Do you make more than the median? Seems like you do. Would love to see any links saying the OWNER of a business is making less than an average working guy.
http://www.gaebler.com/Small-Business-Failure-Rates.htm 2 out of 3 of those scenarios suck. 2 out of 3 of those scenarios makes less than the average guy. Breaking even means no money, never leaving a negative earning scenario means losing money. I guarantee you that the people making no money and negative money would be super happy with your median amount.
Oh god is this that crap that the Small Business Association uses? Yeah I remember this during the whole "Joe the Plumber" shenanigans. By their definition, Wachtell, Lipton, Rosen & Katz, LLP the nation's premier corporate law firm (200 partners/owners, with 400-something employees in the form of associates & support staff) is a small business. How many small businesses do you know that did nearly $1 billion in annual profits in 2008?
Ok so do you have the number for median? No? Just to be clear you still are saying business owners make less than the median amount correct? And that one of your justifications for NHS is to help them make more.
i will accept any definition of small business you want. I agree that small business is a crap term to get people out of paying taxes. SMALL BUSINESS SMALL BUSINESS. It gets used as a slogan like save the children for whatever the current cause is. Then it was to be against tax hikes. Now it seems to be healthcare. Isn't the current standard for medical coverage 25 employees?
This thread has gotten pretty long, but I just want to make a couple points on some of the salient topics. (As a disclaimer, I'm a doctor nearing the end of my specialty training) 1. It's true that drug prices are ridiculously high, but this is generally true only for "new" drugs that are still on patent. You guys have probably seen lots of promotions for $4/month prescriptions, and if you look at those lists, they are all for old generic drugs. Patents are a carrot stick given to pharmaceutical companies to provide them financial incentive to invest in R&D for new drugs. The large majority of expermiental drugs never make it to market, but if you can harvest a winner (i.e Viagra or Lipitor), you can make billions of dollars of profit for years until that patent runs out. One of the problems with our country, which is fed by both physicians and patients, is that everyone wants to use the "latest and greatest" drugs, which are by definition, the most expensive. The phenomenal job done by drug companies to amrket their drugs directly to consumers has fed into this, as it empowers patients to coem to doctors requesting specific drugs by name. Physicians are often unwilling to make a patient unhappy in fear of losing them and since there is rarely clear evidence that one is better than the other and the drug company has given the doc some free samples, they go ahead and prescribe the new one. This model explains the financial success of US drug companies and the skyrocketing costs of drugs in this country. One thing medical institutions try to push is relying on "evidence-based medicine" and encouraging traing physicians to learn and use generic drugs, which often ahve much better afety profiles due to their long track record, equal efficacy, and obviously lower costs. 2. It's true that doctors generally do pretty well in terms of money, but there is huge variability across the different fields and different parts of the country. Basically, for every neurosurgeon or radiation oncologist that pockets over a half million a year, there's a dozen general practitioners who make much closer to $100,00/year. And academic physicians (those who work for medical schools) tend to make much less than those in private-practice. I think there is some room to perhaps make physician pay more equitable and provide more incentive for people to become general practitioners, but the the profession is already starting to drag down under the weight of the unbelievable length of training, increasing debt accumulated during that time, poor re-imbursement, and high malpractice rates. I don't think most people realize that the training for physicians includes paying $25-$50K/year for 8 years of college and medical school and then an additional 3-7 years of post-graduate training (residency, fellowship) during which they are paid $40-$50K/year to work 60-80 hours per week. Bottom line, it's not nearly as profitable or glamorous to become a doctor these days as people make it out to be. 3. I think the fundamental problem with the out-of-control costs of health care in this country is that everyone, rich and poor, wants to have the highest level of health care possible for themselves, but no one, rich and poor, can pay for that themselves much less seem willing to pay for others. However, no single person, rich or poor, wants to hear that a test or treatment is not being offered to you because you can't afford it. The reality is that America and the medical profession here prides itself on not turning away providing health care to everyone, regardless of ability to pay. So while "the haves" have some access to shortcuts and frills due to having private insurance, "the have-nots" which include those on Medicaid and un-insured end up being shunted into the public health care system (i.e county hospitals like LBJ and Ben Taub). In the end though, even those without insurance, tend to get the same tests and treatments, but the bill comes to the taxpayers, which is all of us. As pointed out by others, care for the have-nots tends to be more expensive because the patients are sicker, have less resources for ancillary care, and the system is underfunded and less efficient. So unless we are willing to turn people away or ration care, which goes against our values, we need to find a way to make high-level health care more efficient so that the total cost to our society can be more manageable. 4. Health care is expensive in general, but it's also variable. Most people don't realize that ~60% of health care costs are associated with 2 unique periods of life, the beginning and end of life. If people really knew how much it costs to keep a 23-week premature baby alive or a 90-year terminally ill patient on a ventilator alive, they would be shocked. You'd be tempted to say it's not worth it to keep a premature baby who likely is going to die or be brain-damaged and on a ventilator for years alive or a to extend the life of a 90-year old patient who is demented, has kidney failure, hypertension, and just had a heart attack and is going to die either now or in 6 months. If it costs a $1 million to keep those patients alive, you could make a case that it's not worth it to society to shoulder those cost. But if it's YOUR baby or YOUR grandfather, would you be as callous? Would you be willing to go into bankruptcy to pay for the treatment if insurance/society said no? Just an interesting ethical dilemma that affects this debate in real ways. I'm running out of room to discuss the solutions to this dilemma, but I'm a believer in universal health care, more efficient drug development, and looking into ways to make beginning-of-life and end-of-life care more reasonable. I'd love to hear some feedback.
Good post moonnumack. I’m Canadian and this is perhaps even a bigger issue here with our health care system. It’s the end of life issues that interest me as I don’t think I would favour cutting back on beginning of life medical care. I have wondered about the idea of not having our Medicare pan cover certain procedures after a certain age, say 75. You’d want to phase this in, but the idea would be that a person would have their whole lives to either save for this kind of end of life medical coverage, or perhaps pay into some kind of special insurance fund to cover it, or decide that they were prepared to not spend that kind of money on services that would probably only extend their lives a few months. This way when/if the day comes everyone is prepared for the decision that’s been made. With this kind of advanced thinking and planning I think a lot of people would be very content not having these very expensive procedures. And if they had made the decision that they wanted to extend their lives as long as possible whatever the cost then they would have had time to prepare to pay for it through savings or some kind of insurance. This seems fair to me and I think the general public would accept it.
Regarding life expectancy and mortality rates: I think it's more accurate to view these as indicators of a nation's overall level of HEALTH rather than level of HEALTH CARE. Even so, it's still not entirely accurate to conclude healthiness(?) from mortality rates either (war, violence, natural disasters, acts of God, acts of Man, lifestyle, genetics, among other things come into play). Don't get me wrong, though. I do understand that access to health care can and does indeed affect how healthy you are and how long you live. But, access to healthcare is only one factor out of MANY factors, known and unknown, that contribute to mortality rates. Let's look at infant mortality. It is true that US rate of infant mortality is very high in comparison to other economically advanced nations. Per this government source (LINK), infant mortality (primarily due to LBW - low birth weight) is significantly higher among American minorities. You might theorize that it's because they're possibly poor and may not have access to good care. Strangely however, even among the equally disadvantaged, "Poor birth outcomes for homeless women are worse for homeless women of color .... About 22 percent of black and 16 percent of Hispanic homeless women had LBW babies compared with 5.4 percent of homeless white women. " That's a big difference and it suggests there may not be a direct correlation between an American mother's economic status and infant mortality. Also, "augmented prenatal care does not reduce LBW in poor black women." So, even given additional and, perhaps, better health care, there was no improvement in LBW outcomes. From what I can tell, the research is still very limited, but what's available does not indicate a clear causal link between limited access to health care and infant mortality. But what about infant mortality in general? I mean, even if you look at just infant mortality among white Americans, it's still higher than other advanced nations isn't it? What explains the overall very high rate of infant mortality? .... My guess is that maybe Americans are just less healthy. Maybe we eat too much, play too much, pollute too much. Most likely, I think it's a combination of many factors, of which socioeconomics (including access to healthcare) is only one piece of the puzzle. While I'm on the subject of unhealthy Americans: In this capitalist market-based health care system of ours, it's probably logical to conclude that the major impetus driving up the price of health care is simple supply and demand. Naturally, more unhealthy people should lead to greater demand, leading to higher prices and longer waits. Nationmaster (LINK) indicates we are #2 (among nations with available stats) at going to the Doctor eventhough it keeps getting more expensive. Only the Japanese go more often (boy, do they ever go more often), but their system is heavily regulated with tightly capped fees. Here's some really telling data (LINK). As of 2003, we did not have nearly enough hospitals compared to much of the developed world. No wonder ER's are over-crowded. No wonder hospital stays are enormously expensive. Any plan for universal healthcare will need to address this supply and demand issue. America needs to build more hospitals, educate and produce more health professionals, and encourage preventive health to reduce our unhealthy population. Somewhat off-topic: Nationmaster stats (Link) show US & Mexico lead the world in child deaths from mistreatment. Shame on US.
I've always thought the problem with the american healthcare system was over usage but most people argue that if we had better preventative care that we wouldn't have the the issues paying for expensive procedures. I don't know, it may just go back to we're an unhealthy nation. Another interesting statistic on that site you linked is doctors per captia, cuba and russia were number 2 and 7 and the united states is number 52. now I can understand cuba, maybe poor but its small. but russia?
I thought this was a good read yesterday in the ol' chronicle. And some interesting comments from another forum I frequent.... Just throwing them out there for perusal.
Lowering the Cost of Health Care by Ron Paul As a medical doctor, I’ve seen first-hand how bureaucratic red tape interferes with the doctor-patient relationship and drives costs higher. The current system of third-party payers takes decision-making away from doctors, leaving patients feeling rushed and worsening the quality of care. Yet health insurance premiums and drug costs keep rising. Clearly a new approach is needed. Congress needs to craft innovative legislation that makes health care more affordable without raising taxes or increasing the deficit. It also needs to repeal bad laws that keep health care costs higher than necessary. We should remember that HMOs did not arise because of free-market demand, but rather because of government mandates. The HMO Act of 1973 requires all but the smallest employers to offer their employees HMO coverage, and the tax code allows businesses – but not individuals – to deduct the cost of health insurance premiums. The result is the illogical coupling of employment and health insurance, which often leaves the unemployed without needed catastrophic coverage. While many in Congress are happy to criticize HMOs today, the public never hears how the present system was imposed upon the American people by federal law. As usual, government intervention in the private market failed to deliver the promised benefits and caused unintended consequences, but Congress never blames itself for the problems created by bad laws. Instead, we are told more government – in the form of “universal coverage” – is the answer. But government already is involved in roughly two-thirds of all health care spending, through Medicare, Medicaid, and other programs. For decades, the U.S. healthcare system was the envy of the entire world. Not coincidentally, there was far less government involvement in medicine during this time. America had the finest doctors and hospitals, patients enjoyed high-quality, affordable medical care, and thousands of private charities provided health services for the poor. Doctors focused on treating patients, without the red tape and threat of lawsuits that plague the profession today. Most Americans paid cash for basic services, and had insurance only for major illnesses and accidents. This meant both doctors and patients had an incentive to keep costs down, as the patient was directly responsible for payment, rather than an HMO or government program. The lesson is clear: when government and other third parties get involved, health care costs spiral. The answer is not a system of outright socialized medicine, but rather a system that encourages everyone – doctors, hospitals, patients, and drug companies – to keep costs down. As long as “somebody else” is paying the bill, the bill will be too high.
There was more: The following are bills Congress should pass to reduce health care costs and leave more money in the pockets of families: HR 3075 provides truly comprehensive health care reform by allowing families to claim a tax credit for the rising cost of health insurance premiums. With many families now spending close to $1000 or even more for their monthly premiums, they need real tax relief – including a dollar-for-dollar credit for every cent they spend on health care premiums – to make medical care more affordable. HR 3076 is specifically designed to address the medical malpractice crisis that threatens to drive thousands of American doctors – especially obstetricians – out of business. The bill provides a dollar-for-dollar tax credit that permits consumers to purchase "negative outcomes" insurance prior to undergoing surgery or other serious medical treatments. Negative outcomes insurance is a novel approach that guarantees those harmed receive fair compensation, while reducing the burden of costly malpractice litigation on the health care system. Patients receive this insurance payout without having to endure lengthy lawsuits, and without having to give away a large portion of their award to a trial lawyer. This also drastically reduces the costs imposed on physicians and hospitals by malpractice litigation. Under HR 3076, individuals can purchase negative outcomes insurance at essentially no cost. HR 3077 makes it more affordable for parents to provide health care for their children. It creates a $500 per child tax credit for medical expenses and prescription drugs that are not reimbursed by insurance. It also creates a $3,000 tax credit for dependent children with terminal illnesses, cancer, or disabilities. Parents who are struggling to pay for their children's medical care, especially when those children have serious health problems or special needs, need every extra dollar. HR 3078 is commonsense, compassionate legislation for those suffering from cancer or other terminal illnesses. The sad reality is that many patients battling serious illnesses will never collect Social Security benefits – yet they continue to pay into the Social Security system. When facing a medical crisis, those patients need every extra dollar to pay for medical care, travel, and family matters. HR 3078 waives the employee portion of Social Security payroll taxes (or self-employment taxes) for individuals with documented serious illnesses or cancer. It also suspends Social Security taxes for primary caregivers with a sick spouse or child. There is no justification or excuse for collecting Social Security taxes from sick individuals who literally are fighting for their lives. And there is this: http://www.lp.org/issues/healthcare Today, more than 50 percent of all healthcare dollars are spent by the government.
Ahhh. Thanks for that, Art. None of those bills will do anything to solve Ron Paul's own statement of the problem: Tax relief? How could that be viewed as anything but "somebody else" when the country is already defecit-spending out the wazoo? How does that even remotely encourage the aforementioned groups to keep costs down? Heck, I'd argue Ron Paul's "tax relief" a sly version of the very socialism he decries... I like the "negative outcomes" idea though...
I always think the two should be viewed in tandem - it's incredibly wasteful to have a system that provides top flight, yet incredibly expensive, emergent care but little to no preventive care, or that will not do routine screenings yet order a battery of redundant tests whenever a problem becomes apparent (headline today, 50 percent of all scans are unnecessary). The two are inextricably linked in real life, so I really think they should be discussed together. I think people get caught up in their reptilian brain here, it's like with SUV's and people buying into the myth that they are safer than smaller cars. Sure a big heavy SUV may seem safer, I mean look at the damned thing. Of course, it also makes you a lot more likely to get into an accident due not just to moral hazard but because it doesn't handle as well.
So basically, you don't want to pay the costs (via your tax dollars or time) for those who can't afford insurance? Am I reading your post correctly? Your argument seems to be "I have a job and can pay, so why should I have to pay more or wait longer so everyone (even those who don't work) can be insured". If I am reading it correctly, am I to assume you only think those who can afford it should be able to receive medical attention? I also think your argument would change if your coverage weren't as good or you had a major medical issue and could no longer pay. The fact that you can't get proper medical care unless you can afford it is asinine to me. I finally saw Sicko last night. So how much of the movie was accurate? There is so much spin these days (from both sides) that I don't know what to believe. My fiancée watched the movie with me (3rd yr med student), and she said most in her field would prefer to work in the Euro system if their focus was on patient care, as opposed to money. But then again she wouldn't mind making a little less if everyone could get medical care. Hmm, I wonder if those govt sponsored foreign systems would pay off her student loans?? If so I may start the first Rockets fan club in London....
Why? Health care is a service like anything else in the world. Food isn't free either. You cant go into Kroger and start stealing hot dogs and band-aids. Cutting edge medical treatment is anything but a basic human right. We should get the gov out of health care to make it more affordable for all.
The govt. is barely in health care as it is. Healthcare isn't affordable, and removing the govt. completely isn't going to make it more affordable. IT's going to mean a lot of elderly citizens can't afford medical coverage and prescriptions. Please elaborate on how you thing removing govt. will make it more affordable. Also to clear up some things, govt. does indeed make sure that food is affordable for everyone. Why can't they do the same for health care.
I already wrote plenty about how government involvement caused health care costs to rise. Corporate farmer welfare also destroys the markets.
Everyone should have the right to health care, especially children. FYI, the govt does try to provide food to those who can't afford it....i.e. welfare/food stamps.
