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car wreck that injures you, means you go to the emergency room and get care no matter your ability to pay.

cancer on the other hand. I dunno.

 sebster wrote:

 Hordini wrote:
There aren't very many people in the US who think that people shouldn't get health care of some sort.

There are a significant number of people who don't think that Obamacare is the correct way to go about it.

And until those people form some kind of alternative with congressional level support (even at the 'we're willing to just mention it' level) talk of this other unstated, unknown reform is a nonsense.

It is good an useful to try and figure out what you'd like to have if everything in the world was perfect and good. But that kind of thinking has a place, and it's place isn't as an alternative to the actual policies that are being put in place, and the kinds of policies that might replace it. At some point you have to deal with the reality that's in front of you.

The only existing alternative to the reforms of ACA is no reforms, and a return to what was there before.

I met a disturbingly large number of Europeans who thought that people in America will just be left to die in front of a hospital if they can't pay for their health care. They had something in common: they were all wrong.

Sure, and I've almost certainly spent more time correcting them in healthcare threads on Dakka than you have.

I've also spent an unbelievable amount of time correcting Americans who think European healthcare is a socialist dystopia of insane waiting lists and bureaucracy.

So what?

I'm just saying, most people who oppose Obamacare don't think that people shouldn't be able to get medical treatment or just be left to die. I know a lot of people who oppose Obamacare, and none of them think that people shouldn't be able to get treated. I'm not saying that they all have good or realistic ideas for a solution, but that does not make them "nutbars" or "liars" who require hours to get them to admit they're lying just because they don't think the ACA is all it's cracked up to be.

 KalashnikovMarine wrote:
I admit the capitalist system we're under now is useful at times, i scrimped, saved and got my eye surgery done by one of the best doctors in the country with 0 wait. Screening, Pre Operation appointment, surgery, post op. Total time from contacting the doctor to the post op (this coming monday) no more then a month.

You could do that in Japan, Canada and the UK too. Having a national health system does not prevent private health provision.

I hope your operation was successful.

It's going well so far, we;ll see where my vision is in a month but better then 20/20 is not uncommon

 Frazzled wrote:
No bureaucracy is ever gotten rid of here...ever. We still have the honey subsidy for the World War I. Oh noes we've got to sacrifice to keep the Kaiser at bay!

It was WWII (the one without the Kaiser). And the subsidy is in place because bees provide pollination to crops - benefitting a greater economy than just the bee farmer.

And the grand, whopping total of that subsidy is $3 million. And it is constantly reviewed and cut back, which may well be to the detriment of the greater agricultural industry (I honestly don't know if it is, I'm not an expert on pollination and/or bees, but it is debated among people who are, and all the while the subsidy is cut back for reasons that have nothing to do with the outcome of that scientific debate).

 whembly wrote:
That's a good point...we'll see right?

I just saw something this morning... help me out... what is it called when you STOP receiving any income, and continue to run your business as normal (paying bills/payroll/etc)... and determine how many days you can keep your doors open?

It's called working capital to monthly expenses. Us accountants aren't very good at coming up with catchy names. It's a good ratio to indicate overall financial health and stability, though funnily enough not that effective at determining the likelihood of an immediate liquidity problem (as it doesn't account for overdraft facilities and other emergency debt raising).

We've never seen that before... and apparently it's epidemic around the states.

One of most pressing issues in US healthcare is that for all the money that is splashed through the system, it isn't going to the hospitals. It's a fair criticism that ACA (to my knowledge) didn't really address that.

What this meas is that, if thing don't improve... we could be facing massive closures of hospitals system around the US... thus, overloading the big hospital systems. If that happen, we may get to the point where it's politically possible for Government takeover and implementation of Single-Payer like Canada.

Having had a couple of disasters over here with the farming out of hospital management to for profit private interests who proceded to claim big management fees, cut maintenance, equipment upgrades and other short term forgettable expenses, then walk away when the whole thing turns to gak, I can tell you that governments just don't let hospitals close because of a short term money crisis. They step in and pick up the tab, because the alternative is to see people be denied basic life saving treatment while a perfectly functional hospital is sitting there with the lights turned off.


Automatically Appended Next Post:

 R3con wrote:
The first civil war had more to do with states rights than slavery, but you can keep ignoring Tariff taxes and clashing economic policies if you like.

No, it wasn't. Get over it.


Automatically Appended Next Post:

 Shadowseer_Kim wrote:
My main opposition to the ACA is that it is not in fact affordable.

ACA is a cost control bill. Therefore your main opposition is nonsense.

 Cheesecat wrote:
I never got the small government obsession that some Americans have, wouldn't you want more government services or better quality ones especially considering you're a country with a population of 300,000,000 I don't see how nation that big would work better with a smaller scale

system.

I'd love better quality government services. The assumption that better quality will follow from more money or more bureaucracy is laughable, though.

It's also not the government's place to tell me I need to buy health insurance. I'm currently covered by my employer, but I'm probably going to knock off and go the self-employed route within a year or so here, and if I wasn't obliged to have coverage, I certainly wouldn't have any.

 Seaward wrote:
It's also not the government's place to tell me I need to buy health insurance. I'm currently covered by my employer, but I'm probably going to knock off and go the self-employed route within a year or so here, and if I wasn't obliged to have coverage, I certainly wouldn't have any.

Over the course of this debate I've asked in dakka maybe 30 times how you remove the ability of insurers to deny coverage for pre-existing conditions, without requiring people to get insurance while they are well (otherwise they'll just wait until they do get sick and then go out and get insurance).

Only answer I've ever heard is 'freedom!'

 azazel the cat wrote:

R3con wrote:

 Manchu wrote:
The first civil war was started to keep some people slaves in the name of liberty. Even today, we have people who wouldn't mind a second civil war to keep some people from accessing medical services -- also in the name of liberty.

The first civil war had more to do with states rights than slavery, but you can keep ignoring Tariff taxes and clashing economic policies if you like.

Yeah, the states' right to keep slaves.

I was going to say they were both right. It was about state's rights and the separation of powers. Unfortunately the state right at issue was slavery.

 sebster wrote:

 Seaward wrote:
It's also not the government's place to tell me I need to buy health insurance. I'm currently covered by my employer, but I'm probably going to knock off and go the self-employed route within a year or so here, and if I wasn't obliged to have coverage, I certainly wouldn't have any.

Over the course of this debate I've asked in dakka maybe 30 times how you remove the ability of insurers to deny coverage for pre-existing conditions, without requiring people to get insurance while they are well (otherwise they'll just wait until they do get sick and then go out and get insurance).

Only answer I've ever heard is 'freedom!'

Seb... that still happens.

If you don't have insurance (and you're healthy), you can still refuse to purchase insurance. When tax time comes every April, you'd just pay the tax (fine) for not having insurance. It's waaaaaaaay cheaper now to pay for the tax, than to purchase the insurance. If you get sick, you simply signup for one right away and the insurance cannot deny you. At. All.

See the problem? It actually makes it EASIER to game the system a bit.

 whembly wrote:

If you don't have insurance (and you're healthy), you can still refuse to purchase insurance. When tax time comes every April, you'd just pay the tax (fine) for not having insurance. It's waaaaaaaay cheaper now to pay for the tax, than to purchase the insurance. If you get sick, you simply signup for one right away and the insurance cannot deny you. At. All.

See the problem? It actually makes it EASIER to game the system a bit.

There is no problem, that is merely how the inability to deny coverage for preexisting conditions works.

 dogma wrote:

 whembly wrote:

If you don't have insurance (and you're healthy), you can still refuse to purchase insurance. When tax time comes every April, you'd just pay the tax (fine) for not having insurance. It's waaaaaaaay cheaper now to pay for the tax, than to purchase the insurance. If you get sick, you simply signup for one right away and the insurance cannot deny you. At. All.

See the problem? It actually makes it EASIER to game the system a bit.

There is no problem, that is merely how the inability to deny coverage for preexisting conditions works.

You're missing the point... in order for the Mandate to truly work, you'd need those healthy folks to purchase insurance to drive down the risk pools... thus, driving down (theoretically) the premiums.

If the healthy folks just work around it, and pays the tax until THEY get sick, thats circumventing the system.

Let's put it this way, I guess the system would work if the tax is the average cost of having insurance.

 whembly wrote:

If the healthy folks just work around it, and pays the tax until THEY get sick, thats circumventing the system.

No, it isn't. That is, as I said above, how the system is intended to function.

 dogma wrote:

 whembly wrote:

If the healthy folks just work around it, and pays the tax until THEY get sick, thats circumventing the system.

No, it isn't. That is, as I said above, how the system is intended to function.

I'm not following here...

 whembly wrote:

I'm not following here...

What is there to follow? The system is designed so that people can opt out at a price lower than that of average, individual health insurance premiums. It isn't the best possible design, we should really just have a national insurance provider, but that pesky hatred of "government" gets in the way.

 dogma wrote:

 whembly wrote:

I'm not following here...

What is there to follow? The system is designed so that people can opt out at a price lower than that of average, individual health insurance premiums. .

That wasn't the intent and you know it. The idea was that everyone gets insurance (privately, or via state exchange), so that the risk pools is driven downward.

It isn't the best possible design, we should really just have a national insurance provider, but that pesky hatred of "government" gets in the way.

True... unless hospital systems/Doctor offices starts closing shop... then, it may be appealing to the masses to accept a single payer system.

 whembly wrote:

That wasn't the intent and you know it. The idea was that everyone gets insurance (privately, or via state exchange), so that the risk pools is driven downward.

Of course that was the intent. Policy professionals are not idiots, nor are politicians, despite what many people seem to think.

 sebster wrote:

Automatically Appended Next Post:

 Shadowseer_Kim wrote:
My main opposition to the ACA is that it is not in fact affordable.

ACA is a cost control bill. Therefore your main opposition is nonsense.

Here is what I am talking about and I am super paraphrasing here:

Government: hey, you have to buy health insurance
>50% of USA gamers on this forum: but I have no money
...
Government: hey, you have to buy health insurance
>50% of USA gamers on this forum: but I have no money
...
Government: you have to buy health insurance or will smack you with a big fine
>50% of USA gamers on this forum: but I have no money
Government: oh yea and we are raising your income taxes to help cover this

Now how is that affordable?

We all know several people who fall in that magic income zone where they do not qualify for medicaid, foodstamps whatever, but barely have enough money to pay rent and electricity.

 whembly wrote:
Seb... that still happens.

If you don't have insurance (and you're healthy), you can still refuse to purchase insurance. When tax time comes every April, you'd just pay the tax (fine) for not having insurance. It's waaaaaaaay cheaper now to pay for the tax, than to purchase the insurance. If you get sick, you simply signup for one right away and the insurance cannot deny you. At. All.

See the problem? It actually makes it EASIER to game the system a bit.

I agree, that's a problem I've thought about since the issue began - the fine is much lower than the cost of insurance. As you say, easy to game the system (though how much gaming there will really be depends on a lot of factor (ease of cancelling/getting insurance, minor benefits to coverage outside of coverage of major illness etc).

Of course, for people to then start crowing about the 'freedom' they're losing by paying a cheap fine, and knowing they can get coverage when they get sick... well it just shows how insane the protest against this bill has been from the start.

I mean, if only there had been constructive, informed and considered debate in the first place. Maybe you'd have gotten a better bill.


Automatically Appended Next Post:

 dogma wrote:
Of course that was the intent. Policy professionals are not idiots, nor are politicians, despite what many people seem to think.

And not being idiots, they've designed the policy around political realities, not sound economic modeling. What that means is that when first introduced, the fine is way lower than the cost of insurance, because of the political reality that people freak the feth out over any new government cost.

Of course, in time the economic reality will catch up, and we'll see that fine drift up until it's comfortably greater than the cost of insurance. At the same time though, given that healthy people will be actively taking out insurance as individuals, the market cost of individual insurance will drop massively (currently they're way over-inflated as the only people looking to get them are people who expect major hospital expenses in the near future).

 sebster wrote:

 whembly wrote:
Seb... that still happens.

If you don't have insurance (and you're healthy), you can still refuse to purchase insurance. When tax time comes every April, you'd just pay the tax (fine) for not having insurance. It's waaaaaaaay cheaper now to pay for the tax, than to purchase the insurance. If you get sick, you simply signup for one right away and the insurance cannot deny you. At. All.

See the problem? It actually makes it EASIER to game the system a bit.

I agree, that's a problem I've thought about since the issue began - the fine is much lower than the cost of insurance. As you say, easy to game the system (though how much gaming there will really be depends on a lot of factor (ease of cancelling/getting insurance, minor benefits to coverage outside of coverage of major illness etc).

Of course, for people to then start crowing about the 'freedom' they're losing by paying a cheap fine, and knowing they can get coverage when they get sick... well it just shows how insane the protest against this bill has been from the start.

I mean, if only there had been constructive, informed and considered debate in the first place. Maybe you'd have gotten a better bill.

Right on bro!

Wished Reid/Pelosi engaged with the other side more... but, alas... that's our funky politics now.

Thanks on that term " working capital to monthly expenses"... spent a great deal of google-fu'ing that and came up empty. That spooks me... it really does.

 sebster wrote:

Of course, in time the economic reality will catch up, and we'll see that fine drift up until it's comfortably greater than the cost of insurance. At the same time though, given that healthy people will be actively taking out insurance as individuals, the market cost of individual insurance will drop massively (currently they're way over-inflated as the only people looking to get them are people who expect major hospital expenses in the near future).

Assuming that you're correct about the falling prices of individual coverage, that should happen in 2016 when the hard threshold for the fine increases to 2,085 USD.

 whembly wrote:
Right on bro!

Wished Reid/Pelosi engaged with the other side more... but, alas... that's our funky politics now.

We agree on something, and then you just gotta go and get all screwy on me again. I mean, you think the problem was Reid and Pelosi not working with the other side?!

The whole death panels thing? That was a product of Reid and Pelosi not being bi-partisan enough? I mean, come on dude, the Republicans were telling lie after lie to hammer the Democrats on the healthcare reform bill. You think the problem was with the Democrats?

Thanks on that term " working capital to monthly expenses"... spent a great deal of google-fu'ing that and came up empty. That spooks me... it really does.

Really? I just typed it into google and the first hit came up with an okay enough definition (though in it working capital is defined as equity, which is not correct).


Automatically Appended Next Post:

 dogma wrote:
Assuming that you're correct about the falling prices of individual coverage, that should happen in 2016 when the hard threshold for the fine increases to 2,085 USD.

Uh, I knew it went up, but I forgot the hike was that much. Well there you go then, they're getting the legislation with a small fine, then dragging it up.

And I don't know if individual insurance will increase, but there is a chance that as people take up private insurance its reasonably likely that it will trend towards the group rate given the businesses (given the current trends I'd take equilibrium as good enough proof of my theory).

Plus, Health Exchanges may contribute downward price pressure on the market as competition is increased, where insurance companies now often work regionally. Consumers only have access to one or two insurance carriers.

 sebster wrote:

 whembly wrote:
Right on bro!

Wished Reid/Pelosi engaged with the other side more... but, alas... that's our funky politics now.

We agree on something, and then you just gotta go and get all screwy on me again. I mean, you think the problem was Reid and Pelosi not working with the other side?!

The whole death panels thing? That was a product of Reid and Pelosi not being bi-partisan enough? I mean, come on dude, the Republicans were telling lie after lie to hammer the Democrats on the healthcare reform bill. You think the problem was with the Democrats?

Democrats...all.the.way.

gak... I remember CNN commented on the the fact that eventually the Republicans were locked out of the process.

Stop being so anti-republican and that democrats turns everything to gold.

Thanks on that term " working capital to monthly expenses"... spent a great deal of google-fu'ing that and came up empty. That spooks me... it really does.

Really? I just typed it into google and the first hit came up with an okay enough definition (though in it working capital is defined as equity, which is not correct).

Interesting... I just didn't know enough buzz words to feed google. This was right in your wheelhouse... I'd new you'd get it.

Automatically Appended Next Post:

 dogma wrote:
Assuming that you're correct about the falling prices of individual coverage, that should happen in 2016 when the hard threshold for the fine increases to 2,085 USD.

Uh, I knew it went up, but I forgot the hike was that much. Well there you go then, they're getting the legislation with a small fine, then dragging it up.

And I don't know if individual insurance will increase, but there is a chance that as people take up private insurance its reasonably likely that it will trend towards the group rate given the businesses (given the current trends I'd take equilibrium as good enough proof of my theory).

We'll see in time, eh?

 sebster wrote:

Uh, I knew it went up, but I forgot the hike was that much. Well there you go then, they're getting the legislation with a small fine, then dragging it up.

And I don't know if individual insurance will increase, but there is a chance that as people take up private insurance its reasonably likely that it will trend towards the group rate given the businesses (given the current trends I'd take equilibrium as good enough proof of my theory).

The average, annual individual insurance premium is ~3000 USD, so in order for the fine to exceed the hard cap the average premium needs to fall by ~1000 USD by 2016.

The argument I would make is that people will tend to prefer an option which provides some form of return (health insurance) over one which is nearly as expensive, and provides nothing.

 whembly wrote:
gak... I remember CNN commented on the the fact that eventually the Republicans were locked out of the process.

They were, eventually. After repeated efforts were made, and they responded with gibberish, or openly political requirements (such as the request made at the absolute end of the process that they would come to the table only if Democrats through out everything that had formulated so far).

And that's after the Republicans made such a grossly disingenuous faux-outrage over a 'socialist' takeover of healthcare, that had been (until Democrats announced it as their policy) a market based solution favoured by the Republican party (it had originally come out of their think tanks).

Stop being so anti-republican and that democrats turns everything to gold.

You keep getting confused between anti-Republican and pro-Democrat.

If I am deciding whether to turn left or right on my way home, and I see on the left there is a random stranger milling about, while on my left I see blood drenched hobo torturing a stray cat, I am not being pro-random stranger if I prefer his side to the blood drenched hobo.

The Democrats are a politically compromised collection of professional politicians that judge every single issue on whether or not it will help them get re-elected, along with what their special interests and lobbyists desire.

Whereas the Republican Party... well let me first say the Republican Party has a fine and very proud history. But the party right now is committed to a series of policies that are simply ludicrous, have no basis in reality, and have attempted to achieve these policies through openly partisan means that manipulate the democratic processes of your country.

If you were to return to the party of Eisenhower? To being a party that valued both conservatism and the principles of good, stable government? Man that'd be nice, and I think in most cases I would favour that party over the special interests of the Democrats. But you don't have that party, instead you've got Rand Paul, Paul Ryan and all the rest. And that is a party that no only is incapable of governance, it's a party that seems to reject the idea of governance altogether.


Automatically Appended Next Post:

 dogma wrote:
The argument I would make is that people will tend to prefer an option which provides some form of return (health insurance) over one which is nearly as expensive, and provides nothing.

Fair argument.

 sebster wrote:

 whembly wrote:
If you were to return to the party of Eisenhower? To being a party that valued both conservatism and the principles of good, stable government? Man that'd be nice, and I think in most cases I would favour that party over the special interests of the Democrats. But you don't have that party, instead you've got Rand Paul, Paul Ryan and all the rest. And that is a party that no only is incapable of governance, it's a party that seems to reject the idea of governance altogether.

If you are electing people to government, do you choose the people that think Government doesn't work?

When you are choosing a new CEO for your corporation, do you choose the Marxist who thinks that Capitalism doesn't work?

Do you see why someone could be anti-republican and not necessarily be pro-democrat?

 Manchu wrote:
It will be a mutual reevaluation, as it seems you believe this kind of opposition to the ACA is about something other than reinforcing a system that profits on denying medical treatment.

Opposition to a bill that will double my current healthcare premiums means I actively don't want poorer people to have coverage at all?

That is a broad assumption.

I oppose certain aspects of Obamacare, but I certainly don't want to prevent others from having healthcare.



In California, we have MediCal. It covers ALL children under 18 and most residents under 20 under certain restrictions(mainly income, rich kids don't get it). Once you are an adult, there are regulations you have to meet and follow to maintain eligibility for it. Myself, my wife and our 2 sons had it for a few years while going through employment struggles. Now that I have a regular job and make enough to pay for coverage, CA gave me 12 months of final coverage for my sons only. Mine was terminated the second I had coverage from work, and my wife is covered at her job.

If I were to lose my job tomorrow, I'd qualify for MediCal coverage again, as would my sons since my wife's income is not enough to pay for outside coverage.

California has a system that, while not perfect, functions well enough to afford basic and emergency medical coverage. I shattered my knee in 2011 and 100% of the cost was covered since I only made $8/hr and had no coverage through work.


So why should CA be forced into new laws and regulations when it already has a system in place? Why should any state? The law should have been about getting states to have a MediCal-esque system in place that is regulated by that states own needs.

I fail to see how the social medical needs of Montana are the same as those in Alabama.


Still, I fail to see how me not wanting to pay 2x as much for the same coverage(which will happen come next year) is tantamount to me actively not wanting the less fortunate to have their medicine.

 whembly wrote:

 sebster wrote:

 Seaward wrote:
It's also not the government's place to tell me I need to buy health insurance. I'm currently covered by my employer, but I'm probably going to knock off and go the self-employed route within a year or so here, and if I wasn't obliged to have coverage, I certainly wouldn't have any.

Over the course of this debate I've asked in dakka maybe 30 times how you remove the ability of insurers to deny coverage for pre-existing conditions, without requiring people to get insurance while they are well (otherwise they'll just wait until they do get sick and then go out and get insurance).

Only answer I've ever heard is 'freedom!'

Seb... that still happens.

If you don't have insurance (and you're healthy), you can still refuse to purchase insurance. When tax time comes every April, you'd just pay the tax (fine) for not having insurance. It's waaaaaaaay cheaper now to pay for the tax, than to purchase the insurance. If you get sick, you simply signup for one right away and the insurance cannot deny you. At. All.

See the problem? It actually makes it EASIER to game the system a bit.

The fact that citizens will be taxed for abstaining from a service is absolutely insulting.


Regardless, the problem is (and I hate to say this, because in nearly all cases I oppose government intervention) unregulated, opaque hospital management. There is literally zero relationship between the price they pay for a medical device and the value that you are billed. This would be nothing more than free market capitalism were it not for the fact that, in many cases, people are unable to consent one way or another: If you are in a serious car accident and unconscious, and you make it to a hospital, you're going to get treatment whether you like it or not. In an industry where A) people can't "shop around" for the best hospital, B) people are often given services without ever consenting to them, and C) we're talking something that is already heavily involved with the government anyway (NIH research, etc.), hospitals are one of the few areas where government ought to intervene.

Intervening in the health insurance side of things only makes the problem worse.

Why do we have to make health care (Though honestly, pick whatever you like for that blank) affordable?

Why not just help people afford it?

 Slarg232 wrote:
Why do we have to make health care (Though honestly, pick whatever you like for that blank) affordable?

Why not just help people afford it?

But why treat the disease when you can just treat the symptoms?