Let's Talk Taxes and Medical Insurance

[Superman]

I occasionally beat my head against walls, and with you guys it takes the form of attempting to reveal the "other side of the story" that seems hidden from some of you. I try to do this using the simplest of examples. It usually does not work but......did I say that my habit is to beat my head against walls.

Let's just start this way: Public hospitals are required to treat everyone, regardless of ability to pay. That's why poor people (AKA lazy deadbeats who should not be coddled by tax dollars) go to emergency rooms with their medical issues. This, as you are probably aware, raises the cost of health care, and expends tax dollars. How 'bout we save on both counts (save tax dollars AND lower the cost of health care) by reversing this policy. Let's reverse the policy and allow hospitals.....no, REQUIRE hospitals to treat only persons who can be reasonably expected to pay their bill.

Or to put it more strategically:

"WHY WOULDN'T WE STOP PROVIDING MEDICAL CARE TO PEOPLE WHO CANNOT AFFORD IT?" Yep, that's the form of the question that contains the seed of wisdom, in my view.

discuss....

[Rot 911]

Because even us right-wingers have as part of our genetic, American makeup, the desire to insure that no American goes hungry, homeless and without basic health care. Where we differ is where the threshold level should be set to determine what people should get things free and who should have to pay for them.

[Superman]

Sounds like the question of who should get things free is settled. Anyone and everyone who needs it. That is, if our policy is to provide food, shelter and medical care for those who cannot afford it, then those people should get those things. This is commendable. Generous. Altruistic.

But there is another reason, a more selfish reason, why we would feed the hungry, shelter the homeless and treat the poor and sick. Anybody?

[BlueSkyJaunte]

Gotta fatten them up to make more Soylent Green.

[928ram]

But there is another reason, a more selfish reason, why we would feed the hungry, shelter the homeless and treat the poor and sick. Anybody?

'Cause otherwise Kerry would have gotten no votes at all!

[928ram]

Seriously though; unless we leave them starving and dying in the streets, "we" pay for them no matter how you want to wrap politics and programs around it. Coddled by tax dollars, or coddled by you and I have higher premiums; it's all the same in the end.

[vash]

jim, did you ever read that book "ecology of commerce"? (i think author is HAWKINS)

there is a story, on the tragedy of the commons, where in the old days, people would share grazing grounds for the sheep. everyone is expected to play by the rules, no overgrazing, fair share, etc. well just like everything else, some people DONT play fair. they leave the animals to graze longer, abuse the land, overgraze. the nice guys finish last. their animals are not as healthy, plump, tasty, whatever...and the dishonest sheep herders reap the benefits. the crap is ass backwards!

regards to your question; i would be happy if we could clean up the dishonest bastards. true story, just yesterday my brother went for an AIDS test. apparently he met a woman that fits the "wife" category. he elected to take the test at a clinic, where this is all they do. fast and accurate. he said the office was filled with all walks of degenerate life. he filled out the questionaire which included his job and salary grouping. he was asked to pay $57 dollars. the guy ahead of him got it for free. when he questioned the discrepency, he was told that the test was priced according to the patients ability to pay. even the receptionist told him that he shouldnt have been so honest. what a limp dick system!

[legion]

"To each according to their need. From each according to their ability."

Unfortunately, it never works that way.

[Superman]

The concept I am fishing for here is scratched in 928ram's post. Perhaps someone can expound:

"...unless we leave them starving and dying in the streets, "we" pay for them...."

I would agree that we pay for them. But is it true that if we leave them starving and dying in the streets, that we would NOT pay for them? What is cheaper, paying for the food, shelter and medical services, or NOT paying for it? Which would be cheaper?

[dtw]

That's not what you're asking and you know it. Come out and say it, Jim. I've been respecting you lately for not playing up to the "Uncle Ellsworth" scam. So please, come off it. You can play devil's advocate without being a tool at the same time.

And maybe there's more subtlety than I'm picking up on here, but are you trying to ask "In which hole would you like it, in the tax hole or the medical insurance hole?"

Make mine the insurance hole.

[Evans, Marv]

Super:
It may be cheaper to not pay for them, with a "but.". Most countries don't have the social safety net we have and some have a more extensive net (at the price of almost a 50% tax rate). Some would argue the crime rate would go up, etc. I think the thing to do is to better monitor the social welfare system we have (vash's example) and monitor and enforce the laws we have.
I worked with the welfare system for several years and witnessed a huge amount of deception and fraud. Everybody in the system knew it. Those committing the fraud freely admitted it, because they knew nothing would be done about it. Those administeriing the system knew if all the fraud was wiped out, most of them wouldn't have jobs, because they wouldn't be necessary.
My opinion is that we need a safety net for people who REALLY (that's the "but" part) need it. But they should also be required to do something productive according to their abilities. If the laws and regulations were enforced, enough money could be saved to pay for that small segment that truly needed it.
One thing I did several years ago was to give "job search" workshops to welfare recipients. During these workshops, I would ask, "What would you do if there were no welfare system in the U.S.?" 90% of them would respond that they would go out and get a job. The money saved from eliminating those who are getting benefits (cash aid, medical, clothing, food stamps, child care, etc.) fraudulently, would more than cover those in real need.

[hoff944]

I hate to say it given the controversy this might cause, but what about the role of the church in taking care of the homeless and the "less fortunate". I think churches need to step up. You know, showing Gods love. The Catholic church seems to do a decent job at this in larger cities. I see some of these mega churches and I wonder why they don't help the less fortunate instead of building a mutli-million dollar facility.

[red-beard]

Actually, hospital participation in this federal program was voluntary. If it choose to participate, the fed gave them money to expand/upgrade their facility. Sucker bet.

[asphaltgambler]

Either way, the money originates from us; the average working stiff.

[Superman]

No, Dave. That's not my question. I'm not really as nutty as I sound. Or at least you guys think I'm nuttier than other folks do. Still, I can see how you would think.....

Marv is following. My question has to do with HOW we pay for it. First there is the go/no-go question. Leave them without food, medical care, etc? And I would ask whether that's really an option. But let's assume that it's possible to just deny them these services. Would this increase their sense of desperation? Would it increase their anger? How many additional cops would we need? Would an organization go to bat for them politically, and would we end up with a new plan to take care of them?

But setting that question aside, and assuming we want to take care of them, how? I agree with folks who assert that some welfare recipients are able to work. That's an understatement. Many of them are, and Marv is correct about the fraud. Massive fraud. I like his comment that if the system were monitored carefully enough, the money we would save would easily pay for the small percent that REALLY need the help. Now, these are people that probably cannot be more than marginally productive, and who should be our primary target for basically the free ride. With the others, it would be a matter of monitoring and fraud prevention, training and placement. And perhaps counseling.

But that's if we wanted to make the system work. That's a desription of our current welfare programs. You know, the ones that are underfunded to the degree that there is no hope of efficiency.

But yeah, the crime remark is kinda where I was headed. Some folks in the labor movement (that's my industry for those of you who do not know) would like nothing better than the repeal of ALL worker-protection laws. If that were to happen, labor unions would become suddenly more popular than bread. Similarly, if the pathetic few programs we have were eliminated, then we would need to spend additional dough on security services. And property insurance.

So, some of the things we assume are done for altruistic and charitable reasons, are really just CYA stuff. And some folks think that the more we do deliberately, the more we save money. Because that's doing it the easy way. making poor folk steal for a living is doing it the expensive way. Indeed, some folks think we're still doing it the expensive way, but with a trifle going towards solving the problem the conscious way so as to pretend we're doing something meaningful.

[dtw]

Well I think we are coming at it the same way Jim. I inferred that we can pay for it with health insurers essentially picking up indigent care, or we can let the government pick up the tab. To your question, at least, I would think those are the two 'gimme' responses. And, it would remain consistent with your penchant for pitting business versus government. Right now, I know my check gets hit both times for the 'solution' - Medicaid and health insurance.

That is why I said I'd rather pay for it (exclusively) out of the health insurance line on my check, and leave the gumm'nt out of it (yeah, WWF is on, I'm wearing my #3 Earnhardt tee, I just beat up my wife, all North Carolinians are racists with starchy pointy sheets, say what you want). I have more faith in corporate America, with all the profiteering and whatever else you care to assail them with, than I do in lose/lose government institutions that serve only to perpetuate the ills discussed above.

Now regarding the "IF" we pay for it question - do you really believe any of us right wing nut jobs want to screw people out of care? I mean, other than Stromberg who wants to screw the Mexicans out of just about everything except a trip 'home'? We're both Catholics here, regardless of political stances, Jim, so I imagine we actually see eye to eye on treating with our fellow man after we cut through the partisan shyte.

If you couldn't tell your post raised my ire a bit, and I find some of your undertones to be a bit presumptuous and offensive, but I'm trying to work with you here. Doesn't help that in recent weeks I've adopted the appalling habit of holding a glass of Irish whiskey in one hand, and a pint of Bass in the other...I've been wrestling with that tonight too.

[Superman]

That's a completely cool post, Dave. I've had a bit of cheer myself so I'll not embarrass myself by trying to be substantive. And yeah, we probably disagree. Or at least, I remain convinced that the way to minimize cost is certainly NOT to farm stuff out to private industry. That may be the way to increase services, but not decrease cost. In my humble view. But you raise some good thoughts. I have no doubt your vote is to take care of those in our community who are far less fortinate. This thread was intended to be about comparing the costs of providing the services, with not providing them. Or better, the costs of having a conscious plan for tracking and underwriting them, versus the costs of pretending that there is no cost.

At any rate, I hadn't noticed your 'ire' until just before you confessed to the whiskey/Bass influence. For me it was Red Hook, finishing off with a Fat Tire.

[dtw]

Well gee-whiz, Soup. You came up with a post that would presume some thought-provoking discussion and educated responses. Especially after deciding what the question is, we see it is one that can be addressed and debated without the usual partisan antics. And after more than half a day we've got....crickets chirping.

Guess everyone would rather fight about Iraq.

Well if this ever does get off the ground, I wanna hear from Moses.

[BobS]

Okay, I'll play.

One dimension of the original question posed has to do with the extent to which a person's "destituteness" can be blamed on factors outside of his control or whether they are due to factors totally within his control. As a society, we seem more inclined to help folks (or at least express more sympathy) whose problems seem to be not of their fault, but because of some systemic issue, e.g., a deteriorating economy rather than a propensity to engage in destructive behavior. In part, the literature suggests that without the "safety net" that exists (at whatever level you think it should intervene) people might be likely to take fewer economic/business risks. So, why might we want to provide for people who aren't able to provide (for the moment) for themselves? Because without the support of the community, we might be less likely to take the serious risks. Or, thought of in a different way, "if not for the grace of God there go I" or pick your secular phrase. Now, what we have a very difficult time doing, however, is teasing out those who have engaged in destructive behavior from those whose position is the result of factors beyond their control, which may be why we do it for everyone. If you are talking about a public hospital, who would want to pick who gets health care and who does not? (Although we do this anyway, but in a different way).

I'm not sure how muchof this I believe, but I think it merits some level of plausibility.

[Superman]

Been busy. Yes, I'd like to hear from Moses also.

Bob brings up a good point. Two. First, the strong preference for risk-taking. Many of us know that Wall Street does not like risk avoidance. Management does, but Wall Street does not. If a CEO makes a horrendous mistake he loses his job. But Wall Street is not as afraid of this event, because investors can diversify in order to protect themselves. They want the CEO to be as aggressive as possible, because this is how great earnings are created. Now, "welfare" is not a consideration for the typical Fortune 500 CEO, but the principle flows down to the lowest commercial levels.

Then there is the issue of distinguishing between those whose situation are not their fault, and those whose situations are caused by their own self-destructive behaviors. Anybody see a problem with administering a welfare plan that considers these variables? Anybody want to explain why it does not, or should not, matter anyway?

And finally, there is the "there but for the grace of God go I." There are fruiitcake, misguided liberals out there who believe that our economic system REQUIRES a level of unemployment. In fact, this is challenging to deny. If someone wants to entertain me with the suggestion that a capitalistic economic system is fine with zero unemployment, please do so. And include the impact you suspect this condition might have on wages, for example.

But moreover, some of these crazy, lunatic liberals go so far as to believe that capitalism is served by both groups looking at the other. Those of us who are gainfully employed have a particular perspective when we drive by folks with newspapers under their jackets for insulation. We become quite willing to bust our asses and tow the corporate line at work because we think of our employer as savior. Saving us from that ugly fate. So, this dichotomy of social classes has the effect of ensuring loyalty to the corporations. Again, this would be those communist liberals talking.

And the folks warming themselves on the steam vent, capitalism's discarded refuse, tolerate our policies because they see us driving our Porsches and other German luxury cars and they are supposed to imagine that the American Dream is within their reach also.

How true is that? How true is it that folks growing up in the projects and slums understand and can use the language of business and identify and take advantage of emerging business opportunities? Or, better yet, what proportion of people who come from this subculture can solve transportation and day care problems and emergencies, prepare a selection of clean, presentable clothes in advance of a busy work week, stand up straight, smile like you are glad to see all these grumpy customers and constantly use phrases like "please," "thank you" and "I understand your complaint completely and will bring this up with the manager as soon today as I can talk to him....here is a free Big Mac for your troubles." ??