We're drifitng way, way, way off topic here, even if it's a good discussion. I'll say this about health care and no more...
DaveK's "humility" comment is closer to the mark than you think. My sister's a health care professional, an administrator to be specific, and she's told me there's been plenty of times in her own clinic where people could have been helped sooner but just didn't want to ask for assistance or just didn't know help was available. Certainly "one swallow does not a summer make" but the incidents are there.
Secondly, in an ideal world health insurance shouldn't be non-profit but we don't live in an ideal world. Possibly treating health insurance as public utilities used to be treated is the solution. Utilies, i.e. water, gas, electric were essentially monopolys because it was the only efficient way to deliver the services, attempting competition would have caused chaos. So, public utility commissions were set up to regulate same businesses, ensuring they made enough profit to stay in business but not so much they became abusive of the monopoly status.
One thing is certain, there's no easy answers here.
Phoebe, that is why it should have been mandatory that people could keep their insurance after leaving a job by contuing the same payments as the employer paid.
In Israel, my "Kupot Holim" (translation, sick fund) costs me about $70 a month, $840/year. It covers almost everything. Except that occasional visits for a check-up or a diagnoses require a payment of $7.00 to the apointment. I have had two emergencies since being here, and both were covered completely with timely and excellent treatment in emergency rooms. In both cases, however, I refused ambulance care and insisted that a friend drive me in his personal car instead. (One of the Yeshiva students was an ambulance driver and wanted to use his ambulance, which was the emergency care unit at the large assemby where the accident occured.) Without my asking, the student stayed with me through the whole treatment process. In one case he was wearing civilian clothes, in another case he was on leave from his reserve duty and was wearing his army uniform. In this case, the diagnoses was at the Mt. Scopus Hadassah hospital and the treatment at the other end of the city at the Ein Kerem Hadasah hospital (where the famous Chagall stained-glass chapel windows are), and the hospital insisted we use their bus, not my friends car, between hospitals. So he went witih me on the hospital bus. And in the evening we went back by public transportation to the Mt. Scopus hospital to fetch his car and get to the Yeshiva in time for dinner, but treated ourselves to a light rail ride on the way without going out of the way.
Both accidents required face stitches. But the first was not that serious and was handled at the emergency treatment facility close to the Central Bus Station, without needing to go to Ein Kerem. In the second, before the diagnoses, they were shure a bone was broken, but it was not.
I joined the "Kupot Holim" when I first moved to Israel and studied at the University on Mt. Scopus. It was a requirement; they require their students to join. The University has switched to a different Kupot Holim, but I stayed with the one I had joined. I have not asked what students at the University did.
I suppose it will qualify as mandatory health insurance and save me from any fines or extra taxes under Obamacare.
Very few people who find themselves suddenly and unexpectedly unemployed can afford the COBRA rates for their insurance. I have very good health insurance. If I had suddenly lost my job, it would have cost me more than $1,000 per month to keep that insurance. Suddenly unemployed people are usually more focused on not losing their house than their insurance.
My personal feeling is that they should have just put everyone in Medicare or Medicaid, depending on their financial status and let the Insurance companies write Medigap policies.
That said, we have taken this thread too far off topic, so I am done with this discussion.
Dave
Lackawanna Route of the Phoebe Snow
But Dave, you make me ask the question, do you mean that your employer pays more than $1000/month of health insurance for each employee? Or does the insurance company just charge a lot more for an individual than a group? (It could not under the specific circumstances under my reform.) If you have to pay $1000 if you were a student and I pay $70, I must be getting one huge bargain! And I am 82 and I was 64 when joined the plan.
Dave K: Why insist on private-only for those residing in the US, when you take advantage a state-run plan in Israel, thus paying a paltry $70/month?
C&NW, CA&E, MILW, CGW and IC fan
Because I do not use any state-run plan, i use a state-licenced and regulated plan. I do not know how much if any the state contributes to each of the four private doctor-run cooperatives. These are available to all Israeli citizens, and to foreigners who pay a bit more, unless they are registered students, where all students, foreign and citizens pay less. My cooperative is Miuechedet, meaning special. Another is Klal, meaning for everyone. There are two others, and the four compete with each other in service and price. They all have their own pharmacies. Major hospitals, all of which do receive some government funding and also raise money as charities, have relatons with all four of the cooperatives. Some major specialists are independent, but will accept the plastic cards of any of the four, bill the appropriate one for services, and charge the seven dollar extra for their services. Miyuechedet and Klal both have buildings in the Eastern part of Jerusalem where Arabic is the main language of signs and conversation, and both have built or converted new ones in the last year. But one can meet Arab doctors in any of Miuechedet.'s facilities. Their buildings are of course only for outpatient services, with no beds or operating rooms, which are what the hospitals provide.
What you pay is designed to cover only a portion of the actual costs. Israel has always had a national health plan, primarily funded by the state, ergo, "socialized" medicine. You seem oblivious of this and oppose a national health plan in the US, yet you enjoy the benefits of one in Israel.
http://en.wikipedia.org/wiki/Health_care_in_Israel
"The National Health Insurance Law (1995) set out a system of public funding for health care services by means of a progressive health tax, administered by Bituah Leumi, or the National Insurance Institute, Israel's social security organization, which transfers funding to the Health Maintenance Organizations according to a certain formula based on the number of members in each fund, the age distribution of members, and a number of other indices. The Health Maintenance Organizations also receive direct financing from the states money."
"Israel has maintained a system of socialized health care since its establishment in 1948, although the National Health Insurance law was passed only on January 1, 1995. The state is responsible for providing health services to all residents of the country, who can register with one of the four health service funds. To be eligible, a citizen must pay a health insurance tax. Coverage includes medical diagnosis and treatment, preventive medicine, hospitalization (general, maternity, psychiatric and chronic), surgery and transplants, preventive dental care for children, first aid and transportation to a hospital or clinic, medical services at the workplace, treatment for drug abuse and alcoholism, medical equipment and appliances, obstetrics and fertility treatment, medication, treatment of chronic diseases and paramedical services such as physiotherapy and occupational therapy."
"Participation in a medical insurance plan with one of the four national HMOs is compulsory for all citizens, who can select and participate in any one of them regardless of factors such as age, gender, or pre-existing conditions. All Israeli citizens are entitled to the same Uniform Benefits Package, regardless of which health fund they are a member of, and treatment under this package is government-funded for all citizens regardless of their financial means."
It seems like a good model for US and is similar to what Richard Nixon proposed in 1974:
http://www.kaiserhealthnews.org/stories/2009/september/03/nixon-proposal.aspx
Hats off to you for knowing more than I do about this. Do you have the figures at hand on what the proportion of government contribution and fee contribution is? Remember that Natanyahu during his first period of Prime Minster did steer Israel's economy away from Soicalism, and may have had an impact on health care to some extent. If you don't know the current ratio, i will try to find out.
Arab Jerusalem residents who choose not to hold Israeli citizenship but are permanent Jerusalem residents can join the system and nearly all do, under the same terms as citizens. I mentioned students and foreigners. For Hebrew University foreign students, it is compulsary. I think this is true of Ben Gurion (Beir Sheva), Tel Aviv U., Haifa U., Technion, and the one in the West Bank (blocking on its name at the moment).
I think that the big differences between Israel and Obamacare, are (1) the "Sick Funds" are both the insurance agencies and the health care providers. (2) They are run by doctors, not by economists or beaurocrats or politicians. (3) There is competition. A very different form of "socialism" indeed!
The system had its start in the pre-state period when the system of the British Mandate discriminated against Jews (and Arabs), and Jews therefore formed their own cooperatives to handle health problems,, and these combined into the present four.
Did the Nixon plan fail to get votes because of insurance company opposition? Or did doctors feel they would be too regimented/?
Keep in mind that the AMA was strongly opposed to Medicare when it was first established in the mid-1960's.
Doctors often complain. The biggest complaint of all of us providers is with the insurance companies. One major opponent was Teddy Kennedy,who later regretted that to his death.
(from Israel foreign ministry): "Sources for funding of health costs include progressive health insurance premiums paid by each resident, employers' health tax payments, National Insurance Institute funds, funds from the Ministry of Health budget and consumer participation payments. The insurance premiums are collected by the National Insurance Institute...employers' participation constitutes approximately 30% of total national expenditures for health." I was unable to find the government percentage, but all the funding goes through the government, whether the individual, progressive tax or the employer health tax.
Thanks for the research. For the time being we can assume Government 40%, employers 30%, employees 30%
Always welcome, Dave. Since the individual tax is progressive based on income ("from each according to his means"), that percentage would vary widely. Up on the North German Baltic coast for the month, BTW.
Israeli income tax is progressive, like the USA. But the fee for Kupat Holim is paid directly to the specific Kupat Holim and is not part of the income tax. And unless one is completely indigent, it is not progressive but the same for all clients. If one is completely indigent, one applies to the Government for its welfair department to pay the fee.
According to the Israel foreign office, all individual pay in over their life based on income, but this is separate from the income tax. The government supposedly collects and distributes to your HMO. The monthly fee is lower, since you are retired. it's a great deal for you, since neither you nor your employer paid in earlier , obviously, when you worked in US.
You are correct. It is a great deal. But I pay directly to the Kupot Holim (Sick Fund) Miyuhedet, not to the government. I also could collect a government pension, even though I did not pay taxes working in Israel, since even when i worked in Israel I was working for a USA company, paying USA taxes, and was not then an Israeli citizen. (Now I have dual citizenship. So I can vote in elections in both countries which means I take the responsibilities of a good citizen of both.) I do not collect this pension at the present time, feeling it is not morally responsible to do so as long as Social Security meets my financial needs, in part thanks to the real generosity of the Yeshiva where I study and eat and spend Sabbath and holiday nights.
Sounds great Dave, and obviously was a wise decision when you emigrated. Sometimes I wish it were so easy with health in Germany; if it were, I'd spend longer visits here.
Paul of Covington Phoebe Vet People who deal in absolutes are generally wrong. In this example: Free Market=good, government supported=bad. Amen. I deleted the rest of my comments to avoid stirring up political unrest.
Phoebe Vet People who deal in absolutes are generally wrong. In this example: Free Market=good, government supported=bad.
People who deal in absolutes are generally wrong. In this example: Free Market=good, government supported=bad.
Amen. I deleted the rest of my comments to avoid stirring up political unrest.
I tend to agree. A the end of the day, there are no free markets, just market forces acting within the arena they are allow to play in.
In the case of mass transit, if the subsidies to build and operate are less than fares PLUS the overall good derived from having it, then it's justified.
It's only when one thinks there is some sort of God-breathed, inherent goodness in the way we construct the institutions that govern the market "playing field" that things go awry.
-Don (Random stuff, mostly about trains - what else? http://blerfblog.blogspot.com/)
Wayne,
Somehow I doubt Noam Chomsky spends much time with Roget's Thesaurus. I don't know about Das Kapital. Recently I've been thinking about how ordinary lives of most famous people are. As far as Professor Chomsky and mass transit see my next post.
John
Mike,
What really strikes me about Noam Chomsky is that he teaches in a city, Boston, with an extensive subway system and a more extensive bus system that reaches way out into the suburbs and there is a subway stop at MIT where he works. So exactly what is the guy talking about? If he cannot use public transit from his home it is because he lives in some exurb that is far beyond the city. I have no problem with where he may choose to live but for him to say public transit is not available to him because of the American free market system is simply incorrect. If he is trying to make a more general statement about the lack of public transit in many parts of America he really should be clear about that. But given the area he lives in and the place where he works his statement does not make much sense to me.
Chomsky resides in Lexington. Walking to the bus stop might be a hardship. He is 85.
http://www.mbta.com/uploadedFiles/Documents/Schedules_and_Maps/Bus/route06276.pdf
Here’s a video of the entire interview. He says, “Take mass transportation…” at about 19:30.
http://televisionnetwork.co/video/1mb-74eiLBE/Noam-Chomsky-Ecology-Ethics-and-Anarchism-28-March-2014.html
Transcript
http://chomsky.info/interviews/20140402.htm
Norman Chomsky has four mass transporation choices: He can drive to the Lexington commuter station, take a train to North Cambridge - Porter Square and ride the Red Line to Kendall, near MIT East Campus and walk about a half mile to his office. Or he can go by bus, trackless trolley, or Red Line (form Porter Sq.) one stop, to Harvard Square and ride the Dudley bus almost directly across the street at the MIT main entrance stop on Massachusetts Avenue. Or he can drive to the large park-and-ride Alwife terminal of the Red Line with the choice of getting of at Kendall or changing to the Dudley bus Havard Square as above.
Either way he has to use his car for the start of the trip. Or bicycle or walk..
"The Lexington & West Cambridge Railroad, incorporated by the legislature in 1845, was built to link Lexington and Arlington (then called West Cambridge) with the new line of the Fitchburg Railroad in North Cambridge. The line was completed in 1846, and the first train to use the line, on August 24th, chanced also to be the first train to enter the Fitchburg's depot on Causeway Street in Boston. But as an independent line without right to haul its own traffic on the main line, it could attract little freight, and the company soon petitioned the Fitchburg to purchase the road outright. This the Fitchburg declined to do. Instead, the Boston & Lowell Railroad, reaching after suburban traffic, discovered in the branch a possible feeder and bought control of the road, building a short strip of track from its line at Somerville Junction to Lake Street in Arlington. Renamed the Middlesex Central Branch, the line was extended to Concord in 1874. The Lexington station, probably built about 1846, is the only known survivor of a railroad station form that in the 1840s and 50s was very common, incorporating beneath the station roof, track space for the engine and cars. Although damaged by fire in 1918, the station retains the original elliptical trainshed opening. Along the outer rail, the roof is supported by a row of eleven boxed columns. In the early 1920s, the Boston architectural firm of Kilham, Hopkins & Greeley gave the building its present Colonial Revival details including cupola, roof balustrade, and colonnade along the front of the station. The interior has recently been renovated for use as a bank." (Library of Congress)
http://images.ta-clearinghouse.info/3-Rail-Trails/Minuteman-BikewayMassachusetts/
Getting a bit rusty, I guess. After last post I realized that the rigiht place to transfer from the Red Line, whether coming from Alwife terminal and parking lot or from commuter rail at North Cambridge, to the Harvard - Dudley bus is at Central Square, the station between Harvard Sq. aand Kendall-MIT. Bus between Harvard and Central S, 6-14 minutes dependant on traffic, Red Line 2 miniutes.
On that Lexington station Colonial Revival's putting it mildly. It looks like Kilham, Hopkins and Greely were heavily influenced by George Washington's Mount Vernon.
www.dhr.virginia.gov/registers/Counties/Fairfax/MountVernon_photos.htm
See what I mean?
The Harvard-Dudley bus route is a combination of two streetcar routes, Harvard - Massachusettts Station in Massachusetts Avenue and the Harvard Bridge (at MIT, not Harvard!), and the Massachussttes Station - Dudley via Massachusetts Avenue, Northhampton Street, and Washngton Street (under el on the latter from Northhampton to Dudley.) Both went to part-time bus operation before WWII, then restored to full-time streetcar operation during WWII, then to part-time bus after WWII. Then the day I reported as a new student at MIT in September 1949, Harverd Brridge was closed for reconstruction, and streetcar service began full time between a pancake crossover on Massachusetts Avenue near Memorial Drive in front of MIT and Harvard Square. This lasted one week until Cambridge repaved Massachusettes Avenue between Central Square and Harvard Sq. without tracks. So the Central Square -Memorial Drive section was grafted on to the Central Square Watertown trolley line, with Type 4's running full time, the only line then runniing onlyi Type 4's exclusively. This eliminated PCC weekend service on this line, which was restored when the Harvard Bridge reopened in January with Massachusetts Station - Harvard Square buses, and Watertown cars again looping at the Green Street loop off Cenetral Square. Harvard-Mass.Sta. went trolley-bus with Brill trolleybusses in April, and this lasted about 15 years before reverting to bus and being combined with line to Dudley that had been converted to bus during this period. Watertown - Central Square was the last trolleybus line installation in the Boston area and one of the first to be converted back to bus.
wanswheel ...
...
The track did not look active. I see by the SPV Railroad Atlas that the line thru Lexington is abandoned. MBTA's current commuter rail map also shows no Lexington line. Maybe that is why Mr Chomsky is miffed.
Hidden Power and Built Form: The Politics Behind the Architecture
http://www.chomsky.info/articles/20131001.htm
Chomsky: "The social and physical construction of suburban America really was quite complex. It was a very elaborate system, and clearly a massive social engineering project that has changed US society enormously. Incidentally, I don’t have a personal objection to suburbs, in fact I live in one, but suburbanization is a different question. It starts back in the 1940s with a literal conspiracy. I mean a conspiracy that went to court. The conspirators got a minor pat on the wrist however.
"They were General Motors, Standard Oil of California and, I think, Firestone Rubber. The origins of suburbia reveal an attempt to take over a fairly efficient mass-transportation system in parts of California—the electric railways in Los Angeles and the like—and destroy them so as to shift energy use to fossil fuels and increase consumer demand for rubber, automobiles and trucks and so on. It was a literal conspiracy. It went to court. The courts fined the corporations $5000, or something like that, probably equivalent to the cost of their victory dinner.
"But what happened in California started a process that then expanded—and in many ways. It included the interstate highway system. That was presented as part of the defense against the Russians. It was launched under the Interstate Defense Highway Act of 1956, and was intended to facilitate the movement of people and goods, troops and arms, and, allegedly, to prevent overpopulation in specific areas that could become the focus of nuclear attack. The slogan of defense is the standard way of inducing the taxpayer to pay the cost of the next stage of the hi-tech economy of course. That’s true whether it be computers, the Internet or, as in this case, a car-based transportation system.
"From the late 1940s, into and through the 50s, there developed a complex interaction between federal government, state and local government, real-estate interests, commercial interests and court decisions, which had the effect of undermining the mass transit system across the country. It was pretty efficient in certain areas. If you go back a century ago for example, it was possible to travel all around New England on electric railways. The first chapter of E. L. Doctorow’s Ragtime documents it. Subsequently, we saw the elimination of the mass transport system in favor of fossil fuel use, automobiles, roads and airplanes, which are also an offshoot of federal government.
"Today, we have private airline companies, but if you take a look at a Boeing plane next time you travel, you’ll see that you are basically taking a ride on a modified bomber. A lot of the technology, and the research that goes into the development of apparently independently funded and non-government projects in our economy, comes directly from, or has its origins in, federal government. The Reagan Administration, for example, was committed to an enormous increase in state investment through the ‘Pentagon system’—diverting public finance into hi-tech industries and a state-guaranteed market—largely through arms production. It is essentially public subsidy for private profit—and they call it “free enterprise”. That can only be done by inciting fear in the minds of the public.
"The military has, to a large extent, always fulfilled this role of course. It has been used repeatedly as a site for technological innovation. The US is a perfect example. If you revisit the roots of the aviation industry, it’s a clear case. You can read it in Fortune Magazine and other business journals of the time. It was understood in the 1940s that the airline industry—the private airline industry—could not have developed, and today cannot survive, without extensive federal government subsidy. It was stated perfectly openly, and was well understood. It’s the same today. The airports are government built—and so on and so on.
"The whole infrastructure of air travel was, and is, part of government policy. It is not a natural development of a free economic system—at least not in the way that is claimed. The same is true of the roads of course. It is simply not true that suburbia is a product of the market, or market forces, or people’s ‘uninfluenced’ desires. It is the result of a deliberate social engineering program—led from the center. It is totally political in that sense. It’s often presented as a product of the market—and in that regard, it’s a standard argument that tries to draw upon the writings of Adam Smith to give it some sort of justification.
"But this use of Smith to justify free market economics is just another distortion. Adam Smith would have hated the capitalism we see today. Smith is explicit about it. He was not in favor of free, unbridled, markets. Today he would be called a libertarian socialist. He understood, and stated it clearly in The Wealth of Nations. He argues that England could be “saved” from a form of neoliberal globalization by an “invisible hand”. There needs to be control—or intervention. Daniel Defoe, argued something pretty similar in the eighteenth century.
"Defoe identified that British industry wouldn’t be able to survive in the face of ‘genuine’ productive competition from China, India, and other Eastern countries. Britain had the highest real wages in the world and, at the time, the best organized working class—at least that’s what much recent research suggests. As Defoe argued, in that context, Britain would have been de-industrialized by the cheap costs of Indian production if protectionist policies hadn’t been employed. From that, you can see how this use of Smith to ‘justify’ the market religion is actually false; and there are numerous other, more recent examples, to underline that.
"Thomas Jefferson picked up many of the same themes. Like Smith, he saw the potential destruction the free market could bring. It was foreseeable. In the case we’re talking about here, the same is true. The devastating effects of exclusively profit focused thinking that the development of suburbia represents were foreseeable—and foreseen. Obviously, the interstate highway program and the destruction of public transport were prerequisites for it, but they served more than just limited interests of oil producers and car manufacturers, although they were central to it. It contributed, and was intended to contribute, to the artificial manufacture of other markets. These attempts to scatter the population into suburban areas across the country led to the emergence of shopping malls, for example. It also led to the breaking down of inner cities and so on. It was also accompanied by “white flight” of course. Additionally, racial segregation was one of the other consequences, at least at first.
"That was all part of what we can quite literally call, a massive social engineering project – of a very complex sort. While there are some attractive elements to suburban living, as I said I live in a suburb myself by choice, it has left us with a society, and a physical infrastructure, that is unviable. Just take the Boston area where I live. It takes me forty-five minutes to one hour to drive to work because of traffic jams and detours and so forth. If there was a subway, it would take me ten minutes. But our system is designed so that you don’t have the choice of efficient, humanly beneficial transportation—and Boston is only one example. None of this is ‘natural’ in any way. It didn’t emerge spontaneously—a magical product of the market. It was engineered for a specific range of interests."
wanswheelThat was all part of what we can quite literally call, a massive social engineering project – of a very complex sort. While there are some attractive elements to suburban living, as I said I live in a suburb myself by choice, it has left us with a society, and a physical infrastructure, that is unviable. Just take the Boston area where I live. It takes me forty-five minutes to one hour to drive to work because of traffic jams and detours and so forth. If there was a subway, it would take me ten minutes. But our system is designed so that you don’t have the choice of efficient, humanly beneficial transportation—and Boston is only one example. None of this is ‘natural’ in any way. It didn’t emerge spontaneously—a magical product of the market. It was engineered for a specific range of interests.
+2 thanks for the link.
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