Silversea Water Cooler: Part 3, Welcome!

[ShotsnCruises]

Spins, yes the cake was baked in my bunt pan. Although, you can make it in any cake pan and it tastes just as amazing.

Thanks for the welcome back everyone. I am trying to stay as I can. Weekends have gotten busy and time gets away from me. I am hoping to cook some more over th next 3 days. Food pics to come.

[mysty]

Greetings Coolers! I know that I vowed not to discuss weather. However, we are set to break the all time rainfall record since record-keeping began. Nasty!

 

Miss S. I hope you enjoyed your lunch out with the family! Good times!

 

JP..Safe travels to you and Chris! Hope all goes smoothly and that you have an awesome time with your family!

 

J...Your meal looks very appealing! Nice and light and yummy!

 

Cam...hope your pizza and wings with the grand kids is fun! Enjoy!

 

Have a great day all!

[jpalbny]

Mysty, on the plus side, I have barely had to turn on the lawn sprinkler system all year.

 

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[mysty]

Greetings Coolers!

Absolutely right JP! That is the silver lining behind ALL the clouds! :) Have a great weekend!

 

Have a great day all!

[Camillus112]

Good morning Coolers!

 

Today I am driving to Ithaca to lead our play-reading group. Unless I'm traveling, this is a highlight of the month. We are a fun group of seniors who enjoy acting... but not memorizing. I wonder, apart from traveling, what are the highlights of your month, friends?

[mysty]

Safe driving Cam! Have a wonderful time!

 

I am still searching for something that will turn my crank. :)

[UKCruiseJeff]

 

 

 

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[spinnaker2]

Let the pickling begin!

 

Lurking here because I am stupefied by politics here in the USA.

The players are becoming more dastardly and vile.

 

Enjoy the day and weekend all.

[Solo mi!]

 

 

 

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Beautiful and, I am sure, delicious!

Penny

[UKCruiseJeff]

........ thanks all.

 

Today is fettuccine with ragout snd loads of reggiano .......

 

 

 

 

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[spinnaker2]

Jefe,

Did u make that ragu in instant pot.

Mine still in box.

DH not think I will use it...

[mysty]

J...the pickling looks delicious and so artistic! The ragu looks scrumptious!

 

Spins...those sound like "fighting words". Open the box! :)

[UKCruiseJeff]

Thanks M,

 

No Spins, this was a batch I made pre-IP. I still have a few portions in the freezer. The next batch will be made in the IP. Today I made my tin can doner kebab for Sunday ...... really looking forward to it.

[MissSophia]

DH and l used to love pickling...red cabbage and pickled onions in Sherry were favourites.

 

Think M has sent the rain over here it's been pouring down today while I've been over to my old home town dressmaker to have cruise dress fittings....one long and one short....it seems to add to the excitement building !

Friend and l then enjoyed lunch at a little tearoom in the lakeside town of Ellesmere.

 

Lovely lunch at the river pub yesterday, had their homemade fish cakes with tomato and spring onion salad.

 

Happy Weekend 😊

[UKCruiseJeff]

 

Lurking here because I am stupefied by politics here in the USA.

The players are becoming more dastardly and vile.

 

Enjoy the day and weekend all.

 

Spins,

 

I think we are as bewildered as must be many Americans. Trump has this permanent sort of childish obstinate "I dare you" sort of expression on his face as though he is a person who feels that he is permanently at odds with the majority. But he has just announced that he is the most popular president (except for one evidently) of all time. The same as that his inaugeration was the most highly attended of all time. And just like you should vote for him if you were trans-gender ......

 

The only way you can cope with these things is by pretending it isn't happening and it is simply a bad dream from which we will all one day wake up.

 

If it makes you feel better, we have Brexit which is thanks to the sterling work of our political superiors is going to be an absolute disaster for both Brits and Europeans. We will all suffer because that is what our European masters must achieve for the protection of their own personal interests to dissaude any other simply and feeble minded Europeans seeking release from the tyrrany and gravy train that the EU has become.

 

As I get older and seemingly less-wise I find myself yearning for the end of the this version of democracy and for perhaps a benevolent dictatorship. I can't see what freedoms I'd lose. We are no longer allowed to speak freely through political correctness and ludicrous anti free-speech laws and the effect of allowing our inexperienced and gullible grandchildren to vote they have almost certainly guaranteed an exceedingly unsettled governance and outlook for probably the rest of my life.

 

C'st la bleeding vie. :)

[jpalbny]

Yummy food Jeff! That ragu is making me hungry. Love the cheese.

 

Spins. What a circus. Congress reminds me of the dog who chased the car and finally caught it...now what?

 

I am personally not a fan of Obamacare because it strengthens and perpetuates the third-party payor system which ultimately will need to go away, I think. I work for a single payor and I'm happy enough with that. We eventually have to get there.

 

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[mysty]

OOOOPS! Sorry about that Miss S. I did try to corral the rain clouds but my lasso had a hole in it! :) Glad your cruise dress fittings went well and the added bonus of a lovely lunch with a friend! Yesterday's lunch sounds delicious as well!

[UKCruiseJeff]

Thanks JP,

 

I don't fully understand Obamacare so I am unable to speak about it. But what a mess we have made of our beloved and sacred NHS. It is virtually impossible to manage and improve and every improvement is intended solely to produce and massage statistics that falsely demonstrate how well the government is doing managing the NHS and how our service is improving. But everyone knows it is failing.

 

There was an interesting programme on the BBC by a senior Brit diplomat a week or so ago. He was a part of the team that gave evidence to the Iraq enquiry and headed the UK mission and basically said that there were no weapons of mass distruction. He was a friend of Kelly who you may of read whistle-blew to the press about the weapons and was hounded and took his own life. A real hero.

 

Anyway this diplomat has given up his diplomatic career because he is both ashamed of his role in diplomacy because of the harm he felt he personally did and how much better people are at "governing" themselves.

 

An example he gave was how the Iraqy population at ground and local level were able to very quickly put together complex and fully functioning local governance and releif systems that eluded official governments. And we see the same the world over. The people that responded to the fire here recently was ordinary people who simply conspired together to offer immediate relief and remedy when even today the government has proved inactive and disabled.

 

He was basically saying that as long as you look after the genuinely most needy you should try and allow citizens to look after themselves and that most of the time they will do a better job than governments. He was arguing for a pseudo-chaos approach.

 

His theories were backed up with a fair amount of compelling evidence and I must admit I found myself being influenced by his arguments.

[TLCOhio]

I work for a single payor and I'm happy enough with that. We eventually have to get there.

 

As I get older and seemingly less-wise I find myself yearning for the end of the this version of democracy and for perhaps a benevolent dictatorship. I can't see what freedoms I'd lose. We are no longer allowed to speak freely through political correctness and ludicrous anti free-speech laws and the effect of allowing our inexperienced and gullible grandchildren to vote they have almost certainly guaranteed an exceedingly unsettled governance and outlook for probably the rest of my life.

 

Appreciate BOTH of these very interesting comments and follow-ups from the smart and seasoned J.P. and Jeff. Yes, lots of frustrations with the BIG E.U. bureaucracy trying to run everything in the UK and Europe. Trying to limit free speech is very bad, also.

 

Of special interest was J.P.'s reference to "single payor" as the eventually situation. Not sure exact what that means, looks and how it exactly would work. Clearly, there has been much recent consolidation with big health care companies and insurance conglomerates controlling more and more. And now the government pays about half of the health care cost in America today with Medicare, Medicaid, government pensions, etc. BUT, there still is some choice and options now.

 

To my eye and mind, "single payor" ultimately means the large Federal government would be paying all of the health care, hospital, doctor, etc., bills. AND, if the Feds are paying the bills, then they will, directly or indirectly, sooner or later, be in total control of the hospitals, doctors, drug companies, care to be given, services/treatment to be allowed, deciding who lives and dies, etc. Am I missing something or wrong? Tell me more!! Help me be better educated as to actually what "single payor" would eventually mean and how it would really operate for "real" life or death.

 

THANKS! Enjoy! Terry in Ohio

 

Enjoyed a 14-day, Jan. 20-Feb. 3, 2014, Sydney to Auckland adventure, getting a big sampling for the wonders of "down under” before and after this cruise. Go to:

http://boards.cruisecritic.com/showthread.php?t=1974139

for more info and many pictures of these amazing sights in this great part of the world. Now at 183,969 views for this posting.

[Camillus112]

Let the pickling begin!

 

Lurking here because I am stupefied by politics here in the USA.

The players are becoming more dastardly and vile.

 

Enjoy the day and weekend all.

 

 

We should pickle most politicians, Spins!:evilsmile:

[spinnaker2]

We should pickle most politicians, Spins!:evilsmile:

Yep.

We should.

I think many of them already are.

[UKCruiseJeff]

Yep.

We should.

I think many of them already are.

 

The key EU people are actually self-pickling. junkers is always pickled after 11am.

[jpalbny]

Oh, healthcare...will try to give some background. The history of why we are where we are today is interesting but too much detail; I recommend "The Social Transformation of American Medicine" by Paul Starr if anyone is interested. Great read.

 

We have multiple types of insurance: Medicare for >65 years of age, funded by a payroll deduction tax; Medicaid for poor and disabled, funded by state and local taxes plus federal money; and a large number of private insurers who offer both group and individual policies. The private insurers can operate for profit. Many offer group policies to employees of a company, which can often lower the premiums by pooling together a large number of insured individuals and sharing risk equally. Individual policies tend to be more expensive because the risk is not spread out over a larger population.

 

I will talk finances for a minute. This is not an endorsement, just a statement of fact. I'm not saying I agree with this...

 

Insurance companies, as for-profit, private entities, are in business to make a profit. That does not make them inherently evil, as some have accused. They are what they are. To stay profitable, there are limited things that they can do: they can raise premiums, or pay out less in benefits by offering fewer services, or refuse to offer certain expensive treatments. They can also choose who to insure or who not to insure. Thus, the ban on pre-existing conditions. If you're a smallish insurance company with 10,000 beneficiaries, why would you add another who is likely to cost you more than they pay into your system? It's financially non-viable. Similarly, you'd love to insure a bunch of 20-somethings instead of 60-somethings who all take expensive meds and have much more risk of becoming ill in the short term. Or, if you have to insure the older beneficiaries, you'd want to charge a lot more to cover your expected payouts. This is called cherry-picking.

 

Before Obamacare, this was commonplace. Obamacare set some standards that insurance companies could not refuse coverage for pre-existing conditions, nor could they charge vastly different premiums based on age. It also set up a somewhat artificial form of group policies, where the insurers could offer their policies to anyone in the state who wanted to buy them. This is riskier than the typical employer-based group policy, because uninsured, unemployed people might be sicker than employed, insured people - ON AVERAGE. Obviously there will be exceptions to the generalization above; not all uninsured are unemployed or unhealthy.

 

Insurance works best if everybody pays, including healthy people who have no use for it. The healthy non-users subsidize the sicker insured people who use more than they pay in premiums. But, convincing healthy people to pay for something they don't need is tricky. Thus, the individual mandate of Obamacare - you must have insurance, or you will pay a fine (which the Government uses to pay for Obamacare). This was set up to keep prices relatively low.

 

Obamacare set up a number of additional taxes on high earners. One, a 3.8% surcharge on investment income for those earning >250K/year. Two, an additional 0.9% medicare surtax on income over $250K (or something like that). Three, some taxes on medical devices and insurers who offer expensive, all-inclusive plans. As written, the taxes disproportionally affected the affluent, thus any attempt to dismantle these taxes is immediately branded a "huge tax cut for the rich" and is politically unpopular.

 

Obamacare aimed to make insurance affordable to all by lowering costs (as above, with the group policies called "marketplaces"), by Medicaid expansion (making Medicaid available to more people, though states had to opt-in for that), and by providing subsidies to people of lesser means so that they could purchase insurance at a discounted rate. Well-intentioned, but it can be seen by cynics (such as me) as a massive subsidy to private insurance programs, and you could become frustrated that your extra tax dollars are going towards more profits for an insurance company. Obamacare attempted to limit that by requiring that insurance companies pay at least 85% of their premiums out in benefits (I think it was 85%, going by memory here).

 

So, where to go from here? I think the patchwork of multiple insurers is bad for three reasons. One, it prevents economy of scale. Two, it still is a for-profit industry so there is cost-cutting inherent in how these insurers operate. Furthermore, the companies have little protection against catastrophic loss. Three, the administrative overhead for multiple companies is redundant and ineffective. Obamacare was well-intentioned, and increasing the number of young healthy people paying into the system is absolutely necessary, but it perpetuates the problems inherent in supporting multiple private insurance agencies and I'm not sure we can fix health care without changing that paradigm.

 

Single payor? Got me how it would look. I work for the VA which is a single-payor system and I love it, but we are not without problems. But we have an integrated medical record where I can look up somebody's doctor visit in California last week, and see their X-ray. We have a national drug formulary where we negotiate better prices than I pay when I go to the pharmacy. And we focus on taking care of patients rather than filling out insurance paperwork. So there are elements here that I think are better than what's out there in the "real world." Are we perfect? Lord no. And I don't think Canada and Britain are perfect either. We have wait lists too, and we are chronically understaffed because we pay physicians less than they can earn on the outside.

 

The most qualified candidate to be the single-payor IMO has to be the federal government. They are big enough to absorb the risk, and have taxing authority to raise the money needed to run healthcare. And they don't have to operate under a profit, so they can spend more of the premiums on actual health care expenditure. But we are a long way off from accepting this inevitability. I don't think we'll solve the problems associated with health care in the USA until we uncouple profit from payment. But those who feel that this will stifle innovation have a valid point that I can't answer...unless the NIH expands its grant programs substantially. And given their current state of disarray, who would trust them with such a responsibility?

 

Hope this longwinded explanation stimulates an AMICABLE discussion. Tag, you're all it.

[UKCruiseJeff]

Thanks JP for taking so much time and trouble. I aam going to read it several times to improve my grasp of it.

 

Is the bottom line that you feel that you should end up with a sort of totally federal funded premium paying machine for all and the cost spread across all sources of taxation? Or have I misunderstood?

[jpalbny]

Jeff, I do think that would be the most economically efficient way to provide all citizens with access to basic health care. But it's a huge can of worms, and certainly could create other issues. I doubt it would be a panacea.

 

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