Get News & Views Updates
Most Popular This Week
- Senate Votes to Extend Sweeping Bush Era Surveillance Powers
- Six Weeks After Reelection, Obama Sells Out Liberal Democrats
- The Only Way Left to Beat GOP Fanatics: Call Their Bluff and Go Over the Fabricated "Cliff"
- The Financial Elite's War Against the US Economy
- New Year’s Revolution: Connecting the Dots, Coming Together and Fighting Like Hell
- Six Weeks After Reelection, Obama Sells Out Liberal Democrats
- The Financial Elite's War Against the US Economy
- Revealed: How the FBI Coordinated the Crackdown on Occupy
- Senate Votes to Extend Sweeping Bush Era Surveillance Powers
- New Year’s Revolution: Connecting the Dots, Coming Together and Fighting Like Hell
Popular content
Today's Top News
Insurance Execs Not Happy with Vermont's Single Payer Ideas
Harvard Professor William Hsiao is a single payer supporter.
Twenty years ago, he helped push through a single payer system for Taiwan.
And now, he wants to do something similar in Vermont.
Over the past couple of months, Hsiao has been working feverishly – with a team of 20 researchers – to finish a report to the Vermont legislature on how to best implement a single payer system for the state.
Yesterday, he delivered his 132-page report.
And at the beginning of his one hour presentation to the legislature in Montpelier, he made it clear that “what I’m going to present is not necessarily popular for everyone.”
“Recently I was talking to an insurance executive,” Hsiao said.
“And I asked him if he was in favor of spending $50 billion to manufacture a new shuttle to the moon.”
“And he says – yes, if you will go.”
That got a chuckle out of the gathered legislators.
But clearly, the insurance industry is not at all pleased with Hsiao.
They are watching events in Vermont carefully.
The newly elected Governor – Peter Shumlin – ran on a single payer platform.
Shumlin said that in his first conversation with Hsiao last year, Hsiao told him that he had “given up on America.”
“I told him we are Vermonters,” Shumlin said. “We think independently. We take care of each other, and we do things that others dare not do.”
The Vermont legislature tasked Hsiao with putting forth and analyzing three proposals.
A pure single payer government run system.
The current system with a public option.
And Hsiao’s preferred system – a single payer system run by an independent board.
While Hsiao is not explicit about this in his report, the bottom line is clear – under Hsiao’s single payer proposals, the private health insurers in Vermont would be out of the business of marketing and selling basic health insurance.
That’s why the insurance industry would prefer to see Hsiao headed to the moon than on the ground speaking before the Vermont state legislature.
“Our analysis of the three health insurance companies with significant operations in Vermont – Blue Cross Blue Shield of Vermont, MVP, and Cigna – was much more limited than our analysis of other groups, partly because much of Act 128 has fairly clear implications for those companies,” Hsiao writes in his report.
“It is reasonably safe to assume that health insurance companies would oppose any major health system reform that reduces their autonomy in financing and paying for health care, increases government’s role, and/or introduces new competitors to their market.”
“However, given Vermont’s history with reforms such as guaranteed-issue, community-rating, and the Blueprint program, it must be noted that the remaining health insurers in Vermont – especially those run as non-profits – are likely more accustomed and potentially more open than insurers elsewhere to working with state-led regulations. In addition, a continued market for supplementary insurance would generate ongoing opportunities for private insurance in the state.”
“It is possible that one or more companies may be interested in partnering with the state and substantially reforming their business model in order to continue to operate in Vermont.”
And in fact, Vermont’s largest insurer – Blue Cross Blue Shield – with 75 percent of the state’s health insurance business – signaled yesterday that it might be interested in taking Hsiao at his word.
“If there’s a single payer system, we’d like to be the single payer,” Leigh Tofferi, the Blue Cross-Blue Shield lobbyist in Vermont told vtdigger.org.
But Hsiao warned of another possible insurance industry reaction.
“Of course, the opposite is also possible – that an industry with deep pockets nationally will oppose reforms due to the threats they pose to the Vermont market and other markets that could follow Vermont’s lead,” Hsiao wrote.
There’s not a mention of the report in today’s big three newspapers – the New York Times, the Wall Street Journal or the Washington Post.
Early indications are that supporters of a pure government run single payer system are willing to accept Hsiao’s public/private compromise.
Physicians for a National Health Program’s (PNHP) Deb Richter told vtdigger.org that while a government administered system “makes the most sense in terms of good policy,” the system doesn’t have to be controlled by the government to be effective.
And PNHP’s Don McCanne said that “although advocates of the pure single payer model will find some problems with this report on a reform proposal for Vermont, there is very good news in this analysis. The report emphatically confirms the superiority of the single payer model in ensuring that everyone is included while containing health care costs.”
“One very serious deficiency is that they decided to leave in place Medicare and Medicaid, primarily because of existing barriers to move them into a single payer system,” McCanne wrote. “Thus their proposal is not a single payer system. Leaving these programs in place sacrifices some of the important single payer efficiencies.”
“Within the next couple of days, we’ll have a clearer concept of where the single payer community should be on this report. Tentatively, it seems that it deserves our support, but support that is qualified by strong advocacy to make it right by such measures as including comprehensive benefits, and rolling in and eliminating Medicare and Medicaid,” McCanne said.
Governor Shumlin’s office is reportedly drafting legislation that will be introduced soon.
Clearly, Shumlin hasn’t given up on America.
Or at least on Vermont.
Comments
Note: Disqus 2012 is best viewed on an up to date browser. Click here for information. Instructions for how to sign up to comment can be viewed here. Our Comment Policy can be viewed here. Please follow the guidelines. Note to Readers: Spam Filter May Capture Legitimate Comments...
94 Comments so far
Show AllI would think that leaving Medicare in would make a single payer system more viable. Older people make more claims. Wouldn't that make single payer for the rest of the people cheaper?
Shumlin and Hsaio better be hiring somebody to start their cars in the morning.
Indeed, the Health Insurance companies might prefer sending Hsaio
to the moon that way....
drosera,
What the author means by sacrificing efficiencies is that having the separate systems would cost more just in overhead costs alone. You now have to have two sets of staff to process claims and payments and handle all the other things required to run such a system. And since the elderly still receive care, it still has to get paid for - only now you have to add in the cost of a separate accounting system.
The thing about making single payer cheaper for those who are not elderly misses the entire point about single payer. The reason single payer can provide "cheaper" care is that it spreads the costs among the largest group possible - the entire population. As soon as you start taking groups out of that large pool, one of two things has to happen, either those removed from the single payer pool go without insurance altogether or administrative costs to pay for health care have to go up (you now need separate administrative systems to pay for each of the groups care).
Hope this helps.
Insurance premium costs (medical, auto, you name it) are based more on the size and composition of the POOL than any other factor. Generally, the more people in a POOL and the lower their average age, the lower the premium costs.
Today in the US there are great variations in costs because there are great variations in the size and compositions of the tens of thousands of POOLS.
Premium costs for Federal employees are relatively low because there are millions of people in their POOL.
Small businesses have few people in their POOL and either cannot get insurance or pay high premiums.
Single-payer would create a POOL of 308 million people with an average age of 32 , so premium costs would be very low.
The insurance executives have nothing to worry about. States are now prohibited from enacting single payer of their own.
Is that law constitutional?
Mandating that we do commerce with certain private companies in unconstitutional unless I'm mistaken.
We already have laws mandating all drivers buy auto insurance.
The difference is that the law does not require that all US residents drive cars. You have the opportunity to chose whether to drive on not. With the individual mandate the only way to opt out without paying a fine is suicide.
My understanding is that you pay a tax not a fine. Maybe that is a semantical issue but it makes sense. If you don't have coverage and end up in the hospital the government ends up with the bill. So a tax on the uninsured defrays that expense.
And yes suicide is one way to get to one of the inevetable things in life. And the earlier in life that you do that the less affected you will be by the other inevetability.
Me, I just pay my taxes. Heck even the boatman on the River Styx charges for his services. Even in death there is no free ride.
My 2 cents worth. NPR was saying that if you made so little that you did not pay federal income tax then you don't have to buy health insurance, and if you were something like 150% over the poverty level you didn't have to buy it. Also if it would cost you more than something like 6% of your income you don't have to buy it.
Its free expanded Medicaid coverage for up to 133 percent of the poverty level. And there is a sliding scale advancable subsidy for up to 400% pf the poverty line. But yes, you do still have to "buy it." But you won't have to "buy it" if you have employer-provided insurance. Isn't that most most people who have full-time jobs?
And finally, it will not prevent its future replacement with single payer at the state or at the federal level with HR 676. The completely separate issue of politics is preventing single payer. Vermont, hopefully will lead the way out.
Why, at this late stage, are so many presumably highly politically informed commenters here still so unaware what benefits are in the health care bill?
Good question, Sabocat. I for one would like to read an article on who exactly will be covered by this. Do you have a link? Most of the articles I see don't go into the details.
The boatman too? According to who? And does he accept checks?
And it is this difference which justifies requiring everybody to have health insurance. One can opt out of using a car, but one cannot opt out of using the health care system. If you have a medical emergency and are unconscious, you will be taken to an ER where doctors will treat you.
In this way, we are all participating in our health care system. Therefore, just as the government legally requires that everybody participating in driving a car have insurance, it seems like this would be tantamount to requiring everybody to have health insurance.
It is also this difference which justifies setting up a Medicare for all system, which is the only way to universalize heathcare access AND lower per capita costs, but unfortunately Obama was too timid to take on the insurance industry. There is also one huge difference between auto insurance and health insurance: the former is affordable by most everyone, the latter is unaffordable to most people. So I just don't see any legal or moral justification for requiring people to pay for health insurance, when health insurance does not do anything to promote actual delivery of health care--it is just a big unnecessary TAX on all of us. We should get rid of this costly and unnecessary middleman by eliminating the insurance industry as a requirement. Let those who prefer to pay 10 times more for their healthcare retain their private insurance. Free the rest of us from this ball and chain.
Yes, we have mandated auto insurance, and to make it affordable, we also require auto inspections first. If the vehicle isn't up to safety standards, then it doesn't get insurance. If we did the same in the healthcare business, we would have a 2 tiered system:
first you enroll everyone in part A which gets them an evaluation an into the system. If they "pass inspection" then they can become eligible for part "B" which is full coverage so long as they continue to pass inspection. Passing inspection means that as far as those conditions which are within the person's control are concerned, the person is behaving. eg. non alcoholic, not drug dependent, not obese, fit, etc.. If society can form a risk pool for autos, then they have to meet inspection for being road worthy.
If citizens want society to form a risk pool for their health, then they have to take responsibility for their wellness. It is fair, and is the only way to finance the system without going broke.
I have a new used car that hasn't been inspected, and I'm insured. So there is no requirement that a car be inspected in order to get insurance. You seem to be favoring some kind of means testing for health insurance coverage. I think that is a slippery slope. Who will have the power? Are we going to say, "Oh, you're a drinker, no health care coverage for you?" or "You smoke. No health insurance for you." And to deny coverage to obese people is cruel. We need to universalize coverage via Medicare for all, and that will lower the per capita costa of healthcare dramatically. We need to stop thinking like 'The Man' wants us to think. There is no scarcity when it comes to funds for healthcare. There is plenty of money. Sure, we should promote wellness and prevention too, but not through coercion based on fear of not being covered.
Wouldn't that be challenged in the Supreme Court? Oh wait, if that's the case, we're still screwed.
It is being challeneged and will end up in the Supreme Court, however the Supreme Court is stacked with pro-business judges who will likely uphold the individual mandate.
Is that part of Obamacare? Are you sure?
Obamacare prohibits states from starting their own single payer system until 2017.
2017 is a long ways off and what if the prohibition gets extended to something like 2020, 2030, or just made permanent?
No "what ifs" about it. Obama's plan is to make the ban permanent.
Kucinich tried to push for it as part of Obama(Romney)Care and Obama killed it.
This is interesting, I did not know and have never come across it. Can you give links and more information so I can read it myself? Thanks
http://wonkroom.thinkprogress.org/2010
/04/27/single-payer-erisa-vermont/
"States are now prohibited from enacting single payer of their own."
Maxpayne, where can I read up on that? I think there might be some misunderstanding, having to do with getting any federal funds, those that are presumably available to subsidize insurance for those who can't afford it.
Anyway, let me know.
Thx
It has been mentioned on this site and a lot in other places. One link I posted in response to sivasm. I'm still going to find the full text of that bill and pick out that section where states are prohibited so I can let everyone know.
In the mean time, one good reason people say it is because of an unsuccessful attempt at an amendment to allow states their rights to provide their citizens a single payer plan.
http://www.huffingtonpost.com/2009/11/05
/pelosi-single-payer-amend_n_347017.html
State single payer is supposedly prohibited by the 1974 RERISA Act, not the healthcare bill. But it has never been actually challenged in court. The healthcsare bill will allow exception starting in 2017.
Considering that the selection of Bush in 2000 still seems like yesterday, 2017 does not seem too long off to me. And of course, the law could be changed.
If the 1974 ERISA Act is responsible for prohibiting state wide single payer, then why did states try before Obamacare passed? I should be asking about the suspicious timing of 2017 but I just found out that it gives enough time for these "exchange" programs to make state wide single payer difficult. I have to find out more on it but something's wrong here.
Bernie Sanders, our Senator, is seeking an exemption for the State of Vermont, to allow the state to make single payer possible as a model to see if the plan has merit. It very well may happen.
I would love to see Vermont adapt a single payer model, it would be nice to see if it is competitive or if it proves to be inefficient when compared with other models.
I think the states should be free to develop plans that match the political will of their constituents. Maybe a more libertarian New Hampshire can come up with a free market alternative and over a 20 year period we could see which had the better track record. I hate when the federal government puts us in a "one size fits all" "shut up and like it" box regarding services.
One last thing is the money for state programs should be100% funded from that state's revenue, not subsidized from another state or the federal government.
"Maybe a more libertarian New Hampshire can come up with a free market alternative (to Vermont's single payer) and over a 20 year period we could see which had the better track record."
You must be from a foreign country. That is not how we do things in the USofA, especially on our political right. We just dream up a political stance that has little or no basis in reality, then argue endlessly that that stance is correct no matter how much evidence there may be out there showing it is not.
Hello NC Tom
So true regarding how our political process works (on all sides though), which is why some (myself included) support states having the ability to offer competing solutions to complex problems.
First off, and foremost, there is NO such thing as the "free market", never has been, never will be. It's a fallacy, a fake, a chimera, it does NOT exist. What that really is is a code word for "the big get bigger, everyone else falls into subservient line". Get over it, it's a lie.
Secondly, a HUGE number of state programs of all kinds get federal money. And if you want to get real about that as an idea, then we will have to reapportion the money that the red (the so called "free market") states get from the feds. They take in more than they pay out.
Finally, there are examples from all over the world that the single payer system is the ONLY one that makes sense. What we do in this country costs us DOUBLE what the next most expensive country pays, and whereas they are in the top 5 of outcomes, we are in the mid 30's. Hell of a deal WE'VE got! Meanwhile, the insurance companies, which do NOTHING but fight you to NOT pay off and write a check when they DO pay off, take 30% off the top of EVERY dollar you pay for health care. They don't provide a single aspirin or fix a single child's boo boo. ALL they do is take your money and reward themselves hugely for doing the least they possibly can. We are the ONLY industrialized country in the world that allows it's people to go broke, bankrupt, or die for lack of MONEY given to the check writers. How can single payer NOT be better?
Take away the profit and get people health care. Our businesses won't be saddled with that cost, so they can be more profitable MAKING things, putting people back to work, returning the 47,000 FACTORIES that we shipped off to Asia during W's administration. It will be cheaper and more efficient, because it's NOT paying for the head of United Health Care to get paid $100 MILLION a year, and that is just ONE company. How much can we save if we don't pay ANY of them their profits for you just to survive?
Hello WJM
It is true that if three capitalists get together they will conspire to drive up prices (Human nature is fallen) and has been recognized as such for generations. However, all politicians share the same fallen human nature as the capitalists and serve themselves and their institutions in the same manner as any capitalist. Second, my interactions with corporations is still voluntary for the most part, (I voluntarily pay for the goods and services corporations provide, and in almost all instances the options and choices I make are my own and the choices are many. I have never had that same level of service from the government, they tell me what services I must purchase and they tell me what I will be paying for those services. If I don't like it, I can leave the country or I can go to jail.
I am just more pro choice than most I guess.
Two your second point, I guess I didn't make myself clear. The states should have great latitude in the providing of services, and the federal government should not subsidize a state's services (red, blue green, purple or yellow make no difference).
According to the WHO the USA was ranked a decent amount higher before the federal government got into the healthcare business via medicare and medicade. In my opinion the USA will fall further and its citizens lose freedom because of the current healthcare laws. All the while the government will tell us what a great job they are doing on our behalf, and if not for them things would be much worse (see fallen human nature).
http://www.worldlifeexpectancy.com/country-health-profile/united-states
Once again I wasn't telling you how your state must provide necessary services on the contrary I am pro choice. I was asking that our citizens stop telling the rest of the country how and which services to provide.
Liberty, think for a second. Under single payer, the govt doesn't tell you ANYTHING about what goods and services are covered; your doctor does. Why? Because all doctors are paid on a fee-for-service basis by a govt-based health plan. There are different ways this plan could be administered, but several things should be noted:
1. You do not have more "choice" now under private insurance. You have less and bean-counters are dictating them, not doctors.
2. Medicare overhead is about 3%; private ins overhead is about 30%. Is the illusion of choice worth so much you are willing to give up $0.30/$1.00 to maintain it.
3. Costs are low under single payer because it contains the largest possible pool and therefore the widest possible shared risk. Costs are also lower due to the reduction in office overhead necessitated by the endless expensive legal and financial squabble between doctors, patients and insurance companies over what's covered.
4. Under single payer, you eliminate the employer mandate - another cost savings and a benefit to companies that compete against companies in single payer nations.
5. Under single payer, you could reduce tort lawsuits. If I am injured, I do not have to worry about going broke to pay for my treatment; single payer pays for it. So I am considerably less likely to sue everybody in the picture for money to pay for health care (that's why people sue after accidents). You could even put limits on tort claims based on the available remedy of single payer.
6. Under single payer, you could eliminate worker's compensation and just roll it into the Medicare-for-All system, keeping the "no-fault" umbrella for workplace accidents but otherwise eliminating the entire burdensome WC parallel medical-legal apparatus, thus saving millions.
So, to summarize: premiums go down, bankruptcies and hassles go down, coverage goes up, your neighbor is covered and less likely to sue you, your boss doesn't have to pay, so has more money to keep you employed and nobody comes between you and your doc! And it all costs LESS! What's not to like Liberty? What "choice" are you losing here?
Three SUPER CHEERS for jareilly !
I've worked in health care for 40 years both in the 'free market' based 'system' and in the UK's National Health Service...before it was canabalised by Thatcher to feed private enterprise. I have no choice which Md I see over here if I want my employer 'provided' insurance to cover, the MD has to be 'in network' or I pay a bigger co pay...! Recently my working hours were cut in half jepordising my heatlh insurance coverage, COBRA is available but with the reduced hours I have to choose to pay the rent NOT the health insurance. Health insurance MUST be separated from one's place of employment. There can be no real choice if the insurance plan chooses who you can and cannot see rather than an indivial patient choose for his or her self. How many people are working in a dead end miserable job just because they have some semblance of insurance? I would be quite happy to be mandated to pay a reasonable sum for coverage if I knew that if I lost my job, changed jobs and could honestly choose my own MD (as one still can in Europe) and not loose coverage. Why in the world would we want to leave it up to individual states to have their own programs....what if you live in one state and work in another, move from one state to another what happens your coverage?
This whole conversation about choice is a red herring that is so old now it sticks.
Single payer universal coverage
Hello jareilly
1) How can you say pay this or go to jail is choice? How can you say this is your coverage today, my regulators and my governmental bean counters will tell you what you will be paying and what we will be covering at a later date with no alternative other then leaving the country is choice???? Example when I started paying into SS the government told me I would get full benefits at 65, later they said sorry, we changed our minds, the bean counters said not enough money, keep paying in though or we will jail you…. With a stroke of a pen the government can take everything that we paid and return nothing to us, and millions of our fellow citizens left and right would cheer because it would mean more for them……
2) If Medicare/Medicaid/government healthcare is a great deal then few would opt out, either way, let the people make the choice with the money that they earn. Please don't take it away from them and tell them what they are going to get and what they must pay under penalty of jail. For goodness sakes even the corporations don't do that (although they would if the could).
3) If single payer is so good and efficient, other states will adopt that model, why do you need to force the population into this at the federal level if it will prove itself valuable???
4) The choices I am losing, (to name just a few) are the choice to opt out at my discretion. The choice to look for a better deal and stay a citizen. The choice to spend my healthcare dollars as I determine most appropriate. The choice to determine the % of my income that will be spent on healthcare. Many citizens would accept the responsibility and consequences of those decisions.
No one ever answers the question that leads me to believe that our Government is nothing more than a corporation with nuclear weapons. How is the human nature of politicians different from the human nature of corporate executives? Tell me why they do not share the same self serving interest and will not throw the citizens under the bus to save their hides or that which they have created? Somehow progressives believe that politicians should act for the public good and want to give politicians vast powers to do good, and then are surprised when the very same politician throws them under the bus for a more powerful political constituent.
To climb to the top of a corporation or a government; you have to be ruthless, you have to be vain enough to be comfortable knowing that decisions you make could destroy people's lives or livelihood. You have to be comfortable deciding who wins and who loses. You have to be willing to destroy or slander your competitors. You have to value the corporation or government more then the time spent with loved ones and kids as your time with them will be short.
Single payer allows MORE choice.
It a fallacy suggesting that one has more choices if they have to choose between going hungry for a week or paying the heat for a week. So too with Single payer.
I live in Canada and have these choices.
I can CHOOSE to leave my job and am still covered.
I can CHOOSE to sleep in the streets and am still covered.
I can CHOOSE to move to another Province and am still covered.
I can CHOOSE to put those extra dollars into a savings account instead of my health care premiums and am still covered.
I can choose to be self employed or a farmer and am still covered.
I can CHOOSE to enhance my coverage with "extra insurance" such as private hospital beds and the like and am still covered.
I can CHOOSE to spend extra cash instead of waiting for non critical surgery and am still covered.
If I had a family and CHOSE to stay at home with my kids , my kids and myself are still covered.
I do not have to wait on an INSURANCE company to tell me whether a procedure covered or whether I have a "pre-existing" condition thus making my insurance useless.
I have far more in the way of choices and no matter how much YOU shop around, you will not find a health care choice cheaper then my own.
I do not agree with all your statements but;
If it works for you, Fine, Good for you, Be Happy, I am glad you like your choices.
My request is that you insist on allowing others to decide for themselves if a governmental service is good for them or not.
"That service is so good, I'm going to force you into it and tell you what you are going to pay for it" is just plain wrong and messed up.
"My request is that you insist on allowing others to decide for themselves if a governmental service is good for them or not."
Done and plenty of polls come out in favor of asking government for service, not to be confused with government invading people privacy. By the way, a couple who wanted to start a small business locally with my help and my wife's got sick and ill and their parents and in-laws in Canada brought them home. They promise to come back if things get better but their elders have been telling me the benefits of being self-employed or small business owners in Canada vs the US. If the couple finds out, I wouldn't be surprised if they come back and move out to Canada. I'd move to Canada but colder weather isn't something my wife or I can handle well.
xcellent, you don't choose for me and I won't choose for you. Now all we have to do is convince the masses. If the masses were convinced, the political elite and corporate executives would have no choice but to follow.
Liberty,
You wish to pay more for health care because you want to buy expensive "insurance" that you can afford or that your boss can.
Good for you. Please don't force your choice on me though.
I can afford "insurance" but I do not enjoy paying twice as much for healthcare as people in other countries. Because of what I pay for insurance and the little I get in return, I sure would like to do other things with my money than waste it on the insurance industry's profit line.
Could you please point out which of GWNorth's statements you do not agree with and why?
Liberty, I share your chagrin over the behavior of many US elected officials. The track record is not stellar. However, the responsibility for the kind of government we have rests with the people and their consent. We are allowing that power to be eroded while we squabble over how to pay Master, when we keep enabling corruption by reelecting it and not exercising our power.
Hello donnalou
My wish is for all of us as individuals, that we have the power, and option to choose among competing public and private sector options to acquire services that best meet the needs of our families. I would force nothing on you; I see no reason why government can't supply a service to compete with private sector companies (a third party needs to monitor accounting so that gov can't rob one budget to create an unfair advantage).
Would you extend the same to me?
I disagree with GWNorth because of what he can't do.
He can't choose to opt out.
He can't choose what portion of income to spend on healthcare.
He can't choose to not be covered.
There is no competing service provider with which to compare services.
If he goes for something extra, he still has to pay what the regulations say.
I don't see one size fits all as a positive thing.
I think we are setting ourselves up to be like the horse from animal farm. Pull the plow for as long as we can, and when we need the government's help, they will send us to the glue factory. I know that is what a corporation would do, but human nature dictates the actions of both, government is a corporation with nuclear weapons.
Of course I can CHOOSE to opt out! I can CHOOSE not to use the Medical system at all. I am not forced to use it.
My tax burden is marginally higher then your own. Indeed if you look at just the health services paid by YOUR Taxes for things like medicare/medicaid and the like and compare it to the portion of my taxes that pay for my health care they are almost indentical!
Now you can take the path of the Libertarian and suggest there should be NO taxes collected by government for ANY health care at all and every user should pay for the same out of their own pocket...But that would only drive your premiums higher (as the elderly or sick that Private insurance does not cover now go into the pool) OR would mean you leave millions of Americans without any care at all.
Now YOU might thing it "freedom" to allow a sick neighbor to die because they can not get health care, or a child to die of ill health simply because s/he lives in poverty but *I* do not.
One more time being forced to CHOOSE between getting Medical aid or paying the rent is NOT FREEDOM. It is not "free choice".
I did not know that you can opt out of the Canadian healthcare system. How is an individual's burden to the gov reduced should one opt out of the service they are providing?
Your earlier statements sounded to me a lot like having herpes. No matter what you do, no matter where you go, the service and the burden you pay stays with you (once you got it, you can't get rid of it.) Now that you mention it, it also sounds like a stalker.
Voluntary exchange is such a better way to go as opposed to forced inclusion.
We don't have the option to opt out of Social Security, Medicare, Medicaid or the like. Our government can change what services are covered, and how much we are going to pay for those services with the stroke of a pen and we can do nothing about it. There is little innovation and no competition as they have a Monopoly on those services (they will even continue to extort money from us if we decide not to use a service).
You are correct about taxes, direct taxation is immoral. We used to have terrible things like indentured servitude and slavery down here; where we took 100% of the fruit of one's labor, now we settled on a smaller percentage and use the term paying your fair share. (Somehow taking 100% of a persons effort for desirable services is immoral and taking 20% to 40% is social justice).
I would much prefer a sales tax. It is voluntary, the wealthy purchase more and so would pay more. Also when direct taxation was not allowed, our government got into a lot less wars. Ever since we started paying our fair share, our government starting using that share to pay for military excursions. Public services should be voluntary and fee for service.
How is the human nature of politicians different from that of the corporate executive? You correctly will not trust a corporate executive who captures no more then a miniscule portion of GDP and has competitors, but will trust politicians with Monopoly power, police power, and capture 25% or more of GDP?