Thursday, August 31, 2006

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Frozen in Time and slowly dripping Drip Drip

Public Policy, Education, Economics, Human Welfare Issues, Health Care

237 comments:

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christin m p in massachusetts said...

Oops -- It was actually the fifteenth paragraph into the article.

deb said...

The situation in MA is grim. It has already spiraled out of control. With the workers leaving, the apts. will become uninhabited, forcing many of the "get rich quick" owners into bankruptcy and the apts. will sit empty until someone who needs workers figures it out.

christin m p in massachusetts said...

The apartments have already been half empty since early in 2005, yet prices in the decent neighborhoods have barely budged. There is a constant influx of Central and South American undocumented immigrants here. Even though they come from extreme poverty, they generally are very clean, orderly people -- and they choose the better neighborhoods of the suburbs to live in. They get charged such huge rents that the owners can afford to leave some units vacant. The reason the immigrants can pay those prices is because they arrive in large groups of young working adults -- and all squeeze into one small apartment together. The owners are fully aware of it, but since the building inspectors look the other way -- the owners continue to take advantage of the immigrants.

Then there are the subsidized tenants. The government still pays too much for each rental ("fair" market rent -- that's got to be an oxymoron). But at least the numbers of subsidies have been cut back -- so there's hope yet that the rental market may correct eventually. Even if it does, I'm so soured on this state by now that I'll never return once I escape from it. Anyway, between the immigrants pooling rent money, and the over-inflated subsidies, I don't think rents are going to drop much ever again.

At least home purchase prices in Central and Western Mass are finally starting to go in the right direction.

I read an article at the Maui News site, that gives further proof that young, educated, talented workers are driven away by high housing costs. There were other reasons given, but high housing costs was at the top of the list, and one of the other reasons still had to do with high housing costs: "Reluctance to pile a big mortgage on top of a big debt left over from medical school."
Departing Doctors
That's the same reason all our new college grads and our skilled tradespersons have been leaving in droves. The new grads -- even if they were lucky enough to land jobs with high starting salaries, would not be able to carry such big mortgages on top of their huge college loans. The skilled tradesmen are simply smart enough to know when they're being rooked. The way most of them put it is "Why should I pay $300,000 to $400,000 for a tiny starter home here, when I can get a sprawling beautiful home for half that price in another part of the country?"

The forclosure rate here last year and this year has skyrocketed. Of course California still leads the pack in percentages of foreclosures (not just in numbers). But in this state it's looking like 1991 all over again. Starting in late 1987, a lot of real estate speculators were buying up huge numbers of homes and immediately "flipping" them for instant mega-profit. For example, after my grandfather had a heart attack at 79 years old, my grandparents sold off all their properties (except their own residence) in 1987. They sold the properties for what was then the market price, to a very greedy "investor" who turned around and rapidly re-sold them for nearly double what he bought them for. For the next four years, a huge swarm of real estate reptiles slithered all over Central and Eastern Massachusetts doing the same thing. And although most home buyers had traditional 30-year fixed-rate monthly payment mortgages, interest rates at that time were incredibly high. So of course the monthly payments were that much higher.

Back then, the real estate extortionists "only" inflated prices to the point where you needed two average full-time incomes to afford them. (Nowadays, both income earners have to work overtime to afford them.) As I recall, by 1991 the unemployment rate nationwide had been rising for two years already. So with even one spouse laid off from work, a lot of couples were unable to keep up their loan payments. So that year, our state had a record high number of home foreclosures.

That remained our record year -- until this year. We already passed the 1991 numbers by the end of November. I have an awful feeling that 2007 is going to surpass even the 2006 numbers, because the news reports are saying that throughout the whole United States, most of the adjustable rate mortgages that were taken out during this most recent housing "boom" (predatory get-rich-quick scam) are set to adjust upward from now till around 15 months from now. Since house values are dropping in most -- if not all -- regions of the country right now, refinancing to a fixed rate is probably not going to be an option for most people.

It took five full years (until 1996) for housing prices here to "correct" sufficiently, after all those foreclosures the last time around. And do you think anyone learned their lesson? Of course not. Only a few short years later (beginning in earnest around 2001), they and their now-grown children fell for the same con game. Only this time, the shady mortgage lenders got in on the action.

I'll just never understand how so many people can be so unaware that they're being used. Some of them still admire extreme wealth even when it's ill-gotten -- they're that dysfunctional. (It reminds me of the hazing scene from the late 70's movie Animal House -- "Thank you Sir, may I have another?")

Here is my take on those fools: "Oh, Mr. Second/Third/Fourth Generation Multi-Millionaire -- Can you please charge us more for everything we need to stay alive? Please, please let us pay you even more money? We're just not tired enough from working so hard -- and you just aren't rich enough yet, you poor thing... You need more private jets, and expensive luxury cars, and vacation homes. After all, you've earned it with your lifetime of insider trading and extortion, along with your lifetime of relaxing and vacationing and living entirely off the backs of hundreds of thousands of workers all by yourself. We worship you for the way you deprive us of our time and our rest -- oh, and we especially admire your kindness in depriving us of our homes. A monument should be built to honor you for your talent at draining and polluting the world -- you know, like the ones the Pharoahs made people (people with names and feelings and families) build for them... Pleeease make us work longer hours, so we can pay you more for everything -- especially the things we need for survival. The harder you make our lives, the more we respect you."

That is the way I see the cretins who "think" that ill-gotten or entirely unearned wealth is a good thing. We should only admire people for their positive contributions to society. Those idiots instead are applauding people for using them. How can they be so stupid?

I want to write to our congressmen in order to get them to see that the problem is not that wages are too low -- it's that the prices of absolute essentials are too high in some parts of the country. If wages are raised, price gougers will only drool over the prospect of wringing even more money out of us. Congressmen are too far removed from the rest of us, so someone needs to literally do the math for them. They need to see that in many of the states with the highest salaries, the quality of life is much poorer, while life in some of the lower-wage states is much more luxurious because costs are so low.

Do we have some honest new congressmen in there now? Will they even see my letters?

Anonymous said...

"Do we have some honest new congressmen in there now? Will they even see my letters?"

don't bet on it.

deb said...

Christen, I have learned that my letters are read, and have gotten responses indicating it. Even my ex Congressman Taylor (or staff member) wrote replies explaining why my position wasn't what he would vote for (war, drilling in AK, etc.), but that he respected my opinion.

You are a terrific writer, keep writing! Your reps want and need your support. They realize that you are aware and that you talk to your friends and co-workers. You truly can make a difference.

christin m p in massachusetts said...

Deb,
I'm going to give it a try as soon as the Christmas rush is over. Also, I think I'd like to have you guys proof read it before I send it to all of them too. I want to make sure it's communicated as effectively as possible. I'll be sure to leave out the rants, but I still want to convey how much the loosening of consumer protection laws has hurt the working class in this country.

I'm seeing more and more for myself that it isn't only the Republicans who have hurt us this way. Here is an excerpt from a blog called "Housing Panic" that illustrates this point:

"Being either incompetent boobs, or conniving thieves in the night, or both, when Congress and Clinton passed the "Taxpayer Relief Act of 1997", they caused the Great American Housing Ponzi Scheme to take off.

How?

By allowing gains on home sales ($250,000 single, $500,000 couple) to go tax free.

Why work for a living when you could just flip houses? Why pay taxes when you could live a tax-free life?

Folks, this horrific and corrupt piece of legislation must be overturned, post haste
."

Here is a link to that post:

Tax "relief" enables nationwide house flipping ponzi scheme

Richard Yarnell said...

I don't think I agree with you about the capital gains exclusion on primary residences.

Housing is considered an essential. Like it or not, we emphasize individual ownership of housing: one of the really big economic engines in this country is residential construction.

On average, people move every 5 or 6 years, whether in search of a job, in response to a corporate relocation, or to a retirement situation.

Assuming that most moves are required, that, on average, the price of all housing increases, then the capital gain on a primary residence is incidental. Imposing a tax on it would disadvantage the seller become buyer simply by virtue of the tax. Note that the exclusion does not apply to second homes, speculative purchases, etc.

That exclusion predated the Clinton adjustment. Primarily, the adjustment brought the exclusion in line with the then current price of housing. It also shortened the required time to establish primary residence - I think that was a mistake and didn't/doesn't reflect reality.

There will always be people who will figure out a way to milk the system. Others use the exclusion to help finance their business of buying housing that needs work, improving the property, selling it and moving on to the next project. My Uncle has done that all his life. He doesn't do it to milk the system, but the exclusion does allow him to put more money into the properties he occupies, improves and later sells.

So, on the whole, the exclusion helps ordinary house holders afford the move from one residence to another by permitting them to put all of the proceeds of the sale of their former residence into the next one. And you should also be aware that if the house you're moving into costs less than the one you're leaving, the exclusion applies only to that portion of the sale that is absorbed by the purchase of your new home.

deb said...

I agree with you Richard. I believe that the tax break on homes that have been lived in is helping the middle class be better able to survive retirement, have a more comfortable life or possible just keep up in times of hardship.

The wealthiest 5% have enough tax breaks. The home owner tax break allows the middle class to have a chance to put some away by moving into fixer uppers for a few years and then selling and keeping their profit. Even doing this one or two times before or after kids can mean the difference in a paycheck to paycheck lifestyle and being a bit ahead of the game.

Christin, Jeff and I remodeled a fixer upper when our kids were small and sold for a modest (but nice for us) profit. We put all of that into another fixer upper and remodeled it and lived there for the next 9 years. The house note on the second was small enough that we were able to have enough at the end of the month to give our kids advantages and save more for retirement. Please consider fighting those laws that only benefit the wealthy and spare the ones that help those of us in the middle class.

christin m p in massachusetts said...

"Please consider fighting those laws that only benefit the wealthy and spare the ones that help those of us in the middle class." (quote from Deb)

The problem is that over the past several years, too many people have used that law to become extremely wealthy -- and in the process, have driven home prices in many parts of the U.S. way out of the reach of young middle class families just starting out. Those of you who "got into the game" before that started being done, are not hurt by it. But a lot of the families who are just starting out must either move to one of the few regions of the country that haven't been hard hit with out-of-reach home prices yet, or else they are doomed to a lifetime of renting and will never have a chance for building any wealth for themselves.

My first question is, since all of you have made a major part of your families' livings from real estate profits -- would you say that it's at all possible for young families in most parts of the U.S. starting out with today's already overpriced real estate costs, to build up a nest egg -- with ONLY a modest salary and without profiting from real estate?

Because that does seem to be the case now -- The old myth of hard work all by itself getting people ahead no longer applies (as if it ever did...) You guys have proven my point that passive income is everyone's only chance of ever getting ahead of "the game".

And based on this quote from Richard's response, "It also shortened the required time to establish primary residence - I think that was a mistake and didn't/doesn't reflect reality." -- my second question is:

What do you guys think would be a fair minimum amount of time for the owner to actually live in the house before re-selling it for profit?

Richard Yarnell said...

I tried to hint at that: 5 years, the average tenancy or a little less. The majority of people who benefit from the exclusion are not those who are trying to get rich off of real estate. One house at a time doesn't cut it.

Housing cost is still a matter of supply and demand: believe me, a capital gain adjustment on a primary residence doesn't even register as profit motive.

deb said...

"Housing cost is still a matter of supply and demand"...exactly. I could buy a little 100 yr. old house here in the mtns. for around 80K (1500 sq. ft. with full basement), spend 50 or 60k and my labor to remodel and would be lucky to get 150k...not exactly a get rich quick scenario. The only way to really make a bundle off of a house is to have had the luck or foresight to have bought in an area that became popular.

We all can look back on those "wish I had done that when I had the opportunity" points in time and a few of us are glad that we did take that risk at the time, but hind sight is always 20/20. Jeff and I passed on the opportunity to buy a beachfront lot after hurricane Frederick in 1980 for 30K ...it was tempting, but the note would have been very difficult at the time. 14 years later similar lots consistantly sold for around a million. But later we did end up buying in areas before they became popular and made more than we thought we would from the property...nothing like CA or MA (for that matter) though.

Judy is right about still being able to remodel fixer uppers. The problem is that in popular areas there's a lot of competition for them. The wonderful old houses that are virtually being given away are in places where decent jobs are impossible to find. I was in Bluefield, W Va. a few months ago and gorgeous homes that need little in the way of remodeling are selling in the 70K range. But, who knows, maybe tens of thousands of baby boomers will think W. Va. is the perfect place to retire.

Christin, I firmly believe that you could find an easier job in another area where you could remodel a house and get ahead in life. I'm sure this is really none of my business, but after reading your writing, insight, and ability to research I feel that you could do many jobs that would offer a better life. Hope I haven't offended you by the suggestion.

christin m p in massachusetts said...

I had to re-do this comment -- I meant to address you, Deb. Sorry about that.

There aren't a lot of options for someone who is what I call an "afternoon- and evening-efficient worker / morning-efficient sleeper". I've had this circadian rhythm disorder called delayed sleep phase syndrome since I was seven years old. Obviously, it eliminates nearly all professional and paraprofessional jobs. Although nursing and certain medical technician occupations offer later work shifts, my squeamishness eliminates those options. I can't even watch when they show clips on the news of the annual flu shots being given. And whenever they show us the safety videos at industrial workplaces, I have to turn my head during the dramatizations of workplace accidents. Fine nurse I'd make... And then there's that phobia I have of getting the annual immunizations that are mandatory for health care workers -- but I guess that's neither here nor there, since nursing wouldn't be easier (probably one of the most stressful jobs on the planet); it would only be higher-paying.

As for moving to someplace where I could find a little house that can still be afforded by an industrial worker -- that is my plan.

I began my search for a new home town at sites like this one that gave helpful data like this. Then, while searching for updates on those figures, I instead discovered that there are many, many people in many places all over the United States who are paying such an unfairly large portion of their incomes on overpriced housing (Would that be called "runaway" housing inflation?), that it is putting a huge number of families in this country in financial peril.

This is how the middle class has inadvertently hurt its own children and grandchildren by benefiting from three-fold home value increases (created by inflated asking prices) in only ten years' time. I don't care if there IS a low supply of housing stock in a particular area at a particular time -- sellers and real estate agents should not be expecting such high profits, because it places an unfair burden on the next generation of home buyers, whose incomes cannot possibly keep up with that rate of housing over-inflation. And how can any of those new first-time home buyers ever be expected to be able to put anything into savings when such an enormous portion of the family's monthly income is already eaten up by the huge payments on their overpriced home?

Resuming my search for an affordable place to live, I decided it was best to do it city by city. Here are a few samples of what I found in the price range that a single-income industrial worker can safely afford with a $30,000 down payment (up to $70,000 total price of property -- $40,000 mortgaged at a fixed interest rate of 7 percent or lower -- 15 year amortization schedule):

El Paso, TX
Buffalo, NY
Wichita, KS

And here are some locations that are familiar to some of you at this blog (I wasn't sure which county Judy is in, so I didn't know which cities in Washington to look up, but I'm thinking that Oregon prices are probably similar to Washington's anyway. I also don't know which county in Alabama that Cheryl's in, so I didn't know which city to look up there either):

Only one floating boat garage in that price range in Portland, OR

Asheville, NC

Since you can't even buy a driveway in Kihei, Maui, HI in that price range, I decided it would make more sense to look up Clyde, NC

Detroit, MI

Atlanta, GA

Richard Yarnell said...

Go only to reputable sites: there are many scams to stay clear of.

Last week, for the second time, ABC did a feature on work at home jobs that use both a phone and a computer.

There is active recruitment and very flexible hours to be worked. I think you can find a list to start with on the abc.go site.

Housing is always a function of supply and demand. That driveway is expensive because there are far more people looking than there are driveways to sell.

Likewise, if there's no local work, it's hard to give the housing away. If you can work from home, you may well be able to afford a nice house in a town that doesn't have much local work. Just be sure there are reliable phone and high speed internet connections.

Anonymous said...

{From deb...my pc is down and I'm using a company pc (hint I downloaded the new Explorer 7) and am taking mine to a shop tomorrow...in the meantime I have no idea what my blogger password is since my pc remembers me.}

Demand in the NC mtns has heated up just since I moved there. Here is the closest small town to where I am living: Greeneville, TN It is in the mtns and has the advantage of no state income tax, plus whatever you pay in state sales tax can be deducted from fed income tax. It seems similar to what houses sell for in Hot Springs, NC...but people here are inclined to ask around and see if anyone is looking for a house and they tend to sell without a realtor, unless they are higher end than average people here can afford.

BTW, Fed and most state gov'ts are demanding that women and minority small businesses get a larger piece of the pie.

Anonymous said...

deb again

I went back to the realty link to see what houses in Bluefield, WV were selling for and this was the second on the page. My Granny lived near here and I have such fond memories of the city in it's heyday. A beautiful place nestled in the mtns.

It seems that a savvy entrepreneur would figure out how to place their business in beautiful towns such as this and lure people away from the high priced areas to redevelop areas that have lost their financial mainstay. It seems that it would be a win/win situation for everyone.

Christopher C. NC said...

Even in Clyde NC the driveway is going to be gravel.

christin m p in massachusetts said...

Deb,
That house in West Virginia is pretty. I LOVE historical homes -- especially the restored Victorians. That property looks similar to the one I live in now. The main difference is that instead of the little turret, this house has an additional story (the attic studio). Also, we have a stone porch that was added on at some point -- I think around a half century ago -- when it was owned by a family of professional stone masons.

Christopher,
In places where there isn't a lot of snow to plow and shovel, I prefer gravel driveways over blacktop anyway.

christin m p in massachusetts said...

Judy,
Since the downturn first hit in early 2002, I've been doing seasonal warehouse work. Usually, January to March is the only lean time for distribution warehouses in this region.

Right now, I'm on the overnight shift (10 pm to 6:30 am), although I much prefer the afternoon/evening shift. Whenever I'm on the overnight, sometimes I stay up all morning after work, then sleep straight through from noon till it's time to get ready for work (around 7:30 pm)-- and sometimes I get ready for bed right when I get home in the morning, then get up around 4 pm. So there's some flexibility for me. But I still feel best working the afternoon/evening shift.

I supplement the paid work with my "indentured servant" work. I think I probably already told you guys way back when, but I've been working most weekends on the landlord's other properties in the city, as well as on this one. He deducts it from my rent by an average hourly rate of $20 per hour ($15 per hour for lighter work; $25 per hour for heavier or more detailed work). The only other people in this area that will do the work that cheaply, are the undocumented immigrants. Contractors in Mass charge a fortune even for small jobs. So he makes out better by giving the work to me. From January to March, when I have fewer paid work hours, I'm able to work enough hours on the properties to knock off my entire months' rent, plus some in advance. On this property, we've been gutting the walls and floors, and restoring it room by room -- so I know a lot about restoring old houses. I like doing it anyway -- it's an artistic outlet for me. But since it's not my property, of course I'm not going to do it for free. The only parts I don't like are removing plaster and sanding drywall compound (both very messy jobs). I don't even mind removing floor boards and trim boards. Anyway, I hope that some day I'll have my own house to work on.

As far as education, I can't seem to settle on what I would want to do -- even if I could get later work hours in a higher paying field. I think my problem is that all I think about is how I want to find the perfect companion for me -- and I don't want to settle for someone who isn't completely compatible. Also, I long to have my own little house NOW, and any education that would help me get a higher paying job, would have to be very short term (like a certificate program).

I've been in the workforce for almost thirty years now -- and since the end of 2001 (when my former fiance and I separated), my life has been almost pure tedium. I'm just sick of the same old thing year after year -- just work and go home... work and go home... work and go home... That's why there are moments (thankfully fleeting) when married guys do become tempting. By my age, they're the only ones who are chivalrous and have attractive manners. I imagine that must be what their wives see in them too. It's probably universal -- we all want the same things I think. Anyway, I'm not just looking for excitement -- I want someone of my own -- forever.

See, this is why I'm so discontented all the time -- nothing to look forward to, but another twenty-plus years of boring work just to pay bills, and nothing left over, and no perfect companion to entertain me and sympathize with me to make it all look rosy.

christin m p in massachusetts said...

Small is beautiful... I think I want a tiny house like this one. It looks like it's just the right size for me. I wonder how many square feet of living space it has... It would probably be easy enough to guess if I could see how far back it goes. It looks like it has an upstairs too -- or at least a loft.

Richard, since you've built houses before, I'm thinking you could probably estimate for me what the third dimension of that house is, based on what would be good proportions, and then I could know the square footage.

christin m p in massachusetts said...

This other tiny house I found in Google Images looks like it might be too small -- even for me.

Richard Yarnell said...

I'd go about it differently: start with an inventory - two, actually.

First, figure out what you need to live comfortably. You're not out to be ascetic. A kitchen, a bathroom, a bed, closets, table, desk, etc.

Be cautious about convertable space. An analogy: my father once bought a Sears "Shopsmith." It was a tool that, on paper, looked smart. One motor drove five different bench tools including a table saw, lathe, planer, shaper, and something else. By the time you finished changing the setup every time you need a different tool: well, he's a mild mannered person but I heard him swearing under his breath.

Next, figure out how much space each of the necessities/wants/must-haves actually requires. Susan and I just did that with the living space of the new house by making paper cut-outs of furniture pieces which we placed on the floor plan we've been working on. We tried several different arrangements and found that everything fit and that potential traffic patterns were reasonable.

I'm pretty sure the trailers were brought up tongue-in-cheek. The domes, efficient in the use of material, should be built with something other than canvas covers. There are many books from the 60's and 70's that will suggest well insulated and efficient floor-plans.

As for the first little house: why waste space on a stairway that has to be too narrow to be practical anyway? A very small house, I think, is best done on a single level. It will probably be more efficient and have a better market if you have to sell it. (This is a house I'd certainly built to "Universal Access" standards that provide wheelchair wide doors and passageways as well as the amenities useful to elderly and disabled residents - the likely occupants after you're finished with it.

If you're asking me to flesh out that picture, I'd say there's a kitchen opening into a great room downstairs. There have to be cupboards and closets on every wall and very few windows. Upstairs, a single bedroom with the bath over the kitchen so plumbing is simple.

Probably a conventional, narrow, staircase with a closet under it.

John G. said...

Christin,
Sounds like you are looking for a home. Not a house. You will be successful.

John G. said...

California is taking a shot at Universal Health Care...Do you think they can make it work and start a national trend?
What impact does government oversight and regulation have on insurance costs? I had never thought about that until it was announced as a result of the California plan.

Richard Yarnell said...

I urge all of you to look at the Archimedes Movement site and to participate in the discussions there. John Kitzhaber was governor when Oregon managed to get waivers to permit its health plan to function.

Senator Wyden is pushing a universal health plan (I have had a discussion with his chief of staff about the cost of keeping private insurers in the mix. I see no need. Medicare has a single digit overhead while the commercial insurers are running above 30%) I just saw a headline that Kennedy (MA) is proposing a form of "Universal" health care.

If it were truly universal, then the separate administration of Medicaid, Medicare, Veterans, and other minor programs, not to mention the various state programs would cease to be duplicated.

In a nutshell, Universal Health care should be funded out of general tax revenue. As was done in Oregon, the most effective procedures should be covered and the least effective, not. (Budget moves the cutoff point on the list.) If individuals want additional coverage or want to avoid the system altogether, they would be free to have private insurance which would not relieve them of the need to be enrolled in and contribute to the Universal program.

John G. said...

Can you provide a link to the Archimedes site?

Richard Yarnell said...

http://www.archimedesmovement.org/

I don't think it's been amended except that the list of approved procedures has been shortened in response to funding limitations.

There's a movement in the legislature this term to expand related programs including insurance for children. A program allowing everyone, regardless of income to participate in state acquisition of prescription drugs and negotiated prices passed last year. I just signed up. Greater participation gives the state more leverage.

Cheryl said...

The Archimedes concept is correct, we all benefit from the common good. The health plan looks promising.

There is a federal plan introduced by John Conyers & others.

You can find a description of it here,
http://www.dailykos.com/story/2007/1/4/75654/91637

Another diary by the same author, Six Myths As Barriers to Health Care Reform, is worth the read.
http://www.dailykos.com/story/2006/12/7/65929/5956

John G. said...

"I don't think it's been amended except that the list of approved procedures has been shortened in response to funding limitations."

"Approved procedures" The lady on the Mayan NOVA program recently which reported her findings of bacteria which were relatively harmless until a certain tipping point of them congregating effectively turning them on leads me to ask if this could possibly be the Trojan Horse in UHC?

Today we have countless approved treatments from countless insurance companies and doctors. Even with this level of variance bacteria’s and illness have been known to develop a tolerance to treatments requiring the healthcare industry to constantly adapt for evolving durable strains.

Now if we go to UHC as a nation, limiting these varieties will undoubtedly help many of these strains increase there resistance to treatments substantially and at some point as the researcher on NOVA demonstrated, "turn on" the next pandemic.

Should we not prepare for this while pursuing UHC?
The majority of pandemics throughout history started where UHC and standard treatments were the norm and varieties in treatments were limited...

Richard Yarnell said...

You may be confusing two separate issues:

Generally, a procedure would include treatment with antibiotics where the antibiotic is assumed to be at the doctor's discretion;

In the insurance world, including the Part D Medicare, there is a list of drugs approved for use by (insert agency). My HMO, Kaiser, has a pharmacopia that it has tested itself. It's doctor's usually prescribe from that list. If available, generics are included. It's a moving target as new drugs are approved by the FDA. For example, I'm on a lifetime regimen of Warfarin due to a severe leg injury that affected circulation. While I was in the hospital dealing with my first clot, I learned from the internet that the FDA had just approved warfarin (generic version of Coumadin). On the basis of my request, Kaiser ran their own tests and approved warfarin in their system about 6 months later.

If you look at the lists covered by the many many insurance plans - don't worry, when you hit 64, every insurance company in the country will send you multiple copies of their on lists, you'll appreciate how many variations there are.

Cheryl said...

The formularies (drugs preferred by insurance companies) are set by price negotiations with drug companies. I doubt there is any research into which one works better, especially since different patients will respond to medications differently.

If you take more than one medicaton, it can be a real head-ache finding an insurance company with all of your medications on its formulary. And then the formulary can change at any time.

If the medicine is FDA approved, it should be approved by all insurance companies.

Richard Yarnell said...

Kaiser, with whom I've been insured since 1989, is particularly careful with generics. As I understand it, they are most concerned with dosage: whether generics are, in all ways, including potency, equivalent to their more expensive brand name cousins.

Since I was the first to ask for generic warfarin (which I'd used to control rodents around the farm since I was still living with my folks) I was a little surprised so little work had been done with generic warfarin. Coumadin is nothing more than a refined and carefully manufacture warfarin intende for use by humans instead of rats.

As I said, it took them about six months to finish their testing and to come up with guidelines for their doctors and pharmacies. I'm told that, in the beginning, they started patients on Coumadin and, once the dosage was stabilized, shifted them to warfarin. Whether they still believe that's necessary, I don't know.

Cheryl said...

Then Kaiser is an unusual company. Most insurance companies penalize you for not taking generics, and don't want to hear about any differences in quality.

I pay $10 for generics, and either $35 or $50 for medicines that don't have a generic, depending on which drug company will pay more to get listed on the formulary.

Richard Yarnell said...

I may not have been clear:

I'm don't carry the drug coverage yet.
I'm talking only about what their physicians can prescribe or what their pharmacy carries. At the time I went on Coumadin, Warfarin had only been approved by the FDA for a few days. Coumadin was prescribed and the pharmacy did not carry warfarin until I specifically requested it and pointed out that the FDA had approved it for use in humans.

They do carry warfarin now, together with Coumadin. So far as I know, they are identical compounds.

John G. said...

"What impact does government oversight and regulation have on insurance costs?"
What will happen to all the Insurance companies under UHC?
Will it lead to a windfall for them or unemployment?

Cheryl said...

We spend vastly more money on health care in this country compared to other countries. Despite this, our health care is at the bottom of the developed world. I'll find links to the numbers when I have a little more time.

The insurance companies are a major part of the problem. The complex web of coverages gives us a labyrinth of different forms, all to provide the same information. Insurance companies have departments devoted to finding ways to not pay. Doctors have to hire staff to try to get paid what they are owed. Personally, I have to spend time with almost every claim to see it get paid. You wouldn't believe the excuses they come up with.

Medicare operates with a 4% overhead. I'd like to see it expanded to cover everyone.

When the insurance companies are gone, there will be layoffs. I don't care much about the executives. Many of the others can shift to the single payer system. There are plans to help the rest find new employment in the bills currently being considered.

A few comments up, I had some links to better information than I can give.

http://www.dailykos.com/story/2007/1/4/75654/91637

http://www.dailykos.com/story/2006/12/7/65929/5956

Physicians for a national health plan is a great group.

dan said...

President Bush is reportedly going to include in his State of the Union speech, a proposal to deal with the nation's health care crisis. The core of his idea is to levy new taxes on the middle class to help pay for insurance coverage for the poor. The biggest problem with our current system is that over 20% of the dollars that should be paying for care, now just enrich the insurance industry. The President's plan would further entrench that problem. His proposal is bad medicine for the country and it deserves to be *dead on arrival*.

Cheryl said...

From Dan's link:

"In his radio address on Saturday, Mr. Bush described his proposal as a way to “treat health insurance more like home ownership,” giving people tax deductions for their health insurance in much the same way as they get tax deductions for home mortgage interest. He said the current system “unwisely encourages workers to choose overly expensive, gold-plated plans,” driving up the overall cost of coverage and care."

Gold-plated plans are driving up costs more than insurance and drug company overhead and profits? What a crock.

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