The Problem with Health Care in the US is....

[EyeKhan]

If we guarantee medical care for seniors, we're going to pay for lots of expensive end-of-life stuff unless you want to strictly ration care.

Care is already being rationed, just not for seniors. What is your suggestion for dealing with the old people problem? Lets assume that our civilization will continue to degenerate morally to the point that letting people die without trying to help them is acceptable. What is your vision for the future; what do you hope for in this slashing of Medicare and Medicaid? Will your ideal nation at least be humane enough to euthanize those dying of injury and illness, or will it just let nature take its course? Even euthanazia costs money after all.

I want to get us out of the business of guaranteeing things we can't afford.

A better way is to find a way to afford the things we guarantee.

[EyeKhan]

So, once again, the choice is between rationing and kids draining their bank accounts so their parents can get a new hip.

No it isn't. That's the construct you've embraced. There's always more choices, more ways.

[Aimless]

A better way is to find a way to afford the things we guarantee.

And there it is. Maybe he can start by actually collecting taxes and then continue by not throwing it at the military or military "research".

[GGT]

A better way is to find a way to afford the things we guarantee.

WE, as a first world nation, should be able to guarantee that the ill and elderly won't die from neglect. Every person should have access to assessment, and first tier treatments like antibiotics or oxygen therapy. Second tier therapies like home health aides are better (and less expensive) than third tier nursing home assisted living.


And as minx reminds us, taking care of our ageing and elderly population costs nowhere near to what Wars cost. We could probably fully fund research for cancer cures, with the money we've wasted on wars and weapons.

[GGT]

[Dreadnaught]

No it isn't. That's the construct you've embraced. There's always more choices, more ways.

That don't involve taxing to death the kids who would otherwise be draining their bank accounts so their parents can get a new hip?

[GGT]

Heh, I was just reading about joint replacements in the US. Close to the tipping point where almost half now are done on those under 65 yrs old. Those healthy athletes that ground their knees and hips to bone on bone with all that high-impact running. Looking for that 30-year knee now, and more than one procedure over a life time. We're all paying for those in high private premiums.

[EyeKhan]

That don't involve taxing to death the kids who would otherwise be draining their bank accounts so their parents can get a new hip?

Of course. I don't know what universe you're living in but nobody in the US is even close to 'taxed to death.' You've been eating too much punditry.

[GGT]

Wait, who is "taxed to death"? Certainly not the baby boomers who are retiring now. Workers today are taxed as some of the lowest rates since the 50's. Problem with hip/knee replacements is the sheer number of aged and healthy athletes getting them, our expensive medical technology, and fee-for-service.

[Aimless]

Er. not to mention obesity

[GGT]

Er. not to mention obesity

Nothing proven, of course, but a few decades from now....if the genome project shows certain gene types are prone to thyroid, pancreatic or general metabolism problems, whether from a virus or certain food triggers....our whole model of "judging" obese people could look quite different.

[Aimless]

er. obesity is already known to be heritable, but my point was that being overweight in the way many americans are is not good for knees and hips

[GGT]

Americuns lead the way? whee

[Dreadnaught]

Of course. I don't know what universe you're living in but nobody in the US is even close to 'taxed to death.' You've been eating too much punditry.

Our taxes are high enough, and it's clear the revenue from tax increases won't be able to raise much more. But more importantly, it's also clear that -- no matter the tax rate on the wealthy -- there isn't enough tax revenue out there to pay for our future entitlement spending under existing laws.

[GGT]

How does that translate to cost containment?

Seriously Dread, if you feel you're being "taxed to death" or would have to drain your savings in order to pay for your parent's hip replacement.....you can't come up with a couple of other options that would help everyone, or at least reduce the costs?

[GGT]

The problem with Health Care in the US is......people like Dread or Lewk reducing this to numbers. Large difference between a coal miner a few miles underground, and a social smoker taking the elevator down to Wall Street.

[Dreadnaught]

Because the numbers reflect reality more than our sentimental desire to provide universal socialized healthcare. Figuring out how to reduce costs is going to take a generation. Given our looming debt situation we're going to have to decouple that dilemma from our government's fisc.

[GGT]

Bull. You assign sentimental desire to "socialized healthcare". That's you thinking of your mom or dad at age 75 with a broken hip, trying to figure out if it should be "pinned" or replaced. Your perspective is either being "taxed to death" or draining your bank account dry. A few of us have said your choices are not so binary.

How many joint replacements do you suppose could be done for the cost of one Tomahawk missile?

[GGT]

Figuring out how to reduce costs will not, and should not take a generation. Every generation has said that, but it's not much more than kicking the can down the road. I've been listening to politicians promising fixes for over 30 years now. Nothing really changes, but the names.

[Dreadnaught]

Revenue doesn't add up.

Once again, this idea that we can just sacrifice a little bit more and we can afford this kind of stuff is pure fantasy.

Here is data from the IRS from 2005, a relatively flush year. Sorry for the horizontal scroll:



http://www.irs.gov/taxstats/indtaxst...=96981,00.html

The blue columns are gross income. The red bars are taxable income. The green bar is tax revenue.

The amount of income tax revenue collected in 2005 was 934,835,769,000, or about one trillion dollars. Total taxable income was 5,023,778,024,000 or about five trillion dollars. The taxpayers making more than a million dollars per year made $918 billion of taxable income and paid $235 billion (averages out to 25%).

If we taxed people making over $1 million/year at a 100% tax rate, we would still be a bit underwater on our projected budget deficits.

There is no way around this dilemma without crippling massive tax increases or significant spending decreases.

[GGT]

You can post all the damn charts you want. We, as a nation, need to do two basic things. Reduce spending and increase revenue. Both, together, at the same time. Neither political party would like to admit it, but it's the truth.

[Dreadnaught]

Way to examine data. The charts are directly from a spreadsheet downloadable from the IRS, it's not some kind of magic.

It's very clear from the IRS Data that there isn't enough income out there to pay for what you want. Unless you want to get rid of the military entirely or tax the upper and middle class to death. Then we can afford it.

Saying, "we can do it! Just try/tax harder!" isn't a solution to a very clear situation where the numbers don't particularly add up. Or at least they don't add up to a situation where we can get what you want without massive and potentially crippling tax increases on the upper and middle class.

[GGT]

What would be massive and crippling taxes on the wealthy? They could not become or maintain their wealth in the 90's? I call BS on that. Letting the Bush tax cuts expire wouldn't put any poor rich people in debtors prison for god's sake. Saying "omg any taxes will kill us!" is just plain false.

The Bowles-Simpsom plan laid it out fairly clearly....reduce spending AND raise some taxes.

Boo hoo, we may have to cut military spending. Get out of three wars in the middle east and stop sending billions to our "friendly dictators".

[Dreadnaught]

Actually, no one would be able to maintain their wealth. But what you want to spend seems to be a bit beyond Bowles-Simpson.

[GGT]

Actually, no one would be able to maintain their wealth. But what you want to spend seems to be a bit beyond Bowles-Simpson.

How dare you assume to know what I want, since you have never acknowledge what society would look like based on what you want?

[Enoch the Red]

What would be massive and crippling taxes on the wealthy? They could not become or maintain their wealth in the 90's?

I think it's pretty readily apparent that the country's financial situation today is not exactly the same as the country's financial situation in the 90's. You remember the last time the government had a surplus? Yeah, me either.

[Aimless]

Okay wait so let me get this straight. Half of all earners in the US pay zero or negative federal income tax, your wealthiest pay less in taxes than they have in a couple of decades, and you consistently fail to collect as much as you can be expected to from corporate income... but the situation is unworkable because you'll tax people to death without accomplishing anything?? what the... you've got a trillion dollars in tax breaks every year, you can't do something with that??

[Dreadnaught]

Okay wait so let me get this straight. Half of all earners in the US pay zero or negative federal income tax, your wealthiest pay less in taxes than they have in a couple of decades, and you consistently fail to collect as much as you can be expected to from corporate income... but the situation is unworkable because you'll tax people to death without accomplishing anything?? what the... you've got a trillion dollars in tax breaks every year, you can't do something with that??

The total amount and proportion of total income tax paid by the wealthy is actually larger than it has been in decades. I also didn't get into corporate rates in this one, because we have a dozen different types of corporations.

On the corporate and personal side, there is a strong argument that we could reduce all the loopholes and lower the rates, but get more.

On average, 25% of income is being taxed, with the wealthy paying more and the poor paying less/none. The idea that we can keep having the poor pay no income tax and raise taxes on the wealthy to pay for our projected $10-13 trillion in deficits is not workable. Even the rich don't make that kind of money.

[Ziggy Stardust]

Is anyone saying that?

What I have heard is decrease spending and raise taxes, this isn't an "or" scenario. So your point that raising taxes only would not bridge the gap is irrelevant. The question is, would it decrease it?

[Enoch the Red]

Is anyone saying that?

What I have heard is decrease spending and raise taxes, this isn't an "or" scenario. So your point that raising taxes only would not bridge the gap is irrelevant. The question is, would it decrease it?

What tax rate would decrease it enough to even modestly offset current levels of spending, and what cuts have you seen proposed that would actually begin to balance the budget?