Matt Yglesias tweets:
Yes, I think converting Medicare into a straight cash grant to seniors makes sense.
They might rather have a servant, or a better car, or an apartment which doesn’t require them to drive, or to eat a better diet or join a better gym. Or maybe they would rather live it up, travel, and perhaps die at a younger age. That’s what pro-choice means.
That's not what prochoice means. Prochoice has to do with giving women control over their own bodies. It does not mean giving people the choice to die unnecessarily young because they hoped that this year they wouldn't get too sick, so this year they'd buy actual food and turn the thermostat up to 58. Sorry about that heart attack, better luck next year.
Medicare is for two groups: people over 65 and the disabled. These are not groups known, by and large, for having servants and "better" cars or going to the gym. Or "living it up". Seriously, it's like he's describing rich frat boys.
On the public choice side, this suggestion would turn seniors into an active constituency for health care cost control.
Nonetheless I propose a more modest version of the idea. When people turn a certain age, allow them to trade in the current benefits package for a minimalistic package (set broken limbs and offer lots of potent painkillers), plus some of the rest in cash, doled out over the years if need be. For some people, medical tourism will fill the gap.
Painkillers are hilarious! HAHAHAHAHA!
But if a person wishes, he or she can keep the extant benefit structure and forgo the cash altogether. No one is forced to take this deal.
Really? No one will be forced to take this deal. Forced. Forced. Forced by the government at gunpoint, probably not. Forced by circumstance? Oh, yes, there are many who will be forced.
Do you know how many seniors there are right now choosing between food and heat, between medication and shelter, between electricity and running water? Right now that is happening. Probably within a 50' radius of you. Now imagine telling that person who freezes through every winter, who starves at every meal, who is in treatable pain that they can have some extra money. All they have to do is cut back on their health care.
This idea is so breathtakingly evil, I have to wonder if someone resurrected Mengele to come up with it.
Now imagine the other group on Medicare: the disabled. I know disabled people on Medicare. They're getting a minimal SSDDI check, Section 8 and food stamps. Rolling in dough, they are not. And the ones with children? They spend every day ashamed and stressed out that their illness impacts their children's lives so constantly. They don't want their children to work nearly full time. They want to let their children participate in extracurricular activities at school, but they can't afford the uniforms and fees and such. They want to buy their children the latest clothes, the coolest cell phones, and all that other stuff so very important to teenagers, but they can't. They hope that their children will get scholarships to go to college, because otherwise it's not happening.
Now offer that parent this choice: cut back on your health care and your child can cut back on their work hours. Cut back on your health care and your child can have a pretty prom dress. Cut back on your health care and your child can join softball this year. Cut back on your health care and die a little sooner and your kid can go to college.
This choice will kill people. I'm sure our Randiot friends will tell us that they chose to die and that's prochoice, but no, we will have killed them. We will have killed the most vulnerable among us and we will call it a triumph.
We are beyond wicked.
Funny how the old have screwed over the young, and now the young think nothing of letting the old just simply die.
ReplyDeleteQuite a society we have here.
Supposedly, that was what Oppenheimer said when he saw the first test of a nuclear weapon. This probably isn't true, but I like the quote.
ReplyDeleteProperly, he thought, "I am become death, destroyer of worlds." Or, at least, that's what he said came to mind later.
Quite a society we have here.
And while we eat each other down here, the rich just keep on getting richer. But that's not class warfare, it's just the way things are supposed to be...
As much as I hate to defend Yglesias...
ReplyDelete"Medicare is for two groups: people over 65 and the disabled. These are not groups known, by and large, for having servants and "better" cars or going to the gym"
Really? So you don't think there are plenty of wealthy people over 65 getting Medicare?
"This idea is so breathtakingly evil"
Yeah, letting people make their own decisions is evil. Thanks for presenting an excellent example of the nanny state mentality. People can't be trusted to make decisions in their own best interests, or to manage their money, therefore we need the government to tell them what to do -- for their own good of course. We have to protect them from the consequences of their own actions.
"This choice will kill people. I'm sure our Randiot friends will tell us that they chose to die and that's prochoice, but no, we will have killed them. We will have killed the most vulnerable among us and we will call it a triumph."
What utter nonsense. Do the concepts of personal freedom and responsibility mean nothing? Why should your beliefs on what other people should do be inflicted upon them by force?
Let's pretend that your hypothetical scenario is accurate for some people. If those people choose to sacrifice their health to create a better life for their children, who are you to tell them not to? Why can't adults make personal decisions about their health care for themselves?
I should have noted that there is a 0% chance that Medicare will be replaced by cash grants. The only serious proposal out there that is remotely like it would be to give cash value for Medicare as is done in Medicare Part D, for the purpose of allowing you to choose a plan that best suits your personal needs. In other words, it would just give more flexibility to Medicare, and would certainly not let you take the money and spend it on other things.
ReplyDelete"Let's pretend that your hypothetical scenario is accurate for some people. If those people choose to sacrifice their health to create a better life for their children, who are you to tell them not to?"
ReplyDeleteThey shouldn't have to. Health should be a basic human right, like food, water and clothing, not a privilege to those who can afford to pay for it. If people are being forced to choose between basic human rights, like food and not-living-in-intolerable-pain, and not because the system is failing them but as part of the way the system is meant to work, then that system is evil.
If someone wanted to sacrifice their healthcare for another cell-phone, or an extra car, I wouldn't oppose your philosophy of letting them live with the consequences, even if it is a little cruel towards the mentally ill. But if they instead have to sacrifice either Basic Human Dignity A or Basic Human Dignity B, which is what making the poorest in society choose between extra cash and healthcare equates to, then that's the textbook definition of a sadistic choise. And if you read up on those, you'll note that it's generally not the good guys offering the choise.
"They shouldn't have to. Health should be a basic human right, like food, water and clothing, not a privilege to those who can afford to pay for it. If people are being forced to choose between basic human rights, like food and not-living-in-intolerable-pain, and not because the system is failing them but as part of the way the system is meant to work, then that system is evil."
ReplyDeleteJust because the world doesn't necessarily work the way you think it should under ideal circumstances doesn't make it evil. No "system" is going to be perfect or please everyone. If you give someone enough money for healthcare and they choose to spend it on other things, that's his responsibility, not that of any system.
"If someone wanted to sacrifice their healthcare for another cell-phone, or an extra car, I wouldn't oppose your philosophy of letting them live with the consequences, even if it is a little cruel towards the mentally ill."
The idea that people should be responsible for their own actions is hardly "my philosophy." You might think it would fall under the obvious category.
"which is what making the poorest in society choose between extra cash and healthcare equates to, then that's the textbook definition of a sadistic choise."
That's illogical. You aren't making them do anything. They are getting money that they didn't have. In the favored left-wing scenario -- government control and no choices -- they have one option, to use the money for healthcare. In the second scenario they still can use the money for healthcare if they need it. If they don't need it, or don't need all of it for healthcare, they can use it for other things. Why do you think poor people are helpless, ignorant children incapable of taking any personal responsibility for their actions?
" it's generally not the good guys offering the choise. "
I know, choices and freedom are bad. We need big government to do what's best for us whether we like it or not. Why should we have the freedom to decide anything for ourselves, when we might make the wrong decisions?
PF, I like you.
ReplyDelete"Just because the world doesn't necessarily work the way you think it should under ideal circumstances doesn't make it evil. No "system" is going to be perfect or please everyone."
ReplyDeleteThat's not a reason to accept poverty as 'good enough'. If the system allows people to live with a lack of basic human rights, it's not evil but we should still try to improve it. If it endorses the lack of basic human rights, by failing to provide them and then blaming it's subjects for not having them, then it's evil and needs fixing.
"That's illogical. You aren't making them do anything. They are getting money that they didn't have."
A good point. So the sadistic choise is not "You can only save one of them, and we'll kill the other! Choose!", it's "They're going to die, but we're willing to give you enough to money to save one of them! Choose!"
Okay, in the interests of completely accurate analogies: "You don't have and can't make enough money to afford both not-starving and not-living-in-chronic-pain, but we'll give you enough for one of them! But not both, that would be SOCIALISM! Choose!"
Remind me again why that isn't evil?
"Why do you think poor people are helpless, ignorant children incapable of taking any personal responsibility for their actions? "
Okay, that should really have been in bold, because you don't seriously believe I think that and am deliberately attributing an imaginary position to me in the form of a trick question in an effort to make me appear foolish in your own mind. I award you no points.
Short answer: I don't. Are you still beating your wife?
"I know, choices and freedom are bad. We need big government to do what's best for us whether we like it or not. Why should we have the freedom to decide anything for ourselves, when we might make the wrong decisions?"
Oh noes, here comes the "Big Government" buzzword and the deliberate and sustained strawmanning of opponents positions, and there goes my ability to italicise your comments.
You do remember that I prefaced "choise" with "sadistic" and linked to the TVTropes entry on the aforementioned word combination?
"That's not a reason to accept poverty as 'good enough'."
ReplyDeleteWho said it was?
"If the system allows people to live with a lack of basic human rights, it's not evil but we should still try to improve it."
We do. And that's why we have different proposals as to how to make benefit programs work better. And Medicare is not just a program for poor people.
"A good point. So the sadistic choise is not "You can only save one of them, and we'll kill the other! Choose!", it's "They're going to die, but we're willing to give you enough to money to save one of them! Choose!""
Again, you completely miss the point. The money is for healthcare. There is only an option to use it for something else.
"Okay, in the interests of completely accurate analogies: "You don't have and can't make enough money to afford both not-starving and not-living-in-chronic-pain, but we'll give you enough for one of them! But not both, that would be SOCIALISM! Choose!""
That's not even remotely accurate. We are talking about one specific program, Medicare. It has nothing to do with what other benefits a person might need or be receiving.
"Okay, that should really have been in bold, because you don't seriously believe I think that "
No, you don't believe that, but your policy position fits that belief. That was the point of my rhetorical question.
"Oh noes, here comes the "Big Government" buzzword and the deliberate and sustained strawmanning of opponents positions, and there goes my ability to italicise your comments. "
Since I haven't employed a single strawman I have to question whether or not you even understand what the term means, especially since it has been you actually using strawmen. I pointed out one in the first line.
The portion of what I wrote that you bolded is not a strawman, it's sarcastic, derisive hyperbole that makes a point -- and an accurate point -- about your opposition to personal freedom and responsibility in this particular instance. Do you not oppose giving people the freedom to spend their Medicare benefits on something other than Medicare? If so, isn't it accurate to say that you belief the government should decide for people what they do with their Medicare benefits? Why is a big government proponent offended by the use of the term? Are you in favor of smaller government?
i'm going to fucking repeat this EVERYWHERE, ad nausum:
ReplyDeleteMEDICARE IS SOMETHING WE ALL PAY FOR OURSELVES! with the SOLE exception of people born disabled who have NEVER worked, every US citizen [who has worked] *HAS PAID TO HAVE MEDICARE WHEN THEY RETIRE"
cutting those "benefits" is STEALING FROM US.
changing them is, in a different way, ALSO stealing - because we didn't PAY for fucking vouchers which are tied to "change in living standard" and that WON'T raise in value at the same rate as medical care will.
that, UNNR, is what YOU are missing.
here is the truth of the "voucher" proposal:
right now, each medicare "plan" [i.e. each person on medicare" costs a FIXED amount. [and, individually it may not be true, but the AVERAGE amount is pretty damned constant]
so, they are going to say "look, last year, MEDICARE paid $5,000 for you - here is a $5,000 voucher, go find your own insurance to insure you for that -
OH WAIT YOU CAN'T BECAUSE THE REASON YOU ARE ON MEDICARE IS EITHER THAT YOU ARE TOO OLD OR ARE VERY DISABLED AND THE "FREE MARKET" DECREES THAT WE CAN'T FORCE ANYONE TO INSURE YOU AT ANY PRICE YOU'LL EVER AFFORD. well, enjoy your voucher!"
and THEN, the next year, it will be, "Huh, looks like MEDICARE would have spent $6000 on you this year, but the cost of living has only gone up 2%, so THIS year you get a bigger voucher, you get a WHILE $5010! aren't you excited?! what? what do you MEAN no one will insure you! you have a voucher! what do you MEAN they want 4 times what the voucher is to insure you?! if they want more, pay it or don't get insurance!"
to which i say again: ASIDE FROM THOSE WHO HAVE NEVER HELD A JOB, EVERY US CITIZEN HAS *PAID* **IN ADVANCE** TO HAVE MEDICARE WHEN S/HE BECOMES OLD OR DISABLED!!!!!!!!!!!
christ, i'm so fucking sick of people forgetting that. and Congress is the WORST - ever since they started raiding SS and Medicare for money, they've acted like these are government-paid programs, but they AREN'T - they are DIRECTLY funded by taxpayers - it's a different fucking tax, even! - and they were NEVER meant to be used as part of the budget, let alone borrowed from SO FUCKING OFTEN that they're now BANKRUPT, or almost, because D.C. keeps STEALING from them and ***RAGE***
just as a side note - old rich/well off people who have medicare [WHICH THEY PAID FOR!] if they're *that* rich, they CAN and DO have better, more expensive insurance, and medicare is only secondary
"that, UNNR, is what YOU are missing."
ReplyDeleteNo, I am not. And you are stuck in time decades ago if you actually believe that. You are right that Medicare, like Social Security, was intended to be something that is paid for by contributions -- so that you get your own money back. That is no longer the case. Both programs are now far more expensive than the money they take in. Unless you earned very high wages for a long time, or use minimal benefits, it is highly unnlikely that your contributions match your payout. That's one of the main reasons it needs reform. It is not sustainable in its current form indefinitely because the costs of healthcare have risen geometrically since the program originated. Almost everyone on all sides of the policy spectrum understands that. The question is what to do about it.
"changing them is, in a different way, ALSO stealing -"
That's illogical even if you accept your false premise. It's ridiculous to claim that a change which gives you more freedom to use a benefit is somehow theft.
"right now, each medicare "plan" [i.e. each person on medicare" costs a FIXED amount. [and, individually it may not be true, but the AVERAGE amount is pretty damned constant] ...
People are able to get Medicare Part D, which is similar in concept to the voucher proposal.
"christ, i'm so fucking sick of people forgetting that"
No one is forgetting it; it isn't true. All you have to do is some basic math to understand why. Look at the cost of just one major hospital procedure. The Medicare tax rate is 1.45%. But if it were true, you are making my point. If you really did pay in enough to cover all your benefits, then you would be receiving back your own money. If it's your own money it should be up to you to decide how you want to use it -- which is exactly what the proposal in question calls for.
"just as a side note - old rich/well off people who have medicare [WHICH THEY PAID FOR!] if they're *that* rich, they CAN and DO have better, more expensive insurance, and medicare is only secondary"
I already made that point that Medicare isn't just a program for the poor. Everyone gets it. That's yet another reason to give people more flexibility in how they use it. Some people do not need it for medical coverage, because they already have superior insurance.
" they've acted like these are government-paid programs, but they AREN'T "
Again, yes they are, at least partially. Why do you think Medicare payments to doctors have been cut? There isn't enough money.
you don't see how tying the voucher to "standards of living" increases is theft?
ReplyDeleteyou don't see that FORCING people to a voucher system, in which they WON'T be able to get adequate health coverage, is theft?
you don't understand that the medicare "pool" is almost empty MOSTLY because the gov't "borrows" from it and doesn't pay back - because even on SSI and SSDI, people STILL keep paying taxes - including for medicare?
you don't understand that the reason medicare "cut" how much they pay [or rather, didn't raise it] is because the cost of medical ANYTHING has risen all out of proportion to actual need-to-charge? and that, as usual, medical costs are predicted to rise VERY shockingly, over the next year, while no one is sure at ALL that "cost of living" is going to rise [so many things are in a downward trend] so that even IF the healthiest of people on medicare CAN afford to get insurance off a voucher, today, in the next year or 3, they WON'T be able to pay for it?
the whole POINT of medicare is that people at certain points - old age and disability, mainly - can NOT get coverage from private medical insurance. vouchers aren't going to change that! and these "vouchers" are NOT going to be able to be "cashed in" - they're "use or lose" - so all of us that aren't coverable now, will get these vouchers, which are WORTHLESS, because they WON'T cover insurance that won't be written [or, if it *IS* written, is so much that the voucher WON'T pay for it, and we don't have the other 3/4s or MORE of the payment for the insurance], so it really IS theft, taking our money and giving us a "voucher" that we CAN'T use.
take me - i'm 34, and other than the fact that i need $3,000+ in meds every month, i'm healthy [most of those are, btw, pain meds - and without said pain meds keeping my pain at a level *8*, i don't care to live. YOU try living at a constant pain level of 10 - or even 8! - and tell me how YOU like it!] i am NOT insurable - no private insurance will cover me - and REALLY won't cover me for the "price" of a voucher.
should i just kill myself, then? this seems to be my option - don't cut off the services i've paid for, paid a LOT for, since i was 15 and started working/paying taxes, or take them all away, and leave me to die in a ditch because i have no way to pay for ANYTHING?!
or should my father - a "public servant", a computer programmer for the State of Ohio, who already cares for his wife, who is paranoid schitzo, has fibro and tendionitis and several OTHER health problems [mostly paid for by CHAMPUS, since she was medically retired from the AF, the rest paid out-of-pocket by my dad] ALSO be stuck with the additional burden? a burden he CAN'T afford?
or how about my mother - who herself needs another back surgery, and is on permenent disability, and who's HUSBAND needs 3 back surgeries and is on permanent disability, and they ALREADY have to small children to take care of [my youngest sister's kids]
i know! i should find a "rich man" to marry - except NONE WOULD - i can't have kids, can't have *sex* [your hip is sort of NECESSARY to sex] and while i'm not "run away" ugly, i'm not drop-dead beautiful, if ONLY because i'm in a wheelchair.
*PETE* sure as fuck can't "support me" - right now, as we're waiting with baited breath for the damned SS office to finally get thru everything and start paying my benefits, we can't even pay all the BILLS - and we live VERY cheaply - our rent is one of the cheapest rents in the city [just over $500, and it's one of the WORST areas of town, and it's a basement apartment, to be that cheap, and i can't LEAVE without help]
[cont]
if they "get rid" of medicare, my options will be "Live with constant pain level of 10 with zero further medical treatment" and "kill myself because a constant level of 10 is a damned good reason to do so, and i'm NEVER going to get better, because i have no access to treatments that might make me better, may even allow me to return to work!"
ReplyDeleteif they move to a "voucher" system, i have the same fucking options
and i WON'T be getting MONEY for that voucher, and you [and everyone ELSE] knows it. there wasn't ever an mention by ANYONE in DC of offering money for the vouchers - the ONLY mention of money was "people who wanted more coverage than they can afford with the voucher can use their own money to pay for it" [PF mentioned money, as a form of blackmail by the government. there's NO mention of money being given by the government for vouchers]
the people introducing this bill KNOW that MOST of the people who will be given these vouchers WON'T be able to get health insurance with them - THAT'S WHY MEDICARE WAS CREATED IN THE FIRST PLACE - private insurance WILL NOT cover people like me, or people "of a certain age" - either won't cover at all, or will cover at such a high price they might as WELL not cover.
if i weren't SURE that the Health Care reform was going to be stripped, especially the max anyone could be charged provision, and the provision that anyone at ALL MUST be given insurance, equal to everyone else's, at the same price, i wouldn't protest, wouldn't have written to a ton congresscritters and senators, and the President, and etc - but they ARE going to cut the health care reform. and those vouchers won't be worth the paper they're printed on, once that happens.
and the old and disabled are going to start dying in droves - and, unlike before, it won't be painless dying, with pallative care until the end - it's going to be at maximum pain, with minimal to zero medical support, and will happen YEARS before those people SHOULD die.
a MUCH better idea would be to reform the health care SYSTEM - the one that INSISTS on "heroic measures" for patients who are terminal, "heroically" "saving" them over and over - at HUGE cost - when they don't want to be saved [i've had this happen to ME - i have DNR orders at EVERY hospital in Columbus. i died in surgery - they ignored my DNR. and didn't TELL me i'd "died" until 2 years later - 6 months after the statue of limitations on such things ran out... but i was charged for it! it cost more than the SURGERY! and the insurance didn't want to pay it, because of the DNR, so it's on *ME* to somehow pay of this $200,000 of "saving my life", a thing i'll quite literally never be able to do]
an overhaul of the system, to cut costs where they SHOULD be cut - it should NOT cost $150 or $200 just to see a doctor for 5 minutes. but it DOES. it shouldn't cost $3000 for my fentanyl patches, GENERIC - but it does. it should cost $10,000 or MORE to get an MRI - there isn't an MRI unit in Columbus that hasn't been paid off, at this point they ONLY "cost" to an MRI is the power used and people running it - and the people running BILL SEPARATELY.
but people scream "Free Market" - which is shorthand for "all the customers can pay". health care SHOULDN'T be run on a "free market" plan, at least not an unlimited, unmonitored free market plan. do you know how much a GENERIC ASPRIN costs in a hospital? $2o dollars. the oxy i get each month, for about $150 for 120 - so they cost $1.25 apiece from the pharmacy - cost $50 dollars PER DOSE if one is in the hospital.
why?!?!?! there's NO NEED for it.
[cont]
just being IN the hospital, if you do nothing else, costs around $500 a day - for LESS ammenieties than one would get at a hotel 6. why? because all hosptials charge the same, so everyone does it, and WHY?
ReplyDeleteto make more money. they don't NEED to make more money - every freaking year, every freaking hospital in Columbus has to start a new program with all the money they've made, they MUST find something to spend it ALL on, because EVERY hospital is a "non-profit" and isn't ALLOWED to turn a profit - so they waste millions, every year, making new parking garages and similar, because they OVER CHARGE for everything, and HAVE to get rid of the excess.
why not just lower prices to the point where you DON'T have to create hasty parking garages to NOT make money?
it makes NO SENSE, and THAT'S what needs to be fixed - and, instead, we're being offered vouchers that won't do a DAMNED thing except insure that ALL our treatment will be done on an emergency basis - which not only COSTS MORE, but costs TAXPAYERS more, because poor people like me can get all that ER care for *free* because i'm disabled and poor [and old people are old and poor] and so you'll end up paying MORE for other people's health needs than if medicare were just left the fuck alone.
Apparently, according to unrr, a world where the richest country in the world can guarantee basic health care for it's senior doesn't exist.
ReplyDeleteI guess countries like Canada, Sweden, uk, etc. Are just fantasies or nations in an alien planet. Forget seniors and the disabled, they manage to provide basic healthcare for all ( even foreigners visiting them).