Yes, you is the government since they are teh one’s spending it. IT can’t be the taxpayer because they are not “spending” money. It is being taken from them to spend on a whole bunch of things.
If teh taxpares are voting and want to vote themselves a whole bunch of healthcare goodies, tehn they are essentially voting to spend someone elses money on themselves.
But in a socialized medicine plan, teh patient is never spending any of his own money (not directly, anyway.)
Just imagine the difference in the treatments you would request if you had to write a personal check vs. knowing that anything and everything done for you was completely on the house.
No, they’re voting to spend their own money (taxpayers’ money) on themselves. Why do you assume that they’ll vote for better healthcare rather than lower taxes?
Exactly the same is true of private health insurance.
I imagine that if you had to pay money out of your own pocket every time you needed medical treatment, the treatment you got would be pretty much a function of the level of your private wealth (at the time when you needed the treatment) rather than anything else.
You are assuming that a) they pay taxes and b) that the amount of tax is going to be significant and c) that they plan to use health care that costs about as much as the tax.
Since the top 10% richest housholds pay 90% of the income tax, 96% of the population would spread the remaining 10% out amongst themselves. So a vast majority of voters would really be voting to spend someone elses money. One can assume that those who would be voting themselves the goodies would not have health insurance and would most likely be in the poorest demographic that pays little or no tax. If you don’t have health care insurance, and you want the gov’t to give it to you for free, the benefit to you is going to outweigh any tax increase.
I agree on principal that taxes are the peoples money, but people tend not to think of it this way when they receive teh benefits. Let me ask, do you think that people receiving social services try to save the government money because they feel that they are the government? Do welfare recipients try to scale down what they get to lower taxes?
Sure, those of us who shoulder the majority of the tax burden would vote to keep our taxes lower (well, those of us on the right.) But when the rest are voting to get the goodies, I doubt that they think of it as their money, regardless of what teh Constitution says.
What I’m saying is, I don’t see how your argument about four types of spending applies any differently to a socialised health care system from a private insurance system. In both cases:
Service is provided without payment and payments are made irrespective of whether the service is “claimed”.
The people paying for the service are the people using it.
There is no natural relationship between the level of payment and the level of service: some people pay in all their lives and never get ill, others develop expensive illnesses after only a few payments.
There is an intermediary (insurance company/government) between the person who pays for and uses the service (taxpayer/policy holder)and the service provider.
In my view, it’s item 3 which makes a socialised health care system or an insurance-based system superior to a pay-as-you-go system of the kind advocated in the OP, at least if you are averagely risk-averse.
This may be true in the US, but it’s not true in most of Europe, and in any event you need to look at the total tax burden, rather than just income tax. Even the poorest of the poor buy goods from companies which are taxed which would, in general terms, pass at least some of the benefits on to their customers if their taxes were reduced.
One person, one vote: do the “poorest demographic” really constitute an electoral majority in the US?
Anyway, even if you pay no tax (which, as I’ve pointed out above, almost all of us do directly or indirectly), there’s still an incentive for everybody to seek best value in the provision of publicly-funded healthcare. Every penny that is saved on healthcare is available to be spent on something else: schools, roads, welfare payments, police, defence, the space programme.
You could equally argue that the poorest group, those who are dependent on state-funded benefits, benefit more from healthcare savings since the money is more likely to be passed on as increased benefit payments than in tax cuts. I don’t know whether it is or not, but there’s no a priori reason to assume that one scenario is any more likely than the other.
Well, come on. It still holds. If The Donald buys his nth wife an engagement ring, he pays more sales tax on that one purchase than a whole bunch of really poor people put together. Are you suggesting that the poor pay a larger amount, dollar-wise, of some hypothetical tax than rich people do?
And then:
Depends where you draw your line. The poorest 90 percent definitely have the advantage. Probably even the poorest 55 percent have a demographic advantage, depending on the level of voter participation based on income.
** except that not everyone pays taxes and they pay at different rates. A family making $50k per year is paying a HELL of a lot less for the same service under a socialized plan. Also, under private healthcare, I can choose not to make payments.
** Nope. The richest people paying the taxes that float socialized medecine are probably the people not using it.
**Here I agree. This is called the law of large numbers. The same is true of most every form of insurance.
[b/] Except under socialized care the intermediary has no duty to you, there is no choice of intermediary, and, most importantly, teh governmetn has no incentive whatsoever to remain profitable.
** Huh? So if I pay $10 and can holler and scream until I get $20,000 worth of care, this system is going to be more efficient. Remember, even when you spread out the risk, someone still has to pay for it either in taxes or premium. how on earth does number three make it “superior”?
** Yeah, the poor folks in my neighborhood often keep me up at night as thyy argue over how to receive less benefits so that the government can colonize the moon and fix potholes. I think you and I have a different view of human nature and of how civic minded the poor are.
Socialized healthcare differs from private health care in two important ways. Number one, only people who pay for it receive the benefit. Two, the health insurers must control costs to remain profitable. The government can’t be fired and so does not have to remain profitable.
Sorry, that last paragraph was a mess. What I meant to say was that Private care differs form socialized care in two major ways:
private health care is given only to those who pay, and the price of the policy is the same for everyone.
PRivate health insurers must keep costs down to remain both profitable and competetive. Socialized systems have no such need because a) there is no choice and b) they don’t have to make a profit. If they are in the red, they just raise taxes.
Why, pray tell, is it assumed that people have some sort of “right” to non-emergent health care?
>> Canada’s health care system is a morass of regulation
well, I think that is a common thing everywhere where you have socialized medicine. I have heard some horror stories in Europe and it was recently in the news in Spain that many patients die while waiting for months in long lists for their operations. There is equipment worth millions of dollars underused or unused. The bureaucracy has made the whole system a total waste of resources
I have a recent one which I know first hand:
My friend in Madrid was diagnosed with colon cancer and was to be operated. He was taken to the hospital and made to wait two weeks idly sitting on his hospital bed while waiting for the operation. He was just keeping the bed so it would not be taken. He could not leave during the day or night or he would lose his place in line.
Last week he was operated. Now this is a major operation as you might imagine… two days later they send him home while he has not even begun to recover (they need to have the bed for the next patient to sit on for a while). Today I talked to his wife on the phone and she told me he is quite sick and vomited just a little liquid he tried to ingest. This guy should still be in the hospital!
The whole thing makes my blood boil because he is my good friend but I have to keep telling myself every country has the government and system it deserves and if it is full of idiots who believe father socialist government will solve their problems, then so be it.
I do not know any country that has an effective socialized health care system. I believe it should be private and the government should restrict itself to informational campaigns (Aids prevention, cancer prevention etc) to better educate the public.
People who think they can, on average, get more out of the system than they put into it are dreaming.
One more thing: Contrary to what most people think, individuals pay much more for drugs than health care groups.
In absolute terms, yes, but what about as a proportion of his income/assets?
For the reason I gave in the bit of my quote which you omitted: that you are averagely risk-averse. If you’re not, then it’s inferior: you’d want to take the risk of dying a slow, painful premature death in order to minimise your tax outgoings.
I don’t think we do necessarily have different views of human nature. My point is that it is not in anybody’s own enlightened self-interest for healthcare spending to be any less efficient than it can be. How do the poor benefit from poor value-for-money in socialised healthcare programmes? They don’t. They might not realise that, understand it or attach any importance to it, but it is the case.
Incidentally, I’m not sure that the poor are generally any more or less civic minded than the rich.
Governments that want to get re-elected have an incentive to keep costs (taxes) down while maximising the level of service that they provide.
It looks like this is the root of the problem. There wouldn’t be as much objection to taxation if the US acutally had a middle class. In that ideal case 50% of the population would be paying 50% of the taxes. Instead we have this awful plutocracy where the pseudo-“middle class” have little say in their health care system because of the above reasoning.
**
I don’t see where proportion enters into it. If the Donald “gives” $1,000,000 to the gov’t and a poor person “gives” $100, then the donald is giving a hell of a lot more. In addition, if the poor person receives $10,000 in social services, the Donald is a positive and the poor person is a negative.
No, the non-plutocrats still have less say in socialized health care because they have votes. Teh 96% could easily vote to tax the bajeezus out of teh well-off 6%, which is pretty much what they have done. This is why a small core of people pay the vast majority of the tax.
Is it fair? probably not. But being in that 6%, I begrudge the system very little as it stands. I just don’t think we should have to bear any more. I pay roughly $32K per year in taxes. I think that that is a pretty hefty donation. It doesn’t need to be $40k so that others can forgo the cost of health insurance.
To get back to what started this particular point of disagreement, you contended that taxpayers are spending their own money. Mr. Zambezi countered that since the lower 90% of the population pays only 10% of taxes, then in a democratic system people are really voting to spend someone else’s money. Your question about taxes in proportion to income is tacitly conceding his point.
To my mind, that’s one of the biggest problems with democracy - that a majority can vote to loot the wealth of people who have worked hard and saved their whole lives. To address this, you need a constitutional republic, where the things that the government is allowed to do are spelled out in a contract, to keep the majority from looting. In the US, our constitution is a contract that pretty much limits the government to protecting our liberties. The main reason that I’m against socialized health care is that I feel the purpose of government is to protect our liberties, and paying someone else to look after me is not within that scope.
Mr. Zambezi, what’s with spelling the word “the” as “teh”? I saw another poster at the SDMB doing this, and I can’t figure out why. Your posts seem to be well-edited otherwise, so I’m wondering whether this is intentional, and if you’re making some kind of statement. If so, you might need to explain it to me - I’m kind of slow sometimes. Or is it just finger-dyslexia?
I believe it was C. Northcote Parkinson who, in one of his books, when discussing taxes, said something to the effect that:
(a) There are two kinds of taxes: those that a people vote to impose on themselves and those that a group of people impose on another group of people.
(b) Taxes that people put on their own group are very self limiting for obvious reasons but taxes that one group imposes on another tend to keep growing indefinitely until there is more to be gained by evading the tax than by paying it.
It is well known that many rich people from european countries have gone to take up residence in tax havens. I forget their names now but there was the famous Swedish tennis player, I believe that female Spanish tennis player also took up residence elsewhere, Pavarotty from Italy etc
Citizens from the USA have to pay taxes from all their income world wide even if they reside abroad so the only way to get away from uncle Sam is to renounce their citizenship. A few years ago there seemed to be growing numbers of millionaires doing just that and there was a bill under consideration that would, in essence, impose such a heavy tax on people who renounce their US citizenship that it would almost be confiscatory. I do not remember if it passed but I have not heard about this again.
Of course that is the way to do it legally but my guess is most people in that situation just cheat on their taxes. I would think it is pretty difficult for the IRS to find out you have some investments offshore. The sad part is, at this point, these people are spending their time and energy looking for ways to minimize their taxes rather than to doing business.
BTW, I often make the “teh” typo but I try to correct my messages before posting. I also get “adn” and “i” all the time.
Personally, being a pseudo-middle class citizen, I don’t think the rich are taxed enough. You on the other hand seem taxed quite enough, probably too much. But, unless you take advantage of some serious loopholes in the tax code, I wouldn’t classify you as rich though, but more middle class.
I see it as I think de Tocqueville saw it almost 200 years ago. The tax system should be a way to redistribute wealth to avoid aristocracy, where aristocracy is the atrophy of a Democracy. Unfortunately I think we’re too late, hence the Bushes, Gores, Kennedys, Gates, Forbeses, etc. While the middle-class “right” complain about how the poor rich are being taxed too heavily, the political rug is being pulled from under them. You can see it in things like absolute repeal of the inheritance tax.
What I can’t understand is why many middle-class feel such sympathy for the rich. It seems like anyone who grosses less than $250k a year should want to tax the bejeesus out of those in the upper echelon. The impact on socialized programs such as universal health care is only a side effect of maintaining a rational economic distribution. Sure, there are a few people per capita who would love to swim in a pool of money, but I claim that most people are quite satisfied living a middle-class lifestyle.
for starter, many middle class people would like to make $25k someday and don’t like the idea of having it all taken away when we get there.
But we also oppose it because it is WRONG. Just because one doesn’t wish to take the risks and perform the hard work to make $250k doesn’t give one the right to the wealth of others. Furthermore, it is through the incentive of getting rich that people make inventions, work hard, invest and create business (which create jobs, which create taxable income which feed clothe and shelter countless loafers.)
We should no more make the rich pay for everyone’s healthcare than we should make them pay our mortgage, buy us a car and gurantee us a job. Good God! where did the idea originate that because someone is successful that they should be fined for their success.
CurtC I am a horrible speller. I often forget how to spell “teh” oops, I mean “the”. Is the hule “H” before “E” except after “T”?
Actually, It drives me crazy, but I assume that anyone reading my posts can figure out that it is just a typo.
I think that Tocqueville was talkikng specifically about inheritance tax, though my recollection might be flawed.
CurtC & Mr Zambezi
I’m not arguing about whether or not it’s fair that the rich should be required to subsidise healthcare for the poor. You think it isn’t and I think it is and that’s a different argument, partly about the proper province of government, as CurtC points out. (Incidentally, FWIW, I pay the top rate of income tax in the UK — 40 per cent — so I’m not arguing from unenlightened self-interest.)
I am arguing against the proposition that there is no incentive to seek efficiency or value-for-money in a state-run healthcare system (or for that matter, an insurance-based system). As I have pointed out repeatedly, I think there is.
If efficiency savings are used to fund across the board tax cuts, then the marginal benefit is greatest for the poorest taxpayers: those who are living from hand to mouth and for whom a small increase in disposable income makes a large difference — hence my comment about tax payments as a proportion of income that CurtC picked up on.
If, on the other hand, efficiency savings are used to increase public spending elsewhere, the distribution of benefits will still fall disproportionately on the least well-off: those who claim welfare payments and use other state-run or state-subsidised services like public schools and public transport.
The only circumstance in which the poor do not have a vested interest in greater efficiency in a state-run healthcre system is if they know that any efficiency savings will be used only to fund tax cuts (or specific services) for the rich. Even in that event, they are at worst indifferent towards the level of efficiency in healthcare provision.
Like Mr Zambezi, I rarely find myself kept awake at night by the poor people in my neighbourhood arguing about the best way of pumping more money into the National Health Service for little or no return. Quite the reverse, the quest for efficiency savings in the NHS has become a kind of Holy Grail in British politics and it would be electoral suicide for any politician to say that what was needed for the NHS was more money rather than another round of “reforms” designed to deliver improved efficiency.
In short: Nobody benefits from inefficiency, poor value for money or wastefulness in the provision of healthcare, irrespective of who pays for it.
It’s a red herring to say that public provision is inherently less efficient than private provision and, if I may say so, a dishonest one if your real objection to it is ideological.
The WHO’s World Health Report 2000 has recently found that socialised healthcare systems in a number of countries provide better care, at lower cost, than the US healthcare system:—
The UK has universal healthcare, free at the point of delivery and funded from tax revenue. The US does not.
I disagree. Many middle class people have * fantasies * of being rich, living in castles, owning islands, but very few will actually pursue wealth as a lifestyle. I think it’s because there’s little incentive in being wealthy because of diminishing returns. A truly middle class lifestyle is very enjoyable to most, so why exert more effort? Granted, a few people really desire the power that comes with money enough to let it drive them, but why should the majority “get out of the way”, as Ted Turner says, just to please a very small minority?
You enjoy the fact that others want to gain financial power over you? Personally, I think supporting a tax system that rewards the power-hungry is wrong.
Anyway, I disagree with you that the rich are generally inventive, and hard working. I do agree that they may have made good investments or created business though. To me, it seems as though wealth is 10 percent hard work, 10 percent inventiveness, and 80 percent luck. I say this because if it were true that wealth required hard work and inventiveness, I’d know a lot more wealthy people by now.
My thesis: If we started over tomorrow with clean slate, at the end of the day the wealth distribution of the population will generally be even except for slight abnormalities at the ends. Over time the poor will get poorer and the rich will get richer by economic axioms.
Suppose it costs $10,000 / year to maintain a middle class lifestyle. Those that make less than $10,000 will amass negative equity over time because they will rely on debt. Eventually they will decrease their lifestyle to reach equilibrium. This is lower class.
Those that make more than $10,000 are different. They can reinvest the difference and make wealth with little effort. Since they have no need to live above a middle class lifestyle (because that is the comfort threshold), they will continuously reinvest their excess.
Of course this is where social biology comes in. Even though most of us think of ourselves as Human, a few wealthy think of themselves as Alpha apes. They feel like the working class wants to be ruled and that Uncle Sam is an illusion for their power. They use rhetoric like claiming that the US government is really a Republic or that the Constitution was written to protect them from the looting masses. No, we really are a Democracy, and I don’t want to be ruled by a prehistoric savage. The constitution was written to protect my freedoms—the same freedoms common to all members of the middle class. If you want to be ruled by a despot, then go to Africa.
Essentially why reward good gamblers (the wealthy), while punishing those that work hard and invent (the middle class)? Our punishment comes from long-term wealth stratification where the middle class slowly loses their freedoms.
If you look at the historical record, you’ll most likely find that either individuals with persiverence or corporations with financial incentive spawned the interesting inventions. In many cases you have individuals who created revolutionary ideas, only for those ideas to be stolen from them by corporate executives. Either way, invention is produced by Human nature. I truly doubt that the first human to invent language or clothing or housing charged other to use her ideas.
I’m not talking about punishing success. Success is the middle class. I’m talking about keeping the exuberant rich in check by using the tax code—A side effect being the development of the civilization.
Yes, he was talking about inheritance tax on land ownership. But I’m applying the concept more broadly because in the 1830s there wasn’t the same complex tax system that we have today, nor the large population. But I believe the concept is still the same.
If socialized care is the only choice, then it has to be more ineffecient because it is a monopoly. If there is no incentive for efficiency among the health care providers, what possible reason could they have for being efficient? will they be as efficient as the army? This gets at the heart of a free market economy. If the consumer has no choice and must pay for the services whether they are good or horrible, the health care provider will receive the same pay no matter what type of service they give.
This is dangerous whether it is inexpensive or not. What if the politico do indeed make it a campaign goal to reduce costs. Then perhaps service gets worse and the patients don’t have any choice in the matter. I don’t want to be in a system where my only recourse is to call my local senator and hope that he can effect some change in one of the next 5 legislative sessions.
If there is private insurance as an alternative, then those that buy private insurance are paying twice. I don’t feel like paying for my health care and that of others.
Even if this is the case, the US is a HUGE country. what may work in a country the size of one of our states may very well become byzantian and unmanageable in teh US.
Before you accuse the free market of causing the U.S.'s health care woes, you might want to remember that a large percentage of health-care spending in the U.S. is socialized, through medicare and medicaid. The U.S. also has a very litigious population, and health insurance premiums are skyrocketing. The U.S. has a ‘mixed model’ health delivery system. If it’s broken, it could well be broken on the socialized side.
