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Subject: How Much Support is Too Much? rss

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Michael Hopcroft
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I just received a letter from the managed care plan supplied by the State of Oregon to handle my Medicare drug expenses. Turns out that my monthly medication regimen costs the state more than $1,200 per month.

As the recipient of this largess, I'm outraged. If the general public saw this, they would probably string me up on the nearest oak.

Right now I am working part-time and still receiving Medicare and Medicaid. If I were in a position to be working full-time and paying for private health coverage, the outlay on meds alone would far outweigh any potential profit for the insurer.

Yet I do not deny that based on my current condition I need these meds to continue to function, including work. The question is whether the expense, which is far greater than anything I could return, is worth it for the taxpayer. $14,400 dollars a year is a lot of money to be putting into the pharmaceutical industry on my behalf. It makes me a thief of the worst sort. Is there a more ethical option I could take?
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Before anyone posts that it's time for you to take the "long walk" out onto the ice, let me just say you shouldn't feel bad for our screwed up medical system. You didn't set those prices, they are the misbeggoten result of the various machinations and consequences of big pharma, private insurance companies, the uninsured and short-sighted lawmakers. Don't feel guilty, feel outraged.
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Given this thread in the context of your previous threads, I would suggest talking to a professional psychological counselor. You seem to be questioning whether you are a burden on society and sound potentially suicidal.

A person's worth to society is not just a matter of money. Bill Gates (or whoever has replaced him) is not the most worthwhile person on the planet just because he happens to be the wealthiest nor is the poorest person on the planet the most despicable.

Find ways you can do good and worthwhile things in you life, especially for those about you, and thereby you will make yourself a value contributing member of society, whether or not your income balances your medical and support costs.
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Boaty McBoatface
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A lot would depend on what your medication is for, but at the end of the day look at it like this. You are being paid to be a good citizen, you are being compensated for not taking what you need at the end of a gun.
 
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Boaty McBoatface
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Euroncrowseye wrote:
slatersteven wrote:
A lot would depend on what your medication is for, but at the end of the day look at it like this. You are being paid to be a good citizen, you are being compensated for not taking what you need at the end of a gun.


Not a helpful way of looking at things and one that invites moral hazard.


I would second Moshe's post.

Volunteer, give back to the community. If family and friends take pleasure in your company then you're probably 'earning' the medicine anyway.
It's also the reason why such help exists, to reduce the poverty and or mental health issues that leads to crime.
 
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Everyone needs food, medical care, housing, safety and justice and a clean environment to live in. A nation-state should be judged by how well it looks after its citizens and a society by how it cultivates such a state.

John Rawls's veil of ignorance theory demonstrates that if given the choice without known power differentials people would choose such a system.

I love that you care about this but I think your conclusions are wrong. You deserve this help because no one asks to be suffer from poor health and this could happen to anyone (there but by fortune could go you or I).
I say this as someone who at the age of 21 received close to a million pounds worth of investigation and treatment due to a 1 in ten million chance illness. I'm thankful to my society that didn't charge me a penny and hope that through a lifetime of citizenship I can further cultivate and strengthen this sort of society.

If you want to replay it give something back to the society that holds such values. If you have the time volunteer in some good cause.

Take what you need and give what you can.
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Chad Ellis
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The case for socialized medicine is basically like that for insurance generally, but from a different perspective. I have fire insurance, not because I think it's at all likely that my house will burn down, but so that IF it burns down the impact on my family will be limited. The pool of people with fire insurance are reducing our risk.

Looking at the pool of citizens, many of us are healthy and need no unusual medical attention. I'm lucky enough to be one of those, so far. But in the life lottery we all recognize that we or our children could turn out to be the house that burns down -- in this case the person who needs exceptionally high medical support. So again we pool the risk; each of us who is healthy (or whose house didn't burn down) essentially picks up some of the tab for those who incurred much higher costs because we'd like to have the same done for us if we were the unlucky ones.

That doesn't mean there are no limits (or, for that matter, no reasonable arguments against socialized medicine). But I wouldn't look at your case in isolation. Imagine that you had 100 lives, of which 95 were going to be healthy and 5 were going to have serious medical issues. Would you rather that your healthy 95 selves chipped in to help out the other 5?
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whac3 wrote:
Given this thread in the context of your previous threads, I would suggest talking to a professional psychological counselor. You seem to be questioning whether you are a burden on society and sound potentially suicidal.

A person's worth to society is not just a matter of money. Bill Gates (or whoever has replaced him) is not the most worthwhile person on the planet just because he happens to be the wealthiest nor is the poorest person on the planet the most despicable.

Find ways you can do good and worthwhile things in you life, especially for those about you, and thereby you will make yourself a value contributing member of society, whether or not your income balances your medical and support costs.


Yes, exactly. The question of whether it's morally okay to be a 'burden' is troublesome--what is the other option? To lay down and die?

I think it's only a problem morally if that bill is for viagra

You could, however, check with your pharmacist whether there are generic options for these drugs. In my experience they'll often ask if you want the generic version, but they could be greedy and enjoying the unnecessarily large bill. So, that's worth asking.
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Yeah, you paid the premiums all your life so that if you needed $1200 meds at some point in your life you could have them. Right?
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Chad
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At the end of the day, you would be a fool NOT to take advantage of this benefit.

They exists, you qualify, seems very simple.
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Dave G
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Would you gladly pay into the system for someone else's benefit if you were healthy and they were afflicted the same way you are? That's the part of the ethical question I think you're missing. Add me to the chorus of people who think you should take Moshe's advice and talk to someone professional if you find yourself depressed or wondering about your worthiness.
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I think some good statements have been made, but I also think that you really need to consider the fact that the cost set for the medication is virtually arbitrary.

The way I would look at it is that the state is reasonably providing you with medication, but with regard to the cost, while it's possible that cost represents the genuine R&D and production cost of what you get, it's more probable in my opinion that the price tag represents effectively corporate welfare by the state to big pharma.

So is the state doing something nice for you? Absolutely. Work hard to deserve it. The state is also doing something pretty nice for big pharma. I wish they'd give more back.
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Kelsey Rinella
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Some have sung the praises of various ways of measuring your value other than earnings. I agree with them, but would also make the more general point that it's easy not to see what value you provide. For example, having recent employment makes you much more employable in the future. Sacrificing that current employment, even if it isn't well-paid, would make you less likely to be able to contribute at a high level in the future. So the benefit to society might well be thought of as an investment which may pay off substantially in the future, and this is only one way to see that. You might also consider the damage which society would suffer if we were to think of ourselves as the sort of community which would allow you to suffer without those meds. I suspect that would be a big downer for a lot of folks. What other costs and benefits there are to you being medicated are unclear to me, and I imagine some of them are unclear to all of us, so I'd be cautious in any attempt to substitute my own judgment for that of the system.
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Michael Hopcroft
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As my part-time job is as a records clerk in a health clinic, I see a lot of documentary evidence about whether and how people get medications (but not necessarily how they pay for them). All the time I index records of people whose prescriptions were rejected or approved by their insurance companies. Doctors apparently do not have the time to track the "formularies" (the lists of accepted and non-accepted drugs for each insurer) so all kinds of problems result.

It would probably be easier under single-payer, but then I'd probably be out of a job.

for those of you who wondered if I needed extra help, I am getting most of the help I need. The bulk of the medications I take are for depressive conditions.

But the number of subsidies I receive would probably alarm the more conservative among us. I live in a building that receives HUD support to keep the rent at 30% of the tenant's income. Needless to say my rent jumped when I got work, nearly double, but it is still about $400-$500 less than what I would have to pay for a similar apartment in the private sector. All my transportation needs are met with public transit,funded by payroll and Federal taxes, for which I receive a nearly $100 discount on my monthly pass. I get assistance with housekeeping and general maintenance, case management appointments twice a month, and visits to my regular doctors paid for -- all at taxpayer expense.

The thing I wonder, especially in he current political climate, is how much this is resented by the people who don't receive the subsidies, and who have to pay for them with tax dollars. Years ago people tried to indoctrinate me on how awful an imposition taxation is -- that it was literally robbery. If that is true, that means every benefit I receive makes me a thief, or at the very least a recipient of stolen goods. Someday there will be a reckoning. Someday we will decide that we can't afford that sort of thing, and I and those like me will be left to their own devices to swim or, more likely, sink.

The good news on that front is that I just filed a tax return for the federal government and the state. Of course, between them I'l get about $600 back, much more than I paid in, thanks to Earned Income Credits. I am Glenn Beck's nightmare "citizen".
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Kelsey Rinella
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Michael Hopcroft wrote:
I am Glenn Beck's nightmare "citizen".


I feel vaguely guilty about smiling so widely when I read this.
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Michael Hopcroft wrote:
The thing I wonder, especially in he current political climate, is how much this is resented by the people who don't receive the subsidies, and who have to pay for them with tax dollars. Years ago people tried to indoctrinate me on how awful an imposition taxation is -- that it was literally robbery. If that is true, that means every benefit I receive makes me a thief, or at the very least a recipient of stolen goods. Someday there will be a reckoning. Someday we will decide that we can't afford that sort of thing, and I and those like me will be left to their own devices to swim or, more likely, sink.


It depends, are you also on welfare and food stamps? Do you own a large screen TV and XBox? Do you have a car? Do you buy clothes anywhere but a thrift store (Only got twenty dollars in my pocket...)? How many welfare babies have you fathered? All these things are the touchpoints for some people to condemn you as a parasite destroying our way of life.
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Michael Hopcroft wrote:
As my part-time job is as a records clerk in a health clinic, I see a lot of documentary evidence about whether and how people get medications (but not necessarily how they pay for them). All the time I index records of people whose prescriptions were rejected or approved by their insurance companies. Doctors apparently do not have the time to track the "formularies" (the lists of accepted and non-accepted drugs for each insurer) so all kinds of problems result.

It would probably be easier under single-payer, but then I'd probably be out of a job.

for those of you who wondered if I needed extra help, I am getting most of the help I need. The bulk of the medications I take are for depressive conditions.

But the number of subsidies I receive would probably alarm the more conservative among us. I live in a building that receives HUD support to keep the rent at 30% of the tenant's income. Needless to say my rent jumped when I got work, nearly double, but it is still about $400-$500 less than what I would have to pay for a similar apartment in the private sector. All my transportation needs are met with public transit,funded by payroll and Federal taxes, for which I receive a nearly $100 discount on my monthly pass. I get assistance with housekeeping and general maintenance, case management appointments twice a month, and visits to my regular doctors paid for -- all at taxpayer expense.

The thing I wonder, especially in he current political climate, is how much this is resented by the people who don't receive the subsidies, and who have to pay for them with tax dollars. Years ago people tried to indoctrinate me on how awful an imposition taxation is -- that it was literally robbery. If that is true, that means every benefit I receive makes me a thief, or at the very least a recipient of stolen goods. Someday there will be a reckoning. Someday we will decide that we can't afford that sort of thing, and I and those like me will be left to their own devices to swim or, more likely, sink.

The good news on that front is that I just filed a tax return for the federal government and the state. Of course, between them I'l get about $600 back, much more than I paid in, thanks to Earned Income Credits. I am Glenn Beck's nightmare "citizen".


I don't resent you. I just graduated college and got a real job paying lots of taxes. And I still support taxes and subsidies etc on citizen welfare, like I did when I was the beneficiary and got extra money back for taxes as a broke college student.

The thing is that a lot of it is luck. It's luck that I didn't end up having a serious accident like my little sister, who is on disability. It's luck that I was born into a family of engineers and have a brain for math & science. If I didn't have BOTH those things at the same time I might not be a software engineer--if it weren't for my particular family I might have been one of the millions of women who turn to a different field. It's lucky that my husband & I both have families who can help us financially, we both have that kind of social safety net.

Right now, I'm in a really good place. But in a year, 5 years, 20 years, I could end up unemployed and in a bind. I could end up on disability. I could end up needing assistance for a short period or the rest of my life. But that's not theft, that's my right. Social security etc is insurance--it's possible and affordable because not everyone needs it. Even if you take out more than you put in over your lifetime, that's okay. Many other people put in more than they take out. But they should still be glad to put in and have the safety net there IF they need it. Because it's impossible to know if you're going to need it at some point.

I don't see taxation as theft, I see taxation as essential to living in a society. We use taxes to pay for things that are a public good. Roads, schools, police officers, firemen. And I truly, truly believe that no human being deserves to starve. Nobody deserves to go without necessary medical care. Nobody deserves to sleep out in the cold. You should ignore any conservatives in favor of letting the poor starve, they're not worth your energy to think about.
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Home Skillet

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slatersteven wrote:
It's also the reason why such help exists, to reduce the poverty and or mental health issues that leads to crime.


Poverty has very little to do with crime. The US economy has been awful the past five years, yet crime rates are staying low.
 
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TheChin! wrote:
It depends, are you also on welfare and food stamps? Do you own a large screen TV and XBox? Do you have a car? Do you buy clothes anywhere but a thrift store (Only got twenty dollars in my pocket...)? How many welfare babies have you fathered? All these things are the touchpoints for some people to condemn you as a parasite destroying our way of life.


I don't quite know how to answer that. I certainly am not living a life of ascetic denial -- for example, I do have computers and Internet access -- so even that may be a bit much. Perhaps poverty should be deliberately made so unbearable that people would die to avoid it, but somehow I doubt that.
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Michael Hopcroft wrote:
I just received a letter from the managed care plan supplied by the State of Oregon to handle my Medicare drug expenses. Turns out that my monthly medication regimen costs the state more than $1,200 per month.

As the recipient of this largess, I'm outraged. If the general public saw this, they would probably string me up on the nearest oak.

Right now I am working part-time and still receiving Medicare and Medicaid. If I were in a position to be working full-time and paying for private health coverage, the outlay on meds alone would far outweigh any potential profit for the insurer.

Yet I do not deny that based on my current condition I need these meds to continue to function, including work. The question is whether the expense, which is far greater than anything I could return, is worth it for the taxpayer. $14,400 dollars a year is a lot of money to be putting into the pharmaceutical industry on my behalf. It makes me a thief of the worst sort. Is there a more ethical option I could take?


Well if your health problems are do to something you have no control over, like MS or Parkinson's, then I hope no one faults you for requiring expensive medications. However it does bother me when the taxpayers have to pay to take care of someone who chose to ruin their health via poor diet, no exercise, excess smoking, excess drinking, drug abuse, unprotected casual sex, etc.
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Michael Hopcroft wrote:
Perhaps poverty should be deliberately made so unbearable that people would die to avoid it, but somehow I doubt that.


I agree with you, but those most vocal about making you feel guilty think poverty should be such.

There seems to be a range of opinions, the extreme that gets the most attention are those that say "Don't come asking for money unless you are already living a life of soul-crushing austerity". It some ways that is fair to ask of people to actually "deserve" it before they ask for it, but the problem is what is the level of "deserve"? Also, I think medical concerns are much different than welfare concerns. Let's say you had an xbox, the $200 it cost (or less if you got it used or from a disreputable source) wouldn't even make a dent in your prescription cost, though it could make a dent in grocery bills for a couple weeks. If you were buying $1200 of xbox games a month, then we could start vilifying you.
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whac3 wrote:
Bill Gates (or whoever has replaced him) is not the most worthwhile person on the planet just because he happens to be the wealthiest


It could be argued that Bill Gates' worthwhileness has been tracking almost exactly oppositely to his value.
 
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TheChin! wrote:
Michael Hopcroft wrote:
Perhaps poverty should be deliberately made so unbearable that people would die to avoid it, but somehow I doubt that.


I agree with you, but those most vocal about making you feel guilty think poverty should be such.

There seems to be a range of opinions, the extreme that gets the most attention are those that say "Don't come asking for money unless you are already living a life of soul-crushing austerity". It some ways that is fair to ask of people to actually "deserve" it before they ask for it, but the problem is what is the level of "deserve"? Also, I think medical concerns are much different than welfare concerns. Let's say you had an xbox, the $200 it cost (or less if you got it used or from a disreputable source) wouldn't even make a dent in your prescription cost, though it could make a dent in grocery bills for a couple weeks. If you were buying $1200 of xbox games a month, then we could start vilifying you.


I don't recall ever asking to be in the position I am in. I was dragged into the Social Security system kicking and screaming all the way -- especially since at that time people were trying to feed me Ayn Rand's ideology which is utterly incompatible with the concept of disability.

I do, in fact, have an Xbox. I bought it used a couple of years ago with money that had been saved up from my benefits by the people who were managing them at the time. I was living on $30 a week grocery money and what was left over from that and paying my bills was saved for purchases like that. At the time managing even what money I had from benefits was a struggle.

Now that I'm working, the management of my funds is in my hands again because the bills could no longer be covered from my reduced Social Security benefits. Between the benefits I do get any my wages I pull down about $1,300 a month, which I'm sure will cause the vilification to begin in earnest because there are people without disabilities who do work and pull down less, with no benefits like health care at all. They also pay about 50%-60% of their monthly income just for housing as opposed to the 305 I'm capped at.

I also have the advantages of a very supportive workplace. It's not like the "supported work" shops that many people with severe disabilities have to resort to -- rather it's a place where everyone at the office if fairly understanding and willing to help if there are problems. The expectations of me are still high. This is not a "make work" position, though. What I do is very important to the running of the clinic, I work very hard at it and expect a lot from myself when it comes to my performance. I think a lot is expected of me as well because what I do is important.

Next time you go to the doctor, think about what is involved in keeping him or her informed of everything they need to know for your care. Think about how much easier it is for them to access records of your hospitalizations, specialist visits, lab result, imaging results, and procedures with the records being stored electronically as opposed to in those humongous paper files that used to follow every patient around. Think of how useful it is to have all your medications, from all your providers, easily accessible in one place. That's what I do. I distribute the electronic records that come in to patient charts, convert paper records into electronic ones, and make sure that faxed information gets directly to the care coordinators for each doctor. That's what I do, and I'm finally getting good at it.

That said, continuing my health care is so important that they keep close watch on my hours to keep me on Social Security Disability, even at a reduced amount. If I go over a certain amount of pay over a period of time, my benefit goes away and I need to go through some unpleasant hoops and considerable expense to keep my medicare. Because of the various conditions I already have, joining my employer's health benefit package would be very expensive, both for me and for them. As it is, my health care is largely supported by a specific payroll tax assigned to Medicare use (and unlike income taxes there are no refunds based on income).

The tax burden on American citizens is high (though low compared to some countries) because of programs like this. Every time a budget negotiation in Washington comes up there are complaints that "entitlement spending" is heightening the country debt and that providing for people is a recipe for certain disaster. There is also the commonly-expressed idea that the private sector and the "market" will take care of everything as it sees fit if only they are left alone. Which makes me wonder if the market can be relied on to decide who lives and who dies if it comes down to a situation where government involvement ceases.

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Dearlove wrote:
whac3 wrote:
Bill Gates (or whoever has replaced him) is not the most worthwhile person on the planet just because he happens to be the wealthiest


It could be argued that Bill Gates' worthwhileness has been tracking almost exactly oppositely to his value.


Not necessarily, given his commitment to philanthropy. Being rich in itself is not bad -- it's what you do with it. Indeed, one could make a case that everything good that happens in the world is the result of a rich person's actions.

I don't know whether Carlos Slim, the Mexican tycoon who heads current lists as the richest man on Earth, does in terms of philanthropy. Certainly there are great needs to be addressed in Mexico.
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Michael Hopcroft wrote:
Dearlove wrote:
whac3 wrote:
Bill Gates (or whoever has replaced him) is not the most worthwhile person on the planet just because he happens to be the wealthiest


It could be argued that Bill Gates' worthwhileness has been tracking almost exactly oppositely to his value.


Not necessarily, given his commitment to philanthropy.


Actually that was my point. As he's given it away, he's demonstrated increased worthwhileness.
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