Rubes

Thanks, I was guessing that was your position but I didn't know if you had more specifics. I think you're right, we're not likely to agree on this topic. Similar to your thoughts, I think your plan has significant holes in it as well, and I don't particularly agree with the concept that health insurance should be approached or modeled similar to car or homeowner's insurance. Complete privatization of health care is just a potentially dangerous concept, in my opinion, and carries the prospect of leaving too many citizens behind. I still disagree that this new type of proposal would result in the same situation as socialized medicine, but we're not likely to resolve that. Again, I think it really comes down to how much we, as a people, really want universal access to health care. I'm not convinced that we really do.

It certainly doesn't help that he writes at a high school level.

Thanks, I appreciate that, and it's good to hear concrete reasons why a plan like this would not be supported. The authors definitely make the argument that there are many aspects of the plan that need further research and modification, so it will be interesting to see the editorial rebuttals that arise from the publication. Plus, I think one of the reasons to bring up a proposal like this is not just to convince you it's the right way to go (I'm not completely convinced myself either), but to see if it's a real starting point that could be acceptable given the proper attention to details. I'm interested to hear what your position was on health care reform during your campaign.

It's different from your system in that it actually provides universal health coverage to help out the 45 million people who don't have any. The question is, why don't those people have health insurance? 80 percent of them are either employed or dependents of those who are employed. They can't afford it. The marketplace isn't helping them out. Again, perhaps the real question is, Do we really want universal access to health care? Well, until there is a plan you agree with, we won't get anywhere. The status quo is leading us down a path to economic disaster. We can keep waiting for the ideal plan to arrive, but three times in the past few decades we tried confronting this issue, and three times we failed. At some point we are going to have to make some tough decisions. If broad access to health care is a real goal, if it is ever to be anything more than a political sound bite, it cannot be a casual commitment. The problem is that, for most of us here, universal coverage is nothing but a benefit to somebody else. It's hard to convince people that there are real economic benefits to covering the uninsured, because those benefits don't directly show up in their pockets. Unfortunately, that's too much to sell to some.

I'm not sure why you're saying that. According to the proposal, as in point #3, "People who wanted to purchase additional services or amenities, such as a wider choice of hospitals and specialists or more comprehensive mental health coverage, could do so with their own after-tax dollars." So if you want the ability to choose your own coverage or provider, you can do so. So it's your belief that any system that provides universal health care could be no better than Canada's? Or is that just a reflex response?

Well, under the proposal you can certainly choose how much coverage you want and which provider you want. It just requires you to purchase more than just the basic coverage that would be provided to everyone. It's not a perfect system. A perfect system probably does not exist. But relying completely on the marketplace is not a solution to the problem. We need a solution that provides care for all while reconciling the tension between equality and individual freedom. Some would argue that this proposal could do that better than any alternative proposed so far. I suppose the real question is, Do we really want universal access to health care? How can a country as idealistic and generous as the U.S. fail repeatedly to accomplish in health care coverage what every other industrialized nation has achieved?

Well, there's really no argument that this would need to be addressed, but keep in mind that the article is a 6-page outline of the plan, and really can't/doesn't go into all of the specifics given its limited space. I'm sure that this is an important issue that they have some specific ideas about, and perhaps we'll know more of the details if it garners enough attention. As to the critical health interventions, that has traditionally been less of an issue. The uninsured already receive limited care for their more dramatic crises. As one person puts it, "As a society, we don't want to see childbirth occur in the street or an obivously broken bone ignored. We are willing to pay enough to move the care indoors and out of sight. Bu we are not willing to provide coverage for the chronic conditions and preventive care that might enable the uninsured to lead more productive and happier lives." So we don't say "sucks to be you", nor would we with this plan. And the rest of the taxpayers already pick up that tab. There's no doubt that whoever is responsible for paying for care will determine what they are willing to pay for, whether it's the government or a private insurer. Do you trust a private insurer any more than you do the government? It is clearly a complicated issue. But we need to have a good understanding of the cost of basic health care and how much we would be able to cover with a VAT. And if you aren't satisfied with what is covered under the basic benefit, the VAT can be adjusted. It all depends on how much we, as a society, are willing to cover. And that has absolutely no effect on purchasing additional coverage, which gives you the right to go to a provider of choice or to receive the level of coverage that you want. I appreciate your position, Ken, given your political views and your ability and willingness to discuss them. But if not the government, then who? The marketplace? Not a chance. To paraphrase the same person, perhaps the appeal of the marketplace is that it cannot directly levy taxes and is therefore less threatening to individuals' interests, but to date, market-based solutions have had only modest success at controlling costs and little to none at providing coverage for the uninsured.

Interesting points, but I think you also have to consider the effect that eliminating employer-based insurance would have on American businesses...not to mention the elimination of Medicaid and the eventual elimination of Medicare.

The article itself is just a broad outline for the proposal, so a lot of details are either not well fleshed-out or not discussed. As for medical conditions, the proposal states that everybody is guaranteed basic health care coverage without means testing or exclusions of any kind. Of course, what services you would get from basic coverage would depend on how basic coverage is defined. Their proposal statest that the universal benefits package "should be sufficiently comprehensive to provide most Americans with most of their care most of the time," and the benefits provided should be those typically provided by large employers (including tiered pharmaceutical benefits). They do not discuss much about specific situations like yours, although the option is apparently there to add additional coverage above that provided universally.

Mind you this is just me interpreting what is said in the article, so I may be wrong. Medicare isn't eliminated per se, but is phased out. Anyone currently on Medicare stays on it. No new people are enrolled; as they turn 65, they continue on the voucher system. Funding would come from the earmarked VAT. The cost of the system is difficult to predict right now, since it depends on which services, deductibles, and copayment levels would be incorporated into the universal benefit. Their discussion talks about how the system would result in an increase in the use of health care services by those who are currently uninsured or insured with less generous policies, a dramatic decrease in administrative costs seen with the current system, and other things. The authors acknowledge that, at this point, the idea is a broad outline and more study is needed to determine more precise estimates of the cost of the vouchers, the control of costs over time, and the financing of special services. They didn't go into that very much, other than in one place to say that "services beyond basic care are paid with after-tax income, which ensures that users weigh costs against benefits." Much of this will depend on what is included in the basic coverage, obviously. But it's not unlike what my wife and I see already, where the poor often go without certain non-critical medical interventions because they are too expensive. Perhaps, but I think that's a bit of an overreaction. The authors state that their proposal "does not call for government health care and would not legislate changes in the current private delivery system." The government (and the public, though the VAT) would determine what constitutes basic coverage (as well as deductibles and copayments). That's what the government will reimburse to the health plans. They are choosing which services are covered, basically, for all people, but a system would be in place to provide more than that. Perhaps, but the real question is, is there any form of universal coverage that would not smack, to some degree, of socialized medicine? We have to face the fact that our current system is deeply flawed, inefficient, inequitable, and generates discontinuous coverage. It is a recipe for financial disaster. That's not to say this proposal is not economically flawed, but if you can provide universal coverage while eliminating employer-based insurance, Medicaid, and (eventually) Medicare, I can't help but think it may be headed in the right direction.

I'm not much of an economist, but I remember there was a discussion here recently about VATs and how some people are promoting them as a possibility here. It seemed, from what I can remember, that there was considerable support for the concept. I bring this up because there is an article in the current New England Journal of Medicine that discusses an interesting system of reform for our health care system that involves the incorporation of a VAT. The system provides universal health care coverage through a system of vouchers. Some of the important points of the system include: 1. Universal coverage. All Americans under 65 get a voucher that guarantees coverage for basic health services from an a qualified insurance company or health plan. 2. Free choice of health plan from among several alternatives. 3. Freedom to purchase additional services (wider choice of hospitals, more comprehensive mental health services, etc) using after-tax dollars. 4. Funding by an earmarked VAT. If people want better basic coverage by the voucher, you must support a tax increase to cover it. The tax is based on consumption. 5. Reliance on private delivery systems, not for government health care. 6. End of employer-based insurance, which few would mourn. 7. Elimination of Medicaid and other means-tested programs, since those people are covered. 8. Phasing out of Medicare. Current Medicare enrollees continue with this system, but no new people are enrolled. People turning 65 are continued with the voucher system. 9. Creation of a Federal Health Board (modeled on the Federal Reserve System) with regional boards to manage/oversee geographic regions, with the responsibility of defining and modifying the basic benefits package, contract with health plans, collect data, etc. It's an interesting prospect. I would like to post the article and/or a link, but can't for obvious reasons. I would urge anyone interested in health care reform who has access to this week's NEJM to check it out, at least to read the details of each of those features. It's intriguing in that it does some of the things that really need to be done, such as universal coverage, elimination of Medicaid, elimination of employer-based insurance, and phasing out of Medicare. But I'm not too good with VATs and how that would be implemented, so I'd like to hear some folks thoughts on that proposal.

Crap. I have a good friend in Indonesia right now doing some research. Hope he's okay...

You watch the LPGA?

Too bad Tom Toles left the Buffalo News for the Washington Post. I used to love that guy's cartoons. One of my favorites was when I was back in college, around 1985. Toles drew a cartoon over a reporter interviewing Kay Stephenson after a Bills game, with the score in the background something like 52-3 in favor of some made-up girls high school football team. Kay is saying something to the effect of "Well, we were keeping it pretty close up until about the second half, when they finally showed up..."

No problem. It's often tough to tell with you...

Oh dude, my mom used to take me there all the time. Loved those bowling alleys!

But what about this? Which is it? I'd do that if it was MY wife. Why? Because I actually LOVE her.

Agree with the others...I live here in Salt Lake, and the Utah mountains are awesome *and* close by. Park City is overrated and expensive, and Deer Valley is completely too expensive, but Alta, Snowbird, and Solitude rock. On the other hand, Park City is a cool place to hang out with some awesome restaurants. Plus, we've had one of the best snow years in a long time up in our mountains, and they've been getting dumped on again the past few days, with more to come. The next few days/weeks will be some incredible skiing.

Hey, don't worry, be happy. Most Americans will forget all about Terry Schiavo, pseudo-Republicans, the Congress intervention, and this whole mess by Memorial Day. Mmmm...Barbeque!

Utah. It doesn't get any better (or more convenient) than Utah. Best snow on earth.

Well, you're consistent, I'll give you that.

Now that's just freaky....

I don't know that this means the Bills don't think highly of Shelton, just that they don't think as highly of Shelton as they do Henry. Henry has proven his worth, as FFS says above, by rushing for big yardage 2 straight years and making the Pro Bowl. Shelton has proven he can probably be a good OL in this league, but he has not yet proven he is top-shelf, or Pro-Bowl quality. It will be interesting to see if TD holds out for more to the end or just gets the deal done.

Nicely put.