Socialized National Health Care DOESN'T WORK!*

[Bravus]

Good calls, LynnDel: maybe we need another thread for discussion of education?

[Bravus]

...although I suspect it'd go around in circles. In brief, those on the right politically are all about (external) accountability, and generally believe teachers will only do their jobs if they are pressured with external test scores. Those on the left believe that, in general, teachers are good anf have children's interests at heart, and that giving teachers more autonomy and more opportunities to use professional judgement, and to educate the whole child, will lead to greater success. The philosophical underpinnings are opposite, so discussion of the detail stuff tends to not be very fruitful.

[bevin]

Not just private health insurance.

They are also going to have to pay more for doctors visits, car insurance, home insurance, quite possibly local property taxes, state taxes, ...

/Bevin

[bevin]

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Was the four days worth it?

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This is actually a very interesting question that societies providing socialized medicine must face up to.

How many $$$ is an extra year of independent living worth for an 80yo? $250,000? Clearly not. We can not, as a society, afford to spend $250,000 per year on the medical treatment of all our elderly.

Now, should you give a $10,000 treatment if it has a 10% chance of increasing the patient's life by 1 year? If you think the purpose of government is to increase the total number of live-human-years, the answer is NO. The correct way to spend the money to achieve this on preventive medication and education of children and young adults.

To the extent that the USA medical community recommends spending money in non-cost-effective ways, they are in fact violating their own principle of "do no harm". They are actively promoting the use of money in ways that cost more lives than they save.

/Bevin

[Dr. Shane]

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.I see that on "This old House" many times when the owner reviews the plans and changes things around.

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That is like me telling Bevin I know all about his job because I watch ER.

Sprint reviewed the plans before they ever went out to bid. They worked with the architect in making them. However it was Sprint's planning division that worked with the architect. Once the job bid and we started building it Sprint's construction department made the change. Then once Sprint's Operation's department found out they changed it back. One department doesn't know what the other is doing. That is typical with big organizations.

[Dr. Shane]

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I used an online tax calculator to figure out what my US income tax would be. It said I'd pay $1,410 a month, for a rate of 21.5%.

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Does that include Social Security. Remember that US pays a lot for its military which is an expense much larger than what Canadians pay for theirs.

[Dr. Shane]

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In brief, those on the right politically are all about (external) accountability, and generally believe teachers will only do their jobs if they are pressured with external test scores. Those on the left believe that, in general, teachers are good anf have children's interests at heart, and that giving teachers more autonomy and more opportunities to use professional judgement, and to educate the whole child, will lead to greater success

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The solution is in the MIDDLE. Make the teachers pass yearly tests - not the students.

[LynnDel]

The trouble is this: Knowledge and the ability to pass a test do not necessarily a good teacher make. A good teacher is the result of a combination of knowledge, experience, skill, study, patience, inspiration, inherent ability, and an extraordinary sense of empathy that enables the teacher to understand what it is the student doesn't understand and then work around the block to help them see the light.

I don't know if there is any test for that.

LynnDel

[Gerr]

I did not mean to say that dementia patients are kept in acute care hospitals for dementia per se. But I can tell you case after case Greg, in which an Alzheimer's patient in a SNF is moved to an acute care facility time & time again because the SNF personnel do not want a patient dying in their facility. I finally had to resign from the care of one who was bedfast & had advanced Alzheimer's because of this repeated hospitalization after hospitalization. It was usually for pneumonia. I have two in a SNF right now who have been acutely hospitalized several times already.

Gerry

[Gerr]

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To the extent that the USA medical community recommends spending money in non-cost-effective ways, they are in fact violating their own principle of "do no harm". They are actively promoting the use of money in ways that cost more lives than they save.

/Bevin

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[:"blue"]It's a little bit more complicated than that. I think most of my colleagues will frankly tell their patients when further treatments are futile. But, as you know, the patient and their family also have their say so and often want everything done.

You may have read about Mrs. King going to some alternative medicine treatment facility here in LA even though she had been told her case was hopeless. [/]

Gerry

[Gerr]

You don't pay any taxes to your provincial gov't like we do for our state gov't?

Gerry

[Dr. Shane]

I know we have two topics running in this thread but I am going to go with it and if someone else wants to start another thread they can.

I don't know of any other way to measure knowledge than testing (as imperct as it is). If there was a better way, I suspect we would be doing it. We measure how well a teacher or school does by the test scores of the students. Teachers complain that this means they have to teach to the test. So either we don't test anyone and have no accountability or we test teachers. Are there any other reasonable possibilities?

[Jeannieb43]

[this is not in reply to any particular post... just thoughts on the title topic.]

Bill and Hillary Clinton had it right, back in 1990:

A single-payer national health insurance is the answer. Witness the success of Medicare. Although Medicare under the Bush Administration is now cutting its payments to doctors by a severe percentage, the plan basically works.

For instance, when my doctor orders an MRI for me, he merely needs to have the proper symptoms and/or xrays and blood tests (e.g.) on the chart, and Medicare does not require pre-authorization for the procedure. On the other hand, my sister who's on an HMO has to jump through hoops and wait hours or weeks to get authorization for procedures. PLUS the fact that those insurance companies' employees are all being paid their salaries out of HER premiums.

The nay-sayers in 1990 didn't want "the government" running their medical care. Well, DUH -- it's already BEEN running it for the retirees -- ever since 1935, in fact. (And Medicare runs very smoothly.) So -- the alternative was that now we have the insurance companies making our health care decisions -- all the while becoming filthy rich off our premiums, and paying big dividends to their investors.

Medicare's operating costs are in the single digits. Whereas insurance companies' overhead + profit runs around 75%, leaving only a small amount for actual patient care. [Can't verify these numbers, but it's what I recall.]

[Bravus]

In Canada the provincial and federal taxes are included in one deduction amount on our payslips, and there's just one tax return each year for both. So that's my total income tax load. No, no Social Security payment, Shane, although I'm guessing that parallels the pension and employment insurance payments I listed above.

On teaching, there are much better ways than paper and pencil tests to know whether a teacher is good, but they all cost more to administer - spending a few days observing a teacher's daily classroom practice tells you a lot more about his/her skills but is prohibitively expensive. I wouldn't have a problem with a paper-and-pencil annual test for teachers if it tested the specific content knowledge they were teaching plus some dimension of understanding educational practice (e.g. using hypothetical situations). But if it just meant the teachers had to cram for weeks on some generic or unrelated knowledge while school was in, that'd be counterproductive.

Really, though, accountability for the teachers is one side of the coin, but what about accountability for governments, school boards, administrators et al? The testing stuff basically loads all of the accountability measures at the opposite end of the chain from where the decisions about funding, timetabling, curriculum and so on that deeply effect the quality of schooling are made... and then there are the effects of parenting. Now, an annual *parenting* eaxm I could really get behind! <img src="/ubbtreads/images/graemlins/wink.gif" alt="" />

[Neil D]

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That is like me telling Bevin I know all about his job because I watch ER.

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Aren't you in the construction business??? Don't you see this far more often than I do, who am NOT in the construction business??? Your mocking comments are not appreciated. Which shows us how you truely feel about other.....

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Sprint reviewed the plans before they ever went out to bid. They worked with the architect in making them. However it was Sprint's planning division that worked with the architect. Once the job bid and we started building it Sprint's construction department made the change. Then once Sprint's Operation's department found out they changed it back. One department doesn't know what the other is doing. That is typical with big organizations.

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Yeah, and it's not waste...It's a process. Granted thier decision making process could be better, but this sort of thing happens in small business as well. It only happens with a smaller group of people, or a single individual. It happens all the time, and sometimes it happens with monetary consequences. Sheesh.....

[Gregory Matthews]

Gerry, I recognize the issues that you address.

[Dr. Shane]

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Your mocking comments are not appreciated.

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I am sorry if my comment was offensive. It was made in the spirit of rolling-with-the-punches. I did use the little laughing graemlin in hopes of showing some tongue-in-cheek humor. I will try to be more sensative in the future.

[Dr. Shane]

Bravus: social security and medicare in the US are about 7.5% and the employer "matches" that amount. So that would make your US taxes higher than your Canadian taxes. I suspect our military spending is why.

[bevin]

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social security and medicare in the US are about 7.5% and the employer "matches" that amount

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Bravus probably is not counting in the matching payments his employer makes - yet another thing that makes the comparison difficult

[benherndon]

Been watching this thread for couple of days.

BRAVUS, we have what's called the Alternative Minimum Tax which is hitting many, even most, in the upper middle income brackets. Originally it was designed for the filthy rich which invested only in Tax Free bonds and paid no tax on the earlier considerable returns.

Because of "bracket-creep" AMT hits almost anybody approaching a 6 figure income and cancels out virtually all formerly legal deductions. It turns out that my income tax to the Feds is approaching by some government legerdemain over 38.5% and the state of Calif. takes another 11% in round figures. That's about a 50% of reportable income tax. In addition there are taxes on many other matters such as gasoline, sales taxes, property taxes which for those included in the AMT is negated..at least to my knowledge. Our county's sales tax is almost 10%, for everything other than grocery store foods. Retail prepared food is taxed and there is a pretty socially mandated 15% 'tip tax' on top of all that.

I am not a tax expert at all and some corrections to what I've said may be inorder but in general terms if one makes a comfortable living in this United States he will be paying about 50% on his reportable income....better figure it that way or be surprised on April 15 ....Nat'l Tax day.

What has made so many US citizens so much in recent years is during this rise in real estate values a married couple will owe no taxes on up to $500,000 profit on a home they have occupied for 2 of the previous 5 yrs. People have been selling and reinvesting and repeating such activities for the past several years and have made lots of money tax free.

Ben

[Bravus]

Thanks Ben, and everyone. This has been a useful discussion because the common response of Americans to those with national health care schemes is 'but you pay so much more tax'. That argument has pretty much been shown to be fallacious, which seems to me like a step forward. As Shane says, a lot fo the balance is probably made up in military spending, but that's now something you have enough facts to start having a national debate about (i.e. is it worth having a massive military but poor health care)... your conclusions will, of course, be yours to make.

[Dr. Shane]

If you look at the US' neighbors, Canada and Mexico, niether spend much money on their military. Why? Well it is the same reason a guy who has a neighber that parks his police car in his driveway each evening doesn't need to buy a security alarm.

[Gregory Matthews]

Re: AMT (Alternative Minimumn Tax)

This is a very big issue.

I am aquainted with a person who had to file the AMT form for 2005 simply because that person purchased a hybrid automobile in 2005. You see the AMT is trigered not just on the basis of income, but it may be trigered on the basis of the deductions taken.

The interesting factor is that the person I am speaking about did NOT have to pay the addition AMT tax. You see, the income was not high enough to trigger any additional payment. But, that person had to file the AMT form simply because the hybrid auto deduction was takent. That person figured the tax without taking the hybrid deduction, and did not have to file the AMT form under those circumstances.

Dr. Ben is correct, one does not have to earn a six-figure income to be hit by the AMT.

[bevin]

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Well it is the same reason a guy who has a neighber that parks his police car in his driveway each evening doesn't need to buy a security alarm.

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Actually most countries maintain armies large enough to defend themselves against their immediate threats.

The USA maintains an army large enough to BE an immediate threat to most regions of the world. The purpose of the US military is not just to defend the US of A - instead it is to be a massive threat against any and all other countries/coalitions.

/Bevin

[Dr. Shane]

The size of the US military is due to the Cold War threat. After the Cold War ended our military was drastically reduced which helped balance the budget in the late '90s. Our military is large once again because of the War on Terror.