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Prescription drug bennies...(29 posts)

Prescription drug bennies...BikeViking
Jun 18, 2003 4:55 AM
I have a question regarding the role of government in all of our lives...

Now that this HUGE prescription drug benefit is sure to pass into law, where do the government giveaways end? As with prescription drugs, a "reasonable" case could be made that ALL people also need adequate housing/clothing/food..should the gov't provide that for those in "need"? Being that there is no means test for the new drug benefit, those in "need" really means everyone.
The reason this will pass is easy...Dwayne Barry
Jun 18, 2003 5:35 AM
the AARP is a very effective lobby group because old people vote, not because congress is concerned with the "needy". What's really sad is that so many conditions that drugs are used to treat (often with undesirable side effects, or even side effects that other drugs are required to alleviate) were preventable or are reversable via good diet and exercise (and weight loss), yet doctors don't even go that route with patients most of the time because they know it is largely hopeless.
Why aren't liberals screaming about this handout to the rich?Continental
Jun 18, 2003 7:03 AM
If the "rich" get a tax break, the liberals act like food is being stolen from starving children. But if the same "rich" get included in a government welfare program, the liberals laud the progress towards their utopia. It's all about expanding government and achieving the liberal socialistic agenda. It's almost funny to think about wealthy older people taking tax money (or placing a deficit on) younger middle class families while the Democrats blithely smile.
Because they are oldmoneyman
Jun 18, 2003 8:08 AM
Old people are seen as needing help, even the rich old ones. The prescription drug / health care problem has so many levels, and lack of political courage to do the right thing exacerbates the problem.

should at least be a means test; this is crazy nmDougSloan
Jun 18, 2003 8:52 AM
If I could just inject some reality here...Silverback
Jun 18, 2003 9:12 AM
Could we ease off the stereotypes and ideology here and look at PEOPLE for a second? I'm going to leave out a lot of dead-certain clincher arguments in an attempt to keep this short, but you're all talking in the abstract, and this isn't an abstract decision.
First, a quick point about the self-inflicted conditions Dwayne mentioned: You're right, I agree--but so what? I'm thinking of my father, who used to run around the block FIFTY YEARS AGO because he thought it was healthy. Embarrassed the crap out of me. He's 6'4" and never weighed over 190 in his life, never smoked, watched his diet, and now has cancer. You can argue (and I couldn't disagree) that he's served his purpose and should be allowed to die--but what politician is going to step up and say, "OK, if your kids are grown and you get some serious disease, society isn't going to help you anymore"?
Moneyman, you talk about the political courage to do the right thing. Who decides what's the "right thing"? You? Doug? Me? On a local, regional or national level? Does Florida, where the average age is about 60, feel the same as Alaska, where it's about 27? Should either be forced to adopt the standards of the other?
Should we drop all health coverage for smokers (OK with me, I'm not one--but then there goes your argument that people have a "right" to smoke)? People who don't wear seat belts? People who ride bicycles on the street, where cars might hit them? You can get your cardio workout in a gym. If you CHOOSE to do it in a more dangerous setting, why should others have to pay for your decision?
You guys are trying to sum up a complex subject with platitudes that are about a half-inch deep. This argument isn't, or shouldn't be, about policies and political beliefs. It affects tens of millions of people. It won't fit in some little ideological box.
Jun 18, 2003 9:17 AM
I think the overwhelming concern is having benefits for people who don't financially need them. Why should taxpayers be paying for Bill Gates' drugs when he retires? It's one thing to grant benefits to those who truly need them, but quite another to pay for care for those worth much more than the taxpayers paying for it.

beg to differfiltersweep
Jun 18, 2003 9:42 AM
That is the EXACT issue with America. We DO need to pay for those that do not need them- we need to pay for everybody. Gate's has done his share of paying taxes (and boosting the economy).

Medical need is relatively fixed and finite, and there really aren't too many Bill Gates floating around. It could be Gates' own choice to "opt out" and not "take a handout," but who are we to decide?

It would eliminate much of the stigma of entitlement programs... no one really seems too concerned about using federal financial aid (granted, it is generallly "need based"- but almost anyone can receive the loans). We need MORE of these types of programs. Open child care subsidies to everyone. People would have a much different attitude about taxation if they felt they received more for their money.
Jun 18, 2003 9:51 AM
So, we overcharge most taxpayers to avoid a "stigma" of accepting an unneeded benefit? Are we getting soft, or what? Maybe there *should* be some shame associated with accepting a public benefit -- then maybe people will be more inclined to provide for themselves than rely on others.

Are you serious? It's really hard for me to believe.

I'm all in favor of helping the truly needy, but that's it. We should do what we can to promote self-reliance.

What do you propose?filtersweep
Jun 18, 2003 1:07 PM
Seniors are a "risk" group- they cannot receive decent benefits at an affordable rate on the private market. Many are not receiving insurance through past employers after a given age.

Are they to pay cash and simply use weak supplemental plans? Most pharmacies actually charge MORE for cash than through HMOs or insurance... it is hardly a sane system in the first place.
help those who truly need it, and only them nmDougSloan
Jun 18, 2003 1:40 PM
But care is becoming so expensive that we all need it...TJeanloz
Jun 18, 2003 1:47 PM
Did you see the piece in the WSJ today about the cancer medication that costs $28,000 per shot? At that rate, just about everybody will need a subsidy. We have to get expectations about quality of care down before we can offer free care to anybody.
agree nmDougSloan
Jun 18, 2003 2:00 PM
beg to differBikeViking
Jun 19, 2003 6:56 AM
WHere do the government gimme's stop? In addition to medicine, we also NEED housing and clothing and food, SHould we provide those things to?

This slippery entitlement slope is not the way to go. I have heard about these medical savings accounts where you can save tax-free, your employer pitches in a given amount and you accrue a financial medical "buffer" to help with the standard expenses.
Your point is well takenmoneyman
Jun 18, 2003 9:52 AM
Especially the one about "trying to sum up a complex subject with platitudes that are about a half-inch deep". That is VERY true, except that I'm not sure that I was being platitudinous. Depends on your point of view, I guess.

The arguement is extraordinarily complex. And while you believe it should not be about politics, it is nonetheless. Health care has become the emotional hot-button in politics, and there is sooooooooooo much money involved, that separating the political, emotional, moral and fiscal elements in the argument has become impossible.

Your post brings up another point that I am not prepared to spend a great deal of time on, primarily because I don't have an answer - Does everyone have a "right" to health care? If so, how much? What about liposuction? Cosmetic dentistry? Elective surgeries and treatments of all kinds? Would we deny them to people simply because they can't afford them? Who wold pay for them?

Political courage is needed to tackle the problem, because no matter what ideas are put forth, there will be those who vilify the proposers.

I don't have the answer. Its a huge problem, and its not getting better. Even a $400 billion Rx program is a drop in the bucket. Its very popular, but it does not solve anything. The problems are systemic, needing systemic change, and not just another feel-good government program.

What is your point??filtersweep
Jun 18, 2003 9:34 AM
First of all, "rich" in America barely covers being a millionaire these days- $100,000/year is still middle class-

"Old people," seniors, whatever you want to call them are not stigmatized like a common welfare recipient. Unless you die you, you will end up "old."

Continental- do you have any relatives that are "seniors" ? Do you have any clue what a joke medicaid is? My parents spend more on prescription drug costs on a monthly basis than most young people pay in rent- FWIW.

All "GROUP" insurance plans are based on group utilization. Even in the private sector, it is the basis of what socialism itself is based on- and the only reason someone gets more out of the program than they pay in is because their MEDICAL (not financial) need is greater. Those with fewer medical needs subsidize those with greater needs. It is "medical Marxism"- with a twist: that all of us may someday be in need.

How many people would actually have the cash lying around to pay for bypass surgery, or a kidney transplant? And I won't even touch the EXTORTIONIST tactics (politely termed "experience ratings" that insurers use to gouge groups/employers in the private sector). It is a racket. I know because I work in the business.

I seriously do not understand why we do not regard our medical care as part of our infrastructure, and nationalize it like the rest of the civilized world.

Ask ANY Republican business owner- any conservative- what THEY think of rising health care costs, and providing coverage for their employees. This is a non-partisan issue.

The trouble with the US welfare system is that it largely excludes "the rich." I've advocated for a European style system where everyone benefits. Regardless of income, many Europeans receive actual "welfare" for staying home to raise children (as one example- AND they are guaranteed their old job back). Post-secondary education is often free. Health care is free. But I suppose you feel that there is too much taxation to realize these goals? All that really matters in money in the pocket, and there are many countries that enjoy a higher quality of life and higher per capita income than the US.

As a more enlightened "liberal" I realize the point of tax breaks for the rich when they do receive a disproportionately low return for their tax dollars in the first place (rather than simply viewing taxation along progressive vs. regressive lines).
Jun 18, 2003 9:58 AM
Should health care insurance be tied to employment? Outside of an artificial tax incentive, what natural relationship is there between health care and a job?

Here's my concernContinental
Jun 18, 2003 12:36 PM
Step 1--Federal government pays prescription drug cost.
Step 2--Cost are too high, so government regulates prescription prices.
Step 3--Pharmaceutical companies don't have profit motive and are effectively nationalized.

You might think this is a good sequence of events. I'd rather have private industry with profit motive developing and marketing new drugs. New drugs are developed for the lucrative American market. The Europeans take a free ride on these innovations.

I've spent enough time in Europe to consider your claim of a higher quality of life under a European system to be a myth. I would prefer a system that helps the needy and lets the rest fend for themselves. If your parents are on fixed income and if they must decide between basic needs and drugs, then government should help them. If your parents live as well as or better than the average American even after paying for their pharmaceuticals, I don't think that they need a government handout.
Step 3--Pharmaceutical companies don't have profit motive and arfiltersweep
Jun 19, 2003 4:43 AM
The FDA so heavily regulates the pharms, and US patent law seriously limits profit windows to the point where the pharmaceutical company has already been SQUEEZED... might as well take it one step further...? Seriously though, it isn't like you can write your own prescriptions anyway. This is designed to be a very controlled market. I'd argue a big issue with pharmacies has been irresponsible "pie-in-the-sky" R&D costs (millions of dollars spent barking up the wrong tree).

Your time in Europe? There are already parts of almost every major city in the US that look like a third-world nation. It is all what you choose to look at.

Sure, people in Europe may need to be on a "waiting list" for non-emergency "routine" medical procedures, but I'm not talking about former Soviet republics where you need to bribe the nurses to receive decent care, tip the doctors, and bring your own medications and wound dressing.

On another note: these pharms are motivated solely by profit. There is nothing nobel about them... when you see full-page ads marketing anti-depressants for "social anxiety" and so on? Just watch daytime TV and you'll know America is a nation of hypochondriacs!
I agree with much of what you sayContinental
Jun 19, 2003 7:57 AM
I worked in pharmacuetical dosage form development for 7 years. One of my projects was to develop a potassium supplement that did not cause ulceration. I was perplexed that people wouldn't just eat a piece of fruit and drink a glass of skim milk. Our society's healthcare approach is a "take a pill make it better" instead of a "live a healthy lifestyle." My guess is that more than half the drug sales in the U.S. are unnecessary and that people would be better served by diet, exercise, and positive attitude. I have the same frustration when I go into a grocery store and see 10,000 food products when people should eat vegetables, fruits, whole grains, fish, legumes, soy, and maybe a little meat and dairy. Society whould be better off if 9,900 of those 10,000 food products didn't exist. And then I drive home and see people driving 2 ton SUV's that get 10 mpg, when they could be driving hybrid cars getting 50 mpg, conserving resources and reducing pollution. So, would we be better off if government decided what drugs we should have, what we should eat, and what we should drive? I wouldn't want to live under that system, although you could argue that most people would have a much higher quality of life.
"higher per capita income than the US"TJeanloz
Jun 18, 2003 1:44 PM
I hate to be the nitpicking economist, but according to the world bank, using the old methodology, the US is 7th in the world in per capita income, behind Luxembourg, Leichtenstein, Japan, Norway, Switzerland, and Bermuda. Four of those countries are biased upwards because of their generous banking laws. Under the more accurate PPP (which holds constant for purchasing parity), the United States is third, after only Luxembourg and Leichtenstein. France, for example, has a PPP that is 30% lower than the US'.

In a European style system, everybody doesn't benefit, everybody is equally badly off. Furthermore, if the US wanted to nationalize healthcare, we would have to accept the fact that we would need to lower our healthcare standards. One of the reasons American medicine is so expensive is that everybody has access to the very best care in the world - something that could not be provided under a nationalized system.
What is your point??BikeViking
Jun 19, 2003 7:04 AM
The basis of your argument (as I see it) is that Government knows better what to do with the money YOU earned. The tax rates in Europe are astronomical when compared to US raes. Plus, a lot of countries (after years of giving out the "goodies") are figuring out they cannot afford it anymore as the worker/retiree ratio is getting smaller. The elderly want their "stuff" because they paid for those that came before them, but the younger workers don't want to pay for this growing elderly population because their taxes are going through the roof to support this larger elderly population.

No one has your best interest TRULY at heart except yourself. No politician can ever replace that.
Clean out your earsfiltersweep
Jun 19, 2003 7:19 PM
The basis for my argument that as a RISK GROUP seniors are a serious problem for health care. Either they are healthy and don't want to pay for coverage they don't need, or they have high need and are priced out of anything useful to them. GROUP insurance is based on group utilization. There really is no critical mass available that can sustain affordable useful coverage.

"No one has your best interest TRULY at heart except yourself. No politician can ever replace that."- I agree with that, however sometimes the good of the group needs to take priority over the good of the individual. We do live in a society after all...
Clean out your earsBikeViking
Jun 20, 2003 5:15 AM
"I've advocated for a European style system where everyone benefits. Regardless of income, many Europeans receive actual "welfare" for staying home to raise children (as one example- AND they are guaranteed their old job back). Post-secondary education is often free. Health care is free. But I suppose you feel that there is too much taxation to realize these goals? All that really matters in money in the pocket, and there are many countries that enjoy a higher quality of life and higher per capita income than the US".

With the things you listed that are "free" (paid for by the excessively high European taxes)it is safe to say that a heavy tax burden must be placed on the populace to "pay" for these "free" things, as gov't revenue comes from the taxpayer. It seems reasonable to draw a conclusion that you believe the gov't is a better judge of what to do with a large sum taxpayer-extracted money.

I believe the real point of contention is what the "group" should help with and how much the "group" must pay for this "betterment" of society.
Jun 20, 2003 8:06 AM
I guess all this focus on tax is to be expected from a nation born out of "tax revolt." There are infinite ways to spend money, and all sorts of "sort of taxes" (like tuition "increases" at public universities, increases in public transportation costs, etc.).

What does it really matter if you pay higher taxes for nationalized health care, or have a smaller paycheck due to rising health care costs and employer-based health insurance? Isn't "net pay" the only thing that really matters?

I'm not suggesting that the government necessarily is a better judge of what to do with tax payers' money. I am suggesting that the privatized health care insurance industry (much of which, ironically, is "non-profit") is not working as it should.

One might argue that a huge problem is that the government has MANDATED that these private companies provide services to members of entitlement programs (the privatization of medical assistance). Of course the government purchases these services, but these are generally high risk groups and they have high utilization rates. MA often pays for any HMO co-pays, so there are not even any speed bumps from indiscriminantly accessing services (skip the doctor- go straight to the ER for an ear ache type stuff).

The problem with this model of providing this level of health care through the private sector is it drives costs up for ALL members. We are SUBSIDIZING this group through the private insurers as we speak. It already causes the erosion of the benefits we already have.

Everyone is playing this game with one hand tied behind their backs- there is no holistic approach...

I suppose your answer (and it isn't entirely unreasonable in a market economy where goods and services are not a RIGHT) is to deny health care coverage to anyone who cannot afford it? It would certainly solve some problems.
An anecdote...BikeViking
Jun 20, 2003 12:18 PM
No one can be refused health care, the provider is just going to want you to make payment arrangements

I got stuck with a $2800 "unauthorized procedure bill" a few years ago. I didn't have the money to pay it and told them so. I don't know if all hospitals do it, but all they wanted from me was $50 a month. I made my payments, as it was my responsibilty, and everyone was happy.

I cannot even IMAGINE the bureacratic overhead that would be created by nationalized health care.
An anecdote...from hell....filtersweep
Jun 20, 2003 6:54 PM
Now imagine some hypothetical individual with no insurance who is out biking, loses control, and receives $100,000 worth of medical care that was not made with his consent? I've seen all sorts of horror stories in the mental health field where people lose their houses, etc. after they are committed to a psych hospital to the tune of $1000/day (against their will). Is it your responsibility if you did not consent to services you received?

Also, when buying a car, you can cut corners to save money (skip the in-ground pool, for example). You cannot exactly skip out on itemized medical costs (no thanks, I don't need any of the $10 aspirin, I brought my own- or only one nurse in the OR please...). It just doesn't work that way.
Clean out your earsfiltersweep
Jun 20, 2003 11:48 AM
Another issue is that health care is practically part of the infrastructure. It is "free" to use the freeway system, yet the money comes from all sorts of tax sources and there are all sorts of strings attached.

Can you imagine if they privatized roads? On one hand, you could eliminate any speed limits....
Reality will set in once the bill has to be paid...94Nole
Jun 18, 2003 11:22 AM
It happened here in FL with the class-size amendment in our most recent general election.

Sounds good. Smaller class sizes. More teacher-student interaction. How can that be bad?

More classrooms needed. More schools needed. More teachers needed. Less funds for music, art, etc. Those programs are being killed all over. The cost is huge.

But people vote on emotion and do not rationalize the cost of such "great-sounding" ideas. Politicians seek to stir that emotion to get elected. The results of emotional voting are very expensive.

So, too, will be the prescription drug program. THis will be a huge burden on future taxpayers.