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View Diary: WH Advisor David Plouffe and Goldman Sachs CEO Agree That Medicare and Medicaid Must be Cut (614 comments)

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  •  Like it or not, there will be some compromises (10+ / 0-)

    There is no way Republicans will agree to raise the tax rates on the top 2% and raise the cap on Social Security and Medicare taxes while cutting nothing. I wish we had enough votes in the House and Senate to do this our way, but we don't, and I don't think just letting the debt grow indefinitely is a good idea.

    So I think we need to think about what we want to fight to protect most. For me, I think protecting programs for the poor and avoiding having the retirement age raised should be the top priorities. If Medicare (not Medicaid) has slightly higher copays, I would find that more acceptable. There are also savings that could be achieved in Medicare and Medicaid by going after fraud more aggressively.

    Currently, Medicare has premiums for Part B and copays for certain things, but no copays for primary care or specialist visits. If they instituted a modest copay for that, I think it could do a lot to save costs by discouraging overconsumption. I know that idea probably isn't popular here, but I think it's a much lesser evil than raising the retirement age or cutting payments to doctors (again), which would have the effect of driving quality providers away from taking Medicare and Medicaid.

    •  The Republicans don't need to agree to shit. (108+ / 0-)

      All we need to do is let the Bush tax cuts expire.

      Remember, Bush?  Total idiot?  Played a big role in the collapse of our economy?  Yeah... the tax cuts he thought were a good idea.

      Oh, and we already blew the cap off Medicare almost 15 years ago.  It worked out pretty great.  We don't need to do it again.

      Medicare premiums and co-pays are fucking brutal for most Seniors.  I've seen go without oxygen so they can afford a bus pass.  They don't have any fucking money.  They're fucking broke.  

      The reason your regressive ideas aren't popular here is that they're brutal and intended to harm struggling seniors in order to protect the wealthy.

      They aren't "realistic".  They aren't "pragmatic".

      They are just small, and mean.

      "the Agency continues to verify the non-diversion of declared material at these facilities and LOFs."

      by JesseCW on Wed Nov 28, 2012 at 08:55:07 AM PST

      [ Parent ]

    •  LOL - "overconsumption" FF-Sakes. (58+ / 0-)

      I've got plenty of people of retirement age in my realm and none of those people are freaking engaging in "overconsumption".  Unless you think that going to the doctor to deal with problems like high blood pressure, cancer, blot clots in the brain, or heart conditions is somehow out of bounds on their part.

      Shaking head.  If anything, we should be making healthcare for these people more available so as to keep them as healthy and independent as possible.

      •  Some seniors do overconsume (0+ / 0-)

        One of my older relatives runs to the doctor for every little thing, many of them things that could be resolved with over the counter medication. He has money but is of a depressionist mentality, and if there were even a $5 copay (maybe after a certain number of visits, to ensure that routine checkups are not deterred), he would probably go a lot less.

        •  If he has problems with depression, then (7+ / 0-)

          he probably should see the doctor a bit more.

          •  Don't think that was what was meant (1+ / 0-)
            Recommended by:
            CS in AZ

            It's more likely that it should have been written as "Depressionist mentality", that is, the mentality of many who lived through the Great Depression.

          •  Right, I meant Depressionist Era mentality (0+ / 0-)

            But he is also suffering from severe depression, and I think in a lot of ways the doctors have made things worse by putting him on medicines he didn't need to be on. I think he would be better off if he had to learn to cope with certain issues instead of running to his primary care doctor, who I think has done a really poor job of managing his condition.

            I am really glad that he has Medicare and Medigap so that he has been able to get whatever treatment he needs. I recognize that most seniors are not so lucky. But I think he would rather pay a little more than have programs for poor people cut, if he had to make that choice.

            •  Unfortunately the copays would only increase (1+ / 0-)
              Recommended by:
              Mr Robert

              the amount of medication he ends up on because one of the most effective therapies for depression, talk therapy, requires many more office visits than just getting a prescription for antidepressants or whatever.  Though a primary care doctor is definitely not a very good choice for psychological problems, he needs a psychologist and/or psychiatrist but that would just mean greater copays.

              You have watched Faux News, now lose 2d10 SAN.

              by Throw The Bums Out on Wed Nov 28, 2012 at 11:05:19 AM PST

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              •  I agree. Medicare doesn't pay enough of the cost (0+ / 0-)

                of talk therapy like CBT, which is what he really needs. Yet I believe for primary care visits, there is no cost after the deductible is met. Someone said there is 20% coinsurance for Part B but I couldn't find that on the Medicare website, except for certain services.

                For things like therapy, the copays under Medicare Part B and most insurance plans are too high, because most therapy is only effective if done on a regular basis.

                My grandpa has been to several psychiatrists and we thought we had finally found a good one, but then things ended up getting worse after he went to the hospital because he thought he might try to kill himself. Being there just made him more depressed and when he got out he did try to kill himself the next night. Thank g-d he is ok for now. My mom says he is doing much better, but I am still really worried about him.

        •  I know a real live hypochondriac, but I think (13+ / 0-)

          his innate cheapness outweighs his hypochondria!

          Let's craft our whole Medicare program around this!!!




          "the Agency continues to verify the non-diversion of declared material at these facilities and LOFs."

          by JesseCW on Wed Nov 28, 2012 at 09:49:55 AM PST

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        •  What I think you (13+ / 0-)

          don't get is that, that co-pay will be another advantage to the already too expensive healthcare system we have here in the U.S.  That little co-pay in ten years will end up being $100.00 co-pay.  And already if your on disability such as myself, I already get hit with out of pocket costs to go to the doctor.  Medicare isn't free.  There is a deduction from your monthly social security check for the medicare premium, plus you have to carry a secondary insurance policy that runs a couple of hundred a month, and if you tack on a co-pay it will make it even more difficult.

          I don't think you understand what life is like when your income earning years come to end.  You can have money or be better off, but you still have to be careful not to run out of money before you die.  Plus your whole view on this is according to your relatives, there are a lot more people in the world in different financial situations and your view is very limited.  

          Too bad we don't come with expiration dates it would help us to budget our money better.

          "During times of universal deceit, telling the truth becomes a revolution­ary act. " George Orwell

          by zaka1 on Wed Nov 28, 2012 at 11:05:19 AM PST

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        •  "Overconsumption" of this nation's (8+ / 0-)

          notoriously lousy "health care" by sick elderly people solves itself rather quickly when the patient dies years before s/he otherwise would have, because the health care they get is notoriously lousy. Don't forget that twice as many people die every year of lousy health care in hospitals than die of no access to health care. Nobody knows how many people die outside of hospitals every year due to lousy health care. At least twice the 100K figure.

      •  Not for struggling seniors - I should have said (0+ / 0-)

        that in my last post. If I had my way, any copays instituted or increased would contain an exemption for the poorest seniors. But some Medicare recipients are not poor and can afford to pay a little more.

        •  I've got a much better idea (41+ / 0-)

          Lets expand medicare to everyone and do away with copays all together.

          Every single person should be able to go to the doctor every single time they feel they need to. Period.

          •  I agree with the first point, disagree with 2nd (0+ / 0-)

            In other words, I support Medicare for all, but not doing away with all copays.

            Some people are hypochondriacs, and I think saying that everyone can go to the doctor whenever they need and pay absolutely nothing is a bad idea. An optimal health system would strike a balance between incentivizing necessary care while disincentivizing unnecessary consumption.

            I think the first couple of doctor's visits per year should be free, to ensure that everyone gets an annual checkup, women's health visit, etc. But unlimited free visits is a bad idea that would cause costs to skyrocket for everyone.

            Doctors order tons of unnecessary tests and sometimes do unnecessary surgeries that could be more cost-effectively treated with drugs or conservative care because it's more lucrative to do surgeries.

            If we did what you suggest, health care costs would get so high that they would have to jack up the payroll tax, which would significantly hurt working people.

            I think everyone should be entitled to a certain level of health care as a basic right, but there need to be limits. I don't think hardworking middle class people should have to pay more in payroll tax so that hypochondriacs can run to the doctor every time they have an itch.

            •  Hypochondria is a treatable condition. (31+ / 0-)

              People should be able to go to the doctor whenever they feel like it, without charge.  If visits become excessive or unwarranted, then doctors should address the problem with the patient.

              We are not consumers of healthcare.  It is a not market place that should be run by supply and demand.  Instead we are patients.  The asymmetries of knowledge alone require that we think of health care in a non-market way.

              "The attack on the truth by war begins long before war starts and continues long after a war ends." -Julian Assange

              by Pierro Sraffa on Wed Nov 28, 2012 at 09:41:53 AM PST

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            •  Hypochondriacs have a medical condition (12+ / 0-)

              that needs to be treated!  Mental illnesses need to be treated!

              Did it ever occur to you that instead of punishing someone for having an ailment, we might be able to instead approach the problem by treating it?

              •  But that would cost more money as the most (2+ / 0-)
                Recommended by:
                hester, inclusiveheart

                effective mental therapies require many more office visits than just drug therapy.

                You have watched Faux News, now lose 2d10 SAN.

                by Throw The Bums Out on Wed Nov 28, 2012 at 11:07:11 AM PST

                [ Parent ]

              •  True... (3+ / 0-)
                Recommended by:
                corvo, blueoasis, inclusiveheart

                The hypochondrium is an old term referring to the area just below the condrium, the rib cage, which corresponds to the liver, gallbladder, and pancreas, among other internal organs.

                Often stress results in pain, and pain results in stress. People with chronic stress often report pain in areas like the hypochondrium.

                The mind-body approach is much more enlightened. Chronic stress can lead to disease.

                "In times of universal deceit, telling the truth will be a revolutionary act." -George Orwell

                by ZhenRen on Wed Nov 28, 2012 at 11:11:53 AM PST

                [ Parent ]

            •  Reform the system to include a lot more people (2+ / 0-)
              Recommended by:
              democrattotheend, catwho
              Doctors order tons of unnecessary tests and sometimes do unnecessary surgeries that could be more cost-effectively treated with drugs or conservative care because it's more lucrative to do surgeries.
              Fact is there are a lot more people who do indeed need the surgeries, but can't get them paid for.

              Doctors could stop doing surgeries on those who have money/coverage but don't need the surgeries,  and do surgeries on people who need them if some sort of system existed that would channel those people and some money to them.

              They would be happier I am sure to know they are really making a difference for people rather than milking them to pay off med school loans, more people would get help they truly need, and everybody is better off, and about the same amount of money would be spent, but more effectively with better overall results.

              •  This I agree with 100% (0+ / 0-)

                Maybe a good solution would be to offer med school loan forgiveness to doctors who do a certain percentage of their visits/surgeries on a pro bono or income-dependent basis. Something similar to the federal loan forgiveness program for people who work for government or non-profits.

            •  I have MS (20+ / 0-)

              I spent 20 years having doctors tell me it was all in my head before I finally got a diagnosis. I will repeat it - Every single person should be able to go to the doctor every single time they feel they need to. Period.

            •  An observation: (28+ / 0-)

              Following your thread indicates to me an impression that you do not view health care as a basic human right and that you view moral hazard by Medicare recipients as a major driver of Medicare costs. (I know that overuse is much, much less a cost factor than dramatically rising medical costs. Copays are meant to mitigate frivilous use and to a low income senior would be quite effective.) I see both views as an indication of a lack of confidence in other people and a possible selfish concern. Is it possible that this is due to a conflict caused by a fear someone might get something that you won't or that you will have to pay for it? Please don't feel compelled to answer. I ask this only for you to look inward for the source of why you feel the way you do. I have had this same discussion with many folks and without fail the idea that someone might get something they don't deserve or in their stead has been a major element of their thinking. Simply changing your thinking to medical care as a universal public right and responsibility of society to provide it solves the conflict.

              I would ask you to consider whether you think it is a reasonable function of government to be responsible for the welfare of its citizens. In the US we only grant the right of lower cost health care, with restrictions, to the elderly and to some of our very poor. Your compromise would further restrict access in the interest of reducing costs so that the very wealthy can continue to limit their contribution to the nation's welfare while continuing to reap great benefit. And do it for a slightly higher tax on those who can best afford the money. Do I understand your argument so far? We are the only wealthy industrialized country in the world who does not grant universal medical care to all of its citizens and in some cases to visitors and foreign residents. Our system creates a commodity from a basic human need and sells it to the highest bidder for profit. The result is the most expensive health care system in the world, one that fails to deliver an equally high quality product and fails to include everyone. I obviously think this is an unconscionable state of affairs. Is it possible for you to think about the issue differently?

              Time makes more converts than reason. Thomas Paine, Common Sense

              by VTCC73 on Wed Nov 28, 2012 at 11:09:13 AM PST

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              •  That was a lot nicer and (12+ / 0-)

                far more diplomatic than how I would have stated it.

                Kudos. :)

                Logic will break your heart forever. Be brave. -- The Stills

                by Colorado is the Shiznit on Wed Nov 28, 2012 at 11:21:38 AM PST

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                •  People support and vote their interests. Rule #1 (8+ / 0-)

                  Or what they see as in their best interests. I've heard this same set of arguments an seen the same straw men dozens of times. I don't think dtte is wrong to have his/her thoughts given how this issue has been tainted by disinformation, lies, and obfuscations. I also don't think he has the experiences with poor and/or seniors to let him know how devastating slight changes to costs have on those with limited fixed incomes. How is it not possible to have his apparent position under those circumstances? My objective is to ask another human being to look for empathy and understanding. My hope is he can change how he thinks. Maybe I'm being trolled but I actually think he only needs a slight nudge to find a way to think about the issue differently. I really hope he gets it before he gets the bitch slap of life when his father goes on Medicare.

                  Time makes more converts than reason. Thomas Paine, Common Sense

                  by VTCC73 on Wed Nov 28, 2012 at 11:50:15 AM PST

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              •  I do believe that health care is a human right (0+ / 0-)

                In that I believe that those who cannot afford it should get assistance, so that nobody dies or goes without care they need because they can't afford it.

                I absolutely think it's the responsibility of the government to ensure the welfare of its citizens. I support Medicare for all, and I supported including a public option in the ACA.

                But if the question is whether health care is a human right such that nobody should ever have to contribute anything to the cost of their own care, whether or not they can afford it, then no, I don't believe that.

                I am not concerned about moral hazard with regard to patient conduct. I am far more concerned about doctors who have no incentive to keep costs down under the current system. I think some doctors, combined with all the drug commercials people see, lead patients to believe that they need more visits or more drugs for things that can be more cost-effectively treated another way. And I think patients need to ask their doctor whether certain things are really necessary. I know that I am a lot more likely to do so now that I have student insurance with higher copays than I did when I had very good union insurance that paid for almost everything. On the other hand, I think HMO's go too far in terms of squeezing doctors to keep costs low. So the ideal is to find a balance between the two.  

                I do think that our system is inequitable and it's an outrage. I am hoping the Affordable Care Act will help, but it doesn't go far enough. But I don't think that everything needs to be exactly equitable to the point of stifling innovation. I don't think that people who can afford treatment that Medicare doesn't cover should be barred from doing so, for example.

                I support Medicare for all, but until we have that, I think it is unfair that well-off seniors pay much lower out of pocket costs for their care than struggling lower to middle class people below Medicare age.

                I don't understand why some liberals are so hell bent on taxing the rich who are working age but so adamantly opposed to asking wealthier seniors to pay more.

                •  Good reply that leaves more questions. (6+ / 0-)

                  I hear " I believe health care is a basic human right but..." In other words everything in front of "but" is non-functioning. I think you may be hung up on self interest. Your last three paragraphs are confusing to me although I think they confirm that you are worried about your situation which blocks your ability to look at the issue unemotionally.

                  Let's try looking at Medicare (same as for Social Security) as a an earned benefit that is funded additionally as a gift to an older generation. I paid into MC my entire working life and will receive a benefit not from my contributions but from those working when I  become eligible. That is the same arrangement I paid for while working and, hopefully, you will receive as well. It is a gift between generations. It is a very generous and mature thing for a society to do. I've always thought of it as paying a debt to those who built the world in which I thrived. I hope those who follow me will continue to provide the same gift. It is in their best interests to do so.

                  Stop and think about that a moment. In your best interest.

                  Who will pick up the slack if right wing extremists are successful at destroying MC and your father loses his benefit? How will his circumstance burden you? What about you as a senior? I'm sure you won't be eligible for many years but think what it means to you if you have to pay for your own health care in old age. The history of our country tells a horrible tale of poverty and death for those in old age who are unable to afford proper health care services. Avoiding such a situation is paramount.

                  Your present situation is probably scary. You've mentioned it too many times to not be a serious concern. I know the world is a frightening place. Particularly now. I have a special needs son who should graduate from college next spring. He will be 26 in August when he will be in your situation of using student insurance (grad school we hope) instead of my very good policy. January 1st with the opening of exchanges should help his situation but we live in batshit crazy land of a deep red state. So who knows.

                  The bottom line is that as a principal I never support anything that might enhance my life at the expense of another. Means testing of Social Security by taxing the benefits of higher income retirees was the beginning of what could be a successful campaign to change it to an entitlement rather than an earned benefit. What you suggest might impact MC's viability in the short term but it opens a door to the same assault that is happening to SS. The solution to viability for MC/MC is controlling the rise in health care costs. Full stop. End of story. The PPACA does little enough towards that end. Diddling around the edges with means testing for MC only prolongs the battle and leaves open a door to elimination of a vital benefit. It is in your best interest to step up and fight any degradation to any of these programs.

                  Time makes more converts than reason. Thomas Paine, Common Sense

                  by VTCC73 on Wed Nov 28, 2012 at 12:52:25 PM PST

                  [ Parent ]

                  •  I stopped and thought a moment (0+ / 0-)

                    And my views did not change. I believe health care is a right, but I don't believe that unlimited care with no cost regardless of whether you can afford it is a right, especially when this "right" is not extended to all Americans. I guess we will just have to agree to disagree on that.

                    I don't think I hold these views because I am selfish. If you prefer to interpret it that way I guess that's your right.

                    •  OK. That is all that I asked of you. (1+ / 0-)
                      Recommended by:

                      Please note that I did not call you selfish. That is not a judgement I could or should make. The point is that I think your thinking is blocked by a selfish interest. One act of selfishness does not make anyone selfish. Besides self interest is not necessarily a bad thing. Without it life would be very short. The key is knowing where your best interests lie and that is not often very clear. Oh, and they can change without notice.

                      The reason I took so much of my day to reply to you and have this conversation is to provide a perspective you may have not considered or might benefit from revisiting. I'm not foolish enough to think I will ever change minds. I do, however, know that having the conversation does in some cases provide one more experience upon which a change can grow. Most of those experiences that changed my life were nasty bitch slaps that I could not ignore. I'm probably a slow learner. May your moments be more kind to you. They likely won't be but it could happen.

                      Time makes more converts than reason. Thomas Paine, Common Sense

                      by VTCC73 on Wed Nov 28, 2012 at 02:16:29 PM PST

                      [ Parent ]

                      •  I appreciate your taking the time. And actually, I (0+ / 0-)

                        realized that some of my assumptions when I posted the original comment were wrong. Last week my grandfather was in the hospital for several days and my mom said he had no out of pocket costs. I stupidly thought that Medicare itself paid for all of those costs and forgot that he has a Medigap policy. If he didn't, he would have incurred a cost that would be pretty significant for a lower income senior. Now that I realize how much Medicare recipients already pay out of pocket I am less inclined to favor additional cuts.

                        Also, I strongly disagree with your characterization of Medicare as a "gift" that we give to seniors. I know it was not your intention, but the way you said it makes you sound kind of like a certain losing Republican presidential candidate. :)

                        Medicare is not a is an earned benefit that we need to protect for future generations as well as the present one. Too much of the talk has been about protecting current recipients and not enough about protecting future ones.

                        •  Your discomfort with the term "gift" (1+ / 0-)
                          Recommended by:

                          is understandable. Romney's sullying of a perfectly good word not withstanding, SS and MC are paid for by currently employed people who give up a portion of their earnings in the interest of improving the lives of those who went before them. In that strict sense it is a gift. In the sense of it being neither voluntary nor without the promise of themselves receiving it at a future date, it is not a gift but a community sharing resources to the benefit of all. That is a gift given to themselves. Everyone. So I stand by my characterization as an accurate description of the transaction despite your unease.

                          I was an airline pilot and union member (ALPA) for 27 years until a year ago. I learned from those who went before me that the best way to protect and enhance the careers of those who follow you through life is to protect those in front. But only if you do not sacrifice the young. I think of it as never eating your seed corn. American Airlines' union, APA, accepting B scale, then later a C scale, wages for junior pilots in 1983. That one act began a terrible upheaval throughout the industry that injured every pilot with reduced wages, reduced benefits, and lost gains to work rules that had taken decades to win. The senior AA pilots got theirs but later paid the price when junior ones outnumbered them and returned the favor. Only those who retired before the butcher's bill came due profited in the betrayal of future pilots. The second lesson is to never allow the community to be divided by self interest or envy.

                          That's two lessons to take to this debate. When we, today, protect the benefits of those who already participate in the program by refusing to accept reduced benefits for anyone, we protect the future. At least until our opposition gets brave enough to mount another assault. So you follow up the refusal by retiring at the ballot box those who fought to take away your earned benefits. You notice that these clowns are smart enough to not try to take benefits from those who already receive them. Yet. And they sure didn't put up or vote on a bill before the election. They bet on a hostilely divided electorate to avoid being punished.

                          The third lesson I'd like to give you is to not fear the future. The future is a worry you don't have yet. It is all in your head so you end up fighting yourself, and occasionally do something stupid, over what may or may never be. The challenges, known and unforeseen, will come and you will face them. Being fearful diminishes your ability to do what's needed. Believe me you'll do OK. Oh, and I won't give up that you might come around on the issue of universal health care. Someday.

                          Time makes more converts than reason. Thomas Paine, Common Sense

                          by VTCC73 on Wed Nov 28, 2012 at 06:57:29 PM PST

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            •  Can you quantify the problem of hypochrondria? (9+ / 0-)

              It costs our health care system 20 billion dollars a year and is a form of OCD which is a real live honest to god mental disease that is crippling. So your answer to treat this problem is to charge them more and treat them less and never address their real illness. So I guess your answer to depression or PTSD is to slap them and then tell them to snap out of it. It is an anxiety disorder that is very painful and debillating.

              Economics does not explain everything. I suppose that telling people who are diabetic that treating them is a waste of time because they are fat and it is their own fault.

              In 2010 we spent 2.6 trillion on health care. 20 billion is spent on hypocrondraics which is .9% of our health care budget. So maybe the answer is not to demonize hypochrondriacs.

              FYI When I had a massive heart attack that nearly killed me my wife told the paramedics that I was a hypochrondriac. They told her that I was near death and she had better hope the cardiac team had not gone home yet. Lucky for me they were still there and operated immediately.

            •  For every "hypochondriac" (6+ / 0-)

              you want to penalize for being sick, there are several people who don't like or trust doctors and avoid them like the plague. And, ironically, live healthier lives because of it.

              Besides, most of the people you're pointing at and calling "hypochondriac" really ARE sick. It too often takes years - if ever - for doctors to figure out what's making them sick. Because health care delivery in this country is notoriously lousy, about equivalent to health care in Latvia, not as good as health care in many so-called 'third world' countries. Meanwhile, they end up taking too much medicine prescribed by their lousy doctors for too many symptoms (which cause symptoms all their own) and nothing for the ailment. This often ends in premature death over a few years' time, so it all works out in the end. There is no real reason to financially punish people for being sick. Or even old and sick.

              •  I agree with most of this (0+ / 0-)

                I live with a hypochondriac, and I think going to so many doctors and getting prescribed so many drugs makes her worse off than if she focused less on some of her mental issues. She absolutely has some very real health problems, but sometimes I think (and she doesn't disagree) that being so focused on it makes her worse.

                I just don't think things should be completely free, because that just incentivizes more lousy doctors to prescribe more drugs without really trying to get at the heart of the problem. And I think making things like prescriptions completely free would create perverse incentives. If you can get cholesterol medicine and all the doctor's visits to prescribe it completely free then where's the incentive to eat healthier or go to the gym, both of which cost money?

                I don't believe in punishing people for being sick. I believe everyone should pay for what they use to the extent they can afford it and there should be a social safety net to help those who can't.  

                •  This is a piece of information (0+ / 0-)

                  that I think may inform your attitude towards unlimited health care at the sole discretion of the patient. That's a powerful experience that might make it difficult to avoid conflating a specific example to the general rule.

                  Time makes more converts than reason. Thomas Paine, Common Sense

                  by VTCC73 on Wed Nov 28, 2012 at 02:31:15 PM PST

                  [ Parent ]

                  •  Yeah, maybe (0+ / 0-)

                    I guess the bottom line is, I believe that health care should be affordable for all. I do not believe it should be free for all. I know some people disagree with me...I think it's something on which reasonable minds can differ.

                    •  Nothing in this life really comes free. (1+ / 0-)
                      Recommended by:

                      A national health service would be paid for via dedicated taxes, just like Medicare, Medicaid, VA, and all other government agencies and programs. Only it would be available to everyone, cradle-to-grave. What the poor and working poor can pay is little, what the well-off and rich can pay is more. I have no problem with that at all. What you can't do is pretend that those who can contribute less to the system must receive less health care than those who can contribute a lot. We're all human, we all need health care at some point no matter how rich or poor we are. And no, we aren't talking about nose jobs, face lifts or breast implants here (apart from necessary reconstructions after trauma or cancer, etc.). We are talking actual health care.

                      I'd rather pay my share and have your roommate have as much access as she can get (doctors have little time or patience with hypochondriacs) than pay for the gigantic killing/maiming machine that is the U.S. military/ industrial/ intelligence complex. I get no voice in any of that. Why would I want to decide who can and can't get health care?

                      By the way, I am one of those people who avoids doctors like the plague. Last time I went to a doctor was 18 years ago, and he was so lousy I ended up treating myself as usual. Before that I'd been to a doctor all of three times since I turned 15 years old. I'm more than 60 now. Yeah, I'll need 'em at some point, but in my observation people who go to the doctor regularly are sicker and on way more drugs than people who don't. But when I need health care I want it to be there and I want to have fairly unlimited access. Even just to ease my passing (where are all the GOOD drugs?!?).

                      Many things have to change about health care, access to health care, and what it means to be "healthy" in this strange modern age. Those are systematic as well as personal struggles we have to engage. But if this country can serve as the whole world's police force and slaughter people wholesale and spend more money on it than all the rest of the world combined, then we can cut way, way back on that and afford to let your roommate get all the doctors/drugs she thinks she needs and let me get decent care in my old age. In the end it won't grant any of us immortality, so what's the big deal?

                      P.S. your roommate will eventually encounter a doctor who will tell her the truth unvarnished. Maybe help her get what she really needs from the system. It is not your job to make that determination or insist she be forced to pay more based on your judgments. Unless you are her doctor.

                      •  I was saying the opposite (0+ / 0-)

                        That those who have more should pay more for their own care, so that nobody has out of pocket costs that are too high.

                        I was talking to someone at school recently who is German, and she said that in Germany, the insurance industry is heavily regulated and everyone is in the pool, and everyone pays a percentage of their income for the insurance. That seems like a fair system to me.

                        The ironic thing is, my roommate voted for Romney and believes that the government shouldn't provide health care for people or force people to get it. Even though she has so many health issues that she may not be able to hold a job after graduation and in any event will have expensive medical bills for the rest of her life. Yet she said that if she ever becomes comatose, she would want to be kept on life support indefinitely if there is even the slightest chance they will develop technology to revive her.

                        •  Old rule: no free lunch. (2+ / 0-)
                          Recommended by:
                          Joieau, draghnfly

                          Everyone pays for health care regardless of the system under which it is delivered or is paid for. Every system in the world has features that are efficient and those that aren't. The biggest problem with the American system is that it is almost twice as expensive as the world's second most expensive and delivers a far worse outcome than in the next almost 40 countries. Part of the problem is that the system has been industrialized by middle men whose sole motive is profit. A vital public service has been hijacked to harvest money. The system's only incentive to reduce cost is at the provider level and every increase is passed to the consumer. The double winner is the middle man, the insurance industry. Who you pay to receive care makes a no difference unless that entity has a profit motive.  I can't see being hung up over whether you pay the provider, an insurance company, or the government if that entity has a motive of minimizing expenses not related to the delivery of care. Again, our system fails horribly to either be efficient or provide world class care but does create the most profitable insurance companies in the world. They are parasites pure and simple. Why do we tolerate them? Instead here we are chatting about the importance of whether someone pays what they can afford what they can for a vital service. Forest meet trees.

                          Time makes more converts than reason. Thomas Paine, Common Sense

                          by VTCC73 on Wed Nov 28, 2012 at 07:20:46 PM PST

                          [ Parent ]

                        •  Well, that's not unusual. (1+ / 0-)
                          Recommended by:

                          It's never about them, always about "those" people. Funny thing is, you seem to share that attitude. I should not have to deal with bureaucratic red tape to get whatever "social safety net" you think exists for people like me just so I can see a damned doctor whenever I need to. That's as much or more of a burden on me as you'd like to put on your roommate.

                          Here's a for-instance. My daughter tried to get Medicaid for my grandson 20 years ago while she was in college. She easily qualified, but the waiting list was 5 years long. And they wanted her in the office on the other side of a different county from where she was going to school, once a week, to 'prove' she still needed it (keeping her name on the list). They make it as difficult as possible on purpose because they, like you, want to make sure nobody's getting anything they don't "deserve." Like basic, bottom-line health care.

                          Absolutely not worth it, so she and grandson did without, even after she developed epilepsy and had to give up the career she got her degree in. They're still doing without - she works retail minimum wage after being out of work for years, owes more for her student loans than she'll ever be able to pay so she'll never have more. He's now in community college the next county over, with Pell and some help from us, hoping like hell not to have to take out loans that will forever keep him down. When the ACA requirement hits, they'll either get on the exchange with subsidy or still have to do without.

                          That's all so mind-numbingly stupid and severely insulting in what pretends to be "the richest nation the world has ever known." Health care is a basic requirement of life. It needs to be available to all, even if they can't drive or hitch a ride 80 miles round trip to sit in an office all day once a week to 'prove' how poor they are, sometimes for years, just so they can someday maybe see a doctor when they're sick. The doctor, as well as the only decent hospital in the region, is 45 miles in the other direction, just so you know.

                          •  You are so right (1+ / 0-)
                            Recommended by:

                            Universal health care, a right to health care, takes "don't deserve it" completely out of the equation. The savings of a reduced beauracracy that repeatedly must determine eligibility is another significant savings compared to our current system.

                            Time makes more converts than reason. Thomas Paine, Common Sense

                            by VTCC73 on Thu Nov 29, 2012 at 10:05:44 AM PST

                            [ Parent ]

          •  ... (0+ / 0-)

            In a perfect ideal world that would be wonderful but that's not going to happen until we have get politicians from both parties to push for it...  and there are Republicans who believe in expanding Medicare.

            The greatest trick the Devil ever pulled was convincing online commenters that they have anything to say.-- B.F.

            by lcj98 on Wed Nov 28, 2012 at 09:32:11 AM PST

            [ Parent ]

    •  democrattotheend - there is no cap on Medicare (4+ / 0-)
      Recommended by:
      cherie clark, J M F, VTCC73, Mr Robert

      in addition starting in 2013 Medicare taxes will be paid on investment income. There has never been a cap on earned income.

      "let's talk about that"

      by VClib on Wed Nov 28, 2012 at 09:04:37 AM PST

      [ Parent ]

      •  Correction, the Medicare cap was (0+ / 0-)

        lifted 15 years ago.

        "let's talk about that"

        by VClib on Wed Nov 28, 2012 at 09:07:07 AM PST

        [ Parent ]

      •  You're right, I wasn't clear (2+ / 0-)
        Recommended by:
        VClib, lcj98

        Some people on the left have said that all the problems can be solved by raising the cap. That may be true for Social Security, but not for Medicare. So at some point, unfortunately, some changes are going to be made to Medicare, because current benefit levels are not going to be sustainable as more Boomers retire.

        My dad becomes eligible for Medicare in a few years and I want him to get benefits as good as current seniors have. But I know that at some point they are going to get cut. I certainly don't expect to get Medicare that is as good as what they get now by the time I retire.

        In an ideal world, they would save a lot of money by allowing Medicare to negotiate drug prices. But unfortunately, we don't have a House of Representatives that will agree to that.

        If I thought we were likely to take back the House in 2014, I would say Dems should kick the can down the road until then, and find savings in Medicare by negotiating drug prices. But there has never been a wave in favor of the president's party big enough to pick up the number of seats we need.

    •  Total delusion. (3+ / 0-)
      Recommended by:
      greenbell, corvo, JustinBinFL

      What the hell is "our way?" What makes you think that in the end, Dems are anything more than less Republican than Republicans?

      "You can die for Freedom, you just can't exercise it"

      by shmuelman on Wed Nov 28, 2012 at 09:32:50 AM PST

      [ Parent ]

      •  By our way, I meant the progressive way (1+ / 0-)
        Recommended by:

        If most of us on this site had our way, we would see increased taxes on the rich, no cuts to entitlement programs, no raising of the retirement age, cuts to defense spending, and savings in Medicare by allowing Medicare to negotiate with drug companies.

        I wish we had enough real Democrats in Congress to do it that way, but unfortunately we don't.

    •  There's no need to "compromise" with terrorists. (18+ / 0-)

      The Dems have the option of doing nothing at all, which they've long since shown their proficiency at.

      Let ALL the Obama-Bush tax cuts expire; let sequestering, with its very welcome defense cuts, be the law of the land...

      The downside is... what, exactly?

      When you triangulate everything, you can't even roll downhill...

      by PhilJD on Wed Nov 28, 2012 at 10:20:36 AM PST

      [ Parent ]

    •  How about we cut spending where it makes sense. (16+ / 0-)

      Like look at military spending. And no bid contracts. And the wages paid to consultants. And the life styles of our top military commanders. And the ways in which Congress can be made more efficient. And the practice of picking winners and losers in our tax system.

    •  elections matter (0+ / 0-)

      even midterms.

      people can complain like hell but they also need to vote, every single time, even state and local elections.

      we got Bush because we got plowed over by a right wing supreme court and we got a right wing supreme court because when things were good there were lots of shiny toys to distract people and they bought the shit they were fed.

      morning in america? fuck them. it may have been for some but people didn't pay attention or didn't care or both.

      we are where we are because not enough people gave a shit. got me another large flat screen TV, a Hummer, a 2nd home, jet ski, RV, satellite was a fun ride wasn't it??? chickens came home to roost.

      mittens=edsel. no matter how much money is spent to promote it, if the product sucks, no one will buy it.

      by wewantthetruth on Wed Nov 28, 2012 at 01:17:03 PM PST

      [ Parent ]

    •  I realize I was mistaken about certain things (1+ / 0-)
      Recommended by:

      when I first posted this. My grandfather went to the hospital twice this month and my mom said he didn't have to pay anything. So I mistakenly thought there were no Medicare copays for hospital visits. I forgot until I talked to my mom today that my grandfather has supplemental insurance and that's why he had no out of pocket cost. I didn't realize how high the current out of pocket costs are for seniors who don't have supplemental insurance.

      At the very least, I think Democrats should not agree to any cuts unless the Republicans agree to let Medicare negotiate on drug prices, because that would save a lot more money.

      Sorry if I offended anyone...I realize now that some of my assumptions were mistaken.

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