The 33-year-old Republican candidate for the U.S. House seat representing Evanston says people his age shouldn’t count on getting Social Security.

And Joel Pollak, in an interview with Evanston Now, claims young people are ready to take more responsibility for their own financial future.

Here are some excerpts from the conversation.

The 33-year-old Republican candidate for the U.S. House seat representing Evanston says people his age shouldn’t count on getting Social Security.

And Joel Pollak, in an interview with Evanston Now, claims young people are ready to take more responsibility for their own financial future.

Here are some excerpts from the conversation.

Joel PollakJoel Pollak: We can’t keep running our entitlement programs the way they have been. I think we have to honor the obligations that we’ve made to current beneficiaries. But people my age can no longer expect to get the same kinds of benefits that people have for the last 60 or 70 years. It’s just not going to work.

With people coming into the system, we have to move toward an insurance-based model rather than an entitlement-based model, where you have some personal control over your health insurance, for example, personal control over income and savings for the future, rather than paying today to pay someone else today. It really does have to move to what many people think it is which is an individualized or personal savings or insurance plan.

Evanston Now: But to shift from an entitlement program to one in which people are setting aside money for their own retirement means that a generation of people are going to have to pay double.

Joel Pollak: I think that my generation — I can’t speak for everybody — but my sense is that we’re not expecting our children to take care of us. We’re ready now to take care of ourselves and start planning for a different kind of future.

I mean we can be that generation. We don’t want our parents and grandparents now to be that generation. We want to make sure we can take care of those generations now. But we understand that things have to change.

I got my annual notice from the Social Security Administration. It says don’t worry about what you’ve heard about trouble in Social Security, the money you put away in Social Security — 70 percent of that will still be there by the time you retire. You know, that’s a terrible investment. That I’m going to lose 30 percent, just in dollar terms, never mind what I could have invested it for.

Evanston Now:  A lot of people approaching retirement have also been through a very traumatic experience over the last couple of years with what’s happened to their private savings. Isn’t there a need to strike some sort of a balance so that people have some government-guaranteed floor?

Joel Pollak: Absolutely, and that’s what I’m saying. We need to have that as well, even in the future that I’m contemplating, there has to be some sort of minimum income guarantee, that’s absolutely necessary. But what we don’t want to do is discourage private savings.

You know there’s a question now on the table about how do we balance this budget. The question that the president’s deficit panel is considering is do we cut spending or what do we do. And they’re looking at this entitlement problem. And Rep. Schakowsky said if we do that then we have to take away the tax credits on 401(k)s and IRA accounts — which would be a disaster for retirees and for working families who are doing the right thing by saving.

And I think that’s the wrong way to go. We don’t want to discourage saving as a way to save the entitlements now and forevermore. I think we have to look at the way the system is set up.

It was established at a time when we didn’t anticipate that we would be looking at the kinds of health care expenses, for example, that we have.

Medicare is hugely costly. In order to save it, to make sure that it works, we have to look first of all look at changing the way we spend money on health care. But we also have to look at moving toward a model where people are planning for their health insurance.

In the future — people in my generation — we know those benefits are probably not going to be there when we start collecting. So we have to do something today.

Evanston Now: The medicare crisis is largely a cost containment issue and an issue of the mechanisms for delivering care. Because we’re not going to say to grandma, “Hop in the kayak, you’re going out to sea, it’s all over for you.” That’s just simply not an acceptable alternative. And so it has to be paid for somehow. 

Joel Pollak: Every decision involves rationing. Now, if the rationing happens by the government, people will get angry about it. We don’t want the government telling us that if you’re over 55 you can’t have kidney dialysis, which is the case in some countries. I mean you can have it, you just aren’t going to get paid for it. And nobody can afford that.

So what we have now is a system where its being rationed, essentially, by doctors because doctors can decide whether or not to participate in medicare, and accept those patients.

And that’s a problem as well, because people can’t see the doctors they want. So how do you fix that? Well, the closer you bring those decisions to individuals deciding what they want and don’t want, I think nobody’s happy with having to have these choices, but that’s what life sort of throws at us.

I think people are happy making choices themselves rather than having the government make it for them or some doctor decides not to treat them or some insurance policy that rejects them.

So, the number one thing that I think people are worried about when it comes to health care, not just medicare, is if I get sick am I going to get taken care of, if I get taken care of, can I afford to pay for it.

That means issues of getting denied for pre-existing conditions, losing your insurance when you lose your job.

If we had focused our attention on those two issues actually — loss of insurance when you lose your job and denial of pre-existing conditions– instead of trying to reconfigure the entire health care system, I think we would have seen more consensus around proposals moving forward.

It’s cheaper to cover everybody with pre-existing conditions than it is to redo everyone’s insurance the way we’ve done it now.

But these are tough choices and I think that the anxiety a lot of people are feeling is that if we keep going the way we are those decisions are going to be made by the government.

Now Sarah Palin called it a death panel, and maybe that’s a stretch, but it still means that there is a body with very limited accountability that’s going to be making, if not quite life-and-death decisions, at least cost-benefit analyses that are going to affect individuals.

And I’m not sure that people want those decisions to be made by the government.

Evanston Now: If the government doesn’t control it, then isn’t your insurance company is going to control it?

Joel Pollak: Under the current system. I think over the long run we need to move to a system where patients do control more of it.

Evanston Now: Patients control it now, they can (theoretically) pick up the tab for whatever you need. How are you going to change to an environment in which the patient doesn’t have to pick up the tab but still gets to choose what the treatment is. That seems like it’s impossible.

Joel Pollak: I think you have to distinguish between everyday medical treatment that is less costly and where patients have more discretion and where patients can also do a little more shopping around — if one doctor provides a service for significantly cheaper than another does — you need to allow patients to make those decisions instead of walking into a doctor’s office and not knowing how much something costs. Not knowing whether you need it.

You know, my wife went to the dentist the other day and she had just had her wisdom teeth out a couple months before and they wanted to do another x-ray. And she said, I don’t need another x-ray, I just had an x-ray. And they said, well, you know, we can bill the insurance.

Because none of the decisions are being made at the patient level, doctors have bad incentives to overtreat, patients have bad incentives to over-utilize.
I think what you can do is separate out the catastrophic things — the events and the costs that people are most worried about.

I left my job to focus fulltime on the campaign, and I still have insurance. But look at what happens when it runs out. I don’t want to get caught walking across Chicago Avenue here and get hit by a car and have massive health costs, but I’m perfectly prepared to go and pay for my own medical checkup. I’ll just go to the doctor. I’m pretty healthy. So if I need an annual checkup I’ll just go there, rather than having my insurance pay for it and fill out all the paperwork.

I think that if we can move toward that kind of system where patients are more in control of everyday costs then we can have a broader heatlh system which can include some public elements, not just Medicare, but some form of public insurance where there can be coverage for these catastrophic events that people are worried about.

I think that will preserve the best of our health care system, which is the innovation that happens, and the choices that patients do have, while at hte same time creating a safety net for those people who we are concerned about.

This is the last in a three-part series of stories based on an interview with the candidate. The previous ones dealt with foreign policy and the economy.

Bill Smith is the editor and publisher of Evanston Now.

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29 Comments

  1. My kingdom for one more day of life

    Maybe my comment title is apocryphal, but one can easily imagine it being said.

    When it comes to healthcare spending, the older you get the more you spend, or the more others spend for you. We are stuck on the horns of a dilemma because everyone wants to live as long as they can and nobody wants to say that a life has some finite cost that cannot be surpassed. If personal funds are exhausted, how heartless for society to let a person die for lack of funds!

    It once was the case with native-Americans that the old would simply go into the forest to die or would drop back on the trail and not be seen again. They knew their time had come, no one asked them to do this, but each person knew that he or she would do so at some point. All knew that the continuation of the life of the tribe depended on this custom of the individual acting for the common good.

    I’m reading a biography of Einstein. At the point where his wife is about to die (late 1930’s), the author uses the phrase "nothing more could be done". Today, there is ALWAYS more that can be done and it costs.

    We simply can’t keep supporting longer and longer lives through public funding. The only possible way to start backing off from the brink is to set an age…let’s put it high, at 85? and say at that point Medicare, beyond palliative care, stops. Whatever ails you at that age, nature will then run its course, just as it used to do at 70, at 60, go back in time far enough, at 35.

    Personally, I look at it as drawing a limit to how much we take from our children. I would sign on to this plan, even if it specified a lower age than 85. The way things are going we are giving more and more of our national wealth to the medical professions with no end in sight.

    I’d like to hear other proposals…

     

  2. Clif, Why put an age

    Clif,

    Why put an age limit? 

    What if you have Downs syndrome, ALS, Parkinson’s, MS, cancer, etc?

    What if your IQ is below a certain level, or have a genetic disposition? Should you be allowed to reproduce?

    I recall that something like this was attempted before.

     

     

  3. the cost of immortality

    Come on now Vito, don’t be facetious. Surely you have something to say on this since you are the one who says money is a scarce resource. Nowhere is it more in evidence than with medical care.

    Medicare spending (part of Social Security) is ramping up far faster than Social Secuity retirement funding. It is becoming the norm for people to exhaust their own funds and then fall upon Medicare to keep them going. GWB ramped it up more with prescription drug coverage. 

    This life support is at public expense and the elderly are demanding it almost as a right. Just this last year AARP was trying to get a CPI increase in SS payments even though there was no increase in the CPI (I’m a member and got a letter asking me to hound Congress about it – I told them to forget it).

    If I am to take what you’ve said in the past seriously, you would say to someone who is making minimum wage that there should be no minimum wage, because it is counterproductive, drives away jobs, increases unemployment – all bad for society at large, but do you say to the elderly – the purse is open for your kidney, your new heart valve, your fourth bypass operation, etc., etc.? To keep someone going no matter what means the sky is the limit for funding it.

    Traditionally, the old in society make room for and do all they can to help younger members establish themselves and live a better life, under the philosophy of "I had my day, now you have yours". The way we are going has that turned on its head – that society is to keep each member alive without limit and regardless of the cost to the younger members.

    Kept strictly within the family, how many of us would drive down the standard of living of our children without limit so that we could live longer? Suppose the law said that once the parent’s money is gone, that of the children or relatives might be tapped? There would be an uproar!

    Money is a scarce resource. Now you are ducking it – what’s your solution?

    1. vito’s invalid comparison

      "Money is a scarce resource. Now you are ducking it – what’s your solution?"

      Right…and Vito’s comparisons of Clif’s suggestions to American eugenics laws are not valid.  .  There is a difference between the government FORCING people to be sterilized or not allowing people to get treatment, and the government saying that it will not pay for such treatment.

      Currently the government does not pay for medical procedures for most people who are under 65.  Why should we have this arbitrary lower limit and not an upper limit?   Unless you favor universal health care, there is inevitably some rationing going on by the government.  And if you do favor universal health care, there will necessarily be rationing since doctors and drug companies can alway come up with more procedures and drugs to charge for.

      The government also does not pay for botox, hearing aids, and many other services that may or may not be necessary – but it does not prohibit people from obtaining these with their own money.

      Here is a famous video of a woman asking President Obama about whether her mother (at age 99) should get a pacemaker from Medicare.    Obama’s answer was good,  but the nutcases still try to cite this as an example of how Obama might just let old ladies die.   Still, I would have been happier if President Obama asked the woman why she thinks that the government should pay for a 99 year old woman to get a pacemaker.  Has grandma depleted ALL of her savings?  Is this woman willing to pay anything to help her mother afford a pacemaker?   If grandma has money in the bank, shouldn’t she be forced to pay for her own pacemaker instead of passing the money to the grandkids while taxpayers cover her health care?

      Why should the government pay for pacemakers for 99 year old people,  but not 45 year old people?  Enquiring minds want to know.

      1. Mr Who Knows What? has gone from anti-NIMBY to anti-senior

        Mr Who Knows What?

        The government does pay for people under 65.

        It is called Medicaid. 

        It also pays for employees’ health care through generous tax deductions for employers who provide health benefits.

        We pay for that in taxes.

        You may have a viable point in terms of semantics. As yet, the government does not force people, but once the government makes decisions regarding health care access, the differences become subtle.

        Yes, we ration care by cost, and by denial of procedures and medications that are not on an approved list. BTW the AMA, to which only 17% of doctors belong, controls that list and leases it to providers, including Medicare and Medicaid — one reason why they were for health insurance dithering legislation.

        As far as paying with your own money, the vaunted Canadian health care system was sued by someone who claimed that long waiting periods for access was effectively rationing. Moreover private care was not allowed. The plaintiff won. The court agreed that rationing was in effect.

        "Why should the government pay for pacemakers for 99 year old people,  but not 45 year old people?  Enquiring minds want to know."

        If a 45 year old requires a pacemaker, they are obviously a health risk, using youir logic for cost containment, why waste the money?

        BTW in the hallowed halls of anonymity, is there any thought that what we have now and what is proposed, could be more cost effective. Or do the saves come just from denying patients?

        Here is to a ripe old age!

  4. Care for the aged

    Money is a scarce resource is a given, and denying coverage because of "costs" is akin to politicians saying we have overspent our budget and we must raise taxes. This applies to education as well, where the standard solution is more money rather than fixing the problems.

    One of the reasons medical costs are going up is because of the way we dispense health care.  The recent health insurance dithering legislation will not reduce costs. 

    We should change the way we deliver healthcare to maximize cost effectiveness before we attempt to cut costs by denying it.  There are — and have been — exemplary ways of delivering health care and reducing costs.  One example is Kaiser Permanente.

    The recent "health care" legislation will have unintended consequences. As an example, employers may legally save money by removing employee health care benefits and paying the fine, forcing employees to go through the exchanges, which will only increase costs.

    So before we suggest or attempt draconian measures we should really fix what we have, now or proposed.  Having been involved in the creation of NorthCare in the 1970’s, my experience tells me we are far from achieving effective cost control and improved health care. Denying it is not a solution.

    1. skirting the issue

      Vito, that’s a response that could come from one of one of your despised Democrats.

      As cars age, they cost more to maintain. First one thing fails and then another. Before long, it’s clear that what is being done is building a new car one piece at a time at tremendous cost and the process ends because no sane person would continue with it.

      Exactly the same thing is true of people, of animals, of anything that exists on this planet and is precisely the reason the native-Americans of old would disappear of their own volition. They knew they were a burden and could not perform the services for their band that once they had.

      Maintenance cost rises with age and it doesn’t matter how efficiently the maintenance is performed. You know a politician backs a spending program when he/she speaks only of cost cutting measures and efficiency as you just did.

      More elaborate, complex medical procedures are being developed all the time and many are oriented toward geriatrics – because that is where the money is – that is where Uncle Sam is spending freely. Say a new procedure can replace part of a failing brain for $1 million. Will Medicare pay? How about making it a rule that no new procedures will be paid by Medicare? That might at least slow the growth in spending. You’ve spoken of opportunity costs and of the market being a method of rationing. Ok, so when the elderly get funds, others don’t. When the elderly get the ration card, others don’t.

      You have been loud in your criticism of European socialism where money is lavished on pensions at early ages, unemployment results in little loss in pay, etc. Why is this bad? Because, I think you would agree, people should work and be productive and society doesn’t owe people anything. Don’t you agree with all of that? But society owes, as far as possible, eternal life for all?

      Suddenly you’ve put down the bullhorn of financial rectitude, backed off from your fiscal responsibility podium and quietly taken a seat in the back of the room.

      Your complaints of financial waste have been right on in the past but you can’t be taken seriously when you pick a spending program that you like and benefit from and exempt it. Medicare spending is a monster and no politician will touch it – not surprising when even so-called financial hawks like you back away from it. But it won’t go away.

      Is anyone else reading this thread? Any ideas? Just maybe Joel Pollack is reading and might take something away from what you have to say.

      1. who is skirting the issue?

        Clif,

        Despite an MBA from the U of C and an engineering degree, thus being a "quant" I do not consider myself capable or qualified of placing a value on human life.

        All I am saying is that before we resort to "quantitative" valuation of human life, if it be for age, then what about other human related costs for people with disabilities, or for that matter "undesireable" attributes? They all have costs.

        You base your methodology on cost vs age, which is just opening the door to placing a value on human life. That is a very wobbly path. Once a cost threshold is set for one variable — age — then when do you stop?

        There are already methods in place, such as a living will, that let people make their own decisions regarding their last days. There is counseling available.There is best practices, etc.

        The last thing we want is for the state or any commission to make that decision. I was not being facetious when I refferred to prior history that has occurred in our lifetime.

        As to costs, a good start would be to fix what we have. We certainly have plenty to do there.

        Speaking of cost, what about public pensions? That is a bigger time bomb.

        Anyone else want to chime in?

         

        1. what is a life worth?

          Vito, you’ve answered my question – you consider the amount of money that goes toward Medicare without limits. You say you are not willing to place a value on human life, but you do it every day because you reserve your money for what you want to spend it on. How many would die in Indonesia, or Niger, or even Indiana from starvation before you would pledge your wealth, or even a small fraction of it, to extending their lives? We all do this, so I don’t single you out as an exception. But it is empty for any of us to say that life is priceless and we don’t put a value on it. It’s contrary to fact.

          The further a human life is from us in distance and relationship, the less it is worth. Regardless of what you say, you accept that, as we all do. That’s why the term "Collateral damage" is such an interesting term, because it indicates lives that are so worthless that even collectively they don’t merit the words "human life".

          To get to Medicare, if we allow each person to make a claim on society equal to the value he/she places on his/her own life what will be the result? Should an intensive care unit be devoted to one person? Should a open-heart surgery team be on 24 hour call for one person? To the person involved, to whom their own life is truly priceless, would that be such a bad thing in comparison to their own death, especially if that person doesn’t have to pay a dime for it?

          Who would say, "I’d like to keep on living, but I’ve used up my money and that medical procedure, even though I don’t have to pay for it, is too expensive for Uncle Sam so I’m checking out."

          What close relative would say, "Dad has been comatose for a year and that procedure they recommend to keep him alive is very expensive. Since the government is in so much debt already, let’s let Dad go."

          Right now, we are warehousing the old. It’s going to get worse. Even the fairly well off can end up pledging their estate to get into a nursing home. You approve of businesses making a profit, Vito, and that’s what nursing homes do. They well know the actuarial tables when they consider a person for admittance. Far from considering human life priceless, they have it down to the dollar because they have to figure on making a profit. So, again, you do put a price on human life because you are happy to let them do so. I know I will never see you in front of a nursing home with a sign that says "ADMIT EVERYONE – HUMAN LIFE IS PRICELESS!" In fact, I bet you would be the first to criticize someone who would do that.

          So you want private business to be able to profit off the old, but don’t hesitate to see your fellow citizens made liable without limit for keeping people alive. In fact, much of what the nursing homes take in is a direct transfer of funds from the public purse – a major entry in the ledgers of the homes, assuring they cover their costs and then some.

          But for Uncle Sam, who also must cover costs, there can be no value on human life? It’s absolute and utter nonsense, and from someone who claims to know something about money!

          1. “framing” the issue

            Clif and Mr. Who Knows What?

            Who does your teleprompter framing of issues? Axlerod, Gibbs, Plouff?

            I said I personally cannot place a value on a human life, you then insist that I set no limits and that Medicare is an open purse for seniors to plunder.  You use terms such as "warehousing" seniors and consider people as expendable tools once they cease to be "useful".

            You deride the phrase "money is a scarce resource" and deny its validity yet preach it.

            If you knew anything about medical care, especially for seniors, you will find that there are various approaches to dealing with end of life issues.  My wife and I have Living Wills that are explicit as to what is to be done as we near the end of our existence — even when we cannot make those decisions ourselves.  So there is  a rational approach to dealling with that time.

            To arbitrarily set an age limit — 85 —  is ridiculous. I know people in their late 80’s who are contributing seniors and people in their 40’s who are disasters and a drain on society. What would you recommend?

            I recommend you visit Presbyterian Homes Westminster Place on Golf to see what "useless" seniors can do.

            What do you think about organ donors donating to the highest bidder?

            I thought 1984 was fiction, but it appears alive and well in Evanston.

            BTW many senior facilities are non-profit.

          2. organ donation to the highest bidder

            "I recommend you visit Presbyterian Homes Westminster Place on Golf to see what "useless" seniors can do.

            What do you think about organ donors donating to the highest bidder?"

             

            Organ donations to the highest bidder?  That sounds like capitalism at its finest to me.  Enquiring minds want to know what  Rand Paul and Joel Pollack would have to say about it.

            Like Rand Paul, it looks like Vito wants to have it both ways.  He complains about excessive government spending, but doesn’t want the government to cut back on or limit spending for Medicare.

          3. Come back to the topic

            Vito – we are talking about government support for medical care for the elderly, an open ended entitlement. I am begging PLEADING with you to offer a plan that is not simply cant about your personal value of life and how there should be cost cutting measures with no teeth.

            We are not talking about personal decisions such as living wills, not whether or not nursing homes are for profit or not, not about whether elderly people should receive money based on their usefulness and not about choices for retirement. We aren’t talking about eugenics or the Nazis. All of these things have NOTHING to do with the subject at hand which is, again, open ended entitlement with an ever growing number of claimants, living to ever increasing ages and making ever larger claims.

            Setting an age for ramping down Medicare is far from ridiculous because it does not discriminate between one person and another who reaches that age. In your confusion of issues you bring up the difference in capability between one old person and another. That is precisely what we DON’T want the government judging. 85 years of age is the same number of years on earth for everyone alike; a blind benchmark. Just as an age is defined where Medicare starts, an age can be defined where it will be ramped down or limited to palliative care.

            Vito think of your own past arguments! Nobody is entitled to a unlimited amount of medical care at goverment expense, just as no one is entited to unlimited government funds because she is an unwed, unemployed mother. Have you forgotten the lesson of dismantling welfare just a few short years ago? There is no blank check for anyone from the public purse, except, at the moment, for the elderly, recently treated to prescriptions too!

            One way or another we will arrive at a way to reduce Medicare received per person or a limit on the period during which it can be received. We will do it because not to do so will bankrupt the country (as if it isn’t already). Raise the age at which Medicare kicks in if you will but don’t resort to meaningless statements about your personal distaste for putting a value on human life. You put a value on it every day. You do, we all do. You were a big backer of the war in Iraq and Afghanistan. Collateral damage means nothing, remember? Your value on those lives amounts to "I’m sorry it happened". Gimme a break!

            So for U of C grads, even for a Rhodes Scholar who might be reading, in grade school arithmetic here it is.

            MORE ELDERLY(boomers) + LONGER LIVES (more years making claims) + MORE EXPENSIVE PROCEDURES (new state of the art items always being added) = $$$$$

            I’m sure you know what an asymptote is and that is where Medicare is going.

            You are now my poster boy for the difficulty of addressing the Medicare issue – you are a recipient, you know what a budget is and how to keep one, you claim to understand the value of money, you are the first to call out financial imprudence, you go on and on about "The Peoples Republic of Evanston" and the horror of socialism, but you have nothing to offer about Medicare spending, socialism for the elderly. Tell me how you differ from the unwed mother when asked what she thought of Clinton’s welfare reduction plan.

            P.S. If you think the Presbyterian Home, 3 Crowns and such are representative of elder-care you need to visit some other places. I don’t think you understand what I mean by warehousing. I’ve been to such warehouses where life is a seat in front of an always-on TV, where every face is a vacant stare, where home is a cubicle shared with other(s) and people come right out and say "I want to die", where low paid help is rude and never answers a call for help. To hold up the Presbyterian Home as an example only shows ignorance of what old age means to far too many people…a hell on earth long before death comes, even with Medicare.

          4. which topic

            We are going all over the place. Enquiring Knows What? adds their two cents.

            The original issue was the value of a human life, with Clif’s implication that after 85 it wasn’t worth enough to fund necessary medical care to extend it,

            I countered that I personally could not place a monetary value on a human life, much less use an arbitrary age limit of 85 as a threshold. That is a moral statement. I asume there is a place for moral values or are they obsolete? I do recall cants against war — is that moral or economic?

            As far as age, there are plenty of people under 85 who "cost" society — taxpayers– and are of seemingly "little"value to society, and in fact cost society money. Example: prisoners under life sentence.  Shouln’t we save money by eliminating them as a drain on taxpayers? What about people without financial means who are "warehoused", be they seniors or disabled.  They are a cost and a "drain" on monetary resources.  If we can set an age limit beyond which we should not "waste" monetary resources, what about them?  You claim that is extraneous, i claim it is central to the criteria you use.  It boils down to what is a human life worth? I can’t tell you. I don’t have your "wisdom".  Would a commission have that "wisdom"?

            If old age means a hell on earth, what about all those disabled people?  Should we do them a "favor"?

            As for the organ donor comment.  There is a shortage. Not all are Steve Jobs and can afford to "obtain" one. Should we pay for dialysis,or would it be more cost effective to offer money for a donor, do an opt out on our drivers license or just put the patient out to die after X dollars?

            You sneer at the eugenics comment, but once you place a monetary — or politcal value — it is a slippery slope.  I have history in my side, be it 70 years ago or right now.  There are those who claim that some do not have the right to exist.

            Rather than fester about Medicare cost, what about fixing the medical cost system?  The recent health insurance bill is political dithering at its worst and it does not save money. It hides cost by putting in saves and then replacing them in other bills. Fix that and then let us rejoin this argument.

            Politically unpalatable?

            Jeez, we need a dictator who can get things done (thanks to Woody Allen)

    2. a good effort

      Vito, I never doubt you will stick with your views and your latest posting is your best effort. I don’t think it even begins to address the magnitude of the problem but I won’t persist. The longer we wait the more draconian a solution will have to be.

      As readers may not know, you and I have a history of contention on various issues, and agreement on others, going on many years now. Bill has come up with a real breakthrough in providing local news with this forum and I’d like to see more people using it for serious debate on whatever the topic. I also hope, and think you would agree, that posters use their real names. If an opinion is not worth enough to the one who voices it to stand by it with their name then how can others take it seriously?

      Standing by for the next contest…

      1. Magnitude of the problem

        Clif,

        Well here we are at an impasse. I have never denied the magnitude of the problem, just that on a moral basis I cannot "place an arbitrary monetary value" on a human life. You skirt/deny the moral issue and since we argue from different views we will not come to agreement much less a resolution.

        We recognized the cost and access, as well as quality of care issue, in the 70’s.  That is why we worked with others to get NorthCare going. It was based on best practices as exemplified by Kaiser-Permanente, Almost 40 years later that still holds, even though NorthCare no longer exists. The current health insurance bill passed by Congress is nowhere near the answer as far as quality of care or cost containment..

        You know that when it comes to numbers, be it the 708 Tower or the Pension Problem, I do not mince words or magnitude. As a nation we have a serious financial problem and not just with old farts. Printing money is a political solution, but not a real solution, as the EU is more than aware.

        Clif, until we disagree on something else, one word of advice: don’t get old.

        1. old age

          Well, that last sentence calls for a response, because it goes beyond the issue of Medicare to the heart of our problem in the Western world, but particularly in America – and particularly because you speak of morality as if others are paying no attention to it.

          We don’t understand old age and because of that we fear it. We don’t understand old age because we don’t understand death. Death is, for us, the ultimate terrorist, a monster to be fought with all weapons available.

          To the elderly Indian falling away from the trail to die, it was not a moment of terror.

          In the Hindu epic, the Mahabharata, the protagonist has just lost all of his brothers, poisoned by bad water they had drunk from a pool in desperate thirst, despite a stern warning not to drink.

          He is beside himself with grief at the loss when a disembodied voice is heard that promises to bring them back to life if only our hero will answer a few questions. Now, all of the questions are worth hearing but only one is pertinent to this discussion and that question is: "What is the greatest wonder?"

          The answer is "that death is all around us but we live each day as if we were immortal"

          What should we be ready for each day of our lives? Death.

          But what do we put the furthest from our minds each day? Death.

          Americans in general see themselves as objects to be continually repaired. If no fix is available, one should be found. If it is possible to live to 90, it should be possible to live to 100. Nobody is silly enough to speak of eternal life, but in our dreams that is what we want. What horrifies us is that there is an end to, literally, object-ivity. We will be no more, we will be no-thing in a world that we know is purely and entirely things.

          As folks age, they become more frightened instead of more reflective, more desperate instead of more relaxed. Those who had no use for religion rush to church, just maybe there IS eternal life. We really are a country of youth and even a perusal of the AARP bulletin will show a pathetic obsession with looking young, being vivacious, being attractive, being sexy and the ever-present obsession with celebrities…a glamor magazine for the elderly, an oxymoron if ever there could be one.

          Are young people constantly calling at nursing homes seeking the wisdom of the elderly? Of course not, because a nursing home is a reminder of death and decay. Not only that, the elderly themselves are less likely to impart wisdom than to lament and describe their woes.

          So we are in a fix. We wiped out a civilization that knew things we seem unable to comprehend and the conception of death and dying are at the top of the list. Concerning the environment, we are being forced to admit almost daily that our rejection of all things Indian may have been a little hurried. Our attitude toward old age may change as well. Right now, it’s perverse.

          Live each day as if it were your last, knowing that it might be, and when death comes from age accept it with grace. Or choose anxiety and fear. I forgot something, is it early Alzheimer’s?! My heart just skipped a beat, do I need a pacemaker? And on and on and on and on. 

          By the way, I’m 60. I cannot believe I am still here after all these years. How could I begrudge my own end after having so many many years of life? My brother died of polio at 11, my niece in a car accident at 17. I should make demands of life?!!! I should complain about my aches and pains? I should ask my fellow citizens to pay my medical bills? Who the hell do I think I am?

          Yes, Mr and Mrs elderly native American of 150, 300, 500 and more years ago, I think you were on to something!

          The grim reaper is out there, that’s a fact. What I don’t want are the interventions to hold him off. I admit it would be nice to have a few minutes to say goodbye to folks but, hey, you can’t have everything.

          1. Old age or maturity?

            Clif,

            There is knowledge, which is a collection of facts.

            Then there is wisdom, which is applying knowledge.

            There is getting old and there is maturity.

            Take your choice. Fight the grim reaper or prepare for him.

             

             

          2. well said

            Very well said, but I would add that if one chooses to fight, don’t expect others to fund it when they have been given no choice about doing so.

          3. others funding

            Clif,

            In finalizing our discussion about Medicare age limits you state: "don’t expect others to fund it when they have been given no choice about doing so."

            You cannot just limit that to seniors.

            Do you imply that all public funding should go to public vote or opt in/opt out? That then applies not only to medical help, but schools, street improvement, etc? You cannot be discriminatory once you state that funding must be open to choice.

             

          4. services, entitlements and the individual

            Vito,

            I’d draw two distinctions – one is between services provided to all and entitlements provided to a select group.

            The second is no cap on what can be drawn from the public purse.

            Medicare is a combination of both entitlement to a limited group and no cap on how much a member of that group can demand…unless there is some cap on Medicare that I don’t know about.

            That is why I am calling for some kind of limitation on Medicare – it could be by age or it could be by total amount allowed per person – some method for setting a limit that cannot be exceeded. This will come in one way or another because otherwise it is simply a version of "from each according to his abilities, to each according to his needs" and history has shown how that goes!

            Another thought I had after my last post is to set a maximum period for benefits based on life expectancy at the time of eligibility. When Medicare was signed into law, average life expectancy was, what, 5 years less than it is now…maybe more? So, as average life expectancy moves up, so would the age at which Medicare would start. That would be saying, "the country will provide assistance for the last X years of life as the budget allows". If this was still too expensive, it could be reduced to X-1 years and so forth.

            We are a society that values individualism. The calls to limit government spending are more often than not justified under the concept that no more should be taken from the individual than is necessary to provide for the services that he/she cannot provide for him/herself.

            Indian society was also cognizant of the individual (male) and dedicated to preserving that independence, across tribes and nations. But, as mentioned, the individuals in that society took it upon themselves to depart the scene for the good of the group. Responsibility and liberty were balanced. That is not the modern way.

            So we are in a jam created by the paradox of our society – value the individual, but once old, look not for resposibility but allow each to take without limit for the purpose of…simply going on until all methods of preservation are exhausted.

            Please see this video for an excellent example of where public should go before it goes to the elderly. This little fellow can’t vote and is powerless to act on his own behalf but he has a whole life of promise ahead of him. Old folks do vote and turn out in droves to demand more of SS and Medicare, let alone prevent reductions. We will live under the tyranny of the old if we don’t act, young and old alike, to stop it.

            Prevention of indigence and a painful death for every elderly American – absolutely! Endless life at any price? No.

            A showdown is going to come. Though I’m getting up there, I’m voting with the youngsters.

             

             

          5. entitlements

            Clif,

            We are going around in circles.  If you limit Medicare, one can assume there has to be some criteria for determining a limit, the question is how and who sets the criteria. There are all kinds of entitlements, but who decides what is an entitlement?

            You state:

            I’d draw two distinctions – one is between services provided to all and entitlements provided to a select group.

            The second is no cap on what can be drawn from the public purse.

            What about school funding?  What about those without children?  You may argue the "common good" but what does that mean to a childless person or couple? And from what we see as rising school costs, there appears to be little improvement for the added costs. There appears to be no cap other than bankruptcy.

            What about pensions for public service employees? There seems to be no cap there and that is certainly an entitlement to a select group. You lament the political influence of geezers, yet what about the public service unions, in fact unions in general.

            What about bailing out entities that are too big to fail? Fannie and Freddie have no cap or limit as what may be spent to keep them afloat.

            Are these examples of services provided to all? Or a select group?

            Anytime you set a limit, you are having a disparate impact.

            The nitty gritty is the problem.

             

          6. here it is in a nutshell

            Vito:

            Here it is in a nutshell

            Vito to the public school teacher in a union: "Show us how your are doing a good job educating youth. Prove that the public is receiving value for money and that you are not being paid more than another person who could do as well or better for lower pay. Money is a scarce resource and the taxpayer is not here to pay you more than is required for the job you do. I pay high property taxes here in the People’s Republic of Evanston and I’ve had it. Your unions and the Democrats have a real scam going! I’m paying you and I demand accountability."

            Vito to the elderly: "You say you can’t hold a job? No problem, you’ll get Social Security as long as you live and cost of living increases too. Health issues? Here’s a Medicare claim form, take a dozen, there’s an unlimited supply and as long as you are alive you qualify. If you become unconscious, someone else can make a claim for you.  Almost forgot, have you heard about the prescription drug program – and darn it if those Democrats aren’t trying to close the donut hole, at the taxpayers expense. If this keeps up we will have drugs for free. As it is, we wont pay anything for the benefit in taxes and will really save at the pharmacy. Medicare’s great, we don’t have to do anything to be entitled to it except exist, why it’s almost a scam! As they say, life is priceless, especially when you are the beneficiary and others with others paying for yours! See you later, I’m on my way to city hall to complain about taxes. We really have to stay on top of those politicians."

          7. nutshell solution

            I see that Mr Who Knows What? expands his anti-NIMBY (Not In My Bad Years) campaign.

          8. The answer

            The solution according to Clif:

            Raise taxes, have the Government regulate and decide everything by Commissions of the Know it All.

            When you are 60 you will emigrate to France or Greece. All wealth is turned over to the state since it knows best what to do with it. We will even pay the union dues in euros.

            If you do not want to do that, we have this pill…

             

          9. I’ve got a name for it!

            Raise taxes? Vito, never once did I say that. But that’s something you will have to consider as Medicare hits the wall. Ranting about Europe only puts you in a tighter spot, more evidence of your total blindness to seeing what you decry – when it applies to you. Medicare is European socialism brought to America for the elderly alone.

            Another interesting point – you were vehement about not extending Medicare to all with the health bill because you don’t want the government dictating health care. Yet you are fine with Medicare as it is, limited to a group that includes you and refer to any age or service limitations as "draconian" This is drawing up the bridge to the fort once one is inside.

            From now on you are "Mr. Medicare" whenever you mount the "money is a scare resource", "wasteful government spending", "greedy unions", "tax and spend Democrats", etc. etc. attacks.

            That will be a simple two word way to refer to this sequence of posts, always here for the reading. You may have the honor of tying a ribbon on it and feel free to come up with a name for me too!

             

          10. Medicare as it is? Tch tch…

            Clif,

            Who said I was satisfied with Medicare as it is  — you are assuming, tch tch, or "framing".  I just did not want it to make it worse. As the CBO is unraveling, the legislation that had to be passed to find out what was in it, is costing more and more and will actually make access even less.  The supposed "cost saves" are being restored through other legislation.

            My main issue was with your Peter Singer approach to arbitrarily placing a "monetary value" on a human life, in this case seniors.  (BTW when asked if his views applied to his mother, he waffled) You implied it was old redundants who had exceded their "value" and should be allowed to do their duty and fade away. But once you do that for seniors, then how do you restrict it from being applied to other "non productive" citizens: prisoners on life sentence, physically and mentally disabled, etc.  These are all supposedly non productive by your logic.

            You have avoided responding to this issue. Do these "non productive" citizens have a dollar value or limit? Please respond.

            As for "unions" or public service employees, which is where the union strength lies, you need only look at Illinois, even Evanston, for a good example of the extent of the problem.

            Should I rename you Clif Singer?

          11. a simple pie chart

            "You have avoided responding to this issue. Do these "non productive" citizens have a dollar value or limit? Please respond."

            Reader, if any are left – help me! My friend Vito is not listening so perhaps he will get the message from a simple pie chart

            You have resolutely said you can’t place a value on human life, that’s the whole problem we are talking about right in that silly statement,  that I put away as nonsense in the first couple of postings. Now you ask me to respond to a question that indicates you think it is some trump card. Words are wasted on you. I think I will replace Mr. Medicare with Megaditto Vito! (thank you, anonymous)

            EARTH TO VITO: THERE IS A DOLLAR VALUE TO HUMAN LIFE – there is a limit to what can be spent on the elderly, because we have a budget!!!!! Extension of life is no more immune to spending limits than anything else.

            Again, look at the pie chart of government spending. #1 slice is Social Security, #2 slice is defense, #3 slice is Medicare. So between SS and Medicare (actually part of SS) you have 36% of all government spending and this was 2007 BEFORE Medicare part D kicked in!!!

            36% and growing of the ENTIRE FEDERAL BUDGET is going from ALL TAXPAYERS to the ELDERLY. Money is a scarce resource. We must stop this dialog because I am honestly getting embarrassed for you…and we are running out of space for the postings.

             

          12. slicing the pie

            Clif,

            Nice to know that there are others who worry about the budget.

            There is an inescapable fact, the population is aging, not only here, but even more in Europe. It is called demographics.

            You have answered my question indirectly, by not answering.

            Yes, there is a "dollar value" by legislated Medicare coverage limits in terms of procedure, medication, length of stay, for example: there is an initial medical deductible each year, much as in private insurance.  There are 20% co-insurances for every physician visit, surgeon’s bill, x-ray, lab test, except for the few that are covered at 100%.

            In fact, there is an absolute limit on medicare spending for hospital care.  If you go over that, you have another supplemental amount, called lifetime reserve, and then:  that’s it, so it is not really an individual blank check. It would be interesting to see the statistics on how many medicare beneficiaries actually go into their lifetime reserves.

            The government has set these limits to what it will pay  — the rest is up to you, your supplemental insurer and your kin.

            Are you implying that even this is going too far?

            You do not respond to my issue of improving the delivery system, only that it costs too much.

            The reform that is needed is to the delivery system:  fee-for-service is a large part of what has gotten us into this situation.  Salaried group practices such as the Cleveland Clinic and Mayo and Kaiser Permanente, (although Kaiser is a complete health maintenance organization, and thus able to control costs and quality even more, since they own their own hospitals) were singled out by Obama as examples to follow.

            But you have not answered the question about how much a human life is valued, you avoid the issue of placing a value on the others I mentioned.  In your quest for budget rationality, would it not be logical to set limits on those "costly citizens"?
             

             

             

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