Discussion:New Obama Retirement Program

Dear Citizens,

Due to the current financial situation caused by the slowdown in the economy, I, President Obama have decided to implement a scheme to put workers 60 years of age and above on early retirement.

This scheme will be known as RAPE (Retire Aged People Early).

Persons selected to be RAPED can apply to Congress to be considered for the SHAFT scheme (Special Help After Forced Termination).

Persons who have been RAPED and SHAFTED will be reviewed under the SCREW Program (Scheme Covering Retired-Early Workers).

A person may be RAPED once, SHAFTED twice and SCREWED as many times as I, President Obama deem appropriate.

Persons who have been RAPED could get AIDS (Additional Income for Dependants & Spouse) or HERPES (Half Earnings for Retired Personnel Early Severance).

Obviously persons who have AIDS or HERPES will not be SHAFTED or SCREWED any further by me, President Obama.

Persons who are not RAPED and are staying on will receive as much SHIT (Special High Intensity Training) as possible. I, President Obama have always prided myself on the amount of SHIT I give our citizens

Should you feel that you do not receive enough SHIT, please bring this to the attention of your Congressman, who has been trained to give you all the SHIT you can handle.

Sincerely,

President Obama

We're in a mess, allright. Maybe we can pass a law to assess all the Bush voters in 2000 and 2004 for the costs of the war in Iraq? Or maybe for Bush being asleep at the switch on 911, or asleep at the switch while some of the biggest financial crimes in history were being perpretrated?

Because, unlike what you are advancing, which is all based on fiction, we will be paying for the war in Iraq (and the rest of it) for some years to come (and, all the people connected to the war:  the profiteers, crooked contractors and the like aka Friends of George and Dick, will be enjoying the fruits of their crimes while the rest of us pay for it).

Oh, don't forget freddie mac and fanny mae and the special housing loans that some Donkey Senators got.

I been thinking about health care again lately and you are my single payer expert. Any idea of the size of government agency necessary to administer a single payer? I have never seen anything. It would have to dwarf the IRS. The countries that a have single payer have a population much much small than ours so their single payer organization would be smaller. An organizaion can have economies of scale but it reaches a tipping point where large size brings dis-economies of scale. I cannot imagine what size an organization would have to be to administer the health benefits for a population of 300 million.

How do we get to single payor? It would be a mess, but it could be done. Where can you find a Ray Kroc when you need him? Or a Sam Walton? I understand Walmart is putting it's foot into the fire with some clinics, but I suspect even they will get burned. Kroc would probably be the better pick for the task, because it needs some salesmanship and pizzaz. Alas, these two are gone.

First thing we have to do is get the people straight on one thing: there is rationing now, and there will be rationing until we can solve the problem of scarcity, and I don't think that's going to happen. You need a strong leader or leaders to get the public to understand that.

But it has to be on a McDonald's or Walmart model, let's be honest about it. For the majority of the people (I include myself), that's all we can hope for. BUT, that's a big improvement for the 47 million without insurance! I'd rather have a hamburger and a cheap shirt than no food and no shirt. And the problem of the uninsured will not stop at 47 million people, in fact, it will get worse after this recession because now the world knows that America is not wearing any clothes (it just hasn't dawned on the American people yet). My apologies to the emperor.

It's not just a problem of our debt and the ability to hawk our Treasuries. It's the fact that we don't do anything but run from gimmick to gimmick, and the paper pushing path to national wealth has been shown for the fraud it always was. It get's a lot harder to make a payday loan when no one has a payday!

The model and the salesmanship would ideally preceed single payor: you have to have a stripped down, efficient model that would work before anything becomes affordable. This was the genius of Kroc.

Kroc made "Chefs" and "fry cooks" out of teenagers by breaking it down to essentials and consistent processes, and that reduced what a real cook was paid (and fast) and the food was acceptable. The model may not work for the more complicated branches of the medical arts, but it could work reasonably well for primary care, I think. It has to be neighborhood or community based though, just as your Walmart and McDonald's is community based: convenient.

I've decided that America won't seriously engage on this issue until we get close to 100 million uninsured or under insured.

The problem with the McDonalds analogy is that Big Mc is really an capitalist entrepreneurial model. There are three legs to the model: McDonalds, franchisees and suppliers. In some ways McDonalds is like an insurance company, but with national competition. It does not sell anything to customers, it does not make the food ... it sets adverising, standards, new products and collects money! The Walmart model is one where the single payer is brutal with the suppliers. It works because what they sell is essentially low tech available from many different suppliers. They will hold supplier auctions, because the product is a commodity. Even the number of suppliers Walmart deals with is small compared to the medical industry (hospitals, doc's, etc.).

I think you are stuck in the 19th century with the view that some economists had about profits. They did not see profit as the wages for capital, innovation and efficiency, but rather the exploitation of someone else ... customer or labor. I would propose a third legged competition solution. First eliminate some of the artifical barriers to competition ... national market for insurance and allow customers to organize. The first leg would be to allow consumers to organize for purchasing power and clout with the insurance companies. I worked for a large company with clout, I never heard of someone being denied cancer treatment because they did not report that 10 years before they had their tonsils out. The insurance company is not willing to loose a 20,000 client over some of the things they do to individuals. The insurance companies would be the second leg and the medical community the third. The uninsured could be cover by a high risk pool with government assistance ... and based on this I would keep medicare for now, but base the premiums on income and physical conditions that can be controlled by the person (obesity). The only other solution I see is to band all senior citizens (including me) from buffets ... kind of a revese Id system.

Enough fun, back to CBT CPE ...

What about this hybrid idea: a system of basic primary care, guranteed to all Americans, run on a single payor model. When I say basic, I mean internal medicine, pediatrics, family practice, all that, and basic acute and maintenance drugs (blood pressure, anti-virals, antibiotics, gluclose control, the basic stuff etc).

For anything beyond that, you buy private insurance, as in your improved model (i.e. specialists, hopitalization, surgery, radio, other drugs).

Importantly, the relatively more wealthy would be allowed to buy more or better in the way of primary care BUT they would also bear the tax, and pay the premium, as would all Americans, for the primary care system, because it is a societal good. And I think it is.

I don't envision the single payor system for primary care to be funded only by taxation, there would be a premium and co-pay for all who could afford it. As you know, you have to have this or you get a moral hazard.

.*Any true socialist detests the Welfare State for this very reason, but I'm not a socialist.

I have a plan for the illegal: if he can prove that he has cut a redneck's grass, or built his deck, or painted his house, or weeded his garden, or washed his windows, or even built his house, or swept up after one of his kids at a theme park, or made his profit's look better because he works dirt cheap, then sure, let's cover him. But, there's no free anything to anybody, if they can afford to pay, they pay. And it's insulting and wrong to suggest that these people pay for nothing, they do, and businesses know that.

But, for anyone out there reading this, if you don't like my "Prove you helped a Redneck" plan, what about this....

Let's set up a panel to decide this immigration question. Let's make them all Indians. You know, Native Americans. Because, after all, we can only call ourselves Americans because we killed off most of the real Americans. So then, how are we "legal"? In whose court are we "legal"? In God's court? Surely not.

So, let's set up our all Indian panel, and then let them decide, and we'll all agree to abide by their decision on the matter. Well now, come to think about it, I heard a rumor, but it's only just a rumor, that most of these illegals are....... guess what? Indians! In fact, since we killed off most of the Indians in America (or starved them), the closest any American get's to an Indian is when he points out to his Mexican gardener that he missed a spot.

What a pickle. And again, I respectfully point out, that these illegals pay for things, and buy things everyday here in .... America. Are they saints? No. Are we saints?

However, only at the end of the article do you understand what is happening. You find out that even the same kinds of cancer are not a single disease. "So even though a drug might work well for patients whose tumors have a particular mutation, when the drug is used for a broader population, it shows only a small effect. One solution is to try to determine which patients should get which drug based on the genetic profile of the tumor" Now this is me reading into the article ... so the drug would have zero effect on 95% of the cancer patients but has 5 yrs plus for 5% you get 12 days improved survival. If you can identify the 5% is the drug worthwhile?

Crowjd,

I put you in the wrong century ... you really belong back in the 18th century with Thomas Malthus and John Stuart Mill. :)

As far as drugs YOU the taxpayer pay for the vast majority of basic research for prescription drugs through the NIH. Another lie of big PHARMA that they need all this money for research. They use their money for marketing. And one thing they could do in this legislation is to outlaw all prescription drug advertising to the general public AND stop what is essentially PAYOLA by drug co. salesmen to doctors, fake continuing medical education classes in exoctic locales which are really vacations (paid for by the drug companies), and lavish expensive lunches and dinners for doctors all of which get's added to the price of the drugs. Stop it.

There have been some intelligent interviews on CSPAN this week at the Va. Hosp. Center, and with the former head of the Canadian Medical Association (he's honest about the wait times by the way). http://www.c-span.org/Watch/Media/2009/08/30/Health/A/22621/Dr+Robert+Ouelett+Frm+Pres+Canadian+Medical+Assn.aspx

I saw parts of the CSpan interviews. Did not see all the Canadian interview, but did you note that the Canadian system is not a single payer in the sense of one massive bureaucracy, but individual provinces and other subgroups are involved. In our snowbird travels, we have made friends with Canadians from different provinces and their insurance regarding the number of days they can be absent from Canada varies. The thing to remember about Canada is that they are a net positive trade balance, essential they are a resource exporting country. They have the money to use.

I saw more of the interview of the Hospital COB and Admin. They were asked a question about what worried them the most regarding a public option (single payer?). They said that if the public programs paid at the same rates as Medicare and Medicaid, they would have to cut back greatly in the area of capital expenditures and personal. They said that some of the doctors don't accept Medicare patients. So it is interesting that priviate insurers are carrying the cost of medicare. There are those who argue that hospitals spend too much on non-essentials and personal and therefore could cut back. Look what Michelle Obama was paid as "a hospital administator" and not "the hospital administator" because they started campaigning in earnest.

So, if we went with your plan above, can we at least force the insurance companies to have some standardization?

Also, I agree that Canada is sitting pretty good in the age of natural resources. And, if we do have global warming, they will be able to plant crops right up to the Arctic Circle. Want to buy some farmland up there, way North? I'm buying beachfront property in Florida now, about 200' inland. :)

The universial coverage goal is important because it's civilized. But getting back to the miserly payments from Medicare and Medicaid: that was my original point about the McDonald's model. I just don't see how we have universal coverage without a more efficient model, at least for primary care. That would actually be a huge improvement overall. It would reduce ER admissions for people with no insurance because they would have preventive medicine, and maintenance medicine for chronic conditions.

Did you see the news accounts of the study that just came out that determined that the "Doc in the Box" strip mall medical clincs are not that bad, in fact, they were as good or better than standard care for what they are? I haven't read it that closely, but I'd like to look at that study.

I would be pleased if we could have universal coverage for primary care. However, considering the present reality, I guess I'll have to settle for no pre-existing conditions! Maybe a co-op. Not much of a plan.

Let's continue to tax the upper class. Why pussy foot around. Government workers and the bottom 50 percent need their fair share. Tax at say 90 percent. Would that be fair?

Production would fall so fast it would create unemployemnt like we have never seen.

Until universal health care mandatory for ALL government employees, it will always be second rate.

However, we do have a government plan now, managed by private insurers. It's Medicare. Most older people I know like Medicare. They grumble about it, but I don't know one that would do without it. If we paid more for it, it would still be worth it, because it's brought a tremendous amount of stability and peace of mind to older Americans. Of course, we need to improve the drug benefit, which was a gift to Big Pharma. Simply put, Medicare should get a volume discount on drugs, and right now, the drug benefit law actually prohibits that! Insane.

As far as the public plan, it really is nothing more than Medicare for the masses, but at a higher premium.

The "fix" is in on the public plan. I am beginning to wonder if Obama ever was for a public plan. Obama right now is for a Bill, any Bill. He won't come out and say that, but it's the truth. I think that is a mistake, because there will be no cost control. Survey USA found that a majority of Americans preferred a choice between private insurance and a public plan. This is the public, and the public can't afford a lobbyist, so game over.http://www.surveyusa.com/client/PollReport.aspx?g=5ba17aa2-f1b9-4445-a6b8-62b9d1ba8693

Right now, healtcare reform is looking more and more like a big payday for the health insurance companies, and I swear, I personally don't know anyone in love with their health insurance company. If you're out there and love your health insurer, say something. I might want to use them myself.

I personally believe ALL citizens (emphasis on citizens) should have health care, the SAME health care. It should NOT be provided by an employer.

As long as government workers have cadillac plans, there will never be enough resources to pay for every one unless the rest get a YUGO plan.

Government workers have health several different benefit plans from which to choose. The reason they are cheaper is the economy of scale. With so many federal workers and retirees, it's cheaper to insure them as there is a wider base.

The old Civil Service Retirement System (CSRS) is no longer available for federal employees. It went away after January 1, 1987. You had to be an employee of the feds as of that date or before to be eligible for it. It was a defined contribution plan and a very good benefit. After 1/1/1987, you were under the Federal Employee Retirement System (FERS) that includes the Thrift Savings Plan, which is similar to a 401(k).

The CSRS used to be a "cadillac plan", but FERS is not. If your 401(k) became a 201(k), most likely a federal workers did as well.

True, NIH funds drug research. Numbers I have seen put that funding somewhere at 55% and drug companies at 45%. I have to find that reference again, but I will. In reality, that isn't a large difference.

As far as the polls go, Gallup had this to say:

http://www.gallup.com/poll/122822/Americans-Sharply-Divided-Healthcare-Reform.aspx

It seems to me with his poll numbers slipping, along with Reid's and Pelosi's, Obama might want to stop "rearranging the deck chairs on the Titanic" and start over.

Tom

yet without advertising how would we guys know where to get the latest "viagra" information?

The statins also reduce inflammation in the blood vessels, but they can do this at a much lower dose, and fewer side effects than the full dose used to lower cholesterol.

How many people on statin drugs even know of the risks or whether they may be able to get along on a lower dose?

If interested, here's some info. on HDL cholesterol. Exercise and high dose Nicain (NOT non-flushing Niacin) can help to raise HDL, but genetics is the key. It's best to talk to your doctor before taking a high dose of Niacin. http://www.sciencedaily.com/releases/2006/04/060403130444.htm