Public Funding, Taxations and Insurance Discussion [SPLIT]

[SinbadEV]

[Split from http://springrts.com/phpbb/viewtopic.ph ... 92#p463292 ]

I read a very interesting book called "The Undercover Economist" who had a very different take on how to organize public programs and mentioned health-care in particular. Apparently some country you wouldn't expect ( I think it was Singapore) has a really clever system where there is a "mandatory savings program" where you have to put money into a "healthcare" account and then that, money can only be spent on "healthcare"... so the healthcare is private but the government forces you to be able to afford it... this makes the healthcare providers a free market, generating competition so that prices are driven down and quality of service is driven up... the Author mentioned that the system either was (or could be) improved on by adding a "disaster" insurance for anyone who's medical bills exceed a certain amount (like cancer treatments etc.).


He also explained a different tax scheme he wanted the US to use but it was a bit complicated so you'll have to read it yourself... but basically he was saying that sales taxes damage the free-market, tax breaks for the rich damage the free market but also over taxing the rich gives people less incentive to excel... so he said, no tax on goods/tarrifs, essencially free trade all the way down to your supermarket so everything costs what it cost to produce... then you raise everyone's taxes accordingly... in my province we pay something around 13% tax (it's and HST which means it combines provincial and federal taxes into one number)... so instead of this, and make all "transactional" taxes 0%... so in the end it's going to cost 13% less for the raw materials, 13% less for shipping, 13% less for the electricity and shelving and such where the products are displayed and then I'm going to pay an additional 13% less for the acctual product... so for the givernment to get it's money they will now needs to raise income taxes by 20-30% to make up the shortfall but in acctuality it should improve things over time because no the free market can do what it does best and start paying fair wages and selling products at competitive prices.

He also points out that things like Insurance, Environement and Education Costs are always going to involve everyone paying for a subset's needs and as such ARE the kinds of things that should be regulated by central government... though it would be in everyone's best interest if the providers still had to be competitive with each other (aka public money pays for schools but a parent would be able to choose which school they wanted the publicly provided money to go to)...

I'm not sure I totally agree with all of this but it was a different take then I was used to so it's been added to the background noise in my brain.

[Licho]

Thats really not good idea for many reasons:

* low income people won't have any such savings or wont have enough
* costs of some procedures can exceed that of your savings
* its inefficient to save so much - you are not likely to use all of that money and you just drain it from economy if you keep it on account. Shared insurance system is economically much more effective because it can do with far smaller ammount of money per person.

[SinbadEV]

Thats really not good idea for many reasons:

* low income people won't have any such savings or wont have enough
* costs of some procedures can exceed that of your savings
* its inefficient to save so much - you are not likely to use all of that money and you just drain it from economy if you keep it on account. Shared insurance system is economically much more effective because it can do with far smaller ammount of money per person.

I forgot to mention that if your income was below a certain point the government would pay into our "healthcare savings account". If the cost of the procedure exceeds your savings then it falls under the "disaster" situation that qualifies you for government money.

He also pointed out that when you let the government decide how to spend your money they make decisions like "there is a procedure that could save your eyesight from a degenerative condition but it's expensive so we'll only pay for it on one eye".

While I agree that this takes money out of the economy it is no worse then the american's new system of requiring people to buy health insurance... which I am starting to see the logic in... Government regulates the insurance providers and healcare providers, Government requires all people to buy insurance, you get free-market for healthcare but people aren't denied a procedure because it's expensive and they cannot be denied access to insurance because the government mandates it.

[Licho]

I see no benefit in private savings over same resources being handles by companies or state.

What's the point? It will certainly need more bureaucracy to verify all people and to transfer money from personal accounts and to handle all special cases.

Regulated companies can do the same job more efficiently with lower sum of resources.

Here it's simple, you go to doctor, they do stuff or give you medicine prescription and when you leave you should pay 1Ôé¼.

Doctors get money from insurance companies each month, GP get money based on number of people who use them as main doctor and specialists or hospitals receive money based on actions performed or medicines used.

Hospitals also usually get additional funding from town that hosts it or even from insurance companies which invest in new equipment.

[scifi]

i have to say european sistem of education and healthcare is more eficient and beneficial to the general population than the one used in USA.

There are diferent sistems at play in europe, one that works in a similar way to the one you described is the nordic sistem sweden and denmarks sistem.

Basicly you pay more taxes to support healthcare and education, but these sistems come at a lower cost to you when you need them.
Also the state monitors and hold healthcare/education almost completely.

Things like minimum wage, unemployment money e.t.c.. are more funded in countrys like sweden.

In the end you have fewer money to spend, but you dont have to spend that many when you go to hospitals e.t.c...


Its a nice combination, but to be honest only works in sweden/norway/denmark/finland

In my country we tryed to implement a similar sistem it failed uterly, the state spended more money trying to establish fiscal and regulating sistems, that hospitals and schools couldnt handle with all the burocracy....

We use what we call the French sistem, mixed private/state control,
most schools and hospitals are owned by the state or are mantained with acords with private investors. Each hospital and school are relatively independant from the state but must justify the use of money in the end of the day.

Its not a bad sistem there is a lot of room to improve and alter.
But it causes unfairness, and bad management, the university i was on, (IST) had essencialy to get support (private suport), essencialy it survives by the work theyr own students make, and show to the rest of europe.

The acords with imperial colege in london, and MIT and other universities keep this university alive so to speak.
To be honest each country must figure its own healthcare aka education.

In america theres a tradition of free market in every aspects of life you cant change that from a moment to the other, we in europe in the other hand are used to strong and controling state.

[SinbadEV]

In america theres a tradition of free market in every aspects of life you cant change that from a moment to the other, we in europe in the other hand are used to strong and controling state.

Actually, there are some who would claim that with their protectionism, unions, tariffs and subsidies they are LESS of a free market than many EU countries... but I see your point...

I live in Canada, healthcare is payed for by taxes and available to all legal residents... I don't know how it works but if I get sick, I got to the ER, hospital or privately own (but government certified) clinic and they treat me and then I go home and no-one ever sends me the bill.

edit: Wait... were you being sarcastic?

[Teutooni]

Fully socialized healthcare really is the best choice imo. It has it's problems, for example self inflicted conditions like alcoholism exerting huge and needless strain on the system. But really, not having to worry about money when you need major operations is a huge relief on a personal level - you probably have enough things to worry about if you need a major operation. Not to mention socialized healthcare being ethically sound - the society takes care of everyone equally. It just strikes me as utterly selfish, protesting being required to pay for common health care even if you don't need it's services.

[scifi]

In america theres a tradition of free market in every aspects of life you cant change that from a moment to the other, we in europe in the other hand are used to strong and controling state.

Actually, there are some who would claim that with their protectionism, unions, tariffs and subsidies they are LESS of a free market than many EU countries... but I see your point...

I live in Canada, healthcare is payed for by taxes and available to all legal residents... I don't know how it works but if I get sick, I got to the ER, hospital or privately own (but government certified) clinic and they treat me and then I go home and no-one ever sends me the bill.

edit: Wait... were you being sarcastic?

no i wasnt i was being semi sarcastic.

what i ment was americans are to used to having the liberty of choosing witch company suits theyr needs best, they encourage competition and free choice.

Its not a bad sistem, problem is, it got to mutch "money dependant", people with 0 money equal no healthcare and thats bad.

It can take years before america changes that, specialy during a economic crysis.

ive been to canada and its healthcare sistem and education, its very good compared to the american counterpart.

At least thats the opinion of my famaly that lives there
I Love canada awesome country

[tombom]

Sales taxes are unfair and regressive. An increased income tax to replace it is an excellent idea.

Maybe get the rich actually paying their way again.

"We learn, for instance, that 1941's top executive at IBM, Thomas Watson, collected $517,221 in compensation that year, about $7.7 million in current dollars. Watson paid 69 percent of his total 1941 income in federal income tax.

Last year, today's chief exec at IBM, Sam Palmisano, took home $24.3 million for his executive labors. We don't know how much income above that sum Palmisano reported in 2009, or exactly how much of that total he paid in taxes.

But we do know that the 13,374 Americans who reported incomes over $10 million in 2008, the latest year with IRS stats available, paid an average 24.1 percent of their taxable incomes in federal income tax.

In other words, IBM CEO Palmisano last year took home, after adjusting for inflation, over three times more than his predecessor Thomas Watson took home in 1941. Yet Watson in 1941 paid almost three times more of his income in federal income taxes than Palmisano likely paid in 2009." http://www.openleft.com/diary/21148/new ... od-culture

[Machete234]

Seriously, americans should shut the fuck up about health care.
Albania, probably has a better health care system than you, ask them how to do it.

[Cheesecan]

Well I have grown up living in a Nordic system, which I think is on the whole very humane and responsible.

But I also see failings in that there's a clear lack of quality control(if you get things for free, you can't ask for your money if you get bad service).

Case in point. I once had the misfortune to have to pull out a wisdom tooth in a Swedish emergency clinic, and I can tell you that they did an absolutely horrible job. The waiting time was very long. When I finally came through, it took them almost one hour to take one tooth out and they didn't give proper anesthesia, so the whole procedure was quite painful. A few years later I had to take another wisdom tooth out while traveling, this time in a third world country(China). I went to what I at least believe was a small or medium-sized private clinic and was very well received in a timely fashion. The doctor plucked out my tooth so fast I didn't even know it was out until he told me, completely pain-free unlike the experience in my home country.

Although I haven't been sick much myself, I have relatives and friends who have had similar experiences with Swedish health care, so I'm somewhat disillusioned by the famed Swedish system. To me, free seldom means the same as you get the best that money can buy.

As for coverage, obviously some individuals get through life largely without needing any health care, while other more sickly and/or injury-prone people will have problems every year. Because of this I don't think any one-size-fits-all approach is good.

As I mentioned earlier in the other thread, in my country you can buy dental insurance from the government(which is the biggest provider of dental care in the country). What you do is submit to a exhaustive dental examination. Then the dentist will place you into a certain risk group. So if you're low risk, you would pay less, and high risk would pay more. I think this kind of system is quite fair.

Now I'm all for subsidizing the costs for those who have it tough. But I'm very much against that people who can pay for themselves should get free rides. Many people who have bad health have it because they don't exercise, drink too much alcohol, smoke too much, do drugs, etc, if they can pay their own bills, other tax payers should not have to subsidize their costs. Tough love in other words.

I'm not sure if privatization actually increases effectiveness of health care. After a private company reaches a certain size, it's basically the same as dealing with a government institution. You are nobody to them, and they can do whatever they feel like because they're untouchable and infallible.

[Licho]

Why should ill people pay more? Especially if its not self inflicted. It's imo amoral to let unfortunate pay more than those lucky ones.
Tax according to income (not health state!), spend according to needs is imo best solution.

[Cheesecan]

Is not lung cancer from smoking 2 packs of cigarettes a day self-inflicted? What kind of message are you sending to people then? Isn't it reasonable to demand something from citizens?

Imho socialism has a tendency toward low productivity, it doesn't really motivate people to be excellent, people just rely on the system to provide them with everything. Sweden had that problem ten years ago, people were taking sick leave for long periods of time, not returning to work, even people who still could work at some diminished capacity, because the government allowed them to do so. Of course you cannot, in a humane world, deny people health care, but it's quite reasonable to demand that people not indulge in habits that will diminish their health at an abnormally high rate, and also, to encourage good health in citizens.

Everyone with a sufficient income to cover base living expenses, is left every month with a sum of money which they can freely distribute at their own choosing. Now whereas one man might spend this on things to forward his health, another will go on a drinking binge. Hell if his liver breaks, health care is free right? Can just get a new one cloned and everything will be fine..Nay. I say offer the healthy man an incentive, subsidize his gym card, his jogging shoes. Hell give him a tax deduction for being a healthy citizen, if that is possible to verify.

[Sleksa]

Many people who have bad health have it because they don't exercise, drink too much alcohol, smoke too much, do drugs, etc, if they can pay their own bills, other tax payers should not have to subsidize their costs. Tough love in other words.

Thank god people like you are a minority

A friend of mine goes to gym 4x a week, doesnt smoke and drinks normally and yet is sick atleast once or twice a month, and has a lot of health related issues. Paying for all the things he's went through woulda broken atleast 3 families financially in a privatized system

As for myself, the only reasons in the past year i've been to a doctor have been health checkups for driver's license and a minor surgery, with total costs going at about 200Ôé¼ (because i used private sector)

IE being sick is not always a concious choice like you make it be

but it's quite reasonable to demand that people not indulge in habits that will diminish their health at an abnormally high rate, and also, to encourage good health in citizens.

Jättekul berättelse bror

[Cheesecan]

Your friend, in a system like I propose, would be one of the people receiving tax deductions and free health care. Because he's not sick at any fault of his own. My system is not about denying people who need health care aid, it's about redistributing resources so that those people can have better health care.

Now if he was a chain-smoking, alcoholic, grotesquely overweight guy who likes to do jackass stunts, then he should look himself a private insurance instead, if anyone will have him, because national health insurance shouldn't cover people who are irresponsible with their health, the same way the warranty on your new cellphone doesn't apply if you repeatedly beat it with a hammer. Maybe this relies on an antiquated notion that the state can foster good behavior in people, which probably would never work in the real world, because people would find ways to take advantage of the system. But I don't think it's inhumane or immoral?...

[Licho]

Lol what is "your own fault". Do people even have free will? What in your life is really conscious decision? Do you think that smokers don't want to quit? That fat people don't want to lose weight?

Besides all of these factors are just risks and you can never attribute specific problem to specific risk factor because there are many.

All we can do is to motivate people to avoid taking additional risk. Not punish them for being unfortunate.

You can easilly get cancer in your 20. Eating too much red meat or not eating fish/spending enough time on sun sure increased your risk. Is it your fault?

[Cheesecan]

Lol what is "your own fault". Do people even have free will? What in your life is really conscious decision? Do you think that smokers don't want to quit? That fat people don't want to lose weight?

Everyone has free will, if you don't believe in free will, you must by extension believe that genocide is predetermined to happen, so the slaughter of 6 million jews in WW2 had to happen, millions of people have to die every year from starvation and poverty. ?? Knowing that it's just fate, who are we are we to try and change things ?? Bummer!
Are you a religious man Licho?

Besides all of these factors are just risks and you can never attribute specific problem to specific risk factor because there are many.

All we can do is to motivate people to avoid taking additional risk. Not punish them for being unfortunate.

If you consciously make decisions such as to smoke, drink, fight, why should tax payers have to pay for your lack of inhibition and self-control? Shouldn't it be possible to hold you accountable for your actions? Provide you with health care, but also a reminder that your lifestyle is immoral because it is taking away the resources that society has left for people who actually deserve it.

[Licho]

All your decisions are influenced by genetics, environment, instincts evolved to handle stone age issues. Where is the free will? Is it the decision you make in your inner talk? Well you are often unable to execute it even if you wanted.

If you accept paying for someone being hit by a car, then you might as well accept paying for someone being unfortunate to have genetics predisposing him to alcoholism (which most alcoholics have btw).

If you don't want to pay for someone who cannot control his smoking despite wanting too, why to pay for people who were careless and got accident or were unlucky to have some hereditary disease?

I'm saying there isn't much difference between those. We pay because thats what society is for, I'm happy to be taken care of if I fall ill and I'm happy to contribute for this service to others. If you wan't to restrict it for smokers you would have to restrict it for everyone, because you can always say "it's his fault".

[Teutooni]

If you consciously make decisions such as to smoke, drink, fight, why should tax payers have to pay for your lack of inhibition and self-control?

Do you honestly think people consciously choose to become an alcoholist or drug addict or obese?

[Machete234]

Is not lung cancer from smoking 2 packs of cigarettes a day self-inflicted? What kind of message are you sending to people then? Isn't it reasonable to demand something from citizens?

So these people should die a more painful death, what are you smoking?

Everyone has free will, if you don't believe in free will, you must by extension believe that genocide ....blabloa

Smoking and drinking to an extend that it shortens your life is because of addiction and they also happen to be the rather strong addictions comparable to hard drugs.
Anyways smokers can collect less retirement, so it evens out a bit.

I sometimes wonder how anti social can somebody be that doesnt want to pay for others when they are sick?
If you happen to be sick they pay for you and I dont see any flaw in that system.

For some illnesses you wont be able to pay the treatment on your own, so you just die?
Who is the fatalist now?

You can easilly get cancer in your 20. Eating too much red meat or not eating fish/spending enough time on sun sure increased your risk. Is it your fault?

Chances are its genetic when you get cancer at 20, so you should have been sorted out by genetic engineering?
If they could choose the embryo with the best genes which is less likely to get ill, that means genetic enginerring for the masses.
Then they could trace it back to your actions if you get sick.

As long as this isnt done you cant be punished for bad genes, but that is a bit offtopic.
So this means the same health care for everybody is needed.