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.