$250k = Rich. $172k = "Modest"

[OCinBuffalo]

how bout we just fix the fraud. the reason self pay won't work is that almost no one can afford catastrophic care...and there needs to be an entity with gravitas that represents the populace to decide when those massive expenditures are justified.

Such a mythical beast exists! The County Health Department/Commission.

 

Each county should be allowed to decide what it's citizens are entitled to. I can think of no better way of reaffirming the doctor-patient ideal. Since all the local docs will know what the other local docs are doing, this is also a great way of establishing accountability. But also, ensure that the county commission that oversees this is mostly doctors and nurses. Both you and Doc want doctors to regain their power, this is how. Create a SMALL state entity for appeals. Make each county pay 10% of their revenue into a catastrophic fund, so that a rural county isn't bankrupted by a massive accident for example. Commissioners are elected no different than local judges.

 

You want to fix fraud? This is how. Moving it to the county either wipes fraud out, or, makes it a local issue, instantly.

 

The worst possible way to fix fraud is to nationalize health care. Medicare proves this on a daily basis.

Edited January 22, 2011 by OCinBuffalo

[DC Tom]

Such a mythical beast exists! The County Health Department/Commission.

 

Each county should be allowed to decide what it's citizens are entitled to. I can think of no better way of reaffirming the doctor-patient ideal. Since all the local docs will know what the other local docs are doing, this is also a great way of establishing accountability. But also, ensure that the county commission that oversees this is mostly doctors and nurses. Both you and Doc want doctors to regain their power, this is how. Create a SMALL state entity for appeals. Make each county pay 10% of their revenue into a catastrophic fund, so that a rural county isn't bankrupted by a massive accident for example. Commissioners are elected no different than local judges.

 

You want to fix fraud? This is how. Moving it to the county either wipes fraud out, or, makes it a local issue, instantly.

 

The worst possible way to fix fraud is to nationalize health care. Medicare proves this on a daily basis.

 

Unless I'm misunderstanding you (which, if I do, I consider entirely your fault, by the way), wouldn't that be predicated on the idea that everyone seeks care in their county of residence?

 

'Cause that really isn't necessarily the case.

[jjamie12]

how bout we just fix the fraud.

 

Isn't that precisely the point, though? Finding and fixing this fraud would cost money, and would add layers and layers of "...these things are unnecessary, add nothing to actual quality of care (likely are detrimental to it) and are extremely costly to society benefitting a few at the expense of the many...the antithesis of my philosophy."

[Peace]

Unless I'm misunderstanding you (which, if I do, I consider entirely your fault, by the way), wouldn't that be predicated on the idea that everyone seeks care in their county of residence?

 

'Cause that really isn't necessarily the case.

 

I agree with OC. There is no better way to fix fraud than put health care in the hands of the county commission.

 

Wait...what?

 

OC: That's the first specific proposal I've seen from you and it's great to see all those years of experience and data-gathering paid off.

Edited January 23, 2011 by Peace

[birdog1960]

Isn't that precisely the point, though? Finding and fixing this fraud would cost money, and would add layers and layers of "...these things are unnecessary, add nothing to actual quality of care (likely are detrimental to it) and are extremely costly to society benefitting a few at the expense of the many...the antithesis of my philosophy."

um , no. for the most part, the laws are already on the books. they just aren't being enforced. enforcement efforts would bring in much more in savings than the their marginal costs. really, how difficult would it be to go after scooter companies that coach patients on what to say or organized crime backed medical supply companies out of florida that anyone can clearly see are crooks? it's not that hard. it only requires the will of the populace and gov't. some unfortunately want their "free" hot water bottles, mattress pads and scooters. they need to be told "no" just like those demanding futile care.

[Doc]

There is a huge difference between what should be done and what actually is done. Many of OC's ideas are not new. Which begs the question, "why haven't they been implemented by now?"

[Doc]

And birddog, there are likely a lot of things we agree on; but single payor will never be one of them. Even if I were to believe the myth that CMS has lower administrative costs than private insurance, expecting ing the savings to be passed-onto providers in the form of higher reimbursements is as naive as EII believing that doctors taking a paycut will spur the other 90% of the health care expenditure equation to take pay cuts as well.

[jjamie12]

You're focusing on the end result, which again could be a matter of choice. Bad school districts, bad infrastructure, etc are the result of misallocated resources, which is has been discussed in other topics here. In this one, let's stay on the subject of fair taxation to fund that infrastructure and question what should really be the government's responsibility to provide for its citizens? In that vein, the basic infrastructure should benefit all residents equally. Then it's up to the citizens to determine how effectively the tax dollars are spent.

 

 

 

 

Again, you're focusing on the end result of a system where private capital supplements government spending to provide better opportunities to some vs others. I don't view this as necessarily a bad thing as long as there are no barriers to that private capital, especially if it's more productive. In your case, you bemoan your upbringing that puts you at a disadvantage to the trust fund kid who rode his Exeter stint to Harvard to the corner office at 200 West Street. But if there is an industry where meritocracy rules more than average, if you are an ambitious bright kid, you can rise far in investment banking. Good luck doing that as an outsider in a union shop.

 

I guess I would say: Sure, I'm focusing on the end result. That's the world we live in. Bad school districts and bad infrastructure, while misallocated resources from an economic perspective, are actual problems for a decent chunk of society, not to mention that they are almost ALWAYS misallocated to the benefit of the people who (generally) need those benefits less. Speaking of this: How would changing the tax structure fix this misallocation? Wouldn't this just mean (in general) that folks would be paying even more (relatively) for those bad services that hinder their children's chances at getting out of the economic place they're in?

 

In that vein, the basic infrastructure should benefit all residents equally.

Key word in here is 'should'. Currently, it doesn't. Do you disagree with that? If I live on the East Side of Buffalo, do I have the SAME benefit of infrastructure as a kid in Williamsville? Further: Shouldn't we, as a society, say "Hey- great job on using the infrastructure to your benefit. The fact that you make (say) $350K is due, at least in part, on the fact that the current system in place (the current system being: All of the collective policy choices we've made to get to the point we're at) 'worked better' for you than most others. Since it did, (and since the more you make, obviously, the better it worked for you) we'll ask you to kick in a little more each step of the way as you make more and more dough. Feel free to use any of the tax loopholes we've created to your benefit, and thanks again for using the system to your (and the US's) benefit."

[GG]

I am simply explaining so that you understand why I can't care about your "thoughts".

 

Yet you still respond five days later.

 

Key word in here is 'should'. Currently, it doesn't. Do you disagree with that? If I live on the East Side of Buffalo, do I have the SAME benefit of infrastructure as a kid in Williamsville? Further: Shouldn't we, as a society, say "Hey- great job on using the infrastructure to your benefit. The fact that you make (say) $350K is due, at least in part, on the fact that the current system in place (the current system being: All of the collective policy choices we've made to get to the point we're at) 'worked better' for you than most others. Since it did, (and since the more you make, obviously, the better it worked for you) we'll ask you to kick in a little more each step of the way as you make more and more dough. Feel free to use any of the tax loopholes we've created to your benefit, and thanks again for using the system to your (and the US's) benefit."

 

But why doesn't it? Per capita spending in inner city school districts in the Northeast usually is much higher than in suburban schools. Teacher pay & benefits in public schools are better than in private schools. So what accounts for the differential? Could it be that you've created a perfect trap for the inner city kids that sets up an environment where they're not expected to succeed as you build a mountain of excuses from their first day in school of why it's ok for them to underperform. That's the main rationale for progressive taxation, coupled with guilt & envy that perpetuates the system and keeps the most needy in a perpetual line for the handouts.

 

As for your example, someone making $350K in NYC is likely paying $120k-$150K in combined taxes. I'd say that's paying a fair share for the infrastructure.

[jjamie12]

But why doesn't it?

I don't know. Does it matter? (in the context of a 'What is the basis for a progressive taxation system') In my mind it doesn't -- it's simply a fact that some people benefit from the collective infrastructure more than others. Why they do is of less importance, in this particular discussion. (Granting that the 'why' is far more important, in general... If we could REALLY nail down the 'why' and 'fix' it, then I think the 'This person CHOSE to not take advantage of the infrastructure' argument becomes much stronger.)

 

Per capita spending in inner city school districts in the Northeast usually is much higher than in suburban schools. Teacher pay & benefits in public schools are better than in private schools.[Note: Not true for suburban vs. city schools -- In general, suburban districts pay their teachers more] So what accounts for the differential? Could it be that you've created a perfect trap for the inner city kids that sets up an environment where they're not expected to succeed as you build a mountain of excuses from their first day in school of why it's ok for them to underperform. That's the main rationale for progressive taxation, coupled with guilt & envy that perpetuates the system and keeps the most needy in a perpetual line for the handouts.

I added the bold -- it's been awhile since I've looked at the data, but believe what I wrote to be true... I don't want to focus solely on inner-city, though, either -- it should be noted very rural school districts have the same type of problems.

 

In any event, I agree with you that we've created a perfect expecations trap. We are failing these kids, and in so doing, we are hurting the economic vibrancy of the US, in general. Something is very wrong in many of our schools, no doubt. Again, I fail to see how changing the system of taxation fixes the (previously agreed on by you and I) misallocation of those tax dollars. [All the while understanding that federal taxation does not DIRECTLY affect the quality of the particular school that someone goes to -- Again, I'm arguing from an outcomes based stance, which is fundamentally at odds with how you're viewing the discussion.]

 

As for your example, someone making $350K in NYC is likely paying $120k-$150K in combined taxes. I'd say that's paying a fair share for the infrastructure.

 

No doubt about it. Notice I'm not asking for more.

 

On a side note: Again, thanks for the discourse on this. I initially took the position that I did only to generate some discussion -- I've argued before that I am for a flat tax. Now? I'm not so sure anymore. Maybe I'm changing my mind on this one -- maybe I just am 'wanting' to believe what I'm writing and that is clouding my judgment... I'm not sure yet. I CAN say with certainty that this discussion has certainly spurred me to think more about it, which (I suppose) is all you can ask for from a message board community.

Edited January 24, 2011 by jjamie12

[OCinBuffalo]

Unless I'm misunderstanding you (which, if I do, I consider entirely your fault, by the way), wouldn't that be predicated on the idea that everyone seeks care in their county of residence?

 

'Cause that really isn't necessarily the case.

No, you are misunderstanding me, and it's nobody's fault, because I didn't cover that part.

You can file this under: "Retards on this board complain when something complicated takes more than one sentence to explain"

 

Regarding this specific issue, wrt emergencies: No different than right now.

 

Wrt: outpatient, physicals, etc....That would depend on what the county wants to do, and that mostly depends on the care resources available. 1 of a million examples: rural counties may decide to sign up with cardio unit in another county, and negotiate reimbursement rates. There could be a 1k reasons to do that, and another 1k not to. But, ultimately, it becomes that county's problem. And therefore, NOT the entire country's problem , poorly adjudicated by legions of government employees, none of whom now better what is best for that county than that county's doctors and nurses, and all of whom try to solve these problems with a top-down, uniform, non-"solution". (See: Obamacare and xref micromanagement.)

 

Basically the county is allowed to negotiate with whatever provider they choose. Ultimately, this creates competition amongst counties and providers. Good. If you want to live in lavish health care county, you can, and you can pay for it. Each county can set up its own rules for residency terms, etc.

 

If you have a pre-existing condition, and want to move, your new county may want to hit you with higher rates, or a one time fee, but they can't deny you. That's also where the 10% state contingency fund kicks in.

 

And, that's the only role the state should have: settling disputes between counties, or between individuals and counties.

Edited January 31, 2011 by OCinBuffalo

[OCinBuffalo]

I agree with OC. There is no better way to fix fraud than put health care in the hands of the county commission.

 

Wait...what?

 

OC: That's the first specific proposal I've seen from you and it's great to see all those years of experience and data-gathering paid off.

Buddy, I have been posting this stuff for years. New to you doesn't mean much.

[OCinBuffalo]

There is a huge difference between what should be done and what actually is done. Many of OC's ideas are not new.

Regarding my solution? I keep getting bothered to get a patent. So, no, that's new.

 

Regarding what I have found in health care? Yes, they aren't new. The data is available for anybody with the ability to collect and objectively analyze properly. I am certain that many health care professionals have had these ideas. I am also just as certain that health care people ask this:

Which begs the question, "why haven't they been implemented by now?"

Because either they have no idea how, or, more likely, because they suffer from George Costanza disease:

 

You need small sets of specific data delivered accurately and instantly, able to be changed in real time, and constantly evolving with the care process and the patients. Meanwhile, the hospital needs a real workflow system, so that it can determine and meet your ever-changing needs, and the patients needs as well.

 

You do the opposite: you go dump 10 million on one more antiquated EMR system, which is about massive sets of data, mostly distributed, often inaccurate, rigidly structured, requiring time and hassle to retrieve. Workflow? Please. The EMR companies can't even define it properly, much less build it. :wallbash:

[Doc]

Regarding my solution? I keep getting bothered to get a patent. So, no, that's new.

 

Regarding what I have found in health care? Yes, they aren't new. The data is available for anybody with the ability to collect and objectively analyze properly. I am certain that many health care professionals have had these ideas. I am also just as certain that health care people ask this:

 

Because either they have no idea how, or, more likely, because they suffer from George Costanza disease:

 

You need small sets of specific data delivered accurately and instantly, able to be changed in real time, and constantly evolving with the care process and the patients. Meanwhile, the hospital needs a real workflow system, so that it can determine and meet your ever-changing needs, and the patients needs as well.

 

You do the opposite: you go dump 10 million on one more antiquated EMR system, which is about massive sets of data, mostly distributed, often inaccurate, rigidly structured, requiring time and hassle to retrieve. Workflow? Please. The EMR companies can't even define it properly, much less build it. :wallbash:

That's what I was getting at. You won't get any meaningful reform because of any of a variety of reasons. And ultimately, they're just bandages for the real problems.

[Mr_Blizzard]

Out of curiosity, who here is pulling in $250K?

 

I'll start: not me.

+1