How did they define dying young? Age 30, 40, 50, 60...? In our medical system, people are not so much dying young as they are suffering with chronic illness, often leading to disability for years before they die. Again, what I see in the hospital every day is rampant type 2 diabetes in obese people. Excluding diabetics is interesting research but maybe not that appicable to real life in the USA. This discussion has been focusing on obesity, but as I mentioned above, smoking is also a huge player, as well as drugs and alcohol. And chronic illness is what we should all hopefully be each doing our best to avoid, instead of only focusing on who will pay for it.

Back in 1992, right after Pres. Clinton had been elected, I was talking to two sisters whose mother was on a ventilator due to her emphysema (smoking her only risk factor). They both smoked, so we were talking about why they should try to quit so they didn't end up the same. But one said, "We don't have to worry about it now, Mr. Clinton is going to take care of us." True story!!!
And pretty typical of a frequently encountered mind set.

Obesity is NOT what one would choose were one to desire the best health, is it?

harriet -- Look around. How many anorexics do you see? How many obese people? Let's focus on the bigger problem. (Not LOL)

I think it is not aesthetically pleasing so we feel free to make jokes and pick on the fat person. Even in our comments

In fact, there were other societies such as that of Rubens or many groups of Native Americans where women and men who were larger were revered. In one case it meant you were wealthy enough to afford food in plentiful supply and in the other you might survive a famine better

Now, do you really think some Native Americans in 1750 were fatter than others because they did not excercise enough hunting and taming mustangs and eat too many snickers bars? Or do you think it was because they were genetically better at storing fat?

Fast forward a couple hundred years, the descendents of the revered ones are now made to pay a premium on their health insurance because their bodies are more efficient at storing fat, the same as their ancestors

I think too many assumptions are made about fat people. Yes some people eat too much crap but so do many thin people. And many many thin people have diabetes. Many obese people do excercise and try to control their eating but it is not always as easy as people make it seem. What is known as the thrifty gene is mighty powerful. Plus there is a whole school of thought that people who are prediabetic are much more attracted to Carbs than a more average person, making it more difficult for them to stop and moderate their eating

As for the smoking story, some people are just idiots, what can I say

I guess my main question is..... How many freedoms that you enjoy now are you willing to give up for this "universal" health care?

Doctors who are not in their field for altruistic reasons, but there for the money.... many of which are danged good, will choose a different field. Doctors certainly won't be paid as well as they are now under any of these "plans". Nurses as well. What does this mean to you, who have no plans of attending medical school? Just that there are a whole lot more folks who will choose not to go either. The "cream of the crop" will not settle for middle of the road pay. And the guy who graduates at the bottom of his class is still called "doctor".

You will give up your choice of doctor. You will have to go to who you are assigned to and if they are one of those who suck, well.... that's too bad. If you don't get along, have different beliefs, or just plain don't like each other..... too bad. He's got a hundred other patients, and after all, what are you going to do? Can't go elsewhere.

Yes, I'm sure that last ditch efforts will no longer be such a drain on the medical costs.... of course those last ditch efforts are the ones that end up being standard treatment when they work.... but I guess we're all happy with where things stand now.

Folks on this board are already saying that it's ok to charge someone based on whether or not they smoke or have an extra doughnut. I still think that daycare causes more childhood illnesses to more individuals than smoking..... Let's charge a premium on those whose children are in daycare or attend public school. They will need more medical care than those that do not. And alcohol too.... it causes many deaths per year (besides all the alcohol related illnesses, there's drunk drivers as well)....many of those deaths, of folks who never had a drink in their life. So that would have to have a charge too... and since we can't know when someone who doesn't drink might choose to have one, we'll have to put it on everyone of drinking age and an additional special premium on those that admit they drink. Oh yes!! How much more pollution is there in those cities who have "smog" alerts?!?! That can't be healthy..... so another premium on city dwellers. Then there are those folks who choose high pressure jobs.... I'm sure there are more heart attacks in those kinds of businesses.... so a premium on those. Those are all "choices". Individual decisions that may have an impact on the cost of their health care. (Not to mention the need of health care.)

Every single decision you make on a daily basis could have an impact on your health care costs. Do you really want someone looking over your shoulder in the morning to see what your scale says? Have to buy your alcohol at a government run store? Not be able to buy a car because you live in the city?

One more question that has been bothering me..... What have you done within the current system to ensure that "everyone has care"? Does your MD.... the one that gets all your (and your insurance company's) money.... do they do pro-bono work? Do they work on the un/under insured? What about the pharmacy you get your medicine at? Do they have a program that helps out the elderly? Those without insurance? What about the hospital? The company that makes your medication? Do you know? Does your doctor's office have someone who ONLY handles insurance papers? Can you do that yourself? Has your doctor been paid for all the care he has given you? Or is he still waiting on your insurance company to pay your bill?

Everybody seems ready to have "someone" fix the problem. How about YOU be "someone"? Volunteer at the local free clinic. You could be a nurse (of some kind) in a couple of years. If you don't want to go to that extreme, then check out your doctor and change to one who supports your ideals. Same with all those other questions. How about if everyone just did one thing.... just one of those. But then again, it's probably too much trouble. Big Brother has a nice comfy bosom, until he starts looking at YOUR lifestyle and deciding that it's not quite what he thinks is "right". Didn't our ancestors fight against something very similar?

Every country mentioned has less freedoms than we do. So how many freedoms are you willing to give away so that the government can take care of you? How many decisions do you want them to make for you?

Sadly, I have to agree with saphire..... some people are idiots.

Let me echo what momto6 said.

Recently I saw a story about a fellow in England who had macular degeneration. In case that name isn't familiar, it's an eye disease that causes progressive blindness.

The reason it made the news is that he was informed that because of lack of resources, the National Health Service would not treat him until he became totally blind in the eye that had started showing symptoms. At that point they would be willing to treat the other eye.

Economics 101: Everything has a natural price, which is the price that balances supply and demand. If the government forces the price to be lower than the natural price, some other barrier has to take the place of price in order to balance supply and demand. If the government does not impose the barrier, then someone else will, for instance by increasing waiting times.

So despite politicians' claims to the contrary, there is no such thing as free health care, because there is a finite supply of medical people, expertise, and supplies. Which means that health care has to be rationed somehow.

The question is not whether to ration health care by price; the question is whether to ration it by price or by some other means. Anyone who argues that it should not be rationed by price without proposing a workable alternative is being intellectually dishonest, because there *will* be an alternative--the only question is what it should be.

According to the report that I just received from my insurance company, the biggest drain on their resources is preemies. Do you want to pick on them too? Maybe you think they should just be smothered. These postings are just mean - in both senses of the word.

In March of 2005, Sun Hudson was a six month old baby with serious health issues. His parents had no insurance. Texas Children's Hospital removed him from life support over his parents' objections. It was completely legal under Texas' Futile Care law.

Perhaps other states should follow Texas' example to save money???

Not legal, but hospitals are doing it - dumping patients who have no insurance. There are documented cases of patients being loaded into taxi cabs (wearing only their hospital gowns), driven into slum areas and left there. They are old, confused, sick and poor.

The US spends more money on healthcare than any other industrialized nation. And we have 46 million Americans with no insurance at all. Over 8 million of them are children like Sun Hudson.

Sun Hudson had an invariably fatal and untreatable and uncurable birth defect. He was dying despite the maximum life support. He was kept sedated to prevent him from suffering. The hospital could have overridden the mother's (not the father, he was unknown although the Mother stated that the sun --yes, the one in the sky-- was the father) wishes under Texas law, but instead sent the case to court for a judge to decide--and paid for the mother's lawyer. Just so that the motives would not be questioned. That lawyer, by the way, argued vigourously against the hospital's position. The court appointed an outside guardian. Insurance had nothing to do with it. TCH provides free care to many, as do most hospitals.

Also there is the state children's health insurance program, which provides FREE health care &/or very low cost insurance to poor children (it is targeted to the working poor & financed by the states & federal gov't) and is available in every state for children up to age 19. Medicaid covers the very poorest for free. Either people don't know about the coverage already available for their children or don't take advantage of it.

It is very easy to blame the need for very hard decisions about futile medical intervention on insurance or race or citizenship or whatever. Easier sometimes than accepting that sometimes the doctors and nurses can't --or shouldn't-- do anything to prevent death. Even when we have literally exhausted ourselves, and the hospitals' resources (such as emptying out the blood bank)..., but the patient died, we have been accused of "killing" him , or "letting him die" because he's black, or poor, or ...fill in the blank. People that have been victimized or discriminated against can sometimes too easily believe it's happened again, even when it hasn't.

And the story you saw about the patients being dropped in front of the homeless shelter -- Remember that this was about 2 incidents involving one hopital and one shelter in the same "slum". Hospitals actually do usually provide clothes, (but I can easily believe some individual employees not bothering.) They weren't "dumped" because they had no insurance--remember, they had already received treatment for free & were being discharged. No one accused the hospital of not having treated the person, if I remember correctly, but of not caring what happened after discharge. Is the hospital also supposed to provide an apartment and an income? Or keep the person indefinitely? The shelter is where the person lived. Once you are discharged, the hospital is not even responsible for getting you out the door, much less paying for the taxi (which hospitals do all the time for indigent patients anyway). The thought of leaving the hospital and having no place or no one except a homeless shelter is horrible--and a real social problem--but is that caused by a lack of insurance? We spend a lot of time trying to persuade homeless folks to NOT leave AMA before they have finished treatment, also. But you will never see that on 20/20.

Well I did attend my friends sisters funeral in the last year. I posted her story above. She did not have insurance and received substandard care in one of the richest counties in the country. That she died as a result is without question. I remember when my friend called me to say her sisters toes were turning purple and no one from vascular was even available to come see her. I thought the next phone call would be about gangrene, not to let me know she died. The hospital she was at for most of the time simply did not care because there might not be any money in it for them. If she had a top insurance company she would have gotten the blood tests that could have easily and cheaply diagnosed the sepsis

BTW she was not even overweight, did not drink and did not use illegal drugs or smoke

Well I originally wanted to mention the booming Canadian & Australian economies vs. the USA's not booming one: 2006 stats:

USA unemployment rate 4.8%, growth in GDP 3.2%, inflation rate 2.5%

Canada: 6.4%, 2.7%, 2%

Australia: 4.9%, 2.7%, 3.8%

France: 8.7% (the lowest in 10 years), 2.1%, 1.5% Germany, Netherlands, Spain are similar. Spain has higher inflation

Sweden: 5.6%, 4.7%, 1.4% (well I was wrong here, I thought I read way worse numbers for them) Norway and Denmark have less unemployment.

Let's see, India is a hot place to invest: 7.8%, 9.2%, 5.3%

Venezuela: 8.9%, 10.3%, 15.8% and 37% of the population below the poverty line.

Korea is among the best: 3.3% , 4.2% , 2.2%

Azerbaijan: 1.2%. 34%, 8% ; 50% of the pop. below the poverty line in the fastest growing economy. A demonstration of how good growth can look when you are starting near the bottom.

I've made a fabulous return on my eastern european stock fund, but everyday life there still doesn't sound too enticing. You know, the US stock funds haven't been doing too badly either...

It's not clear what the point of this last post is, BUT, if you are going to tout US unemployment figures, you do need to realize that the way the gov't measures unemployment was changed by the current administration. If you work as much as one hour a month, you are considered "employed".

Now, maybe we can get back to the original topic, retirement and the issue of health care as it affects retirement.

AARP.org has a fairly comprehensive financial planning and retirement section on their website, for those who are interested - all kinds of separate topics nice organized, such as Budgeting, Investing, Creating a Plan, Insurance, Who Can Help You?, etc.

Smokers already pay way more for life insurance. Also, don't they already pay those healthcare "premiums" with that hefty tax that was levied on cigarettes? Until tobacco use becomes illegal, I don't see how smokers or chewers could be forced to pay more for health insurance.

Thank you raee for the numbers. It is unfortunate that our media touts Canadian great economic growth (2.7%) while at the same time telling us how bad our (US) economy is (growth 3.2%);)
My mom lives in Estonia and they have now national health care. Everyone, who works, has amount deducted from their salary that goes to centralized health department that pays the doctors and hospitals. The pay is not very high for medical personnel and good doctors and nurses are leaving to other European Union countries were pay is higher. If you need tests done to find out what is wrong with you, it can take months if not years. My mom told me that in order to have a test done, she needs to see her primary doctor who gives referral to the specialist. The waiting time to see the specialist is month or more. Then the specialist sends her to do a test where the waiting time is again a month or more to get the test done. Then she needed another test done and again to primary doctor first then wait a month then test then wait a month. So it goes until she is done with all her tests and gets back to the primary doctor more than 6 months has past and the earlier results might not be valid anymore. So I hope that we here in US will never have such a system.
As for here, I think we need to have price lists available for every service, so we know how much it costs before we decide to have the procedure. How can we contain cost if no one knows how much it is?

How can we contain cost if no one knows how much it is

The cost isn't the same for everyone. When my husband had his hernia surgery, he asked the surgeon, "So what do you charge for the procedure?"
The surgeon said, "I charge one price if the person has insurance. If they have no insurance I charge less. If I know they can afford it, I charge more. And I've done it for free when I knew the person simply could not pay for it."

I believe that is typical.

Grandma, read the article attached and you will see that "The uninsured can pay three times more for procedures, says Nora Johnson, the senior director of Medical Billing Advocates of America." :(

punamytsike, that happens in the U.S., too, for people who are enrolled in HMOs. You are required to see your primary doctor before you do anything.

Back when I was dealing with Kaiser, the decent doctors were all leaving. The only ones they could get must have graduated at the bottom of their class.

I still think there is a big difference between managed care (such as in a national health system like Estonia's) and a single payer system.

(btw, totally OT, I have an Estonia piano!)

I suspect the issue of health care for everyone could be resolved rather easily if we quit being inefficient about it.

It is inefficient to indirectly load the cost of health care onto employers. It puts them into a business that, for most employers, is alien. It is a "regressive tax", if you will, striking smaller employers harder than larger employers. And it puts us at risk if we ever lose a job or, as is far more frequent today, that job is taken away.

It is inefficient to award huge salaries to doctors and then take it away in the form of punitive malpractice-insurance fees. I'm guessing most doctors would be happy making less if so much didn't have to go out the door to service insurance companies in premiums paid directly and in staff to handle paperwork.

It is inefficient to refuse to cover medications which can prevent serious problems later on. We won't pay for antibiotics or blood-pressure medications for poor people, but we will pay for the eventual hospitalization when the infection runs amok or when untreated blood pressure (however it was acquired) causes a heart attack, stroke, or kidney failure.

It is inefficient to subsidize farmers who grow tobacco when there is no positive health benefit to it at all -- and then to pay for treatment of the diseases that tobacco use can cause. The same argument can be made for alcohol, but it's harder to define when a wheat field will become loaves of bread and when it will become vodka. :-p

No system will be 100% friction-free. There will be sad anecdotal stories regardless of how we choose to fund health care. But if we could get past the powerful money interests lobbying for the status quo, and once we get back to a government by people who actually don't hate government, we might be able to make some progress. It's hard for me to believe that "the greatest country on earth" -- one he11-bent on imposing its great way of life on the rest of the world -- does not consider timely health care a basic human right. We could do it if we stopped being inefficient and stupid about it.

Well said, steve_0 We have always been a "can do" country. I don't believe that we can't fix this broken system.

Harriet, I hope you are enjoying your piano:)

Watch to see what the Presidential candidates are coming up with on the health care front. Some may have thoughtful ideas and some will forward some gobbledygook just to say they "have a plan". It does seem they all realize the present system is not working.

Watch out for the candidates who bring up the same weird and unusual situations we've read in some posts here to distract from the large overall problems.

Al Gore is saying that Exxon and others are spending lotsa bucks to get people to publish articles that question global warming, just as the tobacco industry used to do to question tobacco's entirely detrimental effects.

We will see candidates put out guff about how awful single-payer health insurance would be. Look for catch phrases like "pull the plug" and "limited care" and "government waste", as well as misdirected spotlights on the weird and unusual to distract your attention from how the vast majority would benefit from change.

Most Medicare patients are very satisfied with their care. (So much for the anti-government rant.)

Obese, smoking, drug abusing people DO cost more to care for. Why shouldn't they pay their fair share for their lifestyle choices in a democracy?

Let's all gather around Harriet's piano. Who's got the "American Health Care Solution" lyrics?

Richardson has offered a plan

Basics:
The age limit for medicare lowered to 55,
Children could stay under parents insurance coverage up to age of 25,
and the part I like the best
Require that insurance companies not deny coverage due to pre-existing conditions, and mandating that they spend at least 85 percent of their premiums on health services.

The article also mentions some other candidates' plans, or plans to have a plan.....

Saphire, I can TOTALLY believe that your friend's sister received substandard care. I see it happen too frequently. I just want to convey that lack of insurance is usually NOT the reason, and we can't draw that conclusion unless someone flat out said so. Even the fact that she was there for over 5 weeks--cost much more to the hospital than the "tests for sepsis" that you mention. It sounds like she should have been transferred--administrators normally would have no role in that decision & we get patients almost every day in such transfers, often at family request.(The only exception I can think of would be an HMO system like Kaiser, with its own hospitals: they sent their heart surgery cases to us to perform & we often felt they would wait too long --this was in the 80's).

The reason I respond to these stories is just that I don't want people to be making decisions on how we change health care delivery and payment based on horror stories which tend to be exceptions to the rule or attributed to the wrong cause. Unfortunately our media often fails us here.

Medicare is a system which has been working well (for the patient), but it also often forces the hospital to deliver care at a loss--and requires us to have upteen staff people to make sure the doctor has used exactly the right words in the chart to describe the patient's condition to be sure all the care given is reimbursed. That is an example of why you get different prices, different payors treat the place like a bazaar where they bargain for the service & what it actually costs is ignored. With lots of hospitals in a town, the competition is fierce--

which leads me to Steve-O's post. Right on the nailhead. There are SO many ineffiencies, starting with how we still train doctors (learning on the patient). So much money supports bureaucratic demands on time, not patient care. We need to be sure that any system doesn't just change the burden of payment from individuals, but remakes the way the whole system works.

Warning: what follows is tongue in cheek. But the stats are real, taken from the WebMD.com site.

What am I getting at? I do think we need a serious overhaul of our (lack of) health system. Too many people falling through the cracks; and anything so confusing that even lawyers and insurers have a hard time figuring it out, is clearly inadequate and wasteful.

But lines WILL have to be drawn. It won't be possible to cover every single person no matter what kind of health problems they have. We will, either as voters or consumers, have to make choices. Let us hope we will make the best choices amongst some very hard decisions to make.

****************
>>Obese, smoking, drug abusing people DO cost more to care for. Why shouldn't they pay their fair share for their lifestyle choices in a democracy? Absolutely, let's charge everyone who drives up costs. Let's see: how about these stats on premature babies! Look at how much they are costing us, compared to normal deliveries. And the percentage of them is increasing every year - so obviously we can't keep sustaining this kind of thing. So parents of preemies should count on getting maybe 2x average, and the rest they can pay themselves. No free rides here for anybody, folks!

(Excerpted from the WebMD site)
Estimated Costs of Premature Babies 15 Times Greater

Employers pay nearly $42,000 in average health care costs in a premature baby's first year of life, says the March of Dimes. That compares to about $2,800 for a full-term baby with no complications.

The figures include hospitalization, drugs, doctor visits, and time off from work needed by the mothers of premature babies. The numbers came from a database of millions of U.S. employees and their dependents.

Across the board, premature babies needed more medical attention, bringing higher costs.

Hospital charges alone cost businesses and private insurers $7.4 billion annually, says the report. Other findings include:

Average hospital time: 2.3 days for full-term babies; 16.8 days for premature infants
First-year doctor visits: six for full-term babies; nine for premature babies
Mother's short-term disability leave in the six months after birth: 10 extra days for premature babies (29 days, compared with 19 for full-term babies).

Growing Numbers of Premature Babies:
More and more babies are being born early in America. The numbers have notched upwards for more than 20 years.

The reasons why aren't totally clear. Increases in older mothers and multiple births (such as twins) could have something to do with it. Premature babies are also more common among African-American women and women younger than 17 or older than 35. About half a million premature babies were born in 2003, the journal Pediatrics reported earlier this month. That's 12.3% of all babies, a slight increase from 2002.

The number is up 16% since 1990, says the Pediatrics study. Since 1981, the number has skyrocketed by 29%, says the March of Dimes.

Obese, smoking, drug abusing people DO cost more to care for. Why shouldn't they pay their fair share for their lifestyle choices in a democracy?

I find your categorization offensive. Do you honestly think that most people would CHOOSE to be obese in the same way they choose smoking or drugs. You can quit smoking, you cannot quit eating.

You obviously do not have a weight problem. I know several plus sized people that make every effort and it just does not work. In every way they are responsible citzens

Let us not forget people who ride motorcycles, ski, scuba dive, like to take walks alone at night near parks, people who like to tan, people who do not use proper food safety precautions or carry their lunch to work and do not properly refrigerate it, people who are clumsy or accident prone. Let us not forget people who are left handed, apparently they have a higher risk of accidental death, people who use cell phones constantly, you never know what that can do, people with anger management issues, people who travel to third world countries. Yes big brother could really be watching

"You can quit smoking, you cannot quit eating."

You can quit overeating. Food should not fill an emotional void. I am really sick of people making excuses for their weight. I have maintained my 5'3 110 lb. figure since high school, even after pregnancies. The key word is maintain. I try to do some form of exercise every single day. I go to the gym 5 times a week. I don't overeat. I don't deny myself any foods, but I do watch the portion sizes - that is key. I also choose healthier versions of food when presented with a choice. I never eat to the point of feeling stuffed. I drink plenty of water, etc. It is called willpower. It irritates me when people say "oh you are so lucky to not have to watch your weight". Ha! I do. I make health and fitness a priority. It IS hard work. It is a shame that more people can't take personal responsibility.

C

I think people love to be sanctimonious about weight. Just because I can do it you can too! Maybe your metabolism is different? Ever think of that? Maybe you would have starved in the famines of our ancestors, maybe my obese friend survived because of her thrifty gene. Maybe carbohydrates trigger something in many obese people that they do not in others. I have a friend who is plus sized she plays golf several times a week (withhout a cart she is too cheap), tennis and swims nearly every day, and she is still plus sized. She has been seeing a diet counselor, a professional one not Nutrisystem for over a year. She is happily married with 2 children, has a beautiful home and enjoys her job.

Think about this. In the 1970s and 80s thousands of people successfully quit smoking once the Surgeon General put those warnings out. Even more quit when it became socially unacceptable in the 90s. What are the statistics about successful weight loss, something like 95% of people who lose weight from a diet (as opposed to gastric bypass) gain it back within a couple of years? Those people made a sincere effort, they took personal responsibility. Maybe something else is going on, maybe they are programmed to gain more weight than the average person. I do not think you have walked in my friends shoes

Maybe you should not judge so harshly and discriminate based on asethetics. We are superficial enough as a society

More people vote for American Idol than do for President

saphire: I agree with you.

BTW, interesting piece in the New York Times this week RE body fat (the purpose it serves physiologically).

I don't see any scientific studies supporting the idea that people cannot lose weight by eating less and exercising more. This is NOT about "aesthetics", it's about health. It's not "judgemental" it's science: too many calories + little exercise = obesity.

A friend from childhood fought her weight for years until seeing a new MD whose first words to her were: Why are you so fat? He meant exactly that: Why? With her, as with many people, over-eating was a family lifestyle. That shared quart of ice cream, divided between her and her morose father while watching TV together was the only "bonding" available to her. It can be learned behavoir. It can begin as a stress reliever. It can substitute for or be a buffer against intimacy. There are countless ways people get programed to over-eat, and they need to get help to answer their own individual "Why?"

When the public becomes as conscious of the dangers of obesity as they became about the dangers of tobacco use (took decades, still slow), maybe people will stop getting obese in the first place. Would anyone seriously tell children that obesity is OK or unavoidable?

Premature births are on the upswing for two reasons that I can see. Poor prenatal care and a medical field that wants to "help" women 20 years past their best child-bearing years to acheive parenthood by implanting multiple embryos. (I read recently that the OB field is censoring the latter now and the former is "fixable" with more preventive medicine.) A third reason for rising perinatal costs is because we now can "save" more babies -- save them to live with what kind health deficits is debateable, but if we are going to create life that has unclear chances of optimum survival... All three of these causes require "before the fact" cures.

Here's a possible solution...... How about a welfare type subsidy? For those that can not afford their own insurance? We could set up government hospitals, and everyone who can't afford insurance could go to those for free. Better yet, have co-pays based on what you can afford. Just have to register and prove that you could not afford your own insurance. They could give you a little ID card or something. Then we could pay for doctors and nurses schooling and they would have to serve 5 years or so in one of these hospitals, for substandard pay. After that, they could go out into the world where folks actually pay for their own insurance and medical care, and make money to make the years of schooling worth it.

It solves the problem of folks who can't afford it not having care. It solves the problem of folks who do have care currently, not losing the quality of care and choice that they have now. It solves the problem of losing doctors and nurses who do not want to be overworked for very little pay. It solves the problem of what to do about all the insurance companies and their employees who would be out of jobs under a universal care plan. It doesn't solve the problem of getting care to those who are not located in a city getting care.... perhaps a "traveling clinic" like the blood banks. I'm sure there are other problems as well.... Let's hear them.

I do not have a problem paying for health care in such a manner for those who can not afford it. I, however, have no desire to see a doctor of someone else's choosing. I choose who I trust to work on myself or my children. I want someone who doesn't prescribe an antibiotic for a cold. I want someone who's medical beliefs closely follow my own. I don't want to be seen by a bigot or someone who thinks that fat people should pay more for care (even though that's the same thing).

If I could not afford to take care of myself or my family, then I would not have such a choice. Beggars can't be choosers.

Has anyone stopped to think that every one of those countries mentioned above also have mandatory military service? That's part of the "cost" of their free healthcare. Are we going to do that too? BAHAHAHAHA!!!! That's funny!! Gimme, gimme, gimme, but don't expect me to give back. No worries, it'll never happen. I just couldn't resist when folks are saying how wonderful these countries are because of their health care, that there is a whole lot more involved than just health care. Many things that you would never accept.

OK, I've given one possible solution. (not just a vague someone should do something) Anyone out there have another? Prove me wrong. Prove grandma right. Let's see some of that American initiative. Let's hear from folks who have some kind of plan. Good plans and bad plans we'll have to go through them all, before we get to one that works. Shoot holes in this plan. Let's hear some talk about something concrete. Please keep in mind though, this is not a plan to benefit the majority. You would get further by acknowledging that fact. The majority of Americans have health insurance. This plan is only for the poor unfortunates that we have to save from themselves. Everyone else will see their current health care options diminished under any universal plan. And that, folks, is the hard sell. That is the real reason that those who can and do, are not going to buy a universal plan.

No one has said yet, that they are willing to give up their choice in doctor, or hospital, for this program. No one has said that they, in their day to day life, are doing all they can to ensure that the uninsured have coverage now. I can tell you my doctor, dentist and pharmacy all have programs to help those without insurance. It may not be much. It may only help 2-3 of those uninsured. But it DOES help those 2-3 folks, and all the other patients who use those services may help 1-2 more each (I'm 8 people total, so that's why the difference in numbers). The same number of patients at a doctor who doesn't have such a program - helps 0. I also give to charities who help folks within the US. Many of those are medically related. I give to my church that also helps folks in my community with hospital bills and medical care. I'm doing what I can. How about you? Or is this just a purely intellectual discussion, with no one willing to put their money where their mouth is?

YEAH! I am not going to fussy about who I see for "primary care"... I haven't been thusfar! I go to the local Family Planning clinic every year; guess what?! I don't even see a DOCTOR, I see a Nurse Practitioner.

I go for a mammogram at the local hospital's place. We have a local GP, but only see him for routine visits (bad 'flu., etc.) and because we have to have him for a referral (how dumb is THAT?).

More people need to see skilled Nurse Practioners and take more responsibility for their lifestyles. Sorry! fat people cost more, in actuarial terms.

I don't want to be seen by a bigot or someone who thinks that fat people should pay more for care (even though that's the same thing) Very well said

Would anyone seriously tell children that obesity is OK or unavoidable? Yet by the same token how many teenage and preteen girls feel they are worthless if they are not a size 2? Have low self image even if they are not aneorexic

Maybe Chisues friend had emotional issues but I would not assume all do. I know of several cases where thin and fat people have adopted children and also have biological children. The biological children mirror their parents, the adopted ones do not, whether fat or thin. I even know of one case of identical twins that were separated and one twin was replaced by another child without anyone realizing (it was on 20/20). All 4 biological children were thin like their parents, the misplaced child was obese at 18. Same habits, different outcome.

Do you really believe people are fat because that is what they want? you can educte them all you want, until there is an effective weight loss solution other than simply telling people go excercise and eat right (so easier said than done), nothing will change because people cannot change. If they do change they end up reverting back as happens to 95% of dieters. For some reason it does not happen to 95% of ex smokers

a medical field that wants to "help" women 20 years past their best child-bearing years to acheive parenthood by implanting multiple embryos Now I know you do not know what you are talking about. Triplets and so forth are a result of too many embryos forming in young women who have fertility problems. Non identical Twins in women over age 41 occur rarely. I can find the SART statistics if you are interested. IVF with their own eggs barely works in women over 42. So the odds of having one is slim. The odds of two are almost none. Plus in states with mandatory IVF coverage, as opposed to places where patients are taking a desperate gamble because they only have one shot, the rate of multiple birth above Twins is actually pretty low even in younger women.

Here is my solution. If you really think people get fat from eating too many bonbons, then tax them. Tax regular sodas, it rots your teeth and really does have a redeeming value. Tax anything with a high fat content that does not have an equal amount of protein, anything with more than x grams of sugar. Put the money into a fund for the uninsured. Hey for the bigots out there, maybe only have the tax apply to people with a BMI above 30! That should make the self righteous happy

Should say sugar soda has no redeeming value

Has anyone stopped to think that every one of those countries mentioned above also have mandatory military service? That's part of the "cost" of their free healthcare. Are we going to do that too? BAHAHAHAHA!!!! That's funny!! Gimme, gimme, gimme, but don't expect me to give back. No worries, it'll never happen. I just couldn't resist when folks are saying how wonderful these countries are because of their health care, that there is a whole lot more involved than just health care. Many things that you would never accept.

There was a military draft in the U.S. not that long ago. Some sort of required service, be it military or National Guard or even AmeriCorps, wouldn't be a bad idea if it weren't for the misadventures being directed by the cowards who were too "busy" to serve themselves (talk about "gimme and no give back"!).

For that matter, those countries requiring their citizens to serve often have tax rates significantly higher than the U.S. does. And yet, with all of those "punitive" measures, people are not leaving those countries in droves and no one in those governments has to put up signs that read "Last one to leave (fill-in-name-of-country), turn out the lights."

By several measures, the quality of life in other countries is superior to the quality of life in the U.S. You are right -- it does not come "free". I'm not sure where USians glommed onto that concept, but, if they're honest with themselves, people know it's a fallacy. Now if we could only find statesmen and women who could come clean about that....

No one has said yet, that they are willing to give up their choice in doctor, or hospital, for this program. No one has said that they, in their day to day life, are doing all they can to ensure that the uninsured have coverage now.

Many of us with insurance effectively have given up our choices in doctors and hospitals. Many health plans stipulate which clinic you can use (in non-emergency situations), more require a referral for specialists, and every doctor I can think of is associated with some hospitals but not others. So that restriction of choice already is a reality -- for people who have insurance.

And just because no one is talking about what they may do personally to ensure that the uninsured have coverage does not mean people aren't doing anything. I don't blab in public forums about my charitable contributions or my volunteer work. Hey, we have people running for President who have not articulated a plan for addressing this problem.

Here, here, Steve!

How about Tom's of Maine's effort to privide dental coverage to those most in need? we were delighted to sponsor a child... you wanna talk about prevention, let's start with the mouth.

Don't lay that "gimme gimme" line on me, either. Like Steve, I know what we sponsor and in most cases, to whom it goes. We try to do our good deeds locally.

I should not have limited my criticism of OB/GYNs to just IVF practices. Irresponsible treatment of infertility (amazing costs for little success and some very bad outcomes) is bad regardless of the methods. This is a sad outcome of gimme! and the entrepreneurial side of medicine. BTW, today's news includes warnings that the newborns of obese mothers are at greater risk for neonatal problems.

I do not argue for increased costs for normal human desires to have families, nor for increased costs for any medical condition (heart disease, cancer, whatever) that is not KNOWN to be caused by individual lifestyle choices (obesity, smoking, drug abuse). Yes, it is HARD to resist pressure to over-eat, smoke, take that drink or drug, and harder still to quit -- but people do it every day.

Money can talk. Two states that instituted very high cigarette taxes have seen corresponding drops in the numbers of smokers. When gas prices rise, people realize they don't like their SUVs so much and buy smaller cars. In Europe petrol and electricity cost a LOT; people use less. Maybe taxing empty calories isn't a bad idea! I also like the U-Haul company's idea of paying obese, unfit employees less -- while offering them help to change.

momto6 -- I'm afraid your two-tier system has not worked well for society. (See public health patients waiting days in the ER after failing to recieve preventive care.) I do like the idea of some public service for medicos, and something similar is in place. Medical students can opt for loans that are paid back by terms of service in fields less popular (less lucrative), like family practice. Nurse Practitioners are becoming more accepted, too, to fill some of that same day-to-day need. Proof of need? Drug stores are getting into the clinic business to profit from it!

I'm less skeptical about other countries' health systems. It's only human to complain more than compliment. (Something like the way a customer will tell ten people about the bad meal he had at X restaurant while only two will hear about the good meal.) Bad news is...news! What do surveys say about health care in Canada, the UK, France? (Oh, I would be most interested to see the French survey!)

Here, here! ChiSue!

(the last time I was examined by an OB/GYN physician he told me, " if you want to have kids you'd better 'get busy'!". I was APPALLED and coolly asked him if he'd bothered to read the 10 page "history" I'd filled out? in it was clearly stated my desire to NOT have children, lol.).

And why is it that I am required to pay for "maternity care" when what I'd really rather have is PREVENTIVE care... ummm... birth control?! abortion services if required? NOPE.. not available... not "PC"... how about we start "gettin' real" and leaving the moral judgement out of it?

chelone -- Didn't that doc tell you you could "have it all"? He might have offered to "harvest" your ova to store until you decided to have a baby at age 50, after your career was peaking. (If you decided against motherhood, that would be OK, too. That ova could be fertilized by some anonymous sperm donor and the "result" could be used in stem cell research.)

You may detect a special revulsion I feel for this particular industry.

(I think you mean to say: Hear! Hear! but thanks anyway.)

And I'm right there with you, Chi.!

Pisses me off that I could never get coverage that would cover BIRTH CONTROL or abortion for an unwanted pregnancy resulting from birth control that isn't "fool-proof".

I'm 48 yrs. old. I'm fit, healthy, and have never been pregnant because I've never wanted to be! I've paid attention to details and have paid the price... over the years, in excess several thousand dollars... but the "cost" of my vigilence was to be totally borne by me? even though my CHOICE AND VIGILENCE meant nothing to the premiums I've been forced to pay?! HUH?!

"Well baby"? how about "NO baby"? where's MY discount? After all, my "NO baby" dilutes the "pool" and reduces the price we all must pay for all the f--ked up babies that are delivered to the "uninsured"...

No one wants to talk about that aspect, but how much does it really cost us?... and how many of us are forced to pay for them even though we aren't "given a break" for our assiduous attention to detail over the many years we've NEVER conceived?!

Hot button issue for me, you guys.

This is a crazy thread. I can't believe some of the things I'm reading. It's just not right to say that fat people should pay more for health insurance than skinny people, that smokers should pay more than non-smokers, etc. There are just too many variables to make statements like that.

As far as the high cost of IVF or other fertility treatments, who cares? Insurance doesn't pay for that. People can spend their money however they want. I agree with chelone. Let's keep the moral judgement out of it.

Please, don't start whining about how we are under taxed. How is:

28% of your income taken directly (20% after deductions)
15% taken in your contribution/employer contribution for SS/medicare
Sales taxes that vary from 0% to 10% - let's say average of 4%
if you factor in health insurance premiums being part of taxes - that's another, what, 10%?

I haven't factored in property taxes, local (city) taxes, state income taxes, asset taxes, taxes on fuel (excise taxes), taxes on liquor, tobacco (NEITHER OF WHICH I USE), and I'm sure I could think of more.

Compare this with the European system that tends to have income tax and VAT and nothing else. I would venture to guess that we pay AT LEAST as much as them.

Further many European nations are in the American military umbrella thru NATO. It is we who are funding a significant amount of Europe's defense to this day.

We must find a solution to this healthcare crisis. If our government had a track record of being competent I'd say 'sure!' But I'm not self deluding enough to think that any of this could turn out well, unfortunately.

Nate

Hot thread. But I'll throw this article into the fray. Interesting read. Curious what you think.

(BTW, do not confuse the active military hospital system, e.g. Walter Reed, with the VA system. Apples and oranges.)

celticmoon -- WONDERFUL link! Thanks!

(Also looks like I should find the author's book, given my personal "hot button".)

It is unfortunate that so many do not have any health insurance. But it should not be characterized as a "right." A "right" is something every person can exercise without coercing or taxing someone else, such as the right to free speech. We can all engage in it; it does not come at the expense of someone else. Health insurance for all would certainly mean forcing some to subsidize the care of others. The debate should be couched in terms of public policy, not rights. The question is, is it good public policy to subsidize (at least some) peoples' healthcare? Personally, I find the notion of the government overseeing distribution of healthcare/health insurance very disturbing on many levels. No, I am not a doctor nor do I have anyone close to me in the healthcare field. I think change would be good, but not change engineered by the government.

I am interested in the original question about retirement. Geez, if the typical person nearing retirement has saved so little, guess who is going to fund that bailout? Chisue is on the mark raising that question. It is simply not fair that the "ants" among us would have to pay for the living expenses of the "grasshoppers" who just didn't save enough. So, with all this looming, what will one need to retire to an upper middle class standard of living? In recent years, I think the number was $2M. What will it be in 25 years? 4 or 5M, given that we'll have to bail out Social Security and those people who didn't properly fund their retirement?

It is unfortunate that so many do not have any health insurance. But it should not be characterized as a "right." A "right" is something every person can exercise without coercing or taxing someone else, such as the right to free speech. We can all engage in it; it does not come at the expense of someone else.

I disagree. We have many things we consider "rights" which run afoul of your definition. Voting is a "right" but it certainly costs money to buy off Diebo run elections. We consider it a "right" to live peaceably, but I don't notice that police officers and prison guards (or prison builders) work for free.

And we already are subsidizing other peoples' healthcare through our taxes and our own health-insurance premiums should we be lucky enough to have insurance. When a poor person with no medical insurance shows up at the E.R. for treatment of an illness that could have been attended to much easier (not to mention less debilitatingly) early on, we cover those costs as service is rendered in the most inefficient way possible. (I'm not getting down on E.R.s, BTW; it's just that they are designed for the treatment of major trauma, not persistent coughs or mildly-sick babies.) It's not only good public policy, it's just good economics and good medicine to treat problems sooner so they don't become big expensive problems later.

And, coming as I do from the home of "Dollar Bill" McGuire (very rich former United HealthCare CEO), I'm very leery of letting some for-profit corporation run the system. It's strange how so many people think that government organizations like police forces and armies are always well-run and economically-efficient, but they can't see the government organizing a sack race properly. It certainly would help us to get back into government people who actually want to govern and be states(wo)man-like, not just those who pander or want to build empires.

So, with all this looming, what will one need to retire to an upper middle class standard of living? In recent years, I think the number was $2M

I need some clarification here. Does that mean $2M net worth? Or does that mean $2M excluding the value of one's home (which doesn't really contribute to retirement income unless one sells it or uses a reverse mortgage). In addition, does that figure factor in possible income streams such as pension and/or SS? Or does that mean one should have $2M if they expect no other income?

Re the healthcare issue, Steve0 has nailed the issue, again. I consider it simply good public policy to have universal health care. Especially for children.

Other countries have decided that they are each and every one better off providing a basic standard of health care for all. They are doing it (much better than we are) for half of what we are paying. What is wrong here? Calvinism taken to the extreme?

steve o, I am simply talking about exercising the right itself, not the attendant costs that in today's government/society happen to be in place that are related to that right. That is, again, everyone CAN exercise his right to free speech. It doesn't cost anyone anything when someone exercises his free speech right. Same with being "peaceful" -- it doesn't cost me anything for my neighbor to be peaceful, to mind his own business. And voting, in its simplest form, also fits this definition. One can say "yea" or "nay" or raise or not raise his or her hand. The voting per se does not necessarily cost anything.

And oh, gotta love the efficiency of the military other government institutions. Gotta love the $400 hammer and the $200 toilet seat.

As for zone 8 gma, what one "needs" in retirement is certainly dependent on the definition of "comfortable" eh? Let's say someone owns a home free and clear and the home is worth $500K. If that someone gets a typical SS payment in retirement, I am under the impression that for a household used to a salary of say, $100K per year in a medium- to-high-cost-of-living part of the country that SS payment is a small portion of what they will need to sustain their standard of living. Isn't the rough rule of thumb, you want to plan on living on 75 or 80% of your pre-retirement income? If my example household does not have a pension, as MANY will not in future years, then where's the rest of that money coming from? I think at least $1M today could be comfortable for that example household. You have to figure they still pay property taxes, they need medigap insurance, they may need to weather downturns in the market, they may need nursing home care someday, etc. If their $1M earns 8% per year, that's $80K and great, they have their desired stream of income and they do not deplete their nest egg. Most people want to leave their kids something as an inheritance. I know I want to. To really have a solid cushion, though, I do not think $2M is outrageous. What if there's a recession, if there are BIG increases in taxes due to bailout of entitlements, etc? Seems prudent to assume the worst and hope for the best.

Re the $2M 'average' stat: it's generally agreed that is liquid assets, not net worth. With a recommended drawdown of 5% per year (or less; CFPs used to recommend 3-4%) a $2M portfolio gives you $100K/yr or $8K/mo. This would not include Social Security or pensions/company annuities, so one could reduce that figure substantially in some cases.

I agree with Steve too. Prevention is simply cheaper than anything else. Emergency rooms are closing up all around the country because the influx of uninsureds using them for "last ditch" medical care has forced a burden on local counties they can't keep supporting. You live in any county with an emergency room open, and you ARE supporting healthcare for the masses, in the most painful way.

Let's not forget that the portfolio is earning all along the way. If you have $2M invested it is earning -- even in CDs at 5%, there's $100K without withdrawing from the principal.

I would never count on spending LESS after retirement. We don't. At first, because you have the time, you can travel. Later, health care expenses rise. (You "travel" to more MDs.)

We help our DS and his family NOW while they are young and can use the extra funds. (And to whittle down the potentially taxable estate.) Our first concern is seeing that we are funded ourselves, and will not be a burden on him or on society. If it turns out that there's some extra left over when we are gone, that's fine. Some will go to local charities; some to our DS and his family.