Issues 

• Cost control issues and forced under-performance between doctors due to billing max-outs.
• Discrepancy of quality of health care between the classes.
• “Germany’s health spending was at 10.7% of GDP, third highest in the world”

Pluses

• All individuals making the equivalent of $40k are required to be covered. Others can opt out. Few do.
• Employees who are fired, let go or quit receive health care. Government picks up the employee tab.
• Average annual spending per person about half of the US average. See the spreadsheet on total health care costs . O CanadaWhen
  Nationalized Health care: 1971 

  How
  Everyone is covered, regardless of class. Taxation covers the costs. Tax rates vary according to province. Add-on insurance is not allowed.

  Issues

   

   

   
• Specialists will not receive high compensation for seeing individuals without a GP referral. So they don’t do it.
• Doctors have no reason to withhold care, as they are paid for seeing patients and providing care, period.
• Response to dissatisfaction in quality of care boosted money inflow substantially. No word on effect.
• Hospitals get annual lump-sums, not fee for service. Per my Canadian friends (I have no idea why I have so many), the quality of health care is sub-par due to the low pay.
  • They indicated that most doctors are not worth their salt. But that’s not any different than the US.
  • Not sure if this is true, but my friends indicated that the old and frail do not receive the same care as those in the US, due to quality of life and burden on the system.
  • Response to dissatisfaction in quality of care boosted money inflow substantially. No word on effect.
  • Rated 30th overall. Not so hot.

  Pluses

  • Lower Administrative costs
  • Cost of hospitalization lower
  • Pharma prices much lower
  • Annual cost per individual actually went down in the 90’s.
  • “…though it should be noted that Canadians wait, on average, less time for vital operations such as transplants.”

  France

  When
  Not sure. Covers everyone as of 2000.

  How
  Everyone, everyone is covered. In the entire country. No discrepancies. Funded by corporations, employee contributions and taxes. Rates are uniform within the entire country. Funds are handled privately by employers and unions. and supervised by the state. 75% of costs covered by the public system. Add-on insurance allowed and heavily utilized to cover the additional 25%. Supplemental insurance available for the poor to compensate for those who can afford supplemental insurance.

  Issues

  • Health care costs are rising
  • Disparity of care (although not so bad)
  • Physician strikes for low and unfair pay (per the physicians’ opinion)
  • Physicians make about 1/3rd of what American physicians make.

  Pluses

  • Access to care is unlimited. Period.
  • Physicians can practice anywhere and see anyone.
  • Individuals can see whomever they please.
  • No referrals required for specialists (although this is changing)
  • 8.4 beds in hospitals per 1,000 people (we have 3.6).
  • Individuals can choose which hospital they want to go to.
  • Patient-client confidentiality even though its run by the government.
  • Rated #1 health care system.
  • Annual cost per individual is substantially lower than the US.

  ________________________________________________

  What do we do now?

  Well, Canada sucks. We know that. Germany is pretty good, based upon what my friend says. France is sounding pretty good at first glance. I don’t know what the taxation rate is, but since corporate subsidizes and employees subsidize a portion, I would imagine it would be much lower… Of course, you are paying in through employee contributions as well to subsidize the poor. But this is a plan I can live with based upon first review.

  So what would we have to do to emulate France? Well, it’s bad.

  • Physician pay would have to be reduced substantially. Not bad for us; bad for them. By extension, though, bad for us. Physicians will bail like rats on a sinking ship.
  • Big Pharma will shit a brick. First of all, I don’t know if we lead R&D in pharma. If we do, then that’s going to be a toughie.
  • Big Pharma will have to reduce or eliminate advertising costs and blonde whores that cater to physicians. Oh, poor things. Back to the pole for them.
  • We will have to focus on preventative medicine and provide incentives for the same. Nationally. Not at a corporate level. Not so bad… I can live with that. I need to work out anyway.
  • Fees will have to be dictated by the government. And, due to the diversity of cost of living throughout our nation, that’s a toughie. Probably going to have to go to the state level.
  • Insurance companies: well, they will be there, but they are going to shit a brick too, because it’s going to cause a major overhaul. Lower administrative costs, nationalized and streamlined processes. That’s not so bad. I hate insurance companies anyway. They are all assholes. I imagine you would agree.
  • Taxes, taxes, taxes.

  The biggest problem I see is twofold; the physician pay and big pharma. Insurance companies; well they can kiss my ass. Gone are the days of doctors wanting to help people. It’s all about the almighty dollar. How do we change that? I guess we train a new generation of doctors to think differently. Or at least, go back to the original way of thinking. By the way: did you know that less than half of medical schools require doctors to take the Hippocratic Oath anymore? I didn’t know that until I saw it on CNN a few weeks back. I was horrified.
  ________________________________________________What does Bush want to give us?Frankly, it sucks. It’s a token. It’s basically a statement of “Hey, I am a Republican, so I certainly can’t nationalize. But I can do the token moderate push and hope for the best, continue to support big business and insurance companies like a good Republican, and let the next President fix this shit hole we are in.” (Think Hellary).First of all, he states “There is no question in my mind that a proper role for the federal government is to help the poor and the elderly and the diseased get health care. ” Okay. Point taken. No nationalization. We only care about the poor, the elderly and the diseased that don’t have health care coverage. Um, that’s called Medicare and Medicaid. Been there, done that. But damn, he is really trying to snake around the career-killer “don’t touch Social Security, Medicare or Medicaid” issue.

  Second, he states “The second aspect of our responsibility is to work to make health care available and affordable for all our citizens, and the best way to do that is through private health insurance.” Um, aren’t we already doing that in large part? The people that don’t have health insurance are those that work part time (except at Starbucks), work in low-wage jobs, work for small companies, or don’t work at all. So, how in the hell are we going to give them private insurance if we continue to rely on corporate-sponsored initiatives? We would have to go to the socialized model. Okay. Good. I hope his advisors thought of that, because god knows he can’t generate an original thought all by his lonesome.

  And further…

  • “Americans are fortunate to have the most advanced and innovative health care system in the world. “. Not true.
  • “…move away from reliance on government-run health care and toward a system in which Americans have better access to basic, affordable private insurance, and increased ownership of their medical decisions.”. I assume he is talking about Medicare and Medicaid. In the end, someone is paying for it. You and I are paying for it, along with our employers. So the money will come from the same bucket. Insurance companies have everything to gain. God, how Republican. I wonder how many lobbyists had to get committee and cabinet members laid to agree to that one.

  Now, THE Plan…

  Point One
  “The President’s Plan Will Help More Americans Afford Health Insurance By Reforming The Tax Code With A Standard Deduction For Health Insurance – Like The Standard Deduction For Dependents. The President’s primary goal is to make health insurance more affordable, allowing more Americans to purchase coverage. The President’s proposal levels the playing field for Americans who purchase health insurance on their own rather than through their employers, providing a substantial tax benefit for all those who now have health insurance purchased on the individual market. It also lowers taxes for all currently uninsured Americans who decide to purchase health insurance – making insurance more affordable and providing a significant incentive to all working Americans to purchase coverage, thereby reducing the number of uninsured Americans. “

  Rebuttal
  Okay. Let’s hit this on a couple of points. First of all, I have a lot of health problems. So, when I work for a company, I get lower rates because the other healthy people in our “group” offset my high costs. Sorry. It’s true. Not saying it’s good; it’s just reality. That’s what’s so golden about group insurance; rates are lower because of offsets by healthy individuals. Good for me, bad for you. So, let’s look at it from the other side. You are healthy (probably not, we are indeed Americans). Should you purchase an individual policy, you will pay substantially less than me. But what incentive do you truly have when your company already subsidizes your health care costs for you and your family, and you have little contribution? Do you really think that taking a standard deduction is going to reduce your tax burden all that much? No. Especially since you have a lower rate. If you do, then that leaves the corporations to carry the burden of us “less than healthy” individuals, which will cause corporations to drop the subsidies and cause me to pay the whole kit and caboodle anyway. So, either way, corporations win out, because everyone is going to have to get policies outside of work. Go Republicans. I hope they got laid well.

  Second, “…reducing the number of uninsured Americans”. Typically, those who do not receive health benefits at work are poor. They are paid very low wages. They aren’t going to be able to afford an individual policy. Most of them make so little that they already take major deductions against their tax burden, so it’s not going to make a difference. They will be no better off than they are now. Go Republicans. I hope they got laid well more than once.

  Point Two
  “Under The President’s Proposal, Families With Health Insurance Will Not Pay Income Or Payroll Taxes On The First $15,000 In Compensation And Singles Will Not Pay Income Or Payroll Taxes On The First $7,500. (2.b) At the same time, health insurance would be considered taxable income. This is a change for those who now have health insurance through their jobs. The President’s proposal will result in lower taxes for about 80 percent of employer-provided policies. Those with more generous policies (20 percent) will have the option to adjust their compensation to have lower premiums and higher wages to offset the tax change. “

  Rebuttal
  Okay. So let’s see. If I am a family of four, I can pay a maximum of $1250/month for family healthcare for the tax benefit. What about those individuals with special needs children? Do you honestly think that they will be able to provide familial care less than or equal to that amount? Duh, no. Oh wait, okay, well, we will end up paying for them through our payroll and corporate subsidies anyway… Isn’t that what we are doing now? Group effort, remember? Now, I am single. We all know it, much to my lament (and Mom, stop trying to fix me up with gay guys. Your gaydar is broken). So, I can max out at around $625/month to take the deduction. Hell, I already get to take the medical deduction since I spend at least 10% of my income on healthcare. Plus, my individual policy is going to cost upwards of $1200 a month since I am self-employed. Think of all those people who will be forced to get external insurance (because it’s inevitable). Um, that guy that works over there at Taco Bell? How is he going to afford that for his family? Or even just his wife and himself? You think he gives a shit about the tax break? He is looking at half of his paycheck, at least, going to monthly payments for healthcare. That’s what’s important to him.

  Point 2.b. Huh? Sorry. Someone please clarify for me how health insurance would be considered taxable income. I think what he’s going for here is to drop coverage and increase salaries. Okay, great. Now, who is going to make the corporations do that? I mean, we have to practically dictate ethics to them now. All they see is bottom line growth. Shareholders will be thrilled. Especially since they can afford healthcare. Remember Joe at Taco Bell? I doubt he knows what a share of anything is. Someone is going to have to clarify this point to me. It sounds like he wrote this part himself. Or maybe the IRS wrote it. It reads as bad at tax code.

  Point Three
  “The President’s Affordable Choices Initiative Will Help States Make Basic Private Health Insurance Available And Will Provide Additional Help To Americans Who Cannot Afford Insurance Or Who Have Persistently High Medical Expenses. For States that provide their citizens with access to basic, affordable private health insurance, the President’s Affordable Choices Initiative will direct Federal funding to assist States in helping their poor and hard-to-insure citizens afford private insurance. By allocating current Federal health care funding more effectively, the President’s plan accomplishes this goal without creating a new Federal entitlement or new Federal spending.”

  Rebuttal
  Hm. French fries anyone?

  Point Four
  “The President’s Proposal Would Shift Federal Funding To Help The Uninsured Buy Private Insurance And Take More Ownership Of Their Health Care. The Federal government now pays many of the health care bills of the uninsured through a complex mix of subsidies and payments to health care providers, with the result that billions of taxpayer dollars are spent inefficiently. The health care system needs to be transformed in a way that avoids costly and unnecessary medical visits and emphasizes upfront, affordable private health insurance options. Americans should “own” their own health plan, and money should follow the person rather than the institution.”

  Rebuttal
  Okay. I get it. Privatize. Get away from national healthcare. Huh? Wait. You just said that you are going to federally subsidize states that help uninsured get private insurance… State assistance. So, aren’t we just federally subsidizing the private healthcare industry with no monitoring or control? At least the French keep tabs on what the private healthcare companies do. So, let’s think about what Blue Cross/Blue Shield, United, Aetna and the like are going to do. Cool. Boon!!! Buy stock. NOW!! Because what they are going to do is further restrict health care options to individuals to reduce quality and availability of care and increase profit. Inefficiently spent dollars. Hm. Well, I know that United Health makes my healthcare so fucking complicated that they must have a whole group of people dedicated just to making my life hell. I hope that they are paid well, because those are dollars well-spent. Luckily, I make more per hour than it would cost in effort/man hours to deal with United on discrepancies on payments. It’s not fiscally advantageous for me to fight with them. But I am lucky. Are we actually counting on private insurance companies to run efficiently? When was the last time you worked with an “efficiently-run” healthcare company? God, those Republicans must have prostitutes, oh god sorry, escorts on retainer from the insurance companies.

  Point Five
  “The Affordable Choices Initiative Will Encourage States To Innovate. State participation would be voluntary, and States would design their own programs, subject to approval by the Secretary of HHS. States could offer direct premium assistance to low-income or hard-to-insure populations to purchase private health insurance. States could establish high risk pools, or expand existing high risk pools, for very sick individuals who are deemed uninsurable in the non-group market. States could help facilitate pooling of individuals and small businesses and organize their access to private health plans.”

  Rebuttal
  Yeah, they COULD. First it’s WOULD, then COULD. I thought Clinton was a waffler. Um, innovation? I would not rely on the state to innovate a damned thing. Let’s hope that they put out RFPs for private firms to come up with good ideas. So, if the state COULD establish “high risk pools”, why don’t we go past third base, all the way home and create general pools that offset costs period? Oh wait. That would be nationalization, or at least localization. Nevermind.

  Point Six
  “America Is A Compassionate Nation, And We Will Continue To Take Care Of The Most Vulnerable. For the elderly, disabled, low-income pregnant mothers, and children needing protection, the Federal government provides coverage through Medicare, Medicaid, and SCHIP – the State Children’s Health Insurance Program. Under this Administration, 2 million more children have gained coverage through SCHIP.”

  Rebuttal
  Okay, so we aren’t going to get rid of Medicare and Medicaid. My bad. So now I get to continue paying my medicare and medicaid taxes, have little choice but to get an independent policy and pay through the nose. No wonder the middle class is disappearing. I think I will start spitting out kids, not get healthy, and make sure that I get old and sick as hell. That way, I don’t have to pay a premium for a damned thing and I don’t have to get privatized healthcare coverage. Anyone want to be a sperm donor? I won’t even begin to comment on the “Compassionate Nation” statement. Just don’t go there.

  The rest of the fluff in the article is about how Bush is really trying. So, I am not going to spend time on that.
  ________________________________________________

  Well, I have decided to deal with the other Business Week article later on, since this thing is so incredibly long.

  Thanks for reading. I know it was tough.