My “projections” are based on historical precedent – major government entitlement programs generally cost much more than projected and provide much less in benefits. Go back sometime and read what FDR said about how Social Security was going to “reduce the [government's] necessity of going deeply in debt,” and provide for the United States “an economic structure of vastly greater soundness” – all on a system of 2% payroll taxes on the first $3,000 in wages ($47,000 in today’s dollars).

We now have 12.4% taxes on the first $106,800 in wages – a cost increase of over 1,400%, while retirement ages have been raised and the surviving spouse’s benefit is lost for many workers now, due to the entry of women into the workforce (compared to 1937 when the spouse’s benefit went into effect).

Ironically, it’s the trainwreck of Medicare and Medicaid and their burdens on government that is the driving force behind this new bill. I know you’ll call me paranoid, but it seems naive to believe you can cure vast “fraud, waste and abuse” in programs by vastly expanding their scope.

Is it really paranoid to think that the government’s projections of the costs of health care reform are overly optimistic? The CBO has said that participants in the private health insurance market will see an increase in their premiums. Is it really paranoid to think that their projected increase (16% on average, I believe) is far more likely to be an underestimate than an overestimate? How reliable is ANY estimate that is based on assumptions fed to the CBO by the Administration? Or that, when the head of the Actuarial Office tells Congress he can’t measure the soundness of the assumptions in the bill for “lack of time,” this is a sign that nobody really knows what the heck the thing will cost.

Don’t you see any contradiction in disparaging my views on health care reform as “projections” based on paranoia, while your defense of it is also based on projections? You project that it will “take many years of inflation before an individual income of $200K becomes middle class. That assumes the threshold won’t be lowered, a huge assumption given the historical track record, and ignores the fact that during inflationary cycles, it takes relatively few years for that to happen. (During the inflationary 1970s, it took less than 8 years for $100,000 to turn into $200,000). Perhaps you aren’t aware of what has happened with the Alternative Minimum Tax, which used to be for “rich” families and now hits many middle income people due to the effects of inflation.

You project that “no one will be able to wait until they get sick to buy coverage.” Millions of people engage in Social Security and Medicare fraud today. The idea that fraud will come to a dead halt with the new bill is unrealistic. So is the idea that a relatively small fine compared to the cost of premiums will force people, many of whom are “off-grid” in the sense that they file no tax returns, to buy insurance, when they can join any health plan they want if they get seriously sick and have suckers like you and me pick up the tab for them.

And while you are correct and I mis-spoke that the “rich” tax on individuals doesn’t kick in until $200,000 (for now), you project that the financial impact of the bill will be felt only by those people That is the direct tax only. Indirectly, working and middle class people will indeed see a “tax.” Since I do not plan to add health insurance coverage for my employee, she will pay a “tax” of $2,000, because the amount of the fine I have to pay for not offering insurance will be passed on to her in the form of lower wages than she would otherwise receive. (If I DID offer health insurance, the cost of that too would be passed on to her.) Every employee is worth only so much to a business, and the more the business has to pay the government on account of the employee, the less the employe sees in her pocket. Fact of life. And since she has the same kind of plan I have (high deductible, low frills), she’s going to be paying higher premiums on lower wages. And since she likes both her current pay and her current health plan, she will be worse off, just as I will be by the passage of this law.

Finally, since I also depend on a sound national fiscal policy for my retirement future, and this bill speeds up our national debt and deficit on their collision course with collapse (and on that, if I’m paranoid, so are many widely respected economists), this bill is not good for me or most people in this country.

Point 3 is based on misinformation. The income threshold for individual taxpayers is $200,000, not $125,000. And you’ll only get “hammered” when you sell your home if you make more than $250K in profit on the sale. And it’ll take many years of inflation before an individual income of $200K becomes “middle class.”

Point 1, I’ll admit, is somewhat valid, and if you’d left it at that, I’d have a lot more respect for your position. I’m not a lawyer, and I don’t know the details of your plan, but it seems to me that it may be eligible for status as a “grandfathered plan,” and so will not have to change in many of the ways you fear it will (covering preventive care, for example).

And eventually, of course, no plan will have to cover people who wait until they get sick to buy coverage, because no one will be able to wait until they get sick to buy coverage. That’s the whole point. I’d have thought you’d like that part.

Although, I can not speak for Elizabeth, I can speak for myself. Anyone who thinks I am lazy and want a hand out from the government is sadly mistaken. To suggest so, is rude and uncalled for. My husband and I have worked very hard all our lives. My husband is retired (from the government) and I am still working. And no, my husband does not receive a enormous retirement from the government which is another myth. Recently, $70,000 average government retirement was being bandied about. I know dozens of federal retirees, none of whom come even close to that amount in retirement benefits. Another myth is that the government pays these benefits-they do not, they come from a pension fund which is deducted from employee’s paychecks.
You are absolutely right about the great deal of naivete about what is in the healthcare reform bill as you too, have no clue how it will work. Like Medicare, this healthcare bill will be continually evolving.

Here are (some of) my selfish reasons –

1. My insurance plan currently is not required to cover preventive care, prescriptions, people who wait until they get sick to buy coverage, and various other mandates that the new laws will impose – for starters. Therefore, it is the kind of plan I want – true risk-based insurance based on sound underwriting principles. It is also quite affordable, but the changes in the law will make it much more expensive.

I don’t mind that my insurance pays for other people’s care, because we all made a contract together and with the insurance company to do exactly that, on terms we all agreed to. The new law is adding a bunch of terms none of us agreed to, and then requiring us to pay for this new contract. That, I do mind.

Also, the people in my plan are like me – because we buy high-deductible plans, we are very careful not to overuse medical services, unlike people whose deductibles are $100 a year and will run to the doctor for a cold or a sprained ankle. The new law will limit high-deductible plans, forcing me to into plans for groups that aren’t like me. Again, higher cost.

2. Since from now on, ALL coverage will be driven by political lobbying rather than to customer wishes, we can expect to see all kinds of politically popular additions – smoking cessation programs, substance abuse treatment, acupuncturists, naturopaths, whoever has the best PACs. This will add to our premiums, even though many plan participants would prefer not to have the mandated coverages and keep the extra money.

3. Yes, I think everybody’s taxes will go up, directly or indirectly. First, I don’t make $250,000, but then, since I’m single, all I have to make is $125,000 to get higher taxes. I’ll get hammered when I sell my house. I’ll get hammered by the new investment tax, when I sell stocks. And no “tax the rich” scheme has ever failed to gradually lower the threshold of who is rich. If the law doesn’t do it, inflation will.

4. The long term direction in which this moves us is a government-run health care system. I know the bill doesn’t provide for that now, but this bill is, as its supporters have made clear, only the beginning. The aim of most supporters is and always has been a public health care system along the lines of the NHS in the U.K. Therefore, the primary goal of the current bill is not to fix our health care system but to finish the destruction of our private system that was started with the adoption of Medicare in the 1960s. If you haven’t noticed how Medicare has increased taxes, you haven’t taken a look at your paycheck lately, and if you think the “rich” 5% of the population can afford to pay for everybody’s health care at a high standard of quality (leaving aside why they should), you’re dreaming. Public health care systems around the world are seeing soaring costs in spite of high taxes, and degrading quality of service. This interim measure will move us in that direction, inevitably, and my health care, and the innovations in health care from which I could benefit in the future, will suffer.

5. The law intends to act to punish doctors who fail to conform to models of care dictated by government appointed panels whose interests will eventually be mostly in cost-cutting, rather than quality-enhancement. I consult my doctor for her expertise and judgment, and prefer she not be looking over her shoulder to see what the government says she should tell me, and what it s going to cost her to tell me differently.

6. The federal government has no business interfering in my health care decisions, including the financial parts of them. I didn’t ask for them to meddle in my life this way, and I don’t like it.

7. Because they are involved in paying for the health care of SOME individuals, governments at every level seem to be taking an inordinate interest in matters that should be none of their business, like our diets, our exercise habits, etc. The one who pays the piper inevitably decides he should call the tune. I predict an ever-growing involvement by government in micro-managing our lives for the sake of our health, under the justification that such meddling is necessary to keep “our” collective costs down. This degree of intrusiveness is alien to a free, self-respecting people.

I could actually go on to add quite a number of other ways this will negatively impact me and, indeed, most Americans, but it’s late. The Wall Street Journal had a very excellent summary on its site, including detail on a lot of the taxes hidden in the bill. There’s a great deal of naivete about what’s in this behemoth.

You have insurance, so you’re already paying for other people’s health care (including, perhaps, some people who have Priuses).

You mention the “government’s guns” so maybe you think your taxes are going to go up? Does your family earn more than $250,000 a year? Is your high-deductible plan valued at more than $27,500? Do you make extensive use of indoor tanning services?

How, exactly, do you think this bill is going to negatively impact you?

I guess you both can see the self-interest in my position but not the self-interest in your own. Both of you use as examples of why we need health care reform that you have personally had to pay for your own family’s health care, instead of being able to use the government’s guns to foist that expense off onto other people. Elizabeth complains of bills totalling $28,000 for a seven week premature childbirth as being “crippling” for a middle class family. But many, many middle class families will take on $28,000 or more in debt for a new car and think little of it. Elizabeth’s experience of a high medical cost is likely to be a once or twice in a lifetime experience, while the financing of a new vehicle is likely to happen once every few years. A middle class family that can afford a new Prius (like Trent) can afford $28,000 for the birth of a premature baby, but maybe they can’t afford both in the same five year period. Should I help pay for the baby so that they can have the Prius? Who’s really being selfish?

There is no free lunch. The demand for health care is potentially infinite – we all are subject to numerous ailments, pains, deterioration, injuries, etc., many of which can only moderately be improved by medical treatment. I have no idea what kind of pain Claudia’s husband suffers and make no judgment whether it warrants $3,000 a shot treatments, but I have known quite a number of people who claim pain as part of “drug-seeking” or from what used to be called hypochondria, or whose condition would be better treated with exercise, better diet, less booze, and a better attitude. All of those people are right there next to Claudia’s husband, lining up for pain shots. If they at least have to pay a portion of their own costs, maybe they’ll think twice about it.

The funding to pay for health care must compete with other needs and demands. The farther away the payment for a service gets from the user of a service, the less restraint the user feels in demanding the service.

I think long and hard about the first major medical treatment of an new year, because I have a large deductible. Most years, I tough it out, or go to the walk-in clinic instead of the ER or do some research on the Internet for a reasonable home treatment or to determine what the risks are of waiting, and have saved many thousands of dollars doing that. Yet in the few years when my deductible has been fully met, I find myself actively looking for what I might do in the way of health care, to take advantage of the fact that for the rest of the year, my health care is “free.” This year I’m getting foot surgery done to alleviate some occasional joint pain caused by a bone spur. When it hurts, it really hurts, but if my insurance didn’t cover it, I’d wait or simply live with it. Not because I don’t have the money to pay for it but because I’d rather use that money for other things.

That’s the thing about the middle class. We have the money to buy pretty much anything we really want or need, we just don’t have the money to buy EVERYTHING we want or buy it all at once, and have to make choices. If we want a reserve for a $28,000 health emergency, we may have to drive an older car a few extra years, or take a second job, or buy a smaller house, or send our kids to a state college instead of private and make them work part-time along the way, but we CAN have what we need with proper planning and self-control.

Claudia and Elizabeth are complaining that they have to use their money for advanced medical care of previously untreatable health problems instead of spending it on the other stuff they want. I think they should be greatful that the health system they complain of has allowed the development of those treatments. Advances like that rarely come out of “public” systems.

The health-care debate is actually a perfect example of what I was saying before about shouting down the party in power for doing things that you would have favored if your party were in power. Many elements of the health-care bill are (or at least were) Republican ideas. As I understand it, the individual mandate was favored by many Republicans back in the 1990s. Now, many of those same Republicans are arguing that the individual mandate is unconstitutional. Go figure.

As an aside, I don’t know anybody who thinks we don’t need health care reform. The disagreement is always about what kind. Every change hurts some people and helps others. The most recent change may or may not be to your advantage, Claudia, but it will be to my disadvantage. We are each entitled to urge our representatives to act in our own selfish interests.

The thing with Communism is that there were no “non productive” people. Everyone had a job, because the government gave them one. No matter how crap they were at it, they had to be employed (dissidents were often window-washers when they weren’t in prison or Siberian mines). If you were fired (very rare, from what I understand), you just went to the office and were assigned a new job. A lot of the wanting to get out had more to do with living in fear of the secret police (and btw, there was only one wall, and it was not around a country) than having “their earnings taken from them”. I’m certainly no expert, but I live in a post-communist country and 20 years on, some of the effects are still here, regardless of all the changes that have happened. (And interestingly, here at least the Communist party does still have reasonably strong support, it is currently the 3rd biggest party)

Let’s leave aside the fact that in the U.K.’s parliamentary system, David Cameron was not “elected” but was simply able to cobble together a coalition of enough MPs to obtain a partliamentary majority.

We may choose our head of government differently, but in both the U.K. and the U.S., people elect representatives to REPRESENT them, whether the rest of the country elects representatives of the same party or not.

If I don’t agree with Obama’s health care plan, for instance, and think it is bad for me or bad for the country or both, I want my representative to fight to the very best of his ability to stop it. I want him to use every legal and ethical means to do it, every parliamentary rule in the book, every right of filibuster, amendment, tabling, etc. If it is really true that 52% of voting Americans elected Obama because they predicted he would implement a health care plan totally different from the one he talked about in his campaign, at a cost vastly higher than he estimated, and they ALL really wanted that plan – a huge IF – then it is still my right and duty to try to oppose it and try to elect a representative who will stop it, and it is that representative’s duty to do his best to represent the people who elect him.

One has to have an enormous ego to run for President or seek the Prime Minister’s position. Such people are likely to have social plans and ambitions just as enormous. A vigorous and vocal opposition is the best hope of moderating those ambitions, preventing wild swings of policy that destabilize a country (think Zimbabwe or Venezuela) and keeping the pace of change slow enough that the real results of policy changes can be assessed before the country or its economy is totally wrecked.

I happen to like Cameron much, much better than Brown, and wish him well, but Labour MPs are well within their rights to push back on behalf of their constituencies.

And if you watched the election returns, didn’t you just love that British reserve? In most of the constituencies (other than the Scottish ones), even after the winner was announced you couldn’t tell by looking at the candidates which one it was – they all had such great poker faces. Not at all the way American winning candidates react, with wide grins, punching the air over their heads with a fist, making the V for victory sign, etc.

The presidential election of 1912 was contested between three advocates of an income tax.[22] On February 25, 1913, Secretary of State Philander Knox proclaimed that the amendment had been ratified by the necessary three-fourths of the states, and thus had become part of the Constitution

That’s all I’m saying. I think post #8 and #10 say it well.

And Post #11 makes very very valid points, too :)