View Poll Results: County Cooperatives

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  • I am a liberal and I support this proposal

    2 20.00%
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    2 20.00%
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Thread: Getting rid of entitlements or County Cooperatives

  1. #41
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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by megaprogman View Post
    Ok. I have been watching this thread and while Reefedjib is doing a great job answering questions, the very fact that there are so many questions about what happens to which group tells me that this scheme will not work or at least it will not be any simpler or less costly than what it will be replacing.

    Think about it, if you have any system where you have to start accounting for the multitude of different situations that occur for different groups of people, you are going to end up with a system as complicated and as bloated as the one you are replacing.
    There is another option which is that the domain is complicated and any plan will have to meet that complexity. In addition, I am attempting to do more than just healthcare.

    I see the complexity rising in a few areas:
    1. state/local funding - how are taxes raised to pay for this?
    2. personal payment - what are the peremiums and co-pays? It is up to each state.
    3. benefits - who is covered and who gets subsidized? Poor, elderly, disabled.


    There definitely needs to be a way to classify people as poor, elderly or disabled.

  2. #42
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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by lizzie View Post
    One concern I had was farmers. They have large property holdings but low incomes. They tend to operate on a margin. Increasing property taxes would be devastating. The bottom line is that it is up to each state.
    They also have large property holdings, but pay relatively low property taxes due to agricultural exemptions. Their property taxes would likely not rise.
    I think that agricultural exemptions would apply.

    The concentration of elderly populations seems to be in small towns and rural areas, where costs of living and taxes tend to be smaller, but the needs of the community (health related) seems to be higher, due mostly to aging-related health problems.
    This would have to be funded through state level taxation and disbursement by need to the appropriate counties.

    It's not so much an evaluation of "poor", but federal programs seem to be mostly focused at that level in the general population when it comes to handing out subsidies such as welfare and other programs. I would think a good portion of those who qualify for free health care at a local or state level, are already on the federal roles for federally funded welfare programs, so what I am saying is that the government subsidized programs, at local, state, or federal levels, will be close to the same targeted population. I don't foresee differing standards of determining who qualifies for subsidies, and it seems it would be adding a new level of bean counters and paper pushers on the local or state level. We would in effect be paying more people to determine the same data and information.
    So who determines whether someone is on welfare or disability. That's a great point. I'll have to let that rest a bit. I do think that the county reps know best. We would eliminate the federal programs.

    There's two different disability programs at the federal level. The funding for one of them comes from the general fund, and the other comes from Social Security funds. They pay monthly incomes for those who qualify as disabled, for a variety of reasons. The numbers on these rolls are growing and keeping lots of people out of the working population, adding to the tax burden on the productive. Some of them truly are unable to work, but it seems to be a highly abused and over-utilized system.
    So, like welfare, they would pay a stipend. Like I said about, I don't know who would evaluate them as disabled. When they are, they would be covered under both the Community Co-op and the Healthcare Co-op. For the Community Co-op, they would receive a stipend, but perhaps reduced with access to a food co-op to get free groceries.

    It would shift the burden from the federal to the local and state levels, and most likely (from what I can tell) wouldn't lessen costs, and perhaps raise them instead.
    Yes, it would shift the burden and since I am talking about covering people who were not previously covered, the costs would go up.

    If I were going to restructure health care, you wouldn't recognize it. It would look more like the health care model in the 60's, and shift the responsibility of payment for routine care back into the hands of the consumer.
    I'd love to hear it! It might give me some good ideas...

  3. #43
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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by reefedjib View Post
    I'd love to hear it! It might give me some good ideas...
    Okay, here goes. I don't know your age, but I would bet you don't remember the era of people who paid for doctor's office visits and their own prescriptions.

    In the 1970's, Congress passed HMO legislation, effectively requiring insurance companies to provide coverage for routine care and drugs. What this has done, in effect, is contribute to the rising prices of these services. People who have health insurance (private) do not have to be conscious of costs. They pay their monthly premium and it's all taken care of with the exception of small co-pays for office visits and prescriptions. That all sounds really fun, but it has taken the responsibility off of everyone but the insurance company to care about costs. The doctor doesn't care if drugs are expensive, the patient doesn't care because he's just paying his small co-pay. This has contributed to a national mentality that running to the doctor and taking a pill for every perceived problem is cheap. It's not cheap. What is happening now is that the astronomical costs of covering all these things that used to be paid out-of-pocket, is being seen in rising insurance premiums.
    The primary problem (imo) is not one of money, but one of mind-set. We think and act like sick people who want all our needs met free-of-charge. It is a problem that cannot be fixed with entitlements.

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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by lizzie View Post
    Okay, here goes. I don't know your age, but I would bet you don't remember the era of people who paid for doctor's office visits and their own prescriptions.

    In the 1970's, Congress passed HMO legislation, effectively requiring insurance companies to provide coverage for routine care and drugs. What this has done, in effect, is contribute to the rising prices of these services. People who have health insurance (private) do not have to be conscious of costs. They pay their monthly premium and it's all taken care of with the exception of small co-pays for office visits and prescriptions. That all sounds really fun, but it has taken the responsibility off of everyone but the insurance company to care about costs. The doctor doesn't care if drugs are expensive, the patient doesn't care because he's just paying his small co-pay. This has contributed to a national mentality that running to the doctor and taking a pill for every perceived problem is cheap. It's not cheap. What is happening now is that the astronomical costs of covering all these things that used to be paid out-of-pocket, is being seen in rising insurance premiums.
    The primary problem (imo) is not one of money, but one of mind-set. We think and act like sick people who want all our needs met free-of-charge. It is a problem that cannot be fixed with entitlements.
    I don't know if you noticed, but I set the co-pay for the Healthcare Co-op to $50 to try and place more fiscal responsibility on the patient.

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    Re: Getting rid of entitlements or County Cooperatives

    Here are my objections to this idea:

    1. You can't simply devolve a program from the federal government to the local governments and expect it to work the same. In many ways, this is no different than simply abolishing the entitlements altogether, as that is exactly what many local communities will inevitably do. If we, as a society, consider these programs important enough that they require federal involvement because they affect the entire nation, then they must remain at the federal level.

    2. The document cites lowered federal spending/taxes as a benefit of this idea. But if that is offset by higher local spending/taxes, it's no better from the taxpayer's perspective.

    3. It will be funded by property taxes, which I think is a bad idea for anything other than basic local services and infrastructure...and certainly for entitlements. Just as we've seen with public schools, those in wealthy areas will continue to shine while those in poor areas will get worse and worse.

    4. "For coverage to those with pre-existing conditions, there will be premiums assessed." Enough said.

    5. The promises this proposal makes are not realistic IMO. There is no way that I can think of in which we can have universal coverage, affordable outlays, and complete freedom regarding our choice of doctors/insurance/pharmacies. We can pick any two of those three, but I don't see any realistic way to have them all. Also, the document promises that it will be portable across county lines. But if you've just devolved this responsibility back to the counties, I don't see any way that is possible.

    6. The document correctly points out that you can't do this with social security, because it wouldn't be fair if a person works in New York and then retires in South Carolina. However, the same logic applies to these programs as well. People could work wherever they wanted, then move to the county with the best benefits as soon as they got sick.

    7. Very few local communities would be on board with this idea. For the last 50 years (when revenues exceeded outlays for Medicare/Medicaid), the federal government has been in charge of the program and collecting the money. And now that the programs are about to become a budgetary time bomb, the feds want to hand them over to the local communities? I think most mayors and governors would strongly oppose this.


    There are lots of great ways to get our entitlement spending under control and to cover everyone, but I don't think this is one of them.
    Last edited by Kandahar; 02-08-10 at 02:36 PM.
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  6. #46
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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by Kandahar View Post
    Here are my objections to this idea:

    4. "For coverage to those with pre-existing conditions, there will be premiums assessed." Enough said.
    Everyone should pay something, otherwise you have the situation like we have now.

    Having a decent premium is good and an artificially low premiums just invites people to use the system more without weighing the cost vs benefit.
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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by Harry Guerrilla View Post
    Everyone should pay something, otherwise you have the situation like we have now.
    I agree. But if I understood that correctly, it's saying that there will be an extra premium for those with preexisting conditions.

    Quote Originally Posted by Harry Guerrilla
    Having a decent premium is good and an artificially low premiums just invites people to use the system more without weighing the cost vs benefit.
    Premiums have little to do with how much people use the system. The DEDUCTIBLE is what really affects that, and I'm completely in favor of high-deductible catastrophic plans. I think the government should be pushing harder to make them the norm.
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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by Kandahar View Post
    I agree. But if I understood that correctly, it's saying that there will be an extra premium for those with preexisting conditions.
    I don't think that was it, maybe I'm wrong.


    Quote Originally Posted by Kandahar View Post
    Premiums have little to do with how much people use the system. The DEDUCTIBLE is what really affects that, and I'm completely in favor of high-deductible catastrophic plans. I think the government should be pushing harder to make them the norm.
    Can't argue with that.
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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by reefedjib View Post
    I don't know if you noticed, but I set the co-pay for the Healthcare Co-op to $50 to try and place more fiscal responsibility on the patient.
    That would be a great start. One of the reasons private insurance costs have soared is because people don't have to take the responsibility for their own care, and they do not need to be cost-conscious. Look at it this way: If someone told you that you must own a car, and they would buy you a new car, whatever kind you wanted, no limits, you would buy the Mercedes or Rolls. If, on the other hand, you were told that you had to buy a car, and it would be coming out of your pocket, and you had no choice, you would compare prices, compare reliability, compare features, and you would buy the car that gave you the most bang for the buck. When it's your money, you will by nature, try to get the best you can for what you spend. It creates competition in the market.

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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by Kandahar View Post

    I'm completely in favor of high-deductible catastrophic plans. I think the government should be pushing harder to make them the norm.
    Not only does the government not push them, they don't allow them, except in temporary policies in some states.

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