Greek Riots, day #3, via Flickr
Few should disagree that the 112th Congress is now embarking on what may be gridlock so severe that the nation may be seriously damaged. The economy is still shaky and on the knife-edge of either recovery or a double-dip recession, and the nation’s infrastructure such as roads, bridges, and dams are in terrible shape. Despite all this Senator McConell, R-KY has openly announced that the GOP’s principal goal is to repeal every initiative the president has achieved and to deny him a second term. All else is subordinate to that.
On the house side most Tea Party Republicans have vowed to reduce spending even if it means that the US government defaults on its debts, meaning treasury notes and the like. The result of this, in the words of one official, would be calamitous.
Image by Thomas Hawk via Flickr
Now, into this fray of inane partisanship comes the fourth estate in the form of USA Today newspaper, a publication that has won my admiration over the last year for its balanced opinions and aggressive reporting. When it was first founded some feared that its lean style would result in superficial coverage and shallow thinking. Instead, in my opinion, it has become a top source for reliable and interesting news and information that affects all Americans, a source which, while differing in subject
matter from the WSJ, equals that publication in reliability and quality. I find its material pithy, broad in coverage, thought-provoking and balanced.
In its editorial today (1/5/2010), USA Today lists “5 questions for 112th Congress”. I summarize:
Image via Wikipedia
- If not ObamaCare, what?
- Where to cut spending?
- What about taxes?
- Will Congress change?
- Room for cooperation?
These basic questions have been debated over the past months in these blog pages with greatly varied opinions but equally shared alarm by myself, Anson Burlingame and R. Duane Graham among others. USA Today has answers which, in my opinion, make a world of sense and I found nothing in them with which to disagree. The editorial is a virtual roadmap to progress in a time of great political instability. With this paean I heartily recommend it to all. If you find disagreement with its recommendations I challenge you to do any better.
Thank you, USA Today! Whether in paper or online, our form of government could not survive without the likes of you!
Still Skeptical After All These Years 
Jim,
You wrote, “Tea Party Republicans have vowed to reduce spending even if it means that the US government defaults on its debts,…”
I have not heard ANYONE say that. It is of course insane.
What I have heard people say is to cut spending SO WE DON’T HAVE TO DEFAULT… sometime in the future.
I have also heard liberals say RAISE TAXES SO WE CAN KEEP ON SPENDING… which doesn’t make any sense to me, without accompanying spending cuts as well.
IMHO we have to do both, cut spending and raise taxes. Only the Debt Comm. has suggested such an approach, and again, look what happened to them.
Anson
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On ABC News Diane Sawyer interviewed about a dozen new Tea Party members in a group Q&A. Most of them asserted that they would NOT vote to extend the debt ceiling, no matter what the consequences.
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I heard the same comments for a couple of those guys on a different channel. I put all of them in the INSANE catagory. But actually, I blieve they are just playing “chicken” just as Obama did in 2006.
Anson
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Thanks Jim for pointing to an excellent editorial. What I wonder is this, “What is wrong with our system that politicians cannot talk sense like this editorial?”
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Quite right, JW. IMO, it’s all about money, money and money. Oh, and also power. Think management vs. labor unions as a prime example. It’s more than mere disagreement, I think it rises to real hatred. “Social Justice” is simply another manifestation of this struggle. Compare the pre-Christmas Ebenezer Scrooge with his post-Christmas persona – two extremes.
As USA Today makes clear, the proper solutions involve compromise. I can think of no other conclusion that that each side places their partisan loyalties above the welfare of the country. And at the bottom line, Congress does reflect the will of the people, and people are driven primarily by the economy, unemployment and the price of gasoline. And speaking of gasoline, we also have the talking heads pouring it (metaphorically) on the flames of discontent daily.
Jim
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Jim,
You conclude that “each side places their partisan loyalties above the welfare of the country.” Huh? We just observed Obama and many, many Democrats take it in the you-know-what as they “compromised” with Republicans on the Bush tax cuts. I don’t know how much more Democrats would have to compromise without actually becoming Republicans. From the original stimulus plan to health reform to finance regulation reform to tax cuts for the wealthy, the Democrats have compromised to the point that many of us wonder why we worked so hard to get them elected in 2008.
Yet, my friend, it remains popular to say “both sides” when assigning blame for the mess. Sorry, I just can’t go there with you. Even now, Republicans (as you note) are holding the full faith and credit of the United States hostage, hoping Dems will cave like they did on tax cuts. Is that an example of both sides being irresponsible?
Again, I don’t mean to come across as angry (I’m not), but I just don’t understand how you can hold both sides equally to blame or even close to equally to blame.
Duane
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Duane,
While the Democrat Party has “achieved” many of their goals in the past two years while they dominated both houses of Congress, they let spending grossly exceed income. I see it as excessive, and an exercise in presumed superiority of ideas let loose in a flood of exuberance following the Bush years. Were the motives good? Yes. Could we AFFORD all that was done? NO.
I understand that the stimulus was necessary and was started by Bush, but why were no provisions included in the health-care reform act to control costs? That is the central issue in the financial crisis, as we all know. It absolutely dwarfs all other issues. Democrats had the power to do something about it and failed to do so. It would have been a tough political sell to the people, but instead of talking to the electorate like a Dutch Uncle, they showered them with unfunded benefits. Now they are reaping the whirlwind while the elephant in the room, mushrooming medical costs, grows unabated.
The problem is that we can’t afford what technology can supply. Doesn’t the Democratic Party have enough smart people to figure this out? The USA Today editorial about which I blogged yesterday, “Paean to the Fourth Estate”, contains an outline on what might still be done in a bi-partisan manner with the Republicans on healthcare with compromise, but now the Republicans, recalling the Democrats’ disdain for compromise, are more intent on revenge than the nation’s welfare. The one-party rule created resentment that now childishly, IMO, threatens our financial future.
Democrats always seem to want to cure all the world’s ills with other people’s money and if that isn’t forthcoming, to do so on credit. Their motives are pure but their common-sense is lacking. The credit card has been long max-ed out.
I hold the Republicans equally responsible, if not more so. They have been the party of NO big-time and continue to be so. There are plenty of ideas in the USA Today post to show how compromise, now and in the past two years, could have diminished our financial crises and the faults are not all Republican.
Jim
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[The problem is that we can’t afford what technology can supply]
As succinct a statement of our problem as I’ve seen. My 98 year old father died in Sept after surgery that was his choice in spite of a gentle suggestion by his doctor to choose otherwise. He died within 48 hours and the bill was over $70,000. Medicare paid.
I’m deeply liberal and I loved my father, but this disturbs me. And it is at this very intersection that much of our soul searching will return to again and again.
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Jim,
You asked, “could we afford all that was done?”
I ask, “Could we afford to do nothing?” Or, “Could we afford to do too little?” How do you calculate the cost to our economy of not offering up a government stimulus, when private spending had decreased to dangerous levels? Most economists, even Republican ones, argued that government stimulus was necessary to jump start the economy. Heck, it may still be necessary.
As for the health insurance reform bill and Democrats “showering” the people with “unfunded benefits,” the reason they didn’t include the public option (which would have helped keep costs down) was because a few Democrats opposed it and all Republicans opposed all of the bill. The meme of “socialized medicine” is a very powerful one, and I’m afraid a couple of Democrats didn’t want to go down that road. One of them, Blanche Lincoln, is gone now from the Senate.
And I guess I don’t know exactly what you mean by “unfunded benefits.” The bill was funded mostly by cutting subsidies related to Medicare Advantage and the CBO scored it as cutting costs over twenty years. I realize that Republicans always disputed the CBO numbers, but the CBO is as close to a non-partisan scorer as we are going to get.
While we will have to just disagree on your assertion that Democrats had a “disdain for compromise,” this paragraph you wrote stuns me:
“All the world’s ills”? “Other people’s money”? “On credit?” No “common sense”?
Come on, Jim. Democrats don’t want to cure all the world’s ills. In Rawlsian terms, we just want to create a situation in which the worse off are as well off as possible. That’s quite different from your accusation.
And I suppose it’s easy to forget these days, but aside from the Republican profligacy of the past thirty years, most of the social programs are paid for by payroll taxes, which is an example of people themselves paying for the programs they will either use or are there as insurance in case they need them. That can’t be considered as using “other people’s money” except in the same sense that car insurance premiums are using other people’s money because somewhere built into the cost of the premium is a social calculation. If we ever get to the point of means-testing Social Security and Medicare, then the charge you make will have much more validity.
As for Democrats using the credit card, when “other people’s money” isn’t available, in the last thirty years (prior to Obama) we have had only one Democratic administration and that Democratic administration handed off budget surpluses to George W. Bush. Republican administrations didn’t even come close. (And let’s not argue about the composition of the Congress, because Presidents sign the budget bills.) That Democratic administration fought for a sensible tax increase (on almost all wage earners) that was sufficient to pay our nation’s bills. So, I find it perplexing how you could make such an accusation, although Democrats in the House and Senate have been complicit at times in the Republican profligacy.
Finally, Democrats lack “common sense”? Who was it that established the debt commission? And who opposed it? And who wanted to make it binding on the Congress? That was President Obama. He did so despite some liberal opposition in his own party. Show me anything comparable on the other side.
While there is blame to go around, Jim, and while it is tempting to assign that blame in equal amounts to Democrats and Republicans, it simply isn’t the case.
Duane
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1. If not ObamaCare, what?
Republicans would be wise(r), which they will not be, to offer the strategy of breaking that ridiculous legislation down into separate parts and then correcting the errors that were forced upon everyone (except unions and…) in it
2. Where to cut spending?
Everywhere, starting with Presidents signing Bills with expensive multiple commemorative pens and avoiding use of Camp David for vacations, et al.
3. What about taxes?
The well to do will not notice a bag of nickles being deducted from accounts they do not usually manage in person, and there is zero guarantee (especially until Obamacare is modified) that businesses have ever used monetary gains to hire anyone or buy anything that they would not have done for the sake of self-preservation anyway.
4. Will Congress change?
Yes, in two years.
5. Room for cooperation?
Collaboration, maybe?
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Apropos of reform of health care reform:
http://online.wsj.com/article/SB10001424052748704405704576063892468779556.html?mod=googlenews_wsj
http://blog.heritage.org/?p=49568
http://blogs.forbes.com/sciencebiz/2011/01/05/obamacare-and-price-controls/?boxes=businesschannelsections
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To all,
As Rett Butler say, “Frankly, my dear,…..” in response to the last two elements questioned in the USA editorial. It is the overall results that concern me, not how they achieve them. But that is a side issue, for sure.
Duane plays chicken with the best of them in his one sided condemnation of almost all things conservative. But that is simply my view. Now check out my just posted comment to Jim at the beginning of this “string”.
In 2006 Senator Obama HATED the Iraq War. He was ready to do just about anything to force the Republican administration to leave Iraq at the fastest possible speed. And Senator Obama voted against raising the debt limit to attempt to force that issue.
He knew he would not win that argument so it was a “safe” vote. His vote did not really count. I wonder how he would have voted had HIS vote been the one that would have forced no increase in the debt limit then with the same consequences we might have today.
In my view Obama was “safely” playing chicken based on his principles. So are Tea Party Republicans today, crazy as some of their views might be. Check out today’s edit in the Globe for a different view of the outcome on today’s debt limit debate.
We cannot settle debates on individual issues through defaulting the country. But settle those individual debates on such issues we must, sometime. Maybe the debate on the broader debt limit issue can lend itself to views that make sense on smaller issues.
And Jim, in his rebuttals above is dead on target in my view. We have INSANELY spent money in the last two years and look at where we are today. I will be blogging on that point soon.
Anson
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Duane,
I apologize for not replying on this sooner, but lately I have been inundated by a tide of distraction, and, I always try a little harder when talking to you because I respect your brain and your heart.
As I tried to say to Anson earlier today, try as we might, our words often come out the other end differently than intended at the input, and even if the difference is subtle, it can be jolting when given spin. If it were not so, Alexander Hamilton might have enjoyed old age. And, I might add, I shot my comment (a.k.a., my mouth) off with more haste and emotion than I customarily do. Dang, this stuff is hard to do when someone actually pays attention.
Absolutely no question, the stimulus was necessary. Bush started it, and the auto bailouts. Obama finished it. We can argue about whether it was done well or poorly, but the necessity is hard to challenge.
My shower of unfunded benefits rhetoric was inspired by the notion that nothing was included in the Fair Health Act to cut costs, and therefore was redundant. Then too, the CBO study does not stand alone. There are others that make apparently-valid challenges to it. Anyway, it is not enough that it simply “cuts costs”. It needs to be affordable and self-sustaining.
The comment about other people’s money derived from the same idea – that the reform act actually isn’t insurance because of the absence of adequate funding, the absence of cost controls, and the failure of the Democrat majority to “sell” to the electorate the concept of having to make payment into the system mandatory. There was and is a lot of resentment over the mandatory extraction of money for something like this, and the extraction hasn’t even begun yet! So, I’m not saying it’s easy, I guess I’m saying I didn’t see much of an effort for that on the Democratic majority’s part.
Social security, IMO, was a much easier sell because it started out small with few beneficiaries and many, many more contributors. Medical care didn’t offer that choice. I’m thinking it might be easier to revoke or cap the law that forces hospitals and doctors to treat people for free in ER’s. It would be a way, possibly, to make the public understand that everything has a cost. I’m not saying let grandma die on the steps here, I’m suggesting perhaps that the system try harder to collect on ER bills. Or maybe someone has a better idea. Another idea, my own, is to subsidize medical education so that doctors won’t graduate under a mountain of debt, desperate to capitalize on their specialties. Maybe that would entice some back into family practice from the lucrative specialties.
And, you may have noticed that several of my comments over the past weeks indicate that I think Obamacare is better than nothing, which is basically what is coming from the GOP.
The “common sense” think is the kind of emotionally-charged word that shouldn’t have been in serious discourse. Mea culpa. However, the conservative take is exactly that – to pass such a massively expensive program with no cost controls and no idea on how to pay for it does seem to defy common sense. This whole country needs more backbone and less sense of entitlement. That said, it doesn’t help to pry money out of people’s pockets when corporate coffers are overflowing with record profits and management is sitting on several trillion in cash. The GOP does have trouble seeing itself as the hoi polli see it, and that is part of the (age-old) problem.
The medical problem is the BIG one, dwarfing all others. I see no solution possible without cooperation between the two parties. If the Democrats see it as all the GOP’s problem, then we are doomed to the cliff. Both sides are defensive as hell. I can’t even convince Anson to read David Gergen’s well-reasoned little essay on the recent history of success with moderation and compromise. I hope you did. If he did, he would have seen real examples of how it can actually work.
😦 Jim
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Just a brief comment Jim: you say that limiting ER access “would be a way, possibly, to make the public understand that everything has a cost.”
That’s of course true. But let’s note that we hide real costs on many things. When we tax gasoline do we factor in the cost of oil wars? While we fight obesity, do we factor in the subsidies to crops that cause it.
We have a history of hiding the real cost.
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Moe,
Yes, yes, yes! The true costs of many things are hidden and, IMO, the more they are hidden the less-well capitalism works. Wouldn’t everything work better if the costs were up front?
Having said that, I also have to say (again) that generalizing is hazardous. Some subsidies, such as for agriculture, serve to level-out the vagaries of weather on producers, but even those subsidies I think are now over-done.
The best problematic example I can think of for hidden costs is our rapidly-deteriorating national infrastructure of roads, bridges, dams, sewer and water systems. We are not paying as we go for those and are beginning to reap the consequences. I predict numerous calamities and changes of political parties before we come to grips with the problem, if we ever do. It may be like a death of a thousand cuts. One bridge falling down in Minnesota or one flood in New Orleans won’t do it. Pre-emptive action would require political cooperation and a degree of humility in Congress. David Gergen thinks it’s possible (see my latest post at
http://wheeler59.wordpress.com/2011/01/09/a-new-years-story
Me – I get gloomier by the day.
Jim
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Jim – I am entirely in agreement with you re infrastructure. I think the fact that we’ve ignored it for for so long (and I don’t see any change in the near future) means we have lost our ability as a people, as a government, to act in our own best interests.
Reading the commentary above about spending, I see the same denial on the part of elected officials. Mr. Bush, in his first term alone, gave us Medicare Part D, tax cuts and two wars – all unfunded.
I agree with you that we absolutely will drown in health care costs and yet (again!) refuse to examine the only hope we have of containing costs – a universal single payer option.
Love the civil tone here.
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Gee, thanks Moe. Now there are at least two of us.
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Jim,
I understand how it is in responding to commenters. Often, we are thinking out loud as we respond. But isn’t it nice to know that someone is paying attention?
I like your idea of subsidizing medical education a lot. Perhaps it could be built upon the existing (since 1972) National Health Service Corps.
We’ll just have to disagree on the “no cost controls and no idea how to pay for it” regarding health care reform. Certainly, the Democrats’ bill was far, far from perfect and it lacks an essential ingredient for controlling some costs—the public option—but it does contain provisions that are designed to move in the right direction.
I think Moe’s comment on your blog about her 98-year-old father tells a tale about how we might be able to control some of the Medicare costs in the future, but it involves having a serious national discussion on end-of-life issues, something, I think, on which we both agree. That $70,000 for a two-day life extension is something we definitely need to talk about.
Duane
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To all,
Recently I engaged in a private email debate (none of you guys) on the end-of-life issue. I try to preserve anonimity herein but still make my point.
The debate was over a wrenching decision near the end of life of a family member. The story as told was about all the “hoops” the family and physicians went throught before ultimate death of that elderly (very elderly) family member.
One comment was made by my debating partner in describing his/her turmoil. “Cost was not an issue. Medicare was paying for it”.
There is the crux of the issue in my view, not only for health care but many other entitlement programs. Any one that claims “cost is not an issue” starts from an incorrect premise, in my view.
The only way that I have found to really control costs is when someone themselves must bear the burden of such costs.
I KNOW there are any number of anecdotes that show such an approach as totally immoral which I do not call for, imorality or “leaving people on the streets”.
But to totally ignore costs as a solution to our many problems, impossible, in my view.
Anson
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Anson,
ABSOLUTELY! This is the same point I have tried to make repeatedly in this blogosphere. Some call it health-care rationing. I would call it health-care capitalism. To repeat from a recent comment, one with which Moe agreed as I recall, medical technology has outstripped our capacity to pay for it.
Also, we have “aha” moment here, DQ. There’s that “morality” thing again. 🙂
Jim
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… or, alternatively, manufacturers and distributors of medical services and supplies could cease charging $250 for a single suture and $125 for a ten-minute office visit?
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There is a good reason they do that Wing. In a nutshell, they are desperately trying to make up for the law that FORCES them to accept ER patients who have REFUSED to pay into the system of health-care insurance, and who then DEMAND to be treated, whether they can pay or not. THAT is our present system and THAT is what the Fair Healthcare Act TRIED to fix by FORCING some 40,000,000 uninsured people to pay SOMETHING into the system. Of course the 40,000,000 HATE the idea, even though the payments haven’t even started yet. Rush Limbaugh and Sean Hannity have them OUTRAGED over it.
I KNOW people in the healthcare system and I tell you truthfully, the system is FAILING. It is NOT keeping up and it is unsustainable. The party of NO is now in charge of the nation’s money. The time for NO is now past. If the system continues to fail financially, as it is, and the GOP let’s it, IT IS NOW ON THEIR HEADS. It is approaching HIGH NOON. It is time for the GOP TO FILL THEIR HANDS AND DEAL WITH THIS PROBLEM. Giddy up. Hi-Yo, Silver, Away!
Jim
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That gives me an opening to ask you (and others?) how what you just described there might be influenced by something other than conventional wisdom.
I didn’t know about this beforehand, but years ago Ted Koppel did a fascinating hour on this very topic – i.e. the cost of health care and insurance as it is inflated by under and non-insureds using emergency and other medical services. Ever since, I have had strong doubts about how much, in fact, those costs ARE accounted for in what we pay for care.
Here was the case he made:
– Two men need heart surgery.
– One man has insurance provided by his employer.
– The other has none.
– The insured man’s surgery will cost a total of $30,000, 1/3rd of which he will co-pay.
– The uninsured man’s identical surgery will cost him (in fact, HE will be charged for it and his credit rating diminished when he cannot pay) $60,000.
– The insured man’s surgery was made cheaper because his insurer can buy surgery in bulk. Not cheaper because it cost less, but cheaper because of how much of it can be purchased for in advance, as a statistical projection.
– The uninsured man’s surgery will be covered either by charity (which costs taxpayers only the fraction of value which is deductible), or by government IF (and only if) the man is eligible for something like Medicaid or VA etc.
– If NO other way can be found of paying for it, then the cost is written off as uncollectable. It is in this area, and only in this area, where the cost of medical care and insurance is nominally increased to everyone else and ONLY because the provider’s anticipated profit has been decreased.
– In effect, the high price of the uninsured man’s surgery (if paid) is actually subventing/offsetting in some major degree the insured man’s much lower price because accounts receivable/debt is carried on the books by corporations as an ASSET unless or until it is deemed an uncollectable loss.
– Having such unpaid debt is NOT always something “we” are held responsible for, though government and corporations want us to think it is. The laws are such that debt can even, at times, be assigned to the uninsured man’s family members or spouse, and he will never ever be able to expunge it from his credit record. The myth that such debts are erased after 7 years is nonsense because all three credit rating agencies DO keep and will use a perpetual credit history to either deny benefit to or increase rates on that person.
Our problem is not insurance, but rather pricing. The recent reform Act did and could do absolutely nothing to reduce that.
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Wing,
I will try to give this further study and thought because you have clearly done so yourself. But let me give you this first reaction: I believe that MAJOR MEDICAL can be considered separately from the rest and subsidized by government while still greatly lowering overall costs of the system, if, as Moe below suggests we can transition to some kind of single-payer system that causes patients to shop for health care and question the necessity of expensive tests such as MRI’s and CAT scans. Such a system can, by accounts I have read recently, lower administrative costs by some 40%. That’s not small potatoes.
Jim
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Let me add another element. Although I firmly oppose caps on liability payments to patients who’ve been truly wronged, that doesn’t mean that the medical tort system can’t be opened to all sorts of reforms.
The problem we’ve always heard about is the cost to drs for liability insurance. Increasingly we’re hearing about the use of unnecessary tests to protect drs against lawsuits.
Both of these could be diminished by some sort of tort reform, whereby nuisance suits or those having no merit could be weeded out by some sort of magistrate with authority so they were not allowed to proceed to court. In this process, it would also be much harder to blame drs for what they DIDN’T do (“The doctor didn’t order that test and he should have and now I have a damn cold!”).
Those limitations would mean lower insurance costs and fewer procedures. Both would move us along the road to reducing costs.
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Sounds pretty good to me, Moe, as long as the magistrate process is somehow protected from corruption.
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Jim,
It may, but I hope not 🙂 , surprise you to learn that I agree 100% about what is euphemistically called “single payer” being preferable. I so much wish that the President had insisted upon that, instead of turning the whole thing over to a den of wolves to rip in shreds as they did.
I’ve written before here, insurance is NOT what is involved here – as the term “insurance” is being commonly used.
Insurance is designed to cover what we cannot afford to lose, not what we know we are going to be paying for. In effect, those who do buy but rarely use health coverage are every bit as much paying to care for those who buy and use it constantly as for those who have none at all. I don’t like my costs for health care going up because of hypochondriacs any more than because of irresponsible folks who refuse to buy any when they are able to do so. The indigent, should be taken care of in any decent society.
Hence, single payer all the way, absolutely (though I wish they’d find a better more descriptive term for that).
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Well, right, Wing. I said essentially the same thing as long ago as last April in this post:
Jim
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Practically ALL decent sensible intelligent proposals which could have made the Reform Act meaningful WERE directly proposed by others in Congress at EVERY stage in the development of the Act – from hearings, to mark up, to public debate, to seminars and conferences and even on the floor of both houses as the legislation was being jammed through.
Truth is, the Democrats had been waiting since FDR to enact something that suits their political party and its constituents – that and nothing more is what compelled them to approve that damn thing WITHOUT HAVING READ AND UNDERSTOOD IT against ALL good advice and even VERY strong vocal opposition from their own districts.
They also knew, full well that, if and when party control changed in Congress, exactly how they would argue against repeal or even revision. By stimulating the very false guilt they used to pass the thing in the first place. “Pissing on our leg and telling us it’s rain.”
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To all,
I am so busy with the second amendment debate that I have not given this one careful thought this time around. But at least on the surface, I side with WW.
Unless individuals are really responsible for costs of goods and services, then costs will not be controlled, ultimately. That I think is pure, free market capitalism at least on the “demand” side of the curve.
So the debate becomes what to do about folks that have NO money to purchase life saving goods and services. Well in my view the place to start is society begins to help when in fact poor folks reach the level of NO MONEY. If someone has a big screen TV, drives a fancy or even “good” car, puts gas in the tank every week, has a roof over their heads, buys alcohol or “dope”, etc tries to use “free” medical services, well……?
Maybe if they had to give up their beer, dope or big screen TV before going to the ER they might reconsider.
Anson
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I agree, Anson, but I sure don’t have a solution. I assume you recognize that what you are really talking about in your comment here is the same issue we have discussed at length before, i.e., FUNGIBILITY of money. Aye, there’s the rub.
Some people may be dumb, but most are at least SLY. The “underground economy”, that which flies under the IRS’s radar, is difficult to measure of course, but here is one reference that estimates it in 2005 as 9% of the total economy, or almost ONE TRILLION DOLLARS. That is $1,000,000,000,000. Mind-boggling, is it not?
Jim
Link: http://wsjclassroom.com/archive/05apr/econ_underground.htm
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To both,
Not sure we’ve touched upon this element. If so, please ignore or admonish me.
We noticed that the new Act included substantial (cannot recall the dollar amount) support for so-called “Community Clinics.” We have a popularly supported one here in Joplin, which serves the needy. It is NOT easy to get services there. You really do have to be very far down on your luck to be seen. As it should be, assuming the model that our indigent must be protected and cared for. I do assume that.
However, the provision of support for Community Clinics is not going to do very much to look after that rather substantial body of Americans who have just enough more than nothing but not enough to care for themselves, who are not retired on Social Security and Medicare. The provision was, frankly, a pay out to a large constituency who are gaming the system and, I would submit without fear of successful contradiction, are legally characterized as “underserved constituencies.” At this stage in our history, that group has been institutionally placed where the controlling political structure needs to keep it in order to have a problem to solve.
In my view, if support for Community Clinics were to have been set up properly, then it would have expanded care for those who fall into that gap between indigence and barely surviving – e.g. an enormous number of senior citizens whose sole income is Social Security (many of whom never worked for a salary and whose SS benefit is about as low as can be imagined). With Medicare Part B premiums going up year after year, for many that amount comes to 1/3rd to 1/2 of income! And, although Social Security has not seen a COLA increase recently, costs of everything else HAVE been increasing to the point where many simply cannot afford to sign up for Part B or D for that matter.
I know what should be done, and so do a number of Republicans in Congress. For example; tort reform, being able to buy ANY coverage no matter where it is based, health care savings accounts, forcing unions and exempt workers to pay into what everybody else pays into, means testing, and repeal of the disaster.
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