I know someone who started in the bottom quintile and wound up a billionaire first by bootstrapping himself via education and hard work in six-digit salary, then investing heavily in a tiny start up no one had ever heard of called “Microsoft” at an opportune time…
… but even he admits it was luck/fluke that propelled him into the top 0.01%.
So… it can happen that way, too, but it’s rare.
I’m actually pretty sure that the same is true in the US . The column says only that she failed to appear, and it leaves the impression she just never showed up to court at all and the remedy should have been a default judgement. But the opinion piece doesn’t actually say that -it just says she failed to appear in court . After reading your post, I’ve now done some searching and it’s more likely that the warrant was issued because she was found to be in contempt after failing to appear for a debtor’s examination after there was a judgment already entered against her.
I came across a Canadian case where a Mr Nowack spent 15 days in jail because he failed to provide documents at his judgment debtor examination - I can’t imagine his failure to show up for the examination would have been treated much more leniently.
Oh I’m not denying that the democrats are going to talk about it. They love to talk. But there won’t be meaningful action anytime soon.
Even in states with democratic supermajorities like Vermont & California, they won’t pass genuine health reform. They’ll talk about it until they’re blue in the face. But its all just talk.
Gavin Newsom ran on single payer. California has democratic supermajorities in the state legislature (28 out of 40 senate seats are D and 61 out of 80 house seats are D).
But now that Newsom is actually governor, he is walking back his promise. That or he is going to pretend the Trump administration is blocking him (a state needs permission from the federal executive branch to enact single payer) to justify why he won’t actually push for medicare for all. Nevermind that California had a dem governor the last 8 years when Obama was president, and that there will probably be a democratic president in 2021 who will give the go ahead for single payer in California.
You guys assume I’m being ignorant. I’m not, I’m being realist. The democrats are trying to walk a very fine line of *pretending *they support progressive policies without actually having to enact them. They can’t keep the charade up forever because the voters will eventually wake up to it. The democrats wouldn’t even pass a public option, medicare Rx negotiation or allow Rx importation in 2009 or 2010 via budget reconciliation. It would’ve only taken 50 democratic senators out of 59-60 to pass any of those, and the democrats refused to do it. What makes you think they’ll pass single payer if they won’t even pass those?
I’d love to be wrong and be proven to be a cynical asshole.
But for now, I think ballot initiative is about the only real path towards single payer on the state level. Democrats are just pretending long enough to keep their voters in the voting booth, then coming up with excuses for why they can’t do it when in power.
Technically that counts as owning a business though since he bought stock in the company. My impression is that to become a member of the true rich you need to either work in finance or own (or possibly run) a business.
Survinga, you and I have had this argument several times before, where you insist that UHC can be achieved under the present system “by just plugging up some holes”. The system is so dysfunctional that certainly all kinds of things can be imagined that will improve it. But can any reforms under the existing structure actually take the US to the same health care performance as the rest of the industrialized world? How about you tell me how the following can be achieved under the present system without fundamental change:
Costs. The US system is by far the most costly in the world on a per-capita basis, yet its outcomes are no better than other advanced countries that do the same thing at half the cost or less. How are you going to address costs?
Administrative overhead and paperwork. Every insurance company is an independent business and has its own administrative systems and criteria. Moreover, the system has become so complex now that there are huge areas of overlap – basic private insurance, Medicare, supplementary insurance, etc. – all different, all with their own forms and procedures, and God help you if you forget to cross a “T” or dot an “I” the wrong way when filling out a form – the whole thing will of course be rejected.
Bureaucratic meddling and denials. Every single claim is adjudicated by insurance administrators who intrude between patient and doctor, and their plain objective is to save money by finding ways to reduce or entirely deny the medical payout. This would be considered unconscionable meddling in civilized countries, and deprives patients of clinically guided treatments in favor of corporate cost savings. And the ultimate irony is that patients actually PAY for this overhead, an overhead that is totally to their detriment. But insurance companies, as businesses, can argue that they’re fully justified in running their health insurance businesses according to conventional insurance practices. Too bad that it just doesn’t work for health care, not in any ethical or moral sense that would be acceptable anywhere in the civilized world.
Are you proposing to have the present conventional risk-rated model or a community-rated model of health insurance, where in the latter everyone pays the same and everyone gets the same coverage? If you want community-rated, the insurance companies will vehemently oppose it as unjustified interference with a private business – and understandably so, since they are corporations established for the sole purpose of making money. If you want risk-rated, then you have to also support the previous concept of “bureaucratic meddling and denials”, because risk-rated policies are inherently conditional – you don’t get covered if, say, you failed to disclose a pre-existing condition.
This is just quickly off the top of my head and just the tip of the iceberg, but it’s already getting long so I’ll stop here. Perhaps you can begin to see that the problem with the existing system is not going to be solved by “filling some holes”, since the entire system is just a bunch of giant gaping dysfunctional holes.
Contrast just the above points – and there are many more – with how it works in the single-payer system that I’m used to. When I go to the doctor I may or may not have to present my health card – usually I don’t, because they already have it on file. You may wonder what comes after, but the answer is that nothing comes after. That’s it. I see the doctor, then I go home. Same with a visit to the hospital, whether it’s ER or whether I get admitted. That’s the last I ever hear of it. The provider submits an electronic invoice with a procedure code and gets reimbursed for it, which has nothing to do with me.
Failing to show up for court does not create a debtors prison. If she went to jail for not paying, that would be a debtor’s prison. People should not be able to disrespect a court by throwing a summons in the garbage can and not showing up whether that be a civil or criminal court.
Cool. While we’re taking about things that should not be, ambulance rides to the hospital should not cost thousands of dollars.
What is the proper cost? They are on call 24/7, they keep stock of varieties of medicines and expensive equipment and have trained personnel on staff.
I think you would pay something similar for, say, a team of lawyers to come out immediately and in the middle of the night at a seconds notice.
Before you say it should be free, then keep in mind that someone has to pay, even if it is the taxpayers.
I was going to comment on that, but never got around to it. $3000 for an ambulance ride? Here in Ontario, out-of-pocket costs for the patient for ambulance transportation are fixed at $45, and the Ontario health plan covers the rest. Furthermore, in many cases even the $45 is waived.
This does not apply if some jerk calls for ambulance transportation to a hospital and obviously does not need it, as determined by the admitting doctor. In that case you get hit with the full awesome amount of up to $240. But $3000? The only way to explain the $3000 charge is: that’s US health care.
You might be right. But there has been a shift on the Dem side in the rhetoric since 2016. What was seen as crazy-Bernie stuff is now mainstream talk on the left. Part of that from watching Trump try to decimate the ACA, and watching Hillary lose to Trump even though she campaigned on keeping the ACA and not doing single-payer.
Also, I don’t think you’re giving credit to how huge the ACA itself was as a huge shift in health insurance in the US, as it’s responsible for reducing the uninsured population by about 20 million people. And that’s including sabotage actions by SCOTUS, red states, and then Trump himself. If the law had been implemented as it was originally intended, with each state actively running its own website and doing outreach, with all states taking the medicaid expansion, I think we’d be even further along than we are. Even with the sabotage, there’s still exchanges that are running as they should and standing up with multiple insurers involved.
How much does Ontario pay? Someone is paying.
You and I have been over this many times for sure.
My issue is the politics of the changes, and the disruption. As I’ve told you before, I just don’t think our congress will put together a good, clean, well-run single-payer system. And I would likely be one of the losers if that happened, because I have very good (and affordable) private insurance through my employer, with reasonable co-pays and no hassle on claims.
You bring up a lot of good criticisms of our system. But I think in this country, the way forward to UHC is some sort of mix of private and public. And yes, it will require some community-rating, which the ACA mandated on the exchanges. I think the next step is to get Medicaid expanded in all states, and then increase subsidies across the board so that middle-class people who don’t get insurance through work can afford the exchange policies easier. Some states might need to pursue public options. Some states will need to re-establish the individual mandate penalty. It’s all a matter of price points and penalties. Blue states will have to lead the way, and then the red states will follow.
The next step is to go after drug prices. That can be done without going to single-payer. But it will take federal action, likely. Example of something that could help alot of people: selling hearing-aids over the counter.
Nothing is easy in the US political environment. But we can incrementally make improvements.
I didn’t say free. But while you were listing the costs you failed to include the insurance industry. They get a teensy cut.
Even with a public system, you are going to have employees processing claims and examining submissions for fraud. In any third party payer system, I don’t see how you avoid this.
Snip.
And this hits the nail on the head. Most people are happy with their private health insurance. Before Obamacare, something like the high 80% of people were happy with their current health insurance.
The issue is how to provide care to those that are not getting it. When most people are happy, why throw a bomb into the middle of the entire system?
You don’t get to choose the system anymore. The Insurance companies and their lobbyists have sewn it up.
Then we can just close the thread, right? No need for debate since every Congressperson has been paid to keep the current system.
But in case that is not true, we can pass laws regulating the insurance industry instead of completely destroying it. I have never once argued for complete free market laissez faire capitalism with no restrictions or no consumer protection laws.
My main complaint about health insurance is that it insures too much. You cannot insure against things like doctor visits and contraception anymore than you insure against gasoline in your car. That is a ridiculous cost increase and deadweight in the system to insure against known events. This deadweight loss would be in any public system as well.
Indeed, 15 to 20 percent according to an editorial I read just today coincidentally.
Here is California, private ambulance services receive $1800 from private insurance per trip, $250.00 from Medicare, $100 from Medi-cal, and zero if you can’t pay or don’t fall under some covered category i.e. illegal alien. So private insurance subsidizes public health insurance and helps pay for the safety net.
Private ambulance services bid to operate in a specific area. So the above charges reflect the best deal you can get in California. If some Canadians want to open up an ambulance service and charge us $240 per trip, I’d welcome them with open arms.
Would you kindly link to your source for those reimbursement numbers? TIA
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