Quote of the Day: Guns Aren’t The Same as Mandatory Health Insurance, Apparently

“There is no reason to exempt guns from bankruptcy except for the fact that they’re, you know, guns. And here’s where Second Amendment rights activists often go off the rails: government may not stand in the way of the free exercise of a right, but it is under no obligation to ensure that you DO exercise that right or that you have the wherewithal to do so. If chronic laryngitis kept you from exercising your First Amendment rights, the government wouldn’t be obligated to pay for your treatment.” – Hannah Hill in It’s the right, not the gun [via thenerve.org]

comments

  1. avatar KBonLI says:

    If you owe a debt you should repay it by any means possible. If that means selling your firearms so be it.

    1. avatar neiowa says:

      Likely should also reinstitute debtor prisons?

      “shall no be infringed”?

      Frankly, I can not imagine what political opinion of a 15yr old female would have any relevance or interest.

      1. avatar Jonathan - Houston says:

        Pay your bills, ya deadbeat! Also, shut up and eat your spinach.

      2. avatar Chito says:

        Cuz she’s cute.

      3. avatar Serpent Vision says:

        Why would being female affect the validity of someone’s political views?

      4. avatar KBonLI says:

        Actually there is debtors prison.
        If you don’t pay child support you can end up there.

      5. avatar Bob Jones says:

        By your logic, 6 year old gang members should be allowed to possess .50 caliber machine guns.
        Even 2 year old gang members.

        1. avatar Cliff H says:

          It is not a question of “Allowed”. It is a question of “Infringed”.

          “A well regulated militia, being necessary to the security of a free State, the right of the people to keep and bear arms, shall not be infringed.”

          There are no qualifiers in that statement. No buts, excepts, unless, age limitations, nor any other indication that there is ANY condition under which the government may infringe on the RKBA.

          “If you concede that the same government the Second Amendment was intended to allow you to protect yourself from has the authority to create, maintain and enforce lists (NICS) of persons who, in the opinion of that same government, may not exercise their natural, civil and Constitutionally protected right to keep and bear arms, how will you prevent them from adding your name to one of those lists of prohibited persons?” – Cliff H

      6. avatar cisco kid says:

        Looking past your rabid misogynies she is partially right and partially wrong. She is correct when she says the Government is under no obligation to make sure you have enough money to buy or keep a gun when you owe money but totally wrong when she says the Government would be under no obligation to pay for treatment if you had chronic laryngitis as human health in a CIVILIZED SOCIETY is a right, its just that the U.S. has not yet caught up with the rest of the civilized world in regards to human health but rather marches lock step with Hitler’s belief that when you become no longer a contributor to the economy of the Government by paying taxes, even if it is because of no fault of your own, you are therefore expendable because the Government will not spend any tax money on your health care because it needs all the money it can get to get on with “Nation Building” i.e wars of rape, pillage and conquest to enrich the pocket books of the upper 1 per cent of the ruling elite.

        The current situation in the U.S. mirrors this to a “T” as the recent push to dump more money down the “shit hole” of war needs to be paid for with more taxes and that can only be accomplished by taking away as much of the U.S. health care as possible as the American people are considered expendable by the upper 1 per cent of the ruling elite.

        Today on MSNBC news there is a new proposal that would let Herr Trump play more golf and turn over the running of the “16 year old failed war” in Afghanistan to the mad dog war monger Military Generals who are chomping at the bit to flood the country with more troops, which is exactly what Putin wants. He now is feeding free weaponry into the hands of the Taliban which have recently seized 1/3 of the country despite being bombed day and night for 16 years, shades of Vietnam, as history repeats itself.

        Just one more year of war in Afghanistan and it will equal the time spent in Vietnam. Putin, military genius, is now bankrupting the U.S. over Afghanistan out of revenge for Reagan doing the same to Russia when they were in Afghanistan but Herr Trump who obviously flunked history and the U.S. Generals who live for war at the risk of destroying their own country are oblivious to both history and reality.

        1. avatar Excedrine says:

          Looking past your own rabid projection onto others of things which you damned-well know you have no proof, she’s right. Period. The government is not now, has never been, and shall NEVER be under any obligation to provide medical treatment to anyone — except its own employees. Human health IS NOT A RIGHT, at all, regardless of whoever else says it is. It’s actually just that the rest of the world has stepped further back than the U.S. in forcing others to be responsible for something that will NEVER be fully paid for even if 100% of all incomes are taken solely and explicitly for healthcare. THEY march in lock-step with Hitler’s belief that you are no longer a contributor to society once you no longer agree with them, whether you even express a differing opinion or not.

          The current situation in the rest of the world is what actually mirrors this to a “T” as the recent push to dump more money down the shit hole of welfare to distract from the wars of leftist governments. The American people are considered expendable by you, because you want to doom them to an increasingly broken, under-performing “public option” that will NEVER have enough money or staff or materials.

          But, hey, your own history flunkies in the Senate like Herr Feinstein wanted to federally-license “journalists” so that the left could quite literally own the media. Isn’t it any wonder that no one but demonstrated and repeatedly-proven moral and intellectual inferiors like you even put ANY stock into anything the lamestream fake news propaganda mills have to say in the first place? You are every bit as oblivious to reality, history, and economics as you could ever (and only falsely) accuse anyone else of being.

        2. avatar Anymouse says:

          A right can never be a right if you need to force others to provide it. You have a right to eat, but not a right to the fruits of a farmer or rancher. You have a right to speech, but not to make someone else publish your rantings. You have a right to treat your own injuries or illnesses with your own supplies, but you cannot oblige a doctor, nurse, or the workers of a pharmaceutical company to provide it to you. You have a right to arms, but Ruger doesn’t have to gift a gun to you.

        3. avatar cisco kid says:

          Every Industrialized Nation in the world OUTLAWS HEALTH CARE FOR PROFIT, its immoral, obscene and unjust.

          Studies have shown the other Industrialized Nations have lower health care costs and they regulate what doctors, hospitals and drug companies can charge as well it should be.

          The Republicans according to MSNBC News right now are getting millions from the Drug and Insurance Companies to roll back the ACA so that they can have pre-existing conditions, medical caps and high risk pools. Most of the Republicans are also heavily invested in the Health Care Industry and they rake in millions when people go bankrupt from serious illnesses or if they are dependent on expensive drugs which in the U.S. are way higher than other Industrialized Nations.

          Trumps appointee for Secretary of Health in the past invested 30 million in the Health Care Industry and then sponsored legislation that passed easing restrictions and he cleaned house with a net profit of 300 million increase in his stocks. Now you know why the Republicans are such crooks when it comes to giving the Insurance and Drug Companies free reign to rape the American public of every penny they will ever earn when it comes to paying for Health Care.

          On France24News interviews with both Europeans and Canadians showed that they were aghast at what is going on now in the U.S. over health care and more than one expressed the opinion “Thank God we do not live in the U.S”.

        4. avatar Excedrine says:

          @cisco kid — Not every industrialized nation in the world has actually outlawed for-profit healthcare, nor do you have any spurce for such a bold-faced lie. Hell, even Canada’s Supreme Court said it’s inhumane and against people’s civil rights NOT to have private healthcare. And they’d be RIGHT.

          Studies have actually shown that the other industrialized nations have significantly higher health care costs specifically BECAUSE of price controls, which only HIDE the actual up-front cost to the taxpayer because it’s not out-of-pocket as it ACTUALLY should be. The DemoKKKrats, according MSNBC, were also getting millions from drug and insurance companies to write the ACA in the first place. Most of the DemoKKKrats are equally heavily-invested in the health care industry and they, too, rake in millions when people go bankrupt from serious illnesses or if they are dependent on expensive drugs — which in the U.S. are way cheaper than in other industrialized nations.

          What others say on foreign propaganda networks is irrelevant and inapplicable here — especially since it’s those very people that come here for some of their most urgent medical treatment! Why, you might ask? Because they’d DIE waiting for it there or it’s simply unavailable, because WE innovate and they DON’T.

        5. avatar cisco kid says:

          GIVE UP MORON YOUR MAKING A FOOL OF YOURSELF AGAIN. HERE IS THE RUN DOWN ON THE U.S. COMPARED WITH OTHER COUNTRIES COMPLETE WITH MANY GRAPHS SIMPLY CLICK ON IT.

          http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

          U.S. Health Care from a Global Perspective

          Spending, Use of Services, Prices, and Health in 13 Countries
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          High U.S. health care spending due to greater use of medical technology, health care prices

          U.S. spends more on health care than other high-income countries but has worse outcomes

          Abstract

          This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13 high-income countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. These data predate the major insurance provisions of the Affordable Care Act. In 2013, the U.S. spent far more on health care than these other countries. Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions. In contrast, U.S. spending on social services made up a relatively small share of the economy relative to other countries. Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.

          “Maybe We Could Have Bought Him a Good Pair of Shoes”: Why Peer Nations Spend Less on Health Care but Stay Healthier

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          OVERVIEW

          Cross-national comparisons allow us to track the performance of the U.S. health care system, highlight areas of strength and weakness, and identify factors that may impede or accelerate improvement. This analysis is the latest in a series of Commonwealth Fund cross-national comparisons that use health data from the Organization for Economic Cooperation and Development (OECD), as well as from other sources, to assess U.S. health care system spending, supply, utilization, and prices relative to other countries, as well as a limited set of health outcomes.1,2 Thirteen high-income countries are included: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. On measures where data are widely available, the value for the median OECD country is also shown. Almost all data are for years prior to the major insurance provisions of the Affordable Care Act; most are for 2013.

          Health care spending in the U.S. far exceeds that of other high-income countries, though spending growth has slowed in the U.S. and in most other countries in recent years.3 Even though the U.S. is the only country without a publicly financed universal health system, it still spends more public dollars on health care than all but two of the other countries. Americans have relatively few hospital admissions and physician visits, but are greater users of expensive technologies like magnetic resonance imaging (MRI) machines. Available cross-national pricing data suggest that prices for health care are notably higher in the U.S., potentially explaining a large part of the higher health spending. In contrast, the U.S. devotes a relatively small share of its economy to social services, such as housing assistance, employment programs, disability benefits, and food security.4 Finally, despite its heavy investment in health care, the U.S. sees poorer results on several key health outcome measures such as life expectancy and the prevalence of chronic conditions. Mortality rates from cancer are low and have fallen more quickly in the U.S. than in other countries, but the reverse is true for mortality from ischemic heart disease.

          The Commonwealth Fund has supported a series of publications using OECD Health Data since 1998

          What’s new in this update?
          Health care spending growth has slowed in recent years, both in the U.S. and internationally.

          What remains the same?
          Americans continue to far outspend other wealthy nations on health care but do not have better health outcomes.

          KEY FINDINGS

          The United States is the highest spender on health care. [Exhibits 1, 2]

          Data from the OECD show that the U.S. spent 17.1 percent of its gross domestic product (GDP) on health care in 2013. This was almost 50 percent more than the next-highest spender (France, 11.6% of GDP) and almost double what was spent in the U.K. (8.8%). U.S. spending per person was equivalent to $9,086 (not adjusted for inflation).

          Since 2009, health care spending growth has slowed in the U.S. and most other countries. The real growth rate per capita in the U.S. declined from 2.47 percent between 2003 and 2009 to 1.50 percent between 2009 and 2013. In Denmark and the United Kingdom, the growth rate actually became negative. The timing and cross-national nature of the slowdown suggest a connection to the 2007–2009 global financial crisis and its aftereffects, though additional factors also may be at play.5Squires OECD Exhibit 01 Squires OECD Exhibit 02

          Download these charts in ChartCart

          Private spending on health care is highest in the U.S. [Exhibit 2]

          In 2013, the average U.S. resident spent $1,074 out-of-pocket on health care, for things like copayments for doctor’s office visits and prescription drugs and health insurance deductibles. Only the Swiss spent more at $1,630, while France and the Netherlands spent less than one-fourth as much ($277 and $270, respectively). As for other private health spending, including on private insurance premiums, U.S. spending towered over that of the other countries at $3,442 per capita—more than five times what was spent in Canada ($654), the second-highest spending country.6

          U.S. public spending on health care is high, despite covering fewer residents. [Exhibit 2]

          Public spending on health care amounted to $4,197 per capita in the U.S. in 2013, more than in any other country except Norway ($4,981) and the Netherlands ($4,495), despite the fact that the U.S. was the only country studied that did not have a universal health care system. In the U.S., about 34 percent of residents were covered by public programs in 2013, including Medicare and Medicaid.7 By comparison, every resident in the United Kingdom is covered by the public system and spending was $2,802 per capita. Public spending on health care would be even greater in the U.S. if the tax exclusion for employer-sponsored health insurance (amounting to about $250 billion each year) was counted as a public expenditure.8

          Despite spending more on health care, Americans have fewer hospital and physician visits. [Exhibit 3, 4]

          The U.S. had fewer practicing physicians in 2013 than in the median OECD country (2.6 versus 3.2 physicians per 1,000 population). With only four per year, Americans also had fewer physician visits than the OECD median (6.5 visits). In contrast, the average Canadian had 7.7 physician visits and the average Japanese resident had 12.9 visits in 2012.

          In the U.S., there were also fewer hospital beds and fewer discharges per capita than in the median OECD country.Squires OECD Exhibit 03 Squires OECD Exhibit 04

          Americans appear to be greater consumers of medical technology, including diagnostic imaging and pharmaceuticals. [Exhibit 5, 6]

          The U.S. stood out as a top consumer of sophisticated diagnostic imaging technology. Americans had the highest per capita rates of MRI, computed tomography (CT), and positron emission tomography (PET) exams among the countries where data were available. The U.S. and Japan were among the countries with the highest number of these imaging machines.9

          In addition, Americans were top consumers of prescription drugs. Based on findings from the 2013 Commonwealth Fund International Surveys, adults in the U.S. and New Zealand on average take more prescription drugs (2.2 per adult) than adults in other countries.Squires OECD Exhibit 05 Squires OECD Exhibit 06

          Health care prices are higher in the U.S. compared with other countries. [Exhibit 7]

          Data published by the International Federation of Health Plans suggest that hospital and physician prices for procedures were highest in the U.S. in 2013.10 The average price of bypass surgery was $75,345 in the U.S. This is more than $30,000 higher than in the second-highest country, Australia, where the procedure costs $42,130. According to the same data source, MRI and CT scans were also most expensive in the U.S. While these pricing data are subject to significant methodological limitations, they illustrate a pattern of significantly higher prices in many areas of U.S. health care.

          Other studies have observed high U.S. prices for pharmaceuticals. A 2013 investigation by Kanavos and colleagues created a cross-national price index for a basket of widely used in-patent pharmaceuticals. In 2010, all countries studied had lower prices than the U.S. In Australia, Canada, and the United Kingdom, prices were about 50 percent lower.11Squires OECD Exhibit 07

          The U.S. invests the smallest share of its economy on social services. [Exhibit 8]

          A 2013 study by Bradley and Taylor found that the U.S. spent the least on social services—such as retirement and disability benefits, employment programs, and supportive housing—among the countries studied in this report, at just 9 percent of GDP.12 Canada, Australia and New Zealand had similarly low rates of spending, while France, Sweden, Switzerland, and Germany devoted roughly twice as large a share of their economy to social services as did the U.S.

          The U.S. was also the only country studied where health care spending accounted for a greater share of GDP than social services spending. In aggregate, U.S. health and social services spending rank near the middle of the pack.Squires OECD Exhibit 08

          Despite its high spending on health care, the U.S. has poor population health. [Exhibit 9]

          On several measures of population health, Americans had worse outcomes than their international peers. The U.S. had the lowest life expectancy at birth of the countries studied, at 78.8 years in 2013, compared with the OECD median of 81.2 years. Additionally, the U.S. had the highest infant mortality rate among the countries studied, at 6.1 deaths per 1,000 live births in 2011; the rate in the OECD median country was 3.5 deaths.

          The prevalence of chronic diseases also appeared to be higher in the U.S. The 2014 Commonwealth Fund International Health Policy Survey found that 68 percent of U.S. adults age 65 or older had at least two chronic conditions. In other countries, this figure ranged from 33 percent (U.K.) to 56 percent (Canada).13

          A 2013 report from the Institute of Medicine reviewed the literature about the health disadvantages of Americans relative to residents of other high-income countries. It found the U.S. performed poorly on several important determinants of health.14 More than a third of adults in the U.S. were obese in 2012, a rate that was about 15 percent higher than the next-highest country, New Zealand. The U.S. had one of the lowest smoking rates in 2013, but one of the highest rates of tobacco consumption in the 1960s and 1970s. This earlier period of heavy tobacco use may still be contributing to relatively worse health outcomes among older U.S. adults.15 Other potential contributors to the United States’ health disadvantage include the large number of uninsured, as well as differences in lifestyle, environment, and rates of accidents and violence.

          The Institute of Medicine found that poorer health in the U.S. was not simply the result of economic, social, or racial and ethnic disadvantages—even well-off, nonsmoking, nonobese Americans appear in worse health than their counterparts abroad.Squires OECD Exhibit 09

          The U.S. performs well on cancer care but has high rates of mortality from heart disease and amputations as a result of diabetes. [Exhibits 10, 11, 12]

          One area where the U.S. appeared to have comparatively good health outcomes was cancer care. A 2015 study by Stevens et al. found that mortality rates from cancer in the U.S. were lower and had declined faster between 1995 and 2007 than in most industrialized countries.16 Other research based on survival rates also suggests that U.S. cancer care is above average, though these studies are disputed on methodological grounds.17

          The opposite trend appears for ischemic heart disease, where the U.S. had among the highest mortality rates in 2013—128 per 100,000 population compared with 95 in the median OECD country. Since 1995, mortality rates have fallen significantly in all countries as a result of improved treatment and changes in risk factors.18 However, this decline was less pronounced in the U.S., where rates declined from 225 to 128 deaths per 100,000 population—considerably less than countries like Denmark, where rates declined from 242 to 71 deaths per 100,000 population.

          The U.S. also had high rates of adverse outcomes from diabetes, with 17.1 lower extremity amputations per 100,000 population in 2011. Rates in Sweden, Australia and the U.K. were less than one-third as high.Squires OECD Exhibit 10 Squires OECD Exhibit 11Squires OECD Exhibit 12

          DISCUSSION

          Health care spending in the U.S. far exceeds that in other countries, despite a global slowdown in spending growth in recent years. At 17.1 percent of GDP, the U.S. devotes at least 50 percent more of its economy to health care than do other countries. Even public spending on health care, on a per capita basis, is higher in the U.S. than in most other countries with universal public coverage.

          How can we explain the higher U.S. spending? In line with previous studies,19 the results of this analysis suggest that the excess is likely driven by greater utilization of medical technology and higher prices, rather than use of routine services, such as more frequent visits to physicians and hospitals.

          High health care spending has far-reaching consequences in the U.S. economy, contributing to wage stagnation, personal bankruptcy, and budget deficits, and creating a competitive disadvantage relative to other nations.20 One potential consequence of high health spending is that it may crowd out other forms of social spending that support health. In the U.S., health care spending substantially outweighs spending on social services. This imbalance may contribute to the country’s poor health outcomes. A growing body of evidence suggests that social services play an important role in shaping health trajectories and mitigating health disparities.21,22 Additional cross-national research is needed to better understand the relationship between social services and health, as well as other health determinants like lifestyle and environment.

          New care models that reward health care providers based on their patient population’s health outcomes (e.g., accountable care organizations) are an interesting development. Such accountability could create a business case for health care providers to invest in certain social services or other nonclinical interventions, if doing so would be a cost-effective way to improve patients’ health.23 Over the long term, such a strategy could potentially alter the current balance between health and social services spending.

          METHODS

          The Organization for Economic Cooperation and Development (OECD) annually tracks and reports on a wide range of health system measures across 34 high-income countries, from population health status to health care spending and utilization. This analysis examined 2015 OECD health data for 13 countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. This brief presents OECD data for the year 2013 or, if not available, for 2012 or 2011. The median for all available OECD countries is included in Exhibits 2, 3, 4, 5, 9, and 11; it is excluded for some indicators because of incompleteness of data. All currency amounts are listed in U.S. dollars (USD) and adjusted for national differences in cost of living.

          Data are also included from a report by the International Federation of Health Plans (2013) on prices of hospital procedures and diagnostic tests; an analysis by Kanavos and colleagues (2013) on branded drug prices and spending, originally published in Health Affairs; results from the Commonwealth Fund 2013 and 2014 International Health Policy Surveys, which were published in Health Affairs; an analysis by Stevens and colleagues (2015) on cancer mortality, originally published in Health Affairs; and a book by Bradley and Taylor (2013), The American Health Care Paradox: Why Spending More Is Getting Us Less, on social services and health.

          Notes
          1 D. Squires, “The Global Slowdown in Health Care Spending,” Journal of the American Medical Association, Aug. 6, 2014 312(5):485–86; D. Squires, Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality (New York: The Commonwealth Fund, May 2012); D. Squires, The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations (New York: The Commonwealth Fund, July 2011); G. F. Anderson and D. Squires, Measuring the U.S. Health Care System: A Cross-National Comparison (New York: The Commonwealth Fund, June 2010); G. F. Anderson and B. K. Frogner, “Health Spending in OECD Countries: Obtaining Value per Dollar,” Health Affairs, Nov./Dec. 2008 27(6):1718–27; G. F. Anderson, B. K. Frogner, and U. E. Reinhardt, “Health Spending in OECD Countries in 2004: An Update,” Health Affairs, Sept./Oct. 2007 26(5):1481–89; G. F. Anderson, P. S. Hussey, B. K. Frogner et al., “Health Spending in the United States and the Rest of the Industrialized World,” Health Affairs, July/Aug. 2005 24(4):903–14; U. E. Reinhardt, P. S. Hussey, and G. F. Anderson, “U.S. Health Care Spending in an International Context,” Health Affairs, May/June 2004 23(3):10–25; G. F. Anderson, U. E. Reinhardt, P. S. Hussey et al., “It’s the Prices, Stupid: Why the United States Is So Different from Other Countries,” Health Affairs, May/June 2003, 22(3):89–105; U. E. Reinhardt, P. S. Hussey, and G. F. Anderson, “Cross-National Comparisons of Health Systems Using OECD Data, 1999,” Health Affairs, May/ June 2002 21(3):169–81; G. F. Anderson and P. S. Hussey, “Comparing Health System Performance in OECD Countries,” Health Affairs, May/June 2001 20(3):219–32; G. F. Anderson, J. Hurst, P. S. Hussey et al., “Health Spending and Outcomes: Trends in OECD Countries, 1960–1998,” Health Affairs, May/June 2000 19(3):150–57; and G. F. Anderson and J. P. Poullier, “Health Spending, Access, and Outcomes: Trends in Industrialized Countries,” Health Affairs, May/June 1999 18(3):178–92.

          2 Unlike the Fund’s Mirror, Mirror on the Wall series, this report does not attempt to assess overall health system performance, or rank health systems across various metrics. See: K. Davis, K. Stremikis, C. Schoen, and D. Squires, Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally (New York: The Commonwealth Fund, June 2014).

          3 Organization for Economic Cooperation and Development, OECD Health Data 2015 (Paris: OECD, June 2015).

          4 E. H. Bradley and L. A. Taylor, The American Health Care Paradox: Why Spending More Is Getting Us Less (New York: Public Affairs, 2013).

          5 Squires, “Global Slowdown,” 2014.

          6 Because of data limitations in several countries, the breakdown of health spending by source of financing is for current spending only, meaning it excludes capital formation of health care providers. In most countries, those amounts range between 2 percent and 7 percent of total health spending.

          7 U.S. Census Bureau, Health Insurance in the United States: 2013—Tables & Figures, 2014.

          8 Congressional Budget Office, Options for Reducing The Deficit: 2014 to 2023 (Washington, D.C.: CBO, Nov. 2013).

          9 It should be noted that, despite the comparatively high levels of use in the U.S., growth in medical imaging appears to have leveled off in recent years after surging through much of the 2000s. The slowdown has been attributed to patient cost-sharing, prior authorization, best-practice guidelines, and other strategies to reduce potentially unnecessary utilization. See D. W. Lee and F. Levy, “The Sharp Slowdown in Growth of Medical Imaging: An Early Analysis Suggests Combination of Policies Was the Cause,” Health Affairs, Aug. 2012 31(8):1876–84.

          10 International Federation of Health Plans, 2013 Comparative Price Report.

          11 P. Kanavos, A. Ferrario, S. Vandoros et al., “Higher U.S. Branded Drug Prices and Spending Compared to Other Countries May Stem Partly from Quick Uptake of New Drugs,” Health Affairs, April 2013 32(4):753–61.

          12 Bradley and Taylor, American Health Care Paradox, 2013.

          13 Chronic conditions included hypertension or high blood pressure, heart disease, diabetes, lung problems, mental health problems, cancer, and joint pain/arthritis. See Commonwealth Fund 2014 International Health Policy Survey of Older Adults.

          14 J. D. Freeman, S. Kadiyala, J. F. Bell et al., “The Causal Effect of Health Insurance on Utilization and Outcomes in Adults: A Systematic Review of US Studies,” Medical Care, 2008 46(10):1023–32; and S. H. Woolf and L. Aron (eds.), U.S. Health in International Perspective: Shorter Lives, Poorer Health (Washington, D.C.: National Academies Press, 2013).

          15 Woolf and Aron (eds.), U.S. Health in International Perspective, 2013.

          16 W. Stevens, T. J. Philipson, Z. M. Khan et al., “Cancer Mortality Reductions Were Greatest Among Countries Where Cancer Care Spending Rose the Most, 1995–2007,” Health Affairs, April 2015 34(4):562–70.

          17 T. Philipson, M. Eber, D. N. Lakdawalla et al., “An Analysis of Whether Higher Health Care Spending in the United States Versus Europe Is ‘Worth It’ in the Case of Cancer,” Health Affairs, April 2012 31(4):667–75; S. Soneji and J. Yang, “New Analysis Reexamines the Value of Cancer Care in the United States Compared to Western Europe,” Health Affairs, March 2015 34(3):390–97; D. Goldman, D. Lakdawalla, and T. Philipson, “Mortality Versus Survival in International Comparisons of Cancer Care,” Health Affairs Blog, March 20, 2015; and H. G. Welch and E. Fisher, “Revisiting Mortality Versus Survival in International Comparisons of Cancer Care,” Health Affairs Blog, April 1, 2015.

          18 Organization for Economic Cooperation and Development, Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care (Paris: OECD, June 2015).

          19 Squires, Explaining High Health Care Spending, 2012; Anderson, Frogner, and Reinhardt, “Health Spending in OECD Countries,” 2007; M. J. Laugesen and S. A. Glied, “Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries,” Health Affairs, Sept. 2011 30(9):1647–56.

          20 D. I. Auerbach and A. L. Kellermann, “A Decade of Health Care Cost Growth Has Wiped Out Real Income Gains for an Average U.S. Family,” Health Affairs, Sept. 2011 30(9):1630–36; D. Blumenthal and D. Squires, “Do Health Care Costs Fuel Economic Inequality in the United States?” The Commonwealth Fund Blog, Sept. 9, 2014; D. U. Himmelstein, D. Thorne, E. Warren et al., “Medical Bankruptcy in the United States, 2007: Results of a National Study,” American Journal of Medicine, Aug. 2009 122(8):741–46; RAND Health, How Does Growth in Health Care Costs Affect the American Family? (Santa Monica, Calif.: RAND, 2011); and T. Johnson, Healthcare Costs and U.S. Competitiveness (New York: Council on Foreign Relations, March 2012).

          21 M. Avendano and I. Kawachi, “Why Do Americans Have Shorter Life Expectancy and Worse Health Than Do People in Other High-Income Countries?” Annual Review of Public Health, March 2014 35:307–25; and Bradley and Taylor, American Health Care Paradox, 2013.

          22 E. H. Bradley, B. R. Elkins, J. Herrin et al., “Health and Social Services Expenditures: Associations with Health Outcomes,” BMJ Quality & Safety, published online March 29, 2011.

          23 D. Bachrach, H. Pfister, K. Wallis et al., Addressing Patients’ Social Needs: An Emerging Business Case for Provider Investment (New York: The Commonwealth Fund, May 2014).

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          Publication Details

          Publication Date:
          October 8, 2015 Authors:
          David Squires, Chloe Anderson Contact:
          David Squires, Senior Researcher to the President, The Commonwealth Fund E-mail: ds@cmwf.orgEditor:
          Deborah Lorber Citation:
          D. Squires and C. Anderson, U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries, The Commonwealth Fund, October 2015.

          Related Publications

          May 11, 2017Accountable Care Around the World: Lessons and Policy Implications for the U.S. March 30, 2017Minding the Gap: Factors Associated with Primary Care Coordination of Adults in 11 Countries

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        6. avatar cisco kid says:

          Give up Moron your again making a fool of yourself. Here is the link comparing the tremendous cost of U.S. Health Care to the rest of the world.

          http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

          U.S. Health Care from a Global Perspective

          Spending, Use of Services, Prices, and Health in 13 Countries
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          High U.S. health care spending due to greater use of medical technology, health care prices

          U.S. spends more on health care than other high-income countries but has worse outcomes

          Abstract

          This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13 high-income countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. These data predate the major insurance provisions of the Affordable Care Act. In 2013, the U.S. spent far more on health care than these other countries. Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions. In contrast, U.S. spending on social services made up a relatively small share of the economy relative to other countries. Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.

          “Maybe We Could Have Bought Him a Good Pair of Shoes”: Why Peer Nations Spend Less on Health Care but Stay Healthier

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          OVERVIEW

          Cross-national comparisons allow us to track the performance of the U.S. health care system, highlight areas of strength and weakness, and identify factors that may impede or accelerate improvement. This analysis is the latest in a series of Commonwealth Fund cross-national comparisons that use health data from the Organization for Economic Cooperation and Development (OECD), as well as from other sources, to assess U.S. health care system spending, supply, utilization, and prices relative to other countries, as well as a limited set of health outcomes.1,2 Thirteen high-income countries are included: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. On measures where data are widely available, the value for the median OECD country is also shown. Almost all data are for years prior to the major insurance provisions of the Affordable Care Act; most are for 2013.

          Health care spending in the U.S. far exceeds that of other high-income countries, though spending growth has slowed in the U.S. and in most other countries in recent years.3 Even though the U.S. is the only country without a publicly financed universal health system, it still spends more public dollars on health care than all but two of the other countries. Americans have relatively few hospital admissions and physician visits, but are greater users of expensive technologies like magnetic resonance imaging (MRI) machines. Available cross-national pricing data suggest that prices for health care are notably higher in the U.S., potentially explaining a large part of the higher health spending. In contrast, the U.S. devotes a relatively small share of its economy to social services, such as housing assistance, employment programs, disability benefits, and food security.4 Finally, despite its heavy investment in health care, the U.S. sees poorer results on several key health outcome measures such as life expectancy and the prevalence of chronic conditions. Mortality rates from cancer are low and have fallen more quickly in the U.S. than in other countries, but the reverse is true for mortality from ischemic heart disease.

          The Commonwealth Fund has supported a series of publications using OECD Health Data since 1998

          What’s new in this update?
          Health care spending growth has slowed in recent years, both in the U.S. and internationally.

          What remains the same?
          Americans continue to far outspend other wealthy nations on health care but do not have better health outcomes.

          KEY FINDINGS

          The United States is the highest spender on health care. [Exhibits 1, 2]

          Data from the OECD show that the U.S. spent 17.1 percent of its gross domestic product (GDP) on health care in 2013. This was almost 50 percent more than the next-highest spender (France, 11.6% of GDP) and almost double what was spent in the U.K. (8.8%). U.S. spending per person was equivalent to $9,086 (not adjusted for inflation).

          Since 2009, health care spending growth has slowed in the U.S. and most other countries. The real growth rate per capita in the U.S. declined from 2.47 percent between 2003 and 2009 to 1.50 percent between 2009 and 2013. In Denmark and the United Kingdom, the growth rate actually became negative. The timing and cross-national nature of the slowdown suggest a connection to the 2007–2009 global financial crisis and its aftereffects, though additional factors also may be at play.5Squires OECD Exhibit 01 Squires OECD Exhibit 02

          Download these charts in ChartCart

          Private spending on health care is highest in the U.S. [Exhibit 2]

          In 2013, the average U.S. resident spent $1,074 out-of-pocket on health care, for things like copayments for doctor’s office visits and prescription drugs and health insurance deductibles. Only the Swiss spent more at $1,630, while France and the Netherlands spent less than one-fourth as much ($277 and $270, respectively). As for other private health spending, including on private insurance premiums, U.S. spending towered over that of the other countries at $3,442 per capita—more than five times what was spent in Canada ($654), the second-highest spending country.6

          U.S. public spending on health care is high, despite covering fewer residents. [Exhibit 2]

          Public spending on health care amounted to $4,197 per capita in the U.S. in 2013, more than in any other country except Norway ($4,981) and the Netherlands ($4,495), despite the fact that the U.S. was the only country studied that did not have a universal health care system. In the U.S., about 34 percent of residents were covered by public programs in 2013, including Medicare and Medicaid.7 By comparison, every resident in the United Kingdom is covered by the public system and spending was $2,802 per capita. Public spending on health care would be even greater in the U.S. if the tax exclusion for employer-sponsored health insurance (amounting to about $250 billion each year) was counted as a public expenditure.8

          Despite spending more on health care, Americans have fewer hospital and physician visits. [Exhibit 3, 4]

          The U.S. had fewer practicing physicians in 2013 than in the median OECD country (2.6 versus 3.2 physicians per 1,000 population). With only four per year, Americans also had fewer physician visits than the OECD median (6.5 visits). In contrast, the average Canadian had 7.7 physician visits and the average Japanese resident had 12.9 visits in 2012.

          In the U.S., there were also fewer hospital beds and fewer discharges per capita than in the median OECD country.Squires OECD Exhibit 03 Squires OECD Exhibit 04

          Americans appear to be greater consumers of medical technology, including diagnostic imaging and pharmaceuticals. [Exhibit 5, 6]

          The U.S. stood out as a top consumer of sophisticated diagnostic imaging technology. Americans had the highest per capita rates of MRI, computed tomography (CT), and positron emission tomography (PET) exams among the countries where data were available. The U.S. and Japan were among the countries with the highest number of these imaging machines.9

          In addition, Americans were top consumers of prescription drugs. Based on findings from the 2013 Commonwealth Fund International Surveys, adults in the U.S. and New Zealand on average take more prescription drugs (2.2 per adult) than adults in other countries.Squires OECD Exhibit 05 Squires OECD Exhibit 06

          Health care prices are higher in the U.S. compared with other countries. [Exhibit 7]

          Data published by the International Federation of Health Plans suggest that hospital and physician prices for procedures were highest in the U.S. in 2013.10 The average price of bypass surgery was $75,345 in the U.S. This is more than $30,000 higher than in the second-highest country, Australia, where the procedure costs $42,130. According to the same data source, MRI and CT scans were also most expensive in the U.S. While these pricing data are subject to significant methodological limitations, they illustrate a pattern of significantly higher prices in many areas of U.S. health care.

          Other studies have observed high U.S. prices for pharmaceuticals. A 2013 investigation by Kanavos and colleagues created a cross-national price index for a basket of widely used in-patent pharmaceuticals. In 2010, all countries studied had lower prices than the U.S. In Australia, Canada, and the United Kingdom, prices were about 50 percent lower.11Squires OECD Exhibit 07

          The U.S. invests the smallest share of its economy on social services. [Exhibit 8]

          A 2013 study by Bradley and Taylor found that the U.S. spent the least on social services—such as retirement and disability benefits, employment programs, and supportive housing—among the countries studied in this report, at just 9 percent of GDP.12 Canada, Australia and New Zealand had similarly low rates of spending, while France, Sweden, Switzerland, and Germany devoted roughly twice as large a share of their economy to social services as did the U.S.

          The U.S. was also the only country studied where health care spending accounted for a greater share of GDP than social services spending. In aggregate, U.S. health and social services spending rank near the middle of the pack.Squires OECD Exhibit 08

          Despite its high spending on health care, the U.S. has poor population health. [Exhibit 9]

          On several measures of population health, Americans had worse outcomes than their international peers. The U.S. had the lowest life expectancy at birth of the countries studied, at 78.8 years in 2013, compared with the OECD median of 81.2 years. Additionally, the U.S. had the highest infant mortality rate among the countries studied, at 6.1 deaths per 1,000 live births in 2011; the rate in the OECD median country was 3.5 deaths.

          The prevalence of chronic diseases also appeared to be higher in the U.S. The 2014 Commonwealth Fund International Health Policy Survey found that 68 percent of U.S. adults age 65 or older had at least two chronic conditions. In other countries, this figure ranged from 33 percent (U.K.) to 56 percent (Canada).13

          A 2013 report from the Institute of Medicine reviewed the literature about the health disadvantages of Americans relative to residents of other high-income countries. It found the U.S. performed poorly on several important determinants of health.14 More than a third of adults in the U.S. were obese in 2012, a rate that was about 15 percent higher than the next-highest country, New Zealand. The U.S. had one of the lowest smoking rates in 2013, but one of the highest rates of tobacco consumption in the 1960s and 1970s. This earlier period of heavy tobacco use may still be contributing to relatively worse health outcomes among older U.S. adults.15 Other potential contributors to the United States’ health disadvantage include the large number of uninsured, as well as differences in lifestyle, environment, and rates of accidents and violence.

          The Institute of Medicine found that poorer health in the U.S. was not simply the result of economic, social, or racial and ethnic disadvantages—even well-off, nonsmoking, nonobese Americans appear in worse health than their counterparts abroad.Squires OECD Exhibit 09

          The U.S. performs well on cancer care but has high rates of mortality from heart disease and amputations as a result of diabetes. [Exhibits 10, 11, 12]

          One area where the U.S. appeared to have comparatively good health outcomes was cancer care. A 2015 study by Stevens et al. found that mortality rates from cancer in the U.S. were lower and had declined faster between 1995 and 2007 than in most industrialized countries.16 Other research based on survival rates also suggests that U.S. cancer care is above average, though these studies are disputed on methodological grounds.17

          The opposite trend appears for ischemic heart disease, where the U.S. had among the highest mortality rates in 2013—128 per 100,000 population compared with 95 in the median OECD country. Since 1995, mortality rates have fallen significantly in all countries as a result of improved treatment and changes in risk factors.18 However, this decline was less pronounced in the U.S., where rates declined from 225 to 128 deaths per 100,000 population—considerably less than countries like Denmark, where rates declined from 242 to 71 deaths per 100,000 population.

          The U.S. also had high rates of adverse outcomes from diabetes, with 17.1 lower extremity amputations per 100,000 population in 2011. Rates in Sweden, Australia and the U.K. were less than one-third as high.Squires OECD Exhibit 10 Squires OECD Exhibit 11Squires OECD Exhibit 12

          DISCUSSION

          Health care spending in the U.S. far exceeds that in other countries, despite a global slowdown in spending growth in recent years. At 17.1 percent of GDP, the U.S. devotes at least 50 percent more of its economy to health care than do other countries. Even public spending on health care, on a per capita basis, is higher in the U.S. than in most other countries with universal public coverage.

          How can we explain the higher U.S. spending? In line with previous studies,19 the results of this analysis suggest that the excess is likely driven by greater utilization of medical technology and higher prices, rather than use of routine services, such as more frequent visits to physicians and hospitals.

          High health care spending has far-reaching consequences in the U.S. economy, contributing to wage stagnation, personal bankruptcy, and budget deficits, and creating a competitive disadvantage relative to other nations.20 One potential consequence of high health spending is that it may crowd out other forms of social spending that support health. In the U.S., health care spending substantially outweighs spending on social services. This imbalance may contribute to the country’s poor health outcomes. A growing body of evidence suggests that social services play an important role in shaping health trajectories and mitigating health disparities.21,22 Additional cross-national research is needed to better understand the relationship between social services and health, as well as other health determinants like lifestyle and environment.

          New care models that reward health care providers based on their patient population’s health outcomes (e.g., accountable care organizations) are an interesting development. Such accountability could create a business case for health care providers to invest in certain social services or other nonclinical interventions, if doing so would be a cost-effective way to improve patients’ health.23 Over the long term, such a strategy could potentially alter the current balance between health and social services spending.

          METHODS

          The Organization for Economic Cooperation and Development (OECD) annually tracks and reports on a wide range of health system measures across 34 high-income countries, from population health status to health care spending and utilization. This analysis examined 2015 OECD health data for 13 countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. This brief presents OECD data for the year 2013 or, if not available, for 2012 or 2011. The median for all available OECD countries is included in Exhibits 2, 3, 4, 5, 9, and 11; it is excluded for some indicators because of incompleteness of data. All currency amounts are listed in U.S. dollars (USD) and adjusted for national differences in cost of living.

          Data are also included from a report by the International Federation of Health Plans (2013) on prices of hospital procedures and diagnostic tests; an analysis by Kanavos and colleagues (2013) on branded drug prices and spending, originally published in Health Affairs; results from the Commonwealth Fund 2013 and 2014 International Health Policy Surveys, which were published in Health Affairs; an analysis by Stevens and colleagues (2015) on cancer mortality, originally published in Health Affairs; and a book by Bradley and Taylor (2013), The American Health Care Paradox: Why Spending More Is Getting Us Less, on social services and health.

          Notes
          1 D. Squires, “The Global Slowdown in Health Care Spending,” Journal of the American Medical Association, Aug. 6, 2014 312(5):485–86; D. Squires, Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality (New York: The Commonwealth Fund, May 2012); D. Squires, The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations (New York: The Commonwealth Fund, July 2011); G. F. Anderson and D. Squires, Measuring the U.S. Health Care System: A Cross-National Comparison (New York: The Commonwealth Fund, June 2010); G. F. Anderson and B. K. Frogner, “Health Spending in OECD Countries: Obtaining Value per Dollar,” Health Affairs, Nov./Dec. 2008 27(6):1718–27; G. F. Anderson, B. K. Frogner, and U. E. Reinhardt, “Health Spending in OECD Countries in 2004: An Update,” Health Affairs, Sept./Oct. 2007 26(5):1481–89; G. F. Anderson, P. S. Hussey, B. K. Frogner et al., “Health Spending in the United States and the Rest of the Industrialized World,” Health Affairs, July/Aug. 2005 24(4):903–14; U. E. Reinhardt, P. S. Hussey, and G. F. Anderson, “U.S. Health Care Spending in an International Context,” Health Affairs, May/June 2004 23(3):10–25; G. F. Anderson, U. E. Reinhardt, P. S. Hussey et al., “It’s the Prices, Stupid: Why the United States Is So Different from Other Countries,” Health Affairs, May/June 2003, 22(3):89–105; U. E. Reinhardt, P. S. Hussey, and G. F. Anderson, “Cross-National Comparisons of Health Systems Using OECD Data, 1999,” Health Affairs, May/ June 2002 21(3):169–81; G. F. Anderson and P. S. Hussey, “Comparing Health System Performance in OECD Countries,” Health Affairs, May/June 2001 20(3):219–32; G. F. Anderson, J. Hurst, P. S. Hussey et al., “Health Spending and Outcomes: Trends in OECD Countries, 1960–1998,” Health Affairs, May/June 2000 19(3):150–57; and G. F. Anderson and J. P. Poullier, “Health Spending, Access, and Outcomes: Trends in Industrialized Countries,” Health Affairs, May/June 1999 18(3):178–92.

          2 Unlike the Fund’s Mirror, Mirror on the Wall series, this report does not attempt to assess overall health system performance, or rank health systems across various metrics. See: K. Davis, K. Stremikis, C. Schoen, and D. Squires, Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally (New York: The Commonwealth Fund, June 2014).

          3 Organization for Economic Cooperation and Development, OECD Health Data 2015 (Paris: OECD, June 2015).

          4 E. H. Bradley and L. A. Taylor, The American Health Care Paradox: Why Spending More Is Getting Us Less (New York: Public Affairs, 2013).

          5 Squires, “Global Slowdown,” 2014.

          6 Because of data limitations in several countries, the breakdown of health spending by source of financing is for current spending only, meaning it excludes capital formation of health care providers. In most countries, those amounts range between 2 percent and 7 percent of total health spending.

          7 U.S. Census Bureau, Health Insurance in the United States: 2013—Tables & Figures, 2014.

          8 Congressional Budget Office, Options for Reducing The Deficit: 2014 to 2023 (Washington, D.C.: CBO, Nov. 2013).

          9 It should be noted that, despite the comparatively high levels of use in the U.S., growth in medical imaging appears to have leveled off in recent years after surging through much of the 2000s. The slowdown has been attributed to patient cost-sharing, prior authorization, best-practice guidelines, and other strategies to reduce potentially unnecessary utilization. See D. W. Lee and F. Levy, “The Sharp Slowdown in Growth of Medical Imaging: An Early Analysis Suggests Combination of Policies Was the Cause,” Health Affairs, Aug. 2012 31(8):1876–84.

          10 International Federation of Health Plans, 2013 Comparative Price Report.

          11 P. Kanavos, A. Ferrario, S. Vandoros et al., “Higher U.S. Branded Drug Prices and Spending Compared to Other Countries May Stem Partly from Quick Uptake of New Drugs,” Health Affairs, April 2013 32(4):753–61.

          12 Bradley and Taylor, American Health Care Paradox, 2013.

          13 Chronic conditions included hypertension or high blood pressure, heart disease, diabetes, lung problems, mental health problems, cancer, and joint pain/arthritis. See Commonwealth Fund 2014 International Health Policy Survey of Older Adults.

          14 J. D. Freeman, S. Kadiyala, J. F. Bell et al., “The Causal Effect of Health Insurance on Utilization and Outcomes in Adults: A Systematic Review of US Studies,” Medical Care, 2008 46(10):1023–32; and S. H. Woolf and L. Aron (eds.), U.S. Health in International Perspective: Shorter Lives, Poorer Health (Washington, D.C.: National Academies Press, 2013).

          15 Woolf and Aron (eds.), U.S. Health in International Perspective, 2013.

          16 W. Stevens, T. J. Philipson, Z. M. Khan et al., “Cancer Mortality Reductions Were Greatest Among Countries Where Cancer Care Spending Rose the Most, 1995–2007,” Health Affairs, April 2015 34(4):562–70.

          17 T. Philipson, M. Eber, D. N. Lakdawalla et al., “An Analysis of Whether Higher Health Care Spending in the United States Versus Europe Is ‘Worth It’ in the Case of Cancer,” Health Affairs, April 2012 31(4):667–75; S. Soneji and J. Yang, “New Analysis Reexamines the Value of Cancer Care in the United States Compared to Western Europe,” Health Affairs, March 2015 34(3):390–97; D. Goldman, D. Lakdawalla, and T. Philipson, “Mortality Versus Survival in International Comparisons of Cancer Care,” Health Affairs Blog, March 20, 2015; and H. G. Welch and E. Fisher, “Revisiting Mortality Versus Survival in International Comparisons of Cancer Care,” Health Affairs Blog, April 1, 2015.

          18 Organization for Economic Cooperation and Development, Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care (Paris: OECD, June 2015).

          19 Squires, Explaining High Health Care Spending, 2012; Anderson, Frogner, and Reinhardt, “Health Spending in OECD Countries,” 2007; M. J. Laugesen and S. A. Glied, “Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries,” Health Affairs, Sept. 2011 30(9):1647–56.

          20 D. I. Auerbach and A. L. Kellermann, “A Decade of Health Care Cost Growth Has Wiped Out Real Income Gains for an Average U.S. Family,” Health Affairs, Sept. 2011 30(9):1630–36; D. Blumenthal and D. Squires, “Do Health Care Costs Fuel Economic Inequality in the United States?” The Commonwealth Fund Blog, Sept. 9, 2014; D. U. Himmelstein, D. Thorne, E. Warren et al., “Medical Bankruptcy in the United States, 2007: Results of a National Study,” American Journal of Medicine, Aug. 2009 122(8):741–46; RAND Health, How Does Growth in Health Care Costs Affect the American Family? (Santa Monica, Calif.: RAND, 2011); and T. Johnson, Healthcare Costs and U.S. Competitiveness (New York: Council on Foreign Relations, March 2012).

          21 M. Avendano and I. Kawachi, “Why Do Americans Have Shorter Life Expectancy and Worse Health Than Do People in Other High-Income Countries?” Annual Review of Public Health, March 2014 35:307–25; and Bradley and Taylor, American Health Care Paradox, 2013.

          22 E. H. Bradley, B. R. Elkins, J. Herrin et al., “Health and Social Services Expenditures: Associations with Health Outcomes,” BMJ Quality & Safety, published online March 29, 2011.

          23 D. Bachrach, H. Pfister, K. Wallis et al., Addressing Patients’ Social Needs: An Emerging Business Case for Provider Investment (New York: The Commonwealth Fund, May 2014).

          Get Updates That Matter

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          Downloads

          Issue Brief Chartpack (pdf) Chartpack (ppt) Press Release

          Publication Details

          Publication Date:
          October 8, 2015 Authors:
          David Squires, Chloe Anderson Contact:
          David Squires, Senior Researcher to the President, The Commonwealth Fund E-mail: ds@cmwf.orgEditor:
          Deborah Lorber Citation:
          D. Squires and C. Anderson, U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries, The Commonwealth Fund, October 2015.

          Related Publications

          May 11, 2017Accountable Care Around the World: Lessons and Policy Implications for the U.S. March 30, 2017Minding the Gap: Factors Associated with Primary Care Coordination of Adults in 11 Countries

          Related Infographics

          Technology driving costs High U.S. Health Care Spending Is Largely Driven by Technology Use, Prices

          Related Topics

          International Health Policy
          Health System Performance and Costs

    2. avatar Ollie says:

      Allow a person to keep one firearm valued at less than $400 value for defense of the homestead..

      1. avatar The Gray Poseur says:

        The circle jerk this little girl put to paper is too much thinking for my headache.

    3. avatar Button Gwinnet says:

      In Colorado (and most states, I suspect), firearms are not exempt. A bankrupt person may keep his home equity (subject to limitations), a not-too-nice car, and personal property, including firearms, up to a certain amount. The Court specifically asks the value of any firearms. A person that misrepresents that value has committed Federal bankruptcy fraud and is potentially facing some very serious prison time.

  2. avatar Omer Baker says:

    I’d have to agree with her that guns should not be exempt from bankruptcy, but I would say that nothing should be exempt. And if one loses all their goods due to bankruptcy, this doesn’t take away their ability or right to reacquire other similar or the exact goods that were repossessed.

    1. avatar Jeremy S. says:

      Lots of stuff is exempt. Property and cash/investments are only subject to liquidation once you exceed a certain value. The law allows you to keep a certain value in vehicles, in other real property, real estate, cash, stock, and other categories of stuff. There’s no reason to treat firearms differently, I don’t think. If you’re allowed to keep $20,000 worth of real property or ‘household goods’ or whatever the dollar figure actually is, but anything over that is subject to auction to repay your debt, then you can choose what $20k worth of stuff you want to keep. Maybe that’s all guns maybe none of that is guns, but it’s up to the person filing bankruptcy. I’m no lawyer, but I do believe this is pretty accurate.

      1. avatar Button Gwinnet says:

        Yup. That’s the way it is, I can’t remember the amounts I was allowed to exempt, but I was so F*n broke I never came close. Car, guitar, clothes on my back, and 3 firearms.

      2. avatar Lance Manion says:

        This issue presents a little-known, almost-never-discussed benefit of firearms trusts. Gun owners have in the last decade or so flocked to the use of trusts in order to ACQUIRE firearms, specifically NFA firearms. But on the other side, a properly drafted irrevocable trust with a spendthrift provision may, depending on state of residency, shield those assets from creditors, even in bankruptcy proceedings. There is generally no restriction on what firearms can be placed into a trust – NFA firearms can share space on a page with “regular” firearms, magazines, optics, or anything else that’s valuable and warrants protection from creditors. Or if one wishes, one may create separate trusts for different assets.

        As mentioned above, the most common cause of bankruptcy is catastrophic illness which can happen suddenly to any of us. For that reason, it’s a good idea to at least consider creating an irrevocable spendthrift trust if you have a large or valuable firearm collection, or other assets for that matter. There are many other benefits of trusts, NFA or otherwise. Nobody likes preparing for death or protecting against unforeseen financial disaster, but really, for a few hundred bucks and a meeting with a lawyer, you can protect assets that are worth thousands of dollars and often times have immeasurable sentimental value (Grandpa’s shotgun). Bankruptcy isn’t the only way to lose assets, and a trust may provide protection from ordinary judgments in civil court if it comes to that.

        Of course, the boilerplate gun trusts offered online are unlikely to withstand creditors’ attacks in court, but a trust drafted properly by an attorney might save your gun collection. I spent the extra money and hired a lawyer to prepare my trust. The final document is over 70 pages of carefully planned legalese and it cost less than just one gun in my collection, my SIG P226 Stainless Elite. Hopefully it never comes to bankruptcy, but if it does, at least I’ll have a legal defense to protect my guns for the beneficiaries who are my kids.

        One final thought…I’ve read many comments to the tune of “pay your debt, you deadbeat.” Let me suggest that there is nothing moral or immoral about debt. The bank operates within the law when it lends and collects money and is ruthless. It doesn’t care about you, your family, or your health. As a debtor, your only obligation is to do the same. If lawful discharge of debt in bankruptcy is in your best interest, go for it. If there are exemptions you can take, take them. If the law is in your favor, use it. The bank is an immortal corporation that will never die no matter whether you pay your debt or not. You don’t owe it your short life, your home, your marriage, your kids’ futures, or your health.

  3. avatar KCK says:

    Some laws on the books let you keep your house and a horse.
    So why not your Mare’s Leg on your saddle.

    1. avatar tdiinva (now in wisconsin) says:

      Ok, you should be allowed to keep 1 gun.

      1. avatar Anon in CT says:

        Per adult family member.

  4. avatar NorincoJay says:

    So when healthcare is considered a “right” and tax payers are forced to pay for others “rights” to healthcare will everyone be required to have a gun? Will they force people to own one? Will taxpayers be forced to buy people guns? A “right” is something you can choose to do, but it’s your “right” not to also. If it’s forced its no longer a “right.”

    1. avatar tdiinva (now in wisconsin) says:

      The Militia Act of 1792 required every male who was required to serve in the Militia to have a musket and 20 rounds so apparently it is Constitutional to have a gun mandate. However, the Militia Act was not authorized in by the Second Amendment. The authority is found in Article I, Section 8.

      1. avatar Bohica says:

        And in the Atlanta suburb of Kennesaw, a city ordinance requires that the “head of household” keep and bear arms at all times. Largely symbolic, the ordinance received a huge uproar of hysteria from the yellowstream bedwetters about the streets running in blood.

        All that news apparently got through to the criminal elements because the crime rate plummeted to all time lows, especially homicides, burglaries, armed robberies and rapes.

        Wow, what a concept!

  5. avatar Curtis in IL says:

    I can’t disagree with Ms. Hill here, though I have a generally indignant attitude toward our bankruptcy laws in general. Their abuse makes the cost of credit higher for the rest of us.

    The bill she refers to would exempt up to 3 guns worth up to $3,000. So if you’re a collector with a couple safes full, they’re mostly going bye-bye if you file Chapter 7.

    1. avatar The Gray Poseur says:

      Not if they don’t know about them.

      One of numerous reasons I don’t bare my soul or firearm possessions online.

      1. avatar Mark N. says:

        Failure to disclose assets in a bankruptcy proceeding is a fraud on the court, and if discovered, is sufficient grounds for the dismissal of the bankruptcy petition without any relief. This then allows your creditors to go after anything and everything they can find, including stuff that would otherwise be exempted, and subject only to state law limitations on creditor’s rights. If the creditors sue and get a judgment against the debtor, the debtor can be examined under oath as to any and all assets, and be required to produce any and all records of accounts, etc. Lying in that exam is perjury, punishable both civilly and criminally.

        I’ve been a lawyer for thirty years. I’ve seen many people lie under oath. Most get caught. And when they do, things go badly for them. Lying is not a path to be taken blithely.

        1. avatar Teenage mutant tactical mall ninja says:

          You’re kidding right? I can count the total number of people who have been successfully prosecuted NATIONWIDE for perjury on one hand.

          I am in a case right now with mountains of evidence against the defendant who then admitted she lied in a previous trial and the current case and two judges refuse to bring perjury charges against her.

        2. avatar The Gray Poseur says:

          Good luck with that Mark. Been near there, done that. Your lie detector may not be as highly tuned as you think it is. 99 percent of this stuff doesn’t end up in a courtroom with high priced attorneys. Which is your only professional objective.

        3. avatar Geoff PR says:

          ” I can count the total number of people who have been successfully prosecuted NATIONWIDE for perjury on one hand.”

          You’ll need more than one hand.

          Had a medium-profile one here in central Florida few years back. Beat the murder rap, got nailed for lying about it….

  6. avatar KCK says:

    Some old laws let you keep your house and a horse.
    So why not a Mare’s Leg on your saddle?

  7. avatar CLarson says:

    Ironically, the U.S. constitution doesn’t mention health care at all, but does grant the power to the Federal government to regulate bankruptcies in Article 1, Section 8, Clause 4:
    “The Congress shall have Power To…establish…uniform Laws on the subject of Bankruptcies throughout the United States….”
    The U.S. Congress could pass a law exempting firearms or some value of them and have it apply to States. If the South Carolina State constitution has a similar clause concerning bankruptcies no 2nd Amendment justification is required.

    Off topic but why can’t we have a true health care market as proposed here: https://market-ticker.org/akcs-www?post=231959
    Consumers should not have to pay huge fees to corporations masquerading as insurance to get access to negotiated, fixed prices. The government should be breaking the current system up, not enshrining it in law.

  8. avatar Joe R. says:

    Freedom of the Press is not protected, when it’s just freedom of speech amplified to squelch out the truth or shout down others free speech.

    Remember Ezra Pound? When the government jails its communist_globalist_antifa POS journalists, the people with guns are going to give them the firehose and poke them with sticks through the bars for a few years to make sure they’re nearly solid Fing crazy before freeing them.

  9. avatar FedUp says:

    One might make the argument that income related stuff deserves special treatment, tools of the trade, the car you drive to work, etc.

    One might also argue that other stuff has equally low merit for being a specific exemption, like $3000 of furniture or $3000 of guns. But if Congress has the authority to give a limited exemption for furniture, they likewise have the authority to give a limited exemption for guns.

    Unlimited exemptions are where it gets bogus. Like if you’ve lived in Florida long enough, there’s no limit to your homestead value. Liquidate your million dollar gun collection, buy a mansion, wait a while, take the homestead exemption, sell the mansion, and buy a million worth of guns…

    1. avatar Tom says:

      I would have to wonder if that would work like assisted living care does here.

      If you go into an assisted living care facility (say from you age and illness), once your insurance runs out they liquidate your assets to pay for your care. They can go back 5 years prior to you needing assisted living.
      So for example if you thought you would be smart and give away your savings account to a friend or relative, that friend or relative would have to pay that money back if it was given to them within that 5 year window.
      Same for your house, if you signed it over or sold it, it would have to be returned.

      Sounds like a hassle, and it is, just went through this twice this year with elderly family.

      So I would assume the same would apply to selling your possessions and investing in real estate, they would simply liquidate the real estate and use the cash to offset the bankruptcy.

      Now, the reasons explained to me make perfect sense.

      They say, why should someone who sat on millions of dollars be able to give it away and then fall back on tax payers to pay for their final days and massive medical bills rather than be force to use their own funds for it.

      The water seems awful muddy to me though.

  10. avatar Tom says:

    Well, if bankruptcy is taking all, why not take all, leave a person without clothes, wallet, phone, jewelry, etc..

    Total strip to zero.

    They could always amend it to reduce your arms collection to one defensive weapon of choice.

    But when comparing the what ifs to facts and logic, there’s always going to be a grey area.

    1. avatar TX_Lawyer says:

      Because bankruptcy is not about taking everything. It is about giving someone a fresh start. The number one cause of bankruptcy is (or at least was) catastrophic illness with massive medical expenses. Bankruptcy generally isn’t just, oh, I borrowed too much, so I could have a lambo.

      Bankruptcy is based on principles of mercy. You shouldn’t borrow more than you could pay back, but lenders shouldn’t lend more than someone can pay back either. Are there abuses? Obviously, but there are also abuses of all charitable actions and institutions. It doesn’t mean they aren’t worth while.

  11. avatar Ebby123 says:

    I could see an argument made that you cannot take ALL of a person’s guns over financial debt – they must have at least one to be able to defend themselves.

    That said, guns are financial assets – property. If you screw the pooch to the point where they are seizing your property to pay extremely delinquent debt, guns should not be exempt.

  12. avatar W says:

    As the author notes, many things are already exempted from bankruptcy–cars, homes, tools of the trade, etc. What she doesn’t admit is that she doesn’t want guns excluded, because, like, you know, gun control.

  13. avatar former water walker says:

    Hide your assets. Hide your guns. Never give everything up. Hilarious on TTAG when the vast # of people support a 4time BK dude-Trump. And I do too(of course I understand they were business bankruptcy ). It’s all a shell game anyways…

  14. avatar MamaLiberty says:

    Very simple. Don’t go into debt. Don’t buy things you can’t pay for – including guns. Don’t go into bankruptcy – which causes your creditors to pass on those costs to other customers. It should be up to them how far to take restitution. That would likely cause potential debtors to consider things a little more carefully.

    As for the elderly and care… make sure you are in a great relationship with your younger relatives. Then they will likely want to take care of you when you no longer are able. Hire people to take care of you at home, live in if necessary. That’s always going to be less expensive than any facility, and better all around – and you can keep your guns, probably. But you are not going to be able to do that with taxpayer money.

    I spent long years as a nurse, watching family dynamics. Too many elderly had spent a lifetime being critical, demanding and plain nasty. Then they were shocked when the family and friends they had left had little or no desire to assist them… or even to visit them. You reap what you sow.

    Almost anything can be rationalized if you don’t mind theft and self delusion. These “laws” merely facilitate the rationalization and the delusions. And trust me, you can’t keep a gun in any sort of nursing home or assisted living facility anyway.

    1. avatar pg2 says:

      You do understand our entire monetary system under the Federal Reserve is based on debt? There is no money creation or economy without debt. It is literally mathematically impossible for everyone to be debt free.

      1. avatar MamaLiberty says:

        No, the fiat “money” thing is about the best reason NOT to carry any debt. You do not ever have to buy things you can’t pay for, one way or another.

        But I’m talking about the debt you know you can’t – or never intended to pay. I have a credit card, to use where I can’t pay “cash,” such as on line purchases. I’ve had it for 30 years and have never paid a penny interest. That works as “debt free” for me. I have bought a car (still driving it 16 years later) on payments. I paid it off in about half the time the contract called for. I bought a house, and made mostly double payments… until I sold it, and bought my next house for cash.

        I’m not rich, by any means and with a small fixed income. I live frugally, buying nothing I can’t pay for as agreed on. Right this minute the only “debt” I have is the electric bill for last month. I have no need for “bankruptcy,” and never will. Use it up, wear it out, make it do – or do without.

        1. avatar Anon in CT says:

          I am from the use ONE credit card for EVERYTHING (except rent/mortgage and a few other things you can’t pay with a cc) and pay it all of monthly school of thought. That was you get:

          1) Fraud protection – for the first 30 days or so you’re playing with the bank’s money, not your own – if you or they get hacked, you will have to do some paperwork but won’t be out of pocket.

          2) A single statement showing all your expenditures for the month – you can see what you’re spending on, and where you need to cut back. If you use a formal budget, you can use this to check your compliance.

          3) Avoid the feeling of cash burning a hole in your pocket – for me, my bank account is “real” but once cash is withdrawn it feels like it’s already half-gone, so it’s too easy to spend. So I avoid carrying it.

          4) A balance that goes up (or down) daily – you can see how things are going that month and if you need to cut back.

        2. avatar MamaLiberty says:

          All very good ideas, and good strategy for many people. I commonly carry several hundred dollars at a time, and pay cash for almost everything. I don’t do “impulse” buying, and often spend days trying to decide what and where to buy even essentials. I use the credit card less than once a month, usually… I have a bank account only to receive my pension, then withdraw all but enough to pay the bills I can’t pay in cash. Just a different way to go about it. 🙂

          I was raised by a woman who survived the great depression, paid serious attention to frugality and true value of things. She practiced self ownership and self responsibility, while treating others with great compassion – helping friends and neighbors in any way she could. I do my best to follow in her footsteps.

          Somehow, the stress and anxiety of ten maxed out credit cards, a massive house/ever new car, and all the other things people think they must have – and which never makes them happy anyway – is tragic. But people are free to be as stupid and self destructive as they wish, of course.

          My only point is that no government or “laws” should subsidize or facilitate any of that.

        3. avatar Somebody says:

          Anon in CT
          Many live as you do. I myself am one of them, though I certainly keep cash on hand for opportunistic purchases as well.
          Opponents of such a lifestyle often refer to Dave Ramsey, who says that you are more inclined to spend with a credit card than you are with cash, because the credit card doesn’t feel like “real” money the way cash does. Obviously he doesn’t control your monetary habits, but his words are accurate for his target audience – people who lack financial discipline. That probably isn’t you though.
          Use whatever money management strategy works for you. Some can handle credit and remain debt free, others have proven that they cannot.

        4. avatar Tom says:

          We need “like” buttons for posts like this!!!!

          Some debt makes sense, like a home. Might as well enjoy it while paying for it instead of buying it and not enjoying it.
          Renting and saving for years to buy a home I wont live long enough to use doesn’t make much sense.

        5. avatar pg2 says:

          I’m not saying I disagree with you, at the same time you have to realize the fiat money system is literally musical chairs. There is not enough money created to pay back existing debt. For the system to work, there has to be losers in this scheme. The system cannot stand without ever increasing debt.

        6. avatar MamaLiberty says:

          I don’t “owe” anything to the government. I didn’t borrow any of that, and I don’t owe anyone payment for it. The faster the whole system falls, the better. The longer the can gets kicked down the road, the worse it will be for everyone. But it will be especially bad in the early days for those who have a mountain of personal debt, and those living in cities with no way to provide for themselves.

          Do you have at least a year’s food and essentials put by now? A defensible place to live? Good friends and neighbors who can work together for mutual support and defense? Everyone here probably has plenty of guns and ammunition, but you can’t survive on your own. You have to sleep sometime… among other things. The US is about to resemble Zimbabwe. Are you ready?

        7. avatar pg2 says:

          The prepper shtick is a little dated. When and if a collapse comes, it will be a planned, controlled demolition like the twin towers and all the prepping you think will give you an advantage will be wishful thinking.

        8. avatar MamaLiberty says:

          Do what you will, of course. As for me, I’d rather have it and not need it than need it and not have it.

          Sound familiar? There are no guarantees, and utopia is not an option. And that’s no reason not to do the best we can with what we have to work with.

        9. avatar pg2 says:

          Again, don’t totally disagree.

    2. avatar TX_Lawyer says:

      “Hire people to take care of you at home, live in if necessary. That’s always going to be less expensive than any facility … .” That’s just false. If that were true, no one except people requiring extreme care would be in a facility. Greed alone would see to that, much less what’s best for the elderly person in question.

      1. avatar MamaLiberty says:

        Tx… I guess you didn’t read any of the rest of that post. There’s so much more to it. I spent 30 years as a nurse, working in many different facilities. I’ve seen this issue from many angles.

        Young families and middle age families with elderly dependents are all being taxed and regulated to the point where there is often no way for them to care for their parents and other needy family members… Many have no interest in supporting their elder relatives, and many of the elders have worked a lifetime alienating the younger folks. It’s a complicated subject, and can’t really be covered adequately in a forum like this.

        The answer isn’t to continue robbing strangers to pay for long term care, or anything else. Answers will be found that benefit everyone when the non-voluntary government is kicked out of our family affairs, our health care, our education and child care, and everything else. We’re not going to solve that problem here, now, or any time in the future. But it is worth mentioning. I hope people reading will give it some serious thought.

        Who owns your life? If you don’t own and control it… who does? Who should? By what authority?

        1. avatar TX_Lawyer says:

          I read the rest of your post before posting my original response. You still haven’t explicitly stated your premise that younger family taking care of the elderly members is cheaper than institutions caring for them, if that is what you are trying to state.

          That view fails to take opportunity costs into account.

          I also deal with this as a part of my profession.

          I deal with this on a personal level as well. The oldest generation of my family can no longer care for themselves. Fortunately, they haven’t run out of money and can still afford in home care.

        2. avatar G35x says:

          and what happens to those who never have children? I guess they just didn’t “plan” well enough and should be discarded? This rigid black and white we have now in politics is depressing. It’s like I have to either believe in socialism and total government control or I have to believe in pure capitalism without any social safety net. I can’t possibly believe a little of both, that it’s possible to have a good social safety net, and personal and individual freedom and gun rights can I?

          TX_lawyer your right. Most of these hardcore “self reliance” guys simply haven’t faced real life changing hardship. Or maybe they are so principaled that when faced with the choice between debt/state assistance or death they will choose death? For some reason I doubt it.

          I’m all about sane prepping. I have a couple months food and water, a really serious med kit (and a trauma kit and fire extiquisher in each car) and some cash in the safe. But I realize that if the medical system collapses I’m not going to be around all that long.

        3. avatar MamaLiberty says:

          As I said… this is too large and complex a subject to be adequately discussed here. There are a great many variables involved, and your situation and experience is most likely different than mine. I practiced in home health and hospice – mostly patients at home – and have considerable experience with it.

          I have found in my practice that, when families and friends are willing to provide care, it is far less expensive to keep the patient at home, or living with relatives. (And I should have been more clear about it.) It might still be if they have to rely on hired help and have the money to pay for it. But skilled nursing and other facilities are terribly expensive, and I think we can both agree that overworked strangers cannot provide the quality or quantity of care given by a loving family. And, again as I said, not every family is willing or able to give that care, even if they love the relative. It’s a terrible situation for so many.

  15. avatar DaveW says:

    “The government must not stand in the way”… WRONG! The government must GUARANTEE the individual rights of the people until they are rescinded or altered by the amendment process or a Constitutional Congress. The government is not permitted to ban or infringe a right without the direct approval of the whole of the people. Alteration of rights may not be left to politicians. If politicians held that power, there would be no reason even to enumerate the rights since the politicians would possess the power to grant or deny rights. That is exactly what the Founders sought to avoid since that was the way rights were granted or denied by European royalty. So said the authors.

    1. avatar MamaLiberty says:

      The only person responsible for protecting your “rights” (your natural authority over yourself) is YOU. In voluntary association with others, only you can decide what is right and good for you and your family.

      Any government actually powerful enough to protect your rights, is also powerful enough to deny those rights any time they please. Which one has it been so far?

  16. avatar J says:

    I kill and eat debt collectors for breakfast

  17. avatar Tom W. says:

    Do those with an IQ above room temp. This is on it’s face not even barely enforceable for the folks that file bankruptcy.

    If I lived in the Hamptons in a multi million dollar estate, with a collector’s group of antique double rifles from England and the finest shotguns on the planet, maybe…..

    If not, and unless declared specifically in an insurance document, name rank and serial number, I lost them in a tragic boating accident.

  18. avatar Shose says:

    She needs braces and some serious dental work on her Brit Teeth

  19. avatar pete says:

    Protecting $3,000 total worth of guns isn’t that bad – bankruptcy usually leaves people a car and a house, etc. The basics for survival, and as far as I’m concerned the basics may totally include a gun. We could make people liquidate down to $300 worth of guns, but it’s piddling BS, I mean, what’s the right number? Leave it up to the states to decide.

    I’m not a huge fan of bankruptcy protection in general, it creates an immutable, cartel-like status quo in business sectors and moral hazard in business and private finance. But whatever, let’s not overthink this, it’s the 21st century, we don’t need to turn people into indentured servants and starve their kids, leave them a car, a gun, a house, a few sets of clothes, a comb, some beef jerky, a pint of Old Harper…

    1. avatar G35x says:

      Pretty much. We feed the entire country with 1% of the population, we have a little wiggle room for the excess and helping people. I used to be a believer in the whole “you can fend for yourself / you let things go south” mindset until life happened to me. Even if your making good money if you get truly sick your screwed, and in a short time too. It’s hard to keep insurance when your too sick to work, and when those medications add up to 100k+ per year where exactly do you plan to get the money? You saved up a few million to pay for your on going care right?

      Theres no easy answer. Single payer government care is a terrible idea (and it would definitely benefit me, at least in the short term, but how long before some beuocrat decides I’m too expensive to keep around?!) Forced “insurance” is almost as stupid. Honestly the medicare/medicaid/employee insurance system seemed to work well enough before.. who knows. It’s a big mess, I can tell you that.

  20. avatar TX_Lawyer says:

    Texas has some of the most generous bankruptcy exemptions in the country. They include “Home furnishings, including family heirlooms; food; clothing; jewelry up to 25% of the total exemption limit stated below; 2 firearms; athletic & sporting equipment (includes bicycles); 1 motor vehicle for each adult with drivers license or who relies on another to operate a vehicle; 2 horses, mules, or donkeys, with saddle, blanket & bridle for each; 12 head cattle; 60 head other livestock; 120 fowl; food on hand for these animals; and household pets.” There is a value limit of $50,000 or $100,000 for a head of household. There are other items that are in the “value limit” category and some items, like a homestead, that are outside the value limit category.

    Remember that unexpected medical expenses are the number one cause of bankruptcy. For those of you preaching self-reliance, better not get cancer or some other expensive disease.

  21. avatar cisco kid says:

    She is correct when she says the Government is under no obligation to make sure you have enough money to buy or keep a gun when you owe money but totally wrong when she says the Government would be under no obligation to pay for treatment if you had chronic laryngitis as human health in a CIVILIZED SOCIETY is a right, its just that the U.S. has not yet caught up with the rest of the civilized world in regards to human health but rather marches lock step with Hitler’s belief that when you become no longer a contributor to the economy of the Government by paying taxes, even if it is because of no fault of your own, you are therefore expendable because the Government will not spend any tax money on your health care because it needs all the money it can get to get on with “Nation Building” i.e wars of rape, pillage and conquest to enrich the pocket books of the upper 1 per cent of the ruling elite.

    The current situation in the U.S. mirrors this to a “T” as the recent push to dump more money down the “shit hole” of war needs to be paid for with more taxes and that can only be accomplished by taking away as much of the U.S. health care as possible as the American people are considered expendable by the upper 1 per cent of the ruling elite.

    Today on MSNBC news there is a new proposal that would let Herr Trump play more golf and turn over the running of the “16 year old failed war” in Afghanistan to the mad dog war monger Military Generals who are chomping at the bit to flood the country with more troops, which is exactly what Putin wants. He now is feeding free weaponry into the hands of the Taliban which have recently seized 1/3 of the country despite being bombed day and night for 16 years, shades of Vietnam, as history repeats itself.

    Just one more year of war in Afghanistan and it will equal the time spent in Vietnam. Putin, military genius, is now bankrupting the U.S. over Afghanistan out of revenge for Reagan doing the same to Russia when they were in Afghanistan but Herr Trump who obviously flunked history and the U.S. Generals who live for war at the risk of destroying their own country are oblivious to both history and reality.

    1. avatar Excedrine says:

      She’s actually just plain right, [eriod. The government is not now, has never been, and shall NEVER be under any obligation to provide medical treatment to anyone — except its own employees. Human health IS NOT A RIGHT, at all, regardless of whoever else says it is. It’s actually just that the rest of the world has stepped further back than the U.S. in forcing others to be responsible for something that will NEVER be fully paid for even if 100% of all incomes are taken solely and explicitly for healthcare. THEY march in lock-step with Hitler’s belief that you are no longer a contributor to society once you no longer agree with them, whether you even express a differing opinion or not.

      The current situation in the rest of the world is what actually mirrors this to a “T” as the recent push to dump more money down the shit hole of welfare to distract from the wars of leftist governments. The American people are considered expendable by you, because you want to doom them to an increasingly broken, under-performing “public option” that will NEVER have enough money or staff or materials.

      But, hey, your own history flunkies in the Senate like Herr Feinstein wanted to federally-license “journalists” so that the left could quite literally own the media. Isn’t it any wonder that no one but demonstrated and repeatedly-proven moral and intellectual inferiors like you even put ANY stock into anything the lamestream fake news propaganda mills have to say in the first place? You are every bit as oblivious to reality, history, and economics as you could ever (and only falsely) accuse anyone else of being.

  22. avatar Klause Von Schmitto says:

    “the mad dog war monger Military Generals”…. That is awesome. Haven’t heard anything like that since Radio Moscow quit shortwave.

    What a moroon.

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