I have now received five emails to this Sullivan piece:
Now we see the real struggle for the soul of this administration. Obama wants to tackle the insolvency of the big three entitlement programs: Medicare, Medicaid and Social Security. These three programs, especially Medicare, will destroy the fiscal future, unless we pare them back now. Left untouched, they will also make it much likelier in the near future that global financial markets may finally snap and stop sending money to a country that looks more and more like those subprime mortgage-owners than a serious polity.
A few thoughts. First, I don’t think there is any disagreement anywhere that there is a problem with medicare and medicaid. Second, I simply can not take seriously anyone who worries about Social Security going insolvent in thirty years when there is a solid chance our currency will not make it to 2010. Third, the reason social security is such a hot-button issue is because we have been looting it for decades.
There. I have addressed this. Only a fool can not see the writing on the wall- we are going to have to move to single-payer at some point, because businesses can not compete and the largest problem for Detroit is… their health care obligations and other retiree benefits. Likewise, we spend an enormous amount of our GDP on health care yet have rankings that look third world on issues like infant mortality. Something has to give.
And before the morons start saying I have switched positions on this, I haven’t done anything of the sort. My consistent position the last few years has been that this is sort of inevitable, and whether I want this to happen or not is irrelevant. It will happen. I had sort of felt things were moving this way, and as we all know, our Captains of Industry at Wal-Mart are pretty ok with pushing off the cost of the health care of their employees onto the public. When United Airlines managed to just say to hell with a couple hundred thousand employees and say to hell with their pensions and healthcare in 2005, it sort of became glaringly obvious to me what big business thought the future held for us. Just today a story out of Detroit that Ford is, under an agreement, allowed to substitute their stock for payments to a retiree health care trust. Showing no sense of irony, the other headline at the NY Times is Stocks Slump on Corporate Woes; Indexes Fall by 3.4%. Any of you junior Nostradamus’ want to take a stab at what is going to happen to the retirees covered under that plan? I know what my guess is.
The only thing that is not settled, as far as I can tell, is how much damage we will do moving to the system. It will be a joy to behold, especially listening to folks with lifetime sinecures at prestigious organizations with lucrative health benefits or politicians with government provided health care yelling socialism until their last gasp, but it will happen. Again, the only real question is will we be able to summon up our American ingenuity and in our Solomonic wisdom make a single-payer system that tries to adopt the best of both worlds, does neither, yet still manages to make the members of the gilded class even richer and leaves us with the worst health care system in the industrial and post-industrial world.
The last few years has left me convinced we are up to that challenge. And stop emailing me nonsense.
donovong
From your lips to God’s ( and Sully’s) ears.
Quaker in a Basement
Kudos to you, sir! Far too few–even among writers on "our" side–will say this plainly. About a decade back, there was a fellow in Washington who proposed putting a stop to the looting. A "lockbox" he called it.
People mocked him for it.
gbear
There’s a difference?
joe from Lowell
That "looting" is mandated by the Social Security Act.
By federal law, Social Security surpluses have to be put in the General Fund.
Not even Gore proposed segregating the funds. His plan was to put an amount (taken from the general fund) equal to that year’s Social Security surplus towards paying down the national debt, so we’d have more debt capacity when the Boomers retired.
Josh Hueco
Ah yes, if it’s an even-numbered week in a month ending with ‘-y’ then it’s time for Sully to start screaming ‘ENTITLEMENTS’ and that since he’s got his $$$ meds, everyone else can pound sand.
BDeevDad
This is what I find amusing about the tax cuts folks complaining about entitlement programs bankrupting the government. The entitlements are taxed separately and have been keeping the government solvent on borrowed time.
Zifnab
Social Security works well because when we originally created the system, it wasn’t rigged to explode as a giant money trap. Medicare and Medicaid were at least born in the age when corporate whoring was in its juvenile state.
But every new iteration has been worse than the last. Social Security "reform" in the 80s just ended up gutting benefits and raising taxes without improving the system in the least. HMOs were a fucking disaster, creating a substantial market for industry-funded quacks while generally pissing all over good doctoral practice to make a quick buck. Medicare Plan D was a nightmare, pure and simple. A brutal farce of a bill that made no bones about its purpose – to give pharmaceutical companies copious amounts of money in exchange for large financial contributions to political campaigns.
It will only get worse. Every program we implement that caters to the private sector first, the politicians second, and the tax payer dead last is going to dig us further and further into the fail pit.
Either we drop our knee-jerk paranoia of "socialism" and start putting together programs that genuinely work, or we’re just going to blow money on one boondoggle after another.
After seeing the Obama Administration’s pathetic clinging to the trappings of Regan Era capitalism, I can’t say I have a lot of hope for Entitlement Reform. Give Blue Dogs and GOoPers the run of the show, and we’ll just have higher taxes on those that can least afford it and lower benefits for those most in need. We’ll split the difference between workable and absolute horseshit, then siddle up to horseshit for that 60th Senate vote.
We’re doomed. We’re all doomed.
The Moar You Know
I believe in America and American ingenuity. We can make our national health care system such a clusterfuck of high costs and utter incompetency that we will be the wonder of the world.
jnfr
This is worth reading: Ezra Klein on health care spending and the deficit. How Entitlement Reform Became Health Reform.
The charts are excellent.
Napoleon
I personally think that, that at least in the short term (say 10 years) you will not see single-payer (although I think it would be better).
Just Some Fuckhead
Great post John. I think we’re on again. It feels right.
Napoleon
So exactly as it is today under private "stewardship".
I don’t think so.
Comrade Stuck
What is it, like 2018 or something before outgoing SS benefits matches the current payroll tax surplus. It’s not like Obama has enough to worry about already. Something will have to be done, but our history suggests that we won’t be ready to make the needed changes until the 11th hour, just before some sort of doom is imminent. I don’t think Sullivan ever much liked SS to begin with, and Obama flogging this now encourages the entitlement haters to add another log to fire that is currently burning down our house. Maybe in his second term, if we’re still just a single country then, and not an amalgam of waring tribes.
bootlegger
But if we have a single payer system some bureaucrat will make decisions that should be between you and your doctor and on top of that you will have to wait weeks to get an appointment.
Oh, wait, never mind, that happened to me last week with Blue Cross-Blue Shield.
bobbo
Sully heroically opposes torture. Tough call!! But when it comes to fiscal stuff he is about as knowledgeable as Gregg Easterbrook on global warming.
Dennis-SGMM
But, but, but, that means that Reagan’s "Social Security Reform Act of 1983" was just a cynical ploy to raise taxes on those Americans whose wages never reached the withholding cutoff – i.e. the lower and middle class and not, as he said, to make sure that Social Security would be solvent for the Boomers..
Oh say not so! Not St. Ronnie!
Mark S.
We spend 15% of our GDP and don’t come close to covering everyone. The rest of the industrialized world spends half of that and covers everyone. This should be a no brainer, but our corporate whore media does a great job of not letting the debate even happen.
c u n d gulag
I have complete faith that this country will look at what the rest of the world has, and choose the policy that will be the worst thing for the most people, while enriching the already rich minority.
Complete faith!
Yeah, we’re screwed. Unless enough of us decide to risk our lives for a revolution against money and power, we are totally screwed. And not enough people are. I am. Are you?
zoe kentucky
Here, here, bootlegger.
I’m looking forward to all republicans who oppose any kind of health care insurance reform to voluntarily give up their "gold-plated" TAXPAYER-SUPPORTED health insurance and go out and see what they can get on the open market. I really hope Obama invites them to do so. I also hope that there is some kick-ass organizing around this issue because I don’t know anyone who doesn’t think the health care industry is BROKEN– in fact the people who think it is the most broken are those who work in it. Ask a doctor or a nurse if you want to know how broken health care/insurance industry is right now. It’s broken, folks, and the only people who say it isn’t are far removed from the problems facing ordinary Americans.
The only people who are claiming that health care reform would make things worse are the small minority that have EXCELLENT coverage (read: very EXPENSIVE insurance that someone else pays for).
Chris Johnson
Whatever. I seriously doubt I have any trustworthy health care system, and I’m running on the remains of what Social Security Disability had to offer. I’m grateful for anything at all I can have, and just hope I never get sick or injured in any serious way. I’ve fought my way off disability with a lot of help- notably what’s called the New England PASS cadre- to the point where instead of scraping by on about 8K a year government entitlement money, I am bringing in a hair over 20K a year- gross, NOT net- at least half of it from overseas.
I’m still cranking away at it. I’m right now taking a break from re-doing upwards of 2,300 separate drum samples for a set of projects that will become new products when they’re done. Those too will probably sell overseas, so I’m actually doing export business and bringing money into the USA where it is spent.
I can’t afford to turn around and pay private insurers and pharma companies to dick me around, so I’m gonna exist only as long as I’m not too badly sick or hurt, and only as long as my country manages to patch me up and keep me going. I’ll happily try to help- for instance, I don’t smoke and I’ve lost weight to ward off possible diabetes which runs in my family.
As an american small-small-businessman I am totally in favor of single-payer government healthcare- it’s sort of like having roads and bridges and stuff. Hell with Mayo Clinic bullshit and having the most sophisticated and expensive medicine available only for people with Swiss bank accounts. Let’s be the best damn third world country and see to it that if you’re patient and determined you can get your ass patched up reasonably well and keep fighting on.
Because I don’t see that I can count on that as an American, and to my mind that is such bullshit. 90%, 99% maybe ALL of our big businesses were started at some point by people who weren’t going to be able to budget for overhead like private health insurance. That shit is for bankers and corporate executives and I’m sick of those guys by now.
The Populist
Amen Chris Johnson…I too am a smallish businessman and health care is something that scares me.
Waingro
First of all, Andrew Sullivan may be an eloquent prose stylist, but he is a shit policy analyst. He literally has no clue what he is talking about, but he knows how to make it sound good. It’s nice that he hates Sarah Palin, but he’s an austerity-obsessed Thatcher-ite, so fuck him.
Second, anyone who wants to gut Social Security is either evil or a retard. We’re going to hear a lot of 401k horror stories over the next decade as Boomers serve as our canary in the coalmine. The elimination of defined-benefit pension plans in favor of 401ks has been a beneficial con job for the upper 1%, but it’s going to suck for the average "retiree". Social Security will be the only thing keeping those people afloat- we should be increasing benefits, not cutting them.
Delia
@Waingro:
Amen and amen.
Sully had his conversion moment when he realized that a) the Bushies were always going to be jerks on teh ghey; and b) they liked to torture people just for the helluvit. Oh, and c) they had screwed up the war in Iraq so badly that the Benevolent Empire he was dreaming of just wasn’t going to happen.
But you’re absolutely right on the fiscal issues. I’m one of the people whose various 401 funds have collapsed. With a small pension and Social Security I should be able to squeak by when I hit retirement age, and I haven’t done anything stupid, but there ain’t gonna be any elaborate vacations. So I’m not too amused by the wealthy Villagers who start rattling on about Social Security as an entitlement. I start feeling I’m not too old to play Madame DeFarge.
Anton Sirius
Damn. I thought this was gonna be about Sully wanting to see Obama’s birth certificate.
Et Tu Brutus?
Wake up kids: in the land of capitalism, profit is king, and there ain’t no profit to be had in a single payer system, or any other form of socialized health care ( Medicaid? Are ya kiddin’ me? The only profit to be had there is in outright fraud). You.Are.On.Your.Own. So ya’ll best be figuring out ways to take of yer own health.
D-Chance.
Hey, the world is going to end in 2012, so why worry?
If not the Apocalypse, then surely our financial system will collapse by then… it’s barely hanging onto the cliff’s edge right now.
Social Security is the last thing we need to fret over. Figuring out how we’re going to avoid a complete and total financial meltdown as a nation in the next 24-36 months trumps all that nonsense.
big woo
Hey, deru kui wa utareru.
It’s really interesting that so many people are worried about you not getting with a certain program lately.
kay
Well. I think that about wraps up Social Security and health care.
Good post.
Mnemosyne
@Comrade Stuck:
Actually, that’s the Medicare date. The Social Security date is 2041 and gets pushed out a couple more years every time an analysis is done.
Which is, of course, why we should ignore health care and "help" Social Security NOW NOW NOW. You know, while there’s still money in it to be had for corporations.
Shade Tail
I really don’t know what Sullivan’s specific problem is. But the practical bottom-line is that, at least when it comes to health care, he is a serious elitist who has no idea how lucky he is. He pretends (and seems to honestly believe) that Americans "demand" the best, because the free-market allows us to. And he "demanded" the best when he arrived here fresh off the boat, and therefore ended up with top-flight health insurance.
What an ignorant git. He "demanded" nothing. He got lucky. He has been insured every single day of his miserable life. He had single-payer back in Old Blighty, and when he arrived here, he got lucky by ending up with a nice job that offered him fabulous health benefits. And because the grade-A health insurance he has now is measurably better than the grade-B benefits he had back in the UK, he looks down his nose at people who are struggling with grade-D or even grade-F health insurance. Why, he wonders, would these ignorant peons want to switch to a system that would personally inconvenience Andrew Sullivan?
Because, Sullivan you moron, it would be much better than what they have now. You don’t understand that, because you have no clue what it is like to have crappy health insurance, or to have none at all. You elitist gasbag, you simply have no clue. I wish I could say this to your face.
Napoleon
@Waingro:
Your right, but I would bet that he is 10/20 years from now the new Wills or Brooks respectable conservative, and he is absolutely clueless.
Incertus
Sounds a bit like Instapundit, the mighty tenured libertarian. He really walks that talk, don’t he?
Comrade Stuck
@Mnemosyne:
I was referring to the insolvency date. Or the point where the current trust surplus would disappear on a yearly basis. I believe the 2041 date is the date when all the past IOU’s when collected from the general fun will be used up.
Here is linky. Right now it’s 2017, but changes some every time they audit.
Andre
OMG FLIP FLOP!
NB: This post will make no sense to anyone who knows nothing about New Zealand.
EDIT: On reflection, it will also not be funny to pretty much everyone. However, the "Jandals" Wikipedia page is highly informative.
Comrade Stuck
Now I’m having urges to email John Cole nonsense. Nom Nom Nom. Teh Horror.
jharp
The Moar You Know,
"We can make our national health care system such a clusterfuck of high costs and utter incompetency that we will be the wonder of the world."
I believe that George Bush could have easily fulfilled what you posit.
However, done right, like the other 29 industrialized countries do. It will cut our costs in half.
And also, fuck you.
Waingro
Yep-that’s why it’s important to remind people that he’s essentially a numbskull who doesn’t know shit. He opposes Sarah Palin and torture and he expects a fucking cookie.
I remember his editorship of the New Republic (Bell Curve, Camille Paglia, Stephen Glass/Ruth Shalit), his comments post 9/11 ("fifth-column"), and his relentless trashing of Krugman and later going on to essentially adopt Krugman’s critique on Bush’s fiscal policies.
It took him finally realizing that the Right was actually serious about going after his gay ass that he finally though- "whoa, they actually mean all that stuff?"
If his retirement or healthcare is ever at risk, you can bet we’ll see a hand-wringing, overwrought account of his Personal Journey reconsidering his previous fiscal conservatism. Narcissism can really get in the way of clarity like that.
Walker
That is not insolvency. Insolvency is when you do not have enough money to cover your expenses, either through assets or income. Until the trust surplus is gone, it is not insolvent.
Look, the point that many thick headed people fail to realize is that we are supposed to get to a point where we are spending down the trust fund. This is exactly how the trust fund was designed, and it was supposed to account for the massive demographic distortion of the boomers. We were never supposed to be growing the trust fund forever.
If we believe that paying off the trust fund means insolvency, then we should eliminate the payroll tax now and raise income taxes to cover the difference. Because in that case the payroll tax is nothing more than an extremely regressive income tax that is not helping SS and exists only screw poor people.
Comrade Stuck
@Walker:
It’s all a technical kubbucky dance. Insolvency in the the SS technically means when in a single year SS begins paying out more than it takes in for that year. What it really means is that on a yearly basis there will be no surplus left for politicians to rob to apply toward the yearly deficit to make things look better on the debt. The bonds, or IOU’s are just a piece of paper that says the general fund owes SS some money, which is meaningless, except maybe for accountants, because it’s going to come out of the general fund anyway. Maybe you didn’t click thru my link. Here it is again.
gwangung
If I’m not mistaken (actually, I could be), the boomers’ boom has produced a demographic bulge of its own (not nearly as big, of course), and that boomlet is going to feed back into the trust fund at some point.
gbear
@c u n d gulag:
Go for it. Be brave. You’ll be more productive if you quit looking backwards to make sure you’re not out too far ahead of the crowd.
@Shade Tail:
Isn’t Sullivan’s on a regiment of drugs due to HIV? If he were to ever lose his insurance or change jobs (and lose his coverage of pre-existing conditions) he’d be up shit creek. Does he already have private insurance?
NonWonderDog
As far as I can tell, there is very little truth in this statement. I don’t really know where the talking point came from, but Gore’s lockbox talk has made it really widespread amongst lefties. Wingnuts like it too because it gives them ammo to argue that Social Security should be shut down (I don’t understand the logic there either).
Here’s the situation: the Social Security Trust Funds have taken in more money in taxes than they’ve paid in benefits for decades. The reason for this was to build up a buffer to pay for the retirements of the boomers. All this money (well over $4 trillion by now) has to go somewhere. If they were to bury it all under a huge mattress until it was needed, it would leave a gaping hole in the economy and the wingnut economists who complain that taxes strangle private investment might actually be right for the first time in their lives.
So, the Social Security Trust Funds invest all their money in bonds. They used to invest in private market bonds, and they might still be legally allowed to do so, but it’s better from the trust fund manager’s view to invest in special issue treasury bonds.
The trust funds investing in treasuries is actually the better option from the Treasury’s perspective too. The US Treasury needs to sell its bonds to someone in order to raise money, remember, so there are a couple different scenarios that could play out here:
Scenario one: the treasury sells its bonds to the Social Security trust funds (with special terms: high interest rates and the ability to cash in at any time). This is what’s happening now. The trust funds make more in interest than they can get anywhere else (although this is kind of silly), and the Treasury can sell bonds without actually having to pay interest to outside investors (which is why the interest rates are silly). In five or ten years or so when the trust funds need the cash, they can cash out their bonds and the treasury will have to issue other bonds to private investors to pay off the Social Security Trust Funds.
Scenario two: the treasury doesn’t sell any bonds to the trust funds, but sells to private investors instead. The trust funds can’t buy any government bonds, so they buy market bonds (in big secure companies like Lehman Brothers and AIG). The trust funds don’t make much in interest, but that shouldn’t be the issue; they’re tax supported, and they’re supposed to get their funding through taxes. In five or ten years when the trust funds need cash, their bonds will start to mature and the big businesses they invested in will cash them out (with federal bailout money or bankruptcy notices). The Treasury, during all this time, is paying interest to private bondholders and even further increasing the amount of US national debt held by outside entities.
Scenario one constitutes "looting" Social Security, but I can’t see that scenario two is better in any conceivable way. The "crisis" with Social Security really has fuck all to do with Social Security or the way it’s managed; the fear is that the federal deficit is so huge that it can’t be adequately financed without the Social Security Trust Funds buying up bonds. Very obviously, the solution to that problem is to reduce the federal deficit. (Unless you’re a wingnut, of course; then the solution is to privatize Social Security and cut taxes.)
NonWonderDog
Okay, that was harsh. There’s some truth in it, in that we shouldn’t be running such high deficits that we can’t finance them through any means other than selling treasury bonds to the Social Security Trust Funds. On the other hand, if every single dollar of treasury bonds sold last year had gone to the Social Security Trust Funds I would be ecstatic about our financial situation. That really would be the absolute best case scenario.
kommrade reproductive vigor
doctors want it, yesterday. The only problem with creating a plan that will make them completely happy is they’ll want the right to boil HIP execs in oil.
I’m looking forward to the day when the fRighties denounce the AMA as a bunch of socialists.
c u n d gulag
gbear,
I’m not some macho idiot. I have been a pacifist my whole life. As radical a pacifist as radical pacifism has allowed.
:-)
But, now I see not only my life changing, but my niece and nephew’s, too.
Our economy is at an end game. We have one foot in the grave, economically, the other is on a banana peel…
It’s not ivory tower’s that the interest’s with money hide behind anymore. It’s gated communities. And those are now being protected by former Blackwater personel. And other security firms.
I’m 51 and disabled. But, I will do what I can to help this country change and recover.
I feel that I’m behind a lot of change, time-wise, not ahead of it.
I wish I could way otherwise..
Wile E. Quixote
I like Andrew Sullivan, but I’d really like to pin him down on what he considers a reasonable free market in health care. If we had a total free market in health care Sullivan would be dead, because no insurer in the world would take on anyone with pre-existing conditions, such as the HIV/AIDS that Sullivan suffers from.
There is a group of physicians in Seattle called Qliance that offers an interesting model. You pay a fee of $100 a month for membership in the group and this covers basic health care needs. They don’t accept insurance because of the costs of dealing with it. They can fill some prescriptions on site at low cost, can perform some tests at cost and will refer you to a specialist if necessary. This is designed to provide basic health care from primary care physicians with the idea being that since the patients pay for the health care and not the insurance companies the doctors are focused on what the patients need and not what they need to do to get reimbursed by an insurance company.
D-Chance.
So is Josh Marshall now calling us a Nation of Whiners?
Why, yes, it does appear that some over at TPM are:
So yes, millions are losing their jobs and their homes and we are struggling to figure out what is real and what was fueled by debt dreams. And yet, there isn’t mass starvation, mass homelessness, imminent physical danger, certainly not in those parts of the world that are suffering the most from this credit crisis – the United States, Europe, Japan. The fears and hysteria are based on more intangible issues, though the fear of total loss of home and livelihood and health is just as intense.
While we need to respect that this is a pivotal moment for us all, we also need to halt this pernicious slide into unrelenting negativism.
Suck.It.Up. You ungrateful WATBs!
Wile E. Quixote
@John Cole
OK, but is it OK to mail you naked pictures of myself?
gopher2b
Requiring everyone to get catastrophic health insurance ($5,000 +deductible) and means testing the first $5,000 is the only answer.
I will fight single payer to the death.
gopher2b
Some times, people with more talent than you get more things than you do. Get over it.
gbear
Break a leg.
les
@The Moar You Know:
god, I hate to admit that made me laugh.
gopher2b
@gbear:
At least under my system, I could get an x-ray, get it set and in a cast within a month.
jharp
"I will fight single payer to the death"
So you’d prefer to pay 2 to 3 times what the rest of the world pays? For the same level of care.
And how, might I ask, do you guarantee that you get coverage?
Go fuck yourself, jackass.
gwangung
What? You think Americans are so stupid and incompetent that they can’t match what the rest of the world can do with single payer?
Hm. Wait a minute….
les
Ya know, if this idiot belief were accurate, you would be saying that the US gov is defaulting on treasury notes. If SS goes fucking "insolvent" on those terms, it will be the least of our worries. Third world will be an unreachable dream.
Shell Goddamnit
Requiring everyone to get catastrophic health insurance ($5,000 +deductible) and means testing the first $5,000 is the only answer.
I will fight single payer to the death.
Yeah, that’s the best way…require we tithe to insurance companies to get health care. Genius! That’ll control costs!!
and gopher? you do that thing.
jharp
gopher2b,
"At least under my system, I could get an x-ray, get it set and in a cast within a month."
You’re an imbecile.
Just what in the fuck are you referring to?
Right wing morons such as you spreading outright lies is exactly what has gotten us into this spot.
You really aren’t that fucking stupid that you believe this to anywhere close to the truth? Are you?
Dennis-SGMM
You must one one hell of a fighter too. Having your head so far up your ass must necessitate a constant fight for air.
Jay Severin Has A Small Pen1s
the only thing that will help the big three entitlement programs are Euthanasia.
http://www.youtube.com/watch?v=xVrAv2D1H0I
El Cid
So, maybe we’ll get single payer and be rid of people like you? I’ll take it!
Unfortunately, you’re lying. By "to the death" you mean "I vow to keep talking until you wish to die."
Comrade Stuck
@les:
Don’t blog me nonsense.
It may not be accurate but it is true.
Comrade Stuck
I said on a yearly basis it would become insolvent. Your talking about bankrupt overall, considering the bonds from all the past years of surplus. That won’t happen until 2041.
DaveC
World class cynicism. Prophetic.
Thank you so very much.
NonWonderDog
@Comrade Stuck:
"Insolvent on a yearly basis" is meaningless unless you believe that the US Treasury can’t sell enough bonds to cover the deficit without selling bonds to the Social Security trust funds. That may very well be the case (I’m not quite convinced yet), but it’s not a fucking problem with Social Security.
That 2041 date, by the way, is the most pessimistic projection. The trust funds run three projections, and the moderate and optimistic projections both show Social Security solvent for at least 80 years.
The latest projections were run before the current meltdown, of course, and it’s quite possible that the pessimistic model wasn’t nearly pessimistic enough. Social Security most likely needs an adjustment, but it’s nowhere near a crisis.
Comrade Stuck
@NonWonderDog:
Of course it is meaningless, but it is true. I didn’t attach any right or wrong to it which some are trying to do to start a fight. It is what the trustees call it and simply means that in 2017 SS will begin to pay out more than it takes in on a yearly basis. I see why Cole wrote this post titled "Please Stop Emailing Me". so, I say, please stop blogging me. I am on your side. Jeesh.
Chris Andersen
I came to something of a revelation about a year back. I can’t make a strong, principled argument for single-payer. But I can say with 100% certainty that a for-profit health care system simply cannot work. It cannot work because any system that puts profits BEFORE providing adequate health care is, by definition, a system that says that it cannot provide what it supposed to provide.
For profit health care is one of, if not THE, single greatest lies ever foisted on the American people. It has never worked. It does not work. It never will work.
And if for-profit cannot work, then there is really only one other alternative.
TenguPhule
Yes, yours.
Comrade Stuck
One addendum to this. While it is meaningless in the real world, it is not entirely meaningless in the political world. It is a psychological point that enemies of SS will try to exploit to force cuts long before they are necessary.
iluvsummr
@Et Tu Brutus?: Team up with a bunch of people from work and hire our own personal Cuban doctor? They’re very well-trained and very poorly paid, so it sounds like a plan to me.
Lee
I know I am really late to this thread, but wanted to point something out.
Comparing health statistics across countries is very difficult.
Using this one example (infant mortality) different countries have different standards for live birth. reference
Another statistic everyone likes to point to is how great we are in the US with prostate cancer survival rates. Well that is because we test so early. We do not necessarily TREAT any earlier we just TEST earlier.
brantl
"Some times, people with more talent than you get more things than you do. Get over it."
What talent does Sullivan show? He got the results of the war wrong. He’s gotten his predictions of Republican "fiscal responsibility" wrong. He’s startled that the Republicans actually mean what they say when they talk about gay-bashing in every (even the literal) way. He’s very talented as a glib dip-shit. What’s that worth, exactly?………….. That’s what I thought.
gopher2b
Just wanted to acknowledge the compelling counterargument above like: "go fuck yourself", "you’re a fucking imbecile", etc.
Time and time again, you guys overwhelm me with your intellect. What did I propose? Requiring everyone to get high deductible insurance so in the event of a catastrophic injury or disease he or she is covered. I have this type of health insurance and it costs me and my employer $200 a month for full family coverage. I ALSO said that for those the government should pick up the tab.
There are so many life losers on this site its difficult to participate. Here is an economic lesson for you genius. If you want to lower costs, don’t add 30 million people to the supply side.
The entire point of single payer system is to force (young) healthy people to subsidize the health of (old) sick people. Since the boomers I currently bankrupting my and my kids generations, they can pretty much go fuck themselves.
gopher2b
@jharp:
I just want to highlight you particulary as far too sensitive. What, do you have stock in a single payer system or something. Grow up, learn how to argue and you won’t have to fall back on:
You typed fifty words and said absolutely nothing of substance.
gopher2b
I don’t know. I’m guessing six figures easy, maybe even close to seven.
Shade Tail
@gopher2b:
No they don’t. Luck doesn’t equate to talent. I realize that you selfish "I’ve got mine, so screw you Jack" GOP dead-enders are incapable of understanding that, but truth and reality exist independently of your poor imagination.
Quaker in a Basement
@Stuck:
I don’t know whether that’s illiterate or a tribute to Mencken. Either way, I love it.
Jason Eckelman
@gopher2b – "Time and time again, you guys overwhelm me with your intellect."
This is so classic. Out of the several responses to your inane posts, you pick only the ones with profanity, completely omitting the many responses specifically rebutting your statement, and explaining why. It’s all about your victim complex, apparently. Also, just because you decide a response isn’t "substantive" does not make it so. Hell, the Republican raison d’etre at this point seems to be solely to misrepresent facts & deny reality in every way. I guess that’s real successful with other Republicans – not so much everyone else.
Comrade Stuck
@Quaker in a Basement:
A mix of an incomplete education and hillbilly irony.
gopher2b
@Jason Eckelman:
"completely omitting the many responses specifically rebutting your statement, and explaining why."
Okay, why don’t you go ahead and point me to those posts that rebut my statement and offer an explanation. Waiting…………
gopher2b
@Shade Tail:
What a bunch of babies. How many people on this site are unhappy with their life, jobs, etc? Raise your hands. Here is my feedback: It’s your fault, no one elses.
Grow a sack and go out into the world (yes, its a scary place) and go after what you want. If you get it, great. If you don’t, sorry but I respect your effort. Now try again. Perhaps that means you have to move away from your shit town because there are no jobs there. Perhaps that means you may have to actually apply yourself and risk failure (OH, the HORROR).
I have seen guys like you throughout my life. You try to accomplish something for two weeks, then it gets hard and you quit. I know you guys. I’ve worked with you and gone to school with you. Some of you people are so fucking fearful of failure that you sit in cubicle, bitching about everyone else getting ahead, and blame it on anything but your own failures. Yes, there is absolutely luck involved and if you want to focus on that go ahead. You will be a loser in the end.
Some people need free healthcare. Most do not and I don’t think it my moral obligation to pay for your x-ray because you broke you ankle playing a pickup basketball game. Yet, if anyone wanted to engage in an actual discussion I would agree that employer based coverage is a terrible idea. But you mindless drones then go 180 degrees and "repeat after me"…."must be single payer, must be single payer".
Sister Machine Gun of Mild Harmony
We could also raise the retirement age, because with people living longer and healthier, it is really too low.
Shane
@Comrade Stuck:
Seems to me you’re explaining the prevailing wisdom (and thank you, I now understand the ‘crisis’ much better than I did), but…
NonWonderDog is giving some vital, and accurate, pushback against these enemies and their psychological point. If they want to counter him, how about let them do it themselves?
Jason Eckelman
@ gopher 2b: Alright, well I’ll give it a crack, then. Your argument: "Requiring everyone to get catastrophic health insurance ($5,000 +deductible) and means testing the first $5,000 is the only answer" seems unworkable and impractical on several levels. First, you require the insurance itself – who will be providing that? Employers? Or the American consumers themselves? Second, will the insurance still be run out of private, for-profit Insurers? If so, that in no way improves the situation we are in now, as we pay more for poorer service than other comparable first world economies. Third, "means testing" is well & good in theory, but in practise seems to amount to people who already pay too much for health care having to pay even more. All that and I didn’t even curse at you. Look at me go.
Quaker in a Basement
Mencken it is!
Comrade Stuck
@Shane:
Yes, NWD is giving vital pushback against these enemies. But they are not here on BJ. And I am not one of them, and usually when I discuss these things here, I do it often with a dispassionate style of looking at the issues from both sides. Some people sometimes take that as taking the side of those enemies of SS, or whatever the topic is, and I have to explain that I am on their side in reality, though describing the overall theory of the argument. I can’t help it, and don’t want to because I think a total view is necessary to point out the importance of nuance. When I want to fight with the other side and we have no genuine RW trolls here, I go troll on wingnut websites to do that. I hate engaging in fights over minor details with people I basically agree with.
It was the highlight of my New Years Resolution, to avoid this whenever possible.
TenguPhule
Neither rich nor poor may sleep beneath bridges or beg on the streets.
Yeah, how’s that working out for ya, Mr. One medical disaster away from bankruptcy?
TenguPhule
The entire point of insurance is to pool risk.
Otherwise nobody who needs it can get it.
gopher2b
@Jason Eckelman:
Thanks.
I do not think employers should provide insurance for the obvious reasons. Sickness leads to loss of job which leads to losing insurance. Terrible spiral – everyone knows it. It’s requires too much from employers who would be more competitive if they did have to pay for it and more importantly manage it (how much of an HR staff is devoted to these benefits alone).
So, yes, American consumers would have to go into the market and buy it. I think insurance companies are as evil as you probably do so you would have to heighten regulation. I would simply require insurance companies to pick up the tab whenever the bill goes over $5,000. You shouldn’t need a lawyer to figure out whether this condition or that condition is covered. Its terribly inefficient and expensive.
I personally think we need to cut back on supply, not add to it. My wife is a nurse and so is my mother. Both agree that people with "great health insurance" meaning 100% is covered from the start and Medicaid patients are the worst offenders for abusing the system. There is no "cost" to them so of course they go to the doctor at the drop of a hat.
We need to make the process simpler for everyone involved and let doctors and nurses practice medicine. Medicaid pays its bills 9-12 months after they are due. The paperwork is ridiculous. We’ve made the system this complicated and expensive with HMOs, PPO, layer after layer of bureaucracy. Adding another layer will not make it better.
Finally, I will say that if we go to single payer, two things will happen. (1) There will be shortages. No question about it. (2) 90% of the best nurses and doctors will leave the system. You don’t go to medical school, rack up $500,000 in debt to be told what to do by a government employee. If you think there are two systems of health insurance now, you haven’t seen anything yet.
(PS I would also have used some of the stimulus money, or added more money to start 10-20 more medical schools because (1) its way too hard to get into medical and a lot of qualified people aren’t getting in, and (2) we need more doctors)
Martin
This entire argument applies to everything from the military to public roads to parenting. The reason is that it’s such a steaming pile of shit argument is that virtually everyone pays too much at some point and virtually everyone benefits too much at some point. Why are public police and fire forces and public roads good but a public health system bad? Nobody seems quite able to answer that directly without getting into edge case rambles about welfare queens and shit like that, or paranoid trips into the world of communist socialism.
And John seems to miss the point slightly:
True, but if it’s inevitable for the public good what about it is wrong? What is there to oppose other than a selfish desire to be right about something? Isn’t something that we identify as inevitable for the greater good really the definition of good policy as is relegates pretty much everything else to magical thinking status? Even the I-got-mine arguments have to be tossed aside as the ‘inevitability’ of the move suggests that we recognize that even the majority of those that have theirs would suffer without it in some way.
John isn’t saying it’s bad policy, exactly, but neither does he defend it as good policy. Nor can Sully do the same either. Those threads of ideology haven’t quite torn loose.
gopher2b
@TenguPhule:
It’s "The law, in its majestic equality, forbids rich and poor alike to sleep under bridges, to beg in the streets, and to steal their bread"….. which makes sense whereas your dribble does not. Don’t steal from others, it unbecoming.
Bankruptcy is underrated. Its not that big of deal. Trump does it all the time.
Martin
You do realize that the median household only earns about $15K per member, right? You’ve committed up to 1/3 of median household income to health care. Further, a substantial number of households actually earn right around $5K per household member, so they don’t get food or shelter?
Then why are the majority of nurses and doctors calling for single payer? Do they all hate their job that much?
jake123
gopher2b:
I live under a single-payer system, in Ontario, Canada. Your characterization of it taking a month to get an x-ray and set a broken leg is wholly inaccurate. The major difference between single-payer and for-profit health care is not single payer does triage and makes you wait longer for lower-priority conditions… it’s that the triage done under single-payer is done on the basis of the injury, not on the fatness of the wallet.
Martin
Personal responsibility, bitches!
TenguPhule
Get back to me after you find out you can’t discharge your debts in Bankruptcy and have to do a payoff plan that is two steps to the right of indentured servitude.
hmd
"Looting" Social Security? What the heck does that mean?
Social Security is designed so that surplus payroll taxes should be transferred to the Treasury by the purchase of special bonds. Once in the Treasury, that money is simply fungible. You could use it to provide health care, pay off debt, buy fighter planes, build mass transit, or pay massive bonuses to people whose last name begins with ‘D’. There’s no such thing as looting it. (Unless you want to talk about corruptly funneling the money to your cronies
at Halliburtonunder no-bid federal contracts.)The word you want, I think, is "squandered". Social Security surpluses should be spent on education, infrastructure and other projects that will enhance the productivity of future generations, making it possible for them to redeem those bonds when the time comes. Using them to support bloated defense budgets or feckless deficit spending – that is a poor use of those funds. But it isn’t "looting" by any reasonable definition.
Ottovbvs
Of course we’re ultimately going to go to a single payers system. However, once again the line between "paying" and "delivering" is blurred. The delivery is going to remain largely private, we’re not going to see UK style National Health System run hospitals or govt employed doctors other than outside already govt run parts of the system like the VA. As for the "paying" part we’re not getting there in one step either…..it’s going to happen by a process of attrition over perhaps 15 years when the mandated users turn increasingly to the cheaper govt alternative. It’s not beyond the bounds of possibility that private insurance will remain a player but the odds are against it. Since the delivering is still being done principally privately with some additional horsepower in areas like clinical measurement and electronic data collection the quality will remain fairly good despite the pessimism from John who doesn’t seem to comprehend the difference between paying and delivery. But most important of all this will completely explode the myth with which Republicans have been frightening the country for 40 years that universal healthcare is going to be total mess.
TenguPhule
So you’re basing your whole "fuck you all" approach to medical coverage based on two extremes rather then what most of us have now?
JFCNTZYM.
It’s Darrell II.
TenguPhule
And it’s how insurance companies make the kinds of profits they do now. They will not cover shit if they can get away with it. And five will get you ten that mandating paying off the tab for everyone over $5,000 in costs will simply lead to insurance companies writing 10,000 exceptions to that in their contracts so they still don’t payout and fighting every case in court until the end of time.
TenguPhule
You don’t go to medical school, rack up $500,000 in debt to be told what to do by an
governmentuncaring insurance employee.Except they already do.
SIngle payer at least offers better payments and less chance of being shafted by an organization intentionally DESIGNED to work against the best interests of doctor and patient.
gopher2b
@TenguPhule:
I totally agree with you. As soon as you individualize the contracts, I think the whole system falls apart.
I think the difference of opinion here is how much of the risk should stay with the taxpayer/patient. I’m not wedded to insurance companies. Perhaps the government should be the "insurer" of last resort. I’m less concerned about that then creating a system where you can drop into medical office for lump and bump and it costs you nothing.
If make $40,000 a year and something terrible happened to you, it would suck to be hit with a $5,000 bill. But, life is unfair and you cannot legislate away the friction of life. More importantly, however, I don’t think you would see any hospital stop providing you care because they know you would default on the first $5,000. When they know they won’t get back the $2,000,000, its a different story.
gopher2b
@TenguPhule:
Chapter 7, not 13
gopher2b
@Martin:
I said "90% of the BEST doctors" not all doctors. They will leave the system. Gaurantee it.
Stan
The medical insurance system used in Germany, Switzerland, the Netherlands, and countless other countries is based on an individual mandate, similar to the one used in Massachusetts and the one proposed recently (and defeated) in California. This is the type of plan the Obama administration will present to Congress. I see no chance of single payer coming to the US because of political opposition by the insurance industry. I would prefer single payer, but I don’t think it’s feasible.
gopher2b
You’re assuming everyone would reach the deductible every year. This would not happen.
gopher2b
@Ottovbvs:
Then the government needs to get it shit together. I had a long conversation with a bunch of doctors about how can an business that charges $12 for a single aspirin constantly be broke. They said the main reason was Medicaid and Medicare. The government pays late (really late) and then it only pays 60%. You would think that doctors would love to have the government as a consumer, right? But look at all the doctors out there that refuse to see Medicaid and Medicare patients. Obviously something is wrong and it wouldn’t be fixed by making the system bigger.
You would have two health care systems that are further apart then the ER vs. the Rest of Us world now.
Martin
Translation: "90% of some population I can’t identify will leave." 90% of the 10 best doctors will leave. Ok, sure. Big loss.
The best doctors I’ve found all work at HMOs or teaching hospitals because they permit more time to do medicine relative to billing and other pointless crap. So long as they get paid a reasonable amount, that’s their preferred trade-off. And I can’t tell you how many doctors in private practice I know that have advised their kids in the last decade to not go into medicine because the billing and malpractice hassles aren’t worth the effort.
The corollary to your anecdote is that people today willing to rack up $500K in loans and spend a decade in school are more interested in actually doing medicine than getting rich. If they wanted to get rich there are far faster, easier, and cheaper routes to doing it. Exceptions include plastic surgery and some other specialities that wouldn’t be affected by this anyway. Sure, you need to pay them decently, but that’ll happen anyway. Doctor salaries aren’t the main expense of treatment.
Martin
No, I’m assuming that everyone would need to be prepared to reach the deductible every year. My family has had years where 2-3 of us would have hit that $5K. If we didn’t have $15K to cover that, what would happen? So, you’re saying that the responsible thing would be for us to keep $20K for a family of 4 liquid at all times to cover deductibles.
If you assume everyone does that, you can kiss consumer spending goodbye for about 4 years. If you assume everyone doesn’t do that, what’s tier 2 of your plan?
Jasper
gopher2B
The problem I have with catastrophic policies etc. is those work great if you’re young and/or healthy and don’t ever expect to need them. The insurance companies would love them because they never pay out a dime for the vast majority.
But if you get cancer, or diabetes or have a heart attack, that policy stinks for the insurer now since the odds of a catastrophic claim go through the roof. A profit making entity will drop those folks, or increase the premium so the policy is all but useless. And the chronically sick insured gets dumped into some government pool subsidized by taxpayers. Private insurers cherry pick the pool and lay off any risk to taxpayers – aka virtually guaranteed private profits and public subsidized losses.
You could mandate coverage for any condition as you propose, or you could require insurance companies to cover all applicants, but then what is the damn point of having a profit making entity involved in the process at all? So that they can suck out 10-15% of the premiums to pay bloated upper management salaries while the government mandates all the relevant aspects of coverage? We’d be left with few gigantic insurers with sufficient money to buy the legislation that guarantees the big boys stay rich.