DebateGate
General Category => 3DHS => Topic started by: Kramer on June 01, 2010, 12:03:55 AM
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http://news.yahoo.com/s/nm/20100531/hl_nm/us_health_3/print (http://news.yahoo.com/s/nm/20100531/hl_nm/us_health_3/print)
Soaring costs force Canada to reassess health model
By Claire Sibonney - Analysis Claire Sibonney - Analysis Mon May 31, 2:38 pm ET
TORONTO (Reuters) – Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system.
Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers.
British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee.
And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery.
It's likely just a start as the provinces, responsible for delivering healthcare, cope with the demands of a retiring baby-boom generation. Official figures show that senior citizens will make up 25 percent of the population by 2036.
"There's got to be some change to the status quo whether it happens in three years or 10 years," said Derek Burleton, senior economist at Toronto-Dominion Bank.
"We can't continually see health spending growing above and beyond the growth rate in the economy because, at some point, it means crowding out of all the other government services.
"At some stage we're going to hit a breaking point."
MIRROR IMAGE DEBATE
In some ways the Canadian debate is the mirror image of discussions going on in the United States.
Canada, fretting over budget strains, wants to prune its system, while the United States, worrying about an army of uninsured, aims to create a state-backed safety net.
Healthcare in Canada is delivered through a publicly funded system, which covers all "medically necessary" hospital and physician care and curbs the role of private medicine. It ate up about 40 percent of provincial budgets, or some C$183 billion ($174 billion) last year.
Spending has been rising 6 percent a year under a deal that added C$41.3 billion of federal funding over 10 years.
But that deal ends in 2013, and the federal government is unlikely to be as generous in future, especially for one-off projects.
"As Ottawa looks to repair its budget balance ... one could see these one-time allocations to specific health projects might be curtailed," said Mary Webb, senior economist at Scotia Capital.
Brian Golden, a professor at University of Toronto's Rotman School of Business, said provinces are weighing new sources of funding, including "means-testing" and moving toward evidence-based and pay-for-performance models.
"Why are we paying more or the same for cataract surgery when it costs substantially less today than it did 10 years ago? There's going to be a finer look at what we're paying for and, more importantly, what we're getting for it," he said.
Other problems include trying to control independently set salaries for top hospital executives and doctors and rein in spiraling costs for new medical technologies and drugs.
Ontario says healthcare could eat up 70 percent of its budget in 12 years, if all these costs are left unchecked.
"Our objective is to preserve the quality healthcare system we have and indeed to enhance it. But there are difficult decisions ahead and we will continue to make them," Ontario Finance Minister Dwight Duncan told Reuters.
The province has introduced legislation that ties hospital chief executive pay with the quality of patient care and says it wants to put more physicians on salary to save money.
In a report released last week, TD Bank said Ontario should consider other proposals to help cut costs, including scaling back drug coverage for affluent seniors and paying doctors according to quality and efficiency of care.
WINNERS AND LOSERS
The losers could be drug companies and pharmacies, both of which are getting increasingly nervous.
"Many of the advances in healthcare and life expectancy are due to the pharmaceutical industry so we should never demonize them," said U of T's Golden. "We need to ensure that they maintain a profitable business but our ability to make it very very profitable is constrained right now."
Scotia Capital's Webb said one cost-saving idea may be to make patients aware of how much it costs each time they visit a healthcare professional. "(The public) will use the services more wisely if they know how much it's costing," she said.
"If it's absolutely free with no information on the cost and the information of an alternative that would be have been more practical, then how can we expect the public to wisely use the service?"
But change may come slowly. Universal healthcare is central to Canada's national identity, and decisions are made as much on politics as economics.
"It's an area that Canadians don't want to see touched," said TD's Burleton. "Essentially it boils down the wishes of the population. But I think, from an economist's standpoint, we point to the fact that sometimes Canadians in the short term may not realize the cost."
($1=$1.05 Canadian)
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"Many of the advances in healthcare and life expectancy are due to the pharmaceutical industry so we should never demonize them," said U of T's Golden. "We need to ensure that they maintain a profitable business but our ability to make it very very profitable is constrained right now."
Well , if we make pharmaceuticles less profitable can the reasearch and manufacture be moved to China , where there might be a lot less restriction?
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"Many of the advances in healthcare and life expectancy are due to the pharmaceutical industry so we should never demonize them," said U of T's Golden. "We need to ensure that they maintain a profitable business but our ability to make it very very profitable is constrained right now."
Well , if we make pharmaceuticles less profitable can the reasearch and manufacture be moved to China , where there might be a lot less restriction?
why not, everything else has moved to China. no wonder they have a flourishing economy too.
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This article amounts to nothing more than all the usual suspects trotting out the same old problems that will always plague any publicly funded health-care scheme - - NOT ENOUGH MONEY - - and speculate on what means (short of the never-mentioned but simplest alternative, RAISE THE FUCKING TAXES ON THE RICH!!!) can alleviate this cash crunch, including the dreaded USER FEE.
YAAAAWWWNNN. What else is new?
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This article amounts to nothing more than all the usual suspects trotting out the same old problems that will always plague any publicly funded health-care scheme - - NOT ENOUGH MONEY - - and speculate on what means (short of the never-mentioned but simplest alternative, RAISE THE FUCKING TAXES ON THE RICH!!!) can alleviate this cash crunch, including the dreaded USER FEE.
YAAAAWWWNNN. What else is new?
Can we have your rich?
Ours don't amount to what they used to.
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This article amounts to nothing more than all the usual suspects trotting out the same old problems that will always plague any publicly funded health-care scheme - - NOT ENOUGH MONEY - - and speculate on what means (short of the never-mentioned but simplest alternative, RAISE THE FUCKING TAXES ON THE RICH!!!) can alleviate this cash crunch, including the dreaded USER FEE.
YAAAAWWWNNN. What else is new?
how much?
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<<how much?>>
How much what?
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<<how much?>>
How much what?
how much should the rich be taxed and who is the rich?
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Raise sales tax a couple pennies on the dollar. Everybody pays. Why does every friggin govt program end up being another battle in class warfare.
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<<Why does every friggin govt program end up being another battle in class warfare.>>
Sales taxes ARE class warfare.
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<<how much should the rich be taxed and who is the rich?>>
The rich is anyone earning over $250K per annum. Raise 'em a few percentage points at the top end and a fraction of a percentage point at the low end, and there'd be plenty for health care.
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Sales taxes ARE class warfare.
Bullshit.
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Sales taxes are class warfare because the rich can afford to pay them while the poor can't. They cut into the budgets of those who can least afford the cut.
That's an almost universally acknowledged truth, that sales taxes are most onerous on the poorest citizens - - what on earth is "bullshit" about that?
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Sales taxes are class warfare because the rich can afford to pay them while the poor can't. They cut into the budgets of those who can least afford the cut.
That's an almost universally acknowledged truth, that sales taxes are most onerous on the poorest citizens - - what on earth is "bullshit" about that?
As long as you exempt the staff of life , the opposite is true.
If water and basic food is exempt from Sales tax the poor pay it little and the rich pay it much.
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<<If water and basic food is exempt from Sales tax . . . >>
Basic food is not exempt from sales tax, at least not around here. Water's still free, though. But some fucking Conservative idiots have sold our future supply to the U.S.A.
Your comment is basically on the same lines as "If my aunt had balls . . . "
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Sales taxes are class warfare because the rich can afford to pay them while the poor can't. They cut into the budgets of those who can least afford the cut.
That's an almost universally acknowledged truth, that sales taxes are most onerous on the poorest citizens - - what on earth is "bullshit" about that?
Sales taxes are the most egalitarian of all taxes because it matters not what race, creed, color, ethnic origin, sexual preference, gender or income, all purchases are taxed the same. They are the complete opposite of the progressive tax which charges different rates for different people.
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<<Sales taxes are the most egalitarian of all taxes because it matters not what race, creed, color, ethnic origin, sexual preference, gender or income, all purchases are taxed the same.>>
Not exactly. Although in theory the effect of the tax is felt regardless of race, creed, color, ethnic origin, sexual preference or gender, it's effect is most severely felt in the lowest income group.
<< . . . all purchases are taxed the same.>>
Exactly. All purchases. Since purchases don't have kids to feed, payments to make, rent to pay, the purchase feels nothing in regard to the tax imposed on it. Only the taxpayer making the purchase feels the pinch, and since it's only the most disadvantaged socioeconomically of the taxpayers that really feels the pinch, fuck 'em. Who gives a shit about the poor and the disadvantaged?
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<<how much should the rich be taxed and who is the rich?>>
The rich is anyone earning over $250K per annum. Raise 'em a few percentage points at the top end and a fraction of a percentage point at the low end, and there'd be plenty for health care.
how much are they already paying?
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<<how much are they already paying?>>
Who really knows? They hide their wealth in off-shore trusts, phony expense accounts and various tax dodges. I'd guess the official maximum tax rate in Canada would be somewhere between 45 and 50%. (It used to be 53% but that was a long time ago.) But the official rate is virtually meaningless with these weasels. It's basically whatever their accountants can make it to be.
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<<how much are they already paying?>>
Who really knows? They hide their wealth in off-shore trusts, phony expense accounts and various tax dodges. I'd guess the official maximum tax rate in Canada would be somewhere between 45 and 50%. (It used to be 53% but that was a long time ago.) But the official rate is virtually meaningless with these weasels. It's basically whatever their accountants can make it to be.
how much do you pay?
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Free Markets: Pro-Rich or Pro-Poor
Listening to America's liberals, who now prefer to call themselves progressives, one would think that free markets benefit the rich and harm the poor, but little can be further from the truth. First, let's first say what free markets are. Free markets, or laissez-faire capitalism, refer to an economic system where there is no government interference except to outlaw and prosecute fraud and coercion. It ought to be apparent that our economy cannot be described as free market because there is extensive government interference. We have what might be called a mixed economy, one with both free market and socialistic attributes. If one is poor or of modest means, where does he fare better: in the freer and more open sector of our economy or in the controlled and highly regulated sector? Let's look at it.
Did Carnegie, Mellon, Rockefeller and Guggenheim start out rich? Andrew Carnegie worked as a bobbin boy, changing spools of thread in a cotton mill 12 hours a day, six days a week, earning $1.20 a week. A young John D. Rockefeller worked as a clerk. Meyer Guggenheim started out as a peddler. Andrew Mellon did have a leg up; his father was a lawyer and banker. Sam Walton milked the family's cows, bottled the milk and delivered it and newspapers to customers. Richard Sears was a railroad station agent. Alvah Roebuck began work as a watchmaker. Together, they founded Sears, Roebuck and Company in 1893. John Cash Penney (founder of JCPenny department stores) worked for a local dry goods merchant.
It wasn't just whites who went from rags to riches through open markets; there were a few blacks. Madam C.J. Walker, born Sarah Breedlove, just two years after the end of slavery, managed to build an empire from developing and selling hair products. John H. Johnson founded Johnson Publishing Company, which became an international media and cosmetics empire. There are many modern-day black millionaires who, like other millionaires, black and white, found the route to their fortunes mostly through the open, highly competitive and more free market end of our economy.
Restricted, regulated and monopolized markets are especially handicapping to people who are seen as less preferred, latecomers and people with little political clout. For example, owning and operating a taxi is one way out of poverty. It takes little skills and capital. But in most cities, one has to purchase a license costing tens of thousands of dollars. New York City's taxicab licensing law is particularly egregious, requiring a person, as of May 2007, to pay $600,000 for a license to own and operate one taxicab. Business licensing laws are not racially discriminatory as such, but they have a racially discriminatory effect.
The Davis-Bacon Act of 1931, still on the books today, had a racially discriminatory intent and has a racially discriminatory effect. The Davis-Bacon Act is a federal law that mandates "prevailing wages" be paid on all federally financed or assisted construction projects and as such discriminates against non-unionized black construction contractors and black workers. During the 1931 legislative debate, quite a few congressmen expressed racist motives in their testimony in support of the law, such as Rep. Clayton Allgood, D-Ala., who said, "Reference has been made to a contractor from Alabama who went to New York with bootleg labor. This is a fact. That contractor has cheap colored labor that he transports, and he puts them in cabins, and it is labor of that sort that is in competition with white labor throughout the country." Today's supporters of the Davis-Bacon Act use different rhetoric, but its racially discriminatory effects are the same.
The market is a friend in another unappreciated way. In poor black neighborhoods, one might see some nice clothing, some nice food, some nice cars but no nice schools. Why not at least some nice schools? Clothing, food and cars are distributed by the market mechanism while schools are distributed by the political mechanism.
Walter E. Williams is a professor of economics at George Mason University.
Free Market Principles (http://econfaculty.gmu.edu/wew/articles/10/FreeMarketsProRichOrProPoor.htm)
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Although in theory the effect of the tax is felt regardless of race, creed, color, ethnic origin, sexual preference or gender, it's effect is most severely felt in the lowest income group.
So?
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Basic food is not exempt from sales tax, at least not around here.
It is in many parts of the US.
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how much are they already paying?
Kramer....
In the US the Top 50% of Wage Earners Pay about 96.03% of Income Taxes
(http://www.rushlimbaugh.com/home/menu/top_50__of_wage_earners_pay_96_09__of_income_taxes.Par.0008.ImageFile.jpg)
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but what does 50% pay? 100k or 50k?
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<<So?>>
So you couldn't ask for a more clearly defined example of the class war in action.
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Mikey, How much do you pay in taxes each. % and total $?
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well
here in california food is not taxed but water is. but nobody complains about the cost of water. it`s the maintenence cost that`s the problem . 65%+ of the water bill cost is maintence.
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So you couldn't ask for a more clearly defined example of the class war in action.
If everybody pays the same rate, how is it class warfare? Especially when you consider that food purchase for the poor are supplemented by food stamps and programs like WIC which the middle and upper classes are not eligible for.
Meanwhile your much favored progressive income tax certainly targets one class over another.
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<<If everybody pays the same rate, how is it class warfare?>>
Maybe if you think of it not as how much everyone pays but what the purchaser has to give up to make the purchase, it might be helpful. If you take a guy at the bottom rung of the socioeconomic ladder, he's just getting by, no luxuries, buys nothing but basics, and then he gets hit by the increase in sales tax, he's gotta start making choices between things he can buy and things he can do without.
If you take a rich guy, he'll pay the same tax, but he's got enough income that he can still buy all the basics, he doesn't have to give up any one of them to buy any other of them.
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The jealously & envy are nearly tangible
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Mikey how much do you pay in taxes? Total $ and Total % of income. That would be combine income, vehicle registration, sales, property, gas, capital gains and other taxes like cell phone, cable TV, utility, toll bridges, CRT's, fees to enter parks, parking fees, and all other nuisance taxes that nickle and dime you to death.
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Don't forget to ask him how many cars the family has, if he's taken any vacations, how many TV's, cell phones, and Electronic devices, such as laptops & playstations
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If you take a guy at the bottom rung of the socioeconomic ladder, he's just getting by, no luxuries, buys nothing but basics, and then he gets hit by the increase in sales tax, he's gotta start making choices between things he can buy and things he can do without.
So? Why should that qualify them for special treatment?
And wtf is so onerous about making choices and setting priorities.
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Don't forget to ask him how many cars the family has, if he's taken any vacations, how many TV's, cell phones, and Electronic devices, such as laptops & playstations
it's looking like he does not want to answer. Either he's a moocher or one of the filthy swine rich that hide from paying taxes.
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<<If water and basic food is exempt from Sales tax . . . >>
Basic food is not exempt from sales tax, at least not around here. Water's still free, though. But some fucking Conservative idiots have sold our future supply to the U.S.A.
Your comment is basically on the same lines as "If my aunt had balls . . . "
http://en.wikipedia.org/wiki/Sales_taxes_in_the_United_States (http://en.wikipedia.org/wiki/Sales_taxes_in_the_United_States)
In Georgia the sales tax is less for grocerys .
I would like to meet your aunt someday.
As of July 2008, total sales tax rates in Georgia are 3% for groceries and 7% for other items in the vast majority of its 159 counties. A few counties charge only 2% local tax (6% total on non-grocery items), and four partially exempt groceries from the local tax by charging 2% on food, and 3% (7% total) on other items. Fulton and DeKalb counties charge 1% for MARTA, and adjacent metro Atlanta counties may do so by referendum if they so choose. For the portions of Fulton and DeKalb within the city of Atlanta, the total is at 8% (4% on groceries) due to the MOST.[49]
Similar to Florida and certain other states, Georgia has two sales tax holidays per year. One is for back-to-school sales the first weekend in August, but sometimes starting at the end of July. A second usually occurs in October, for energy-efficient home appliances with the Energy Star certification.
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<<how much are they already paying?>>
Who really knows? They hide their wealth in off-shore trusts, phony expense accounts and various tax dodges. I'd guess the official maximum tax rate in Canada would be somewhere between 45 and 50%. (It used to be 53% but that was a long time ago.) But the official rate is virtually meaningless with these weasels. It's basically whatever their accountants can make it to be.
This is less of a problem with sales taxes.
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Oh no....
Not the pig farmers!
ATLANTA — For years, state legislators have talked about taking a hard look at the 100-plus sales tax exemptions that dot Georgia's tax code, giving various groups a free pass on taxes when they buy equipment, fuel, food and a multitude of other things.
A comprehensive study may be in the offing during the next year. But in this difficult budget climate, it's much more likely that the state Legislature will take an easier route to reform.
Nine sales tax exemptions are up for renewal this year, meaning that they'll go away unless the Legislature votes to keep them. The exemptions benefit food banks, volunteer health clinics, military contractors, back-to-school shoppers, mass transit systems and pig farmers, among others.
The Legislature is poised to let all or most of those nine exemptions die.
"Frankly, because we can't afford them," said state Rep. Larry O'Neal, who chairs the House of Representatives tax-code writing legislative committee.
Those entities would end up paying more in taxes. For the Middle Georgia Community Food Bank in Macon, for example, it would mean another $41,000 or so in costs, director Ronald Raleigh said.
Read the complete story at macon.com
Read more: http://www.mcclatchydc.com/2010/03/24/90989/some-georgia-state-tax-exemptions.html#ixzz0sUSsE4lL (http://www.mcclatchydc.com/2010/03/24/90989/some-georgia-state-tax-exemptions.html#ixzz0sUSsE4lL)