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US House Democrats Unveil a Health Care Plan
gollum123 sends in this piece from a political blog in the NY Times. Here is the text of the bill in question (PDF). "House Democrats on Friday answered President Obama's call for a sweeping overhaul of the health care system by putting forward [an] 852-page draft bill that would require all Americans to obtain health insurance, force employers to provide benefits or help pay for them, and create a new public insurance program to compete with private insurers — a move that Republicans will bitterly oppose. ... But the chairmen said they still did not know how much the plan would cost, even as they pledged to pay for it by cutting Medicare spending and imposing new, unspecified taxes. The three chairmen described their bill as a starting point in a weeks-long legislative endeavor that they said would dominate Congress for the summer and ultimately involve the full panorama of stakeholders in the health care industry, which accounts for about one-sixth of the nation's economy. ... House Republicans, who have had no involvement in the development of the health legislation so far, quickly denounced the Democrats' proposal as a thinly disguised plan for an eventual government takeover of the health care system. ... The House Democrats' plan is one of three distinct efforts underway on Capitol Hill to draft the health overhaul legislation. In the Senate, both the Finance Committee and the health committee have separate bills in the works, and in recent days those efforts seem to have stumbled."
"If you think health care is expensive now, just wait until it's free."
"But the chairmen said they still did not know how much the plan would cost..."
I'm not sure the politicians care how much it's going to cost since it's not their money.
Healthcare is screwed up because of the various regulations and monopolys the govt has created.
If we had a free market instead of the quasi-socialist/fascist system in place now, the market would set fair prices.
No one ever talks about health care in laize-fair jurisdictions. Last time I was out of the US I paid $65 for a doctors visit and two prescriptions TOTAL. Open system. No govt price fixing. No government subsidies. My friend had a tooth extracted there, cost $150. My father just had the same in the US, cost $800.
Get the government the hell out of my life!
but we're in a deep recession here and now isn't the most appropriate time to start spending billions.
Actually, during a recession is the best time for the government to increase spending. The government is the only employer/buyer/spender that can afford to run counter to economic cycles. It has the ability to lessen the boom and bust cycle of the economy by running counter to it. IF the government followed the cycle of the rest of the market, then it would make booms worse and it wake make busts worse.
It seems obvious from this look into the early stage of a house bill that 'democrats' and 'republicans' are acting as either side of a polar debate, one proposing knowing it's plan leans far too far one way, confident that the other side will try as hard as possible the other way, reaching a stalemate.
it's kinda like the game my brother and I would play as children splitting a piece of cake , one cuts - the other chooses.
Of course, what happens when there is more then two ways to look at a problem, i don't know.
CS majors know the time/space tradeoff, but they never get taught the 3rd, crucial, tradeoff of the set: comprehension!
Is that the House Democrats are essentially following the blueprint for Healthcare provided by Republican Mitt Romney in Massachussetts. So far, the Massachusetts model has pretty much worked, in that, they did reduce the number of uninsured significantly. However, costs for the state provided side of the plan have come in way more than anyone either promised or expected. Quite frankly, the expansion of the health insurance pool did not increase the economies of scale and drive down costs for everyone. Now everyone just has procedures that they cannot afford done.
The other irony is that Obama's said to be considering the McCain plan's idea of taxing health care benefits and requiring employers to purchase it.
This is my sig.
I ain't registering for a goddamn thing
.
In the glorious and free country of the United States a citizen's decision to register for government-mandated healthcare is absolutely and completely voluntary.
Being forced to pay for those that do register, however, is another story.
Seriously. I can't understand why anyone would expect a decent economic discussion on a semi-technical website full of wild-eyed conspiracy theorists, Ron Paul anti-government Libertarians, and other zealots who interpret forceful opinion as actual fact.
Economics IS a difficult subject to understand, let alone interpret correctly. Even professional economists who do nothing but study the economy often get things wrong. Yet, everyone talks about the economy as if they are the expert and they actually know what's going on, even if they've had zero education on the subject.
Disclaimer: I live in a small country in the northwestern part of Europe.
weÃ(TM)re in a deep recession here and now isnÃ(TM)t the most appropriate time to start spending billions
Who says anything about spending? They are drafting a proposal and they want a public health care system. Good. It's 10 years overdue. Every time I read about 'republican' opposition they are screaming 'Obama is spending too much' or 'democrats are going to make this country a new communist state'. Well if I look at recent history I know what 8 years of spending has done to the United States: No good and (the seeds of) a global recession.
Now, I'm not saying the northwestern part of Europe or the U.S. is a better place to live in. But for public health care: Take a look how it's done in most European countries and then calculate medical spending per capita for an average European and an average American (Hint: You pay more and get less). Some popular (maybe too popular for some tastes) American documentary maker even made a film out of it. Google for 'Sicko'. It might not be to your liking but it also might give you another perspective.
The question you have to ask yourself is, do you think access to health care is a right or do you think that it is just another commodity to be bought and sold. If you say health care is a right then you have to be willing to pay for everyone to have it, it will be expensive, very expensive. If you think it's a commodity then you need to admit that poor people don't deserve to see doctors, or deserve a substantially lower quality of care from understaffed and overwhelmed free clinics.
I happen to think health care is something society needs to provide to everyone equally. I know where the money can come from without raising taxes too. I have my eye set on the bloated defense budget. Cut the military fully in half (by dollars spent) and we'd still have the best armed forces in the world for DEFENSE of the nation and we'd have the money to take care of every sick and injured man woman and child.
There are other things we can do to reduce costs as well such as approve the use of drugs that are already available in Europe and Canada and have been proven safe, and reform the liability insurance system.
which is private providers who are paid by the Canadian government out of a health tax. If the United States had a single payer system we could save $350 billion a year. It would be a huge boost for small companies.
Even if Canada, England and the rest of the countries with modern health care system were spending 1% or even 0% covering everyone if would still be considered and abomination by right wing people in the US.
Even the suggestion, let alone reality, of a poor minimum wage worker or homeless person getting access to universal health care is abhorrent.
That's just not how things are supposed to work.
Poor people are supposed to be...poor.
Wasting the massive overhead costs on insurance companies and the rest of the garbage that makes the US is worth it for right wing people in the US.
Will this bill stop the pre existing condition BS? Let you buy any plan that you want? UN tie it from your job?
Actually, no the bill won't do any of that. Are you sure you are not asking for someone else to pay your medical bills? I agree that employers should be untied from medical care and all insurance should be
privately purchased. But I think if you have a pre-existing condition you should be shuffled into a government program that covers your costs since you most likely cannot cover them yourself.
Take, for example, HIV treatment. Most people probably couldn't afford the cocktail that keeps them alive. But I don't think its too terrible to throw in a couple bucks of year in taxes per person to help another guy stay alive, as long as he doesn't bitch about Republicans, in which case, I'd vote to cut him off.
How about having a Bankruptcy that is just for Health stuff and does not show up on any back round check?
Nope. Why should it? I would think that, as a lender, paying back your health loans first would be the thing that they look for... you know, do the logical thing and pay the people to keep you alive.
Not let people ask about you medial history before offering your a job?
Quite frankly I think any credit check should be off limits when applying for a job or a place to live.
Make it so you can not be dropped by a insurance provider.
That would throw too many programmers out of work. Besides, the whole point of insurance is about risk management. If an insurance cannot manage the risk, it cannot operate as a company. Quite frankly the thing to do would be to deregulate all the coverage provided by insurance and get rid of all the various state mandates that make it more expensive.
This is my sig.
Yeah, spending all the money you decry, spent in the 12 YEARS of Bush, being spent in the first three MONTHS under the current administration is however enlightened and useful.
You *really* need to get caught up.
If the congress and the PolitBureau really wanted to pay for hospital services, they would pay the "going rate" of hospitals. Instead, they pay $36 for a $500 procedure, causing hospitals to charge $8 for aspirin. Congress is WHY the system is broken, not the cure.
The plan is to crush as many industries as possible with legislation, then arrive as if uninvolved and claim "Capitalism did this!" and "We need more regulation!
Then, the Fed, despite the strict outlines in the Constitution, controls everything in exactly the same way as Communist governments. (Where life universally SUCKS.)
This is a means to secure control. Banking, Mortgages, Car manufacturing, everything but Hollywood is getting a "bailout" and then finding themselves so bound to do the WRONG thing, they don't want it. It's instead a "BUY OUT".
These are the end-times for the America of freedom. And in the next world war, there will be no one to save France, Belgium, Luxemburg, and all the other countries we've saved twice in the last two.
The problem with Republicans is that they're not Conservative; McCain and Obama had nothing on which to disagree- both loved the idea of central control, sweeping the Constition under the rug, and consolidating power.
Sorry, but this is where we stand. Thank the media, on our way to hell.
--- For a good time mail uce@ftc.gov
Anti-government I am. Not an economist by far. But even a fucking moron can see this tripe is designed with the insurance companies profits in mind. Screw the BS. Go ahead and kick the private insurance companies to the side and make it truly government supplied health care. Single ayer with no private companies taking a cut from the pie. There will be waste and corruption no matter what, but leaving private companies involved will double waste, corruption and cost at the bare minimum.
The whole point of insurance is to have other people pay for your problems, you dumbass. If insurance doesn't do that, it is a scam that takes everyone's money and does not help people when they need it.
Contrary to the popular belief, there indeed is no God.
If anyone had any questions why the US health care 'system' continues to be a complete joke compared to the rest of the Western World just read this single post from this fucked in the head wacko.
Miserable little fucks screaming about people getting a free ride while wasting their own 'precious' money on more than 50 percent extra on health care costs in the US compared to every other modern aka 'Socialized' health care system.
Democracy's fatal flaw. Too many people are just fucking stupid like jstork.
We see what you are doing here. Government provision of services, by definition, is the exact opposite of free market competition. When you take money from people by force and give it to others, that is NOT competition. Please stop saying that it is.
You underestimate them. They will add awful ideas no other country ever thought of.
This tagline is copyrighted material. Please send $10 for an affordable replacement.
First, it appears to requires universal coverage. This is good. I remember a long time ago when universal coverage was not the norm for automobiles. All these irresponsible people would drive around, damage other peoples property, and then not pay. What was more they often continued to damage other peoples property with little consequence. This meant that those who were responsible had to pay higher premiums. Now everyone has to have proof of financial responsibility. One consequence of this is that I can get coverage against the irresponsible motorist for very little money. The benefit of health care should be similar. No more irresponsible people going to the hospital without health insurance. This should mean that those of us who actually pay for medical treatment, instead of expecting others to cover the bills,
Second, there will be a public option. Auto insurance in many states has the same option. Most of us do not use the public option. Most of us still pay private firms to carry our insurance. The public option is used by those those who cannot or chooses not to afford private insurance. Sure this public option costs money, but not nearly as much as having some irresponsible asshole crash into your house in his SUV, then discovering he has no insurance or assets because all his or her income went to pay the note of the truck. Every uninsured person costs us money. The public option will insure that hospitals and doctors get some money for every patient, so they do not have to gouge the rest of us.
Third, and this is what I hope, that they reform payments and set standards for care. For instance, it make no sense to pay 80% of a standard cost for a procedure, when in most cases doctors charge double the standard costs. Pay 100% of the standard cost, and don't worry about co-pays. The co-pay is built in with real and opportunity costs. Likewise, set minimum standard for diagnostics. Hospitals are spending money on proton accelerators rather than prene care. We can live without proton accelerators and other machines that go beep. What we need is care.
And this is what I think many people are afraid of. That medicine is going to go back to giving care, rather than huge returns on investments for the HMO or funding for lavish and extravagant building and equipment that rich people can then put their name on because they paid half. Or, as mentioned, we might be concerned that in the US we have a higher infant mortality rate than Cuba or Hungary, the worst in the developed world.
"She's a scientist and a lesbian. She's not going to let it slide." Orphan Black
Healthcare currently is costing America approximately 15% of GDP and getting poor results. A well-implemented national plan could bring that down into line with the other developed democracies of the world such as Germany and the U.K., or about 10% (your numbers may vary depending on calculation method, etc, and may be somewhat lower, but let's go with 10% for a rough estimate). This saves 5% of the current US economy that can be put to productive uses instead of pointless quality-of-life-diminishing health insurance bureaucracy. This also means many of the paper-pushers currently drawing down salaries denying people coverage will have to go do productive work instead, further improving the economic situation. Further, US companies will no longer be at a competitive disadvantage with their foreign competitors, who do not have to shell out for their workers' health coverage.
So, yes, fixing health care is a plausible means to repair the economy. It is entirely possible to fix two interrelated problems at once. Whether it is an economic issue is not really in question, given the size of the healthcare industry in the US. You might dispute the efficacy of a national healthcare plan, but it'll still have an economic impact one way or another, and President Obama has made it clear in previous statements that he believes that fixing the U.S. health system will have beneficial economic effects.
Long? What do you mean the signature at the bottom of every comment I post on Slashdot is too lo
I've been paying for my own medical insurance out of my own pocket since I was 23, now 36. A few months ago, my automatically deducted premiums jumped from $290ish to $530ish a month. Why?
Because Medicare sent my HMO (Group Health) a message indicating that I was on Medicare, and so they automatically combined the billing, without notifying me. I'm not even on Medicare! I may get a refund in Mid-August... meanwhile, I'm scraping by, because I saved some money for emergencies... having this happen during my regular period of unemployment (MSFT contractor 'break') makes it extra painful.
Make healthcare more affordable, so more people will choose to have it. NOT mandatory, involving buerocrats that'll screw it up even worse. Offer tax incentives, etc to businesses to cover their employees, don't cram it as another effective mandatory tax.
Any time an unpopular social program is established, the government tries to sell it under "special" tax provisions, e.g. only those that enroll have to pay.
Once the issue is mostly forgotten, the program inevitably merges with general government spending and starts drawing money from the general tax pool (e.g. your and my tax dollars).
This ALWAYS is going to happen for a simple reason: if everyone who wanted to enroll in the program could afford to pay for it, there would not be a need for a program in the first place. The sole reason for it to exist is to get those who don't use it to pay for those that do (that is the concept of welfare).
NEVER vote for a program on the basis of it having "special" tax provisions such as pay-as-you-enroll. If you are not willing to accept a government program under the understanding that it will be paid for with general tax dollar's, don't vote for it at all, since that is inevitably what is going to happen after a while.
If the goal is truly to do some good for the country, then the place to start is the FDA. They need to seriously rethink their views on health and nutrition and what should be allowed in the foods sold in the U.S. There are nations with a fraction of the health issues (per capita) of the U.S. and they also have better policies regarding the contents of food. The corn syrup has GOT to go for starters and they should take with it all of the aspartame and any of the dozens of other things that do not belong in our food. And let's not get into farming, dairy and livestock practices or we'd go on for days. Monsanto has GOT to go. Hormones and antibiotics on "healthy animals" have also got to go.
There is so much wrong going on in with U.S. food system that it just makes me sick... it makes us all sick. Get rid of that stuff and we will see a LOT less need for healthcare and a lot less obesity.
It's a huge pity, really. We in the US are far better at being anti- or pro- state than we are at being anti- or pro- free market.
Thus, we get grotesque situations where, in order to avoid charges of "socialism" government functions are essentially "laundered" through private sector intermediaries that take their big fat cut and, all too often, deliver seriously subpar results. We would be much better off if we abandoned that charade and, instead, let the state attend to state functions, the private sector attend to private sector functions, and avoided the incestuous interrelations of the two.
Then he sent all of them this note: "A socialistic government will also ultimately fail - because when the reward is great, the effort to succeed is great, but when government takes all the reward away, no one will try or want to succeed."
Actually, the real lesson is that a socialist government will fail when you let a tinpot dictator practice collective punishment to advance his own political agenda as happened in the USSR under Stalin but didn't happen in Sweden under a democratic government. This is really more of a fable about college professors pushing an agenda and punishing students' grades when they disagree.
If it's for-profit but free, you're not the customer -- you're the product (e.g., the Slashdot Beta's "audience").
Except that national health care is highly unlikely to be unpopular. In countries that have national health care, again such as Britain and Germany, the national health care program is enormously popular. This is part of why the Republicans are fighting the idea so hard; they know that, much like Social Security, once a large national program is established to provide for everyone something that they want (cheaper health care), it will be impossible to kill again later.
Long? What do you mean the signature at the bottom of every comment I post on Slashdot is too lo
You forgot the alien mind-control rays, unmarked helicopters, mention of 'jack-booted thugs,' and blaming the U.N. But otherwise, nice conspiracy rant!
Long? What do you mean the signature at the bottom of every comment I post on Slashdot is too lo
There are two sides:
1. The entire modern world that has low cost universal health care
2. The Democrats and Republicans on the other side with Republicans off in 'teh free market' la-la land and Democrats too fearful of the 'Insurance' company lobbying/campaign contribution dollars to propose any real long term solution
How is this geek centric news?
Have you seen all of the nightmare stories about the Veterans' Administration hospitals? This is how we in the U.S. treat our heroes -- imagine what health care will look like for the rest of us if we allow the government to ram *this* turd down our throats?
At last glance, the Constitution has no language about a federal health care system, and if that document doesn't explicit tell the federal government to do something, then the responsibility devolves to the states.
Also, bear in mind that the readership of this site is heavily skewed towards males age 18-34 with a college education (or attending college now). These people will have proportionately far fewer medical issues than the population at large, esp. the poor and elderly. Many here probably take no medication at all (except perhaps recreational), and haven't been inside a hospital for years. So from their perspective, what good is government-guaranteed health care? But the perspective may change as they grow older, raise a family, and have possibly ailing parents to look after, with all the visissitudes that come along the way.
What you really need to have is a health care center that works more like the DMV does in Delaware. Basically, everyone goes in and gets a ticket. There are separate lines for separate things. you might have some nurse look at you and determine if you are obviously dying, and have a special line for that. Then, you have a line for people with colds and coughs and stuff, and so forth. You wouldn't need to schedule an appointment, everyone could walk in, just, if you walked in for a stupid reason, you would wait a long, long time.
This is my sig.
Except that national health care is highly unlikely to be unpopular. In countries that have national health care, again such as Britain and Germany, the national health care program is enormously popular. This is part of why the Republicans are fighting the idea so hard; they know that, much like Social Security, once a large national program is established to provide for everyone something that they want (cheaper health care), it will be impossible to kill again later.
Wait? People like Social Security? That pit my employer and I throw money into every month? You realize in the United States there is a huge industry to actually save for retirement because we have no illusion that social security works right? If I could opt out tomorrow I'd be waiting in the queue before dawn. 15% from me, 15% from my employer and 100% worthless.
It's a huge pity, really. We in the US are far better at being anti- or pro- state than we are at being anti- or pro- free market.
Thus, we get grotesque situations where, in order to avoid charges of "socialism"...
Most US Americans seem to have no clue at all about what socialism or for that matter communism actually is. Every time they start throwing those words around on Fox News, accusing their various political opponents of being "socialists", it makes me laugh.
Only to idiots, are orders laws.
-- Henning von Tresckow
Ron Paul has a lot of good points. He was the only 'no' vote this week on a Congressional resolution slamming Iran for its voter fraud issue - and while denouncing the fraud seems like a good idea, it really hurts the anti-theocratic movement by letting the mullahs scream that the reformists are American stooges. But economics is not one of his good points. 'Unmanaged' economies are, at best, like the Gilded Age in the US, and at worst like Somalia. The boom-and-bust cycle of the Gilded Age was catastrophic for large percentages of the American population; toning it down via regulation and trust-busting was a major breakthrough in the development of the American economy.
Long? What do you mean the signature at the bottom of every comment I post on Slashdot is too lo
Joseph Schumpeter http://en.wikipedia.org/wiki/Joseph_Schumpeter is an economist from the Austrian School once wrote, in a previously unpublished and still obscure paper this:
"The fundamental evil that the science of economics suffers from is that current discussions of economic questions almost always displays the sad fact that some and occasionally all who take a hand in it do not know what they are talking about." (please note "science of economics)
Schumpeter, Joseph A. "The "Crisis" in Economics - Fifty Years Ago", Journal of Economic Literature, 20, 3, (Sep. 1982), pp 1049-1059.
He wrote that in 1939. It was published in 1982. You could say, in a nutshell, nothing has changed since 1939.
I also encourage you to read Schumpeter's works. In my mind, he is the most brilliant economist to have ever lived. He just wasn't and still isn't an attention grabbing diva.
AnonCow
Let's require that whatever bill they propose, that all of the US government, especially congress & house, have to operate under that bill for one year before it can be forced on the rest of us.
Or how about this? The congress already has single payer health care -- they get to pick from a list of premium plans from health insurers, and taxpayers pick up the tab. Since you want the congress to live with whatever plan they foist on us, we can go ahead tomorrow with the plan that the congress currently has -- government back private health insurance.
Computers are useless. They can only give you answers.
-- Pablo Picasso
And as a way to redistribute money, insurance is pretty lousy. If insurance was a tax, it would be a very regressive tax and burden those with lower income a lot more than those with higher incomes.
The World Wide Web is dying. Soon, we shall have only the Internet.
Here are the real differences between a single payer public health care provider plan and the hodgepodge private health care/insurance system we have now:
1) under a public plan, your health care is decided by a government bureaucrat sitting in a government office. While in a private system, you health care is decided by corporate bureaucrat sitting in a corporate office.
2) under a government plan you, or your employer would send hundreds of dollars in tax money each month to the health a agency to cover care. Under private plans, you or your employer must send hundreds of dollars each month to insurance companies each month to get coverage.
3) Under a government plan you a guaranteed coverage. You are not under private plans.
4) Under a government plans you are essentially covered for life. Under private plans you are limited in the number of claims you can make.
5) From what I have seen, government plans overseas control costs by focusing on preventative care and reward doctors who get patients to quit smoking and lose weight for example. Insurance companies in the us drop patients and increase deductibles.
6) Under a government plan, you and your doctor would have to fill out government paperwork to get benefits paid. Under the private system, each insurance company has it's own form to fill out which requires staff, meaning non-medical overhead, to proper fill out and file the forms in the proper manner.
There, those are are the real differences.
Basically, there are some problems the private sector is poorly equipped to solve. Medical care is one of them. Medical care is less of a free market choice and should be thought of more as an essential public utility. Market forces do not work very well do to the complexity of medical care and the urgency of catastrophic cases making comparison shopping impossible.
putting the 'B' in LGBTQ+
This is the kind of right-wing idiocy that has left the Republican party in its current state. Democratic areas do have more access to abortion clinics as it stands now, and yet the demographics that associate with Democrats are growing faster than the demographics that associate with Republicans. Democrats, far from sobbing and calling it 'genocide,' actively seek to expand access to these clinics on the basis that government should not be intervening in a woman's personal medical decisions. The vast majority of pregnancies that become naturally viable are not terminated; most abortions are for cases where the fetus would not survive for one reason or another (including that the mother might not survive delivery). Most of the rest are because the prospective parent is not ready or able to provide a stable family life, but many do go on later in life to have a child when they are better able to provide for one with a decent quality of life. Republicans have a stupid idea that Democrats 'want' to have abortions. Democrats want to make it an option for people who, for whatever reason, need one.
Long? What do you mean the signature at the bottom of every comment I post on Slashdot is too lo
You don't seem to understand the word "mandated".
FanFictionRecs.net
Oh, I'm sorry. I just had poll results saying Canadians were happy with their care. You have unsupported anecdotes. Clearly I should accept your premise, Anonymous.
Long? What do you mean the signature at the bottom of every comment I post on Slashdot is too lo
I think the fear is more that, like Social Security, they don't trust that it isn't going to completely fuck us later BECAUSE we can't kill the program.
FanFictionRecs.net
Let's test the hypothesis that Social Security is popular. You would expect, therefore, that when the President of the United States proposes making adjustments to it, this would be loudly and vigorously denounced. Lo and behold, this is what happened. Yes, Social Security is very popular in the US, and only small minorities (yes, including many Libertarians) want to do away with it.
Long? What do you mean the signature at the bottom of every comment I post on Slashdot is too lo
Well, considering part of the plan is to let people keep their current providers, I'm sure that'd work just fine. Nice of you to assume the plan is stupid though.
The rest of the first world has national health care. They are healthier than us, live longer than us, and pay less than us. Stop believing the FUD that the Republicans are pumping out.
Right, we have forty-seven million healthy, middle-aged, rich people who are the ones not getting insurance. Working poor who, for example, don't take their kids to see the doctor until they've gotten seriously, seriously ill and in need of expensive publicly-paid treatment when cheap preventative care would have nipped the issue in the bud if they could afford it... why, they just don't want health care!
Long? What do you mean the signature at the bottom of every comment I post on Slashdot is too lo
If it is so popular there should be no need to mandate participation, right? People will just opt in because they love it so much.
It's unpopular among the younger people who can see that there likely be nothing left in the system by the time it's their turn, but among older people it is extremely popular.
The 55+ year old portion of the population is what has primarily stopped social security reform. They happen to be a very large voting block, and it is hard to get past them. The people in this block either are currently drawing social security or will be drawing it soon, so they certainly don't want to remove it. Also, people in this category tend to be more active voters than other categories, so even politicians who may otherwise be amiable to removing or revamping Social Security won't dare touch the subject.
It's a self perpetuating problem; more people are drawing social security than can be supported by the younger workforce. These people rely on it, and so will adamantly fight anything that jeopardizes that income (imagine if the government tried to slash your paycheck, and how adamantly you'd fight that, it's the same from their perspective). Combine them with idealogues who can't see past their ideology to see that the system is unsustainable and WILL crash at some point in the near future, and you've got a voting base that is nigh unsurmountable.
The fact is, there are more people who are pro Social Security, at least more people who vote anyway, than there are anti Social Security. This is pretty much the definition of Popular.
What we need is a welfare reform that fixes the problem without harming the people who currently rely on the system, or those who are currently expecting to be able to use those funds in the near future.
I believe it is doable, but a plan hasn't so far been presented in a way that it reassures the people at the highest risk.
Security is mostly a superstition... Avoiding danger is no safer in the long run than outright exposure. - Helen Keller
I disagree only partially here. If you kick out private insurance entirely then you get some of the horror stories Canada grapples with. Instead leave the private insurance industry legally able to operate... then compete against them with the Government. If the Government can do it cheaper and more efficiently then the private insurers will either all go out of business until the government gets bloated and slows down or (more likely) they'll all cut their massive profit margins and start actually operating efficiently.
The problem with the US health system is that there is no negative feedback of any sort to control costs. Places like Massachusetts actually made it worse because the state has become the policeman for the insurance industry. I have heard comparisons of health insurance and car insurance. A car is optional. Health is only optional if you are dead.
Another point people are confusing is health *care* and health insurance. They are completely different beasts (even though they overlap a bit).
I believe most people (in congress) who preach free markets have no idea that a free market system should have some negative feedback somewhere in the loop. The few proposals which have cost controls will not make it anywhere (sigh).
Clueless patients wanting every possible test
Not to mention:
Doctors who are forced to order every possible test because if they skip one and fail to detect a 1-in-10,000,000 condition, they're subject to a $20,000,000 lawsuit and the end of their career.
Dewey, what part of this looks like authorities should be involved?
I read a bunch of slashdot comments, and the only logical conclusion i can find is that all healthcare systems suck and don't work for shit. I wonder if this means we need a completely new healthcare model. Or slashdotters just like to argue. Either way.
It's popular with the people currently receiving benefit from it. Social Security is a complete ponzi scheme. Every generation it takes more and more workers to support the people receiving benefits, and the system will eventually collapse. This is not a secret at all, and the government is well aware of it.
So yeah, it's popular with the elderly (a major voting block) because they get SS checks every month, but it's unpopular with every who's oh, 50 or younger because we're literally paying for grandpa with no expectation of having SS actually take care of us when the time comes.
One has to wonder if Canada benefits disproportionally because the research for their healthcare (Drugs, methods, etc) is primarily bankrolled by the companies in the United States.
"I disagree only partially here. If you kick out private insurance entirely then you get some of the horror stories Canada grapples with. "
Oh please. I don't know what you've heard but it's probably on the order of the things we hear about the states, that is, if you walk any street at night you'll be mugged there.
I've in the states for a decade and the rest in Canada. There simply is no comparison. It's overpriced lunacy down there, the embarrasment of the world.
I'm sure you can find people that feel hard done by by the Canadian system. And for each of those there are a plethora of problems with the American system. It's so bad poeple makes movies about it.
Last year in the US the health sector spent $3.4 Billion lobbying, the only sector that spent more was the finance sector. That's 5X than defense lobbyists. They don't want to kill the gooose that lays the golden eggs.
Cite: http://www.opensecrets.org/lobby/top.php?indexType=c
Need Mercedes parts ?
...w/out health insurance.
http://www.washingtonpost.com/wp-dyn/content/article/2009/06/19/AR2009061902334.html
"Although 70 percent of insured Americans rate their health-care arrangements good or excellent, radical reform of health care is supposedly necessary because there are 45.7 million uninsured....About 21 percent -- 9.7 million -- of the uninsured are not citizens. As many as 14 million are eligible for existing government programs -- Medicare, Medicaid, SCHIP, veterans' benefits, etc. -- but have not enrolled. And 9.1 million have household incomes of at least $75,000 and could purchase insurance."
rounding...
46 million
- 14 million (qualify but don't act)
- 9 million (income > 75k w/out insurance)
- 10 million (illegals)
------------
13 million
Why not just increase the minimums to qualify for govt health insurance and instead focus on making the current system more efficient? If I had a way of "carrying" my medial history w/me, I wouldn't have to fill out endless paperwork everytime I see a new Dr / dentist / optometrist. Less paper work = less paper pushers = cheaper insurance.
If 25% of those who can afford to pay do not, it dumps their costs and a higher portion of the costs of those who cannot pay onto me. Why? Because in the end, you're going to get the care either way.
Your freedoms do not include the freedoms to burden others.
The only debate then, is over denying all care to those who do not pay their own way. As a society, we have long since decided that isn't acceptable. Show up at an emergency room, and you'll get care. It will be the most expensive, least long term successful kind of care, but it will be care.
Unless you plan to argue that this should also be stopped, my only response is quit whining and pay your part.
Oh -- and PLEASE don't give me the "nobody helped me, I'm a self made...." like of crap. We live in a society where it is POSSIBLE to be successful only as a result of the sacrifice of all those who came before and all those around you sharing in the building of such a society. Taxes are how you pay for the upkeep of that environment in which you excelled. Consider it greens fees.
The problem with quotes on the internet, is that nobody bothers to check their veracity. -- Abraham Lincoln
Roads - should be privatized ($x/mile driven)
Water supply - should be privatized ($x/gallon taken into the house)
Sewage treatment - should be privatized ($x/gallon taken out of the house)
Police - should be privatized ($x/call to 911 etc)
Fire department - should be privatized ($x upfront to have your fire put out, but the neighbors can chip in so their houses won't be next)
Army - should be privatized (don't want that North Korean missile landing in your backyard? I hope you have the money to pay for it)
Schools - should be privatized ($x/day of school, and of course for missing school, turning in homework, missing homework etc)
Power (including lease of the lines that feed your house) - should be privatized
Street lighting - should be privatized (why not charge neighborhoods for the privilege of light?)
Garbage collection - should be privatized ($x/lbs of garbage, extra charges if you don't sort everything perfectly)
Ambulance - should be privatized (got mugged, wallet and ID stolen, head smashed in? Too bad - if you don't have the cash or picture ID to show that you're covered, the EMTs won't help you)
I wonder what other publicly provided services I left out.
Stop repeatedly using his full name, as if you want to rub in how foreign it sounds. It makes YOU sound like the xenophobe. Why didn't you use Hillary Clinton's full name?
Now ... repeat after me ... correlation does not equal causation.
I don't believe I said it did. However, if you're going to complain about how awful Canada's national health plan is, you had better deal with the fact that, awful health plan or no, they live two years longer than Americans do. That "rotten" health plan, which costs on the average about half what Americans pay for health care, doesn't seem to be producing worse results.
http://www.geoffreylandis.com
Wrong. Insurance helps to distribute high cost, low probability risks among a group. On average, each insurance customer is paying for themselves.
Slashdot, insightful? Really? I need to stop reading the comments.
I'd also like to see them come up with a country that has socialized medicine, that produces as many new cures and drugs as the USA. Hmmm... So long longevity.
"Thoughts are more powerful than any weapon, and I don't even let my people own guns." --Joseph Stalin
Part of the rationale behind Social Security is that people are too stupid to voluntarily put away their money.
The number of bankruptcies and foreclosures that took place over the past year should be sufficient to confirm this.
I don't like paying for irresponsible people any more than you do. However, the societal cost of widespread poverty would be far greater than the cost of the social security tax. Once again, the current economic kerfuffle is a perfect example of how the irresponsible decisions of a few have lead to the suffering of a great many.
-- If you try to fail and succeed, which have you done? - Uli's moose
It doesn't need to have 'nothing ever wrong with it.' What it needs is to have a distinct improvement over the alternative. The argument is that the set of problems inherent in a national health care system is preferable to the set of problems inherent in the current mess. If a public/private mix works best, great, go with that. But rejecting the premise that a national plan could be better due to ideological rejection of government programs is no way to make policy.
Long? What do you mean the signature at the bottom of every comment I post on Slashdot is too lo
Let's require that whatever bill they propose, that all of the US government, especially congress & house, have to operate under that bill for one year before it can be forced on the rest of us.
And the District of Columbia, since that's under federal jurisdiction.
Let me be clear: there hasn't been a *good* president since Regan. And there's no argument that Carter was anything but inept and worthless as a president. Especially since I was there; I remember it. We liked Bush I thinking he'd be a continuation; he wasn't. Bush II was even less. Voting for McCain required an act of discipline.
The underlying, unalterable fact is that we're so far in debt we're about to collapse, and Obama, in continuation of a Democrat plan (they were first to be seduced) they want to put in a few trillion for Healthcare.
We don't need it. No one (statistically speaking) gets turned away. And as soon as we can't borrow any more, we'll be inventing new "Depression Songs" because no one will be able to power our computers or boom boxes anymore: collapse is that way. And the only people to survive will be those with tons of power now, and government jobs.
Government never has to cut back. Never has to sacrifice; it's been that way too long.
They work for us; they're working for themselves just now, both Democrat and Republican. And surprise of surprises, it's the Conservatives that want to keep the Constitution rather than shred it. Surprise of surprises, the gunman at the holocaust memorial shooting was on Obama's side, not the Conservative side.
We've all been duped. Most on the Left, but many on the right. It's time to do something about it.
--- For a good time mail uce@ftc.gov
I would agree, that your body is inviolate so long as you pay for its upkeep, but once you start waving the cup around for someone else's dough to take care of you, the placer of the coin in the cup has more say than you.
In other words, you only believe that people have the rights their money can buy and that once someone pays a dime to help you, that they own you. You might as well not have a right to an attorney if you're poor by that logic.
Frankly, I find this worldview abhorrent because it denies that people have any rights at all -- only that which they have the might to take for themselves. I can't think of any more anti-democratic notion than that right there.
Quite honestly, the thing that is causing abortions more than anything else is free trade and its attendant destruction of the middle class.
Actually, I'd argue that refusing to teach kids about condoms is probably causing more abortions than any other policy decision in America today.
If it's for-profit but free, you're not the customer -- you're the product (e.g., the Slashdot Beta's "audience").
The problem with a state run insurance plan is that that the state has never made anything more efficient. Ever.
Except perhaps the fire department, post office and schools. In the last two cases, we have private and semi-private solutions competing against state based solutions, which seems to work well enough. I guess that means that one solution doesn't fit all situations.
On another note, it costs 11x as much to treat a broken leg in the USA than in Canada, purely from a billing perspective. Clearly the private insurance companies don't have sufficient incentives to keep prices low - perhaps because of a conflict of interest. So it seems that once again laissez-faire economics can introduce inefficiencies.
I'm 100% pro free-market, contingent upon when it works better. The history of public and private institutions shows that private institutions work better most of the time, but not all of the time. I thus support public schools, fire departments, police, libraries and health care. It's not perfect world.
Like all pain, suffering is a signal that something isn't right
Insurance (of any kind) is an exchange where you pay a higher average (i.e. expected value) in exchange for a smaller variability in the outcome (statistical variance or standard deviation).
For example, suppose that each year one out of ten people one will incur a $10000 medical expense while the others incur no expense. The average cost is $1000, but there is a wide variability ($0-$10000).
Now suppose an insurance company charges $1100. If you take the insurance your average costs would be $100 higher. However, you have also eliminated variability. You no longer have to worry about being surprised by a $10000 bill. Instead you know exactly how much you will have to pay each year.
For things that have only a small amount of variability (e.g. utilities), insurance does not make sense. However, for things (e.g. house burning down) where there is a small but very real chance (e.g. 1 in 10000) of a very high cost (e.g. $100,000), insurance decreases the risk of financial ruin in case you happen to be the unlucky 1 in 10000.
Of course that would necessitate the typical US citizen learning how to be responsible, like we used to be a few decades ago.
no, that would require the average American to become an active consumer of health care -- something most of us simply aren't qualified for. (Quote POTUS: "We just do what you tell us to.")
The economics should align with the descion making power. I pay a set amount to a doctor or medical practice of my choice, and then they have responsibility for my health care. If it's $500 cheaper for me to have one procedure over the other, the doctor gets a goodly amount of that. (All, ideally. I already paid for it when I paid for his overall service.) Doctors would then buy insurance to cover extraordinary cases.
What is their diet and exercise habit? Where is your study that compares the same economic-socio groups.
I prefer the "u" in honour as it seems to be missing these days.
You had me until this bombshell: Healthcare often isn't an individual problem, but rather a societal one.
How do you reconcile a statement like that with the quote above? Apart from special cases, such as epidemics, I don't see how on earth can you justify interfering with the individual's liberty (i.e forcing us to pay for the healthcare of others, forcing us to take part in the government's system instead of setting up a different one or opting out altogether etc)? If I am sick, how is that your problem, and what right do I have to force you to pay for my doctor's bills so that I can get well?
Negative moral value of force outweighs the positive value of good intentions.
Social Security also normalizes risk across the whole population. A system that relies totally on individuals to save and invest would have a certain percentage of people ending up with no or negative return on their investment and some who overwhelmingly exceed the average (and don't think it's because everyone at the top "deserves" it - there's an element of randomness in markets). SS trims both tails off the curve -- preventing complete devastation on the left side at the expense of the fortunate ones on the right side. For those Masters of the Universe who feel slighted because you think you should be on the right side of the curve, I wouldn't worry about it. Fire up your E*Trade account make up for it with your investing superiority.
"Democrats, far from sobbing and calling it 'genocide,' actively seek to expand access to these clinics on the basis that government should not be intervening in a woman's personal medical decisions."
I don't want to hear that abortions are "personal medical decisions." That's like calling me murdering my brother because he's an inconvenience a "personal family decision." Abortion is murder, easy as that. It is not a "choice." A mother has NO RIGHT to murder their unborn child.The only time it is EVER justified is if the mother is going to die. Which brings me to your next point:
"most abortions are for cases where the fetus would not survive for one reason or another (including that the mother might not survive delivery)"
Abortion clinics do not need to exist to serve this kinda "need." If a doctor determines that an abortion is the only thing that will save the mothers life then the mother can have the abortion in the hospital. Now on to one of your scarier points:
"Most of the rest are because the prospective parent is not ready or able to provide a stable family life"
Holy (insert diety here)! I'm back to murdering my brother because he is an inconvenience! So, if you were sitting in the jury for my murder trial you'd see my deed justified? I'll be sure to give you a call! How can you justify killing an innocent VIABLE life just because the parents can't provide for him? Are you really going to kill someone just because their parents, in all likelihood, were too careless to use a simple condom? It's called foster care. There are plenty of alternatives to abortion.
So in short:
Abortion is murder.
It is only justified to save the mother's life. Stop getting mad at republicans for wanting to stop murder. I challenge you this: go attend an optional abortion. Watch the doctor end the life of another human being. Watch him remove arms, legs, and other body parts. Watch him place those bloody, translucent, partially-formed, parts into a bowl. Don't you dare turn your head away, watch it. Then come back and defend optional abortions.
P.S. I'm not a republican, I don't even pledge an allegiance to any kind of God, but I still recognize and despise murder when I see it.
If I am sick, how is that your problem, and what right do I have to force you to pay for my doctor's bills so that I can get well?
You don't. However, most people do not know in advance if they will someday require a million dollar medical treatment. Therefore, it is to their advantage to pay a flat fee into a huge risk-amortization pool managed by US government. To avoid ethical questions about government's use of force, let people opt out of the pool and stop paying any related taxes. However, they will then have to rely on their own private hospitals for treatments, even in emergency. And organ donations made to public system will not be available for private transplants. Let them see if resources of 10 million mega-rich people can buy more MRI machines than resources of 300 million not-so-rich people. And rejoining the pool will not be easy/cheap as it's not fiscally sound to let people join the insurance pool only when they get sick.
So hard-core libertarians get to die on the road after a car accident, knowing that nobody forced them to pay taxes for a public ambulance service. And the rest of us, who think that government services are for emergencies such as fire, disaster relief or cancer and private sector is for extras like iPods, dining out or plastic surgery, get to have some peace of mind.
The biggest problem that I have with nationalized health care is that it effectively guarantees that we're stuck with paying for health care using the insurance model for the rest of our days. The trouble with insurance is that, in theory, less money is supposed to be spent than is put in. This guarantees that there will always be profiteering and "waste" - that's why insurance works. If we didn't already legislate the insurance model so thoroughly already, market-based innovations like interest-bearing health savings accounts might be able to take a better hold.
In an ideal world, I'd like to see all health care spending be tax deductible. If my employer wants to spend money on insurance for me, great. If my employer wants to put money in an interest-bearing health account, like a 401k or something similar, so much the better, provided it's portable from job to job. Heck, if my employer just pays my bills directly - sweet! Let them earn their tax credit either way, and if I choose to do the same, well, let's encourage that, too. It'll never happen, though, especially if this bill gets passed. Besides, all of the market-based innovation in payment methods in the world isn't going to change one basic, simple fact:
Health care is scarce.
There is a finite supply of people willing and capable of being doctors and, due to generational constraints (fewer people in the younger generations than during the Boomer generations), there are fewer and fewer of them than there used to be. Meanwhile, more and more people are consuming more and more health care. This isn't just a case of the Baby Boomers getting older, though that's a big part of it. The other part is that the health care industry can do far more than it could in, say, 1950. In 1930, if you had an infection, they gave you sulfates and told you to start praying. Nowadays, we have books that list nothing but types of antibiotics. We can transplant organs, cure most kinds of cancer if we catch it soon enough, cure nearly any imaginable infection, and on and on and on. If I get an ingrown toenail now, I see a doctor (possibly even a podiatrist - specialist rates!). If I got an ingrown toenail in 1930, I probably would have grabbed a bottle of whiskey and a pocketknife. Simply put, the health care industry can provide far more services than it could years ago, increasing demand, while also seeing fewer and fewer people willing to provide the services. As long as that dynamic is true, it won't matter how we pay for health care. If we try to make it cheap, there will be increased scarcity, which means longer waits for procedures. If we try to make it plentiful, such that nobody has to wait, it will be expensive. That's just the way it is.
If you really want to make health care affordable, you need to loosen up who provides non-emergency health care. This might involve getting nurses involved, but they're nearly as scarce as doctors right now. This might involve robots - heck, Japan's been playing with them in health care for years. This might involve computerized quizzes - fill in some blanks (I have the sniffles but I don't have a fever) and receive a diagnosis (You have a cold or mild allergies). In short, think of it sort of like IT. You don't need to throw a CCNA or MCITP/MCSE at every infected workstation - why should you throw a doctor at every minor ailment? Yeah, I know - when you're holding a hammer, every problem looks like a nail, but there's some wisdom here.
In the end, no matter how you shuffle the cards around, it will never change the fact that, as long as health care is as scarce as it is (and there's no reason to suggest it won't be anytime soon), it will be expensive, one way or another. There isn't a Republican or Democrat sponsored piece of legislation in the world that will ever change that.
My COBRA coverage got pulled at about the 1/2 point because my old company was small and both of the spouses had coverage, so at the annual renew time, they just stopped offering health.
After talking with an Insurance rep that I have used for company insurance at a few places, it became clear that my family and I would NEVER get personal health insurance. Currently, I suffer from chronic foot pain (for the past 6 years), my oldest son suffers from depression and bi-polar disorder (for the past 4 years), and my wife gets migraines (from childhood). You can see why an insurance company would not want to touch us, but we still need insurance.
As my COBRA ran out my agent tried to get us on a temporary plan. We know that if we claim the meds that my son and I require, $2,000 to $3000 a month, we will also not be allowed to re-up the temp plan. We decided that we would not claim any of the chronic things that we have to deal with so that we have the plan if we have a major issue, but once we do, we no for sure that we will not be allowed to re-up.
For the temp plan we went with a carrier that haven't been covered by for over 12 years. But we were denied coverage by this carrier because they had on record that...
1) My wife had been treated for headaches.
2) One of my 2 sons had been treated for a sore throat.
OVER10 YEARS AGO!!
Those 2 reasons were all that it took to deny even temporary coverage.
We had to find a carrier that had never insured me and my family before just to get temp insurance.
We are still looking for a permanent option, but as we do our savings are being drained rapidly as we try and cover our ongoing issues. We need to minimize claims to preserve our temp insurance in case of a major issue. Because of that none of us are getting any ongoing treatment, so no one is getting any better. Were stuck with little chance at improving medically, and at this point we have not found an insurer who will offer us insurance at any price.
If you have now, or have ever had anything more that a minor medical issue, your chance of getting coverage as an individual are effectively 0%
I have been looking for work for 2 years, sending out, and following up on at least a dozen job openings ever month (12 is my self imposed min). While the economy is bad I have no idea if I will be able to get a job, and while I am in this catch 22 I am spending more and more of my time trying to find coverage.
In the mean time, I have one of my cars for sale, family jewelry is listed, and while our house is not under water, real estate is not exactly booming either.
I dunno. Does my government really want me to be broke, unemployed, and perhaps homeless, before I can get health care for my family?
Or can they come up with some way for people to purchase coverage, to allow them to get healthy, before they loose everything?
Eschew Obfuscation
If these companies are American, why do the documents and tax forms say they are based in Antigua?
It is popular because of mandated participation. It isn't an individual savings system. It redistributes "retirement savings" from people who had long careers to those who got disabled and those who did very well financially to those who did not. The welfare aspects are what makes it popular.
USA drug companies do research to make money. They'll happily take Canadians money.
The question you should be asking is WHY the same drug can be so much cheaper in Canada vs the USA? Why are drugs so much more expensive in the that bastion of free enterprise? Why do USA drug companies spend more on marketing each year than on research? Most of this marketing is illegal in Canada so they don't waste as much money on marketing in Canada. Canada doesn't have huge private health insurance companies skimming huge profits, denying claims, and thwarting doctors from using what they feel is the best treatment. Why does virtually all health care cost more in the USA? Why does they USA spend MORE per person on healthcare yet still lag behind Canada in almost all indicators of health care like infant mortlity, and longevity?
Why do many USA citizens still want a good chunk of their health spending to be taken by private insurance companies?
Anarchists never rule
Apologies for asterisks, the slashdot post box simply will not accept proper line breaks and mangles the post regardless of what text entry mode I set it to.
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This is total bullshit. The big pharma companies have rolled this one out for years as the reason it is necessary to keep drugs expensive in the US where the same medicine in other counties cost less. It has nothing to do with research costs and everything to do with holding onto the goose that lays the golden egg: a healthcare system in a first world country that is exclusively set up to make a few people and companies rich. It has almost nothing to do with making people well, other than a side effect of making huge profits at the expense of people's health. They sell the drugs worldwide, at enormously variable prices. There is no shortage of research money at the prices and volumes sold outside the US. Also, not all drug companies are US companies.
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They'll also claim that FDA certification makes the drugs cost more in the US, which is also FUD of the highest order. If it does have an effect, it's not enough to explain the ludicrous prices. If there is anything that affects the cost of drugs, it's the money that buys senators and congressmen, though not directly passed on to the consumers as a cost of doing business, certainly affects the price of drugs with their purchased legislation.
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For a country that positions itself at the head of the world table, as a shining beacon and example to follow, the US healthcare system is a huge, nasty, malignant tumour that threatens to kill off a large portion of your population.
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There are so many things I like about the United States, but the healthcare system is most certainly not one of them - a society is judged by how it treats its poorest and most disadvantaged members, and looking after their wellbeing is extremely important. I don't think anyone could make a case that the US Social Security system should die (the people would not stand for it) - the health care system is no different. The current one has very, very limited support for the people that cannot afford to pay artificially inflated prices for insurance and drugs, and have to fight a system that employs people (who are not doctors) whose sole job it is to overrule doctors who say you need some treatment and list it as "optional" or "unnecessary" so that they don't have to pay for it with the insurance (and by the way, that'll be another $550 this month in insurance premium, pay up so you're covered!)...
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Even if you think the current US system is "fine" (which it clearly is not), there needs to be some system that runs along side it that helps the millions of Americans who simply cannot afford to sit at that table. For something like a fancy house or a fancy car it does not matter - if you can't afford one, you can go without, and perhaps envy the rich guy down the block who has a Lincoln Navigator. This is not true for healthcare though, since you simply cannot go without it, so you need to provide a system that they can take part in.
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"Get a job with good health insurance" you may say, but it's not always that easy. Remember that health insurance companies exist for one thing only, and it's not making sure people get good medical treatment. If you are in a "good" program, that is normally expensive, where they just simply cannot legally get out of paying for the treatment you are insured for then you are lucky. You may not even be able to get minimal coverage - a huge number of Americans exist in a salary range that they cannot escape from (easily) and that provides them with insufficient money to afford good treatment or insurance.