Fix Social Security, Medicare, Medicaid and the deficit in one act.

  • Posted by a hidden member.
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    Feb 24, 2009 8:35 AM GMT
    It's very simple, deny benefits to anyone with voluntarily acquired conditions. You want to smoke for 40 years, don't come calling on Medicare to treat your lung cancer. You're obese, we give you two years to drop the weight, if not no benefits for you. The people who make decisions to ingest known carcinogens stronger then rattlesnake venom or arsenic should not be allowed to be a continuous burden on the rest of us. If you have preventable health conditions or treatable health conditions and refuse to do so, why should the American people be forced to spend billions and billions of dollars to care for you when you won't care for yourself?
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    Feb 24, 2009 2:04 PM GMT
    What about colds? People stupidly put themselves in the vicinity of people sneezing. And then there are accidents. If you cause an auto accident and you're lying in your car bleeding, why should we bother to remove you from your car and take you to a hospital? And then there's any medical problem that develops while you're on vacation. Hey, you took the vacation in India. You're responsible for treating your own giardia. And poor people who get themselves knocked up and want Medicaid to pay for obstetrical care? Sterilize 'em!

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    Feb 24, 2009 2:09 PM GMT
    YngHungSFSD saidIt's very simple, deny benefits to anyone with voluntarily acquired conditions. You want to smoke for 40 years, don't come calling on Medicare to treat your lung cancer. You're obese, we give you two years to drop the weight, if not no benefits for you. The people who make decisions to ingest known carcinogens stronger then rattlesnake venom or arsenic should not be allowed to be a continuous burden on the rest of us. If you have preventable health conditions or treatable health conditions and refuse to do so, why should the American people be forced to spend billions and billions of dollars to care for you when you won't care for yourself?


    I do hope you're prepared to never leave the house, and that your house is a sterilized plastic bubble. After all, if you slip on the ice and break your neck that could have been prevented by just not leaving the house in the first place. Or the gods forbid you contract any sort of STD; after all, they're all preventable if you just don't have sex.

    Yes, this plan of yours is foolproof.
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    Feb 24, 2009 3:10 PM GMT


    There's also the good folk that cremate everything they barbeque and that's carcinogenic - acrylamides for one.
    Last year the tax revenue from cigarettes in Canada was 7 billion dollars, and that's not including sales taxes.. Cost to Canada for cigarette related illnesses? 3.5 billion last year. So, ahem, just who is really addicted to cigs? Or at least, the revenue?

    One of my palliative patients was a smoker. She died at 51. Cost to the system? 2 radiation treatments - 4 doctor's appointments and 2 hours a week of in home care from the government. Meds were Tylenol and morphine. We saved the system money too, by inviting her to stay with us and pass away in our home, which she did.

    She paid 1.00 to 8.00 a day for her habit in taxes over 32 years. Roughly, her tax contribution over the years was about 10 - 15,000 dollars. I'd say the government cleaned up. They saved a whole pile of Canada pension plan too.

    Though it can be frustrating to help those that don't or haven't helped themselves, it's also a measure of the quality of a society, (and ourselves) - their collective compassion for those perceived as 'less than ourselves'.

    Cigarettes, fast food, alcohol, sky-diving - race driving - bungie jumping etc etc are all legal with variable risks. But they're legal.
    We treat illegal drug addicts.

    We have social medicine in this county (Canada), because as its founder back in 1963 said, your ability to get help (health-care) shouldn't be determined by the size of your wallet.

    The nasty carcinogens spewed out of vehicle exhaust pipes in vast volumes means too, that a health tax charged to the oil companies and NOT permitted to be handed down to consumers makes a bit of sense, eh?

    There's something odd about a country that would legalize and vastly benefit monetarily from a potentially lethal product and then refuse to treat the people that got ill from consumption of it.

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    Feb 24, 2009 3:21 PM GMT


    PS This is similar to what many said when gay men began getting AIDS back in '82 -

    It's very simple, deny benefits to anyone with voluntarily acquired conditions.
  • DiverScience

    Posts: 1426

    Feb 24, 2009 3:29 PM GMT
    Not to point a counter out but there's actually very little correlation, much less causal evidence of anything but morbid obesity having a statistically significant effect on morbidity.

    Not to mention the large number of people who aren't "obese" but have their only fat deposits around organs, which *is* causally linked to lung, heart, and liver problems.
  • InsatiableBlo...

    Posts: 442

    Feb 24, 2009 3:30 PM GMT
    What about people who are genetically prone to obesity? Smoking I can understand, but obesity some people just can't help. Also how can we distinguish people who are genetically prone to disease from those who have acquired them from unhealthy habits?
  • DiverScience

    Posts: 1426

    Feb 24, 2009 3:33 PM GMT
    Also, Social Security doesn't need fixing. It's not broken. We may not be able to borrow huge amounts of money from it for other things, but it is not itself bankrupt or in danger of being so.
  • silverfox

    Posts: 3178

    Feb 24, 2009 5:33 PM GMT
    Devils advocate.

    What about mental health care costs? Will someone seeing a therapist/psychiatrist be expected to "fix" their problem within a certain time frame or else lose health care benefits? That is, if they should get any benefits at all. Will someone only be allowed to have perscription meds for mental issues for only a pre set term?
  • havingfunmtl9...

    Posts: 258

    Feb 24, 2009 5:41 PM GMT
    Hey,

    Certainly an interesting topic, looking in from a Canadian perspective. Medicare here is a great thing, although it comes with some problems. For one, waiting lists are long and the quality of service is not always as high as one might find in private medical facilities. However, getting your medication for 5 dollars is a hell of a lot better than having to pay 80 for the same bottle.

    A small comment to the original message especially in the case of obese individuals. Working in the health field, I can tell you that for individuals who are in shape, obesity seems like a choice and is a matter of will power and life style - however it is not always the case. Differences in people's genetic composition means that their bodies process food differently, their exist hormonal differences as well as differences in their liposites and lymbic systems. Telling someone they have to be within 'normal' BMI in two years is not a realisitc goal.

    Overall, medicare is amazing and is certainly something I believe is of paramount importance - just please be careful when drawing lines between who gets it and who doesn't... I would not want to be the person with that on my conscience.
  • Posted by a hidden member.
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    Feb 24, 2009 6:00 PM GMT
    As my brother once said somewhat facetiously, if you want to save money in the health care system you should encourage smoking, not discourage it. Coming from a doctor that statement took me a bit aback. But it makes sense. The majority of costs that the health care system incurs is treating old people. The soaring cost of health care is mainly due to its' success in better treatments that have kept people alive longer.

    For example, men that used to die in their 60s from heart disease are now on statin drugs and have stents in their arteries, and are living into their 80s and 90s. There are superior treatments for cancer, diabetes and other diseases. Visit a doctor's office or an Emergency ward of a hospital and you will witness the impact of medicine's advances. A roomful of people who are now in their 80s and above.

    Let us face it more and more of our taxes is going to go towards the health care system at the expense of other government programs. Very difficult choices will have to be made eventually in terms of taxes, government expenditures on programs (e.g. defence, social security) and on health care.

  • Roch_Athlete

    Posts: 45

    Feb 24, 2009 6:40 PM GMT
    DiverScience saidAlso, Social Security doesn't need fixing. It's not broken. We may not be able to borrow huge amounts of money from it for other things, but it is not itself bankrupt or in danger of being so.


    You can't be serious. Money has already been borrowed from Social Security. People just don't understand how it's been accounted for. Sure, the national debt may be a paltry $10.8 billion, but that's just the cash debt: money that has actually been used. But when you take into account the future obligations that the governement has, which is mostly Social Security and Medicare, the actual debt is more like $59 billion. The total assets of the federal govt is around $64 billion. To discount the $59 billion would be like discounting your mortgage as part of your debt because you haven't paid it yet.
  • Posted by a hidden member.
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    Feb 24, 2009 6:41 PM GMT
    Of all people I do understand the compassion issue. My point was somewhat meant to encourage a little debate on this. The U.S. has 76 trillion dollars, the GDP of the entire planet for one year, in future payment obligations. The largest percentage of this is due to medicare and medicaid costs, as well social security. Something has to be done to reign in these costs. Who in Canada is subsidizing all this or are people not receiving the latest and greatest in medical care? In the U.S. caring for a cancer patient can easily exceed one million dollars.

    I wouldn't exactly say that leaving the house is voluntary, it's pretty necessary for most of us. While there may be a very select few people with genetic abnormalities of metabolism, these is a very small percentage of the obese population. Again my point is to say look, 60% of Americans are overweight, and 99% of the 60% could deal with it if they choose. I wouldn't consider AIDS to be a voluntarily acquired condition. If you smoke long enough you will die from the complications of it. Why should our national debt skyrocket taking care of smokers? Why should we all be stuck paying for outrageous expenses because people refuse to live a healthy lifestyle. They overeat, don't exercise, and don't manage their stress. A lot of them throw in smoking on top of it. Maybe the answer isn't denying benefits, maybe it's incentives. I don't know the answer. But I think it's an issue begging to be addressed when health care costs are soaring and causing soaring government deficits.

    What do you think the solution is?
  • DiverScience

    Posts: 1426

    Feb 24, 2009 6:43 PM GMT
    Roch_Athlete said
    You can't be serious. Money has already been borrowed from Social Security. People just don't understand how it's been accounted for. Sure, the national debt may be a paltry $10.8 billion, but that's just the cash debt: money that has actually been used. But when you take into account the future obligations that the governement has, which is mostly Social Security and Medicare, the actual debt is more like $59 billion. The total assets of the federal govt is around $64 billion. To discount the $59 billion would be like discounting your mortgage as part of your debt because you haven't paid it yet.


    FROM, not FOR. SS is not the problem. It's borrowing FROM it to balance other things that's the problem.
  • Posted by a hidden member.
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    Feb 24, 2009 8:51 PM GMT
    I don't agree with the OP. I say we should tax the things that ultimately burden the public health care system - the way we do with cigarettes - and force people to pay for their future health care in that way.

    InsatiableBloom saidWhat about people who are genetically prone to obesity?


    Dr Phil talks about this all the time. Being genetically prone to obesity does not put KFC and McDonald's in your mouth, and stop you from exercising. It's only a tendency, not a surety. A fat tax - that could be a surety.


    silverfox1 saidWill someone seeing a therapist/psychiatrist be expected to "fix" their problem within a certain time frame or else lose health care benefits?


    Last year Australia started subsidising psychologists and psychiatrists in exactly this way. You visit a GP and you can get a referral to a psychologist for 10 visits. If you need more, you need to return to the GP and you can have 10 more visits. So you can get about two years of therapy for about $200. I don't know if that's enough for most people, but it has to be better than the previous system where people paid that per hour.

  • allatonce

    Posts: 904

    Feb 24, 2009 9:20 PM GMT
    I agree with what several people say. A better solution would be a Pigovian type of fee, or a tax on the things that we do not like. A tax on junk food, carbon tax, etc would better able to account for externalities such as health care costs and environmental damage. Money talks and when things cost more people switch.

    THIS, as the case of cigarettes has shown, would increase the government's revenue in a substantial way and indeed be much better at balancing the budget than simply not allowing them to access the benefits. This type of "survival of the fittest" Darwinian thinking is not the friend of an advanced society.
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    Feb 24, 2009 9:24 PM GMT
    DiverScience saidAlso, Social Security doesn't need fixing. It's not broken. We may not be able to borrow huge amounts of money from it for other things, but it is not itself bankrupt or in danger of being so.


    Not yet, but based on current deductions, it will eventually go bankrupt unless the government and or the employer/employee pay more into it. The other option as you said is to slash other government programs or raise taxes to put it on a sound basis. It is more of a "pay as you go" system as opposed to being on an actuarily sound basis.

    In Canada in the 1990s the Canada Pension Plan was put on a sound footing by significantly increasing the contributions from both employer and employee. It used to max out at around $700 in 1993 per employee (matched by employer). This year the max. contribution per employee is over $2,000 (matched by employer). But at least that is one part of retirement income working Canadians do not have to worry about.
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    Feb 24, 2009 9:29 PM GMT
    Roch_Athlete said
    DiverScience saidAlso, Social Security doesn't need fixing. It's not broken. We may not be able to borrow huge amounts of money from it for other things, but it is not itself bankrupt or in danger of being so.


    You can't be serious. Money has already been borrowed from Social Security. People just don't understand how it's been accounted for. Sure, the national debt may be a paltry $10.8 billion, but that's just the cash debt: money that has actually been used. But when you take into account the future obligations that the governement has, which is mostly Social Security and Medicare, the actual debt is more like $59 billion. The total assets of the federal govt is around $64 billion. To discount the $59 billion would be like discounting your mortgage as part of your debt because you haven't paid it yet.


    Trillion not billion I think/hope!

    You are right social security needs to be looked at from the view of 2030 not 2009.

    The US government has not tackled the looming entitlement program costs that will start exploding post 2020 as the baby boom bulge works its' way through the system. Medicare, social security, the drug benefit plan are all very expensive, but the US is still very lightly taxed compared to other countries with similar programs. Then there is the $600 billion dollar defence budget that politicians are loathed to touch.

    I almost feel sorry for the politicians of the future as they try and put a round peg into a very square hole.