So, the Affordable Care Act is finally before the Supremes. Do you think it's likely to pass, in whole or in part?
I also have a tangential question over an argument that was put forth today.
When Solicitor General Donald Verrilli tries to explain to Justice Scalia that the health care market is unique because “getting health care service … [is] a result of the social norms to which we've obligated ourselves so that people get health care.” Scalia’s response is a curt: “Well, don't obligate yourself to that.”
My interpretation of that answer is that he disagrees that hospitals should have a legal duty to handle patients who show up in emergency rooms and cannot pay. Do you agree with this?
I've seen it happen a few times where people walk into the county emergency room over a cold. I think his question is that we'll be obligated to treat people that walk into the hospital over minor things.
It's already a law that if you are bleeding, even private hospitals have to treat you. and if you have a cold, wait til Monday and go to the county clinic, that's what it's for.
Not at all. Understanding justice Scalia's response requires understanding his position generally. Justice Scalia consistently believes in a strict interpretation of the constitution. A natural consequence of this is that he winds up opposing most (but not all) things that expand the reach of the federal government.
Whether one agrees with that or not, he's merely being cosistent with a valid view on the constitution. His response stems from that- he feels that it is not the place of the federal government to extend itself further in to that arena. The curtness of his response is also consistent- if you look up cases in which he writes either the opinion or the dissent (but especially the dissent) you will find he has a particular style (best seen in the dissents). He is a little sharp of tongue, and it is intentional- when asked about it, he says that it is done so that people will actually read the damn things, rather than just glaze over them.
To say that he doesn't want emergency rooms to treat patients is a logical leap. Something on par with "I don't like clocks or chocolate, so I hope Switzerland is destroyed." In fact, it is so out there, that I'm fairly sure the OP is just trolling. But it is 3am, and I am bored.
Oops, point of clarification, before we get going (and also for the UK/international readers) - in the United States, hospitals are currently legally obligated to provide emergency services to stabilize you regardless of your ability to pay. If you walk into a emergency room with a gunshot wound and no money, they must patch you up (and also call the police, since they are mandatory reports for gunshot wounds but thats a whole other thing). However, they can and will turn you away if you show up with a cold and no insurance.
My only thought as to why there is an Affordable Care Act. is that is other states there aren't count run hospitals and clinics. Where I'm from there is a county hospital and county clinic, they both work off of an income scale system.
I'm honestly surprised the ACA is being challenged in court considering this was the Conservative plan back when Hilarycare was being proposed. In addition, it gives a huge "bailout" to private Health insurance companies.
Now, let's say the ACA is deemed unconstitutional, or at least the mandate protion. Then guess what becomes the next only logical step for advocates of Universal health care? That's right, Single-payer.
The case for it gets much easier to sell. The alternatives become; the status quo that many Americans acknowledge is broken. Or, Single-Payer which provides additional protections and can be structured to avoid the problems of this plan.
Do conservatives really want to abandon the plan they created in the 90's to just have to eventually lose the Healthcare battle over Single payer instead? Seems kind of stupid to me, but I don't understand politics.
BARACK OBAMA signed his health reform into law on March 23rd, 2010. Within minutes Florida’s attorney-general had filed suit against the law, along with 12 other states. Since then they have been joined by the National Federation of Independent Business, four private individuals and 13 additional states. Starting today the Supreme Court will hear their case. A decision is expected by the end of June.
Most political brawls are drummed-up follies, but the fight over health-care reform is legitimately historic. The law is the biggest achievement of Barack Obama’s presidency. If it survives, Democrats say, it will expand and transform American health care. Republicans, though, see it as a government intrusion into private affairs. If the law is upheld, they say, no area of American life will be safe.
America’s highest court usually devotes one hour to arguments. For this case it will devote six hours, spread over three days. The Economist has a seat for the proceedings; we'll be posting our thoughts on Wednesday, and a detailed story will appear in next week’s issue. In the meantime, here is a guide to the arguments.
Reams have been written about the case. This guide attempts to provide a simplified summary. Readers hungry for additional information should visit the American Bar Association, the SCOTUS blog and the ACA Litigation blog, which are stocked with briefs and other resources. C-SPAN has a video of a great debate between Paul Clement (the lawyer for the states), Mike Carvin (the lawyer for the National Federation of Independent Business), Neal Katyal (a former Solicitor General) and Akhil Amar (a constitutional law professor at Yale).
QUESTIONS BEFORE THE COURT
There are four issues before the Supreme Court. Attention has centred on the constitutionality of the “individual mandate”, which requires most Americans to buy health insurance or pay a penalty. However there are three other questions before the court, two that are procedural and one that is substantive: whether the case must wait until 2015, after the mandate takes effect; whether the rest of the law must fall if the individual mandate is struck down; and whether the law coerces states to expand Medicaid, the health programme for the poor.
MONDAY: DECIDE NOW OR LATER?
Question: Does the Anti-Injunction Act prevent the court from deciding this case until 2015? The court has granted 90 minutes for arguments on this topic.
Background: The Anti-Injunction Act of 1867 bars court challenges to taxes before those taxes have been levied. The individual mandate will go into effect in 2014. Those who fail to buy insurance will pay their first penalty in 2015.
Mr Obama’s argument: This is the rare instance in which Mr Obama and the states agree, albeit for different reasons. Mr Obama’s lawyers want the court to decide the case now, arguing that Congress did not intend the law’s “penalty” to be treated as a tax under the Anti-Injunction Act.
Challengers’ argument: The case should be decided now. The health law assesses a “penalty”, not a tax. Furthermore, the suit challenges the mandate itself, not the penalty. The Anti-Injunction Act bars a person from suing, but it does not bar a state from doing so.
Court-appointed lawyer’s argument: Because neither the challengers nor Mr Obama want a decision to be delayed, the court appointed a lawyer to argue that the case should wait until 2015. Robert Long, of Covington and Burling, contends that the court should not rule on a constitutional matter until it is compelled to do so, that is, after the tax has been levied.
Analysis: The government’s argument here is among its most confusing. Mr Obama’s lawyers argue that the penalty falls within Congress’s power to tax, but the penalty should not be treated as a tax under the Anti-Injunction Act. Nevertheless, only one appellate court, in Virginia, ruled that the suit must wait until 2015.
TUESDAY: THE INDIVIDUAL MANDATE
Question: May Congress mandate the purchase of health insurance and penalise those who fail to obey? The court will spend two hours hearing arguments on this topic.
Background: America’s health-care market has clear failings. In 2009 50m people without insurance bought health care they could not pay for. This shifted costs to those with insurance, in the form of higher fees. Meanwhile insurers may raise rates or deny coverage to the sick. The Democrats’ health law attempts to remedy these problems, among others. The poor receive subsidised insurance. Those who can afford insurance are required to buy it. Those who disobey are assessed a small penalty. According to Democrats, requiring insurance for the healthy will balance the cost of insuring the sick. Those who buy insurance will no longer subsidise those who do not.
Mr Obama’s argument: The constitution’s commerce clause authorises Congress to regulate health care, an industry that accounts for nearly 18% of America’s GDP. The health law seeks to expand insurance coverage and lower the cost of care. The individual mandate is a necessary, proper way to meet the law’s goals. The law does not regulate inactivity, as the states contend. Not buying insurance is an economic decision to pay for your own health care. Given that millions of Americans buy more health care than they can pay for, the decision to self-insure has a substantive effect on interstate commerce. Furthermore, the mandate’s penalty falls within Congress’s power to tax.
Challengers’ argument: The mandate is an unprecedented expansion of Congress’s power, “a revolution in the relationship between the central government and the governed.” The commerce clause authorises Congress to regulate economic activity. It does not authorise Congress to regulate economic inactivity. Allow this mandate and Congress may require Americans to eat broccoli or buy cars to support Detroit’s carmakers. The government’s insistence that the penalty is a tax is undermined by Democrats’ constant assertion, in 2009, that the penalty is nothing of the kind. Furthermore, the states are challenging the mandate, not the penalty.
Analysis: Two federal courts of appeals, in Ohio and Washington, DC, upheld the mandate. One federal court of appeals, the Eleventh Circuit, overturned it. The Supreme Court agreed to hear the appeal from the Eleventh Circuit. Working in Mr Obama’s favour is a recent case, Gonzalez v Raich, in which the Supreme Court ruled that Congress could criminalise an individual’s growth of medical marijuana for personal use. Antonin Scalia, a conservative justice, wrote: “Congress may regulate even noneconomic local activity if that regulation is a necessary part of a more general regulation of interstate commerce.”
WEDNESDAY: "SEVERABILITY"
Question: If the individual mandate falls, must the rest of the law fall too? The court will devote 90 minutes to this argument.
Background: The mandate is the most prominent piece of Mr Obama’s health reform. However the law is gargantuan. Its 2,700 pages cover everything from calorie counts on menus to drug rebates for the elderly.
Mr Obama’s argument: Should the mandate be overturned, only two other provisions should fall with it. The reform requires insurers to cover those with pre-existing conditions and bars them from hiking fees for the ill. Mr Obama’s lawyers concede that the mandate is necessary for these requirements to work—without the mandate, individuals would simply wait until they got sick to buy insurance. This would prove disastrous for insurers. However the rest of the law should stand. The states may not fight provisions of the health law that do not apply to them.
Challengers’ argument: Health reform sought to achieve near universal health coverage without increasing the deficit. The mandate was the main way to do this, but the entire law served this goal. If the mandate falls, the entire law should fall, too.
Court-appointed lawyer’s argument: The Supreme Court appointed an impartial lawyer, Bartow Farr, to argue that the rest of the law should remain if the mandate falls. Mr Farr contends that the provisions outside of the mandate are “perfectly lawful”. Congress would rather have the law without the mandate than no health law at all.
Analysis: The insurance industry supported the law because of the mandate. The requirement that individuals buy insurance balanced the myriad, onerous rules on insurers. The Eleventh Circuit’s ruling was insurers’ worst nightmare. The appellate court struck down the mandate but upheld every other part of the law.
WEDNESDAY: MEDICAID
Question: Is Congress’s expansion of Medicaid unduly coercive to the states? The court will hear one hour of arguments on this topic.
Background: Medicaid provides health care to the poor. It is paid for by both the federal government and the states. However Washington foots most of the bill, providing 50% to 83% of funding for each state’s Medicaid programme. Beginning in 2014, the health law will expand Medicaid to childless adults with incomes of up to 138% of the federal poverty line.
Mr Obama’s argument: This is not the first time that the federal government has expanded eligibility for Medicaid. The government may attach requirements to the aid that it provides. Strike down this expansion as coercive and other federal requirements would be similarly vulnerable. Besides, the federal government will pay for most of the expansion—100% in 2014, tapering to 90% by 2020.
Challengers’ argument: The law’s expansion of Medicaid is unduly coercive. Technically, states could refuse the government’s new terms for Medicaid. But the federal government’s support for Medicaid is so large that refusing Washington’s help is impractical. States have no choice but to acquiesce to the government’s terms, even though they are strapped for cash.
Analysis: No lower court sided with the states, making this challenge the least likely to succeed. However the Supreme Court surprised observers by agreeing to hear this issue in the first place, so another surprise may come in June.
As someone who would prefer single payer and am generally in favor of healthcare reform, I must say that the argument "It does not authorise Congress to regulate economic inactivity. " is quite compelling. It doesn't seem to me that Congress can compel participation in a market so that they may then regulate it. The slippery slope stuff, I dunno, but I can't see how the mandate is possible under the grounds they are arguing for - it's a pretty big reach.
The problem is that it's more complicated than that, Ouze, and certainly not the only way to interpret it:
To quote what I just posted:
Mr Obama’s argument: The constitution’s commerce clause authorises Congress to regulate health care, an industry that accounts for nearly 18% of America’s GDP. The health law seeks to expand insurance coverage and lower the cost of care. The individual mandate is a necessary, proper way to meet the law’s goals. The law does not regulate inactivity, as the states contend. Not buying insurance is an economic decision to pay for your own health care. Given that millions of Americans buy more health care than they can pay for, the decision to self-insure has a substantive effect on interstate commerce. Furthermore, the mandate’s penalty falls within Congress’s power to tax.
On Monday (the day SCOTUS was to hear the timeliness argument), the Justices were already diving into the other issues. So, clearly they are going to rule that it's timely.
PaPACA itself won't be ruled unconstitutional as a whole. The government clearly has the ability to regulate health care, and most of this law is clearly constitutional.
The Medicaid argument is also ridiculous. There's no way it's outside federal power to change the rules for Medicaid, unless all of Medicaid is going to be ruled unconstitutional (which won't happen).
So, the only real issue is the individual mandate. I think it's constitutionality is somewhat questionable. I think Obama's argument (inactivity is still participating in health care by paying for things out of pocket) is weak. We'll have to see how this plays out, and it will be decided by people with a much better understanding of the issues than any of us.
My personal stance: People should be allowed to opt out. But, once you opt out, you can never, ever get insurance. And, hospitals won't be obligated to treat you unless you can pay, up front, for any procedures.
PaPACA itself won't be ruled unconstitutional as a whole. The government clearly has the ability to regulate health care, and most of this law is clearly constitutional.
If the mandate to buy insurance is overturned but PaPACA is not as a whole then the system will collapse into a huge under financed quagmire that will suck in more money than can go into it. It would be that way anyway, but it'll be worse.
The law as a whole needs to pass or struck down in its entirety.
My personal stance: People should be allowed to opt out. But, once you opt out, you can never, ever get insurance. And, hospitals won't be obligated to treat you unless you can pay, up front, for any procedures.
That's a little extreme. What do we do? Tell the dying guy "Sorry you opted out of the opportunity that allows us to save you"?
My personal stance: People should be allowed to opt out. But, once you opt out, you can never, ever get insurance. And, hospitals won't be obligated to treat you unless you can pay, up front, for any procedures.
That's a little extreme. What do we do? Tell the dying guy "Sorry you opted out of the opportunity that allows us to save you"?
Yes. If someone chooses not to get health insurance when easily affordable options are out there, they are saying "I will pay for anything I need myself". As such, they should have to pay for anything they need. If they can't, then they aren't treated. (And, I'd consider it a form of suicide, so life insurance policies don't pay out.)
My personal stance: People should be allowed to opt out. But, once you opt out, you can never, ever get insurance. And, hospitals won't be obligated to treat you unless you can pay, up front, for any procedures.
That's a little extreme. What do we do? Tell the dying guy "Sorry you opted out of the opportunity that allows us to save you"?
Yes. If someone chooses not to get health insurance when easily affordable options are out there, they are saying "I will pay for anything I need myself". As such, they should have to pay for anything they need. If they can't, then they aren't treated. (And, I'd consider it a form of suicide, so life insurance policies don't pay out.)
Problem with that is to refuse treatment to that person would put a doctor in the position of breaking their Hippocratic Oath. Don't know whether they still take that seriously but I wouldn't think of denying a person medical treatment if they really needed it if I were a doctor.
It costs a crap ton of money and has poor service (and I'd propose a lot of administrative stupidity) but arguably it suffers from being a single payer system jerryrigged into the larger US medical industry.
Frazzled wrote:Sweet Baby Jebus you don't want to be on Medicare. If thats your idea odf a good system you're %*^%*ed in the head.
What's so bad about Medicare?
It used to be better but sucks now.
-It pays below market for doctors and treatments. As a result there are shortages of doctors willing to take medicare patients.
-There are several loopholes of coverage in it. Those loopholes were filled by 3rd party providers at minimal cost. Funds for those providers have been reduced substantially under the current adminstration.
-Fees have been rising steadily in the last 5 years.
Johnny-Crass wrote:I hope it sicks honestly but I am just the angry angsty youth.
Also the day we start charging people to come into the hospital is the day I leave this country.
Try these out:
The day we start charging people that come into McDonald's is the day I leave this country.
The day we start charging people that come into a car dealership is the day I leave this country.
The day we start charging people that come into the airport ...
The day we start charging people that come into <insert business or industry here>...
Doesn't really sound right, does it?
Obamacare should be struck down completely (though I believe they are only considering the mandate att). I'm certain that even people that only won popularity contests (politicians) can understand that this is unconstitutional. It's simply a powergrab.
"I'm leaving the country" is a response to the government taking over every aspect of our lives.
Frazzled wrote:Sweet Baby Jebus you don't want to be on Medicare. If thats your idea odf a good system you're %*^%*ed in the head.
What's so bad about Medicare?
It used to be better but sucks now.
-It pays below market for doctors and treatments. As a result there are shortages of doctors willing to take medicare patients.
-There are several loopholes of coverage in it. Those loopholes were filled by 3rd party providers at minimal cost. Funds for those providers have been reduced substantially under the current adminstration.
-Fees have been rising steadily in the last 5 years.
So it wasn't very well thought out in regards to its coverage.
Paying doctors below market rate is very odd. I'm guessing it can't get enough funding to be able to pay market rate? Probably does bleed a lot of money in the form of admin and bureaucracy which doesn't help. Probably also explains the rise in fees. Why don't you try asking Cuba for some doctors? They have plenty to spare
I think the main problem is trying to attach a universal healthcare system to what is already there whilst trying to keep all the insurance companies happy. I've never really understood how people can oppose giving healthcare to those who can't afford it but that's most likely because I was raised here in England so I always thought of healthcare as a basic human right or whatever you want to call it.
Frazzled wrote:Sweet Baby Jebus you don't want to be on Medicare. If thats your idea odf a good system you're %*^%*ed in the head.
What's so bad about Medicare?
It used to be better but sucks now.
-It pays below market for doctors and treatments. As a result there are shortages of doctors willing to take medicare patients.
-There are several loopholes of coverage in it. Those loopholes were filled by 3rd party providers at minimal cost. Funds for those providers have been reduced substantially under the current adminstration.
-Fees have been rising steadily in the last 5 years.
So it wasn't very well thought out in regards to its coverage.
Paying doctors below market rate is very odd. I'm guessing it can't get enough funding to be able to pay market rate? Probably does bleed a lot of money in the form of admin and bureaucracy which doesn't help. Probably also explains the rise in fees. Why don't you try asking Cuba for some doctors? They have plenty to spare
I think the main problem is trying to attach a universal healthcare system to what is already there whilst trying to keep all the insurance companies happy. I've never really understood how people can oppose giving healthcare to those who can't afford it but that's most likely because I was raised here in England so I always thought of healthcare as a basic human right or whatever you want to call it.
Well you have to understand. The US government is not especially good at...well anything. Private anything in comparison may still suck, but its world's better. Take the actual law. Its thousands of pages of stuff that no one actually looked at, a byzantine monster of bureaucracies, specifal benies and forvoritsm to favored entities and states. It screams bad.
Maybe if we had the Swiss government. WOuld they mind if we stole their bureaucrats? They could have New Mexico if they wanted.
Johnny-Crass wrote:I hope it sicks honestly but I am just the angry angsty youth.
Also the day we start charging people to come into the hospital is the day I leave this country.
Try these out:
The day we start charging people that come into McDonald's is the day I leave this country.
Mcdonalds is not a need, there are other options if you are hungry like make your own food.
The day we start charging people that come into a car dealership is the day I leave this country.
You can walk, buy a bike, or take a bus. It is not likely to die from not having a car now is it?
The day we start charging people that come into the airport ...
You do not need to travel to live. You can also drive, take a ship or train.
The day we start charging people that come into <insert business or industry here>...
Doesn't really sound right, does it?
Obamacare should be struck down completely (though I believe they are only considering the mandate att). I'm certain that even people that only won popularity contests (politicians) can understand that this is unconstitutional. It's simply a powergrab.
"I'm leaving the country" is a response to the government taking over every aspect of our lives.
Regards,
Obviously red is mine in the above. None of the comparisons you drew are decent there. Lets say I have pulmonary embolism, my choices are healthcare through a hospital followed by medication or likely death (possible in the hospital as well, just lesser chance with proper medications). Hospitals provide a different kind off service than Mcdonalds or the other options you posted, and to say they are comparable is a stretch. They make money and that is where it ends. You are comparing a luxury (haha mcdonalds a luxury) with a possible life saving need. To be clear I am not saying we should not pay for these services, just that your comparison is poor.
Ouze wrote:So, the Affordable Care Act is finally before the Supremes. Do you think it's likely to pass, in whole or in part?
I also have a tangential question over an argument that was put forth today.
When Solicitor General Donald Verrilli tries to explain to Justice Scalia that the health care market is unique because “getting health care service … [is] a result of the social norms to which we've obligated ourselves so that people get health care.” Scalia’s response is a curt: “Well, don't obligate yourself to that.”
My interpretation of that answer is that he disagrees that hospitals should have a legal duty to handle patients who show up in emergency rooms and cannot pay. Do you agree with this?
What it sounds like to me, is that he was referring to the system of "insurance" itsself as health care coverage, and to not obligate yourself to it.
The social norm currently is to have health insurance of some sort, or you feel like you have no health care. This is how the system is set up, and is broken. One of the things being said here, is what a lot of people fail to recognize, you can visit a regular doctor whenever you want, and get glasses, and get glasses and prescriptions, etc, anytime you want it, you could just pay for it.
Now on to the Supreme Court Verbal arguements being held. I have heard them bring up matters of interstate commerse, but I heard no rebuttal to that. My first thought when "interstate commerse" was brought up was invalid arguement, because you can not purchase insurance over state lines. If you lived in Ohio, and had insurance you really liked, but had to move to Washington, and wanted to keep your insurance coverage, you could not. You would have to drop your insurance, and then get a new plan in Washington. So interstate commerse is a losing arguement, and maybe it was too obvious to all the smart people in the room that they didn't bother responding to it.
Johnny-Crass wrote:I hope it sicks honestly but I am just the angry angsty youth.
Also the day we start charging people to come into the hospital is the day I leave this country.
Try these out:
The day we start charging people that come into McDonald's is the day I leave this country.
Mcdonalds is not a need, there are other options if you are hungry like make your own food.
The day we start charging people that come into a car dealership is the day I leave this country.
You can walk, buy a bike, or take a bus. It is not likely to die from not having a car now is it?
The day we start charging people that come into the airport ...
You do not need to travel to live. You can also drive, take a ship or train.
The day we start charging people that come into <insert business or industry here>...
Doesn't really sound right, does it?
Obamacare should be struck down completely (though I believe they are only considering the mandate att). I'm certain that even people that only won popularity contests (politicians) can understand that this is unconstitutional. It's simply a powergrab.
"I'm leaving the country" is a response to the government taking over every aspect of our lives.
Regards,
Obviously red is mine in the above. None of the comparisons you drew are decent there. Lets say I have pulmonary embolism, my choices are healthcare through a hospital followed by medication or likely death (possible in the hospital as well, just lesser chance with proper medications). Hospitals provide a different kind off service than Mcdonalds or the other options you posted, and to say they are comparable is a stretch. They make money and that is where it ends. You are comparing a luxury (haha mcdonalds a luxury) with a possible life saving need. To be clear I am not saying we should not pay for these services, just that your comparison is poor.
Actually, no.
We are supposed to be a free market capitalist Republic of Republics.
Healthcare, automobiles, and hamburgers are all equally commodities.
It should be for the individual to decide which is more important in their life. Neither the government nor you should decide for me.
Life, Liberty, and the pursuit of Happiness.
Healthcare is important, but being important doesn't make it a Right.
Frazzled wrote:McDonalds...hospital and pending death...is there a relationship?
Absolutely. Eat too much of the former and the latter happens.
I'm in the camp that says Congress can't force people into the market so that they can be regulated. Universal health care sounds nice, but not this way.
Phanatik wrote:
Actually, no.
We are supposed to be a free market capitalist Republic of Republics.
The Constitution stipulates that the US economy should be predicated on a free market?
Why wasn't I told!
Phanatik wrote:
Healthcare, automobiles, and hamburgers are all equally commodities.
Sure, they're all commodities, but they don't all have equal value. Food is a necessity provided you want to not die, automobiles are not. Healthcare, similarly, is often a necessity if you want to not die, and more often a necessity if you want to work in order to buy food for the purpose of not dying.
Phanatik wrote:
Healthcare is important, but being important doesn't make it a Right.
Actually, whether or not something is important is pretty much how rights are determined, or at least the protection of them if you want to base you decision on the Supreme Court's opinion.
Frazzled wrote:Well I'm sure that last statement is not correct, unless the Swiss allow regions to opt out depending on if they supported the relevant legislation...
States can opt out, but not really as they still need to adhere to Obamacare standards. That clause is just political chicanery.
But basic premise of requiring the purchase of a certain level of coverage is the foundation of the Swiss system.
I find Obamacare kind of scary personally, I am unhappy with the government mandating what we purchase. I can also however see the otherside of the issue as well, since I sold life and health insurance for a number of years. Certain conditions seriously affect your premium, so people who needed it could not afford it.
As a healthcare provider, albeit an alternative healthcare provider, I truly hope we do not all end up on medicare. Medicare is very rough on providers and not very profitable. Most DCs only accept it because they care about the elderly, many healthcare providers see it as a loss.
For those of you who are not healthcare providers, you should be aware that the insurance industry seems to be in a panic about the whole process. They are altering their fee schedules significantly in prep for a change. Several of my patients are medical doctors and they are also losing income due to the changes going on in the insurance industry. This case is very important.
Bastion of Mediocrity wrote:medical doctors and they are also losing income due to the changes going on in the insurance industry
My god, they may have to by last years BMW new instead of this years.
All joking aside, doctors will be well paid either way. It isn't as if Doctors in the UK or Switzerland are hobos, working at an office and sleeping in a cardboard box. Of course there are going to be changes.
Bastion of Mediocrity wrote:Several of my patients are medical doctors and they are also losing income due to the changes going on in the insurance industry. This case is very important.
Their income isn't terribly important outside the parallel issues of inflated higher education costs.
Chief Justice Roberts said “the concern is that the secretary (of Health and Human Services) has the total and complete say because the secretary has the authority under this provision to say you lose everything (all federal Medicaid funds). No one's suggested in the normal course that will happen, but so long as the Federal government has that power, it seems to be a significant intrusion on the sovereign interests of the State.”
But Roberts also suggested that the states were mostly to blame for letting themselves reliant on federal funds.
“Isn't that a consequence of how willing they have been since the New Deal to take the Federal government's money?” he asked. “And it seems to me that they have compromised their status as independent sovereigns because they are so dependent on what the Federal government has done, they should not be surprised” at the federal government exercising control over them.
The states, Roberts said, “tied the strings, they shouldn't be surprised if the Federal government isn't going to start pulling them.”
I know several Governors (Rick Perry springs to mind) have claimed it (as well as the recent medicare change) should be invalidated as an encroachment on states rights. I don't think it's unreasonable for the feds to have a say in how you spend federal dollars, not when they are handing you 18 billion dollars a year for medicaid alone (Texas 2010). You always have the right to turn it down if you want to be all bootstrappy.
Chief Justice Roberts said “the concern is that the secretary (of Health and Human Services) has the total and complete say because the secretary has the authority under this provision to say you lose everything (all federal Medicaid funds). No one's suggested in the normal course that will happen, but so long as the Federal government has that power, it seems to be a significant intrusion on the sovereign interests of the State.”
But Roberts also suggested that the states were mostly to blame for letting themselves reliant on federal funds.
“Isn't that a consequence of how willing they have been since the New Deal to take the Federal government's money?” he asked. “And it seems to me that they have compromised their status as independent sovereigns because they are so dependent on what the Federal government has done, they should not be surprised” at the federal government exercising control over them.
The states, Roberts said, “tied the strings, they shouldn't be surprised if the Federal government isn't going to start pulling them.”
I know several Governors (Rick Perry springs to mind) have claimed it (as well as the recent medicare change) should be invalidated as an encroachment on states rights. I don't think it's unreasonable for the feds to have a say in how you spend federal dollars, not when they are handing you 18 billion dollars a year for medicaid alone (Texas 2010). You always have the right to turn it down if you want to be all bootstrappy.
So, the federal government forces states to participate in medicaid, and should then use extortion to force states to kowtow to the Imperial Will without brooking complaint?
<grimace>
To those who stated that the income of medical doctors is not important need to look at it long term. Becoming a medical doctor (MD) is extremely difficult and requires considerable sacrifice by the individual. Definitely more than most occupations. The reward for that dedication and acceptance of risk (i.e. malpractice suits) is that BMW you spoke of.
If the field loses its highter income benefit, then who will go through the b.s. to become one? Certainly not the best minds. . .
Also I do not think these measures take into account the cost of malpractice insurance at all. With medicare paying pennies on the dollar for healthcare, if all citizens become part of medicare it is likely that many hospitals and medical centers will fall apart. So if we go national healthcare, I hope it is not on the medicare model.
Bastion of Mediocrity wrote:To those who stated that the income of medical doctors is not important need to look at it long term. Becoming a medical doctor (MD) is extremely difficult and requires considerable sacrifice by the individual. Definitely more than most occupations. The reward for that dedication and acceptance of risk (i.e. malpractice suits) is that BMW you spoke of.
If the field loses its highter income benefit, then who will go through the b.s. to become one? Certainly not the best minds. . .
Also I do not think these measures take into account the cost of malpractice insurance at all. With medicare paying pennies on the dollar for healthcare, if all citizens become part of medicare it is likely that many hospitals and medical centers will fall apart. So if we go national healthcare, I hope it is not on the medicare model.
You'd end up with an industry full of "army doctors"... those of you in a military branch (I'd feel fairly safe including most 1st world countries here), you will know what I'm talking about... Typically, these are the bottom of the barrel, barely finished med school, and need a job that pays for their education... You get what amounts to cut-rate docs who don't inspire ANY confidence in your care. Additionally, especially in our system for the military, IF I see a "real" doctor, I get maybe a few minutes with the actual doc, not much time for real care right? Honestly, THIS is what I see coming for America, if the mandated healthcare is upheld as law, because we frankly don't know anything other than medicare, or military style healthcare.
One problem in American society, is of course our Sue Happy environment. A doctor makes an honest mistake, and suddenly a patient needs to sue the guy for doing his job??? I've never understood it. I mean, sure, leaving a pair of scissors in a dude's gut after surgery would be seen as a "sue-able offense" but diagnosing a cold as allergies should not be.
Frazzled wrote:
Well you have to understand. The US government is not especially good at...well anything. Private anything in comparison may still suck, but its world's better. Take the actual law. Its thousands of pages of stuff that no one actually looked at, a byzantine monster of bureaucracies, specifal benies and forvoritsm to favored entities and states. It screams bad.
Maybe if we had the Swiss government. WOuld they mind if we stole their bureaucrats? They could have New Mexico if they wanted.
No, there's one thing the US Gov is very good at: Obstructing. If you need something stonewalled, they're very good at that.
This does have it's advantages: National parks still exist, despite numerous requests to clear cut them/use them as toxic waste dumps/otherwise despoil them in the name of profit, which have been percolating through the system for the last century, and may eventually make their way through the bureaucracy sometime in the next 3700 years.
And we don't need to steal Switzerland's politicians, we just need to make lobbying ours a capital crime, punishable by death by keelhauling. Or maybe having molten gold poured over them. Something nice and ironic. Oh, and making political campaign ads illegal. Just have them debate each other on TV and give each candidate equal coverage. Mind you, this would require burning everyone at Fox News and MSNBC at the stake, but I can get behind that too...
And we don't need to steal Switzerland's politicians, we just need to make lobbying ours a capital crime, punishable by death by keelhauling. Or maybe having molten gold poured over them. Something nice and ironic. Oh, and making political campaign ads illegal. Just have them debate each other on TV and give each candidate equal coverage. Mind you, this would require burning everyone at Fox News and MSNBC at the stake, but I can get behind that too...
I propose we use an American classic: We beat them with a hickory cane
Phanatik wrote:So, the federal government forces states to participate in medicaid, and should then use extortion to force states to kowtow to the Imperial Will without brooking complaint?
<grimace>
Hardly. States can opt out of medicaid, if they so desire.
The problem with Obama care isn't the scope it's HOW they go about doing it. If the government wants to provide universal healthcare they need to control the INFRASTRUCTURE, not insurance. If you thought Obamacare was expensive the cost of instiuting state run health care would be staggering, but that's really how you provide people with universal health care. Don't outlaw private health care, or insurance; but don't mandate the purchase of health care. Force private medical care to compete with public medical care, and make public health care available for taxpayers as a part of thier public entitlements rather than publically funded health insurance in the private field.
Performing medicine is an ages old trade, before the modern era very few doctors were rich, or wealthy. Well paid and respected but not rich. If you think that the only way to get competent medical care is by paying doctors exhorbiant rates you have another thing coming. Medicine has always and will always be a respected field tha will allow you to feed your family in comfort. It does not have to put you in a palace.
Easy E wrote:Do conservatives really want to abandon the plan they created in the 90's to just have to eventually lose the Healthcare battle over Single payer instead? Seems kind of stupid to me, but I don't understand politics.
Sounds like you understand this really well. I think the trick is to understand that a lot of the time there's really very little thought given to the end game in politics, it's just about winning this week's battle. The Republicans were looking at woeful numbers in the wake of the Bush presidency, and needed something to reinvigorate their core support.
Obama attempted healthcare reform, and the Republicans knew they had something they could get people fired up over. It didn't really matter that the bill was something they used to think was good and needed reform.
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Grakmar wrote:Yes. If someone chooses not to get health insurance when easily affordable options are out there, they are saying "I will pay for anything I need myself". As such, they should have to pay for anything they need. If they can't, then they aren't treated. (And, I'd consider it a form of suicide, so life insurance policies don't pay out.)
The problem is that society simply isn't going to refuse to treat someone who can be saved. We will always be charitable to someone in a life or death situation. Any healthcare system proposed needs to recoginise that and account for it.
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Phanatik wrote:Try these out:
The day we start charging people that come into McDonald's is the day I leave this country.
The day we start charging people that come into a car dealership is the day I leave this country.
The day we start charging people that come into the airport ...
The day we start charging people that come into <insert business or industry here>...
Pretending the healthcare works like other industries is stupid. It plainly, obviously doesn't, and so any attempt to structure it like other industry is doomed to failure.
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Phanatik wrote:Actually, no.
We are supposed to be a free market capitalist Republic of Republics.
No, not really. You're supposed to be whatever you democratically decide you're supposed to be.
Healthcare, automobiles, and hamburgers are all equally commodities.
It should be for the individual to decide which is more important in their life. Neither the government nor you should decide for me.
Choice is wonderful thing. Choice is a great thing when a person decides whether they want to cook for themselves, get a take out or go out for dinner. And the impact of everyone's individual choice, working with pricing mechanisms and individual suppliers making their own choices to supply certain products, is collectively called the market and if certain conditions it's works as a wonderful mechanism for reaching, more or less, optimum conditions, provided certain conditions are met.
The issue is that even the briefest study of economics will show you that those conditions aren't met with healthcare. Markets rely on diminishing returns, that is to say going out to dinner once a month is wonderful treat and worth a lot to the consumer, but the more you go out each month the less special each ocassion is. Healthcare doesn't have that model, instead you have a situation where people are either healthy, and have absolutely no utility to be gained from healthcare, or they're sick, and healthcare will stop them from dying. This kind of system completely screws with traditional economic models, and makes their application to healthcare a complete and utter nonsense. And that's without getting into issues of imperfect information, and entry barriers.
Of course, that doesn't champions of the free market from calling for them anyway, because free market champions are rarely, if ever, actual students of economics, so it wouldn't even occur to them to study market conditions to see if they apply to the industry in question.
Which is really the big problem with so much of the libertarian ends of politics. They have absolute, undying commitment to economic solutions they never bothered to learn anything about.
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Bastion of Mediocrity wrote:To those who stated that the income of medical doctors is not important need to look at it long term. Becoming a medical doctor (MD) is extremely difficult and requires considerable sacrifice by the individual. Definitely more than most occupations. The reward for that dedication and acceptance of risk (i.e. malpractice suits) is that BMW you spoke of.
Thing is, in other developed countries doctors are still driving BMWs, unless their taste runs higher and they want Audis or whatever. Nothing says government run healthcare has to pay woefully.
I agree that Medicare in the US is underfunded and that one result is underpaying doctors, but a driving factor in that is the amount of federal health funds that get diverted into propping up other sections of an overall failing healthcare system. Seriously, when 18% of your economy is dedicated to health, which is about double what it is in any other developed country, you should be able to pay doctors enough for everyone of them to drive gold plated BMWs, and deliver the best standard of healthcare in the world. But they aren't paid that well, and the standard of health is mid-tier at best, because so much money gets sunk into inefficiency.
Bastion of Mediocrity wrote:To those who stated that the income of medical doctors is not important need to look at it long term. Becoming a medical doctor (MD) is extremely difficult and requires considerable sacrifice by the individual. Definitely more than most occupations. The reward for that dedication and acceptance of risk (i.e. malpractice suits) is that BMW you spoke of.
If the field loses its highter income benefit, then who will go through the b.s. to become one? Certainly not the best minds. . .
Also I do not think these measures take into account the cost of malpractice insurance at all. With medicare paying pennies on the dollar for healthcare, if all citizens become part of medicare it is likely that many hospitals and medical centers will fall apart. So if we go national healthcare, I hope it is not on the medicare model.
Please go back and reread what was written. No one, especially not I, stated that doctors pay was unimportant. In fact I stated that doctors will still make more than average even with these changes. Do you think doctors in the UK make the same as GW manager at a retail store? Of course not.
There are a myriad of reasons that people go into medicince and not all of them are financially motivated, and many of those are at the top of their field. Not everyone goes to med school just for the pay, so I don't find that a compelling argument: pay isn't based on 'best minds'. If it were, Snooki wouldn't make more than most physicists.
The BMW bit was a joke and was even specifically stated as such. It was there becuase of the "I couldn't live on less than four million a year*" kind of attitude being presented.
Ensis Ferrae wrote:You'd end up with an industry full of "army doctors"... those of you in a military branch (I'd feel fairly safe including most 1st world countries here), you will know what I'm talking about... Typically, these are the bottom of the barrel, barely finished med school, and need a job that pays for their education... You get what amounts to cut-rate docs who don't inspire ANY confidence in your care. Additionally, especially in our system for the military, IF I see a "real" doctor, I get maybe a few minutes with the actual doc, not much time for real care right? Honestly, THIS is what I see coming for America, if the mandated healthcare is upheld as law, because we frankly don't know anything other than medicare, or military style healthcare.
I think you need to learn about healthcare elsewhere in the world. We have public healthcare broadly available, and yet we aren't full of "army doctors". The real world is in direct opposition to what you're claiming.
One problem in American society, is of course our Sue Happy environment. A doctor makes an honest mistake, and suddenly a patient needs to sue the guy for doing his job??? I've never understood it. I mean, sure, leaving a pair of scissors in a dude's gut after surgery would be seen as a "sue-able offense" but diagnosing a cold as allergies should not be.
Malpractice reform has been estimated as representing likely cost savings of 2-3% by the Congressional Budget Office. Which is a nice saving, but nothing like the scale of reform needed.
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AustonT wrote:The problem with Obama care isn't the scope it's HOW they go about doing it. If the government wants to provide universal healthcare they need to control the INFRASTRUCTURE, not insurance. If you thought Obamacare was expensive the cost of instiuting state run health care would be staggering, but that's really how you provide people with universal health care. Don't outlaw private health care, or insurance; but don't mandate the purchase of health care.
That last sentence is the key. Have a base level of care available, which then makes private insurers work at being something people want, and not something they have to put up with because being uninsured is disastrous.
One of the things to me about Obamacare is that it should be seen as one step along a long line of steps to reform healthcare, to bring costs under control and restore sanity to the sector. Unfortunately you've got the politics you've got, and that makes progressive reform impossible. Maybe in another generation, when you have a healthier political climate.
Performing medicine is an ages old trade, before the modern era very few doctors were rich, or wealthy. Well paid and respected but not rich. If you think that the only way to get competent medical care is by paying doctors exhorbiant rates you have another thing coming. Medicine has always and will always be a respected field tha will allow you to feed your family in comfort. It does not have to put you in a palace.
Most of that is because for most of history wealth was based on land ownership, which was heriditary. There were very few people who's own skill was enough to command a healthy wage.
Doctors ought to be paid a health wage, because you don't want your best and brightest young people deciding they'd rather be merchant bankers because it pays so much more.
My personal stance: People should be allowed to opt out. But, once you opt out, you can never, ever get insurance. And, hospitals won't be obligated to treat you unless you can pay, up front, for any procedures.
That's a little extreme. What do we do? Tell the dying guy "Sorry you opted out of the opportunity that allows us to save you"?
Yes. If someone chooses not to get health insurance when easily affordable options are out there, they are saying "I will pay for anything I need myself". As such, they should have to pay for anything they need. If they can't, then they aren't treated. (And, I'd consider it a form of suicide, so life insurance policies don't pay out.)
Where your stance turns asinine is when you give them ONE opportunity to get insurance. Peoples' needs and wants change over time. My 20 something son's needs are a lot different than my 60 something father's needs. If my son doesn't want to fork over money for something he does not want right now, no reason he shouldn't be able to decide at a later date he wants it. He goes into that decision knowing prices and coverage differ, but hey, that is a valid choice for him to make, and he should be allowed to make it.
As for paying up front for any services, why shouldn't a hospital (or other health service provider) not be able to accept credit/payment terms. If a hospital believes they can can offer some type of payment program (and many do) why the heck should they not be allowed to do so? Conversely, if they choose NOT to do so and want payment up front, that is a business decision they should be allowed to make.
Ensis Ferrae wrote:You'd end up with an industry full of "army doctors"... those of you in a military branch (I'd feel fairly safe including most 1st world countries here), you will know what I'm talking about... Typically, these are the bottom of the barrel, barely finished med school, and need a job that pays for their education... You get what amounts to cut-rate docs who don't inspire ANY confidence in your care. Additionally, especially in our system for the military, IF I see a "real" doctor, I get maybe a few minutes with the actual doc, not much time for real care right? Honestly, THIS is what I see coming for America, if the mandated healthcare is upheld as law, because we frankly don't know anything other than medicare, or military style healthcare.
I think you need to learn about healthcare elsewhere in the world. We have public healthcare broadly available, and yet we aren't full of "army doctors". The real world is in direct opposition to what you're claiming.
One problem in American society, is of course our Sue Happy environment. A doctor makes an honest mistake, and suddenly a patient needs to sue the guy for doing his job??? I've never understood it. I mean, sure, leaving a pair of scissors in a dude's gut after surgery would be seen as a "sue-able offense" but diagnosing a cold as allergies should not be.
Malpractice reform has been estimated as representing likely cost savings of 2-3% by the Congressional Budget Office. Which is a nice saving, but nothing like the scale of reform needed.
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AustonT wrote:The problem with Obama care isn't the scope it's HOW they go about doing it. If the government wants to provide universal healthcare they need to control the INFRASTRUCTURE, not insurance. If you thought Obamacare was expensive the cost of instiuting state run health care would be staggering, but that's really how you provide people with universal health care. Don't outlaw private health care, or insurance; but don't mandate the purchase of health care.
That last sentence is the key. Have a base level of care available, which then makes private insurers work at being something people want, and not something they have to put up with because being uninsured is disastrous.
One of the things to me about Obamacare is that it should be seen as one step along a long line of steps to reform healthcare, to bring costs under control and restore sanity to the sector. Unfortunately you've got the politics you've got, and that makes progressive reform impossible. Maybe in another generation, when you have a healthier political climate.
Performing medicine is an ages old trade, before the modern era very few doctors were rich, or wealthy. Well paid and respected but not rich. If you think that the only way to get competent medical care is by paying doctors exhorbiant rates you have another thing coming. Medicine has always and will always be a respected field tha will allow you to feed your family in comfort. It does not have to put you in a palace.
Most of that is because for most of history wealth was based on land ownership, which was heriditary. There were very few people who's own skill was enough to command a healthy wage.
Doctors ought to be paid a health wage, because you don't want your best and brightest young people deciding they'd rather be merchant bankers because it pays so much more.
I really hope that people that think like you do that you can "structure" society/economies from the top down have an increasingly diminishing influence over decision-making processes.
I say stick your one-size-fits-all top-down models where the sun doesn't shine. We somehow managed to survive for decades without keynesians mucking stuff up with their we-know-better-than-everyone-else attitudes.
Only true believers in an unrealistic way of thinking that brought us social security, medicare and medicaid would want to quadruple down to bring us government healthcare as well.
So if the individual mandate goes, then the whole funding mechanism is gone from the bill. I wonder if the SC will take it all down, or still leave some of the ideas around pre-existing conditions, coverage revisions, electronic records, etc.
If they leave some of these ideas in the bill, how will they get paid for.
IF the SC decides to strike down the mandate, I personally would hope they scrap the whole thing. It will make it easier in the coming battles to start from scratch.
If we have some hybrid law, then it will be a frankenstein's monster to piece together new legislation.
Phanatik wrote:I really hope that people that think like you do that you can "structure" society/economies from the top down have an increasingly diminishing influence over decision-making processes.
It's a very European philosophy; that the Great and Good of enlightened intellectuals know what is best for the masses.
To be fair, America has generally accepted a fair amount of economic meddling, but much of the hullabaloo in the past few years is the degree to which the Executive office has tried to shift us socially further left.
Healthcare is important, but being important doesn't make it a Right.
Now, I apologize. I am -extremely- stupid, in fact I'm really not sure how I breathe on a regular basis. So, this particular comment is probably just going over my head.
Now see you've stated here that people have a right to life but not a right to health care. That... that confuses me. Again, probably because as I've mentioned already: I'm stupid. So.....
If one has the right to life, and I'm assuming here you mean "The right to their life" or to put it another way "Generally speaking, the right to be alive". You know, breathing, heart beating, brain.. braining... that kind stuff.
Does this mean for example that one has the right not to be say, shot with a gun? As that typically has a chance of impinging on ones right to life. Exceptions of course if you're say waving your gun at people threatening to take away their right to life. You know pow, pow, pow blammo! I just mean generally, do people have the right to not be shot is what I'm asking?
If they have the right to not be shot, I think I follow that from the whole... right to life thing that you stated. Now if they don't could please explain how one has the right to life without the right to not-be-shot-by-a-gun? Break it down very simply into steps on how being shot with a gun (with intent to kill) is not impinging on your right to life. Just explain that for me please.
Now, let's say one DOES have the the right to not be shot with a gun, generally speaking of course. Let's say despite having this right someone shoots with a gun, like boom pow right in gut. Ouch! (Gunshots are painful)
Let us say: That is a thing that happened. Someone got with a gun. Ok Follow? Bullet in their torso. Now, they are still alive and still have a right to that life (per your previous statement about the rights people have). See now if the bullet wound remains untreated they will in fact die (I checked with a doctor on this, trust me gaping holes in torso - fatal). When they die they lose that life you've said they had a right to. Now, if the bullet wound is treated they'll live and have a kick-ass scar as well. In this case the reciving the health care will allow them to live, thus keeping the life they have right to.
So in mind, in this scenario... the health care has become equivalent with life, therefore right to life has become equivalent with right to health care. Therefore I don't really understand your statement.
If you could break it down for me, I'm really dumb. So like, make sure you break it down for me step by step, so I can really grasp it fully.
Chongara wrote:I need some help understanding something.
Life, Liberty, and the pursuit of Happiness.
Healthcare is important, but being important doesn't make it a Right.
Now, I apologize. I am -extremely- stupid, in fact I'm really not sure how I breathe on a regular basis. So, this particular comment is probably just going over my head.
Now see you've stated here that people have a right to life but not a right to health care. That... that confuses me. Again, probably because as I've mentioned already: I'm stupid. So.....
If one has the right to life, and I'm assuming here you mean "The right to their life" or to put it another way "Generally speaking, the right to be alive". You know, breathing, heart beating, brain.. braining... that kind stuff.
Does this mean for example that one has the right not to be say, shot with a gun? As that typically has a chance of impinging on ones right to life. Exceptions of course if you're say waving your gun at people threatening to take away their right to life. You know pow, pow, pow blammo! I just mean generally, do people have the right to not be shot is what I'm asking?
If they have the right to not be shot, I think I follow that from the whole... right to life thing that you stated. Now if they don't could please explain how one has the right to life without the right to not-be-shot-by-a-gun? Break it down very simply into steps on how being shot with a gun (with intent to kill) is not impinging on your right to life. Just explain that for me please.
Now, let's say one DOES have the the right to not be shot with a gun, generally speaking of course. Let's say despite having this right someone shoots with a gun, like boom pow right in gut. Ouch! (Gunshots are painful)
Let us say: That is a thing that happened. Someone got with a gun. Ok Follow? Bullet in their torso. Now, they are still alive and still have a right to that life (per your previous statement about the rights people have). See now if the bullet wound remains untreated they will in fact die (I checked with a doctor on this, trust me gaping holes in torso - fatal). When they die they lose that life you've said they had a right to. Now, if the bullet wound is treated they'll live and have a kick-ass scar as well. In this case the reciving the health care will allow them to live, thus keeping the life they have right to.
So in mind, in this scenario... the health care has become equivalent with life, therefore right to life has become equivalent with right to health care. Therefore I don't really understand your statement.
If you could break it down for me, I'm really dumb. So like, make sure you break it down for me step by step, so I can really grasp it fully.
Secondary Question: Can the Kool-Aid man dance.
Thats the Declaration of Independence not the US Constitution. You're right you need to read more if you are going to be successful in future trolling endeavors.
Frazzled wrote:Thats the Declaration of Independence not the US Constitution. You're right you need to read more if you are going to be successful in future trolling endeavors.
I wasn't quoting either document. I was quoting that rather melancholy looking dog that made the post.
Frazzled wrote:Thats the Declaration of Independence not the US Constitution. You're right you need to read more if you are going to be successful in future trolling endeavors.
I wasn't quoting either document. I was quoting that rather melancholy looking dog that made the post.
He can look melancholy at times. Often, the 110lb dog tries to look like he hasn't eaten in days so I'll feed him again.
People don't have a right not to be shot. There are laws that say you shouldn't shoot someone except in extreme cases.
I think people can decide amongst themselves that a gunshot to the torso would be painful, without bringing in outside experts. (No doubt, at this point, sebster will weigh in with the various sections of the torso that could sustain a gunshot without necessarily being painful or life threatening.)
As only about 1/10 of the population isn't covered under insurance (and some of those may be illegals anyway) it's more likely that the gunshot victim does have insurance to get the lead out. If they are the 1/10 of the population, they will still receive emergency room attention to remove the offending bullet.
I don't see the logic in putting the healthcare of 9/10 of the population at risk because of the various reasons 1/10 of the population doesn't have insurance.
Notice, 90% of the population has health insurance.
100% of the population receives healthcare.
Get the trivial insurance fraud, emergency room visits for splinters, and trial lawyers away from the healthcare system, and everything would be hunkydory.
About the right to life, I always thought that referred to the government taking your life. As in for some types of autocratic governments the nation literally owns your life and can kill you without recrimination.
It does bring up an interesting point. How many would be opposed to a bill that grants "disaster" policies to U.S. Citizens?
Usually it is the life threatening illnesses that are used as defenses of Universal Healthcare, but most of the real problems of such a program (ignoring for the moment of the significant problem with government forcing individuals to purchase something) would involve all of the non-life threatening abuses that such a system would entail.
And anyone who does not think it would be abused needs to read up on just how horribly abused government programs to help the "common man" are. (Sadly, since the spirit of such programs is in the right place)
Phanatik wrote:We somehow managed to survive for decades without keynesians mucking stuff up with their we-know-better-than-everyone-else attitudes.
Survive, sure, but is survival really living?
But seriously, some of us are smarter than you are, or at least have more knowledge than you do. I couldn't rebuild an engine if I tried, and most people wouldn't consider it insulting if someone told me that. But O...M...G when policy enters into the equation any suggestion that you might not be intellectually equipped to deal with the matter is demeaning.
Phanatik wrote:
Get the trivial insurance fraud, emergency room visits for splinters, and trial lawyers away from the healthcare system, and everything would be hunkydory.
Well, aside from all the people without insurance that suffer life-threatening injuries (or have, say, cancer), sure.
But I'll reiterate: "I know things, therefore I know, and have valuable opinions on, policy."
One of the things that has always bothered me about civilian health insurance, is the apparent costs to the individual... From what I understand, in America it is perceived as being far too expensive.. But, having family members who work in the health care industry, I know that the reason why H.C. costs are "so high" is because of those without insurance (for whatever reason, be it poverty or illegal immigration or what have you) going to a hospital get "free" health care (what you thought it was actually free???). Basically it boils down to those who have insurance or large sums of money paying for those without.
Enter "mandatory government healthcare"... does this mean that the average civilian health insurance plan cost go down? If, in theory every person in the US has healthcare coverage that means that no uninsured person is cared for in a hospital or other clinic type, which should, in turn bring overall costs down for everyone. However, I just can't see it working this way at all. IF any of the HC bill remains after the supreme court goes through it, I foresee a medicaid style system, which will bring about much of the "army doctors" that I talked about in a previous post.
And realistically, in the US, only a complete medicaid system would bring about the "army doctors" that I talk about. IF they manage to keep our system "as is" with a few tweaks that allow more people to receive the care they need, while retaining the incentive for doctors to specialize in their given fields.
Phanatik wrote:
Get the trivial insurance fraud, emergency room visits for splinters, and trial lawyers away from the healthcare system, and everything would be hunkydory.
Erm, and the drug companies, who at the very least are leacherous sods that demand markups with triple digits or more for even basic medications that are 40 years old. And when I say triple digits I dont mean 110% I mean more like x00% where x is = just about anything.
Yes, the big pharma companies are notoriously corrupt. It's not even something they bother to hide at the moment.
Though I doubt it matters to phanatik, for reference I studied in the field for two years before switching to chemistry. The methods that the pharmaceutical industry uses to get around having to show side effects are just morally wrong and for that matter unscientific.
Melissia wrote:Yes, the big pharma companies are notoriously corrupt. It's not even something they bother to hide at the moment.
Though I doubt it matters to phanatik, for reference I studied in the field for two years before switching to chemistry. The methods that the pharmaceutical industry uses to get around having to show side effects are just morally wrong and for that matter unscientific.
Au contraire, I have no delusions that Big Pharma wouldn't sell their grandmothers to improve their bottom line.
broodstar wrote:I still don't understand what Obamacare will change from the way it is now, except for insurance rate going up.
As I understand, It's like this:
Currently, some people have health care. And some don't. Those that don't, often get expensive medical treatment anyway, and the money that they can't/don't pay has to come from somewhere.
So, for every uninsured person that doesn't pay, their costs get thrown onto the honest, hard working, healthcare-having Americans.
Healthcare being a requirement prevents irresponsible Americans from leeching off the system and placing the burden on those who do pay for their healthcare.
Phanatik wrote:I really hope that people that think like you do that you can "structure" society/economies from the top down have an increasingly diminishing influence over decision-making processes.
I say stick your one-size-fits-all top-down models where the sun doesn't shine. We somehow managed to survive for decades without keynesians mucking stuff up with their we-know-better-than-everyone-else attitudes.
Only true believers in an unrealistic way of thinking that brought us social security, medicare and medicaid would want to quadruple down to bring us government healthcare as well.
I say go away!
Regards,
Here we go again. I explain to you basic economic arguments for why certain economic models can't be applied to certain industries, and you reply with empty rhetoric that doesn't even remotely address the point I made to you. All I can do at this point is plead with you that if you want to argue points on economics, you need to actually gain an appreciation of economics. Go and read some foundational economics texts, learn about what actually makes an effective market and why that effective market doesn't (and can't exist) for all products.
Please go and learn something. Come back with something more than political rhetoric to shout, and maybe you'll have a contribution to make to the discussion.
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sourclams wrote:It's a very European philosophy; that the Great and Good of enlightened intellectuals know what is best for the masses.
To be fair, America has generally accepted a fair amount of economic meddling, but much of the hullabaloo in the past few years is the degree to which the Executive office has tried to shift us socially further left.
No, it isn't European. It's basic economics, the kind that's accepted everywhere around the world.
This argument of meddling assumes there's some inherently pure form of market that's free of human interference. That's a fantasy, invented by people who know nothing of economics.
Property laws are an invention of human governments. Contract laws are an invention of human governments. It's all rules written by humans. To pretend that stuff is inherent, but that some other rule is now suddenly intervention is utter nonsense.
sourclams wrote:
It's a very European philosophy; that the Great and Good of enlightened intellectuals know what is best for the masses.
Its not really a European thing, it just sort of a thing.
Some people know a lot about some things, and others know a lot about other things.
I can't rebuild the engine in my car, and I damn sure can't present a non-lethal blowfish for consumption, but I have a ton of knowledge and experience regarding domestic and international politics, and the making of policy.
I've never really understood why people get offended when they're told they don't know how policy works, while freely accepting that that they can't fix an engine, or code a video game. Not that I'm complaining, people with unjustified beliefs are generally easy to manipulate.
broodstar wrote:I still don't understand what Obamacare will change from the way it is now, except for insurance rate going up.
As I understand, It's like this:
Currently, some people have health care. And some don't. Those that don't, often get expensive medical treatment anyway, and the money that they can't/don't pay has to come from somewhere.
So, for every uninsured person that doesn't pay, their costs get thrown onto the honest, hard working, healthcare-having Americans.
Healthcare being a requirement prevents irresponsible Americans from leeching off the system and placing the burden on those who do pay for their healthcare.
Phanatik wrote:I really hope that people that think like you do that you can "structure" society/economies from the top down have an increasingly diminishing influence over decision-making processes.
I say stick your one-size-fits-all top-down models where the sun doesn't shine. We somehow managed to survive for decades without keynesians mucking stuff up with their we-know-better-than-everyone-else attitudes.
Only true believers in an unrealistic way of thinking that brought us social security, medicare and medicaid would want to quadruple down to bring us government healthcare as well.
I say go away!
Regards,
Here we go again. I explain to you basic economic arguments for why certain economic models can't be applied to certain industries, and you reply with empty rhetoric that doesn't even remotely address the point I made to you. All I can do at this point is plead with you that if you want to argue points on economics, you need to actually gain an appreciation of economics. Go and read some foundational economics texts, learn about what actually makes an effective market and why that effective market doesn't (and can't exist) for all products.
Please go and learn something. Come back with something more than political rhetoric to shout, and maybe you'll have a contribution to make to the discussion.
Automatically Appended Next Post:
sourclams wrote:It's a very European philosophy; that the Great and Good of enlightened intellectuals know what is best for the masses.
To be fair, America has generally accepted a fair amount of economic meddling, but much of the hullabaloo in the past few years is the degree to which the Executive office has tried to shift us socially further left.
No, it isn't European. It's basic economics, the kind that's accepted everywhere around the world.
This argument of meddling assumes there's some inherently pure form of market that's free of human interference. That's a fantasy, invented by people who know nothing of economics.
Property laws are an invention of human governments. Contract laws are an invention of human governments. It's all rules written by humans. To pretend that stuff is inherent, but that some other rule is now suddenly intervention is utter nonsense.
Here we go again.
I explain to you the basic tenets of freedom and you bore me with talk about your beloved models. I would much rather have the freedom to make my own mistakes than have you try to plan my life with a model, even if it were somehow perfect.
I can argue about government meddling without assuming some "pure form of market that's free of human interference." Many people are fed up with government meddling and are pushing back. And guess, what? There are more of us.
I believe you are in Australia? and suffering under socialized medicine? Keep it. Just don't try to foist it off on us.
I was probably engaging in economics when you were still a bubble in your momma's martini. Keep your pleadings and explanations to yourself.
In any case, why should I go and read a book when you'll just tell me I didn't read it or don't even own it because I disagree with you, again?
Regards,
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broodstar wrote:You are a citizen of this country, so I do care about you in the collective sense, I will defend you.
I don't know. These central planners all have big egos.
They would make good cover.
broodstar wrote:I still don't understand what Obamacare will change from the way it is now, except for insurance rate going up.
Here is a high-level and therefore caricutre look at how Insurance works. The the more people healthy people you have to pay the costs for the percentage of sick people, the farther you can spread out those costs. This is called risk pooling.
For example, let's say I have a policy with 10 other people and we all pay $10 a month. Every month, the Insurance pool collects $100, and over a year, we have accrued $1,200. Now, let's say on new Year's I get injured in a drunken fall. I go to the doctor, and the service cost $1,000. I go to my insurance company and they pay the $1,000, leaving the policy with $200 left over.
Then, my fellow Policy holder Bob has an incidnet on january 15th. This costs $500. That is not enough to cover the costs. The policy has a couple options. They can either increase the number of people in the pool from 10 to 20, raise how much each person pays, or cut Bob and I out and replace us with healthier and less accident prone people.
So that's how Insurance works. Here's what Obamacare does to that system.
1. You can not simply cut Bob and I out of the policy when we become expensive anymore.
2. It forces you increase your risk pool, by taking on more people. Therefore, more people paying premiums to cover the other sick ones.
3. It will require the set-up of Health Care Exchanges (essentially alternate Policies) that people can choose form, thereby allowing more competition for less expensive premiums; limiting a Policies ability to simply raise premiums.
In a nutshell, Obamacare is betting that increasing the risk pool will solve all our problems. Therefore, if the inidividual mandate goes, you aren;t increasing the Risk Pool, but still limiting the options of Policies to pay claims. It is the worst of all possible worlds.
Easy E wrote:2. It forces you increase your risk pool, by taking on more people. Therefore, more people paying premiums to cover the other sick ones.
The people being taken on, however, are primarily young and healthy people who don't need health insurance/much health insurance. In its simplest form, this is an age-based subsidy where young people subsidize older (older meaning less healthy) people.
Easy E wrote:2. It forces you increase your risk pool, by taking on more people. Therefore, more people paying premiums to cover the other sick ones.
The people being taken on, however, are primarily young and healthy people who don't need health insurance/much health insurance. In its simplest form, this is an age-based subsidy where young people subsidize older (older meaning less healthy) people.
And poor people don't forget that.
Except of course the unions and companies that have been exempted because ...er why again? oh yea I remamber now
$$$$$
They'll still have to make enough money to pay for the elderly insurees' healthcare, which is by nature higher costing than the healthcare of younger or middle-aged people.
Easy E wrote:2. It forces you increase your risk pool, by taking on more people. Therefore, more people paying premiums to cover the other sick ones.
The people being taken on, however, are primarily young and healthy people who don't need health insurance/much health insurance. In its simplest form, this is an age-based subsidy where young people subsidize older (older meaning less healthy) people.
How is that different than any othe rHealth Insurance? The health insurance company WANTS healthy people so it can gain premiums, sit on the money they don't spend on sick ones; and place it in investments until needed, and thereby making a profit.
Oh I get it. it's only good and virtuous if a company does it. Check.
Easy E wrote:2. It forces you increase your risk pool, by taking on more people. Therefore, more people paying premiums to cover the other sick ones.
The people being taken on, however, are primarily young and healthy people who don't need health insurance/much health insurance. In its simplest form, this is an age-based subsidy where young people subsidize older (older meaning less healthy) people.
How is that different than any othe rHealth Insurance? The health insurance company WANTS healthy people so it can gain premiums, sit on the money they don't spend on sick ones; and place it in investments until needed, and thereby making a profit.
Oh I get it. it's only good and virtuous if a company does it. Check.
Pretty basic difference. In one, a person freely chooses to enter or not enter the pool. In the other case, the person MUST enter the pool or be punished. So, threat of force vice free choice. Seems pretty easy to see the difference.
As we use to say in the insurance industry, "of course you don't need insurance.... until you need insurance."
I have yet to meet a person who has never needed it, because insurance is synonymous with Healthcare in the US.
And I would put forward many people agree. What we may agree less on is WHAT insurance we as individuals want and or need. As I mentioned earlier, my 20 something son, assuming he wants coverage, would probably choose a much different plan than a plan my 60 something father might choose. Certain lifestyle choices and even jobs would push a person towards a certain type of coverage. Under Obama care, all plans start to look the same and then start to cost the same. So you are forced into the pool, and cannot decide a level of risk/coverage you think is right for you. I have issues with that as well. In my opinion, I should be able to shop companies and find a plan I think is best for me at a price I am willing to pay. If I don't want certain coverage, I should not have to buy it. Frankly if I want no coverage, I shouldn't be forced into the pool at all.
Obviously many folks on this thread are happy to be forced into the pool and use the Fed Gov't to force others in as well. I am very much against that.
Under Obama care, all plans start to look the same and then start to cost the same.
Actually I see quite the opposite happening-- a widening variety of choices, rather tahn a single comprehensive plan for everyone.
Wrong, certain things MUST be offered in every plan, which means they must be paid for. Employers for example MUST buy plans for employees that meet certain criterea/contain certain provisions. Hence they start looking a lot alike. Since most folks get insurance through their employer, it affects most insured people.
CptJake wrote:Wrong, certain things MUST be offered in every plan, which means they must be paid for.
Which means that they can offer several packages, anything from a range of the bare legal minimum to covering everything, even elective surgery such as cosmetics.
CptJake wrote:Wrong, certain things MUST be offered in every plan, which means they must be paid for.
Which means that they can offer several packages, anything from a range of the bare legal minimum to covering everything, even elective surgery such as cosmetics.
I would bet my prediction of less choice being offered is correct. Ask the HR folks for businesses out there what their insurance providers are telling them.
And insurance for elective surgery is asinine. The whole premise of insurance is it covers you when something unexpected comes up. Sometimes that coverage includes access to certain preventive procedures/treatments beacuse it makes good business sense for those to be offered. But elective procedures? If someone wants 10k worth of boobs put on their chest, they are going to pay 10k. No insurance plan SHOULD cover that elective* procedure, and being forced into a pool to subsidize elective surgery for others is morally corrupt.
*Obviously some plans may cover corrective cosmetic surgery, but never elective.
Perhaps less choice from businesses, but more choice in the market.
I have a feeling the business Group plans would cease being one of the main ways people are insured. There are several reasons for this.
1. Cheaper for businesses to not offer Healthcare, if it is widely available through other means. Right now, it is a Golden handcuff. The higher end employers will keep it, but I imagine a lot of smaller firms will dump Group coverage ASAP.
2. People will want customizable options, and to tailor their coverage/premium. They will go to private insurance and the exchanges for this. Plus, it is portable.
Easy E wrote:Perhaps less choice from businesses, but more choice in the market.
I have a feeling the business Group plans would cease being one of the main ways people are insured. There are several reasons for this.
1. Cheaper for businesses to not offer Healthcare, if it is widely available through other means. Right now, it is a Golden handcuff. The higher end employers will keep it, but I imagine a lot of smaller firms will dump Group coverage ASAP.
2. People will want customizable options, and to tailor their coverage/premium. They will go to private insurance and the exchanges for this. Plus, it is portable.
I think you are missing part of the point of Obamacare. Businesses will also get penalized if they don't provide insurance meeting Obamacare standards. Yes, many will drop coverage and pay the penalty, others will not hire as many folks as each they do will cost more/cut into their bottom line more. To think individuals will have the buying power to demand better prices than companies buying 10s to 100s (or more) plans is silly. Individual coverage is going to cost more. And it will be mandatory.
There will not be a lot of 'customizable' options because each plan will have to have minimum coverage as defined by the law, a buyer can not opt out of that coverage because he/she does not want it.
I strongly suspect you folks have not really thought out/looked at the implications of this. Premiums are already going up in anticipation of the mandatory coverage the law requires. That is not a shock. Insurance providers have no real incentive to offer better deals, the Gov't ensures an unlimited customer base (or one only limited by the size of the population) and subsidizes those who cannot afford the minimum coverage. Employers ditching coverage will force more people into that category.
Add in that whole Gov't Force thing and I am very much against this.
As for the Business requirement. I think companies will just accelerate the move to HSA/HRA self-service only plan options; just like they are doing now anyway. These plans are cheaper to administer and have higher deductibles/co-insurance than HMO/PPO plans. Therefore, no real change for the employee, EXCEPT now they can also go look at the Health Exchanges for a better deal and still take advantage of group rates. now, you choose between individual plans or your businesses group plan. This should create more competition, and that is good right?
I will admit I'm not an expert on Obamacare, and in the spirit of learning, what minimum coverages are you talking about? Is it more than just, no pre-existing conditions, no recisions on policies, coverage for college kids to 26, etc. As far as I am aware, it doesn't put too many restrictions around deductibles, Out-off-pocket maximums, and other technical aspects of the plans. However, I could be wrong.
Phanatik wrote:
I explain to you the basic tenets of freedom and you bore me with talk about your beloved models.
What are the basic tenets of freedom?
Phanatik wrote:
Many people are fed up with government meddling and are pushing back. And guess, what? There are more of us.
In the US?
Maybe, but not many more if polling is to be believed.
Phanatik wrote:
I believe you are in Australia? and suffering under socialized medicine? Keep it. Just don't try to foist it off on us.
Their healthcare system is generally considered to be superior to the US system.
Phanatik wrote:
I was probably engaging in economics when you were still a bubble in your momma's martini. Keep your pleadings and explanations to yourself.
Always love the age argument. Nothing like an old man who thinks being an old man somehow makes him smarter, more knowledgeable, or otherwise superior.
dogma wrote:
Their healthcare system is generally considered to be superior to the US system.
A friend of mine from there as genuinely shocked at how backward the US healthcare system was, pre 'Obamacare'. Particularly how certain life saving medical procedures that were commonly in practice in Australia were prohibited in the US for ideological reasons. (Such as those based on stem cell research)
BaronIveagh wrote:
A friend of mine from there as genuinely shocked at how backward the US healthcare system was, pre 'Obamacare'. Particularly how certain life saving medical procedures that were commonly in practice in Australia were prohibited in the US for ideological reasons. (Such as those based on stem cell research)
While I'm not convinced that Obamacare is a good solution, or even really a solution, to the problems we have with medical care in the US I do generally agree with that sentiment.
Hell, I got better treatment in France at 60% coverage than I did here with a 1200 USD deductible, and in France I didn't have to pay a premium.
dogma wrote:Always love the age argument. Nothing like an old man who thinks being an old man somehow makes him smarter, more knowledgeable, or otherwise superior.
The human brain deteriorates just as much as the body does. It's just harder to notice as it is not a visible deterioration unless you'r going in for regular CAT scans.
I think somebody mentioned it, but the way I understand it, Obamacare is an imperfect solution that aims to fix a broken system without having to demolish it and rebuild from scratch. A patch to make do so there are at least quick results. So of course it's not going to be really satisfying (for anybody, mind you), but if the Republicans had drawn the same plan before, you'd think there is at least a consensus about the existence of a problem and therefore about the need for a solution...
I was wondering : would drawing a parallel with vehicle insurance be relevant ? If I'm not mistaken it is mandatory in a number of states and in the ones where it's not, you pay a fee to the state if you choose not to cover your car. No need to pounce on me screaming, just trying to figure it out.
BaronIveagh wrote:And we don't need to steal Switzerland's politicians, we just need to make lobbying ours a capital crime, punishable by death by keelhauling. Or maybe having molten gold poured over them. Something nice and ironic. Oh, and making political campaign ads illegal. Just have them debate each other on TV and give each candidate equal coverage. Mind you, this would require burning everyone at Fox News and MSNBC at the stake, but I can get behind that too...
I'd agree, but judging from what we have here, you'd likely find it boring once the smoke is gone
Hyd wrote: I was wondering : would drawing a parallel with vehicle insurance be relevant ? If I'm not mistaken it is mandatory in a number of states and in the ones where it's not, you pay a fee to the state if you choose not to cover your car. No need to pounce on me screaming, just trying to figure it out.
Not really. For example, my brother who lives in Washington DC and previously lived in Atlanta does not own a car. He isn't forced to buy one nor to buy auto insurance. In most cases, mandatory auto-insurance requirements are to cover OTHER peoples' cars and medical costs if you hit them. You can have very limited coverage for your own car. Additionally, if you get into wrecks or have a bad driving record (lots of moving violation tickets) the insurer is allowed to do the financially correct thing and raise your premiums or even drop you from coverage. Additionally requirements are set BY STATES vice the Federal Gov't. Our Fed Gov't, like it or not, is supposed to be pretty limited in power by the Constitution...
Also, you really only need to be licensed and insured to drive on public roads (and again, to cover damage you cause vice damage to you). I know this is not the norm for most people, but there are folks who have ranches and such where they have ranch vehicles that they can drive unregistered and uninsured on their property if they choose.
So, though you can make some parallels, there really are a lot of differences, the key one being the Fed Gov't cannot force you to buy auto insurance or buy a car. States may deny you the privilege to drive on public roads (yes I said privilege vice right) if you refuse to register your vehicle and get insurance.
Hyd wrote:I was wondering : would drawing a parallel with vehicle insurance be relevant ? If I'm not mistaken it is mandatory in a number of states and in the ones where it's not, you pay a fee to the state if you choose not to cover your car.
No need to pounce on me screaming, just trying to figure it out.
Not really. For example, my brother who lives in Washington DC and previously lived in Atlanta does not own a car. He isn't forced to buy one nor to buy auto insurance. In most cases, mandatory auto-insurance requirements are to cover OTHER peoples' cars and medical costs if you hit them. You can have very limited coverage for your own car. Additionally, if you get into wrecks or have a bad driving record (lots of moving violation tickets) the insurer is allowed to do the financially correct thing and raise your premiums or even drop you from coverage.
People have the option to not drive. They don't have the option to not get sick and not need healthcare.
This approach would only work if we as a society were willing to let sick people without coverage die in our ER waiting rooms. Or probably parking lots, as presumably we'd ask them to leave once finding out they didn't have coverage. But that's not what we do. We have decided, for many years, to provide care to people in need regardless of whether they can afford coverage.
Right now the costs of that coverage are passed on to everyone else in the forms of higher costs at the hospitals (raising service charges to compensate for unpaid-for care), higher premiums from insurers (again, raising charges to compensate for the hospitals charging more), and higher taxes (compensating for tax write-offs given to the hospitals for unpaid-for care). We're ALREADY paying for this stuff, only we're doing it the stupid way, after the fact and with no control.
If we require everyone to either buy insurance or pay a penalty, we create a larger risk pool with more healthy people in it, and we're (or the insurance companies are) able to invest that money ahead of time. This makes funding the healthcare we ALREADY provide to the unisured in emergency form more feasible. It actually SAVES us money in many areas, because insured people actually tend to go to the doctor and get a (fairly) cheap appointment and maybe a prescription, rather than waiting until they feel desperate and going to the ER, which is what uninsured people commonly do. Compare a $100 doctor's visit and $100 prescription with a $1000 ER visit.
Remember that the "Obamacare" solution is the Republican-devised option. The one focused on using private-sector insurance companies rather than moving to a single-payer system like most of the rest of the civilized world has. The Republican arguments for it, going back to the ancient days of 2006 when Mitt Romney and Newt Gingrich were talking about what a great idea it was, included that requiring people to buy insurance or be penalized is requiring people to take "personal responsiblity".
Here's a quote from Mitt Romney, from the ancient days of six years ago, talking about this same concept:
Mitt Romney wrote:“But once we put in place the reforms I am describing, with new affordable products as well as a subsidized product, where your premium can be as low as $2.30 a week, now everybody can get insurance,” said Romney. “And that’s basically what this slide says. And that is, look, now that we have these products available for you, we want everybody to get insurance and you have responsibility of having insurance, and we are going to mandate that you have insurance.
“Now, how do we mandate it?” said Romney. “Well, I won’t spend a lot of time on this, other than to indicate that we are going to insist that everybody be covered one way or the other and that those who don’t comply have certain problems. They are going to lose their personal tax exemption. We will withhold any of their tax refund. We will keep it in an account at the state level which we will be able to tap to pay the hospital if they go there for free care. The legislature has also put in place consideration of not providing drivers’ licenses to people unless they can show their health insurance coverage, and so forth.
“We also, I just note there, we also, if people go and get free care and don’t pay for it, we go after them,” said Romney. “We garnish wages if we have to make sure that we get paid. People are either going to buy insurance or they are going to pay for their own care. They’re not going to say, I got care and you, Mr. Taxpayer, or you Mrs. Premium Payer, you have to pay for me.”
If I don't get coverage and insure myself I am being irresponsible, and I am dumping the consequences and costs of my decision off on every other American taxpayer and healthcare consumer.
CptJake wrote:Additionally requirements are set BY STATES vice the Federal Gov't.
The requirement has to be set at the Federal level to deal with the fact that people move from state to state. If I spent all my young and healthy years up here paying my premiums into a separate NH pool, then retired down in FL and stuck them with my older, sick years, they're not benefitting from the pool the way they need to.
Mannahnin wrote:The requirement has to be set at the Federal level to deal with the fact that people move from state to state. If I spent all my young and healthy years up here paying my premiums into a separate NH pool, then retired down in FL and stuck them with my older, sick years, they're not benefitting from the pool the way they need to.
Why? Folks with auto insurance surely move from state to state as well, no?
As for it saving everyone money, that is a poor, poor argument. Again, premiums are already going up due to the types of coverage mandated by the law, and there are a lot of estimates most folks will see up to a 30% increase in premiums when everything is implemented. Add in the cost to businesses which directly results in less employees and your argument falls apart quickly.
Add in that the latest CBO predictions say this law adds a huge chunk to the debt over the next decade and it is VERY difficult to see how this 'saves' money. In fact, it burdens us quite a bit.
And again, using force to make people buy something is wrong in my opinion.
Mannahnin wrote:The requirement has to be set at the Federal level to deal with the fact that people move from state to state. If I spent all my young and healthy years up here paying my premiums into a separate NH pool, then retired down in FL and stuck them with my older, sick years, they're not benefitting from the pool the way they need to.
Why? Folks with auto insurance surely move from state to state as well, no?
Because...
1. States already mandate that all drivers have insurance (my state, NH, has the lowest requirement, only requiring liability coverage; everyone else requires more), so they're already putting safe drivers (the equivalent of young healthy people) in their risk pools.
2. People retire to warmer states when they're older, and age demographics matter a lot more with health insurance costs than with car insurance costs. Older drivers get in fewer accidents, until they get so old that they need their licence taken away.
3. A person who has no car insurance and so can't afford to drive can stop driving. For a sick person who has no health insurance, the only way to do that is to shoot themselves.
If every state required people to sign up the way Massachusetts does, and the way all the states do for car insurance, sure, we could do it state by state. But if they don't, then people living in a no-mandate state while they're healthy and getting sick/old after moving to a mandate state sabotage the funding for the system.
CptJake wrote:As for it saving everyone money, that is a poor, poor argument. Again, premiums are already going up due to the types of coverage mandated by the law,
Have you paid any attention to insurance premiums in the last fifteen or twenty years? They've been spiraling up and up and up for years. Every small business owner whom I've talked to is in support of the ACA or something like it, precisely because something's got to be done about premiums. Yes, some premiums are undoubtedly bumping up right now to compensate for provisions of the law which are already in effect (like allowing kids to stay on their parents' plan until 26) while the funding measures aren't in effect yet. But we've also just put in the 80% rule, where 80% of premiums collected have to be spent on actual care or refunded to the insured.
CptJake wrote:Add in that the latest CBO predictions say this law adds a huge chunk to the debt over the next decade and it is VERY difficult to see how this 'saves' money. In fact, it burdens us quite a bit.
The last time the Congressional Budget Office looked at the whole law was when the House of Representatives tried to repeal the Affordable Care Act. And that report found that the Affordable Care Act reduces the deficit by over $100 billion in the next ten years and even more in the subsequent decade. Here’s what CBO had to say then:
“CBO estimates that enacting H.R. 2 would increase federal deficits during the decade following the initial 10-year period . . . CBO anticipates that enacting H.R. 2 would probably continue to increase budget deficits relative to those under current law in subsequent decades.”
CptJake wrote:And again, using force to make people buy something is wrong in my opinion.
More wrong than them taking care without paying for it?
More wrong than forcing us all to pay for it when they inevitably do so?
There's no ideal way out of this. Uninsured people DO and WILL use healthcare, and the costs ARE and WILL be passed on to everyone else. As Romney and Gingrich argued six years ago, making people buy insurance is making them take responsibility for those inevitable and inarguable facts.
And again, using force to make people buy something is wrong in my opinion.
Right, so why do you support the uninsured's right to force me to pay for THEIR health care?
Can you point to where I state my support for that?
I don't think you can.
I'm sorry, health care and insurance are NOT a Federal matter, and if you go with the constitution, it shouldn't be. Does the system need refoms? Yep. Is Obamacare the right way to go about it? No, not at all.
CptJake wrote:
I'm sorry, health care and insurance are NOT a Federal matter, and if you go with the constitution, it shouldn't be.
Well, again, that depends on if you define Heath Care and Insurance as 'commerce' or not. If it is, actually the Constitution says that Congress is well within it's powers to make laws about it. This is sort of why this is at the Supreme Court, because the fundamental question is: Is it Commerce? Technically it involves a service and the exchange of funds, so, by my own measure, yes, it is. How the Court will rule, however...
Remember, the Constitution was intended to LIMIT the power of the Federal Gov't. If you buy off on "it is commerce therefore they can force you and control you", you will have a very hard time defining anything in your personal life they cannot control and anything they cannot force you to buy or do under the same argument.
Honestly, that bothers me. A lot. To use a limiting document to grant damned near unlimited control is wrong. I strongly suspect this is NOT what the founders intended.
Mannahnin wrote:
If every state required people to sign up the way Massachusetts does, and the way all the states do for car insurance, sure, we could do it state by state. But if they don't, then people living in a no-mandate state while they're healthy and getting sick/old after moving to a mandate state sabotage the funding for the system.
Even then there are issues due to variance in coverage and, more importantly, mean and median population age.
Weird fact: Utah has the lowest media population age by a fairly wide margin at 28. The highest is Maine at 42.
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CptJake wrote:Remember, the Constitution was intended to LIMIT the power of the Federal Gov't. If you buy off on "it is commerce therefore they can force you and control you", you will have a very hard time defining anything in your personal life they cannot control and anything they cannot force you to buy or do under the same argument.
I'm not sure why the federal government having the power to compel purchase is especially different from state governments possessing the same power. I guess you could make the argument that you could always move, but you can do that with respect to the US as well; plenty of people seem to think its actually a very good option. The major distinction is likely that state policy is thought to be easier to influence than national policy, but I'm not necessarily sure that's true, or even good if it is.
Regardless, the government can regulate or compel pretty much whatever it wants to, the only real barrier there is willingness, same as always.
CptJake wrote:
Honestly, that bothers me. A lot. To use a limiting document to grant damned near unlimited control is wrong. I strongly suspect this is NOT what the founders intended.
What they intended is of little concern in my mind. The Founders weren't all knowing god-kings (though some people seem to feel differently), or even unified as a group of flawed, but fairly intelligent people.
There is one thing i did just think of in relation to this issue...
There are in America, certain religions and religious groups who feel that any medicine other than prayer, and God, are not acceptable to be used on them....
This includes health insurance, because hey... God works on prayers, not AFLAC. So, in essence, forcing someone to buy something that goes against their religion is actually an infringement of their individual 1st Amendment right, regardless of whether it is considered "Commerce" or not..
Regardless of how you feel about religions or even certain religions, you have to be extremely wary of a Government who will impinge upon the rights of its citizens, even if they veil it behind a figurative smoke screen
Ensis Ferrae wrote:There is one thing i did just think of in relation to this issue...
There are in America, certain religions and religious groups who feel that any medicine other than prayer, and God, are not acceptable to be used on them....
This includes health insurance, because hey... God works on prayers, not AFLAC. So, in essence, forcing someone to buy something that goes against their religion is actually an infringement of their individual 1st Amendment right, regardless of whether it is considered "Commerce" or not..
Regardless of how you feel about religions or even certain religions, you have to be extremely wary of a Government who will impinge upon the rights of its citizens, even if they veil it behind a figurative smoke screen
I might point out that argument has failed in court repeatedly in cases where the family's religion conflicted with giving their children proper medical treatment and they died, leading to said parents arrest.
CptJake wrote:Remember, the Constitution was intended to LIMIT the power of the Federal Gov't. If you buy off on "it is commerce therefore they can force you and control you", you will have a very hard time defining anything in your personal life they cannot control and anything they cannot force you to buy or do under the same argument.
Honestly, that bothers me. A lot. To use a limiting document to grant damned near unlimited control is wrong. I strongly suspect this is NOT what the founders intended.
I might point out two things: First, The government has 'forced' people to buy insurance for various things for a long time. It's usually a licensing requirement. Second, The Founding Fathers deliberately worded it the way they did realizing they could not see all possible situations where Congress would need to regulate Commerce. It was deliberately written as broad (unlike several other sections) as possible to try and cover a very wide range of possibilities, because they were all more then aware of the rapidly changing nature of commerce. It's one of the few areas that the Founding Fathers gave the Federal Government wide discretionary power, because the regulation of Commerce was seen as a key role the Fed had to play.
BaronIveagh wrote:I might point out that argument has failed in court repeatedly in cases where the family's religion conflicted with giving their children proper medical treatment and they died, leading to said parents arrest.
Hopefully setting precedent for later on when people start dying of pertussis because of all the gaks out there that think vaccines cause autism.
BaronIveagh wrote:I might point out that argument has failed in court repeatedly in cases where the family's religion conflicted with giving their children proper medical treatment and they died, leading to said parents arrest.
Hopefully setting precedent for later on when people start dying of pertussis because of all the gaks out there that think vaccines cause autism.
Given that we don't know what actually causes autism to show up in children, what evidence is there to suggest that a given vaccine might not actually be the cause?? (obviously, that vaccine would only cause autism in those whose genetics mesh wrong with said vaccine..we all know that vaccines by and large do far more good than bad)
I mean, the same could be said of SIDS or ALS, or any number of diseases that we don't know what the cause of them is. I should point out that I am in favor of just about all vaccines out there (can't really think of one that is all that controversial, even that cervical cancer one for girls.. hopefully when that comes up for my daughter, my wife and I will have been good enough parents that she wont be a tramp)
Ensis Ferrae wrote:what evidence is there to suggest that a given vaccine might not actually be the cause??
The complete and utter, 100% lack of evidence that it does.
I mean you could argue that nitrogen in the air is what really causes alcoholism, but you'd still have no leg to stand on because you have no proof whatsoever.
Also? We know, generally speaking, what causes autism. The problem is that it is not one specific thing, no silver bullet, but a wide collection of things (vaccines have been proven by clinical studies to not be amongst them). We have an entire field of study dedicated to understanding abnormalities in physiological development, called Teratology.
BaronIveagh wrote:I might point out that argument has failed in court repeatedly in cases where the family's religion conflicted with giving their children proper medical treatment and they died, leading to said parents arrest.
Hopefully setting precedent for later on when people start dying of pertussis because of all the gaks out there that think vaccines cause autism.
Given that we don't know what actually causes autism to show up in children, what evidence is there to suggest that a given vaccine might not actually be the cause?? (obviously, that vaccine would only cause autism in those whose genetics mesh wrong with said vaccine..we all know that vaccines by and large do far more good than bad)
I mean, the same could be said of SIDS or ALS, or any number of diseases that we don't know what the cause of them is. I should point out that I am in favor of just about all vaccines out there (can't really think of one that is all that controversial, even that cervical cancer one for girls.. hopefully when that comes up for my daughter, my wife and I will have been good enough parents that she wont be a tramp)
Because nowadays drugs go through such incredibly strict testing before they are deemed appropriate for human consumption that if Aspirin were to be discovered today it wouldn't pass these tests.
Ensis Ferrae wrote:
This includes health insurance, because hey... God works on prayers, not AFLAC. So, in essence, forcing someone to buy something that goes against their religion is actually an infringement of their individual 1st Amendment right, regardless of whether it is considered "Commerce" or not..
Most of the people in those groups, while certainly devout, aren't stupid. They won't refuse or fail to seek medical treatment in the case of severe injury, and I imagine most of them carry some level of insurance even they don't make use of it as freely as other might.
Ensis Ferrae wrote:Given that we don't know what actually causes autism to show up in children, what evidence is there to suggest that a given vaccine might not actually be the cause??
Wakefield has been unable to reproduce his results in the face of criticism, and other researchers have been unable to match them. Most of his co-authors withdrew their names from the study in 2004 after learning he had had been paid by a law firm that intended to sue vaccine manufacturers -- a serious conflict of interest he failed to disclose. After years on controversy, the Lancet, the prestigious journal that originally published the research, retracted Wakefield's paper last February.
The series of articles launched Wednesday are investigative journalism, not results of a clinical study. The writer, Brian Deer, said Wakefield "chiseled" the data before him, "falsifying medical histories of children and essentially concocting a picture, which was the picture he was contracted to find by lawyers hoping to sue vaccine manufacturers and to create a vaccine scare."
Spoiler:
In before conspiracy theories about pharmaceutical companies.
dogma wrote:Most of the people in those groups, while certainly devout, aren't stupid. They won't refuse or fail to seek medical treatment in the case of severe injury, and I imagine most of them carry some level of insurance even they don't make use of it as freely as other might.
Or, as I imagine they think of it, "God helps those that help themselves". I know there was a old joke that was repurposed right around when Hurricane Katrina hit, of people evacuating.
As the last bus is going, they ask the Joneses are you sure you won't go? And, of course, they reply "We'lll be safe, God will save us".
The storm gets worse, and the Joneses go to the second flood, as the first is totally flooded. A rowboat goes by, and the occupants yell into the windows to come with us, to safety. The Joneses reply that "We'll be OK, God will save us."
Finally, as the whole house is flooded, they go onto the roof. A Coast Guard chopper swoops down, and throws them a rope. They turn away from it, insisting that they will be fine - God will save us.
Right after the chopper leaves, the entire house is covered, and they slip off the roof into the water. Shortly thereafter, they drown. As they go to the Pearly Gates of Heaven, they come across St. Peter, shaking his head. They ask, we lived as devout Christians, why did not God save us? St. Peter replies, "He tried 3 times!"
CptJake wrote:And again, using force to make people buy something is wrong in my opinion.
Right, so why do you support the uninsured's right to force me to pay for THEIR health care?
Can you point to where I state my support for that?
What's your alternate plan, Jake?
As a society, we choose to provide emergency care to people who can't pay, rather than let them suffer or die. To do that, the rest of us all wind up paying for that care.
The individual mandate is a way of addressing that fact and attempting to fund it in a more intelligent way, requiring people who CAN afford the care they will inevitably use to pay ahead of time the way most of us do, and the taxpayers to pay ahead of time for the poor and indigent so that money can be invested and more efficiently used, rather than paying after the fact (like now). Again, if people have coverage studies show that most of them will see a doctor and get preventive and other cheaper care, rather than waiting until they are desperate and using emergency rooms, clogging the system and racking up comparatively enormous charges which still get dumped off on those of us who pay takes and pay for our own insurance.
Again, we're paying for it either way, unless you can get society as a whole to agree NOT to provide emergency care to people who can't afford it. Is this what you'd like to see happen? Do you believe it's more ethically acceptable to let folks die in the ER waiting room or parking lot rather than to care for them? Because if not, we've got to pay for it somehow, and the individual mandate is the smarter and more cost-effective way.
Of course, we could also have a genuinely government-provided single payer healthcare system, like most first-world countries (say, like our neighbors Canada) do. But the "Obamacare" plan is a compromise solution designed by Republicans to give business to private sector insurance companies, rather than having the government actually take over healthcare.
I wonder how much it costs to drag dead folks from the waiting rooms to the funeral homes. I mean, someone would have to do it. And in this hypothetical future, since people wouldn't pay for the uninsured, their deaths wouldn't be a crime, would the police still handle the processing of the body? Would relatives have to do it? Or would it be the janitors?
How did this become a discussion of vaccination? Mosts vaccinations are not really necessary any longer with how improved public health is, it is trading temporary immunity for life long immunity.
Anyway, I think this topic really highlights the difference between right and left thinking. The left wants goverment to protect the "common man", like a benevolent version of Orsen Well's Big Brother.
Right thinkers want the "common man" to chose for himself, like the rugged pioneers of early America. They also want him to suffer the consequences of his poor decisions.
So who is right? Big government that protects or small government that allows choice? Both sound like opinions to me.
Bastion of Mediocrity wrote:How did this become a discussion of vaccination? Mosts vaccinations are not really necessary any longer
After the hubub that stupid, vapid woman caused about it, a small minority of parents chose not to vaccinate their children.
Coincidentally, that same population were also found to have sicker children because of an outbreak of the viruses the vaccines were preventing being caught by them.
Bastion of Mediocrity wrote:How did this become a discussion of vaccination? Mosts vaccinations are not really necessary any longer with how improved public health is, it is trading temporary immunity for life long immunity.
Anyway, I think this topic really highlights the difference between right and left thinking. The left wants goverment to protect the "common man", like a benevolent version of Orsen Well's Big Brother.
Right thinkers want the "common man" to chose for himself, like the rugged pioneers of early America. They also want him to suffer the consequences of his poor decisions.
So who is right? Big government that protects or small government that allows choice? Both sound like opinions to me.
You mean George Orwell. Orson Welles is Citizen Kane.
How did this become a discussion of vaccination? Mosts vaccinations are not really necessary any longer with how improved public health is, it is trading temporary immunity for life long immunity.
I'm confused. For disease like small pox, that don't mutate much, vaccination is permanent immunity. For diseases that mutate regularly, like the common cold, it doesn't matter if your vaccinated or not. No immunity will be permanent. Vaccines use the bodies natural immune system and give it a hi jump kick in fighting infection there's no 'trade' involved.
Besides, the mentality that 'its not necessary' is how we ended up with drug resistant strains of TB.
Bastion of Mediocrity wrote:How did this become a discussion of vaccination? Mosts vaccinations are not really necessary any longer with how improved public health is, it is trading temporary immunity for life long immunity.
.
Thats one of the most interesting yet dangerous opinions ever put forth on Dakka. You sir win an award.
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What's your alternate plan, Jake?
The Swiss Plan?
Hey if its good enough for de Swiss Miss its good enough for me.
@Frazzled, while I love the pic, I did say "most" not "all". I think that you insinuated "rabies" with the picture, but that dog lacks the symptoms. I'd be more worried about Lymes personally.
@LordofHats: many vaccines use antigens of dangerous vectors of disease, but many also use attenuated viruses (which means functional "since viruses are not considered to be alive" but weakened). All immunity is based on the bodies own immune system, but if you would like to see that most vaccines do not provide life-long immunity you should take either a pathology course or a pediatrics course. Or look up the zoster virus (chicken pox).
Sorry, did not mean to continue altering this thread to a vaccination one. I was enjoying reading the conflicting views on Obamacare.
Automatically Appended Next Post: @LordofHats: I am interested in the idea of drug-resistant TB, living in the capitol of TB in the states (Los Angeles) I am curious if you have a link. Thanks
As a society, we choose to provide emergency care to people who can't pay, rather than let them suffer or die. To do that, the rest of us all wind up paying for that care.
So, what is my alternate plan? First I want to see exactly what you consider the problem(s) to be. Without scoping and defining the problem it is hard for me to come up with a plan. Is the problem 'Health Service is Too Expensive"? That is a pretty all-encompassing statement. What is "too expensive" and why is it considered such? If "too expensive' is the problem set, I disagree the Fed Gov't is the answer.
What specific problem/issue was the ACA supposed to address? I'm not being a smart ass here. My perception is that the Democratic Party has held the idea of 'Universal Healthcare As A Right' as part of their platform for decades and that the ACA was an attempt to get that started. Since I do not believe 'Universal Healthcare' IS a 'right' I have issues with it, especially as the provided solution limits individual choices and freedoms and grants the Federal gov't more expansive powers.
We have already seen insurance premiums go up. The latest CBO projections indicate they believe penalty payments from individuals and companies will be higher than the earlier projections showed (because it is cheaper to pay the penalty than to comply with the law, that should say something), companies, especially small businesses, currently view the restrictions and requirements of the ACA as reasons to not expand/hire new employees, and the cost to the country is higher than initially projected.
First let me lay out some assumptions, you can agree or disagree with them as you want, once I have a defined problem I'm most likely going to base any plan on these assumptions.
1. As it stands, if you purchase insurance, either on your own or through your employer, YOU are freely entering a transaction in which YOU perceive the cost you pay is worth the benefits you gain from having paid that cost. As such, it really does NOT matter who else benefits or does not benefit from that transaction. If YOU are not happy with it, no one currently forces you into the transaction.
2. Health care is not a right. It is a commodity/service someone provides. The more money you are willing to pay (or the more debt you are willing to incur) does indeed help to define the level and types of care you have access to, even in places with Gov't Provided Healthcare. As a society we collectively believe ourselves rich enough to provide some level of basic care to those who need it and cannot provide for it on their own. There are programs in place for that (Medicaid for example). People who pay state and federal taxes are already putting into those programs. Frankly if someone is not covered by one of those programs and chooses not to purchase insurance, they are accepting risk. That should be allowed. There should also not be freedom from consequences. Using tax payer dollars to mitigate the consequences from bad choices encourages those bad choices. Remember too there are many private organizations which help those in need of help, some quite extensive (Shriner's kids hospitals for example).
3. The gov't systems are not and will never be the most efficient way to solve a problem (though often we accept the inefficiencies to ensure the problem is solved), and the inefficiencies cost everyone who pays taxes. The multiple thousands of pages of tax code at the federal level are a fantastic example of inefficiency. A couple thousand pages of bill that (I paraphrase) 'must be passed so we can see what is in it' is another great example.
4. No one is currently denied basic emergency services, regardless of their (in)ability to pay. People don't generally die in the ER because treatment was refused. Yes, I know someone will point out some case where it has happened, those are very isolated and not indicative of a systemic/policy level problem. gak happens, no system is ever perfect.
5. The Federal Gov't has constitutionally limited powers. Every power we grant the gov't takes some freedom away from the governed. We pay (taxes and acceptance of limits on our freedoms) for the benefits we receive from the Federal Gov't, and those benefits do exist. Freedom is not inherently easy or comfortable and there is freedom to fail as well as to succeed.
So based on those and freely admitting I am not anything like an expert on health service and that the problem set has not really been defined I submit the following improvements to the 'as is'. I am sure they are filled with holes and inaccuracies:
1. Allow insurance providers to sell policies across state lines. Allow for 'bare minimum' policies. Encourage employers to allow new employees to bring their current policies if they choose to do so (perhaps paying the employee a portion of what the employer would have contributed to the employer sponsored policy and allowing the employee to buy their own with pre-tax dollars).
2. Implement some type of tort reform. A lot of hospitals do a lot of tests and treatments not because they are medically required but because the hospital administration is scared of lawsuits. Personal example. My son crashed a car and went to the ER under his own power just to get 'checked out'. He was shaken up but not really hurt. No ambulance ride, no traumatic blood gushing injuries. They gave him an MRI 'just to be sure'. Several thousand dollars worth of 'being sure' because the hospital was scared if they didn't perform it they may be sued.
3. Crack down HARD on lazy, incompetent or corrupt Fed employees and on private companies that commit fraud against existing programs. As a tiny example, all those 'Scooter Store' and 'Testing Supply' commercials you see where the company files your Medicare/Medicaid paperwork for you. In many cases they are forcing us, the tax payer, to fund a service that is not actually needed because they know how to fill out paperwork to make it appear as if the service or product is needed. In other cases certain Fed employees either through laziness, incompetence or corruption approve these types of paperwork and worse, again costing tax payers. Frankly the fact that a whole class of businesses exists to take advantage of Federal programs is a great example as to why Fed porgrams are rarely a good answer.
4. Quit duplication of effort/benefits at taxpayer expense. The whole mandated birth control coverage is a decent example of this. There are already plenty of clinics and organizations (many of which are in part already funded through tax dollars) giving access to cheap and in many cases free birth control. Why should the Federal Gov't mandate redundant coverage and the funding there of? It just doesn't come across as a non-resourced requirement. Allocating more resources is wasteful. DON'T get hung up on my example, the fact is there are redundant programs, anothe hallmark of gov't efficiency.
5. Force individuals to be responsible for their actions. If I lead a lifestyle which includes high risk activities I should expect insurance companies to charge me higher premiums or even deny coverage for injuries or illnesses related to those high risk activities. If I choose as an individual to skip coverage and still engage in those activities I should reasonably expect to only receive rudimentary emergency care until I can show I have a mechanism to pay for more (to include ability to secure credit if that is what is needed). If that means a person doesn't get expensive fancy care, so be it. Freedom of choice is not freedom from consequences.
I have the ultimate solution to the US health care crisis. I've mixed up a large batch of cherry flavor aid and every politician, trial lawyer, lobbyist, insurance CEO and judge in the US needs to drink some.
CptJake wrote:...the fact is there are redundant programs, anothe hallmark of gov't efficiency.
By that definition of inefficiency the fact that there are multiple companies marketing identical drugs shows that the private sector is highly inefficient.
The presence of multiple sources of coverage, and multiple outlets for a medical service, does not indicate that the system is particularly because people don't carry, as per your example, carry birth control coverage and then buy 18 different types of birth control from 18 different places. Similarly, what birth control is purchased is still purchased at the same actual costs, its simply that the insured person isn't paying directly in most cases.
CptJake wrote:...the fact is there are redundant programs, anothe hallmark of gov't efficiency.
By that definition of inefficiency the fact that there are multiple companies marketing identical drugs shows that the private sector is highly inefficient.
Mind you, some are not entirely identical. Even the illegal ones have a degree of variation, and for much the same reasons, namely to dodge the law. (at least until they came up with that one that made the actual act of getting high illegal. Why they are not arresting people for running or having sex under that one I don't know.) They just differ in which law they're dodging. I mean, seriously, move a carbon atom but otherwise be exactly the same and they seem to think it's the Harvard Mouse all over again.
Throughout this whole debate I've been left wondering exactly who out there is that bothered at the idea of sending the government the maximum fine of $600, in exchange for knowing that if they get sick they can join a healthcare fund, and be safe in the knowledge that once insured they won't ever be left high and dry because the insurer declared you had a pre-existing condition?
Ensis Ferrae wrote:Given that we don't know what actually causes autism to show up in children, what evidence is there to suggest that a given vaccine might not actually be the cause?? (obviously, that vaccine would only cause autism in those whose genetics mesh wrong with said vaccine..we all know that vaccines by and large do far more good than bad)
We actually have a pretty decent handle on the causes of autism, and the biggest one is the age of the mother and father. Autism rates tie very closely to older mums and dads. Not absolutely, but the relationship is most definitely there.
The problem is people don't like hearing that their decision to wait until they were 38 or whatever played a contributing factor in their child having autism. They'd rather blame vaccinations, and as a result there's a whole mess of lying liars out there willing to play on the emotions of those parents.
I mean, the same could be said of SIDS or ALS, or any number of diseases that we don't know what the cause of them is.
We've got a pretty decent idea with SIDS too, sleeping on their stomach and being exposed to cigarette smoke are the major risk factors.
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Bastion of Mediocrity wrote:How did this become a discussion of vaccination? Mosts vaccinations are not really necessary any longer with how improved public health is, it is trading temporary immunity for life long immunity.
Uh, one of the major drivers in increasing life expectancy has been vaccinations. There is 'improved public health' for polio, it's the vaccine that's solved the problem.
You don't get to just make gak up. Stop it.
Anyway, I think this topic really highlights the difference between right and left thinking. The left wants goverment to protect the "common man", like a benevolent version of Orsen Well's Big Brother.
Right thinkers want the "common man" to chose for himself, like the rugged pioneers of early America. They also want him to suffer the consequences of his poor decisions.
So who is right? Big government that protects or small government that allows choice? Both sound like opinions to me.
Both are absurd, ridiculous bits of nonsense. The real world doesn't find working solutions by shouting one vague slogan, then shouting another and seeing which one people like. It solves problems by studying the system, identifying issues and working to fix those system specific problems.
"Government protects the common man" and "the common man should choose for himself" are political theatre, and great for people who want to pick a side and yell at people who picked the other one, but absolutely, completely fething useless for addressing matters of policy.
If the people you're listening to are talking about things on those vague terms, then you need to find new people to listen to.
Oh, and like A Town Called Malus said, you meant George Orwell. And for the record 1984 is a critical analysis of communism, written by a socialist. The real world is complicated like that.
CptJake wrote:So, what is my alternate plan? First I want to see exactly what you consider the problem(s) to be. Without scoping and defining the problem it is hard for me to come up with a plan. Is the problem 'Health Service is Too Expensive"? That is a pretty all-encompassing statement. What is "too expensive" and why is it considered such?
Because it costs you about 16% of GDP, while plans with superior health outcomes in other countries cost as little as 8%. How do you not know that?
What specific problem/issue was the ACA supposed to address? I'm not being a smart ass here.
Outside of the GFC, the primary cause of bankruptcy in the US was medical costs. This came from people being denied coverage. This is not an obscure thing, and again I really have to wonder you can be honestly asking that question this late into the issue.
And the ACA is designed, among other things, to begin a clawback of spiralling healthcare costs, specifically in pharamceuticals and insurance. The former is achieved through better negotiations with pharmaceutical providers (already begun) and in insurance by reducing the portion taken by insurers (there's now a fixed minimum of total revenue generated by a healthcare fund that must be spent of patient health, not swallowed in advertising and admin).
1. As it stands, if you purchase insurance, either on your own or through your employer, YOU are freely entering a transaction in which YOU perceive the cost you pay is worth the benefits you gain from having paid that cost. As such, it really does NOT matter who else benefits or does not benefit from that transaction. If YOU are not happy with it, no one currently forces you into the transaction.
Your assumption here is let down by the simple fact that healthcare coverage is necessary. As such, a person who can afford it will still take it, even if it's a poor deal. For example, food might have a completely disfunctional system, where your employer pays for you to get into a collective, who hands out food whenever you get really hungry, leaving you with a co-pay. Advertising and promotions for these food providers are astronomical, and so are the court cases they run from constantly denying coverage to paying customers once they become too expensive, if they manage to find a technicality that allows them to deny coverage.
You will still buy into because you need food, even though the system to get food sucks.
2. Health care is not a right. It is a commodity/service someone provides.
People keep saying this. But unless society is willing to turn a dying person away from the emergency room because they cannot afford coverage, it remains not true. Everyone gets coverage. At which point you need to accept that, and figure out the best system for paying for it.
The more money you are willing to pay (or the more debt you are willing to incur) does indeed help to define the level and types of care you have access to, even in places with Gov't Provided Healthcare. As a society we collectively believe ourselves rich enough to provide some level of basic care to those who need it and cannot provide for it on their own. There are programs in place for that (Medicaid for example). People who pay state and federal taxes are already putting into those programs. Frankly if someone is not covered by one of those programs and chooses not to purchase insurance, they are accepting risk. That should be allowed. There should also not be freedom from consequences. Using tax payer dollars to mitigate the consequences from bad choices encourages those bad choices. Remember too there are many private organizations which help those in need of help, some quite extensive (Shriner's kids hospitals for example).
There remains a large gap in the system, of people who are not so poor as to qualify for medicaid, but not in jobs that pay enough to provide healthcare. Paying for your own healthcare is prohibitively expensive for most people. This simply can't be ignored.
3. The gov't systems are not and will never be the most efficient way to solve a problem (though often we accept the inefficiencies to ensure the problem is solved), and the inefficiencies cost everyone who pays taxes. The multiple thousands of pages of tax code at the federal level are a fantastic example of inefficiency. A couple thousand pages of bill that (I paraphrase) 'must be passed so we can see what is in it' is another great example.
An actual study of market systems will demonstrate that the things that make the private sector more efficient simply aren't present in the healthcare industry. Nor does reform mean a government take over. You can look elsewhere and find much more successful health sectors, built around a private sector operating under better incentives, with a strong level of baseline, government provided care. The health outcomes are better, there is more choice for the consumer, there are no bankruptcies because people can't pay their bills, and it costs as little as half what the US system costs.
As a society, we choose to provide emergency care to people who can't pay, rather than let them suffer or die. To do that, the rest of us all wind up paying for that care.
So, what is my alternate plan? First I want to see exactly what you consider the problem(s) to be. Without scoping and defining the problem it is hard for me to come up with a plan.
...What specific problem/issue was the ACA supposed to address? I'm not being a smart ass here.
Well, there are a lot of problems related to health care. The ACA is so big because legislators tried to address a bunch of them. Edit: Ninja'd by Sebster; well, he gave the better, high-level view, here are a few smaller examples:
-People with pre-existing conditions not being able to get insurance.
-Insurance companies dropping people from coverage once they got sick.
-Kids not being able to get a job immediately after leaving their parents home/college and needing to stay on their parents' policy a bit longer.
-A large percentage (over 20%) of premiums being drained out of the system for profit rather than providing patient care.
-People without insurance incurring massive emergency room charges because they have no insurance and don't get preventive checkups or a simple doctor's visit and prescription when they have lesser symptoms and the problem can be caught when it's not as bad.
-The costs of said emergency care being passed on to taxpayers and premium-holders because we (and the Hippocratic Oath) require doctors to provide care even to people who can't afford it.
CptJake wrote:My perception is that the Democratic Party has held the idea of 'Universal Healthcare As A Right' as part of their platform for decades and that the ACA was an attempt to get that started. Since I do not believe 'Universal Healthcare' IS a 'right' I have issues with it, especially as the provided solution limits individual choices and freedoms and grants the Federal gov't more expansive powers.
Interesting. My perception is that both Republicans and Democrats (and most Independents, like me) have agreed for centuries that at least some care must be provided to people regardless of their ability to pay. It's not a Democratic ideal specifically to not let poor people die in the parking lot of the ER rather than help them. Now, I've known some hardcore Libertarians who are (or at least claim to be) just fine with the idea of letting those folks die, but I think that's extremism and putting a principle or ideal above other people's lives. I can honor and respect holding a principle above one's own life, but when it comes to a choice between slightly higher taxes or letting folks die, if a Libertarian chooses letting people die, I'm not really okay with that. In general, providing care to people who can't pay is the better approach. But the way we're doing it now is stupid and inefficient, and inadvertently encourages people to postpone care, get sicker, and wind up incurring greater costs and resulting in worse outcomes for themselves, their families, and the taxpayers/insurance premium-payers. Some kind of reform has got to be enacted.
I do agree that some Democrats have advocated for the idea of universal health care. Many people think that having a system like Canada or the UK (Or Switzerland, or Germany) would be good. The ACA is fundamentally a compromise idea, created by Republicans, as a way to try to address the many problems we're having with healthcare in this country. The Democrats caved and quit trying to get a real government-run program, or even a government-run OPTION (which Obama promised and which many of us supported him for), and instead went with the Republican idea, figuring that some reform was better than no reform, and hopefully they could get some progress made with bipartisan cooperation.
And instead we got opportunistic sentationalist scumbags making up lies about death panels, and scaring ignorant people into yelling at their Congressional representatives at town hall meetings.
CptJake wrote:We have already seen insurance premiums go up.
Yes, we've been seeing them go up for decades. Very rapidly. I've worked in health insurance or in service provision for health or travel insurance companies for most of the last decade. Every year the costs go up, and the premiums go up, and the benefits get reduced. At one point I worked at a major insurance company as a rep who specifically serviced the HR managers/health insurance admins/owners at medium and small businesses, and helped them every year with renewing and altering their plans to try to save costs. As every year the premiums went up and up, and so the companies cut benefits further and further.
There are a lot of reasons why costs go up. One of the biggest is because health insurance is largely a private, for-profit enterprise, and when you're operating for a profit, you need to take money out of the system for those profits. You also need to spend it on advertising and marketing. And on big executive salaries.
CptJake wrote: The latest CBO projections indicate they believe penalty payments from individuals and companies will be higher than the earlier projections showed (because it is cheaper to pay the penalty than to comply with the law, that should say something), companies, especially small businesses, currently view the restrictions and requirements of the ACA as reasons to not expand/hire new employees, and the cost to the country is higher than initially projected.
Some companies and business owners may view them that way. Do you have some figures on how many?
CptJake wrote:1. As it stands, if you purchase insurance, either on your own or through your employer, YOU are freely entering a transaction in which YOU perceive the cost you pay is worth the benefits you gain from having paid that cost. As such, it really does NOT matter who else benefits or does not benefit from that transaction. If YOU are not happy with it, no one currently forces you into the transaction.
It does matter. Because when people make the irresponsible decision not to get coverage, when they need help later, they come asking for it. Some help is given, and it costs everyone else.
CptJake wrote:2. Health care is not a right. It is a commodity/service someone provides.
No? "Life" isn't the first "inalienable right"? I'm pretty sure that it is. I'm pretty sure that the Hippocratic Oath also means doctors have generally sworn to disagree with you on this one.
CptJake wrote: The more money you are willing to pay (or the more debt you are willing to incur) does indeed help to define the level and types of care you have access to, even in places with Gov't Provided Healthcare. As a society we collectively believe ourselves rich enough to provide some level of basic care to those who need it and cannot provide for it on their own.
Yup. And we manifestly are. We're the richest country in the world, and dozens upon dozens of poorer countries do so.
CptJake wrote: There are programs in place for that (Medicaid for example). People who pay state and federal taxes are already putting into those programs.
Yes, and expanding who all are eligible for Medicaid is one of the biggest and most expensive parts of the ACA.
CptJake wrote: Frankly if someone is not covered by one of those programs and chooses not to purchase insurance, they are accepting risk. That should be allowed. There should also not be freedom from consequences. Using tax payer dollars to mitigate the consequences from bad choices encourages those bad choices.
Okay, so this sounds like you are okay with the idea of hospitals refusing emergency care at the ER, or making patients wait until they produce proof of coverage. I understand what you're saying, but I think this is obviously a choice between a greater and lesser evil, and to my mind and morals I know which one is the greater evil. Are you sure you disagree with me about which one?
CptJake wrote:3. The gov't systems are not and will never be the most efficient way to solve a problem (though often we accept the inefficiencies to ensure the problem is solved), and the inefficiencies cost everyone who pays taxes.
I disagree. Many problems can only or can most efficiently be solved only by government, because a given problem is not one that profit-minded industries have any interest in.
In the 1960s the challenge presented was winning the space race against the Soviet Union, and putting a man on the moon. The government was the most efficient and probably the ONLY way to make this happen.
The interstate highway system is another prime example of an achievement accomplished by government that private industry wouldn't have accomplished, but which has resulted in massive economic benefits to the nation.
Fire Departments were private, profit-making organizations in many parts of the US in the 19th century. They famously in some case ignored houses burning down because the owners weren't paying them. We wised up and fixed that.
The police are another socialized institution in the US. Do you think crime would be better addressed by private industry?
In my view healthcare is much more akin to police or fire services than to selling vacuum cleaners. It's providing critical services on which people's lives depend, and on which the health and safety of the community rely. In fact I think you've got the idea of efficiency in this case exactly backwards. Because when you make healthcare a for-profit enterprise you immediately guarantee that money will be taken out of the system, away from patient care, to serve as profit.
CptJake wrote:4. No one is currently denied basic emergency services, regardless of their (in)ability to pay. People don't generally die in the ER because treatment was refused. Yes, I know someone will point out some case where it has happened, those are very isolated and not indicative of a systemic/policy level problem. gak happens, no system is ever perfect.
This makes me think you haven't read my last couple of posts at all. I TOLD YOU THIS. What I also told you is that WE PAY FOR IT.
We pay for it in the form of higher costs at the hospital because they have to jack up the prices for everyone else to compensate for the people who can't pay. We pay for it in the form of higher insurance premiums when the hospitals pass on their higher costs to the insurers. We pay for it in the form of taxes when the hospitals get tax write-offs for care they're not able to get compensated for. WE'RE PAYING FOR THE ER CARE RIGHT NOW. We're just doing it the dumb, expensive, inefficient, counterproductive way. We could save lives and money if those people had regular coverage, got care before it turned into absurdly expensive ER care, and paid the hospitals.
CptJake wrote:1. Allow insurance providers to sell policies across state lines. Allow for 'bare minimum' policies. Encourage employers to allow new employees to bring their current policies if they choose to do so (perhaps paying the employee a portion of what the employer would have contributed to the employer sponsored policy and allowing the employee to buy their own with pre-tax dollars).
That's part of the idea of the insurance exchanges which are part of the ACA, isn't it? So you're agreeing with at least one part of the ACA.
CptJake wrote:2. Implement some type of tort reform. A lot of hospitals do a lot of tests and treatments not because they are medically required but because the hospital administration is scared of lawsuits. Personal example. My son crashed a car and went to the ER under his own power just to get 'checked out'. He was shaken up but not really hurt. No ambulance ride, no traumatic blood gushing injuries. They gave him an MRI 'just to be sure'. Several thousand dollars worth of 'being sure' because the hospital was scared if they didn't perform it they may be sued.
There are more factors here than just fear of being sued. The culture of healthcare in the US right now is one of "always provide the higher level of care"; it's easier for hospitals to get compensated by the insurance for doing so, and bringing in the dollars for those expensive procedures when someone CAN afford it and DOES have coverage helps them offset the poor people. Tort reform has been enacted all over the country. Malpractice insurance premiums NEVER go down in the states that enact it. The malpractice insurance companies just keep jacking the premiums. Tort reform is also an area where business lobbies are working very hard to take away your freedom to seek compesation for induries done to you. If you're interesting in protecting freedom, I strongly recommend that you check out the HBO documentary "Hot Coffee" for an easy and entertaining way to learn more. Here's an article about it:
http://www.idonotwanttobeyourlawyer.com/hot-coffee-hbos-must-see-documentary-about-tort-reform/
CptJake wrote:3. Crack down HARD on lazy, incompetent or corrupt Fed employees and on private companies that commit fraud against existing programs. As a tiny example, all those 'Scooter Store' and 'Testing Supply' commercials you see where the company files your Medicare/Medicaid paperwork for you. In many cases they are forcing us, the tax payer, to fund a service that is not actually needed because they know how to fill out paperwork to make it appear as if the service or product is needed. In other cases certain Fed employees either through laziness, incompetence or corruption approve these types of paperwork and worse, again costing tax payers. Frankly the fact that a whole class of businesses exists to take advantage of Federal programs is a great example as to why Fed porgrams are rarely a good answer.
I agree that fraud and waste absolutely needs to be weeded out. There's a bunch of stuff for that in the ACA. I guess that's another part of it you agree with.
Members of Congress of both parties often complain about fraud and abuse in Medicare and Medicaid (M&M), usually charging that the President is not doing enough to keep bad guys from stealing money from these vital programs.
Guess what? Thanks to provisions in the Affordable Care Act (ACA/ObamaCare) and to an unprecedented effort by the Obama Administration, more progress has been made in the past three years to combat health care fraud and abuse than ever before. There was a 68.9 percent increase in criminal health care fraud prosecutions from 2010 to 2011, and 2010 was already the highest ever.
McDonough helped work on the ACA’s provisions related to fraud prevention, and sketches out the areas in which the law is improving enforcement.
Part of the effort involves hyper-charged efforts to catch bad guys through the Health Care Fraud Prevention and Enforcement Action Team (HEAT), and a bigger part involves re-engineering the system to keep them out. For example, prior to the ACA, if a bad guy got kicked out of one state Medicaid program for fraud, he got kicked out of one program; under the ACA, when he gets kicked out of one, and he gets kicked out of all them, including Medicare. That’s smart, and that’s just a tiny bit of what the ACA does on fraud & abuse.
CptJake wrote:5. Force individuals to be responsible for their actions. If I lead a lifestyle which includes high risk activities I should expect insurance companies to charge me higher premiums or even deny coverage for injuries or illnesses related to those high risk activities. If I choose as an individual to skip coverage and still engage in those activities I should reasonably expect to only receive rudimentary emergency care until I can show I have a mechanism to pay for more (to include ability to secure credit if that is what is needed). If that means a person doesn't get expensive fancy care, so be it. Freedom of choice is not freedom from consequences.
What's a high risk activity? How about working at a factory where you get exposed to carcinogens, and get cancer? Is that your fault, if you chose to work there to feed your family? How about if the factory concealed the health risks? Government health and safety regs are about the only things giving those workers a chance to avoid some of these risks in the first place. Even if the factory's on the up and up, how about if they just didn't know? Do you think mesothelioma is people's own fault and they should just suck it up?
Mannahnin wrote:Interesting. My perception is that both Republicans and Democrats (and most Independents, like me) have agreed for centuries that at least some care must be provided to people regardless of their ability to pay.
Indeed. The Emergency Medical Treatment and Active Labor Act was the act that mandated hospitals accept anyone, regardless of their ability to pay. It was signed into power in 1986... by Ronald Reagan.
The Insurance Mandate was conceived by far right think tank The Heritage Foundation, as a means of resolving the issue of uncovered people and reforming the system (because even to them the idea of simply not providing healthcare was an absolute non-starter).
I'm beginning to think all this whole, ridiculous mess shows is that you can't move reform forward by taking the other side's ideas and expecting them to go along with the thing they'd originally argued for. All they'll do is reflexively oppose the idea, and move further to the right to do so.
sebster wrote:
I'm beginning to think all this whole, ridiculous mess shows is that you can't move reform forward by taking the other side's ideas and expecting them to go along with the thing they'd originally argued for. All they'll do is reflexively oppose the idea, and move further to the right to do so.
Its symptomatic of the present US political culture, where compromise is the devil.
People will variously argue over whose fault that is, but ultimately its just about everyone's fault; Democrats, Republicans, their devotees (no one ever blames them, for some reason), and the people that throw their hands in the air while opting out.
It would have been nice if Obama and the Dems would have/could have actually put in a public option (single payer being a dreamlike fantasy), while they had their majorities in the house and senate. Instead they went compromise, and have been getting the hand of cooperation slapped away ever since.
Mannahnin wrote:It would have been nice if Obama and the Dems would have/could have actually put in a public option (single payer being a dreamlike fantasy), while they had their majorities in the house and senate. Instead they went compromise, and have been getting the hand of cooperation slapped away ever since.
Well, one thing that I think politicians and their advisers are still getting used to is that most people who really care actually don't want compromise, even if its beneficial to the interests of both sides. The trend towards partisan polarization has been pretty consistent since Reagan, but its only just now reaching its stride, and with the internet (among other things) around its harder to simply lie. Moreover, because web publishing is relatively easy, people can make a pretty penny via ad revenue by basically engaging in tabloid journalism with respect to political gaffes.
There are lots of issues in play, and many people presently studying why the parties became more polarized, and how we can pull them closer together. Personally, I think the issue is that no one has yet figured out how to pull liberal social issues together with conservative economic ones due to the existence of significant crossover between the two spheres (healthcare and environmentalism primarily). And that the parties will grow closer as the religious right loses political capital, given that they are essentially the only group really clinging to purely social issues of any sort. I guess the disappearance of gay rights and abortion rights activists would have a similar effect, but I don't see that happening, and it hasn't happened in culturally similar nations.
dogma wrote:Its symptomatic of the present US political culture, where compromise is the devil.
People will variously argue over whose fault that is, but ultimately its just about everyone's fault; Democrats, Republicans, their devotees (no one ever blames them, for some reason), and the people that throw their hands in the air while opting out.
Funnily enough, the US was until very recently seen as the place where bills could be passed with support from both sides, where members weren't expected to vote along the party line.
Compare that to countries with the Westminster system, where it makes the news whenever a single person crosses the floor to against a bill put up by his side.
But the US has changed very quickly, the antagonistic tone thrown out is all of a sudden so much nastier than we get over here, and the demand for absolute party loyalty has surpassed us. The treatment of Olympia Snowe, for instance, in just voting to have a bill brought out of committee (when her vote wasn't even needed to bring it out of committee, and she ended up voting against it in the senate anyway) was incredible.
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Mannahnin wrote:It would have been nice if Obama and the Dems would have/could have actually put in a public option (single payer being a dreamlike fantasy), while they had their majorities in the house and senate. Instead they went compromise, and have been getting the hand of cooperation slapped away ever since.
The issue was that they ended up having to compromise with the blue dogs in their own party, who were running away from healthcare reform as fast as the Republicans could make up stupid nonsense about it.
Which, I think, came back to no Democratic actually going out and championing the bill. To this day no Democratic leader has actually gone out and sold the savings, expanded care and other benefits of the bill.
sebster wrote:The treatment of Olympia Snowe, for instance, in just voting to have a bill brought out of committee (when her vote wasn't even needed to bring it out of committee, and she ended up voting against it in the senate anyway) was incredible.
She's gotten a lot of flak for her stance of the birth control issue too.
Its a shame she's retiring, she was a great Senator.
sebster wrote:Nor does reform mean a government take over. You can look elsewhere and find much more successful health sectors, built around a private sector operating under better incentives, with a strong level of baseline, government provided care.
Hell, the "Obamacare" system (originally proposed by the Republican party, so I bet you five bucks that if this was being argued five years ago we'd be seeing people who are decrying it instead support it) is specifically designed to compromise and allow the free market to continue.
Basically this PREVENTS a government takeover, because the only other vialbe alternative that's been suggested is the single government payer plan.
sebster wrote:
And a welcome check on the lunatic set that's becoming more and more prominent in the Republican party.
If nothing else, the election to replace her looks to be close in terms of crazy, versus not crazy.
Sadly, I have to say that the founders of the GOP would not recognize it (I have actually read some of the personal letters of the earliest Republicans to rise to the Federal level during the Buchanan administration). You know, being that they founded the party partially out of a desire to right social injustices rather then to inflict them out of bizarre notions of ideology or conservatism, and showed a willingness to at least try to work with those that disagreed with them on compromise.
BaronIveagh wrote:
Sadly, I have to say that the founders of the GOP would not recognize it (I have actually read some of the personal letters of the earliest Republicans to rise to the Federal level during the Buchanan administration). You know, being that they founded the party partially out of a desire to right social injustices rather then to inflict them out of bizarre notions of ideology or conservatism, and showed a willingness to at least try to work with those that disagreed with them on compromise.
Its fair to say that any ~160 year old political party wouldn't likely be recognized by its founders. I'm sure the founders of the Democratic Party wouldn't recognize it either, which is why the whole argument who freed the salves, or even who enacted the New Deal, is basically a joke.
That aside, I tend to believe (but have no evidence to support) the notion that as material conditions improve, minor political issues like ideology become more important by way of eliminating major issues like "Lots of people in our country are starving to death."
So since the thread has been derailed from the Supreme Court doing their job and determining a law is constitutional or not, I will chime in on the new yet related subject matter.
Who here pays out of pocket for minor medical expenses? You know, yearly check ups at the doctor, the occassional or ongoing generic prescription, or even more expensive procedures like xrays and outpatient surgeries?
I do. Let me tell you, our society is so brain washed to not know the difference between health insurance and healthcare, that people literally think they can not go see a doctor unless they have insurance.
Also, since I do pay out of pocket for these things, I shopped around for a doctor. Some offices could not answer the simple "how much if I pay in cash?" question. I found a doctor I like, I get my annual checkup and it runs me about $150.
I had a minor outpatient surgery awhile back, I shopped around for that as well, and got prices from reputable surgeons ranging from $800 to $5,000 I opted for the $800 and paid it off in a timely manner.
Eye Exam and glasses every couple years, $99
If I had paid for "health insurance" that would cover all those things, it would cost me $700-$800 a month. I have saved a lot of money going the cash route on this.
For health insurance, I have what used to be called Major Medical, but is now known as Catastrophic coverage. Basically it covers things like broken leg, chopped off a finger or hand, stroke, heart attack, cancer treatments, what have you. That costs about $150 a month.
When insurance is added to the mix, now a doctors office has to have a billing department that knows how to bill each insurance company correctly, this tacks on an extra cost, and the insurance companies are often mandated by local governments about what has to be covered on all plans, so this increases your premiums.
Most people have insurance provided through employers and pay about $150-300 a month, and the company is paying the other $400-1,000 depending on the plan.
Doctors offices that vary in price for procedure from $800 to $5,000 causes a problem in the insurance industry because they want it all even and will pay X amount. This screws up the market place, and increases the overall costs, because doctors will creep it up to they will eventually get paid more.
Patients rarely have any idea what a procedure costs, so they do not object to procedures that cost in the thousands of dollars, when it may not be needed. Doctors are under pressure to run a billion and one tests even if they are unlikely to help, because of medical malpractice insurance which they are all required to carry. Further driving up the costs of health insurance.
Basic public education math skills should help you determine what the best option is.
I am all for less "health insurance" and more "health care."
dogma wrote:
Its fair to say that any ~160 year old political party wouldn't likely be recognized by its founders. I'm sure the founders of the Democratic Party wouldn't recognize it either, which is why the whole argument who freed the salves, or even who enacted the New Deal, is basically a joke.
That aside, I tend to believe (but have no evidence to support) the notion that as material conditions improve, minor political issues like ideology become more important by way of eliminating major issues like "Lots of people in our country are starving to death."
You would be surprised on the Democratic Party, actually. Some of the original founders would have little trouble recognizing it, particularly if you count it's earliest incarnations. Espousing intellect and education over inherited wealth and position, eschewing big business in favor of a 'people centric' approach, adopting controversial positions on the role of government in people's lives, both financial and otherwise. They would, however, be horrified at the abandonment of the idea of limited government. (It should be pointed out though that opposition to 'big government' was one of the few things that almost every early politician agreed on. It was not really until the late 19th century that government really started to balloon due to the rapidly increasing size of the US).
I disagree. As people become more desperate, infighting along ideological lines can become fracture points in a society, causing it's collapse.
BaronIveagh wrote:
I disagree. As people become more desperate, infighting along ideological lines can become fracture points in a society, causing it's collapse.
In that instance there generally isn't an established government, or even any true political parties.
Look at Africa, there are plenty of groups that call themselves political parties, but they're really somewhere between armed militia and clans.
dogma wrote:
In that instance there generally isn't an established government, or even any true political parties.
Look at Africa, there are plenty of groups that call themselves political parties, but they're really somewhere between armed militia and clans.
Actually it happens when there is an established government and pressure gets to high as well. Look at the Yugoslav Wars. Once thing reach a certain tipping point, this sort of factionalism become inevitable.
sebster wrote:Nor does reform mean a government take over. You can look elsewhere and find much more successful health sectors, built around a private sector operating under better incentives, with a strong level of baseline, government provided care.
Hell, the "Obamacare" system (originally proposed by the Republican party, so I bet you five bucks that if this was being argued five years ago we'd be seeing people who are decrying it instead support it) is specifically designed to compromise and allow the free market to continue.
Basically this PREVENTS a government takeover, because the only other vialbe alternative that's been suggested is the single government payer plan.
There is another step in between, with the option of baseline healthcare being guaranteed, and people able to go out and buy better healthcare plans from private insurers if they want (single payer means there is only government healthcare).
But I definitely agree that this plan could very easily have come out of a Republican government, and if it did then most of the people arguing that it's unconstitutional would be arguing that it is constitutional and vice versa.
It's kind of why the only result I don't want to see come out of the Supreme Court decision is a 5-4 split along party lines. That'd basically be the Supreme Court telling the country that it's now just a political body, no different to either house of government.
BaronIveagh wrote:Sadly, I have to say that the founders of the GOP would not recognize it (I have actually read some of the personal letters of the earliest Republicans to rise to the Federal level during the Buchanan administration). You know, being that they founded the party partially out of a desire to right social injustices rather then to inflict them out of bizarre notions of ideology or conservatism, and showed a willingness to at least try to work with those that disagreed with them on compromise.
There's been countless changes along the way, but basically the core changes that have defined how everything has ended up as it is today came from the South switching its vote over Civil Rights, and Reagan's showing how to capture the evangelical vote for the right wing (helped in large part by a broad drift of the evangelical community to the right, likely started with Billy Graham).
I just love showing these pictures because of how clear they make the switch in Southern voting patterns. Here's an immensely popular Republican candidate, Eisenhower, who in 1956 wins the whole of the country except the South, who would never vote Republican because of the Civil War.
And here's the vote from 1964, where a popular enough candidate in Johnson beat Goldwater, running on a segregationist platform. Johnson won everything but the South. Up until then the South had turned out for the Democrats, and since then the South has been a stronghold for Republican votes.
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Shadowseer_Kim wrote:Also, since I do pay out of pocket for these things, I shopped around for a doctor. Some offices could not answer the simple "how much if I pay in cash?" question. I found a doctor I like, I get my annual checkup and it runs me about $150.
I agree with your overall point, and think a broad review of the healthcare system in the US should consider making a large number of small scale treatments as user pays, and encourage the user to chase the lowest price.
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LordofHats wrote:In Yugoslavia's pseudo defense they were a fractured country doomed to failure to begin with.
People mock current attempts at nation building. Gotta say, we're doing it better now than the post-WWII world
Well, it's funny how it works, though. Germany was a collection of individual states, with many tied to Austria more than they were tied to the other Germanic states. Yet they were unified, and had little internal strife. Even in to the middle of the 19th century French wasn't the most common language in France. India to this day has hundreds of languages, and is only one nation because Britain declared it such.
I'm not saying what happened in Yugoslavia didn't come in large part from gluing a bunch of countries together and expecting them to get along, but at the same time it's funny how often that's actually worked.
But yeah, modern efforts are at least better than what they used to be. Which is faint praise, but praise none the less.
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Melissia wrote:Yeah, even 6:3 would be better...
If it's going to go down, it's better that it at least looks like the constitution decided the matter, and not partisan politics.
BaronIveagh wrote:
Actually it happens when there is an established government and pressure gets to high as well. Look at the Yugoslav Wars. Once thing reach a certain tipping point, this sort of factionalism become inevitable.
Yugoslavia is a bad example because the factions predated the government by quite some time, centuries in some cases.
sebster wrote:It's kind of why the only result I don't want to see come out of the Supreme Court decision is a 5-4 split along party lines. That'd basically be the Supreme Court telling the country that it's now just a political body, no different to either house of government.
Which is why I'm reasonably confident a 5-4 split is likely. We shall continue to get the government we deserve.
sebster wrote:It's kind of why the only result I don't want to see come out of the Supreme Court decision is a 5-4 split along party lines. That'd basically be the Supreme Court telling the country that it's now just a political body, no different to either house of government.
Which is why I'm reasonably confident a 5-4 split is likely. We shall continue to get the government we deserve.
I suspect that even a 6:3 will be regarded as politically motivated by many, with the conservative swing being regarded as a RINO.
