My Socialist Insurance Payments

[Aargh]

In 1958 about any small town with over 1,500 people had a hospital and a doctor. That doctor was making more money than most people in the town, but not a lot more. The doctor who delivered your children was also the doctor who treated your heart disease.

Any current doctor offering the level of health care available in 1958 would be sued out of existence. There are diseases, syndromes, and disorders that were unknown in 1958. There are pharmaceuticals that didn't exist in 1958. An acquaintance of mine is about to take one pill a month for 12 months that is supposed to cure Hepatitis C. The cost is $90,000 that will be paid through his insurance at Spirit Aerosystems.

If you were 90 years old in 1958 and needed a knee replacement, the medical treatment was to prescribe a wheelchair. With Medicare, in 2014, a 90-year-old person gets the knee replaced, so Medicare is involved in rising medical costs. If you are that 90-year-old person, which do you want, the wheelchair or the surgery? If the 90-year-old person is your mother, which do you want? If the 90-year-old person is a black man who was born in Mississippi in 1924, denied access to a decent education, spent his life as a janitor, and has no resources, does he get the wheelchair or the surgery?

Another question: If health insurance should be optional and the level of coverage should be optional, what do you do when someone who has elected not to have medical insurance gets Ebola? That is not a rhetorical question. If health care coverage should be a personal choice, how do you handle that situation?

[ShockTalk]

Alcohol and cigarettes are taxed at absurdly high rates. Why isn't that revenue used to fund the medical cost of such decisions? Same with gas. Shouldn't nearly all the gas taxes fund the roads? Fatty foods should likewise be taxed to pay for healthcare. It would seem that there is a simple solution for this in that these programs could be self funded by the choices of the citizens.

So, how is the .24 tax used?

[Shocker-maniac]

Another question: If health insurance should be optional and the level of coverage should be optional, what do you do when someone who has elected not to have medical insurance gets Ebola? That is not a rhetorical question. If health care coverage should be a personal choice, how do you handle that situation?

Stores recover their losses from shoplifting by charging a higher rate to their paying customers. In the same way, private pay patients are subsidizing at least some of the losses a hospital has encountered for its uninsured patients. This is part of the reason that health care reform taxes the uninsured. In order for the system to work everyone has to be in the insurance pool. Again we're back to the compulsory insurance issue that we discussed about auto insurance.

[wufan]

So, how is the .24 tax used?

The federal gas tax is mostly used for interstate highway maintenance, however, money is often siphoned off for other projects, and more money is spent on highway construction than is gained from the tax.

State gas tax (such as in Kansas) is being used to fund Medicaid and Education. Some of it is also being used for infrastructure, but not nearly enough.

In my mind, a self funded program either needs to raise enough taxes to pay for expenses, or it needs to cut down on services (costs); otherwise, it is just another way for politicians to funnel tax money into their pet project.

[ShockTalk]

The federal gas tax is mostly used for interstate highway maintenance, however, money is often siphoned off for other projects, and more money is spent on highway construction than is gained from the tax.

State gas tax (such as in Kansas) is being used to fund Medicaid and Education. Some of it is also being used for infrastructure, but not nearly enough.

In my mind, a self funded program either needs to raise enough taxes to pay for expenses, or it needs to cut down on services (costs); otherwise, it is just another way for politicians to funnel tax money into their pet project.

I do not disagree with your last statement, however, I though most all of the .24 state gas tax was used on roads. Do you have a link/source that shows otherwise and those percentages to back your statement (I don't have one for mine)?

[wufan]

I do not disagree with your last statement, however, I though most all of the .24 state gas tax was used on roads. Do you have a link/source that shows otherwise and those percentages to back your statement (I don't have one for mine)?

http://www.transportation-finance.org/funding_financing/funding/federal_funding/motor_fuel_taxes.aspx

http://www.forbes.com/sites/taxanalysts/2013/10/24/the-gas-tax-doesnt-work-because-politicians-broke-it/

[wufan]

The gas tax is probably as close to a pay for itself program as there is, but it isn't iron clad and it does not go up and down with the cost of highway repair.

[ShockTalk]

Thanks. It was my thinking that currently, most all of the federal and Kansas gas tax was used for roads or related transportation issues (mass transit/storage leakage).

You are right. It isn't iron clad and should be.

[shocka khan]

Here's a graph of medical insurance inflation over the last 30 years:

http://www.metricmash.com/3ibe

There are a couple of things that stand out to me:
1) look closely at the flatness of the curve from about 1992-2000. What was different about this time period? Clinton was president and the first thing he and Hillary did when they got into office was to try to institute national health insurance.
2) The rate of inflation before and after the Clintons was high. We had republicans in the White House.

I learned about this in the late 1990's when the Missouri insurance commissioner gave a group of regulators a presentation regarding health insurance trends. I have subsequently followed these trends.

Here's an additional tidbit, healthcare inflation is at a 50 year low:

http://www.forbes.com/sites/brucejapsen/2014/01/06/health-inflation-at-50-year-low-as-obamacare-emerges/

I don't think this is a republican vs. democrat thing. I think what the information and graphs show is that the price increases were discretionary rather than structural. When the threat of controls loomed (or the controls were actually implemented), the inflation rate went down. That means someone(s) were manipulating the system. Was it hospitals? Doctors? Pharma? (note my vote is more for hospitals and pharma and less for doctors). But it sure wasn't insurance companies, it was the perceived or actual threat of caps that changed pricing behaviors. Insurance exists as a risk transfer mechanism, insurance companies cannot and do not control market pricing.

Another thing I would also like to comment on (especially since I'm from Texas) is tort reform. We were promised by Rick Perry (and others) if we enacted tort reform our insurance rates would go down and availability would go up. Sadly, they were wrong on both counts. We not only have the highest home owner insurance rates in the US here in Texas, we also have the largest share of individuals who do not have health insurance, which proves that tort reform does not result in lower insurance rates.

[shocka khan]

Wufan has a good question regarding why our tax dollars are not used to subsidize healthcare. In Australia, which has government-sponsored health care, cigarettes and alcohol is taxed at an enormous rate because cigarette smoking and excessive alcohol consumption both have a negative impact on healthcare costs.

The funny thing about all this is that the alcohol tax does not apply to beer and wine (a lot of wine comes from Australia). However, I do think they are on the right track. If you like to make lifestyle choices that contribute to your morbidity you pay extra sin taxes. Also, the gas tax is actually used to construct roads. Our legislators (at least the ones in Texas) have grown accustomed to raiding these funds to pay for their pet projects. Our roads in the country are broken down (and are reverting to unpaved) and our roads in the city cannot handle the capacity. As voters we need to hold all politicians accountable for this behavior, no matter what party they belong to.

[Shocker-maniac]

Here's a graph of medical insurance inflation over the last 30 years:

http://www.metricmash.com/3ibe

There are a couple of things that stand out to me:
1) look closely at the flatness of the curve from about 1992-2000. What was different about this time period? Clinton was president and the first thing he and Hillary did when they got into office was to try to institute national health insurance.
2) The rate of inflation before and after the Clintons was high. We had republicans in the White House.

There is no way that you can attribute all of that to the health care reform discussion of the 90's. You are completely discounting other factors that have had much more profound impact on our health care specifically the demographic shift of our population . High cost specialty Rx started appearing in the early 2000's. Sorry but you're giving way too much credit to a relatively brief policy discussion that never materialized.

[wufan]

Here's a graph of medical insurance inflation over the last 30 years:

http://www.metricmash.com/3ibe

There are a couple of things that stand out to me:
1) look closely at the flatness of the curve from about 1992-2000. What was different about this time period? Clinton was president and the first thing he and Hillary did when they got into office was to try to institute national health insurance.
2) The rate of inflation before and after the Clintons was high. We had republicans in the White House.

I learned about this in the late 1990's when the Missouri insurance commissioner gave a group of regulators a presentation regarding health insurance trends. I have subsequently followed these trends.

Here's an additional tidbit, healthcare inflation is at a 50 year low:

http://www.forbes.com/sites/brucejapsen/2014/01/06/health-inflation-at-50-year-low-as-obamacare-emerges/

I don't think this is a republican vs. democrat thing. I think what the information and graphs show is that the price increases were discretionary rather than structural. When the threat of controls loomed (or the controls were actually implemented), the inflation rate went down. That means someone(s) were manipulating the system. Was it hospitals? Doctors? Pharma? (note my vote is more for hospitals and pharma and less for doctors). But it sure wasn't insurance companies, it was the perceived or actual threat of caps that changed pricing behaviors. Insurance exists as a risk transfer mechanim, insurance companies cannot and do not control market pricing.

Another thing I would also like to comment on (especially since I'm from Texas) is tort reform. We were promised by Rick Perry (and others) if we enacted tort reform our insurance rates would go down and availability would go up. Sadly, they were wrong on both counts. We not only have the highest home owner insurance rates in the US here in Texas, we also have the largest share of individuals who do not have health insurance.

Hold on now. Per your graph the increase was 18% during Obama's first 4 years (projects to 36%). Bush II's 8 years were 38%. Clinton's 8 years were 36% Over the past 20 years on the graph the average rise has been 4.5 to 4.75% per year. The prior 20 years it was about 15-25% per year. I don't thing there is any correlation to the rise in healthcare and the presidency, except maybe the Clinton's. Not enough info to draw a conclusion however.

[wufan]

Interestingly, I found an article from 1995 that followed healthcare from 1960 to 1993. Average "real" healthcare cost increased at the following rate:

1960-69: 4.9% faster than inflation
1970-79: 3.8% faster than inflation
1980-89: 2.2% faster than inflation
1990-93: 1.7% faster than inflation

It seems it is coming back into trend with reality

[shocka khan]

McPherson's premise (I believe his first name was Mike) was that medical inflation under Bush/Reagan was 2X the Clinton's. I think the graph pretty clearly bears this out.

It would be a lot nicer if someone had an actual index over these years from the Bureau of Labor Statistics, as it is pretty clear the increases from

[wufan]

McPherson's premise (I believe his first name was Mike) was that medical inflation under Bush/Reagan was 2X the Clinton's. I think the graph pretty clearly bears this out.

It would be a lot nicer if someone had an actual index over these years from the Bureau of Labor Statistics, as it is pretty clear the increases from

See my post above. As inflation went down, so to did the excess rate of health care. No statistics provided thus far bare out McPhersons premise.