the estate planner wanted him to do, 10 years ago, and put his assets where the government can't get at them, so he could look poor), then the government would be paying for it.

He will never get any better. He'll never be able to stand up, let alone walk. He's gone blind. (Nobody really knows why.)

His nursing home, and his prescriptions, are costing him about $9K a month. (I assume that, if the government were paying, they'd be paying considerably less.)

Which, frankly, also raises a lot of other questions, for me. I know from experience that, in other areas of health care, it's not at all unusual for the "cash price" for a service to be triple the "government price", or even more. Assuming that the same rule applies to Dad and his nursing home, is Dad really paying that nursing home $9K, when the Medicare patient in the bed next to him is paying 1/3 that? If the nursing home is willing to take $3K a month from the government, and can make ends meet for that price, then where do they get off charging Dad $9K for supposedly the same thing?

I also wonder if the reason Dad has lived so long, compared to many of the other people in that nursing home (He's had at least 5 room mates die in the time he's been in there) is because the nursing home is making so much money off of him.

Eventually, Dad is going to go broke. At that time, Medicaid will start paying. At that time, will the nursing home suddenly decide that he has to leave? Will he die a few months after his bank account is empty?

Sorry. depressing subject.

He's, well, I can't say "happy", but "content" seems to fit. He lays in bed with the blankets over his head (he's always cold), and sleeps until they come and get him for breakfast. They get him into a wheel chair, they wheel him to breakfast, he eats, and then he wants back into bed, instantly. (If they don't put him back into bed quickly enough, then he tries to do it himself. About once a week, he tries it, and fails. But he doesn't seem to be injuring himself when he falls.)

Assuming that the government was paying for him, what do you do?

Pay for him to lay around and wait for him to eventually die?

Try to talk him into choosing some kind of assisted suicide?

Writing blank checks, for the rest of his life, can get expensive.

Are those the only two options? Pay forever, or tell somebody that we're not paying any more, they can die or go sleep on the street?

[Burgold]

What you seem to have a hard time understanding is those who make less need more of their check to get by those who have more need a smaller percentage of their check, funny how many people have said they have no problem with the higher taxes it is those who pay the talking heads on am radio that complain and get the not so thinking masses to go along with them.

There is a hell of a lot of... "Let them eat cake" attitudes being espoused whenever someone mentions the poor struggling to buy bread these days.

[mardi gras skin]

There is a hell of a lot of... "Let them eat cake" attitudes being espoused whenever someone mentions the poor struggling to buy bread these days.

Back to Ryan's medicare proposal, I don't think that's the case. Best I can tell, Ryan's plan would eliminate the deductible payment for the poor.

I think there's more perception of "let them eat cake" than there is reality.

[Larry]

How does he propose to cause health care costs to only go up at the rate of inflation, when they never have, before?

(Other than simple, religious, faith that if a corporation does something, then it will be better, even though that hasn't been true, before, either.)

[mardi gras skin]

How does he propose to cause health care costs to only go up at the rate of inflation, when they never have, before?

People who aren't poor will have to pay more. The poor (150% of poverty I've read) get a voucher to cover the high deductible. The rest of us, those who aren't poor, will have to start paying more. There's no getting around that. But I really don't have a problem with people who aren't poor paying for more of their health care.

There are also incentives within the payment structure for people to spend less. This is typical of all high deductible/HSA plans.

[Larry]

There are also incentives within the payment structure for people to spend less. This is typical of all high deductible/HSA plans.

But high deductable/HSA plans are plans designed for people who a) have assets which they can put away for future need, and chose to gamble that they won't need health insurance.

They're great for people with average or above average income, good health, and are willing to gamble that they stay that way.

Somehow, I don't see them as good plans for senior citizens whose retirement plan is the government.

[doctorshockalu]

But high deductable/HSA plans are plans designed for people who a) have assets which they can put away for future need, and chose to gamble that they won't need health insurance.

They're great for people with average or above average income, good health, and are willing to gamble that they stay that way.

Somehow, I don't see them as good plans for senior citizens whose retirement plan is the government.

Or it is for peoPle with preexisting conditions that have no other option.

[mardi gras skin]

But high deductable/HSA plans are plans designed for people who a) have assets which they can put away for future need, and chose to gamble that they won't need health insurance.

They're great for people with average or above average income, good health, and are willing to gamble that they stay that way.

Somehow, I don't see them as good plans for senior citizens whose retirement plan is the government.

There is provision for the poor. They won't have to pay the deductible. The problem is that, when it comes to entitlements, we think almost everyone is poor.

I have an HSA plan and my income is well below average for a family of 4 in this part of the country. We have to set aside enough money each month to cover the deductible. If the deductible is $6000 a year, this would require us to set aside $500 a month (currently, we set aside $400 a month).

The HSA is a very good plan for us because the total of our deductible plus the health insurance plan is less than the cost of a no deductible health insurance plan. There is a net savings from that alone.

Additionally, I have skin in the game and I'm keen to talk to my primary about generic drugs and other steps our family can take to stay below our deductible. My family is spending less than we used to under our no deductible plan because used to receive no personal benefit from being a conscientious consumer.

Some years, a serious issue comes up and we blow the whole deductible. But some years, if we're careful, we stay below the deductible and we pocket the difference. Overall, we spend less on medical services and use less medical insurance than we used to.

By the way, this is misleading:

high deductable/HSA plans are plans designed for people who...chose to gamble that they won't need health insurance.

We aren't gambling. We have insurance and, if we need it, we'll use it. But we don't view insurance as a health care entitlement. We view it as insurance against some medical event that is out of the ordinary, not insurance for normal health maintenance costs.

Standard health care expenses come out of our deductible (our HSA account). Our insurance (a high deductible plan separate from our HSA account) is for emergencies. There is no gambling involved.

[Larry]

I have an HSA plan and my income is well below average for a family of 4 in this part of the country.

How's your income compare to 150% of the poverty level?

According to Wiki (first hit I found on Google), "For example, the poverty level for 2011 was set at $22,350 (total yearly income) for a family of four."

150% of that looks to me like $33.5K/year. (I assume that's before taxes.)

And how many of your family of four are over age 65?

According to this link (pdf), the "poverty guideline" (the web page says it's often called the "federal poverty level", but says we shouldn't call it that), for a family of two in the continental US is $14,710. So I'm assuming from what I've read in this thread, then The Plan is that if Grandma and Grandpa are making more than $22K/year, (before taxes), then they aren't poor, (and Medicare isn't going to cover people who aren't poor, any more), and they should set aside $500/mo to cover their health care costs that the government won't be covering? (And the plan won't cover as many things as Medicare covers right now?)

[mardi gras skin]

How's your income compare to 150% of the poverty level?

Above it. Right now, my family is just about 200% so I assume we would have to pay the full amount. But like I said, we're paying $400 a month now. This plan would mean an increase of $100 a month for our family. It would suck, but we could do it. No one in our family is elderly.

Now, this does assume a before tax income as you say. I don't know if that is the case with Ryan's plan but, assuming a worst case scenerio, my family is just about as poor as you can be and still have to pay the deductible.

I do think it makes sense to create sliding scale of benefits for households between 150% and 200% of poverty...my family makes for a good cut off point between poor and not poor.

[DRSmith]

Has the current Medicare scheme reduced costs?

Do you believe reduced payments to providers will result in the same benefits?

The current medicare scheme is not single payer and exists to prop up insurance companies and help those who sell insurance hence why many people belive medicare is a private insurance and want the goverment to leave it alone.

[twist]

The current medicare scheme is not single payer and exists to prop up insurance companies and help those who sell insurance hence why many people belive medicare is a private insurance and want the goverment to leave it alone.

Medicare/Medicaid is a horribly inefficient system compared to single payer. For less than the amount the government spends on programs to just cover the poor and elderly in the United States, we could give everyone full coverage in a French style single payer system and still spend more than almost every country on earth.

So, we could institute single payer and be paying fewer taxes to get full coverage and better health outcomes.

How inefficient is our health-care system?

http://economix.blogs.nytimes.com/2009/07/08/us-health-spending-breaks-from-the-pack/

We could be spending 4% less of GDP on health-care and still be spending among the most in the world.

That is about 600 billion in waste every year to prop up our private health care providers, a subsidy that dwarfs anything in the Bank bailouts.

The Republican solution? Make Medicare a voucher based system and eliminate all aspects of collective payment bargaining.

Nice.

[twa]

The Republican solution? Make Medicare a voucher based system and eliminate all aspects of collective payment bargaining.

Nice.

The Rep program is closer to the French model you endorsed

The Dem solution?....reduce compensation for services and Hope for Change...Nice

[DRSmith]

The Rep program is closer to the French model you endorsed

The Dem solution?....reduce compensation for services and Hope for Change...Nice

Reduce the profit out of the insurance market and cap costs so you are not over paying for services

[twa]

Reduce the profit out of the insurance market and cap costs so you are not over paying for services

We clearly need to do that with Canadian oil too....I like where this is going

[DRSmith]

We clearly need to do that with Canadian oil too....I like where this is going

Hey I have said I have no problem with the nationalization of North American oil with both nations getting their oil at cost and the rest being sold on the open market.

http://www.rense.com/general37/petrol.htm

[twist]

The Rep program is closer to the French model you endorsed

The Dem solution?....reduce compensation for services and Hope for Change...Nice

:ols::ols::ols::ols::ols::ols::ols:

Irony of Ironies the French system is Medicare for everyone on steroids with um, lower compensations to doctors for services!

To grasp how the French system works, think about Medicare for the elderly in the U.S., then expand that to encompass the entire population. French medicine is based on a widely held value that the healthy should pay for care of the sick. Everyone has access to the same basic coverage through national insurance funds, to which every employer and employee contributes. The government picks up the tab for the unemployed who cannot gain coverage through a family member.

SAFETY NET

But the french system is much more generous to its entire population than the U.S. is to its seniors. Unlike with Medicare, there are no deductibles, just modest co- payments that are dismissed for the chronically ill. Additionally, almost all French buy supplemental insurance, similar to Medigap, which reduces their out-of-pocket costs and covers extra expenses such as private hospital rooms, eyeglasses, and dental care.

In France, the sicker you get, the less you pay. Chronic diseases, such as diabetes, and critical surgeries, such as a coronary bypass, are reimbursed at 100%. Cancer patients are treated free of charge. Patients suffering from colon cancer, for instance, can receive Genentech Inc.'s (DNA ) Avastin without charge. In the U.S., a patient may pay $48,000 a year.

France particularly excels in prenatal and early childhood care. Since 1945 the country has built a widespread network of thousands of health-care facilities, called Protection Maternelle et Infantile (PMI), to ensure that every mother and child in the country receives basic preventive care. Children are evaluated by a team of private-practice pediatricians, nurses, midwives, psychologists, and social workers. When parents fail to bring their children in for regular checkups, social workers are dispatched to the family home. Mothers even receive a financial incentive for attending their pre- and post-natal visits.

A typical PMI can be found in Goutte d'Or, a poor neighborhood at the foot of Montmartre that has been home for the past 20 years to a swelling population of immigrants from Africa and Southeast Asia. On Rue Cavé, a tidy modern building is given over entirely to caring for expecting mothers, infants, and young children. The place usually is bustling with kids scrambling over toys, while mothers, often immigrants in colorful headdresses and with babies strapped to their backs, talk to their doctors as part of twice-monthly evaluations.

PMI and other such programs are starting to get attention in U.S. health-care circles. "If we really want to ensure that no child is left behind, then the PMI system is a good way to do it," says Daniel J. Pedersen, president of the Buffett Early Childhood Fund. "It's based on the practical idea that high-quality investments made at the start of a child's life will pay huge dividends to both the child and society in the future."

To make all this affordable, France reimburses its doctors at a far lower rate than U.S. physicians would accept. However, French doctors don't have to pay back their crushing student loans because medical school is paid for by the state, and malpractice insurance premiums are a tiny fraction of the $55,000 a year and up that many U.S. doctors pay. That $55,000 equals the average yearly net income for French doctors, a third of what their American counterparts earn. Then again, the French government pays two-thirds of the social security tax for most French physicians—a tax that's typically 40% of income.

http://www.businessweek.com/magazine/content/07_28/b4042070.htm

The Republican plan is to give everyone a voucher and toss them into the private insurance market without any method of cost control (and stripping the ones that medicare has) comparing it to the French health care system is some sort of hilarious joke you seem to have stumbled upon for no sane reason.

The Republicans are NOT for anything like the French plan, heck the Democrats are far too in the pocket of the medical industry to ever try anything like this.

The problem is that both of these parties are screwing us with a massively inefficient system that moves most of the cost onto the American consumer (as per usual).

[Baculus]

The Rep program is closer to the French model you endorsed

The Dem solution?....reduce compensation for services and Hope for Change...Nice

Oh. my. lord.

So, a year or two ago, you and other Republicans were attacking any reform even remotely similar to a French-style health care system -- how many times have we heard from the GOP that Obama "wants to turn America into a European socialist state!" -- and now you are using this as some sort of defense? Especially since Republicans are trying to overturn "ObamaCare" as part of their platform?

Do you or the Republicans have any sort of consistency, or, as usual, are you flailing around and simply winging it?