tag:blogger.com,1999:blog-5154018758799451116.post8818142728660145278..comments2023-11-05T06:01:46.501-05:00Comments on Solo Docs, So Long: My Ideas for Fixing our Healthcare System, 2OnaColasantehttp://www.blogger.com/profile/12516818299832410490noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-5154018758799451116.post-81013842279235500982012-09-19T14:40:13.765-04:002012-09-19T14:40:13.765-04:00First, we have to agree on what matters to us, as ...First, we have to agree on what matters to us, as a country. Second, we have to set goals. Third, we have to find practical ways to meet those goals. Fourth, we must work out the details of meeting those goals--which involves rules and laws and consequences--as we figure out how to make what we believe in a reality. Fifth, we revisit the things that matter to us, to see if they matter as much as they cost in terms of money, compromises, and the effect on our lives and our children's lives. You are asking me to jump to Stages 3 and 4, which require terrific group effort based on trial and error, and statistical analysis, and a lot of creative input from experts. I can propose how some of the details might be worked out, but then you will say, "But what about this?" and "What about that?"--citing one example after another about how people might abuse the system, or find loopholes. Putting ideas into concrete form is very difficult, and it's what separates nebulous dreamers from reality-based pragmatists.OnaColasantehttps://www.blogger.com/profile/12516818299832410490noreply@blogger.comtag:blogger.com,1999:blog-5154018758799451116.post-20579333742070520692012-09-19T10:29:23.473-04:002012-09-19T10:29:23.473-04:00Dr. Colasante, I accept everything you've said...Dr. Colasante, I accept everything you've said (and agree with most of it). But you haven't resolved the most basic question of how to practically decriminalize an activity while at the same time imposing a tax on it unless you have the tax enforced by the state's police powers (and therefore subject non-compliant participants with a criminal penalty)?<br /><br />Who would pay taxes if there was nothing the government could do to you for not paying? If you enforce it, then there will be bootleggers seeking to exploit the arbitrage between tax paid and untaxed goods.<br /><br />Just look at Amazon and the fights it has with states over the collection of sales taxes. In Florida, if you (the consumer) buy a good that is not subject to sales tax collection by the out-of-state seller, you are required to file a "use tax" return and pay the corresponding tax with the state of Florida. Do you know of anyone who has bought something on Amazon and has filed a FL Use Tax Return? I don't. Given the use tax collection data, almost nobody does, precisely because the state of Florida has no effective means of enforcing the tax against the consumer.<br /><br />So if you decriminalize crack and tax it, what will keep the same criminals from simply selling non-taxed crack? Don't you end up just replacing a drug crime with a tax crime? <br /><br />I agree that there should be a national dialogue about these things, but shouldn't that dialogue have a basis in reality. Idealized solutions offered by politicians sound nice and appeal to their respective constituencies, but as we know, rarely solve the problem.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5154018758799451116.post-47627408523557271762012-09-18T18:47:19.300-04:002012-09-18T18:47:19.300-04:00The monetary cost of health problems related to ci...The monetary cost of health problems related to cigarette smoking has been calculated. In the same way, the economics of other food and non-food items could be calculated. Most physicians agree that the caloric and sugar load of fruit juice outweighs the nutritional benefits, except for people who are malnourished or who have malabsorption. A health tax would be placed on foods if a cost to health could be calculated for those foods. Perhaps it would be more accurate to tax people whose weight exceeds a healthy limit, and who therefore will have obesity-related health problems, just as airlines are contemplating charging more for obese passengers. There are no fodds that are healthy for everyone. People with wheat or peanut allergies shouldn't eat these foods, but taxing wheat or peanuts for everyone wouldn't make sense. There should be a tax on crack cocaine, and mushrooms, and marijuana based on the health cost to society of these substances--this would be a function of statistical analysis,not ethics. There is a place for a national ethic about healthcare, but not when it comes to the cost of habits and substances that cost healthcare dollars. That's just mathematics. The problem of lawbreakers, smuggling, freeloaders wouldn't go away with this system. There should continue to be a national dialogue about what's good or bad for the country, what's healthy, what's not, and how a limited budget for healthcare can best be apportioned. OnaColasantehttps://www.blogger.com/profile/12516818299832410490noreply@blogger.comtag:blogger.com,1999:blog-5154018758799451116.post-35870010578083303152012-09-14T09:32:05.039-04:002012-09-14T09:32:05.039-04:00So who determines what is a greater risk to health...So who determines what is a greater risk to health than nutritional benefit? For example, let's take fruit juices. Parents give their kids fruit juices because they think they are healthy (and to some extent they are) but ignore the calorie issues involved with their 2 year-old sucking down apple and grape juice boxes like Lindsay Lohan sucks down drinks. How about beef? Would you be given a ration - 4 oz a week ok, but 16 oz you pay a penalty? How would you enforce it, and how would you implement it. What would keep people from going from store to store using up their beef ration the way people go from doctor to doctor getting multiple prescriptions for the same drug?<br /><br />Secondly, the drug idea - let's take crack cocaine. I'm not a medical profession but it strikes me as a very bad drug, so as I understand what you are proposing we would simultaneously decriminalize the use possession, distribution and manufacturing of it and impose a tax on it. I assume the tax on crack would be higher than the tax on mushrooms or MJ because they are less risky. Is that right? <br /><br />So what would keep drug smugglers from dealing in untaxed cocaine the way illegal cigarettes are imported to avoid the taxes. If you've decriminalized the activity but impose a tax which has to be enforced, aren't you just shifting the enforcement from police to the IRS? I imagine customs would still have to be involved to ensure untaxed crack doesn't make it to our shores.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5154018758799451116.post-11534122425667421792012-09-13T14:27:08.441-04:002012-09-13T14:27:08.441-04:00The "penalty" for eating would only appl...The "penalty" for eating would only apply to nonfoods, or foods that pose a greater risk to health than nutritional benefit. Using drugs would no longer be an illegal activity in my program--there would be acknowledgment that people use drugs, and a penalty for doing so. Again, the penalty would be calculated as a function of the risk the drug use posed. If you consider the algorithm used by insurance companies, perhaps it won't come across as punitive. As I grow older, my life insurance premiums go up--is that a "penalty" for growing older, or simply an understanding on the part of both my insurance company and me that my risk has gone up, and the cost for it should be shared? People who drink sodas have an increased risk of dental caries, osteoporosis, and diabetes. The cost of soda, therefore, would include a risk-added tax. The revenues accrued from the tax would pay for the added cost of healthcare, provided by the nation, for individuals who choose to buy sodas. All of us participate willingly in a version of this system when we buy automobile insurance (which is required by the government), or health insurance (to a more limited extent than I have outlined), or when we have to pay out of pocket for dental care, paying more if we haven't cared for our teeth properly. OnaColasantehttps://www.blogger.com/profile/12516818299832410490noreply@blogger.comtag:blogger.com,1999:blog-5154018758799451116.post-13127521600085003442012-09-12T17:15:32.547-04:002012-09-12T17:15:32.547-04:00I like many of the free market ideas you propose, ...I like many of the free market ideas you propose, however from a pure "fairness" perspective it seems kind of crazy to penalize people for legal activities (like eating) and reward people for illegal behaviors (like drug use). I agree that "vice" activities need to bear their full societal cost by those who choose to participate in them. Anonymousnoreply@blogger.com