How would a Romney/Ryan budget change the funding of dialysis in the US?

[Willis]

I certainly don't have any answers to any of these big and important questions, but it might help if we all remember that Medicare and Social Security are insurance policies that we have been paying for during our working lives.  These are NOT "entitlement programs" unless you think about it in terms of "I bought insurance so I am entitled to reimbursement should I have a claim."  If we allow ourselves to believe that these are truly "entitlement programs", then that becomes code for "money for lazy people who don't deserve anything."

Even IF Medicare and Social Security are insurance they are actuarially unsound and always have been. Any private insurance company that operated like Social Security would go bankrupt. Then, to make things even worse, it was decided decades ago to "borrow" from Medicare and Social Security and use that money for the General Revenue. So all the Social Security Administration has is IOUs from the Treasury. Sure, on paper they "have" the funds...as long as the debtor (i.e., the Treasury) is good for it. But they aren't!

It would be like giving your kids the checkbook to your life savings with the promise that they would pay it back when you retire. You could even make them sign a promissory note and record every withdrawal carefully. But when you need the money, if the money's been squandered and they're bankrupt, all you'd have is the IOUs with no chance of recovery.

And that's just about where we all are now. Sooner or later the rest of the world isn't going to buy our bonds anymore and then there won't be enough revenue for current obligations, much less promised ones.

But back to the main point. Is Medicare/Social Security insurance? No, it's not. Prior to the passage of the Social Security Act the Supreme Court had ruled all government-sponsored or implemented insurance programs as unconstitutional under the 10th Amendment. Between 1934 and 1936 the Supreme Court struck down perhaps a dozen major bills which were passed as part of Roosevelt's New Deal initiatives. The most famous act to be ruled unconstitutional was the Railroad Retirement Act which was very similar--and considered a test case--for the Social Security Act.

With an incredible plan to push his agenda through, after his re-election in 1936, Roosevelt came up with his famous plan to "pack" the court. He presented a bill to Congress in 1937 empowering the President to appoint one additional Justice for every Justice who turned 70 and did not retire, for a maximum of six, which could have increased the Supreme Court from nine Justices up to fifteen. (All loyal Roosevelt supports no doubt.)

This put the fear of God into the Justices sitting in the majority who were in danger of losing their independence. And with that threat hanging over them, the Roosevelt Administration changed their tactics by insisting that Social Security was NOT insurance, but rather was a TAX. (Justice Roberts, incredibly, came to the same conclusion recently concerning ObamaCare.) In Helvering v. Davis the Act's constitutionality came before the Court. Ultimately the Court evaded a definitive ruling as to whether or not the Act constituted insurance (which was considered unconstitutional). The plaintiff (Davis et al) had argued strongly that it was an unconstitutional insurance scheme. The government argued that it wasn't--so if it wasn't insurance it had to be a tax. Yet, the government managed to downplay the tax angle for political reasons while always insisting that it was NOT insurance. The court--with a political gun to its head--voted 7-2 against the plaintiff.

Thus, to appease those advocating for the court-packing scheme, the majority opinion written by Justice Cardozo managed to tap-dance around the issue by ruling that the Social Security Act was within the legitimate taxing powers of the Legislative Branch under the General Welfare Clause. In other words, the Court basically punted in perhaps the most politically influenced case in history. What was said behind closed doors we'll never know, but after the favorable ruling in this case the court-packing scheme went quietly away.


 

[Bill Peckham]

Has Social Security been good for the United States? Did Social Security improve the general welfare? I say yes and am having trouble imagining the alternative position.

Willis this idea that SS just has a bunch of IOUs does not reflect reality. Nor does the idea that US Treasuries are some kind of con.

The Social Security Trust fund has a positive balance, it is in our collective interest to invest that money until it is needed. US Treasuries are the safest investment in the world, by law the Social Security Trust has to invest in treasuries, there is no scam or con. It puzzles me that people who proclaim the power of the free market would scorn the collective wisdom of the market that is currently pricing in no inflation risk. Zero. None. The current yield on a 10 year US Treasury is less than 2% http://www.treasury.gov/resource-center/data-chart-center/interest-rates/Pages/TextView.aspx?data=yield

How can you be a champion of the free market and claim that the dollar is about to collapse and treasuries are worthless IOUs? The market has spoken. Today the US Government can borrow for 30 years for less than three percent. Over a ten year term the market is willing to pay us to borrow. Let me say that again: the effective 10 year interest rate is negative - the rate of interest is below the rate of inflation - the world is willing to pay us just to hold onto their money.

If it wasn't  for the politically expedient debt fetish among the so called free market champions in the Republican Party we could quickly lower the unemployment rate and improve state finances by setting up a municipal lending bank and rehiring the firefighters, police and teachers that have been laid off since 2008. We should be borrowing money and taking full advantage of this historic opportunity.

[Bill Peckham]

PatDowns if you want to compare the NIH to a Federal Health Care system it would be the VA. Like the NIH the VA pays the doctors a salary, the VA owns the hospitals, the VA set the care standards, in other words the VA is the NIH in the US, yet I do not hear the calls from Republicans/Libertarians to privatize the VA. To sell the VA to industry and let our veterans be served by the free market. Why is that? Why would Republicans want to subject our veterans to healthcare bondage? What explains this dissonance in the Republican mind?

And about this 47% concern, who among them should be paying federal income taxes? Active duty military? Retired seniors? People who are disabled? People who are unemployed? Or is it the thirty years of Republican tax policy that you regret and you would like to see the earned income tax credit, and the various child credits rescinded? Or are you thinking about the "162,000 people among the top 10% of earners [who] have found ways to avoid paying any federal income tax. This includes approximately 3,000 people in the top 0.1%, a group that makes $2,178,886 per year or more."
http://www.dailyfinance.com/2012/09/19/mitt-romney-surprising-facts-pay-no-income-tax/

[cariad]

It is my understanding that anyone who doesn't ordinarily live in the UK – including tourists – is meant to pay for any NHS treatment they receive with exceptions being urgent care received in A&E departments or treatment for infectious and sexually transmitted diseases.  Refugees and asylum seekers are given free NHS treatment, but if their application to remain in the UK is turned down by the Home Office they lose the entitlement.   Is this incorrect?

Yes, that is incorrect. I am considered an illegal alien here and when I rang the NHS direct line (thanks, Billy) they brushed off my concerns that a GP would not see me. The nurse's exact words were "You're here now." and that was the end of it. In theory they have the legal right to demand that money back but considering the average financial state of illegal immigrants, I would be amazed if they bothered. Also, the pound amount they would bill you for would look like a co-pay or co-insurance to an American. I probably wrote this before, but when I had labs drawn they warned me I might have to pay for it. I asked if they could give me an idea of cost and the response (after much digging, they really don't know these numbers because they don't need to) was between £30 and £80 pounds. Those labs are billed at $1500 in the US. I never was asked to pay it. Incidentally, I have two friends in the exact same immigration situation as me and they were both treated with no questions by the NHS.

- You fail to mention that in many instances hip surgery will not be an option in the UK.  For older folks and those with certain co-morbidities, they will not be approved and told to stay on pain meds.  Yes, we "pay more" (as individuals, not the collective as in the UK) in the US, but wait times for surgery are usually dependent on when patients wish to go "under the knife," not availability of operating room time and physician availability.

You fail to mention that if you don't have the money or insurance to pay for this, you are not even let in the queue. Of course wait times for certain procedures will be longer when you refuse to turn any human being away. Wait times for child developmental issues, serious mental health conditions, and I'm sure a host of other areas I have little experience with can be shamefully long in the US. People are turned down for surgery all the time in the US and any other reputable country for medical reasons like co-morbidities!

Every one that works full time pays some tax. People who work part time may have to pay a little. Why do you think our country is in such a mess. There are more people taking out than putting in.

Everyone who earns a pay check in the US - everyone - pays federal tax toward Medicare and SS (the payroll tax). Medicare tax is always capped at some stupidly low number like $100,000. That means that the lowest earners take on the greatest proportion of that tax. These are often people who could not get insurance themselves.

I have no doubt that the UK and US are suffering from similar immigration problems. In an earlier post, Pat compared the Grampian region (the US population is 600 times larger than this corner of Scotland) to the entire US. That shows a blatant disregard for mathematics and statistical significance, so I am not sure why I am even bothering with this discussion. People in the UK - Tory, Labour, LibDem, Plaid Cymru, and many other parties overwhelmingly support the NHS and its principles and mission. They are perfectly aware of the American system and have rejected it as a path for themselves. If that changes, perhaps we will change countries yet again.

[billybags]

PatDowns, Are you coping my post?  You little monkey.

[jbeany]

   The quote tags got messed up - I couldn't figure out who was quoting who without carefully re-reading the whole post, so I never fixed them! 

jbeany, Moderator-lying-down-on-the-job   

[billybags]

jbeany, Moderator-lying-down-on-the-job   . I love this.

[Simon Dog]

"They get free dental as well as free prescriptions."

Can you tell us how easy it is to find a dentist in the UK who actually accepts NHS rates?  I've read articles that basically say the only way to get quality dental care in the UK without horrendous wait or access problems is to find a private payment based dentist, and that "national health dentist" (for new patients) is about as realistic as finding a rent controlled apt in NYC.

[Whamo]

I'm told that hemo patients don't make our local hospital money, but PD patients do.