Lamorindans are not bashful about sharing their opinion, we know by looking at our comment stream, but we have grown curious about increasingly hard-line positions adopted and defended by Patch users of late.
Many of these ideas and positions appear to mirror those expressed by Tea Party members, several of whom made no bones about what should happen to an ailing countryman during a recent GOP presidential debate (see related video).
Disclaimer: The video includes some anti-Tea Party messaging at the beginning and end, but was chosen for its image quality solely, and not because of its support for one group over another.
A new, "No more big government, more personal responsibility" mentality seems to have emerged, with many apparently feeling it's okay to leave others to die at the side of the road if they can no longer pay their own way.
To us, that response seemed unusually harsh for a country known for its largesse, but perhaps we're missing something, we're not exactly sure. We'd be interesed in finding out if this position is shared by a relative few or many here in Lamorinda.
The attached poll might help us better gauge the depth of current local sentiment.
Finally, the rack-rate "out-of-pocket" prices are skewed dramatically higher for a variety of reasons that have nothing to do with the inherent cost of procedures. Need $100K of brain surgery and don't have insurance? Sorry, buddy--- you're gonna die. Am I a monster? Substitute $1M. How about $10M? $100M? Where do I cease being a monster-- it's just a question of line drawing, isn't it? In terms of property and liens, I agree with you that poor people are poor (duh), but to the maximum extent possible I want to shift the policy from "free" to "we will begrudgingly save your butt, but you will owe us." I am worried about INCENTIVES more than likelihood of collecting. If something is perceived as free, will people tend to consume more or less than the socially optimal amount?
Or you could just tell me to drop dead.
I obviously just made up $5K-- maybe that's not the right number, but if it were $50K, why would anyone get insurance?
In terms of what to do with the 40% of births from medicare, I personally think that contraception or abortion would be preferred versus encouraging financially irresponsible people to have kids they can't afford. (Apologies to Mr. Santorum) Statistically, the vast majority of births (>80% ?) would go off without a hitch even with zero spend on pre-natal care. How about this rule: if you have one baby on Medicaid, we force you to get Norplant until you can prove your financial responsibility.
My baseline is: no money and no insurance equals no care. I am just trying to temper that extreme position with the most basic of safety nets (e.g., don't let people bleed to death when first aid or a few stitches could save them). That is my framework. That I do not have all the answers on the details is not a rebuttal of my framework. What would you do?
Regarding the other matter, I think you own whatever you can keep. If the mob (Roman) takes away your property it's no longer your's. Ideology is not relevant in the face of reality. About my plan. It might be an interesting starting point. I'm sure I would need to iterate to perfect it in practice. If I force you to keep your wealth active in the economy am I taking it from you or simply forcing you to participate in society, economically? You might lose your money but you could also make more. The more money you make the wealthier you are, but you can't just sit on it. As a wealthy individual you still derive satisfaction, accomplishment, power, capability, and station. All you lose is the ability to sit on vast amounts of wealth to provide for your future security while taking no risk and essentially hoarding your gains in life, and the gains of many generations of your family as such.
We spend about $50B on prisons and $180B on public safety, so I think $6B is a reasonable part of total spending on criminal justice. Probably some savings to be had there, but I personally would go after prison guard pensions before telling an indigent guy accused of a felony that he needs to fly solo in court. Our justice system relies on adversarial representation, so you'd have to totally overhaul it if you wanted to save on indigent defense costs (assuming you cared about justice and fairness).
National defense gets $1,016, or 26.3% of the total bill. Health care: $939 (24.3%). Job and family security: $846 (21.9%). Education and job training: $185 (4.8%). Veteran benefits: $158 (4.1%). Natural resources, energy, and environment: $81 (2.1%). International affairs: $66 (1.7%). Science, space, and technology programs: $46 (1.2%). Immigration, law enforcement, and justice: $77 (2%). Agriculture: $31 (0.8%). Community, area, and regional development: $19 (0.5%). Response to natural disasters: $15 (0.4%). Additional government programs: $93 (2.4%). Net interest: $286 (7.4%).
Maybe you mean "force them to invest in high risk equities." Before you do that, you should do the thought experiment of the macro impact of preventing people from investing in public and private bonds. What would your world look like? Is that a better world than we have now?
Again, I would humbly request that you spend more time thinking about what money is really "idle" and why we would ever prefer a rule that requires people NOT invest where the expect the highest (risk adjusted) returns.
1 in 7 American homes are empty 1 in 42 Americans are homeless Imagine for a second the sort of things that just wouldn't happen if everyone was essentially not allowed to leave income or assets idle.
The current health care delivery and payment system in the US is oddly distorted v. other "insurance" and "service delivery" systems here. First, the AMA has consciously limited the expansion of MD-granting progams in the US, contributing to a shortage in the supply of new doctors into our growing market. Second, the fact that two families with equal "demands" on the system, in terms of family size and health, might be required to pay different monthly co-pays - for the insurance premium, co-pay for a doctor visit or a prescription - based on the negotaiting power of their employer, or the fact that they have no employer sponsor, is absurd. Third, doctiors need to be better informed about the cost of services when advising patients - as any lawyer or accountant would be when providing counsel. I visited my MD prior to a trip to a Central American country and while discussing immunization options, he could not tell me what the costs of the recommendeed drugs in "oral" v. "injected" form would be. (This was pertinent as it would be out of pocket and there was evidently some meaningful difference.) I would like to see more reforms to the wacky current system, by whichever President and Congress is in place, for the betterment of America.
I am firmly against Obamacare and the current staus quo at the same time. I believe that with some smart adjustments to the current system it is possible to keep the incentives and keep costs and future increases reasonable. But it has to cross some 3rd rails to get there. Maybe the threat of centralized gov't care can convince us freemarket capitalist types to make the jump.At the end of the day it becomes a key cost component at the very core economics of it.
If we are talking about health care reform fundamentally, then I agree with KDDT that we need to look at the whole value chain and figure out how to get more with less. I think this means using much better bang-for-buck for basic care. I think one important key here is more "nurse practitioner" type of jobs and fewer specialized/expensive doctors/gear/drugs. Your analogy to poor kids going off to war is actually pretty accurate (although opens it's own can of worms). People like to survive (it's in the DNA). Improving odds of survival requires resources. Resources are scarce. All other things being equal, those with more resources will live longer. I don't think this is a problem/anomaly to be fixed. It describes the basic human condition on earth since our species evolved. In a very real sense, this is part of what makes us human....
If you want to have a real conversaton about these issues, stop with the stupid polls. Let's have a dialog or debate what types of solutions make sense. For every dollar that goes to the FEDERAL government, something like 20% of it actually get used for the goods or services. The rest is overhead. Let's keep the money local and make decisions locally.
The next step if this doesn't occur you will really not like.
Fearful that the new, monstrously large democracy is more and more ungainly and vulnerable to harsher realities like totalitarianism or fascism, attempts are made to moderate rhetoric so as to reach the largest amount of people possible and thus gain support (power). Symptomatic of the Mediocracy is an utter absence of leadership figures, strong personalities so appealing with such rhetorical aplomb that they galvanize the population into alignment along traditional political lines. A certain type of political huckster recognizes the opportunities presented by this stagnant state and revisits simplistic, "common sense" solutions with historical significance endemic to that society. The rudderless populace is desperate for relief as this essential condition (political stability) slips slowly into chaos. Enter Sara Palin and the Tea Party. History will see this barely educated, simplistic, unsophisticated demagogue's brief rise to insane heights as the result of the absence of true political leadership. She and her ilk, managed to lift fringe-thinkers out of the shadows and empower them.