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We see and hear a lot of reasons presented why we need to adopt a universal healthcare model in the United States.  The most frequently cited is that if we look at other developed nations, they have universal healthcare and spend less of their GDP on healthcare than we do; that if we adopt a model similar to theirs, our healthcare costs will be lowered and the delivery of healthcare will improve.

The Walker Report makes the case using the newly signed stimulus package as a cost comparison:

If we adopt any one of the health care systems used by the dozens of first world nations with universal health care, we would save the equivalent of one stimulus package a year.

The article above even goes so far as opining that if we could only be as efficient as Luxembourg or Finland, our healthcare system would be great…but that might not be an attainable goal, so maybe doing as well as  Germany, France, or Switzerland might be our best goal for now.

One thing I love about the internet is quick access to numbers and statistics.  While GDP serves as one measure, perhaps a better one is actual dollars spent per capita in US dollars?  That way we’re comparing real dollars to real dollars rather than an abstract percentage of gross-domestic-product.

Nation Master is a neat site that lets you define out statistics by category and includes the category “health” for the nations in its database.  When we do a search for across the board “health” and then  “total expenditure in US$” we are returned statistics that reveal that in 2004 (latest data available for all reporting countries) the following was spent, in US-dollars, by each country in the list, sourced from the World Development Indicators Database:

United States:  $6096 per person annually

Luxumborg:  $5904 per person annually

Finland:  $2664.30 per person annually

France:  $3464 per person annually

Germany:  $3521.4 per person annually

Switzerland:  $5571.90 per person annually

I’m left scratching my head about why Luxembourg is considered more efficient when they only spend $194 less per person each year?  I mean Finland is obviously spending less – with only $2664.30 per person each year, that’s $3,431.70 less spent per person each year.

How do they do it?

Well, another interesting statistic can be had on Nation Master – how often a population visits the doctor, and in the United States we average 8.9 consultations with physicians each year per person; in Finland they consult with a doctor just 4.3 times a year per person. 

So in Finland they use their system about half as often as we do across the population, thus spend about half as much as we do.  Interesting.

Are they really “efficient” as Walker Report thinks they are?

If we spend $6096 on average, for each person each year, and they see the doctor 8.9 times on average in a year, then we’re spending an average $684.94 per doctor visit (or whatever encounter you have – ER visit, hospitalization, etc.)….compare this to Finland, spending $2664.30 per year, per person for 4.3 doctor visits each year – or $619.60 per doctor visit…..now it’s only a difference of $65.33 per doctor visit – not significantly different or more efficient than the United States, huh?

Yet we won’t see these numbers in the media, nor will we hear them on the radio – but the numbers and statistics are out there if you want to find them!

No doubt our healthcare system can be improved – but let’s not rely on myths to reform the system. 

We need facts and data to be able to make good decisions, not myths!

The framing of the debate about private health insurance is that it is too costly because it exists as a for-profit business model.  Insurance companies, we’re told make huge profits and pay exorbitant executive salaries; worse, they waste money on overhead, marketing and administrative expenses!

For example, an article on the Physicians for a National Health Program, Upgrading To National Health Insurance (Medicare 2.0), has us consider the following:

The private insurance industry spends about 20 percent of its revenue on administration, marketing, and profits. Further, this industry imposes on physicians and hospitals an administrative burden in billing and insurance-related functions that consumes another 12 percent of insurance premiums. Thus, about one-third of private insurance premiums are absorbed in administrative services that could be drastically reduced if we were to finance health care through a single non-profit or public fund.

The first question must be, is this true? 

How about we take another look, from another source?

Two years ago, the Council for Affordable Health Care issued a paper detailing Medicare administrative costs, many which are not accounted for or paid by employers or other government agencies.

Just because the government doesn’t reflect all of the various costs of doing business in its official estimates of Medicare administrative costs, that doesn’t mean they don’t exist. Or that taxpayers don’t pay those costs. They do. A hidden cost is still a cost, even if taxpayers don’t know they are paying it.

The CAHC found that “Medicare’s method of calculation makes administrative costs, albeit unintentionally, appear to be lower than they really are.”

On the laundry list of unaccounted for, or hidden administrative costs, we find:

1. The “cost of capital” isn’t included; that capital comes from the government on an as needed basis

2. Cost of developing policy is not included, but Congress, that sets those policies costs taxpayers money

3.  The salaries of those professionals at the Centers for Medicare and Medicaid Services (CMS), are excluded from Medicare’s administrative cost estimates

4. The cost of the buildings that house that part of the leadership team are not included

5. The cost of collecting payroll taxes is not included because it’s part of the administrative costs paid by employers and the IRS

6. The cost of marketing various programs, like Medicare Part D, are excluded from the tally

7. The cost of collecting premiums from seniors is not included, but is part of the administrative costs of the Social Security Administration which deducts those premiums from social security checks

8. The cost of signing up for Medicare is borne by the social security administration since they handle the paperwork when a senior is eligible

9. In the case of fraud, enforcement costs are paid by the Department of Health and Human Services

10. Premium taxes are paid by businesses in each state, by employers who include health insurance as part of their benefits package; Medicare system has no equivalent expense on its bottomline.

The above help to highlight the insurance industry’s administrative costs are not because the private sector is inefficient or wasteful – instead government is taxing it and imposing regulations and unfunded mandates (that is, it tells the private sector to do something, but doesn’t reimburse its costs – like collect payroll taxes for us).

There is something a little disingenuous about imposing unwanted taxes and regulations on an industry and then criticizing it because its administrative costs are higher than the untaxed government program.

But this isn’t really about having an open and honest discussion about how to fix our current system to really do better. 

As the Physicians for a National Health Program article says,

In sum, we will not be able to control health care costs until we reform our method of financing health care. We simply have to give up the fantasy that the private insurance industry can provide us with comprehensive coverage when this requires premiums that average-income individuals cannot afford. Instead, the U.S. already has a successful program that covers more than forty million people, gives free choice of doctors and hospitals, and has only three percent administrative expense. It is Medicare, and an expanded and improved Medicare for All (Medicare 2.0) program would cover everyone comprehensively within our current expenditures and eliminate the need for private insurance. This is the direction we must go.

Medicare for all?

Share your thoughts in the comments!

…in a sea of red.

While the progressives may *think* because they have the White House they can do whatever they please, America remains a traditional, conservative place.  Take a look at the county-by-county voting patterns over the last eight years:

Presidential Election 2000

Presidential Election 2000

 

2004 Presidential Election

2004 Presidential Election

 

2008 Presidential Election

2008 Presidential Election

Socialism within these maps?  I think not!

They can try, but they’ll fail because they’re not going to be able to convince the large swaths within our republic to accept socialism.

From the Heritage Foundation, Two Americas: One Rich, One Poor? Understanding Income Inequality in the United States

Class warfare has always been a mainstay of liberal politics. Politicians frequently depict the United States as a nation starkly divided between the rich and poor. For example, vice presidential candidate John Edwards decries “two Americas…one privileged, the other burdened…one America that does the work, another that reaps the reward. One America that pays the taxes, another America that gets the tax breaks.”

Obama is no exception – his rhetoric is rich with intent to foster continuation of the  class warfare (envy) in the United States to promote entitlement mentality and dependence on the government; aka socialism.

The “rich” are defined by Obama as those households earning $250,000 or more each year.

We’re told the “rich” don’t pay enough in taxes, they exploit others for their personal gain, and they benefit off the sweat of the lower income earners.

We hear a lot about how Obama will address the needs to “hard working Americans” and provide tax relief to “hard working Americans”; that “hard working Americans” deserve a dignified retirement, incentives to save more money, tax breaks and, the big one, redistribution of the wealth in the country – take from the “rich” to give to the “hard working Americans” who deserve more.

As if the “rich” doesn’t include ANY hard working Americans.

So, I’m going to say it – the rich not only work as hard, or harder for their wealth…but they also work smarter – they work the money they have.

That’s the real rub between those who have and those who don’t.

Simple fact of life:  it isn’t what you earn, it’s what you spend that matters at the end of the day.  If you spend your money on things that are not necessary you will be poor even if you have a high income.

What irks me lately is the government seems intent on destroying the very people who drive our economy – yes, I’m talking small business owners. 

I’m one of them. 

My husband and I own our business and employ 14 people, all whom have families, all whom we feel a great responsibility toward, pay well and provide top-notch benefits to.  Like many other small business employers, we’re being taxed to death!

Last year, I kid you not, even with our deductions, we still paid 50% of our income in taxes – to the federal government, the state, social security, medicare, AMT penalty; I’m not even including sales tax or property tax. 

Now Obama wants more?  Are you kidding me?

How much more can the government take?  How much more can they regulate us?  How long until they drive small business owners completely out of business?

The government seems to think it’s fair to take our hard earned money and re-distribute it to others less fortunate?  Good grief, I can do that by choosing my charities, I don’t need to government to do that for me!

Tax credits – checks of $500-$1000 – going out to people who PAY NO TAXES?  How the hell is that fair?

Another increase in the minimum wage coming this year – to $7.25 an hour, with Obama promoting an increase to $9.50 an hour by 2011….who the hell is going to pay for that 26% pay raise (from the $7.25 an hour) and the social security and medicare match employers have to make?  I don’t get a 26% raise unless I WORK HARDER AND DO MORE TO EARN MORE!

Oh and the one I just love (note sarcasm), the 50% of matching contribution from the government into savings accounts by “hard working Americans” for the first $1000 placed in their accounts through payroll deductions!  We’re “rich” so we wouldn’t qualify, of course.  But tell me – why the hell the government is getting into the business of matching contributions now, anyway?  They’re going to use the taxes they take from me to again, give it to someone else – money I could have used toward my retirement. But they’re not just content with taking my money – they’re only happy when they totally exclude me from even participating in these programs simply because my balance sheet deems me “rich”!

Small business will be crippled by the programs and plans being outlined by the new administration. When this happens, who will be the employers of the future?  Cause it sure as hell isn’t going to be motivated young people – by then, they’ll be fully entrenched in the entitlement mentality and totally dependent on government handouts.

As Wikipedia notes,

Even though there is no universally accepted definition of ‘democracy’, there are two principles that any definition of democracy includes.

The first principle is that all members of the society have equal access to power and the second that all members enjoy universally recognized freedoms and liberties.

There are several varieties of democracy some of which provide better representation and more freedoms for their citizens than others.

On this page we find a number of varying styles of democracy, all sharing similar fundamentals like free elections and universal freedoms and liberties. Within the framework of democracy lie differing execution of socialism. Here it is laid out as,

Socialist thought has several different views on democracy. Social democracy, democratic socialism, and the dictatorship of the proletariat (usually exercised through Soviet democracy) are some examples. Many democratic socialists and social democrats believe in a form of participatory democracy and workplace democracy combined with a representative democracy.

When we read through the various definitions of each style of socialism, it’s clear the United States was not and is not designed for socialism.

Yet, we are a democracy.

But what form?

Later on that same page we find a section about a Republic,

The Founding Fathers of the United States rarely praised and often criticized democracy, which in their time tended to specifically mean direct democracy; James Madison argued, especially in The Federalist No. 10, that what distinguished a democracy from a republic was that the former became weaker as it got larger and suffered more violently from the effects of faction, whereas a republic could get stronger as it got larger and combats faction by its very structure. What was critical to American values, John Adams insisted, was that the government be “bound by fixed laws, which the people have a voice in making, and a right to defend.” Also, as Benjamin Franklin was exiting after writing the U.S. constitution, a woman asked him Sir, what have you given us?. He replied A republic ma’am, if you can keep it.

Aha!

We learned this in school, the United States is a Constitutional Republic!

What then is a Constitutional Republic? 

From Wikipedia we learn a Constitutional Republic is,

A constitutional republic is a state where the head of state and other officials are elected as representatives of the people, and must govern according to existing constitutional law that limits the government’s power over citizens. In a constitutional republic, executive, legislative, and judicial powers are separated into distinct branches and the will of the majority of the population is tempered by protections for individual rights so that no individual or group has absolute power. The fact that a constitution exists that limits the government’s power makes the state constitutional. That the head(s) of state and other officials are chosen by election, rather than inheriting their positions, and that their decisions are subject to judicial review makes a state republican; should the judicial review be maximized.

[…]

John Adams defined a constitutional republic as “a government of laws, and not of men.” Constitutional republics are a deliberate attempt to diminish the perceived threat of majoritarianism, thereby protecting dissenting individuals and minority groups from the “tyranny of the majority” by placing checks on the power of the majority of the population. The power of the majority of the people is checked by limiting that power to electing representatives who are required to legislate with limits of overarching constitutional law which a simple majority cannot modify.

Yes, I know, this is the very basics we learned in school, but it can’t hurt to lay it out again.

I often wonder how many people truly understand the principles of our form of government?

How is it that so many seem to recognize we are a form of democracy, yet fail to understand we’re a Constitutional Republic in form and function? Or, at least, we’re supposed to be.

What has happened to us, as a nation, that we stray so easily from our founding principles?

Perhaps you’d like to share your thoughts on how we’ve arrived where we are now?

One reason I started this blog is because I’m concerned about the direction our country is headed.

While I’m a registered Republican, I can’t say that I identify with the Republicans of the last eight years. Nor can I say that Democrats are to be ignored on all things simply because they’re Democrats.

I tend to judge people on their actions, not their rhetoric. What do they really do when put to the test? As far as I’m concerned, both Democrats and Republicans are cut from the same cloth these days, two sides of the same coin, simply two different styles of rhetoric with little difference in action at the end of the day.

When I turned 18, I chose to register as a Republican.

Not for the ideology per se, but because in principle the party stood for independence, personal responsibility and the idea that if you work hard you’ll reap the rewards of your hard work. At the time I turned 18, I’d already, with the help of my father, managed my own business for three years, so I’d come to appreciate how true it was that if I worked hard, I could advance myself in life and reap the rewards of my hard work – not only did I manage a business, I graduated with honors and headed off to a top school for college with a comfortable bank account for my needs while advancing my education.

Now in my 40’s, I’ve not only worked hard, but have what many would call a comfortable life. My lifestyle wasn’t just given to me, I’ve earned it by making sacrifices along the way, saving, investing and paying attention.

My husband and I waited to buy our first house, waited until we could afford not only the mortgage payments, but the responsibility that comes with maintenance and upkeep of a home. Of course there were times we were quite tempted to jump in and buy when the housing market seemed limitless, ever increasing in value, with everyone, it seemed, worried if one didn’t buy “now” they’d be forever priced out of owning a home. Despite favorable “teaser” interest rates, we passed and waited; and the wait was worth it since we found the house of our dreams and can afford it. It wasn’t an easy decision to wait and pay rent, but for us it made financial sense, something it seems many Americans have lost sight of these last eight years.

Rather than take a long hard look at how the govenment, banks and consumers all contributed to the housing mess, we focus on the banks – let’s blame the banks and the bankers, it’s their fault. If only they’d had more regulation, more oversight, more rules, we wouldn’t be in the mess we’re in. It’s easy to do, but that doesn’t make it true.

How many people, now troubled financially by their increasing mortgage payments, actually did the math for the worst case scenario (interest rates rise to maximum cap on the loan) before signing on the dotted line for their ARM or interest-only loan?

I’d guess few to none. We did though and took a pass on the ARM offered because, in the worst case scenario our mortgage payment had the potential to double – yes double – within seven years of the loan start date. That was simply unacceptable, so we took the 30-year fixed even though it appeared to cost us $50 more a month for the payments from day one. I’d much rather pay $50 a month and know I can afford our mortgage for the long-term than try to guess where interest rates will be in the future. I remember the 80’s and I remember 18% interest for a mortgage!

So, while the banks promoted their loans and the government encouraged homeownership for everyone, few are taking a long hard look at the responsibility of the homeowner – and their lack of personal oversight of their financial situation.

What I’m getting at with this very long post is that I’m very much about personal responsibility. I’m not heartless when it comes to those less fortunate; in fact I do think we who are fortunate have a great responsibility to those around us – I don’t think it is a responsibility of the government necessarily, but of families and the community.

I come from a blue collar family, parents who worked hard to provide for us, buy a home, live the American dream; whom pushed us to do better, which me and my sister indeed accomplished – we both went to college and worked hard for where we are now, something my parents are infinitely proud of us doing.

It wasn’t by government mandate we received a college eduction, it was by my parents working hard and setting examples of personal responsibility, holding us accountable for our actions, expecting us to do well in school and to continue our education beyond high school.

These days it seems we hold a fear that if the government doesn’t take the lead no one will.

What I find most disturbing is our march toward socialism, under the use of terms like “progessive;” a term used to imply we’re doing a good thing, making progress, advancing our thinking and policies….progessive policies are socialist policies and few in the media are defining the terms in use for the average American!

Which is why I opened my blog by providing the various definitions of the word “change” – when the politicians speak of “change” we have no definition of their meaning, we’re left to interpret the meaning ourselves and wind up with a mish-mash of understanding across the population. If we want to understand just what they mean by change, we have to examine their stated agenda – tease it apart, look at the long-term goals, and then decide what their “change” means.

In looking at the agenda set forth on the White House website, it’s clear to me that “change” is moving toward a socialist structure for government. I hope that here, in my blog, I can articulate where I see these policies shifting and offer alternative options to consider. I’m no expert on government or politics, but I am my own expert on life – if we fail as Americans to avert the policy changes in the air, we’ll have no one to blame but ourselves when we find we’re living under a system never intended by our Founding Fathers.

My blog is neither Democrat or Republican, it’s American. While I’ve identified myself as a registered Republican, I am more a Libertarian these days. I won’t abandon my party though, for I do have hope that we can get the party back on track and move things back in the right direction. For that, I do have hope.

1959: Mike Wallace with Ayn Rand, Part 1

1959: Mike Wallace with Ayn Rand, Part 2

Hat tip to Tammy Bruce, whose book The Death of Right and Wrong: Exposing the Left’s Assault on Our Culture and Values is a good read!