Obamacare for Floor Sweepers

OK, I promise I’ll go back to being funny in a future blog soon, but I did have some really important things I needed to get off my chest on the economy and healthcare. In “Why Do Liberals Hate Corporate America?” I mentioned the guy who sweeps the halls at night at IBM. I suggested that he would lose his excellent healthcare benefits under Obamacare. I’ve never been more clear that this is true. 

I got the single best insight into Obamacare I’ve had yet over a business dinner this week and it does not bode well for our friend sweeping floors at IBM. I dined with a successful businessman (read: highly paid) from London. I asked him about the national health system there and his view of what we’re doing here with Obamacare. Interestingly, he was a self-described “right winger,” but said he liked the NHS. That puzzled me so I probed a bit more and he told me the following story. He was in a meeting one day and stood up from his chair and burst a disk in his back. He said it was the most painful thing that he’d ever experienced. He had to have surgery and said because he has private insurance he was able to get the surgery done about a week later. The surgery was successful and he was out of pain and back at work quickly. However, he said that if he were on the national health plan, he would have waited about 3-6 months or more for the surgery. If you’ve ever had back pain, you can imagine what a nightmare that would have been, not to speak of the lost time from work and the implications of that, broadly speaking, on work productivity and GDP.

My British colleague went on to explain to me that “highly paid” people all have private insurance in the UK to make sure they don’t have to wait when they need something done quickly, and they use the NHS for routine stuff. In other words, he likes the NHS for the very reason that he’s not forced to use it when it doesn’t work for him.

My takeaway from this conversation was 2-fold. First, the NHS works well in England so long as you make enough money to avoid it when you need to avoid it. And, second, I’ll be just fine when Obamacare takes us where it must, which is national health with long waits. I’ve been very blessed to have done well enough in my career and personal finances that I will always be able to afford supplementary insurance. And, no doubt, such a market will develop quickly in the United States after our system is fully nationalized. Sadly, the guy sweeping the floors at IBM will not likely be able to afford supplemental insurance. Like so many lower and middle class Brits, he’ll be forced to wait months and months for treatment and access to care. Today, he gets his insurance through IBM and gets back surgery in a week. Once healthcare is fully nationalized here, he will no longer be able to afford the supplemental insurance he needs and will wait 3-6 months. Huge bummer for him.

I continued to ponder this discussion in the taxi back to my hotel and I kept asking myself “why the hell am I spending so much energy caring about the woes of Obamacare? For $10,000 per year or so, I’ll be buying my way out of it like the guy from London.” It simply won’t impact me at all, other than the $10,000, which I can afford. The answer is I’m upset about it because I care about the little guy. I care about the floor sweeper at IBM. I knew the  President lied when he said anyone who wanted to keep their current coverage could do so, but the floor sweeper is more likely to trust him. You can only keep your insurance if it’s still offered and it won’t be. And, more than anything it frustrates the shit out of me that liberals claim the mantra of caring about the little guy while simultaneously sticking it to him to achieve an ideological endgame on healthcare.

As a final note, I’m sure some of you are quite rightly asking, “but, wait, how do we deal with the 40 million (the actual number is much lower; that’s a political number, but let’s run with it) people who have no insurance at all? Won’t they suffer a lot longer than the 3-6 month wait for back surgery under Obamacare” I agree – that’s a real problem. Let’s address it together as a nation. But, if you have a system that works very well for 260 million people and not at all for 40 million, why in the world would you toss out the system that’s working for the 260 in order to provide one for the 40? The only conceivable reason you’d do that is if you are more interested in ideology than success. Fortunately, there are now numerous DEMOCRATS running on a platform of repealing key parts of Obamacare so perhaps we’ll get rid of this horrid piece of legislation after all. But, til then, the floor sweeper should quite rightly be nervous.

Next up: Something funny again (I hope)

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About Bruce Robertson

Bruce Robertson is an amateur writer and professional provocateur
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7 Responses to Obamacare for Floor Sweepers

  1. Dan Grabois says:

    I start by quoting you: “if you have a system that works very well for 260 million people and not at all for 40 million, why in the world would you toss out the system that’s working for the 260 in order to provide one for the 40?” A quick response. I am fortunate that one of my small-j jobs provides me with benefits. Not my family, just me. My wife’s job provides her with partial benefits. She (= we) has to pay something like 20% of the cost. My son isn’t covered in either case. We each recently checked with our employers on how much it would cost to add our son – one child, mind you. Through my insurance, it would be $650 a MONTH. Through hers, it would be $850 a month. For the math-phobes out there, $650/month comes to $7800/year. That’s a LOT of dough for me. I actually used to have to pay for the whole family’s insurance, and that cost $10,000/year (and that was 3 years ago). BTW, I was fortunate that I could pay as little as that – I thank good old Local 802 for the discount price.

    Anyway, I am lucky that I live in the commie state of NY, where there is a program to insure children at a discount rate. I pay about $225/month for my kid, your first cousin once removed, for a total of a marginally affordable $2700 per annum. The premium goes up about every quarter, but who’s counting?

    The last two medical issues that cost anything to speak of for us involved an expensive trip to the doctor for my wife and a trip to the emergency room for me (ear infection: incredibly painful if not life-threatening, but yes career-threatening for a musician). Both of our insurances denied coverage and we had to appeal. Yes, we did appeal and did win. My argument was that I went to the emergency room because my doctor told me to go to the emergency room. I count myself fortunate that the insurer (Aetna, if you care) was persuaded by this logic.

    The point of all this is that our insurance system is, in fact, not working. We are (over-) educated in this household, and we are able to put together a fairly persuasive appeal, plus we do not allow ourselves to be cowed by denials from the insurer. But insurers deny many, many claims that are reasonable. Why not? The appeals process costs them next to nothing, and many customers undoubtedly do take NO for an answer.

    Believe it or not, I have colleagues our age who have no health insurance. They can’t afford it. Some of them have it for their kids, but not for themselves. Others are drastically underinsured (like with insurance that caps out at $2000 paid out per year).

    In short, the system we have now works quite well for the wealthy and the educated, and not so well for everyone else. Which actually sounds a lot like what they’ve got in England. Bloody hell, what?

  2. Dan, thank you very much for your personal stories. They help my perspective and, as you might guess, evoke some thoughts. Some relate to your stories and some more generally to what’s really wrong with our healthcare system, but nobody is talking about fixing. They also bring out some sensitive thoughts about class warfare in this country that I think are worth sharing.

    My first reaction is to your conclusion that the US healthcare system isn’t working for you. Uh, yeah it is. It’s expensive (more on that later) and has caused you a few headaches and fights with your insurance company, but you’ve said nothing like “I had this really bad health problem and I couldn’t get it treated.” That’s what happens in the UK. I will send you by e-mail a story I posted to FB (pre-blog) about a taxi driver I had in the UK last year who’s mum (yes, mum) needed surgery and had to wait 9 months, bedridden. Of course, he didn’t have supplemental insurance, but when she needed it a second time, he paid for it on the “black market” and got it done right away. The cost to him was devastating, but what was he going to do, let his dear ol’ mum suffer for 9 months again? Furthermore, there’s an agency in the UK NHS called NICE (terrible choice of acronym because it’s anything but) that decides what (potentially life saving) drugs the NHS will pay for and which it won’t. They have a formula that puts a financial value on a year of your life and hesitate not one iota to say, “sorry, that’s too expensive to keep you alive for 6 more months.” In the abstract, those types of cost saving decisions may sound good, but God forbid it’s your own child or parent or dear friend. And, Obamacare creates just such an agency (they use the benign term “comparative effectiveness”).

    My second thought is that I believe you have taken your specific case and over-generalized it to conclude that the US system is not working for everyone who’s not both wealthy and educated. I stand by my statement that the US system works for MOST people who are employed, which is currently 90.4% of the population. There are lots and lots of relatively low paid employees (factory workers, secretaries, mail room clerks, teachers, firemen, etc.) who are currently getting very generous healthcare benefits from their employers and it’s working just fine for them. Taking this away and giving them the NHS is clearly an unmitigated disaster. I think the proof of this is in the poll and will be in the November election. This legislation was wildly unpopular and was forced through on a procedural vote. It’s the first time in our nation’s history that a major game-changing piece of legislation was passed without at least some semblance of a bipartisan majority. But, politics aside, the country did NOT want this and the reason is they knew they (as the majority) were going to have something good taken away and replaced with something crappy.

    I think the biggest problem is that nobody is talking about the biggest problems. Neither party, none of the so-called experts on CNN or Fox News (I can guess which one you watch – ). People are happy to talk about run-away healthcare costs, but the conversation quickly turns to how nasty the insurance companies are and we end up with a 1300 page bill that is 99% aimed at the insurance industry. The problem isn’t with the insurance companies, but rather how we use them. Insurance should be in place to pool risk so that nobody has to pay for things they otherwise can’t afford. I have homeowners insurance in case my house burns down, not in case my hot water heater goes out. In the latter situation, I call the plumber and pay him $1000 to replace it. Yeah, it sucks, but it’s part of owning a home. I have auto insurance in case I get into an accident and get sued for $1,000.000. I don’t file a claim when my car needs an oil change (personally, I don’t even insure the physical car much at all; I take the highest deductible they’ll give me).

    Compare that to the way we use health insurance. When you went to the ER with your ear infection (I admit that the thought of an ear infection being career threatening was a very eye-opening thought for me), I’m guessing they gave you a prescription for an antibiotic. That visit probably cost $500-1000 (ER visits are expensive). Had it been less emergent and you could have waited til the next day to visit your own doc in his/her office (not saying you should have), it would have cost more like $100. I don’t know your particular insurance, but you probably paid out-of-pocket $100 or less for the ER visit in co-pay and would have paid $20 or less in the doc’s office. You could have afforded to pay the full amount. It’s crazy to insure amounts like that, especially when it drives your annual insurance costs up to $10,000 per year.

    What we’re talking about is basic economic incentives (yep, the free market at work again). In our current system, in almost every interaction between the patient and healthcare system, the consumer of the service is completely different than the payer for the service. That’s a terrible set up for economic abuse. Think about how much time you spent researching the price/cost of your last car and how much effort you put into shopping for the best deal. Yet, if you needed an MRI on your knee, would you go on the Internet and then call 5 MRI centers and maybe drive an extra 30 miles to find one that cost 15% less? Of course not, you’d go to the one your orthopedic surgeon handed you the address for. That’s absolutely insane. We’ll never get healthcare costs under control until we match up people paying for services with the consumers of those services…..again, in the context of insuring the big stuff only (and recognizing that “big” may be different for people of different economic means). And, let’s be really clear – Obamacare makes this impossible. Instead, it mandates gold-plated coverage for everyone, says nothing about how to pay for it, will wait for costs to escalate, and then start rationing care. Welcome to long waiting lines and denied coverage for all.

    My last point is really touchy, but I’m going there because I think our nation is at a boiling point (see Parties, Tea). If I really dig down on your message (and this is not personal because I think it’s what many are saying and certainly what Obamacare is all about), you’re saying you want more and better healthcare coverage and you want me to pay for it. Yeah, under the president’s somewhat dubious definition of “rich,” (based on annual income alone, without regard to personal situation, where you live, or net worth) I am “rich.” Call it the “allegedly rich.” I can quite assure you that when I look at my bank account at the end of the month or my financial stress level on a daily basis with 2 kids, college starting in 18 months, etc., I do not feel rich, but I acknowledge my status as such under the president’s definition.

    Here’s what has us “allegedly rich” people really pissed off right now, and not just about Obamacare. We are already paying for EVERYTHING in this country (well, everything that the Chinese are not financing for us). The top 10% (those making over $113,000 – a sum that can’t possibly be described as rich, unless you’re single and living in Des Moines) are paying over 70% of the federal income taxes. The top 25% (those making over $66,000) are paying 86.6%. Even the top 1% (those making greater than $410,000) are paying 40.4% of all federal income taxes. With these numbers in hand, the president has the friggin’ audacity to raise taxes this year on “the rich” with the categorically fallacious explanation that it’s in the name of “fairness.” I mean, seriously, what the fuck is he talking about? If people making over $250,000 per year (about the top 2-3% earners) are already paying more than half of all taxes, in what mystical world is it “only fair” for them to pay even more.

    This is an unsustainable situation and I do believe it’s coming to a boiling point. All of this out-of-control spending (be it Obamacare, wasted stimulus, or otherwise) is being financed by a very small group of people (1% of the country is 3 million people, our about half the population of Maryland). And, at the very time we are being asked to finance more and more, we are being vilified on a daily basis by the press and president in a game of all out class warfare. And, quite frankly, we’re sick of it. Speaking only for myself (having not yet been elected spokesperson for the “allegedly rich”), I actually have no problem paying well over my “fair share” of taxes. I feel like God has blessed me with the financial means to do it. What I do mind is having my money spent frivolously and what I really mind is being told I’m not paying my fair share when I’m paying treble it. And, as discussed in a prior blog, the only way we’ll ever get out of this economic mess is the grow the economy. The only way to grow the economy is to cut taxes. The only way to cut taxes is to cut them for people who actually pay them. And the only people who pay them are the “rich.” So, if you want the economy to grow and create jobs, you have to cut taxes on the “rich.” QED.

    I’m waaaaaay off topic on healthcare, but maybe not really. Maybe all of this would work better if we could just have an honest discussion. But think about this. Suppose a friend came to you and said, “Hey, I’m in some trouble. You’ve always been a great friend. Could I borrow $100? Honestly, I don’t know if I’ll ever pay you back.” You’d probably do it and feel good about it. Now, suppose someone came to you and said, “You know, you’ve always been a son-of-a-bitch. I never liked you and I never will. Actually, you’re the root of all evil. Fuck you. Oh, by the way, I need $100 and will never pay you back. Can I have it?” You’d laugh. Yet, that’s exactly what the president is doing when he vilifies the “rich” has having benefited in some unfair way and now we have to pay more than the super-majority of taxes we’re already paying. I don’t know about the rest of the “allegedly rich” out there, but I can assure you I became “allegedly rich” by working my arse off.

    I know this is fanciful, but suppose the president gave a state of the union address where he looked into the camera (while, of course, glancing at the telestrator) and said, “right now, I’m speaking to all of you Americans who make more than $250,000 a year. I know you don’t feel rich. I know you have trouble meeting your monthly bills. I understand you have financial stresses like everyone. And, I know you’re paying way more than your fair share of taxes in this country. You must feel like a lot is put on your backs right now. First, on behalf of all citizens, I want to thank you. We couldn’t do it without your hard work. On behalf of every teacher, every federal employee, and every older citizen on Medicare – we thank you. I know this is hard, but I have one more favor to ask of you. We need to fix our healthcare system. And, tonight, I’m going to ask you to step up one more time and pay for it. I know it’s not fair and I know it’s yet another financial burden on you, on top of all the ones we’ve put on you already, but we really need you.”

    I dunno, but I have a feeling I’d come out of that speech feeling a whole lot better than being asked to pay another $10-20K in taxes while simultaneously being vilified as having ill-gotten gains and being told the system is unfair in my favor. It’ll never happen, but it’s fun to think about.

    • Blueloom says:

      “Yet, if you needed an MRI on your knee, would you go on the Internet and then call 5 MRI centers and maybe drive an extra 30 miles to find one that cost 15% less?”

      I once tried to do exactly that. Not one single institution would give me a price.

  3. Dan Grabois says:

    Bruce, you are good. Right now, I only have time to make a quick comment, so I’m going to play a numbers game. There is a village, with a population of 100. Five are rich and earn $1000 a year. The other 95 are workers who earn $100 a year. Let’s set a graduated tax rate, which I think is fair and you likely do not: 5% if you earn under $200, and 10% if you earn over.

    Calculating the payments, the alleged rich pay $100 each, for a total of $500 to the common till. The poor pay $5 each, for a total take of $475. In this instance, the top 5% pay more than half of the state revenue each year. UNFAIR!

    This is what I believe underlies some of the argument that the allegedly rich make (by the way, let’s not assume that ALL people with money are only allegedly rich, or that it’s fair to say you are only allegedly rich because the payments on the Rolls really take it out of your hide). Compare my salary, which is solidly NOT allegedly rich, to the income of Bill Gates or George Soros (to dump on a lefty). If there are 95 earners like me, and 5 earners like them, then you are damn right they’ll pay more than 5% of the total village income. They should pay a gigantic majority of the total.

    So perhaps your quibble is more with the definition of rich than with the concept that the rich should pay more than the poor.

    • Likewise, I don’t have a lot of time right now, so I’m wondering if your villagers are beer drinkers? If so, this vignette is probably important to them. The question isn’t whether or not to have a progressive tax system. We do. And, I’m fine with that. What I’m not fine with is paying the lion’s share of taxes AND getting beat up by the people whose share I’m paying. Read on!

      Bar Stool Economics:
      Suppose that every day, ten men go out for beer and the bill for all ten comes to $100. If they paid their bill the way we pay our taxes, it would go something like this:

      The first four men (the poorest) would pay nothing.
      The fifth would pay $1.
      The sixth would pay $3.
      The seventh would pay $7.
      The eighth would pay $12.
      The ninth would pay $18.
      The tenth man (the richest) would pay $59.

      So, that’s what they decided to do.

      The ten men drank in the bar every day and seemed quite happy with the arrangement, until one day, the owner threw them a curve.

      ‘Since you are all such good customers, he said, ‘I’m going to reduce the cost of your daily beer by $20.’ Drinks for the ten now cost just $80.

      The group still wanted to pay their bill the way we pay our taxes so the first four men were unaffected. They would still drink for free. But what about the other six men, the paying customers? How could they divide the $20 windfall so that everyone would get his ‘fair share?’ They realized that $20 divided by six is $3.33. But if they subtracted that from everybody’s share, then the fifth man and the sixth man would each end up being paid to drink his beer. So, the bar owner suggested that it would be fair to reduce each man’s bill by roughly the same amount, and he proceeded to work out the amounts each should pay.

      And so:

      The fifth man, like the first four, now paid nothing (100% savings).
      The sixth now paid $2 instead of $3 (33%savings) .
      The seventh now pay $5 instead of $7 (28%savings) .
      The eighth now paid $9 instead of $12 (25% savings).
      The ninth now paid $14 instead of $18 (22% savings).
      The tenth now paid $49 instead of $59 (16% savings).

      Each of the six was better off than before. And the first four continued to drink for free. But once outside the restaurant, the men began to compare their savings.

      ‘I only got a dollar out of the $20,’ declared the sixth man. He pointed to the tenth man,’ but he got $10!’

      ‘Yeah, that’s right,’ exclaimed the fifth man. ‘ I only saved a dollar, too. It’s unfair that he got ten times more than I!’

      ‘That’s true!!’ shouted the seventh man. ‘Why should he get $10 back when I got only two? The wealthy get all the breaks!’

      ‘Wait a minute,’ yelled the first four men in unison. ‘We didn’t get anything at all. The system exploits the poor!’

      The nine men surrounded the tenth and beat him up.

      The next night the tenth man didn’t show up for drinks, so the nine sat down and had beers without him. But when it came time to pay the bill, they discovered something important, They didn’t have enough money among all of them for even half of the bill!

      And that is how our tax system works. The people who pay the highest taxes get the most benefit from a tax reduction. Tax them too much, attack them for being wealthy, and they just may not show up anymore.

      In fact, they might start drinking overseas where the atmosphere is somewhat friendlier.

  4. Dan Grabois says:

    Nice story about the beer. I’d like to look at this from a different perspective.

    Say you earn a million a year (I hope you do!). Just to make the computation simple, let’s say you pay 35% tax on the whole thing, so you pay $350,000 tax (that’s known in my business as a shitload of money, but the $650,000 you keep is also known as a shitload). If your tax rate is then lowered to 33%, you go down to $330,000 and save $20,000. Meanwhile, say I make 100k a year, so I pay $3,500. My tax rate also goes down to 33%, and I now pay $3,300, for a savings of $200 (thank you, George Bush). Point being, that tax break wasn’t worth shit to me, but it was worth a half-year of college tuition to you. So, when the upper bracket tax rates go down, most of the DOLLARS saved are saved by the high earners. The middle class saves the same percentage but gets little actual benefit.

    So, when you argue that lowering taxes is the only way to stimulate the economy, I have to disagree. You stimulate the economy by putting money in the pockets of the middle class – people who right now are staying in the fucking American Way Motel in Hartford, with a moth-eaten bedspread, because it only costs $50 a night (I won’t name names, but there’s also a fly buzzing around my head). If you earn a million a year, you are going to be able to spend what you need, and you’re not going to spend that extra $20,000 you saved on your taxes. And my friend who doesn’t have a job is spending next to nothing now, but if he can get a job, he will start spending and start paying taxes. But businesses are not hiring him now, not because of high taxes, but because nobody is buying their stuff.

    This is what I object to about the economic theory of Reagan and his followers. Putting money in the hands of people who already have money does not lead to an automatic benefit for the middle class, not to mention the poor. If it did, then we should reverse the Obama plan, and INCREASE taxes on the middle class. In fact, I can just see the reasoning. “You make $100,000 a year. Your taxes will only go up $2000. The wealthy will have to pay much more, and that’s not fair.” We concentrate money as much as possible at the top to stimulate business so it can come back to the people we took it from in the first place.

    At least, that seems to me to be the theory behind supply side economics. I am surprised that nobody has had the balls to make the argument for much higher taxes for the middle class and lower taxes for the wealthy. I guess Steve Forbes sort of did, but it seems to be the logical conclusion of the theory.

    Another point I would like to make is about a deep feeling that I have but that you might not share, and I would love to hear your response on this. I will start with some basic examples. I drive to Hartford every week. I take an interstate highway. There is no toll on the road. My strongly held belief is that we all need this highway. It carries many trucks, which carry food to many people’s supermarkets. It carries many people to work. I believe – and this is now not any kind of logic, but just a gut feeling – that WE should together, all of us, pay for that highway. I am also happy to pay for the Beltway, even though I use it about once every three years. And all the other interstate roads.

    I also would like the federal government to be in charge of the safety of my food and medicine. Yes, I suppose I could subscribe to a lab, for a monthly fee, to do testing, but since we all need food to be tested, why not do it all together? Same goes for air safety.

    We’re probably on the same page so far. But I’m going to push. I feel that the people (the government) should also contribute to the arts. Not a huge contribution, but enough to have a strong cultural scene of music, art, and dance of the type that can’t pay for themselves. Lady Gaga doesn’t need the assistance, God help us.

    To go further, as I understand it, an economy with 100% employment is not a healthy economy (the old supply and demand again). Let’s say 5% unemployment is best – I believe I’m in the ballpark for maximum efficiency. I think we have a responsibility to help the 5% who aren’t working. We’re trying to keep unemployment at that level, so it’s not just that they are lazy fucks. I’m willing to pay for that. I’m also willing to pay to keep homelessness down. I think there are better ways to do that than giving money to the homeless, like providing them with places to live. Yes, some people will exploit the benefit, but many will clean up their lives. The only option, if you don’t help these people, is the option that’s being chosen now: the wealthy isolate themselves in gated communities. That’s just not the kind of society that feels right to me.

    Leaving aside health insurance for the moment, we’ve got lots of expenses I’ve just mentioned. We can’t pay for them without taxing ourselves. So, the Tea Party objection to any tax just seems crazy to me. Then you’re talking about a world of tolls on every road, private police and fire departments (can we agree, btw, that the police calling to raise money is a really scary thing? I get called three times a week), drug safety subscriptions, and so on.

    I’m guessing that you agree with me up to this point, and that your objection to higher taxes is that the government is, in your opinion, overreaching on its duties or responsibilities (we can agree that pork-barrel projects waste TONS of money, and we can talk later, if you want, about whether campaign finance reform would fix this problem). I would suspect that you think the free market can sort out the insurance issue, but you are not going to leave the police in the hands of the free market. I’d love to know if I’m wrong about this. Perhaps a case can be made that cities should bid on private security forces, but I would posit that we are then living in a world of city-states, and this is not the US I know.

    There is an emotional case to be made that health insurance is in the same category – a collective responsibility. I am well aware that you do not buy this argument, but you can probably see that some people would think that everyone has a right to the kind of health care available in this country just as everyone has an equal right to use the roads or fly on safe planes. I find odious the argument that you are entitled only to the health care that you can afford.

    Everyone seems to have accepted the argument that the elderly are entitled to health care. At least I haven’t been hearing calls for the repeal of Medicare. As I understand it, the Medicare system functions decently – people get what they need, at reasonable rates, and Medicare negotiates decent prices with hospitals, etc. Obviously it is imperfect and there is waste. I do know that doctors are not getting the kinds of fees they would like to get (I have a musician friend who is married to a radiologist, and the musician has become the major breadwinner). Health care is not rationed among the elderly, or if it is, I haven’t heard about it.

    I guess the real question, if you accept my premise that everyone deserves let’s-call-it-average healthcare, is how to deliver it. You say there aren’t 40 million uninsured people in the county, and I’m not sure where you or anyone gets their numbers, but my impression is that there are many many uninsured people. I know how expensive insurance is. I do agree that there are some people who subscribe to expensive cable TV and don’t buy any health insurance, and of course this is insane and irresponsible. But I don’t think this is the case for 40 million, or 30, or 20. So, how do you insure those people? What is fair?

    It seems to me that the least unfair way is to expand Medicare to cover everyone. You do it slowly and smartly. It will be clumsy and lumbering, especially at first. Doctors will not make the kind of dough they are used to (frankly, if they are only in it for the money, maybe we’re better off without them). I don’t see how you can automatically assume that this will lead to 6-month waits for surgery, death panels, and extermination of the infirm (I’m attacking a straw man, but it has been a long day). And by the way, all that fear of having a government agent make decisions about your health? Not much different than having an insurance company flunky making those decisions.

    How do we pay for this? We pay together. We can have a private option, like in Britain. You can insure yourself up to the eyeballs if you want. You mentioned earlier that insurance is a way to distribute risk across a population. Well, you have to admit that this would happen with a single payer system.

    The country could probably save a lot of money by getting the hell out of Iraq, but that’s for another day and another blogument.

    Incidentally, when you mention that my medical care for my ear infection cost me very little, you are right, unless you factor in all the money I have paid over the years for medical insurance – probably around $75,000. In the years I have paid those monies (love the plural), I have probably visited the doctor an average of once a year, and gotten maybe one blood test every year that had lab work done. So in that sense, if you divide my use over fifteen years with my outlay over fifteen years, my ear infection cost me an absolute fortune and my health care, far from working great for me, has robbed me blind (but at least not deaf, thanks to my antibiotics).

    Getting back to your beer example, to conclude, I have many thoughts. Nobody in the example is acting particularly rationally, and I’m not sure I see the analogy to tax paying. The wealthy get the biggest break when taxes are cut, and they pay much more when taxes go up. That’s going to be the case as long as taxes are calculated with percentages. Bush cut taxes, and taxes have been low for the wealthy for almost ten years. That’s a LOT of money saved for them (why has this money not trickled back to the rest of the country?????). Now the country is in trouble, and taxes need to go up. The wealthy will pay more. Meanwhile, middle class taxes went down a little bit. They will stay the same. Perhaps that is not fair and they should have a small tax increase. But I would disagree – these are exactly the people into whose hands we need to put more money. They will spend it, and it will trickle … up!

    And if the wealthy choose to start drinking overseas where the atmosphere is friendlier, they are free to do it. They can go to Paris, where there is excellent wine and lovely liqueur. They can pay 60% taxes, but at least they’ll get good health care, an awesome subway system, and waiters who bring handheld credit card readers to the table for instant service.

  5. rodneynorth says:

    First, an embarrassing disclaimer: I’ve not actually read the approx 4,000 words above – but it looks like a juicy debate that I _will_ read, but later.

    Second, the link I’m about to share is offered in sincerity. It’s not a “gotcha” kind of thing.

    Third, today a Fellow at the American Enterprise Institute published a column explaining the conservative case for Obama/RomneyCare. http://tinyurl.com/9dowtvr

    So – and here’s my pt – I’d like to hear hear Bruce’s response to it. AND if it you, Bruce, already – more or less – gave that response above then please don’t feel obliged to pt out that I’ve demonstrated bad blog etiquette here. I’ll figure that out soon enough. And your readers will already know.

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